Showing papers by "Andrzej Rynkiewicz published in 2015"

Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy

Abstract: BackgroundThe natural history, management, and outcome of takotsubo (stress) cardiomyopathy are incompletely understood. MethodsThe International Takotsubo Registry, a consortium of 26 centers in Europe and the United States, was established to investigate clinical features, prognostic predictors, and outcome of takotsubo cardiomyopathy. Patients were compared with age- and sex-matched patients who had an acute coronary syndrome. ResultsOf 1750 patients with takotsubo cardiomyopathy, 89.8% were women (mean age, 66.8 years). Emotional triggers were not as common as physical triggers (27.7% vs. 36.0%), and 28.5% of patients had no evident trigger. Among patients with takotsubo cardiomyopathy, as compared with an acute coronary syndrome, rates of neurologic or psychiatric disorders were higher (55.8% vs. 25.7%) and the mean left ventricular ejection fraction was markedly lower (40.7±11.2% vs. 51.5±12.3%) (P<0.001 for both comparisons). Rates of severe in-hospital complications including shock and death were ...

A new version of cardiovascular risk assessment system and risk charts calibrated for Polish population

Abstract: 1Zakład Prewencji i Dydaktyki, Gdański Uniwersytet Medyczny, Gdańsk 2I Klinika Kardiologii i Elektrokardiologii Interwencyjnej oraz Nadciśnienia Tętniczego, Instytut Kardiologii, Uniwersytet Jagielloński, Collegium Medicum, Kraków 3II Klinika Kardiologii oraz Interwencji Sercowo-Naczyniowych, Instytut Kardiologii, Uniwersytet Jagielloński, Collegium Medicum, Kraków 4Klinika Neurologii Dorosłych, Gdański Uniwersytet Medyczny, Gdańsk 5Katedra Medycyny Społecznej i Zapobiegawczej, Uniwersytet Medyczny w Łodzi, Łódź 6Zakład Epidemiologii, Prewencji Chorób Układu Krążenia i Promocji Zdrowia, Instytut Kardiologii, Warszawa 7Katedra i Klinika Chorób Wewnętrznych, Nadciśnienia Tętniczego i Angiologii, Warszawski Uniwersytet Medyczny, Warszawa 8Klinika Wad Wrodzonych Serca, Instytut Kardiologii, Warszawa 9Katedra Kardiologii, Wrodzonych Wad Serca i Elektroterapii, Śląski Uniwersytet Medyczny, Katowice 10Klinika Kardiologii, Pomorski Uniwersytet Medyczny, Szczecin 11Klinika Chorób Serca i Naczyń, Instytut Kardiologii, Uniwersytet Jagielloński, Collegium Medicum, Kraków 12III Klinika Chorób Wewnętrznych i Kardiologii, Warszawski Uniwersytet Medyczny, Warszawa 13I Katedra i Klinika Kardiologii, Warszawski Uniwersytet Medyczny, Warszawa 14Zakład Epidemiologii i Badań Populacyjnych, Instytut Zdrowia Publicznego, Wydział Nauk o Zdrowiu, Uniwersytet Jagielloński, Collegium Medicum, Kraków 15Klinika Rehabilitacji Kardiologicznej i Elektrokardiologii Nieinwazyjnej, Instytut Kardiologii, Warszawa 16Katedra Kardiologii i Kardiochirurgii, Uniwersytet Warmińsko-Mazurski, Olsztyn 17Klinika Kardiologii Dziecięcej, I Katedra Pediatrii, Uniwersytet Medyczny im. K. Marcinkowskiego, Poznań 18Klinika Intensywnej Terapii Kardiologicznej, Instytut Kardiologii, Warszawa 19Zakład Medycyny Rodzinnej, Katedra Chorób Wewnętrznych i Gerontologii, Uniwersytet Jagielloński, Collegium Medicum, Kraków 20Narodowy Instytut Zdrowia Publicznego — Państwowy Zakład Higieny, Warszawa

