The Significance of Genetically Determined Methylation and Folate Metabolism Disorders in the Pathogenesis of Coronary Artery Disease: A Target for New Therapies?

Methylation is a biochemical process involving the addition of a methyl group (-CH3) to various chemical compounds. It plays a crucial role in maintaining the homeostasis of the endothelium, which lines the interior surface of blood vessels, and has been linked, among other conditions, to coronary artery disease (CAD). Despite significant progress in CAD diagnosis and treatment, intensive research continues into genotypic and phenotypic CAD biomarkers. This review explores the significance of the methylation pathway and folate metabolism in CAD pathogenesis, with a focus on endothelial dysfunction resulting from deficiency in the active form of folate (5-MTHF). We discuss emerging areas of research into CAD biomarkers and factors influencing the methylation process. By highlighting genetically determined methylation disorders, particularly the MTHFR polymorphism, we propose the potential use of the active form of folate (5-MTHF) as a novel CAD biomarker and personalized pharmaceutical for selected patient groups. Our aim is to improve the identification of individuals at high risk of CAD and enhance their prognosis.

The Influence of Hybrid Comprehensive Telerehabilitation on Anxiety in Heart Failure Patients: The TELEREH-HF Randomized Clinical Trial.

Telerehabilitation for heart failure (HF) patients is beneficial for physical functioning, prognosis, and psychological status. The study aimed at evaluating the influence of hybrid comprehensive telerehabilitation (HCTR) on the level of anxiety in comparison to usual care (UC). The TELEREH-HF study was a multicenter prospective RCT in 850 clinically stable HF participants. Patients underwent clinical examinations, including the assessment of anxiety, at entry and after the 9-week training program (HCTR) or observation (UC). The State-Trait Anxiety Inventory (STAI) was used. 20.3% HCTR and 20.1% UC patients reported high level of anxiety as a state at baseline, with higher STAI results in younger participants (< 63 y.o.) (p = .048 for HCTR; p = .026 for UC). At both stages of the study, patients with lower level of physical capacity (measured by a peak VO2) had shown significantly higher level of anxiety. There were no significant changes in anxiety levels during the 9-week observation for the entire study population, although there were different patterns of change in anxiety (both trait and state) in younger and older groups,with the decrease in younger patients, and the increase-in the older group.Trial registry number NCT02523560 (Clinical Trials.gov), date of registration: August 14, 2015.

Predictors of proarrhythmic effect in heart failure patients after 9-week hybrid comprehensive telerehabilitation and their influence on cardiovascular mortality in long-term follow-up: Subanalysis of the TELEREH-HF randomized clinical trial.

BACKGROUND: Regular exercise training is beneficial in heart failure (HF) patients. However, its potential proarrhythmic effect is possible but has not been sufficiently investigated. OBJECTIVE: To identify patients at risk for proarrhythmic effect after the 9-week of hybrid comprehensive telerehabilitation (HCTR) program vs the 9-week of usual care (UC) and to investigate its predictors and impact on cardiovascular mortality based on data from the TELEREH-HF RCT. METHODS: Proarrhythmic effect, strictly defined on the basis of available standards was evaluated by comparing 24-h Holter ECG before and after 9-week of HCTR or UC of 773 HF patients (The New York Heart Association class I-III, left ventricular ejection fraction ≤40%). RESULTS: The proarrhytmic effect was found in 78 (20.4%) and in 61 (15.6%) patients in the HCTR and UC group respectively, and the difference between groups was not statistically significant (p = 0.081). However, univariate analysis identified several statistically significant predictors of proarrhythmia in HCTR only vs the UC group. After a multivariate analysis ischaemic aetiology of HF (OR = 2.27, p = 0.008), peak oxygen consumption at baseline <14 ml/kg/min (OR = 2.03, p = 0.012) and level of N-terminal-pro B-type natriuretic peptide (NT-proBNP) in the first and the second tercile (OR = 1.85, p = 0.043) were identified to be independent predictors of proarrhytmic effect of exercise training among the HF patients in HCTR group only. CONSLUSIONS: Patients who underwent a 9-week HCTR were not at a higher risk of proarrhythmic effect after its completion compared to UC. However, predictors of proarrhythmia such as ischemic aetiology of HF, poor physical capacity, lower NT-proBNP level were discovered in the HCTR group only, yet it does not cause a significant risk of cardiovascular mortality including sudden cardiac death in long-term follow-up.

Disturbances of circadian profile and blood pressure control in patients with systemic lupus erythematosus without overt heart disease.

