Left ventricular function is related with amphiregulin and fibrosis markers in cirrhotic cardiomyopathy.

The relationship between left ventricle (LV), extracellular matrix remodeling and fibrosis-linked amphiregulin (ARG) in cirrhotic cardiomyopathy (CCM) is unknown. The aim of the study was to investigate the associations between markers of extracellular matrix remodeling and ARG in cirrhosis and their association with indicators of ventricular remodeling and LV functional parameters. In hepatitis C virus (HCV) patients with cirrhosis, who underwent echocardiography, the presence of left ventricular diastolic dysfunction (LVDD) was determined by having gradable diastolic dysfunction in accordance with modified 2020 Cirrhotic Cardiomyopathy Consortium criteria. A total of 87 cirrhotic patients were consecutively analyzed. Based on detailed echocardiographic assessment - 35 HCV patients with cirrhosis had normal left ventricular diastolic function (non-CCM group), whereas 52 patients had LVDD (CCM group). ARG was measured by enzyme-linked immunosorbent assay. The ARG levels were significantly increased in the CCM group compared to the non-CCM group (P<0.001). ARG levels in all HCV patients were independently associated to the presence of CCM, and showed significant correlations with LVDD. The close relationship between ARG levels and the direct serum marker of fibrosis, and selected markers of extracellular matrix (i.e. transforming growth factor-beta1 (TGF-ß1), and carboxyterminal propeptide of type I collagen (PICP), amino-terminal propeptide of type III procollagen (PIIINP), tissue inhibitor of matrix proteinase-1 (TIMP-1), respectively), ventricular remodeling (i.e. N-terminal pro B-type natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin-T (hs-TnT)), and LV functional parameters suggest an active role in the myocardial injury. Using ROC analysis, the best marker for the diagnosis of CCM was NT-proBNP with AUROC = 0.796. The area under the curve of ARG (AUROC = 0.709) for predicting CCM was greater than this for PICP (AUROC = 0.662) and similar to this hs-TnT (AUROC = 0.753). The simultaneous monitoring of serum ARG and markers of extracellular matrix and ventricular remodeling can be helpful for the alterations in myocardial function control in HCV patients with cirrhosis.

Prognostic factors in medically treated patients with chronic pulmonary embolism.

OBJECTIVE: To evaluate risk factors in medically treated patients with chronic pulmonary embolism (CPE) who are not suitable candidates for definitive surgical therapy. STUDY DESIGN: A total of 53 consecutive patients with angiographically confirmed CPE were involved. Four patients underwent pulmonary endarterectomy, and 49 patients received continuous anticoagulation therapy and were followed up over an average period of 18.7 months (range, 6 to 72 months). RESULTS: Sixteen patients died during the follow-up period, mostly from progressive right ventricle failure. Among the nonsurvivors, 12.5% had distal CPE and 87.5% had proximal CPE (p = 0.03). The survivors had a higher (mean +/- SD) level of PaO(2) (59.3 +/- 11 mm Hg) than the nonsurvivors (50.8 +/- 9 mm Hg; p = 0.02), a lower mean pulmonary artery pressure (mPAP; 30.3 +/- 15 mm Hg vs 51 +/- 21 mm Hg; p = 0.0004), a lower hematocrit value (40.0 +/- 6 vs 44.2 +/- 6; p = 0.03), and better exercise tolerance (4.8 +/- 3 multiples of resting O(2) consumption [METs] vs 2.5 +/- 1 METs; p = 0.02) achieved during the maximal symptom-limited exercise. The patients with coexisting COPD had a higher mortality rate (62.5%) than those without COPD (37.5%; p = 0.04). Independent risk factors in the Cox analysis were as follows: mPAP (p = 0.04), exercise tolerance (p = 0.02), and COPD (p = 0.04). In the Kaplan-Meier analysis, the patient group with lower mortality achieved > 2 METs (p = 0.02) and had mPAP < 30 mm Hg (p = 0.04). CONCLUSION: The prognosis for the medically treated CPE patients, particularly those with pulmonary hypertension, was unfavorable. The prognostic factors for these patients were mPAP, coexistence of COPD, and severe exercise intolerance.

