Procalcitonin (PCT) Predicts Worse Outcome in Patients with Chronic Heart Failure with Reduced Ejection Fraction (HFrEF).

INTRODUCTION: Procalcitonin (PCT) is an excellent marker of sepsis but was not extensively studied in cardiology. The present study investigated PCT plasma concentration in patients with chronic heart failure with reduced ejection fraction (HFrEF) and its prognostic value during 24-month follow-up. MATERIAL AND METHODS: Study group consisted of 130 patients with HFrEF (LVEF ≤ 45%) and 32 controls. PCT level was assessed on admission in all patients. Telephone follow-up was performed every three months over a period of 2 years. Endpoints were death of all causes and readmission for HFrEF exacerbation. RESULTS: HFrEF patients had significantly higher PCT concentration than controls (166.95 versus 22.15 pg/ml; p < 0.001). Individuals with peripheral oedema had increased PCT comparing to those without oedema (217.07 versus 152.12 pg/ml; p < 0.02). In ROC analysis, PCT turned out to be a valuable diagnostic marker of HFrEF (AUC 0.91; p < 0.001). Kaplan-Meier survival curves revealed that patients with PCT in the 4th quartile had significantly lower probability of survival than those with PCT in the 1st and 2nd quartiles. In univariate, but not multivariate, analysis, procalcitonin turned out to be a significant predictor of death during 24-month follow-up. (HR 1.002; 95% CI 1.000-1.003; p < 0.03). CONCLUSIONS: Elevated PCT concentration may serve as another predictor of worse outcome in patients with HFrEF.

Tissue-factor-bearing microparticles (MPs-TF) in patients with acute ischaemic stroke: the influence of stroke treatment on MPs-TF generation.

BACKGROUND AND PURPOSE: Stroke is an important cause of death and disability throughout the world. Microparticles play a cardinal role in vascular hemostasis. The primary aim of this study was to evaluate the procoagulant activity of microparticles and levels of tissue-factor-bearing microparticles (MPs-TF), tissue factor (TF) and tissue factor pathway inhibitor (TFPI) in patients with acute ischaemic stroke. METHODS: Seventy-three patients with a diagnosis of acute ischaemic stroke were included. Venous blood samples were drawn on the first day and the seventh day after stroke onset. Plasma microparticles, MPs-TF, TF and TFPI were determined by enzyme-linked immunosorbent assay. Assessment variables were timing of blood collection, type of stroke treatment, presence or absence of diabetes mellitus and hypertension, and scores on the National Institutes of Health Stroke Scale together with scores on the modified Rankin Scale. RESULTS: Whilst MPs-TF and TFPI levels of stroke subjects were significantly higher (median, 1.63 vs. 0.73 pg/ml; median, 114.26 vs. 78.60 ng/ml, respectively), TF levels in the plasma of stroke patients were significantly lower (median, 82.27 vs. 97.80 pg/ml) than those of healthy individuals. Lower levels of TF were detected in patients with severe stroke in comparison with patients with mild stroke. Moreover, the data also showed that in stroke patients not treated with alteplase the activity of microparticles was significantly higher 1 week after diagnosis in comparison with the activity at the time of diagnosis. CONCLUSION: Our findings suggest that patients with acute ischaemic stroke have increased generation of MPs-TF. Nevertheless, further studies are needed in order to confirm such inference.

Efficacy and tolerability of amlodipine/valsartan combination therapy in hypertensive patients not adequately controlled on valsartan monotherapy.

