Showing papers in "Kardiologia Polska in 2011"

Radial vs femoral approach with StarClose clip placement for primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction. RADIAMI II: a prospective, randomised, single centre trial.

Abstract: Background : Compared to the transfemoral approach (TFA), the transradial approach (TRA) for primary percutaneous coronary intervention (PCI) is associated with less risk of access site complications, greater patient comfort and faster mobilisation. Using vascular closure devices during TFA can offer similar advantages. Aim : To compare the results of TRA and TFA using a StarClose device for primary PCI in patients with ST-elevation myocardial infarction (STEMI). Methods : Patients were randomised to PCI using TRA (n = 49) or PCI using TFA and StarClose (n = 59). Results : Door-to-balloon inflation time was 67.4 ± 17.1 vs 57.5 ± 17.5 min (p = 0.009) in the TRA and TFA groups respectively. Procedural success rate was 100% and 98.3%, respectively (NS). There were no significant differences in the incidence of major adverse cardiac events (MACE) or bleeding complications between the groups: 2.1% and 8.2% in the TRA group vs 1.7% and 10.2% in the TFA group (NS). Time to resume an upright position and time to full mobility was comparable in both groups. Conclusions : The TRA for PCI in patients with STEMI is related to a significantly longer door to balloon time compared to the TFA. This had no influence on the incidence of MACE. The duration and efficacy of PCI were comparable in both groups. Using StarClose after PCI performed via the TFA resulted in an incidence of access site and bleeding complications comparable to that found when using TRA. Kardiol Pol 2011; 69, 8: 763–771

Two models of early cardiac rehabilitation in male patients after myocardial infarction with preserved left ventricular function: comparison of standard out-patient versus hybrid training programmes.

Abstract: Background: The key to increase the percentage of cardiac patients undergoing cardiac rehabilitation is to follow a welldesigned exercise programme at home. To maximise the benefits while minimising the risks of aggravating health status, home-based exercise should be tele-monitored. Aim: To compare the effects on physical capacity and sympatho-vagal balance of two types of early cardiac rehabilitation in post-myocardial infarction (MI) male patients: the hybrid model, partly out-patient and partly home-based and tele-monitored vs standard rehabilitation performed only in the out-patient setting. Methods: Sixty two male patients aged 54.7 ± 6.9 years, mean 27.3 ± 13.5 days after MI with preserved left ventricular systolic function (EF > 50%) underwent an eight-week training programme consisting of 24 training sessions. After performing the first ten interval trainings on a cycloergometer, 30 patients (the hybrid group) exercised at home while being monitored via TeleECG, while 32 patients (the out-patient group) continued their rehabilitation in the out-patient clinic. At entry and after completion of the rehabilitation programme, all patients underwent a symptom-limited treadmill stress test. The following parameters were analysed: maximal workload (METs), exercise duration (ED, min), heart rate (HR, bpm), blood pressure (BP, mm Hg), double product i.e. product of HR and systolic BP at rest and at peak exercise (DP, mm Hg/min, HR × systolic BP), and HR recovery (HRR) in the first and second minute of the recovery period. Results: Maximal workload (out-patient: 7.3 ± 1.4 vs 7.8 ± 1.2, p Conclusions: 1. Hybrid rehabilitation improved physical capacity and positively influenced the sympatho-vagal balance in post-MI male patients with preserved left ventricular systolic function. 2. The hybrid model was effective and comparable with standard out-patient-based programme. Kardiol Pol 2011; 69, 3: 220-226

Uric acid as a link between renal dysfunction and both pro-inflammatory and prothrombotic state in patients with metabolic syndrome and coronary artery disease.

Abstract: Background: Hyperuricaemia has long been known to be associated with cardiovascular disease, and it is particularly common in patients with kidney disease, metabolic syndrome and diabetes mellitus. Metabolic syndrome is associated with pro-inflammatory and prothrombotic state. Aim: To examine the association between renal function, serum uric acid and markers of both pro-inflammatory and prothrombotic state in patients with diabetes mellitus (DM), metabolic syndrome and coronary artery disease. Methods: The study population consisted of 91 patients (58 men, 33 women) aged 57.6 ± 10.3 years with metabolic syndrome and type 2 DM. Patients were selected from a large group of patients scheduled for routine coronary angiography between 2006 and 2009. The patients were evaluated for the common risk factors for atherosclerosis: smoking, hypertension, DM, family history and hyperlipidaemia. Laboratory tests included complete blood counts, serum urea and creatinine, aminotransferases, C-reactive protein (CRP), fibrinogen, uric acid, total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, fasting glucose, glycated haemoglobin (HbA1c), glomerular filtration rate (GFR) and urinary protein. We also measured body mass, height, waist circumference, hip circumference and calculated body mass index (BMI) and waist-to-hip ratio (WHR). Results: The following significant correlations were observed: body mass vs serum creatinine (r = 0.291; p = 0.009), WHR vs serum creatinine (r = 0.672; p 1c vs platelet count (r = 0.263; p = 0.0112). Multiple stepwise regression analysis showed that uric acid level was independently associated with WHR, GFR and CRP. Conclusions: In patients with ischaemic heart disease, DM and metabolic syndrome, obesity, particularly visceral obesity, is associated with renal dysfunction and elevated markers of pro-inflammatory state. Renal dysfunction co-exists with elevated serum uric acid. Elevated serum uric acid is associated with markers of pro-inflammatory state. Markers of pro-inflammatory state correlate with prothrombotic markers such as serum fibrinogen and platelet count. Uric acid should be taken into consideration as a link between renal dysfunction and both pro-inflammatory and prothrombotic state in patients with metabolic syndrome and coronary artery disease. Kardiol Pol 2011; 69, 4: 319-326

Plasma visfatin and tumor niecross factor-alpha (TNF-α) levels in metabolic syndrome

