Aneta I. Gziut

Stenting of Culprit Lesions in Unstable Angina Leads to a Marked Reduction in Plaque Burden: A Major Role of Plaque Embolization? A Serial Intravascular Ultrasound Study

Background—Intravascular ultrasound (IVUS) studies have shown that a mechanism of plaque compression/embolization contributes toward the poststenting increase in lumen area. The aim of this IVUS study was to compare the mechanisms of lumen enlargement after coronary stenting in 54 consecutive patients with unstable angina (UA) (group 1) and 56 with stable angina (group 2) to verify whether plaque embolization plays a major role in the former. Methods and Results—Both groups underwent the IVUS assessment (speed, 0.5 mm/sec) before the intervention and after stent implantation. The lumen area, the external elastic membrane area, and the plaque+media area (PA) were measured at 0.5-mm intervals. PA reduction in the lesion site was significantly greater in group 1 (−2.50±1.97 versus −0.53±1.43 mm2, P <0.001). After stenting, 47% of the lumen area increase in group 1 was obtained by means of PA reduction, and 53% was attributable to external elastic membrane area increase; the corresponding figures in group 2 were 13% and 87% (P <0.05). Decrease in PA after stenting was the only significant predictor of the MB fraction of creatinine kinase (CK-MB) release in a multiple regression model (P =0.047). Conclusions—Serial volumetric IVUS assessment revealed in UA lesions a marked poststenting reduction in plaque volume, which is significantly greater than in stable angina and is associated with postprocedural CK-MB release. The decrease in PA during the procedure predicts CK-MB release in a multiple regression model. These findings suggest that stent deployment is often associated with plaque embolization in patients with UA.

Eccentric atherosclerotic plaques with positive remodeling have a pericardial distribution: A permissive role of epicardial fat—A three-dimensional intravascular ultrasound study of left anterior descending artery lesions

AIMS The transversal distribution of coronary atherosclerotic plaques (AP) (myocardial vs pericardial) affects vessel remodelling. The aim of this study was to define the impact of transversal lesion distribution on vessel remodelling in proximal and distal coronary segments using a 3D intravascular ultrasound (IVUS) reconstruction. METHODS The study group included 70 lesions located in the left anterior descending artery within 5mm of the septal take-off, and imaged using 3D-IVUS. The take-off of the septal branch was used to divide the plaque into a myocardial and pericardial surface. The IVUS index of vessel remodelling was calculated as: [narrowest external elastic membrane (EEM) site cross-sectional area (CSA)-reference EEM CSA)/reference EEM CSAx100]. The lesions with an intermediate vessel remodelling index (between -25% and +15%) were excluded from analysis. RESULTS Of the 38 APs with a pericardial distribution, 34 (89%) showed positive remodelling (P<0.001). The distal lesions had a positive vessel remodelling index regardless of transversal plaque distribution. At multivariate analysis, pericardial distribution and the distal location of AP were the only independent variables predictive of positive remodelling. CONCLUSIONS The transversal distribution of atherosclerotic plaque affects vessel remodelling in left anterior descending coronary lesions, probably because of an extravascular splinting effect. Distal lesions usually show positive remodelling regardless of transversal plaque distribution.

Effects of renal sympathetic denervation on blood pressure and glycaemic control in patients with true resistant hypertension: results of Polish Renal Denervation Registry (RDN-POL Registry)

