Grzegorz Kubiak

Tako-tsubo cardiomyopathy as a recurrent disease with doubtful prognosis of recovery and heterogenic symptoms

Tako-tsubo cardiomyopathy, known since 1990, is described as hypo/akinesis of apical heart segments with the hyperkinesis of the basis of the heart which mimics the shape of a traditional Japanese octopus trap.

The Role of Parathyroid Hormone and Vitamin D Serum Concentrations in Patients with Cardiovascular Diseases

25-hydroxyvitamin D (25(OH)D) plays a crucial role in human homeostasis. Its deficiency (vitamin D deficiency—VDD), being common in European population, combined with elevated concentration of parathyroid hormone (PTH), represents a vicious cycle of mechanisms leading to heart failure (HF). Despite several papers published in that field, the effect of VDD and PTH concentration on cardiovascular system remains unequivocal; thus, the aim of the study was to compare these data among HF and non-HF patients being prospectively enrolled into the study during hospital stay in the cardiology ward. Patients with HF had higher PTH concentration (85.0 ± 52.6 versus 64.5 ± 31.7, p ≤ 0.02) compared to non-HF patients. Mean PTH values were associated with the clinical status expressed by the New York Heart Association class (NYHA class) (“0”—66.04, “I”—56.57, “II”—72.30, “III”—85.59, and “IV”—144.37 pg/ml, p ≤ 0.00004). Interestingly, neither 25(OH)D (31.5 versus 29.7 ng/ml, p ≤ ns) nor phosphorus (P) (1.23 versus 1.18 mmol/l, p ≤ ns) nor total calcium (Ca2+) concentration (2.33 versus 2.37 mmol/l, p ≤ ns) differed among the groups. Reassuming PTH serum concentration in contrary to 25(OH)D, P and Ca2+ are significantly raised among the patients with HF and shows significant relationship with the clinical status expressed by the NYHA class.

Assessment of Autonomic Nervous System Dysfunction in Elderly Women Suffering from Chronic Heart Failure with or Without Type 2 Diabetes

Assessment of Autonomic Nervous System Dysfunction in Elderly Women Suffering from Chronic Heart Failure with or Without Type 2 Diabetes Research evaluated frequency of autonomic nervous system dysfunction in a group of women with chronic heart failure with type 2 diabetes (group 2, n= 44) or without type 2 diabetes (group 1, n=41), as compared to control (group 0, n=34). Also evaluated was the influence of concentration of hemoglobin and serum creatinine on the frequency of autonomic nervous system dysfunction.

Quality of life in patients with severe left ventricle dysfunction due to coronary artery disease

AbstractBackgroundThe majority of randomized trials comparing surgical treatment with percutaneous coronary intervention exclude patients with severe left ventricle dysfunction, resulting in the lack of a clear strategy for treatment.AimRetrospective post treatment evaluation of New York Heart Association classification (NYHA) and quality of life (QOL) in patients submitted to different methods of treatment.MethodologyPatients with Left Ventricle Ejection Fraction (LVEF) ≤ 30% and verified atherosclerotic lesions in their coronary arteries were divided into groups depending on the method of treatment: 1.Pharmacological Treatment (PT).2.Coronary Artery Bypass Graft (CABG).3.Percutaneous Coronary Intervention (PCI). NYHA classification and the quality of life were assessed during follow-up examination performed after the mean time of 28,16 months in all three groups. All patients received pharmacological treatment of heart failure according to current guidelines.ResultsFinally, 120 consecutive patients with severe dysfunction of left ventricle were enrolled in the study. Quality of Life was assessed after the mean time of 28,16 months in all three groups. QOL improved in the 58 percent of the patients in the pharmacological treatment group, 40 percent of the patients in the CABG group and 48 percent of the patients in the PCI group. Comparison between the groups did not reveal statistically significant differences: group 1 vs. 2 (p=0.48), 2 vs. 3 (p=1.0), 1 vs. 3 (p=0.11). The improvement of NYHA class in group of patients submitted to CABG treatment comparing to those patients who were only pharmacologically treated occurred in 8 patients and was statistically significant (p=0.00256). Improvement of NYHA class was achieved in 20 patients from the Pharmacological comparing to PCI group (p=0.055) and in 19 patients from the CABG comparing to PCI group (p=0.044) however these differences were not statistically significant.ConclusionsImprovement of NYHA functional class in patients with severe left ventricular dysfunction was statistically significant in patients submitted to CABG comparing to pharmacological treatment (p=0.00256). Improvement of QOL in particular groups was not statistically significant.

