Takotsubo cardiomyopathy: serious early complications and two-year mortality - a 101 case study.

BACKGROUND: Takotsubo cardiomyopathy (TTC) is characterised by transient contractility disturbances of the apex of the left ventricle. METHODS: We enrolled 101 patients from the northern-eastern part of Poland in the years 2008-2012 who were hospitalised for TCC. The control group consisted of female patients diagnosed with anterior myocardial infarction with ST-segment elevation (anterior STEMI) (n = 101). RESULTS: 89 % of the study group were women. Patients with TTC had diabetes (12.6 % vs 29.7 %; p = 0.002) and hyperlipidaemia (36.8 % vs 64.4 %; p = 0.0001) significantly less frequently, and better kidney function assessed by estimated glomerular filtration rate versus patients with anterior STEMI (74.52 % vs 64.30 %; p = 0.004). In the TTC group there were more patients with chronic obstructive pulmonary disease (11.6 % vs 1.0 %; p = 0.002) and thyroid disturbances, especially hyperthyroidism (23.4 % vs 11.0 %; p = 0.021). In patients with TTC sudden cardiac arrest, pulmonary oedema and cardiogenic shock were observed less frequently than in the control group (14.7 % vs 30.7 %; p = 0.0078). Hospitalisations in TTC patients were less frequently complicated by pneumonia (20.0 % vs 35.6 %; p = 0.0148) and urinary infection (4.2 % vs 21.8 %; p = 0.0003). Cardiac rupture occurred in 3 patients with TTC and in 1 with anterior STEMI. In-hospital mortality was significantly lower in the group with TTC. Also, mortality at 30 days, 3 months, 1 year and 2.5 years was significantly lower in patients with TTC than in patients with MI (p = 0.035; p = 0.0226; p = 0.0075; p = 0.009). CONCLUSIONS: Previously considered to be a benign syndrome, TTC should be reconsidered as a clinical condition at risk for serious complications such as cardiac arrest, cardiogenic shock, pulmonary oedema and cardiac rupture leading to death and causing substantial early hazard. The prognosis in TTC is significantly better than in patients with anterior STEMI.

Absolute and Functional Iron Deficiency Is a Common Finding in Patients With Heart Failure and After Heart Transplantation.

BACKGROUND: Anemia is relatively common in patients with heart failure and heart transplant recipients. Both absolute and functional iron deficiency may contribute to the anemia in these populations. Functional iron deficiency (defined as ferritin greater than 200 ng/mL with TSAT (Transferrin saturation) less than 20%) is characterized by the presence of adequate iron stores as defined by conventional criteria, but with insufficient iron mobilization to adequately support. The aim of this study was to determine prevalence of absolute and functional iron deficiency in patients with heart failure (n = 269) and after heart transplantation (n = 130) and their relation to parameters of iron status and inflammation. METHODS: Iron status, complete blood count, and creatinine levels were assessed using standard laboratory methods. C-reactive protein, hepcidin and hemojuvelin were measured using commercially available kits. RESULTS: Absolute iron deficiency was present in 15% of patients with heart failure and 30% in heart transplant recipients, whereas functional iron deficiency was present in 18% of patients with heart failure and 17% in heart transplant recipients. Functional iron deficiency was associated with significantly higher C-reactive protein and hepcidin levels in heart failure patients, and higher hepcidin and lower estimate glomerular filtration rates in heart transplant recipients. Prevalence of anemia (according to the World Health Organization) was significantly higher in heart transplant recipients (40% vs 22%, P < .001), they were also younger, but with worse kidney function than patients with heart failure. CONCLUSIONS: Both absolute and functional iron deficiency were present in a considerable group of patients. This population should be carefully screened for possible reversible causes of inflammation.

Significant narrowing of the circumflex artery leads to worse outcomes than right coronary artery narrowing in patients with anterior myocardial infarction treated invasively.

