Effect of atorvastatin on endothelial function and inflammation in long-duration type 1 diabetic patients without coronary heart disease and arterial hypertension.

AIM: We evaluated the ability of atorvastatin, an HMG-CoA reductase inhibitor, to affect endothelial function and inflammation in long-duration (>10 years) type 1 diabetes mellitus (T1DM) patients without coronary heart disease (CHD) and arterial hypertension (AH). METHODS AND RESULTS: We randomized 204 Caucasians with long-duration T1DM into either the atorvastatin 40 mg/day plus hypolipaemic diet group (n = 154) or the placebo plus hypolipaemic diet group (n = 50) for 6 months. Endothelium-dependent flow-mediated (FMD) and endothelium-independent flow-mediated vasodilatation, serum levels of plasminogen activator inhibitor-1 (PAI-1), von Willebrand factor (vWF) and high sensitivity C-reactive protein (hs-CRP) were estimated before and after treatment. After 6 months of therapy, FMD was increased by 44% in the atorvastatin plus diet group compared with the placebo plus diet group. Treatment with atorvastatin led to a significant reduction in levels of PAI-1 and hs-CRP; however, the elevation of vWF level was observed. In the placebo plus diet group, we observed a significant reduction in levels of hs-CRP but not of vWF and PAI-1. CONCLUSIONS: Atorvastatin improves endothelial function and reduces some proinflammatory and prothrombotic markers of atherosclerosis in T1DM patients without CHD and AH. The surprising effect of atorvastatin on serum vWF levels in T1DM requires further study.

Opportunistic fungal infections in patients treated with heart transplantation--own centre experiences.

The aim of this study was to analyse frequency, type and course of fungal infection in patients treated with heart transplantation (HT) and to estimate the efficacy of diagnostic procedures in patients before and after HT. The study was conducted on 30 patients (group I) aged 20-64 referred for HT and treated after HT in Coronary Disease Department in Cracow. Standard immunosuppressive protocol consisting of CSA-A, Aza, Prednisone was administered to all recipients after HT. As a control group 40 healthy persons aged 25-65 were examined. In all persons quantitative and mycoserological examinations were carried out according to a special protocol. In some justified cases despite serological and quantitative examinations, bronchoscopy with BAL, biopsy procedure, histological examination of tissue were performed in patients after HT. The commonest infections in patients after HT were oropharyngeal Candida infections. They mostly occurred in the first months after HT, and were observed in 67% of recipients. Besides, in two patients deep Aspergillus infections were documented. Quantitative mycological examinations were very useful in diagnosing early stages of superficial mycoses. In none of these patients before HT were permanent oropharyngeal yeast and Aspergillus colonizations observed. Diagnosis of deep Aspergillus mycoses was difficult. Even antigen detection did not allow for making definitive diagnosis, because antigen was found in some recipients without infections and in some healthy persons. Definitive diagnosis depended on histological and mycological examinations of tissue sections obtained by surgical procedure and in second case by autopsy.

[Evaluation of magnesium cation levels in serum of patients with mitral valve prolapse syndrome]. / Ocena stezenia kationów magnezowych w surowicy krwi u chorych z zespolem wypadania platka zastawki dwudzielnej.

Magnesium deficiency has been suggested to be related to the mitral valve prolapse syndrome (MVPS). The aim of the present study was to analyse the concentration of magnesium in blood plasma of patients (pts) with MVPS. In the group of 80 subjects, including 50 pts with MVPS and 30 healthy people matched for age and gender, who comprised the control group (CG), concentration of magnesium in blood plasma was estimated. Magnesium levels were measured by atomic absorption spectrophotometry. Mean concentration of magnesium cation in plasma in pts with MVPS was 0.74 +/- 0.12 mmol/l (range 0.47-1.02 mmol/l). It was only 1.02% lower than in the CG (x = 0.76 +/- 0.07 mmol/l; range 0.67-0.97 mmol/l). However evaluation of the magnesium concentration in blood plasma did not prove magnesium deficiency in the mitral valve prolapse syndrome. Moreover the study revealed that histograms of magnesium concentration values in both investigated groups were divergent.

[Myocardial bridge of the coronary arteries and its clinical significance]. / Mosty miesniowe naczyn wiencowych i ich znaczenie kliniczne.

