Robert Sawicki

Blood pressure in relation to neurogenic, inflammatory and endothelial dysfunction biomarkers in patients with treated essential arterial hypertension

PURPOSEnClinical relevance of relations among blood pressure (BP), inflammation, endothelial dysfunction and sympathetic activation is unknown. Study aimed, whether in patients with diagnosed and treated essential arterial hypertension (HTN) biomarkers of inflammation (hs-C-reactive protein, hs-CRP), endothelial dysfunction (endothelin-1, ET-1), and sympathetic nervous system modulation (epinephrine, E and norepinephrine, NE) could be related to BP values.nnnMATERIAL AND METHODSnIn 62 patients with diagnosed and treated HTN (mean time of disease 5±3.2 years), serum hs-CRP and ET-1 as well as plasma E and NE concentrations were measured. 24-hour ambulatory blood pressure measurement device (ABPM) was used to estimate efficacy of treatment.nnnRESULTSnA positive correlation between epinephrine and norepinephrine concentrations was found (r=0.246, p=0.05), however such a statistically significant correlation neither to hs-CRP, nor ET-1 were found. Patients with the highest hs-CRP and NE concentrations had the highest systolic (SBP) and diastolic (DBP) blood pressure values. Similar relation was found in subgroup of patients with suboptimal blood pressure values (SPB ł 130mmHg, DBP ł 80mmHg). In a group of optimal treated patients, elevated levels of ET-1 and NE related to increased blood pressure values. ROC analysis identified ET-1 as statistically significant to diagnose elevated blood pressure: 0.665 (95% Confidence interval 0.512 to 0.796).nnnCONCLUSIONSnIn patients with diagnosed and treated arterial hypertension, there are relations among measurements of hs-CRP, ET-1, NE and blood pressure values in spite of treatment, which may improve understanding of mechanisms involving inflammation, endothelial dysfunction and sympathetic nerve activation and may identify patients with refractory hypertension.

High-sensitivity C-reactive protein and total antioxidant status in patients with essential arterial hypertension and dyslipidemia.

PURPOSEnTo assess low-grade, systemic inflammation and antioxidant status as additional factors contributing to pathophysiology of essential arterial hypertension (HTN) and compare them with traditional risk factors, like abnormal lipids profile, considering their potential diagnostic usefulness.nnnMATERIAL AND METHODSnSerum high-sensitivity C-reactive protein (hs-CRP) concentrations and total antioxidant status (TAS) were measured in 143 subjects - 71 patients with diagnosed HTN and in 72 healthy controls.nnnRESULTSnIn hypertensive patients, as compared to healthy control group, the median hs-CRP concentration was higher (2.0 mg/L, 25%; 75% quartile range: 0.1; 27.1 vs 0.4 mg/L, 25%; 75% quartile range: 0.0; 4.6, respectively, p<0.001) and TAS concentration lower (1.4 mmol/L, 25%; 75% quartile range: 1.0; 2.1 vs 1.5 mmol/L, 25%; 75% quartile range: 0.5; 1.8, respectively, p=0.048). Hypertensives had higher low-density lipoprotein cholesterol concentration (LDL-C) as well as triglycerides concentration (TG) and lower high-density lipoprotein cholesterol concentration (HDL-C). Higher diagnostic sensitivity was found for hs-CRP (87%) and for TAS (89%). According to the global linear regression analysis, age, gender, hs-CRP, TAS and HDL-C were the only parameters influencing the occurrence of HTN. ROC analysis identified hs-CRP, HDL-C and TG as statistically significant to diagnose HTN (0.839; 0.816 and 0.855, respectively). Moreover, in ROC analysis there were no differences in hs-CRP and TAS in females and males.nnnCONCLUSIONSnThese results indicate that low-grade, systemic inflammation measured by hs-CRP as well as antioxidant status assessed by TAS, in the presence of traditional risk factors, are significant factors contributing to pathophysiology and diagnosis of essential arterial hypertension.

Radial access during percutaneous interventions in patients with acute coronary syndromes: should we routinely monitor radial artery patency by ultrasonography promptly after the procedure and in long-term observation?