BACKGROUND: Occlusion of the circumflex artery (Cx) often does not present signs in the ECG. It can lead to delayed angiography during ST-elevation myocardial infarction (STEMI). The aim of this analysis was to determine if Cx narrowing is related to diverse outcomes in comparison with right coronary artery (RCA) stenosis in patients with STEMI, treated with percutaneous coronary intervention (PCI) of the left descending artery (LAD). METHODS AND RESULTS: Inclusion criteria were as follows: first STEMI treated with PCI of the LAD and additional significant (≥ 70 %) Cx or RCA narrowing-two-vessel disease. A total of 234 consecutive patients with STEMI were included. Total mortality was estimated during long-term follow-up, at mean 639 (± 224) days after STEMI. Patients with Cx narrowing constituted 46 % (N = 108) of the study population, and patients with RCA narrowing amounted to 54 % (N = 126). Patients with narrowing of the Cx had worse long-term outcomes in terms of mortality than patients with RCA narrowing (22 vs. 11 %, p < 0.05, respectively). Multiple regression analysis showed independent risk factors for death during long-term follow-up such as: age, ejection fraction and Cx narrowing. CONCLUSION: Significant Cx narrowing leads to worse outcomes than RCA narrowing in patients with STEMI treated with PCI of the LAD.

Attitudes of members of the Baptist Church toward organ transplantation.

INTRODUCTION: The Baptist Church in Poland has not presented its official stance on organ, tissue, or cell transplantation so far. The aim of the work was to find out Baptists' knowledge and opinions concerning organ transplantation. METHODS: The respondents were 296 members of the Baptist Church. The research tool used in the study was an original survey questionnaire. RESULTS: The vast majority of Baptists (72%) would agree to have organs removed from a deceased family member. The fact of knowing someone who has had an organ transplanted was a factor promoting such a decision. Three fourths of the respondents would agree on removal of their organs for transplantation after death, but only 47% have talked about that with their families. Of the respondents, 37% think that the transplant recipient should have the opportunity to meet the family of the donor. The respondents who did not agree to have organs removed from a deceased person most often mentioned such reasons as aversion to violating bodily integrity of the deceased person (55%), religious beliefs (54%), failure to agree with the death of the deceased person (46%), not knowing the deceased person's will (34%), and lack of trust in health service (32%). CONCLUSION: Propagation of knowledge of transplantation is the only effective method of increasing the number of organ transplantations, because many ethical, social, and religious barriers in the society result from insufficient education.

Opinions of town residents on organ transplantation.

INTRODUCTION: Organ transplantation is connected with many very difficult ethical and social issues that evoke a lot of emotion. The aim of this work was to determine the knowledge and opinions of the 612 residents of selected towns in Podlaskie voivodeship (in northeastern Poland) on organ transplantation. MATERIAL AND METHODS: A diagnostic poll with the use of a survey questionnaire was implemented in the study. The respondents were divided into 2 groups (towns <100,000 and >100,000 residents). RESULTS: Respondents from larger towns were more often willing to donate organs of close relatives for transplantation than those from small towns (67.1% vs 32.9%; P = .022). Respondents with higher education levels accepted organ donation from close relatives after their death significantly often than those with no more than a primary education (46.7% vs 22.2%; P < .001). Of the respondents, 83% would agree to donation after death and to donating their own organs (higher with primary education, 90.6% vs 63.5%; P < .001). Of respondents from big towns, 61.0% have informed their family of the decision for donation after death compared with 38.5% of respondents from small towns. Respondents with higher education significantly more often informed their family of such decision than persons with primary education (60.9% vs 42.9%; P < .007). CONCLUSIONS: More emphasis should be on educating the communities living in small towns and people with primary and vocational education, because an adequate level of knowledge is a significant factor influencing the readiness to give one's organs for transplantation.

Growth differentiation factor 15 is related to anemia and iron metabolism in heart allograft recipients and patients with chronic heart failure.

BACKGROUND: Growth differentiation factor (GDF) 15 was recently identified as a hepcidin-suppression factor that is expressed at high levels in patients with ineffective erythropoiesis. Hepcidin is a small defensin-like peptide whose production by hepatocytes is modulated in response to anemia, hypoxia, or inflammation. The aim of this study was to assess GDF15 levels and its correlation with iron parameters in 134 stable heart transplant recipients compared with 157 patients with chronic heart failure (CHF). METHODS: Complete blood count, urea, creatinine, lipids, fasting glucose, and iron status were studied with the use of standard laboratory methods. We assessed GDF15, hepcidin, and soluble transferrin receptor (sTfR) with commercially available assays. RESULTS: Mean levels of GDF15 and hepcidin were significantly higher in heart allograft recipients compared with patients with chronic heart failure (P < .001). GDF15 was significantly higher in patients with anemia compared with nonanemic counterparts in both groups. In univariate analysis in heart transplant recipients, GDF15 was related to kidney function, age, time after transplantation, hepcidin, sTfR, hemoglobin, transferrin saturation, ejection fraction (EF), and New York Heart Association functional class. GDF15 was not related to serum iron or ferritin in both groups. In multivariate analysis, sTfR, creatinine, and age were found to be predictors of GDF15. In univariate analysis in CHF patients, GDF15 was related to creatinine, erythrocyte count, hemoglobin, hepcidin, and total iron binding capacity and tended to correlate with EF. In multivariate analysis, hepcidin, creatinine, and EF were found to be predictors of GDF15 in CHF. CONCLUSIONS: GDF15, by affecting iron status, might be involved in the pathogenesis of anemia in patients with cardiovascular pathology.

