Showing papers by "Andrzej Rynkiewicz published in 2013"

A Phase 2, randomized, partially blinded, active-controlled study assessing the efficacy and safety of variable anticoagulation reversal using the REG1 system in patients with acute coronary syndromes: results of the RADAR trial

Abstract: Aims We sought to determine the degree of anticoagulation reversal required to mitigate bleeding, and assess the feasibility of using pegnivacogin to prevent ischaemic events in acute coronary syndrome (ACS) patients managed with an early invasive approach. REG1 consists of pegnivacogin, an RNA aptamer selective factor IXa inhibitor, and its complementary controlling agent, anivamersen. REG1 has not been studied in invasively managed patients with ACS nor has an optimal level of reversal allowing safe sheath removal been defined. Methods and results Non-ST-elevation ACS patients ( n = 640) with planned early cardiac catheterization via femoral access were randomized 2:1:1:2:2 to pegnivacogin with 25, 50, 75, or 100% anivamersen reversal or heparin. The primary endpoint was total ACUITY bleeding through 30 days. Secondary endpoints included major bleeding and the composite of death, myocardial infarction, urgent target vessel revascularization, or recurrent ischaemia. Enrolment in the 25% reversal arm was suspended after 41 patients. Enrolment was stopped after three patients experienced allergic-like reactions. Bleeding occurred in 65, 34, 35, 30, and 31% of REG1 patients with 25, 50, 75, and 100% reversal and heparin. Major bleeding occurred in 20, 11, 8, 7, and 10% of patients. Ischaemic events occurred in 3.0 and 5.7% of REG1 and heparin patients, respectively. Conclusion At least 50% reversal is required to allow safe sheath removal after cardiac catheterization. REG1 appears a safe strategy to anticoagulate ACS patients managed invasively and warrants further investigation in adequately powered clinical trials of patients who require short-term high-intensity anticoagulation. Clinical Trials Registration: ClinicalTrials.gov [NCT00932100][1]. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT00932100&atom=%2Fehj%2Fearly%2F2012%2F08%2F01%2Feurheartj.ehs232.atom

Prognostic Value of the Six-Minute Walk Test in Heart Failure Patients Undergoing Cardiac Surgery: A Literature Review

Abstract: Background. The prognostic value of cardiopulmonary exercise testing (CPET) is known, but the predictive value of 6MWT in patients with heart failure (HF) and patients undergoing coronary artery bypass grafting (CABG) is not established yet. Objective. We conducted a systematic review exploring the prognostic value of 6MWT in HF patients undergoing cardiac surgery. The aim was to find out whether the change in the distance walked during follow-up visits was associated with prognosis. Data Source. We searched “PubMed” from January 1990 to December 2012 for any review articles or experimental studies investigating the prognostic value of 6MWT in HF patients and patients undergoing cardiac surgery. Results. 53 studies were included in the review, and they explored the role of 6MWT in cardiology, cardiac surgery, and rehabilitation. The results did not show the relation between the six-minute walk distance and adverse events after CABG. The predictive power of the distance walked for death in HF patients undergoing cardiac surgery was not found. It is not yet proved if the change in the six-minute walk distance is associated with prognosis. The predictive power of the six-minute walk distance for death in HF patients undergoing cardiac surgery remains unclear.

Management of familial heterozygous hypercholesterolemia. Position paper of the Polish Lipid Expert Forum.

Abstract: Heterozygous familial hypercholesterolemia (HFH) affects on average 1 in 500 individuals in European countries, and it is estimated that HeFH in Poland may affect more than 80,000 people Cardiovascular mortality in individuals with FH between 20 and 39 years of age is 100 times higher than in the general population HFH is a relatively common lipid disorder, but usually still remaining undiagnosed and untreated A very high risk of cardiovascular diseases and a shortened lifespan in patients with this condition require early diagnosis and intensive treatment The aim of the position paper was to present the importance and scale of this problem in Poland, which has not been raised enough so far, as well as the recommendations of diagnosis, treatment and prevention methods

