Vascular and cardiac function in young adults with classical congenital adrenal hyperplasia.

INTRODUCTION: Patients with classical congenital adrenal hyperplasia (CAH) have increased cardiovascular risk, but the vascular and cardiac function during longitudinal corticoids replacement therapy is not known thoroughly. MATERIAL AND METHODS: Cross-sectional study of 19 Caucasian adults with CAH (age 23.7 ± 3.8 years; twelve males) compared to 20 healthy volunteers matched for origin, sex, age, and body mass index (BMI). All of the participants were assessed for flow mediated dilatation of the brachial artery (FMD), intima-media thickness of the common carotid artery (cIMT) and common femoral artery (fIMT), standard echocardiography, and global longitudinal left ventricular function using two-dimensional speckle-tracking echocardiography (LSTE). RESULTS: The patients with CAH, compared with controls, had decreased FMD (9.4 ± 3.9 vs. 19.8 ± 5.2; p < 0.01), and the difference was still significant after correction for potential confounders. cIMT and fIMT were higher in the CAH group at baseline (for cIMT 0.47 ± 0.4 mm vs. 0.40 ± 0.03 mm; p < 0.01, for fIMT 0.47 ± 0.05 mm vs. 0.41 ± 0.04 mm; p < 0.01) but not after correction for potential confounders. The CAH subjects, compared with controls, had normal or similar left ventricular (LV) ejection fraction and LV mass index. The mean absolute value of LSTE differed in the CAH patients compared with controls (-20.5% ± 1.2 vs. -22.5% ± 1.7; p < 0.01), but it was still within the normal range. CONCLUSIONS: Young adults with CAH and glucocorticoid long-lasting treatment had impaired FMD, an insignificant increase of IMT, and subclinical changes in LV diastolic function in echocardiography.

Prosthesis-patient mismatch and left ventricle systolic strain in patients with severe degenerative aortic stenosis, who are undergoing surgical valve replacement.

BACKGROUND: Prosthesis-patient mismatch (PPM) is an independent predictor of post-operative mortality after aortic valve replacement (AVR), particularly when it is associated with a left ventricle (LV) dysfunction. Two-dimensional speckle-tracking echocardiography (2D-STE) could be useful in assessing LV function in patients with PPM. AIM: To evaluate the impact of PPM on myocardial multidirectional LV systolic strain in patients who are undergoing AVR for severe degenerative aortic stenosis (AS). METHODS: Sixty-five patients (38 females, 27 males, age: 69.9 ± 9.1 years) with severe degenerative AS and preserved LV ejection fraction were enrolled into the study. Pre- and three-month postoperative 2D-STE was performed to assess LV peak systolic longitudinal strain (LV PSLS), circumferential strain, and LV rotation. The indexed prosthesis effective orifice area (iEOAprosth) was used to define PPM (≤ 0.65 cm2/m2), and it was used to distinguish the study groups: PPM (+) (n = 35) and PPM (-) (n = 30). RESULTS: A significant association of LV PSLS and interaction in the groups [PPM (+) vs. PPM (-)] and intervention (before vs. after AVR; p = 0.019) was observed - the lowest value of LV PSLS was in the PPM (+) group (-14.9 ± 3.5%) after AVR. A significant difference in the mean delta (before/after AVR) values of LV PSLS (0.7 ± 3.1% vs. -1.2 ± 3.6%; p = 0.04) in the PPM (+) vs. the PPM (-) groups was found. LV PSLS correlated with iEOAprosth (r = -0.520, p < 0.001) that was obtained three months after AVR. CONCLUSIONS: The occurrence of PPM in patients undergoing AVR for severe degenerative AS was associated with reduced LV PSLS in a three-month observation.

Increased Oxidation as an Additional Mechanism Underlying Reduced Clot Permeability and Impaired Fibrinolysis in Type 2 Diabetes.

