What Do We Know So Far About Ventricular Arrhythmias and Sudden Cardiac Death Prediction in the Mitral Valve Prolapse Population? Could Biomarkers Help Us Predict Their Occurrence?

PURPOSE OF THE REVIEW: To summarize currently available data on the topic of mitral valve prolapse (MVP) and its correlation to the occurrence of atrial and ventricular arrhythmias. To assess the prognostic value of several diagnostic methods such as transthoracic echocardiography, transesophageal echocardiography, cardiac magnetic resonance, cardiac computed tomography, electrocardiography, and electrophysiology concerning arrhythmic episodes. To explore intra and extracellular biochemistry of the cardiovascular system and its biomarkers as diagnostic tools to predict rhythm disturbances in the MVP population. RECENT FINDINGS: MVP is a common and mainly benign valvular disorder. It affects 2-3% of the general population. MVP is a heterogeneous and highly variable phenomenon with three structural phenotypes: myxomatous degeneration, fibroelastic deficiency, and forme fruste. Exercise intolerance, supraventricular tachycardia, and chest discomfort are the symptoms that are often paired with psychosomatic components. Though MVP is thought to be benign, the association between isolated MVP without mitral regurgitation (MR) or left ventricle dysfunction, with ventricular arrhythmia (VA) and sudden cardiac death (SCD) has been observed. The incidence of SCD in the MVP population is around 0.6% per year, which is 6 times higher than the occurrence of SCD in the general population. Often asymptomatic MVP population poses a challenge to screen for VA and prevent SCD. Therefore, it is crucial to carefully assess the risk of VA and SCD in patients with MVP with the use of various tools such as diagnostic imaging and biochemical and genetic screening.

Pulmonary vein anatomy variants as a biomarker of atrial fibrillation - CT angiography evaluation.

BACKGROUND: It has been suggested that changes in pulmonary veins (PV) and left atrium (LA) anatomy may have an influence on initiating atrial fibrillation (AF) and the effectiveness of pulmonary vein isolation (PVI) in patients (pts) with atrial fibrillation. The aim of the study was to assess anatomy abnormalities of the PV and LA in the patients with the history of AF and compare it with the control group(CG). METHODS: The multi-slice tomography (MSCT) scans were performed in 224 AF pts. before PVI (129 males, mean age 59 ± 9 yrs). The CG consisted of 40 pts. without AF (26 males, age 45 ± 9 yrs). LA and PV anatomy were evaluated. Diameters of PV ostia were measured in two directions: anterior-posterior (AP) and superior-inferior (SI) automatically using Vitrea 4.0. RESULTS: Pulmonary veins anatomy variants were observed more frequently in the atrial fibrillation group - 83 pts. (37%) vs 6 pts. (15%) in CG; 9% (21 pts) left common ostia (CO), 2% (5 pts) right CO, 19% (42 pts) additional right PV (APV), (1.8%) 4 pts. APV left, 8% right early branching (EB) and 3.5% left EB. The LA diameter differed significantly in AF vs CG group (41.2 ± 6 mm vs 35 ± 4.2 mm, p < 0.0001) respectively. CONCLUSIONS: The anomalies of pulmonary vein anatomy occurred more often in pts. with AF. They can be defined as an image biomarkers of atrial fibrillation. Right additional (middle) pulmonary vein was the most important anomaly detected in AF patients as well as enlargered diameters of the LA and PV ostia.

Low testosterone and sexual symptoms in men with acute coronary syndrome can be used to predict major adverse cardiovascular events during long-term follow-up.

