Rodzinny napadowy częstoskurcz węzłowy — obserwacja wielopokoleniowej rodziny

We report a three-generation family coming from southeastern region of Poland (Podkarpackie voivodship) with 6 women having normal hearts and presenting with a history of paroxysmal tachycardia with onset of symptoms in the adulthood. Recordings of clinical SVT, dual AVN electrophysiology, induction of typical AVNRT and results of RFCA are available. The history of this family shows the significance of a careful and detailed collection of medical history, and point towards the importance of family screening in AVNRT patients

Mental stress, heart rate and endothelial function in patients with syndrome X

Background: The aim of the study was to determine whether the baseline heart rate (HR) and changes in HR after mental stress (MS) can influence endothelial function in syndrome X. Methods: Forty four patients with syndrome X (F/M: 21/23, mean age: 55.4 &#177; 10.7 years) were examined. The endothelium-dependent flow-mediated dilation (FMD) was defined as the percentage change in the brachial artery diameter during reactive hyperaemia related to baseline (%FMD). The %FMD was assessed before and after (at 10, 30, and 45 min) standardised three-minute MS. HR and blood pressure were monitored simultaneously. The %FMD values were compared between subgroups characterised by baseline HR, maximum HR and DHR, and HR after MS below and over the median values. Results: The values of %FMD measured at 10, 30 and 45 min after MS (4.39 &#177; 5.4%, 4.99 &#177; 3.9%, 4.03 &#177; 3.5%, respectively; p < 0.001) were significantly lower than baseline values (7.73 &#177; 4.9%). Impaired vasodilatation after MS was observed in the following subgroups of patients: those with baseline HR below the median (< 71.5 bpm; baseline: 8.35 &#177; 5.8%; 10 min: 2.87 &#177; 3.6%, 45 min: 4.56 &#177; 3.9%; p < 0.001); those with HR after MS below the median (< 76.5 bpm; baseline: 8.19 &#177; 5.5; 10 min: 3.88 &#177; 4.3%, 45 min: 4.59 &#177; 3.7%; p < 0.01); and those with maximum HR after MS below the median (< 84 bpm; baseline: 8.88 &#177; 5.6%; 10 min: 3.88 &#177; 3.8%, 30 min: 5.88 &#177; 3.9%, 45 min: 4.51 &#177; 3.8; p < 0.01). Conclusion: The stress-induced endothelial dysfunction syndrome X is related to the baseline HR and the changes in HR after MS, suggesting that the autonomic nervous system plays a part in its pathogenesis. (Cardiol J 2007; 14: 180-185

Severe degenerative aortic stenosis with preserved ejection fraction does not change adipokines serum levels

Background: The role of the adipokines in the pathogenesis of aortic stenosis (AS) is not well established. The aim was to evaluate the relationship between adipokines and clinical characteristics as well as echocardiographic indices and noninvasive markers of vascular remodeling in patients with severe AS with preserved ejection fraction (EF). Methods: Sixty-five patients (F/M: 38/27; age: 68.3 ± 9.0 years; body mass index [BMI]: 29.6 ± 4.3 kg/m2) with severe AS with preserved EF: 33 patients with paradoxical low-flow low-gradient AS (PLFLG AS) and 32 patients with normal flow high-gradient AS (NFHG AS) were prospectively enrolled into the study. Twenty-four subjects (F/M: 14/10; age: 65.4 ± 8.7 years; BMI: 29.6 ± 4.3 kg/m2) who matched as to age, sex, BMI and coronary artery disease (CAD) constituted the control group (CG). Clinical data and markers of vascular remodeling were related to the serum adipokines. Results: There were no differences in the adipokines concentrations in the AS/CG. Patients with AS and coexisting CAD were characterized by decreased serum adiponectin (9.9 ± 5.5 vs. 12.7 ± 5.8 μg/mL, p = 0.040) and leptin (8.3 ± 7.8 vs. 21.6 ± 17.1 ng/mL, p &lt; 0.001) levels compared to subjects without CAD. There were no differences in the serum adipokines concentrations between patients with PLFLG AS and NFHG AS. Systemic hypertension, diabetes, hyperlipidemia or markers of vascular remodeling did not discriminate adipokines concentrations. Multivariate regression analysis indicated that age (F = 3.02; p = 0.015) and E/E’ index (F = 0.87, p = 0.032) were independent predictors of the adiponectin level in the AS group. Conclusions: The presence of AS with preserved EF did not change the adipokine serum profile. Adipokines levels were modified by coexisting atherosclerosis but not the typical cardiovascular risk factors or the hemodynamic type of AS

