Outcomes of 23 patients diagnosed with New Delhi metallo-beta-lactamase (NDM)-producing Klebsiella pneumoniae infection treated with ceftazidime/avibactam and aztreonam at a single center in Poland.

PURPOSE: Amongst all etiologic hospital-acquired infection factors, K. pneumoniae strains producing New Delhi metallo-ß-lactamase (KP-NDM) belong to pathogens with the most effective antibiotic resistance mechanisms. Clinical guidelines recommend using ceftazidime/avibactam with aztreonam (CZA + AT) as the preferred option for NDM-producing Enterobacterales. However, the number of observations on such treatment regimen is limited. This retrospective study reports the clinical and microbiological outcomes of 23 patients with KP-NDM hospital-acquired infection treated with CZA + AT at a single center in Poland. METHODS: The isolates were derived from the urine, lungs, blood, peritoneal cavity, wounds, and peritonsillar abscess. In microbiological analysis, mass spectrometry for pathogen identification, polymerase chain reaction, or an immunochromatographic assay for detection of carbapenemase, as well as VITEK-2 system, broth microdilution, and microdilution in agar method for antimicrobial susceptibility tests were used, depending of the pathogens' nature. CZA was administered intravenously (IV) at 2.5 g every eight hours in patients with normal kidney function, and aztreonam was administered at 2 g every eight hours IV. Such dosage was modified when renal function was reduced. RESULTS: KP-NDM was eradicated in all cases. Four patients (17.4%) died: three of them had a neoplastic disease, and one - a COVID-19 infection. CONCLUSION: The combination of CZA + AT is a safe and effective therapy for infections caused by KP-NDM, both at the clinical and microbiological levels. The synergistic action of all compounds resulted in a good agreement between the clinical efficacy of CZA + AT and the results of in vitro susceptibility testing.

Comparison of Second- and Third-Generation Parathyroid Hormone Test Results in Patients with Chronic Kidney Disease.

BACKGROUND In patients with chronic kidney disease (CKD), secondary hyperparathyroidism is assessed by measuring serum parathyroid hormone (PTH) levels. Well-established, recommended, second-generation intact parathyroid hormone (iPTH) tests are typical; rarely are more recent third-generation PTH 1-84 assays used. The agreement between results of the 2 tests in patients with CKD has not been sufficiently defined. MATERIAL AND METHODS This study aimed to compare Roche second- and third-generation PTH assays by establishing a quantitative relationship between the results of assays in patients with CKD and assessing degree of their correlation with kidney function and calcium-phosphate and bone metabolism parameters. In 205 patients with stages 3 to 5D CKD and 30 healthy controls, we measured levels of iPTH and PTH (1-84), creatinine, urea, cystatin C, calcium, inorganic phosphate, magnesium, alkaline phosphatase, bone alkaline phosphatase, osteocalcin, and ß-CrossLaps. RESULTS The third-generation PTH assay results were more than 40% lower than those obtained with the second-generation test in patients undergoing dialysis and approximately 30% lower in patients in the pre-dialysis period. PTH concentrations determined with both assays were almost to the same extent correlated with calcium-phosphate and bone metabolism parameters, and renal function indices. Formulas have been developed enabling 2-way conversion of PTH results determined with both the second- and third-generation PTH assays: For dialyzed patients, PTH (1-84)=0.5181iPTH+18.0595. Serum osteocalcin, ß-CrossLaps, and total calcium were independent predictors of PTH levels. CONCLUSIONS Correcting for the established quantitative differences, the second-and third-generation PTH tests can be used interchangeably, given the almost identical pathophysiological correlations of their results with calcium-phosphate and bone metabolism parameters.

Low lean tissue mass can be a predictor of one-year survival in hemodialysis patients.

