Serum interleukin-6: Association with circulating cytokine serum levels in patients with sinus arrhythmia and patients with coronary artery disease.

In this study, we were focused on the differences between certain circulating cytokine levels in patients with or without sinus arrhythmia, according to the median IL-6 level. All patients were stable with regards to symptoms and therapy for at least one month prior to the measurements conducted within this study.Exclusion criteria were: patients with sleep apnea, asthma, respiratory insufficiency of any genesis, active infection, allergy, inflammatory diseases, cancer, diabetes of any type and treatment with anti-inflammatory drugs. The study was approved by the Institutional Review Board. All recruited patients gave their verbal and written consent for participation in the study. The study group consisted of 74 patients divided into two groups: with (38) and without sinus arrhythmia but with diagnosed coronary artery disease (36). Sinus arrhythmia was confirmed by 24h Holter monitoring. From all test parameters only cytokines IL-2, IL-8, IL-10, IL-17 and IL-18, showed statistically significant increasing in patients with statistically higher IL-6 levels. It is possible that IL-6 may not be a marker for the selection of patients with sinus arrhythmia or coronary artery disease. The findings indicate that IL-6 represents a reliable indicator for increased expression of IL-2, IL-8, IL-10, IL-17 and IL-18 in patients with sinus arrhythmia or coronary artery disease. Further studies in a large number of patients would be necessary to confirm our observations.

Annual rate of progression of aortic-jet velocity and survival in cases of severe asymptomatic aortic stenosis.

(Full text is available at http://www.manu.edu.mk/prilozi). The aim of the study was to establish the predictive role of maximal aortic-jet velocity, i.e. its annual rate of progression, in the decision in favour of aortic valve replacement (AVR), as well as in the event appearance and/or patients' survival with severe asymptomatic aortic stenosis. 49 patients were analysed who belonged to the clinical and echocardiography group with severe asymptomatic valve aortic stenosis, with an average of 22 +/- 10 months follow-up period. The echocardiography parameters were: ejection fraction, maximal aortic-jet velocity (AV_Vmax), trans-valve maximal gradient and aortic valve area, as well as calcification rate, all of which were included in the predictive model. The progression rate of the aortic-jet velocity was established, reduced to an annual level. The variable ECHO status worsening was defined as worsening when the progression rate of the AV_Vmax at the annual level was > or = 0.3 mps per year. The results show that in 20% of the patients an annual rate of progression of the aortic-jet velocity over > or = 0.3 mps per year was registered. For the follow-up period, event appearance was registeredin 20% of the patients , where the risk of event appearance is 4.3 times higher in patients with ECHO worsening status, in relation to those without ECHO worsening status. It was established the that the probability of survival of the asymptomatic patients with severe AS over a period of 3 years was 0.57 +/- 0.11. The average length of survival in patients without ECHO worsening status was 32.8 +/- 1 months, while in patients with ECHO worsening status it was 23.5 +/- 4 months. It can be conclude that the maximal trans-valve aortic-jet velocity, especially the rate of its annual progression, is a significant predictor of the rapid progression of the disease, which contributes to the risk stratification in the risk group of patients with severe asymptomatic aortic stenosis while referring for AVR. Key words: severe asymptomatic valve aortic stenosis, echocardiography, annual rate of progression of the maximal aortic-jet velocity, survival.

Effect of nephrology referral on the initiation of haemodyalisis and mortality in ESRD patients.

Late nephrology referral of patients with chronic kidney disease (CKD) has been suggested as increasing mortality after the initiation of dialysis. The aim of this study was to assess the impact of nephrology referral on the initiation of haemodyalisis (HD) and mortality during HD treatment in end-stage renal disease (ESRD) patients who have died in our institution over a five-year period. We studied data from all 117 patients on HD treatment in our institution who died (after 90 days of HD treatment) in the period between 01.01. 2002 and 31.12. 2006. Early (ER) and late referral (LR) were defined by the time of follow-up by a nephrologist greater than or less than 6 months, respectively, before the initiation of haemodialysis. Out of a total of 117 patients, 37.6% (44 patients) started HD in the ER group and 62.4% (73 patients) in the LR group. At the start of HD, LR patients were older, had a higher proportion of temporary catheters and had a significantly lower levels of haemoglobin and diuresis. Creatinine clearance was less in the LR (7.67 +/- 3.86 ml/min/1.73 m2) vs. the ER group (8.70 +/- 3.62 ml/min/1.73 m2), but not significantly different. Cardiovascular disease (CVD), defined by a history of myocardial infarction, cerebral vascular disease, peripheral arteriopathy, and/or heart failure, was also significantly more common among LR patients compared to ER (56%; 27%, p = 0.002). During the haemodyalisis treatment, the LR group had significantly lower levels of haemoglobin and haematocrit. CVD accounted for about 64% of deaths observed in the LR group. According to echocardiography data, there were no significant differences in the left ventricular mass index (LVMI) between the LR and ER groups at the time of dialysis initiation, but during haemodialysis treatment the LR group had significantly greater LVMI than the ER group (232,96 +/- 92,48 g/m2 vs.184,09 +/- 51,74 g/m2; p = 0,031). The time until death in months during dialysis treatment was significantly different between the LR and ER group, (69.51 +/- 64.03 vs.113.27 +/- 89.03, p = 0.0025). LR patients experienced a greater degree of anaemia and a high prevalence of CVD at the time of dialysis initiation. Our data suggest that the anaemia, CV damage and progression of left ventricular hypertrophy (LVH) in the LR patients during haemodialysis treatment are associated with poor survival on haemodialysis.