Links between chronic exposure to outdoor air pollution and cardiovascular diseases: a review.

Acute exposure to air pollution is associated with an increasing risk of death and cardiovascular disorders. Nonetheless, the impact of chronic exposure to air pollution on the circulatory system is still debated. Here, we review the links of chronic exposure to outdoor air pollution with mortality and most common cardiovascular diseases, in particular during the coronavirus disease 2019 event (COVID-19). We found that recent studies provide robust evidence for a causal effect of chronic exposure to air pollution and cardiovascular mortality. In terms of mortality, the strongest relationship was noted for fine particulate matter, nitrogen dioxide, and ozone. There is also increasing evidence showing that exposure to air pollution, mainly fine particulate matter and nitrogen dioxide, is associated with the development of atherosclerosis, hypertension, stroke, and heart failure. However, available scientific evidence is not strong enough to support associations with cardiac arrhythmias and coagulation disturbances. Noteworthy, for some pollutants, the risk of negative health effects is high for concentrations lower than the limit values recommended by the European Union and Word Health Organization. Efforts to diminish exposure to air pollution and to design optimal methods of air pollution reduction should be urgently intensified and supported by effective legislation and interdisciplinary cooperation.

Prognostic significance of atherogenic index of plasma, atherogenic coefficient and lipoprotein combined index among elderly patients with non-ST-segment elevation myocardial infarction in 1-year follow-up.

OBJECTIVES: Coronary artery disease (CAD) remains a leading cause of death in elderly patients. Recently, novel lipoproteins- Atherogenic Index of Plasma (AIP), Atherogenic Coefficient (AC) and Lipoprotein Combine Index (LCI) have been suggested as CAD risk factors; their clinical usefulness, however, remains unknown. The aim of the study was to assess the predictive value of AIP, AC and LCI concerning incidence of major adverse cardiovascular events (MACE) and all-cause mortality in 1-year follow-up. METHODS: For the study, 1,083 patients, aged 60 or older, with NSTEMI were enrolled and divided into two groups: young-old and old-old. RESULTS: MACE occurred in 11.8 % of the patients; LCI showed a borderline significance, but only in univariate analysis. Analysis in groups revealed ambiguous results. None of the examined indices was a predictor of MACE in the young-old group whereas all three of them were significant, but negative predictors in the old-old group. Finally, all-cause mortality at follow-up was 14.9 %. AC predicted 1-year mortality in the whole study population (OR = 1.1 (95% CI: 1-1.2; p = 0.02), but was insignificant in the multivariable model. Additionally, it was an independent predictor in the old-old group, but with borderline significance (OR = 1.14 (95% CI: 1-1.3, p = 0.036). CONCLUSIONS: AIP, AC and LCI should not be used as predictors of MACE and 1-year mortality among elderly patients with NSTEMI (Tab. 5, Ref. 23).

Prognostic value of non-traditional lipid parameters: Castelli Risk Index I, Castelli Risk Index II, and triglycerides to high-density lipoprotein cholesterol ratio among patients with non-ST-segment elevation myocardial infarction during 1­year follow-up.

Aim    Concentrations of classical lipoproteines have a well-established role in non-invasive cardiology. The efficacy of the Castelli Risk Index I (CRI I), Castelli Risk Index II (CRI II), and triglycerides to high-density lipoprotein cholesterol (TG / HDL-C) ratio in clinical practice are currently under evaluation. The study aimed to assess the predictive value of CRI I, CRI II and TG / HDL-C for the incidence of Major Adverse Cardiovascular Events (MACE) and for all-cause mortality during 1­year follow-up of patients with non-ST-segment elevation myocardial infarction (NSTEMI).Material and Methods    1,301 patients were enrolled in the study. Associations between CRI I, CRI II, TG / HDL-C and occurrence of MACE and 1­year mortality were studied. Moreover correlations between CRI I, CRI II, and TG / HDL-C and the severity of coronary artery disease (CAD) were assessed.Results    MACE occurred in 10.9 % (142) of patients, and 1­year mortality was 13.4 % (174). None of the evaluated indices appeared to be an independent predictor of MACE in either the entire population or subpopulations, as divided according to the presence of diabetes or CAD diagnosed prior to admission. Furthermore, no dependence between 1­year mortality and the examined indices was found. Additionally, only a weak correlation between CAD severity and CRI I was observed (R=0.08, p=0.02). No significant correlations for CRI II (p=0.07) and TG / HDL-C (p=0.6) were detected.Conclusions    CRI I, CRI II and TG / HDL-C should not be used as predictors of MACE or all-cause mortality among patients with NSTEMI. Moreover, these indices do not reflect CAD severity.