OBJECTIVE: To demonstrate additional BP-lowering effects of amlodipine/valsartan combination in patients whose BP was not adequately controlled on valsartan alone. METHODS: This was a multi-centre, randomised, double-blind, active-controlled study in patients with essential hypertension. After a washout period followed by a single-blind valsartan 160 mg run-in period, patients with mean sitting diastolic blood pressure (DBP) >or= 90 mmHg and < 110 mmHg were randomised to receive amlodipine/valsartan (10/160 mg or 5/160 mg o.d.) or valsartan (160 mg o.d.) for 8 weeks. TRIAL REGISTRATION: NCT00170963 MAIN OUTCOME MEASURES: Primary efficacy variable was change from baseline in mean DBP at study end. Secondary efficacy variables included change from baseline in mean sitting systolic blood pressure (SBP), responder rate (mean DBP < 90 mmHg or >or= 10 mmHg reduction from baseline), and DBP control rate (mean DBP < 90 mmHg). Safety was also assessed. RESULTS: Of 1136 patients enrolled in single-blind phase, 947 (mean age: 54.6 years) were randomised. Statistically significantly greater reductions in mean SBP/DBP were observed in both amlodipine/valsartan combinations (10/160 mg: 14.3/11.5 mmHg, 5/160 mg: 12.2/9.6 mmHg; both p < 0.0001) compared to valsartan 160 mg (8.3/6.7 mmHg). The 10/160 mg combination (p < 0.05) showed statistically significantly greater reductions in mean SBP/DBP compared to 5/160 mg (p < 0.001). Responder rates were higher in both combination therapy groups (10/160 mg: 81% [p < 0.0001]; 5/160 mg: 68% [p = 0.0018], respectively) compared to monotherapy (57%). Peripheral oedema was the most frequent adverse event, reported in amlodipine/valsartan 10/160 mg (9.1%), 5/160 mg (0.9%), and valsartan 160 mg (1.3%). CONCLUSIONS: The combination of amlodipine/valsartan in this 8-week double-blind study provided additional BP control and was well-tolerated in patients inadequately controlled with valsartan monotherapy.

[Relationship between results of electrocardiographic exercise tests and intraesophageal pH in men with atypical chest pain]. / Zaleznosc wyników elektrokardiograficznej próby wysilkowej od pH wewnatrzprzelykowego u mezczyzn z nietypowymi bólami w klatce piersiowej.

Changes in intraesophageal pH can influence myocardium perfusion via neural reflexes. The aim of this study was to estimate the relationships between intraesophageal pH and the course of electrocardiographic exercise test. 38 male patients with atypical chest pain in mean age 41.1 +/- 7.8 years were studied. In all among other 24-hours oesophageal pH monitoring and exercise test on running track with simultaneous oesophageal pH monitoring were made. Pathological acid reflux in 24-hours monitoring had 11 (29%) patients, exertional acid gastroesophageal reflux in 8 (21%) patients was found and significant ST interval depression in ecg in 11 (29%) patients was observed. The differences in patients quantity in respective subgroups were not significant. Patients with significant ST interval depression during exercise test, in comparison with patients without significant ecg changes, had lower HDL cholesterol level and higher values of daily and exertional gastroesophageal acid reflux parameters. Multiple-regression analysis showed that indicators of functional (pH-metry) and morphological (endoscopy and histology) oesophageal status were the independent factors determining variance of: exercise test duration, percentage of maximal heart rate during exercise test, double product value and maximal ST interval depression. In conclusion, changes in intraesophageal pH can influence exercise test course.

Evaluating the profile of selected cytokines in patients with food allergy and chronic gastritis.

INTRODUCTION: Evaluating the profile of selected cytokines in patients with food allergy and chronic gastritis. Cytokines are produced by many cells and they play a role of mediators in the development of local and systemic inflammatory reaction. The aim of the study was to determine serum concentrations of IL-4, IL-5, IL-8, TNF alpha in patients with chronic gastritis and food allergy, who had been infected with H. pylori. MATERIAL AND METHODS: The study was conducted on patients with atopic diathesis, who were allergic to certain foods. The study group consisted of 71 patients, including 42 females aged 16-54 years (mean age 35.5 years) and 29 males aged 18-60 years (mean age 36.2 years). One control group was formed of 40 non-atopic patients aged 18-56 years (mean age 34.8 years), suffering from chronic gastritis. The other control group consisted of 30 subjects with the diagnosis of functional dyspepsia. Serum levels of selected cytokines were determined with the kits manufactured by ENDOGEN (Cambridge MA, USA) using enzyme immunoassay ELISA. The concentrations of parameters were determined in two tests and they were given as mean value. RESULTS: Mean serum Il-4 level in atopic patients was 27.85 pg/ml, while it was 13.26 pg/ml in non-atopic subjects with chronic gastritis and 4.3 pg/ml in patients with functional dyspepsia. The concentration of IL-5 ranged between 0 and 111.3 pg/ml (mean value: 7.43 pg/ml) in subjects with food allergy. Comparative analysis of IL-4 and IL-5 concentrations in atopic patients and in control subjects showed the presence of statistically significant differences (p < 0.001). The remaining cytokines, i.e. IL-8 and TNF alpha showed a significant increase in serum levels in patients chronic gastritis when compared to the subjects with functional dyspepsia, without inflammatory changes. CONCLUSIONS: Chronic exposure of the patients with food allergy to a given food allergen makes the levels of IL-4 and IL-5 rise. In atopic subjects with chronic gastritis and H. pylori infection, the increase in IL-4, IL-5, IL-8 and TNF alpha levels suggests that both infectious and allergic factors play an important role in the pathogenesis of inflammation.