Access-site vascular complications in patients undergoing transradial coronary procedures are rare but may have relevant clinical consequences. The aim of the study was to evaluate: (1) radial artery’s (RA) patency immediately after the procedure and in long-term observation, (2) factors influencing the frequency of radial artery’s occlusion (RAO) after percutaneous coronary intervention (PCI) procedures performed via transradial access in the group of 220 patients with acute coronary syndromes (ACS). RA ultrasound was performed 48–72xa0h after the procedure and in those who were diagnosed with RAO-again after 6–12xa0months. According to the ultrasonographic findings, the patients were divided into two sub-groups: 187 pts (85xa0%) with patent RA after PCI and 33 pts (15xa0%) with RAO. Both sub-groups significantly statistically differed with regard to the frequency of local hematomas—15 versus 27.3xa0% (pxa0=xa00.02), the frequency of applying IIbIIIa inhibitors in PCI—6.4 versus 15.1xa0% (pxa0=xa00.015) and procedure duration—0.59xa0±xa00.37 versus 0.77xa0±xa00.38 (pxa0=xa00.014), respectively. In a multifactorial analysis the only factor influencing RA patency promptly after the procedure was PCI duration (pxa0<xa00.05, rxa0=xa0−0.22). In the follow-up, right RA remained still obstructed in 28 patients (12.7xa0%) whereas in five patients (2.3xa0%) the regular flow in RA was resumed. The chronic RAO was clinically silent. Due to insignificant frequency of the occurrence of RAO after PCI procedure in patients with ACS as well as practically lack of clinical consequences of this artery’s occlusion in long-term observation, we do not see any implications to routine ultrasound periprocedural RA evaluation.

Myocardial perfusion and intima-media thickness in patients with subclinical hypothyroidism.

PURPOSEnThe data concerning the relation between subclinical hypothyroidism (SH) and the risk of cardiovascular disease are divergent. We aimed to assess myocardial perfusion in contrast-enhanced echocardiography and intima-media thickness (IMT) in patients with SH.nnnMATERIAL/METHODSnForty females with SH without symptoms of coronary artery disease and 15 healthy female volunteers were examined. Echocardiographic evaluation of the left ventricle function as well as carotid and femoral IMT complex measurements were performed at baseline. Thereafter, dobutamine stress echocardiography with myocardial perfusion assessment at rest and on the peak of stress test was performed. SonoVue® intravenous bolus as a contrast medium was used. The myocardial perfusion was assessed by quantitative method using Q-LAB Philips software (ROI modality). The perfusion index was calculated (a number of left ventricle segments with improved perfusion/a number of all segments).nnnRESULTSnA mean IMT value in the SH group was significantly higher than in the controls (0.7 mm vs. 0.38 mm, p=0.001). Myocardial perfusion at rest and at the peak of stress test was significantly lower in the SH patients as compared to the controls (at rest 120 Db in SH vs. 181 Db in controls, p=0.039 and at the peak of stress 115 Db and 188 Db, p=0.01, respectively). The perfusion index was not significantly worse in the SH group (p=0.6). IMT values negatively correlated with the myocardial perfusion index at the peak of stress (r=-0.54, p=0.014).nnnCONCLUSIONSnIn patients with SH contrast-enhanced echocardiographic examination revealed myocardial hypoperfusion and increased IMT. Our results may suggest that the patients with SH are at risk of the development of cardiovascular disease.