Polyhedrocytes in blood clots of type 2 diabetic patients with high cardiovascular risk: association with glycemia, oxidative stress and platelet activation.

BACKGROUND: Little is known about factors that affect the composition of contracted blood clots in specific diseases. We investigated the content of polyhedral erythrocytes (polyhedrocytes) formed in blood clots and its determinants in type 2 diabetes (T2D) patients. METHODS: In 97 patients with long-standing T2D [median HbA1c, 6.4% (interquartile range 5.9-7.8)], we measured in vitro the composition of blood clots, including a clot area covered by polyhedrocytes using scanning electron microscopy and the erythrocyte compression index (ECI), defined as a ratio of the mean polyhedrocyte area to the mean native erythrocyte area. Moreover, plasma fibrin clot permeability (Ks), clot lysis time (CLT), thrombin generation, oxidative stress [total protein carbonyl (total PC), total antioxidant capacity and thiobarbituric acid reactive substances (TBARS)], and platelet activation markers were determined. The impact of glucose concentration on polyhedrocytes formation was assessed in vitro. RESULTS: Polyhedrocytes content in contracted clots was positively correlated with glucose (r = 0.24, p = 0.028), glycated hemoglobin (r = 0.40, p = 0.024), total cholesterol (r = 0.22, p = 0.044), TBARS (r = 0.60, p = 0.0027), P-selectin (r = 0.54, p = 0.0078) and platelet factor-4, PF4 (r = 0.59, p = 0.0032), but not with thrombin generation, platelet count, Ks or CLT. Patients who formed more polyhedrocytes (≥ 10th percentile) (n = 83, 85.6%) had higher glucose (+ 15.7%, p = 0.018), fibrinogen (+ 16.6%, p = 0.004), lower red blood cell distribution width (RDW, - 8.8%, p = 0.034), reduced plasma clot density (- 21.8% Ks, p = 0.011) and impaired fibrinolysis (+ 6.5% CLT, p = 0.037) when compared to patients with lesser amount of polyhedrocytes (< 10th percentile). ECI and the content of polyhedrocytes were strongly associated with total PC (r = 0.79, p = 0.036 and r = 0.67, p = 0.0004, respectively). In vitro an increase of glucose concentration by 10 mmol/L was associated with 94% higher polyhedrocytes content (p = 0.033) when compared to the baseline (7.1 mM). After adjustment for age, sex and fibrinogen, multiple regression analysis showed that RDW was the only independent predictor of polyhedrocytes content in T2D (OR = 0.61, 95% CI 0.39-0.92). CONCLUSIONS: Poor glycemic control, together with enhanced platelet activation and oxidative stress, increase the content of polyhedrocytes in blood clots generated in T2D patients.

Relationship between polyunsaturated fatty acid composition in serum phospholipids, systemic low-grade inflammation, and glycemic control in patients with type 2 diabetes and atherosclerotic cardiovascular disease.

BACKGROUND: There are inconsistent data about the role of serum phospholipid fatty acid composition in patients with type 2 diabetes (T2DM) and atherosclerotic cardiovascular disease (ASCVD). The aim of the study was to investigate the relationship between serum phospholipid fatty acid composition, systemic low-grade inflammation, and glycemic control in high-risk T2DM patients. METHODS: Seventy-four patients (26% women, mean age 65.6 ± 6.8 years) with T2DM (median diabetes duration 10 years) and documented ASCVD (74 with coronary artery disease, 26 with peripheral arterial disease) were enrolled in the study. Baseline HbA1c was estimated using turbidimetric inhibition immunoassay. According to the median value of HbA1c the patients were grouped into those with HbA1c < 7.0% (< 53 mmol/mol) (n = 38) and those with HbA1c ≥ 7.0% (≥ 53 mmol/mol) (n = 36). Serum phospholipid fatty acids were measured with gas chromatography. RESULTS: Patients with HbA1c ≥ 7.0%, compared with those with HbA1c < 7.0% had similar composition of saturated and monounsaturated fatty acids in serum phospholipids, but had higher concentrations of linoleic acid (LA) and higher n-6/n-3 polyunsaturated fatty acid (PUFA) ratio as well as lower levels of eicosapentaenoic acid (EPA), total n-3 PUFAs, and the EPA/arachidonic acid ratio. We found that LA (r = 0.25; p = 0.03) and n-6/n-3 PUFA ratio (r = 0.28; p = 0.02) were positively correlated with HbA1c. Multivariate logistic regression analysis showed that n-6/n-3 PUFA ratio, hsCRP and T2DM duration were independent predictors of worse glycemic control in patients with T2DM and ASCVD. CONCLUSIONS: This study showed that glycemic control in high-risk T2DM patients with ASCVD was significantly associated with unfavorable serum phospholipid n-6/n-3 PUFA ratio and greater systemic inflammation.