Introduction: Lupus erythematosus (SLE) is an autoimmune disease that causes a significantly increased risk of cardiovascular diseases. This process is underlain by the early and accelerated atherosclerosis. Aim: To assess the diurnal blood pressure profile disturbances in normotensive patients without overt cardiovascular disease and to correlate with early atherosclerotic markers. Material and methods: The study included 32 baseline normotensive women with SLE and 30 healthy control women. Each participant underwent a 24-hour automatic blood pressure measurement and an ultrasound assessment of intima media thickness (IMT) and the presence of carotid atherosclerotic plaques. Results: Atherosclerotic plaques were present in 46.9% of SLE women. They had a significantly higher IMT compared to those without atherosclerotic plaques and control group (0.833 ±0.216 vs. 0.606 ±0.121 vs. 0.66 ±0.16 mm). A significant positive correlation was found between IMT and age of patients, nocturnal systolic blood pressure (SBP), nocturnal systolic pressure (SP) load, nocturnal SBP decline and presence of atherosclerotic plaques. The plaques positively correlated with age and with ambulatory blood pressure monitoring (ABPM) parameters. Fifty percent of SLE women had an abnormal 24-hour BP profile, of which 4 had non-dipper, 8 invers, and 4 hyper-dipper profile. Based on ABPM, hypertension can be diagnosed in 14 (43.75%) initially normotensive women. Women with SLE and arterial hypertension (HA) had atherosclerotic plaques significantly more often, especially in nocturnal hypertension. Conclusions: The authors confirm the underestimation of hypertension in SLE. Most women diagnosed with hypertension by ABPM had nocturnal hypertension. We showed a more frequent disturbed BP and a significant relationship between the abnormal BP profile, especially nocturnal hypertension, and accelerated development of atherosclerosis.

Effects of hybrid comprehensive telerehabilitation on cardiopulmonary capacity in heart failure patients depending on diabetes mellitus: subanalysis of the TELEREH-HF randomized clinical trial.

BACKGROUND: Type 2 diabetes mellitus (DM) is one of the most common comorbidities among patients with heart failure (HF) with reduced ejection fraction (HFrEF). There are limited data regarding efficacy of hybrid comprehensive telerehabilitation (HCTR) on cardiopulmonary exercise capacity in patients with HFrEF with versus those without diabetes. AIM: The aim of the present study was to analyze effects of 9-week HCTR in comparison to usual care on parameters of cardiopulmonary exercise capacity in HF patients according to history of DM. METHODS: Clinically stable HF patients with left ventricular ejection fraction [LVEF] < 40% after a hospitalization due to worsening HF within past 6 months were enrolled in the TELEREH-HF (The TELEREHabilitation in Heart Failure Patients) trial and randomized to the HCTR or usual care (UC). Cardiopulmonary exercise tests (CPET) were performed on treadmill with an incremental workload according to the ramp protocol. RESULTS: CPET was performed in 385 patients assigned to HCTR group: 129 (33.5%) had DM (HCTR-DM group) and 256 patients (66.5%) did not have DM (HCTR-nonDM group). Among 397 patients assigned to UC group who had CPET: 137 (34.5%) had DM (UC-DM group) and 260 patients (65.5%) did not have DM (UC-nonDM group). Among DM patients, differences in cardiopulmonary parameters from baseline to 9 weeks remained similar among HCTR and UC patients. In contrast, among patients without DM, HCTR was associated with greater 9-week changes than UC in exercise time, which resulted in a statistically significant interaction between patients with and without DM: difference in changes in exercise time between HCTR versus UC was 12.0 s [95% CI - 15.1, 39.1 s] in DM and 43.1 s [95% CI 24.0, 63.0 s] in non-DM, interaction p-value = 0.016. Furthermore, statistically significant differences in the effect of HCTR versus UC between DM and non-DM were observed in ventilation at rest: - 0.34 l/min [95% CI - 1.60, 0.91 l/min] in DM and 0.83 l/min [95% CI - 0.06, 1.73 l/min] in non-DM, interaction p value = 0.0496 and in VE/VCO2 slope: 1.52 [95% CI - 1.55, 4.59] for DM vs. - 1.44 [95% CI - 3.64, 0.77] for non-DM, interaction p value = 0.044. CONCLUSIONS: The benefits of hybrid comprehensive telerehabilitation versus usual care on the improvement of physical performance, ventilatory profile and gas exchange parameters were more pronounced in patients with HFrEF without DM as compared to patients with DM. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02523560. Registered 3rd August 2015. https://clinicaltrials.gov/ct2/show/NCT02523560?term=NCT02523560&draw=2&rank=1 . Other Study ID Numbers: STRATEGME1/233547/13/NCBR/2015.