[Recurrent ventricular fibrillation in a patient with Prinzmetal angina pectoris--case report]. / Nawracajace migotanie komór u chorego z dusznica bolesna typu Prinzmetala--opis przypadku.

The description of the case of 35 years old patient with paroxysmal ventricular fibrillation in a course of Prinzmetal angina pectoris treated unsuccessfully with antiarrhythmic drugs who required implantation of cardioverter/defibrillator. The via-venous cardioverter/defibrillator was implanted (ICD). During 6 months observation ventricular tachycardia and ventricular fibrillation occurred four times and was effectively interrupted by the cardioverter/defibrillator.

[Evaluation of the circulatory system in workers in the cellulose-paper industry]. / Ocena stanu ukladu krazenia u pracowników przemyslu celulozowo-papierniczego.

The effect of occupational exposure on the circulatory system disorders was evaluated in 802 workers (675 men and 127 women). Occupational histories were analysed, as well as physical and X-ray examinations, laboratory tests (fasting blood cholesterol, triglycerides and glucose) and ECGs were performed. In doubtful cases echocardiography and stress tests on an ergonometer were carried out. Ischaemic heart disease was diagnosed in 1.37% and symptoms suggesting this disease in 6.48% of workers. The incidence of hypertension, anginal pain and dysrhythmias reported were significantly related to workers' age and duration of employment. Smoking, obesity, hypercholesterolaemia and positive family history were found to be most frequent risk factors. Arterial hypertension was diagnosed in 9.48% of workers. Non-occupational factors seem to be mainly responsible for the circulatory system disorders, however, the effects of occupational factors occurring in the cellulose and paper industry which may accelerate the development of ischaemic heart disease, arterial hypertension and dysrhythmias cannot be excluded.

[Eosinophilic activation based on measurements of eosinophil cationic protein in patients with acute myocardial infarction and patients with angina pectoris]. / Aktywnosc eozynofilów oceniana na podstawie oznaczania wartosci eozynofilowego bialka kationowego (ECP) u chorych ze swiezym zawalem miesnia sercowego i pacjentów z dusznica bolesna.

Increased activation of polymorphonuclear neutrophils in the wideness of irreversible myocardial injury was described by many authors. Released proteolytic enzymes may cause deliquescence of necrotic muscle tissue and attenuate collagenic structure of myocardium, lead to endothelium damage and generate free oxygen radicals. Eosinophilic leucocytes reveal also enhanced proinflammatory activation. They take participation in inflammatory and immunologic reactions, among others, by producing and releasing many biologic mediators. One of the most important and powerful mediators is eosinophil cationic protein (ECP), the specific marker of eosinophil activation in vivo. We studied 17 patients (pts) with acute myocardial infarction (MI) and 21 pts with angina pectoris (AP). The plasma concentrations of ECP and the number of eosinophils in peripheral blood were measured 3 times-near before beginning of the treatment, and on the 4-th and 8-th day of MI. During the first 4 days measurements of CK-MB every 6 hours were made. We observed the significant increase of eosinophils and ECP correspondingly on the 8-th and 4-th day, when compared to the first day of MI (p < 0.05) and the patients with AP (p < 0.01). Despite tendency, the significant correlation of eosinophils and ECP values was not obtained (r = 0.36). In the group of patients with AP the eosinophil and ECP values were significantly higher at the pts with unstable angina, when compared to pts with stable angina (p < 0.001).

[Early post myocardial infarction syndrome--a trial of assessment based on clinical course and immunologic tests]. / Wczesny zespól pozawalowy--próba oceny w oparciu o przebieg kliniczny i badania immunologiczne.