Low total testosterone (TT) and sexual symptoms are common among men with coronary artery disease, however its impact on major adverse cardiovascular events (MACE) is still debatable. We investigated whether low TT and coexisting sexual symptoms in men with acute coronary syndrome (ACS) can be used to predict the incidence of MACE. In the prospective study 120 consecutive men (mean age 58 ± 9 years; diabetes 27%; current smokers 58%; left ventricular ejection fraction 50 ± 10%) with ACS were included. The group of men with the presence of three sexual symptoms (decreased frequency of morning erections, a lack of sexual thoughts and erectile dysfunction) and with TT serum concentration <3.2 ng/mL was distinguished. All of the patients had their prognosis assessed according to the Global Registry of Acute Coronary Events (GRACE Score 2.0). Primary composite endpoint - MACE (recurrent ischaemia, non-fatal myocardial infarction, stroke and death) and secondary endpoint - in stent restenosis (ISR) were registered during the 18.3 month follow-up period. The mean TT level in the entire group was 3.7 ± 0.5 ng/mL. Low TT was diagnosed in 63 (52.5%) men. Both low TT and sexual symptoms were diagnosed in 57 (47%) participants. During the follow-up, 29 (24.2%) participants experienced MACE, 20 (16.6%) men ISR. In the Cox proportional hazards regression, high risk of death on the GRACE score (HR 3.16; 95% CI: 1.5-6.6; p = 0.002), the presence of low TT and sexual symptoms (HR 2.75; 95% CI: 1.26-6.04; p = 0.02) independently predicted an incidence of a MACE (p = 0.006). For the secondary endpoint only low TT and sexual symptoms (HR 2.68; 95% CI: 1.03-6.94; p = 0.034) were independent covariates which predicted IRS. Low TT which coexists with sexual symptoms in males with ACS can be used to predict MACE, especially IRS independently of classic cardiovascular risk factors.

The influence of a 3-month weight reduction therapy with Orlistat on serum vitamin B12 and folic acid concentration in obese women.

OBJECTIVE: Serum folic acid, but not the vitamin B(12) concentration, was found to be significantly lower in obese subjects than in the control ones. DESIGN: The aim of this study was to examine the levels of serum vitamin B(12) and folic acid in obese women before and after weight reduction therapy with Orlistat in comparison to healthy controls with normal body weight. SUBJECTS: Twenty obese women participated in a 3-month weight reduction therapy. The control group consisted of 20 healthy women. MEASUREMENTS: Body weight and height were measured and BMI was calculated. Body composition was analyzed with the impedance method using a Bodystat analyzer. In all patients before and after 3-month weight reduction therapy, serum concentrations of folic acid and vitamin B(12) were assessed. RESULTS: In obese women, serum concentrations of folic acid and vitamin B(12) did not change significantly after 3-month weight reduction therapy with Orlistat.

[Tumor necrosis factor alpha and its soluble receptors in serum of patients with coronary artery disease]. / Czynnik martwicy nowotworów alpha i rozpuszczalne formy jego receptorów w surowicy u chorych na chorobe wiencowa.

TNF-alpha as a pleiotropic, proinflammatory cytokine seems to play a role in the pathogenesis of atherosclerosis and coronary artery disease (CAD). TNF-alpha is binding to two cell surface receptors and its serum activity is modified by soluble forms of these receptors: sTNF-R I and sTNF-R II. The aim of this study was to assess serum concentrations of TNF-alpha, sTNF-R I and sTNF-R II in patients (pts) with CAD. We examined serum concentrations of TNF-alpha, sTNF-R I and sTNF-R II by ELISA in: 45 pts with stable exertional angina (group I); 32 pts with unstable angina (group II) within 6, 24, and 48 h after the chest pain; and 23 pts before and 6, 24, and 48 h after PTCA (group III). The control group (group C) consisted of 20 healthy subjects. We evaluated: clinical state of patients and results of some diagnostic examinations (lipids, ECG, echocardiography, coronary angiography). Mean serum concentrations of TNF-alpha were significantly higher in pts ith CAD (group I: 18.25 +/- 5.5 pg/ml; group II: 17.24 +/- 4.0 pg/ml; group III: 18.70 +/- 0.6 pg/ml; p < 0.001) than in healthy pts (8.31 +/- 1.4 pg/ml). In turn mean serum concentrations of sTNF-R I were significantly higher both in group I (1399.6 +/- 536.3 pg/ml; p < 0.05) and III (1544.0 +/- 391.4 pg/ml; p < 0.01) than in control group (1093.9 +/- 456.9 pg/ml). There were not differences in mean serum concentrations of sTNF-R II. We found no differences between mean serum concentrations of TNF-alpha, sTNF-R I and sTNF-R II either after the chest pain (group II); or before and after PTCA (group III). In group I mean TNF-alpha correlated with serum triglycerides and HDL-cholesterol (r = 0.412 and r = -0.424; p < 0.01); sTNF-R I correlated with LDL-cholesterol (r = -0.309; p < 0.05); and sTNF-R II correlated with total cholesterol and LDL-cholesterol (r = 0.311 and r = 0.316; p < 0.05). The serum concentrations of TNF-alpha are increased in patients with CAD, but this does not reflect the clinical state of patients. In pts with stable angina these increased levels of TNF-alpha may be accompanied with higher concentrations of sTNF-R I--it seems to be the compensatory mechanism in long-term atherosclerosis. Lipid disturbances may influence the cytokines metabolism in pts with CAD.