Abstract: Background : Experimental studies have shown that tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) downregulate visfatin gene expression in adipocytes. On the other hand, the induction of cytokine production by visfatin in leucocytes and monocytes has also been described. Aim : To assess the possible interrelation between plasma concentrations of visfatin and TNF-α and TNF soluble receptor in obese women fulfilling, or not, the criteria of metabolic syndrome (MS). Methods : Ninety two obese women were included in the study. Metabolic syndrome, based on IDF criteria (2005) was diagnosed in 71 subjects (mean age 53 ± 9 years; body mass index 39.1 ± 5.6 kg/m 2 , waist circumference 109.6 ± 11.4 cm). The remaining 21 formed the non-MS subgroup (mean age 52 ± 9 years, body mass index 36.3 ± 5.2 kg/m 2 , waist circumference 104.7 ± 11.0 cm). Fourteen healthy normal weight women served as controls. In all subjects, body composition was assessed by the bioimpedance method. Results : In the MS subgroup, but not in the non-MS subgroup, visfatin levels were significantly higher than in controls. We did not observe any significant difference in plasma concentrations of visfatin, TNF-α or sTNFRs between the MS subgroup and the non-MS subgroup. Only in the MS subgroup and in the combined analysis of all study subgroups did plasma visfatin concentrations correlate significantly with TNF- α levels (R = 0.31, p = 0.01, R = 0.21, p = 0.03; respectively). Additionally, in the MS subgroup there was a positive correlation between visfatin levels and insulin resistance (R = 0.53, p = 0.01). Conclusions : Our findings suggest that visfatin in metabolic syndrome should be regarded as a proinflammatory factor indirectly favouring the development of insulin resistance. Kardiol Pol 2011; 69, 8: 802–807

Relationship between carotid intima-media thickness, cytokines, atherosclerosis extent and a two-year cardiovascular risk in patients with arteriosclerosis.

Abstract: Aim : To investigate the relationship between carotid intima-media thickness (CIMT), biomarkers, atherosclerosis extent and a two-year cardiovascular (CV) event risk in patients with arteriosclerosis. Methods : The CIMT, levels of high-sensitivity C-reactive protein (hs-CRP), tumour necrosis factor alpha (TNF-α), transforming growth factor beta (TGF-β), interleukin-6 (IL-6), interleukin-10 (IL-10), and NT-proBNP were measured in 279 subjects with atherosclerotic disease, mean age 64.1 ± 9.6 years. The patients were included when they had artery stenosis ≥ 50% in one, two, three or four arterial territories (coronary, supra-aortic, renal and/or lower limb arteries), and this was found in 97, 80, 69 and 33 patients, respectively. During a two-year follow-up, the incidences of CV death, myocardial infarction, ischaemic stroke and lesion progression were recorded. Results : The identified independent predictors of ≥ 3-territorial stenoses ≥ 50% were CIMT > 1.3 mm (RR 1.72; p 5 mg/dL (RR 1.28; p = 0.005), IL-6 > 6.5 pg/mL (RR 1.08; p = 0.089), IL-10 (RR 0.86; p = 0.002), diabetes (RR 1.11; p = 0.027), total-cholesterol (RR 1.21; p 1.3 mm (p 6 pg/mL (p = 0.018), LDL-cholesterol > 3.35 mmol/L (p = 0.012) and NT-proBNP (p = 0.074) were independent CV event risk factors associated with a 27%, 14%, 15%, 15% and 11% higher CV risk, respectively. However, after adjustment for a baseline location of artery stenosis ≥ 50%, CIMT became a non-significant predictor (p = 0.245). Conclusions : Levels of hs-CRP, IL-6, IL-10 are independently associated with atherosclerosis extent, while TNF-α and NT- -proBNP are mostly related to a two-year CV event risk. The CIMT > 1.3 mm seems to be a clinically relevant marker associated with atherosclerosis extent and CV risk, although CV event risk is primarily related to the baseline stenosis location. Kardiol Pol 2011; 69, 10: 1024–1031

Characteristics of the heart failure population in Poland: ZOPAN, a multicentre national programme

Abstract: Background: It is difficult to define the optimal management of elderly heart failure (HF) patients with complex comorbidities. Thus, comprehensive characterisation of HF patients constitutes a crucial pre-condition for the successful management of this fragile population. Aim: To analyse the ‘real life’ HF patients, including the evaluation of their health conditions, management and their use of public health resources. Methods and results: We examined 822 consecutive patients diagnosed with HF in NYHA classes II–IV in primary care practices. The mean age was 68.5 years, and 56% were male. Only 23% of the patients who were of pre-retirement age remained professionally active. Ischaemic or hypertension aetiology was found in 90% of participants. Nearly all patients had multiple comorbidities. Most patients received converting enzyme inhibitors (88%) and beta-blockers (77%), 60% of them both, although dosing was frequently inadequate. During the six months preceding the study, 31% had cardiovascular hospitalisation and 66% required unscheduled surgery visits. Conclusions: The real life HF population differs from trial populations. Most of the real life patients who had not yet reached retirement age were professionally inactive, mainly due to a disability caused by cardiovascular conditions. Moreover, extremely few participants were free from any comorbidity. Compared to 20th century Polish data, there has been an improvement in the overall quality of HF-recommended pharmacotherapy. It must be stressed, however, that the percentage of those on optimal dosage remains unsatisfactory. Kardiol Pol 2011; 69, 1: 24-31

What has changed in the treatment of ST-segment elevation myocardial infarction in Poland in 2003-2009? Data from the Polish Registry of Acute Coronary Syndromes (PL-ACS).

