Jacek Imiela

Role of β2-microglobulin in postoperative cognitive decline

AIM β2-microglobulin (β2M) was proved to affect hippocampal functions in mice. MATERIALS & METHODS Seventy-one patients undergoing aortic valve replacement were analyzed in prospective observational study. Kidney biomarkers and Mini Mental State Examinations (MMSEs) were performed before procedure, at discharge and after 6 months. RESULTS Patients with β2M increase over the median change (>0.42 mg/l) experienced a significant in-hospital drop in MMSE (p = 0.005). Patients with β2M increase over the median change also failed to improve a delayed-word-recall domain of the test (p = 0.826) while patients with a lower increase improved results in the domain (p = 0.004). After 6 months, MMSE improvement was associated with a significant decrease in β2M (p = 0.042). CONCLUSION These are the first in man data demonstrating relation between changes in cognition and β2M. The phenomenon was reversible which indicates its therapeutic potential.

Renal resistive index in patients with true resistant hypertension: results from the RESIST-POL study

BACKGROUND Increased ultrasound Doppler renal resistive index (RRI) is a marker of atherosclerotic and hypertensive organ damage both at renal and systemic level. AIM To evaluate RRI in patients with true resistant hypertension (TRHT) in the RESIST-POL study. METHODS From 204 patients diagnosed with TRHT in the RESIST-POL study, 151 patients (90 male, 61 female, mean age: 47.7 ± 10.4, range: 19-65 years) without secondary hypertension were included into the analysis. All patients were characterised by estimated glomerular filtration rate > 60 mL/min/1.73 m2 and no history of diabetes prior to the study. As a control group we included 50 age- and gender-matched patients (35 male, 15 female, mean age: 46.8 ± 10.4, range: 19-65 years) with primary well-controlled hypertension. The groups also did not differ in respect to the number of years of known history of hypertension. The RRIs were evaluated on the basis of the Doppler ultrasound examination. Increased RRI was defined as ≥ 0.7. RESULTS Both groups did not differ in terms of renal function. Patients with TRHT were characterised by higher RRI as compared with the group with well-controlled hypertension (0.62 ± 0.05 vs. 0.60 ± 0.05, p < 0.05). In the TRHT group RRI correlated significantly with age, clinic and ambulatory blood pressure measurement, diastolic blood pressure (DBP) levels, as well as with clinic pulse pressure (PP) (r = 0.297; p = 0.001), with daytime (r = 0.355; p < 0.001) and nighttime (r = 0.313; p < 0.001) PP, and with fasting glucose concentration (r = 0.215; p = 0.008) and E/E’ ratio (r = 0.289; p = 0.001) on echocardiography. RRI values were significantly higher in TRHT patients with newly diagnosed diabetes as compared with TRHT patients without diabetes (0.65 ± 0.05 vs. 0.62 ± 0.05, p = 0.022). Age, daytime DBP, daytime PP, and E/E’ ratio but not fasting glucose concentration correlated independently with RRI in the model. Among patients with TRHT, patients with increased RRI were characterised by older age (52.2 ± 4.9 vs. 47.3 ± 10.6 years, p = 0.012), higher body mass index (32.8 ± 6.0 vs. 29.7 ± 4.5 kg/m2, p = 0.034), as well as lower daytime and nighttime DBP values and lower daytime and nighttime heart rate, as compared to patients with RRI < 0.7. The TRHT patients with increased RRI as compared to patients with RRI < 0.7 were characterised also by higher daytime and nighttime PP. Both groups did not differ in respect of renal function. CONCLUSIONS Our study showed that the patients with TRHT were characterised by significantly higher RRI values as compared to the subjects with well-controlled hypertension. It may also be suggested that in the subjects with TRHT renal vascular resistance is related to blood pressure values, selected echocardiographic abnormalities, and some surrogate markers for metabolic and cardiovascular events, including fasting glucose plasma concentration and PP, respectively.

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

Serum beta-2 microglobulin levels for predicting acute kidney injury complicating aortic valve replacement

OBJECTIVES Acute kidney injury complicating both transcatheter and surgical aortic valve replacement is associated with high rates of morbidity and mortality. The aim of this study was to investigate the role of serum beta 2 (β2) microglobulin, cystatin C and neutrophil gelatinase-associated lipocalin levels in detecting periprocedural acute kidney injury. METHODS Eighty consecutive patients who were 70 years of age or older and who were having surgical (n = 40) or transcatheter (n = 40) aortic valve replacement were recruited in a prospective study. The biomarkers were tested before the procedure, 6 times afterwards, at discharge and at a 6-month follow-up visit. RESULTS The baseline β2-microglobulin level was the strongest predictor of acute kidney injury as a complication of transcatheter aortic valve replacement [odds ratio (OR) 5.277, P = 0.009]. Its level 24 h after the procedure reached the largest area under the curve (AUC) of 0.880 (P < 0.001) for detecting acute kidney injury. In multivariate logistic regression analysis, the levels of β2-microglobulin and cystatin C 24 h after the procedure were significantly associated with acute kidney injury after transcatheter valve replacement (OR 38.15, P = 0.044; OR 1782, P = 0.019, respectively). In the surgical aortic valve replacement group, the highest AUCs belonged to β2-microglobulin and cystatin C at 24 h (AUC = 0.808, P = 0.003 and AUC = 0.854, P = 0.001, respectively). Their higher values were also associated with acute kidney injury (OR 17.2, P = 0.018; OR 965.6, P = 0.02, respectively). A persistent increase in the postoperative levels of β2-microglobulin following acute kidney injury was associated with the progression of chronic kidney disease for 6 months after both transcatheter (OR 6.56, P = 0.030) and surgical (OR 7.67, P = 0.03) aortic valve replacements. CONCLUSIONS Serum β2-microglobulin had the potential to predict acute kidney injury complicating transcatheter valve replacement and to diagnose it as early as 24 h after both the transcatheter and the surgical procedures. Furthermore, the serum level of β2-microglobulin was indicative of the progression of chronic kidney disease.

Hyperuricemia and its treatment in patients with a high cardio-vascular risk — experts opinion

Department of Hypertensiology and Internal Diseases, Pomeranian Medical University in Szczecin I Academic Department of Cardiology, Warsaw Medical University I Department of Internal Diseases, Specialist Hospital in Miedzylesie, Warsaw I Academic Department of Cardiology and Electrotherapy, Department of Medicine and Health Science, Jan Kochanowski Memorial University in Kielce Academic Department of Internal Diseases and Rheumatology, Silesian Medical University in Katowice III Academic Department of Internal Diseases and Cardiology, Warsaw Medical University Faculty of Nephrology, Arterial Hypertension and Internal Diseases, Mikolaj Kopernic Memorial University in Torun, Ludwig Rydigier Memorial Collegium Medicum in Bydgoszcz Faculty and Academic Department of Hypertensiology, Angiology and Internal Diseases, Karol Marcinkowski Memorial Medical University in Poznan