Increased plasma pro-inflammatory cytokine concentrations after myocardial infarction and the presence of depression during next 6-months

Abstract: Objectives The aim of this study was to investigate plasma concentrations of four pro-inflammatory cytokines (IL17a, IL6, TNFα and IL12p70) in patients with myocardial infarction and to analyse them according to presence of depression observed during first 6 months after myocardial infarction. Methods In 44 patients with the first acute STEMI (ST segment elevation myocardial infarction) plasma levels of IL17a, IL6, TNFα and IL12p70 were measured on the 3rd and 5th day after the MI. Cytokine concentrations were analyzed according to the presence of depression during 6 months of observation. Results Two groups of patients distinguished according to presence of depression during 6 months of observation differed in their inflammatory reaction to MI. In the depression group all four cytokines on the 3rd day after the MI were elevated compared to control and on the 5th day two of them: IL17a and IL6 were still elevated. In the group without depression on the 3rd day only two of four investigated cytokines were elevated and on the 5th day only IL6 concentration remained higher. Conclusions It can be assumed that more pronounced inflammatory response as an element of stress reaction after MI can predispose to depression. IL17a increase can play particularly important role in this process.

Successful versus unsuccessful antegrade recanalization of single chronic coronary occlusion: eight-year experience and outcomes by a propensity score ascertainment

Abstract: Aims The effectiveness of revascularization of chronic total occlusion (CTO) remains intriguing. Thus, we sought to investigate whether a successful PCI for single CTO improves outcomes in a setting of stable angina and chronic occlusion of single coronary artery. Methods and Results Of 11 957 consecutive patients referred for nonurgent PCI between 2003 and 2010, 1110 displayed single CTO and were enrolled to the central CTO-registry database. The primary end-point included all-cause mortality, the secondary end-point a composite of safety outcome measure of all-cause death, nonfatal-MI, the need for urgent revascularization and stroke. The major adverse cardiovascular event (MACE) records were extracted from the national administrative database and all patients were linked to the long-term follow-up. Since the patient assignment was not random, we performed the propensity scoring to minimize selection bias; 734 patients (66%) had a successful PCI-CTO. Compared with successful procedures, unsuccessful procedures had similar rates of all-cause death both in crude (HR, 0.78; 95%CI, 0.49–1.25; P = 0.30) and adjusted analysis (HR, 0.80; 95%CI, 0.50-1.28; P = 0.34). A similar, significant reduction in overall MACE was noted with successful PCI-CTO compared with unsuccessful procedure in unadjusted (HR, 0.74; 95%CI, 0.56–0.96; P = 0.020) and adjusted calculation (HR, 0.73; 95%CI, 0.56–0.96; P = 0.019). Patients after successful PCI-CTO as compared with failed recanalization less frequently underwent surgical revascularization. The benefit was sustained at 3 years follow-up. Conclusions Successful PCI for single CTO does not improve long-term survival, nonetheless, is associated with reduced overall MACE and the need for surgical revascularization. © 2015 Wiley Periodicals, Inc.

The Polish MacNew heart disease heath-related quality of life questionnaire: A validation study

Abstract: Background: The MacNew health-related quality of life questionnaire was designed to assess feelings about how heart disease affects their daily physical, emotional and social functioning in patients with 1 of the 3 major coronary artery diagnoses, stable coronary artery disease (CAD) with angina, ST-elevation myocardial infarction (STEMI), and ischemic heart failure (HF). The aim of this study was to determine the reliability and validity of the Polish version of the MacNew in patients with CAD. Methods: Patients with CAD completed a self-report sociodemographic and clinical ques­tionnaire: the MacNew, the Short-Form 36 Health Survey, and HADS at baseline; 10% of the patients completed each questionnaire 2 weeks later. Results: We studied patients with stable CAD with angina (n = 115), with STEMI (n = 112), and with ischemic HF (n = 105). Internal consistency reliability was demonstrated with Cronbach’s a from 0.86 to 0.95 for the MacNew global scale and subscales. The original 3-factor structure was confirmed for the Polish version of the MacNew explaining 53.5% of the variance. Convergent validity of similar MacNew and SF-36 subscales was confirmed in the total group and in each diagnosis. Discriminant validity with the SF-36 health transition was fully confirmed in the total group and in patients with HF and partially confirmed in patients with stable CAD with angina or myocardial infarction. Conclusions: The Polish MacNew health-related quality of life questionnaire can be recommended in patients with stable CAD with angina, myocardial infarction and HF.

