Andrzej Wykretowicz

Impairment of Endothelial Function in Unipolar and Bipolar Depression

BACKGROUNDnPrevious studies have suggested an association between abnormal endothelial function and depression. We therefore tested this hypothesis in patients with depression in the course of mood disorders and assessed the effect of antidepressant treatment.nnnMETHODSnPsychometric evaluation and hemodynamic and endothelial function studies using pulse wave analysis were performed on a group of 31 patients with unipolar or bipolar depression. The control group consisted of 18 healthy subjects, age- and gender-matched.nnnRESULTSnArterial endothelial function was impaired in patients compared with that in control subjects, both during a depressive episode and when in remission after pharmacological treatment. The diagnosis, intensity of depression, and type of antidepressant drugs did not influence the results.nnnCONCLUSIONSnThe impairment of endothelial function might constitute a trait marker of the biological make-up of patients with mood disorders and might contribute to the increased frequency of cardiovascular conditions observed in these patients.

Chronic kidney disease-related atherosclerosis - proteomic studies of blood plasma

BackgroundAtherosclerosis is considered the major cause of the dramatic increase in cardiovascular mortality among patients suffering from chronic kidney disease (CKD). Although the close connection between atherosclerosis and kidney dysfunction is undeniable, factors enhancing CKD-mediated plaque formation are still not well recognized.ResultsTo increase our knowledge of this process we carried out a comparative proteomic analysis of blood plasma proteins isolated from 75 patients in various stages of renal dysfunction (CKD group), 25 patients with advanced cardiovascular disease (CVD group) and 25 healthy volunteers (HV group). The collected samples were subjected to 2D electrophoresis. Then, individual proteins were identified by mass spectrometry. The comparative analysis involving CKD and HV groups showed a differential accumulation of α-1-microglobulin, apolipoprotein A-IV, γ-fibrinogen and haptoglobin in patients with kidney disease. Exactly the same proteins were identified as differentially expressed when proteomes of CVD patients and HV were compared. However, a direct comparison of CKD and CVD groups revealed significant differences in the accumulation of two proteins: α-1-microglobulin and apolipoprotein A-IV.ConclusionsThe obtained results indicate that at least two processes differentially contribute to the plaque formation in CKD- and CVD-mediated atherosclerosis. It seems that the inflammatory process is more intense in CKD patients. On the other hand, the down- and up-regulation of apolipoprotein A-IV in CVD and CKD groups, respectively, suggests that substantial differences exist in the efficacy of cholesterol transport in both groups of patients.

Prospective evaluation of hydroperoxide plasma levels and stable nitric oxide end products in patients subjected to angioplasty for coronary artery disease

BACKGROUNDnOxidative stress appears to be involved in several processes that contribute to atherogenesis and restenosis following vascular intervention.nnnMETHODSnThe aim of our study was to evaluate prospectively the plasma concentrations of a hydroperoxide (ROOH) and nitric oxide end product (NO(x)) in patients subjected to coronary angioplasty (PTCA) and routine control angiography 6 months after the initial procedure. We prospectively studied 48 consecutive patients (39 men, nine women, mean age 52 years) with stable angina who underwent successful elective angioplasty. A vascular segment was considered successfully treated when the residual luminal narrowing in the dilated segment immediately after angioplasty was <50%. Angiographic follow-up was obtained in all of the patients. Plasma samples were drawn at baseline (before angioplasty) and serially after angioplasty (1, 3 and 6 months afterwards). Hydroperoxides were determined by the FOX II assay (ferrous oxidation in xylenol orange, Pierce Rockford, IL). Nitrate was converted in the presence of NO3 reductase. The Griess reagent was used for the measurement of NO2.nnnRESULTSnThe overall angiographic restenosis rate was 35%. There were no significant differences in clinical variables between the patients with or without restenosis. The baseline levels (0.8+/-0.09 vs. 0.6+/-0.2 micromol/l) as well as the concentrations of authentic lipid hydroperoxide in plasma after 1 month (0.7+/-0.09 vs. 1.0+/-0.2 micromol/l) and 6 months (0.8+/-0.1 vs. 1.0+/-0.2 micromol/l) were similar in both groups. Three months after the angioplasty a significant increase in the ROOH level was noticed in the patients with restenosis (0.9+/-0.1 vs. 1.4+/-0.2, P=0.04). Plasma levels of NO(x) were similar in both groups at baseline (23.6+/-2.1 vs. 22.7+/-2.6 micromol/l) and 1 month after procedure (24.4+/-2.2 vs. 23.4+/-3.3 micromol/l). However, in patients with restenosis significant decreases in stable NO end products were observed 3 and 6 months after PTCA (18.1+/-1.5 vs. 13.3+/-1.7, P=0.04; 14.2+/-1.0 vs. 8.7+/-1.3, P=0.02, respectively).nnnCONCLUSIONSnIn patients with angiographic restenosis a significant increase in lipid peroxidation accompanied by a reduction in the stable end products of nitric oxide in plasma is observed several months after PTCA.