The study analysed clinical and immunological course of 22 patients (aged 56.3 +/- 9.5) with fever (38.5 degrees C) and greatly increased erythrocyte sedimentation rate (ESR) in the first week after myocardial infarction. The control group consisted of 25 patients (aged 50.7 +/- 11.2) without inflammatory and infectious diseases. Clinical courses of the disease, chest x-ray, echocardiography, leucocytosis and serial CK-MB levels were analysed. The immunological investigations involved quantitative estimation of IgG, C3 complement, C4 complement and the identification of T and B lymphocytes on the basis of the rosette tests A, E and EAC. Post myocardial infarction syndrome (PMIS) manifested by fever and greatly increased ESR we observed in 64% of examined patients, but fully manifested PMIS in 14% with tendency to recurrences. We found the differences in immunological examinations compared to the control group. Pericardial effusion occurred in 64% of the patients. The treatment with corticosteroids brought dramatic relief of the symptoms with objective improvement of clinical condition. Patients with high temperature with accompanying greatly raised ESR in the first week after MI may demonstrate abortive form of the post myocardial infarction syndrome.

[Digoxin level as a limited drug toxicity indicator in the assessment of post-digitalis arrhythmia]. / Poziom digoksyny jako ograniczony wskaznik toksycznosci leku w ocenie ponaparstnicowych zaburzen rytmu serca.

A clinical-laboratory analysis was carried out in 18 patients on long-term treatment with digoxin in whom toxic arrhythmia occurred, taking into account serum digoxin level measurement. In 11 patients the toxic arrhythmia correlated with high digoxin concentration in blood, in six cases it was observed with the concentration of the drug within the therapeutic level range, and in one patient it was seen below this range. Blood digoxin level in patients with hypokalemia was significantly lower in comparison to those with normal serum potassium level. Severe clinical condition of patients, especially elderly persons with hypokalemia, respiratory acidosis and renal failure contributes to the development of toxic arrhythmia; for this reason it is useful to apply in these patients the therapy monitored by blood level of the drug. Electrocardiographic features of digitalis action and non-cardiac adverse effects were seldom observed in patients with toxic arrhythmia.

[Evaluation of heart function during endoscopic examination of the upper gastrointestinal tract together with a trial of direct provocation of the sensitizing allergen--initial report]. / Ocena czynnosci serca podczas badania endoskopowego górnego odcinka przewodu pokarmowego polaczonego z próba bezposredniej prowokacji alergenem uczulajacym--doniesienie wstepne.

The heart function was evaluated during endoscopy examination connected with the gastric challenge with the sensitizing allergen. The study involved 13 patients with diagnosed pollinosis and without any disorder of the cardiovascular system. The heart function was evaluated by Holter monitoring, performed both in 24 hours of control before endoscopy examination and in 24 hours of exposure during and after gastric challenge with the sensitizing allergen. In all cases, there was no important heart dysfunction, in spite of positive results of provocation confirmed by histopathological and immunological examinations.

[Therapeutic effectiveness of molsidomine in patients with exercise-induced angina pectoris]. / Dorazna skutecznosc molsidominy u chorych z wysilkowa dusznica bolesna.

Exercise tolerance was tested with cycloergometer, and ECG recorded in 33 patients with exercise-induced angina pectoris. Patients' age ranged from 36 to 65 years. Tests were performed prior to and after a single oral dose 2 mg of molsidomine or placebo. Molsidomine reduced the number of patients with exercise-induced coronary pain from 33 to 25, i.e. from 84.5% to 27.27%. Pain-free period was significantly longer in patients given molsidomine whereas postexercise pain and total duration of the coronary pain were significantly shorter. Total work was markedly higher, and maximum ST depression in ECG record following exercise was significantly lower than the values noted prior to molsidomine administration and in placebo group. Heart rates both resting and during exercise did not differ in molsidomine and placebo groups. Molsidomine may be considered as an effective drug preventing exercise-induced anginal pain within 1 hour after administration.

[Myocardial infarction in young women--clinical analysis]. / Zawal serca u mlodych kobiet--analiza kliniczna.

Authors studied an incidence of myocardial infarction in women, specially aged below 50 years. Infarct localisation, complications during the treatment, coronary disease risk factors and mortality were estimated. In the most young women with myocardial infarction 2-3 risk factors were found, simultaneously specially cigarette smoking--all studied women aged below 50 years smoked cigarettes. Hospital course of myocardial infarction was as a rule not complicated. Mortality in young and in all observed women was however twice higher in comparison to control group of males.

