[Association of common cyclooxygenase-2 (COX-2) gene polymorphisms with clinical and angiographic characteristics of patients with coronary artery disease]. / Ocena zwiazku czestych polimorfizmów genu cyklooksygenazy-2 (COX-2) z obrazem klinicznym choroby niedokrwiennej serca i zaawansowaniem zmian miazdzycowych w tetnicach wiencowych.

BACKGROUND: Chronic inflammation of the arterial wall plays a crucial role in the pathogenesis of atherosclerosis. Cyclooxygenase-2 (COX-2) is a key enzyme in the synthesis of proinflammatory prostanoids. At least two of the common genetic polymorphisms of the COX-2 gene have phenotypic effects: G-765C (rs20417) and T8473C (rs5275). AIM: To assess the relation of G-765C and T8473C COX-2 polymorphisms to clinical and angiographic characteristics of patients with coronary artery disease (CAD). MATERIAL AND METHODS: The study comprised 186 consecutive patients with angiographically defined CAD (> or =70% stenosis of > or =1 coronary artery). The study population were divided into two groups: A-123 patients with stable angina (mean age, 62.6 +/- 11.2 years; 30.1% women), and B-63 patients with unstable angina (mean age, 64.0 +/- 10.8 years; 19.0% women). The controls comprised 70 individuals without symptoms of CAD (mean age, 37.6 +/- 9.9 years; 57.1% women). Results: No significant differences were observed in -765C and 8473C allele frequencies between the patients with CAD and control subjects. In CAD patients, the studied COX-2 polymorphisms were not significantly associated with the age of the onset of symptoms and clinical presentation of CAD. In the B group, a difference was observed within the frequency of significant (>50%) left main coronary artery stenosis (LMCAS) and/or three-vessel CAD (3-CAD) between the -765C allele carriers and 765G 765G homozygotes (14.3% vs. 49.0%; p=0.044). In the CAD patients (group A and group B) the prevalence of LMCAS and/or 3-CAD was significantly lower among 365C allele carriers (22.8% vs. 40.3%: CONCLUSIONS: There were no significant differences in -765C and 8473C allele frequencies between patients with CAD and subjects without symptoms of CAD; In patients with CAD, COX-2 G-765C and T8473C polymorphisms had no significant association with the age of the onset of symptoms and clinical presentation of ischaemic heart disease; The G-765C COX-2 polymorphism is associated with less frequent occurrence of multivessel CAD in the studied population. p=0.021

Reduced thrombin formation and altered fibrin clot properties induced by polyunsaturated omega-3 fatty acids on top of dual antiplatelet therapy in patients undergoing percutaneous coronary intervention (OMEGA-PCI clot).

OBJECTIVE: The goal of this study was to investigate whether omega-3 polyunsaturated fatty acids (n-3 PUFA) are able to alter plasma fibrin clot properties and reduce thrombin formation in stable coronary artery disease patients undergoing percutaneous coronary intervention (PCI). METHODS AND RESULTS: In an investigator-initiated, prospective, double-blind, placebo-controlled, randomized study, patients undergoing PCI who received standard pharmacotherapy were assigned to the treatment with 1 g/day n-3 PUFA (n = 30) or placebo (n = 24) for 1 month. Plasma fibrin clot permeability (K(s)); lysis time (t(50%)); prothrombin fragment 1.2; and peak thrombin generation from automated thrombogram, 8-isoprostaglandin F(2α) (8-iso-PGF(2α), an oxidative stress marker), and C-reactive protein were determined at baseline, 3 to 5 days after randomization, and 30 days after randomization. At baseline, both treatment groups did not differ significantly. A 1-month treatment with n-3 PUFA compared with placebo was associated with 15.3% higher K(s), indicating larger pores in the fibrin network (P = 0.0005); 14.3% shorter t(50%), indicating increased susceptibility to fibrinolysis (P<0.0001); 33.8% lower prothrombin fragment 1.2 (P = 0.0013); 13.4% lower peak thrombin generation (P = 0.04); and 13.1% lower 8-iso-PGF(2α) (P = 0.009). Treatment with n-3 PUFA had no effect on fibrinogen and C-reactive protein. After 1 month of treatment, fibrinogen (r = -0.53, P<0.0001), treatment assignment (r = 0.29, P = 0.006) and 8-iso-PGF(2α) (r = -0.27, P = 0.015) were independently associated with clot permeability (P<0.0001, R(2) = 0.66). CONCLUSIONS: Adding n-3 PUFA to standard therapy in stable patients undergoing PCI significantly decreases thrombin formation and oxidative stress and favorably alters fibrin clot properties. These findings indicate novel antithrombotic effects induced by n-3 PUFA in humans.

