Prospective multicenter Polish Stress Echocardiography Registry (PolStress-Echopro) - the role in clinical practice.

BACKGROUND: Stress echocardiography (SE) is becoming an increasingly frequently performed diagnostic examination in Poland. After the published retrospective PolSTRESS Registry, this prospective study is the first one available so far. OBJECTIVES: The aim of the study was to analyze SE tests, taking into account the clinical characteristics of the patients, indications, applied protocols, and diagnostic and therapeutic decisions. MATERIAL AND METHODS: Reference cardiological centers in Poland were asked for a 1-month prospective analysis of the data obtained. The study included 189 SE examinations. To evaluate coronary artery disease (CAD) (178 tests), all 17 centers performed dobutamine SE (DSE) (100%), 3 centers (17%) performed pacing, while cycle ergometer and treadmill SE were performed by 1 (5%) and 2 (11%) centers, respectively. In patients with valvular heart disease (VHD) (11 tests), 3 centers (16%) performed SE to evaluate low-flow/low-gradient aortic stenosis (AS), 4 (22%) in asymptomatic AS and 1 (5%) to evaluate mitral regurgitation. RESULTS: For CAD assessment, a positive result was found in 37 (20%) patients, negative in 109 (61%) and nondiagnostic in 32 (19%). In the CAD group, coronarography was performed in 41 (23%) people. The analysis of the significance of the SE results for decision-making on interventional measures revealed that 30 patients (from the total study population of 189) were referred for the intervention. CONCLUSIONS: The most commonly used SE is the DSE. Negative test results allowed in almost half of the patients to resign from invasive coronarography. Stress echocardiography should be more frequently used in patients with VHD in the qualification for invasive treatment.

Prosthesis-patient mismatch and left ventricle systolic strain in patients with severe degenerative aortic stenosis, who are undergoing surgical valve replacement.

BACKGROUND: Prosthesis-patient mismatch (PPM) is an independent predictor of post-operative mortality after aortic valve replacement (AVR), particularly when it is associated with a left ventricle (LV) dysfunction. Two-dimensional speckle-tracking echocardiography (2D-STE) could be useful in assessing LV function in patients with PPM. AIM: To evaluate the impact of PPM on myocardial multidirectional LV systolic strain in patients who are undergoing AVR for severe degenerative aortic stenosis (AS). METHODS: Sixty-five patients (38 females, 27 males, age: 69.9 ± 9.1 years) with severe degenerative AS and preserved LV ejection fraction were enrolled into the study. Pre- and three-month postoperative 2D-STE was performed to assess LV peak systolic longitudinal strain (LV PSLS), circumferential strain, and LV rotation. The indexed prosthesis effective orifice area (iEOAprosth) was used to define PPM (≤ 0.65 cm2/m2), and it was used to distinguish the study groups: PPM (+) (n = 35) and PPM (-) (n = 30). RESULTS: A significant association of LV PSLS and interaction in the groups [PPM (+) vs. PPM (-)] and intervention (before vs. after AVR; p = 0.019) was observed - the lowest value of LV PSLS was in the PPM (+) group (-14.9 ± 3.5%) after AVR. A significant difference in the mean delta (before/after AVR) values of LV PSLS (0.7 ± 3.1% vs. -1.2 ± 3.6%; p = 0.04) in the PPM (+) vs. the PPM (-) groups was found. LV PSLS correlated with iEOAprosth (r = -0.520, p < 0.001) that was obtained three months after AVR. CONCLUSIONS: The occurrence of PPM in patients undergoing AVR for severe degenerative AS was associated with reduced LV PSLS in a three-month observation.

Obesity and antiplatelet effects of acetylsalicylic acid and clopidogrel in patients with stable angina pectoris after percutaneous coronary intervention.

