Zamknięcie uszka lewego przedsionka z wykorzystaniem systemu Watchman

The left atrial atrial appendage occlusion (LAAO) is aimed at reducing the risk of stroke by eliminating the potential source of embolism. In Poland, the LAAO procedure is intended primarily for patients with non-valvular atrial fibrillation, risk factors for stroke and contraindications to chronic oral anticoagulation. The article presents the Watchman occluder for percutaneous closing of the left atrium appendage - the best and the most rigorously tested device from all available for such an application and at the same time the most frequently implanted not only in Poland, but also in the world. The implantation technique as well as the main studies on the effectiveness and safety of this method of therapy have also been presented.Zabieg zamknięcia uszka lewego przedsionka ma celu zmniejszenie ryzyka udaru mózgu poprzez eliminacje potencjalnego źródła zatorowości. W Polsce jest on przeznaczony przede wszystkim dla chorych z niezastawkowym migotaniem przedsionków, czynnikami ryzyka udaru mózgu oraz przeciwwskazaniami do przewlekłej doustnej antykoagulacji. W artykule przedstawiono zapinkę Watchmana do przezskórnego zamykania uszka lewego przedsionka — najlepiej i najbardziej rygorystycznie przebadane urządzenie ze wszystkich dostępnych do takiego zastosowania, a jednocześnie najczęściej implantowane nie tylko w Polsce, ale także na świecie. Zaprezentowano również technikę implantacji oraz główne badania dotyczące skuteczności i bezpieczeństwa tej metody terapii

Prediction models for different plaque morphology in non-significantly stenosed regions of saphenous vein grafts assessed with optical coherence tomography

Introduction: Coronary artery bypass grafting (CABG) is a method of choice in treatment of diffuse coronary artery disease (CAD), although it has some limitations such as late saphenous vein graft (SVG) patency loss, which occurs in one fifth of all conduits at 5 years. Since atherosclerosis in SVG has diffuse characteristics, it appears that significantly and non-significantly stenosed lesions may have an equal impact on worse prognosis. Aim: To assess non-significant lesions of SVG by the use of optical coherence tomography (OCT) and investigate the clinical and laboratory findings with the potential impact on plaque composition. Material and methods: Twenty-nine patients with 43 non-significant lesions were enrolled in the study. All variables were assessed using uni- and multivariable logistic regression analysis with each plaque morphology as a dependent variable. Odds ratio (OR) and 95% confidence interval (CI) were computed. Results: Plaque rupture (PRT) was independently associated with age (OR = 1.49, 95% CI: 1.09–2.04, p = 0.015) and lower rates of high-density lipoproteins (HDL) cholesterol (OR = 0.67, 95% CI: 0.49–0.92, p = 0.016). Intimal tearing or rupture (ITR) was related to reduced GFR (OR = 0.52, 95% CI: 0.38–0.72, p = 0.0004). Lipid-rich plaque (LRP) was associated with raised platelet count (PLT) (OR = 1.51, 95% CI: 1.16–1.96, p = 0.004) and increased frequency of smoking (OR = 1.45, 95% CI: 1.12–1.89, p = 0.007). Conclusions: Atherosclerosis of SVG is not restricted to significantly stenosed lesions. Plaque composition is independently associated with different types of clinical and laboratory findings, mostly recognized as risk factors of CAD

Stress Reduction Using Bilateral Stimulation in Virtual Reality

The goal of this research is to integrate Virtual Reality (VR) with the bilateral stimulation used in EMDR as a tool to relieve stress. We created a 15 minutes relaxation training program for adults in a virtual, relaxing environment in form of a walk in the woods. The target platform for the tool is HTC Vive, however it can be easily ported to other VR platforms. An integral part of this tool is a set of sensors, which serves as physiological measures to evaluate the effectiveness of such system. What is more, the system integrate visual (passing sphere), auditory (surround sound) and tactile signals (vibration of controllers). A pilot treatment programme, incorporating the above mentioned VR system, was carried out. Experimental group consisting of 28 healthy adult volunteers (office workers), participated in three different sessions of relaxation training. Before starting, baseline features such as subjectively perceived stress, mood, heart rate, galvanic skin response and muscle response were registered. The monitoring of physiological indicators is continued during the training session and one minute after its completion. Before and after the session, volunteers were asked to re-fill questionnaires regarding the current stress level and mood. The obtained results were analyzed in terms of variability over time: before, during and after the session