Partitioning total heart rate variability

Abstract This study investigates the structure of total heart rate variability (HRV) by partitioning the variance of RR intervals into normalized short-( CS ) and long-term ( CL ) contributions, and CS into contributions derived from heart rate accelerations ( CS a ) and decelerations ( CS d ). Total HRV ( SDNN ) and its partitions were quantified in resting 30-minute ECG recordings from 160 young healthy volunteers (18–30xa0years old; 75 females). CS (13.4+/–6.4%) was lower than CL (86.6+/–6.5%) in all subjects ( p −15 ) while CS d (7.3+/–3.8%) was higher than CS a (6.1+/–2.9%) in 124 participants ( p −12 ). CS , CL , CS d and CS a have significantly different contributions to total HRV.

Add-On Therapy with a Nighttime Dose of Doxazosin in Patients with Uncontrolled Hypertension: Effects on Autonomic Modulation of the Cardiovascular System

This study was designed to determine whether or not the addition of a single nighttime dose of doxazosin in extended-release form (GITS; gastrointestinal therapeutic system) would affect the autonomic modulation of the cardiovascular system in patients with uncontrolled hypertension treated with a multi-drug regimen. Resting 5-min noninvasive finger blood pressure and ECG signals, as well as 24-h Holter ECGs, were recorded in 30 patients with uncontrolled hypertension on multi-drug treatment before and after 16-week add-on therapy with doxazosin GITS. Cardiovascular autonomic modulation was evaluated by spectral analysis of heart rate variability (HRV) and a cross-correlation method for spontaneous baroreflex sensitivity (BRS) in 5-min resting recordings, and by the analysis of Poincaré plots and phase-rectified signal averaging of the duration of cardiac cycles in 24-h ECG recordings. This combined therapy significantly reduced systolic pressure (19.4±3.5 mmHg; p<0.0001), diastolic blood pressure (9.4±2.0 mmHg; p=0.0003), and pulse pressure (10.0±2.8 mmHg; p=0.0021). Concomitantly, there was a significant increase in resting spontaneous BRS (p=0.0191) and increases in 24-h short-term (p=0.0129) and total (p=0.0153) HRV, but with no significant change in heart rate or other measures of HRV. The improvements in HRV and BRS were observed mainly in patients already treated with thiazide diuretics. There was a significant association (r=0.49; p=0.0065) between the degree of change in diastolic blood pressure and short-term HRV caused by the combined treatment. The addition of 4 mg doxazosin GITS to multi-drug antihypertensive therapy is associated with an improvement in cardiovascular autonomic control.

The influence of electrical cardioversion on superoxide anions (O2−) production by polymorphonuclear neutrophils, hydrogen peroxide (H2O2) plasma level and malondialdehyde serum concentration

We studied the influence of electrical cardioversion on unstimulated and stimulated superoxide anion production by polymorphonuclear neutrophils in 22 patients with atrial flutter or atrial fibrillation. We also estimated hydrogen peroxide plasma level, as well as malondialdehyde serum concentration, in these subjects. We noted an increase in spontaneous production of superoxide anions from 14.9 +/- 1.8 nmol/10(6) neutrophils per 20 min to 21.37 +/- 2.7 nmol/10(6) neutrophils per 20 min (P = 0.002) in neutrophils obtained after electrical cardioversion. Similarly, stimulated production of O2- also increased after electrical cardioversion (41.8 +/ 3.4 nmol/10(6) neutrophils per 20 min vs. 59.0 +/- 5.9 nmol/10(6) neutrophils per 20 min, P = 0.0027). Moreover, hydrogen peroxide plasma level increased significantly after electrical cardioversion (39.9 +/- 6.2 mumol/l vs. 53.4 +/- 7.6 mol/l, P = 0.003). Serum malondialdehyde concentration also increased after countershock (2.56 +/- 0.26 nmol/ml vs. 2.94 +/- 0.26 nmol/ml, P = 0.023). These results seem to indicate that electrical cardioversion may lead to polymorphonuclear neutrophils activation, increased H2O2 production and lipid peroxidation.

