Maciej Podgórski

Electrocardiographic evaluation in patients with systemic scleroderma and without clinically evident heart disease.

Background: In patients with systemic scleroderma (SSc), clinically evident cardiac involvement is recognized to be a poor prognostic factor. The aim of the study was to evaluate electrocardiographic changes, parameters of heart rate variability (HRV), and heart rate turbulence (HRT) in patients with SSc without evident symptoms of heart disease.

Renal artery denervation due to refractory hypertension in a patient after kidney transplantation – 3 years of observation - Case Report

INTRODUCTION Hypertension is prevalent in most patients after renal transplantation, and it is the main factor contributing to cardiovascular diseases that cause death of a significant number of these patients. Up to 95% of patients after transplantation have hypertension, and among them are patients with refractory hypertension. Elevated blood pressure is one of the causes of deterioration of transplant function and may accelerate transplant loss. CASE REPORT We present the first case in the world of a patient (who was 61 years old) in whom denervation of native renal arteries was performed after renal transplantation (2004). The patient was suffering from uncontrolled refractory hypertension. Antihypertensive therapy was used but the effect was not satisfactory. The patient received amlodipine, bisoprolol, clonidine, furosemide, and doxazosin in high doses. Clinical assessments with ambulatory blood pressure monitoring revealed a predominant blood pressure 149/96 with incidents of hypertensive crises. High blood pressure is a cardiovascular risk factor and it also has a significant influence on transplant failure, which was the reason for performing the denervation. The procedure was carried out through the femoral artery with the use of a 6F guiding catheter. During a 3-year observation, significant decreases in ambulatory blood pressure monitoring systolic and diastolic blood pressures were observed after the procedure (149/96 mm Hg vs 134/91 mm Hg before and after the denervation, respectively). There was a significant regression of left ventricle mass (577 g before denervation vs 470 g after 3 years). The functioning of the renal transplant became stable after 3 years of observation (38 mL/min before denervation and 38 mL/min after 3 years). CONCLUSIONS The first case in the world of a renal transplant patient who had denervation of native renal arteries has demonstrated a positive effect in controlling blood pressure over a 3-year observation. Three years after denervation, a reduction of heart hypertrophy and stabilization of renal function were noted. The presented case shows that denervation of native renal arteries denervation may be successful and safe in kidney transplant recipients.

Effect of electromagnetic field accompanying the magnetic resonance imaging on human heart rate variability – a pilot study

ABSTRACT The effect of electromagnetic field on cardiovascular system in the literature is defined in ambiguous way. The aim of this study was to evaluate the effect of electromagnetic field on the heart rate variability (HRV) during the examination with magnetic resonance. Forty-two patients underwent Holter ECG heart monitoring for 30 minutes twice: immediately before and after the examination with magnetic resonance imaging (MRI). HRV was analysed by assessing a few selected time and spectral parameters. Is has been shown that standard deviation of NN intervals (SDNN) and very low frequency rates increased, whereas the low frequency:high frequency parameter significantly decreased following the MRI examination. These results show that MRI may affect the HRV most likely by changing the sympathetic-parasympathetic balance.

Heart rate variability – clinical significance

Heart rate variability (HRV) is a statistical evaluation of ECG Holter analysis used for non-invasive assessment of autonomic nervous system activity. The autonomic nervous system plays a major role in human homeostasis. Autonomic dysfunction and altered HRV are observed in many life-threatening conditions, like myocardial infarction, multiple organ dysfunction syndrome, sepsis and severe brain injuries. Analysis of HRV uses two major techniques for assessing ECG intervals – time and frequency analysis. Additionally, there is also an alternative non-linear method of assessing HRV called fractal analysis. Clinical evaluation of HRV has been performed in medicine for more than three decades. Recent studies show that heart rate variability is a strong predictor of cardiovascular risk and mortality. It has also become common practice in everyday medicine, especially in family medicine, cardiology, neurology and psychiatry. There are some variables affecting HRV analysis: age, gender, physical activity and body mass index. Age and body mass index have negative correlation with HRV. Correlation of gender with HRV is not clearly specified in literature. Recent studies show that young males have increased HRV, and this diminishes faster during aging. Young women present decreased values of HRV, but these differences become indistinguishable after 50. Physical activity may enhance HRV by increasing vagal tone and decreasing sympathetic activity.