Artur Mamcarz

PoLA/CFPiP/PCS Guidelines for the Management of Dyslipidaemias for Family Physicians 2016

Dyslipidaemias are the most common yet the least well-controlled risk factor for cardiovascular disease (CVD) in Poland [1]. The main modifiable risk factors for atherosclerosis and its complications including ischaemic heart disease (IHD), stroke and peripheral artery disease (PAD) are: smoking, type 2 diabetes, arterial hypertension, inappropriate diet and eating habits, inadequate physical activity as well as the resulting overweight and obesity [6]. As shown by epidemiological studies conducted in Poland, there is a nationwide growth in the above risk factors (with the exception of smoking in the majority of age groups), which is attributable to the increasing prevalence of poor eating habits and sedentary lifestyle [1]. The elimination of risk factors represents one of the greatest challenges to be faced in the domain of public health. In order to rise to up to the challenge, wide-ranging population prevention measures are needed. However, family physicians as well as other health professionals (cardiologists, internists) have a special responsibility towards high-risk patients. The group definitely comprises a considerable proportion of dyslipidaemia patients. Consequently, dyslipidaemia management should be an element of a broader strategy targeted at lowering total CV risk and, hence, reducing mortality, morbidity and disability associated with CVD.

The influence of systematic pulse-limited physical exercise on the parameters of the cardiovascular system in patients over 65 years of age

Introduction The influence of physical exercise on the parameters of the cardiovascular system of elderly persons has not been sufficiently investigated yet. The aim of the study was to assess the influence of regular 6-week physical exercise using the Nordic walking (NW) method in a group of elderly persons on their physical performance and regulation of selected parameters assessing the cardiovascular system. Material and methods Fifty patients over 65 years of age participated in the study. The study encompassed: medical interview, physical examination, resting ECG, spiroergometry examination, 6MWT (6-minute walk test) and 24-hour ambulatory blood pressure monitoring (ABPM). During the exercise programme, the pulse was monitored using pulsometers. After the completion of the training, check-up tests assessing the same parameters were performed. The control group consisted of 18 persons over 65 years of age with similar cardiovascular problems. Results In the test group, duration of the physical effort increased by 1.02 min (p = 0.0001), the maximum load increased by 10.68 W (p = 0.0001), values of VO2max by 2.10 (p = 0.0218), distance improved in 6MWT by 75.04 m (p = 0.00001), systolic blood pressure decreased by 5.50 mm Hg (p = 0.035) and diastolic blood pressure by 3.50 mm Hg (p = 0.054) as compared to the control group. Conclusions Systematic NW physical exercise limited by the pulse had a beneficial effect on the physical performance of elderly persons as assessed with main parameters. A short 6-week programme of endurance exercises had a hypotensive effect in elderly persons over 65 years of age.

The Influence of Extreme Mixed Exertion Load on the Right Ventricular Dimensions and Function in Elite Athletes: A Tissue Doppler Study

Aims: The athletes heart is a widely discussed topic regarding the adaptation of the left ventricle (LV) to regular training. The data on the morphology and—even more—the function of the right ventricle (RV) are less well studied. The aim of the study was to assess the influence of prolonged exertion on morphology and function of the RV. Methods and Results: We examined 38 elite athletes, members of the Polish Olympic Team and a control group of 41 age and sex‐matched healthy volunteers. Specifically, we assessed the details of RV size and function including: RV enlargement, transtricuspid systolic gradient, and dilatation of main pulmonary artery (PA) as compared with the values derived from the control group. There was no significant difference in the function of the RV assessed using tissue Doppler echocardiography (TDE) between the athletes and controls (S’: 15.0 cm/sec vs. 14.0 cm/sec; E’: 15.8 cm/sec vs. 15.7 cm/sec; A’: 9.9 cm/sec vs. 10.4 cm/sec), but the athletes had a higher transtricuspid systolic gradient (23.6 mm Hg vs. 19.0 mm Hg, P = 0.004). There were no significant differences in TDE velocities in athletes with dilated RV or PA. However, those with elevated tricuspid regurgitation velocity had lower systolic velocities of the tricuspid annulus then the rest (S’: 12.3 cm/sec vs. 15.5 cm/sec, P = 0.01). Conclusions: RV enlargement in professional athletes is not connected with deterioration of diastolic or systolic RV function. Athletes with elevated pulmonary systolic pressure at rest, however, present with lower longitudinal systolic velocities of RV assessed using TDE. (Echocardiography 2011;28:753‐760)