PURPOSE: Nutritional status has a significant impact on the outcomes in the dialysis population. The aim of this study was to evaluate the association between body composition and a one-year survival of hemodialysis patients. METHODS: Forty-eight patients with chronic kidney disease stage V treated with hemodialysis for more than three months were included. Body composition was assessed by bioimpedance spectroscopy (Body Composition Monitor, Fresenius Medical Care). Blood samples for serum creatinine, serum albumin, serum prealbumin, high sensitivity C-reactive protein (hsCRP), interleukin 6 (IL-6), insulin-like growth factor 1(IGF-1) concentrations were taken before the midweek dialysis session. RESULTS: Over the course of a one-year observation, seven patients died. We observed a significantly lower lean tissue index (LTI) (p = .013) and higher IL-6 (p = .032) and hsCRP levels (p = .011) among the patients who died. The remaining biochemical markers did not differ between these two groups. Kapplan-Meier analysis revealed a worse survival rate in patients with sarcopenia (lower than the 10th percentile for their age and gender) in comparison with those with normal LTI. However, it was not of statistical significance (p = .055). LTI inversely correlated with age and IL-6 and positively with IGF-1. CONCLUSIONS: Sarcopenia defined as decreased LTI, is a relatively common condition among patients undergoing maintenance hemodialysis, it can also be associated with a lower one-year survival rate. Decreased lean tissue mass can be associated with old age, lower IGF-1 levels and higher IL-6 levels. Body composition assessment may provide prognostic data for hemodialysis patients.

Association of N-terminal pro-brain natriuretic peptide and hemodynamic parameters measured by impedance cardiography in patients with essential hypertension.

The aim of this study was to evaluate the association of NT-proBNP with clinical and hemodynamic assessment in 156 patients with arterial hypertension. NT-proBNP correlated positively with, i.e. age (r=0.310, p=0.00008), mean blood pressure (MBP; r=0.199, p=0.0136), Heather index (HI; r=0.375, p<0.00001) and negatively with thoracic fluid content (TFC; r=-0.300, p=0.0002). The patients with higher NT-proBNP were older (46.1 versus 40.6 years, p=0.001), with higher MBP (102.6 versus 98.5 mm Hg, p=0.0043), HI (14.54 versus 11.93 Ohm s2, p=0.009) and lower TFC (27.5 versus 29.4 1/kOhm, p=0.0032). The independent predictors of higher NT-proBNP were: age, MBP and HI.

[Cardiovascular risk and inflammatory markers in patients with hypertension]. / Ryzyko sercowo-naczyniowe a markery zapalne u chorych na nadcisnienie tetnicze.

UNLABELLED: Arterial hypertension (AH) is one of the main risk factors of negative cardiovascular (CVR) events and the complex evaluation of CVR is necessary for the successful treatment of patients with AH. Simultaneously CVR increases when the inflammatory markers levels are elevated. AIM: The aim of study was to evaluate the frequency of CVR factors presence and their relation to the inflammatory markers in patients with AH. MATERIALS AND METHODS: The study was conducted in group of 144 patients (99 men, mean age 45.2 years) with AH and no other diagnosed cardiovascular diseases. The clinical assessment included: i.e. fasting glucose (FG), total cholesterol (T-C), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), triglycerides (TG) and inflammatory markers: fibrinogen, high-sensitive C-reactive protein (hsCRP) and leukocytes count (WBC). CVR was assessed based on the presence of the risk factors included in the ESC guidelines. RESULTS: Dylipidemia was observed in over 90% of patients in the study group (most often as the elevated level of T-C and LDL-C), abdominal obesity in 54.9%, more than 3 CVR factors in over 70% and increased levels of at least one of inflammatory markers in 40.3% of patients (most often hs-CRP - 35.4%). The statistically significant correlations between anthropometric parameters (BMI, waist cirfumference), laboratory parameters (HDL-C, TG) and inflammatory markers were observed, the strongest for BMI versus hs-CRP (r = 0.42, p < 0.000001). In the logic regression analysis the factors increasing the probability of the elevated inflammatory activity turned out to be: abdominal obesity - OR 3.05 (95% CI: 1.49 - 12.22; p = 0.002); BMI ≥ 30 kg/m2 - OR 3.18 (95% CI: 1.57 - 6.44; p = 0.0012) and the presence of more than 3 risk factors - OR 2.57 (95% CI: 1.13 - 5.83; p = 0.023). CONCLUSIONS: The increased level of inflammatory markers is related to the complex metabolic disturbances and the assessment of the activation of inflammatory process (especially hsCRP) can be useful in the complex CVR evaluation and profound defining of therapeutical goals.