Abstract: Background : A substantial progress has been made in Poland in the field of acute coronary syndromes (ACS) management over the last 10 years. Aim : To present the data from the Polish Registry of Acute Coronary Syndromes (PL-ACS) collected between 2003 and 2009. Changes in treatment strategies and outcomes in ST-segment myocardial infarction (STEMI) were analysed. Methods : We analysed patients enrolled to the PL-ACS Registry — a nationwide multicenter, prospective observational study of consecutive patients hospitalised with ACS in Poland. Results : Overall, 284,162 patients with ACS were enrolled in 512 centres including 88 invasive cardiology centres. The STEMI was diagnosed in 35–36% of these patients in 2003–2005, and this proportion remained stable at 30% to 32% in 2006–2009. The mean age of STEMI patients increased from 62.5 years in 2003 to 64.5 in 2009. During this period, women represented 32.7% to 34.6% of the STEMI patients. Proportion of patients presenting with pulmonary oedema or cardiogenic shock decreased with time, from 15.5% in 2003 to 8% in 2009. Delays to reperfusion tended to reduce over time: pain-to- -admission time was 240 min in 2005 and 229 min in 2009 and door-to-balloon time was 32 and 25 min in 2005 and 2009, respectively, with the delay being longer in the elderly population. The proportion of patients undergoing coronary angiography showed a constant increase, from 55% in 2003 to 84% in 2009. Percutaneous coronary intervention was performed in 51% and 78% of patients in 2003 and 2009, respectively. At the same time, the proportion of patients undergoing thrombolysis declined from 14% to 1%. Aspirin, beta-blocker, statin and ACE inhibitor use was constantly high, while nitrate use declined from 82% to 15%. The proportion of patients receiving clopidogrel increased from 40% to 97% over the analysed period. Significant reductions in mortality rates were observed: in-hospital mortality decreased from 11.9% to 6.4%; 30-day mortality from 13.5% to 9.6%; and 12-month mortality from 19.8% to 15.4% in 2003 and 2009, respectively. Invasive treatment strategy was associated with better in-hospital and long-term patient survival. Conclusions : The PL-ACS Registry results demonstrate low short- and long-term mortality rates in STEMI patients, mainly due to frequent use of interventional strategy, satisfactory logistics and appropriate drug therapy used. As a consequence, hospitalisation time has shortened. However, there are several issues that need to be improved such as shortening of pre- -hospital delays and increasing the rate of invasive treatment in patients presenting with cardiogenic shock. Kardiol Pol 2011; 69, 11: 1109–1118

Comparison of intravascular and conventional hypothermia after cardiac arrest

Abstract: Background : Therapeutic hypothermia is currently the best-documented method of improving neurological outcomes in patients after cardiac arrest and successful resuscitation. There is a variety of methods for lowering body temperature. However, there are no data showing that any specific method of cooling improves the results or increases survival. A simple method involving surface cooling and ice-cold intravenous fluids, as well as more technologically advanced methods, are used in clinical practice. One of the more advanced methods is intravascular hypothermia, during which cooling is carried out with the use of a special catheter located in the central vein. Aim : To compare cooling with the use of intravascular hypothermia and cooling using the traditional method. Methods : A prospective study was performed in 41 patients with acute coronary syndromes who did not regain consciousness after out-of-hospital or in-hospital cardiac arrest and restoration of spontaneous circulation. Therapeutic hypothermia (32–34°C) was obtained with the use of an intravascular method (group A, n = 20) or a traditional method (group B, n = 21) for a period of 24 hours. Intravascular cooling involved the use of a catheter inserted in the femoral vein connected to a heat exchanger (Alsius Coolgard, Zoll, Chelmsford, MA, USA). Traditional cooling was carried out using uncontrolled surface cooling, ice-cold intravenous fluids and ice-cold gastric lavage. Nasopharyngeal and urinary bladder temperatures were recorded hourly. The main analysed temperature was the urinary bladder temperature, as the heat exchanger in the intravascular hypothermia group was controlled by the readings taken from this site. Temperature profiles were compared. Results : Temperature o C was reached in 19 (95.0%) patients in group A and in 11 (52.4%) patients in group B (p = 0.004). Stable temperature profile (temperature in the range 32–34°C during the final 12 h of cooling) was reached in 16 (80%) patients in group A and in three (14.3%) patients in group B (p 34°C) and temperature overshoots (temperature Conclusions : The presented technique of intravascular hypothermia provides more precise temperature control in comparison with the traditional method. Kardiol Pol 2011; 69, 11: 1157–1163

Exercise capacity and the quality of life late after surgical correction of congenital heart defects.

Abstract: Background : The long-term impact of surgical correction of congenital heart defects (CHD) on exercise capacity and quality of life (QoL) has not been well established. Aim : To evaluate exercise capacity, QoL, physical activity and depression in young adult patients with a history of congenital heart defect surgery (GUCH) for simple left-to-right shunts, and to compare these parameters with those obtained in healthy volunteers. Methods : The study group consisted of 30 young adults with congenital heart defects (14 males, 16 females), aged 18–36 (mean 24.6) years who underwent corrective cardiac surgery at least 10 years earlier. The control group comprised 30 healthy students (15 males, 15 females), aged 21–28 (mean 24.4) years. We performed cardiopulmonary exercise testing on bicycle ergometer, QoL and physical activity tests, and depression inventory. Results : In young adult GUCH patients the exercise parameters were lower when compared to healthy peers. The Stanford questionnaire showed that physical activity was diminished as well as QoL in EuroQoL5 test. The Beck inventory showed more expressed depression in GUCH group. Conclusions : The exercise capacity, physical activity and QoL of young adults with a history of surgical treatment of CHD are worse than observed in healthy peers, and the health status does not fulfil the definition of complete recovery. Kardiol Pol 2011; 69, 8: 810–815

The significance of anaemia in patients with acute ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention.

Abstract: Background: The effects of pre-existing anaemia on the occurrence and course of an acute coronary syndrome has recently become a topic of extensive research. The data on the significance of anaemia in patients with ST-elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI) are less abundant and the conclusions equivocal. Aim: To evaluate the incidence of anaemia and its impact on early outcomes in patients undergoing primary PCI for STEMI. Methods: Based on a retrospective review of the medical records of hospitalised patients we selected a study group comprising 551 consecutive patients with STEMI, including 164 females, mean age 63.4 ± 12 years, undergoing primary PCI within the first 12 hours after the onset of chest pain. Anaemia was diagnosed according to the World Health Organisation criteria based on haemoglobin (Hb) values on admission ( Results: Anaemia was diagnosed in 61 (11%) patients (in 13% of females and 10% of males). The anaemic patients were older (71 vs 63 years, p Conclusions: Patients with anaemia who develop STEMI are, right from the admission, a separate, higher-risk population of patients with considerably increased risk of death and in-hospital cardiovascular complications. The unfavourable impact of anaemia on outcomes in patients with acute MI undergoing PCI is complex and cannot be explained by the increased extend of post-infarction myocardial damage. In patients with STEMI, anaemia on admission should be treated as an additional risk factor. Kardiol Pol 2011; 69, 1: 33-39