[Left and right ventricular function in acromegalic patients]. / Ocena czynnosci skurczowej i rozkurczowej komór serca u chorych z akromegalia.

Recent studies have proved close relations between cardiovascular and endocrinic systems. This relation has been observed in acromegaly, the disease connected with unrestrained secretion of growth hormone. The aim of the study was to assess Holter monitoring and echocardiography of acromegalic patients. The study group consisted of 28 acromegalic patients, including 15 patients with hypertension, was considered. As control groups we examined 20 patients with essential hypertension and 20 normotensive healthy subjects: All subjects underwent twenty-four hour Holter recordings, complete M-mode, two-dimentional and spectral Doppler echocardiography. Ventricular premature complexes occurred in 65% of acromegalic patients. Frequency and severity of ectopic beats were significantly increased compared to control groups. Left ventricular ejection fraction was considered to be normal, although significant decreased compared to healthy subjects. Left ventricular mass was above normal value in acromegalic patients--no significant difference was found between hypertensive and normotensive acromegalics. Doppler examination has shown the abnormalities of left and right ventricular filling in 89% of acromegalics. We have observed the correlations between left and right ventricular filling indices and the duration of the disease, and left ventricular mass. Left ventricular hypertrophy frequently occurs in acromegalic patients and this is not simply secondary to systemic hypertension. The prevalence of ventricular arrhythmias in acromegalic patients seems to be associated with left ventricular hypertrophy. Doppler examination suggests impaired left and right diastolic filling in patients with acromegaly.

[P-selectin and E-selectin in serum of patients with coronary artery disease]. / Selektyna P i selektyna E w surowicy krwi chorych na chorobe wiencowa.

UNLABELLED: Evidence for the role of chronic inflammation in atherogenesis has been well documented. Selectins mediate the first step in leukocyte adhesion and may contribute to the pathogenesis of stable and unstable angina. METHODS: The study group consisted of 59 patients (pts) with coronary artery disease (CAD) documented coronarographically: 27 pts with stable exertional angina (group A), 32 pts with unstable angina (group B). 20 healthy persons were the control group (group C). Serum levels of E-selectin and P-selectin were measured by ELISA method both before and after the treadmill ECG stress test (ST) in groups A and C. In group B the measurements were carried out at 6, 24, and 48 hours following an episode of chest pain. RESULTS: There were no differences between the baseline serum levels of selectins as determined in groups A and C. In patients with stable angina, the post-ST concentrations of E-selectin were significantly higher (68.8 +/- 29 ng/ml) in comparison to both baseline (38.7 +/- 15 ng/ml), and group C-values (pre-ST: 35.1 +/- 16; post-ST: 49.9 +/- 15 ng/ml). In unstable patients, serum P-selectin levels were higher when compared to those found in groups A and C (group A: 142.3 +/- 24; group B: 190.1 +/- 99; group K: 136.4 +/- 33 ng/ml). No differences between selectins concentrations were observed at fixed times after an episode of chest pain. CONCLUSIONS: Soluble selectins levels in pts with stable angina are comparable to those of healthy persons. Significant increase of E-selectin concentration as induced by ST may reflect endothelial response to exercise. Patients with unstable angina had elevated levels of P-selectin, which seems to be associated with enhanced platelet and leukocyte activation. The serum levels of selectins may indirectly reflect clinical condition of pts with CAD.