BACKGROUND AND AIM The assessment of percutaneous renal sympathetic denervation (RDN) efficacy in patients with true-resistant hypertension (true-RH) in a newly established net of Polish centres (RDN-POL Registry). METHODS AND RESULTS Forty-four patients with true-RH (23 men, mean age 52.3 years) with daytime systolic blood pressure (SBP) in ambulatory blood pressure monitoring (ABPM) ≥ 135 mm Hg, on ≥ three antihypertensive agents, including diuretic, underwent RDN and completed 12-month follow-up. Mean reductions of office SBP/diastolic blood pressure were -23.8/-10.0, -12.5/-4.6, and -12.6/-6.1 mm Hg at 3, 6, and 12 months, respectively (all significant except diastolic at 6 months). Diabetes was the only predictor of office SBP reduction at 6 months (OR 9.6, 95% CI 1.4-66.5, p < 0.05). Mean 24-h SBP change was -8.3 mm Hg at 6 months and -4.6 mm Hg at 12 months. Increased 2 h-glucose in oral glucose tolerance test was the only predictor of 24-h SBP reduction at 6 months (OR 1.24 for 10 mg/dL glucose increase, 95% CI 1.04-1.48, p < 0.05). At 12 months, 24-h SBP change predictors were: baseline office SBP (OR 4.93 for 10 mm Hg SBP increment, 95% CI 1.01-24.1, p < 0.05) and 2 h-glucose (OR 1.47, 95% CI 1.08-2.00, p < 0.05). In ABPM responders, significant reduction of 2 h glucose was found as compared to the non-responders (-45.8 vs. -7.7 mg/dL, p < 0.005). CONCLUSIONS The RDN-POL Registry demonstrated moderate blood pressure decrease after RDN. The predictors of blood pressure reduction were diabetes, 2 h-glucose, and baseline office SBP. Analysis of ABPM responders indicates a probable positive impact of RDN on glycaemic control.

Niewydolność serca w przebiegu nieleczonego nadciśnienia tętniczego oraz zaburzeń metabolicznych

We present the case of a 38-year-old previously untreated patient admitted to the hospital because of hypertensive crisis. The patient apart from hypertension was initially diagnosed with heart failure, diabetes type 2, dyslipidemia. Coronary ischemic disease was excluded due to angiography. Cardiac magnetic resonance imaging has shown the alternations indicating metabolic etiology of heart failure. After hypertension, hypolipidemic and diabetes treatment, patient’s general condition, normalization of blood pressure and lipids values, glycemic control and the improvement of left ventricular systolic function were observed.

Nowo rozpoznane nadciśnienie tętnicze u pacjentki w trakcie hormonoterapii anastrozolem z powodu raka gruczołu piersiowego

We present the case of 63-year-old patient with breast cancer treated with anastrozole, in whom the development of arterial hypertension during chemotherapy occurred. The patient using an aromatase inhibitor for the oncological treatment, did not experience the development of other diseases of the cardiovascular system besides elevated blood pressure. After inclusion of five antihypertensive drugs normal blood pressure was achieved.

Ostre rozwarstwienie aorty u pacjenta z wieloletnim nieleczonym nadciśnieniem tętniczym oraz zespołem metabolicznym

Acute aortic dissection (AOD) is one of the possible complications of untreated hypertension. Its symptoms (severe popping chest pain radiating to the back) are often confused with acute coronary syndrome. The basis of diagnosis is a computed tomography of the aorta. Patients with AOD requires emergency vascular surgery. One of the conditions for the success and good prognosis is to reduce blood pressure. The paper presents a case of a patient with long-standing untreated hypertension, in whom there was a dissection of the descending aorta and its branches, and consequently the deterioration of renal function. After initial difficulties in determining the optimal pharmacotherapy reduction of blood pressure was achieved and widening gates delamination is not observed.

First‑in‑man experience with renal denervation of multiple renal arteries in a patient with solitary kidney and resistant hypertension

1 Department of Cardiology and Hypertension, Central Clinical Hospital, Ministry of the Interior, Warsaw, Poland 2 Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Center for Preclinical Research and Technology CEPT, Warsaw, Poland 3 Department of Invasive Cardiology, Central Clinical Hospital, Ministry of the Interior, Warsaw, Poland 4 Faculty of Medicine, Lazarski University, Warsaw, Poland

Left ventricular function — assessment by echocardiography

This article describes the different modalities for assessment of systolic and diastolic left ventricular function by transthoratic echocardiography. The assessment of left ventricular function has a significat impact on medical decisions and prognostic information.