The successful treatment of cardiogenic shock with primary percutaneous coronary intervention (T-stenting) of total occluded unprotected left main performed during cardiopulmonary resuscitation.

Abstract: A 61-year-old male with no previous cardiovascular history was admitted to the coronary care unit suffering from acute angina. On presentation the patient was conscious, the heart rate was 100 bpm, and the blood pressure was 80/60 mm Hg. Standard electrocardiogram displayed prominent ST-segment elevation in the anterolateral leads. The initial treatment was 300 mg of aspirin, 600 mg of clopidogrel, and intravenous bolus of unfractioned heparin, all given in the ambulance. In the catheterisation laboratory, sudden cardiac arrest occurred and the patient was subsequently defibrillated. The patient needed defibrillation because of ventricular fibrillation followed by pulseless electrical activity. A cardiopulmonary resuscitation (CPR) was started. Through the left femoral artery a balloon for intra-aortic balloon counterpulsation (IABP) was introduced. The coronary angiogram of the left coronary artery (LCA) selectively engaged with a 6 French EBU-4 guiding catheter revealed an acute total occlusion of the left main stem (LMS) (Fig. 1A). During the CPR, a manual thrombectomy was performed and the blood flow in left anterior descending artery was restored (Fig. 1B). The left circumflex artery (LCX) was opened after a second thrombectomy (Fig. 1C). The patient received a subsequent intracoronary bolus of abciximab. Finally, the culprit lesion localised in the distal portion of the LMS was treated with a second-generation everolimus eluting stent 3.5/18 mm deployed at 20 atmospheres (Fig. 1D), and post dilated with a 4.0/15 mm non-compliant balloon. The final kissing-balloon inflation was complicated with a dissection of the ostial portion of the LCX (Fig. 1E). It was subsequently covered with a 3.0/18 mm drug eluting stent using a “T and protrusion” technique (Fig. 1E, inset). As percutaneous coronary intervention of the LCA was accomplished, the angiography of the right coronary artery showed no significant disease. After the procedure, the patient was transferred to the coronary care with catecholamine infusion and IABP 1:1 support. On the third day of hospitalisation, the patient received a red blood cell transfusion due to the large local haematoma and severe anaemia. IABP was removed 6 days after baseline; the patient was weaned from the respirator and extubated. In 4-month follow-up the patient remained asymptomatic with New York Heart Association class II. The control angiography revealed a good result in both left main and left circumflex arteries with no signs of in-stent restenosis (Fig. 1F). Figure 1. A. Acute occlusion of the left main coronary artery; B. The angiographic result after manual thrombectomy in left anterior descending artery; C. The angiographic result after manual thrombectomy in left circumflex artery (LCX); D. The angiographic result after implantation of drug eluting stent to the left main; E. Ostial dissection in LCX after kissing balloons and the final angiographic result; F. The angiographic follow-up after 4 months A C

LDL apheresis in a woman with severe heterozygous familial hypercholesterolemia. Late, but not too late

Abstract: Familial hypercholesterolemia (FH) is an under-recognized and undertreated common lipid metabolism disorder [1, 2]. Early and intensive treatment reduces consequent mortality from coronary heart disease [3, 4]. A promising tool for retarding or arresting the atherosclerotic process in hypercholesterolemic patients refractory to maximally tolerated pharmacotherapy is LDL apheresis [5, 6].