Effects of polyunsaturated omega-3 fatty acids on responsiveness to dual antiplatelet therapy in patients undergoing percutaneous coronary intervention: the OMEGA-PCI (OMEGA-3 fatty acids after pci to modify responsiveness to dual antiplatelet therapy) study.

OBJECTIVES: The purpose of this study was to investigate whether omega-3 polyunsaturated fatty acids (PUFAs) are able to modify platelet responsiveness to dual antiplatelet therapy in stable coronary artery disease patients undergoing percutaneous coronary intervention (PCI). BACKGROUND: Although previous studies have suggested antiplatelet properties of omega-3 polyunsaturated fatty acids, it is unknown whether they can enhance platelet inhibition on standard aspirin and clopidogrel treatment. METHODS: The OMEGA-PCI (OMEGA-3 Fatty Acids After PCI to Modify Responsiveness to Dual Antiplatelet Therapy) study was an investigator-initiated, prospective, single-center, double-blind, placebo-controlled, randomized study. Patients receiving standard dual antiplatelet therapy (aspirin 75 mg/day and clopidogrel 600 mg loading dose followed by 75 mg/day) were randomly assigned to receive the addition of 1 g of omega-3 ethyl esters (n = 33) or placebo (n = 30) for 1 month. Platelet function was measured serially by light transmission aggregometry (adenosine diphosphate and arachidonic acid [AA] were used as agonists) and assessment of the phosphorylation status of the vasodilator-stimulated phosphoprotein at baseline, 12 h, 3 to 5 days, and 30 days after randomization. RESULTS: The P2Y(12) reactivity index was significantly lower, by 22.2%, after 1 month of treatment with omega-3 polyunsaturated fatty acids compared with placebo when used in addition to dual antiplatelet therapy (p = 0.020). Maximal platelet aggregation induced by 5 and 20 micromol/l adenosine diphosphate was lower by 13.3% (p = 0.026) and 9.8% (p = 0.029), respectively, after 1 month of treatment with omega-3 polyunsaturated fatty acids compared with placebo. Platelet aggregation after AA stimulation was low and did not change significantly throughout the study. There were no cases of aspirin resistance during follow-up that was suggestive of good compliance with the medication. CONCLUSIONS: The addition of omega-3 ethyl esters to the combination of aspirin and clopidogrel significantly potentiates platelet response to clopidogrel after percutaneous coronary intervention.

[Endomyocardial disease as the first manifestation of hypereosinophilic syndrome]. / Choroba endomiokardialna jako pierwsza manifestacja zespolu hipereozynofilowego.

A case of hypereosinophilic syndrome (HES) initially manifesting as endomyocardial disease in a 21-year-old man is presented. The diagnosis of HES was made according to the Chusid's criteria. Myeloproliferative disorders were excluded and corticosteroid therapy with prednisone at a dose of 1 mg/kg/d was started immediately. After 30 days of continuous corticotherapy the patient recovered completely. His blood eosinophil count decreased from 8740 cells/microL (48.7%) to 30 cells/microL (0.3%). Then, prednisone was discontinued gradually. During 18-month follow-up the patient was free from cardiovascular symptoms and his complete blood count was normal. We also present the current state of knowledge on the cardiovascular complications of hypereosinophilic syndrome.

Stenotrophomonas maltophilia pacemaker endocarditis in a patient with d-transposition of the great arteries after atrial switch procedure.

