Rafał Januszek

Eicosanoid biosynthesis during mucociliary and mucous metaplastic differentiation of bronchial epithelial cells

The purpose of this study was to examine the profile of eicosanoids secreted by human bronchial epithelial cells (HBEC) during their in vitro differentiation toward mucociliary or mucous metaplastic phenotype. Eicosanoids were measured in supernatants by mass spectrometry, and corresponding gene expression by real-time PCR. Primary HBEC produced mainly prostaglandins (PGE2, PGD2) and epoxides (e.g. 14,15-EET), but during further mucociliary differentiation we observed a gradual increase in secretion of lipoxygenase derived HETEs. Treatment with IL-13 and IL-4 induced mucous metaplasia and resulted in downregulation of PG pathway, and potent induction of 15-lipoxygenase (marked release of 15-HETE). The deficiency in PG production sustained during long term culture of mucous metaplastic epithelia. In conclusions, Th2-type cytokines induce changes in eicosanoid metabolism of airway epithelial cells, resulting in an immense induction of 15-lipoxygenase pathway, and inhibition of PG pathways. Deficient production of immunomodulatory PGs may promote chronic inflammation and airway remodeling.

Long-term effects of rotational atherectomy in patients with heavy calcified coronary artery lesions: a single-centre experience

BACKGROUNDnRotational atherectomy (RA) plays a significant role in contemporary percutaneous coronary interventions (PCI), especially in the era of population aging and expansion of PCI indications.nnnAIMnThe aim of the current study was to evaluate the rate of periprocedural complications, the long-term effectiveness of RA, and potential factors influencing the incidence of major adverse cardiac events (MACE) and major cardiac as well as cerebrovascular events (MACCE) after RA.nnnMETHODSnThe study included 60 consecutive patients who underwent effective RA between January 2002 and May 2016. Patients were followed-up for 2,616 days for MACE and MACCE.nnnRESULTSnThe mean age of the enrolled patients was 72.1 years, and 78.3% were males. The mean follow-up period lasted 835.3 ± 611.8 days. Periprocedural complications occurred in 12 (20.0%) patients. In the follow-up of up to 2,616 days, 64% of patients were free of MACCE and 68% were free of MACE. Univariate Cox analysis revealed that MACCE occurred more often in patients from the high-risk group based on the EuroSCORE II and those with longer lengths of the implanted stent(s) after the RA procedure. In multivariate Cox regression analysis, both high-risk category and mean stent(s) length were identified as independent predictors of MACCE. EuroSCORE II was confirmed to be the only independent predictor of MACE after RA.nnnCONCLUSIONSnRotational atherectomy is a safe and sufficient technique for the endovascular treatment of heavily calcified coronary artery lesions. Individuals at a higher risk as assessed by the EuroSCORE II before RA and those with longer stent(s) implanted after RA are predisposed to MACCE in the follow-up.

Chronic obstructive pulmonary disease and periprocedural complications in patients undergoing percutaneous coronary interventions

Background The relationship between chronic obstructive pulmonary disease (COPD) and periprocedural complications of percutaneous coronary interventions (PCIs) is influenced by several factors. We aimed to investigate the association between COPD, its complication type and rate in patients undergoing PCI. Methods Data were prospectively collected using the Polish Cardiovascular Intervention Society national registry (ORPKI) on all PCIs performed in Poland between January 2015 and December 2016. COPD was present in 5,594 of the 221,187 patients undergoing PCI. We assessed the frequency and predictors of periprocedural complications in PCI. Results Patients with COPD were elder individuals (70.3 ± 9.9 vs. 67 ± 10.8 years; p < 0.05). We noted 145 (2.6%) periprocedural complications in the COPD group and 4,121 (1.9%) in the non-COPD group (p < 0.001). The higher incidence of periprocedural complications in the COPD patients was mainly attributed to cardiac arrest (p = 0.001), myocardial infarctions (p = 0.002) and no-reflows (p < 0.001). COPD was not an independent predictor of all periprocedural complications. On the other hand, COPD was found to be an independent predictor of increased no-reflow risk (odds ratio [OR] 1.447, 95% CI 1.085–1.929; p = 0.01), and at the same time, of decreased risk of periprocedural allergic reactions (OR 0.117, 95% CI 0.016–0.837; p = 0.03). Conclusions In conclusion, periprocedural complications of PCIs are more frequent in patients with COPD. COPD is an independent positive predictor of no-reflow and a negative predictor of periprocedural allergic reactions.