Fulminant adrenergic myocarditis complicated by pulmonary edema, cardiogenic shock and cardiac arrest.

Adrenergic myocarditis is an uncommon presentation of pheochromocytoma and extremely rare cause of de novo acute heart failure (AHF). We present a case of a 31-year-old Caucasian woman with a history of hypertension and recurrent occipital headaches who was admitted to the emergency department due to severe de novo AHF presenting as pulmonary edema and cardiogenic shock. During the hospital admission the patient experienced asystolic cardiac arrest and was successfully resuscitated, intubated, and mechanically ventilated. Bedside transthoracic echocardiography revealed severe diffuse left ventricular hypokinesis with ejection fraction (LVEF) of 10%. Coronary angiography disclosed normal epicardial coronary arteries. The diagnosis of fulminant myocarditis was based on clinical, laboratory and imaging findings including cardiac magnetic resonance imaging (cMRI) Lake Louise criteria. STIR-cMRI sequences revealed myocardial edema in the lateral, inferior and posterior walls of the left ventricle, whereas T1-weighted early contrast-enhanced sequences showed myocardial hyperemia and capillary leak. An ultrasound and computed tomographic scan of the abdomen disclosed a solid, heterogeneous mass (3.6×3.2×2.8-cm) in the right suprarenal area. Urinary and plasma catecholamines and metanephrines were markedly elevated. A pheochromocytoma was suspected and laparoscopic resection of the tumor was performed after pharmacological preparation with phenoxybenzamine. The histopathological findings were consistent with pheochromocytoma. Follow-up cMRI showed complete reversal of myocardial edema and hyperemia. At 12-month follow-up, the patient has remained asymptomatic and normotensive with no recurrence of cardiovascular symptoms.

Trauma-induced acute myocardial infarction due to delayed dissection of the left anterior descending coronary artery.

Acute myocardial infarction is a very rare, life-threatening complication of blunt chest trauma. A 27-year-old man with no previous medical history was admitted to the emergency department due to multiple trauma following a car accident. After 48h following the accident, the patient's condition rapidly deteriorated, with severe dyspnea at rest, tachycardia, and increasing chest pain. A 12-lead ECG showed a sinus tachycardia at 120bpm with significant ST-segment elevation in leads V1 to V5, pathologic Q wave in I, aVL, and QS complex in leads V1 to V4. Bedside echocardiography disclosed akinesis of the anterior and lateral walls, apex, and anterior septum with severely decreased left ventricular ejection fraction of 30%. Urgent coronary angiography revealed an occlusive dissection of the proximal left anterior descending coronary artery. Primary percutaneous coronary intervention with a Biolimus A9™-eluting stent implantation were successfully performed. The further course was uneventful. At 12-month follow-up, the patient has remained asymptomatic with no recurrence of cardiovascular symptoms.

[Evaluation of sleep apnea, detected by 24-hour ECG Holter monitoring analysis in patients with stable coronary artery disease and ischemic heart failure - correlations with clinical data]. / Ocena zaburzen oddychania w czasie snu na podstawie 24-godzinnego monitorowaniu EKG metoda Holtera u chorych ze stabilna choroba wiencowa oraz u chorych z niewydolnoscia serca ­ korelacje z danymi klinicznymi.

