Jakub Podolec

Influence of chronic inflammation and autoimmunity on coronary calcifications and myocardial perfusion defects in systemic lupus erythematosus patients

ObjectiveConventional risk factors for coronary artery disease fail to explain the increased frequency or cardiovascular morbidity in systemic lupus erythematosus (SLE) patients. This study was conducted to determine the possible influence of autoimmune and inflammatory phenomena markers on coronary artery calcifications and myocardial perfusion abnormalities in SLE patients.Materials and methodsMulti-detector computed tomography (MDCT)-based coronary calcium scoring and single photon emission computerized tomography (SPECT) studies (Tc-99m sestamibi) were performed in 60 SLE patients in stable clinical condition, without a prior history of coronary artery disease. Laboratory evaluation included serum C-reactive protein (CRP), complement C3c and C4 components and antiphospholipid antibodies (aPL). The latter included anticardiolipin (aCL) and anti-β2-glycoprotein I (aβ2GPI) antibodies, of both IgG and IgM classes, and lupus anticoagulant (LA) in plasma.ResultsSPECT revealed persistent perfusion defects in 22 (36.7%) patients and exercise-induced defects in eight (13.3%), while MDCT revealed coronary calcifications in 15 (25%). Calcium scores ranged from 1 to 843.2 (mean 113.5xa0±xa0259.7). No association was found between conventional coronary artery disease risk factors (obesity, hypertension, tobacco use, hyperlipidaemia, diabetes) nor CRP, C3c or C4 levels and coronary calcifications or myocardial perfusion defects. On the contrary, in patients with these pathologies, augmented autoimmunization was found, reflected by increased aCL IgG and antiβ2GPI IgG levels. In patients with aCL IgG >20xa0RU/ml or antiβ2GPI IgG >3xa0RU/ml, the relative risk of coronary calcification formation was 4.1 compared to patients with normal values. Accordingly, in LA-positive patients the relative risk of coronary calcification formation was 4.4 compared to LA-negative patients.ConclusionsConventional risk factors for coronary artery disease as well as markers of an ongoing inflammation did not show any association with perfusion defects and/or coronary artery calcifications in SLE patients. On the contrary, calcified atherosclerotic plaques and myocardial perfusion defects were observed mainly in patients with elevated levels of anticardiolipin and aβ2GPI antibodies of the IgG class. It might be speculated that coronary artery calcifications and perfusion defects are a result of antiphospholipid antibodies-induced coronary artery microthrombosis.

Transcranial doppler ultrasonography should it be the first choice for persistent foramen ovale screening

BackgroundPersistent foramen ovale (PFO) is considered a cause of cryptogenic stroke and a risk factor for neurological events in young patients. The reference standard for identifying a PFO is contrast-enhanced transesophageal echocardiography (TEE).The goal of this study was to evaluate the feasibility of transcranial color Doppler (TCD) and its diagnostic sensitivity compared with TEE.MethodsWe investigated 420 patients admitted to our department with cryptogenic stroke, transient ischemic attacks or other neurological symptoms. All patients underwent TCD and TEE evaluation. TCD and TEE examinations were performed according to a standardized procedure: air-mixed saline was injected into the right antecubital vein three times, while the Doppler signal was recorded during the Valsalva maneuver. During TCD the passage of contrast into the right-middle cerebral artery was recorded 25xa0seconds following the Valsalva maneuver.ResultsWe detected a right-to-left shunt in 220 patients (52.3%) and no-shunts in 159 patients (37.9%) with both TCD and TEE. In 20 (4.8%) patients TEE did not reveal contrast passage which was then detected by TCD. In 21 (5.0%) patients only TEE revealed a PFO. The feasibility of both methods was 100%. TCD had a sensitivity of 95% and a specificity of 92% in the diagnosis of PFO.ConclusionsTCD has a relatively good sensitivity and specificity. TCD and TEE are complementary diagnostic tests for PFO, but TCD should be recommended as the first choice for screening because of its simplicity, non-invasive character, low cost and high feasibility.

Aspirin resistance in adult patients after Fontan surgery

BACKGROUNDnThrombotic complications are common in adult patients who have had a Fontan operation early in life for treatment of congenital heart disease.nnnOBJECTIVEnTo characterize platelet function and responsiveness to aspirin in relation to thrombogenesis, systemic inflammation, and markers of endothelial function in adults with Fontan circulation (FC).nnnMETHODSnThirty-four FC patients (age 18-40years; 62% taking aspirin chronically and 38% not taking aspirin) and 32 age- and sex-matched healthy controls were studied. Platelet function was evaluated by measurement of basal concentrations of thromboxane B2 (TXB2) and sCD40L and ex-vivo generation of TXB2 and sCD40L. Plasma concentrations of thrombin-antithrombin, endothelin-1, vWF, IL-6, IL-8, MCP-1, MIP-1β, TNFα, sVCAM-1, and syndecan-1 also were measured.nnnRESULTSnPlatelet numbers were significantly lower in FC patients than in controls, but the patients had significantly higher platelet activity, as evidenced by higher TXB2 and sCD40L concentrations and higher ex vivo generation of TXB2. Chronic aspirin treatment had no effect on plasma concentrations of TXB2 and sCD40L in FC, but in 52% of aspirin-treated FC subjects, TXB2 concentrations remained elevated at 60min of TXB2 generation, indicating aspirin resistance. In addition, FC patients had increased levels of thrombin-antithrombin, endothelin-1, vWF, IL-8, MCP-1, MIP-1β, TNFα, sVCAM-1, and syndecan-1 but not of IL-6.nnnCONCLUSIONnAdults with FC had lower platelet numbers but increased platelet activity, increased thrombogenesis, systemic inflammation, and endothelial dysfunction. A significant proportion of aspirin-treated FC adults had aspirin resistance, which may be at least in part responsible for their increased incidence of thrombotic complications.