Left Atrial Enlargement in Young High-Level Endurance Athletes – Another Sign of Athlete’s Heart?

Abstract Enlargement of the left atrium is perceived as a part of athlete’s heart syndrome, despite the lack of evidence. So far, left atrial size has not been assessed in the context of exercise capacity. The hypothesis of the present study was that LA enlargement in athletes was physiological and fitness-related condition. In addition, we tried to assess the feasibility and normal values of left atrial strain parameters and their relationship with other signs of athlete’s heart. The study group consisted of 114 international-level rowers (17.5 ± 1.5 years old; 46.5% women). All participants underwent a cardio-pulmonary exercise test and resting transthoracic echocardiography. Beside standard echocardiographic measurements, two dimensional speckle tracking echocardiography was used to assess average peak atrial longitudinal strain, peak atrial contraction strain and early left atrial diastolic longitudinal strain. Mild, moderate and severe left atrial enlargement was present in 27.2°%, 11.4% and 4.4% athletes, respectively. There were no significant differences between subgroups with different range of left atrial enlargement in any of echocardiographic parameters of the left ventricle diastolic function, filling pressure or hypertrophy. A significant correlation was found between the left atrial volume index and maximal aerobic capacity (R > 0.3; p < 0.001). Left atrial strain parameters were independent of atrial size, left ventricle hypertrophy and left ventricle filling pressure. Decreased peak atrial longitudinal strain was observed in 4 individuals (3.5%). We concluded that LA enlargement was common in healthy, young athletes participating in endurance sport disciplines with a high level of static exertion and was strictly correlated with exercise capacity, therefore, could be perceived as another sign of athlete’s heart.

A new version of cardiovascular risk assessment system and risk charts calibrated for Polish population

1Zakład Prewencji i Dydaktyki, Gdański Uniwersytet Medyczny, Gdańsk 2I Klinika Kardiologii i Elektrokardiologii Interwencyjnej oraz Nadciśnienia Tętniczego, Instytut Kardiologii, Uniwersytet Jagielloński, Collegium Medicum, Kraków 3II Klinika Kardiologii oraz Interwencji Sercowo-Naczyniowych, Instytut Kardiologii, Uniwersytet Jagielloński, Collegium Medicum, Kraków 4Klinika Neurologii Dorosłych, Gdański Uniwersytet Medyczny, Gdańsk 5Katedra Medycyny Społecznej i Zapobiegawczej, Uniwersytet Medyczny w Łodzi, Łódź 6Zakład Epidemiologii, Prewencji Chorób Układu Krążenia i Promocji Zdrowia, Instytut Kardiologii, Warszawa 7Katedra i Klinika Chorób Wewnętrznych, Nadciśnienia Tętniczego i Angiologii, Warszawski Uniwersytet Medyczny, Warszawa 8Klinika Wad Wrodzonych Serca, Instytut Kardiologii, Warszawa 9Katedra Kardiologii, Wrodzonych Wad Serca i Elektroterapii, Śląski Uniwersytet Medyczny, Katowice 10Klinika Kardiologii, Pomorski Uniwersytet Medyczny, Szczecin 11Klinika Chorób Serca i Naczyń, Instytut Kardiologii, Uniwersytet Jagielloński, Collegium Medicum, Kraków 12III Klinika Chorób Wewnętrznych i Kardiologii, Warszawski Uniwersytet Medyczny, Warszawa 13I Katedra i Klinika Kardiologii, Warszawski Uniwersytet Medyczny, Warszawa 14Zakład Epidemiologii i Badań Populacyjnych, Instytut Zdrowia Publicznego, Wydział Nauk o Zdrowiu, Uniwersytet Jagielloński, Collegium Medicum, Kraków 15Klinika Rehabilitacji Kardiologicznej i Elektrokardiologii Nieinwazyjnej, Instytut Kardiologii, Warszawa 16Katedra Kardiologii i Kardiochirurgii, Uniwersytet Warmińsko-Mazurski, Olsztyn 17Klinika Kardiologii Dziecięcej, I Katedra Pediatrii, Uniwersytet Medyczny im. K. Marcinkowskiego, Poznań 18Klinika Intensywnej Terapii Kardiologicznej, Instytut Kardiologii, Warszawa 19Zakład Medycyny Rodzinnej, Katedra Chorób Wewnętrznych i Gerontologii, Uniwersytet Jagielloński, Collegium Medicum, Kraków 20Narodowy Instytut Zdrowia Publicznego — Państwowy Zakład Higieny, Warszawa

