[Plasma nitric oxide and vascular endothelial growth factor levels in patients with metabolic syndrome and co-existing vascular complications]. / Stezenie tlenku azotu i naczyniowo-sródblonkowego czynnika wzrostu w osoczu chorych na zespól metaboliczny ze wspólistniejacymi powiklaniami naczyniowymi.

UNLABELLED: Subjects with metabolic syndrome (MS) are especially exposed to co-existing several cardiovascular risk factors. It's aggregated action leads to the endothelial damage. Tissue hipoxaemia increases VEGF synthesis. NO may also play the crucial role in VEGF synthesis The balance between factors increasing and decreasing VEGF synthesis has special importance in development of vascular complications. The aim of the study was to estimate plasma nitric oxide (NO) and vascular endothelial growth factor (VEGF) levels in patients with metabolic syndrome and vascular complications. MATERIAL AND METHODS: The study was conducted in two groups of patients. I Group--54 patients with metabolic syndrome (diagnosed according to the IDF criteria from 2005) and macro- and microvascular complications, aged 46-67 (58 +/- 6.7) years. II Group--20 healthy subjects, aged 40-61 (51 +/- 5.1) years. Plasma levels of NO and VEGF were determined in all participants. RESULTS: Plasma level of nitric oxide in subjects with metabolic syndrome and vascular complications was 6.48 +/- 1.5 micromol/l and in healthy participants 10.08 +/- 1.09 micromol/l (p < 0.05). Plasma level of vascular endothelial growth factor in subjects with metabolic syndrome and vascular complications was 193.45 +/- 131.0 pg/ml and in healthy participants 71.09 +/- 14.49 pg/ml (p < 0.05). CONCLUSIONS: Endothelial dysfunction seems to be the substantial factor responsible for the vascular complications in subjects with metabolic syndrome, which manifests in increased plasma level of VEGF and decreased plasma level of NO.

Plasma total antioxidant activity in comparison with plasma NO and VEGF levels in patients with metabolic syndrome.

INTRODUCTION: The aim of our study was to estimate plasma antioxidant activity as well as plasma nitric oxide (NO) and vascular endothelial growth factor levels in patients with metabolic syndrome compared with healthy participants. MATERIAL AND METHODS: Fifty patients (24 women and 26 men, mean age 55.9 + 11.8 years) with metabolic syndrome were compared with 25 healthy participants (12 women and 13 men, mean age 54.2 + 12.8 years). Plasma total antioxidant activity and plasma levels of NO and VEGF were determined in all participants. RESULTS: In the patients with metabolic syndrome, plasma total antioxidant activity, nitric oxide, and vascular endothelial growth factor were significantly lower (P < .001) than that observed in healthy participants (3.2 + 1.6 vs 6.4 + 2.1 mM/L), (6.3 + 2.2 vs 9.8 + 2.7 muM/L), and 71.0 + 16.9 vs 137.5 + 12.6 pg/mL), respectively. CONCLUSIONS: Decreased plasma total antioxidant activity, NO, and VEGF levels in patients with metabolic syndrome reflect significant endothelial dysfunction. This suggests that oxidation-reduction balance disorders might play an important role in this process.

The significance of preoperative atrial fibrillation in patients undergoing cardiac surgery: preoperative atrial fibrillation--still underestimated opponent.

Atrial fibrillation (AF) has been described as an 'epidemic' due to its increasing prevalence in the ageing population. The prevalence of AF in the UK has risen from 0.78% in 1994 to 1.42% in 2006. The pathogenesis of AF seems to be multifactorial, and includes electrical and structural remodelling, and inflammation. As a result of recent developments in invasive cardiology together with improved pharmacological treatments, cardiac surgeons are increasingly operating on elderly patients with very advanced heart disease and other co-existent diseases. Therefore, AF is often present before cardiac surgery, increasing the risk of surgery and the occurrence of postoperative complications. According to available data, preoperative AF (pre-AF) should be considered as a high-risk marker of postoperative complications, which also significantly reduces long-term patient survival. However, although some multivariate models have concluded that pre-AF seems to be an independent predictor of outcome, this does not prove a cause-effect relationship. Therefore, such a link would need to be proven in prospective randomized studies, yet to be undertaken.

