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1.
Neth Heart J ; 24(9): 511-9, 2016 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-27401602

RESUMEN

BACKGROUND: Takotsubo cardiomyopathy (TTC) is characterised by transient contractility disturbances of the apex of the left ventricle. METHODS: We enrolled 101 patients from the northern-eastern part of Poland in the years 2008-2012 who were hospitalised for TCC. The control group consisted of female patients diagnosed with anterior myocardial infarction with ST-segment elevation (anterior STEMI) (n = 101). RESULTS: 89 % of the study group were women. Patients with TTC had diabetes (12.6 % vs 29.7 %; p = 0.002) and hyperlipidaemia (36.8 % vs 64.4 %; p = 0.0001) significantly less frequently, and better kidney function assessed by estimated glomerular filtration rate versus patients with anterior STEMI (74.52 % vs 64.30 %; p = 0.004). In the TTC group there were more patients with chronic obstructive pulmonary disease (11.6 % vs 1.0 %; p = 0.002) and thyroid disturbances, especially hyperthyroidism (23.4 % vs 11.0 %; p = 0.021). In patients with TTC sudden cardiac arrest, pulmonary oedema and cardiogenic shock were observed less frequently than in the control group (14.7 % vs 30.7 %; p = 0.0078). Hospitalisations in TTC patients were less frequently complicated by pneumonia (20.0 % vs 35.6 %; p = 0.0148) and urinary infection (4.2 % vs 21.8 %; p = 0.0003). Cardiac rupture occurred in 3 patients with TTC and in 1 with anterior STEMI. In-hospital mortality was significantly lower in the group with TTC. Also, mortality at 30 days, 3 months, 1 year and 2.5 years was significantly lower in patients with TTC than in patients with MI (p = 0.035; p = 0.0226; p = 0.0075; p = 0.009). CONCLUSIONS: Previously considered to be a benign syndrome, TTC should be reconsidered as a clinical condition at risk for serious complications such as cardiac arrest, cardiogenic shock, pulmonary oedema and cardiac rupture leading to death and causing substantial early hazard. The prognosis in TTC is significantly better than in patients with anterior STEMI.

2.
Scand J Immunol ; 82(3): 163-73, 2015 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-25997925

RESUMEN

The inflammation underlying both atherosclerosis and acute coronary syndromes is strongly related to monocyte-related actions. However, different monocyte subsets can play differential roles in the formation and destabilization of atherosclerotic plaque as well as healing of damaged myocardial tissue. Monocytes are currently being divided into three functionally distinct subsets with different levels of CD14 (cluster of differentiation 14) and CD16 expression. Thus, there are classical CD14++CD16-, intermediate CD14++CD16+ and non-classical CD14+CD16++ monocytes. Here, we summarize the current knowledge on complex activities of different monocyte subsets in atherosclerosis and acute coronary syndromes. Moreover, we discuss which monocyte subsets can serve either as predictive biomarkers of cardiovascular risk or as potential targets used in atherosclerosis and its complications.


Asunto(s)
Síndrome Coronario Agudo/patología , Aterosclerosis/patología , Monocitos/inmunología , Placa Aterosclerótica/patología , Síndrome Coronario Agudo/inmunología , Aterosclerosis/inmunología , Biomarcadores , Adhesión Celular/inmunología , Proteínas Ligadas a GPI/metabolismo , Humanos , Inflamación/inmunología , Receptores de Lipopolisacáridos/metabolismo , Placa Aterosclerótica/inmunología , Receptores de IgG/metabolismo , Factores de Riesgo
3.
J Pharm Biomed Anal ; 154: 354-363, 2018 May 30.
Artículo en Inglés | MEDLINE | ID: mdl-29571133

RESUMEN

Cardiac and extracardiac lipid metabolism is known to be significantly altered in the course of the heart failure with reduced ejection fraction (HF-REF), however the precise mechanisms are not fully elucidated. The aim of the study was to use of untargeted metabolomics to identify and validate changes in the blood metabolites profile, occurring as a result of HF-REF development. The analyses were performed first in the derivation set (36 chronic HF-REF patients and 19 controls without the disease) and repeated in validation cohort (31 chronic HF-REF patients and 20 controls). Independent analyses of both sets revealed statistically significant decline in intensities of phosphatidylcholine (PC): 34:4 and 36:5, lysophosphatidylcholine (lyso-PC): 14:0, 15:0, 18:0, 18:2, 20:3, lysophosphatidylethanolamine (lyso-PE): 18:1 and 18:2 in chronic HF-REF patients. More symptomatic patients and those with ischaemic etiology of HF-REF presented greater deficit in phospholipids (PLs) intensities. The decrease of identified PLs intensities (as compared to controls) correlated with decreased serum cholesterol level, impaired renal function, reduced exercise capacity, enhanced ventilatory response and metabolic parameters associated with altered fatty acids oxidation. In multiple regression analysis PLs deficit was significantly associated with age, carnitines serum intensity, renal function, uric acid, cholesterol level. In conclusion, HF-REF is associated with significant disturbances in phospholipids metabolism. Greater reduction in serum intensities of particular identified PLs is associated with older age, worse clinical condition, impaired oxidative muscle metabolism and enhanced catabolic status.


