Impaired fibrinolysis in patients with atrial fibrillation and elevated circulating lipopolysaccharide.

It is unknown whether elevated gut-derived serum lipopolysaccharide (LPS) can affect thrombin generation, fibrinolysis, and fibrin clot properties in atrial fibrillation (AF). We aimed to evaluate associations of circulating LPS with prothrombotic markers in AF patients. A total of 157 (women, 57.3%) ambulatory anticoagulant-naïve AF patients aged from 42 to 86 years were recruited. Clinical data together with serum LPS, inflammation, endothelial injury, coagulation and fibrinolysis markers, including fibrin clot permeability (Ks) and clot lysis time (CLT), were analyzed. A median LPS concentration was 73.0 (58.0-100.0) pg/mL and it showed association with CLT (r = 0.31, p < 0.001) and plasminogen activator inhibitor-1 (PAI-1, r = 0.57, p < 0.001), but not other fibrinolysis proteins, thrombin generation, inflammatory markers, or Ks. There were weak associations of LPS with von Willebrand factor (vWF, r = 0.2, p = 0.013), cardiac troponin I (r = 0.16, p = 0.045), and growth differentiation factor-15 (r = 0.27, p < 0.001). No associations of LPS and CHA2DS2-VASc or other clinical variables were observed. Multivariable regression adjusted for potential confounders showed that serum LPS ≥ 100 pg/mL was an independent predictor of prolonged CLT. This study is the first to demonstrate antifibrinolytic effects of elevated LPS in AF patients largely driven by enhanced PAI-1 release.

Level of basic hope and symptoms of anxiety and depression in women after miscarriage.

Introduction: The study aimed to determine the level of basic hope and symptoms of anxiety and depression in women after miscarriage.Methods: To evaluate the symptoms of anxiety and depression, and basic hope, the standardized questionnaires the Hospital Anxiety and Depression Scale (HADS) and the Basic Hope Inventory (BHI-12), respectively, were used. Patients hospitalized at the Department of Obstetrics and Gynaecology of the Provincial Combined Hospital in Kielce due to miscarriage in the period from September 2019 to August 2021 were included in the study. Results: The sense of basic hope increased after 3 months (p < 0.001). The intensity of symptoms of anxiety and depression decreased (p < 0.001). The BHI-12 correlated significantly and negatively with the level of anxiety (r = -0.438, p < 0.001) and depression symptoms (r = -0.456, p < 0.001) during and after hospitalization (anxiety r = -0.649, p < 0.001; depression r = -0.643, p < 0.001). Conclusions: It was found that the level of hope significantly increased after 3 months compared to this level during hospitalization. Hope was associated with lower levels of anxiety and depression symptoms.

Basic hope, level of stress and strategies used to cope with stress after miscarriage during hospitalization and 3 months after its completion.

OBJECTIVES: Basic hope is important for successfully coping with, and adapting to, difficult situations. The aim of the study was to determine the level of stress and basic hope and identify the associated coping processes in women after miscarriage during hospitalization and threemonths after discharge. MATERIAL AND METHODS: Atotal of 161women hospitalized due to miscarriage were included. To evaluate the level of stress, basic hope and coping strategies, the following standardized questionnaires were used: the Perceived Stress Scale (PSS-10), the Inventory to Measure Coping Strategies with Stress (Mini-COPE) and the Basic Hope Inventory (BHI-12). RESULTS: 110 patients declared high levels of stress during hospitalization and 80 claimed the same three months after discharge. The level of stress decreased after three months (p < 0.001). Adaptive stress-coping strategies were employed more frequently than maladaptive stress-coping strategies. During hospitalization, the most frequently used strategies were acceptance and seeking emotional support; with planning, acceptance, seeking emotional and instrumental support being used three months after discharge. The sense of basic hope increased after three months (p < 0.001). The level of the sense of basic hope correlates significantly (p < 0.001) and negatively (r ˂ 0) with the severity of stress symptoms during and after the hospital stay. CONCLUSIONS: The sense of basic hope increased significantly after three months in relation to the level experienced during the hospitalization period, and the intensity of stress decreased. Preventive women-oriented interventions are needed to minimize the risk of post-traumatic stress disorder.

Betaine supplementation improves CrossFit performance and increases testosterone levels, but has no influence on Wingate power: randomized crossover trial.

