Urszula Cieślik-Guerra

Evaluation of the impact of atmospheric pressure in different seasons on blood pressure in patients with arterial hypertension.

OBJECTIVES Atmospheric pressure is the most objective weather factor because regardless of if outdoors or indoors it affects all objects in the same way. The majority of previous studies have used the average daily values of atmospheric pressure in a bioclimatic analysis and have found no correlation with blood pressure changes. The main objective of our research was to assess the relationship between atmospheric pressure recorded with a frequency of 1 measurement per minute and the results of 24-h blood pressure monitoring in patients with treated hypertension in different seasons in the moderate climate of the City of Łódź (Poland). MATERIAL AND METHODS The study group consisted of 1662 patients, divided into 2 equal groups (due to a lower and higher average value of atmospheric pressure). Comparisons between blood pressure values in the 2 groups were performed using the Mann-Whitney U test. RESULTS We observed a significant difference in blood pressure recorded during the lower and higher range of atmospheric pressure: on the days of the spring months systolic (p = 0.043) and diastolic (p = 0.005) blood pressure, and at nights of the winter months systolic blood pressure (p = 0.013). CONCLUSIONS A significant inverse relationship between atmospheric pressure and blood pressure during the spring days and, only for systolic blood pressure, during winter nights was observed. Int J Occup Med Environ Health 2016;29(5):783-792.

Circumferential strain of carotid arteries does not differ between patients with advanced coronary artery disease and group without coronary stenoses

PURPOSE Speckle tracking echocardiography is widely used for the analysis of myocardial function. Recently, circumferential strain (CS) of carotid arteries was postulated as novel indicator of vascular function. Our aim was to characterize and compare CS of carotid arteries in patients with advanced coronary artery disease and controls without significant coronary stenoses. PATIENTS/METHODS We compared CS of both common carotid arteries (CCA) in the 25 patients with three-vessel coronary artery disease (3VD) (mean age 69±9 years, 9 male) and in 16 age-matched subjects without significant coronary lesions (C) (69±8 years, 7 male). Additionally in 11 patients we estimated pulse wave velocity (PWV) and assessed the correlation between PWV and CS. Short-axis images of arteries were acquired for strain analysis with linear probe of echocardiograph. The assessment of CS was performed off-line by two observers. RESULTS The intraobserver variability for the CS (coefficient of variation) were 4.9 and 5.4% for left and right CCA and interobserver variability were 11.7% and 12.5%, respectively. The mean CS for left and right CCA did not differ between compared groups. We did not find correlation between CS strain and PWV. The only difference was related to the more prevalent plaque presence and thicker intima-media complex (IMT) in 3VD (p=0.0039 for IMT of left CCA and p=0.016 for IMT of right CCA). CONCLUSIONS The global CS of CCA, contrary to IMT, did not allow for differentiation between 3VD and C subjects. Despite good feasibility and concordance of CS measurements its clinical significance remains to be established.

Cardiotoxic effect due to accidental ingestion of an organic solvent.

Toxic myocardial injury can be misdiagnosed as a myocardial infarction, resulting in the patient undergoing standard treatment for cardiac rehabilitation. However, such inadequate therapeutic strategies can lead to cardiovascular complications including dilated cardiomyopathy. This study presents a case of a 65-year-old man after accidental ingestion of organic solvents (toluene and xylene), whose condition demonstrated all the criteria for diagnosis of myocardial infarction. The qualitative determinations of the above mentioned volatile organic compounds (VOCs) in whole blood were carried out using a headspace sampling by means of gas chromatography. Cardiac catheterization revealed no specific coronary lesions, only a muscular bridge causing a 30-50% stenosis in the middle of the circumflex branch of the left coronary artery.