We report a case of pacemaker endocarditis due to Stenotrophomonas maltophilia in a 22-year-old Caucasian man with d-transposition of the great arteries after atrial switch procedure. S.maltophilia isolated from blood cultures was susceptible to trimethoprim-sulfamethoxazole and amikacin, and resistant to ciprofloxacin and all tested ß-lactam antibiotics. The infected pacemaker system was completely removed by thoracotomy. Simultaneously, a new DDD pacemaker and epicardial electrodes were successfully implanted and selective antibiotic therapy consisting of trimethoprim-sulfamethoxazole (480 mg i.v. q 6 h) and amikacin (250 mg i.v. twice daily) was continued. However, the post-operative course was complicated by septic shock and the patient died on 9th day after surgery. Importantly, S.maltophilia isolated from extracted pacemaker leads was multidrug-resistant including to trimethoprim-sulfamethoxazole, ciprofloxacin, all tested aminoglycosides, and ß-lactams, with the exception of ticarcillin-clavulanate. In conclusion, pacemaker endocarditis due to Stenotrophomonas maltophilia is an extremely rare but serious complication of permanent pacing therapy. The susceptibility of S.maltophilia isolates to antimicrobial agents can change during the course of infection. Despite the inherent resistance of S.maltophilia to most ß-lactam antibiotics, multidrug-resistant strains may be susceptible in vitro to ticarcillin-clavulanate. Further studies are needed to determine the optimal management of patients with pacemaker endocarditis caused by Stenotrophomonas maltophilia.

The effects of gender and test protocol on the results of head-up tilt test in patients with vasovagal syncope.

BACKGROUND: Head-up tilt testing (HUTT) is a well-established method for the diagnosis of reflex syncope. Some controversies exist whether gender and HUTT protocol influence HUTT results. AIM: To analyse the results of HUTT in patients with syncope in relation to their gender and used protocol of HUTT. METHODS: We retrospectively analysed data of 537 consecutive patients (313 women and 224 men), aged 13-79 years with history of neurally-mediated syncope referred to HUTT. The cardiogenic and neurological aetiology of syncope was excluded in all patients based on previous examination. In 375 patients standard HUTT (STD HUTT), according to the Westminster protocol, was used. In 257 patients in whom STD HUTT was negative, HUTT was continued with pharmacological provocation using isoproterenol intravenous infusion--114 patients (ISO HUTT) or sublingual nitroglycerin--143 patients (NTG HUTT). In the remaining 162 patients HUTT was performed according to the Italian protocol (ITL HUTT). The HUTT results were classified according to the VASIS scale. RESULTS: Female gender dominated, however, syncope was induced in a similar proportion of women and men (77.3 vs. 70.5%, NS). There were also no significant differences in the type of vasovagal response (VVR) to HUTT between women and men. Mixed type of VVR was the most frequent after isoproterenol provocation (ISO HUTT), whereas cardioinhibitory type of VVR was the most frequent after nitroglycerin provocation (NTG HUTT). CONCLUSIONS: There is no significant relationship between gender and the result of HUTT. The type of VVR is related to HUTT protocol--cardioinhibitory response is more frequent following nitroglycerin administration in comparison to standard protocol and HUTT with isoproterenol provocation.

Evaluation of sinus and atrioventricular nodes function in patients with vasovagal syncope.

AIM: Evaluation of sinus and atrioventricular nodes function as a potential factor responsible for prolonged bradycardia, asystole, or both in patients with cardioinhibitory and non-cardioinhibitory vasovagal syncope (VVS). The study included 258 patients (mean age = 47.7 +/- 17.2 years; range 18-62; 147 females) with a history of VVS. They were divided among four groups, according to results of head-up tilt test (HUTT). METHODS: All patients underwent standard HUTT, carotid sinus massage (CSM), and rapid transesophageal atrial pacing for evaluation of total sinus node recovery time (SNRT), and corrected sinus node recovery time (CNRT), resting and intrinsic heart rate (IHR), and Wenckebach point (WP). Values of SNRT > 1,500 ms, CNRT > 525 ms, WP < 130 bpm, and CSM-induced pause >3 seconds were considered abnormal. RESULTS: SNRT, CNRT, and WP before and after pharmacological blockade, resting heart rate, and IHR did not differ significantly among the study groups. The prevalence of mild sinus node dysfunction (SND), decreased value of WP, and cardioinhibitory carotid sinus hypersensitivity was similar among all study groups. CONCLUSIONS: The prevalence of mild SND, abnormal atrioventricular conduction, and carotid sinus hypersensitivity (CSH) was similar among patients with VVS regardless of the type of vasovagal reaction. SND and CSH do not seem to play an important role in the pathogenesis of cardioinhibitory vasovagal reaction.

