Neither cyclosporine nor tacrolimus deteriorate endothelial function in renal transplant recipients assessed with reactive hyperernia index.

BACKGROUND: Cardiovascular mortality in renal transplant recipients is nearer 10-fold higher than in general population. Immunosuppressive therapy is one possible cause, for these drugs can modify cardiovascular risk factors, which can induce endothelial dysfunction, the first step in the process of atherosclerosis. The aim of this study was to compare vasodilatatory function of endothelium in renal transplant recipients in relation to the immunosuppressive drug-cyclosporine or tacrolimus. MATERIALS AND METHODS: We examined 40 patients at 48.9 ± 36 months post-renal transplantation: 22 taking tacrolimus (group 1) and 18 taking cyclosporine (group 2). The renal transplant recipients were compared with a control group of 18 healthy people. Endothelial function was assessed by peripheral arterial tonometry (PAT) using the EndoPAT 2000 device to measure RHI (reactive hyperemia index) and AI% (augmentation index%). RESULTS: The overall median values of RHI were higher than the value accepted as a normal (1.67). The RHI median value in group 1 was 2.00 (quartile 1: 1.66; quartile 2: 2.72), not different from that in group 2 [1.90 (quartile 1: 1.56; quartile 2: 2.17)] or the controls [2.11 (quartile 1: 1.77; quartile 2: 2.50)]. Multivariate analysis revealed age to be the independent factor influencing RHI in all examined groups but treatment with calcium channel blockers appeared to be the only independent factor influencing RHI among renal transplant recipients. AI% values were not significantly different between the 2 groups of renal transplant recipients, but it was significantly higher among the controls than among subjects treated with tacrolimus. CONCLUSIONS: Vasodilatatory function of endothelium assessed by PAT in renal transplant recipients was not worse than in healthy people. It was not different between cyclosporine or tacrolimus. Arterial stiffness measured as AI% depend on age but not the calcineurin inhibitor, which showed little effect.

[Retrospective analysis of prognostic factors for annual mortality in 97 patients with chronic congestive heart failure]. / Analiza retrospektywna czynników prognostycznych jednorocznej umieralnosci u 97 chorych z przewlekla niewydolnoscia serca.

The aim of our study was to find clinical and biochemical factors, which are prognostically important for the annual mortality in patients with chronic congestive heart failure (CHF). The studied group consisted of 97 people with CHF (31 females and 66 males, mean age--61). The causes of the heart failure were: coronary artery disease or/and hypertension (80 patients), valvular mitral heart disease--(12 patients), dilated cardiomyopathy--(5 patients). On the first day of the hospitalization patients were classified as functional class II-IV according to NYHA classification. Patients were divided into: group 'A'--34 patients, who had died during the 1st year of observation, and group 'B'--63 patients who have survived the 1st year of observation. According to the results of our study patients from group A had lower concentration of plasma sodium, lower left ventricular ejection fraction, lower mean heart rate, higher frequency of ventricular arrhythmias (according to 3&4 Lown class).

[Infections with Chlamydia pneumoniae, Helicobacter pylori or cytomegalovirus and atherosclerosis]. / Zakazenie chlamydia pneumoniae, Helicobacter pylori i wirusem cytomegalii a miazdzyca.

It's known that common risk factors of atherosclerosis can explain only 50% of its etiology. In only 40% patients risk factors modification inhibits progression of atherosclerosis. Therefore looking for new risk factors of atherosclerosis is necessary. In recent years the inflammatory-infectious hypothesis of atherosclerosis has been reevaluated. The discovery of heavy infections load in the serum of patients with acute coronary syndromes might suggest a potential immunological mechanism triggered by bacterial proteins. Chlamydia pneumoniae, Helicobacter pylori and cytomegalovirus infections are very common in human population and therefore they are suspected as the main infectious pathogen in the coronary disease. Clinical studies have demonstrated higher anti-Chlamydia and ani-Helicobacter antibody titres in patients with myocardial infarction (60-70% pts), stable and unstable angina (50-60% pts) than in control groups (12-15% pts). Two studies were performed with antibiotic (azotromycin, roxitromycin) influence on the prevalence of acute coronary syndromes after myocardial infarction and unstable angina. These studies have shown statistically significant reduction of the prevalence of acute coronary episodes in follow-up period.

[The heart in arterial hypertension]. / Serce w nadcisnieniu tetniczym.

The data is presented on the pathogenesis of myocardial changes in arterial hypertension. The non-haemodynamic causes are discussed of myocardial hypertrophy, as well as the participation of collagen in its early phase and the haemodynamic consequences of hypertrophy and its regression. Hypotensive drugs and their ability ot prevent myocardial hypertrophy and (or) inducing of its regression were compared.