Małgorzata Peregud-Pogorzelska

Cardiac Arrhythmias and Conduction Disturbances in Patients With Ankylosing Spondylitis

Conduction disturbances, aortic incompetence, and myocardial fibrosis are known complications in adult patients with ankylosing spondylitis (AS). Its incidence has been reported to be 10% to 30%; however, less attention has been paid to all cardiac arrhythmias. The aim of this study was to evaluate arrhythmias and conduction disturbances in patients with AS using electrocardiograms and Holter monitoring (including heart rate variability analysis) and to estimate its relationships with age, gender, clinical features, and duration of AS. Thirty-one patients with AS (20 to 69 years old, mean 50 ± 14) and 22 healthy volunteers (26 to 69 years old, mean 49 ± 13) underwent rheumatologic and cardiologic evaluations. Ventricular extrasystoles were present in 55% of AS patients and in 28% of controls. Supraventricular extrasystoles were present in 94% of AS patients and 100% of controls. The frequency of ventricular extrasystoles was found to be higher in the AS patients than in the control subjects. Significant differences were found in heart rate variability analyses: ultra low-frequency power and root mean square recessive difference (r-MSSD) were lower in the AS group. When the AS group was divided into subgroups (stages 3 and 4), significant differences were found between control subjects and stage 3 patients in PR interval, heart rate (HR), T-wave duration, ultra low frequency, and r-MSSD and between controls and stage 4 patients in HR, T-wave duration, and r-MSSD. QTc and QTd were not significantly different in groups and subgroups and were not correlated with any other clinical or electrocardiographic parameter. Cardiac arrhythmias were more frequent in patients with AS than in the healthy population. Simple electrocardiograms and Holter parameters do not correlate with the incidence of VESs, age, gender, clinical features, and duration of AS.

Rhythm Disturbances in the Form of Atrial Tachycardia in a Female Patient with Polymyositis A Case Report

The presented case report describes a female patient suffering from polymyositis, in whom atrial tachycardia and depressed left ventricular function were diagnosed. Atrial tachycardia was confirmed by electrophysiological study, and the radiofrequency ablation failed to restore sinus rhythm. This case is an example of the tachy phase in brady-tachy syndrome. The patient is evaluated cardiologically on a regular basis with emphasis on bradycardia and asystole episodes because she was symptomatic for many years.

Intracavitary mass as the initial manifestation of primary pericardial mesothelioma: a case report.

A 31-year-old woman presented with a 3-month history of progressing fatigue and effort dyspnea. Echocardiography depicted a tumor within the free wall of the right ventricle and right atrium, located on both sides of the tricuspid annulus. Computed tomography showed disseminated circular shadows sized up to 7 mm—most likely metastatic lesions—in both lungs. The diagnosis of low-grade mesothelioma bifasicum was confirmed with histopathologic and immunohistochemical studies of the samples taken by thoracoscopy from parietal pleura, lung tumor, and diaphragm region. Chemotherapy, which included gemcitabine and carboplatin, resulted in transient improvement of the clinical status of the patient and reduction of the tumor mass lasting several months followed by progression of the disease. Significant amounts of pleural fluid and huge tumors within both pleural cavities emerged. The patient died due to respiratory and circulatory insufficiency 11 months following the diagnosis.

Effect of cardiac resynchronisation therapy on coronary blood flow in patients with non-ischaemic dilated cardiomyopathy

BACKGROUND Cardiac resynchronisation therapy (CRT) has beneficial effects on cardiac function, exercise tolerance, symptoms, and prognosis. Coronary blood flow impairment has been observed in patients with non-ischaemic dilated cardiomyopathy (DCM) despite angiographically normal coronary arteries. No data are available on coronary blood flow and coronary flow reserve (CFR) measured by intracoronary Doppler in different coronary arteries in patients with DCM and left bundle branch block (LBBB) before and during treatment with CRT. AIM Thus, the major aim of our study was to assess the effect of CRT on coronary blood flow in patients with non-ischaemic DCM and to compare coronary blood flow and CFR measured in the 3 major coronary arteries (left anterior descending [LAD], left circumflex [LCX], and right coronary artery [RCA]). METHODS Twenty one patients with DCM and LBBB (mean left ventricular ejection fraction 26 ± 7%, 5 females, mean age 57.8 ± 8.1 years) were studied. Average peak velocity, diastolic/systolic velocity ratio and CFR were measured using intracoronary Doppler before and 6-9 months after implantation of CRT-D or CRT-P. RESULTS In patients with a clinical improvement (71.4%), CFR increased in LAD. CFR measured in LCX and RCA did not improve either in the overall study group or in patients with a clinical improvement. The observed increase in CFR in LAD correlated only with reduction of QRS duration. CONCLUSIONS In non-ischaemic DCM, CFR is reduced only in LAD. A significant improvement of CFR in LAD after CRT correlates with reduction of QRS duration.

VAMP-8 gene variant is associated with increased risk of early myocardial infarction.