Effect of cardiovascular drugs on adenosine deaminase activity.

OBJECTIVE: Adenosine deaminase catalyzes the conversion of adenosine and deoxyadenosine to inosine and deoxyinosine, respectively. Because raising adenosine concentration can affect several physiological processes we studied the effect of a selection of cardiological drugs on adenosine deaminase activity in red blood cells and rabbit plasma after 21 days administration. METHODS AND RESULTS: We determined the activity of adenosine deaminase isoenzymes (ADA(1) and ADA(2)). Simvastatin, aspirin, metoprolol, and isosorbide mononitrate significantly decreased plasma total adenosine activity (by 50%, 34%, 29%, and 19%, respectively; P < .05 to P < .001) mainly by decreasing the activity of ADA(2). CONCLUSIONS: As a consequence of decreased ADA(2) activity , the half-life of adenosine will be lengthened. This may, at least in part, explain some of the beneficial effects of analyzed drugs. Our results might be clinically relevant in patients with coronary artery disease, acute coronary syndromes, heart failure, or stroke where the investigated drugs are commonly used. However, our results should be confirmed in large studies in humans.

[Estimation of pulse pressure in subjects with metabolic syndrome]. / Ocena cisnienia tetna u pacjentów z zespolem metabolicznym.

UNLABELLED: The occurrence of the metabolic syndrome (MS) increases the cardiovascular risk in comparison with healthy subjects. The pulse pressure (pp) is an independent risk factor for cardiovascular complications. The aim of the study was to evaluate the pulse pressure in subjects with MS accompanied or not by cardiovascular diseases. Material and methods. The study comprised 104 subjects with MS aged 48.65 +/- 7.89 years--group I; 477 clinically healthy subjects aged 45.75 +/- 4.68 years--group II; 137 subjects with MS accompanied by cardiovascular diseases aged 60.05 +/- 12.77 years--group III; 94 subjects with cardiovascular diseases without MS aged 57.80 +/- 9.67 years--group IV. Metabolic syndrome was diagnosed on the basis of NCEP ATP III criteria. Increased value of pulse pressure (pp) was above 63 mmHg. RESULTS: Increased values of pp (> 63 mmHg) were found in 20.2% subjects with MS--group I, in 7.1% clinically healthy subjects--group II, in 40.88% subjects with MS accompanied by cardiovascular diseases and in 36.17% subjects with cardiovascular diseases without MS. CONCLUSIONS: Pulse pressure is simple and helpful method in assessment of vascular changes and cardiovascular risk in subjects with MS. In subjects with cardiovascular diseases with and without MS, increased values of pulse pressure are found in similar percentage of cases.

L-arginine improves hemodynamic function and coronary flow in an experimental model of ischemia-reperfusion injury.

BACKGROUND: Ischemia and reperfusion injury decrease the release of nitric oxide by vessels endothelial cells, which influences postischaemic coronary flow and return of left ventricle haemodynamic function. The study was conducted to answer the question how addition of L-arginine in cardioplegic and reperfusion fluids influences nitric oxide release, inducing the coronary flow and postischaemic haemodynamic heart function. MATERIALS AND METHODS: The research was conducted on 56 rats, divided randomly into seven groups: control (C) and six experimental groups (E), where L-arginine was administrated in increasing doses of 0.3, 3.0 and 30.0 mM/L to cardioplegic (E1, E2 and E3 group) or reperfusion solution (E4, E5 and E6 group). To simulate a course of cardiac surgery the following stages of experiment were carried out: initial perfusion on the nonworking and working heart, cardioplegia, cold cardioplegic arrest and reperfusion of the non-working and working heart. RESULTS: Level of nitric oxide during cardioplegic perfusion decreased in all groups. During reperfusion on non-working and working heart model we noticed the significant increase of nitric oxide for all groups. Along with nitric oxide increase, coronary flow increases, whereas with the decrease of level of nitric oxide, the coronary flow also diminished. During cardioplegic perfusion coronary flow constantly decreased in all groups and during reperfusion we observed the new increase of coronary flow. In groups E1, E2 and E3 the increase of coronary flow was significant. CONCLUSIONS: Obtained data suggest that administration of L-arginine in the preischaemic and in the initial phase of reperfusion stimulates increase in nitric oxide release what is positively correlated with the increase of coronary flow.