Renal function after percutaneous coronary interventions depending on the type of hydration.

PURPOSE: The aim of our study was to evaluate renal function assessed by serum creatinine as well as novel biomarkers in 142 patients with stable coronary heart disease and normal serum creatinine undergoing percutaneous coronary interventions (PCI) depending on the type of hydration: physiological saline vs. sodium bicarbonate (1:1 randomization). MATERIALS AND METHODS: Serum and urinary NGAL were evaluated before and after 8-12, and 24 hours after PCI. Serum cystatin C, serum creatinine, estimated glomerular filtration rate using different formulae were assessed before PCI, and 24 hours after the procedure. RESULTS: Only 2 patients (2.8%) from the saline-hydrated group fulfilled the criteria for CI-AKI. In patients hydrated with sodium bicarbonate serum creatinine declined significantly (p<0.01). In patients hydrated with sodium bicarbonate a significant fall in serum NGAL after 8-12 hours was found. In sodium bicarbonate group cystatin C decreased non significantly after 8-12 hours, then returned to the baseline values. In patients hydrated with physiological saline serum NGAL before PCI and after 24 hours correlated positively with cystatin C and eGFR by CKD-EPI. In patients hydrated with sodium bicarbonate baseline serum NGAL correlated with NGAL baseline cystatin C and eGFR by CKD-EPI, similarly serum NGAL after 24 hours correlated with cystatin C. CONCLUSION: We suggest to rather use sodium bicarbonate in a hydration protocol in patients undergoing PCI. However, the value of NGAL in this setting remains to be elucidated and volume expansion remain the unquestionable prevention methods of CI-AKI.

Assessment of kidney function in diabetic patients. Is there a role for new biomarkers NGAL, cystatin C and KIM-1?

PURPOSE: Assessment of kidney injury early detection in diabetic patients has great importance for therapy and prognosis. The aim of this study was to assess whether neutrophil gelatinase-associated lipocalin (NGAL), cystatin C, and kidney injury molecule-1 (KIM-1) could represent sensitive markers of kidney function/injury in patients with coronary heart disease and diabetes. MATERIALS AND METHODS: The study comprised 121 consecutive patients with diabetes referred for coronary angiography due to coronary heart disease and a reference group consisting of 64 patients without diabetes. RESULTS: Cystatin C, serum and urinary NGAL values were significantly higher in diabetics than in non-diabetics. There was no significant difference in KIM-1 levels in both groups. Serum NGAL in diabetic group was associated with serum creatinine, fibrinogen, urinary NGAL, cystatin C and inversely related to kidney function assessed with 4 equations. After analysing levels of studied biomarkers in both groups, no significant difference in patients with estimated glomerular filtration rate (eGFR) below 60 ml/min/1.73m² was found. The analysis of patients with eGFR over 60 ml/min/1.73m² showed significant differences in cystatin C and urinary NGAL levels. The area under the curve for serum NGAL, urinary NGAL and cystatin C was 0.60 (95% CI, 0.51 to 0.69), 0.59 (95% CI, 0.5 to 0.68), 0.62 (95% CI, 0.54 to 0.71), respectively, good cut-off values of studied biomarkers to detect diabetes were not found. CONCLUSION: NGAL, cystatin C and KIM-1 are not more useful than eGFR in the assessment of kidney function in diabetic patients with coronary heart disease.

Compliance with lifestyle recommendations in kidney allograft recipients.