AIMS: We sought to investigate whether enhanced oxidation contributes to unfavorable fibrin clot properties in patients with diabetes. METHODS: We assessed plasma fibrin clot permeation (K s , a measure of the pore size in fibrin networks) and clot lysis time induced by recombinant tissue plasminogen activator (CLT) in 163 consecutive type 2 diabetic patients (92 men and 71 women) aged 65 ± 8.8 years with a mean glycated hemoglobin (HbA1c) of 6.8%. We also measured oxidative stress markers, including nitrotyrosine, the soluble form of receptor for advanced glycation end products (sRAGE), 8-iso-prostaglandin F2α (8-iso-PGF2α ), oxidized low-density lipoprotein (oxLDL), and advanced glycation end products (AGE). RESULTS: There were inverse correlations between K s and nitrotyrosine, sRAGE, 8-iso-PGF2α , and oxLDL. CLT showed a positive correlation with oxLDL and nitrotyrosine but not with other oxidation markers. All these associations remained significant for K s after adjustment for fibrinogen, disease duration, and HbA1c (all P < 0.05), while oxLDL was the only independent predictor of CLT. CONCLUSIONS: Our study shows that enhanced oxidative stress adversely affects plasma fibrin clot properties in type 2 diabetic patients, regardless of disease duration and glycemia control.

Flow-mediated dilatation (FMD) and prevalence of cardiovascular risk factors: the value of FMD assessment in high risk patients is limited.

BACKGROUND: Since flow-mediated dilatation (FMD) is influenced by different factors, its clinical usefulness and validation is widely discussed. AIM: To assess the major factors that determine FMD values in a wide range of subjects with and without cardiovascular (CV) risk factors/diseases (CVRF/CVD). METHODS AND RESULTS: 617 consecutive patients (mean age: 50.1 ± 14.9 years, males: 349/56.5%) hospitalised between 2005 and 2011 were enrolled into the study. Demographic data and CVRF/CVD with a significant impact on FMD values were analysed: hyperlipidaemia, active smoking, arterial hypertension, coronary artery disease, diabetes mellitus and heart valve disease. The population was divided depending on the number of coexisting CVRF/CVD (0-, 1-, 2-, 3-, 4-, 5-CVRF/CVD groups). The median FMD value in the entire group of patients was 10% (5-17). An analysis of the FMD percentage in particular groups showed significantly higher FMD values in patients without any CVRF/CVD (group 0), as well as in patients with one coexisting CVRF/CVD (group 1) compared to the other groups. The presence of two or more CVRF/CVD was not associated with a significantly higher FMD reduction. The analysis of patients with only one CVRF/CVD revealed the lowest FMD values in patients with coronary artery disease. CONCLUSIONS: FMD is related to the number of traditional CVRF/CVDs; however, coronary artery disease has the most significant influence on FMD decrease among analysed factors. The value of FMD assessment in high risk patients is limited.

Anthracycline chemotherapy impairs the structure and diastolic function of the left ventricle and induces negative arterial remodelling.

BACKGROUND: Anthracycline affects various cell lines, which may contribute to left ventricular (LV) dysfunction and vascular remodelling. AIM: To assess the complex influence of anthracycline chemotherapy on the echocardiographic parameters of LV systolic and diastolic function and indices of vascular function and structure. METHODS: 35 women (age 50 ± 9 years old) with breast cancer scheduled for standard anthracycline chemotherapy were enrolled into the study. Examinations were performed at the baseline and six months after the last dose of anthracycline with a clinical follow-up of 9-12 months. LV systolic and diastolic function were assessed by: ejection fraction, transmitral flow, isovolumetric relaxation time, Tei index, mitral ring movement velocity and E/E' ratio. Vascular parameters, including flow-mediated dilatation, intima-media thickness (IMT), aortic compliance, common carotid artery (CCA) compliance, and stiffness indices b were measured. RESULTS: None of the patients revealed any cardiovascular symptoms during follow-up. LV systolic function parameters remained normal. However, LV end-diastolic diameter (46 ± 3.5 vs. 48 ± 4 mm, p = 0.004) and LV end-diastolic volume (101 ± 25 vs. 112 ± 26 mL, p = 0.01) increased. The diastolic function changed - the Tei index increased (0.49 ± 0.09 vs. 0.54 ± 0.1, p = 0.04) and E' (p = 0.049), A' (p = 0.02) and S (p = 0.01) decreased. The E/E' index increased (p < 0.0001) within the LV lateral wall. We observed an increase in carotid IMT (p < 0.0001), a decrease in aortic compliance (p = 0.042) and CCA compliance (p = 0.004), and an increase in aorta as well as the CCA stiffness indices (p = 0.046, p = 0.003, respectively). CONCLUSIONS: Standard-dose anthracycline chemotherapy is associated with LV dilatation and diastolic dysfunction, regardless of the preserved global systolic function. It coexists with negative structural arterial remodelling.

