Ocena funkcji serca oraz naczyń u pacjentów z klasyczną postacią wrodzonego przerostu nadnerczy

Introduction: Patients with classical congenital adrenal hyperplasia (CAH) have increased cardiovascular risk, but the vascular and cardiac function during longitudinal corticoids replacement therapy is not known thoroughly. Material and methods: Cross-sectional study of 19 Caucasian adults with CAH (age 23.7 ± 3.8 years; twelve males) compared to 20 healthy volunteers matched for origin, sex, age, and body mass index (BMI). All of the participants were assessed for flow mediated dilatation of the brachial artery (FMD), intima-media thickness of the common carotid artery (cIMT) and common femoral artery (fIMT), standard echocardiography, and global longitudinal left ventricular function using two-dimensional speckle-tracking echocardiography (LSTE). Results: The patients with CAH, compared with controls, had decreased FMD (9.4 ± 3.9 vs. 19.8 ± 5.2; p < 0.01), and the difference was still significant after correction for potential confounders. cIMT and fIMT were higher in the CAH group at baseline (for cIMT 0.47 ± 0.4 mm vs. 0.40 ± 0.03 mm; p < 0.01, for fIMT 0.47 ± 0.05 mm vs. 0.41 ± 0.04 mm; p < 0.01) but not after correction for potential confounders. The CAH subjects, compared with controls, had normal or similar left ventricular (LV) ejection fraction and LV mass index. The mean absolute value of LSTE differed in the CAH patients compared with controls (–20.5% ± 1.2 vs. –22.5% ± 1.7; p < 0.01), but it was still within the normal range. Conclusions: Young adults with CAH and glucocorticoid long-lasting treatment had impaired FMD, an insignificant increase of IMT, and subclinical changes in LV diastolic function in echocardiography.Wstęp: Pacjenci z klasyczną postacią wrodzonego przerostu nadnerczy (congenital adrenal hyperplasia, CAH) charakteryzują się zwiększonym ryzykiem sercowo-naczyniowym, jednak funkcja naczyń oraz serca podczas długotrwałej substytucyjnej terapii glikokortykoidami nie została jednoznacznie określona. Pacjenci i metody: W badaniu obserwacyjnym, 19 dorosłych rasy białej z CAH (wiek 23,7 ± 3,8 roku; 12 mężczyzn) porównywano z 20 zdrowymi ochotnikami dobranymi pod względem pochodzenia, płci, wieku i współczynnika masy ciała. U wszystkich uczestników badania oceniono wazodylatację tętnicy ramiennej indukowaną przepływem (flow mediated dilatation, FMD), grubość kompleksu intima–media tętnicy szyjnej wspólnej (intima-media thickness of the common carotid artery, cIMT) oraz tętnicy udowej (common femoral artery, fIMT) wspólnej oraz oceniono odkształcenie lewej komory przy zastosowaniu techniki śledzenia markerów akustycznych (longitudinal speckle-tracking echocardiography, LSTE). Wyniki: U pacjentów z CAH w porównaniu z grupą kontrolną zaobserwowano mniejszą wartość FMD (9,4 ± 3,9 vs. 19,8 ± 5,2; p < 0,01) i różnica ta była nadal istotna po uwzględnieniu wpływu średnicy tętnicy ramiennej. Wyjściowo cIMT i fIMT były większe u pacjentów z CAH (cIMT 0,47 ± 0,4 mm vs. 0.40 ± 0,03 mm, p < 0,01; fIMT 0,47 ± 0,05 mm vs. 0,41 ± 0,04 mm, p < 0,01), ale nie po uwzględnieniu klasycznych czynników ryzyka sercowo-naczyniowego. Frakcja wyrzutowa oraz masa lewej komory w obu grupach były podobne. Średnia wartość LSTE była różna u pacjentów z CAH z porównaniu z grupą kontrolną (–20,5 ± 1,2% vs. –22,5 ± 1,7%, p < 0,01), ale nadal pozostawała w granicach normy. Wnioski: U młodych dorosłych z CAH długotrwale leczonych glikokortykosteroidami FMD jest upośledzona, występuje nieistotne pogrubienie cIMT i fIMT oraz podkliniczne zmiany w funkcji rozkurczowej serca w echokardiografii

The relationship between cardiovascular risk estimated by use of SCORE system and intima media thickness and flow mediated dilatation in a low risk population