[Verification of therapeutic levels of procainamide and N-acetyl- procainamide in ventricular arrhythmia]. / Weryfikacja zakresu stezen terapeutycznych prokainamidu i N-acetyloprokainamidu w komorowych zaburzeniach rytmu serca.

Therapeutical efficacy was clinically evaluated in 21 patients with ventricular cardiac arrhythmias. The drug was given orally with preceded intramuscular dose. Therapeutic effect was verified by the measurements of procainamide and N-acetylprocainamide concentrations in blood serum to determine the minimal effective concentration of the drug required to obtain satisfactory antiarrhythmic effect. Procainamide proved effective in cardiac arrhythmias in 14 patients (66.7%) with statistical significance in the acute myocardial infarctions; blood serum procainamide plus N-acetylprocainamide levels being were below the therapeutical range. The poor correlation of the dose of the drug and respective procainamide, N-acetylprocainamide concentrations in blood was observed. Relationship of the therapeutical effects blood serum level of the drug should be estimated basing of the assays of both procainamide and N-acetylprocainamide .

[Therapeutic effectiveness of lidocaine in patients with ventricular arrhythmias estimated relative to measurements of drug concentration in serum]. / Skutecznosc terapeutyczna lidokainy u chorych z komorowymi zaburzeniami rytmu serca, oceniana z uwzglednieniem pomiaru stezenia leku we krwi.

Therapeutic effectiveness of lidocaine intravenous infusions preceded by an initial intravenous dose was studied in 29 patients with ventricular arrhythmias in a course of ischemic heart disease admitted to CCU. Clinical effects were evaluated in correlation with obtained lidocaine concentrations and basic pharmacokinetic parameters. Regression of cardiac arrhythmias was stated in 23 patients (79.3%), inclusive of all acute MI cases. Partial therapeutic effect was observed in 4 patients (13.8%) and no effect in 2 (6.9%). In 12 patients (52.2%) with stated regression of ventricular arrhythmias the full therapeutic effect was observed after initial dose administration. Serum drug concentrations were above the lower limit of the therapeutic range in all cases. Side effects were observed in 3 cases with high serum lidocaine levels caused by impaired drug metabolism or elimination due to the patient's clinical state. Correlation between the infusion rate and obtained stationary condition of drug concentration within therapeutic range seemed to be highly effective in management of ventricular premature beats caused by acute myocardial ischemia but less effective in cases of ischemic and postinfarction cardiomyopathy with heart failure.

The immunologic response to tobacco antigens in smokers. VI. Phagocytosis of tobacco antigens by peripheral blood polymorphonuclear leucocytes studied by immunofluorescence.

Polymorphonuclear leucocytes (PMNL) isolated from the defibrinated blood of 44 healthy volunteers (20 no smoking subjects and 22 smokers) were examined for the presence of tobacco antigens using specific rabbit antiserum conjugated with FITC. In 11 persons from the smokers group PMNL were examined by the direct immunofluorescence technique, using appropriate antisera, as well as for the presence of IgG, IgM and C3. It was stated that the number of PMNL with fluorescent tobacco antigens rose significantly after exposure to tobacco smoke. The above cells were detected both in non-smokers and smokers venous blood, while their percentage was more important in the latter. IgG, IgM and C3 were found in PMNL of all 11 examined smoking subjects. In the authors opinion, tobacco antigens are phagocytized after penetration into the organism, either alone or in the shape of immune complexes formed with specific serum antibodies. The possibility of vascular injuries caused by the above complexes as well as the question of a presumed affinity of tobacco and solanaceae antigens are discussed.

The immunologic response to tobacco antigens in smokers. IV. Effect of heparin, aspirin, promethazine and prednisone.

The effects of heparin, aspirin, promethazine and prednisone on late skin reactions, provoked by tobacco extracts were studied in four groups of 17 patients with coronary artery disease. In all patients, intracutaneous tests were made with four different tobacco preparations, both on the first day of their hospitalisation and after 14 days of therapy. It was found that strongly positive late skin reactions with tobacco extracts were decreased or suppressed in patients taking heparin and in patients taking prednisone, but not in those who were treated with promethazine or with aspirin. This seems to confirm the hypothesis that these reactions are really provoked by a local type III allergy to tobacco antigens.