Obstructive sleep apnoea (OSA) is frequently undiagnosed in patients with heart failure (HF) and coronary artery disease (CAD). Simple and widely available screening tests are needed to diagnose patients with SA. Measurements of thoracic impedance and heart rate variability during 24-hour ECG Holter (H-EKG) monitoring allows to calculate estimated apnoea-hypopnoea index (eAHI). AIM: The aim of the research was to assess prevalence of OSA evaluated with the use of H-EKG and determination of its clinical relevance in patients with CAD and ischeamic HF. MATERIALS AND METHODS: The study groups comprised of: 30 consecutive patients with ischeamic HF with reduced LVEF (HFrEF) (group A) and 30 patients with CAD (group B). Control group (C) comprised of 30 patients with arterial hypertension but no CAD nor HF. H-ECG monitoring was performed and eAHI was calculated. On the basis of AHI result group A was subdivided to subgroups A1 (eAHI <15) and A2 (eAHI ≥15). RESULTS: Study groups differed with eAHI values (27,9±19,9 vs. 21,8±17,3 vs. 15,7±12,2; p=0,022). Post hoc analysis revealed that eAHI in group A was higher in comparison to group C (27,9±19,9 vs. 15,7±12,2; p=0,006). SA prevalence was higher in group A compared to group C (70,0% vs. 40,0%; p=0,019). Significant but weak correlation between eAHI and LVEDD was found (r=0,282; p<0,05). Subgroups A1 and A2 did not differ in terms of clinical and demographical parameters, HF symptoms, LVEF and NT-proBNP levels. CONCLUSIONS: OSA coexists more frequently with HF than with arterial hypertension Significant but weak correlation between eAHI and LVEDD was demonstrated. However, in patients with symptomatic ischeamic heart failure eAHI ≥15 was not related to NYHA class, lower LVEF and higher NT-proBNP levels.

Relationship between abdominal obesity, platelet blood count and mean platelet volume in patients with metabolic syndrome.

AIM: There is evidence that patients with the metabolic syndrome have altered platelet indices including higher mean platelet volume. According to the 2009 International Diabetes Federation criteria of metabolic syndrome diagnosis, elevated waist circumference (≥94 cm in M, ≥80 cm in F), as a determinant of abdominal obesity, is not an obligatory component. The aim of this study was to evaluate the relationship between platelet indices, including mean platelet volume, and abdominal obesity in patients with metabolic syndrome. METHODS: 382 consecutive patients were enrolled in the study and divided into three groups: group A, 218 patients with metabolic syndrome and abdominal obesity (132 M, mean age 65.3 ± 10.9 yrs); group B, 35 patients with metabolic syndrome without abdominal obesity (28 M, mean age 63.3 ± 11.2 yrs); and, group C, 129 patients without metabolic syndrome and without abdominal obesity (99 M, mean age 62.2 ± 13.8 yrs). RESULTS: In group A, mean platelet volume was significantly higher than in group C (10.70 ± 1.01 vs. 10.35 ± 0.94 fL, p = 0.007). However, there was no difference in mean platelet volume between group A and B (10.70 ± 1,01vs. 10.63 ± 1.03 fL, p >0.05). Furthermore, in group A, mean platelet volume was correlated with waist circumference (r = 0.14, p = 0.041) and body mass index (r = 0.14, p = 0.045). In all study groups, a significant association between mean platelet volume and platelet count (r = -0.33, p <0.001) was found. CONCLUSION: In individuals with metabolic syndrome and abdominal obesity mean platelet volume is positively correlated with waist circumference and significantly higher than in patients without these abnormalities.

[Association of common cyclooxygenase-2 (COX-2) gene polymorphisms with clinical and angiographic characteristics of patients with coronary artery disease]. / Ocena zwiazku czestych polimorfizmów genu cyklooksygenazy-2 (COX-2) z obrazem klinicznym choroby niedokrwiennej serca i zaawansowaniem zmian miazdzycowych w tetnicach wiencowych.