Effects of n-3 polyunsaturated fatty acids on depressive symptoms, anxiety and emotional state in patients with acute myocardial infarction.

BACKGROUND: Our aim was to assess whether an early introduced n-3 polyunsaturated fatty acids (n-3 PUFA) supplementation affects depression symptoms, anxiety and emotional state in patients with acute myocardial infarction (AMI) and no history of mental disorders. METHODS: Fifty two patients with AMI were enrolled into the study and randomized to the study group (group P; n=26; standard therapy+n-3 PUFA 1 g daily) or the control group (group C; n=26; standard therapy). The following psychological tests were used at the baseline (3rd day of AMI) and after one month (30±1 days): Beck Depression Inventory (BDI), State-Trait Anxiety Inventory in a specific situation (STAI-S) and as a general trait (STAI-T), Emotional State Questionnaire (ESQ). RESULTS: The baseline characteristics, pharmacotherapy and BDI, STAI-S/T and ESQ were similar between both groups. The mean test scores assessed for all patients (group P and C) during the one-month observation were significantly lower for BDI (p=0.04), STAI-T (p=0.03), STAI-S (p=0.01) and harm/loss emotions (p=0.005). After adjusting for age, sex, body mass index, coronary artery disease severity, ejection fraction, serum troponin level and the baseline tests results, n-3 PUFA intervention revealed additional significant decrease in BDI (p=0.046), STAI-S (p=0.03) and harm/loss emotions (p=0.04). CONCLUSIONS: Our study provides novel and preliminary observations--n-3 PUFA supplementation reveals additional decreasing effects on depressive and anxiety symptoms in early post-MI patients.

N-3 polyunsaturated fatty acids do not influence the efficacy of dual antiplatelet therapy in stable angina pectoris patients after percutaneous coronary intervention.

BACKGROUND: We aimed to prospectively assess the influence of the recommended dose, 1.0 g of polyunsaturated fatty acids (N-3 PUFA) daily, on platelet reactivity in patients with stable angina pectoris (SAP) after elective percutaneous coronary intervention (PCI). METHODS: Forty consecutive patients with SAP and successful PCI were randomized to the study group (group PUFA: n = 20; age 65 ± 8; standard therapy + 75 mg acetylsalicylic acid + 75 mgclopidogrel + N-3 PUFA/Omacor 1 g daily) and the control group (group C: n = 20; age 65 ± 9; standard therapy + 75 mg acetylsalicylic acid + 75 mg clopidogrel). Platelet reactivity tests (COL, TRAP, ASPI, ADP) were performed using whole blood aggregometry (multiplate platelet [PLT] function analysis) on the 2,nd and 30th day after PCI. RESULTS: Baseline patients' characteristics and clinical outcomes were comparable between the groups. There were no differences between both groups in the mean values of the PTL tests measured 30 days after PCI (PUFA vs. C ASPI: 18.5 ± 17 vs. 27 ± 29 U, COL: 30.4 ± 14.3 vs. 30.3 ± 13.4 U, ADP: 25.4 ± 16.1 vs. 20 ± 10.7 U, TRAP: 65.8 ± 25.6 vs. 57.1 ± 20.4 U, p = NS). The mean delta values of the PTL tests (18-24 h post-PCI/30 days post-PCI) were also comparable between the groups. The PTL aggregometry results were related to time - the baseline values of the ADP (p = 0.003), COL (p = 0.037) and TRAP (p < 0.001) tests were smaller and the ASPI (p = 0.027) test was higher than those measured after 1-month. CONCLUSIONS: N-3 PUFA supplementation does not affect the efficacy of dual antiplatelettherapy in patients with SAP after PCI.