Asunto(s)
Insuficiencia Cardíaca/metabolismo , Fosfolípidos/metabolismo , Anciano , Carnitina/metabolismo , Colesterol/metabolismo , Cromatografía Liquida/métodos , Enfermedad Crónica , Estudios de Cohortes , Ácidos Grasos/metabolismo , Femenino , Humanos , Metabolismo de los Lípidos/fisiología , Masculino , Persona de Mediana Edad , Espectrometría de Masas en Tándem/métodos , Ácido Úrico/metabolismo
4.
Acta Diabetol ; 44(1): 30-3, 2007 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-17357883

RESUMEN

Glycoprotein IIIa (GpIIIa) is a membrane receptor, found in various tissues, that has two alleles: A1 and A2. Signalling cascade of GpIIIa is modulated by enzymes called calpains, proteases that may also influence glucose metabolism. There is one small study that shows a high association of A1/A2 polymorphism with type 2 diabetes mellitus. In our research we planned to evaluate the association of A1/A2 polymorphism with type 2 diabetes in a population of patients with ST elevation acute myocardial infarction (STEMI). The study comprised 352 individuals. From the cohort of patients hospitalised for STEMI we chose 113 patients with diagnosed diabetes (diabetic group) and 118 patients with STEMI and normal glucose metabolism (non-diabetic group). The population group consisted of 121 persons. Genotyping was performed by the restriction fragments length polymorphism (RFLP) method. The frequency of alleles in all groups was in Hardy-Weinberg equilibrium. The percentage of A2 allele carriers was comparable among all groups : 20.4% (diabetic patients), 23.7% (nondiabetic) and 21.5% (control group) (p>0.05). There was no significant difference in frequency of A2 allele among the groups. We have not observed any association between GpIIIa polymorphism with either type 2 diabetes or STEMI.


Asunto(s)
Diabetes Mellitus Tipo 2/genética , Integrina beta3/genética , Polimorfismo de Longitud del Fragmento de Restricción , Anciano , Estudios de Casos y Controles , Diabetes Mellitus Tipo 2/complicaciones , Angiopatías Diabéticas/complicaciones , Angiopatías Diabéticas/genética , Femenino , Frecuencia de los Genes , Ligamiento Genético , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/complicaciones , Infarto del Miocardio/genética
5.
Int J Cardiol ; 219: 156-63, 2016 Sep 15.
Artículo en Inglés | MEDLINE | ID: mdl-27323342

RESUMEN

Heart failure (HF) is a complex syndrome representing a final stage of various cardiovascular diseases. Despite significant improvement in the diagnosis and treatment (e.g. ACE-inhibitors, ß-blockers, aldosterone antagonists, cardiac resynchronization therapy) of the disease, prognosis of optimally treated patients remains very serious and HF mortality is still unacceptably high. Therefore there is a strong need for further exploration of novel analytical methods, predictive and prognostic biomarkers and more personalized treatment. The metabolism of the failing heart being significantly impaired from its baseline state may be a future target not only for biomarker discovery but also for the pharmacologic intervention. However, an assessment of a particular, isolated metabolite or protein cannot be fully informative and makes a correct interpretation difficult. On the other hand, metabolites profile analysis may greatly assist investigator in an interpretation of the altered pathway dynamics, especially when combined with other lines of evidence (e.g. metabolites from the same pathway, transcriptomics, proteomics). Despite many prior studies on metabolism, the knowledge of peripheral and cardiac pathophysiological mechanisms responsible for the metabolic imbalance and progression of the disease is still insufficient. Metabolomics enabling comprehensive characterization of low molecular weight metabolites (e.g. lipids, sugars, organic acids, amino acids) that reflects the complete metabolic phenotype seems to be the key for further potential improvement in HF treatment (diet-based or biochemical-based). Will this -omics technique one day open a door to easy patients identification before they have a heart failure onset or its decompensation?


Asunto(s)
Insuficiencia Cardíaca/metabolismo , Insuficiencia Cardíaca/terapia , Metabolómica/métodos , Medicina de Precisión/métodos , Enfermedad Crónica , Insuficiencia Cardíaca/genética , Humanos , Metabolómica/tendencias , Medicina de Precisión/tendencias , Proteómica/métodos , Proteómica/tendencias , Resultado del Tratamiento
6.
Can J Cardiol ; 21(2): 153-8, 2005 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-15729414