BACKGROUND: Because betaine (BET) supplementation may improve muscular strength and endurance, it seems plausible that BET will also influence CrossFit performance (CF). PURPOSE: The aim of this study was to evaluate the effects of three weeks of BET supplementation on body composition, CF performance, muscle power in the Wingate anaerobic test (WAnT), and the concentrations of selected hormones. The secondary aims were to analyze the effectiveness of two different BET doses (2.5 and 5.0 g/d) and their interaction with the methylenetetrahydrofolate reductase (MTHFR) genotype. METHODS: The study was designed in a double-blinded randomized cross-over fashion. Forty-three CF practitioners completed the entire study. CF performance was measured using the Fight Gone Bad (FGB) workout and muscle power was evaluated in a 30-second WAnT. Body composition was determined by air-displacement plethysmography. Blood was drawn to assess hormone concentrations. The C677T single nucleotide polymorphism (rs180113) in the MTHFR gene was analyzed. RESULTS: FGB total improved with BET by 8.7 ± 13.6% (p < 0.001), but no significant changes were observed with placebo (- 0.4 ± 10.0%, p = 0.128). No changes were also observed in WAnT and body composition. After BET supplementation testosterone concentration increased by 7.0 ± 15.4% with BET (p = 0.046) (no change with placebo: 1.5 ± 19.6%, p = 0.884) but had no effect on concentrations of insulin-like growth factor or cortisol. Finally, there were no significant interactions between MTHFR genotype and BET dose in any outcome. CONCLUSIONS: BET supplementation may improve CF performance and increase testosterone concentration. However, there was no evidence of a difference between dosages (2.5 and 5.0 g/d) and MTHFR genotypes. The trial was registered on clinicaltrials.gov (NCT03702205) on 10 October 2018.

Blood-brain barrier function in response to SARS-CoV-2 and its spike protein.

The typical manifestation of coronavirus 2 (CoV-2) infection is a severe acute respiratory syndrome (SARS) accompanied by pneumonia (COVID-19). However, SARS-CoV-2 can also affect the brain, causing chronic neurological symptoms, variously known as long, post, post-acute, or persistent COVID-19 condition, and affecting up to 40% of patients. The symptoms (fatigue, dizziness, headache, sleep disorders, malaise, disturbances of memory and mood) usually are mild and resolve spontaneously. However, some patients develop acute and fatal complications, including stroke or encephalopathy. Damage to the brain vessels mediated by the coronavirus spike protein (S-protein) and overactive immune responses have been identified as leading causes of this condition. However, the molecular mechanism by which the virus affects the brain still needs to be fully delineated. In this review article, we focus on interactions between host molecules and S-protein as the mechanism allowing the transit of SARS-CoV-2 through the blood-brain barrier to reach the brain structures. In addition, we discuss the impact of S-protein mutations and the involvement of other cellular factors conditioning the pathophysiology of SARS-CoV-2 infection. Finally, we review current and future COVID-19 treatment options.

Predictors and periprocedural outcomes of access crossover during primary percutaneous coronary interventions - a contemporary report from the Polish ORPKI registry.

BACKGROUND: The radial artery became preferable access for percutaneous coronary interventions (PCI). The latest European Society of Cardiology guidelines strongly recommended transradial access in patients with ST-segment elevation myocardial infarction (STEMI). Though, in a significant portion of the coronary artery, invasive procedure crossover to femoral is necessary. AIMS: This study aimed to determine the ratio, risk factors, and periprocedural outcomes of crossover from radial to femoral access during PCI in a contemporary STEMI registry. METHODS: Based on data from the Polish registry ORPKI, we analyzed 90245 patients with a diagnosis of STEMI that were intended to be treated invasively via transradial access between 2014 and 2019. RESULTS: In 1484 (1.6 %) individuals, a switch to femoral access was necessary during the procedure. The most important independent predictors of vascular crossover were female sex, previous coronary artery bypass graft, class 3 and 4 of the Killip scale, left main disease, as well as any complications during coronary angiography. In that cohort, the risk of bleeding at the puncture site was over 20-fold higher. Major disparities in periprocedural outcomes (death during procedure, cardiac arrest during PCI, Thrombolysis In Myocardial Infarction (TIMI) after PCI, and no-reflow) between these groups resulted from disparities in initial characteristics, and they were not associated with crossover itself. CONCLUSIONS: Even though the risk of crossover to femoral is currently low, it appears to be indispensable to sustain operators' experience both in radial and femoral approaches to achieve the best outcomes in these patients.