Background: The SCORE system is a simple, currently recommended method of cardiovascular risk assessment. The aim of this study is to determine the relationship between SCORE risk and intima media thickness (IMT) and flow mediated dilatation (FMD) in a low risk population. Methods: 119 people (59 men) without known cardiovascular disease and estimated by means of SCORE system risk < 5%, were included in the study. The ultrasound method was used to assess brachial artery diameter (BAd), FMD, nitroglycerin mediated dilatation (NMD) of brachial artery and IMT of common carotid. FMD × BAd and FMD/NMD indexes representing hyperemia-induced vasodilatation independent of brachial artery properties were analyzed. Results: IMT measured was 0.52 &#177; 0.08 mm; FMD: 17.5 &#177; 7.8%; NMD: 27.0 &#177; 9.0%; FMD × BAd: 58.2 &#177; 22.4, FMD/NMD: 0.64 &#177; 0.19. Independent predictor for both FMD and NMD was BAd (R2 &#8211;0.31; p < 0.001; R2 &#8211;0.44; p < 0.001; respectively), for FMD × BAd index and FMD/NMD index was IMT (R2 &#8211;0.04; p = 0.02; R2 &#8211;0.04; p = 0.015) in a multivariate analysis. Risk estimated by use of the SCORE system was between 0 and 4% (median-1, 25&#8211; &#8211;75 Q: 0&#8211;2). A relationship between SCORE risk and IMT (ANOVA p < 0.001), FMD (ANOVA p < 0.001), NMD (ANOVA p < 0.001), FMD × BAd index (ANOVA p = 0.017), but not FMD/NMD index (ANOVA p = 0.27), was found. Conclusions: The association of a simple stratifying scale (SCORE system) with indices of early vascular remodeling in a low risk population supports its clinical significance

Ocena przydatności testu Hand Grip we wczesnej profi laktyce nadciśnienia tętniczego wśród młodzieży szkół ponadgimnazjalnych w regionie południowo-wschodniej Polski — badanie przekrojowe

Introduction. It is assessed that the increased reaction of arterial pressure to physical exertion occurs in about 20% of healthy young people and it is connected with hyperkinetic reaction of the circulatory system. Early identifi cation in young people may be of vital importance in early prophylactics and treatment of arterial hypertension (HT). The aim was to assess the relation between the use of the Hand Grip Test (HGT) and early diagnosis of the primary arterial hypertension (PHT) in youth aged 16–19.Material and method. Research was carried out using a survey questionnaire among 511 people aged 16–19 and their parents. The surveyed youth had blood pressure measured in various conditions, including after a provocative stimulus — HGT. In the statistical study we used the ANOVA single factor analysis of variance, χ2 independence test, the V-Kramer test, the tau-b Kendall test and the method: percentages (%), arithmetical average (X) and standard deviation (SD).Results. Increased pressure rise after HGT test regarded more frequently the systolic aspect (34.8%) rather than the diastolic aspect (7.0%) (p &lt; 0.001). Increased response of systolic blood pressure was observed more frequently in persons with its elevated, rather than normal values (p &lt; 0.05). Increased response for both systolic and diastolic blood pressure was found in persons with a high HT intensity history in the family more often than in youth with low hyper intensity or no propensity towards HT, with predominance of systolic pressure (p &lt; 0.01 vs. p &lt; 0.05). Conclusions. Our research shows that the HGT, which is used to detect hyper reactivity of the circulatory system, is a viable method for identifi cation of people susceptible to PHT. The application of the test may result in the lowered costs of treatment of people suffering from a hypertension disease.Wstęp. Szacuje się, że zwiększona reakcja ciśnienia tętniczego (HT) na wysiłek fizyczny występuje u około 20% młodych zdrowych osób i jest związana z hiperkinetyczną reakcją układu sercowo-naczyniowego. Wczesna identyfi kacja młodych osób może mieć istotne znaczenie we wczesnej profilaktyce i leczeniu nadciśnienia tętniczego. Celem pracy była ocena związku między stosowaniem Testu Hand Grip (HGT) a wczesnym wykrywaniem pierwotnego nadciśnienia tętniczego (PNT) u młodzieży w wieku 16–19 lat. Materiał i metody. Badania przeprowadzono metodą wywiadu z użyciem kwestionariusza wśród 511 osób w wieku 16–19 lat i ich rodziców. U młodzieży wykonano pomiary ciśnienia tętniczego w różnych warunkach, w tym po bodźcu prowokacyjnym (HGT). W opracowaniu statystycznym wykorzystano jednoczynnikową analizę wariancji ANOVA, test niezależności χ2, test V-Kramera, test tau-b Kendalla oraz metody statystyki opisowej: wartości procentowe (%), średnia arytmetyczna (x) i odchylenie standardowe. Wyniki. Zwiększony przyrost ciśnienia po teście HGT dotyczył częściej komponenty skurczowej (34,8%) niż rozkurczowej (7,0%) (p &lt; 0,001). Hiperreakcję skurczowego ciśnienia tętniczego częściej obserwowano u osób z jego podwyższonymi niż prawidłowymi wartościami (p &lt; 0,05). Hiperreakcja zarówno ciśnienia skurczowego, jak i rozkurczowego częściej dotyczyła osób w grupie z dużą intensywnością HT w rodzinie niż młodzieży z małą intensywnością lub brakiem obciążenia w kierunku HT, z przewagą ciśnienia skurczowego (p &lt; 0,01 v. p &lt; 0,05) Wnioski. Z badania wynika, że HGT, wykrywający nadreaktywność układu sercowo-naczyniowego jest dobrą metodą do identyfikacji osób zagrożonych PNT. Zastosowanie testu może przynieść wymierne efekty w postaci zmniejszenia w przyszłości nakładów na leczenie osób z chorobą nadciśnieniową