Assessment of ECG during hybrid comprehensive telerehabilitation in heart failure patients-Subanalysis of the Telerehabilitation in Heart Failure Patients (TELEREH-HF) randomized clinical trial.

BACKGROUND: Exercise training in heart failure (HF) patients should be monitored to ensure patients' safety. Electrocardiographic (ECG) telemonitoring was used to assess the safety of hybrid comprehensive telerehabilitation (HCTR). OBJECTIVE: Analysis of ECG recorded during HCTR in HF patients. METHODS: The TELEREH-HF multicenter, randomized, controlled trial enrolled 850 HF patients with New York Heart Association class I-III and left ventricular ejection fraction of ≤40%. This subanalysis focuses on 386 patients (aged 62 ± 11 years, LVEF 31 ± 7%) randomized to HCTR. HCTR was telemonitored with a device allowing to record 16-s fragments of ECG and to transmit the data via mobile phone network to the monitoring center. ResultsIn 386 patients, 16,622 HCTR sessions were recorded and 66,488 ECGs fragments were evaluated. Sinus rhythm was present in 320 (83%) and permanent atrial fibrillation (AF) in 66 (17%) patients, respectively. The most common arrhythmias were ventricular and atrial premature beats, recorded in 76.4% and 27.7% of the patients, respectively. Non-sustained ventricular tachycardia (21 episodes in 8 patients) and paroxysmal AF episodes (6 in 4 patients) were rare. None of the analyzed demographic and clinical characteristics was predictive for onset of the new arrhythmias on exercise. CONCLUSION: Telerehabilitation in HF patients was safe without the evidence for symptomatic arrhythmias requiring discontinuation of telerehabilitation. Only one mildly symptomatic paroxysmal AF episode led to the short-term suspension of the training program. The most common arrhythmias were atrial and ventricular premature beats. These arrhythmias did not result in any changes in rehabilitation and therapy regimens.

[The influence of hydrotherapy and physical training procedures on selected haemodynamic parameters of the circulatory system in patients with atherosclerotic peripheral vascular disease]. / Wplyw zabiegów z zakresu wodolecznictwa i treningu fizycznego na wybrane parametry hemodynamiczne ukladu krazenia u chorych z miazdzycowa choroba naczyn obwodowych.

Currently, the most common cause of death among highly developed countries are cardiovascular diseases. In terms of incidence, they take epidemic proportions. The main cause of the development of cardiovascular disease in 90% of cases is atherosclerotic lesions. The most important complications of atherosclerosis in addition to myocardial infarction and stroke include peripheral arterial disease, including arteries of the lower limbs. It is estimated that 3-10% of the general population suffers from atherosclerotic peripheral vascular disease. In people over 70, the number of patients with peripheral vascular disease increases up to 15-20%. AIM: The aim of the study was to evaluate the influence of vortex massages and physical training on the temperature of lower limbs and selected haemodynamic parameters of the circulatory system in patients with atherosclerotic peripheral vascular disease. MATERIALS AND METHODS: The study included 50 patients, both sexes, aged from 39 to 79 years, with impaired peripheral circulation of the lower limbs. The subjects were randomly divided into two groups. In group I, a series of 10 lower limb massage vortex procedures and an individually selected training including breathing, relaxation and active exercises of the lower limbs were used. In Group II, individually selected training was conducted. Measurements of blood pressure and heart rate (HR) were carried out before and after the series of treatments. The technique of performing the measurements was consistent with the recommendations of the Polish Society of Arterial Hypertension regarding blood pressure measurements. RESULTS: After the end of the series of treatments, in group I there was a statistically significant decrease in systolic blood pressure (SBP) and heart rate (HR). CONCLUSIONS: The applied eddy massage treatments significantly influenced the improvement of the hemodynamic parameters of the cardiovascular system.

[The influence of treatments in the field of hydrotherapy and controlled physical training on the temperature of lower limbs in patients with atherosclerotic peripheral vascular disease]. / Wplyw zabiegów z zakresu wodolecznictwa i treningu fizycznego na temperature konczyn dolnych u chorych z miazdzycowa choroba naczyn obwodowych.