RESUMEN

AIM: To assess clinical outcome and improvement in left ventricular (LV) contractility during a six-month follow-up after successful primary percutaneous transluminal coronary angioplasty (PTCA), according to rapid ST segment resolution. The usefulness of early dobutamine echocardiography (DE) in the prediction of LV functional recovery in patients treated with primary PTCA was tested. PATIENTS AND METHODS: One hundred ten consecutive patients with first acute myocardial infarction after successful primary PTCA (Thrombolysis in Myocardial Infarction (TIMI) 3 flow and stenosis of less than 30%) were divided into two groups according to whether ST segment resolution occurred 1 h after the procedure. The patients underwent clinical assessment and echocardiography (ejection fraction [EF] and wall motion index [WMI]) after primary PTCA, during DE on the fourth day of hospitalization, and again after three and six months. RESULTS: In patients with ST segment resolution (n=76 [69.1%]), LVEF increased significantly during the six-month follow-up (P=0.0001). Changes found in the group without ST segment resolution were insignificant (P=0.4). Early DE in patients with rapid ST segment resolution revealed significant improvements in LV contractility measured by EF and WMI. Patients without ST segment resolution had a higher incidence of death (three of 34 [8.8%] versus zero of 76 [0%], P=0.0086), reinfarction (five of 34 [14.7%] versus two of 76 [2.6%], P=0.28) and revascularization (four of 34 [11.8%] versus three of 76 [3.9%], P=0.12). The combined end point (death, reinfarction and revascularization) was significantly lower in patients with ST segment resolution (P=0.03). CONCLUSIONS: Rapid ST segment resolution is associated with LV contractility recovery, and a better clinical outcome and prognosis after successful primary PTCA. Early DE after primary PTCA predicts LV functional recovery. Patients with ST segment resolution are likely to respond to early dobutamine testing.


Asunto(s)
Angioplastia Coronaria con Balón , Ecocardiografía de Estrés , Infarto del Miocardio/terapia , Evaluación de Resultado en la Atención de Salud , Femenino , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Contracción Miocárdica/fisiología , Infarto del Miocardio/mortalidad , Infarto del Miocardio/fisiopatología , Polonia , Estudios Prospectivos , Recuperación de la Función/fisiología , Recurrencia , Retratamiento , Volumen Sistólico/fisiología , Disfunción Ventricular Izquierda/fisiopatología , Disfunción Ventricular Izquierda/terapia
7.
Ann Cardiol Angeiol (Paris) ; 64(4): 285-91, 2015 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-25869465

RESUMEN

INTRODUCTION: Atrial fibrillation (AF) is the most common arrhythmia and is associated with significant morbidity and mortality. The impact of matrix metalloproteinases (MMPs) on structural atrial remodeling and sustainment of AF in patients with persistent and permanent AF is unresolved. OBJECTIVES: The aim was to evaluate MMP-9 and its tissue inhibitor-1 (TIMP-1) as markers of atrial remodeling in patients with persistent AF (PAF) who underwent electrical cardioversion (ECV) and in patients with permanent AF (continuous AF, CAF). PATIENTS AND METHODS: Plasma levels of MMP-9 and TIMP-1, clinical findings, and echocardiographic parameters were evaluated in 39 patients with AF and in 14 controls with sinus rhythm. RESULTS: The concentrations of MMP-9 were significantly higher in patients with PAF and CAF compared to controls. There was a significant increase of MMP-9 after ECV in the persistent AF group. The values of TIMP-1 were not significantly different between the groups. In patients with AF, MMP-9 levels were positively related to posterior wall thickness of the LV (r=0.356, P=0.049) and body mass index (r=0.367, P=0.046). CONCLUSION: Elevated levels of MMP-9 were related to the occurrence and maintenance of AF. This suggests that MMP-9 can be a marker of atrial remodeling in patients with AF. Regulation of the extracellular collagen matrix might be a potential therapeutic target in AF.


Asunto(s)
Fibrilación Atrial/fisiopatología , Remodelación Atrial/fisiología , Metaloproteinasa 9 de la Matriz/sangre , Adulto , Anciano , Anciano de 80 o más Años , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/terapia , Biomarcadores/sangre , Enfermedad Crónica , Ecocardiografía Doppler , Cardioversión Eléctrica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Inhibidor Tisular de Metaloproteinasa-1/sangre
8.
J Physiol Pharmacol ; 66(1): 111-28, 2015 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-25716971

