Pregnancy-related cardiac non-elective hospitalizations and pregnancy outcomes. A tertiary referral cardiac center experience

Background: Pregnant women with cardiovascular diseases (CVD) and their offspring are at higher risk of morbidity and mortality.Aims: To provide data on pregnancy outcomes among women with different types of CVD requiring non-elective cardiac hospitalization in a tertiary referral cardiac center.Methods: We identified all records of non-elective hospitalizations of pregnant women hospitalized between January 2009 through March 2018, at our institution — a tertiary referral cardiac center. The incidence and types of cardiac complications during pregnancy, as well as the pregnancy and offspring outcomes, were determined.Results: One hundred and sixty-one out of 328 pregnancy-related hospitalizations in 140 pregnancies were non-elective. Cardiac complications occurred in 62 (44%) pregnancies, with the most frequent being episodes of arrhythmia (22.1% pregnancies), followed by heart failure exacerbations (6.4% pregnancies). Maternal mortality reached 2.1% and affected only women with primary cardiomyopathies (CMP). Offspring mortality was 2.8%. Newborns of mothers with cardiac complications had significantly lower Apgar scores and gestational age at delivery, compared to mothers without cardiac complications.Conclusions: In our series mortality and morbidity among pregnant women with CVD hospitalizations were high. An unfavorable maternal outcome mainly affected women with CMP. Offspring of mothers with cardiovascular complications are prone to have a lower gestational age and Apgar score

L-arginine and Its Derivatives Correlate with Exercise Capacity in Patients with Advanced Heart Failure

Methylated arginine metabolites interrupt nitric oxide synthesis, which can result in endothelium dysfunction and inadequate vasodilation. Since little is known about the dynamics of arginine derivatives in patients with heart failure (HF) during physical exercise, we aimed to determine this as well as its impact on the patient outcomes. Fifty-one patients with HF (left ventricle ejection fraction-LVEF ≤ 35%, mean 21.7 ± 5.4%) underwent the cardiopulmonary exercise test (CPET). Plasma concentrations of L-arginine, citrulline, ornithine, asymmetric dimethylarginine (ADMA), and symmetric dimethylarginine (SDMA) were measured before and directly after CPET. All patients were followed for a mean of 23.5 ± 12.6 months. The combined endpoint was: any death, urgent heart transplantation, or urgent LVAD implantation. L-arginine concentrations increased significantly after CPET (p = 0.02), when ADMA (p = 0.01) and SDMA (p = 0.0005) decreased. The parameters of better exercise capacity were positively correlated with post-CPET concentration of L-arginine and inversely with post-CPET changes in ADMA, SDMA, and baseline and post-CPET SDMA concentrations. Baseline and post-CPET SDMA concentrations increased the risk of endpoint occurrence (HR 1.02, 95% CI 1.009–1.03, p = 0.04 and HR 1.02, 95% CI 1.01–1.03, p = 0.02, respectively). In conclusion, in patients with HF, extensive exercise is accompanied by changes in arginine derivatives that can reflect endothelium function. These observations may contribute to the explanation of the pathophysiology of exercise intolerance in HF

Czynniki ryzyka występowania zmian miażdżycowych w tętnicach szyjnych u chorych zakwalifikowanych do pomostowania naczyń wieńcowych