Takotsubo cardiomyopathy in a male during a Euro 2012 football match

Abstract: Sirs: Takotsubo cardiomyopathy (TTC) was first described by Sato et al. [1] in 1990. According to the clinical features, TTC usually affects postmenopausal women and is preceded by a psychical or physical stress. Characteristics of TTC contain ST-segment elevation or T wave inversion in ECG, modest biomarker release (troponin, CK, CK-MB) and almost always complete wall-motion resolution. However, the clinical spectrum of the TTC patients could be heterogeneous and occurs extremely rarely in the male population [2]. Here we present a case on a 56-year-old male with no past cardiovascular history who was admitted to the emergency room due to sudden chest pain and dyspnoea. Symptoms followed an acute emotional stress event caused by the defeat of his favorite soccer team, he watched at the fan zone during the Euro 2012 cup. Initial ECG revealed sinus rhythm of 76 bpm, RBBB with negative T waves in V3–V6 and heart rate-corrected QT interval (QTc) was 447 ms. Blood pressure was 145/85 mmHg, troponin I level of 0.21 ng/dl and elevated BNP (243 pg/ml). With subsequent diagnosis of acute coronary syndrome, the patient was referred for urgent coronary angiography, which documented no coronary artery disease (Fig. 1a top). Ventriculography revealed an apical ballooning pattern with contrast retention in the apex (Fig. 1a lower). Bedside echocardiogram revealed akinesis of apical and midventricular segments of left ventricle with ejection fraction (LVEF) of 30 % and diminished average global longitudinal peak systolic strain (GLPS −10.3 %) (Fig. 1b). Cardiac magnetic resonance T2-weighted sequence did not record any pathological regional increase of the myocardial signal intensity (Fig. 1c); delayed postcontrast hyperenhancement was absent, consistent with viable myocardium (Fig. 1D). Four days later an ECG showed deep negative T waves in V3–V6, II, III, aVF. The patient was initially treated for STEMI and received β-blockers, aspirin and ACE inhibitor after the final diagnosis had been made. The patient’s recovery was uneventful and the patient was discharged after 5-day hospitalization. Fig. 1 Left and right coronary artery (a top), cardiac ventriculography at diastole at systole (a lower), left ventricular average global longitudinal peak systolic strain (GLPS) at acute phase (b), cardiac magnetic resonance T2-weighted sequence (c), cardiac ... Three weeks later echocardiography recorded no signs of left ventricle apical ballooning with RBBB wall motion pattern, estimated LVEF of 65 % and GLPS improvement to −14, 9 % (Fig. 1e). It has been proved that great and important sport events such as the European Championships are associated with physical stress and emotional strain especially after a favorite team’s loss [3]. Incidences of sudden cardiac death or other cardiovascular events are suggested to be increased during an important football match due to increased sympathetic tone and catecholamine levels. Interestingly, the impact of adrenergic stimulation increasing the risk of cardiovascular events may persist for several days after the game [4]. Stressful events and elevated catecholamine plasma levels in the acute course of TTC indicate a possible involvement of the sympathetic nervous system in this cardiomyopathy as well [5]. A minor size of the LV and hormonal disruption in the female subset may play a key-role in the pathology of TTC [6]. The small LV size observed in women could potentially predispose the LV-outflow tract obstruction raising the intraventricular pressure gradient and an oxygen mismatch in the region of the apex. The studies on animals have shown the important protective roles of estrogen in myocardial damage including through stimulating transcription of cardioprotective substances such as atrial natriuretic peptide [7]. Among the male population TTC, however, is triggered more often by physical stress [8]. Therefore, we present a particular case of a man with the TTC-event after participating in football match at the Fan Zone Euro 2012 Cup in the Host City of Gdansk, Poland. Bill Shankly, the former F.C. Liverpool manager, could be right in saying: “Some people believe football is a matter of life and death… I can assure you it is much, much more important than that.”

