Katarzyna Mizia-Stec

Serum levels of selected adhesion molecules in patients with coronary artery disease.

BACKGROUNDnAdhesion molecules have been suggested as mediators of atherosclerotic inflammatory process. They may contribute to the pathogenesis of stable and unstable angina.nnnMETHODSnThe study group consisted of 59 patients with coronary artery disease: 27 patients with stable exertional angina (group A), 32 patients with unstable angina (group B). 20 healthy persons acted as controls (group C). Serum levels of soluble Intercellular Adhesion Molecule 1 (sICAM-1), Vascular Cell Adhesion Molecule 1 (sVCAM-1), sE-selectin, sP-selectin were measured both before and after the treadmill ECG stress test in groups A and C. In group B the measurements were carried out at 6, 24, and 48 hours following an episode of chest pain.nnnRESULTSnThere were no differences between the baseline serum levels of adhesion molecules as determined in groups A and C. In patients with stable angina, the post-exercise concentrations of sE-selectin were significantly higher (68.8+/-29 ng/ml) in comparison to both baseline- (38.7+/-15 ng/ml), and group C-values (pre-exercise: 35.1+/-16; post-exercise: 49.9+/-15 ng/ml). In unstable patients, serum sP-selectin (190.1+/-99 ng/ml) and sVCAM-1 levels (1359+/-299 ng/ml) were higher when compared to those found in groups A (142.3+/-24; 962+/-352 ng/ml, respectively) and C (136.4+/-33; 851+/-168 ng/ml, respectively).nnnCONCLUSIONSnSerum levels of soluble adhesion molecules in patients with stable angina are comparable to those of healthy persons. Stress test-induced increase of sE-selectin concentration may reflect endothelial response to exercise. Unstable angina is characterized by significant elevation of sP-selectin and sVCAM-1 serum levels which seems to be related to enhanced platelets and leukocytes activation.

Cigarette smoking and inflammatory indices in coronary artery disease

BACKGROUNDnSmoking-induced endothelial dysfunction may lead to inflammatory activation within a vascular wall mediated by cytokines and adhesion molecules. The aim of the study was to assess the relationship between the smoking status and serum levels of tumor necrosis factor (TNF) alpha, sTNFR 1 and 2 (soluble forms of TNF receptor), Interleukin (IL)-2, IL-10 and some selected adhesion molecules (AM): sE-selectin, sP-selectin, Vascular Cell AM-1 (sVCAM-1) and Intercellular AM-1 (sICAM-1) in patients with coronary artery disease (CAD).nnnMETHODS AND RESULTSnThe study group consisted of 122 consecutive admissions with stable CAD (class II/III CCS): 31 current smokers (group I; mean age+/-S.E.M.: 53.8+/-1.6 years), 38 ex-smokers (group II; mean age+/-S.E.M.: 57.8+/-1.4 years) and 53 patients who have never smoked (group III; mean age+/-S.E.M.: 62.4+/-1.1 years). Serum concentration of IL-2 was higher in the group of active smokers (77.5+/-12.7 pg/ml) than in ex-smokers (40.0+/-10.6 pg/ml; P=0.017). AM determination also revealed differences between groups I and II-elevated serum sP-selectin levels in active smokers (174.7+/-17.1 ng/ml) than in ex-smokers (123.5+/-10.3 ng/ml; P=0.024). Serum sTNFR 2 level was higher in group III (2457.3+/-120.5 pg/ml) in comparison to group II (2018.4+/-121.5 pg/ml; P=0.006). There were no differences between TNF alpha, sTNFR 1, IL-10, sE-selectin, sICAM-1, sVCAM-1 levels in the groups examined.nnnCONCLUSIONSnCigarette smoking is associated with the elevation of IL-2 and sP-selectin serum levels in patients with stable CAD. CAD patients who have never smoked are characterized by delayed onset of angina and increased sTNFR 2 concentrations.

Selected cytokines and soluble forms of cytokine receptors in coronary artery disease

Background: Cytokines may play a role in the pathogenesis of atherosclerosis and coronary artery disease (CAD). Methods: We examined serum concentrations of selected pro- (TNFalpha, IL-2) and anti-inflammatory (IL-10) cytokines, and soluble forms of TNF receptors (sTNFR 1 and sTNFR 2) by ELISA in 45 patients with stable exertional angina (group 1), 32 patients with unstable angina (group 2), and 20 healthy subjects (group C). Results: Serum concentrations of both TNFalpha (group 1, 18.3; group 2, 17.2 pg/ml; P<0.001) and IL-10 (group 1, 46.1; group 2, 41.5 pg/ml; P<0.05) were significantly higher in patients with CAD than in group C (8.3 and 14.3 pg/ml, respectively). sTNFR 1 serum level was higher in group 1 (1399.6; P<0.05) than in healthy volunteers (1093.9 pg/ml). In turn, the serum level of IL-2 was significantly higher in unstable patients than it was in groups 1 and C (89.4, 59.8 and 52.8 pg/ml, respectively). In group 1, both TNFalpha and IL-2 correlated with serum lipids. Conclusions: Patients with CAD, irrespective of the form of the disease, have higher serum levels of pro- and anti-inflammatory cytokines than control subjects. Increased concentrations of IL-2 in unstable angina may suggest additional immunologic activation. The pro-inflammatory cytokine levels seem to be related to lipid disturbances.