Asymptomatic Caseous Calcification of the Mitral Annulus in a 66-Year-Old Woman with 3-Year Imaging Follow-Up.

BACKGROUND Caseous calcification of the mitral annulus (CCMA) is an uncommon form of mitral annular calcification and can be misdiagnosed as heart abscess, neoplasm, or other lesions occupying the atrioventricular groove. Data regarding imaging follow-up of patients with CCMA are limited. This report presents a case of CCMA with a 3-year imaging follow-up. CASE REPORT A 66-year-old asymptomatic woman was referred to our cardiology department for further evaluation of a rapidly expanding intracardiac mass observed using transthoracic echocardiography (TTE) in an outpatient setting. A neoplasm was suspected. Echocardiographic examination was normal 5 years ago, and 2 years later, TTE revealed an echodense structure (10×10 mm) occupying the atrioventricular groove. Three years later, TTE revealed an increase in the size of the lesion (21×18 mm) and a mild acoustic shadow. Cardiac magnetic resonance imaging revealed a pathological mass (20×20×37 mm) in the posterior portion of the mitral annulus that extended into the left ventricle. Using computed tomography, a round mass (20×19×39 mm) with a demarcated area of calcification was revealed in the posterior portion of the mitral annulus. Thus, the intracardiac mass was diagnosed as CCMA. Although there was a considerable increase in lesion size (doubling of lesion size within 3 years), normal intracardiac flow and asymptomatic course of the disease remained. Therefore, this patient underwent conservative management with imaging follow-up. CONCLUSIONS In cases of atypical presentation of CCMA, multimodal imaging may provide an accurate diagnosis and important information regarding the course of the disease.

Left atrial appendage thrombus in patients referred for electrical cardioversion for atrial fibrillation: a prospective single­center study.

INTRODUCTION: Left atrial appendage thrombus (LAAT) is a risk factor for stroke; however, the actual health risk associated with LAAT in patients with atrial fibrillation (AF) on chronic anticoagulation is unknown. OBJECTIVES: We aimed to assess the prevalence and predictors of LAAT, and its predictive role in relation to mortality, stroke, and systemic thromboembolic events among consecutive AF patients on oral anticoagulation (OAC) admitted for electrical cardioversion. PATIENTS AND METHODS: This was a prospective, single­ center cohort study. The participants underwent transesophageal echocardiography before electrical cardioversion. A total of 296 patients were enrolled. The primary outcome was the presence of LAAT. All participants were followed for 12 months to evaluate the incidence of systemic thromboembolic events, stroke, and death. RESULTS: Despite uninterrupted OAC in patients with AF of above 48-hour duration scheduled for cardio-version, we found a high prevalence of LAAT, reaching 14.5%. There was no difference in the prevalence of thrombi between different types of OAC (P = 0.26). The independent predictors of LAAT were chronic obstructive pulmonary disease, heart failure, prior myocardial infarction, greater left atrial diameter, lower left ventricular ejection fraction, higher CHA2DS2­VASc score, and reduced dabigatran dose. The optimal cutoff values for the prediction of LAAT were the age of at least 74 years, left atrial diameter equal or greater than 52 mm, left ventricular ejection fraction equal or lower than 40%, and CHA2DS2­VASc score equal or greater than 3. No strokes or systemic thromboembolic events occurred over the follow­up period. CONCLUSIONS: The presence of LAAT had no practical value for predicting stroke, thromboembolic events, or death in patients with AF and on chronic anticoagulation.

Mitochondrial DNA and Epigenetics: Investigating Interactions with the One-Carbon Metabolism in Obesity.