The prevalence rate of overweight and obesity among adult patient population in Poland, according to the LIPIDOGRAM2004 and LIPIDOGRAM2006 studies, in context of previous Polish national screening surveys.

An increase of the body mass often aggravates cardiovascular risk factors. In Poland, over the past 25 years, some epidemiological studies, focused on body mass disorders were conducted. Their results suggest an increase of the prevalence rate of overweight and obesity. The goal of the studies LIPIDOGRAM2004 and LIPIDOGRAM2006 was to assess the prevalence rate of abnormal body mass among adult patients remaining under the care of family physicians in Poland. 17.065 patients in 2004 and 17.152 in 2006, older than 30 years, recruited by 675 study physicians in 444 sites across Poland, were involved into these studies. It was found that approximately 3/4 of the patients included into these studies had BMI > or = 25 kg/m2. Overweight rate was much more prevalent among men than women (48,0% vs. 39,2% in 2004, p<0,0001; 47,4% vs. 39,7% in 2006, p<0,0001). In 2004, obesity was present in above 30% of the participants, including small, but statistically significant difference in the population of men (32,8% vs. 31,2%, p<0,05). In 2006, an increase in the prevalence of obesity in men, compared to women was reported (34,7% vs. 31,6%, p<0,001). Health care actions aimed at decreasing these phenomena would require targeted efforts of family physicians, in collaboration with a multidisciplinary team of specialists.

Life-threatening cardiac manifestations of primary antiphospholipid syndrome.

We report a rare case of primary antiphospholipid syndrome (APS) in a 43-year-old man presenting as recurrent acute coronary stent thrombosis and complicated by three myocardial infarctions. As illustrated in this report, in APS patients recurrent life-threatening arterial thrombotic events may occur in spite of recommended anticoagulant therapy. We conclude that the APS should be considered as a potential cause of acute coronary syndrome, particularly in young individuals with a history of recurrent thrombotic events and/or with abnormal coagulation test results. Further studies are needed to determine the best therapeutic strategy for APS patients with acute coronary syndrome.

Preoperative right ventricular function in patients with organic mitral regurgitation.

AIMS: To assess the right ventricular (RV) function in patients with severe mitral regurgitation (MR); to find a relation between preoperative and postoperative parameters. METHODS: RV function was echocardiographically assessed by determining the tricuspid annular plane systolic excursion (TAPSE) and the peak systolic velocity of the lateral tricuspid annulus (Sa) in 45 patients with severe organic MR (53.3% men, age 58 +/- 10 years). Mean NYHA class was 2.6 +/- 0.4, LVEF was 55.3 +/- 12%, RV end-diastolic diameter was 28.7 +/- 4.7, left ventricular end-systolic diameter (LVESD) was 44.6 +/- 12.6 mm, and LV end-diastolic volume (Simpson) was 160.6 +/- 50.3 ml. All patients underwent mitral valve replacement with posterior chordal sparing. RESULTS: Mean preoperative TAPSE and Sa were 19.4 +/- 4.3 mm and 10.3 +/- 3 cm/sec, respectively. RV dysfunction, defined as TAPSE < 22 mm, had 66.6% of the patients, and Sa < 11 cm/sec was found in 62.2% of the patients preoperatively. Preoperative TAPSE and Sa were significantly correlated (P < 0.00001, r = 0.61). Both TAPSE and Sa were correlated with the RV end-diastolic diameter (P < 0.01), LVESD (P < 0.05) left ventricular dp/dt (P < 0.05), and LVEF (P < 0.0001). Postoperative LVEF was 50% (P < 0.001), Sa 5.3 +/- 2 cm/sec (P < 0.001), and TAPSE 8.7 +/- 3.2mm (P < 0.001). Twenty-one patients (46.6%) reached the study end point of decrease of LVEF by more than 10%. Univariate predictors were age (P = 0.04), male gender (P = 0.01), TAPSE (P = 0.007), and Sa (P = 0.009), while a trend was found for regurgitation fraction (P = 0.058) and LV end-diastolic volume index (P = 0.09). By multivariate analysis, TAPSE (P = 0.01) and Sa (P = 0.01) were predictive for the study end point. CONCLUSION: The assessment of the RV function by echocardiography is a simple tool that provides prognostic information in patients with MR.