RESUMEN

UNLABELLED: Observational studies have suggested that statins may have beneficial effects on outcomes in chronic obstructive pulmonary disease (COPD) patients. These effects may be mediated through an anti-inflammatory effect of statins. The purpose of this pilot-study was to determine whether statins have an anti-inflammatory effect on the lungs of COPD patients. We conducted randomized, controlled, parallel group pilot-study to compare the effects of atorvastatin (n=12) or placebo (n=6) on lung inflammation in patients with mild to moderate COPD. The primary endpoint was change in CD45+ cells expression measured by immunohistochemistry and changes in expression of genes measured using microarrays in lung biopsy (TBB) samples before and after 12 weeks of treatment with atorvastatin 40 mg/day. All subjects had spirometry, lung volumes, diffusing capacity of the lungs for carbon monoxide (DLCO), St George's Respiratory Questionnaire (SGRQ), 6 minute walk distance (6 MWD), serum lipids, hs-CRP, induced sputum (IS), bronchoscopy and TBB carried out at baseline and after treatment. TBB specimens were processed for histology, immunohistochemistry and genome-wide association studies (GWAS) profiling. Seventeen subjects completed the study. There was a significant improvement in SGRQ with mean SGRQ decreased by 12 points after treatment with atorvastatin (P=0.012). Atorvastatin treatment produced a significant 34% reduction in sputum neutrophil count, and a 57% reduction in CD45+ cells in lung biopsies (expressed as integrated optical density -IOD; median IOD 62.51% before, 27.01% after atorvastatin treatment, P=0.008). In patients' lung tissue atorvastatin treatment produced downregulation of key genes involved in inflammatory processes, immune response, and leukocyte activation. These data demonstrate the pulmonary anti-inflammatory effects of atorvastatin in COPD patients with the potential for beneficial clinical effects. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01748279.


Asunto(s)
Antiinfecciosos/uso terapéutico , Atorvastatina/uso terapéutico , Pulmón/efectos de los fármacos , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológico , Anciano , Biopsia , Femenino , Perfilación de la Expresión Génica , Regulación de la Expresión Génica/efectos de los fármacos , Marcadores Genéticos , Estudio de Asociación del Genoma Completo , Humanos , Inmunohistoquímica , Mediadores de Inflamación/inmunología , Pulmón/inmunología , Pulmón/fisiopatología , Activación de Linfocitos/efectos de los fármacos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Polonia , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/genética , Enfermedad Pulmonar Obstructiva Crónica/inmunología , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Recuperación de la Función , Pruebas de Función Respiratoria , Índice de Severidad de la Enfermedad , Método Simple Ciego , Factores de Tiempo , Resultado del Tratamiento
9.
Kardiol Pol ; 39(9): 188-91; discussion 192, 1993 Sep.
Artículo en Polaco | MEDLINE | ID: mdl-8231016

RESUMEN

Catheter ablation was used to cure refractory ventricular tachycardias (VT) in a 20-years old lady with arrhythmogenic right ventricular dysplasia. Antiarrhythmic drugs (procainamide, amiodarone, gilurytmal, flecainide and beta-blockers) used in monotherapy or combination didn't prevent recurrence of sustained VT. During electrophysiological study 3 different morphologies of tachycardia were induced, indicating multiple sites of arrhythmia. One of them was typical for right ventricular outflow tract and similar to the VT recorded in clinical conditions. Endocardial mapping in that region showed pathological low amplitude, fragmented potentials. They preceded by 35 ms the onset of QRS complexes during VT. This area was suggested as a presumed origin of the VT and chosen for transvenous ablation. 11 direct current shock of 200-250 joules (total energy 2400 j) were delivered. No complications were seen during and after ablation. The procedure was terminated when only non sustained VT can be induced by programmed stimulation. The same results were obtained during the control study one month later. However, the patient was taking sotalol and mexiletine. During 6 months period of ambulatory observation the patient was doing well, free of arrhythmias.


Asunto(s)
Taquicardia Ventricular/cirugía , Adulto , Ablación por Catéter , Electrocardiografía , Femenino , Cardiopatías/complicaciones , Cardiopatías/cirugía , Ventrículos Cardíacos/cirugía , Humanos , Recurrencia , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/etiología
10.
Kardiol Pol ; 37(10): 209-14, 1992 Oct.
Artículo en Polaco | MEDLINE | ID: mdl-1464997

RESUMEN

Intracardiac defibrillation to produce complete heart block is a modern and effective method for treatment of refractory supraventricular arrhythmias. The main drawback of this technique is the necessity of implantation of permanent pacemaker. There is however a growing interest in modification of atrio-ventricular (A-V) conduction to prevent arrhythmias without producing complete heart block. A new energy source used for this purpose is the radiofrequency (RF) current. Preliminary clinical results of modification of antegrade conduction in 5 patients with recurrent supraventricular arrhythmias are presented. HAT 100 (Dr Osypka GmbH, Germany) a high frequency generator was used for modification. Electrophysiological studies showed slow/fast type of junctional reentry tachycardia in 4 patients and paroxysmal atrial flutter with rapid ventricular response in 1. Since RF current produces much smaller and more discrete lesion, the precise localization of the active electrode was of primary importance. We manipulated the catheter, used for modification, in AV region until a relatively large atrial potential with only barely visible His bundle deflection was obtained. During reentry tachycardia the place of the earliest retrograde atrial depolarization was searched for. Current and voltage were monitored during the modification procedure. It was possible to titrate the HF energy to achieve the desired effect changing the power and the time of current application. The modification was repeated several times since PQ and AH interval increased > 50%. No prolongation of HV was noted. The modification was effective in all patients and allowed to avoid the induction of reentry despite the persistence of 1:1 AV conduction.(ABSTRACT TRUNCATED AT 250 WORDS)