Mitochondrial DNA copy number (mtDNAcn) has been proposed for use as a surrogate biomarker of mitochondrial health, and evidence suggests that mtDNA might be methylated. Intermediates of the one-carbon cycle (1CC), which is duplicated in the cytoplasm and mitochondria, have a major role in modulating the impact of diet on the epigenome. Moreover, epigenetic pathways and the redox system are linked by the metabolism of glutathione (GSH). In a cohort of 101 normal-weight and 97 overweight/obese subjects, we evaluated mtDNAcn and methylation levels in both mitochondrial and nuclear areas to test the association of these marks with body weight, metabolic profile, and availability of 1CC intermediates associated with diet. Body composition was associated with 1CC intermediate availability. Reduced levels of GSH were measured in the overweight/obese group (p = 1.3∗10-5). A high BMI was associated with lower LINE-1 (p = 0.004) and nominally lower methylenetetrahydrofolate reductase (MTHFR) gene methylation (p = 0.047). mtDNAcn was lower in overweight/obese subjects (p = 0.004) and independently correlated with MTHFR methylation levels (p = 0.005) but not to LINE-1 methylation levels (p = 0.086). DNA methylation has been detected in the light strand but not in the heavy strand of the mtDNA. Although mtDNA methylation in the light strand did not differ between overweight/obese and normal-weight subjects, it was nominally correlated with homocysteine levels (p = 0.035) and MTHFR methylation (p = 0.033). This evidence suggests that increased body weight might perturb mitochondrial-nuclear homeostasis affecting the availability of nutrients acting as intermediates of the one-carbon cycle.

Long-term outcomes in patients with acute myocardial infarction and no ischemic changes on electrocardiogram.

BACKGROUND: Acute myocardial infarction (MI) is commonly associated with ischemic abnormalities on electrocardiography (ECG). However, a significant proportion of patients present with no ischemic changes (NIC), and their baseline characteristics and management differ considerably from those with other ECG patterns. In the era of rapid troponin assays, the exact prognostic effects of normal ECGs remain unclear. OBJECTIVES: This study aimed to compare the outcomes of patients with MI without ischemic changes and those with other ECG patterns. METHODS: Between 2012 and 2018, 155,073 patients with MI were enrolled in the prospective nationwide Polish Registry of Acute Coronary Syndromes (PL-ACS). The patients were assigned to one of the following groups: NIC, ST-segment elevation (STE), ST-segment depression (STD), T-wave inversion (TWI), and other ST-T abnormalities (STT). RESULTS: The NIC group accounted for 9.56% of all patients. The in-hospital risk of death was lower in the TWI group than in the NIC group. In the STE, STD, and STT groups, the short-term results were substantially worse. During the 12-month observation period, TWI had the best prognosis. The worst long-term prognoses were associated with STT and STD. The outcomes of the STE and NIC groups were similar (12-month death rate 9.0% vs. 8.7%, respectively; P=0.534), despite the fact STE was an independent predictor of 12-month prognosis. CONCLUSIONS: The prognosis of patients with MI and NIC is not as favorable as previously thought. Their long-term outcomes were equal to those of the TWI and STE MI groups.

Heterogeneity of the No-Reflow Group After Primary Percutaneous Coronary Intervention Due to ST-Segment Elevation Myocardial Infarction - Are There Sex Differences?

AIMS: Assessment of the diversity in the no-reflow population after primary percutaneous coronary intervention (pPCI) due to ST-segment elevation myocardial infarction (STEMI). Are there any gender-related differences? MATERIAL AND METHODS: Analysis of 1063 STEMI patients with Thrombolysis in Myocardial Infarction (TIMI) grade 0 or 1 following pPCI. The study group consisted of 685 patients with TIMI grade 0 and of 378 patients with TIMI grade 1. We analyzed clinical characteristics, in-hospital mortality and 2-year follow-up in both groups. RESULTS: Among women with the TIMI grade 1 an atrial fibrillation, tachycardia and impaired ejection fraction were more common than in men. The vessel responsible for myocardial infarction was most commonly the left anterior descending (LAD) in women, whereas the right coronary artery (RCA) in men. These differences were not observed in group with TIMI grade 0. We observed a higher incidence of in-hospital death in the population with TIMI grade 0 compared with TIMI grade 1 (21.9% vs 17.2%; p 0.0189). In the TIMI grade 1 group there was significantly higher incidence of in-hospital mortality in women compared to men (13.2% vs 22.7%; p 0,0159). Among women with postprocedural TIMI grade 0 in all periods of long-term follow-up the mortality was significantly higher compared to men (9.5% vs 17%; p 0,0111; 11.8% vs 19.7%; p 0.0139 and 16.7% vs 23.9%; p 0.043 for 6-,12-months and 2-years of follow up respectively). CONCLUSIONS: Patients with no-reflow phenomenon in infarct related artery after pPCI constitute a more diverse group than previously thought. Some differences are most likely gender-specific. The female sex might have an adverse effect on in-hospital mortality in case of TIMI grade 1 and on the long-term prognosis among patients with TIMI grade 0.