INTRODUCTION: Obesity is a cluster of medical conditions affecting several pathophysiological processes, including platelet (PLT) function. OBJECTIVES: We evaluated the association between obesity and PLT response to dual antiplatelet therapy over 1 month in patients with stable angina pectoris after percutaneous coronary intervention (PCI).  PATIENTS AND METHODS: Patients with stable angina pectoris (n = 130) and prior therapy with acetylsalicylic acid (ASA, 75 mg/d) after PCI were enrolled into the study and divided based on a body mass index (BMI): BMI <25 kg/m² (group A); BMI = 25-29.9 kg/m² (group B); and BMI ≥30 kg/m² (group C). PLT function was assessed by impedance aggregometry 24 hours after PCI and a loading dose (LD) of clopidogrel (CLO, 600 mg) and after 30 days of a maintenance dose (MD) of CLO and ASA of 75 mg/d. The delta values were calculated as the difference between the tests performed 30 days and 24 hours after PCI. RESULTS: The PLT function changed significantly over a 30-day follow-up. The initial PLT reactivity to adenosine diphosphate (ADP1) was lower in group A and was the highest in group C (P <0.05). The PLT reactivity to collagen (COL1) and arachidonic acid was lower in group A (P <0.05) with no differences between groups B and C. There were no differences among the subgroups in PLT reactivity assessed after 30 days. A multivariate regression analysis showed that BMI (P = 0.03), creatinine serum concentration (P <0.01), male sex (P <0.01), and active smoking (P <0.001) are the independent predictors of ΔADP. CONCLUSIONS Obesity is associated with a lower response to CLO LD but PLT function after 30 days of CLO MD is similar in patients with obesity and normal-weight.

Flow-mediated dilatation (FMD) and prevalence of cardiovascular risk factors: the value of FMD assessment in high risk patients is limited.

BACKGROUND: Since flow-mediated dilatation (FMD) is influenced by different factors, its clinical usefulness and validation is widely discussed. AIM: To assess the major factors that determine FMD values in a wide range of subjects with and without cardiovascular (CV) risk factors/diseases (CVRF/CVD). METHODS AND RESULTS: 617 consecutive patients (mean age: 50.1 ± 14.9 years, males: 349/56.5%) hospitalised between 2005 and 2011 were enrolled into the study. Demographic data and CVRF/CVD with a significant impact on FMD values were analysed: hyperlipidaemia, active smoking, arterial hypertension, coronary artery disease, diabetes mellitus and heart valve disease. The population was divided depending on the number of coexisting CVRF/CVD (0-, 1-, 2-, 3-, 4-, 5-CVRF/CVD groups). The median FMD value in the entire group of patients was 10% (5-17). An analysis of the FMD percentage in particular groups showed significantly higher FMD values in patients without any CVRF/CVD (group 0), as well as in patients with one coexisting CVRF/CVD (group 1) compared to the other groups. The presence of two or more CVRF/CVD was not associated with a significantly higher FMD reduction. The analysis of patients with only one CVRF/CVD revealed the lowest FMD values in patients with coronary artery disease. CONCLUSIONS: FMD is related to the number of traditional CVRF/CVDs; however, coronary artery disease has the most significant influence on FMD decrease among analysed factors. The value of FMD assessment in high risk patients is limited.

The use of iloprost in the treatment of 'out of proportion' pulmonary hypertension in chronic obstructive pulmonary disease.

CASE: Pulmonary hypertension secondary to respiratory disease most often occurs as a complication of chronic obstructive pulmonary disease, which currently constitutes one of the leading causes of death. Some patients with hypoxaemia reveal "out of proportion" pulmonary hypertension with inappropriate increase of pulmonary artery pressure. Iloprost, analogue of prostacyclin, dilates systemic vessels and pulmonary vessels in particular if administered by inhalation. It appears to be important, life-saving, complementary therapy. However, there is no evidence for its routine use in out of proportion arterial pulmonary hypertension. This case study presents a 44-year old man with chronic obstructive pulmonary disease and "out of proportion" pulmonary hypertension. We present the results of his treatment with iloprost. CONCLUSION: In a patient with "out of proportion" pulmonary hypertension due to chronic obstructive pulmonary disease, inhaled iloprost led to improvement in clinical status and echocardiographic parameters, including a reduction of right ventricular systolic pressure.