Intracoronary infusion of bone marrow-derived selected CD34+CXCR4+ cells and non-selected mononuclear cells in patients with acute STEMI and reduced left ventricular ejection fraction: results of randomized, multicentre Myocardial Regeneration by Intracoronary Infusion of Selected Population of Stem Cells in Acute Myocardial Infarction (REGENT) Trial.

AIMS: Comparison of intracoronary infusion of bone marrow (BM)-derived unselected mononuclear cells (UNSEL) and selected CD34(+)CXCR4(+) cells (SEL) in patients with acute myocardial infarction (AMI) and reduced <40% left ventricular ejection fraction (LVEF). METHODS AND RESULTS: Two hundred patients were randomized to intracoronary infusion of UNSEL (n = 80) or SEL (n = 80) BM cells or to the control (CTRL) group without BM cell treatment. Primary endpoint: change of LVEF and volumes measured by magnetic resonance imaging before and 6 months after the procedure. After 6 months, LVEF increased by 3% (P = 0.01) in patients treated with UNSEL, 3% in patients receiving SEL (P = 0.04) and remained unchanged in CTRL group (P = 0.73). There were no significant differences in absolute changes of LVEF between the groups. Absolute changes of left ventricular end-systolic volume and left ventricular end-diastolic volume were not significantly different in all groups. Significant increase of LVEF was observed only in patients treated with BM cells who had baseline LVEF < median (37%). Baseline LVEF < median and time from the onset of symptoms to primary percutaneous coronary intervention > or = median were predictors of LVEF improvement in patients receiving BM cells. There were no differences in major cardiovascular event (death, re-infarction, stroke, target vessel revascularization) between groups. CONCLUSION: In patients with AMI and impaired LVEF, treatment with BM cells does not lead to a significant improvement of LVEF or volumes. There was however a trend in favour of cell therapy in patients with most severely impaired LVEF and longer delay between the symptoms and revascularization.

Concentration of BNP, endothelin 1, pro-inflammatory cytokines (TNF-alpha, IL-6) and exercise capacity in patients with heart failure treated with carvedilol.

BACKGROUND: Recent studies on the pathophysiology of heart failure indicate the role of neurohormones and immune and inflammatory processes as potential mechanisms involved in the pathogenesis and clinical course of chronic heart failure (CHF). AIM: To analyse the relationship between concentrations of brain natriuretic peptide (BNP), endothelin-1 (ET-1), inflammatory cytokines (TNF-alpha, IL-6) and cardiopulmonary stress test parameters, and to evaluate their changes during carvedilol treatment. METHODS: The study included 86 patients (81 men and 5 women) aged from 35 to 70 years (56.8+/-9.19) with symptomatic heart failure and left ventricular ejection fraction <40%, receiving an inhibitor of angiotensin II converting enzyme, diuretic and/or digoxin but not beta-blockers. All patients at baseline, and then at 3 and 12 months after treatment, underwent a panel of studies to assess functional capacity according to NYHA, echocardiographic and cardiopulmonary stress test (CPX) parameters, and serum concentrations of BNP, ET-1, TNF-alpha and IL-6. Before introducing carvedilol we found a weak relationship between concentrations of BNP, ET-1, IL-6 and decreased VO2 peak. RESULTS: At 12 months exercise tolerance was significantly improved (exercise stress testing prolonged by 143.9 s, p=0.001) and an increase in metabolic equivalent (MET) by 1.41 (p=0.001) was observed. The VO2 peak was nonsignificantly increased by a mean of 0.9 ml/kg/min. In patients with baseline VO2 peak <14 ml/kg/min the concentrations of ET-1 and TNF-alpha were significantly higher than in the remaining ones, and after treatment they were significantly reduced. In these patients VO2 peak%N was also significantly increased (39.5+/-7.5 vs. 50.1+/-15,0; p=0.013). The number of patients with VO2 peak <14 ml/kg/min also significantly decreased from 39 to 21 (p=0.013). CONCLUSIONS: In patients with HF decreased value of VO2 peak is associated with LV systolic function disorders and increased levels of BNP, ET-1, TNF-alpha and IL-6. Chronic treatment with carvedilol improves LV systolic function, exercise tolerance and peak oxygen consumption and is associated with significant decrease of BNP, ET-1, TNF-alpha and IL-6 concentrations.