Management in familial hypercholesterolaemia in children and adolescents. Position of the Lipid Expert Forum

Abstract: 1Katedra i Klinika Pediatrii, Diabetologii i Endokrynologii, Gdanski Uniwersytet Medyczny, Gdansk 2Klinika Pediatrii, Endokrynologii, Diabetologii, Chorob Metabolicznych i Kardiologii Wieku Rozwojowego, Pomorski Uniwersytet Medyczny, Szczecin 3Klinika Pediatrii, Endokrynologii i Diabetologii Dzieciecej, Śląski Uniwersytet Medyczny, Katowice 4Klinika Patologii Noworodka, Instytut Pediatrii, Centrum Zdrowia Dziecka, Warszawa 5Instytut Żywności i Żywienia, Warszawa 6I Katedra i Klinika Kardiologii, Warszawski Uniwersytet Medyczny, Warszawa 7Wydzial Medyczny, Uniwersytet Rzeszowski, Rzeszow 8Klinika Pediatrii, Hematologii, Onkologii i Diabetologii, Łodzki Uniwersytet Medyczny, Łodź 9I Katedra i Klinika Kardiologii, Gdanski Uniwersytet Medyczny, Gdansk 10Katedra i Klinika Transplantacji Szpiku, Onkologii i Hematologii Dzieciecej, Wroclawski Uniwersytet Medyczny, Wroclaw 11Klinika Gastroenterologii, Hepatologii i Żywienia Dzieci, Centrum Zdrowia Dziecka, Warszawa 12Zaklad Genetyki, Instytut Psychiatrii i Neurologii, Warszawa 13Zaklad Prewencji i Dydaktyki, Katedra Nadciśnienia Tetniczego i Diabetologii, Gdanski Uniwersytet Medyczny, Gdansk 14Katedra i Zaklad Biologii i Genetyki, Gdanski Uniwersytet Medyczny, Gdansk 15Katedra Nefrologii i Nadciśnienia Tetniczego, Łodzki Uniwersytet Medyczny, Łodź

Morning and afternoon serum cortisol level in patients with post-myocardial infarction depression.

Abstract: Background: Post-myocardial depression is a highly prevalent condition which worsens the course and prognosis of coronary artery disease. One possible pathogenetic factor is dysregulation of the hypothalamic-pituitary-adrenal axis, resulting in cortisol profile disturbances. Methods: Thirty seven patients hospitalized due to a first myocardial infarction (MI) were enrolled in this study. The Beck Depression Inventory (BDI) was used to rate the severity of their depressive symptoms. Morning and afternoon serum cortisol samples were taken on the fifth day of the MI. Results: Depression, defined as BDI ≥ 10, was present in 34.4% of the patients. A statistically significant difference was observed between the mean morning and the evening plasma concentrations in patients with depression compared to the no-depression group: F (1.29) = 5.0405, p = 0.0328. Conclusions: Patients with depressive symptoms directly after MI have a flattened diurnal serum cortisol profile. This is particularly expressed in patients with longer lasting symptoms.

Design and methodology of POWER, an open-label observation of the effect of primary care interventions on total cardiovascular risk in patients with hypertension.

Abstract: This article describes the design and methodology of the POWER study (Physicians' Observational Work on Patient Education According to their Vascular Risk). POWER is an open-label multinational postmarketing study of the angiotensin II-receptor blocker eprosartan. The Systemic Coronary Risk Evaluation (SCORE) model has been used to estimate total cardiovascular risk and changes in total cardiovascular risk status during treatment for patients recruited in all countries other than Canada. Framingham Heart Study equations have been used to estimate risk in the Canadian contingent of POWER. Observations from POWER will provide insights into how clinicians try to achieve blood pressure goals within the framework of total cardiovascular risk management and how they integrate their treatment of blood pressure with other interventions. Experience during the POWER study may also help to affirm the utility, practicability and perhaps limitations of the SCORE system for estimating total cardiovascular risk and identify ways to improve the acceptance and implementation of risk estimation methods in cardiovascular primary prevention.

Major adverse cardiovascular events after drug-eluting stent implantation in patients with single chronic total occlusion: a single-center registry.