BACKGROUND: Many factors affect long-term graft and patient survival. Compliance with lifestyle recommendation may be an important factor. Lifestyle modifications may play a therapeutic and protective role against graft failure and possible death. METHODS: The aim of this work was to assess compliance with lifestyle recommendations among 110 kidney allograft recipients. All patients were asked to complete a questionnaire regarding life style, frequency of outpatient visits, self-control, diet, physical activity and addictions. RESULTS: The mean age of the population was 48.79±13.18 years, and their mean time after transplantation was 69±44.5 years with a mean serum creatinine value of 1.45±0.7 mg/dL. Physicians were the major source of information (40%) for patients while in the hospital; nurses informed patients in only 5.5% of cases. The majority of patients (97.5%) attended regular outpatient clinic visits. A similar percentage of subjects regularly measured their blood pressure at home. One-fifth of the patient wrote a self-control diary. Only 55.5% of patients knew the immunosuppressive regimen, including the doses of the medications. An overweight condition was diagnosed in 39%, with obesity in 22%; 16% of the patients were smokers; one-fourth of the patients drank alcohol at least several times a month; 85.3% of patients did not change their diet after kidney transplantation; and one-half of the patients (64.2%) were not aware of dietary recommendations after kidney transplantation. CONCLUSIONS: The majority of patients regularly attended the outpatient clinic and ingested immunosuppressive medications. However, their knowledge regarding diet, cancer prophylaxis, and self-control was insufficient. Therefore, there is a need to introduce more intense organizational and educational activities to improve patient knowledge.

Early and long-term prognosis of patients with coronary artery disease treated with percutaneous coronary interventions in 2005. Experience of single large-volume PCI center.

PURPOSE: The progress which has been made in interventional cardiology contributes to the gradual improvement of the results of CHD (coronary heart disease) therapy. The aim of the study was the assessment of early and long-term prognosis in all the patients with CHD treated invasively in one large-volume PCI center in 2005. MATERIAL AND METHODS: 1390 consecutive patients with CHD treated with PCI in 2005 were included in the analysis. Patients with ST-elevation myocardial infarction (STEMI) accounted for 50% of cases, patients with stable angina (SA) amounted to 25%, and patients with non-ST elevation acute coronary syndromes (NSTE-ACS) constituted 25%. Mean follow-up was 738 (±237) days. RESULTS: The highest mortality during the hospitalization was noted within the STEMI group(SA vs. NSTE-ACS vs. STEMI; 0% vs. 0.3% vs. 4.1%, respectively; p<0.001). The highest mortality during a 2-year follow-up was also observed in the STEMI group (SA vs. NSTE-ACS vs. STEMI, 6.3% vs. 8.5% vs. 13.8%, respectively; p<0.001). Multiple regression model showed that independent risk factors for death during the follow-up were: age, glycaemia at admission, heart rate, blood pressure, ejection fraction, STEMI, ineffective PCI (R=0.3613; F(10.131)=19.672; p<0.0001 for the model). CONCLUSIONS: The highest relative increase of mortality after the discharge of patients with CHD undergoing PCI referred to the patients with NSTE-ACS. However, in the real life PCI practice STEMI patients have the worst hospital and long-term prognosis. Well recognized risk factors for death in patients with CHD are still of great importance in negative prognosis of patients undergoing PCI.

NGAL (neutrophil gelatinase-associated lipocalin) and L-FABP after percutaneous coronary interventions due to unstable angina in patients with normal serum creatinine.

PURPOSE: The value of NGAL (neutrophil gelatinase-associated lipocalin) and L-FABP (liver-type fatty acid binding protein) has been highlighted as a novel biomarker of detection of acute renal failure in children after cardiac surgery. Interventional cardiologists are being asked more frequently to perform percutaneous coronary intervention (PCI) and contrast nephropathy is its potentially serious complication. We aimed to prospectively assess NGAL and L-FABP in patients with normal serum creatinine undergoing PCI due to unstable angina. MATERIAL AND METHODS: We measured serum NGAL, urinary NGAL and L-FABP using commercially available kits before and after 2, 4, 12, 24 and 48 hours following PCI in 25 patients. RESULTS: We found a significant rise in serum NGAL after 2 and 4 hours. Urinary NGAL and urinary L-FABP followed the same pattern. Both markers increased significantly after 4 hours and remained elevated up to 48 hours after PCI. Serum creatinine did not change significantly during the study period. CONCLUSIONS: NGAL and L-FABP may represent a sensitive early biomarkers of renal impairment after PCI. Persistently increased urinary NGAL and L-FABP may suggest renotubular damage in this population.