Background: Carotid artery disease is thought to be a risk factor for neurological complications after cardiac surgery. Routine ultrasonographic screening is still not performed in every patient scheduled for coronary artery bypass grafting (CABG). Aim: To assess factors which may facilitate the selection for elective carotid artery ultrasound examination in patients undergoing CABG. Methods: 682 patients (mean age 63.2 &#177; 8.7, range: 37&#8211;85 years) scheduled for CABG underwent preoperative duplex ultrasound examination of the carotid arteries. The following factors were collected and analysed: age, sex, LVEF, history of cerebrovascular accidents (stroke and/or TIA), myocardial infarction, and presence of hypertension, diabetes, unstable angina, chronic obstructive pulmonary disease, chronic kidney disease, left main stenosis &#8805; 50%, lower-extremity peripheral arterial disease, and obesity (BMI > 30 kg/m2). Logistic regression analysis was used to determine the risk factors for carotid artery stenosis. Results: Internal or common carotid artery stenosis &#8805; 50% was detected in 123 (18%) patients. Bilateral stenosis occurred in 35 (5.1%) patients, of whom 29 (4.5%) presented at least a monolateral vessel diameter reduction of &#8805; 70%. History of cerebrovascular accidents, presence of lower-extremity peripheral arterial disease, and unstable angina were independent risk factors for at least monolateral vessel diameter reduction &#8805; 50%. Although older age was also an independent predictor (Exp(B) = 1.035, p < 0.05), the ROC curve analysis did not reveal an age threshold above which the probability of detecting carotid disease increases significantly with satisfying sensitivity and specificity. The predictors of bilateral stenosis (at least one of them &#8805; 70%) were a history of stroke, presence of left main disease, and lower-extremity peripheral arterial disease. Conclusions: Carotid disease is common in patients scheduled for CABG. Preoperative carotid artery ultrasound examination should be performed, regardless of age, in all patients with more advanced symptomatic atherosclerosis, such as a history of cerebrovascular accidents, presence of lower-extremity peripheral arterial disease, left main disease, or unstable angina. Kardiol Pol 2010; 68, 7: 789-794Wstęp: Istotne hemodynamicznie miażdżycowe zwężenia w tętnicach szyjnych są uznanym czynnikiem ryzyka powikłań neurologicznych po zabiegach kardiochirurgicznych. Badanie ultrasonograficzne tętnic dogłowowych nie zawsze jest rutynowo przeprowadzane u wszystkich chorych zakwalifikowanych do pomostowania naczyń wieńcowych. W szczególności dyskusyjne jest wykonywanie badania u chorych młodszych. Cel: Celem niniejszej pracy było określenie czynników ryzyka występowania zwężeń w tętnicach szyjnych mogących ułatwiać dobór chorych do badań ultrasonograficznych. Metody: Ultrasonograficznemu badaniu z opcją doplerowską tętnic szyjnych poddano 682 chorych (wiek: 63,2 &#177; 8,7, 37-85 lat) zakwalifikowanych do pomostowania naczyń wieńcowych. Stworzono bazę danych uwzględniającą następujące czynniki demograficzne i kliniczne: wiek, płeć, frakcję wyrzutową lewej komory, wywiad w kierunku przebytych incydentów naczyniowo-mózgowych (udar lub TIA), zawału serca, występowanie nadciśnienia tętniczego, cukrzycy, dławicy niestabilnej, przewlekłej obturacyjnej choroby płuc, przewlekłej choroby nerek, zwężenia pnia lewej tętnicy wieńcowej &#8805; 50%, miażdżycy zarostowej kończyn dolnych i otyłości. Wykorzystano analizę regresji logistycznej w celu określenia czynników ryzyka występowania zwężeń w tętnicach szyjnych. Wyniki: Zwężenie w tętnicy szyjnej wspólnej lub wewnętrznej &#8805; 50% stwierdzono u 128 (18%) chorych. Obustronną stenozę tętnic szyjnych wykryto u 35 (5,1%) pacjentów, przy czym u 29 (4,5%) z nich przynajmniej po jednej stronie redukcja światła naczynia była większa niż 70%. Przebyte incydenty naczyniowo-mózgowe, obecność miażdżycy zarostowej kończyn dolnych i dławicy niestabilnej stanowiły niezależne czynniki ryzyka wystąpienia istotnych zwężeń w tętnicach szyjnych w badanej populacji chorych. Mimo że podeszły wiek był również czynnikiem ryzyka (Exp(B) = 1,035; p < 0,05), to w analizie krzywej ROC nie udało się wyznaczyć wartości progowej, powyżej której to ryzyko znacząco by wzrastało. Predyktorami występowania obustronnych zwężeń w tętnicach szyjnych (w tym co najmniej jedno &#8805; 70%) były: przebyty udar, istotne zwężenia pnia lewej tętnicy wieńcowej i miażdżyca kończyn dolnych. Wnioski: Istotne hemodynamicznie zmiany miażdżycowe w tętnicach szyjnych występują u znacznego odsetka chorych kierowanych na zabieg pomostowania naczyń wieńcowych, dlatego też uzasadnione jest wykonywanie oceny ultrasonograficznej tętnic szyjnych u wszystkich chorych kwalifikowanych do chirurgicznej rewaskularyzacji wieńcowej, jeśli tylko istnieją takie możliwości. Natomiast badanie to powinno być przeprowadzone obligatoryjnie, niezależnie od wieku pacjenta, w grupie obciążonej czynnikami ryzyka, takimi jak: wywiad w kierunku incydentów naczyniowo-mózgowych, niestabilnej dławicy piersiowej, miażdżycy zarostowej tętnic kończyn dolnych lub istotnego zwężenia pnia lewej tętnicy wieńcowej. Kardiol Pol 2010; 68, 7: 789-79

Low-Level Light Therapy Protects Red Blood Cells Against Oxidative Stress and Hemolysis During Extracorporeal Circulation

Aim: An activation of non-specific inflammatory response, coagulation disorder, and blood morphotic elements damage are the main side effects of the extracorporeal circulation (ECC). Red-to-near-infrared radiation (R/NIR) is thought to be capable of stabilizing red blood cell (RBC) membrane through increasing its resistance to destructive factors. We focused on the development of a method using low-level light therapy (LLLT) in the spectral range of R/NIR which could reduce blood trauma caused by the heart-lung machine during surgery.Methods: R/NIR emitter was adjusted in terms of geometry and optics to ECC circuit. The method of extracorporeal blood photobiomodulation was tested during in vivo experiments in an animal, porcine model (1 h of ECC plus 23 h of animal observation). A total of 24 sows weighing 90–100 kg were divided into two equal groups: control one and LLLT. Blood samples were taken during the experiment to determine changes in blood morphology [RBC and white blood cell (WBC) counts, hemoglobin (Hgb)], indicators of hemolysis [plasma-free hemoglobin (PFHgb), serum bilirubin concentration, serum lactate dehydrogenase (LDH) activity], and oxidative stress markers [thiobarbituric acid reactive substances (TBARS) concentration, total antioxidant capacity (TAC)].Results: In the control group, a rapid systemic decrease in WBC count during ECC was accompanied by a significant increase in RBC membrane lipids peroxidation, while in the LLLT group the number of WBC and TBARS concentration both remained relatively constant, indicating limitation of the inflammatory process. These results were consistent with the change in the hemolysis markers like PFHgb, LDH, and serum bilirubin concentration, which were significantly reduced in LLLT group. No differences in TAC, RBC count, and Hgb concentration were detected.Conclusion: We presented the applicability of the LLLT with R/NIR radiation to blood trauma reduction during ECC