[A test for evaluating specificity and course of tilt table testing based on two groups of healthy volunteers (adolescent athletic swimmers and controls)]. / Próba oceny swoistosci i przebiegu testu pochyleniowego w oparciu o badania dwóch grup zdrowych ochotników (mlodziezy wyczynowo uprawiajacej plywanie i grupy jej rówiesników).

The aim of this study was to estimate the results of tilt table testing in two groups of healthy adolescents--swimmers and control. Cardio-vascular reactions on tilting were determined by the measurements of heart rate (HR), systolic (SBP) and diastolic blood pressure (DBP). The study was carried out in accordance with the Polish Cardiac Society procedure. The positive tilt table testing results were observed in most young swimmers and in about thirty per cent of controls. The differences in the cardiovascular reactions were observed, too. The clinical interpretation and usefulness of these results must be established by future investigations.

[The QT interval dispersion and ventricular late potential in obese women]. / Ocena dyspersji odstepu QT i wystepowania póznych potencjalów komorowych u kobiet z otyloscia prosta.

UNLABELLED: Obesity is known to be a risk factor of cardiac death, that is associated first of all with cardiac arrhythmias. Increased QT dispersion (QTd) and ventricular late potentials (LP) are measurable indices of ventricular arrhythmias risk. The aim of this study is to asses QTd and LP in women with obesity. 62 obese women (mean BMI 36.7 kg/m2) and 15 apparently healthy subjects (mean BMI 24.5 kg/m2) were included in our study. QTd and correlated QT interval dispersion (QTdc) were calculated from 12-lead ECG. LVM were assessed from echocardiograms. LP were obtained by signal averaging of surface electrocardiograms. RESULTS: QTd, QTdc, LVM were significantly higher in patients. We found LP in six cases and higher QTdc in this subgroup. According to our research, increased QTd in obese women seems to be associated with left ventricular hypertrophy and increased QTd is significantly higher in subjects with LP.

[The role of cytokines in pathogenesis of cardiovascular disorders]. / Rola cytokin w patogenezie chorób ukladu krazenia.

Cytokines are hormone-like proteins playing very important role in the cellular interactions. They are produced by the immunological as well as the cardiovascular system structural cells. Cytokines are pathogenic factors in many disorders, where inflammation etiology is suspected such as heart failure and atherosclerosis. Cytokines stimulate proliferation processes in the vascular wall for example restenosis after percutaneous coronary angioplasty. It is suggested, that wider knowledge of cytokines and their role in cardiovascular diseases may be of future clinical importance.

[The selected pro- and anti-inflammatory cytokines in the patients with coronary heart disease: preliminary communication]. / Wybrane cytokiny pro- i antyzapalne w surowicy krwi chorych z choroba wiencowa--doniesienie wstepne.

Recent findings suggest that inflammation and cytokines regulation may play a role in the pathogenesis of atherosclerosis and coronary heart disease. The aim of this study was to assess serum concentrations of selected pro- (TNF alpha) and antiinflammatory (IL-10) cytokines in patients with coronary heart disease. We studied 29 patients with coronary heart disease: 14 with stable angina (group I) and 15 with unstable angina (group II). The control group (group K) consisted of 10 healthy subjects. Patients with inflammatory diseases, previous myocardial infarction (last 6 months) and with ECG abnormalities, that would invalidate ST-segment analysis, were excluded from examined groups. We evaluated: clinical state of patients and results of some diagnostic examinations (lipids, ECG, echocardiography, coronary angiography, concomitant diseases). In each patients serum levels of TNF alpha and IL-10 were measured according to the special protocol by ELISA. The mean serum concentrations of TNF alpha and IL-10 were significantly higher in group I (respectively: 18.75 +/- 11.7 pg/ml, 89.0 +/- 114.9 pg/ml) and II (14.21 +/- 5.9 pg/ml, 49.38 +/- 72.9 pg/ml) in comparison to the healthy subjects (9.41 +/- 1.7 pg/ml, 9.69 +/- 4.5 pg/ml). We found positive correlations between mean TNF alpha and IL-10 concentrations in group II (48 hours after last symptom) and between mean TNF alpha concentration and LVM (left ventricular mass), LVMI (left ventricular mass index) in group I. The concentrations of TNF alpha and IL-10 did not correlate with other clinical parameters. The results of our study suggest that serum concentrations of pro- (TNF alpha) and antiinflammatory (IL-10) cytokines may be increased in patients with stable and unstable angina. These increased concentrations do not reflect the clinical state of patients.