Impact of MTHFR C677T gene polymorphism and vitamins intake on homocysteine concentration in the Polish adult population

Abstract: Background : Homocysteine (Hcy) levels are modulated by nutritional and genetic factors, among which is the enzyme 5,10-methylenetetrahydrofolate reductase (MTHFR). Aim : To determine the effects of the MTHTR C677T polymorphism, as well as the intake of folate, vitamins B 6 and B 12 on serum Hcy concentration in the Polish population. Methods : Within the framework of the National Multicentre Health Survey (WOBASZ), a representative sample of the whole Polish population aged 20–74 was screened in 2003–2005. Vitamins intake, Hcy level and known MTHTR C677T genotype were available for 1,561 men and 1,712 women. Results : In the Polish population, T/T, C/T and C/C genotype frequencies were 10%, 43% and 47%, respectively in men, and 9%, 42% and 49%, respectively in women. The T/T genotype was associated with increased levels of Hcy (13.14 μmol/L in men, and 9.77 mmol/L in women) compared to the C/C and C/T genotypes (10.18 and 8.77, respectively), after adjustment for age, methionine, coffee and alcohol intake, smoking and drugs used. In a multivariable linear regression model, among subjects with the T/T genotype, the only factor influencing Hcy was age in women. In the case of the other groups (C/C and C/T), there was a relationship between Hcy and age, alcohol consumption, drugs used, folate and vitamin B 6 in men, and age, smoking, coffee consumption, drugs used, folate and vitamin B 12 in women. Conclusions : The T/T genotype is associated with higher levels of Hcy (29% in men, and 11% in women) compared to other genotypes. Nutritional factors affect Hcy levels only in the C/C and C/T MTHFR genotypes. Kardiol Pol 2011; 69, 12: 1259–1264

Prospective randomised pilOt study evaLuating the safety and efficacy of hybrid revascularisation in MultI-vessel coronary artery DisEaSe (POLMIDES) - study design.

Abstract: Background : Hybrid coronary artery revascularisation (HCR) is a combination of minimally invasive left internal mammary artery bypass grafting to the left anterior descending artery (LAD) and percutaneous coronary interventions (PCI) with drug eluting stent implantation to other coronary arteries. Due to the paucity of data from large, prospective randomised trials comparing HCR to standard surgical revascularisation, the POLMIDES study has been designed to assess the safety and efficacy of HCR in patients with multivessel coronary artery disease (CAD) referred for standard coronary artery bypass grafting (CABG). Aim : The primary objective is evaluating the feasibility and safety of HCR. Methods : Feasibility has been defined by means of the percentage of patients with a complete hybrid procedure according to the study protocol and a percentage of conversion to standard CABG. Safety has been defined as the occurrence of major adverse cardiac events such as death, myocardial infarction, stroke, repeat revascularisation and major bleeding within the 12 month period after randomisation. All consecutive patients with angiographically confirmed multivessel CAD involving LAD and a critical (> 70%) lesion in at least one major epicardial vessel (except LAD) amenable to both PCI and CABG referred for conventional surgical revascularisation, will be randomised in a 1:1 fashion for HCR or standard surgical revascularisation. Conclusions : The POLMIDES is a prospective, randomised pilot trial designed to determine whether HCR in patients with multivessel CAD referred for conventional CABG is safe, feasible and efficacious (ClinicalTrials.gov number, NCT01035567). Kardiol Pol 2011; 69, 5: 460–466

The value of ECG parameters in estimating myocardial injury and establishing prognosis in patients with acute pulmonary embolism

Abstract: Background : The electrocardiogram (ECG) is characterised by little sensitivity and specificity in the diagnostic evaluation of acute pulmonary embolism (APE). Aim : To assess the significance of ECG changes in predicting myocardial injury and prognosis in patients with APE. Methods : The study group consisted of 225 patients (137 women and 88 men), mean age: 66.0 ± 15.2 years, in whom the diagnosis of APE was made, mostly based on computed tomography (n = 206, 92%). Results : We observed 26 in-hospital deaths (mortality rate: 11.5%) and complications occurred in 58 (25.7%) patients. Elevated levels of troponin were observed in 103 (46%) patients. Logistic regression analysis showed that in-hospital mortality was associated with: coronary chest pain (0.06–0.53, OR 0.18), systolic blood pressure below 100 mm Hg (2.3–13.64, OR 5.61), heart rate above 100 bpm (1.17–15.11, OR 4.21), the S1Q3T3 sign (1.31–6.99, OR 3.02), QR in V 1 (1.60–12.32, OR 4.45), ST-segment depression in V 4 –V 6 (0.99–5.40, OR 2.31), ST-segment elevation in III (0.99–6.96, OR 2.64), ST-segment elevation in V 1 (1.74–9.49, OR 4.07); borderline (1.51–16.07, OR 4.93), moderate (1.42–17.74, OR 5.01) and severe troponin elevation (2.88–36.38, OR 10.24). In patients with cTnT(+), compared to patients with normal troponin levels, the following ECG changes were significantly more common: the S1Q3T3 sign (43 vs 21%, p = 0.003), negative T waves in V 2 –V 4 (57 vs 27%, p = 0.0001), ST-segment depression in V 4 –V 6 (40 vs 14%, p = 0.001), ST-segment elevation in III (22 vs 7%, p = 0.0006), V 1 and V 2 (43 vs 10%, p = 0.0001) and QR in V 1 (16 vs 5%, p = 0.007). Conclusions : ECG parameters are useful in predicting myocardial injury and assessing prognosis in patients with APE. Kardiol Pol 2011; 69, 9: 933–938

The effects of cardiac rehabilitation on haemodynamic parameters measured by impedance cardiography in patients with heart failure.