Abstract: BACKGROUND: There are limited data on the long-term safety and efficacy of drug-eluting stents (DES) implantation in patients with stable angina referred for elective percutaneous coronary intervention (PCI) of chronic total occlusion (CTO). We therefore aim to investigate whether DES compared with bare-metal stent (BMS) implantation improves long-term outcomes after successful recanalization of single CTO. METHODS: A total of 345 consecutive patients who underwent successful recanalization of single CTO and received DES or BMS in the Cardioangiology Laboratories of the Medical University of Gdansk between January 1, 2006 and December 31, 2010 were included in the CTO Registry database. We compared the 1-year and long-term clinical outcomes of 137 consecutive patients who underwent PCI for CTO and DES implantation with outcomes of 208 patients after successful CTO treatment with BMS implantation. The median follow-up was 22.6 ± 3 months (21.0 ± 3.9 months for DES vs 23.6 ± 1.5 months for BMS; P<.001). The primary endpoints included a composite of all-cause death and non-fatal myocardial infarction (MI) and composite safety endpoint of major adverse cardiovascular events (MACEs), including death, MI and symptom-driven target lesion revascularization (TLR). A secondary endpoint was a symptom-driven TLR. RESULTS: After stent implantation we noted lower rates of the composite endpoint at 1-year (9.5% DES vs 18.3% BMS; P=.01) and long-term follow-up (11.7% DES vs 21.1% BMS; P=.02) due to fewer episodes of TLR in the DES group (5.1% DES vs 14.4% BMS; P=.006 at 1-year follow-up; 7.3% DES vs 14.4% BMS; P=.04 at long-term follow-up). No significant differences were documented in the rate of death, MI, or in-stent thrombosis between investigated subsets. After adjusting for patient and procedural characteristics as well as propensity, BMS implantation remained independently associated with an increased hazard of 1-year MACE (adjusted hazard ratio [AHR], 2.09; 95% confidence interval [CI], 1.2-3.64; P=.005) and long-term MACEs (AHR, 1.99; 95% CI, 1.18-3.38; P<.01). CONCLUSIONS: DES implantation during PCI for single CTO reduces MACE rate at 1-year and long-term follow-up due to the significant reduction of TLR in the DES group. Therefore, DES implantation should be preferred as an optimal treatment strategy of single CTO in stable angina patients.

Successful recanalisation of isolated chronic total occlusions improves outcomes in long-term observation: a case-control study

Abstract: Background and aim: The long-term benefit of percutaneous recanalisation of chronic total occlusion (CTO) is still unclear. Given advances in interventional cardiology over the last two decades, we sought to investigate whether a successful percutaneous coronary intervention for CTO (PCI-CTO) improves outcomes in an age- and gender-matched single-centre cohort of stable angina patients. Methods: Out of 401 consecutive patients enrolled to the CTO-Registry database, 276 patients were included in the final analysis. Patients with unsuccessful PCI-CTO (n = 138) were age- and gender-matched in a 1:1 ratio with patients who underwent a successful procedure. The primary end-points included hard end-points comprising death and nonfatal myocardial infarction (MI) and a composite safety outcome measure of death, nonfatal MI and ischaemia-driven revascularisation. The secondary end-point was improvement in angina status or complete resolution of angina symptoms. Patients were followed up for six months and at two years. Results: Patients who underwent a successful recanalisation of CTO, compared to those who underwent an unsuccessful procedure, revealed similar rates of composite death and MI at six months (0.7% vs. 1.4%; hazard ratio [HR], 0.50; 95% confidence interval ratio [CI], 0.05–4.80; p = 0.56) and two years (1.4% vs. 5.8%; HR 0.24; 95% CI 0.07–0.85; p = 0.053). A significant difference in composite safety end-points between subsets, although not recorded after six months of observation (8.7% vs. 15.2%; HR 0.54; 95% CI 0.27–1.07; p = 0.095), was noted at two years follow-up (15.2% vs. 29.7%; HR 0.47; 95% CI 0.29–0.77; p = 0.004). A greater improvement in symptom burden or resolution of angina symptoms was documented after a successful PCI at both six months (68.1% vs. 23.2%, p < 0.001; 80.4% vs. 34.8%, p < 0.001, respectively) and two years (52.2% and 8.0%, p < 0.001; 68.1% vs. 22.5%, p < 0.001, respectively). Conclusions: Successful recanalisation of CTO improves outcomes in long-term observation.