Prevalence of dyslipidemia and general ineffectiveness of its treatment in both primary and secondary prevention of coronary heart disease within family medicine framework--results of LIPIDOGRAM 2005--a nationwide epidemiological study. Dyslipidemia in Poland--ineffective treatment.

PURPOSE: Despite major advances in cardiology dyslipidemia continues to be underdiagnosed and undertreated. The study aimed to evaluate current prevalence of dyslipidemia and treatment efficacy in both coronary and non-coronary subjects. METHODS: 17,065 subjects aged 30-95 years (20.51%--coronary heart disease (CHD) patients), seeking medical help for disparate reasons from 675 family physicians, were randomly enrolled. Family physicians completed pertinent questionnaires against available medical records and measured patients' lipid levels during a single appointment. RESULTS: Dyslipidemia was detected in 73% of the CHD subjects vs. 46% of the non-CHD ones (p = 0.00001); its severity differing regionally. Hypolipemic treatment was administered to 82% of the CHD subjects vs. 12% of the non-CHD ones (p = 0.00001). Mean concentrations of LDL-cholesterol were higher in the treated subjects (p = 0.00002). Only 10% of the CHD subjects and 20% of the non-CHD ones were treated effectively for dyslipidemiae. CONCLUSIONS: Dyslipidemia was found widely prevalent nationwide, as well as poorly pharmacologically controlled in both primary and secondary prevention. Diversity of economic factors notwithstanding, this was mainly attributable to ineffective patient educational policies, meriting therefore immediate expansion and enhancement of existing disease management system in terms of adequate monitoring and effective treatment of key coronary risk factors.

[Massive pulmonary embolism mimicking ST-elevation acute coronary syndrome successfully treated with hybrid therapy in a trauma patient receiving nadroparin: diagnostic and therapeutic dilemmas]. / Masywny zator tetnicy plucnej imitujacy ostry zespól wiencowy z uniesieniem odcinka ST skutecznie leczony terapia hybrydowa u chorej po zlozonym urazie ortopedycznym otrzymujacej nadroparyne

A case of a 48-year-old woman with a comminuted fracture of the left tibia and receiving prophylactic doses of nadroparin, with massive pulmonary embolism mimicking ST-elevation acute coronary syndrome and complicated by cardiogenic shock and cardiac arrest, is presented. Pulmonary angiography showed total right pulmonary artery occlusion. Intraarterial thrombolysis with reduced dose of alteplase (50 mg), platelet GP IIb/IIIa blockade with eptifibatide, endovascular embolus fragmentation with a pigtail rotation catheter, and rescue pulmonary balloon angioplasty were performed, after which complete recovery was achieved. On day 4 of hospitalisation the patient was transferred to the orthopaedic ward where she underwent uneventful tibial surgery.

[Spontaneous recanalisation of the superficial femoral artery following angioplasty of the femoral artery in a patient with disseminated atherosclerosis--a case report]. / Samoistne udroznienie zamknietej tetnicy udowej powierzchownej u pacjenta z wielonaczyniowa choroba wiencowa i wielopoziomowa miazdzyca tetnic konczyn dolnych po angioplastyce tetnicy udowej z wszczepieniem stentu IntraCoil.