Abstract: Background: Cardiac rehabilitation (CR) is an important element of heart failure (HF) treatment although the mechanisms of its beneficial effects remain debatable. Aim: To evaluate the haemodynamic effects of CR measured by impedance cardiography in patients with HF. Methods: Study group included 50 HF patients (aged 56.2 ± 8.8 years, NYHA class II and III, left ventricular ejection fraction ≤ 40%) who underwent 8-week CR. Clinical and haemodynamic assessment was performed before and after CR. Results: As a result of CR, exercise tolerance improved significantly as measured by peakVO 2 (18.7 ± 4.4 vs 20.8 ± 4.7 mL/kg/min; p = 0.025), six-minute walking test distance (6-MWT; 417.8 ± 103.6 vs 467.7 ± 98.4 m, p = 0.016) and NYHA class (change to the lower NYHA class in 30% of subjects). A significant reduction of the left atrial diameter was observed in echocardiography (4.55 ± 0.63 vs 4.43 ± 0.59 cm, p = 0.017). Impedance cardiography revealed a significant change in diastolic to systolic wave ratio (O/C ratio; 54.8 ± 24.0 vs 47.9 ± 20.8%, p = 0.021). A significant change in the haemodynamic profile of the left ventricular blood ejection was also observed. Before CR, transthoracic fluid content (TFC) correlated with stroke index (SI; R = 0.37, p 2 (R = 0.40, p = 0.006). Subjects who benefited from CR tended to have lower heart rate (61.4 ± 9.0 vs 67.7 ± 10.7 1/min, p = 0.07), longer pre-ejection period (PEP; 12.2 ± 11.6 ms vs -2.6 ± 23.1 ms, p = 0.018) and non-significantly higher STR (0.423 ± 0.123 vs 0.377 ± 0.102, p = 0.37). Conclusions: Impedance cardiography revealed beneficial effects of CR, manifested by reduced fluid retention and a reduced effect of preload on left ventricular relaxation and ejection. Kardiol Pol 2011; 69, 4: 309-317

The effects of intracoronary delivery of mononuclear bone marrow cells in patients with myocardial infarction: a two year follow−up results

Abstract: Background : Transplantation of bone marrow stem cells (BMSC) is a new method of prevention of left ventricular (LV) remodelling in post-infarction patients. Studies published to date point to LV systolic and diastolic function improvement following this therapy however only a few studies assessed the long-term effects of BMSC. Aim : To assess the 2 year prognosis in patients with anterior myocardial infarction (MI) treated with BMSC transplantation in the acute phase. Methods : The study group consisted of 60 patients with first anterior ST-segment elevation MI (STEMI), treated with primary percutaneous angioplasty, with baseline LV ejection fraction (LVEF) Results : Absolute increase of LVEF compared to baseline values was higher in the BMSC group than in the control group. The LVEF increase in BMSC group at 1 month was 7.1% (95% CI 3.1–11.1%), at 6 months — 9.3% (95% CI 5.3–13.3%), at 12 months — 11.0% (95% CI 6.2–13.3%) and at 24 months — 10% (95% CI 7.2–12.1%). In the control group, LVEF increase was 3.7% (95% CI 2.3–9.7%) at 1 month, 4.7% (95% CI 1.2–10.6%) at 6 months, 4.8% (95% CI 1.5–11.0%) at 12 months and 4.7% (95% CI 1.4–10.7%) at 24 months. The composite end-point occurred significantly more frequently in the control group (55%) than in the BMSC group (23%): OR 2.72; 95% CI 1.06–7.02, p = 0.015. Conclusions : Treatment with mononuclear bone marrow cells on day 7 of the first anterior MI in patients with significant baseline systolic dysfunction improves 2-year outcome. Kardiol Pol 2011; 69, 12: 1234–1240

Usefulness of echocardiography in the identification of an excessive increase in pulmonary arterial pressure in patients with systemic sclerosis

Abstract: Background: In systemic sclerosis (SSc), changes in the lungs and pulmonary hypertension (PH) are complications most adversely affecting the prognosis. Given the availability of specific treatment, early diagnosis of PH is very important. Exercise echocardiography, by increasing the patient’s cardiac output, makes it possible to identify patients with elevated pulmonary artery pressure (PAP) during exercise. The diagnostic role of exercise echocardiography is still unclear, mainly because of the lack of prospective studies. Aim: To identify SSc patients with abnormally elevated PAP at rest or with a significant increase PAP during exercise, subsequently verified by right heart catheterisation (RHC). Methods: A total of 71 consecutive patients (67 females and 4 males, mean age 56.9 ± 17.1 years) with SSc diagnosed according to the American College of Rheumatology criteria were enrolled in this prospective study. The patients underwent transthoracic echocardiography (Philips iE33) with the measurement of tricuspid regurgitation peak gradient (TRPG) and an exercise test involving the standard treadmill exercise according to the Bruce protocol with the evaluation of TRPG at 1 min following the completion of exercise. The PH was suspected when TRPG at rest was > 31 mm Hg (V max > 2.8 m/s) or increased by at least 20 mm Hg from baseline following exercise. Patients with suspected PH were referred for resting and exercise RHC. Results: The exercise testing was performed in 67 patients revealing normal left ventricular (LV) systolic function in all of them. The mean LV ejection fraction was 66.1% ± 3.9%. The TRPG at rest could be recorded in 65 (97%) patients with the mean value of 26.9 ± ± 7.6 mm Hg (range 17–57 mm Hg). A resting TRPG of > 31 mm Hg, suggestive of possible PH, was demonstrated in 14 (21%) patients. During exercise test 56 (84%) patients achieved the maximum heart rate. A Doppler spectrum enabling the measurement of TRPG following the exercise was obtained in 66 (98.5%) patients. The gradient following the exercise could not be measured in one patient with a resting TRPG of 30 mm Hg. The mean post-exercise TRPG was 40.3 ± 4.1 mm Hg (range 17–70) and the mean post-exercise increase in TRPG was 12.9 ± 8.5 mm Hg (range 2–38). A TRPG increase of > 20 mm Hg was found in 11 (16%) patients (including 4 patients with resting values exceeding 31 mm Hg and 7 patients with normal resting values). Twenty-one (31%) patients with echocardiographic suspicion of PH (TRPG > 31 mm Hg at rest and/or a post-exercise increase in TRPG of more than 20 mm Hg) were referred for RHC with 16 patients actually undergoing the procedure. Four out of these 16 patients were qualified because of the “positive” exercise echocardiography in the presence of normal TRPG values. During catheterisation arterial PH was found in 2 patients, and an excessive precapillary PAP elevation in 2 further patients. Resting venous PH was found in 1 patient and an excessive postcapillary PAP elevation at rest was demonstrated in 11 patients. Conclusions: Exercise echocardiography is a safe and useful screening tool for PH diagnosis in patients with SSc. It enables to identify patients with normal systolic PAP at rest but a significant increase during exercise. The final confirmation of PH and differentiation between precapillary arterial and postcapillary venous PH requires RHC. Kardiol Pol 2011; 69, 1: 9-15

The effects of osteoprotegerin (OPG) gene polymorphism in patients with ischaemic heart disease on the morphology of coronary arteries and bone mineral density.