[Diagnosis of chronic pulmonary embolism in patients with advanced chronic obstructive pulmonary disease]. / Rozpoznawanie przewleklej zatorowosci plucnej u chorych z zaawansowana POCHP.

The coexistence of chronic obstructive pulmonary disease (COPD) and chronic pulmonary embolism (PE) worsens prognosis and requires complex therapeutic procedures. However, the diagnosis COPD + PE is difficult because of similar clinical symptomatology. Pulmonary angiography was performed in 20 patients aged 60.9 (37-75) years with COPD and with clinical suspicion of chronic pulmonary embolism (PE). Of 13 patients with PE 8 had proximal PE and in 5 patients peripheral PE was found. Both groups of patients did not differ with regard to their age 60.2 +/- 7 vs 59 +/- 10 years (NS), FEV1 0.9 +/- 0.3 vs 1.1 +/- 0.4 l (NS) as well as platelet cells count, fibrinogen, hematocrit and hemoglobin. Patients with COPD + PE compared to patients with COPD had higher pH 7.38 +/- 0.05 vs 7.32 +/- 0.03 (p = 0.01), and tendency to lower PaCO2 44.3 +/- 12 vs 52.0 +/- 7 mmHg(NS), and higher mean pulmonary artery pressure 48 +/- 17 vs 36.3 +/- 9 mmHg(NS). Patients with COPD+ proximal PE compared to COPD patients had higher pH 7.4 +/- 0.05 vs 7.3 +/- 0.03 (p = 0.004) and lower paCO2 39.6 +/- 10 vs 52 +/- 7 mmHg (p = 0.03).

[The impact of 2-year rehabilitation on exercise tolerance and transcutaneous oxygen saturation during exercise in patients with chronic obstructive pulmonary disease]. / Wplyw 2-letniej rehabilitacji na tolerancje wysilku i wysycenie tlenem krwi tetniczej w czasie wysilku u chorych na przewlekla obturacyjna chorobe pluc.

We compared results of symptom-limited exercise test (ET) and percutaneous oxygen saturation (SaO2) during ET in rehabilitated COPD patients (R) and in control COPD patients (C) before and after 2 years of study. Group of R consisted of 27 patients (FVC 2.15 l, FEV1 1.17 l, mean age 58, range 32-76 years) who underwent comprehensive, in-hospital and domestic R, group C consisted of 19 patients (FVC 1.95 l, FEV1 1.42 l, mean age 68, range 55-83 years). The studied groups did not differ in their FVC and FEV1, but R patients were younger (p = 0.05), had more sustained ET (p = 0.0002) and greater number of METs achieved during ET (p = 0.0008). After study we found increased number of METs during ET from 3.94 to 4.77, p = 0.003, improved 10 grade Borg score in 3' ET from 4.0 to 2.5, p = 0.05 and tendency to decrease maximal drop of SaO2 during ET from 6.8 to 3.1% (NS). Patients in C group failed to improve results of ET: from 2.7 to 2.5 METs (NS), and pulse oximetry: maximal drop in SaO2 during ET from 3.1 to 3.07%, NS) and also 10-grade Borg score in 3'ET (from 2.0 to 2.8, NS). In conclusion, although differences in age and in initial exercise tolerance between studied groups could influence the results of this study, it seems that long term rehabilitation can improve both exercise tolerance and oxygen saturation during exercise in COPD patients.

[Value of classical and new criteria of electrocardiography in diagnosis of hypoxic cor pulmonale evaluated by hemodynamics tests]. / Wartosc klasycznych i nowych kryteriów elektrokardiograficznych rozpoznawania hipoksyjnego serca plucnego oceniana badaniami hemodynamicznymi.