Copeptin constitutes a novel biomarker of degenerative aortic stenosis.

Copeptin is a new biomarker of cardiovascular diseases. Its diagnostic value in degenerative aortic valve stenosis (AS) with preserved left ventricle systolic function is unknown. We aimed to assess the association of serum copeptin levels with AS severity and coexistence of coronary artery disease (CAD). Sixty-four patients with AS and preserved left ventricle systolic function including 40 with severe degenerative AS (group sAS, effective orifice area EOA = 0.67 cm(2)) and 24 with moderate degenerative AS (group mAS, EOA = 1.40 cm(2)) were enrolled into the study. Twenty-three patients without AS and heart failure, matched for age, sex, and CAD occurrence served as the control group (group C). Serum levels of copeptin and N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured using enzyme-linked immunosorbent assay. The mean serum copeptin concentrations were significantly higher in patients with AS: sAS (405 pg/ml) and mAS (351 pg/ml; sAS vs mAS P < 0.05), compared with group C (302 pg/ml, P < 0.05). Serum copeptin levels correlated inversely with EOA (r = -0.55; P < 0.001) in AS patients. There was no correlation between copeptin and NT-proBNP or association with the coexisting CAD. Receiver-operating characteristics analysis showed that copeptin was a good marker of severe/moderate AS (sensitivity 71 %; specificity 87 %), with the optimized cut-off value of 354 pg/ml. Serum copeptin concentration constitutes a novel biomarker of degenerative AS. Coexisting CAD does not interfere with copeptin level.

N-3 polyunsaturated fatty acids do not influence the efficacy of dual antiplatelet therapy in stable angina pectoris patients after percutaneous coronary intervention.

BACKGROUND: We aimed to prospectively assess the influence of the recommended dose, 1.0 g of polyunsaturated fatty acids (N-3 PUFA) daily, on platelet reactivity in patients with stable angina pectoris (SAP) after elective percutaneous coronary intervention (PCI). METHODS: Forty consecutive patients with SAP and successful PCI were randomized to the study group (group PUFA: n = 20; age 65 ± 8; standard therapy + 75 mg acetylsalicylic acid + 75 mgclopidogrel + N-3 PUFA/Omacor 1 g daily) and the control group (group C: n = 20; age 65 ± 9; standard therapy + 75 mg acetylsalicylic acid + 75 mg clopidogrel). Platelet reactivity tests (COL, TRAP, ASPI, ADP) were performed using whole blood aggregometry (multiplate platelet [PLT] function analysis) on the 2,nd and 30th day after PCI. RESULTS: Baseline patients' characteristics and clinical outcomes were comparable between the groups. There were no differences between both groups in the mean values of the PTL tests measured 30 days after PCI (PUFA vs. C ASPI: 18.5 ± 17 vs. 27 ± 29 U, COL: 30.4 ± 14.3 vs. 30.3 ± 13.4 U, ADP: 25.4 ± 16.1 vs. 20 ± 10.7 U, TRAP: 65.8 ± 25.6 vs. 57.1 ± 20.4 U, p = NS). The mean delta values of the PTL tests (18-24 h post-PCI/30 days post-PCI) were also comparable between the groups. The PTL aggregometry results were related to time - the baseline values of the ADP (p = 0.003), COL (p = 0.037) and TRAP (p < 0.001) tests were smaller and the ASPI (p = 0.027) test was higher than those measured after 1-month. CONCLUSIONS: N-3 PUFA supplementation does not affect the efficacy of dual antiplatelettherapy in patients with SAP after PCI.

Effects of pantoprazole on dual antiplatelet therapy in stable angina pectoris patients after percutaneous coronary intervention.