Ultrafiltration rate and diabetes as useful indicators of cardiovascular-related death in hemodialysis patients below 60 years of age

Background: The survival rate of elderly hemodialyzed (HD) patients is commonly thought to be poor. In a prospective, single center, non-interventional, observational study, the cause of all-cause and cardiovascular (CV) and heart failure (HF) mortality in this patient group were examined and compared with a younger cohort (below 60 years). Material/Methods: The study included 223 patients (90 women and 133 men) with age ranging from 34.5 to 75.0 years treated with HD. Median duration of HD was 70.0 months (24.0-120.0). Mortality data was collected over a period of six years. We divided patients into groups: <60 (n=123), ≥60 years (n=100), and with (n=33) and without DM type 2 (n=190). Results: During a six-year follow-up, 100 patients (44.8%) died, including 83 (37.2%) patients who died due to CV reasons. Median follow-up was 2015.0 days (946.0-2463.0) with the median time to death of 1166.0 days (654.5-1631.0). The factors negatively affecting patients’ survival in univariate Cox regression analysis included for all-cause mortality were: inter-dialytic weight gain (IDWG) (hazard ratio [HR]=1.60; p=0.01), ultrafiltration (UF) rate (HR=3.63; p=0.012) for group <60 years; for CV death: UF rate (HR=4.20; p=0.03), DM (HR=5.11; p=0.002) for group <60 years; for HF death: mellitus type 2 (DM) (HR=2.93; p=0.027) for group ≥60 years). In a multivariate Cox regression analysis for patients <60 years, the UF rate was the only independent predictor of all-cause mortality (HR 3.63 (1.34-9.67); p=0.011). Both DM (HR 4.91 (1.71-14.10); p=0.003) and UF rate (HR 3.62 (1.04-12.61); p=0.044) were independent predictors of CV-related mortality in patients <60 years. Conclusions: The UF rate can be a simple, useful indicator of higher long-term all-cause and CV mortality in HD patients <60 years of age. Also, DM may be a predictor of CV–related mortality in younger HD patients

Ranolazyna — nowy lek w nawracających opornych na leczenie arytmiach komorowych?