Complexity of the heart rhythm after heart transplantation by entropy of transition network for RR-increments of RR time intervals between heartbeats

Abstract: Network models have been used to capture, represent and analyse characteristics of living organisms and general properties of complex systems. The use of network representations in the characterization of time series complexity is a relatively new but quickly developing branch of time series analysis. In particular, beat-to-beat heart rate variability can be mapped out in a network of RR-increments, which is a directed and weighted graph with vertices representing RR-increments and the edges of which correspond to subsequent increments. We evaluate entropy measures selected from these network representations in records of healthy subjects and heart transplant patients, and provide an interpretation of the results.

Heart rate and double product in relation to insulin resistance in patients with hypertension and coronary artery disease.

Abstract: Background: Elevated values of heart rate (HR) and insulin resistance (IR) reflect enhanced sympathetic nervous system activity and may be connected to the development of coronary artery disease (CAD) and diabetes. Aim: To evaluate the relationship between HR, blood pressure (BP), double product and IR in nondiabetic hypertensive patients with stable CAD. Methods: There were 73 patients included in the study. Ambulatory BP monitoring was recorded in all patients by a Spacelabs 90207 device. Homeostasis model assessment (HOMA-IR) was used to estimate IR. Double product was calculated by multiplying systolic BP and HR. Results: In the study population (mean age 67.1 ± 8.4 years, 52% males) there was a positive correlation between HOMAIR and 24-h double product (r = 0.35, p < 0.01) and body mass index (BMI) (r = 0.45, p < 0.001). The receiver operating characteristic analysis of 24-h double product and BMI as predictive markers of IR did not reveal statistical differences between AUC (0.72 ± 0.09 vs. 0.72 ± 0.08, 24-h double product and BMI, respectively, p = NS). The best cut-off points in predicting IR were 8,978 mm Hg/min for 24-h double product and 33.02 kg/m2 for BMI. There were differences between the non obese (n = 44, mean age 67.9 ± 9.2 years) and obese (n = 29, mean age 65.8 ± 6.9 years) groups in: serum insulin level (7.3 ± 2.3 µU/mL vs. 12.0 ± 7.3 µU/mL, p < 0.01), HOMA-IR (1.8 ± 0.7 µU/mL × mmol/L vs. 3.0 ± 2.0 µU/mL × mmol/L, p < 0.01), and day systolic BP (128.0 ± 10.8 mm Hg vs. 134.1 ± 10.1 mm Hg, p < 0.02). Conclusions: 24-h double product and BMI may be complementary parameters in the prediction of IR in hypertensive nondiabetics with CAD confirmed by percutaneous coronary interventions in history and/or at least one coronary artery stenosis ? 70% in elective coronary angiography.

Effect of Antihypertensive Therapy on SCORE-Estimated Total Cardiovascular Risk: Results from an Open-Label, Multinational Investigation—The POWER Survey

Abstract: Background. High blood pressure is a substantial risk factor for cardiovascular disease. Design & Methods. The Physicians' Observational Work on patient Education according to their vascular Risk (POWER) survey was an open-label investigation of eprosartan-based therapy (EBT) for control of high blood pressure in primary care centers in 16 countries. A prespecified element of this research was appraisal of the impact of EBT on estimated 10-year risk of a fatal cardiovascular event as determined by the Systematic Coronary Risk Evaluation (SCORE) model. Results. SCORE estimates of CVD risk were obtained at baseline from 12,718 patients in 15 countries (6504 men) and from 9577 patients at 6 months. During EBT mean (±SD) systolic/diastolic blood pressures declined from 160.2 ± 13.7/94.1 ± 9.1 mmHg to 134.5 ± 11.2/81.4 ± 7.4 mmHg. This was accompanied by a 38% reduction in mean SCORE-estimated CVD risk and an improvement in SCORE risk classification of one category or more in 3506 patients (36.6%). Conclusion. Experience in POWER affirms that (a) effective pharmacological control of blood pressure is feasible in the primary care setting and is accompanied by a reduction in total CVD risk and (b) the SCORE instrument is effective in this setting for the monitoring of total CVD risk.