The ever-increasing pace of life, and thus constant stress, poor nutrition and lack of time for physical activity caused the development of many diseases referred to as civilization diseases, i.e., obesity, diabetes, hypertension, metabolic diseases or generalized atherosclerosis. They have a significant impact on the development of pathological changes in all tissues of the human body. AIM: The aim of the study was to evaluate the effect of vaginal massages and controlled physical training on the temperature of lower limbs in patients with atherosclerotic peripheral vascular disease. MATERIALS AND METHODS: The study included 50 patients, women and men, aged from 39 to 79 years, with impaired peripheral circulation of the lower limbs. The subjects were randomly divided into two groups, each of 25 patients. In group I, a series of 10 lower limb massage vortex procedures and an individually selected training including breathing, relaxation and active exercises of the lower limbs were used. In Group II, individually selected training was conducted. The temperature of the lower extremities was measured in all the subjects using an infrared multifunction thermometer (IR). The measurements were carried out before the beginning of the rehabilitation program and after its completion. RESULTS: There was a statistically significant increase of lower limbs' temperature in group I (p <0.001). CONCLUSIONS: The applied vortex massage treatments significantly influenced the improvement of the lower limbs' warmth. Treatments in the field of hydrotherapy have a beneficial effect in the treatment of patients with chronic lower limb ischemia.

[Evaluation of renal function in the course of hypertension in the elderly]. / Ocena funkcji nerek w przebiegu nadcisnienia tetniczego u osób w podeszlym wieku.

Hypertension is one of the most common chronic diseases in Poland. It occurs in all age groups, but most often affects people over 65 years of age. The correct diagnosis of hypertension in older people includes documenting elevated blood pressure values, differentiating disease changes from physiologically related changes to aging, as well as assessing organ related complications. Detection of organ complications is also an important parameter of prognosis assessment. AIM: The aim of the study was evaluation of renal function in the course of hypertension in the elderly. MATERIALS AND METHODS: The study involved 63 women and 17 men, aged from 75 to 93 years, who were diagnosed with arterial hypertension in accordance with the guidelines of the Polish Society of Hypertension. Patients were divided into two groups. The first pair consisted of a group of 1 hypertensive patients (HA) lasting up to 10 years of age over 85 years and a group of 2 patients with HA lasting up to 10 years at the age of 75-85 years. The second pair is group I - patients with HA over 10 years of age over 85 years and group II - patients with HA lasting over 10 years at the age of 75-85. The assessment of glomerular filtration was made using the estimated glomerular filtration rate (GFR), which was calculated according to the mathematical formula of MDRD, while the renal resistance index was assessed using spectral Doppler after visualization of the flow in the renal arteries. RESULTS: The value of glomerular filtration in the examined groups divided by age was 55.1±15 (group 1) and 66.9±16 (group 2). The values of the kidney artery resistance index (depending on age) were in 1 group: 0.61±0.04 vs 0.60±0.05 and in the second group: 0.59±0.06 vs 0.58±0.05. The values of the renal artery resistance index (depending on the duration of HA) were 0.62±0.04 vs 0.61±0.03 (group I) and 0.61±0.04 vs 0.60±0.04 ( group II). CONCLUSIONS: GFR depends on the duration of hypertension. A relationship was found between the value of the kidney artery resistance index and age. There was no significant relationship between the value of the kidney artery resistance index and duration of hypertension.

[Evaluation of the incidence of stroke in the course of hypertension in elderly patients]. / Ocena czestosci wystepowania udaru mózgu w przebiegu nadcisnienia tetniczego u chorych w podeszlym wieku.

One of the more common chronic diseases is hypertension. After 70 years of age, it is found in over 70% of this population. It causes a number of organ complications that cause death. AIM: The aim of the study was to evaluate the prevalence of stroke in hypertension in elderly patients. MATERIALS AND METHODS: The study involved 63 women and 17 men, aged from 75 to 93 years, who were diagnosed with arterial hypertension in accordance with the guidelines of the Polish Society of Hypertension. Patients were divided into two groups. The first pair consisted of a group of 1 hypertensive patients (HA) lasting up to 10 years of age over 85 years and a group of 2 patients with HA lasting up to 10 years at the age of 75-85 years. The second pair is group I - patients with HA over 10 years of age over 85 years and group II - patients with HA lasting over 10 years at the age of 75-85. The test confirming the history of stroke was obtained from medical records. RESULTS: In the study, no significant differences were found in the incidence of stroke between younger patients and those older than 85 years. In the group of patients treated for more than 10 years due to hypertension, the percentage of patients with diagnosed stroke was slightly higher than in patients treated for shorter periods, however these were not statistically significant differences p <0.43. CONCLUSIONS: In the study population, the incidence of stroke was not significantly influenced by the age or duration of hypertension.

[Evaluation of selected results of laboratory blood tests in the course of hypertension in elderly patients]. / Ocena wybranych wyników badan laboratoryjnych krwi w przebiegu nadcisnienia tetniczego u chorych w podeszlym wieku.