Electrocardiogram is commonly used in the diagnosis of cor pulmonale in patients with chronic obstructive pulmonary disease (COPD). Pulmonary hemodynamics being the definite method for diagnosis the disease can be used to vary the ecg criteria for diagnosis cor pulmonale. After excluding patients with old myocardial infarction and with pulmonary wedge pressure > 12 mm Hg in 66 patients aged 65.2 with advanced COPD (FEV1 0.78 +/- 0.3 litre) pulmonary hemodynamics and ecg were performed at the same time. The signs of right ventricular hypertrophy were sought for using 3 sets of criteria: the World Health Organisation criteria, new compiled Lehtonen et al. Criteria and right ventricular precordial leads. WHO criteria had a specificity and sensitivity of 50% and 57.6%, the modified right precordial leads-53% and 64.5% and compiled Lehtonen's criteria -57% and 59% respectively. In 32 patients with mild pulmonary hypertension (20-29 mm Hg) sensitivity of WHO criteria was 46.8%, right precordial leads -51.6%, and Lethonen and co. Criteria -50%, in 10 patients with moderate pulmonary hypertension (30-39 mm Hg) 59%-62.5%-50%, in 9 patients with severe hypertension (> or = 40 mm Hg) 100%-100%-100% respectively. Our studies confirm the poor sensitivity and of ecg criteria for diagnosis of cor pulmonale (pulmonary hypertension) in COPD. However, in mild and moderate pulmonary hypertension, sensitivity of ecg diagnosis of cor pulmonale is improved if right modifieds precordial leads are used. New, compiled Lehtonen's criteria failed to improved diagnosis of diagnosis of cor pulmonale. All studied sets of criteria are highly sensitive in COPD patients with severe pulmonary hypertension.

[Effect of acute exercise on cardiac arrhythmias in the course of chronic obstructive pulmonary disease]. / Wplyw ostrego wysilku na niemiarowosc serca w przewleklej obturacyjnej chorobie pluc.

It is suggested that ventricular arrhythmias may be the reason of sudden death in stable patients with COPD. Strenuous effort might provoke danger ventricular arrhythmias in those patients. The impact of maximal exercise test on cardiac ventricular arrhythmias was studied in 24 patients with advanced chronic obstructive pulmonary disease (COPD). The treadmill, self limited exercise test according to Bruce protocol and accompanied by pulse oximetry was performed during 24 hour Holter monitoring. We found ventricular extrasystoles in all patients, in an average 492 +/- 770, complex ventricular extrasystoles in 17 patients and nonsustained ventricular tachycardia in 8 patients. 81% of all ventricular extrasystoles, 80% complex ventricular extrasystoles and 70% nonsustained ventricular tachycardia occurred during the test and up to 2 hour after the test. Patients with complex ventricular arrhythmias were younger and mostly achieved more MET during exercise, but they did not differ in advancing of COPD as measured by spirometry, gas measurements and echocardiography. Although maximal exercise test enhances ventricular arrhythmias it produced no sustained, symptomatic ventricular arrhythmias in patients with advanced and stable COPD.

[Chronic thromboembolic pulmonary hypertension--observation of personal case reports]. / Nadcisnienie plucne na tle przewleklej zatorowosci do duzych naczyn plucnych--obserwacja wlasnych przypadków.

The clinical picture, differential diagnosis and prognosis in chronic thromboembolic pulmonary hypertension (CTEPH) is being discussed on the basis of a dozen of the authors' cases. The clinical course of CTEPH in 2 patients fulfilling the main criterium for pulmonary thromboendarterectomy and undergoing one year anticoagulation is examined. As a result patient with one large pulmonary vessel occlusion (a. lobaris superior sinistra) improved his clinical status as well as hemodynamic and echocardiographic outcome. In patient with multivessel pulmonary occlusion gradual clinical aggravation and hemodynamic-echocardiographic progression of CTEPH was observed.

[Atrial fibrillation with chronic obstructive pulmonary disease]. / Migotanie przedsionków w przewleklej obturacyjnej chorobie pluc.

