Iwona Gorczyca-Michta

Oral health status and the occurrence and clinical course of myocardial infarction in hospital phase: A case-control study

BACKGROUND Periodontitis may contribute to destabilization of atherosclerotic plaque leading to acute coronary syndrome and myocardial infarction (MI). The aim of the paper was to evaluate the state of the oral cavity and test the association between chosen parameters of acute, hospital phase MI in patients aged 60 and younger. METHODS We examined patients with acute MI, age 60. Control group consisted of matched group of patients with stable angina. Patients enrolled in the study underwent dental, cardiovascular and biochemical examination. Left ventricular ejection fraction (LVEF) was measured during echocardiographic examination, intima-media thickness (IMT) was assessed by ultrasonographic examination at the same time. RESULTS The case group included 112 hospital patients with acute MI. Patients with acute MI were characterized by higher level of cardiovascular disease risk factors and poor oral health status in comparison to the control group. There was higher prevalence of edentulousness (p = 0.0039) and advanced periodontal disease (APD) (p < 0.0001) in the case group than in the control group. Patients with edentulousness and APD were characterized by the highest levels of fi brinogen, interleukine-6, tumor necrosis factor-a, increased IMT and numerous atherosclerotic plaques. Logistic regression analysis revealed association between biomarkers of myocardial injury, LVEF and chosen periodontal parameter (API, CAL, PDI, BI) and edentulousness. CONCLUSIONS Poor oral health status, especially periodontal disease may infl uence on the occurrence and clinical course of MI.

Variability of circadian blood pressure profile during 24-hour ambulatory blood pressure monitoring in hypertensive patients

BACKGROUND Evaluation of circadian blood pressure (BP) profile is an important element of ambulatory BP monitoring (ABPM). Abnormal nocturnal fall in BP is more common in patients with secondary causes of hypertension and in the elderly. Cardiovascular risk is substantially increased in these patients. AIM Analysis of circadian BP profile in a population of treated hypertensives and identification of factors affecting variability of nocturnal fall in BP. METHODS 24-h ABPM was performed in hypertensive patients. Based on nocturnal fall pattern, four subgroups were identified:dippers, non-dippers, extreme dippers, and risers. Comorbidities were assessed, and data obtained in all groups were compared with the dipper profile group. RESULTS We analysed 161 patients (86 men, 53.4%). A dipper profile was noted in 44.7% of patients. Abnormal circadian BP profile was observed in 55.3% of patients, including a non-dipper profile in 21.1% of patients, an extreme dipper profilein 32.3% of patients, and a riser profile in 1.9% of patients. No significant differences in the rates of dyslipidaemia, previous myocardial infarction, previous stroke, and coronary artery disease were seen between the groups. The whole study population was also characterised by similar rates of excessive body weight and abdominal obesity. CONCLUSIONS An abnormal circadian BP profile was found in over 50% of hypertensive patients. A negative correlation was found between nocturnal BP fall and the patient age. No differences were found between groups with different circadian BP pattern regarding duration of hypertension and the presence of dyslipidaemia, obesity, diabetes, or coronary artery disease.

The relationship between admission heart rate and early prognosis in patients with ST-elevation myocardial infarction

BACKGROUND Heart rate (HR) is a basic cardiovascular parameter. The relationship between HR and cardiovascular mortality and morbidity has been indicated in clinical trials and epidemiological studies. AIM The evaluation of the relationship between HR upon hospital admission and the in-hospital prognosis in a group of patients with ST-elevation myocardial infarction (STEMI). METHODS The medical records of 927 patients were subject to retrospective analysis. The patients were classified on the basis of HR upon hospital admission: < 60 bpm (n = 75), 60-69 bpm (n = 169), 70-79 bpm (n = 245), 80-89 bpm (n = 172), 90-99 bpm (n = 134), and ≥ 100 bpm (n = 132). A group of patients with HR of 60-69 bpm on hospital admission (n = 169) constituted a reference group. Patients with atrioventricular blocks and arrhythmias were excluded from the analysis. Early mortality and co-existing diseases were evaluated in the study population. RESULTS Patients with HR ≥ 90 bpm demonstrated heart failure symptoms considerably more often than patients with HR of 60-69 bpm (p = 0.0010). In-hospital mortality was significantly higher in patients with a HR of more than 90 bpm and bradycardia. The relationship between HR and cardiovascular mortality is shown with a J-shaped curve. CONCLUSIONS HR is strictly correlated with early cardiovascular mortality in a population of patients with STEMI. The relationship between HR and early mortality is demonstrated by a J-shaped curve.