Hypertension is one of the most common chronic diseases. The incidence is estimated at about 30% of the general population, with a clear tendency of increasing the frequency with age. AIM: The aim of the study was to assess selected results of laboratory blood tests in the course of hypertension in elderly patients. MATERIALS AND METHODS: The study involved 63 women and 17 men, aged from 75 to 93 years, who were diagnosed with arterial hypertension in accordance with the guidelines of the Polish Society of Hypertension. Patients were divided into two pairs of groups - in terms of the duration of hypertension and the age of the subjects. Blood samples were taken in patients to determine blood counts, glucose, creatinine, total cholesterol, LDL, HDL and triglycerides. In the morphological examination of the blood, the number of leukocytes, erythrocytes and platelets in 1 µl of blood was assessed, as well as the concentration of CRP, ALAT and ASPAT were assessed. RESULTS: In the study, no significant differences were found between the results of selected biochemical tests and peripheral blood morphology between the analyzed subgroups of patients with respect to age and also depending on the duration of hypertension. CONCLUSIONS: Both the older age of patients and the duration of hypertension do not significantly affect the results of selected blood laboratory tests in the study population.

[Assessment of the intima and media of carotid arteries in the course of hypertension in the elderly]. / Ocena kompleksu blony wewnetrznej i srodkowej tetnic szyjnych w przebiegu nadcisnienia tetniczego u osób w podeszlym wieku.

According to the position of the European Society of Hypertension in 2009, the thickening of the inner and middle membrane complex of the carotid arteries (I-M CCA), or the finding of atherosclerotic plaques is associated with high cardiovascular risk. The increase in I-M CCA thickness, assessed within the carotid artery, is considered the initial stage of atherosclerosis. According to the concept of parallel development of atherosclerosis in many arterial areas I-M CCA is a recognized marker of the process involving other arteries, such as coronary arteries, kidney or lower limbs. AIM: The aim of the study was evaluation of the intima and media of carotid arteries - I-M in the course of hypertension in the elderly. MATERIALS AND METHODS: The study involved 63 women and 17 men, aged from 75 to 93 years, who were diagnosed with arterial hypertension in accordance with the guidelines of the Polish Society of Hypertension. Patients were divided into two groups. The first pair consisted of a group of 1 hypertensive patients (HA) lasting up to 10 years of age over 85 years and a group of 2 patients with HA lasting up to 10 years at the age of 75-85 years. The second pair is group I - patients with HA over 10 years of age over 85 years and group II - patients with HA lasting over 10 years at the age of 75-85. Carotid artery examination was performed using the Aloka SSD-1100 ultrasound machine. The measurements were made within the left and right carotid wall of the common carotid artery in the anterior and lateral-posterior projection. The maximum thickness of the inner and middle membranes was measured in three places within two segments of the common carotid artery. RESULTS: It was observed that in the group of patients treated longer due to hypertension, the thickness of the intima-media complex is significantly higher than in patients with shorter duration. Moreover, in the examined group of patients in the analysis of individual correlations, life expectancy was influenced, among others, by significantly on the thickness of I-M CCA. CONCLUSIONS: Both the older age of patients and the longer duration of hypertension caused thickening of the intima-media complex. The duration of hypertension greater than 10 years had a greater impact on the thickness of this complex than the age of the patients.

[The usefulness of the scale before exercise and exercise to identify coronary artery disease by physiotherapists]. / Przydatnosc skali przedwysilkowej i wysilkowej do rozpoznawania choroby wiencowej przez fizjoterapeutów.

Myocardial ischemia can be assessed by ECG at rest or doing the stress test, which also serves to evaluate the results of cardiac rehabilitation. AIM: The aim of this study was to determine the usefulness of the scale before exercise and exercise to assess the risk of coronary heart disease and recognition by physiotherapists. MATERIALS AND METHODS: The study included three groups of people: 1. 65 patients with stable coronary heart disease (IHD), including 45 men and 20 women, ranging in age from 33 to 79 years, an average of 60.18 ± 9.43 years who exercise test was positive; 2. 24 patients after myocardial infarction undergoing subsequent rehabilitation, including 20 men and 4 women, aged from 42 to 78 years, an average of 58.75 ± 8.45 years; 3. 70 healthy subjects without ischemic heart disease, including 34 men and 36 women, ranging in age from 24 to 70 years, an average of 56.24 ± 12.33 years. All healthy people and patients were hospitalized in the Department of Internal Medicine and Cardiac Rehabilitation, University Hospital im. WAM in Lodz. The study groups were assessed risk of coronary heart disease based on the result obtained in the scale before exercise and exercise. The results were statistically analyzed using Statistica version 12 (StatSoft, Poland). For the statistically significant level of p<0.05. RESULTS: Compared to healthy individuals in both the ischemic heart disease (p=0.04) and in the group treated with rehabilitation (p=0.03) results in a scale before stress was significant higher. Compared to healthy individuals, both in the group of ischemic heart disease (p <0.001) and in the group treated with rehabilitation (p<0.001) The results on a scale of exercise were significantly higher. CONCLUSIONS: The use of scale before exercise to assess the risk of coronary heart disease is useful for physical therapists in their professional practice. There legitimacy of the use of scale exercise for the initial diagnosis of coronary artery disease without knowing the interpretation of the ECG stress test.