Inadequate blood pressure control in most kidney transplant recipients and patients with coronary artery disease with and without complications.

BACKGROUND: Hypertension is a widely accepted risk factor for coronary artery disease (CAD), chronic heart failure, and chronic kidney disease (CKD). In kidney transplant recipients, the prevalence of hypertension is 60% to 80%. OBJECTIVE: To assess the prevalence of target blood pressure in 2 high-risk populations: patients with CAD and kidney allograft recipients. PATIENTS AND METHODS: The study included 520 patients with CAD and 150 kidney allograft recipients. In the CAD population, 30% of patients had diabetes mellitus and 33% had CKD. In kidney allograft recipients, 52% had diabetes (15%) or CKD. Hypertension was diagnosed and treated in 72% of patients with CAD and 90% of kidney allograft recipients. In the CAD population without diabetes but with CKD, target blood pressure was achieved in 47% compared with 31% in the CKD population. Treatment included angiotensin-converting enzyme (ACE) inhibitors in 72% of patients, calcium channel blockers in 28%, diuretic agents in 27%, and beta-blockers in 89%. In allograft recipients, more than 60% required 3 or more hypotension agents. Only 40% demonstrated target blood pressure. In the latter group, the most commonly used hypotension agents were ACE inhibitors in 38%, calcium channel blockers in 84%, diuretic agents in 51%, beta-blockers in 68%, and alpha-blockers in 15%. CONCLUSION: Both cohorts demonstrated a high prevalence of hypertension. Despite polytherapy, optimal blood pressure control was not achieved in most patients. Greater efforts should be expended to optimize blood pressure control, in particular in the presence of comorbidities. In transplant recipients, beta-blockers are widely used, whereas ACE inhibitors are used infrequently.

Neutrophil gelatinase-associated lipocalin is a new and sensitive marker of kidney function in chronic kidney disease patients and renal allograft recipients.

BACKGROUND/AIMS: Few biomarkers exist to monitor chronic kidney disease (CKD). Neutrophil gelatinase-associated lipocalin (NGAL), a member of lipocalin family, has recently been proven useful to quantitate CKD. The aim of the study was to assess whether NGAL could represent a novel, sensitive marker of kidney function in adult patients with CKD and in kidney transplant recipients. METHODS: We studied possible relations between serum NGAL, creatinine, and estimated glomerular filtration rate (eGFR) in 80 nondiabetic patients with CKD stages 2 to 4; 80 nondiabetic kidney transplant recipients on a calcineurin inhibitor mycophenolate mofetil, or azathioprine as well as prednisone and in healthy volunteers (n = 32, mean age 50 years). RESULTS: Serum NGAL and creatinine values were significantly higher and eGFR significantly lower in kidney allograft recipients and patients with CKD compared with controls. NGAL rose gradually, reaching the higher value in stage 4 CKD. In univariate analysis serum NGAL was related to serum creatinine, hemoglobin, hematocrit, leukocyte count, and eGFR. Predictors of serum NGAL were creatinine and eGFR among patients with CKD. On univariate analysis serum NGAL was related to serum creatinine, urea, hemoglobin, hematocrit, white blood cell count, calcineurin concentration, eGFR, and albumin in kidney transplant recipients. On multiple regression analysis, predictors of NGAL were creatinine, calcineurin concentration, and high-sensitivity C-reactive protein. In healthy volunteers, serum NGAL correlated with age, serum creatinine, eGFR, and leukocyte count. CONCLUSION: NGAL should be investigated as a potential early, sensitive marker of kidney impairment/injury, which might provide an additional accurate measure of kidney impairment in CKD and among transplant recipients, particularly at advanced stages.

NGAL (neutrophil gelatinase-associated lipocalin) and cystatin C: are they good predictors of contrast nephropathy after percutaneous coronary interventions in patients with stable angina and normal serum creatinine?

The aim of the study was to assess whether NGAL and cystatin C could predict contrast-induced nephropathy in non-diabetic patients (n=60, mean age 60+/-11 years) with normal serum creatinine undergoing elective PCI. We found a significant rise in serum NGAL after 2, 4 and 8 h, and in urinary NGAL after 4, 8 and 24 h after PCI. Cystatin C rose significantly 8 and 24 h after the procedure. Prevalence of CIN was 10%. We found 90% sensitivity and 74% specificity of serum and 76% sensitivity and 80% specificity of urinary NGAL increase. NGAL may represent a sensitive early biomarkers of renal impairment after PCI.