[In the search for effective and safe dose of amikacin in patients with chronic kidney disease]. / W poszukiwanlu skutecznego i bezplecznego dawkowania amikacyny u chorych na przewlekla chorobe nerek.

UNLABELLED: The aim of the study was to asses safe and effective amikacin (AMK) doses in patients with different stages of chronic kidney disease. MATERIAL AND METHODS: The study included 25 patients, among them was 12 (48%) men and 13 (52%) women, aged 73.1 +/- 11.9 (38-89) years. AMK was applied in intravenous infusion during 10 days. The dosage was dependent on the stage of chronic kidney disease (CKD). Patients in stage 3A CKD (GFR 59--40 ml/min/1.73 m2) received 7.5 mg/kg/day, in stage 3B (GFR 39--30 ml/min/1.73 m2) received 4 mg/ kg m.c./day, in stage 4 (GFR 29--15 ml/min/1,73 m2) received 4 mg/ kg/day or 6.0 mg/kg every two days, in stage 5 treated with hemodialysis received 5 mg/kg every two days, in stage 5 treated with continuous ambulatory peritoneal dialysis received 4 mg/kg every two days. Trough levels of the drug (minimal level, before the next dose) and maximal levels (one hour after beginning of the infusion) were measured on day 3, 5, 9. Hearing tests were done twice, on day 1 and 9. Urine cultures were tested on day 1 and 5. Complicated urinary tract infections were the reasons of antibiotic treatment in 22 patients (88%). Other reasons were: sepsis (2 patients) and neutropenic fever (1 patient). RESULTS: Average maximal level of the drug was 25.5 +/- 8.8 (9.6-50.4) microg/ml, average trough level was 3.1 +/- 2.9 (0.4-14.1) microg/ml. Bacterial eradication confirmed by negative culture was observed in 14 patients (56%). In patients with stage 4 CKD eradication was observed more often when AMK was used every day than every two days. Mean trough level was 6.9 +/- 5.5 microg/ml for every day dosage in comparison with 1.9 +/- 0.5 microg/ml for dosage every two days. Mean maximal level was 24.1 +/- 7.2 microg/ml for every day dosage and 21.8 +/- 5.8 microg/ml for every two days dosage. CONCLUSION: Amikacin usage in described, lowered doses with prolonged interval between them is safe in terms of ototoxicity and nephrotoxicity in patients with chronic kidney disease. Every two days dosage is less effective than every day dosage in patients with stage 4 CKD. It can be a result of too lower minimal (trough) levels of the drug in serum. AMK trough levels are associated with effective therapy in patients with chronic kidney disease.

Urine 11-Dehydro-Thromboxane B2 in Aspirin-Naive Males with Metabolic Syndrome.

Urine 11-dehydro-thromboxane B2 (11-dehydro-TXB2), an indirect measure of platelet activity, is elevated in cardiovascular diseases and diabetes. The purpose of our study was to determine whether urine 11-dehydro-TXB2 is elevated in aspirin-naive males with metabolic syndrome (MS) and to determine predictors of 11-dehydro-TXB2 levels. The secondary aim was to evaluate whether these MS patients could be potential candidates for the aspirin-mediated prevention of atherosclerotic cardiovascular diseases (ASCVDs). In 82 males with MS (76 hypertensive), anthropometric measures, urine 11-dehydro-TXB2, platelet count, creatinine, glucose, insulin, estimated insulin resistance, lipid parameters, high-sensitivity C-reactive protein (hs-CRP), adiponectin, homocysteine, and ten-year risk of fatal cardiovascular disease (SCORE) were assessed. Urine 11-dehydro-TXB2 levels were elevated (≥2500 pg/mg creatinine) in two-thirds of patients, including 11 high-risk patients (SCORE ≥ 5%). Homocysteine, adiponectin, hs-CRP, waist-to-hip ratio, and total cholesterol were found to be predictors of urine 11-dehydro-TXB2. In conclusion, there is a high incidence of elevated urine 11-dehydro-TXB2 in males with MS, including in some patients who are at a high or very high risk of ASCVDs. 11-dehydro-TXB2 levels are associated with hyperhomocysteinemia, inflammation, fat distribution, hypercholesterolemia, and adiponectin concentrations. Elevated 11-dehydro-TXB2 levels may support the use of personalised aspirin ASCVD prevention in high-risk males with MS. Giuseppe Patti.