Does the use of rotational atherectomy procedure during percutaneous coronary interventions influence the frequency of procedure-related myocardial injury assessed by cardiac magnetic resonance?

The usage of gadolinium-enhanced cardiac magnetic resonance (CMR) in the differentiation of heart failure related to dilated cardiomyopathy and coronary artery disease has been demonstrated in previously published studies. It currently remains one of the basic methods for assessing myocardial ischemia, which has been reflected in many international guidelines, including those of the European Society of Cardiology (1-3). Also, T2 mapping for myocardial edema, cine CMR for regional wall motion abnormalities, rest first pass and adenosine stress perfusion are well sanctioned methods of myocardial ischemia assessment, also used in patients with acute coronary syndromes (4-6).

Predictors of in-hospital effectiveness and complications of rotational atherectomy (from the ORPKI Polish National Registry 2014-2016)

The aim of the study was to assess trends in the use and periprocedural outcomes of rotational atherectomy (RA) in Poland between January 2014 and December 2016.

Bailout rotational atherectomy in patients with myocardial infarction is not associated with an increased periprocedural complication rate or poorer angiographic outcomes in comparison to elective procedures (from the ORPKI Polish National Registry 2015–2016)

Introduction Many years of experience and refinement of existing rotational atherectomy (RA) techniques have resulted in improved clinical outcomes and a tendency to broaden the spectrum of RA usage. Aim To compare the angiographic effectiveness and periprocedural complications in patients with stable angina (SA) and acute myocardial infarction (AMI) treated using RA. Material and methods Data were prospectively collected using the Polish Cardiovascular Intervention Society national registry (ORPKI) on all percutaneous coronary interventions (PCIs) performed in Poland in 2015 and 2016. In total, 975 RA procedures were recorded out of 221,187 PCI procedures. Results We compared angiographic effectiveness and periprocedural complications in 530 patients with SA and 245 with AMI in the RA group of patients, and 60,522 patients with SA and 91,985 with AMI in the non-RA group. The overall rate of periprocedural complications did not differ between SA and AMI patients in the RA group (2.3% vs. 2.0%; p = 0.84), while it was lower in AMI patients from the RA group compared to those from the non-RA group (2.0% vs. 3.0%; p = 0.34). The percentage of patients with angiographic success in the RA group was similar to the non-RA group in SA patients (97.3% vs. 97.1%; p = 0.75), whereas in the AMI group it was significantly higher compared to the non-RA group (96.7% vs. 92.6%; p < 0.001). Conclusions The angiographic effectiveness of PCI with RA in patients with AMI was not worse than in patients with SA.

Coronary Perforation of Distal Diagonal Branch Followed by Prolonged Recurrent Cardiac Tamponade Finally Resolved with Pericardiotomy - the Potential Risk of Hydrophilic Guide-Wires

Purpose: Coronary artery perforation (CAP) is a complication of percutaneous coronary interventions (PCIs). Hydrophilic guide-wires have been shown to increase the probability of CAP. Depending on the size of perforations we adopt different treatments. Case: We present the case of a 73-year old male with coronary artery disease and severe aortic valve stenosis. The patient was in the process of qualifying for a transcatheter aortic valve implantation. Unfortunately, CAP of the first diagonal branch of the LAD occurred during PCI. Initially, abrupt bleeding to the pericardial sac was primarily restrained. However, in the following days, pericardial bleeding became silent, prolonged and finally resulted in surgical pericardiotomy and surgical aortic valve replacement. Conclusion: This case depicts that in some cases, more aggressive endovascular treatment of CAP during the acute phase could decrease the probability of future radical surgical treatment. Although, in other cases, avoiding radical endovascular treatment of CAP and secondary necrosis along the distribution of the artery culminates in a higher risk for conversion to a surgical cardiac procedure. Accurate primary assessment of CAP seriousness and careful observation after PCI could improve results and lead to avoiding severe complications.

