Stanislaw Tubek

Carotid body removal for treatment of chronic systolic heart failure

BACKGROUND Augmented reflex response from peripheral chemoreceptors characterises chronic heart failure (CHF), contributes to autonomic imbalance and exercise intolerance and predicts poor outcome. METHODS AND RESULTS We present a case of a 56-year-old male patient with ischaemic CHF, who underwent surgical, unilateral carotid body resection to reduce peripheral chemosensitivity. At 2-month and 6-month follow-ups, we document a persistent decrease in peripheral chemosensitivity accompanied by an improvement in exercise capacity, sleep disordered breathing and quality of life. Autonomic balance was favourably affected as evidenced by improved heart rate variability and augmented cardiac baroreflex sensitivity. There were no procedure-related adverse events. CONCLUSIONS Denervation of a carotid body may offer a clinical strategy to restore autonomic balance and improve morbidity in heart failure (NCT01653821).

Dissociation between blood pressure and heart rate response to hypoxia after bilateral carotid body removal in men with systolic heart failure

What is the central question of this study? Carotid body denervation removes the ventilatory response to acute hypoxia, although haemodynamic responses to acute hypoxia after carotid body removal have not been described conclusively in humans. What is the main finding and its importance? Carotid body removal results in dissociation of heart rate and blood pressure responses to hypoxia in human subjects. While the heart rate response (tachycardia) is maintained, there is a significant attenuation of the blood pressure response (hypertension), which indicates the existence of different sensory afferent pathways in the haemodynamic response to hypoxia that has important clinical implications for this novel therapeutic modality.

Carotid body resection for sympathetic modulation in systolic heart failure: results from first-in-man study.

Augmented reflex responses from peripheral chemoreceptors, which are mainly localized in the carotid bodies (CBs), characterize patients with systolic heart failure and contribute to adrenergic hyperactivation. We investigated whether surgical resection of CBs in these patients can be performed safely to decrease sympathetic tone.

Consequences of peripheral chemoreflex inhibition with low‐dose dopamine in humans

Low‐dose dopamine reduces the ventilatory response to acute hypoxia both in animal and in human studies. In this study we show that low‐dose dopamine also attenuates the haemodynamic responses (tachycardia, hypertension) to acute hypoxia in healthy humans. Moreover, we found that dopamine withdrawal results in a temporary increase in minute ventilation. The magnitude of the increase in minute ventilation after dopamine withdrawal correlates with the degree of ventilatory response to acute hypoxia and depends on the duration of dopamine administration. Dopamine may provide a novel method for assessing differences in the level of peripheral chemoreceptor activity, which has important clinical implications given the recently reported pathological role of the carotid body in cardiovascular diseases in animals and humans.

The Content of Elements in Rainwater and its Relation to the Frequency of Hospitalization for Arterial Hypertension, Chronic Obstructive Pulmonary Disease, and Psoriasis in Opole Voivodship, Poland During 2000–2002

The content of chemical elements in rainwater is a suitable indirect indicator of its presence in airborne dust, sometimes referred to as rain fallout. Rainwater is considered a suitable monitor for environmental or natural pollution. The yearly content of chemical elements in rainwater may be considered as a good indicator for determining the influence of these environmental factors on the human body. We decided to investigate the relationship between chemical elements in rainwater and the frequency of hospitalizations for arterial hypertension, chronic obstructive pulmonary disease, and psoriasis. There is a mild correlation between zinc and cadmium and cases of arterial hypertension. For obstructive pulmonary disease, there is a strong correlation with the content of potassium, calcium, iron, manganese, lead and nickel, and with chloride, sulfide, total nitrogen, and nitrites. There is also a mild correlation with magnesium, zinc, copper, cadmium and chromium, and with ammonium nitrogen. In cases of hospitalization for psoriasis, a correlation was revealed with such elements as potassium, ammonium nitrogen, and phosphorus.

Effects of selective carotid body stimulation with adenosine in conscious humans

In humans, excitation of peripheral chemoreceptors with systemic hypoxia causes hyperventilation, hypertension and tachycardia. However, the contribution of particular chemosensory areas (carotid vs. aortic bodies) to this response is unclear. We showed that selective stimulation of the carotid body by the injection of adenosine into the carotid artery causes a dose‐dependent increase in minute ventilation and blood pressure with a concomitant decrease in heart rate in conscious humans. The ventilatory response was abolished and the haemodynamic response was diminished following carotid body ablation. We found that the magnitude of adenosine evoked responses in minute ventilation and blood pressure was analogous to the responses evoked by hypoxia. By contrast, opposing heart rate responses were evoked by adenosine (bradycardia) vs. hypoxia (tachycardia). Intra‐carotid adenosine administration may provide a novel method for perioperative assessment of the effectiveness of carotid body ablation, which has been recently proposed as a treatment strategy for sympathetically‐mediated diseases.