Asunto(s)
Sistema de Conducción Cardíaco/efectos de la radiación , Terapia por Radiofrecuencia , Taquicardia por Reentrada en el Nodo Sinoatrial/terapia , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad
11.
Kardiol Pol ; 33(8): 16-21, 1990.
Artículo en Polaco | MEDLINE | ID: mdl-2074633

RESUMEN

Transvenous ablation of atrioventricular (AV) junction is an accepted method for treatment of refractory supraventricular arrhythmias. In the classic method the proper position of the ablation electrode is based on registration of the potentials of the conduction system. However according to Bredykis et all. Localization of the catheter is also possible under fluoroscopic control. The study presents a 67-year old patient with recurrent supraventricular tachycardias. Repeated bouts of arrhythmia, refractory to various antiarrhythmic drugs, caused severe hemodynamic consequences. Several cardioversions were performed for arrhythmia termination. Electrophysiologic study using transesophageal pacing showed a concealed accessory pathway conducting only in retrograde direction and the patient was designated for transvenous ablation of AV junction. The specially developed 6F USCI electrode with enlarged tip was used. The catheter was introduced into the right ventricle under fluoroscopic control and then slowly withdrawn until the tip was placed within the tricuspid valve at the border of atrium and ventricle. Cathodal pole of the defibrillator was connected with the electrode. Then the procedure was similar to the classic ablation. Single 200 joules DC shock caused complete AV block. No complications were seen during and after the procedure. A permanent cardiac pacemaker was implanted at the 4th day after ablation. The patient was doing well, without medication and no arrhythmias were observed during the 9 month period. The AV block persisted stable, also retrograde conduction was absent.


Asunto(s)
Sistema de Conducción Cardíaco/cirugía , Taquicardia Supraventricular/cirugía , Anciano , Cateterismo Cardíaco/métodos , Resistencia a Medicamentos , Electrocirugia , Fluoroscopía , Humanos , Masculino , Recurrencia
12.
Pol Merkur Lekarski ; 1(5): 351-4, 1996 Nov.
Artículo en Polaco | MEDLINE | ID: mdl-9273217

RESUMEN

Atrial fibrillation in people over 70 years old increase to 2-4% of a population. Atrial fibrillation is often complicated by. Authors discussed some new views of contemporary treatment and prophylactic.


Asunto(s)
Fibrilación Atrial/complicaciones , Embolia/prevención & control , Anciano , Anciano de 80 o más Años , Antiarrítmicos/uso terapéutico , Fibrilación Atrial/terapia , Embolia/etiología , Fibrinolíticos/uso terapéutico , Humanos , Persona de Mediana Edad
13.
Adv Med Sci ; 58(1): 44-9, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-23640950

RESUMEN

PURPOSE: The data concerning the relation between subclinical hypothyroidism (SH) and the risk of cardiovascular disease are divergent. We aimed to assess myocardial perfusion in contrast-enhanced echocardiography and intima-media thickness (IMT) in patients with SH. MATERIAL/METHODS: Forty females with SH without symptoms of coronary artery disease and 15 healthy female volunteers were examined. Echocardiographic evaluation of the left ventricle function as well as carotid and femoral IMT complex measurements were performed at baseline. Thereafter, dobutamine stress echocardiography with myocardial perfusion assessment at rest and on the peak of stress test was performed. SonoVue® intravenous bolus as a contrast medium was used. The myocardial perfusion was assessed by quantitative method using Q-LAB Philips software (ROI modality). The perfusion index was calculated (a number of left ventricle segments with improved perfusion/a number of all segments). RESULTS: A mean IMT value in the SH group was significantly higher than in the controls (0.7 mm vs. 0.38 mm, p=0.001). Myocardial perfusion at rest and at the peak of stress test was significantly lower in the SH patients as compared to the controls (at rest 120 Db in SH vs. 181 Db in controls, p=0.039 and at the peak of stress 115 Db and 188 Db, p=0.01, respectively). The perfusion index was not significantly worse in the SH group (p=0.6). IMT values negatively correlated with the myocardial perfusion index at the peak of stress (r=-0.54, p=0.014). CONCLUSIONS: In patients with SH contrast-enhanced echocardiographic examination revealed myocardial hypoperfusion and increased IMT. Our results may suggest that the patients with SH are at risk of the development of cardiovascular disease.