[QT interval dispersion and the type of obesity in women]. / Dyspersja odstepu QT a typ otylosci u kobiet.

UNLABELLED: The risk of sudden cardiac death is higher in patients with obesity, particularly in the upper body obesity. The most common cause of cardiac events are serious ventricular arrhythmias. Delayed cardiac repolarization leading to the prolongation of the QT interval is a well characterised precursor of arrhythmias. The QT interval dispersion reflects inhomogeneity of repolarization. The aim of this study was to assess QT interval dispersion (QTd) in obese women and to establish the relationship between obesity and QTd. 62 patients with obesity (group 1) and 15 apparently healthy women (group 2) were included in our study. Obese subjects were distinguished in accordance to the waist to hip ratio (WHR) into three subgroups: 1a--obese women with upper body obesity; 1b--obese women with WHR: 0.75-0.85; 1c--obese women with lower body obesity. A standard 12-lead ECG was performed in each subjects and QTd, QTdc (QT correlated interval dispersion), QTdR (QTd ratio) were calculated. The left ventricular mass (LVM) and left ventricular mass index (LVMI) were obtained from echocardiograms. We found QTd, QTdc, QTdR and LVM, LVMI to be significantly higher in obese women as well as positive correlation between BMI and both LVM, LVMI. QTdR was significantly higher in subgroup 1a compared with subgroup 1c. CONCLUSIONS: 1) QT interval dispersion was increased in obese women compared with healthy subjects, 2) supposedly increased QTd was associated with the type of obesity.

[Mastopathy and simple goiter--mutual relationships]. / Mastopatia a wole obojetne--wzajemne powiazania.

UNLABELLED: There have been assessed physical and ultrasonographic examination in patients with mastopathy and concentration of prolactin, thyrotropin, thyroxine in blood serum of these patients. The examination was carried out in 65 patients with mastopathy (group M), at the age ranging from 18 to 53 years, and in 30 healthy women (group K), at the age from 18 to 55 years as a reference group. The group of the patients with mastopathy and the control group were divided into three subgroups (taking into account the age and function of ovaries). There were excluded from the examined group patients whose general health state, particularly endocrinological disease, and applied drugs might condition occurrence of pathological changes in mammary glands. Particular attention was paid to exclusion from examination of patients with both primary and secondary hyperprolactinemia. Non-toxic goitre was found in 80% patients with mastopathy, and the results of palpation examination of thyroid were confirmed by thyroid ultrasonographic examination. Non-toxic goitre was significantly more often in patients with mastopathy in comparison with healthy women, and there was found significantly higher thyroid volume in these patients. The hormonal evaluation showed first of all significantly higher mean concentration of prolactin in blood serum of the patients with mastopathy than in the blood serum of healthy women in comparison with both the whole examined group and subgroups. There were not significant differences between the mean concentration of thyrotropic hormone, triiodothyronine and thyroxine in blood serum in premenopausal patients with mastopathy and mean concentration of these hormones in healthy women. Only postmenopausal patients were characterized by significantly lower mean concentration of triiodothyronine in comparison with the healthy subgroup. CONCLUSIONS: 1. In patients with mastopathy, there often coexists enlargement of thyroid gland, and prolactin may be also considered as an agent which influences genesis of a goitre. 2. It should be thus admitted that hormonal examinations with particular consideration to prolactin and thyroid hormones are appropriate management in diagnosing and treatment of patients with mastopathy.