Introduction. The pharmacological treatment of ventricular arrhythmias (VA) has significant limitations. Ranolazine is a relatively new drug with documented antianginal and anti-ischaemic mechanisms and where preclinical data provides evidence of additional antiarrhythmic properties.  The aim of this article was to evaluate the safety and efficacy of ranolazine in patients with recurrent antiarrhythmic therapy-refractory VA.  Material and methods. This prospective evaluation included 30 patients (pts) (male/female: 26/4; mean age: 65 ± 10 years; coronary artery disease/dilated cardiomyopathy: 20/10; New York Heart Association class I/II/III/IV: 2/14/12/2, left ventricular ejection fraction: 27 ± 10%; implantable cardioverter-defibrillator (ICD): 15 pts, implantable cardioverter- -defibrillator with cardiac resynchronisation therapy (CRT-D): 14 pts with recurrent significant VA [ventricular fibrillation, sustained ventricular tachycardia (VT) and/or non-sustained VT, multiple ventricular premature complexes > 1,000/ /day, biventricular stimulation (BiV) < 95%] and where standard treatment options, i.e. pharmacotherapy, coronary revascularisation, and percutaneous ablation, had proved ineffective. The severity of the arrhythmia was assessed by 24-hour electrocardiographic (ECG) Holter monitoring and in ICD/CRT-D memory recording. The patients received, in addition to the standard pharmacotherapy (amiodarone: 18 pts, beta-blocker: 26 pts) ranolazine 375 mg twice daily for three months. Baseline data was compared to the data obtained after the three months of ranolazine treatment.  Results. We observed a significant reduction of total ventricular extrasystoles determined by ECG Holter monitoring (median: 1,737 vs 1,260, p = 0.04). Similarly, significant VA in ICD/CRT-D memory recording was diminished (67.7 vs 35.5%, p = 0.03). The number of ICD interventions in terms of both antitachycardia pacing (9 pts vs 2 pts, p = 0.01), and shock delivery (8 pts vs 2 pts, p = 0.01), was lower after the three-month observation. The therapy was ineffective for nine (29%) patients — two were hospitalised during the three-month follow-up because of recurrent arrhythmia and in seven pts there was no noticeable reduction in the amount of VA. Adverse effects, in the form of gastrointestinal symptoms (diarrhoea: two, constipation: one), occurred in three (10%) patients.  Conclusions. Authors observed no significant QT prolongation in any patient. There were no differences between the baseline and the post-ranolazine patient clinical characteristics. Ranolazine seems to be a safe and effective second- line therapy in the reduction of VA and ICD interventions in patients with recurrent antiarrhythmic therapy-refractory events.   Wstęp. Farmakologiczne leczenie komorowych zaburzeń rytmu (VA) jest ograniczone. Ranolazyna to stosunkowo nowy lek o udokumentowanym działaniu przeciwdławicowym i przeciwniedokrwiennym oraz z danymi przedklinicznymi wska- zującymi na dodatkowe właściwości antyarytmiczne.  Celem pracy była ocena bezpieczeństwa i skuteczności ranolazyny u pacjentów z nawracającymi opornymi na leczenie VA.  Materiał i metody. Prospektywną oceną objęto 30 pacjentów (pts) (mężczyźni/kobiety: 26/4, średnia wieku: 65 ± 10 lat; choroba wieńcowa/kardiomiopatia rozstrzeniowa: 20/10, klasa I/II/III/IV według New York Heart Association: 2/14/12/2, frakcja wyrzutowa lewej komory: 27 ± 10%; kardiowerter-defibrylator [ICD]: 15 pts, terapia resynchronizują- ca serce z funkcją defibrylacji [CRT-D]: 14 pts) z nawracającymi istotnymi VA (migotanie komór, utrwalony częstoskurcz komorowy [VT] i/lub nieutrwalony VT, liczne pojedyncze ekstrasystolie komorowe &gt; 1000/d., stymulacja biwentrikularna (BiV) &lt; 95%) i z wyczerpaną standardową opcją leczenia, tj. farmakoterapią, rewaskularyzacją wieńcową i przezskórną ablacją. Nasilenie arytmii oceniano w 24-godzinnym monitorowaniu elektrokardiograficznym (EKG) metodą Holtera oraz w pamięci holterowskiej ICD/CRT-D. U pacjentów do standardowej farmakoterapii (amiodaron: 18 pts, beta-adrenolityk: 26 pts) dołączono ranolazynę w dawce 375 mg 2 razy/dobę przez 3 miesiące. Wyjściowe dane porównano z danymi uzyskanymi po 3-miesięcznym leczeniu.  Wyniki. Autorzy zaobserwowali istotną redukcję liczby ekstrasystolii komorowych w monitorowaniu EKG metodą Holtera (mediana: 1737 v. 1260; p = 0,04). Podobnie odnotowano istotne zmniejszenie częstości istotnej VA w zapisie pamięci ICD/CRT-D (67,7 v. 35,5%; p = 0,03). Liczba interwencji ICD zarówno pod względem stymulacji antyarytmicznej (9 pts v. 2 pts; p = 0,01), jak i wyładowań (8 pts v. 2 pts; p = 0,01) była niższa po 3-miesięcznej obserwacji. Terapia była nieskuteczna u 9 (29%) pacjentów — 2 hospitalizowano w trakcie 3-miesięcznej obserwacji z powodu nawrotu VA, a u 7 nie stwierdzono zauważalnego zmniejszenia występowania VA. Działania niepożądane pod postacią dolegliwości żołądkowo-jelitowych (biegunka: 2, zaparcie: 1) wystąpiło u 3 (10%) chorych. U żadnego z pacjentów nie obserwowano istotnego wydłużenia odstępu QT. Nie obserwowano istotnych różnic w charakterystyce klinicznej pacjentów wyjściowo i po podaniu ranolazyny.  Wnioski. Ranolazyna wydaje się bezpiecznym i skutecznym lekiem drugiego rzutu, który może być stosowany w redukcji VA i liczby interwencji ICD u pacjentów z nawracającymi opornymi na leczenie VA.