Abstract: Background : The incidence of coronary artery disease (CAD) and osteoporosis increases with age, especially in the elderly. Many studies have shown that vessel calcification is associated with low bone mineral density (BMD) and an increased risk of bone fractures. Experimental studies have shown that osteoprotegerin ( OPG ) gene knockout mice have aortic calcification and osteoporosis at the same time. Aim : To assess the frequency of OPG gene polymorphisms in patients with CAD and to analyse the relationship between the severity of CAD and BMD. Methods : The study group comprised 31 postmenopausal women (mean age 65.6, range 39–82 years) undergoing elective coronary angiography for CAD symptoms. The BMD was measured at the hip by dual X-ray absorptiometry (DEXA). Clinical data were collected using a questionnaire developed by the authors which addressed CAD risk factors, treatment, previous diagnosis of osteoporosis and the risk factors of osteoporosis. The control group consisted of 30 postmenopausal women attending the osteoporosis clinic without the history of CAD (mean age 70.5, range 56–84 years). Written informed consent was obtained from all the patients. Genotyping of two polymorphisms 209, 245 in the promoter region and 1181 in the exon of the OPG gene was performed in both groups. Results : Coronary angiography in study group revealed normal coronary arteries in 35% (n = 11) of the women. The analysis of 209 C/T polymorphism showed no presence of TT homozygotes in either group. Also, no significant differences between the 209 C/T polymorphic variants, BMD and progression of atherosclerosis in coronary arteries were found. In both groups no CC homozygous variants for 245 A/C were revealed. However, a statistically significant relationship between 245 A/C polymorphism and BMD was shown. The AC carriers had osteoporosis more frequently (57%) than AA carriers (12%) of the OPG gene (p = 0.0382). There were no significant differences in the OPG gene 245 A/C polymorphisms and CAD progression. Homozygotes for CC 1181 were shown to have normal coronary arteries more frequently (60%) than heterozygotes for CG 1181 (29%; p = 0.0023). We failed to show significant differences between 1181 C/G polymorphism and BMD in both groups. Conclusions : 1. This study revealed a significant association between homozygotes for AA 245 and normal BMD in study group. 2. The analysis of 209 C/T and 245 C/T C polymorphisms has shown no presence of homozygotes for TT 209 OPG or CC 245 OPG in both groups. 3. Carriers of the homozygous CC 1181 OPG gene were shown to have normal coronary arteries more frequently when compared to heterozygotes for CG or homozygotes for GG. Kardiol Pol 2011; 69, 6: 573–578

Two-dimensional longitudinal strain for the assessment of the left ventricular systolic function as compared with conventional echocardiographic methods in patients with acute coronary syndromes.

Abstract: Background: The evaluation of the left ventricular (LV) function is one of the most important elements of diagnosis in patients with cardiovascular (CV) diseases. A low LV ejection fraction (LVEF) is a strong and independent predictor of CV events. Traditionally, echocardiography characterises the LV systolic function by the estimation of LVEF with use of the Simpson method, supported by the wall motion score index (WMSI). Speckle tracking imaging is a new method of LV function imaging based on the estimation of longitudinal peak systolic strain (LPSS), by tracing of the automatically detected myocardial speckles. Aim: To evaluate the usefulness of global longitudinal peak systolic strain (GLPSS) and regional longitudinal peak systolic strain (r-LPSS) in LV systolic function assessment and to compare LPSS with conventional parameters such as LVEF, WMSI and regional wall motion score index (r-WMSI). Methods: The study was performed in a group of 44 patients with a clinical diagnosis of acute coronary syndrome (mean age 63.6 ± 12.2 years). The LVEF, WMSI, r-WMSI were estimated by echocardiography (VIVID 7 Dimension, GE Healthcare, USA). Moreover, LPSS (GLPSS and r-LPSS) with use of automated function imaging (AFI) were also estimated. Results: In the study group mean LVEF was 43.1 ± 12.7%, mean WMSI: 1.68 ± 0.52, and GLPSS: -13.8 ± 5.6%. A very strong linear correlation between the conventional and new parameters was observed - for GLPSS and LVEF: r = -0.86 (p Conclusions: These results suggest a considerable usefulness of LPSS - a new method of echocardiographical imaging - in the estimation of global and regional LV function in patients with acute coronary syndrome and its agreement with conventional parameters such as LVEF and WMSI. Kardiol Pol 2011; 69, 4: 357-362

Direct comparison of the diagnostic value of point-of-care tests detecting heart-type fatty acid binding protein or glycogen phosphorylase isoenzyme BB in patients with acute coronary syndromes with persistent ST-segment elevation.