Copeptin constitutes a novel biomarker of degenerative aortic stenosis.

Copeptin is a new biomarker of cardiovascular diseases. Its diagnostic value in degenerative aortic valve stenosis (AS) with preserved left ventricle systolic function is unknown. We aimed to assess the association of serum copeptin levels with AS severity and coexistence of coronary artery disease (CAD). Sixty-four patients with AS and preserved left ventricle systolic function including 40 with severe degenerative AS (group sAS, effective orifice area EOA = 0.67 cm(2)) and 24 with moderate degenerative AS (group mAS, EOA = 1.40 cm(2)) were enrolled into the study. Twenty-three patients without AS and heart failure, matched for age, sex, and CAD occurrence served as the control group (group C). Serum levels of copeptin and N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured using enzyme-linked immunosorbent assay. The mean serum copeptin concentrations were significantly higher in patients with AS: sAS (405 pg/ml) and mAS (351 pg/ml; sAS vs mAS P < 0.05), compared with group C (302 pg/ml, P < 0.05). Serum copeptin levels correlated inversely with EOA (r = -0.55; P < 0.001) in AS patients. There was no correlation between copeptin and NT-proBNP or association with the coexisting CAD. Receiver-operating characteristics analysis showed that copeptin was a good marker of severe/moderate AS (sensitivity 71 %; specificity 87 %), with the optimized cut-off value of 354 pg/ml. Serum copeptin concentration constitutes a novel biomarker of degenerative AS. Coexisting CAD does not interfere with copeptin level.

Effects of pantoprazole on dual antiplatelet therapy in stable angina pectoris patients after percutaneous coronary intervention.

BACKGROUND: Our aim was to prospectively assess the potential influence of pantoprazole therapy on the antiplatelet effects of acetylsalicylic acid (ASA) and clopidogrel (CLO) in stable angina pectoris (SAP) patients after percutaneous coronary intervention (PCI). METHODS: Forty-four patients with SAP (CCS I-III) and successful PCI with stent implantation were enrolled into the study. The patients were divided into group proton pump inhibitors (PPI): 23 patients with indications for PPI (F/M = 9/14; age = 64 ± 9; standard therapy + 20 mg pantoprazole) and the control group (group C): 21 patients (F/M = 6/15; age = 64 ± 8; standard therapy). The platelet function analysis in whole blood based on impedance aggregometry (ASPI, COL, ADP, TRAP tests) using Multiplate--V2.02.11 was performed 18-24 h after the PCI + CLO loading dose (600 mg) and 30 days after PCI. RESULTS: Both baseline patient characteristics and clinical outcomes were comparable between the study groups. There were no differences in the mean values of the platelets (PTL) tests measured at the 30(th) day after PCI between both groups (PPI vs. C: ASPI: 24.6 ± 10.0 vs. 42.1 ± 14.8 U, COL: 32.9 ± 8.6 vs. 34.0 ± 7.7 U, ADP: 26.8 ± 12.4 vs. 30.4 ± 8.1 U, TRAP: 78.7 ± 16.6 vs. 78.1 ± 22.6 U, p = ns). The mean delta values of the PTL tests (18-24 h post-PCI/30 days post-PCI) were also comparable between the groups. The PTL aggregometry results were related to time (ADP, ASPI, TRAP vs. time, p = 0.001; COL vs. time, p = 0.03)--the baseline values of ADP, ASPI, COL and TRAP tests were smaller than those measured after the one-month observation. CONCLUSION: Pantoprazole treatment does not impair the efficacy of dual antiplatelet therapy in patients with SAP after PCI.

Biomarkers of calcification and atherosclerosis in patients with degenerative aortic stenosis in relation to concomitant coronary artery disease.

