Zuzanna Rymarczyk

Supraventricular and Ventricular Arrhythmias Are Related to the Type of Myotonic Dystrophy but Not to Disease Duration or Neurological Status.

Patients with myotonic muscular dystrophy (dystrophia myotonica, DM) are at risk of sudden cardiac death due to diverse arrhythmias, especially progressive atrioventricular (AV) conduction abnormalities. However, there are limited data on supraventricular and potentially life‐threatening ventricular arrhythmias, especially according to type 1 and type 2 DM.

Correlation between clinical parameters of periodontal disease and mean platelet volume in patients with coronary artery disease: a pilot study

BACKGROUND Cardiovascular diseases as well as periodontitis can be regarded as current epidemics and have become a social problem. Mean platelet volume (MPV) is a simple, routinely assessed biochemical parameter, which is becoming regarded asa new, independent risk factor of acute coronary syndromes and stroke. AIM Assessment of a potential relationship between clinical indices of periodontal disease and MPV in relation to the presence of coronary artery disease (CAD) and chronic periodontitis. METHODS The study included 57 individuals aged from 50 to 65 years. Patients were divided into three groups. Group 1 consisted of 19 patients with previously diagnosed CAD and coexisting chronic periodontitis. Group 2 included 18 patients with diagnosed chronic periodontitis with excluded CAD. Group 3 was a control group and consisted of 20 healthy individuals without CAD or periodontitis. RESULTS Unsatisfactory oral hygiene defined by plaque index (PI) was observed in all patients. Mean PI was significantly higher in Groups 1 and 2 than in Group 3 (76.7% vs. 45.7%, p < 0.01). Mean bleeding index (BI) was significantly higher in Group 2 than in Groups 1 and 3 (46.4% vs. 29.8%, p < 0.05). Mean periodontal pocket depths (PD) (2.75 mm, 2.93 mm,1.97 mm, respectively, p < 0.05, p < 0.01) and clinical attachment loss (CAL) were significantly higher in Groups 1 and 2 than in Group 3 (5.13 mm, 4.79 mm, 1.31 mm, respectively, p < 0.01). Mean WBC, fibrinogen and hsCRP were not significantly different among the examined groups (WBC 6.81 G/L vs. 6.71 G/L vs. 6.18 G/L, fibrinogen concentration 4.31 g/L vs. 3.94 g/L vs. 3.67 g/L; hsCRP concentration 4.08 mg/dL vs. 6.61 mg/dL vs. 4.33 mg/dL). In Group 1, MPV was significantly higher than in Group 3 (10.39 fL vs. 9.39 fL, p < 0.01). There was a weak, although significant, correlation between periodontal parameters and MPV and correlations between MPV and PD as well as CAL (MPV-PD: r = 0.45, p < 0.05; MPV-CAL: r = 0.42, p < 0.05). CONCLUSIONS Chronic periodontitis in patients with CAD results in an increased MPV that may suggest increased platelet activity. This observation could indicate a potential pathophysiological link between chronic periodontitis and an increased risk of acute coronary syndromes.

Assessment of systemic and pulmonary arterial remodelling in women with systemic sclerosis.

Objectives: Systemic sclerosis (SSc) leads to pulmonary circulation dysfunctionand there are some indications of systemic circulation impairment. We evaluated the influence of SSc on the elastic properties of large systemic arterial walls and potential correlations between systemic and pulmonary circulation involvement. Method: We examined 75 consecutive women (mean age 53.13 ± 10.1 years) with confirmed SSc [mean disease duration (DD) 7.1 ± 9.1 years] and 21 age-matched female volunteers (mean age 52.6 ± 8.3 years, ns). Pulse wave velocity (PWV) and transthoracic echocardiography were performed. SSc patients were divided into two groups according to the median of DD: ≤ 3 years (39 patients) and > 3 years (36 patients). Results: Patients with DD > 3 years had higher PWV than those with DD ≤ 3 years and controls (log PWV: 2.23 ± 0.23 vs. 2.13 ± 0.16 and vs. 2.11 ± 0.16 m/s; p = 0.028 and 0.029, respectively). In addition, echocardiographic indices showed impaired right ventricular (RV) function in the patients with DD > 3 years. Also in these SSc patients, PWV correlated with clinical and echocardiographic parameters of pulmonary circulation: age (r = 0.64, p < 0.0001), acceleration time of pulmonary ejection (AcT; r = −0.38, p = 0.021), and tricuspid regurgitation peak gradient (TRPG; r = 0.34, p = 0.04). Multiple linear regression analysis showed that PWV was independently associated with DD (β = 0.22, p = = 0.02), AcT (β = −0.215, p = 0.03), and age (β = 0.44, p < 0.001). Conclusions: In patients with SSc lasting more than 3 years, the disease is characterized by increased stiffness of the large systemic arteries. Longer duration of SSc leads simultaneously to the increased stiffness of the large systemic arteries and to the progressive impairment of RV function and its coupling to the pulmonary arterial bed.

