Krzysztof Chiżyński

Apelin - a potential target in the diagnosis and treatment of the diseases of civilization.

Objective Apelin is a novel peptide of a wide expression in the human body and with multiple biological functions. It was first isolated and described in 1998 by Tatemoto et al. It exerts its biological functions by acting on a transmembrane G protein-coupled APJ receptor. Together with its receptor APJ apelin is referred to as an apelinergic system, which in the recent years has gained the interest of many researchers due to its role in many different processes regarding homeostasis, physiology and pathophysiology in the human body. Methods and results The literature review included the analysis of electronic databases – PubMed, EBSCO, ScienceDirect. The purpose of this review is to introduce the wide biological role of apelin and to indicate it’s possible diagnostic, prognostic and therapeutic implications with particular emphasis on cardiovascular and metabolic disorders. Conclusions Although there has been a large number of studies concerning the role of the apelinergic system and a high amount of new discoveries in recent years, much is still to be discovered.

The relationship between early recanalization and serum NT-proBNP levels in patients with a first ST-segment elevation myocardial infarction treated with primary coronary angioplasty

Objective — Primary coronary angioplasty (PCI) performed in the first hours after the onset of chest pain plays an important role in the prevention of death and heart failure after acute myocardial infarction (MI). Levels of circulating natriuretic peptides (BNP and NT-proBNP) reflect the severity of left ventricular (LV) dysfunction. The blood concentration of these peptides is increased in patients with MI. The aim of this study is to evaluate whether early PCI (< 3 hours) after onset of chest pain modulates NT-proBNP levels in patients with first ST-elevation acute MI. Methods and results — Serum NT-proBNP levels were measured on hospital admission and 4 to 5 days post MI.Transthoracic echocardiography was performed on the 4th day after MI.We included 111 consecutive patients with first ST-elevation acute MI treated with PCI with stent implantation. In 55 patients (49.5%) PCI was performed within 3 hours after the onset of symptoms (the study group). Multivariate analysis revealed that only the time from the onset of chest pain to PCI and EF/WMI were independently associated with serum NT-proBNP > 105 pg/ml on admission. Only EF/WMI and evolution of non-Q myocardial infarction correlated with an NT-proBNP level > 388.5 pg/ml on discharge. Conclusions — NT-proBNP concentration measured both on admission and 4 to 5 days after acute MI independently correlates with echocardiographic parameters of LV systolic function (EF and WMSI). One hour delay in PCI raises the risk of NT-proBNP level elevation on admission by 30%.

Diagnostic performance of myocardial perfusion single-photon emission computed tomography with attenuation correction

BACKGROUNDnMyocardial perfusion single-photon emission computed tomography (SPECT) is one of the basic tools used for the purpose of diagnosis of coronary artery disease (CAD), prognosis of its unfavourable consequences, and evaluation of therapy effectiveness. However, its efficacy is compromised by a relatively low specificity of detection of perfusion defects, which is attributed to attenuation of gamma rays inside the patients body, causing artefacts erroneously taken for perfusion defects. It is expected that attenuation correction (AC) could eliminate such artefacts.nnnAIMnTo evaluate whether visual, semi-quantitative analysis of attenuation-corrected myocardial perfusion imaging provides an advantage over a non-corrected study.nnnMETHODSnA retrospective study applying AC was performed in 107 patients who had coronary angiography within three months. Patients underwent a stress/rest Tc-99m methoxyisobutylisonitrile (MIBI, POLATOM) double day SPECT/CT myocardial perfusion imaging. Images were analysed by two experienced nuclear medicine specialists (a consensus) applying a visual semiquantitative method. Coronary angiography findings were used as a reference for the analysis of diagnostic performance of myocardial perfusion study protocols.nnnRESULTSnAC increased the specificity of detection of CAD in the whole group of patients from 63% to 86% (p = 0.0005), with a slight reduction in sensitivity (from 83% to 79%). The improved specificity was also noted in subgroups of male and female patients. Accuracy in the whole group of patients increased from 71% to 83% (p = 0.01). AC improved the specificity and accuracy of the method in the detection of perfusion defects in the right coronary artery (RCA) area from 73% to 88% (p = 0.005) and from 74% to 83% (p = 0.04), respectively, and the accuracy of the method in the left anterior descending (LAD) artery area from 79% to 87% (p = 0.043). It also reduced the number of ambiguous results of the study.nnnCONCLUSIONSnAC improved the diagnostic performance of myocardial perfusion study in the detection of CAD and identification of critically stenosed LAD and RCA vessels, with enhanced comfort of study interpretation.

N-terminal Pro-brain Natriuretic Peptide in the Elderly with Myocardial Infarction

The myocardial infarction (MI) results in the change of the levels of N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) in blood. In addition, attention is paid to the dependence of NT‐proBNP levels on the patients age. However, the behavior of natriuretic peptide levels has not been recognized well enough in the elderly with MI treated with invasive methods.

Patients with the tako-tsubo cardiomyopathy-clinical evaluation and outcome

Abstract Objective Tako-tsubo cardiomyopathy (TTC) or is a rare, acute, reversible cardiac dysfunction mimicking an acute coronary syndrome (ACS) and usually connected with a preceding intense physical or emotional stress trigger. This case series-observational study is to evaluate the clinical findings (including the depression and anxiety disorders) and outcome in patients with the tako-tsubo cardiomyopathy treated in our Centre, during 18 month period. Methods From the group of 730 patients, who were admitted with the suspected acute myocardial infarct, ten patients, who fulfilled diagnostic criteria for TTC, were evaluated. For each patient we assessed: clinical characteristic, previous medical history including coronary disease risk factors and preceding stress trigger, 12-leads electrocardiography and laboratory tests. All patients underwent coronary-artery angiography, trans-thoracic echocardiography and completed the questionnaire evaluating the depression and anxiety disorders. Results The estimated prevalence and clinical features of patients with the tako-tsubo cardiomyopathy in our Centre were similar to those in the literature, with the wide range of stress triggers. There was a statistically significant improvement in the ejection fraction during the hospitalization. Psychological tests revealed the 0.7 occurrence of depression or anxiety disorders among our patients. Conclusions The exact pathogenesis of the tako-tsubo cardiomyopathy remains uncertain, but it is important to take it into account as a differential diagnosis in patients with the clinical features of myocardial infarct in the absence of coronary artery stenosis.

Myopericarditis in a patient with ulcerative colitis treated with mesalamine—Case report and review of the literature

Mesalamine has been successfully used as a maintenance treatment in inflammatory bowel diseases such as ulcerative colitis and Crohns disease for years. Most frequent adverse reactions to this medication are gastrointestinal disorders and headaches while cardiovascular complications are rare and poorly understood. We present a case of a 26-year-old male with ulcerative colitis developing myopericarditis on mesalamine therapy. Although cardiac involvement is reported to be an extraintestinal manifestation of the bowel disease, we describe evidence confirming the diagnosis of mesalamine-induced myopericarditis in our patient and discuss other reports on this topic. Even though myopericarditis is an uncommon adverse reaction to mesalamine, it should be considered in patients with chest pain during mesalamine therapy. In such cases, drug withdrawal may result in rapid clinical improvement. <Learning objective: Mesalamine therapy of inflammatory bowel disease (IBD) can be connected with common adverse reactions such as headaches and gastrointestinal problems. Cardiovascular complications in patients with IBD may be associated with the disease but may also occur due to mesalamine therapy. Drug cessation is then sufficient to achieve clinical improvement.>.