INTRODUCTION: There is an ongoing debate regarding aortic valve degenerative processes. Some markers of calcification and atherosclerosis may be potentially useful in establishing their etiology. OBJECTIVES: The aim of the study was to assess the biochemical markers of calcification and atherosclerosis in patients with degenerative aortic stenosis (AS) in relation to the aortic valve calcium score (AVCS) and concomitant coronary artery disease (CAD). PATIENTS AND METHODS: The study involved 88 patients: 68 patients with degenerative AS (group A), including 44 patients with severe AS (A1; 25 patients with CAD) and 24 patients with moderate AS (A2; 13 patients with CAD) and 20 matched subjects as controls (18 patients with CAD). In all patients, clinical data were assessed, laboratory tests were done (including the analysis of serum interleukin4 [IL-4], osteoprotegerin [OPG], and fetuin-A levels), coronary angiography was performed, and the AVCS was measured. RESULTS: Study groups and subgroups had comparable serum IL-4, OPG, and fetuin-A levels. There were significant differences in the AVCS between patients with severe AS, moderate AS, and controls (3605 ± 2542 Agatston units [AU], 1390 ± 1143 AU, 100 ± 194 AU, respectively; P <0.001). There were no significant correlations between the AVCS and serum IL-4, OPG, or fetuin-A levels. In moderate AS, serum OPG levels were higher in subjects with concomitant CAD (5.84 ± 1.4 vs. 4.03 ± 1.3 pmol/l, P = 0.036). In severe AS, the mean AVCS was similar in patients with and without CAD. Higher AVCS was observed only in patients with moderate AS and coexisting CAD compared with patients without CAD (1644 ± 1285 vs. 902 ± 789 AU, P = 0.038). CONCLUSIONS: There were no significant differences between patients with and without degenerative AS in selected biochemical markers. The presence of CAD in moderate AS was associated with increased AVCS and serum OPG levels suggesting the effect of atherosclerosis on early valve calcification. In patients with severe AS, there were no correlations between calcification and atherosclerotic markers.

Preoperative quantification of aortic valve stenosis: comparison of 64-slice computed tomography with transesophageal and transthoracic echocardiography and size of implanted prosthesis.

Precise measurements of aortic complex diameters are essential for preoperative examinations of patients with aortic stenosis (AS) scheduled for aortic valve (AV) replacement. We aimed to prospectively compare the accuracy of transthoracic echocardiography (TTE), transoesophageal echocardiography (TEE) and multi-slice computed tomography (MSCT) measurements of the AV complex and to analyze the role of the multi-modality aortic annulus diameter (AAd) assessment in the selection of the optimal prosthesis to be implanted in patients surgically treated for degenerative AS. 20 patients (F/M: 3/17; age: 69 ± 6.5 years) with severe degenerative AS were enrolled into the study. TTE, TEE and MSCT including AV calcium score (AVCS) assessment were performed in all patients. The values of AAd obtained in the long AV complex axis (TTE, TEE, MSCT) and in multiplanar perpendicular imaging (MSCT) were compared to the size of implanted prosthesis. The mean AAd was 24 ± 3.6 mm using TTE, 26 ± 4.2 mm using TEE, and 26.9 ± 3.2 in MSCT (P = 0.04 vs. TTE). The mean diameter of the left ventricle out-flow tract in TTE (19.9 ± 2.7 mm) and TEE (19.5 ± 2.7 mm) were smaller than in MSCT (24.9 ± 3.3 mm, P < 0.001 for both). The mean size of implanted prosthesis (22.2 ± 2.3 mm) was significantly smaller than the mean AAd measured by TTE (P = 0.0039), TEE (P = 0.0004), and MSCT (P < 0.0001). The implanted prosthesis size correlated significantly to the AAd: r = 0.603, P = 0.005 for TTE, r = 0.592, P = 0.006 for TEE, and r = 0.791, P < 0.001 for MSCT. Obesity and extensive valve calcification (AV calcium score ≥ 3177Ag.U.) were identified as potent factors that caused a deterioration of both TTE and MSCT performance. The accuracy of AAd measurements in TEE was only limited by AV calcification. In multivariate regression analysis the mean value of the minimum and maximum AAd obtained in MSCT-multiplanar perpendicular imaging was an independent factor (r = 0.802, P < 0.0001) predicting the size of implanted prosthesis. In patients with AS echocardiography remains the main diagnostics tool in clinical practice. MSCT as a 3-dimentional modality allows for accurate measurement of entire AV complex and facilitates optimal matching of prosthesis size.