Functional class and type of pulmonary hypertension determinate severity of cardiac autonomic dysfunction assessed by heart rate variability and turbulence.

OBJECTIVE Heart rate variability (HRV) and turbulence (HRT) are validated methods of evaluation of cardiac autonomic nervous system (cANS) dysfunction which is associated with sudden cardiac death. There is limited data on cANS imbalance and its significance,in patients with pulmonary hypertension (PH), so we assessed HRV and especially HRT alterations in PH. METHODS AND RESULTS Thirty-three out of 41 PH patients were enrolled in the study: 22 (66.7%) with pulmonary arterial hypertension (PAH) and 11 (33.3%) with chronic thromboembolic PH (CTEPH), 11 patients were in World Health Organization Functional Class (WHO-FC) I-II, and 22 others in WHO-FC III-IV. The control group consisted of 25 healthy persons. Routine evaluations, echocardiography, right heart catheterization and 24-hour Holter monitoring with time-domain HRV and HRT evaluation were performed. Most of HRV indices and both of HRT parameters were significantly impaired in PH patients, as compared to control subjects. Abnormal HRT (turbulence onset 0.0% and/or turbulence slope 2.5 ms/RR) was found in 36.4% WHO-FC I-II and in 77.3% WHO-FC III-IV patients (P=0.05). Patients in WHO-FC III-IV or with CTEPH presented compromised HRV and HRT values when compared to patients in WHO-FC I-II or with PAH, respectively. Multivariate analysis showed that abnormal HRT occurrence in PH was influenced by higher WHO-FC only (odds ratio 5.3, 95% CI 1.4-19.9, P= 0.01). CONCLUSION Higher WHO-FC and probably type of pulmonary hypertension (CTEPH more than PAH) determinate the severity of cANS dysfunction assessed by heart rate variability and turbulence. Potential clinical consequences of our findings need further investigations.

Questionable validity of left ventricular hypertrophy cutoff values in morbidly and super-morbidly obese patients

Current diagnostic ECG criteria of left ventricular hypertrophy in obese patients are still lacking.

Response to Letter to the Editor from Anthanont Pimjai: Emerging Markers of Atherosclerosis Before and After Bariatric Surgery

Dear Dr. Anthanont Pimjai, We have carefully read with great interest your letter to the Editor with comments and concerns about the results of our study [1]. We would like to make some remarks. All women included in our study, both in the study and in the control group, were Caucasian [2]. Therefore, the study group was homogeneous in terms of ethnicity, so no ethnic variations could be observed. However, we agree with you that the available data on the potential influence of adiponectin on cardiovascular disease is rather equivocal. Aung et al. in their meta-analysis (14,063 CVD patients enrolled) showed a strong positive association of adiponectin with cardiovascular mortality (n = 11 studies, overall pooled effect estimate = 1.69 [1.35–2.10]) [3]. That was in accordance with a study by Schondorf et al. as well as our research [2, 4]. Furthermore, it is worth noticing that some studies have suggested that high-molecular-weight adiponectin is a stronger risk factor for cardiovascular diseases than total adiponectin level [5]. In another study, serum adiponectin levels were found to be inversely correlated with intima-media thickness as a marker of carotid atherosclerosis [6]. As Dr Pimjai mentioned before, other adequately powered studies failed to identify adiponectin as a cardiovascular risk factor. Some researchers claim that these contradictory results in this field might be caused by confounding factors, sex and age of the analyzed subjects, different oligomers of adiponectin tested, other methodological issues (various assays: radioimmunoassays or ELISAs), or handling of laboratory samples.[7] We agree with Dr Pimjai that further, well-designed studies are needed to clarify the full relationship between adiponectin and the risk of cardiovascular disease.