BACKGROUND: Chronic inflammation of the arterial wall plays a crucial role in the pathogenesis of atherosclerosis. Cyclooxygenase-2 (COX-2) is a key enzyme in the synthesis of proinflammatory prostanoids. At least two of the common genetic polymorphisms of the COX-2 gene have phenotypic effects: G-765C (rs20417) and T8473C (rs5275). AIM: To assess the relation of G-765C and T8473C COX-2 polymorphisms to clinical and angiographic characteristics of patients with coronary artery disease (CAD). MATERIAL AND METHODS: The study comprised 186 consecutive patients with angiographically defined CAD (> or =70% stenosis of > or =1 coronary artery). The study population were divided into two groups: A-123 patients with stable angina (mean age, 62.6 +/- 11.2 years; 30.1% women), and B-63 patients with unstable angina (mean age, 64.0 +/- 10.8 years; 19.0% women). The controls comprised 70 individuals without symptoms of CAD (mean age, 37.6 +/- 9.9 years; 57.1% women). Results: No significant differences were observed in -765C and 8473C allele frequencies between the patients with CAD and control subjects. In CAD patients, the studied COX-2 polymorphisms were not significantly associated with the age of the onset of symptoms and clinical presentation of CAD. In the B group, a difference was observed within the frequency of significant (>50%) left main coronary artery stenosis (LMCAS) and/or three-vessel CAD (3-CAD) between the -765C allele carriers and 765G 765G homozygotes (14.3% vs. 49.0%; p=0.044). In the CAD patients (group A and group B) the prevalence of LMCAS and/or 3-CAD was significantly lower among 365C allele carriers (22.8% vs. 40.3%: CONCLUSIONS: There were no significant differences in -765C and 8473C allele frequencies between patients with CAD and subjects without symptoms of CAD; In patients with CAD, COX-2 G-765C and T8473C polymorphisms had no significant association with the age of the onset of symptoms and clinical presentation of ischaemic heart disease; The G-765C COX-2 polymorphism is associated with less frequent occurrence of multivessel CAD in the studied population. p=0.021

Complement activation is associated with right ventricular dysfunction and the severity of pulmonary embolism: links with prothrombotic state.

Background: Little is known about the role of complement activation in acute pulmonary embolism (PE). We investigated whether complement activation is associated with the severity of acute PE, along with the associated prothrombotic state, systemic inflammation and neutrophil extracellular traps (NETs) formation. Methods: We studied 109 normotensive, non-cancer PE patients (aged 58.1±15.0 years). On admission prior to initiation of anticoagulation, plasma soluble complement components, i.e., C3a and sC5b-9, were measured with enzyme-linked immunosorbent assay (ELISA), along with thrombin generation, fibrinolysis proteins (plasminogen, antiplasmin, plasminogen activator inhibitor-1), factor VIII (FVIII) activity, and fibrin clot properties, including clot permeability (Ks, a measure of clot density) and clot lysis time (CLT). Moreover, we determined inflammatory markers and citrullinated histone H3, a specific marker of NETs formation. Results: Patients in the lower tertile of C3a (≤1.45 ng/mL, n=37) had lower simplified Pulmonary Embolism Severity Index (sPESI) values and were less likely to have right ventricular (RV) dysfunction compared to the remaining subjects. The former subgroup also had 13% lower FVIII activity, but not fibrinogen, interleukin-6, fibrinolysis proteins, and thrombin generation. Plasma C3a levels correlated inversely with Ks and positively with CLT indicating formation of denser and poorly lysable clots in subjects with elevated C3a. Despite a positive association between C3a and sC5b-9, the latter parameter was solely associated with higher FVIII, but not with other variables. Conclusions: We showed that in acute PE enhanced complement activation characterizes patients with poorer short-term prognosis who display prothrombotic fibrin clot properties and elevated FVIII, which supports the involvement of complement proteins in acute thromboembolism.

Predictive value of metabolic score for insulin resistance and triglyceride glucose-BMI among patients with acute myocardial infarction in 1-year follow-up.