Association of Estimated Insulin Resistance with N-Terminal B-Type Natriuretic Peptide Concentration in Men with Metabolic Syndrome.

BACKGROUND: The diagnostic and prognostic role of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in heart failure is well established. However, additional factors may influence its concentration. One of them is obesity, which in general is accompanied by reduced NT-proBNP levels. However, specific data concerning metabolic syndrome (MS) are equivocal. The aim of the present study was to evaluate the association of NT-proBNP with estimated insulin resistance (eIR) in men with MS. METHODS: In 86 male patients with MS (78 of them hypertensive), blood pressure, anthropometric measures, NT-proBNP, creatinine, glucose, and insulin were assessed and eIR was calculated using homeostatic model assessment (HOMA-IR). RESULTS: Both eIR and age were independently associated with NT-proBNP concentrations (b = 0.2248, p=0.019; b = 0.0102, p=0.049, respectively). Blood pressure, anthropometric measures, and eGFR were not correlated with NT-proBNP. Patients without eIR had higher NT-proBNP than those with eIR (32.2 ± 26.4 vs 21.4 ± 25.4 pg/mL, p=0.014). The difference was even higher in the younger subgroup of patients reaching nearly 50%. CONCLUSIONS: Insulin resistance and, to a lesser degree, age were associated with NT-proBNP levels in men with MS. In younger subjects with eIR, mean NT-proBNP level was lower than in corresponding healthy age males.

Complex assessment of patients with decompensated heart failure: The clinical value of impedance cardiography and N-terminal pro-brain natriuretic peptide.

BACKGROUND: Acute decompensated heart failure (ADHF) is a serious clinical problem and a condition requiring immediate diagnostics, supporting the therapeutic decision adequate to the specific ADHF mechanism. N-terminal pro-brain natriuretic peptide (NT-proBNP) is an established biochemical marker of heart failure, strongly related to hemodynamic status. Impedance cardiography (ICG) provides non-invasive hemodynamic assessment that can be performed immediately at the bedside and revealed to be useful diagnostic tool in some clinical settings in cardiology. OBJECTIVES: The aim of this study was to evaluate the usefulness of ICG in the admission diagnostics and monitoring the effects of treatment in patients hospitalized due to ADHF, with special emphasis on its relation to NT-proBNP. METHODS: This study enrolled 102 patients, aged over 18 years, hospitalized due to ADHF. The subjects underwent detailed clinical assessment, including ICG and NT-proBNP at admission and at discharge day. RESULTS: Among all analyzed ICG parameters thoracic fluid content (TFC), a marker of chest overload, was the most significantly correlated with NT-proBNP level (R = 0.46; p = 0.000001). In comparison with patients with low thoracic fluid content (TFC ≤ 35/kΩ), those with higher TFC values (>35/kΩ) exhibited a greater severity of symptoms (NYHA functional class); higher NT-proBNP levels; lower left ventricular ejection fraction (LVEF), stroke index (SI), and cardiac index (CI); as well as significantly higher systemic vascular resistance index (SVRI). These TFC-based subgroups showed no significant differences in terms of heart rate (HR), systolic blood pressure (SBP), or diastolic blood pressure (DBP). CONCLUSIONS: The evaluation of hemodynamic parameters, especially TFC, seems to be a worthwhile addition to standard diagnostics, both at the stage of hospital admission and while monitoring the effects of treatment. Impedance cardiography is a useful method in evaluating individual hemodynamic profiles in patients with ADHF.