Asunto(s)
Grosor Intima-Media Carotídeo , Enfermedad de la Arteria Coronaria/complicaciones , Hipotiroidismo/complicaciones , Hipotiroidismo/fisiopatología , Imagen de Perfusión Miocárdica , Miocardio/patología , Adulto , Índice de Masa Corporal , Colesterol/sangre , LDL-Colesterol/sangre , Medios de Contraste/farmacología , Enfermedad de la Arteria Coronaria/fisiopatología , Ecocardiografía de Estrés/métodos , Femenino , Humanos , Riesgo , Programas Informáticos
14.
Clin Chim Acta ; 413(7-8): 749-52, 2012 Apr 11.
Artículo en Inglés | MEDLINE | ID: mdl-22269158

RESUMEN

OBJECTIVE: The aim of the study was to establish whether adiponectin may act as an independent risk factor of coronary artery disease (CAD) and if adiponectin has potential relations with a new marker of cardiovascular risk -intima-media thickness (IMT). METHODS: 165 patients, who had undergone coronary angiography due to symptoms of CAD were enrolled. Selected clinical and biochemical risk factors were assessed, adiponectin concentrations and IMT were measured. RESULTS: A significantly lower adiponectin concentrations in the CAD group, as compared to the controls, were found. Adiponectin concentration did not correlate with a degree of coronary vessels changes advancement. No correlation between adiponectin concentrations and IMT values in the studied peripheral arteries were found. The value of 9.8 ug/ml has been assigned as a cut-off value. Adiponectin concentrations <9.8 µg/ml had the highest positive predictive value (PPV=95.7%) and specificity (90.9), but low sensitivity (30.8). In the multilogistic regression analysis significant variables influencing the appearance of CAD were found: HDL-C (p=0.011, OR=0.88, 95%CI 0.80-0.97), IMT in CCA (p=0.0048, OR=5.25, 95%CI 1.65-16.75), IMT in CFA (p=0.015, OR=1.65, 95%CI 1.10-2.48 ), and adiponectin concentration <9.8 µg/ml (p=0.032, OR=28.95, 95%CI 1.31-641.48). CONCLUSIONS: Adiponectin is an independent risk factor of coronary artery disease occurrence, but not its advancement. No correlation between adiponectin concentration and IMT values in peripheral arteries was shown.


Asunto(s)
Adiponectina/sangre , Arterias/metabolismo , Enfermedad de la Arteria Coronaria/sangre , Adulto , Arterias/diagnóstico por imagen , Humanos , Persona de Mediana Edad , Análisis de Regresión , Ultrasonografía Doppler
15.
Adv Med Sci ; 57(1): 94-9, 2012 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-22328203

RESUMEN

PURPOSE: In recent years several reports have suggested involvement of interleukin 6 (IL-6) in beta-adrenergic effects on myocardium, particularly in enhancement of STAT3 phosphorylation (downstream signal transducer of IL-6). Here we present a study of isoproterenol effects on hearts of IL-6 deficient mice. METHODS: Male 12 week old C57Bl6/J mice and age and sex matched mice from IL-6 knockout strain (C57Bl6/J(IL6-/-)) received a single intraperitoneal bolus of either isoproterenol (15 mg/kg) or placebo (0.9% NaCl) and were sacrificed after 1 or 24 hours (n=8 in each group). Another group of mice from both genotypes received a three-day isoproterenol treatment (20 mg/kg every 8h). Activation of STAT3 and MEK/ERK pathways were assessed after a single dose of isoproterenol by means of western blotting. RESULTS: After injection of placebo a significantly lower level of STAT3 phosphorylation was observed in IL-6 KO animals. This difference was abolished after isoproterenol both at 1 and 24-hour time points. Isoproterenol produced potent and rapid activation of both STAT3 and MEK/ERK pathways that returned to the levels of placebo treated controls after 24 hours. Lack of IL-6 did not affect phosphorylation of ERKs. Three-day treatment with isoproterenol caused significant increase of indices of RV and LV hypertrophy in both WT and IL-6 KO animals with no significant differences between genotypes. CONCLUSION: IL-6 is not necessary for isoproterenol induced STAT3 phosphorylation, but may affect activation of this pathway by mild non-specific stimuli. Lack of IL-6 does not affect activation of MEK/ERK pathway nor cardiac hypertrophy by beta-adrenergic agonists.


Asunto(s)
Agonistas Adrenérgicos beta/farmacología , Hipertrofia/metabolismo , Interleucina-6/metabolismo , Miocardio/metabolismo , Factor de Transcripción STAT3/metabolismo , Animales , Interleucina-6/genética , Isoproterenol/farmacología , Masculino , Ratones , Ratones Endogámicos C57BL , Ratones Noqueados , Fosforilación/efectos de los fármacos , Fosforilación/genética
16.
Adv Med Sci ; 57(1): 112-7, 2012 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-22548915