[Evaluation of oxidative-reduction markers of blood in patients with acute coronary syndromes (ACS) subjected to cardiac rehabilitation]. / Evaluation of oxidative-reduction markers of blood in patients with acute coronary syndromes (ACS) subjected to cardiac rehabilitation.

Role in the pathogenesis of atherosclerosis play a reactive oxygen species. In the case of disturbance of dynamic balance between their production and antioxidant defense mechanisms comes to undesirable consequences - oxidative stress. Excessive exercise can, among others, disrupting the balance. AIM: The aim of the study was to evaluate the exponents of the processes of oxidation - reduction of blood in patients with ACS undergoing rehabilitation in a hospital setting. MATERIALS AND METHODS: The study included 25 patients after ACS STEMI, including 19 men and 6 women, aged 51.5±6.5 years, underwent rehabilitation in the Department of Internal Medicine and Cardiac Rehabilitation, University Hospital im. WAM in Lodz. Blood samples were taken after an initial exercise test (I) and after the final exercise test (IV). Marked: SOD-1, CAT, GPX- in red blood cells, plasma antioxidant activity (TAS) and the concentration of MDA in the red blood cells. Cardiac rehabilitation program included 15 interval training, each lasting 40-45 minutes. RESULTS: The results were statistically analyzed. For the statistically significant level of p<0.05. No significant effect of cardiac rehabilitation on the activity of GPX, SOD-1, MDA and antioxidant activity of plasma. There was only a significant impact on the rehabilitation of CAT activity (p=0.002). CONCLUSIONS: Properly conducted cardiac rehabilitation does not disturb the balance of oxidation - reduction of blood in patients with ACS. Exercise should be selected in such a way that this balance is maintained.

[Echocardiographic evaluation in the course of hypertension in the elderly]. / Ocena echokardiograficzna w przebiegu nadcisnienia tetniczego u osób w podeszlym wieku.

Factor contributing to the high prevalence of hypertension in the elderly is currently observed high survival rate of people diagnosed and treated hypertension, as well as the aging process itself. Detection of systemic complications was considered to be an important element of the diagnosis of hypertension as well as an important parameter of prognosis. Nowadays, echocardiography is the main tool used to assess heart cavities and to diagnose ventricular hypertrophy. AIM: The aim of the study was echocardiographic evaluation of the heart in the course of hypertension in the elderly. MATERIALS AND METHODS: 80 patients (63 women and 17 men) aged 75 to 93 years (mean age 81±5.3 years) with diagnosed hypertension were enrolled. Patients were divided into two groups because of the duration of hypertension and age. Hypertension was diagnosed based on clinical measurements. All patients underwent echocardiography. RESULTS: The echocardiographic study showed a significant effect of duration of hypertension on the dimensions of both the left ventricular heart chambers and the thickness of the ventricular septum and the posterior wall. CONCLUSIONS: Long-term hypertension results in left atrium and right ventricular hypertrophy, diminished left ventricular systolic and diastolic dimensions, and increases ventricular septal thickness in diastole and posterior wall thickness, without affecting the diastolic dimension of the right ventricle.

[Evaluation of selected vascular active factors in patients after myocardial infarction subjected to cardiac rehabilitation]. / Ocena stezenia wybranych czynników naczyniowo aktywnych u chorych po ostrym zespole wiencowym poddanych rehabilitacji kardiologicznej.