A 64-Year-Old Woman with Imaging Features Consistent with a Posterior Intrapericardial Lipoma and 5-Year Imaging Follow-Up.

BACKGROUND Primary cardiac and pericardial neoplasms are rare and may be found incidentally on echocardiography. We present a case of a 5-year imaging follow-up in a patient with a large posterior pericardial lipoma diagnosed by magnetic resonance imaging of the mediastinum. CASE REPORT A 64-year-old woman was admitted to the Department of Cardiology for detailed assessment due to an intrapericardial mass revealed on transthoracic echocardiography in an outpatient setting. Computed tomography revealed a capsulated posterior intrapericardial homogenous mass of fat density. There was no enhancement of the lesion with contrast agent administration. Ultimately, magnetic resonance imaging confirmed the benign nature of the tumor, leading to the intrapericardial mass being classified as a lipoma. Due to the clinical features of the lesion - the preserved intracardiac flow and the asymptomatic course of the disease - conservative treatment was appropriate for this patient. A 5-year imaging follow-up was uneventful, the patient remained asymptomatic, a mild tumor growth was identified by computed tomography, and there was still no recommendation for surgery. CONCLUSIONS This case has shown that although echocardiography and computed tomography imaging can identify posterior intrapericardial tumors, magnetic resonance imaging can identify diagnostic features and support the benign nature of a tumor that may not be amenable to surgical removal.

Giant Left Atrial Thrombus Despite Anticoagulation with Apixaban in a Patient with Mitral Stenosis and Atrial Fibrillation.

BACKGROUND In patients with atrial fibrillation (AF), the presence of a left atrial thrombus correlates with the highest risk of stroke. Mitral stenosis (MS) is an acquired disease that leads to atrial pressure overload and subsequent significant anatomical and electrical remodeling of the left atrium. This promotes the occurrence of AF and atrial thrombus formation. Proper anticoagulation decreases the stroke risk in AF patients. Unfortunately, there is insufficient data on the effectiveness of non-vitamin K antagonist oral anticoagulants (NOAC) in patients with AF and MS. CASE REPORT We present a case of 64-year-old woman referred for electrical cardioversion (CV) due to symptomatic AF. She was administered an apixaban for stroke prevention, but she missed the scheduled echocardiography prior to referral. Imaging performed on-site revealed a giant left atrial thrombus and moderate MS. High mobility of the intracardiac mass together with moderate AS and MS were assessed as significant predictors of distal embolization. The patient underwent mitral valve replacement with the thrombus removal. Her further recovery was uneventful. CONCLUSIONS Mitral stenosis significantly affects the anticoagulant selection in patients with atrial fibrillation. Thus, echocardiography is mandatory if the first diagnosis is atrial fibrillation to exclude contraindications for NOAC therapy.

Choosing a treatment method for post-catheterization pseudoaneurysms guided by the late to early velocity index.

Ultrasound-guided thrombin injection (UGTI) is often the first-line treatment for iatrogenic post-catheterization pseudoaneurysms (psA). There are also first reports of the use of biologically derived tissue glues (TG) instead of sole thrombin especially when UGTI was unsuccessful or in case of psA recurrence. Previously, we have established that a late to early velocity index (LEVI) < 0.2 could be a predictor of an increased risk of psA recurrence after standard UGTI. In this paper, we report our first experiences when the choice of the first-line treatment method was based on LEVI assessment. From May 2017 till January 2020 we included 36 patients with psA. Of them, 10 had LEVI < 0.2 and they underwent ultrasound-guided tissue glue injection (UGTGI) with biological TG and 26 had LEVI > 0.2 and they underwent UGTI. The injection set containing human thrombin and fibrinogen was used for UGTGI. Bovine thrombin was used for UGTI. The success rate was 100% and no psA recurrence was detected during a 2-week follow-up. It was significantly better when compared to the expected recurrence rates based on our previous 14 years of experience (0% vs. 13%, p = 0.01). All complications (10% in the UGTGI group and 15% in the UGTI group) were mild and transient and included clinical symptoms of paresthesia, numbness, tingling, or pain. Their rates were comparable to the rates we previously reported. No significant differences in other characteristics were observed. The approach to choose the first-line treatment method for iatrogenic psA based on LEVI is encouraging. It may increase the success rate and avoid unnecessary repetition of the procedure, without increasing complication rate while keeping costs of the procedure reasonable.

