[Cardiovascular system in patients in different stages of chronic kidney disease]. / Stan ukladu sercowo-naczyniowego u pacjentów w róznych stadiach przewleklej choroby nerek.

The term "chronic kidney disease" (CKD) was introduced recently to nephrological literature. CKD is a growing epidemic problem, which affects 11% of adult US population. CKD, particularly with GFR below 60 ml/min/1, 73 m2 is associated with increased risk of cardiovascular morbidity and mortality. It is a result of coexistance of "traditional" cardiovascular risk factors cumulation such as hypertension, lipid and carbohydrate disorders but also "non-traditional" cardiovascular risk factors such as: anemia, calcium-phosphate metabolism disturbances, chronic inflammation and others. The paper discusses changes in left ventricle structure and function, arterial structure and function and cardiovascular calcifications in different stages of chronic kidney disease, and their prognostic significance. Result of the study in 31 CKD patients (GFR 39,4 +/- 14, 1 ml/min/m2) and 18 appearently healthy controls are also presented in the paper. Cardiovascular risk factors assessment, echocardiography, common carotid artery USG with diameter and intima-media thickness (IMT) measurement and aortic pulse wave velocity (PWV) measurement were performed in all participants. We found higher total cholersterol, LDL-cholesterol, triglicerides, CRP, advanced glycation end-products (AGE), and calcium x phosphorus product and lower hemoglobin concentration in CKD patients. Fasting glucose and insulin concentration did not differ between CKD patients and control group but insulin/glucose ratio was higher in CKD group. Abnormal left ventricular heart structure was found in 55% of CKD patients. Carotid artery internal diameter, intima-media thickness and aortic PWV--a marker of increased arterial stiffness - were higher in CKD patients. The study indicates that cardiovascular risk factors and cardiac and arterial abnormalities should be evaluated from the start of CKD.

Endothelial function parameters in patients with unstable angina and infection with Helicobacter pylori and Chlamydia pneumoniae.

BACKGROUND: Endothelial dysfunction may be a factor linking infection with atherosclerosis. The aim of our study was to assess the relationship between seropositivity to Helicobacter pylori (Hp) and/or to Chlamydia pneumoniae (Cp) and some endothelial function parameters in patients with unstable angina. METHODS: In 31 patients with unstable angina, we determined the serum concentration of the von Willebrand factor (vWF), thrombomodulin, tissue plasminogen activator antigen, and tissue plasminogen activator inhibitor type 1 antigen, the concentration of IgG antibodies to Hp and Cp (all by ELISA), and the level of C-reactive protein. The Western blot test was performed for all patients seropositive to Hp. It allowed us to identify 15 different antigen proteins of Hp. RESULTS: Sixty-one percent of the patients were seropositive to both Hp and Cp, and 35% were seropositive to Hp only. We did not find significant differences in serum concentrations of endothelial function parameters and CRP between the two groups of patients. The patients seropositive to both Hp and Cp had a significantly higher serum concentration of vWF when Hp did not contain the 95 kDa protein (p=0.01) and a significantly higher serum concentration of PAI-1:Ag when Hp did not contain the 57 kDa protein (p=0.002) and the 66 kDa protein (p=0.02). CONCLUSION: The results show that the antigenic profile of bacteria may play a more significant role in coronary artery disease than seropositivity.

The role of intrinsic fibrinolytic system activation in pathogenesis of hemostasis disturbances in hemodialyzed patients with chronic renal failure.

In the hemodialysis patient, hemostasis changes may occur. The contribution of fibrinolysis in pathogenesis of these disorders is unclear. The aim of the study was to estimate intrinsic fibrinolysis pathway in patients treated with hemodialysis (HD) because of chronic renal failure caused by chronic glomerulonephritis. The study was performed with 43 patients; the control group consisted of 51 healthy volunteers chosen by sex and age. The following parameters were determined: concentration of the urokinase plasminogen activator antigen (uPA:Ag), plasmin--antiplasmin complexes (PAP), fibrin and fibrinogen degradation products (FDP), activity of prekallikrein (PK) and C1-inhibitor (C1-INH) and also euglobulin clot lysis time (ELT). The above parameters were assessed in the patients before and after HD and were compared with the control group. In the HD patients, in comparison with the control group, prolonged statistically ELT [153 (125;215) vs. 105 (75;142) min.; p<0.001], with increase of PAP (508.6 +/- 274.7 vs. 184.7 +/- 69.4 microg/L; p<0.001) and FDP concentrations [5 (5;15) vs. 2.5 (0;0.3) microg/mL; p<0.05] before the procedure were determined. It suggests increased plasmin production and fibrin digestion despite determination of decreased general fibrinolytic activity. The C1-INH activity before HD was also significantly increased as compared with the control group [157 (136;171) vs. 107 (100;124)%; p<0.001], and its significant decreased after the HD is 157.7 +/- 23.9 vs. 122.3 +/- 20.3%; p<0.001, as it seems to be a nondirect proof of intrinsic pathway contribution in fibrinolysis activation in the HD patients. The remaining examined parameters did not change significantly after the dialysis procedure.