[Assessment of selected hormonal parameters in patients with mastopathy in postmenopausal period]. / Ocena wybranych parametrów hormonalnych u chorych z mastopatia w okresie pomenopauzalnym.

There have been assessed selected hormonal parameters in patients with mastopathy in postmenopausal period. The hormonal evaluation showed significantly higher mean concentration of prolactin in blood serum of patients with mastopathy than in the blood serum of healthy women. There was not functional hyperprolactinaemia in the patients in postmenopausal period. In the examined patients in postmenopausal age, there was revealed significantly higher mean concentration of oestradiol in blood serum, in comparison with the healthy women. There was also found significantly lower mean concentration of follicle-stimulating and luteotrophic hormones, which is probably due to enhanced inhibition of gonadotrophic hormones secretion by prolactin and oestradiol. The results of the conducted hormonal examinations suggest that prolactin is an agent, which produces mastopatial changes in women. Furthermore, it seems that genesis of mastopathy in postmenopausal period may be connected not only with disprolactinaemia but also with persistent oestrogenic activity. It should be thus admitted that hormonal examinations (with particular consideration given to prolactin) are appropriate management in diagnosis and treatment of patients with mastopathy.

[Some aspects of fibrocystic breast disease]. / Niektóre aspekty choroby wlóknisto-torbielowatej sutka.

The fibro-cystic disease is very common disease. Hormonal factors: hyperestrogenemia, luteal deficiency, dysprolactinemia are inconstant. They are neither necessary nor sufficient to induce the cystic disease. The relations GCD (gross cystic disease) with breast cancer remain the fundamental problem. Although the cyst itself only exceptionally degenerates into cancer, the presence of macrocystic disease multiplies by 3 to 4 the risk of cancer. A lot of interesting examinations were performed on cyst fluids aspirated from patients to identify women with benign breast disease and particular risk for breast cancer. Electrolyte profiles showed, that cysts fluids may be divided into major subpopulations, which differ in terms of histological appearance of cyst lining epithelium and levels of other fluid constituents. At the present time, the biochemical measurements in cyst fluids aren't popular to identify women likely to develop breast cancer. We should use other diagnostic methods to examine these patients.

[Biochemical and endocrinological analysis of breast cyst fluid]. / Charakterystyka biochemiczno-endokrynologiczna plynu torbieli mastopatycznych.

The gross cystic disease (breast cyst < 3 mm in diameter) is common benign disease of the breast. The relations GCD with breast cancer remain the fundamental problem. Although the cysts itself only exceptionaly degenerates into cancer, the presents of macrocystic disease multiplies by 3 to 4 the risk of cancer. A lot of interesting examinations were performed on cyst fluids aspirated from patients to identify women with benign breast disease and particular risk for breast cancer. There are two groups of breast cysts: these lined by apocrine epithelium and those lined by flattened epithelium. It is generally accepted that measurement of intracystic [Na+]/[K+] is a simple way of differentiating between these two groups of cysts. Higher intracystic concentrations of same substances may provide an explanation for the higher risk of breast cancer, which has been observed in low electrolyte group. Breast cyst fluid samples were analyzed for a lot of hormones, proteins, specific growth factors, adhesion molecules, bile acids, tumor markers and their levels were compared with breast cancer risk. At the present time, the biochemical measurements in cyst fluids aren't popular to identify women likely to develop breast cancer. We should use other diagnostic methods to examine these patients.

[Fibrocystic disease of breast and pituitary-thyroid axis function]. / Choroba wlóknisto-torbielowata sutka a funkcja osi przysadka--tarczyca.

The aim this study was to report findings on the concentrations of mean triiodothyroxine (T3), thyroxin (T4), thyroid stimulating hormone (TSH) and prolactin (Prl) in patients with benign mastopathy and in control group. All of the examined subjects were clinically euthyroid. The mean T4 concentrations in women with mastopathy (78.25 +/- 15.27 ng/ml) were significantly lower than in control group 88.73 +/- 15.27). The mean TSH and PRL concentration in women with mastopathy were higher, but not significantly, than in control women. This results indicate, that benign mastopathy seems to be connected with thyroid functions.