Prothrombotic fibrin clot properties associated with NETs formation characterize acute pulmonary embolism patients with higher mortality risk

Abstract Venous thromboembolism is associated with formation of denser fibrin clots resistant to lysis. We investigated whether prothrombotic plasma clot properties are associated with the severity of acute pulmonary embolism (PE). We enrolled 126 normotensive acute PE patients (aged 58 ± 14 years) and 25 age- and sex-matched healthy controls. Plasma fibrin clot permeability (Ks), clot lysis time (CLT), endogenous thrombin potential (ETP), plasminogen activator inhibitor-1 (PAI-1), and citrullinated histone H3 (citH3) were evaluated on admission. PE patients compared to controls had 370% higher citH3 levels, 41% higher ETP, 16.5% reduced Ks, and 25.6% prolonged CLT. Patients with intermediate-high (n = 29) and intermediate-low (n = 77) PE mortality risk had reduced Ks and prolonged CLT, increased PAI-1 and ETP as compared to low-risk PE (n = 20) patients. Prolonged CLT was predicted by PAI-1 and citH3, while low Ks by C-reactive protein. During a 12-month follow-up 9 (7.1%) patients who had 24% higher ETP, 45% higher citH3 levels, and 18% prolonged CLT at baseline died. High ETP combined with elevated citH3 levels and prolonged CLT was associated with eightfold increased risk of PE-related death. Prothrombotic fibrin clot properties and enhanced neutrophil extracellular traps formation are associated with higher early mortality risk in acute PE patients, which suggests a prognostic role of these biomarkers

Czy osteoprotegeryna jest potencjalnym czynnikiem hamującym ubytek masy kostnej otyłych kobiet w wieku okołomenopauzalnym?