N-3 polyunsaturated fatty acids early supplementation improves ultrasound indices of endothelial function, but not through NO inhibitors in patients with acute myocardial infarction: N-3 PUFA supplementation in acute myocardial infarction.

BACKGROUND & AIMS: Our aim was to evaluate early initiated one month n-3 polyunsaturated fatty acids (PUFA) supplementation effects on ultrasound indices of endothelial function and serum asymmetric dimethylarginine (ADMA) levels in patients with acute myocardial infarction (AMI). METHODS: Forty patients with AMI and successful percutaneous coronary intervention (PCI) were recruited into the study and randomized to the study group (group P; n = 20; standard therapy + n-3 PUFA 1 g daily) or the control group (group C; n = 20; standard therapy). Ultrasound indices of endothelial function: flow-mediated dilatation (FMD), nitroglycerin-mediated dilatation (NMD) and serum ADMA concentrations (ELISA) were obtained before and after one month (30 ± 1 days) therapy (presented as means ± standard deviations). RESULTS: There was a significant difference between both groups in mean delta (baseline/after one month) FMD (P: 8.1 ± 12.6% vs C: -2.2 ± 11.8%; p = 0.02) with no difference in mean delta NMD (P: 3.3 ± 11.9% vs 0.66 ± 14.3%; p = 0.53). We found also a significant increase in mean FMD (7.4 ± 6.4 to 15.5 ± 10.5%; p = 0.02) with a nonsignificant change in mean NMD values (26.9 ± 12.1 to 30.2 ± 14.0%; p = 0.24) after 1-month therapy with n-3 PUFA. FMD and NMD mean values did not change in control patients (FMD: 11.6 ± 6.1% to 9.4 ± 8.0%; p = 0.5 NMD: 25.1 ± 11.4% to 25.8 ± 14.0%; p = 0.84). The comparison of mean delta ADMA values for both groups revealed no differences (P: 6.2 ± 9.7 µmol/l vs C: 3.6 ± 9.5 µmol/l; p = 0.43). Mean serum ADMA concentrations were significantly increased after 1-month therapy in the group P (P: 2.1 ± 1.8 to 8.3 ± 9.7 µmol/l; p = 0.001; C: 4.5 ± 7.1 to 8.1 ± 9.5 µmol/l; p = 0.09). However, there was a nonsignificant difference in mean baseline serum ADMA levels between both groups (P: 2.1 ± 1.8 µmol/l vs C: 4.5 ± 7.1 µmol/l; p = 0.32). There were no significant correlations between FMD, NMD, ADMA levels and demographic, clinical or biochemical parameters. CONCLUSIONS: Early and short-term n-3 PUFA supplementation improved ultrasound indices of endothelial function without affecting serum ADMA levels in patients with AMI and successful primary PCI.

N-3 Polyunsaturated fatty acid therapy improves endothelial function and affects adiponectin and resistin balance in the first month after myocardial infarction.

INTRODUCTION: N-3 Polyunsaturated fatty acids (n-3 PUFA) exert clinical beneficial effects in patients after acute myocardial infarction (AMI). However, their exact mechanisms of action are not well recognized yet. Our aim was to evaluate effects of early introduced n-3 PUFA supplementation on endothelial function and serum adipokine concentrations in patients with AMI. MATERIAL AND METHODS: Thirty-eight patients with AMI and successful coronary stent implantation were randomized to the study group (PUFA group: n = 19; standard therapy + PUFA 1 g daily) and the control group (control group: n = 19; standard therapy). The study group patients were given n-3 PUFA (Omacor 1 g daily) starting from the 3(rd) day of AMI. Ultrasound vascular indexes (flow-mediated dilatation [FMD], nitroglycerine-mediated dilation [NMD]) and serum concentrations of adiponectin and resistin (ELISA) were evaluated before and after 30 days of pharmacotherapy. RESULTS: Comparison of the mean delta values (baseline/after 30 days of therapy) between groups revealed significant differences for delta FMD (PUFA 7.6 ±12.4% vs. control -1.7 ±10.5%, p = 0.019) and delta resistin concentrations (PUFA 1.0 ±3.8pg/ml vs. control -1.6 ±2.9pg/ml, p = 0.028). Multiple linear regression analysis for all subjects revealed the n-3 PUFA supplementation (r = 10.933, p = 0.004) and waist circumference (r = -0.467, p = 0.01) as independent factors associated with delta FMD values (R-adjusted 0.29; p = 0.002). CONCLUSIONS: Early and short-term n-3 PUFA supplementation in AMI with successful primary PCI and optimal pharmacotherapy improves endothelial function. However, increased resistin serum levels observed after 1-month n-3 PUFA supplementation merits further investigations.