Depression in patients after coronary artery bypass grafting

Surgical revascularization is a recognized method of treatment ofischaemic heart disease. The number of patients undergoing coronary artery bypass grafting (CABG) is constantly increasing, both in a population of young patients with coronary heart disease and in elderly patients. It is estimated that even one out of three patients undergoing CABG in the perioperative period can develop symptoms of depression. Numerous individual factors as well as factors related to the surgery have an impact on the occurrence of depression. The most common factors are: age, sex, socio-economic status, co-existing diseases, and the occurrence ofpreoperative depression. Researchers are currently looking for biochemical markers concentration of which before surgery could serve as a predicator for the occurrence of post-CABG depression. It is suggested that inflammatory response, particularly intense in the perioperative period, is linked to the occurrence of depression after surgical revascularization. Recognizing these factors is of utmost importance since it will help develop a stratification aiming at the identification of patients who are particularly prone to the occurrence of postoperative depression. Due to the fact that depression not only lowers the quality of life but also affects the short-term and long-term prognosis, identifying patients at risk is significantly important.

Prevalence and predisposing conditions for atrial fibrillation in hospitalised patients with hypertension.

BACKGROUND Hypertension, due to its prevalence, is a common and independent risk factor for atrial fibrillation (AF). High blood pressure causes structural and functional changes in the myocardium, leading to an increased risk of arrhythmia. This risk is higher when hypertension is accompanied by concomitant diseases that contribute to the development of AF. AIM To estimate prevalence of AF and predisposing factors for AF in patients with hypertension hospitalised in our cardiology unit. METHODS This retrospective analysis included 4459 patients hospitalised in the Clinical Department of Cardiology in 2009-2010. Hypertension was identified in 2512 (56.3%) patients. The study group consisted of 685 (27.3%) patients with hypertension and concomitant AF, and the control group included 1827 (63.7%) hypertensive patients without AF. We analysed clinical data including AF type, coexisting diseases and left ventricular ejection fraction evaluated by echocardiography. RESULTS Mean patient age in the study group was 74 years compared to 67 years in the control group. Most patients in the study group had either paroxysmal (46%) or permanent AF (45.5%). The following rates of coexisting diseases were found in the study and control groups: heart failure (HF) 54.3% vs. 31.4%, respectively (p < 0.001), ischaemic heart disease (IHD) 44.4% vs. 25.2% (p < 0.001), diabetes 28.3% vs. 24.2% (p = 0.126), hypercholesterolaemia 25.4% vs. 30.4% (p = 0.067), stroke 10% vs. 3% (p = 0.0028), hyperthyroidism 4.7% vs. 1.9% (p = 0.0002), hypothyroidism 5.1% vs. 2.1% (p = 0.0001), and euthyroid goitre 5.3% vs. 2.1% (p < 0.0001). Multivariate logistic regression analysis identified the following factors that significantly affected the occurrence of AF in patients with hypertension: hypothyroidism (hazard ratio [HR] 3.27), IHD (HR 2.75), hyperthyroidism (HR 2.55), euthyroid goitre (HR 2.13), previous myocardial infarction (HR 1.96), and HF (HR 1.66). CONCLUSIONS Among hospitalised patients with hypertension, AF is present in a significant proportion of patients. Conditions predisposing to this arrhythmia in hypertensives include HF, IHD, thyroid diseases, and previous myocardial infarction. There was no evidence that diabetes, abnormal lipid profile, and impaired kidney function affected AF rate among patients with hypertension.

