Piotr Szymański

Left atrial and left atrial appendage systolic function in patients with post-myocardial distal blocks

Introduction The study aimed to evaluate function of the left atrium (LA) and of the left atrial appendage (LAA) after myocardial infarction (MI) complicated by intracardiac conduction disturbances. Material and methods The study comprised 59 patients with persistent post-myocardial distal blocks, who were allocated to one of the three following subgroups: study group I – 20 patients with left bundle branch block (LBBB); study group II – 20 patients with right bundle branch block (RBBB), and study group III –19 pts with left anterior hemiblock (LAHB). The control groups included patients with MI in their history and no BBBs (19 pts – group IV) and clinically healthy people (16 patients – group V). The parameters of LA and LAA systolic function were determined by means of transthoracic (TTE) and transoesophageal echocardiography (TOE). Results We showed that patients who experienced myocardial infarction not complicated with conduction disturbances expressed compensatory LA systolic function enhancement. In patients with post-myocardial RBBB and LAHB significant enhancement of LA systolic function was observed as well but it was expressed to a lesser degree. There was also a tendency towards deterioration of LA systolic function in patients with post-myocardial LBBB. LBBB did not affect LAA systolic function negatively. Conclusions Parameters of LAA systolic function showed its enhancement in all patients after myocardial infarction irrespective of whether it was complicated by conduction disturbances.

Collagen turnover biomarkers and systemic right ventricle remodeling in adults with previous atrial switch procedure for transposition of the great arteries

Background Myocardial fibrosis is a potential pathophysiological mechanism leading to systemic right ventricular (SRV) deterioration. We hypothesize that circulating levels of collagen deposition markers are elevated in patients with SRV remodeling and this elevation may have a predictive value. Methods We prospectively evaluated 56 patients with D-TGA after the atrial switch procedure (mean age 25.6 ± 4.8, range 18–37 years; 67% males). Serum levels of procollagen type III amino-terminal propeptide (PIIINP), collagen type I carboxy-terminal telopeptide (CITP), procollagen type I N-terminal propeptide (PINP), matrix metalloproteinase (MMP 1, MMP 9) and a tissue inhibitor of matrix metalloproteinase (TIMP 1) and N-terminal pro-brain natriuretic peptide (NT-pro-BNP) were measured and compared with healthy controls. The relationship between these serum markers, echocardiographic and cardiac magnetic resonance parameters and the outcome at a follow-up of 61 months (range, 24–85 months) was determined. Results Compared with the healthy control group, the study group had significantly higher levels of TIMP1, PIIINP, CITP, PINP and NT-pro-BNP (p<0.05, each). The levels of PIIINP and CITP were significantly higher among patients with an SRV mass index above the mean value. The level of PIIINP was significantly higher among patients with an SRV EDV index above the mean value. CITP was significantly elevated in SRV late gadolinium enhanced (LGE) positive patients, compared to patients without SRV LGE. MMP9 and TIMP1 predicted an adverse clinical outcome on univariate Cox proportional hazard survival analysis in addition to well proven predictors of outcome (SRV EF and NYHA). Conclusions We demonstrated a pattern of altered collagen turnover adversely related with the indices of SRV remodeling and an adverse clinical outcome in patients with SRV.

Transesophageal echocardiography in adults — guidelines of the Working Group on Echocardiography of the Polish Cardiac Society

This document presents current Polish guidelines on the clinical use of transthoracic echocardiography, including stress examinations, in adult patients. The examinations with pocket-size imaging devices are also discussed. The authors present recommendations regarding indications and contraindications, staff and equipment requirements, patient preparation and information, examination protocol, reporting and reimbursement.

Drug-class-specific changes in the volume and cost of antidiabetic medications in Poland between 2012 and 2015

Aim to investigate the drug-class-specific changes in the volume and cost of antidiabetic medications in Poland in 2012–2015. Methods This retrospective analysis was conducted based on the National Health Fund database covering an entire Polish population. The volume of antidiabetic medications is reported according to ATC/DDD methodology, costs—in current international dollars, based on purchasing power parity. Results During a 4-year observational period the number of patients, consumption of antidiabetic drugs and costs increased by 17%, 21% and 20%, respectively. Biguanides are the basic diabetes medication with a 39% market share. The insulin market is still dominated by human insulins, new antidiabetics (incretins, thiazolidinediones) are practically absent. Insulins had the largest share in diabetes medications expenditures (67% in 2015). The increase in antidiabetic medications costs over the analysed period of time was mainly caused by the increased use of insulin analogues. Conclusions The observed tendencies correspond to the evidence-based HTA recommendations. The reimbursement status, the ratio of cost to clinical outcomes and data on the long-term safety have a deciding impact on how a drug is used.

Regional differences in the frequency of diabetes occurrence and its treatment costs during the years 2008–2013, based on the NFZ (National Health Fund) database

In the European region in 2013 the International Diabetes Federation (IDF) estimated the number of patients with diabetes at 56 million [1]. The costs of treatment in Europe were estimated at 140 million Euro. Recently Tamayo et al., when presenting the data for Poland in the updated IDF Diabetes Atlas report, estimated the morbidity at approx. 6.5% [2]. This number was estimated based on the “Wieloośrodkowe Ogolnopolskie Badanie Stanu Zdrowia (WOBASZ)” project of 2003–2005 and earlier analyses from 1998–2001 [3]. Other studies include: Screen-Pol, Polish Multicenter Study on Diabetes Epidemiology (PMSDE) and “Nadciśnienie Tetnicze w Polsce Plus Zaburzenia Lipidowe i Cukrzyca (NATPOL-PLUS)” [4–6]. These analyses were partially local or were based on relatively small groups of patients. In 2004 the total cost of diabetes treatment in Poland was estimated at approx. PLN 6 billion [7]. High social costs of diabetes necessitate uninterrupted preventive activities, enabling the restriction of morbidity and public expenses for its treatment. The studies dedicated to regional variability of diabetes prevalence may help to identify specific risk factors and differences in management. In the region of Europe the differences of morbidity are very high, within the range from 2.4% in Moldavia up to 14.9% in Turkey [2]. In addition to the actual differences in the frequency of occurrence, they certainly are related to uneven and not fully reliable method of data calculation in individual countries [2]. Within Poland, the regional data concerning the frequency of diabetes occurrence in the years 2003–2005 ranged from 4.2% in women in Malopolska province up to 9.0% in men in Wielkopolska province [3]. Current data on regional differences may form the basis for future more detailed analyses on social, epidemiological and economic reasons for the variability of diabetes occurrence frequency in Poland.

Number of erythrocytes as a prognostic marker in patients undergoing heart valve surgery

INTRODUCTION Anaemia is defined by the Word Health Organisation as a haemoglobin level < 130 g/L for men and < 120 g/L for women [1]. It has been shown that lower haemoglobin levels are associated with increased mortality and morbidity among the elderly, and in patients with chronic heart failure or myocardial infarction [2–4]. The role of haemoglobin or haematocrit as independent predictors of mortality and morbidity in patients undergoing cardiac surgery has been described primarily in patients with coronary artery disease undergoing coronary artery bypass grafting [5, 6], as well as in patients undergoing heart valve surgery or congenital heart defects surgery [7–9]. In contrast, the predictive role of the red blood cell count (RBC) in patients undergoing valvular cardiac surgery has not been described. Given this gap in knowledge, we decided to assess a predictive value of the individual parameters of blood cell counts in patients undergoing heart valve surgery.