The relationship between cardiovascular risk estimated by use of SCORE system and intima media thickness and flow mediated dilatation in a low risk population.

BACKGROUND: The SCORE system is a simple, currently recommended method of cardiovascular risk assessment. The aim of this study is to determine the relationship between SCORE risk and intima media thickness (IMT) and flow mediated dilatation (FMD) in a low risk population. METHODS: 119 people (59 men) without known cardiovascular disease and estimated by means of SCORE system risk < 5%, were included in the study. The ultrasound method was used to assess brachial artery diameter (BAd), FMD, nitroglycerin mediated dilatation (NMD) of brachial artery and IMT of common carotid. FMD x BAd and FMD/NMD indexes representing hyperemia-induced vasodilatation independent of brachial artery properties were analyzed. RESULTS: IMT measured was 0.52 +/- 0.08 mm; FMD: 17.5 +/- 7.8%; NMD: 27.0 +/- 9.0%; FMD x BAd: 58.2 +/- 22.4, FMD/NMD: 0.64 +/- 0.19. Independent predictor for both FMD and NMD was BAd (R(2) -0.31; p < 0.001; R(2) -0.44; p < 0.001; respectively), for FMD x BAd index and FMD/NMD index was IMT (R(2) -0.04; p = 0.02; R(2) -0.04; p = 0.015) in a multivariate analysis. Risk estimated by use of the SCORE system was between 0 and 4% (median-1, 25-75 Q: 0-2). A relationship between SCORE risk and IMT (ANOVA p < 0.001), FMD (ANOVA p < 0.001), NMD (ANOVA p < 0.001), FMD x BAd index (ANOVA p = 0.017), but not FMD/NMD index (ANOVA p = 0.27), was found. CONCLUSIONS: The association of a simple stratifying scale (SCORE system) with indices of early vascular remodeling in a low risk population supports its clinical significance.

In-stent coronary restenosis, but not the type of stent, is associated with impaired endothelial-dependent vasodilatation.

BACKGROUND: Precise mechanisms leading to restenosis are not fully understood. The type of implanted stent and the intensity of atherogenic processes may affects the restenosis rate. AIM: To compare the long-term effects of the coronary stent implantation - paclitaxel-eluting stent (PES) or bare-metal stents (BMS) - on endothelial-dependent flow-mediated dilation (FMD), platelet-derived growth factor (PDGF) and asymmetric dimethylarginine (ADMA) serum levels and to assess the relationship between FMD, PDGF, ADMA and every-stage in-stent restenosis (eISR). METHODS: The study population included 40 patients with coronary artery disease, who underwent elective percutaneous coronary intervention (PCI) of the left anterior descending artery (LAD) with stent implantation (PES - 21 patients; BMS - 19 patients). Follow-up examination was performed 12 months after PCI. RESULTS: There were no differences between the PES and the BMS patients regarding FMD (PES: 11.8+/-7.8%, BMS: 10.5+/-9.2%), PDGF (PES: 5540+/-2209 pg/ml, BMS: 4923+/-2924 pg/ml) and ADMA (PES: 0.474+/-0.04 micromol/l, BMS: 0.456+/-0.03 micromol/l) serum levels. The follow-up angiography was performed when clinically indicated in 25 patients: in 15 patients with PES and 10 patients with BMS implanted. The eISR was found in 12 subjects: in 7 (47%) with PES and in 5 (50%) with BMS (NS). In all patients with eISR, the FMD values were significantly lower (6.1+/-3.5%, p=0.003) compared to the patients without eISR (14.3+/-7.8%). FMD was the only independent risk factor for eISR (OR=0.631, 95% CI 0.412-0.942, p=0.0003). The cut-off point for FMD < or = 8.4% as a parameter predicting eISR was established (p=0.0001, sensitivity: 83.3%, specificity: 92.3%, PPV: 90.9%, NPV: 85.7%). CONCLUSIONS: The type of stent implanted into LAD does not affect the FMD, PDGF and ADMA serum levels assessed one-year after a PCI procedure. The occurrence of an early in-stent restenosis is associated with impaired FMD at the time of one-year follow-up.