New oral anticoagulants for the prevention of thromboembolic complications in atrial fibrillation: a single centre experience

BACKGROUND Prevention of thromboembolic complications is a priority in patients with atrial fibrillation (AF). Based on the current guidelines, the role of vitamin K antagonists (VKA) in stroke prevention has decreased in favour of novel oral anticoagulants (NOAC). AIM To evaluate the proportion of AF patients who were prescribed a NOAC, compare populations of patients treated with VKA and NOAC, and identify factors predisposing to NOAC prescription at hospital discharge of AF patients. METHODS A single-centre prospective study was carried out based on medical records of 550 patients who were diagnosed with non-valvular AF and discharged from a Cardiology Department from September 2012 till August 2013. RESULTS Among 550 patients with AF, an oral anticoagulant (OAC) was prescribed for stroke prevention in 463 (84.2%) patients. At discharge, VKA was prescribed in 373 patients (80.6% of those treated with OAC), and NOAC was prescribed in 90 patients (19.4% of those treated with OAC). Among patients receiving NOAC, dabigatran was prescribed to 41 (45.6%) patients and rivaroxaban was prescribed to 49 (54.4%) patients. The mean CHA2DS2VASc scores in patients treated with VKA and NOAC were 3.8 ± 1.7 and 4.1 ± 1.7, respectively (p = NS). The mean HASBLED score in patients treated with VKA and NOAC was 2.2 ± 1.0 and 2 ± 0.9, respectively (p = NS). Patients treated with NOAC were older than patients treated with VKA (mean age 74.7 ± 11.9 vs. 70.5 ± 10.8 years, p = 0.0005). In multivariate analysis, factors associated with an increased likelihood of NOAC prescription included a history of bleeding (odds ratio [OR] 3.43), hospitalisation due to AF (OR 2.82), age ≥ 80 years (OR 2.8), paroxysmal arrhythmia (OR 1.77), and living in a rural area (OR 1.77). CONCLUSIONS A NOAC was used in one fifth of all hospitalised AF patients receiving anticoagulant treatment. The risk of thromboembolic and bleeding complications did not differ between AF patients treated with NOAC or VKA. Factors associated with an increased likelihood of NOAC prescription included a history of bleeding, age ≥ 80 years, paroxysmal arrhythmia, hospitalisation due to AF, and living in a rural area.

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.

Implantable cardioverter-defibrillator in a patient with left ventricular non-compaction cardiomyopathy

Address for correspondence: Iwona Gorczyca-Michta, MD, 1st Department of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, ul. Grunwaldzka 45, 25–001 Kielce, Poland, e-mail: iwona.gorczyca@interia.pl Conflict of interest: none declared Kardiologia Polska Copyright

Rupture of ventricular septum leading to acute heart failure due to myocardial infarction of the inferior heart wall

Address for correspondence: Anna Szpotowicz, MD, Department of Cardiology, ZOZ Ostrowiec Swietokrzyski, ul. Szymanowskiego 11, 27–400 Ostrowiec Świętokrzyski, Poland, e-mail: szpotowiczanna@wp.pl Conflict of interest: none declared Kardiologia Polska Copyright

Uporczywe, groźne komorowe zaburzenia rytmu jako późny objaw reperfuzji u chorego z zawałem serca leczonego angioplastyką tętnic wieńcowych

We present a case of a 66-year-old patient with myocardial infarction with ST-segment elevation, multivessel coronary artery disease and recurrent ventricular tachycardia after percutaneous coronary angioplasty. Patient was transferred to our Clinic to consider implantable cardioverter-defibrillator implantation. On the basis of the presented case, authors point out difficulties in making decisions concerning management of patients with persistent ventricular arrhythmias complicating acute coronary syndrome.