BACKGROUND: Our aim was to prospectively assess the potential influence of pantoprazole therapy on the antiplatelet effects of acetylsalicylic acid (ASA) and clopidogrel (CLO) in stable angina pectoris (SAP) patients after percutaneous coronary intervention (PCI). METHODS: Forty-four patients with SAP (CCS I-III) and successful PCI with stent implantation were enrolled into the study. The patients were divided into group proton pump inhibitors (PPI): 23 patients with indications for PPI (F/M = 9/14; age = 64 ± 9; standard therapy + 20 mg pantoprazole) and the control group (group C): 21 patients (F/M = 6/15; age = 64 ± 8; standard therapy). The platelet function analysis in whole blood based on impedance aggregometry (ASPI, COL, ADP, TRAP tests) using Multiplate--V2.02.11 was performed 18-24 h after the PCI + CLO loading dose (600 mg) and 30 days after PCI. RESULTS: Both baseline patient characteristics and clinical outcomes were comparable between the study groups. There were no differences in the mean values of the platelets (PTL) tests measured at the 30(th) day after PCI between both groups (PPI vs. C: ASPI: 24.6 ± 10.0 vs. 42.1 ± 14.8 U, COL: 32.9 ± 8.6 vs. 34.0 ± 7.7 U, ADP: 26.8 ± 12.4 vs. 30.4 ± 8.1 U, TRAP: 78.7 ± 16.6 vs. 78.1 ± 22.6 U, p = ns). The mean delta values of the PTL tests (18-24 h post-PCI/30 days post-PCI) were also comparable between the groups. The PTL aggregometry results were related to time (ADP, ASPI, TRAP vs. time, p = 0.001; COL vs. time, p = 0.03)--the baseline values of ADP, ASPI, COL and TRAP tests were smaller than those measured after the one-month observation. CONCLUSION: Pantoprazole treatment does not impair the efficacy of dual antiplatelet therapy in patients with SAP after PCI.

N-3 Polyunsaturated fatty acid therapy improves endothelial function and affects adiponectin and resistin balance in the first month after myocardial infarction.

INTRODUCTION: N-3 Polyunsaturated fatty acids (n-3 PUFA) exert clinical beneficial effects in patients after acute myocardial infarction (AMI). However, their exact mechanisms of action are not well recognized yet. Our aim was to evaluate effects of early introduced n-3 PUFA supplementation on endothelial function and serum adipokine concentrations in patients with AMI. MATERIAL AND METHODS: Thirty-eight patients with AMI and successful coronary stent implantation were randomized to the study group (PUFA group: n = 19; standard therapy + PUFA 1 g daily) and the control group (control group: n = 19; standard therapy). The study group patients were given n-3 PUFA (Omacor 1 g daily) starting from the 3(rd) day of AMI. Ultrasound vascular indexes (flow-mediated dilatation [FMD], nitroglycerine-mediated dilation [NMD]) and serum concentrations of adiponectin and resistin (ELISA) were evaluated before and after 30 days of pharmacotherapy. RESULTS: Comparison of the mean delta values (baseline/after 30 days of therapy) between groups revealed significant differences for delta FMD (PUFA 7.6 ±12.4% vs. control -1.7 ±10.5%, p = 0.019) and delta resistin concentrations (PUFA 1.0 ±3.8pg/ml vs. control -1.6 ±2.9pg/ml, p = 0.028). Multiple linear regression analysis for all subjects revealed the n-3 PUFA supplementation (r = 10.933, p = 0.004) and waist circumference (r = -0.467, p = 0.01) as independent factors associated with delta FMD values (R-adjusted 0.29; p = 0.002). CONCLUSIONS: Early and short-term n-3 PUFA supplementation in AMI with successful primary PCI and optimal pharmacotherapy improves endothelial function. However, increased resistin serum levels observed after 1-month n-3 PUFA supplementation merits further investigations.