BACKGROUND: Recently two indicators - metabolic score for insulin resistance (METS-IR) and triglyceride glucose-BMI (TyG-BMI) have been proposed as surrogate markers of IR and potential cardiovascular risk factors. The aim of the study was to assess the predictive value of METS-IR and TyG-BMI concerning the incidence of major adverse cardiovascular events (MACE) and all-cause mortality in 1-year follow-up among patients admitted with acute myocardial infarction (AMI). METHODS: Two thousand one hundred fifty-three patients with a median age of 68 years were enrolled in the study. Patients were divided into two groups according to the type of AMI. RESULTS: MACE occurred in 7.9% of the patients in the ST-segment elevation myocardial infarction (STEMI) group and in 10.9% of the non-STEMI (NSTEMI) group. No significant difference in median MACE-IR and TyG-BMI between patients with and without incidence of MACE was found in both groups. None of the examined indices were predictors of MACE in the STEMI and NSTEMI groups. Moreover, both of them did not predict MACE in subgroups of patients classified according to the presence of diabetes. Finally, METS-IR and TyG-BMI were significant predictors of 1-year morality, however with low prognostic value and only in univariate regression analysis. CONCLUSION: METS-IR and TyG-BMI should not be used in predicting MACE among patients with AMI.

Comparison of the population of Polish patients participating in the TRANSITION study with the international population: a post hoc analysis.

INTRODUCTION: Heart failure (HF) patients discharged from a hospital are at a high risk of death and rehospitalization. Scarce data are available on the use of sacubitril / valsartan in this population in Poland. OBJECTIVE: The aim of this study was to compare the efficacy and tolerability of sacubitril / valsartan in the group of Polish patients who participated in the TRANSITION study with the patients recruited at other sites. PATIENTS AND METHODS: This is a post hoc secondary analysis of the TRANSITION study comparing sacubitril / valsartan initiation pre- vs postdischarge in 991 patients hospitalized for acute decompensated HF with reduced ejection fraction (HFrEF). The Polish subgroup consisted of 104 patients. RESULTS: Significant differences were identified in the characteristics of Polish vs non­Polish populations. At baseline, the Polish population showed higher proportion of men, higher body mass index, lower heart rate, N­terminal pro-B­type natriuretic peptide and high­sensitivity troponin T levels, and significantly lower New York Heart Association class. The Polish patients were better managed in terms of implanted electrotherapy devices, percutaneous coronary interventions, and drug therapy, and were more often hospitalized. The primary end point of achieving the target dose of sacubitril / valsartan at treatment week 10 was met by 45.6% of the Polish patients and 48.4% of the non­Polish population (P = 0.61). Approximately 90% of the Polish patients received and maintained any sacubitril / valsartan dose for 2 weeks over 10­week treatment vs 87.5% of the non­Polish patients (P = 0.36). The rate of permanent sacubitril / valsartan treatment discontinuation was low in both Polish (3.9%) and non­Polish populations (6.4%) (P = 0.33). CONCLUSIONS: Sacubitril / valsartan can be used safely in the early period after an episode of acute HF both in the Polish and non­Polish patients with HFrEF, and the likelihood to achieve the maximum dose is the same despite significant differences between the studied populations.

Right ventricle to pulmonary artery coupling as a predictor of perioperative outcome in patients with secondary mitral valve insufficiency.

BACKGROUND: The aim of the study was to assess some parameters of right ventricle (RV) function as predictors of short-term mortality in patients with severe secondary mitral regurgitation (SMR) after mitral valve surgery. METHODS: We conducted a retrospective analysis of 112 consecutive patients with severe SMR who had undergone mitral valve repair or replacement with or without concomitant coronary artery bypass surgery. We assessed RV to pulmonary artery coupling by calculating the ratio of tricuspid annular plane systolic excursion (TAPSE) to non-invasively estimated RV systolic pressure (RVSP). The study endpoint was 30 days post-procedural mortality. RESULTS: Overall, the 30-day mortality was 6%. TAPSE/RVSP ratio < 0.42 mm/mmHg was a significant predictor of mortality and remained so after adjusting for age and sex. The Kaplan-Meier survival analysis showed that patients with RVSP > 55 mmHg and those with TAPSE/RVSP ratio < 0.42 mm/mmHg had a lower survival probability. CONCLUSIONS: TAPSE/RVSP < 0.42 mm/mmHg is a strong predictor of short-term mortality in patients with SMR when considered for valve surgery.

Reduced thrombin formation and altered fibrin clot properties induced by polyunsaturated omega-3 fatty acids on top of dual antiplatelet therapy in patients undergoing percutaneous coronary intervention (OMEGA-PCI clot).