Coronary artery calcium score assessed by a 64 multislice computed tomography and early indexes of functional and structural vascular remodeling in cardiac syndrome X patients.

BACKGROUND: Regardless of normal coronary angiograms, coronary artery calcium (CAC) can be found in cardiac syndrome X (CSX) patients. According to some data, a relationship between the CAC score and markers of early atherosclerosis in CSX has been observed. Our aim was to assess whether the extent of the CAC score assessed by multislice computed tomography (MSCT) with a 64-slice system in CSX patients is related to brachial artery reactivity, intima-media thickness (IMT), and arterial compliance indexes. METHODS AND RESULTS: High-resolution ultrasound was used to measure flow-mediated dilatation (FMD) and nitroglycerin-mediated vasodilatation, as well as the following parameters of arterial structural changes: IMT, pulse wave velocity, total arterial compliance, and stiffness index. MSCT was used to assess the presence and the quantity of CAC. The study group consisted of 46 CSX patients (mean age, 56.3 +/- 9 years), whereas the control group comprised 21 healthy subjects (mean age, 54.9 +/- 7 years). The assessment of the vascular parameters showed significantly decreased FMD and increased IMT in the CSX subjects (9.06% +/- 3.2% and 0.67 +/- 0.1 mm, respectively) in comparison to the control subjects (17.42% +/- 8.4% [P = .008] and 0.57 +/- 0.2 mm [P = .021], respectively). CAC was detectable in 19 CSX patients (41%) (CAC range according to Agatston score, 2-500; mean, 101.6; median, 26.5) and in 1 control subject (4.8%) (CAC value, 13). CSX patients with detectable CAC were characterized by a significantly higher age (P = .001), lower body mass index (P = .017), and increased stiffness index (P = .020); there were no differences in FMD and IMT values. In a multivariate logistic and linear regression analysis, age was the only risk factor independently associated with the presence of CAC (P = .001) and the log(CAC + 1) value (P = .01). In the subgroup of women, log(CAC + 1) significantly correlated with age (r = 0.587, P = .002) and stiffness index (r = 0.427, P = .024), and in a borderline significant manner, it correlated with weight (r = -0.329, P = .07) and waist-hip ratio (r = 0.315, P = .07). There were no significant correlations in the male subgroup. CONCLUSIONS: Low ranges of CAC are frequently detectable in CSX patients, and the results are age-related and independent of impaired early indexes of functional and structural vascular remodeling.

[Constrictive pericarditis in the course of rheumatoid arthritis]. / Zaciskajace zapalenie osierdzia w przebiegu reumatoidalnego zapalenia stawów.

We describe a case of a patient with advanced heart failure. On the basis of clinical status, echocardiography and the results of magnetic resonance, constrictive pericarditis was diagnosed. The seropositive rheumatoid arthritis was the cause of the constriction. Constrictive pericarditis should be considered in differential diagnosis in patients with rheumatoid arthritis and heart failure.

[Patient with dyspnoea and gigantic tumor of the chest]. / Pacjentka z dusznoscia i olbrzymim guzem sciany klatki piersiowej.

We describe the patient with gigantic chest tumor admitted to the hospital because of dyspnoea. The patient was operated on after the elimination of suspicion of acute pulmonary embolism. Cardiovascular failure was caused by the huge arterial-venous fistula in the tumor and diastolic heart failure were the reasons for dyspnoea. On the basis of the microscopic examination hemangiopericytoma (HPC) was diagnosed--a mesenchymal tumor derived from pericytes. We present in our paper the rules applying to dealing with HPC.