[Relation between local CMV infection and inflammatory cytokine expressionon in pts sheduled for CABG]. / Obecnosc wirusa cytomegalii w obrebie sciany aorty a miejscowa aktywacja zapalna u pacjentów z przewlekla choroba wiencowa poddawanych zabiegowi pomostowania aortalno-wiencowego.

INTRODUCTION: Cytomegalovirus (CMV) infection has been suggested to play a role in the development of cardiovascular diseases. It has not yet been established yet whether the possible adverse vascular effect is associated with chronic inflammation process caused by CMV. The aim of our study was to evaluate a possible role of CMV infection in local inflammatory activation in pts with coronary artery disease (CAD). MATERIAL AND METHODS: We enrolled 55 patients (mean age 62 years, 42 males, 13 females) with angiographically proven CAD scheduled for CABG surgery. Vessel specimens retrieved from ascending aorta (as a part of routine proximal venous graft development procedure) and peripheral blood mononuclear cells (PBMC) were evaluated for the transcriptional activity of IL-6 and TNF-alpha (the key cytokines involved in atherosclerosis) and for CMV DNA presence. Polymerase chain reaction reaction was performed in order to detect DNA of CMV as well as IL-6 and TNF-alpha transcriptional activity. RESULTS: CMV was present in 67.3% of aortic and in 60% of blood specimens accordingly; median level in aorta tissues: 114.63 +/- 116.54, PBMC: 107.89 +/- 132.39; non statistically significant (NS). An inflammatory response expressed as IL-6 and TNF-alpha transcriptional activity equaled in aorta 159.93 +/- 120.15, 299.55 +/- 154.89 and in PBMC: 190.85 +/- 122.08, 249.64 +/- 32.4; (NS). CMV DNA in PBMC was associated with CMV DNA in aortal tissue p = 0.0049. The analysis revealed positive correlation between IL-6 transcriptional activity and CMV DNA titer in aortic samples R = 0.35, p = 0.036. There were no statistically significant correlations between TNF-alpha transcriptional levels and CMV DNA concentration. Statistical analysis was made by use of Statistica 8.0; StatSoft program. We used arithmetical mean value, standard deviation, Spearmann correlation, X2 and U Mann-Whitney test. CONCLUSIONS: A local inflammatory response expressed against CMV could be a marker of longstanding inflammatory response that eventually would cause advanced clinical atherosclerosis. Our findings support the infectious theory and an association between CMV infection and atherosclerosis.

Early results of coronary artery bypass graft surgery in women.

BACKGROUND: Coronary artery disease is one of the leading causes of death among women in developed countries all over the world. Coronary artery bypass grafting (CABG) is a well established therapeutic modality to treat diffuse coronary artery atherosclerosis. AIM: In this study we focused on the retrospective assessment of the early results of CABG in women as compared to the results of such treatment in men. METHODS: This analysis involved 2881 patients (677 women and 2204 men) who underwent CABG between 2003 and 2005. An operative technique (conventional on-pump or off-pump) was applied in a similar proportion of patients in both groups (on-pump: 59.4% of women and 59.6% of men; NS). Women were older than men and had higher body mass index. Concomitant disorders such as diabetes mellitus, hypertension and hypercholesterolaemia were noted more frequently in female patients. RESULTS: In the perioperative period, left ventricular failure requiring intra-aortic balloon pump insertion and administration of high doses of catecholamines was observed significantly more often in women than in men (22.1 vs. 16.1%, respectively; p <0.001). Perioperative myocardial infarction was diagnosed more frequently in women (5.5 vs. 2.9%; p <0.001). In female patients, the rate of repeat operation was higher (8.9 versus 5.1%; p <0.001) and more subjects required blood transfusions (45.5 vs. 27.5%; p <0.001). Female gender featured a higher rate of postoperative acute renal failure requiring renal replacement therapy (8.5 vs. 0.95%; p <0.001). Mechanical ventilation was longer, and women stayed longer in the postoperative intensive care unit as well as in hospital. Early postoperative mortality among women was 3.6%, i.e. significantly higher than in male patients (1.6%) (p <0.01). CONCLUSIONS: The analysis performed herein suggests that mortality and morbidity after CABG is higher in women than in men.