Cardiac troponin I after external electrical cardioversion for atrial fibrillation as a marker of myocardial injury--a preliminary report.

BACKGROUND: It is uncertain whether external electrical cardioversion (CV) of atrial fibrillation (AF) can cause myocardial injury identifiable by troponin I (cTnI). AIM: To examine whether external CV of AF can cause cTnI rise as measured with high-sensitivity assay, and to identify factors determining this elevation. METHODS: Patients with non-valvular AF selected for CV were included. Exclusion criteria were myocardial ischaemia, elevated D-dimer, heart and renal failure. Patients underwent monophasic or biphasic CV. Troponin I was measured before, and 6 and 12 hours after the procedure with TNI-ADV assay; NT-proBNP was measured before CV. Echocardiography was performed in all patients. RESULTS: Twenty-two patients were examined. Troponin I 6 and 12 hours after CV [0.04 ng/ml (0.00-0.30), 0.04 ng/ml (0.00-0.13)] was significantly higher than before [0.017 pg/ml (0.00-0.08)] (p=0.01, p=0.02). Only in one patient did cTnI exceed the cut-off for myocardial infarction after 6 hours (>0.16 ng/ml) with subsequent normalisation after 12 hours. Left ventricular end-diastolic dimension (LVEDD) was significantly higher and ejection fraction lower in the group with cTnI rise in comparison with the group with no cTnI elevation (54,2+/-6,3 vs. 47,6+/-5,7 mm, p=0,02; 56,2+/-8,9 vs. 63,2+/-7,1%, p=0,05). LVEDD=53 mm had 75% sensitivity and 72% specificity for predicting cTnI elevation after CV. Age, gender, AF duration, type of CV, energy, left atrial dimension, baseline cTnI and NT-proBNP were not predictive of cTnI increase. CONCLUSIONS: Cardioversion can lead to mild but significant cTnI rise as measured with a high-sensitivity assay. The influence of CV on cTnI elevation appears to be more pronounced in patients with relatively large LVEDD.

Echocardiographic assessment and N-terminal pro-brain natriuretic peptide in hypertensives with metabolic syndrome.

BACKGROUND: N-terminal pro-brain natriuretic peptide (NT-proBNP) release is associated with left ventricular expansion and pressure overload. Elevation of serum levels of natriuretic peptides is observed in patients with impaired as well as preserved left ventricular systolic function. High NT-proBNP has been shown to be related not only to preload but also to increased afterload, especially blood pressure and arterial stiffness. OBJECTIVES: The aim of the study was to evaluate the association of NT-proBNP and echocardiographic parameters in hypertensives with metabolic syndrome. MATERIAL AND METHODS: The study group comprised 133 patients (99 men; mean age 45.9 ± 9.4 years) with at least a 3-month history of arterial hypertension (stages 1 and 2) and fulfilling the diagnostic criteria for metabolic syndrome. Following initial clinical assessment, which included NT-proBNP levels, they underwent two-dimensional echocardiography. RESULTS: Echocardiographic abnormalities were observed in 60 subjects (45.1%), including left ventricular diastolic dysfunction (LVDdf) in 41 (30.8%) and left ventricular hypertrophy (LVH) in 35 (26.3%). Higher NT-proBNP concentrations were observed in patients with LVH, especially in the presence of LVDdf. Further analysis demonstrated that NT-proBNP correlated negatively with septal E' (r = -0.38; p = 0.015) and heart rate (r = -0.42; p = 0.006) in patients with LVDdf, and positively with left ventricular end diastolic diameter (r = 0.46; p = 0.006) and left ventricular mass index (r = 0.49; p = 0.005) in subjects with LVH. However, the analysis of ROC curves revealed no NT-proBNP level of good sensitivity and specificity in diagnosing LVDdf/LVH (maximal area under the curve 0.571). CONCLUSIONS: Even a relatively low NT-proBNP concentration can be a useful marker of left ventricular hypertrophy and end-diastolic wall stretch. However, in the present study there was no NT-proBNP level of satisfactory predictive value to diagnose LV abnormalities.