Introduction Single nucleotide polymorphism in the 3’ untranslated region of the vesicle-associated membrane protein gene (VAMP-8) has been associated with increased risk of early-onset myocardial infarction (MI). In this study the risk of early onset MI conferred by VAMP-8 gene polymorphism was investigated in a group of 171 male subjects. Material and methods Male patients with a history of MI who underwent coronary angiography were enrolled and divided into early (incident < 55 years of age) and late (incident ≥ 55 years of age) MI onset groups. Apart from the RFLP-PCR based analysis of the VAMP-8 variant, history of hypertension, lipid abnormalities, smoking and body mass index were recorded. In statistical analyses odds ratios and relative risk were used as a measure of genotype-MI association while logistic regression was implemented for evaluation of MI risk factor strength. Results VAMP-8 A allele frequency proved to be significantly higher in the early-onset MI group and conferred higher relative risk of early MI in the investigated cohort, when calculated for the individual A allele (p = 0.029). In logistic regression analyses no association between risk genotypes and traditional risk factors was observed. Conclusions In this study VAMP-8 A variant was identified as a risk allele for early MI in male subjects.

Heart failure in systemic lupus erythematosus treated by cardiac resynchronization. A case report

The presented case report describes a female patient suffering from systemic lupus erythematosus, in whom dilated cardiomyopathy with progressive heart failure was a very first symptom of the disease. The advanced invasive treatment method, cardiac resynchronization therapy, was successfully applied to improve the quality of life, clinical symptoms, and exercise tolerance.

Coronary stenosis treated by percutaneous angioplasty in a patient with dermatomyositis.

A female patient suffering from dermatomyositis in whom symptoms of heart failure without angina is described. An impairment of left ventricular function and significant coronary lesions were diagnosed using noninvasive and invasive procedures. Coronary angioplasty with stent implantation was successfully applied to improve the quality of life and clinical symptoms.

Vasculitis or coronary atherosclerosis? Optical coherence tomography images in polyarteritis nodosa

A 29-year-old man was admitted to hospital for assessment of the coronary artery disease and further diagnostic work-up. Medical history revealed cutaneous polyarteritis nodosa diagnosed at the age of 17 years, treated with low-dose glucocorticoids, and arterial hypertension treated with a b-blocker. He was a non-smoker and had no diabetes or hypercholesterolaemia. Eight months earlier he had a pacemaker implanted due to third-degree atrioventricular block. Four months after the implantation he was treated for acute coronary syndrome (ACS). Stenoses within the left anterior descending artery (LAD) (Fig. 1A, D) and the right coronary artery (RCA) (Fig. 1B, E) were treated with drug-eluting stents (DESs). In the subsequent two weeks a bioresorbable stent was implanted (in another hospital) to the left circumflex branch because of another ACS (Fig. 1C, F). Due to the presence of stenosis in the proximal segment of the LAD, a subsequent stage of invasive treatment was planned and intensive anti-inflammatory treatment was implemented (methylprednisolone and cyclophosphamide). During the hospital stay, the patient underwent coronary angiography and optical coherence tomography (OCT). The results of previous stent implantations were assessed as optimal. The previously described stenosis of the LAD was observed along with new stenosis in the mid-RCA (Fig. 2A, 3A). OCT confirmed significant stenosis in the LAD. Additionally, a marked intimal thickening was observed in the RCA without typical features of atherosclerotic plaque, including fibrous cap, calcifications, or lipid core (Fig. 4A). Previously implanted stents were partially covered with a thin layer of neointima (Fig. 4B). Two further DESs were implanted with optimal results (Fig. 2B, 3B). Intensive systemic therapy is currently being continued and no angina has been observed. The clinical importance of our case lies in the fact that clear criteria for a differentiation between atherosclerotic and inflammatory lesions have not been defined yet, and the images described herein have not yet been published. OCT revealed a lesion of the RCA, which is not typical of atherosclerosis. Intimal thickening reached over 500 μm without typical features of plaques (Fig. 4A). The importance of systemic treatment in patients with all inflammatory or autoimmune disease must be emphasised. After a period of high disease activity (ACS, progression of lesions in the coronary arteries), aggressive systemic treatment slowed down the disease progression. The invasive treatment included multi-stage angioplasty (instead of bypass grafting), which is an accepted therapeutic option in such patients, although with limited experience. No restenosis or excessive numbers of uncovered struts were observed (Fig. 4B). The process of stent endothelialisation probably depends both on the appropriate stent implantation technique and on intensive systemic treatment. To summarise, the diagnosis and appropriate treatment of vasculitis and atherosclerosis remain a challenge and require the cooperation of the rheumatologist, cardiologist, and vascular medicine specialist. OCT can be a useful modality for the assessment and monitoring of the treatment process. Figure 1. A–F. Endovascular treatment during acute coronary syndrome (arrows)

Zmiany w sercu po przeszczepieniu płuc z powodu włóknienia z towarzyszącym nadciśnieniem płucnym

Chronic lung tissue disease leads to secondary pulmonary hypertension (PH). The conservative treatment has limited possibilities and lung transplantation (LuTx) remains the final treatment solution. This case report presents the natural course of diagnostics and treatment of the patient with idiopatic pulmonary fibrosis and secondary PH, who underwent LuTx.

Symptomatic arrhythmia in the form of multiple premature ventricular extrasystoles as the first symptom of polymyositis

Polymyositis (PM) is an autoimmune disease characterized by the involvement of multiple internal organs, including the cardiovascular system. The involvement of heart is observed in up to 75% of patients with PM. Conduction and rhythm disorders are one of the most common cardiological abnormalities in these patients. The presented clinical case is the patient where ventricular arrhythmia (in the form of multiple premature ventricular extrasystoles) was the first symptom of polymyositis.