Oxidation as an Additional Mechanism Underlying Reduced Clot Permeability and Impaired Fibrinolysis in Type 2 Diabetes

Aims. We sought to investigate whether enhanced oxidation contributes to unfavorable fibrin clot properties in patients with diabetes. Methods. We assessed plasma fibrin clot permeation ( , a measure of the pore size in fibrin networks) and clot lysis time induced by recombinant tissue plasminogen activator (CLT) in 163 consecutive type 2 diabetic patients (92 men and 71 women) aged 65 ± 8.8 years with a mean glycated hemoglobin (HbA1c) of 6.8%. We also measured oxidative stress markers, including nitrotyrosine, the soluble form of receptor for advanced glycation end products (sRAGE), 8-iso-prostaglandin F 2 (8-iso-PGF 2 ), oxidized low-density lipoprotein (oxLDL), and advanced glycation end products (AGE). Results. There were inverse correlations between and nitrotyrosine, sRAGE, 8-iso-PGF 2 , and oxLDL. CLT showed a positive correlation with oxLDL and nitrotyrosine but not with other oxidation markers. All these associations remained significant for after adjustment for fibrinogen, disease duration, and HbA1c (all &lt; 0.05), while oxLDL was the only independent predictor of CLT. Conclusions. Our study shows that enhanced oxidative stress adversely affects plasma fibrin clot properties in type 2 diabetic patients, regardless of disease duration and glycemia control

The evaluation of vasculature in post-mortem angio-computed tomography for anatomy research purposes: method description based on celiac trunk analysis

Background: Anatomical research based on deceased body specimens is a time-consuming process that requires a great deal of skill and time to perform correctly. Three-dimensional medical image analysis is an excellent tool for anatomic evaluation, but it often includes patients with comorbidities in the study group, which can skew the results. The purpose of this study was to develop and evaluate methods for anatomic research based on postmortem contrast-enhanced computed tomography angiography 3D reconstruction of the celiac trunk. Materials and methods: Postmortem contrast-enhanced computed tomography angiography of 105 (28.6% female, age 50.8±18.7) decedents without abdominal trauma or tumor was analyzed. The abdominal portion of the aorta and the celiac trunk with its branches were reconstructed and evaluated. The type of celiac trunk was evaluated. The results were analyzed. Results: The celiac trunk, splenic artery, and common hepatic artery were visualized in all cases. The left gastric artery was visible in 97.1% of cases. The dorsal pancreatic artery was visualized in 61.0% of cases. The most common type of celiac trunk was 1 (88.6%), and the rarest types were 2, 3, and 6 (1.0%). We observed 4 morphologies of the truncus celiacus that did not fit the classification presented previously. Conclusions: This study has demonstrated that three-dimensional reconstruction of postmortem contrast-enhanced computed tomography is an excellent tool for performing accurate morphometric analyzes for anatomic research purposes. This method can serve as a source for anatomic studies in the healthy population

Superior mesenteric artery clinical classification and morphometrical analysis

Background: The superior mesenteric artery is one of the most important arteries in the abdominal cavity, which is of great clinical importance, especially in surgical procedures and fatal ischemic complications. The aim of this study was to develop a clinical classification of the superior mesenteric artery. Materials and methods: Postmortem contrast-enhanced computed tomography of 104 (29.8% female, age 50.7±18.7) human bodies were analyzed. Based on anatomic predisposition to ischemic and iatrogenic complications, a three-tiered clinical classification of the superior mesenteric artery was developed. Type 0 was defined as standard risk for ischemic and iatrogenic complications. Type 1 was defined as increased thromboembolic risk with decreased risk of iatrogenic bleeding, and type 2 was defined as decreased ischemic risk with increased risk of iatrogenic bleeding. The supply area of the superior mesenteric artery was divided into 4 regions: pancreas, caecum, ascending colon, and transverse colon. Results: Type 0 (standard risk) was found in 62.5% of cases. Type 1 was most frequently observed in the ascending colon region (15.4%). Type 2 was most frequently observed in the pancreatic region (17.3%). Regarding type, most abnormalities were found in the region of the ascending colon (18.3%), pancreas region (17.3%), and transverse colon (16.3%). Conclusions: The proposed clinical classification of SMA links anatomic variations in morphology with their clinical significance. A simple, three-level classification can be easily applied in daily practice and serve as a great support for preoperative evaluation and recognition of patients at risk of iatrogenic or thromboembolic complications