[Increased sensitization prevalence to common inhalant and food allergens in young Polish males]. / Narastanie czestosci uczulen na pospolite alergeny wziewne i pokarmowe u mlodych mezczyzn w Polsce.

UNLABELLED: Numerous epidemiological studies concluded recently have suggested that the prevalence of allergic diseases has increased, which mainly results from an increase in the prevalence of atopic diseases. The prevalence of sensitization to atopic allergens and its time dynamicity is unknown nowadays. THE AIM OF THE STUDY: has been to find the prevalence of atopic sensitization in the population of young Polish males and to compare these findings with those obtained 16 years before. MATERIAL AND METHODS: The present study was performed on a group of 156 randomized healthy men, voluntary blood donors, aged 18-27 years. Having filled out a questionnaire, they had a blood sample taken to have serum total IgE concentration and allergen-specific IgE (asIgE) determined to inhalant and food allergens. RESULTS: In 54 (35%) subjects asIgE to inhalant allergens was found, including 11 (7%) who had been tested for food allergens. While comparing the present findings with those of a similar study carried out in 1986, we found that in the last 16 years there had been a 52% increase in the prevalence of asIgE to atopic allergens. This means that the percentage of sensitized people can be estimated to have increased at a rate of approximately 3.25%/year. CONCLUSION: At present, 27% of young men in Poland whose history finding for an allergic disease is negative, are diagnosed with allergy to atopic allergens.

[Correlation of high-sensitivity CRP concentration with the extent of coronary atherosclerosis in men with symptoms of ischemic heart disease]. / Korelacja stezenia bialka C-reaktywnego mierzonego metoda o wysokiej czulosci z nasileniem zmian miazdzycowych w tetnicach wiencowych u mezczyzn z objawami choroby niedokrwiennej serca.

UNLABELLED: Atherogenesis is combined with inflammation of low intensity within endothelium. To-date studies have demonstrated that C-reactive protein is the best marker of this type of inflammation because its concentrations not only reflect the intensity of the process but they also carry prognostic information in apparently healthy general population as well as in patients with symptomatic atherosclerosis. The aim of this study was to evaluate the correlation between high-sensitivity CRP (hsCRP) and the extent of coronary atherosclerosis in men undergoing coronary angiography. The secondary aim was to assess the influence of statin treatment on hsCRP levels by comparing these levels in statin-treated and statin-naive patients. MATERIALS AND METHODS: 112 men with symptoms of ischemic heart disease were included in the study. In 98 cases coronary angiography was performed 52 patients were treated with statins. The extent of atherosclerosis in the coronary bed was evaluated according to four indexes: Gensini score (G), Friesinger score (F), Number of Vessels Diseased (NVD) and Arterial Segment Score (ASS). Concentrations of hsCRP concentrations were obtained with NB100 Dade-Behring kit. Pearson correlation coefficient was calculated for CRP concentrations following their logarithmic transformation. Correlation evaluation was confined to statin-naive patients due to convincing data about the influence of statins on CRP levels. RESULTS: A significant correlation between levels of hsCRP and extension of coronary atherosclerosis was found with all used indexes (G: R=0.335; p=0.0151, F: R=0.406; p=0.0028, NVD: R=0.0338; p=0.0142, ASS=0.368; p=0.071). The mean concentration of hsCRP was 27.7% lower in the patients on statins than in statin-naive patients within the low and moderate range of concentrations (up to 70th percentile, 2.4 mg/l) (p<0.02). In 25% of study subjects hsCRP exceeded the level of 3.0 mg/l which is the cut-off value for increased risk of atherothrombotic complications. CONCLUSIONS: The study showed a significant correlation between hsCRP and the extent of coronary atherosclerosis in men with symptoms of ischemic heart disease. A significantly lower concentration of hsCRP was observed in the group of patients treated with statins compared to statin-naive patients, which may result from the proposed CRP reducing influence of these drugs. A quarter of study subjects had hsCRP levels exceeding the cut-off value for increased cardiovascular risk.