Chronic obstructive pulmonary disease affects the angiographic presentation and outcomes of patients with coronary artery disease treated with percutaneous coronary interventions

INTRODUCTIONxa0xa0 xa0The incidence of chronic obstructive pulmonary disease (COPD) in patients treated with percutaneous coronary intervention (PCI) is underestimated, and the effect of COPD on atherosclerosis and the outcomes of PCI is not fully understood. OBJECTIVESxa0xa0 xa0The aim of this study was to assess the impact of COPD on periprocedural outcomes of PCI, as well as its relationship with clinical presentation and the type of coronary artery lesions. PATIENTS AND METHODSxa0xa0 xa0Data were prospectively collected using a national electronic registry of PCI procedures performed in Poland between January 2015 and December 2016. Out of the 221 187 PCIs, 5594 patients had been diagnosed with COPD before the intervention. RESULTSxa0xa0 xa0Patients with COPD were older than those without COPD (mean [SD] age, 70.3 [9.9] years vs 67 [10.8] years; P <0.001) and more often were males (72.3% vs 67.8%; P <0.001). Non-ST‑segment elevation myocardial infarction (NSTEMI) was a more common clinical presentation of coronary artery disease (CAD) in the COPD group, while ST‑segment elevation myocardial infarction (STEMI) occurred more frequently in the non‑COPD group. Multivessel disease (MVD) with or without left main coronary artery (LMCA) involvement and separate LMCA was diagnosed more often in the COPD group. At baseline, the culprit lesion was more often restenosis and in‑stent thrombosis in the COPD group, whereas de‑novo lesion-in the non‑COPD group. The rates of periprocedural mortality and myocardial infarction did not differ between the groups with and without COPD (0.13% vs 0.12%, P = 0.88 and 0.53% vs 0.45%, P = 0.39, respectively). COPD was found to be an independent predictor of restenosis assessed before PCI in patients with a history of PCI (P = 0.006). CONCLUSIONSxa0xa0 xa0Patients with COPD diagnosed before PCI are at an increased risk of MVD with or without LMCA involvement and NSTEMI. Restenosis and in‑stent thrombosis occur more often in patients with COPD before PCI.

Fractional flow reserve measurement modification with monorail pressure catheter

A number of symptomatic patients with coronary artery disease undergo revascularization without definite evidence that particular coronary stenosis is responsible for their symptoms [1]. Currently, the borderline coronary artery stenoses are most commonly assessed by intravascular ultrasound and fractional flow reserve (FFR) alongside with quantitative coronary angiography [2]. FFR measurement, as performed by pressure wire (PW), requires its multiple removals during FFR and percutaneous coronary intervention (PCI), and results in a relatively high signal drift with loss of accuracy. The novel exchange microcatheter (RXi) was invented to assess FFR in a safer mode [3, 4]. A 61-year-old man was admitted to hospital with exertional stenocardia. The patient underwent myocardial infarction in 1988 and coronary artery bypass grafting operation in 1999. Angiography revealed total occlusion of the left anterior descending artery (LAD), as previously. In the right coronary artery (RCA) occurred disseminated, multi-segmental stenoses up to 40% with borderline stenosis of 60% in the distal portion (Fig. 1A). The aorto-marginal saphenous vein

The successful retrieval of a broken guide wire from the diagonal branch of the left anterior descending coronary artery complicated by partial stent rolling.

Percutaneous coronary interventions (PCIs) are relatively safe, and the complication rate is low in comparison to cardiac surgery revascularization. The incidence of broken or retained PCI equipment is about 0.1–0.8% [1]. We report a successful retrieval of a fractured guide wire by using a percutaneous catheter Amplatz GooseNeck Snare and Microsnare Kit (Covidien, Plymouth, USA), which was complicated by stent deformation in the form of rolling up its distal part after retracting a piece of the guide wire. This artificial damage to the implanted stent was initially ineffectively treated with balloon angioplasty and finally successfully with double drug-eluting stent (DES) deployment.