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.

[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.

The effect of near-infrared MLS laser radiation on cell membrane structure and radical generation.

The therapeutic effects of low-power laser radiation of different wavelengths and light doses are well known, but the biochemical mechanism of the interaction of laser light with living cells is not fully understood. We have investigated the effect of MLS (Multiwave Locked System) laser near-infrared irradiation on cell membrane structure, functional properties, and free radical generation using human red blood cells and breast cancer MCF-4 cells. The cells were irradiated with low-intensity MLS near-infrared (simultaneously 808 nm, continuous emission and 905 nm, pulse emission, pulse-wave frequency, 1,000 or 2,000 Hz) laser light at light doses from 0 to 15 J (average power density 212.5 mW/cm(2), spot size was 3.18 cm(2)) at 22 °C, the activity membrane bound acetylcholinesterase, cell stability, anti-oxidative activity, and free radical generation were the parameters used in characterizing the structural and functional changes of the cell. Near-infrared low-intensity laser radiation changed the acetylcholinesterase activity of the red blood cell membrane in a dose-dependent manner: There was a considerable increase of maximal enzymatic rate and Michaelis constant due to changes in the membrane structure. Integral parameters such as erythrocyte stability, membrane lipid peroxidation, or methemoglobin levels remained unchanged. Anti-oxidative capacity of the red blood cells increased after MLS laser irradiation. This irradiation induced a time-dependent increase in free radical generation in MCF-4 cells. Low-intensity near-infrared MLS laser radiation induces free radical generation and changes enzymatic and anti-oxidative activities of cellular components. Free radical generation may be the mechanism of the biomodulative effect of laser radiation.

[Assessment the lifestyle in patients after recent acute coronary syndrome qualified for cardiac rehabilitation and in healthy subjects]. / Ocena stylu zycia chorych po swiezo przebytym ostrym zespole wiencowym zakwalifikowanych do rehabilitacji kardiologicznej oraz zdrowych.

UNLABELLED: Results of a lot of research indicate that preventive activities consisting in the fighting of risk factors have the greatest influence on the reduction of the incidence of ischaemic heart disease. THE AIM OF THE STUDY was to assess the lifestyle in patients after recent acute coronary syndrome (ACS) qualified for cardiac rehabilitation and in healthy subjects (with no diagnosis of coronary thrombosis). MATERIAL AND METHODS: The research included 86 patients, 64 men and 22 women aged 42-78 (mean age 61.7 +/- 9.6 years) after recent ACS, treated with PCI (percutaneous coronary interventions), and qualified for cardiac rehabilitation (stage II)--group I. The control group included 88 people, 54 men and 34 women aged 34-75 (mean age 56.2 +/- 9.7 years), who were clinically healthy--group II. The assessment of a lifestyle was performed based on the presence of four positive behaviours, i.e. eating appropriate amount of vegetables and (or) fruit every day, refraining from smoking, satisfactory levels of physical activity, and correct body mass. Based on these factors, a lifestyle index was calculated, from 0 (no positive health behaviours) to 4 (all positive health behaviours present), the so-called healthy lifestyle index. RESULTS: Among the examined elements of lifestyle index in ill and healthy subjects, satisfactory physical activity was the rarest (in 16.67% of men and in 9.09% women after ACS and in 16.22% of healthy men and 11.63% healthy women). Healthy lifestyle index was determined in 4.88% of patients after ACS. It was not found in healthy subjects. CONCLUSION: The analysis of the lifestyle index shows that a change of one's lifestyle is necessary as an initial and secondary prevention.

[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.

Comparative analysis of analgesic efficacy of selected physiotherapy methods in low back pain patients.

BACKGROUND: Low back pain syndromes are one of the most frequent causes of movement limitation in populations of highly industrialized countries. They are listed as the main cause of inability to work among people of working age. Chronic pain and the associated limitation of movement underlie the quest for effective therapies. The use of ultrasound, LLLT, vacuum therapy with Ultra Reiz current in physical therapy of these patients prompts research over their effectiveness in the therapy of patients with low-back pain. The aim of the work was to evaluate the analgesic efficacy of LLLT, ultrasound, and vacuum therapy with Ultra Reiz current in patients with low back pain. MATERIAL AND METHODS: The study involved 94 people divided into three groups (A,B,C). Group A (n=35) received a series of 10 low energy laser therapy sessions (wave length 808 nm, surface density of radiation 510 mW/cm(2), continuous wave form, scanning mode, a dose of 12 J/cm(2) on a surface of 100 cm(2) [10x10cm]). Patients in Group B (n=27) had ultrasound sessions with a wave intensity of 1 W/cm(2) for 3 minutes. Patients in Group C (n=32) underwent vacuum therapy (8 kPa) combined with Ultra Reiz current. Subjective pain assessment was carried out using a modified Latinen questionnaire and a visual analogue scale of pain intensity. Lumbosacral spine mobility was evaluated with the Schober test and the finger-to- floor test. RESULTS: In Group A, following low energy laser therapy, a statistically significant decrease in pain intensity was observed, together with decreased analgesic consumption compared to the other groups. In Group C, following vacuum therapy combined with Ultra Reiz currents, a significant decrease in the frequency of pain was observed together with increased physical activity compared to both Groups A and B, assessed according to a modified Laitinen pain indicator questionnaire. The biggest improvement in global spine mobility and lumbosacral flexion was observed in Group C (vacuum therapy plus Ultra Reiz current) compared to the other groups. However, the most significant improvement in lower spine extension was noted in Group B (ultrasound). CONCLUSIONS: 1. The study showed slightly higher analgesic efficacy of laser biostimulation in comparison to vacuum therapy combined with Ultra Reiz current in patients with low back pain. 2. A more prominent increase in lumbosacral spine mobility was observed after vacuum therapy combined with Ultra Reiz current and ultrasound therapy.