Measures of Heart Rate Variability in 24-h ECGs Depend on Age but Not Gender of Healthy Children

Many methods computing heart rate variability (HRV) have been applied in studies in children. Not all of these methods have a comprehensive physiological interpretation, and not all of studies are in agreement with the Task Force Standards on HRV from 1996, and the New Joint Position Statement on the advances of HRV from 2015. The study aim was to analyse HRV in the 24-h ECGs of healthy children by the Poincare plots and Lomb-Scargle periodograms, and to follow proper HRV recommendations. Additionally, we investigated the associations between age, childrens sex and measured HRV indices. One hundred healthy children, aged 3–18 underwent 24-h ECG Holter monitoring. HRV was analyzed by the Poincaré plots and spectral by Lomb-Scargle periodograms of RR intervals. The Mann-Whitney test was used to compare sex differences in HRV, the van Elterens test was used to correct for the age-gender interaction, and non-parametric Spearman correlation was applied to analyse the association between age and HRV indices. None of the HRV measures differed significantly between boys and girls. None of the HRV indices was modified by the age-gender interaction. There were statistically significant associations of age with measures of ultra-low (rho = 0.42; p < 0.0001), very low (rho = 0.35; p = 00004) and low (rho = 0.30; p = 0.0028) frequency powers, the ratio of the low to high frequency power (rho = 0.38; p = 0.0001), indices of long-term (SD2; rho = 0.37; p = 0.0002) and total (SDNN; rho = 0.33; p = 0.0008) HRV, and the contribution of the long-term HRV to total HRV (CL; rho = 0.32; p = 0.0012). In general, HRV parameters derived from the analyses of Poincaré plots and Lomb-Scargle periodograms appear not to be affected by gender, however, most of them increase with age in the 24-h ECG recordings in healthy children.

Aortic excess pressure and arterial stiffness in subjects with subclinical white matter lesions

a Department of Radiology, University School of Medicine, 49 Przybyszewskiego, 60-355 Poznan, Poland b Department of Cardiology-Intensive Therapy, University School of Medicine, 49 Przybyszewskiego, 60-355 Poznan, Poland c Institute of Physics, University of Zielona Gora, 4a Szafrana, 65-516 Zielona Gora, Poland d Department of Surgery, University School of Medicine, 49 Przybyszewskiego, 60-355 Poznan, Poland

Presence of retinopathy in type 1 diabetic patients is associated with subclinical macroangiopathy

Abstract Purpose. The aim of the study was to assess the relationships between diabetic retinopathy, subclinical atherosclerosis and wave reflection in type 1 diabetic patients. Methods. The investigation involved 87 type 1 diabetic patients aged 34 years (interquartile range [IQR]: 29–43), with a disease duration of 10 years (IQR: 9–14). Of these 39 (45%) had diabetic retinopathy. Carotid intima-media thickness (CIMT) was measured using high resolution ultrasonography. Wave reflection and central hemodynamics [central (CAIx) and peripheral augmentation index (PAIx)] were determined with the use of tonometry. Results. Patients with retinopathy compared to those without had increased CIMT (530 vs 480 μm, p = 0.017) and wave reflection (CAIx [118.90 vs 110.96 %, p = 0.03] and PAIx [64.95 vs 57.44 %, p = 0.029]). In logistic regression analysis, patients age, duration of diabetes, systolic and diastolic blood pressure, postprandial glycemia, HbA1c value, CIMT (p = 0.017), CAIx (p = 0.03) and PAIx (p = 0.016) were associated with the presence of diabetic retinopathy. However, in the multivariate model, CIMT and CAIx did not remain predictors of retinopathy. Conclusions. We have shown that the presence of retinopathy in type 1 diabetic patients is associated with subclinical atherosclerosis and wave reflection.

Contribution of arterial excess pressure and arterial stiffness to central augmentation pressure in healthy subjects.

pressure in healthy subjects J. Piskorski , T. Krauze , K. Katulska , M. Wykretowicz , A. Milewska , D. Przymuszala , H. Wysocki , A. Wykretowicz ⁎, P. Guzik b a Institute of Physics, University of Zielona Gora, 4a Szafrana, 65-516 Zielona Gora, Poland b Department of Cardiology-Intensive Therapy, University School of Medicine, 49 Przybyszewskiego, 60-355 Poznan, Poland c Department of Radiology, University School of Medicine, 49 Przybyszewskiego, 60-355 Poznan, Poland