Abstract: Background: Myocardial infarction (MI) with its complications is one of the most serious challenges in contemporary cardiology. Among biochemical markers of myocardial necrosis, heart-type specific fatty acid binding protein (h-FABP) showed excellent sensitivity and specificity for the early diagnosis of an acute MI. The h-FABP is released rapidly (after 30 min) from the cardiomiocyte to the circulation in response to myocardial injury and may be useful for rapid confirmation or exclusion of MI. In recent years, glycogen phosphorylase BB (GP-BB) also emerged as a promising early specific marker of myocardial necrosis. Rapid, qualitative "point of care" tests (POCT) detecting h-FABP (Cardio Detect med) and GP-BB (Diacordon) have recently become available. Aim: To evaluate and compare qualitative POCTs detecting h-FABP and GP-BB in patients with an acute coronary syndrome (ACS). Methods: We studied 52 patients with a strong suspicion of ACS with persistent ST-segment elevation and chest pain lasting less than 6 hours. The ultimate diagnosis of ST-segment elevation MI (STEMI) was confirmed in case of a second (6 h after admission) positive quantitative result of a cardiac troponin T (cTnT) test. On admission, POCTs to detect both h-FABP and GP-BB were performed. The study population was divided into two groups, with chest pain lasting Results: The sensitivity of h-FABP (84%) was superior in comparison to the other biomarkers, GP-BB and cTnT, which had sensitivity of 64% and 50%, respectively. Comparison of typical parameters of the diagnostic value of a test (sensitivity, predictive values and accuracy) in both time periods demonstrated that h-FABP was superior to GP-BB. In particular, sensitivity and accuracy of h-FABP was excellent in the group of patients with chest pain lasting Conclusions: The h-FABP seems to be an excellent early biomarker of cardiac necrosis in the group of patients with chest pain lasting Kardiol Pol 2011; 69, 1: 1-6

Impact of multivessel coronary disease on one-year clinical outcomes and five-year mortality in patients with ST-elevation myocardial infarction undergoing percutaneous coronary intervention

Abstract: Background: Multivessel coronary disease (MVD) occurs in approximately 40–65% of patients with ST-segment elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention (PCI), and is associated with significantly increased morbidity and mortality rates. Aim: To evaluate the impact of MVD on in-hospital and long-term clinical outcomes in patients with STEMI and PCI, and to compare these results with those from a group of patients with a single coronary vessel disease (SVD). Methods: Consecutive patients with STEMI treated with PCI were included in the analysis. Patients were divided into two groups: patients with SVD (n = 828, 46.6%) and patients with MVD (n = 948, 53.4%). Clinical follow-up was performed at 12 months, and five-year mortality was assessed. Major adverse cardiac events (MACE) at 12-month follow-up were defined as death (from any cause), stroke, need for percutaneous or any surgical coronary artery revascularisation, and non-fatal myocardial infarction. Results: The in-hospital mortality was 2.9% vs 9.5% (p Conclusions: The presence of MVD in patients with STEMI is a strong and independent risk factor for higher long-term mortality. Kardiol Pol 2011; 69, 4: 336-343

Efficacy and safety of closing postcatheterisation pseudoaneurysms with ultrasound−guided thrombin injections using two approaches: bolus versus slow injection. A prospective randomised trial

Abstract: Wstep : Rutynowe stosowanie przezskornych zabiegow interwencyjnych w kardiologii i radiologii interwencyjnej wiąze sie ze wzrostem czestości wystepowania jatrogennych tetniakow rzekomych (JTR). W latach 2005–2006 w Klinice Kardiologii CMKP rozpoczeto stosowanie alternatywnego sposobu podawania trombiny do jamy JTR. Z doświadczenia autorow wynikalo, ze podanie określonej dawki trombiny w szybkim pojedynczym wstrzyknieciu (bolus) do jamy JTR powoduje szybszą dystrybucje leku, znaczące skrocenie czasu potrzebnego do wykrzepienia krwi i zmniejszenie dawki leku. Ponadto podejrzewano, ze zastosowanie metody szybkiej iniekcji trombiny do światla naczynia moze byc obiecującą, alternatywną metodą w leczeniu JTR bez szyi. Cel : Celem pracy bylo porownanie skuteczności i bezpieczenstwa dwoch sposobow przezskornego podawania trombiny (powolny wlew v. bolus) pod kontrolą USG do jamy JTR. Metody : Pacjenci byli losowo wlączani do zabiegu przezskornego leczenia tetniakow rzekomych w bolusie lub powolnej iniekcji. Przed podaniem trombiny do jamy JTR mierzono dlugośc i średnice szyi tetniaka, predkośc przeplywu krwi w szyi i liczbe jam. Przed zabiegiem, w trakcie trwania i po zabiegu mierzono saturacje krwi na paluchu stopy konczyny z tetniakiem rzekomym w celu wykrycia cech mikroebolizacji. Po zabiegu określano dawke podanego leku i czas tworzenia stabilnej skrzepliny oraz rejestrowano kliniczne objawy obwodowej embolizacji. W okresie 01.2006–12.2009 z grupy 7500 chorych poddanych procedurom inwazyjnym (koronarografia, angioplastyka, ablacja) do badania wlączono kolejnych 73 pacjentow (33 mezczyzn, 40 kobiet) w wieku średnio 67,8 ± 11,9 roku z rozpoznanym JTR. Do grupy leczonej bolusem wlączono 40 osob, do grupy leczonej powolną iniekcją — 33 pacjentow. Wyniki : Skutecznośc obu metod w leczeniu tetniakow rzekomych wynosila 100% do dnia wypisu w obu grupach i 100% v. 96.8% w obserwacji 3-miesiecznej (bolus v. wlew). Skutecznośc zabiegu nie zalezala od dlugości i średnicy szyi. Niezaleznymi czynnikami embolizacji obwodowej byly: dawka stosowanego leku (OR 4,2; 95% CI 0,92–19,3), dlugośc szyi (OR 4,66; 95% CI 1,1–19,9) i wiek > 80 lat (OR 10,9; 95% CI 1.0–116.8). W grupie leczonej metodą bolusa stwierdzono istotnie cześciej embolizacje obwodową niz w grupie leczonej powolną iniekcją (OR 7,6; 95% CI 1,3–44,9). Zaobserwowano zjawisko niemej klinicznie mikroembolizacji, ktora wystąpila w 38% przypadkow w grupie, w ktorej zastosowano bolus i 33% w grupie powolnego wlewu. Wnioski : Zamykanie tetniakow rzekomych dwoma sposobami podania trombiny przy zastosowaniu malych dawek leku jest skutecznym sposobem leczenia. Obie metody (wlew lub bolus) są skuteczne i bezpieczne w przypadku tetniakow z szyją lub bez szyi. W badaniu zaobserwowano zjawisko niemej klinicznie mikroembolizacji. Kardiol Pol 2011; 69, 9: 898–905

Transcatheter aortic valve implantation using transfemoral/transsubclavian or transapical approach: 30-day follow-up of the initial 30 patients