Gender Differences in Correlations Between the Content of Elements in Rain Water and the Frequency of Hospitalization for Arterial Hypertension, Chronic Obstructive Pulmonary Disease, and Psoriasis in Opole Voivodship, Poland, During 2000-2002

The aim of this work is to show and give a plausible explanation to gender-dependent differences in correlations between the content of selected elements in rainwater and the frequency of hospitalization by reason of arterial hypertension, chronic obstructive pulmonary disease (COPD), and psoriasis in the area of Opolskie Voivodeship, Poland, during the period 2000–2002. The elements analyzed were sodium, potassium, calcium, magnesium, manganese, iron, total phosphorus, total nitrogen, ammonium nitrogen, zinc, copper, lead, cadmium, nickel, chromium, chloride, nitrate, and sulfate. Hospitalization due to arterial hypertension was more frequent in women, whereas those for COPD and psoriasis were more frequent in men. In the case of women hospitalized for arterial hypertension, the correlations were low, except for zinc (r = 0.47) and for cadmium (r = 0.43). In men hospitalized for COPD, all of the correlation coefficients were higher than 0.4, except for phosphorus. The coefficients for nickel, ammonia nitrogen, and total nitrogen ranged from 0.5 to 0.6 and the remaining elements from 0.6 to 0.7. In women, the correlation was limited to five elements where the coefficient was r > 0.4 for chloride, calcium, nitrate, phosphorus, and chromium. In cases of hospitalization for psoriasis, the correlation in men was between 0.4 and 0.5 for chloride, phosphorus, copper, lead, and total nitrogen and greater than 5 for sulfate, potassium, calcium, iron, manganese, nitrate, and ammonium nitrogen. The correlation in women was between 0.48 and 0.5 for ammonium nitrogen and phosphorus.

Sexual dimorphism in socioeconomic differences regarding the risk factors, symptomatology and management of patients with stable coronary artery disease in Poland

BACKGROUND Relationships between socioeconomic status (SES) and the risk factors, applied treatment and outcomes of patients with coronary artery disease (CAD) have been demonstrated in Western European countries, however analogous evidence is missing from Eastern and Central European countries. The aim of the study was to investigate SES gradients regarding the risk factors, symptoms and management of patients with stable CAD in Poland, separately in men and women. METHODS We analyzed the data of 2,593 participants of the RECENT study. SES was assessed based on the level of education attainment: university, secondary school or primary school. RESULTS Socioeconomic differences in risk profile were most markedly seen in women: lower the education, higher body mass index (p < 0.01), systolic and diastolic blood pressure (p < 0.05), resting heart rate (p < 0.01), and greater prevalence of heart failure (p < 0.05) and dyslipidemia (p < 0.05). Importantly, smoking habit was the most frequent in women who graduated from univer-sity (p < 0.01). In men, socioeconomic gradients were only seen within resting heart rate (p < 0.01), LDL cholesterol level (p < 0.05) and smoking habit (p < 0.05). In both genders, better education was associated with less severe symptoms of angina and more frequent use of statins (p < 0.05). CONCLUSIONS SES stratified based on education level differentiates patients with stable CAD in Poland regarding their risk profile, symptom control and the use of statins. Sexual dimorphism is found mainly within SES gradients regarding the prevalence of risk factors.

Late Cardiac Tamponade as a Result of Parietal Pericardium Erosion

Late onset cardiac tamponade is a rare and particularly challenging (both from diagnostic and management perspectives) complication of intracardiac lead implantation. We present a case of a late tamponade leading to cardiogenic shock, which occurred 1,164 days after implantable cardioverter-defibrillator (ICD) implantation. Open repair revealed unusual and, to our knowledge, not yet reported mechanism of the disease. A pressure sore caused by an ICD lead was found in the parietal layer of pericardium with no visible damage to the visceral layer. Conservative management in the described clinical scenario could be fatal, thus awareness of this pathomechanism of tamponade is critical.

Human carotid bodies as a therapeutic target: new insights from clinician perspective

From the physiological point of view, carotid bodies are mainly responsible for the ventilatory response to hypoxia; however, they also take part in the regulation of sympathetic tone. According to preclinical data, these structures likely contribute to the development and progression of sympathetically mediated diseases. Moreover, carotid body deactivation in animal models improved blood pressure control in hypertension and reduced mortality in heart failure, along with reducing sympathetic activity. On this basis, two first-in-man studies have been recently performed to investigate the safety and feasibility of such an approach in humans. In this review we summarise the current knowledge regarding the function of carotid bodies, the prevalence of their abnormalities, and the consequences of their excision in human hypertension and heart failure.