Atherosclerosis is an inflammatory process that develops in the coronary arteries. Clinically active agents such as proinflammatory interleukins, TNF-α, tissue inhibitors of metalloproteinases (including TIMP-1), and vascular endothelial growth factor (VEGF), are important factors in the development of acute coronary syndromes. AIM: The aim of the study was to evaluate the effect of cardiac rehabilitation (stage II) on the concentration of selected vascular active factors (IL- 1, IL-6, TIMP-1, VEGF). MATERIALS AND METHODS: The study involved 24 patients after ACS who underwent complex cardiac rehabilitation (stage II) in the Department of Internal Medicine and Cardiac Rehabilitation at the Medical University of Lodz. The study involved 20 men and 4 women aged 42-78 years (average age 58.75 ± 8.45 years). The ELISA method was used in the vascular endothelial cell assay using readymade sets for determining individual molecules: Human Quantum ELISA Kit (DTM100; R & D Systems, BIOKOM, Poland), Human VEGF Quantikine ELISA Kit (DVE00; R & D Systems, BIOKOM, Poland) Human IL-1 beta / IL-1F2 Quantikine ELISA Kit (DLB50; R & D Systems, BIOKOM, Poland), Human IL-6 Quantikine ELISA Kit (D6050, R & D Systems, BIOKOM, Poland). TIMP-1 concentration is expressed in ng / ml, VEGF in pg / ml, IL-1 in pg / ml, IL-6 pg / ml. The results of the study were analyzed statistically at significance level p <0,05. RESULTS: There was no significant effect of cardiac rehabilitation on vascular endothelial factors: TIMP-1, VEGF, IL-6. Significant effect of cardiac rehabilitation was observed on the increase of IL-1 concentration (p=0.016). CONCLUSIONS: The absence of post-cardiac rehabilitation in patients after ACS, significant changes in vascular endothelial activity, confirm the hypothesis that adequate physical effort does not involve changes in blood concentrations and justifies perception of rehabilitation as a safe and risk-free intervention.

[Three-month rehabilitation of a patient with the III, IV and VI cranial nerve damage caused by a neurosurgery of the left internal carotid artery aneurysm].

OBJECTIVE: Introduction: Oculomotor nerve palsy is an eye condition resulting from damage to the third cranial nerve or a branch thereof. Third nerve damage weakens the muscles innervated by the nerve . Also adversely affect the fourth and sixth nerve , causing impairment of their activity. Rehabilitation third nerve palsy is rarely described in the available literature . The whole process is very difficult , but the effects of physiotherapy is very beneficial for the patient. The aim:The assessment of the influence of the outpatient rehabilitation on the patient's condition after a three-month treatment and the use of physical therapy. PATIENTS AND METHODS: Material and methods:Case studies of the 38-yerar-old patient after having operated a big aneurism of the left ICA, which was clipped. After the procedure, the III, IV and VI cranial nerves were deeply impaired and the amnesic aphasia occurred. The patient started the rehabilitation a month after the incident. To assess the process of rehabilitation, the own movement examination of the eyeball was implemented. Active and passive exercises, Tigger Point therapy, kinesiotaping, laser and electrostimulation were inserted. RESULTS: Results: The significant improvement of the eyeball movement has been proved on the basis of the same own examination. A physiotherapy has had a positive influence on the speech disorder, namely amnesic aphasia, and after the month of the rehabilitation it has been completely removed. The positive influence of the rehabilitation, which has been pointed out, is clinically essential. CONCLUSION: Conclusions: Obtained results have not been described in literature yet, that is why it is essential to widen further research and emphasise the importance of the rehabilitation, which is rarely implemented in an intense way in such medical conditions.

[The impact of the dosing, a 12-week physical training on the concentration of NT-proBNP and D-Dimer in patients with heart failure and impaired functional capacity in VII-X decade of life]. / Wplyw dozowanego 12-tygodniowego treningu fizycznego na stezenia NT-proBNP i D-Dimer u chorych z niewydolnoscia serca i zaburzeniami sprawnosci funkcjonalnej w VII­X dekadzie zycia.

Chronic heart failure (CHF), despite the preventive measures taken is the most common problem of modern cardiology. The aging of the body predisposes to the development of PNS, because qualitative changes taking place in the heart of the patient in the elderly are similar to those occurring among patients with heart failure. A growing problem of eldery patients becomes a deterioration of physical fitness leading to the reduction of activity and sedentary lifestyle. There is no doubt that increasing physical activity in the elderly should aim not only to restore the patient to a previous level of functioning, but also improve their physical resources to a higher level of efficiency and to facilitate independent functioning in everyday life. AIM: The aim of the study was to analyze the assessment of 12-week controlled physical training on the concentration of NT-proBNP and D-Dimer in patients with heart failure and impaired functional capacity in VII-X decade of life. MATERIALS AND METHODS: The study included a group of 72 patients, elderly men and women (within a mean age of 81,6 ± 6,4) with stable heart failure. The plasma concentration of B-type natriuretic peptide and D-Dimer was measured in each and every subject. The subjects were also asked to perform a Timed Up and Go Test (TUG) and the normal gait speed was analyzed over a 6 meter distance. RESULTS: 12-weeks cardiac rehabilitation process, improved the functional capacity of patients which is proved by reduction in duration of the TUG. Analysis of the results showed a correlation between the results of the test TUG and speed of gait. In the group of patients who underwent rehabilitation, a decrease in the concentration of plasma NT-proBNP and D-Dimer were observed. CONCLUSIONS: The low-intensity physical training increases functional capacity which is shown to shorten the duration of the TUG test and affects the modulation of neuroendocrine and concentration of NT-proBNP in patients with CHF, regardless of gender.

