Katarzyna Piestrzeniewicz

Resistin increases with obesity and atherosclerotic risk factors in patients with myocardial infarction

The objective of the study was to assess the relation of resistin to the anthropometric parameters, metabolic risk factors, and C-reactive protein (CRP) in men with myocardial infarction. Subjects were 40 obese (age, 53.6 +/- 7.39 years; body mass index, > or =30 kg/m2) and 40 lean (age, 54.4 +/- 6.62 years; body mass index, <25 kg/m2) men with first acute myocardial infarction. Waist and hip circumferences, CRP, uric acid, fasting glucose, lipid profile, and blood resistin concentration were measured. In obese patients, triglycerides, fasting glucose, and CRP were significantly higher whereas high-density lipoprotein cholesterol was lower than in lean patients. The range of blood resistin concentration was 6.0 to 70.5 ng/mL: 27.84 +/- 12.15 ng/mL in obese subjects and 17.35 +/- 11.08 ng/mL in lean subjects (P < .0001). Significant positive correlation was revealed between blood resistin concentration and each of the analyzed anthropometric parameter and with fasting glucose, low-density lipoprotein cholesterol, and CRP, whereas negative relation was observed between resistin and high-density lipoprotein cholesterol. As revealed by univariate logistic regression analysis, risk of blood resistin concentration being greater than the median value (19.75 ng/mL) was increased by obesity, high-density lipoprotein cholesterol <40 mg/dL, hypertension, and CRP. In multivariate model, independent variables associated with higher median of resistin were obesity and CRP. Obesity increased 5.5-fold the probability of blood resistin concentration being greater than 19.75 ng/mL, whereas each 1-mg/dL increase in CRP increased this probability by 13%. In patients with acute myocardial infarction, obesity is positively related to blood resistin concentration. Resistin is likely to play a major role in the atherogenesis and its complications, and this action seems to be mostly related to the inflammatory reaction.

Systemic blood osteopontin, endostatin, and E-selectin concentrations after vertical banding surgery in severely obese adults.

BACKGROUND Obesity is associated with endothelial dysfunction and increased inflammation as well as with expansion of the capillary bed in regional adipose deposits, and a balance between these factors is involved in angiogenesis. Osteopontin (OPN) is a proinflammatory cytokine involved in regulating immune processes and mediating chronic inflammation. Its level is usually elevated in the plasma and adipose tissue of obese subjects. E-selectin, an adhesion molecule which is released by dysfunctional endothelial cells, is believed to be a marker of an early atherosclerotic process. Endostatin (END), an angiogenesis inhibitor, is present in the blood of obese subjects. The most effective treatment to achieve weight loss in morbidly obese subjects is bariatric surgery. The aim of the study was to evaluate and compare the circulating concentrations of OPN, E-selectin and END as well as the insulin resistance (HOMA-IR) of severely obese patients with metabolic syndrome before and after vertical banded gastroplasty (VBG). MATERIAL AND METHODS The test cohorts comprised eight males and 20 females (total 28 patients) aged from 20 to 59 years with simple obesity and the presence of metabolic syndrome, both before and 3, 6, 12, 24 months after bariatric surgery (six patients were also checked after 36 and four after 48 months). RESULTS Bariatric surgery significantly reduced (over 24 months) body weight, BMI, waist circumference, HOMA-IR and blood concentrations of CRP. Plasma OPN gradually increased after VBG and E-selectin in systemic blood decreased. We did not observe any differences in END concentrations from 12 to 48 months after surgery. CONCLUSION VBG improves metabolic syndrome parameters, decreases E-selectin and gradually increases OST blood concentrations but it does not have any significant influence on END levels.