Polish Forum for Prevention Guidelines on Diabetes: update 2017

1Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland 21st Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Poznan, Poland 3Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland 4Department of Haemodynamics and Angiocardiography, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland 5Chair of Epidemiology and Population Studies, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland 6Department of Preventive Medicine and Medical Education, Medical University in Gdansk, Gdansk, Poland 71st Department of Cardiology, Interventional Electrocardiology, and Hypertension, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland 8Department of Pharmacogenomics, Division of Biochemistry and Clinical Chemistry, Medical University of Warsaw, Warsaw, Poland 9Department of Family Medicine, Jagiellonian University Medical College, Krakow, Poland 10Department of Paediatric Cardiology and Rheumatology, Medical University of Lodz, Lodz, Poland 11Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland 122nd Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland 13Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland

Wytyczne Polskiego Forum Profilaktyki Chorób Układu Krążenia dotyczące nadciśnienia tętniczego: aktualizacja 2017

11st Department of Cardiology, Interventional Electrocardiology and Hypertension, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland 2Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College at John Paul II Hospital, Krakow, Poland 3Department of Clinical Epidemiology and Population Studies, Institute of Public Health, Jagiellonian University Medical College, Krakow, Poland 4Department of Haemodynamics and Angiocardiography, John Paul II Hospital, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland 5Department of Preventive Medicine and Medical Education, Medical University in Gdansk, Gdansk, Poland 6Department of Epidemiology, CVD Prevention, and Health Promotion, Institute of Cardiology, Warsaw, Poland 7Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland 8Department of Pharmacogenomics, Division of Biochemistry and Clinical Chemistry, Medical University of Warsaw, Warsaw, Poland 9Department of Family Medicine, Jagiellonian University Medical College, Krakow, Poland 10Department of Paediatric Cardiology and Rheumatology, Medical University of Lodz, Lodz, Poland 11Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland 122nd Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland 13Department of Allergy and Immunology, 2nd Chair of Internal Medicine, Jagiellonian University Medical College, Krakow, Poland 14Department of Hypertensiology, Angiology and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland 15Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Krakow, Poland 16Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland

Rare cardiovascular diseases: from European legislations to classification and clinical practice

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Elevated level of plasma endothelin-1 in patients with atrial septal defect

BackgroundThe study aimed to assess the level of plasma Endothelin-1 (ET-1) in patients before and after transcatheter closure of atrial septal defect (ASD) and to evaluate the usefulness of measuring ET-1 levels for the diagnosis and selection of candidates for ASD closure.Methods80 patients (55xa0F, 25xa0M), mean age 42,2u2009±u200911,5xa0years were enrolled for an attempt at ASD closure. A group of 19 healthy volunteers, (12xa0F, 7xa0M) mean age 39.2u2009±u20099.15 served as controls. All ASD patients underwent: clinical and echocardiographic study and cardiopulmonary exercise test. ET-1 levels were measured before and after closure. Whole blood was collected from femoral artery and vein and from pulmonary artery during cardiac catheterization.ResultsET-1 levels at peripheral artery and vein in ASD patients were significantly higher than in the volunteers (pu2009<u20090.0001). The ASD subjects with highest ET-1 level presented the larger area of right ventricle and right atrium and higher pulmonary artery systolic pressure(pu2009<u20090.05). The ASD subjects with lower ET-1 level demonstrated longer time of exercise and higher peak oxygen consumption (pu2009<u20090.05). There was a decrease of ET-1 at peripheral artery (5.128u2009±u20098.8 vs. 2.22u2009±u20096.2; pu2009<u20090.001) and at peripheral vein (4.401u2009±u20093.33 vs. 2.05u2009±u20091.35; pu2009<u20090.001) within 48xa0hours after ASD closure, as compared to the baseline data. After 6 and 12xa0months farther drop in ET-1 level was observed.Conclusions1. The level of ET-1 in ASD patients is elevated in compare to healthy subject.2. The significant reduction of ET-1 level is observed after percutaneous closure of ASD.3. Elevated level of ET-1 in patients with ASD is associated with right heart enlargement.4. Measurements of ET-1 may be a supplemental diagnostic tool and may be helpful in establishing indications for defect closure.