Could neutrophil-gelatinase-associated lipocalin and cystatin C predict the development of contrast-induced nephropathy after percutaneous coronary interventions in patients with stable angina and normal serum creatinine values?

The value of neutrophil-gelatinase-associated lipocalin (NGAL) was highlighted as a novel biomarker for the detection of acute renal failure. We tested the hypothesis whether NGAL could represent an early biomarker of contrast-induced nephropathy (CIN) in 100 patients with normal serum creatinine values undergoing percutaneous coronary interventions (PCI). In addition, we assessed serum and urinary NGAL in relation to cystatin C, estimated glomerular filtration rate, and serum and urinary creatinine in these patients. We measured urinary and serum NGAL values before and 2, 4, 8, 24, and 48 h after the PCI. We found a significant rise in serum NGAL levels 2, 4, and 8 h after the PCI and in urinary NGAL values 4, 8, and 24 h after a PCI procedure. Cystatin C rose significantly 24 h after the procedure. The prevalence of CIN was 11%. The NGAL levels were significantly higher 2 h after the PCI (serum NGAL) or 4 h after the PCI (urinary NGAL), whereas the cystatin C values were higher only 8 and 24 h after a PCI procedure in patients with CIN. In multivariate analysis, only serum creatinine was a predictor of serum NGAL before a PCI. NGAL may represent a sensitive early biomarker of renal impairment after PCI. Serum creatinine level, the presence of diabetes, and the duration of the PCI may affect serum NGAL values and kidney function following a PCI procedure.

Neutrophil-gelatinase-associated lipocalin and renal function after percutaneous coronary interventions.

BACKGROUND/AIMS: The value of neutrophil-gelatinase-associated lipocalin (NGAL), a novel biomarker in the detection of acute renal failure in children after cardiac surgery, has been highlighted in previous studies. The incidence of percutaneous coronary intervention (PCI) increases, which may possibly result in increased incidences of contrast nephropathy, its potentially serious complication. Therefore, the aim of our study was to assess prospectively NGAL in patients undergoing elective PCI in relation to serum creatinine. METHODS: NGAL was assessed in the serum and urine using commercially available kits. RESULTS: We measured urinary and serum NGAL before, and 2, 4, 12, 24 and 48 h after PCI. We found a significant rise in serum NGAL 2 and 4 h after PCI, and a rise in urinary NGAL 4 and 12 h after PCI. Before PCI, serum NGAL was significantly associated with serum creatinine, urea, urinary NGAL, hemoglobin, hematocrit, albumin, age and presence of diabetes. In multivariate analysis, serum creatinine was the only predictor of serum NGAL. Serum NGAL 2 h after PCI correlated with serum creatinine, duration of PCI, HbA1c, hematocrit, hemoglobin and urinary NGAL. In multivariate analysis, the only predictors of serum NGAL 2 h after PCI were serum creatinine, time of PCI and HbA1c. Serum NGAL before PCI was significantly higher in diabetics than in non-diabetics. CONCLUSIONS: NGAL may represent a sensitive early biomarker of renal impairment after PCI. Serum creatinine, duration of PCI, but not type and amount of contrast agent, and appropriate treatment of diabetes, reflected by HbA1c, predict a rise in serum NGAL and kidney function following PCI.

Plasma adiponectin and E-selectin concentrations in patients with coronary heart disease and newly diagnosed disturbances of glucose metabolism.

