Agnieszka Wachsmann

Influence of air pollution on exhaled carbon monoxide levels in smokers and non-smokers. A prospective cross-sectional study

Background The poor air quality and cigarette smoking are the most important reasons for increased carbon monoxide (CO) level in exhaled air. However, the influence of high air pollution concentration in big cities on the exhaled CO level has not been well studied yet. Objectives To evaluate the impact of smoking habit and air pollution in the place of living on the level of CO in exhaled air. Methods Citizens from two large cities and one small town in Poland were asked to complete a survey disclosing their place of residence, education level, work status and smoking habits. Subsequently, the CO level in their exhaled air was measured. Air quality data, obtained from the Regional Inspectorates of Environmental Protection, revealed the differences in atmospheric CO concentration between locations. Results 1226 subjects were divided into 4 groups based on their declared smoking status and place of living. The average CO level in exhaled air was significantly higher in smokers than in non‐smokers (p<0.0001) as well as in non‐smokers from big cities than non‐smokers from small ones (p<0.0001). Created model showed that non‐smokers from big cities have odds ratio of 125.3 for exceeding CO cutoff level of 4 ppm compared to non‐smokers from small towns. Conclusions The average CO level in exhaled air is significantly higher in smokers than non‐smokers. Among non‐smokers, the average exhaled CO level is significantly higher in big city than small town citizens. These results suggest that permanent exposure to an increased concentration of air pollution and cigarette smoking affect the level of exhaled CO. HighlightsThere is increased exhaled carbon monoxide in big, polluted cities citizens.Higher level of CO in exhaled air in smokers than non‐smokers has been observed.Increased exhaled CO level is 125 times more likely in big cities than small towns.

Urinary cysteinyl leukotrienes in one-year follow-up of percutaneous transluminal angioplasty for peripheral arterial occlusive disease

BACKGROUND AND AIMS Treatment of severe peripheral arterial occlusive disease requires percutaneous revascularization. However, little is known about risk factors or predictors for reocclusion/restenosis. Cysteinyl leukotrienes are highly bioactive lipid mediators of inflammation. Their intravascular production may take place in the atheromatous plaque or result from interaction within activated leukocyte-platelet aggregates. METHODS We prospectively measured urinary leukotriene E4, the main end-metabolite of cysteinyl leukotrienes in a group of 179 subjects with peripheral artery occlusive disease of the lower extremities. At the enrollment to the study, 22.9% had angioplasty and the remaining had angioplasty with stent implantation. During 12-month follow-up, 29.6% developed reocclusion/restenosis despite a standard pharmacotherapy. We evaluated treatment outcomes at 1, 3, 6 and 12-month follow-up visits, along with urinary leukotriene E4 excretion. RESULTS During the study period, we observed a linear increase of urinary leukotriene E4 excretion only in subjects whose lower limb ischemia worsened. Moreover, elevated leukotriene E4 in urine was found only in subjects who developed reocclusion/restenosis. This was significant not only as a coincidence at the time of the follow-up visit, but leukotriene E4 elevation preceded clinical manifestation of reocclusion/restenosis. CONCLUSIONS Our results demonstrated that serial measurements of urinary leukotriene E4 allowed to predict failure of angioplasty with/or without stent implantation for peripheral artery occlusive disease. However, to prove causality between cysteinyl leukotrienes overproduction and occlusive lower limb ischemia, a clinical trial with leukotrienes modifying drugs would be required.

Dynamics of below-the-knee arterial blood flow after endovascular revascularization of peripheral arteries as a potential predictor of clinical outcomes during a one-year follow-up period

BACKGROUND Patients with advanced lower limb ischaemia are, at present, mainly treated using revascularisation. AIM The aim of the study was to investigate whether the dynamics of blood flow in below-the-knee (BTK) arteries assessed by angiography correlate with clinical outcomes after a 12-month follow-up in patients with severe leg ischaemia treated per-cutaneously. METHODS The current study enrolled 287 consecutive patients who underwent 302 endovascular procedures on the infrain-guinal arteries. The mean age of the included participants was 67.4 ± 10.4 years. After the procedure, blood flow in all patent BTK arteries was assessed using frame count (FC). Patients were then evaluated after one, three, six, and 12 months. During the follow-up visits, clinical condition was evaluated based on the Rutherford scale, ankle-brachial index, and the need for reintervention or amputation. RESULTS Clinical improvement at the end of the follow-up period was observed in 242 (80.1%) cases and no improvement or worsening in was seen in 42 (13.0%) patients. In total, 66 (21.8%) reinterventions and 18 (6%) amputations during the follow-up period were recorded. Patients with higher FC in the tibial anterior artery experienced significantly better clinical improvement within the 12-month follow-up period (p = 0.02). Lower FC predisposed to worse clinical outcomes after an-gioplasty. Similar tendencies were found for the tibial posterior and fibular arteries but without statistical significance. CONCLUSIONS The results suggest a negative relationship between FC observed on the final angiogram and clinical outcomes in patients undergoing endovascular treatment of the peripheral arteries.