Inflammatory markers in a 2-year follow-up of coronary artery disease

Our study was designed in an attempt to determine the dynamics of changes in serum tumor necrosis factor (TNF)-α, soluble forms of its receptors (sTNFR 1, sTNFR 2), and adhesion molecules (sE-selectin, sP-selectin, sVCAM-1, sICAM-1) over a 2-year follow-up of patients with coronary artery disease (CAD). The study involved 70 patients with stable CAD (stable angina class II/III according to the Canadian Cardiovascular Society) and 20 apparently healthy subjects. Over the follow-up period a marked attenuation of angina (P < 0.001) was observed. Interventional treatment (percutaneous coronary intervention, coronary artery bypass grafting) was used in 53 CAD patients. Laboratory analysis revealed a significant decrease of serum TNF-α and sTNFR1 at 2 years (TNF-α: 12.1 ± 0.7u2009pg/ml; sTNFR 1: 1306 ± 46u2009pg/ml) as compared to baseline levels (16.5 ± 0.7u2009pg/ml, P = 0.030; 1551 ± 82u2009pg/ml, P = 0.048, respectively). The levels of sP-selectin (159 ± 7 vs 201 ± 14u2009ng/ml, P < 0.01) and sICAM-1 (133 ± 4 vs 153 ± 6u2009ng/ml, P < 0.05) were found to be significantly increased as compared to the baseline. Interventional procedures resulted in suppression of both cytokine (TNF-α, sTNFR 2) and adhesion molecule (sE-selectin, sP-selectin) activation in the CAD group. The baseline and post-follow-up TNF-α and sTNFR 1 levels showed persistent elevation in CAD patients as compared to the controls (9.0, 956.3u2009pg/ml, respectively; P < 0.01). There were no differences between baseline and final cytokines and adhesion molecules in healthy subjects. The course of CAD as modified by a clinically effective therapy is characterized by changes of immune markers activation. Revascularization seems to be an important factor suppressing both cytokine and adhesion molecule activation in CAD patients.

Tilt table testing in obesity

INTRODUCTIONnAn imbalance between the sympathetic and parasympathetic nervous systems has been indicated in obesity. The aim of the present study was to evaluate the results of tilt table testing (TT) in obese patients.nnnMETHODSn59 patients with simple obesity (F/M: 50/9; BMI: 36.9+/-3.9 kg/m(2)), and 19 healthy subjects of the control group (F/M: 16/3; BMI: 24.7+/-4.3 kg/m(2)) were examined. Additionally, TT was carried out in 11 patients from the obese group after a 3-month weight reduction treatment. We evaluated HR (heart rate), SBP (systolic blood pressure), DBP (diastolic blood pressure): values at rest, post-inclination values (HRt-1, SBPt-1, DBPt-1), differences between the maximum and minimum values as obtained on TT (HRt-range, SBPt-range, DBPt-range), and % differences of HR (%HRt-increase, %HRt-decrease, %HRt-range).nnnRESULTSnA positive TT response was observed in 10 obese patients, and in none of the controls. Higher differences of HR values were observed in the obese (P<0.05) in comparison to control group. Patients with a positive TT response presented a significant increase in HRt-1, HRt-range, and %HRt-range when compared to negative TT and controls (P<0.02). A 3-month weight reduction treatment resulted in a decrease in HR at rest, and decrease in SBP and DBP-both rest values and values after table-inclination.nnnCONCLUSIONSnA positive TT response is observed more often in patients with simple obesity. HR reaction to tilting varies between the patients and controls. A 3-month weight reduction treatment influences the cardiovascular response to tilting. Our results seem to support the hypothesis of autonomic imbalance in obesity.

Churg–Strauss syndrome and congenital factor Leiden thrombophilia as nontypical causes of intracardiac thrombosis

We present and discuss the case of a 26-year-old man suffering from Churg–Strauss syndrome (CSS). In our patient the disease severely affected both the heart and the lungs. Left ventricular dysfunction and intracardiac thrombosis, probably secondary to the cardiotoxic effect of eosinophils, were revealed by echocardiography. The risk of thrombosis was additionally increased by the coexistence of the factor V Leiden gene mutation. An opportunely established diagnosis allowed institution of an appropriate pharmacotherapy and subsequently to obtain a significant abatement of the clinical symptoms as well as the laboratory manifestations of the disease.