Late to early velocity index as a predictor of iatrogenic femoral artery pseudoaneurysm recurrence in patients treated with ultrasound-guided thrombin injection.

INTRODUCTION: Ultrasound-guided thrombin injection (UGTI) is the preferred treatment of pseudoaneurysms (psA). The potential risk of complications increases with the number of UGTI treatments needed for complete psA obliteration. Identification of risk factors for recurrent psA is needed. MATERIAL AND METHODS: In total, 508 patients with femoral artery psA underwent UGTI, followed by ultrasound examination repeated twice, at 1-week intervals, to assess UGTI effectiveness. In cases of psA recurrence, the procedure was repeated. Clinical and ultrasound data were prospectively collected. RESULTS: The psA recurrence occurred in 76 (15%) patients. UGTI was repeated twice in 49 (64%), three times in 15 (20%) and more than three times in 12 (16%) patients. The median thrombin dose was 150 IU (80-250 IU), and was lower in initial procedures than repeated UGTI (p = 0.025). The median psA volume was 2.26 ml (0.86-5.47 ml). The median length of the communicating channel was 4 mm (0-12 mm). A time interval between vessel catheterization and UGTI greater than 7 days (p < 0.001), a late to early velocity index (LEVI) of < 0.2 identified during the outflow phase (p < 0.001), a psA volume > 5 ml (p = 0.032), and a short communicating channel between the psA and the artery (p = 0.037) predicted psA recurrence. Antiplatelet and anticoagulant agents did not increase the risk. CONCLUSIONS: The LEVI and time interval between artery cannulation and UGTI treatment are strong parameters identifying patients at risk of psA recurrence. The psA volume and communicating channel length are less substantial risks, but still significant. Concomitant antiplatelet and anticoagulant therapy do not affect the success rate of UGTI.

Stress, anxiety, depression and basic hope in family members of patients hospitalised in intensive care units - preliminary report.

INTRODUCTION: The family response to intensive care unit (ICU) hospitalisation includes development of adverse psychological outcomes such as stress, anxiety or depression. These complications from exposure to critical care are termed post-intensive care syndrome-family (PICS-f). Psychological repercussions of critical illness affect the family member's ability to perform care functions after hospitalisation. MATERIAL AND METHODS: A total of 37 family members of patients hospitalised in an ICU were included. To evaluate the level stress, anxiety, depression and basic hope the standardized questionnaires the Perceived Stress Scale (PSS-10), the Hospital Anxiety and Depression Scale (HADS) and the Basic Hope Inventory (BHI-12) respectively were used. RESULTS: In 33 respondents (89.19%) a high level of stress was identified, and 14 (37.84%) and 12 (32.43%) respondents had severe anxiety and depression, respectively. Higher levels of stress, anxiety and depression were found in spouses and family members living with the patient. Female subjects had a higher level of basic hope (P = 0.026). It was found that perceived stress correlated with anxiety (r = 0.456, P = 0.005) and depression (r = 0.481, P = 0.003). CONCLUSIONS: Most relatives of the patients reported stress, anxiety, depression and low basic hope. Preventive family-centred interventions are needed to minimize the risk of adverse psychological repercussions, including post-intensive care syndrome family.

Heat Shock Protein 27 Is an Emerging Predictor of Contrast-Induced Acute Kidney Injury on Patients Subjected to Percutaneous Coronary Interventions.