We present a case of a 51-year-old male with multivessel coronary artery disease and disseminated peripheral arterial disease (PAD) who underwent coronary angioplasty, followed by angioplasty with stent implantation of the left superficial iliac artery and right femoral artery. Thirty days later the patient was admitted for elective angioplasty of the previously closed superficial right femoral artery; however, angiography showed that the artery was patent with a residual stenosis which narrowed the vessel lumen by 10%. We believe that spontaneous recanalisation of this artery was caused by multiple factors, including cessation of smoking, physical training, pharmacological therapy and previous angioplasty of the right femoral artery.

[Acute toxoplasmic perimyocarditis in a 67-year-old HIV-negative woman--a case report]. / Ostre toksoplazmowe zapalenie miesnia sercowego i osierdzia u 67-letniej HIV-negatywnej chorej.

Acquired toxoplasmosis is a widespread parasitic disease caused by an obligate intracellular protozoan, Toxoplasma gondii. Humans are infected by consuming undercooked or raw meat containing tissue cysts or by ingesting oocysts in food or water contaminated with feline faeces. Most cases of Toxoplasma gondii infections in immunocompetent individuals are asymptomatic. Although acquired toxoplasmosis is usually a mild infection, it may be life-threatening in immunocompromised patients. In this report we present a 67-year-old HIV-negative woman with acute toxoplasmic perimyocarditis, heart failure and with a history of ischemic heart disease, hypertension and dyslipidemia. The diagnosis was based on clinical characteristics, echocardiographic examinations, elevated inflammatory markers and the presence of IgM and IgG antibodies against Toxoplasma gondii. We conclude that Toxoplasma gondii infection should be considered in each case of perimyocarditis with concomitant, significant diagnostic and therapeutic problems, especially in immunocompromised patients. This paper also reviews differential diagnosis of elevated CA 125 serum levels in postmenopausal women.

[Cardiac tamponade as the first symptom of oesophageal carcinoma -- a case report]. / Tamponada serca jako pierwszy objaw raka przelyku -- opis przypadku.

We present a case of a 56-year-old male who was admitted to our hospital due to cardiac tamponade. A 600 ml of purulent fluid was evacuated from the pericardium. The patient received antibiotics, however, due to recurrent pericardial effusion a pericardial drainage was required. Esophagoscopy and computerised tomography revealed oesophageal carcinoma with oesophago-pericardial fistula.

ST segment elevation in lead aVR and coronary artery lesions in patients with acute coronary syndrome.

INTRODUCTION: Recently, the prognostic value of ST segment elevation in lead aVR in acute coronary syndrome (ACS) and its relationship with significant stenosis of the left main coronary artery (LMCAS) and three-vessel disease have been highlighted. AIM: Analysis of the relationship between ST segment elevation observed in aVR lead and angiographic severity of coronary artery disease in patients with ACS. METHODS: The study involved 134 patients with ACS, including 54 subjects with ST elevation in aVR (group A) and 80 patients without elevation of ST in the same lead (group B), aged 33-78 years, mean 59.9+/-9.7 years. The severity of coronary artery disease was compared between the two groups. The logistic regression model was used for the analysis of factors affecting ST segment in aVR, as well as LMCAS and three-vessel disease probability. RESULTS: In patients with ST elevation in aVR, three-vessel disease prevalence was two times higher (61.1% vs 35.0%; p <0.01), and LMCAS - three times higher (55.6% vs 17.5%; p <0.000001) than in those without ST elevation in aVR. Factors independently associated with ST elevation in aVR were LMCAS (OR 6.1; 95% CI 2.62-14.23; p <0.00005), ST segment elevation in V1 (OR 3.03; 95% CI 1.34-6.86; p <0.01) and diabetes (OR 2.89; 95% CI 1.17-7.15; p <0.05). The predictors of LMCAS were three-vessel disease and ST elevation in aVR, while the predictors of three-vessel disease were: LMCAS, diabetes, male gender and history of myocardial infarction. CONCLUSIONS: Elevation of the ST segment in aVR in the setting of acute coronary syndrome identifies patients with severe coronary artery disease. Only left main coronary artery disease, however, remains independently associated with ST segment elevation in aVR. Three-vessel disease and the left main coronary artery stenosis equivalent are not independent predictors of ST segment elevation in aVR of standard electrocardiograms recorded in patients with acute coronary syndrome.