Cardiology telemedicine solutions — opinion of the experts of the Committee of Informatics and Telemedicine of Polish Society of Cardiology, Section of Non-invasive Electrocardiology and Telemedicine of Polish Society of Cardiology and Clinical Sciences C

For several years, we have observed the dynamic development of technologies that allow patients to access medical care from the comfort of their homes, without direct contact with the doctor. Innovative solutions based on telemedicine improve care coordination and communication among clinicians, patients, and their families, as well as increases patients security and gives them greater independence, thus eliminating health care inequalities. The rapidly growth of telemedicine and the adoption of new technologies in clinical practice is also observed in Poland. Crucial moment for the telemedicine facilitation process in our country was Baltic Declaration approved by Minister of Health in 2015, as well as the Medical Profession Amendment Act and remote medical care admission. Since then, as part of the work of the Information Technology and Telemedicine Committee of the Polish Cardiac Society and the Telemedical Working Group, important steps have been taken to implement a telemedicine solutions in the Polish healthcare system, resulting in improved quality and efficiency of this system. The presented document reflects the above actions and encompasses following issues: available telemedicine solutions in the world, analysis of their effectiveness based on clinical trials, funding opportunities, legal status and development prospects telecardiology in Poland.

First in Poland, unique 60-mm long single drug eluting tapered stent implantation in a patient with unstable angina

Coronary artery disease is still a disease with high morbidity and mortality rates. Technology development is one of the most important factors among treatment methods and provides a personalised approach to patients. A 66-year-old patient was admitted to the Interventional Cardiology Clinic with symptoms of unstable angina, recently progressing up to class III according to Canadian Cardiovascular Society classification. The patient was diagnosed and treated for arterial hypertension and dyslipidaemia, without other significant comorbidities. Three weeks earlier the patient underwent coronary angiography, which revealed a single, long lesion in the left anterior descending (LAD). After Heart Team consultation a single coronary artery by-pass graft (CABG) to the LAD was proposed as the best treatment option. The patient did not agree to undergo CABG and was re-qualified to percutaneous coronary intervention. Coronary angiography confirmed critical long stenosis in the proximal/mid LAD (Fig. 1A, B). An extra back-up therapeutic catheter was introduced via the right femoral artery. A Ryiujin 1.25/10 mm balloon was used to cross and pre-dilate the proximal lesion. Then the lesion was treated with long inflations of a non-compliant 2.5/15 mm balloon with pressures up to 22 atm. After intracoronary vascular ultrasound (IVUS) for artery size and plaque morphology estimation (Fig. 2A) a tapered sirolimus drug-eluting stent Meril, Biomime Morph, 60 mm long, with proximal 3.0 mm and distal 2.5 mm diameter was prepared for this patient. The stent was introduced and implanted with pressure of 10 atm without any complications. Post dilatation was performed with a 3.25/15 mm non-compliant balloon with 8 atm pressure in the distal and up to 24 atm in the mid and proximal parts of the stent. The guide wire was easily repositioned to a diagonal branch and the “kissing balloon” technique was applied to finalise the result (Fig. 3). Proper apposition of the stent was confirmed with IVUS (Fig. 2B). The patient was discharged. Long and complex lesions are becoming more common in patients presenting to interventional cardiology cath-labs. New, tapered, long drug-eluting stents are designed to cover the whole lesion and adjust to native vessel anatomy. A single-stent technique is favourable, avoiding the risk of sub-optimal apposition of overlapping stents, and after correct lesion preparation with non-compliant balloon it is easy and safe to introduce. We present a unique case of a very long 60-mm tapered stent implantation in a patient with unstable angina. The long term-results of long stent implantations still need to be assessed in clinical trials; however, our first experiences are promising. Figure 1. A, B. Left anterior descending lesion prior to percutaneous coronary intervention A B

Polish Forum for Prevention Guidelines on Dyslipidaemia: update 2016

1National Institute of Food and Nutrition, Warsaw, Poland 21st Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland 3Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College at John Paul II Hospital, Krakow, Poland 4Department of Epidemiology, Cardiovascular Disease Prevention and Health Promotion, Institute of Cardiology, Warsaw, Poland 5Department of Clinical Epidemiology and Population Studies, Institute of Public Health, Jagiellonian University Medical College, Krakow, Poland 6Department of Haemodynamics and Angiocardiography, John Paul II Hospital, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland 7Department of Hypertension and Diabetology, Medical University in Gdansk, Gdansk, Poland 81st Department of Cardiology and Hypertension, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland 9Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland 10Department of Pharmacogenomics, Division of Biochemistry and Clinical Chemistry, Medical University of Warsaw, Warsaw, Poland 11Department of Paediatric Cardiology and Rheumatology, Medical University of Lodz, Lodz, Poland 122nd Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland 13Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland 142nd Department of Internal Medicine, Jagiellonian University Medical College, Krakow, Poland 15Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland 16Department of Family Medicine, Jagiellonian University Medical College, Krakow, Poland 17Department of Congenital Heart Disease, Institute of Cardiology, Warsaw, Poland