[Evaluation of changes in the central and peripheral circulatory system under the influence of physical training carried out under the standard procedure of improving patients after acute coronary syndrome]. / Ocena zmian w centralnym i obwodowym ukladzie krazenia pod wplywem kontrolowanego treningu fizycznego prowadzonego w ramach standardowej procedury usprawniania chorych po ostrym zespole wiencowym.

UNLABELLED: The observed with age, atherosclerotic changes in vessels and increasing damage to the vascular endothelium, causing an increase in the occurrence of cardiovascular events. An important element in the rehabilitation of patients with coronary artery disease is a physical activity, to complement the pharmacological treatment. AIM: The aim of the study was to evaluate the influence of a controlled exercise training on changes in central and peripheral circulatory system in patients after acute coronary syndrome. MATERIALS AND METHODS: Group comprising 92 patients were divided into three subgroups. The rehabilitation period ranged from 2 to 4 weeks. In group I and II performed a series of interval training on a bicycle ergometer supplemented by general conditioning exercises; in the group III training individually tailored program, consisting of breathing exercises, relaxation and small muscle groups. In all groups, before and after the training cycle test was performed impedance plethysmography of the chest, echocardiography, exercise test. RESULTS: After completing the program, the parameters plethysmography improved in all groups, with the largest changes were observed in the group treated to the longest training: increase PAmpl (pulse wave amplitude) of 16.7% and PSlope (systolic slope) of 17.6%, while decline in the value of CT (crest time) by 5.7% and PT (propagation time) by 6.3%. In groups, which carried out a controlled exercise training have improved as well: exercise capacity of patients, stroke volume SV, cardiac output CO and global myocardial contractility EF. Moreover, a correlation between the results plethysmography parameters and SV, CO and EF. CONCLUSIONS: Controlled physical training, which comes under the standard procedure rehabilitation of patients after acute coronary syndrome, leads to better blood perfusion in vessels of the legs and improve myocardial functional parameters, thereby affecting the growth of physical capacity of patients.

[The use of controlled physical training in patients with acute coronary syndrome treated with intervention - assessment of effects on biochemical parameters and functional myocardial]. / Zastosowanie kontrolowanego treningu fizycznego u chorych po ostrym zespole wiencowym leczonych interwencyjnie - ocena wplywu na parametry biochemiczne i czynnosciowe miesnia serca.

UNLABELLED: Diseases of the cardiovascular system is one of the most common causes of death among people over 65 years. Due to its course and incidence are a major cause of disability and impaired quality of life for seniors, as well as a serious economic problem in health care. Important role in the prevention of cardiovascular disease plays making systematic physical activity, which is a component of any rehabilitation program. Regular physical training by doing cardio-and vasoprotective has a beneficial effect on cardiovascular status and physical performance in patients with diagnosed coronary heart disease, regardless of age. AIM: The aim of this study was to evaluate the effect of controlled exercise on selected biochemical parameters and functional myocardial infarction. MATERIALS AND METHODS: A group of 89 patients were divided into 3 subgroups. In group I (n = 30) was performed 2 weeks cardiac rehabilitation program, in group II (n = 30) 4 weekly. Streamline the program consisted of a series of interval training performed using a bicycle ergometer and general exercise. The remaining group (gr. III, n = 29) participated in individually selected training program. In all subjects before and after the training cycle underwent thoracic impedance plethysmography, also determined the level of plasma natriuretic peptide NT-proBNP and echocardiography and exercise test. RESULTS: After training, in groups, which carried out a controlled physical training, improvement was observed: exercise capacity of patients respectively in group I (p = 0.0003), group II (p = 0.0001) and group III (p = 0.032), stroke volume SV, cardiac output CO and global myocardial contractility, there was also reduction in the concentration of natriuretic peptide NT-proBNP. Furthermore, the correlation between the results shown pletyzmography parameters and NT-proBNP, SV, CO and EF. CONCLUSIONS: Regular physical training as part of the cardiac rehabilitation has a beneficial effect on biochemical parameters and functional myocardial infarction in patients with ACS. Size of the observed changes conditioned by the nature and duration of the training.