We compared 8 patients with COPD and fixed atrial fibrillation (group I) and 46 patients with COPD and sinus rhythm in ecg (group II). None of the patients had valvular heart disease, arterial hypertension or clinical signs of coronary artery disease. The studied groups did not differ while comparing their gas measurements, spirometry, pulmonary hypertension and right ventricular diameter (as measured in echo study). Patients with fixed atrial fibrillation had larger circuit and area of right atrium (p = 0.001), left atrial and left ventricular diameter (p = 0.001) as well as lower LV function (expressed by FS%). In conclusion, enlargement of both atria may be considered as a cause for fixed atrial fibrillation in patients with COPD. However symptomless coronary artery disease rather then COPD may be the reason for this arrhythmia.

[Chronic obstructive lung disease: does accompanying arrhythmia have any clinical significance?]. / Przewlekla obturacyjna choroba pluc. Czy towarzyszaca arytmia ma znaczenie kliniczne?

Clinical significance of cardiac arrhythmias in patients with advanced and stable chronic obstructive pulmonary disease was assessed 22-24 hour Holter monitoring revealed supraventricular and ventricular arrhythmias in all 65 patients. There was a great variation of arrhythmia quality and quantity in the study group. Among others, 1808 complex ventricular extrasystoles in 33 patients and 302 episodes of nonsustained ventricular tachycardia in 19 patients were recorded. No sustained symptomatic ventricular arrhythmias were observed. We found no correlation between the intensity of ventricular and supraventricular extrasystoles and clinical parameters as assessed by echocardiography, spirometry and gasometry. However, patients with complex ventricular arrhythmias had larger right ventricular diameter in echocardiography. Of 65 studied patients, 14 (21%) died during follow-up ranging from 1 month to 3.2 years, mean 12.2 months. Two outpatients died suddenly. These 14 patients had larger right ventricle and left atrial dimension, more pronounced PaO2 decrease as well as lowered FEV1 as compared to the survivors. No differences in the incidence of cardiac arrhythmias were noted. Summarizing, despite the great prevalence of cardiac arrhythmias in patients with advanced stable COPD we found no life-threatening ventricular arrhythmias during approximately 1500 hours of holter monitoring. Cardiac arrhythmias seem not to influence the prognosis in these patients.

[Enalapril improves hemodynamics and exercise tolerance in pulmonary heart disease caused by obstructive lung disease]. / Enalapril poprawia hemodynamike i tolerancje wysilku w zespole plucno-sercowym spowodowanym przewlekla obturacyjna choroba pluc.

Chronic enalapril therapy was assessed in 11 patients with cor pulmonale due to chronic obstructive pulmonary disease. Enalapril was added to the maintenance dose of diuretics and digitalis and when clinical stabilisation was achieved haemodynamics, spirometry, blood gases and maximal treadmill exercise test accompanied by +pulse oximetry were performed before and after 30 days, 10-20 mg a day, enalapril therapy. Haemodynamic study showed moderate but significant decrease in mean pulmonary artery pressure, from 24 +/- 3 to 21 +/- 5 mmHg (p = 0.05). There were no substantial differences in cardiac output as well as in blood gases and spirometry after enalapril therapy. Slight decrease in oxygen delivery, on an average from 9157 +/- 3808 to 8074 +/- 3574 (p = NS), was accompanied by a concomitant fall in haemoglobin. We noted significant improvement of maximal exercise test results after enalapril therapy. Maximal workload achieved and the time of exercise increased. It was accompanied by subjective improvement as assessed by Borg scale. We observed no adverse effects of enalapril during one month therapy in patients with cor pulmonale and COPD.

[Osteoporosis caused by long-term steroid therapy of patients with chronic asthmatic bronchitis]. / Osteoporoza w przebiegu przewleklej sterydoterapii u chorych z przewleklym astmatycznym niezytem oskrzeli.

14 patients with chronic bronchitis were observed after from 1.5 to 8 years of regular treatment with corticosteroids of sustained action given intramuscularly. The patients were analysed from the standpoint of age, sex, duration of corticosteroid treatment, type and dose of the drugs, and smoking. In 9 of them accelerated development of osteoporosis was noted its appearance depended significantly only on age and sex.