Redo surgery risk in patients with cardiac prosthetic valve dysfunction

Introduction The aim of the study was to analyse the risk factors of early and late mortality in patients undergoing the first reoperation for prosthetic valve dysfunction. Material and methods A retrospective observational study was performed in 194 consecutive patients (M = 75, F = 119; mean age 53.2 ±11 years) with a mechanical prosthetic valve (n = 103 cases; 53%) or bioprosthesis (91; 47%). Univariate and multivariate Cox statistical analysis was performed to determine risk factors of early and late mortality. Results The overall early mortality was 18.6%: 31.4% in patients with symptoms of NYHA functional class III-IV and 3.4% in pts in NYHA class I-II. Multivariate analysis identified symptoms of NYHA class III-IV and endocarditis as independent predictors of early mortality. The overall late mortality (> 30 days) was 8.2% (0.62% year/patient). Multivariate analysis identified age at the time of reoperation as a strong independent predictor of late mortality. Conclusions Reoperation in patients with prosthetic valves, performed urgently, especially in patients with symptoms of NYHA class III-IV or in the case of endocarditis, bears a high mortality rate. Risk of planned reoperation, mostly in patients with symptoms of NYHA class I-II, does not differ from the risk of the first operation.

Papillary fibroelastoma of the mitral valve as an unusual cause of myocardial infarction in a 20-year-old patient

The incidence of primary cardiac tumours is <0.1% and papillary fibroelastomas are relatively rare when compared with myxomas and lipomas. Papillary fibroelastoma is generally small and single, occurs most often on valvular surfaces, and may be mobile. Despite the embolic potential of primary cardiac tumours, they are extremely uncommon cause of ischaemic vascular accidents. Patients …

The relationship between features of metabolic syndrome and blood adipocytokine concentrations in the morbid obese patients during dynamic weight loss

Bariatric surgery is the most effective method to achieve weight loss in obese subjects.The aim of this study was to evaluate some adipocytokines and insulin, as well as parameters of metabolic syndrome of the obese patients, for three and six months after vertical banded gastroplasty, in the time of dynamic weight loss.Seven males and two females aged 28 to 49 years, with long lasting simple obesity and the presence of metabolic syndrome, were studied. After surgical treatment the values of the body mass index, waist circumference, systolic and diastolic blood pressure, total cholesterol, LDL cholesterol, triglycerides, and blood concentrations of leptin decreased significantly.Before surgical operation of all obese patients no statistically significant correlations between studied parameters were noted. Three and six months later a lot of correlations between studied parameters appeared.In conclusion, (a) vertical-banded gastroplasty is a valuable method in treatment of obese subjects, leading to a significant decrease in body weight and improvement in some parameters of metabolic syndrome in a few months after surgery, (b) adipocytokines, together with an unknown gastric factor, may be key factors in the control of some features of the metabolic syndrome.

Paradoxical arterial and pulmonary embolism in a patient with a thrombus between atrial septum and patent foramen ovale.

We describe a 50-year-old woman with an incident of systemic and pulmonary embolism in whom transoesophageal examination (TEE) with the aid of contrast echocardiography (CE) identified a patent foramen ovale (PFO) with a residual thrombus between atrial septum and PFO valve suggesting paradoxical systemic embolization. The patient was diagnosed as heterozygous for prothrombin G20210A mutation. Control TEE performed after fibrinolysis, 2 months of heparin treatment followed by oral anticoagulation did not show any embolic material within the PFO.

A second delivery after heart transplantation - a case study

Pregnancy after organ transplantation is becoming relatively common. We present the case of a heart transplant recipient who gave birth to a second child. Despite the fact that the transplanted heart seems to adapt well to the changes caused by pregnancy, gestation in patients after heart transplantation may be complicated by hypertension, pre-eclampsia, or preterm labor. In this article, we consider the issues of preterm uterine contractions, anemia, thrombocytopenia, and several other complications in pregnant patients with transplanted hearts. We also present current opinions regarding the use of glucocorticoids as a form of preventing breathing disorders in neonates as well as breast-feeding by mothers receiving immunosuppressive agents. Pregnancies in heart transplant recipients should be considered high-risk. A second successful delivery of a healthy child remains a challenge for such patients and their doctors.