PURPOSE: Adiponectin is a fat derived hormone, which enhances insulin sensitivity. In experimental studies adiponectin was shown to have antiatherogenic properties by suppressing endothelial expression of adhesion molecules. Therefore, the aim of the study was to evaluate plasma adiponectin and E-selectin concentrations in patients with coronary artery disease and impaired glucose metabolism and evaluation of their relationship with selected anthropometric, biochemical and clinical parameters. MATERIAL AND METHODS: The study group consisted of 62 patients with coronary heart disease, without previous diagnosis of diabetes mellitus (mean age 48.6 +/- 6.0 years; mean BMI 28.6 +/- 3.13 kg/m2). In the studied group the OGTT with glucose and insulin estimation was performed and insulin resistance index (HOMA-IR) was calculated. In the fasting state, the plasma adiponectin, soluble form of E-selectin, HbA1c and lipid parameters were estimated. RESULTS: Adiponectin concentration was not different in patients with type 2 diabetes mellitus and impaired glucose tolerance (n = 36) in comparison to the group with normal glucose tolerance (n = 26). There was also no difference in adiponectin concentration in relation to atherosclerosis progression. There was no significant correlation between adiponectin and calculated insulin resistance index, while there was marked inverse correlation between adiponectin and BMI (r = -0.30; p = 0.018), body weight (r = -0.33; p = 0.008), E-selectin (r = -0.263; p = 0.039), TG concentration (r = -0.27; p = 0.036), duration of coronary heart disease (r = -0.33; p = 0.009) and borderline significance with ejection fraction (r = -0.268; p = 0.06). CONCLUSIONS: Our study supports the hypothesis that adiponectin could be recognised as a protective protein for the development of atherosclerosis.

Relationship between gastroesophageal reflux disease and myocardial ischemia. Effect of reflux on temporary activity of autonomic nervous system.

PURPOSE: Assessment of the gastroesophageal reflux disease (GERD) influence on myocardial ischemia and autonomic nervous system (ANS) activity. MATERIAL AND METHODS: In 50 patients with angiographically confirmed ischemic heart disease (IHD) in I-III CCS class, simultaneous 24-hour ECG and esophageal pH-metry monitoring was performed. We assessed: (1) GERD occurrence in patients with IHD, (2) influence of pathological reflux (PR) on myocardial ischemia--number and total duration of ST depression episodes in GERD and non-GERD patients, (3) temporary activity of ANS was determined according to the dynamics of spectral HRV (Heart Rate Variability) analysis components (LF, HF, VLF, LF/HF). RESULTS: 23 patients (46%) fullfilled the GERD criteria. Patients with GERD had significantly higher number of ST depression episodes (4.13 vs 2.85, p = 0.013) as well as longer total duration of ischemia (64.73 vs 35.2 min, p = 0.034). Spectral HRV analysis showed the significant decrease of LF/HF ratio (p < 0.035), which indicates the sympathovagal balance shift towards the parasympathetic system caused by PR. CONCLUSIONS: 1. GERD is frequent condition in patients with angiographically confirmed IHD. Coexistence of GERD may predispose to the myocardial ischemia. 2. Gastroesophageal reflux may cause the shift of sympathovagal balance towards its parasympathetic component. This mechanism may induce esophago-cardiac reflex, leading to diminished myocardial perfusion.

Disturbances of glucose metabolism in men referred for coronary arteriography. Postload glycemia as predictor for coronary atherosclerosis.

OBJECTIVE: In some studies, fasting and postload glycemia are a strong predictor of coronary events and cardiac death. Therefore, we investigated the relationship between fasting and postload glucose concentrations and coronary status in 363 men referred for coronary arteriography without a previous history of diabetes. RESEARCH DESIGN AND METHODS: A total of 363 men (mean age 53.0 +/- 9.1 years, mean BMI 27.9 +/- 3.7 kg/m2) with positive results of exercise testing were included in the study. A standard oral glucose tolerance test (OGTT) with glucose and insulin estimations was performed on all subjects. The concentrations of total cholesterol, HDL cholesterol, triglycerides, and HbA1c were also measured. All patients were divided into four groups, according to coronary status: no changes in coronary arteries (group 0, n = 61), one-vessel disease (group 1, n = 113), two-vessel disease (group II, n = 116), and three-vessel disease (group III, n = 73). RESULTS: The highest postload glucose concentrations were observed in group III. Also, insulin concentrations and HbA1c increased with the progression of atherosclerotic lesions in the coronary arteries. Based on results of the OGTT, 16% of the patients (n = 59) fulfilled the World Health Organization criteria for type 2 diabetes and 36% of the patients (n = 131) met criteria for impaired glucose tolerance. Significant correlations were observed between the number of involved vessels and postload glycemia, HbA1c, fasting insulin, and postload insulin. The multiple stepwise regression analysis showed that age, total cholesterol, and HDL cholesterol independently correlated with the number of involved vessels. CONCLUSIONS: We conclude that patients with advanced changes in the coronary arteries experience more pronounced metabolic disturbances. Postload glycemia could be an important predictor of nondiagnosed disturbances of glucose metabolism.