[Evaluation of surgical treatment of mitral valve defect in patients with chronic renal failure]. / Ocena wyników leczenia operacyjnego wady zastawki mitralnej u chorych z przewlekla niewydolnoscia nerek.

UNLABELLED: Renal failure of patients qualified for open-heart surgical treatment seems to be very important problem since years. The operation with extracorporeal circulation is large burden for kidneys and there is huge risk of intensifying of existing failure. The aim of the study was the evaluation of renal parameters, complications occurrence and mortality of patients with chronic renal failure (ChRF) (grade II--mild ChRF) subjected to mitral valve replacement. MATERIALS AND METHODS: To retro- and prospective analysis were subjected 34 patients with severe mitral valve defect, subjected to operation between 1998 and 2002 in Department of Cardiac Surgery in Lodz. All patients included to study had increased level of creatinine--1, 5-3, 0 mg/dl (at least in three measurements). All examined patients were subjected to artificial mitral valve replacement and 13 patients to simultaneous tricuspid valve plastic surgery. Postoperative evaluation of clinical condition and renal parameters was performed twice: early (till 30 day after operation) and long-term (after meanly 14 months). RESULTS: In seven patients, in early postoperative period, it was necessary to implement extracorporeal dialysis with artificial kidney dialysis machine. Among these patients we ascertained three deaths (intrahospital mortality was 8.8%). During long-term observation we noted two cases of infective endocarditis requiring reoperation and re-implantation of mitral valve. During this time of observation only one death was noted (post-hospital mortality was 3.2%). CONCLUSIONS: Dysfunction of kidneys, even in mild degree, causes significant increase of risk of early death (about 2.5 times). In most research population in long-term observation we ascertained the large improvement of kidney functions (significant decrease of creatinine level; p < 0.001). Concomitant tricuspid valve regurgitation, requiring plastic surgery is an additional factor incriminating long-term results of surgical treatment.

Blood serum levels of IL-2, IL-6, IL-8, TNF-alpha and IL-1beta in patients on maintenance hemodialysis.

Cytokines are essential mediators of immune response and inflammatory reactions. Patients with chronic renal failure (CRF) commonly present with abnormalities of immune function related with impaired kidney function and the accumulation of uremic toxins in addition to bioincompatibility of dialyzer membranes. During a hemodialysis (HD) session, cytokines are released mainly by monocytes activated by endotoxin-type compounds in dialyzer fluid, complement factors and direct contact with dialyzer membrane. The study included 15 CRF patients, aged 36.4 +/- 2.9 years, on regular HD maintenance therapy for mean 68 +/- 10 months and 15 healthy controls. It was designed to assess serum levels of a panel of inflammatory cytokines: IL-1beta, IL-2, IL-6, IL-8 and TNF-alpha in CRF patients on regular maintenance HD before, 20, 60 and 240 minutes of a single HD session in parallel with C-reactive protein (CRP) as an additional parameter. CRP concentration was increased in HD patients when compared with healthy controls. The concentrations of IL-1, IL-6, IL-8 and TNF-alpha were increased, whereas the serum level of IL-2 was not altered during a single HD session.

Risk factors of atrial fibrillation following coronary artery bypass grafting: a preliminary report.

BACKGROUND: To evaluate the risks factors of atrial fibrillation (AF) following coronary artery bypass grafting (CABG). METHODS AND RESULTS: Twelve hundred patients subjected to CABG were included. Postoperative AF developed in 278 patients (23.2%). Statistical analysis identified 5 independent predictors of AF: advanced age, history of supraventricular arrhythmias, preoperative heart failure, operation with standard CABG technique and repeated revascularization. CONCLUSIONS: Postoperative AF caused a significant increase in mortality and hospitalization length. There were 4 independent risk factors of postoperative AF. Administration of beta-blockers and the OPCAB (off-pump CABG) operating technique were identified as protective factors.