Adiponectin – An independent marker of coronary artery disease occurrence rather than a degree of its advancement in comparison to the IMT values in peripheral arteries

OBJECTIVEnThe aim of the study was to establish whether adiponectin may act as an independent risk factor of coronary artery disease (CAD) and if adiponectin has potential relations with a new marker of cardiovascular risk -intima-media thickness (IMT).nnnMETHODSn165 patients, who had undergone coronary angiography due to symptoms of CAD were enrolled. Selected clinical and biochemical risk factors were assessed, adiponectin concentrations and IMT were measured.nnnRESULTSnA significantly lower adiponectin concentrations in the CAD group, as compared to the controls, were found. Adiponectin concentration did not correlate with a degree of coronary vessels changes advancement. No correlation between adiponectin concentrations and IMT values in the studied peripheral arteries were found. The value of 9.8 ug/ml has been assigned as a cut-off value. Adiponectin concentrations <9.8 μg/ml had the highest positive predictive value (PPV=95.7%) and specificity (90.9), but low sensitivity (30.8). In the multilogistic regression analysis significant variables influencing the appearance of CAD were found: HDL-C (p=0.011, OR=0.88, 95%CI 0.80-0.97), IMT in CCA (p=0.0048, OR=5.25, 95%CI 1.65-16.75), IMT in CFA (p=0.015, OR=1.65, 95%CI 1.10-2.48 ), and adiponectin concentration <9.8 μg/ml (p=0.032, OR=28.95, 95%CI 1.31-641.48).nnnCONCLUSIONSnAdiponectin is an independent risk factor of coronary artery disease occurrence, but not its advancement. No correlation between adiponectin concentration and IMT values in peripheral arteries was shown.

MMP-9 in atrial remodeling in patients with atrial fibrillation

INTRODUCTIONnAtrial fibrillation (AF) is the most common arrhythmia and is associated with significant morbidity and mortality. The impact of matrix metalloproteinases (MMPs) on structural atrial remodeling and sustainment of AF in patients with persistent and permanent AF is unresolved.nnnOBJECTIVESnThe aim was to evaluate MMP-9 and its tissue inhibitor-1 (TIMP-1) as markers of atrial remodeling in patients with persistent AF (PAF) who underwent electrical cardioversion (ECV) and in patients with permanent AF (continuous AF, CAF).nnnPATIENTS AND METHODSnPlasma levels of MMP-9 and TIMP-1, clinical findings, and echocardiographic parameters were evaluated in 39 patients with AF and in 14 controls with sinus rhythm.nnnRESULTSnThe concentrations of MMP-9 were significantly higher in patients with PAF and CAF compared to controls. There was a significant increase of MMP-9 after ECV in the persistent AF group. The values of TIMP-1 were not significantly different between the groups. In patients with AF, MMP-9 levels were positively related to posterior wall thickness of the LV (r=0.356, P=0.049) and body mass index (r=0.367, P=0.046).nnnCONCLUSIONnElevated levels of MMP-9 were related to the occurrence and maintenance of AF. This suggests that MMP-9 can be a marker of atrial remodeling in patients with AF. Regulation of the extracellular collagen matrix might be a potential therapeutic target in AF.

Serum adiponectin and markers of endothelial dysfunction in stable angina pectoris patients undergoing coronary artery bypass grafting (CABG)

PURPOSEnIt has been established that endothelial dysfunction (ED) occurs after coronary artery bypass grafting (CABG). The aim of the study was to assess whether adiponectin may act as a novel marker of ED and its potential relations with new markers of ED: novel cell adhesion molecule CD146, a natural anti-thrombin glycoprotein - thrombomodulin (TM) and the well-established ED marker - Von Willebrand factor (VWF) in coronary artery disease (CAD) patients undergoing CABG.nnnMATERIAL/METHODSn45 CAD patients undergoing elective CABG were included in the study.nnnRESULTSnIn the study group the concentration of adiponectin and CD146 before the surgery were significantly lower than in the control group - 6.06 μg/ml ± 3.06 vs. 19.0 μg/ml ± 6.4 and 303.2 ng/ml ± 28.7 vs. 328.1 ng/ml ± 22.6 (p<0.05). Significant increase of adiponectin and CD146 concentration 3 months after CABG vs. before the surgery was found. Adiponectin concentration 3 months after CABG correlated with VWF, TM, CD146, and a number of grafts. CD146 before and 3 months after CABG correlated significantly with adiponectin, VWF activity as well as the statins therapy after the surgery.nnnCONCLUSIONSnIn CAD patients undergoing CABG new markers of endothelial cell dysfunction as adiponectin and CD146 are significantly lower compared to healthy volunteers. Significant increase in adiponectin and CD146 concentration 3 months after CABG vs. before the surgery was found. However adiponectin concentrations 3 months after CABG were still significantly lower compared to healthy individuals, whereas CD146 concentration returned to the values comparable to the control.

