[Cardiovascular risk and inflammatory markers in patients with hypertension]. / Ryzyko sercowo-naczyniowe a markery zapalne u chorych na nadcisnienie tetnicze.

UNLABELLED: Arterial hypertension (AH) is one of the main risk factors of negative cardiovascular (CVR) events and the complex evaluation of CVR is necessary for the successful treatment of patients with AH. Simultaneously CVR increases when the inflammatory markers levels are elevated. AIM: The aim of study was to evaluate the frequency of CVR factors presence and their relation to the inflammatory markers in patients with AH. MATERIALS AND METHODS: The study was conducted in group of 144 patients (99 men, mean age 45.2 years) with AH and no other diagnosed cardiovascular diseases. The clinical assessment included: i.e. fasting glucose (FG), total cholesterol (T-C), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), triglycerides (TG) and inflammatory markers: fibrinogen, high-sensitive C-reactive protein (hsCRP) and leukocytes count (WBC). CVR was assessed based on the presence of the risk factors included in the ESC guidelines. RESULTS: Dylipidemia was observed in over 90% of patients in the study group (most often as the elevated level of T-C and LDL-C), abdominal obesity in 54.9%, more than 3 CVR factors in over 70% and increased levels of at least one of inflammatory markers in 40.3% of patients (most often hs-CRP - 35.4%). The statistically significant correlations between anthropometric parameters (BMI, waist cirfumference), laboratory parameters (HDL-C, TG) and inflammatory markers were observed, the strongest for BMI versus hs-CRP (r = 0.42, p < 0.000001). In the logic regression analysis the factors increasing the probability of the elevated inflammatory activity turned out to be: abdominal obesity - OR 3.05 (95% CI: 1.49 - 12.22; p = 0.002); BMI ≥ 30 kg/m2 - OR 3.18 (95% CI: 1.57 - 6.44; p = 0.0012) and the presence of more than 3 risk factors - OR 2.57 (95% CI: 1.13 - 5.83; p = 0.023). CONCLUSIONS: The increased level of inflammatory markers is related to the complex metabolic disturbances and the assessment of the activation of inflammatory process (especially hsCRP) can be useful in the complex CVR evaluation and profound defining of therapeutical goals.

Cognitive impairment after appropriate implantable cardioverter-defibrillator therapy for ventricular fibrillation.

BACKGROUND: Short periods of cerebral ischaemia during ventricular defibrillation testing may be associated with neuropsychological impairment. However, the impact of out-of-hospital ventricular fibrillation (VF) converted by implantable cardioverter-defibrillator (ICD) shock on cognitive functioning is unknown. AIM: To assess the impact of out-of-hospital VF converted by ICD shock on cognitive functioning. METHODS: The study included 52 primary prevention ICD recipients. Patients with a history of stroke or other neurological impairment, previous head injury and individuals unable to see or speak to complete neuropsychological tests were not included.Initially, a Mini-Mental State Examination was performed in all patients and one patient with a result below 24 points was excluded from the study. The cognitive battery consisted of four tests (six measurements): 1) the Digit Span subtest of Wechsler Adult Intelligence Scale-Revised; 2) the Digit Symbol subtest of Wechsler Adult Intelligence Scale-Revised; 3) the Halstead-Reitan Trail-Making Test A and B; and 4) the Ruff Figural Fluency Test. RESULTS: The mean time from ICD implantation to cognitive assessment was 26 months. During this period, 15 appropriate shocks for VF were observed in seven (14%) patients. The patients with appropriate ICD therapy were significantly worse in two out of the six neuropsychological measurements and had a significantly lower aggregate result. In multivariate linear regression analysis, defibrillation therapy was an independent factor of poor cognitive functioning, along with age and education. CONCLUSIONS: Short periods of out-of-hospital VF converted by ICD are associated with cognitive impairment in the recipients of primary prevention ICD.

Diuretic-resistant congestive heart failure treated successfully with peritoneal ultrafiltration.

We present a case of successful peritoneal ultrafiltration (pUF) treatment in a 60 year-old patient diagnosed with diuretic-resistant congestive heart failure fulfilling the criteria for type 2 cardio-renal syndrome. Six months of pUF treatment with one daily dialysis exchange with icodextrin as an osmotic agent resulted in better functional status (from IV to II/III NYHA class), quality of life and improvement of haemodynamic parameters measured by impedance cardiography. During the follow-up (six months), pUF was well tolerated by the patient and he did not require hospitalisation for decompensated heart failure.

[The influence of myocardial infarction on depression in patients with coronary artery disease]. / Ocena wplywu przebytego zawalu miesnia sercowego na nasilenie depresji u chorych na chorobe niedokrwienna serca.

UNLABELLED: The recent studies revealed the relation between depression and the prevalence of cardio-vascular diseases, as well as their complications. However the correlation between the risk factors of coronary artery disease and depression in patients suffering from cardio-vascular disorders hasn't been sufficiently examined. The history of myocardial infarction (MI) is a well known factor, which increases mortality. The aim of the study was to determine if there was any relation between the history of myocardial infarction and depression rate in patients with cardio-vascular diseases. MATERIAL AND METHODS: The study involved 163 patients, 75 women and 88 men, aged 29 to 86 years (mean age 60.75 +/- 11.01), hospitalised for the purpose of undergoing coronary angiography or percutaneous transluminal coronary angioplasty (PTCA). Before the procedure, the symptoms of depression were evaluated in all the patients. Each of them filled the Beck's scale inquiry-sheet. Two groups of patients were detached: group A consisted of patients with the history of MI (n = 96), group B-of patients with negative history of MI, diabetes who had never undergone PCI, or coronary artery bypass graft (CABG) before (n = 42). The control group (group C) consisted of 75 individuals, aged 20 to 80 (mean age 45 +/- 11.14 y), who felt healthy according to WHO criteria, weren't on any medication, hadn't been hospitalised in previous 5 years (at any reason) and in whom cardio-vascular diseases and their modificable risk factors were excluded. RESULTS: The median of the Beck's score of depression for group A (9 points) was significantly higher (Wilcoxon test), than for group B (6.5 points), p < 0.02 and for the group C (3 points), p < 0.05. (tab. 1). CONCLUSIONS: In patients with cardio-vascular disorders depression is more frequent, than in health individuals. History of MI increases the prevalence of depression.