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.

[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.

[Type IV dual left anterior descending coronary artery - a rare congenital coronary artery anomaly. A case report]. / Podwójna lewa tetnica zstepujaca przednia typu IV - rzadko wystepujaca wrodzona anomalia tetnic wiencowych. Opis przypadku.

An extremely rare case of type IV dual left anterior descending coronary artery coexisting with myocardial bridging in a 50-year old Caucasian man with acute coronary syndrome is presented. Emergency cardiac catheterisation revealed no coronary atherosclerotic lesions. The potential causal relationship between the type IV dual left anterior descending coronary artery and myocardial ischaemia was discussed. We also summarised the current knowledge on the epidemiology and clinical significance of dual left anterior descending coronary artery in the adult population.

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.

Comparison of the efficacy and safety of pharmacological treatment versus percutaneous coronary angioplasty in patients with intermediate coronary artery lesions.

BACKGROUND: It is unclear if patients with intermediate coronary artery lesions (40-70% of diameter reduction) benefit from percutaneous coronary intervention (PCI) as compared with pharmacological treatment. AIM: To investigate whether PCI of intermediate coronary artery lesions may improve the outcome in this group of patients. METHODS: We performed a retrospective analysis of data of 232 symptomatic patients with intermediate coronary lesions. Hundred sixty five patients received only pharmacological treatment (group A) while 67 were treated with PCI with or without stent implantation (group B). Primary study endpoints were defined as follows: death (cardiac and non-cardiac), myocardial infarction, unstable angina, recurrent angina and coronary reintervention. Demographic and clinical variables were evaluated to identify predictors of the composite endpoint (exacerbation of angina, hospitalisation because of severe angina, restenosis in the intermediate coronary lesion, acute coronary syndrome and cardiac death). RESULTS: In group A, patients were treated with typical pharmacotherapy including beta-blockers, Ca-blockers, ACE-inhibitors, and antiplatelet drugs. In group B, 68 PCI procedures were performed in 67 patients and optimal pharmacotherapy was administered. The average age of patients in both groups was 58.0 +/- 9.1 years and the majority were males (76%). Preinterventional coronary angiography showed that the intermediate lesions were most frequently localised in the left anterior descending (LAD) coronary artery; the next most frequent localisation was the right coronary artery (RCA). During the 12-month follow-up in 9 (13%) patients from the group B repeated PCI due to restenosis was performed, while in group A intervention was necessary in 7 (4%) of patients due to aggravation of symptoms (p = 0.01). The cumulative probability of restenosis after PCI in intermediate coronary lesions was 14%. Recurrent angina was more frequent in group B as compared to group A (34 vs. 19%; p = 0.005). None of the patients in any group died during 12 months of follow-up. In patients with intermediate coronary lesions, the independent predictors of the composite study endpoint were: history of previous percutaneous coronary angioplasty, type 2 diabetes, persistent ST-segment elevation in 12-lead ECG, heart rhythm disturbances, presence of the intermediate lesion in the LAD, and left ventricular dysfunction. CONCLUSIONS: Patients with intermediate coronary artery stenoses could safely undergo pharmacological treatment and PCI may be postponed until aggravation of symptoms occurs. In the presence of predictors of the composite study endpoint, the use of intracoronary diagnostic methods may be considered to obtain more reliable and precise measurements of coronary stenosis severity.

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.