Contrast-induced acute kidney injury (CI-AKI) is a serious complication associated with considerable morbidity and mortality. Heat-shock protein 27 (HSP27) plays a role in the defense of the kidney tissue against various forms of cellular stress, including hypoxia and oxydative stress, both features associated with CI-AKI. The aim of our study was to evaluate a potential predictive value of HSP27 for CI-AKI in patients subjected to percutaneous coronary interventions (PCI). Included were 343 selected patients subjected to PCI. Exclusion criteria were conditions that potentially might influence HSP27 levels. HSP27 serum levels were evaluated prior to PCI, together with serum creatinine, the concentration of which was also evaluated twice at 48 and 72 h post PCI. CI-AKI was diagnosed in 9.3% of patients. Patients in whom CI-AKI was diagnosed were older (p < 0.001), were more often females (p = 0.021), had higher prevalence of diabetes (p = 0.011), hypotension during PCI (p < 0.001), albuminuria (p = 0.004) as well as multivessel disease (p = 0.002), received higher contrast volume (p = 0.006), more often received contrast volume (CV) above the maximum allowed contrast dose (MACD) (p < 0.001), and had lower HSP27 level (p < 0.001). On multivariate analysis, CV > MACD (OR 1.23, p = 0.001), number of diseased vessels (OR 1.27, p = 0.006), and HSP27 (OR 0.81, p = 0.001) remained independent predictors of CI-AKI. Low concentration of HSP27 is an emerging, strong and independent predictor of CI-AKI in patients subjected to PCI.

Cardiovascular risk in patients with plaque psoriasis and psoriatic arthritis without a clinically overt cardiovascular disease: the role of endothelial progenitor cells.

Psoriasis is an autoimmune, chronic disease determined by environmental and genetic factors. The occurrence of psoriasis is accompanied by metabolic diseases, cardiovascular diseases (CVD) and depression, disturbances on interpersonal interactions and a tendency towards social isolation. Regardless of the form of psoriasis and the severity of the disease, early arterial lesions are recorded in arterial vessels of patients. Nevertheless, the chance of CVD is higher in the population of patients with severe psoriasis than in patients with mild to moderate psoriasis. The correlation between the presence of atherosclerotic plaque and psoriatic plaque is partially explained by: (1) a similar inflammatory pathway - via the T helper cells, (2) impaired angiogenesis, and (3) endothelial dysfunction. In the considered tests, the diagnostic tools used showed a reduced level of endothelial progenitor cells in the circulation of patients with psoriasis. Endogenous angiopoietin stimulation in patients with psoriasis leads to deterioration of endothelial regeneration, atherosclerosis which secondarily contributes to the progression of heart failure. Clinical and experimental data confirm the potential of immunomodulatory methods to combat both autoimmune and cardiovascular diseases through the use of immunosuppressive drugs. Full understanding of the way in which CVD develops in patients with autoimmune diseases would enable the implementation of targeted cell therapy allowing the quality and life expectancy of patients to be improved. Modern cellular diagnostic tools allow the use of highly specific biomarkers, which in the near future will enable a reduction in morbidity and mortality due to CVD.

Associations of changes in patient characteristics and management with decrease in mortality rates of men and women with ST-elevation myocardial infarction - a propensity score-matched analysis.

INTRODUCTION: The aim of this study is to estimate how much of the recent decrease in mortality among patients with myocardial infarction with ST-segment elevation (STEMI) can be attributed to improved treatment strategies, and how much it is related to changes in baseline clinical characteristics, and to compare these findings for men and women. MATERIAL AND METHODS: This was a retrospective analysis of 32,790 patients with STEMI from the Polish Registry of Acute Coronary Syndromes PL-ACS hospitalised in 2005 and 2011. Changes in treatment strategies including pharmacotherapy were analysed. Observed in-hospital and 12-month mortality rates were compared with the outcomes in the groups matched on the propensity scores. RESULTS: There was a substantial improvement in STEMI patient management between 2005 and 2011 in Poland. It included greater use of percutaneous coronary interventions and other guideline-based adjunctive therapies, and it was associated with a significant decline in in-hospital mortality. Relative 12-month mortality reduction rates were less pronounced and more related to changes in patients' clinical characteristics. Higher mortality risk reductions were observed in women and were driven by relatively more positive changes in their baseline risk profiles when compared to men. CONCLUSIONS: The progress in the treatment strategies has helped to achieve better survival rates in STEMI patients. However, the ongoing changes in clinical characteristics of patients also played an important role, especially in women. Clinicians should focus on modifiable risk factors and post-discharge management to possibly prolong the positive aspects of in-hospital efforts.