OBJECTIVE: The goal of this study was to investigate whether omega-3 polyunsaturated fatty acids (n-3 PUFA) are able to alter plasma fibrin clot properties and reduce thrombin formation in stable coronary artery disease patients undergoing percutaneous coronary intervention (PCI). METHODS AND RESULTS: In an investigator-initiated, prospective, double-blind, placebo-controlled, randomized study, patients undergoing PCI who received standard pharmacotherapy were assigned to the treatment with 1 g/day n-3 PUFA (n = 30) or placebo (n = 24) for 1 month. Plasma fibrin clot permeability (K(s)); lysis time (t(50%)); prothrombin fragment 1.2; and peak thrombin generation from automated thrombogram, 8-isoprostaglandin F(2α) (8-iso-PGF(2α), an oxidative stress marker), and C-reactive protein were determined at baseline, 3 to 5 days after randomization, and 30 days after randomization. At baseline, both treatment groups did not differ significantly. A 1-month treatment with n-3 PUFA compared with placebo was associated with 15.3% higher K(s), indicating larger pores in the fibrin network (P = 0.0005); 14.3% shorter t(50%), indicating increased susceptibility to fibrinolysis (P<0.0001); 33.8% lower prothrombin fragment 1.2 (P = 0.0013); 13.4% lower peak thrombin generation (P = 0.04); and 13.1% lower 8-iso-PGF(2α) (P = 0.009). Treatment with n-3 PUFA had no effect on fibrinogen and C-reactive protein. After 1 month of treatment, fibrinogen (r = -0.53, P<0.0001), treatment assignment (r = 0.29, P = 0.006) and 8-iso-PGF(2α) (r = -0.27, P = 0.015) were independently associated with clot permeability (P<0.0001, R(2) = 0.66). CONCLUSIONS: Adding n-3 PUFA to standard therapy in stable patients undergoing PCI significantly decreases thrombin formation and oxidative stress and favorably alters fibrin clot properties. These findings indicate novel antithrombotic effects induced by n-3 PUFA in humans.

Prognostic value of the triglyceride-glucose index among non-diabetic patients with acute myocardial infarction at one-year follow-up.

BACKGROUND: The triglyceride-glucose index (TyG index) is a novel metabolic marker initially used as an indicator of insulin resistance. Recently, its use as a cardiovascular risk factor has been taken into consideration; however, there is a shortage of evidence for its clinical importance. AIMS: The study aimed to assess the relationship between the TyG index = ln (fasting triglyceride [mg/dl] × fasting glucose [mg/dl]/2) and the incidence of major adverse cardiovascular events (MACE) at a 1-year follow-up among non-diabetic patients with acute myocardial infarction (MI). In addition, the predictive value of the TyG index concerning all-cause mortality in the study group was evaluated. METHODS: For the study, 1340 non-diabetic patients with acute MI (median age, 67 years, 70.4% male) were consecutively enrolled between 2013 and 2019. The fasting lipid profile and the fasting glucose level were assessed within 24 hours of admission. RESULTS: MACE occurred in 8.13 % (n = 109) of the study group, whereas 1-year mortality rate was 14.5% (n = 195). There was no difference in the median TyG index value among patients with and without incidence of MACE at a 1-year follow-up (8.73 [8.36-9.08] vs. 8.81 [8.5-9.17]; P = 0.09). Moreover, the TyG index was not a predictor of these events (P = 0.06). In multivariable regression analysis, only previously diagnosed coronary artery disease (CAD) was an independent predictor of MACE (odds ratio [OR], 1.54; 95% CI, 1.02-2.32; P = 0.03). Finally, the TyG index was not an indicator of all-cause mortality (P = 0.25). CONCLUSIONS: The TyG index should not be used as a predictor of MACE and all-cause mortality among non-diabetic patients with MI at a 1-year follow-up.

Right ventricular echocardiographic parameters associated with prothrombotic abnormalities in normotensive patients with acute pulmonary embolism.