[Cardiac tamponade as a cause for exploratory laparatomy - a case report]. / Tamponada serca jako przyczyna laparotomii zwiadowczej.

We present a case of 39-year-old male with symptomatic cardiac tamponade due to neoplastic disease. Because of abdominal symptoms the patient was diagnosed as having acute abdomen and underwent exploratory laparatomy which revealed enlarged liver and ascites. Correct diagnosis was established later by echocardiography and effective pericardiocentesis was performed. Diagnostic difficulties in patients with cardiac tamponade are discussed.

[Coronary artery stenting in the treatment of 5-fluorouracil-induced unstable angina]. / Stentowanie wiencowe w leczeniu dusznicy bolesnej niestabilnej ujawnionej w trakcie farmakoterapii 5-fluorouracylem.

Cardiotoxicity is a rare but very serious side effect of 5-fluorouracil (5-FU) treatment. Many theories have been suggested to explain the mechanism of this problem. Most commonly, coronary artery spasm is considered responsible in cardiovascular toxicity. Ischemic symptoms and signs related to 5-FU therapy are observed during the late phase of the administration of the drug. The close and careful monitoring of all patients, especially the ones with pre-existent coronary artery disease, during 5-FU infusion is mandatory. Because there is not a single and effective modality of prevention of 5-FU cardiotoxicity, the patients should be selected carefully for its administration, 5-FU infusion should be stopped as soon as symptoms are encountered. A case of a 58-year-old woman treated with 5-FU due to colon cancer is described. In the late phase of 5-FU administration, the patient developed anginal pain with transitional ST segment elevation in ECG. Patient, after coronary angiography, was successfully treated with percutaneous coronary intervention. Interventional methods, most of all stent implantation, seem to be the best treatment of 5-FU-related acute coronary syndromes.

[The diagnostic value of stress dobutamine echocardiography in stable coronary artery diseases]. / Wartosc diagnostyczna echokardiograficznej próby dobutaminowej w rozpoznawaniu stabilnej choroby wiencowej.

UNLABELLED: The relation of stress dobutamine echocardiography test results to angiographic features was assessed in 551 patients with chest pain regarded as definite or probable stable angina pectoris. The indications for catheterization in each patient were determined at the discretion of the attending physician. All patients underwent diagnostic coronary angiography (clinically important coronary artery disease was defined as > 50 per cent narrowing of the diameter of at least one major vessel or > or = 50 per cent of the left main coronary artery) and stress dobutamine echocardiography (DSE): Ischemia was defined as new or worsening wall motion abnormalities using a 16-segment model. Sensitivity and specificity of DSE was calculated: 85% and 69% respectively for the entire group, 79% and 71% in women, 87% and 66% in men and compared with diagnostic value of the electrocardiographic exercise test (EE) in the same population. Sensitivity and specificity of the EE was respectively: 93% and 21% for the entire group, 91% and 16% in women, 94% and 27% in men. CONCLUSIONS: 1. DSE has comparable sensitivity but significantly higher specificity than EE. 2. Variables determining false positive result of DSE are as follows: mean maximal heart rate, reached % of the target heart rate and wall motion abnormalities present in single segment. 3. Variables determining false negative results are: sex (male) and one vessel disease. 4. Treatment with beta-adrenolytic agents increases incidence of nondiagnostic results of DSE.

[Incomplete percutaneous coronary revascularization in 82-year-old patient with chronic renal failure and neoplastic disease. Case report]. / Niepelna przezskórna rewaskularyzacja wiencowa u 82-letniego chorego z przewlekla niewydolnoscia nerek i choroba nowotworowa. Opis przypadku.

We report a case of octogenarian with pharmacotherapy resistant angina pectoris, who was successfully treated by percutaneous coronary intervention.

Antibodies to Chlamydia pneumoniae and haemostatic factors in acute coronary syndrome without ST segment elevation.