Abstract: Background: Transcatheter aortic valve implantation (TAVI) is a new method for the treatment of aortic stenosis (AS). Aim: To evaluate early results of TAVI using transfemoral/transsubclavian approach (TFA/TSA) or transapical approach (TAA) in patients with severe AS and high risk for surgical aortic valve replacement. Methods: Between January 2009 and May 2010, 30 high-risk patients underwent TAVI. The primary treatment option was TFA, and TAA was used if contraindications to TFA were present; one patient underwent the procedure using TSA. Reasons for selecting TAA were as follows: small diameter ( Results: Mean patient age was 82.46 ± 5.79 years, mean NYHA class was 3.23 ± 0.41, and predicted mean surgical mortality using logistic Euroscore was 29.18 ± 16.9% (22.72 ± 12.07% in the TFA/TSA group vs 34.6 ± 15.4% in the TAA group; p = 0.031). Eleven patients were treated using TAA. The valve was implanted successfully in 96% of patients. Inhospital mortality was 3.3%. Mean 30-day mortality was 6.6% in the entire cohort, 0% in the TFA/TSA group and 18% in the TAA group. There were no cases of periprocedural myocardial infarction (MI), cardiogenic shock, stroke/transient ischaemic attack, or need for cardiopulmonary resuscitation. One patient died suddenly three weeks after the procedure; except for this case, there were no major adverse cardiovascular events (MACCE: MI, cerebrovascular accident, re-do procedure) at 30-day follow-up. The TAVI was associated with a significant reduction in the mean maximal aortic gradient in both groups (from 99.6 ± 22.07 mm Hg to 21.83 ± 9.38 mm Hg post-procedure and to 23.25 ± 9.22 mm Hg at 30-day follow up), with no cases of severe aortic valve regurgitation. The NYHA class at 30 days improved from 3.23 ± 0.41 to 1.72 ± 0.52 (p = 0.03). Conclusions: Our results demonstrate lower 30-day complication rate and mortality in the TFA/TSA group. The availability of several techniques of valve implantation in the group of non-surgical patients with severe AS potentially broadens the patient population with indications for this treatment. Kardiol Pol 2011; 69, 2: 105-114

Patent ductus arteriosus at low and high altitudes: anatomical and haemodynamic features and their implications for transcatheter closure.

Abstract: Background : Living at high altitude increases the prevalence of patent ductus arteriosus (PDA) and may affect its morphology. Aim : To compare the anatomical and haemodynamic features of isolated PDA in patients living at low and high altitudes (1,500–4,200 metres above sea level — m.a.s.l.). Methods : We studied retrospectively data from 1,404 consecutive patients — 708 living in lowland areas (group L) and 696 in highland areas (group H), in whom transcatheter closure of PDA was attempted. The mean age of the patients in group L was 9.9 ± 13.5 years and in group H it was 8.2 ± 19.7 years. Results : The diameter of PDA in group L was 2.3 ± 1.3 mm and 4.1 ± 1.2 mm in group H (p Conclusions : In catheterised patients with PDA living at high altitude, larger ductal diameter, anatomic type A and higher pulmonary artery pressure were more frequently observed. This finding has important implications for future strategy regarding transcatheter closure in populations living at different altitudes. Kardiol Pol 2011; 69, 5: 431–436

Resolution of exercise oscillatory ventilation with adaptive servoventilation in patients with chronic heart failure and Cheyne−Stokes respiration: preliminary study

Abstract: Background : Exercise oscillatory ventilation (EOV) is a common pattern of breathing in heart failure (HF) patients, and indicates a poor prognosis. Aim : To investigate the effects of adaptive servoventilation (ASV) on ventilatory response during exercise. Methods : We studied 39 HF patients with left ventricular ejection fraction (LVEF) £ 45. Cardiorespiratory polygraphy, cardiopulmonary exercise testing (CPET), echocardiography, and measurement of N-terminal pro-brain natriuretic peptide (NT-proBNP) concentration were performed. Twenty patients with Cheyne-Stokes respiration and apnoea–hypopnoea index (AHI) ≥ 15/h were identified. Of these, 11 patients were successfully titrated on ASV and continued therapy. In the third month of ASV treatment, polygraphy, CPET, echocardiography, and measurement of NT-proBNP concentration were performed again. Results : The EOV was detected at baseline in 12 (31%) HF patients, including eight (67%) who underwent ASV. The EOV was associated with significantly lower LVEF, peak oxygen uptake (VO 2 ), and ventilatory anaerobic threshold (VAT), and a significantly higher left ventricular diastolic diameter (LVDD), slope of ventilatory equivalent for carbon dioxide (VE/VCO 2 ), AHI, central AHI and NT-proBNP concentration. In seven patients with EOV, reversal of EOV in the third month of ASV therapy was observed; only in one patient did EOV persist (p = 0.0156). Conclusions : The EOV can be reversed with ASV therapy. The EOV in association with central sleep apnoea and Cheyne- -Stokes respiration (CSA/CSR) is prevalent in HF patients and correlates with severity of the disease. Kardiol Pol 2011; 69, 12: 1266–1271

The prognostic value of ST-segment elevation in the lead aVR in patients with acute pulmonary embolism.

Abstract: Background : Electrocardiogram (ECG) in patients with acute pulmonary embolism (APE) presents many abnormalities. There are no data concerning prognostic significance of ST-elevation (STE) in lead aVR in patients with APE. Aim : To assess the prevalence of STE in aVR in patients with APE and its correlation with clinical course as well as other ECG parameters recorded at admission. Methods : The retrospective analysis of 293 patients with APE diagnosed according to the ESC guidelines (182 females, 111 males, mean age 65.4 ± 15.5 years). Results : The STE in lead aVR was observed in 133 (45.3%) patients. In comparison with patients without STE, patients with STE in lead aVR (STaVR[+]) had significantly more often systolic blood pressure 4 –V 6 (48.9% vs 7.5%, p Conclusions : The presence of STE in lead aVR in patients with APE is associated with poor prognosis. The presence of STE in lead aVR could be an easily obtainable and noninvasive ECG parameter, helpful in risk stratification of patients with APE. Kardiol Pol 2011; 69, 7: 649–654