Incidental diagnosis of unicuspid aortic valve in an asymptomatic adult

Abstract: A 38 year-old male with no cardiovascular history was referred for computed tomography (CT) of chest aorta due to prominence of the right cardiac contour in prophylactic chest X-ray examination required by his employer. Initially, transoesophageal echocardiography (TEE) was performed and revealed abnormal aortic valve morphology with a posteriorly positioned commissural attachment and ascending aorta aneurysm coupled by a moderate aortic regurgitation without valve orifice stenosis (Fig. 1A, B). With the suspicion of unicuspid aortic valve (UAV) and the diagnosis of ascending aorta aneurysm, he was referred for further cardiovascular evaluation. Physical examination revealed a regular heart rate with a mild diastolic murmur at the right upper sternal border, blood pressure of 125/83 mm Hg and heart rate 68 bpm. Scheduled 64-slice multi-detector CT (MDCT) confirmed dilatation of ascending aorta up to 53 mm and UAV with only one distinctive commissure (Fig. 1C). The Bentall de Bono procedure was performed and a size 29 ATS aortic valved conduit was implanted (ATS Medical, Minneapolis, MN, USA). During surgery, the valve was found to be unicommissural and unicuspid without significant calcification and thickening (Fig. 1D). There were no postoperative complications and the patient made a full recovery. UAV is mainly discovered during surgery or autopsy and can be easily mistaken for a more common bicuspid aortic valve. Morphologic similarities between unicuspid and bicuspid valves in TEE can often provide diagnostic difficulties. The incidental finding in TEE or MDCT substantially affects further management, including Bentall procedure, ascending aorta surgery and aortic valve replacement, with the need for endocarditis prophylaxis.

Triple occurrence of Takotsubo cardiomyopathy.

Abstract: A 51 year-old woman after a quarrel with her husband and with no previous cardiovascular history was admitted to hospital with a suspicion of anterior myocardial infarction (MI) in 2005. She was suffering from chest pain; ECG documented ST-segment elevation in the V1–V3 leads and a positive troponin I level (2.8 ng/dL) was documented. An echocardiogram revealed akinesia of apical and mid-wall segments of left ventricular (LV) anterior wall and intraventricular septum with an ejection fraction (EF) of 45% (Fig. 1A, B). An urgent coronary angiography demonstrated no coronary artery disease (CAD). We observed full recovery with no LV contraction abnormalities at one-month follow-up. The subsequent focal type of Takotsubo cardiomyopathy (TTC) was diagnosed. Three years later, she presented with an inverse-type of TTC after knee surgery due to chest pain, ST-segment abnormalities in ECG and an increased troponin level (5.3 ng/dL). An echocardiogram and ventriculography revealed akinesia of all basal and mid-wall LV segments with an EF of 38% (Fig. 1C, D). We observed again a full clinical recovery with no LV wall motion abnormalities. A third hospitalisation, following a panic attack, occurred in 2009. The patient was referred for invasive diagnostics due to chest discomfort, ST-segment depression in ECG and a troponin I level of 1.1 ng/dL. Echocardiography and coronarography results were similar to those from the second episode (Fig. 1E, F). Therefore, a third occurrence of TTC was subsequently recognised. The most recent echocardiography showed normal LV contraction with an EF of 68% and normal longitudinal peak systolic strain for all LV regions (Fig. 1G, H). TTC, first described in 1990, usually affects postmenopausal women and is proceeded by psychological or physical stress. TTC mimics acute MI due to angina chest pain, ST-segment elevation pattern in ECG and a positive troponin level. However, obstructive CAD is in the majority of cases excluded. TTC, which is sometimes also known as apical ballooning syndrome, is predominantly characterised by transient, reversible, regional systolic dysfunction involving the LV apex and mid-ventricle with hyperkinesis of the basal LV segments. Case reports from the last 2 decades have also shown different faces of TTC concerning atypical TTCs such as inverse TTC with basal wall motion abnormalities, mid-segment TTC with akinesia presentation of all LV mid-segment and hyperkinesias of the basal and apical regions of LV, and focal TTC with regional wall motion disturbances. We here present a unique case of three TTC episodes in one patient after different stress events.