Introduction: Assessment of serum osteoprotegerin (OPG) concentrations in obese patients in comparison to healthy controls and evaluation of a possible correlation between OPG and other markers of bone turnover or calcitropic hormones. Material and methods: 50 obese perimenopausal women without concomitant diseases (BMI 36.7 &#177; 4.1 kg/m&#178;, mean age 50.4 &#177; 4.9 yrs). The control group consisted of 19 healthy women (BMI 24.2 &#177; 2.1 kg/m&#178;; mean age 53.8 &#177; 5.1 yrs). In all patients serum concentration of OPG, C telopeptide of type I collagen containing the crosslinking site (CTX), osteocalcin, parathormone (PTH) and vitamin D (25-OH-D3) was assessed. Dual energy x-ray absorptiometry (the DXA method) of the lumbar spine and femoral neck was performed using a Lunar DPXL to measure bone marrow density (BMD). Results: In obese perimenopausal women serum OPG, osteocalcin and 25-OH-D3 levels were significantly lower, and the serum PTH level was significantly higher in comparison to healthy controls. A significantly positive correlation was found between serum OPG level and age in both obese and control subjects. Conclusion: The serum OPG level in obese perimenopausal women is significantly lower in comparison to healthy controls and does not correlate significantly with biochemical markers of bone turnover, calcitropic hormones and BMD. It probably cannot play a protective role in the pathogenesis of bone loss in obese perimenopausal women.Wstęp: Celem niniejszej pracy była ocena stężenia osteoprotegeryny (OPG) w surowicy otyłych pacjentek w porównaniu z grupą kontrolną oraz próba wykazania ewentualnych powiązań osteoprotegeryny ze wskaźnikami obrotu kostnego oraz hormonami kalcitropowymi. Materiał i metody: 50 kobiet w wieku okołomenopauzalnym z otyłością prostą bez chorób towarzyszących (BMI 36,7 &#177; 4,1 kg/m&#178;, wiek 50,4 &#177; 4,9 roku). Grupę kontrolną stanowiło 19 zdrowych kobiet (BMI 24,2 &#177; 2,1 kg/m&#178;; wiek 53,8 &#177; 5,1 lat). U wszystkich badanych oznaczono w surowicy stężenia OPG, C-końcowego usieciowanego telopeptydu kolagenu typu I (CTX), osteokalcyny, parathormonu (PTH) oraz 25-OH-D3. Badanie gęstości mineralnej kości (BMD, bone mineral density) w obrębie odcinka lędźwiowego kręgosłupa oraz szyjki kości udowej wykonano metodą absorpcjometrii podwójnej energii promieniowania rentgenowskiego (DXA, Dual Energy X-ray Absorptiometry) przy użyciu aparatu Lunar DPXL. Wyniki: W grupie otyłych chorych obserwowano znamiennie niższe stężenie OPG, osteokalcyny i 25-OH-D3 oraz znamiennie wyższe stężenie PTH w porównaniu z grupą kontrolną. Zarówno w grupie badanej, jak i w grupie kontrolnej zaobserwowano dodatnią korelację pomiędzy stężeniem OPG a wiekiem pacjentek. Wnioski: U otyłych kobiet w wieku okołomenopauzalnym stężenie osteoprotegeryny w surowicy krwi jest znamiennie niższe w porównaniu z grupą kontrolną i nie koreluje ze wskaźnikami obrotu kostnego, hormonami kalcitropowymi ani z BMD. Osteoprotegeryna prawdopodobnie nie spełnia funkcji ochronnej w patogenezie ubytku masy kostnej u otyłych kobiet w wieku okołomenopauzalnym

Analysis of PD-1 expression in the monocyte subsets from non-septic and septic preterm neonates

Programmed death-1 (PD-1) receptor system represents a part of recently reported immunoregulatory pathway. PD-1 is an immune checkpoint molecule, which plays an important role in downregulating the immune system proinflammatory activity. Until recently, PD-1 expression was not established on immune cells of the preterm infants. The study objectives were to confirm expression of the PD-1 receptors on the monocytes isolated from very low birth weight newborns (VLBW), and to analyze their expression during the first week of life and late-onset sepsis. Peripheral blood mononuclear cells were isolated from 76 VLBW patients without early-onset sepsis on their 5th day of life (DOL). PD-1 expression was determined on the monocyte subsets (classical, intermediate, non-classical) by flow cytometry. In case of late-onset sepsis (LOS), the same analysis was performed. Our results demonstrated that on the 5th DOL, PD-1 receptors were present in all the monocyte subsets. Children, whose mothers had received antenatal steroids, presented higher absolute numbers of non-classical monocytes with PD-1 expression. Infants born extremely preterm who later developed LOS, initially showed a lower percentage of PD-1 receptor-positive intermediate monocytes in comparison to neonates born very preterm. During LOS, we observed a rise in the percentage of classical monocytes with PD-1 expression. In case of septic shock or fatal outcome, there was a higher percentage and absolute count of intermediate monocytes with PD-1 expression in comparison to children without these complications. In conclusion, monocytes from VLBW children express PD-1 receptors. Antenatal steroid administration seems to induce PD-1 receptor expression in the non-classical monocytes. PD-1 might play a role in immunosuppressive phase of sepsis in the prematurely born children with septic shock and fatal outcome