Obstructive and nonobstructive coronary artery disease in long-lasting type 1 diabetes: a 7-year prospective cohort study.

INTRODUCTION It is widely believed that patients with diabetes are at increased risk of severe and premature coronary artery disease (CAD) when compared with nondiabetic individuals. OBJECTIVES The aim of the study was to evaluate the prevalence, 7­year incidence, predictors, and outcomes of obstructive and nonobstructive CAD in patients with long­lasting type 1 diabetes. PATIENTS AND METHODS We enrolled 2330 patients at a median age of 50 years and a median diabetes duration of 32 years. All participants underwent diagnostic workup for CAD with an exercise treadmill test (ETT), single­photon emission computed tomography (SPECT), or both. Coronary angiography was performed in patients with abnormal ETT/SPECT results and repeated during the study if clinically indicated. RESULTS The prevalence of obstructive and nonobstructive CAD was 6.9% and 42%, respectively, while the 7­year incidence, 1.9% and 7.4%, respectively. Of the 160 revascularized patients, 38% underwent complete revascularization. Acute coronary syndromes were reported in 3.6% of patients (54% with nonobstructive CAD). Cardiac deaths were reported in 1.07% of the population, and only in patients with obstructive CAD. Age, diabetes duration, hypertension, and renal failure were predictors of obstructive CAD, while type 1 diabetes duration, glycated hemoglobin A1c levels, frequent severe hypoglycemia, hypertension, triglyceride levels, renal failure, and cardiac autonomic neuropathy predicted nonobstructive CAD. CONCLUSIONS Nonobstructive CAD was the most frequent coronary complication in patients with type 1 diabetes. Both obstructive and nonobstructive CAD showed a similar incidence of nonfatal outcomes and selected predictors. Positive ETT/SPECT results were related to glycemic control only in patients with nonobstructive CAD.

Common polymorphisms of cyclooxygenase-2 and prostaglandin E2 receptor and increased risk for acute coronary syndrome in coronary artery disease.

The arachidonic acid metabolites participate in development of coronary artery disease (CAD) and the plaque's instability. We assessed two common genetic polymorphisms: of cyclooxygenase-2 (COX-2) (COX2.8473, rs5275) and prostaglandin EP2 receptor gene (uS5, rs708494) in patients with CAD. Out of 1,368 patients screened by coronary arteriography, two groups fulfilled the entry criteria and were studied: stable coronary disease (sCAD, n = 125) and acute coronary syndromes (ACS, n = 63). They did not differ in the main characteristics. All patients were on aspirin at least seven days prior to the study. In 70 control subjects, the same genotypes were ascertained, expression of cyclooxygenases in peripheral blood monocytes was assessed by flow cytometry, and in-vitro biosynthesis of PGE(2) was measured by mass spectrometry. COX-2 CC homozygotes (variant allele), were more common, while EP2 GG homozygotes (wild-type) were less common in ACS (p = 0.03 and p = 0.017) than in the sCAD group. A combined genotype characterized by the presence of the wild-type COX2.8743T allele and the wild type homozygous EP2uS5 genotype (TT or CT | GG) decreased risk ratio of ACS in CAD patients (relative risk 0.41; 95% confidence interval 0.21-0.81). COX-2 polymorphism in control subjects did not affect the enzyme expression or PGE(2) production by peripheral blood monocytes, but production of PGE(2) increased by 40.1% in the subjects homozygous for EP2 receptor allele uS5A following lipopolysaccharide stimulation. In conclusion, the combined COX-2 (COX2.8473) and the EP2 receptor (uS5) genotypes seem to influence CAD stability, but in peripheral blood monocytes only EP2 receptor modulates PGE(2) production.

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.

[Lyme carditis presenting as acute coronary syndrome: a case report]. / Boreliozowe zapalenie serca manifestujace sie jako ostry zespól wiencowy.