Porównanie poprawy tolerancji wysiłku u pacjentów poddanych rehabilitacji kardiologicznej leczonych beta-adrenolitykami lub iwabradyną

Introduction. Ivabradine is an agent that selectively decreases heart rate (depending on the dose) and does not affect other cardiovascular parameters. In particular, it does not influence left ventricular ejection fraction and does not inhibit vascular relaxation during exercise. Due to these properties, ivabradine can be used in those patients in whom beta-blockers are contraindicated or their dose escalation is not possible. These properties also suggest that use of ivabradine during cardiac rehabilitation in patients with contraindications to beta-blockers or beta-blocker intolerance might increase exercise tolerance. The aim of the study was to evaluate whether administration of ivabradine (in addition to or instead of beta-blockers) during a cardiac rehabilitation program improved exercise tolerance in comparison to patients receiving only beta-blockers. Materials and methods. Fifty patients treated with ivabradine during cardiac rehabilitation were enrolled into this retrospective study. The control group was matched for gender, age and other comorbidities and consisted of 50 subjects. The improvement in exercise tolerance was compared between the group receiving beta-blockers alone and those on ivabradine treatment. Results. The study included 100 patients — 60 males and 40 females. Our analysis of exercise test results expressed in metabolic equivalents of task (MET) suggested a positive effect of ivabradine on the improvement of exercise tolerance. The percentage improvement was significantly higher in patients on ivabradine compared to the control group (26.8% ± 27.73% vs. 11.64% ± 19.34%, p = 0.002). In addition, a larger increase in the duration of exercise test was noted in patients treated with ivabradine (52.76% ± 47.29% vs. 32.59% ± 42.94%, p = 0.0101). No difference was found between patients who were already treated with ivabradine before cardiac rehabilitation and those in whom ivabradine was initiated during the cardiac rehabilitation program. Conclusions. Treatment with ivabradine during a cardiac rehabilitation program was associated with a better improvement in exercise tolerance compared to patients receiving beta-blockers alone.

Diabetes as an independent predictor of left ventricular longitudinal strain reduction at rest and during dobutamine stress test in patients with significant coronary artery disease

Aims Diabetes (DM) is a strong cardiovascular risk factor modifying also the left ventricular (LV) function that may be objectively assessed with echocardiographic strain analysis. Although the impact of isolated DM on myocardial deformation has been already studied, few data concern diabetics with coronary artery disease (CAD), especially in all stages of dobutamine stress echocardiography (DSE). We compared LV systolic function during DSE in CAD with and without DM using state-of-the art speckle-tracking quantification and assessed the impact of DM on LV systolic strain. Methods and results DSE was performed in 250 patients with angina who afterwards had coronarography with ≥50% stenosis in the left main artery and ≥70% in other arteries considered as significant. In this analysis, we included 127 patients with confirmed CAD: 42 with DM [DM(+); mean age 64 ± 9 years] and 85 patients without DM [DM(-); mean age 63 ± 9 years]. The severity of CAD and LV ejection fraction (EF) were similar in both groups. Global and regional LV peak systolic longitudinal strain (PSLS) revealed in all DSE phases lower values in DM(+) group: 14.5 ± 3.6% vs. 17.4 ± 4.0% at rest; P = 0.0001, 13.8 ± 3.9% vs. 16.7 ± 4.0% at peak stress; P = 0.0002, and 14.2 ± 3.1% vs. 15.5 ± 3.5% at recovery; P = 0.0432 for global parameters, although dobutamine challenge did not enhance further resting differences. LV EF, body surface area, and diabetes were independent predictors for strain in 16-variable model (R2 = 0, 51, P < 0.001). Conclusion PSLS although diminished in both groups with CAD was lower in diabetics at all DSE stages, and DM was an independent predictor of this impairment. However, the dobutamine challenge did not deepen the resting differences, suggesting that the direct impact of coronary stenoses effaces the influence of DM during DSE. The comparison with our previous data revealed synergistic, detrimental effect of coexisting CAD and DM on myocardial strain.

One patient — many faces of myocardial ischaemia

We present the case of a woman treated with coronary angioplasty due to non-ST segment elevation myocardial infarction,then again because of restenosis, who continued to complain of chest pain and syncope. Holter electrocardiogram recording revealed atrioventricular block related to ST-segment elevations and variant angina was diagnosed. Despite administered medications, the patient required pacemaker implantation.