Simple exercise test score versus cardiac stress test for the prediction of coronary artery disease in patients with type 2 diabetes.

INTRODUCTION: Type 2 diabetes markedly increases the risk of coronary heart disease (CHD), and screening for CHD is suggested by the guidelines. OBJECTIVES: The aim of the study was to compare the diagnostic usefulness of the simple exercise test score, incorporating the clinical data and cardiac stress test results, with the standard stress test in patients with type 2 diabetes. PATIENTS AND METHODS: A total of 62 consecutive patients (aged 65.4 ±8.5 years; 32 men) with type 2 diabetes and clinical symptoms suggesting CHD underwent a stress test followed by coronary angiography. The simple score was calculated for all patients. RESULTS: Significant coronary stenosis was observed in 41 patients (66.1%). Stress test results were positive in 36 patients (58.1%). The mean simple score was high (65.5 ±14.3 points). A positive linear relationship was observed between the score and the prevalence of CHD (R2 = 0.19; P <0.001) as well as its severity (R² = 0.23; P <0.001). The area under the receiver-operating characteristic curve for the simple score was 0.74 (95% confidence interval [CI], 0.62-0.86). At the original cut-off value of 60 points, the score had a similar prognostic value to that of the standard stress test. However, in a multivariate analysis, only the simple score (odds ratio [OR], 1.46; 95% CI, 1.11-1.94; P <0.01 for an increase in the score by 1 point) and male sex (OR, 1.57; 95% CI, 1.24-1.98; P <0.001) remained independent predictors of CHD. CONCLUSIONS: In patients with type 2 diabetes, the simple score correlated with the prevalence and severity of CHD. However, the cut-off value of 60 points was inadequate in the population of diabetic patients with high risk of CHD. The simple score used instead of or together with the stress test was a better predictor of CHD than the stress test alone.

Evaluation of the relations between the presence of the metabolic syndrome and the degree of visceral obesity and the severity of coronary artery disease by coronary angiography.

BACKGROUND: The prevalence of the metabolic syndrome (MetSy) steadily increases worldwide. AIM: To evaluate the relation between the presence of MetSy and visceral obesity and the presence of coronary lesions, and to assess correlations between waist circumference and body mass index (BMI) and coronary lesions. METHODS: We studied 105 patients who underwent elective coronary angiography. The study population was divided into four groups depending on the presence of MetSy and visceral obesity. Coronary angiographic evaluation was performed by an invasive cardiologist. For ultimate objective evaluation of the degree of coronary stenoses, quantitative coronary angiography was performed. Based upon coronary angiography results, patients were divided into four groups depending on the severity of coronary artery disease (CAD): with no coronary lesions, with haemodynamically insignificant lesions (1-69% stenosis), with haemodynamically significant lesions (> 70%) in 1 or 2 vessels, and with multivessel disease (> 70% stenoses in 3 vessels or a > 50% stenosis in the left main coronary artery). RESULTS: Normal coronary arteries were significantly more commonly found in patients without obesity and MetSy (50% of patients). Haemodynamically significant lesions were most frequently found among obese patients with MetSy (40% of patients) and among obese patients without MetSy (38.1% of patients). Concomitant presence of obesity among patients with MetSy (i.e., MetSy with obesity as compared to MetSy without obesity) was not found to be significantly related to the severity of CAD. In addition, advanced CAD was significantly more frequent in obese patients with MetSy compared to the other groups. Isolated visceral obesity in patients without MetSy (i.e., obese patients without MetSy as compared to non-obese patients without MetSy) was found to correlate with haemodynamically significant coronary lesions. When we evaluated nonparametric correlations between waist circumference, BMI; and the severity of CAD, BMI did not correlate with coronary lesions (r = 0.08, p = 0.37). In contrast, a significant correlation was found between waist circumference and the severity of CAD (r = 0.55, p < 0.001). Haemodynamically significant lesions were more significantly more frequent in patients with MetSy compared to patients without MetSy (76% vs. 24%, p < 0.001). Haemodynamically significant lesions were found in 67.7% of patients with isolated visceral obesity compared to 23.2% of non-obese patients without MetSy. In multivariate analysis, CAD was significantly more likely among patients with MetSy regardless of the analysed model (OR 5.3, 95% CI 1.1-25.8, p < 0.05). CONCLUSIONS: 1. The presence of MetSy significantly correlates with haemodynamically significant coronary lesions. 2. The degree of visceral obesity significantly correlates with the severity of CAD. 3. BMI does not correlate with the severity of CAD. 4. Isolated visceral obesity is a weaker determinant of haemodynamically significant coronary lesions compared to MetSy with associated obesity. 5. MetSy is associated with significantly more advanced coronary lesions, i.e. multivessel disease.