Simultaneous predictive value of NT-proBNP and CA-125 in patients newly diagnosed with advanced heart failure: preliminary results.

Introduction New markers of cardiac events and new monitoring methods which can improve care of patients with advanced heart failure (HF) are still being looked for. Material and methods Sixty-five patients below 75 years old (mean age: 60.34 ±9.54 years), hospitalized with the first manifestation of HF (left ventricular ejection fraction ≤ 40%) and New York Heart Association (NYHA) class II-IV symptoms, not optimally treated before the study, were included. Blood samples for NT-proBNP and CA-125 were taken at baseline and during the 12-month follow-up period. The doses of β-adrenolytics and angiotensin-converting enzyme (ACE) inhibitors were titrated to maximal tolerated ones according to the guidelines in 1-year follow-up. The endpoint was established as overall death and time to death. Results Worse prognosis was observed in groups with: 1) NT-proBNP and CA-125 above medians (OR = 492.9, p = 0.006), 2) baseline higher NT-proBNP and CA-125 (HR = 0.016, p < 0.001), 3) increased or stable marker levels during the first 3 months after treatment implementation. Conclusions Elevated values of NT-proBNP and CA-125 are found as the independent death risk factors. The group with initial elevated NT-proBNP and CA-125 concentrations had a worse prognosis. Changes in NT-proBNP and CA-125 levels after treatment implementation predict unfavourable cardiovascular events with better CA-125 than NT-proBNP performance.

Reference Values of Maximal Oxygen Uptake for Polish Rowers

Abstract The aim of this study was to characterize changes in maximal oxygen uptake over several years and to elaborate current reference values of this index based on determinations carried out in large and representative groups of top Polish rowers. For this study 81 female and 159 male rowers from the sub-junior to senior categories were recruited from the Polish National Team and its direct backup. All the subjects performed an incremental exercise test on a rowing ergometer. During the test maximal oxygen uptake was measured with the BxB method. The calculated reference values for elite Polish junior and U23 rowers allowed to evaluate the athletes’ fitness level against the respective reference group and may aid the coach in controlling the training process. Mean values of VO2max achieved by members of the top Polish rowing crews who over the last five years competed in the Olympic Games or World Championships were also presented. The results of the research on the “trainability” of the maximal oxygen uptake may lead to a conclusion that the growth rate of the index is larger in case of high-level athletes and that the index (in absolute values) increases significantly between the age of 19-22 years (U23 category).