RESUMEN

PURPOSE: Intima-media thickness (IMT) assessed in peripheral arteries correlates with presence and progression of atherosclerosis in coronary arteries. IMT measurements may help to select high risk patients and evaluate the efficacy of the therapy used. AIM: The aim of the study was to assess the usefulness of ultrasonographic measurement of IMT in atherosclerosis progress monitoring in patients after myocardial infarction (MI). PATIENTS AND METHODS: 70 men (mean age 52.8 ± 8.4) treated with PCI due to acute myocardial infarction, were enrolled in the study. All subjects underwent ultrasound examination of the IMT complex of: common carotid artery (CCA), carotid bulb and common femoral artery (CFA) during hospitalization and follow-up period (3.83 ± 1.29 years). RESULTS: During the follow-up 3 patients (4.3%) were not on any medications, 8 pts (11.4%) were on reduced doses of ß-blocker, statin or ACE-I (non-compliant pts.). The others (compliant) - 59 pts (84.3%) received standard pharmacological treatment after MI. Nevertheless, an increase of IMT complex value after follow-up compared to initial IMT values of all examined peripheral arteries was observed (respectively: IMT CCA - 0.91 ± 0.26 vs 1.10 ± 0.36, p=0.002, IMT of carotid bulb - 1.31 ± 0.55 vs 1.82 ± 0.69, p=0.012, IMT CFA - 1.38 ± 0.64 vs 1.97 ± 0.75, p=0.014). Non-compliant patients had statistically significant higher IMT values after follow-up when compared to compliant subjects (1.62 vs 1.20, p= 0.017). Patients with higher IMT values were reported to have cardiac events more frequently during the follow-up (p<0.05). CONCLUSIONS: Our results provide evidence that ultrasonographic IMT complex assessment of peripheral arteries in everyday clinical practice allows monitoring efficacy of pharmacological therapy in CAD patients after MI. They also suggest treatment intensification if necessary.


Asunto(s)
Grosor Intima-Media Carotídeo , Infarto del Miocardio/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Humanos , Masculino , Persona de Mediana Edad
17.
Adv Med Sci ; 57(1): 106-11, 2012 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-22440940

RESUMEN

PURPOSE: Methylenetetrahydrofolate reductase (MTHFR) is an enzyme involved in endothelial nitric oxide synthase (eNOS) coupling and homocysteine metabolism. The rs1801133 polymorphism of the MTHFR gene affects risk of coronary artery disease. We assessed its influence on 5-year survival of patients with ST-elevation acute myocardial infarction (STEMI). MATERIAL/METHODS: The study group comprised consecutive patients with STEMI. Genotyping was performed with a TaqMan SNP Genotyping Assay using the ABI 7500 Real Time PCR System (Applied Biosystems). The analyzed end-point was all-cause 5-year survival. RESULTS: The study group comprised 637 patients (mean age 62.3 ± 11.9 years; 25.1% females, n=160; 5-year mortality 16.3%, n=104). The percentages of TT, CT and CC genotypes were: 10.8 (n=69), 39.7 (n=253) and 49.45 (n=315), respectively. No significant differences in clinical characteristics were identified between the genotypes (p>0.05 for all parameters). Eleven (15.9%) TT homozygotes, 40 (15.8%) heterozygotes and 53 (16.8%) CC homozygotes died during follow up (p=0.99 log-rank test). TT homozygotes presented only weak and insignificant tendency towards higher mortality rates in subgroups of patients ≤75 years old (15.6 vs. 11.54%, p=0.35) or with intermediate risk according to the GRACE risk score (13.3% vs. 8.76%, p=0.42). CONCLUSIONS: The rs1801133 polymorphism did not show significant association with 5-year survival.


Asunto(s)
Metilenotetrahidrofolato Reductasa (NADPH2)/genética , Infarto del Miocardio/genética , Polimorfismo Genético/genética , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/mortalidad , Reacción en Cadena en Tiempo Real de la Polimerasa
18.
Adv Med Sci ; 56(1): 80-7, 2011.
Artículo en Inglés | MEDLINE | ID: mdl-21515487

RESUMEN

PURPOSE: Clinical relevance of relations among blood pressure (BP), inflammation, endothelial dysfunction and sympathetic activation is unknown. Study aimed, whether in patients with diagnosed and treated essential arterial hypertension (HTN) biomarkers of inflammation (hs-C-reactive protein, hs-CRP), endothelial dysfunction (endothelin-1, ET-1), and sympathetic nervous system modulation (epinephrine, E and norepinephrine, NE) could be related to BP values. MATERIAL AND METHODS: In 62 patients with diagnosed and treated HTN (mean time of disease 5±3.2 years), serum hs-CRP and ET-1 as well as plasma E and NE concentrations were measured. 24-hour ambulatory blood pressure measurement device (ABPM) was used to estimate efficacy of treatment. RESULTS: A positive correlation between epinephrine and norepinephrine concentrations was found (r=0.246, p=0.05), however such a statistically significant correlation neither to hs-CRP, nor ET-1 were found. Patients with the highest hs-CRP and NE concentrations had the highest systolic (SBP) and diastolic (DBP) blood pressure values. Similar relation was found in subgroup of patients with suboptimal blood pressure values (SPB l 130mmHg, DBP l 80mmHg). In a group of optimal treated patients, elevated levels of ET-1 and NE related to increased blood pressure values. ROC analysis identified ET-1 as statistically significant to diagnose elevated blood pressure: 0.665 (95% Confidence interval 0.512 to 0.796). CONCLUSIONS: In patients with diagnosed and treated arterial hypertension, there are relations among measurements of hs-CRP, ET-1, NE and blood pressure values in spite of treatment, which may improve understanding of mechanisms involving inflammation, endothelial dysfunction and sympathetic nerve activation and may identify patients with refractory hypertension.