Parameters influencing in-hospital mortality in patients hospitalized in intensive cardiac care unit: is there an influence of anemia and iron deficiency?

We investigated the incidence and prognostic value of anemia as well as of the iron status in non-selected patients admitted to an intensive cardiac care unit (ICCU). 392 patients (mean age 70xa0±xa013.8xa0years, 43xa0% women), 168 with acute coronary syndromes (ACS), 122 with acute decompensated heart failure, and 102 with other acute cardiac disorders were consecutively, prospectively assessed. The biomarkers of iron status—serum iron concentration (SIC), total iron binding capacity (TIBC), and transferrin saturation (TSAT) together with standard clinical, biochemical and echocardiographic variables—were analyzed. In-hospital mortality was 3.8xa0% (15 patients). The prevalences of anemia (according to WHO criteria), and iron deficiency (ID) were 64 and 63xa0%, respectively. The level of biomarkers of iron status, but not anemia, was lower in patients who died (pxa0<xa00.05). Anemia was less frequent in patients with ACS as compared to the remaining ICCU population (pxa0=xa00.019). The analysis by logistic regression indicated the highest risk of death for age [odds ratio (OD) 1.38, 95xa0% CI 1.27–1.55], SIC (OR 0.85, 95xa0% CI 0.78–0.94), TIBC (OR 0.95, 95xa0% CI 0.91–0.98), left ventricle ejection fraction (OR 0.85, 95xa0% CI 0.77–0.93), as well as hospitalization for non-ACS (OR 0.25, 95xa0% CI 0.14–0.46), (pxa0<xa00.05). The risk of death during hospitalization tended to increase with decreasing levels of TIBC (pxa0=xa00.49), as well as with the absence of ACS (pxa0=xa00.54). The incidence of anemia and ID in heterogeneous ICCU patients is high. Parameters of the iron status, but not anemia per se, independently influence in-hospital mortality. The prevalence of anemia is higher in non-ACS patients, and tends to worsen the prognosis.

Is Real Time Contrast Echocardiography Useful for Assessment of the Right Ventricular Morphology, Function, and Perfusion?

Contrast‐enhanced echocardiography (CE) is recommended to assess left ventricular function and perfusion but is rarely used to assess the right ventricle (RV). We used CE to assess RV function and perfusion and evaluated whether RV perfusion defects varied in different patient groups with RV failure due to pressure overload.

Effect of on-pump versus off-pump coronary bypass surgery on cardiac function assessed by intraoperative transesophageal echocardiography.

PURPOSEnTo compare cardiac function assessed by intraoperative transesophageal echocardiography in patients undergoing cardiac revascularization with or without cardiopulmonary bypass.nnnMATERIAL AND METHODSnForty-one patients scheduled for elective, isolated cardiac revascularization (21 on-pump and 20 off-pump) were prospectively analyzed. Patients were matched for demographic (age and gender), anthropometric (BMI), clinical (co-morbidities, EuroScore) and laboratory variables (blood counts, renal function, left ventricular function). Transesophageal echocardiography was performed after induction of anesthesia, protamine sulfate administration, and chest closure. Left ventricular wall motion score index, end-diastolic area, fractional area change, right ventricular area change and end-diastolic area were assessed. Troponin I and C-reactive protein concentrations were measured.nnnRESULTSnRegarding echocardiographic parameters of left and right ventricular function no significant differences between on-pump and off-pump groups at any point-of-time measurements were found. Troponin I and C-reactive protein were higher in on-pump as compared to off-pump group (p=0.001 and p=0.002; p=0.003 and p=0.001, respectively).nnnCONCLUSIONSnIn elective patients scheduled for cardiac revascularization there were no difference in cardiac performance assessed by intraoperative echocardiography regardless of surgical method used.