[Difficulties in the differential diagnosis of left ventricular aneurysm -- a case report]. / Trudnosci w róznicowaniu tetniaków lewej komory. Opis przypadku.

Difficulties in the differential diagnosis of left ventricular aneurysm - a case report. A case of a 55-year-old male with a post- infarction left ventricular aneurysm is described. The results of such non-invasive tests as echocardiography, angiography and magnetic resonance did not allow to differentiate between true and false aneurysm. The patient underwent successful surgery which revealed the presence of true left ventricular aneurysm. Difficulties in the differentiation between true aneurysm and pseudoaneurysm are discussed.

[Cardiopulmonary stress test in patients with heart failure and atrial fibrillation]. / Wysilkowy test spiroergometryczny u chorych z niewydolnoscial serca i migotaniem przedsionków.

BACKGROUND: The cardiopulmonary stress test (CPST) allows the objective assessment of stress capacity in patients (pts) with heart failure (HF). There are a small number of studies concerning CPST in pts with HF and AF. AIM: to assess the influence of AF on CPST parameters in pts with HF. MATERIAL: The study group consisted of 56 males aged 35-65 years (x = 57.3 year) with diagnosed HF lasting at least 3 months, in the II and I NYHA functional class and with l eft ventricular ejection fraction(EF) below 40%. 12 pts had an idiopathic cardiomyopathy and 44--cardiomyopathy of ischemic origin. All study pts were divided into two groups: group I (gr. I) - with persistent AF and group II (gr. II)--with sinus rhythm. METHODS: The BNP ad IL-6 levels were measured and transthoracic echocardiography and CPST were performed in all study pts.We have analysed the echocardiographic and CPST parameters in both study groups. RESULTS: We found no significant differences in age, BMI, ethiology, left ventricular echocardiographic parameter values and NYHA functional class between both groups. In pts with AF (gr. I) we found significantly higher LA diameter (mm) 49.5, SD = 6.7 vs. 44.8, SD = 6.7 (p = 0.01), significantly higher BNP level (pg/ml) 582.75, SD = 179.36 vs. 442.94, SD = 213.75 (p = 0.03) and IL-6 level (pg/ml) 13.55, SD = 10.94 vs. 8.6, SD = 7.83 (p = 0.05). We also found significant differences in: HRmin (bpm) (gr. I--98.45, SD = 21.70, gr. II--80.48, SD = 15.25 p = 0.001), HRmax (bpm) (gr. I--146.82, SD = 16.14, gr. II--123,14, SD = 16.69 p = 0.001), tmax (sec) (gr. I--414.0, SD = 252.33, gr. II--618.11, SD=268,69, p = 0.02), METS (gr. I--2.09 SD = 1.04, gr. II--4.42, SD = 2.15 p = 0.002) and VO2peak (ml/kg/min) (gr. I--11.52, SD = 1.86, gr. II - 15,03, SD = 4.42, p = 0.01). CONCLUSIONS: (1) Persistent atrial fibrillation in pts with HF is associated with 23% lower VO2peak and lower stress tolerance as compared to pts with sinus rhythm. (2) Higher IL-6 level in pts with HF and AF indicates the sympatethic system's overactivation and the presence of inflammatory reaction in these pts.

[Abscess of the mitral annulus mimicking left atrial tumour - case report]. / Ropien pierscienia zastawki mitralnej imitujacy guz lewego przedsionka. Problem diagnostyczny.