[Troponin I levels after uncomplicated, elective percutaneous coronary intervention in patients with stable coronary heart disease]. / Stezenia troponin po niepowiklanych zabiegach planowanej angioplastyki wiencowej u chorych ze stabilna choroba wiencowa.

UNLABELLED: Percutaneous coronary intervention is a proven method of treatment of significant number of patients with coronary artery disease. Sometimes it is accompanied by increases of troponin levels. Frequency and degree of these phenomena are not well known. THE AIM: of the present study was to establish frequency and a degree of the increase of cardiac troponin I (cTnI) in patients with stable coronary artery disease who underwent elective PTCA without complications during hospitalization. MATERIAL AND METHODS: Our study included 99 patients fulfilling the above mentioned criteria. Average patients' age was 58,7 years (range 37-82 years). In 67 patients PTCA was performed on one artery, in 27 on two and in five on 3 arteries. In 36 patients standard stents were implanted, in the remaining (63 patients) only PTCA was performed. In the group with stents 29 patients had 1 stent implanted, 6 patients had 2 stents and one had 3 stents implanted. In all the patients cTnI (Abbott AxSYM Immunoassay) were determined before PTCA, 12 and 24 hours after PTCA. RESULTS: After 12 hours percentage of cTnI results above 1.22 microg/L (cut-point for spontaneous infarction according to the new definition of heart infarction) amounted to 35% and above 2.0 microg/L (cut-off according WHO infarction definition) 28%. After 24 hours the percentages were similar. Typical cTnI results (90%) after PTCA were below 10 microg/L. cTnI levels were weakly but statistically significantly correlated with number of vessels, which underwent PTCA. CONCLUSION: Moderate increases in troponin I after PTCA seem to correspond to minimal, in general, cardiac injury.

Increased concentration of C-reactive protein in obese patients with type 2 diabetes is associated with obesity and presence of diabetes but not with macrovascular and microvascular complications or glycemic control.

The purpose of this study was to assess the concentration of C-reactive protein (CRP) in obese type 2 diabetes mellitus (DM2) patients and its association with macrovascular and microvascular complications. The study group consisted of 80 obese DM2 patients, including 20 macrovascular, 20 microvascular, 20 both macrovascular and microvascular, and 20 with no complications patients. The control group comprised 40 normoglycemic subjects--20 obese and 20 of normal body weight. Highly sensitive CRP and metabolic control parameters were assessed. CRP levels in obese diabetes subgroups and normoglycemic obese were similar and significantly higher than those in nonobese controls. No correlation was found between CRP and diabetes control parameters. There was a strong positive correlation between CRP level and body mass index in all groups. A multivariate analysis showed that DM2 and obesity are independent factors increasing CRP levels. Increased concentration of CRP in obese DM2 patients is related to obesity and diabetes itself. The lack of association between CRP and vascular complications remains unclear.

Significance of Haemodynamic and Haemostatic Factors in the Course of Different Manifestations of Cerebral Small Vessel Disease: The SHEF-CSVD Study-Study Rationale and Protocol.

Rationale. This paper describes the rationale and design of the SHEF-CSVD Study, which aims to determine the long-term clinical and radiological course of cerebral small vessel disease (CSVD) and to evaluate haemostatic and haemodynamic prognostic factors of the condition. Design. This single-centre, prospective, non-interventional cohort study will follow 150 consecutive patients with different clinical manifestations of CSVD (lacunar ischaemic stroke, vascular dementia, vascular parkinsonism or spontaneous deep, intracerebral haemorrhage) and 50 age- and sex-matched controls over a period of 24 months. The clinical and radiological course will be evaluated basing on a detailed neurological, neuropsychological and MRI examinations. Haemodynamic (cerebral vasoreactivity, 24 h blood pressure control) and haemostatic factors (markers of endothelial and platelet dysfunction, brachial artery flow-mediated dilatation test) will be determined. Discussion. The scheduled study will specifically address the issue of haemodynamic and haemostatic prognostic factors and their course over time in various clinical manifestations of CSVD. The findings may aid the development of prophylactic strategies and individualised treatment plans, which are critical during the early stages of the disease.