Stanowisko dotyczące postępowania w rodzinnej hipercholesterolemii u dzieci i młodzieży. Stanowisko Forum Ekspertów Lipidowych

Abstract: Familial hypercholesterolemia (FH) is a genetic disease that causes accelerated atherosclerosis and a high risk of occurrence of cardiovascular events. Atherosclerosis in the course of FH develops insidiously and reaches an advanced stage before the onset of clinical symptoms. Homozygous form of FH occurs in the Caucasian population with a frequency of one per million, while the heterozygous form of FH in European countries applies on average in 1 person per 500. FH diagnosis is an indication to take the whole family under medical care, education, and to introduce dietary and pharmacological treatment. The aim of treatment in children with FH is to achieve more than 50% reduction in LDL level or to achieve LDL-cholesterol concentrations below 130 mg/dl and below 100 mg/dl in diabetic children. The effectiveness of low fat diet in the treatment of FH is limited. The medicaments of first choice in the treatment of FH are statins. After initiation of therapy in children, cholesterol levels and the side effects of therapy and its impact on children's development, nutritional status, degree of sexual maturity should be routinely evaluated. Familial hypercholesterolemia is a relatively common metabolic disorder, but still quite rarely recognized and not properly treated. Early diagnosis and appropriate treatment of FH in children and adolescents can significantly reduce the risk of cardiovascular disease and sudden death in adults. The purpose of these recommendations is to describe the current epidemiological situation in Poland, to establish the guidelines for identifying FH in children and adolescents and to enable the introduction of effective treatment. This document is a supplement to the position of Lipid Expert Forum on FH in adults.

Multifractal age? Multifractal analysis of cardiac interbeat intervals in assessing of healthy aging

Abstract: 24-hour Holter recordings of 124 healthy people at different age are studied. The nocturnal signals of young people reveal the presence of the multiplicative structure. This structure is significantly weaker in diurnal signals and becomes less evident for elderly people. Multifractal analysis allows us to propose qualitative and quantitative methods to estimate the advancement of the aging process for healthy humans.

Magnetic resonance imaging in a patient with an implantable cardioverter-defibrillator

Abstract: The number of patients with cardiac pacemakers (PM), implantable cardioverter-defibrillators (ICD) and cardiac resynchronisationtherapy PM systems is increasing. The number of magnetic resonance imaging (MRI) examinations is also growingand amounts to about 60 million tests per year worldwide. The presence of an ICD is still considered to be an absolute contraindicationto MRI by most experts. We present a patient with an implanted ICD who successfully underwent brain MRIwith use of special precautions.

Badanie rezonansem magnetycznym przeprowadzone bez powikłań u chorego z wszczepionym kardiowerterem-defibrylatorem Magnetic resonance imaging in a patient with an implantable cardioverter-defibrillator

Abstract: The number of patients with cardiac pacemakers (PM), implantable cardioverter-defibrillators (ICD) and cardiac resynchro nisation therapy PM systems is increasing. The number of magnetic resonance imaging (MRI) examinations is also growing and amounts to about 60 million tests per year worldwide. The presence of an ICD is still considered to be an absolute contraindication to MRI by most experts. We present a patient with an implanted ICD who successfully underwent brain MRI with use of special precautions.