A case of a 70-year-old female with hypertension, atrial fibrillation and angina pectoris, admitted to the hospital due to echocardiographically detected left atrial tumour, is presented. Differential diagnosis included thrombus, myxoma, infectious or neoplastic tumour. The patients underwent surgery. Histopathological examination revealed the presence of an abscess in the left atrium. This report underlines the difficulties in the diagnosis of cardiac tumours.

[Characteristics of coronary diseases in women]. / Obraz kliniczny choroby niedokrwiennej serca u kobiet.

Clinical picture of coronary artery disease is different in men and women. Later incidence of coronary disease in women than in men, presence of less typical symptoms, lower specificity of non invasive diagnostic tests as well as higher mortality during percutaneous or surgical revascularization are underlined. Aim of the study was to examine clinical variables, diagnostic and treatment methods in women with coronary disease on the basis of retrospective analysis of patients hospitalized in the Department of Coronary Artery Disease of the Jagiellonian University Medical School in Cracow between 1991 and 1999. 929 patients aged 31-95 years mean 56.95 +/- 10.02 years were enrolled in the study. Clinical usefulness in women with coronary disease of diagnostic tests: electrocardiographic exercise test, exercise thalium-201 scintigraphy and stress echo-cardiography with dobutamine were analyzed. The highest sensitivity was found in exercise scintigraphy (92.9%) compared to ECG exercise test (80.6%) and stress echocardiography with dobutamine (76.9%). The highest specificity characterized stress echocardiography with dobutamine (76.9%) versus exercise scintigraphy (34.7%) and ECG exercise test (25.9%). Between 1991 and 1999 women with coronary artery disease consisted 19.4% of all patients hospitalized in the Department of Coronary Artery Disease in Cracow. Among patients investigated with coronary angiography there were 18.2% of women. Among percutaneously revascularized patients women constituted 17.8%. In the analyzed period 3.5-fold increase of the number of women with CAD hospitalized in the Department of Coronary Artery Disease in Cracow, 7.5-fold increase of the number of women investigated with coronary angiography and 10.5-fold increase of the number of percutaneously or surgically revascularized women was observed. On the basis of performed diagnostic tests 650 women (69.9%) were treated pharmacologically. In 157 patients (16.9%) percutaneous coronary angioplasty was performed, in 118 patients (12.7%) coronary artery bypass surgery was done. In 4 women (4.3%) heart transplantation was performed.

[Myocardial and coronary vessel dysfunction in diabetes I patients]. / Uposledzenie funkcji miesnia serca i naczyn wiencowych u osób z cukrzyca typu 1.

Despite of dramatic improvement in diagnostic procedures and treatment of diabetic patients, cardio-vascular complications are still the most frequent causes of death in these patients. Diabetes influences myocardial and coronary vessels function by coexisting macroangiopathy, microangiopathy, metabolic disturbances and autonomic nervous system neuropathy. All these factors result in diastolic and systolic dysfunction of the heart. Cardiomyopathy, congestive heart failure and serious arrhythmias are the end stage of diabetic complications. Macroangiopathy demonstrates accelerated atherosclerosis (involving coronary arteries), which consequences can be observed in 1 type diabetes patients at around the age of 30. Causes of increased risk of macroangiopathy in type 1 diabetic patients are not clear. There are not many clinical, prospective trials which can allow for etiology determination of the increased incidence of atherosclerosis and mortality due to coronary artery disease in this population. Adding to traditional risk factors of atherosclerosis like genetic factors, hypertension, dyslipidemia, obesity, smoking and improper diet, other important risk factors are observed in diabetic patients. Only few clinical trials suggest that hyperglycemia, glycation, glycoxidation of proteins, lipoproteins, changes in their composition, microalbuminuria, coagulation, fibrinolytic disturbances are additional risk factors of endothelium dysfunction and atherosclerosis. Prevention and treatment of accelerated coronary artery disease and it's consequences are more complicated in the diabetic population than in others. Some of the clinical trials suggest that even improved glycemic control does not eliminate the elevated risk of coronary artery disease in type 1 diabetic patients.