BACKGROUND: Various chronic infections, including Chlamydia pneumoniae (C. pneumoniae), are regarded as one of the possible factors which initiates, progresses and exacerbates atherosclerotic process. The relationship between C. pneumoniae infection and haemostatic factors which also may promote atherosclerosis, has not yet been established. AIM: To assess the relationship between C. pneumoniae-specific IgA and IgG serum antibodies and haemostatic factors in patients with acute coronary syndrome (ACS). METHODS: The study group consisted of 31 patients (17 males, mean age 62 years, and 14 females, mean age 60.6 years) with ACS and without ST segment elevation in whom antibodies to C. pneumoniae and such haemostatic factors as von Willebrand factor (vWF), thrombomodulin (TM), tissue plasmin activator (tPA), tPA inhibitor (PAI-1) and fibrinogen were measured. RESULTS: The proportion of patients with C. pneumoniae seropositivity was 35.4% in our study which is lower than that reported in literature. No significant relationship between vWF, TM, tPA and PAI-1 levels, and C. pneumoniae infection was found whereas a significant (p=0.05) relationship between C. pneumoniae-specific IgG antibodies and fibrinogen level was detected. CONCLUSIONS: Excluding fibrinogen, the presence of antibodies to C. pneumoniae is not associated with increased levels of haemostatic factors in patients with ACS without ST segment elevation.

Calcium blocker therapy before myocardial infarction increases post-infarction short- and long-term mortality. Data from the INJECT trial.

BACKGROUND: Short-acting calcium channel blockers (Ca-blockers) have been shown in some studies to increase the risk of myocardial infarction (MI) and post-MI complications. Data from large, international, randomised studies such as the INJECT trial may bring new important information on the effects of medication used before MI, on the course of MI and post-MI complications. AIM: To assess the effects of beta-blocker and Ca-blocker therapy administered prior to MI on the early and late outcome after MI. METHODS: The study group consisted of 6001 patients with acute MI treated according to the INJECT protocol. The patients were divided into four groups according to the type of treatment before the index MI: Group I (n=580) - patients treated with beta-blockers; Group II (n=831) - patients treated with Ca-blockers; Group III (n=277) - patients treated with both beta-blockers and Ca-blockers; and Group IV (n=4313) - no beta-blocker or Ca-blocker treatment. The analysed end-points were 35- and 180-day mortality as well as angina recurrences, occurrence of heart failure, atrial fibrillation/flutter and asystole. RESULTS: During hospital stay, supraventricular arrhythmias, asystole, recurrent ischaemia and heart failure occurred more frequently in patients from groups II and III than in other groups. Early mortality was significantly higher in group II (p<0.001) and group III (p<0.002) than in group IV. Late mortality was the lowest in group IV, followed by group I. Cox proportional hazards multivariable analysis revealed that hypotension, Killip class IV (p<0.001), previous Ca-blocker (p<0.01) or Ca- and beta-blocker treatment (p<0.01) as well as previous MI (p<0.05) were the independent predictors of death. CONCLUSIONS: Compared with beta-blocker therapy or no treatment, previous use of Ca-blockers increases both early and long-term complication rates in patients with MI.

Endothelial dysfunction in acute coronary syndrome without ST segment elevation in the presence of Helicobacter pylori infection.

BACKGROUND: Helicobacter pylori (H. pylori) infection is one of the most common chronic infections in humans. While a causative relationship between H. pylori infection and several gastrointestinal disorders has been well established, the association between this condition and the development of atherosclerosis and coronary artery diseases (CAD) is less clear. AIM: To examine the relationship between H. pylori infection and endothelial function in patients with acute coronary syndrome (ACS) without ST segment elevation. METHODS: The study group consisted of 31 patients (17 males aged 38-78 years and 14 females aged 45-80 years) with ACS and without ST segment elevation in whom we measured antibodies to H. pylori and haemostatic factors indicating endothelial function, such as von Willebrand factor (vWF), thrombomodulin (TM), tissue plasmin activator (tPA:Ag), tPA inhibitor (PAI-1:Ag) and fibrinogen. RESULTS: The proportion of patients with H. pylori seropositivity was 93.5%. No significant relationship between parameters of endothelial function and IgG antibodies to H. pylori were found. There was a significant association between antibodies to p54 protein and vWF (p=0.027) and between antibodies to p33 protein and PAI:Ag concentration (p=0.019). CONCLUSIONS: These results suggest that the type of H. pylori antigens and antibodies to these antigens rather than the presence of IgG antibodies to H. pylori may play a role in the development of CAD.