Poziom lęku u pacjentów poddanych przezskórnej interwencji wieńcowej w trybie elektywnym

Abstract: Wstep. Objawy lekowe mają silny i niekorzystny wplyw na rokowanie i przebieg chorob ukladu sercowo-naczyniowego. Jednocześnie objawy lekowe obserwuje sie u wiekszości pacjentow oddzialow kardiologicznych. Material i metody. Badaniu poziomu leku poddano 136 pacjentow I Kliniki Kardiologii Gdanskiego Uniwersytetu Medycznego w Gdansku oczekujących na zabieg przezskornej angioplastyki naczyn wiencowej. W badanej grupie bylo 86 mezczyzn (63,2%; średnia wieku 54,59 ± 7,03 roku) oraz 50 kobiet (36,8%; średni wiek 54,98 ± 4,13 roku). Wyniki. Wśrod osob oczekujących na pierwsze PCI średni poziom leku w grupie kobiet wynosil 7,0 ± 1,5 stenow, natomiast w grupie mezczyzn 6,3 ± 2,4 stenow. Przed drugim PCI średni poziom leku u kobiet wynosil 7,3 ± 2,6 stenow, natomiast u mezczyzn 6,5 ± 2,4 stenow. Przed trzecim PCI średni poziom leku w grupie kobiet wynosil 7,5 ± 1,0 stenow, w grupie mezczyzn 5,7 ± 2,3 stenow. Wśrod osob oczekujących na co najmniej czwarte PCI średni poziom leku wynosil 6,5 ± 1,9 stenow u kobiet i 6,0 ± 2,3 stenow u mezczyzn. Wnioski. Nie ma zalezności pomiedzy liczbą interwencji wiencowych a nasileniem leku jako stanu, natomiast poziom leku obniza sie u kobiet poźniej niz u mezczyzn.

Postępowanie w heterozygotycznej hipercholesterolemii rodzinnej. Stanowisko Forum Ekspertów Lipidowych* Management of familial heterozygous hypercholesterolaemia. Position paper of the Polish Lipid Expert Forum

Abstract: 1I Katedra i Klinika Kardiologii, Gdański Uniwersytet Medyczny, Gdańsk 2Instytut Żywności i Żywienia, Warszawa 3Katedra Nefrologii i Nadciśnienia Tętniczego, Uniwersytet Medyczny, Łódź (Prezes Polskiego Towarzystwa Lipidologicznego) 4I Katedra i Klinika Kardiologii, Warszawski Uniwersytet Medyczny, Warszawa (Przewodniczący Sekcji Farmakoterapii Sercowo-Naczyniowej PTK) 5Katedra i Klinika Chorób Wewnętrznych i Medycyny Wsi, Collegium Medicum, Uniwersytet Jagielloński, Kraków (Prezes Towarzystwa Internistów Polskich) 6Katedra i Klinika Chorób Metabolicznych, Collegium Medicum, Uniwersytet Jagielloński, Kraków 7I Oddział Wewnętrzny i Nefrologii, Międzyleski Szpital Specjalistyczny, Warszawa (Konsultant Krajowy w Dziedzinie Chorób Wewnętrznych) 8I Klinika Kardiologii i Nadciśnienia Tętniczego, Instytut Kardiologii, Collegium Medicum, Uniwersytet Jagielloński, Kraków (Przewodniczący Komisji Promocji Zdrowia PTK) 9Zakład Medycyny Społecznej i Higieny, Warszawski Uniwersytet Medyczny, Warszawa 10Katedra i Zakład Biologii i Genetyki, Gdański Uniwersytet Medyczny, Gdańsk (Prezes Polskiego Towarzystwa Genetyki Człowieka) 11Klinika Pediatrii, Hematologii, Onkologii i Endokrynologii, Gdański Uniwersytet Medyczny, Gdańsk (Przewodnicząca Sekcji Pediatrycznej PTD) 12I Katedra i Klinika Kardiologii, Warszawski Uniwersytet Medyczny, Warszawa (Konsultant Krajowy w Dziedzinie Kardiologii) 13Katedra i Zakład Medycyny Rodzinnej, Uniwersytet Medyczny, Wrocław (Prezes Polskiego Towarzystwa Medycyny Rodzinnej) 14Klinika Intensywnej Terapii Kardiologicznej, Instytut Kardiologii, Warszawa (Prezes Polskiego Towarzystwa Kardiologicznego) 15Zakład Prewencji i Dydaktyki, Katedra Nadciśnienia Tętniczego i Diabetologii, Gdański Uniwersytet Medyczny, Gdańsk (Przewodniczący Komisji Współpracy z Parlamentem i Administracją Państwową PTK)