Biological artificial valve dysfunction – single-centre, observational echocardiographic study in patients operated on before age 65 years

Introduction Patients with implanted bioprostheses are at risk of structural dysfunction which results from the limited durability of biological valves. The aim of this study was to analyse the mechanism of bioprosthesis degeneration and to evaluate the usability of transthoracic and transoesophageal echocardiography in determining the indications for reoperation in 117 patients with a bioprosthesis implanted before 65 years old. Material and methods The study comprised 117 consecutive patients (M – 27, F – 90, age 48-74 years, 57.5 ±9.5 years) with a bioprosthesis implanted under the age of 65, who were examined in accordance with the accepted protocol and whose complete clinical and echocardiographic documentation was collected. The scheduled echocardiographic examination was performed annually from the 5 year after implantation of the bioprosthesis in patients with a valve implanted over the age of 35 years and from the 1 year after bioprosthesis implantation in patients with a prosthesis implanted at a younger age. Unscheduled echocardiographic examinations were performed only on clinical indications. Results During the period under observation, due to degeneration of the bioprosthesis 76 patients were reoperated, including 62 patients with mitral bioprostheses. In 88.7% of patients with degeneration of mitral valve bioprostheses, regurgitation was observed. In 69% of patients with aortic bioprostheses, valve dysfunction was the dominant mechanism of stenosis. Conclusions The most common mechanism of structural dysfunction of a mitral bioprosthesis is regurgitation caused by prolapse or perforation of one of the leaflets. Degeneration of an aortic bioprosthesis usually results in aortic stenosis. In cases of bioprosthesis degeneration connected with stenosis, transthoracic echocardiography was sufficient for the evaluation of valve dysfunction. In the case of bioprosthesis dysfunction accompanied by regurgitation, transoesophageal echocardiography was more informative to decide when the operation should be performed.

Potential benefit of optimizing atrioventricular & interventricular delays in patients with cardiac resynchronization therapy

Background & objectives: The clinical benefit of optimization (OPT) of atrioventricular delay (AVD) and interventricular delay (VVD) in cardiac resynchronization therapy (CRT) remains debatable. This study was aimed to determine the influence of AVD and VVD OPT on selected parameters in patients early after CRT implantation and at mid-term follow up (FU). Methods: Fifty two patients (61±10 yr, 23 males) with left bundle branch block, left ventricular ejection fraction (LVEF) ≤35 per cent and heart failure were selected for CRT implantation. Early on the second day (2DFU) after CRT implantation, the patients were assigned to the OPT or the factory setting (FS) group. Haemodynamic and electrical parameters were evaluated at baseline, on 2DFU after CRT and mid-term FU [three-month FU (3MFU)]. Echocardiographic measures were assessed before implantation and at 3MFU. The AVD/VVD was deemed optimal for the highest cardiac output (CO) with impedance cardiography (ICG) monitoring. Results: On 2DFU, the AVD was shorter in the OPT group, LV was paced earlier than in FS group and CO was insignificantly higher in OPT group. At 3MFU, improvement of CO was observed only in OPT patients, but the intergroup difference was not significant. At 3MFU in OPT group, reduction of LV in terms of LV end-diastolic diameter (LVeDD), LV end-systolic diameter, LV end-diastolic and systolic volume with the improvement in LVEF was observed. In FS group, only a reduction in LVeDD was present. In OPT group, the paced QRS duration was shorter than in FS group patients. Interpretation & conclusions: CRT OPT of AVD and VVD with ICG was associated with a higher CO and better reverse LV remodelling. CO monitoring with ICG is a simple, non-invasive tool to optimize CRT devices.

Thrombus formation on the Amplatzer device: a need for critical attitude in percutaneous patent ovale closure decision-making

A 37-year-old female was admitted to the hospital for the gradually increasing fatigue 2 months after 9-PFO-025 Amplatzer Occluder implantation. The decision to close patent foramen ovale (PFO) with right-to-left shunt upon Valsalva manoeuvre was made after the clinically diagnosed transient ischaemic attack. According to her medical history, 3 years ago an incident of deep vein thrombosis followed by the diagnosis of the …