[N-terminal pro-brain natriuretic peptide (NT-proBNP) and ischemia modified albumin (IMA) in exercise induced ischemia in patients with stable coronary artery disease]. / N-koncowy propeptyd natriuretyczny typu B (NT-proBNP) i albumina modyfikowana niedokrwieniem (IMA) w niedokrwieniu wysilkowym u pacjentów ze stabilna choroba wiencowa.

INTRODUCTION: Preliminary data indicate that B type natriuretic peptides' levels may rise in exercise induced myocardial ischemia in patients with stable coronary artery disease. Such findings hint at a potential broader application of these markers reaching beyond its present use in chronic heart failure and acute coronary syndromes. Ischemia modified albumin (IMA) is a novel diagnostic marker in acute coronary syndromes as its value increases in states of myocardial ischemia and necrosis. The role of this marker in the assessment of exercise induced myocardial ischemia in stable coronary artery disease has not been extensively investigated and remains unknown. AIM: To examine changes in N-terminal pro-brain natriuretic peptide (NT-proBNP) and ischemia modified albumin (IMA) during an ECG stress test in patients with stable coronary artery disease and to assess the potential of these markers to detect exercise induced myocardial ischemia. PATIENTS AND METHODS: Patients with angiographically confirmed coronary atherosclerosis were included into the study. In all of them prognostic ECG stress test according to Bruce protocol was performed. The test was considered true positive (ischemia present) in case of significant ST-segment depression in the presence of significant coronary stenosis. The test was considered true negative (ischemia absent) when no significant ST depression was noted in the absence of significant coronary stenosis. In all patients echocardiography was performed and blood was drawn for NT-proBNP, IMA, serum albumin and creatinine before and within the first five minutes after exercise. RESULTS: 41 patients with unequivocal stress test result corresponding to coronary angiogram were included in the final analysis (out of 51 examined patients). 21 patients demonstrated ischemia during exercise, 20 did not. NT-proBNP concentration was significantly higher after the stress test than before in the whole group: 127.9 (10.7-994.2) pg/ml and 110 (10.5-990.2) pg/ml respectively; p < 0.0001. NT-proBNP increase was higher in the ischemic than in the non-ischemic group; however, the difference was not statistically significant: deltaNT-proBNP 12.3 (1.0-172.3) pg/ml and 4.2 (1.0-77.1) pg/ml respectively; p = 0.09. This manifested itself in poor sensitivity and specificity of NT-proBNP in detecting exercise induced myocardial ischemia: 62 and 55% respectively (AUC 0.589). In the whole group the increase of NT-proBNP depended on baseline NT-proBNP concentration (r = 0.54; p = 0.0003), the magnitude of ST-segment depression (r = 0.38; p = 0.01), creatinine concentration (r = 0.34; p= 0.03) and history of myocardial infarcion: log deltaNT-proBNP in post-MI patients and in patients without prior MI 1.19 ( +/- 0.54) i 0.61 ( +/- 0.57) respectively; p = 0.004. In multiple regression analysis the only factor independently determining NT-proBNP increase during exercise was the history of myocardial infarction (beta = 0.342; p = 0.01) but not left ventricle ejection fraction. IMA decreased during exercise in all patients significantly--the mean value before and after exercise was 88.20 (7.72) and 78.05 (8.33) U/ml respectively; p = 0.0001. Decrease in IMA correlated only with increase in albumin concentration measured before and after exercise (r = -0.6; p < 0.0001). CONCLUSIONS: Exercise induced myocardial ischemia has little influence on NT-proBNP increase. The test measuring it has therefore insufficient ability to detect exercise induced ischemia in stable coronary artery disease. In patients with stable coronary artery disease without severe impairment of left ventricular function the history of myocardial infarction is the main factor determining NT-proBNP increase during exercise. Changes in serum albumin concentration during exercise seem to exclude the use of IMA in the assessment of exercise induced myocardial ischemia.