The co-application of hypoxic preconditioning and postconditioning abolishes their own protective effect on systolic function in human myocardium

Background: Ischemic preconditioning (IPC) and postconditioning (POC) are well documented to trigger cardioprotection against ischemia/reperfusion (I/R) injury, but the effect oftheir both co-application remains unclear in human heart. The present study sought to assessthe co-application of IPC and POC on fragments of human myocardium in vitro.Methods: Muscular trabeculae of the human right atrial were electrically driven in the organbath and subjected to simulated I/R injury – hypoxia/re-oxygenation injury in vitro. To achieveIPC of trabeculae the single brief hypoxia period preceded the applied lethal hypoxia, and to achieve POC triple brief hypoxia periods followed the lethal hypoxia. Additional muscular trabeculae were exposed only to the hypoxic stimulation (Control) or were subjected to the non-hypoxic stimulation (Sham). 10 μM norepinephrine (NE) application ended every experiment to assess viability of trabeculae. The contraction force of the myocardium assessed as a maximal amplitude of systolic peak (%Amax) was obtained during the whole experiment’s period.Results: Co-application of IPC and POC resulted in decrease in %Amax during the re-oxygentaionperiod and after NE application, as compared to Control (30.35 ± 2.25 vs. 41.89 ± 2.25, 56.26 ± 7.73 vs. 65.98 ± 5.39, respectively). This was in contrary to the effects observed when IPC and POC were applied separately.Conclusions: The co-application of IPC and POC abolishes the cardioprotection of either intervention alone against simulated I/R injury in fragments of the human right heart atria

The influence of high-density lipoprotein cholesterol on maximal lipid core burden indexing thin cap fibrous atheroma lesions as assessed by near infrared spectroscopy

Background: Previous studies suggest that higher plasma concentrations of several lipid molecules are associated with higher lipid core burden index (LCBI) NIRS imaging. The aim of this study was to investigate whether an association between plasma lipids depends on plaque morphology (thin cap fibrous atheroma [TCFA] vs. non-TFCA) as measured by near-infrared spectroscopy–intravascular ultrasound (NIRS-IVUS). Methods: 64 patients retrospectively enrolled were diagnosed with stable coronary artery disease or acute coronary syndrome who underwent NIRS-IVUS imaging. Before percutaneous coronary intervention, blood samples were collected for measurement of serum levels of total cholesterol (TC), low-density lipoprotein cholesterol (HDL-C), high-density lipoprotein cholesterol (HDL-C) and triglycerides. Patients were divided into two groups based on maxLCBI4mm and IVUS imaging. Those with maxLCBI4mm ≥ 323 were included into TCFA group (n = 35) while others were assigned to the non-TCFA group (n = 29). Results: Thin cap fibrous atheroma (TCFA) lesions were significantly longer than the non-TCFA lesions (25.66 ± 9.56 vs. 17.03 ± 9.22, p = 0.001). TCFA characterizes greater plaque burden (78.4 [70.9, 82.2] vs. 72.70 [64.77, 76,05]; p = 0.021) and plaque volume (176.1 [110.75, 247.5] vs. 68.1 [55.58, 143.35]; p = 0.000) as compared to non-TCFA. In TCFA suspected lesions, there was no correlation between maxLCBI4mm and LDL levels (r = 0.105, p = 0.549) nor TC levels (r = –0.035, p = 0.844) but a negative correlation was found between HDL-C and maxLCBI4mm (r = –0.453, p = 0.007). Conclusions: The present study showed that there was no correlation between plasma LDL-C, TCH and TG level and the amount of lipids in coronary plaque assessed by NIRS in both TCFA and non-TCFA groups. Only HDL-C correlated with maxLCBI4mm in TCFA lesions