A case of a 26-year-old man with Lyme carditis (LC) mimicking acute coronary syndrome is presented. Considering clinical presentation, electrocardiographic findings and markedly elevated levels of cardiac biomarkers, emergency coronary angiography was performed and revealed normal coronaries. Ventricular arrhythmias of Lown grade IVb during catheterization were recorded. Echocardiography showed mild global left ventricular dysfunction with ejection fraction of 50%. The diagnosis of LC was confirmed by ELISA and Western blot serologic testing. After 21 days of continuous antibiotic therapy with ceftriaxone (2.0 g/d) the patient recovered completely. We also present the current state of knowledge on the cardiovascular aspects of Lyme borreliosis.

[Subintimal recanalisation of chronic superficial femoral artery occlusion with the use of a re-entry system]. / Subintimalna rekanalizacja przewleklej niedroznosci tetnicy udowej powierzchownej z zastosowaniem systemu re-entry.

We present a case of a 59-year-old man with symptomatic long-segment occlusion of the superficial femoral artery. Subintimal recanalization was initially unsuccessful due to the inability to re-enter the true lumen after crossing the occlusion in the subintimal space. We report, for the first time in Poland, our use of the Outback catheter for a successful intraluminal re-entry. There were no procedure-related complications. We indicate that the Outback catheter can be used safely in case of an unsuccessful conventional re-entry to the true lumen artery. This catheter can allow reduction the time of the procedure and minimize potential complications.

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.

[Prolonged successful resuscitation with simultaneous complex angioplasty of the left anterior descending coronary artery in acute myocardial infarction complicated by cardiogenic shock--a case report]. / Dlugotrwala skuteczna resuscytacja z równoczesna zlozona angioplastyka galezi zstepujacej przedniej lewej tetnicy wiencowej w ostrym zawale serca powiklanym wstrzasem kardiogennym.

A case of a 69-year-old woman with non-ST-segment elevation myocardial infarction (NSTEMI) complicated by cardiogenic shock and in-hospital cardiac arrest is presented. During prolonged (60 min) cardiopulmonary resuscitation successful complex coronary angioplasty with stenting of the left anterior descending coronary artery was performed, after which the patient recovered completely. The total time of cardiac arrest was 60 min, including the approximately 45-minute period of asystole. Post-resuscitation course was uneventful and neurological examination was normal. The patient, free of cardiovascular, respiratory and neurological symptoms, was discharged from hospital after 16 days.

[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.

Sudden cardiac death risk factors in patients with heart failure treated with carvedilol.

BACKGROUND: Chronic heart failure (CHF) is associated with a high risk of sudden cardiac death (SCD). Most frequently SCD occurs in patients with NYHA class II and III. AIM: To evaluate the influence of prolonged carvedilol therapy on SCD risk in CHF patients. METHODS: The study included 86 patients (81 men and 5 women) aged 56.8+/-9.19 (35-70) years with CHF in NYHA class II and III receiving an ACE inhibitor and diuretics but not beta-blockers. At baseline and after 12 months of carvedilol therapy the following risk factors for SCD were analysed: in angiography - occluded infarct-related artery; in echocardiography - left ventricular ejection fraction (LVEF) <30%, volume of the left ventricle (LVEDV) >140 ml; in ECG at rest - sinus heart rate (HRs) >75/min, sustained atrial fibrillation, increased QTc; in 24-hour ECG recording - complex arrhythmia, blunted heart rate variability (SDNN <100 ms) and abnormal turbulence parameters (TO and TS or one of them); in signal-averaged ECG - late ventricular potentials and prolonged fQRS >114 ms. The analysis of SCD risk factors in basic examination in patients who suddenly died was also performed. RESULTS: During one-year carvedilol therapy heart transplantation was performed in 2 patients; 5 patients died. At 12 months the following risk factors for SCD were significantly changed: HRs >75/min (50 vs. 16 patients, p=0.006), LVEF <30% (37 vs. 14 patients, p=0.01), SDNN <100 ms (19 vs. 9 patients, p=0.04). At 12 months the number of risk factors for SCD in each patient was significantly reduced (p=0.001). In patients who suddenly died we found a greater amount of SCD risk factors in basic examination (7 vs. 5) as compared to alive patients. CONCLUSIONS: Prolonged beta-adrenergic blockade reduces risk of sudden cardiac death through significant LVEF increase, reduction of HR at rest and improvement of HRV.