Renal function and adaptive changes in patients after radical or partial nephrectomy.

INTRODUCTION: Renal function after renal surgery depends on the volume of renal parenchyma loss and improves in the postoperative period. However, the knowledge on kidney function after radical (RN) and partial (PN) nephrectomy is still insufficient. The aim of this study is to analyze the global renal function and compensatory hyperfunction of the non-operated kidney in patients with renal cancer after RN or PN. METHODS: Fifty-one patients of mean age 62.2 years with renal cancer were included. Thirty-three RN and eighteen PN were performed. We measured creatinine serum concentrations, and we estimated glomerular filtration rate (eGFR) preoperatively and postoperatively at two time intervals: 3 and 12 months after surgery. Additionally, we assessed effective renal plasma flow (ERPF) in dynamic scintigraphy preoperatively and 12 months after surgery. RESULT: At the baseline, all mean measured values were comparable in RN and PN groups (P > 0.05). Three months after surgery, creatinine level increased in both groups, more remarkably in RN group (128 mmol/l vs. 95 mmol/l; P < 0.05), while eGFR diminished (47 ml/min/1.73 m(2) vs. 70 ml/min/1.73 m(2); P < 0.05). Similar biochemical values were observed 12 months after surgery. The mean ERPF of the non-operated kidney 12 months after surgery in RN and PN groups increased by 3.8% (232 ml/min) and 0.1% (200 ml/min), respectively (P > 0.05). The mean ERPF of the operated kidney in PN group decreased by 24.7% (149 ml/min). CONCLUSION: The deterioration of renal function after partial nephrectomy is nearly insignificant clinically. In 1-year postoperative observation, the renal function does not improve. This causes potential compensatory mechanisms to be insufficient.

[Cardiogenic shock secondary to the tako-tsubo syndrome in young male patient]. / Wstrzas kardiogenny w przebiegu zespolu tako-tsubo u mlodego mezczyzny.

Tako-tsubo's syndrome is usually induced by sudden stress reaction, however symptoms may also occur without any cause. Most reported cases of this syndrome, more than 95%, affect women older than 60 years. We present a case of a 45 year-old man in good health with severe cardiovascular complication due to "simple" laryngological surgery using systemic anaesthesia. On the basis of clinical features and results of additional tests we recognize tako-tsubo syndrome.

[Congenital disorders of the cardiovascular system and their complications in a 21-year-old woman with Turner syndrome--a case report]. / Wrodzone wady ukladu sercowo-naczyniowego i ich powiklania u 21-letniej kobiety z zespolem Turnera--opis przypadku.

A 21-year-old woman with Turner syndrome was admitted to hospital because of progressive heart failure. Echocardiography revealed a bicuspid aortic valve with one cusp ruptured due to infective endocarditis and anomalous pulmonary venous drainage. The patient underwent successful aortic valve replacement.

Treatment of dyslipidemia in patients with diabetes mellitus.

The article reviews the key aspects of pathophysiology of diabetic dyslipidemia, its treatment and associated risk of cardiovascular complications. It examines the difference in lipid metabolism between type 1 and type 2 diabetes mellitus. The diagnostic values of particular lipid abnormalities as risk predictors for cardiovascular events are analyzed. Guidelines on hypolipemic treatment in diabetes are summarized and commented on. Standard and newly introduced methods as well as new opportunities of hypolipemic treatment are presented.