Agata Bielecka-Dąbrowa

Malignancy-Associated Dyslipidemia

Cholesterol and triglycerides, important lipid constituents of cell, are essential to carry out several vital physiological functions. Lipids might be associated with cancers because they play a key role in the maintenance of cell integrity. The pathway for cholesterol synthesis may also produce various tumorigenic compounds and cholesterol serves as a precursor for the synthesis of many sex hormones linked to increased risk of various cancers. In some malignant diseases, blood cholesterol undergoes early and significant changes. The mechanism for the link between cancer and cholesterol remains controversial. The dates from studies are confusing because both hypolipidemia and hypercholesterolemia might be connected with malignancy. Not only cancers but also antineoplastic therapies have an influence on lipid profile. There are also dates suggesting that antihyperlipemic drugs might nfluenced malignancy.

Influence of co-existing atrial fibrillation on the efficacy of atorvastatin treatment in patients with dilated cardiomyopathy: a pilot study

IntroductionThe aim of the study was to assess the influence of co-existing atrial fibrillation (AF) on inflammatory condition factors, left ventricular function, clinical course and the efficacy of statin treatment of congestive heart failure in the course of dilated cardiomyopathy (DCM).Material and methodsIn a prospective, randomized, open-label study, 69 patients with DCM and left ventricular ejection fraction (LVEF) ≤40% were divided into two groups, with and without AF, who were treated according to the recommended standards. 68% of patients from the group with AF and 59% of patients from the group without AF were administered atorvastatin 40 mg daily for 8 weeks and 10 mg for next 4 months. Clinical examination with the assessment of body mass index (BMI) and waist size were followed by routine laboratory tests, measurement of concentration of tumor necrosis factor (TNF-α), interleukin-6 (IL-6), and IL-10 in blood plasma, N-terminal pro-brain natriuretic peptide (NT-proBNP) concentration in blood serum, echocardiographic examination, and the assessment of exercise capacity in 6-minute walk test (6-MWT). After six months, morbidity rate and the number of heart failure hospitalizations were also observed.ResultsIn the whole population of patients, a significantly higher concentration of NT-proBNP was observed in the AF group (2669 ± 2192 vs 1540 ± 1067, p = 0.02). After statin treatment, in patients with DCM and co-existing AF, higher values of NT-proBNP and IL-6 were observed compared to non-AF patients (1530 ± 1054 vs 1006 ± 1195, p = 0.04 and (14.16 ± 13.40 vs 6.74 ± 5.45, p = 0.02, respectively).ConclusionIn patients with DCM and co-existing AF, a weaker effect of atorvastatin concerning the reduction of IL-6 and NT-proBNP concentration was observed than in patients without atrial fibrillation.Trials Registration(ClinialTrial.gov No.: NCT01015144)

Redo surgery risk in patients with cardiac prosthetic valve dysfunction

Introduction The aim of the study was to analyse the risk factors of early and late mortality in patients undergoing the first reoperation for prosthetic valve dysfunction. Material and methods A retrospective observational study was performed in 194 consecutive patients (M = 75, F = 119; mean age 53.2 ±11 years) with a mechanical prosthetic valve (n = 103 cases; 53%) or bioprosthesis (91; 47%). Univariate and multivariate Cox statistical analysis was performed to determine risk factors of early and late mortality. Results The overall early mortality was 18.6%: 31.4% in patients with symptoms of NYHA functional class III-IV and 3.4% in pts in NYHA class I-II. Multivariate analysis identified symptoms of NYHA class III-IV and endocarditis as independent predictors of early mortality. The overall late mortality (> 30 days) was 8.2% (0.62% year/patient). Multivariate analysis identified age at the time of reoperation as a strong independent predictor of late mortality. Conclusions Reoperation in patients with prosthetic valves, performed urgently, especially in patients with symptoms of NYHA class III-IV or in the case of endocarditis, bears a high mortality rate. Risk of planned reoperation, mostly in patients with symptoms of NYHA class I-II, does not differ from the risk of the first operation.

The meaning of early percutaneous coronary intervention in acute coronary syndrome with preserved ST elevation

To determine if delaying the primary precutaneous coronary intervention (PCI) for >6 hours for acute coronary syndrome with preserved ST elevation (STE-ACS) affects the PCI angiography effectiveness and clinical prognosis. The PCI was performed: for 71% of patients <6h (group 1), for 29% of patients >6h from the beginning of pain (group 2). For 1% of patients from group 1 and 3.4% of patients from group 2, no passage has been opened in the artery after STE-ACS. In spite of opening the passage mechanically, the phenomenon of lack of tissue reflow occurred in 2.7% of patients from group 1 and 12% of patients from group 2. Dangerous ventricular arrhythmias occurred more frequently in patients from group 2, including VF, asystole, haemodynamic complications classed 4° according to the Killip-Kimball scale and death. In an univariate logistic regression analysis, the following risk factors for death during the hospital phase were identified: delayed PCI >6 hours, 4° haemodynamic complications according to the Killip-Kimball scale, LVEF <40%, FV, p-k III block, TIMI <3, and no-reflow. In a multivariate logistic regression analysis, 4° according to the Killip-Kimball scale turned out to be the only risk factor for death during the hospital phase. Delaying PCI during STE-ACS for >6 hours significantly lowers the statistical chance to recover both full permeability and effective tissue reflow in the artery responsible for STE-ACS, which is connected with a significantly higher risk of serious complications, as well as with 8.5% risk of death during the hospital phase. The most significant, independent factor determining the survival of patients with STE-ACS after PCI is lack of cardiogenic shock.

Udar jako wynik zatoru kardiogennego — charakterystyczne cechy w kontekście diagnostyki i wtórnej prewencji

Embolism of cardiac origin accounts for around 15–30% of ischaemic strokes. It is worth noting that stroke from a cardiac source carries a poorer outcome compared with other sources, having a 50% mortality at three years. Diagnosis of the cardioembolic source of stroke is frequently uncertain and relies on the identification of the potential cardiac source of embolism in the absence of significant autochthone cerebrovascular occlusive disease. Early diagnosis and appropriate treatment are mandatory to prevent the recurrent events that can lead to greater disability and the increased healthcare cost. Since cardioembolic stroke is not a single disease entity, its diagnosis requires initial clinical suspicion and a comprehensive evaluation, including electrocardiography, echocardiography, brain imaging, and cardiac monitoring. There are characteristic features suggestive of cardioembolic stroke, which help the clinicians to choose a right direction of diagnosis. The primary role of echocardiography is to establish the existence of the source of embolism, determine the likelihood that such a source is a plausible cause of stroke or systemic embolism, and guide the therapy in an individual patient. There is still a need for further studies assessing the optimal diagnostic methods of potential cardiac sources of embolism and establishment of the rules of the optimal medical prevention (antiplatelet therapy versus oral anticoagulation) and interventional procedures to reduce the incidence of ischaemic strokes.