Saphenous graft atherosclerosis as assessed by optical coherence tomography data for stenotic and non-stenotic lesions from the OCTOPUS registry

Introduction Coronary artery bypass grafting (CABG), although widely used for a long time in diffuse coronary artery disease (CAD), has serious limitations associated with graft aging and its degeneration. Aim The relationship between saphenous vein graft (SVG) plaque morphology assessed by optical coherence tomography (OCT) and clinical findings has not been elucidated yet. Material and methods We compared the morphology of SVG in stenotic vs. non-stenotic lesions using OCT imaging in 29 patients hospitalized in our center within the OCTOPUS registry. Results Stenotic lesions were characterized by higher incidence of thin-cap fibroatheroma (TCFA) (33% vs. 0%, p = 0.0048), thrombus (28% vs. 0%, p = 0.0008), lipid-rich plaque (LRP) (75% vs. 35%, p = 0.0013) and plaque within the SVG valve (19% vs. 0%, p = 0.0114) as compared to non-stenotic lesions. Patients with intimal tearing or rupture (ITR) were older (75.8% vs. 68.9 years, p = 0.047) and had lower left ventricular ejection fraction (LVEF) (32.0% vs. 49.7%, p = 0.001) and glomerular filtration rate (GFR) (36.0 vs. 73.6 ml/min/1.73 m2, p = 0.010). Patients with calcified lesions vs. those without had lower high-density lipoprotein (HDL) cholesterol (33.2 vs. 44.1 mg/dl, p = 0.018), similarly to those with ruptured plaque vs. those without (28.3 vs. 41.7 mg/dl, p = 0.047). Conclusions Presence of ITR was associated with advanced age, decreased LVEF and renal insufficiency. Decreased concentration of HDL was associated with higher occurrence of calcified and ruptured plaque.

ST segment elevation myocardial infarction caused by post-traumatic coronary artery perforation

Address for correspondence: Grzegorz Kubiak, MD, Department of Cardiology, Invasive Coronary Care Unit, District Hospital, ul. dr. Witolda Antesa 11, 43–200 Pszczyna, Poland, e-mail: greg_kubiak@yahoo.com Conflict of interest: none declared Kardiologia Polska Copyright

Handheld Capillary Blood Lactate Analyzer as an Accessible and Cost-Effective Prognostic Tool for the Assessment of Death and Heart Failure Occurrence during Long-Term Follow-Up

Impact of tissue lactate accumulation on prognosis after acute myocardial infarction (AMI) is biased. The study aimed to assess the prognostic role of lactate concentration (LC) in patients with AMI during one year of follow-up. 145 consecutive patients admitted due to AMI were enrolled. The data on the frequency of endpoint occurrence (defined as I, death; II, heart failure (HF); and III, recurrent myocardial infarction (re-MI)) were collected. The patients were divided into group A (LC below the cut-off value) and group B (LC above the cut-off value) for the endpoints according to receiver operating characteristic (ROC) analysis. The cumulative survival rate was 99% in group I-A and 85% in group I-B (p = 0.0004, log-rank test). The HF-free survival rate was 95% in group II-A and 82% in group II-B (p = 0.0095, log-rank test). The re-MI-free survival rate did not differ between groups. A multivariate Cox analysis showed a statistically significant influence of LC on death [Hazard Ratio (HR): 1.41, 95% Confidence Interval (CI) (1.13–1.76), and p = 0.002] and HF [HR: 1.21, 95% CI (1.05–1.4), and p = 0.007] with no impact on re-MI occurrence. LC in capillary blood may be considered a useful prognostic marker of late-onset heart failure and death after AMI.

Acute aortic syndrome mimicking anterior wall ST-elevation myocardial infarction

We present a case of a 58-year-old man presenting with chest pain irradiating to the back and left arm, history of smoking and untreated hypertension. The anamnesis, symptoms and ECG findings consisting of ST elevation in leads aVR and V1-V2 suggested ST segment elevated myocardial infarction. Performed ECHO examination revealed possible acute aortic dissection. Considering haemodynamic instability, augmentation of chest pain and passing time which was obviously worsening the prognosis patient was submitted to aortography which finally proofed acute aortic dissection. Patient was subsequently transferred to cardiac surgery unit and successfully treated.