BACKGROUND: In acute pulmonary embolism (PE) right ventricular (RV) pressure overload negatively affects prognosis. Recently we have shown that RV dilatation is associated with a prothrombotic state in PE. We investigated which RV echocardiographic parameters best indicate prothrombotic alterations in acute PE. METHODS: In 121 normotensive, noncancer PE patients, markers of RV dilatation and dysfunction were evaluated on admission using transthoracic echocardiography, along with prothrombotic state markers, i.e. increased endogenous thrombin generation (ETP), low fibrin clot permeability (Ks, a measure of clot density), and prolonged clot lysis time (CLT). RESULTS: RV parasternal long axis (RVOT PLAX) >30 mm was associated with ETP (OR 3.86; 95% CI 1.55-9.62; p = 0.004) and CLT (OR 4.08; 95% CI 1.58-10.54; p = 0.004) in the top quartiles, but not with Ks. RV short parasternal axis (RVOT PSAX) >27 mm showed similar associations with higher ETP (OR 3.54; 95% CI 1.50-8.37; p = 0.004) and prolonged CLT (OR 2.78; 95% CI 1.17-6.62; p = 0.021). RV basal diameter >41 mm solely predicted prolonged CLT (OR 2.93; 95% CI 1.23-6.99; p = 0.016). The right atrium area, pulmonary trunk diameter, and tricuspid regurgitation maximum velocity were not related to prothrombotic markers, except for tricuspid annular plane systolic excursion weakly associated with ETP. Multivariable analysis showed that RVOT PSAX is independently associated with prolonged CLT (OR 1.16; 95% CI 1.04-1.30; p = 0.007), low Ks (OR 1.21; 95% CI 1.02-1.44; p = 0.029), and higher ETP (OR 1.14; 95% CI 1.03-1.26; p = 0.009). CONCLUSIONS: Among RV echocardiographic parameters, the RVOT dilatation measured in PSAX best predicts prothrombotic alterations in PE patients.

Subclinical cardiac performance in obese and overweight women as a potential risk factor of preeclampsia.

OBJECTIVES: Failure to increase cardiac output owing to suboptimal cardiac performance in obese women may contribute to placental hypoperfusion, and therefore subsequently to the abnormal placental development. The aim of this study was to evaluate the relationship between left ventricle (LV) function in overweight and obese pregnant women and parameters of blood flow in uterine arteries. STUDY DESIGN AND MAIN OUTCOME MEASURES: We conducted a prospective cohort study, which included consecutive 87 women with singleton pregnancy - 56 women with normal weight and 31 overweight and obese women. During pregnancy blood pressure, echocardiography and the assessment of blood flow in uterine arteries - pulsatility index (PI) and resistance index (RI) were assessed on two visits (V): V1 between 10 and 14 weeks and V2 between 25 and 30 weeks of gestation. A stepwise logistic regression analysis was performed to determine the independent predictors of upper quartile of RI and PI during V2 in the study population. RESULTS: The multivariate logistic regression analysis showed that LVCI and LV mass measured on V1 were the only independent predictors of upper quartile of RI during V2, whereas LVCI was the only independent predictor of upper quartile of PI during V2. CONCLUSIONS: Subclinical left ventricle dysfunction in obese and overweight women, present from the first trimester, may contribute to placental hypoperfusion and higher resistance in uterine arteries later during pregnancy. This may lead in some women to preeclampsia.

Life-threatening cardiac manifestations of primary antiphospholipid syndrome.

We report a rare case of primary antiphospholipid syndrome (APS) in a 43-year-old man presenting as recurrent acute coronary stent thrombosis and complicated by three myocardial infarctions. As illustrated in this report, in APS patients recurrent life-threatening arterial thrombotic events may occur in spite of recommended anticoagulant therapy. We conclude that the APS should be considered as a potential cause of acute coronary syndrome, particularly in young individuals with a history of recurrent thrombotic events and/or with abnormal coagulation test results. Further studies are needed to determine the best therapeutic strategy for APS patients with acute coronary syndrome.

[Percutaneous revascularisation of subacute occlusion of the left subclavian artery manifesting as acute coronary syndrome in a patient after coronary artery bypass grafting]. / Przezskórna rewaskularyzacja podostrego zamkniecia lewej tetnicy podobojczykowej manifestujacego sie jako ostry zespól wiencowy u chorego po zabiegu pomostowania aortalno-wiencowego.

A case of subacute occlusion of the left subclavian artery (LSA) manifesting as acute coronary syndrome and associated with coronary-subclavian steal syndrome (CSSS) in a 56-year-old man following coronary artery bypass grafting (CABG) is presented. Complex percutaneous angioplasty with stenting of the LSA and left vertebral artery were successfully performed. In this article, the clinical management of unstable post-CABG patients with occlusion of the subclavian artery is discussed.