Asunto(s)
Presión Sanguínea , Endotelio Vascular/fisiopatología , Hipertensión/inmunología , Mediadores de Inflamación/sangre , Inflamación Neurogénica/etiología , Adulto , Biomarcadores/sangre , Femenino , Humanos , Hipertensión/sangre , Hipertensión/tratamiento farmacológico , Hipertensión/fisiopatología , Masculino , Persona de Mediana Edad
19.
Adv Med Sci ; 56(2): 207-14, 2011.
Artículo en Inglés | MEDLINE | ID: mdl-22112432

RESUMEN

PURPOSE: To evaluate a real-time myocardial contrast echocardiography (MCE) as a tool to select candidates for coronary revascularization among patients with ESRD and to assess the rate of revascularization and mortality. MATERIAL/METHODS: 58 ESRD patients were screened for CAD using MCE. We analyzed the rate of coronary revascularization during 3-year follow-up. Patients with and without perfusion disturbances on MCE were compared. RESULTS: CAD was found in 46.2% patients out of 39 who underwent coronary angiography. 11 (39.3%) patients out of 28 from the group with perfusion defects on MCE underwent revascularization procedure (21.4% - PCI, 17.9% - CABG). No one from the group without perfusion defects had revascularization procedure. Perfusion defect (OR 1.37 CI 1.37-1.86, p=0.022) was related to revascularization in multivariant analysis (OR 12.87, CI 1.86-89.21, p=0.025). There was no difference in mortality between the group which underwent invasive procedures and treated conservatively (p=0.6643). In ROC analysis defects on MCE and CAD on angiography were equally good in anticipating combined end-point (AUC 0.716, CI 95% 0.544-0.851 and AUC 0.747, CI 95% 0.577-0.875, p=0.701) and death (AUC 0.752, CI 95% 0.582-0.878 and AUC 0.729, CI 95% 0.558-0.861, p=0.805). CONCLUSIONS: Our results indicate that MCE is a safe and uncomplicated method which may help along with other methods to select candidates for coronary revascularization among ESRD patients. In our study coronary revascularization procedures were successful but they did not improve patients' survival on 3-year follow-up.


Asunto(s)
Ecocardiografía/métodos , Fallo Renal Crónico/diagnóstico , Anciano , Angioplastia/métodos , Angioplastia Coronaria con Balón/métodos , Área Bajo la Curva , Medios de Contraste/farmacología , Angiografía Coronaria/métodos , Femenino , Estudios de Seguimiento , Humanos , Fallo Renal Crónico/patología , Masculino , Persona de Mediana Edad , Análisis Multivariante , Revascularización Miocárdica , Perfusión , Curva ROC
20.
Adv Med Sci ; 56(2): 215-21, 2011.
Artículo en Inglés | MEDLINE | ID: mdl-21983450

RESUMEN

PURPOSE: A femoral artery pseudoaneurysm - is the most common complication associated with invasive coronary interventions. The aim of the study was to analyze the effectiveness of various methods used for femoral pseudoaneurysm treatment and to assess how routine use of radial approach leads to reduction of these site complications. METHODS: The study comprised 1854 consecutive patients who were hospitalized in years 2005-2008 and underwent coronary angiography (with or without angioplasty) via femoral artery access. Since 2009 routine radial approach has been introduced for both coronary angiography and angioplasty. In patients with symptoms suggesting entry site complications Doppler ultrasound was performed. RESULTS: Femoral access site complications requiring additional procedures were observed in 63 patients (3.4%): in 56 femoral pseudoaneurysms (88.8%) and in 7 arteriovenous fistulas (11.1%) were diagnosed (all appeared after coronary angioplasty). The patients were treated in following ways: standard compression with an elastic bandage prolonged to 12 hours - in 14 cases (25%), ultrasound guided compression - in 13 patients (23.2%), finger compression followed by standard compression with an elastic bandage prolonged to 12 hours or ice compress - in 10 patients (17.8%), surgical treatment - in 3 patients (5.3%). Only 2 patients required thrombin injection (3.6%). Since the time routine radial approach was introduced extreme reduction in the rate of local complications was registered. CONCLUSION: Although iatrogenic femoral pseudoaneurysms following invasive percutaneous coronary interventions are still important complications, most of them can be treated conservatively. It seems that radial access completely eliminates the risk of this complication.


Asunto(s)
Aneurisma Falso/diagnóstico , Arteria Femoral/patología , Anciano , Aneurisma Falso/patología , Angioplastia/métodos , Angioplastia Coronaria con Balón/métodos , Fístula Arteriovenosa/patología , Angiografía Coronaria/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recurrencia , Factores de Riesgo , Resultado del Tratamiento , Ultrasonografía/métodos
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