Loop diuretics: old and new ones — which one to choose in clinical practice? Experts’ Group Consensus endorsed by the Polish Cardiac Society Working Group on Cardiovascular Pharmacotherapy and Working Group on Heart Failure

1III Klinika Chorób Wewnętrznych i Kardiologii, II Wydział Lekarski, Warszawski Uniwersytet Medyczny, Warszawa 2I Katedra i Klinika Kardiologii, Warszawski Uniwersytet Medyczny, Warszawa 3Klinika Kardiologii, Katedra Kardiologii i Kardiochirurgii, Uniwersytet Medyczny w Łodzi, Łódź 4Klinika Choroby Wieńcowej i Niewydolności Serca, Uniwersytet Jagielloński Collegium Medicum, Krakowski Szpital Specjalistyczny im. Jana Pawła II, Kraków 5Katedra i Klinika Hipertensjologii, Angiologii i Chorób Wewnętrznych, Uniwersytet Medyczny im. Karola Marcinkowskiego, Poznań 6Klinika Immunologii, Transplantologii i Chorób Wewnętrznych, Warszawski Uniwersytet Medyczny, Warszawa 7I Klinika Kardiologii i Elektroterapii, Świętokrzyskie Centrum Kardiologii, Uniwersytet Jana Kochanowskiego, Kielce

Aktualne problemy terapii dyslipidemii w Polsce - Deklaracja Sopocka. Stanowisko ekspertów wsparte przez Sekcję Farmakoterapii Sercowo-Naczyniowej Polskiego Towarzystwa Kardiologicznego

Actual problems of dyslipidaemia treatment in Poland — 2nd Declaration of Sopot. Experts’ Group Consensus endorsed by the Polish Cardiac Society Working Group on Cardiovascular Pharmacotherapy Beata Wożakowska-Kapłon, Krzysztof J. Filipiak, Artur Mamcarz, Marcin Barylski, Barbara Cybulska, Rafał Dąbrowski, Jarosław Drożdż, Dariusz Dudek, Grzegorz Dzida, Edward Franek , Jerzy Górny, Stefan Grajek, Maciej Haberka, Jacek Imiela, Piotr Jankowski, Jarosław D. Kasprzak, Marek Koziński, Dariusz Kozłowski, Katarzyna Mizia-Stec, Krzysztof Narkiewicz, Janusz Siebert, Władysław Sinkiewicz, Andrzej Tykarski, Krystyna Widecka, Tomasz Zdrojewski

The influence of metabolic syndrome coexistence on the prognosis of patients with heart failure without atrial fibrillation. Analysis of Polish data from the pilot survey for the ESC Heart Failure Registry

INTRODUCTION Chronic heart failure (HF) is one of the most serious challenges of cardiology in the 21st century. At present, the prevalence of HF in the general population is estimated at between 1% and 2% [1]. Thus, this condition affects between 6.5 and 10 million Europeans (including 600–700 thousand people in Poland) and over 5 million citizens of the United States [2, 3]. The prognosis is frequently unfavourable and at the same time difficult to assess precisely. The continuous search for factors significantly influencing the prognosis of patients with HF is of considerable importance, especially given the ageing population as well as a clear relationship between age and an increase in incidence of HF [1]. A paradoxical impact of obesity on the prognosis of HF patients has been observed for many years. Obesity increases the risk of HF occurrence, but at the same time, if HF is diagnosed, obesity appears to be a factor improving the prognosis [4–6]. Obesity is seldom an isolated abnormality, more frequently being part of metabolic syndrome (MS) — the coincidence of obesity, hypertension, dyslipidaemia, and carbohydrate metabolism disorders. The importance of MS coexistence for the prognosis of patients with HF remains unclear. The aim of the study was to analyse the influence of MS on the one-year surveillance of HF patients without atrial fibrillation (AF). METHODS The study was a post hoc analysis of data concerning 893 patients included in the pilot survey for the Heart Failure Registry, carried out in Polish medical centres for the European Society of Cardiology. In this study we presented the results of subgroup analysis of patients without diagnosed AF. For statistical analysis, it was assumed that a patient with MS was a patient with simultaneous occurrence of diabetes, hypertension, and obesity. Detailed information about the methods and limitations of the study are presented in the Appendix (see journal website).