[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.

[Aortic valve replacement in patients with heart failure]. / Wymiana zastawki aortalnej u chorych z niewydolnoscia miesnia serca.

UNLABELLED: Severe aortic regurgitation and stenosis are urgent indication for aortic valve replacement in patients with left ventricular dysfunction, however the effect of cardiac surgery may differ in both groups. The aim of the study was to evaluate the early changes of haemodynamic parameters of heart: ejection fraction, endsystolic and enddiastolic left ventricle diameters, endsystolic and enddiastolic left ventricular wall thickness and left atrium diameter, depending on ejection fraction value (EF), in patients undergoing aortic valve replacement due to isolated aortic stenosis or regurgitation. MATERIALS AND METHODS: 250 patients engaged to the study were subjected to the mechanical aortic valve replacement in Cardiac Surgery Department in Lodz. All patients were divided into two groups--patients operated due to aortic regurgitation and aortic stenosis. Then each group, depending on EF volume before operation, was divided into two subgroups (A - EF between 35 and 50%; B - EF below 35%). RESULTS: Comparing the pre- and early postoperative period, ejection fraction rose markedly in both subgroups of patients with aortic stenosis and the highest increase was ascertained in subgroups A. Analyzing endsystolic and enddiastolic left ventricle diameters we observed the reduction of left ventricle diameters in all groups. Evaluating endsystolic left ventricular wall thickness we observed the increase of wall thickness in both subgroups B. Analogically enddiastolic left ventricular wall thickness increased in all analyzing groups, whereas in groups with lowest fraction the rise was essential. CONCLUSIONS: Aortic valve replacement both due to aortic stenosis and regurgitation is associated with improved haemodynamic status in early postoperative period.

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.

[Prevention and treatment of atrial fibrillation following cardiac surgery]. / Zapobieganie i leczenie migotania przedsionków po operacjach serca.

Atrial fibrillation is the most common complications after cardiac surgery, occurring in 20-60% of patients depending on definition and diagnostic methods. Usually appears between 2 and 4 day after operation and often turns back during first 30 days in postoperative time. Treatment of this complication is often protracted, requiring increased monitoring and hospital resources, and extending hospital length of stay Clinical consequences can be significant and include hemodynamic instability and stroke. Recently we can see the increase of atrial fibrillation's frequency occurrence. It is related both with enlargement of patients qualified to cardiac operations and with more and more severe conditions of patients subjected to surgery. Despite of existence unique guidelines there are still many doubts, regarding to choice of antiarrhythmic agent, optimal time of therapy initiation or performing invasive treatment. Atrial fibrillation influences the worsening of patient's postoperative condition (e.g. significantly increasing postoperative mortality) and considerably increases the costs of hospitalization. Therefore competent prevention and suitable treatment of postoperative atrial fibrillation is one of the most important tasks for cardiac surgeons or clinicians who manage the patients after cardiosurgical operations.

[Transthoracic fine-needle lung biopsy with linear transducer and bioptic channel monitored ultrasonographically]. / Biopsja aspiracyjna cienkoiglowa pluca monitorowana ultrasonograficznie przy uzyciu glowicy liniowej z kanalem biopsyjnym.

From 1999 to 2002 81 transthoracic fine-needle lung biopsies (TFNB) were performed with use of linear transducer (3.5 MHz) and bioptic channel, monitored ultrasonographically. The procedure was applied in 70 patients with peripheral lesions on chest X-ray or CT, which needed histopathological examination. Our study showed that linear transducer with bioptic channel is useful in monitoring needle path and material aspiration during transthoracic fine-needle biopsy. Application of this equipment makes the procedure safe for patients and the percentage of observed complications is low. Specificity and sensitivity of the procedure is comparable to other imaging techniques.