Alicja Stępień-Wałek

Blood pressure load in adults with treated hypertension

BACKGROUND AND AIM To assess blood pressure (BP) load in a population of treated hypertensive patients. METHODS The study group consisted of 137 hypertensive adults, including 75 (54.75%) men and 62 (45.25%) women, with either formerly or newly diagnosed hypertension based on office BP measurements. The median age in the whole study group was 52 years (47 and 56 years among men and women, respectively). The mean body mass index (BMI) was 27 ± 4 kg/m², and median duration of hypertension was 3 years. We divided the study group into subgroups depending on age, gender, BMI, and duration of hypertension. All patients underwent single 24-h ambulatory BP monitoring. We calculated 24-h, daytime and nighttime BP loads separately for systolic and diastolic BP. Statistical analysis was carried out using the SPSS 15.0 environment. RESULTS Men were significantly younger than women (48.17 vs. 55.48 years, p < 0.02). Mean BMI was higher in men than women (28 vs. 26 kg/m², p < 0.044). There were no differences in the mean values of BP load depending on gender, BMI and, duration of hypertension (p = NS). Twenty-four hour and daytime diastolic BP load was higher in patients aged 41-65 years than in patients above 65 years (32.4 vs. 20.8%, p < 0.04; and 29.6 vs. 17.5%, p < 0.03). A negative correlation was found between daytime diastolic BP load and age (r = -0.19, p < 0.026) and a positive correlation was found between night time systolic BP load and age (r = 0.24, p < 0.005). CONCLUSIONS There was no relationship between BP load and gender, BMI, and duration of hypertension. Diastolic BP load was age-related. Middle-aged patients were characterised by significantly higher values of 24-h and daytime diastolic BP load than the elderly patients.

Double left anterior descending artery: Congenital anomaly or normal variant of coronary arteries?

A 73-year-old female patient was referred for coronary artery computed tomography angiography (CTA) due to dyslipidemia, hypertension, and mild ventricular arrhythmia. The study demonstrated a double left anterior descending artery (LAD) Type 1 variant (Fig. 1A) and significant atherosclerotic lesions in the coronary arteries. Conventional coronary angiography confirmed presence of an anomaly and significant atherosclerotic lesions within the second marginal branch (Mg 2) and the right coronary artery (RCA). The patient was treated with percutaneous coronary intervention (PCI) of Mg 2 and RCA with drug-eluting stenting (DES). A 63-year-old female smoker with hypertension, had a positive stress test with low exercise tolerance (5.9 METS) and significant ST depression in leads II, III, aVF, V5 and V6, with chest pain. The 24-h Holter electrocardiography monitoring demonstrated ventricular arrhythmia with nonsustained ventricular tachycardia (nsVT). The CTA revealed multifocal significant atherosclerotic lesions and dual LAD Type 1 (Fig. 1B). The patient did not consent to coronary angiography. Computed tomography angiography is the preferred imaging method in the assessment of coronary arteries anomalies. The main advantages

Left anterior descending coronary artery fistula into the left atrial appendage

A 69-year-old patient was diagnosed due to angina and cardiac arrhythmia (atrial tachycardia, paroxysmal atrial fibrillation). A 24-h Holter monitoring electrocardiogram (ECG), confirmed normal sinus rhythm with episodes of atrial tachycardia (Fig. 1). Due to dynamic changes of the ST segment in the ECG, and presence of chest pain, coronary angiography testing was proposed, to which the patient did not agree. The coronary computed tomographic angiography showed an abnormal, wide branch of 4 mm calibre, extending from the mid segment of the left anterior descending artery (LAD) (Fig. 2A, B, arrowed). The LAD calibre before and immediately after the branch take off was, respectively, 5.5 mm and 2.2 mm. The abnormal vessel gave rise to several smaller branches draining into the left atrial appendage (LAA) (Fig. 3). Atherosclerotic plaques were not found in any of the coronary arteries. The above described left coronary artery fistula draining into the LAA may be an important factor promoting the occurrence of paroxysmal supraventricular arrhythmia and the reason for the steal syndrome.

The effect of left ventricular diastolic function on the secretion of B-type natriuretic peptide at rest and directly after exercise test in asymptomatic patients with diabetes or after myocardial infarction with preserved left ventricular systolic functi

BACKGROUND Clinical evaluation of patients with diabetes or after myocardial infarction (MI) with preserved left ventricular (LV) systolic function is not very precise in isolating patients at particularly high risk of developing manifest cardiac failure and associated cardiovascular incident. Early diagnosis of LV diastolic dysfunction is essential because implementation of the appropriate treatment can positively affect the course of the disease. AIM To assess the impact of LV diastolic function on B-type natriuretic peptide (BNP) concentration at rest and immediately after exercise test, and to search for the relationship between LV diastolic function and BNP secretion, tolerance, and duration of exercise in the studied groups of patients. METHODS Ninety-nine consecutive patients were qualified for the study: in Group 1 - patients with type 2 diabetes without a history of MI, and in Group 2 - patients after MI with preserved LV systolic function (ejection fraction ≥ 40%), without diabetes. The studied patients had echocardiography with LV systolic and diastolic function evaluation, an electrocardiographic exercise test and blood sampling for BNP determination before and immediately after exercise test. RESULTS The study included 99 patients aged 40-75 years (60 patients after MI and 39 patients with diabetes). The study group included 62 patients who were diagnosed with diastolic dysfunction. Diastolic dysfunction occurred in 41 (68.4%) patients in the group after MI, and in 21 (53.8%) patients in the group with diabetes, severe disorders in the form of pseudonormal and restrictive mitral valve inflow occurred in 13 (21.7%) and five (12.8%), respectively. The average BNP concentration in patients with severe diastolic dysfunction at rest was 188.3 vs. 25.2 pg/mL in patients with normal diastolic function (p < 0.001). In all patients with severe diastolic dysfunction BNP after exercise was 285.2 vs. 37.5 pg/mL in patients with normal diastolic function, and the increase in BNP during exercise was 96.9 vs. 12.4 pg/mL, respectively. Duration of exercise and exercise tolerance in patients with normal diastolic function was better in comparison with the studied patients with disturbed diastolic function, but did not reach statistical significance. CONCLUSIONS The BNP initial concentration and its value immediately after exercise were significantly higher in subjects with severe diastolic disorders than those in subjects with normal LV diastolic function and in subjects with impaired LV relaxation.