Myocardial bridge is a congenital anomaly of the coronary artery and appears on an angiogram as a systolic narrowing. Major coronary veins are rarely covered by myocardial bridges. The functional significance of coronary bridging remains controversial. Generally, bridging is not though to result in symptoms, as the coronary narrowing occurs during systole and most coronary flow occurs during diastole. Some authors reported this condition in association with angina pectoris, myocardial infarction, cardiac arrhythmias and sudden cardiac death. The mechanism of ischemia, connection with atherosclerosis are not clear. The symptomatic compressive myocardial bridge is in itself an indication for operation by simple section of the bridge. But if there exist associated atheromatous lesions, the surgeon should combine aortocoronary bypass with section or coronary angioplasty.

[Fungal infections in heart transplant patient]. / Zakazenia wywolane przez grzyby u chorych po transplantacji serca.

Considering imparied immunity in heart transplant patients as a result of immunosuppressive therapy, they are often exposed to the fungal infections. These infections are especially important because they still stay the main reason of death in transplant patients. Besides immunosuppressive therapy also antibiotics therapy, prolonged artificial ventilation of lungs, passed infections for example tuberculosis, or cytomegalovirus infection and Diabetes mellitus are the factors, which increase possibility of fungal infections in heart transplant patients. Fungal infections are the most often between first and sixth month after heart transplantation. They are caused mostly by species of Candida and Aspergillus fungi. Later than six months after heart transplantation also Cryptococcus fungi can develop fungal infection. The most often fungal infections in heart transplant patients is candidiasis. These kind of fungi colonize a skin and a mucose membrane and can very easy cause infection in friendly conditions. Infections caused by Aspergillus proceed as invasive aspergillosis, allergic, bronchopulmonary aspergillosis and aspergilloma. Depend on kind of infection we use pharmacologic or surgical therapy.

[Variability of heart auscultation in patients with mitral valve prolapse]. / Zmiennosc zmian osluchowych serca u pacjentów z zespolem wypadania platka zastawki dwudzielnej.

The aim of the study was to analyze the auscultatory findings and its variability in 84 patients (pts) with mitral valve prolapse syndrome (MVPS) who were examined in the different body positions. All the pts underwent the echocardiographical examination and in 32 subjects (38%) prolapse of the anterior mitral leaflet was found, in 40 pts (48%) prolapse of the posterior mitral leaflet and in 12 (14%) pts prolapse of the both mitral leaflets. The auscultation of the heart was done in the supine position, in the lying position on the left side and in the upright position of the patient's body. Characteristic for the mitral valve prolapse (MVP) auscultatory findings (midsystolic murmur, late-systolic murmur and/or mid-systolic "non ejection" click) were demonstrated by 43 pts (51%) in the supine position. During the auscultation in the lying position of the pts on the left side, the auscultatory findings were found in 57 pts (68%) while in the upright position in 64 pts with MVPS (76%). The study showed that the auscultatory findings in pts with MVPS were demonstrated more frequently in the lying position of the body on the left side or in the upright position compared with the supine position. Moreover we found that 20 pts with MVPS (24%) did not demonstrate the characteristic auscultatory findings of MVP.

Association between anthropometric obesity measures and coronary artery disease: a cross-sectional survey of 16,657 subjects from 444 Polish cities.

BACKGROUND: Excessive body weight is known to cluster with cardiovascular (CV) risk factors, but it is not clear which anthropometric obesity measure provides best independent predictive value of coronary artery disease (CAD). METHODS AND RESULTS: We explored associations between CAD and four different obesity measures (body mass index (BMI), waist circumference, waist/height and waist/height(2)) in a cohort of 16 657 subjects (40.4% men; 20.8% CAD patients), recruited by 700 primary care physicians in 444 Polish cities. 42.8% of subjects were classified as overweight, 31.7% as obese and 39.8% had abdominal obesity. In univariate analyses all obesity measures correlated with CAD (p>0.001), but waist/height(2) was the strongest discriminator between CAD patients and controls. Age-adjusted and sex-adjusted analyses confirmed a graded increase in CAD risk across distributions of all four obesity measures-1 standard deviation (SD) increase in BMI, waist, waist/height and waist/height(2) increased the odds of CAD by 1.23, 1.24, 1.26 and 1.27, respectively (all p<0.001). In models fully adjusted for CV risk factors, waist/height(2) remained the strongest obesity correlate of CAD, being the only independent associate of CAD in men. In a fully adjusted BMI-waist circumference stratified model, sarcopenic obesity (waist > median, BMI < median) and simple obesity (waist and BMI > median) were the strongest independent associates of CAD in men (p = 0.008) and women (p>0.001), respectively. CONCLUSION: This cross-sectional study showed that waist/height(2) may potentially offer a slightly higher predictive value of CAD than BMI or waist circumference and revealed an apparent sexual dimorphism in correlations between obesity measures and CAD.