Relationship among the leptin-to-adiponectin ratio, systemic inflammation, and anisocytosis in well-controlled type 2 diabetic patients with atherosclerotic cardiovascular disease

Background: Previous studies have shown that red blood cell distribution width (RDW) is an independent predictor of poor prognosis in type 2 diabetes (T2D) and atherosclerotic cardiovascular disease (ASCVD). The mechanisms underlying increased anisocytosis in patients with T2D and confirmed ASCVD remain poorly understood. Aims: We sought to evaluate the relationship among the leptin-to-adiponectin ratio, systemic low -grade inflammation, and RDW in optimally treated patients with T2D and established ASCVD. Methods: A total of 68 patients, aged 47 to 85 years (mean [SD], 65.3 [6.8] years) and including 21 women (30.9%), were enrolled and grouped according to median RDW into those with RDW < 13.5% (n = 33) and those with RDW ≥13.5% (n = 35). Results: Patients with RDW ≥13.5% had a significantly higher median (interquartile range [IQR]) serum leptin-to-adiponectin ratio (1.7 [0.49–2.3] ng/μg vs 0.66 [0.31–1.25] ng/μg; P = 0.04) and median (IQR) tumor necrosis factor α levels (1.58 [1.42–1.97] pg/ml vs 1.39 [1.18–1.57] pg/ml; P = 0.02). There were no significant differences in the concentrations of other inflammatory markers. The leptin-to-adiponectin ratio (r = 0.25; P = 0.04) and levels of tumor necrosis factor α (r = 0.32; P = 0.01) and soluble intercellular adhesion molecule 1 (r = 0.31; P = 0.01) were positively correlated with RDW, which was confirmed by univariate linear regression analysis. A multivariable regression model, which included demographic, clinical, and laboratory data, showed that white blood cell count (β = 0.25; 95% CI, 0.05–0.45; P = 0.01), soluble intercellular adhesion molecule 1 levels (β = 0.21; 95% CI, 0.02–0.41; P = 0.03), and mean corpuscular hemoglobin concentration (MCHC), (β = –0.48; 95% CI, 0.67 to –0.28; P < 0.001) were independent predictors of RDW in our patients. Conclusions: In well-controlled patients with T2D and ASCVD, the RDW values are associated with leptin-to-adiponectin imbalance and selected inflammatory markers

Long-term follow-up of DDD pacing mode

Background and aim: The aim of this study was to determine the long-term survival of DDD pacing and identify the main reasons for its loss. Methods: The study group consisted of 496 patients in whom a DDD pacing system was implanted between October 1984 and March 2002 and who were followed up until July 2010. The follow-up period was 152.1 ± 35.5 months. The patients’ meanage at the time of implantation was 59.5 ± 12.5 years, and 53.5% were male; 58% had sick sinus syndrome (SSS), 26% had atrioventricular block (AVB), 15% had both of these indications simultaneously, and 1% had other indications. The incidence of lead malfunction, progression to chronic atrial fibrillation (AF), and the rate of infective complications was analysed. Results: During the follow-up, 369 patients remained in DDD mode stimulation. DDD mode survival rate at one, five, ten and 15 years was, respectively, 96%, 86%, 77% and 72%. The most common reason for reprogramming out of DDD mode was the development of permanent AF in 65 (13.1%) patients. The occurrence of chronic AF was associated with a priorhistory of paroxysmal AF (p = 0.0001), SSS (p = 0.0215), and older age at time of implantation (p = 0.0068) compared to patients who remained in sinus rhythm. Lead malfunction caused loss of DDD mode pacing in 56 (11.3%) patients. Atrial leads were damaged in 37 patients, ventricular in 12 patients, and both leads in seven patients. The subclavian vein puncture was correlated with the mechanical damage of the atrial lead (p = 0.02935) compared to cephalic vein access. At the moment of complication, the patients with a dysfunctional lead were significantly younger than those who progressed to chronic AF(p = 0.0019). Infective complications which caused temporary loss of DDD pacing were observed in six patients: five had pocket infection and one had lead-dependent infective endocarditis. Conclusions: 1. Effective DDD pacing from the originally implanted system was noted in a high percentage (72%) of patients in long-term observation (15 years). 2. Progression to permanent AF is the most common reason for loss of DDD pacing;a history of paroxysmal AF and old age are the risk factors. 3. Subclavian vein puncture is associated with a higher rate of atrial lead damage

Przezżylne usunięcie złamanej i przemieszczonej do żyły podobojczykowej elektrody przedsionkowej z dostępu udowego przy użyciu systemu Evolution

We present a case of an 82-year-old patient who underwent transvenous lead extraction of a broken atrial lead, a functional ventricular lead and an abandoned ventricular lead due to suspicion of lead dependent infective endocarditis. The atrial lead was implanted 18 years ago, and 10 years ago it dislodged into the subclavian vein following a fracture. The lead was removed via the femoral vein approach using a pigtail catheter, lasso, Dotter basket, Needle’s Eye Snare and finally the Evolution system.Autorzy prezentują przypadek kliniczny 82-letniego mężczyzny, u którego wykonano zabieg przezżylnego usunięcia złamanej i wpadniętej elektrody przedsionkowej, czynnej elektrody komorowej i porzuconej elektrody komorowej z powodu silnego podejrzenia infekcyjnego zapalenia wsierdzia związanego z układem stymulującym. Elektrodę przedsionkową implantowano 18 lat temu; złamała się w mechanizmie crush syndrome i 10 lat temu przemieściła się do żyły podobojczykowej. Elektrodę tę usunięto z dostępu udowego za pomocą cewnika typu pigtail, cewnika typu lasso, koszyczka Dottera, chwytaka Needle’s Eye Snare i ostatecznie mechanicznego systemu Evolution

Femoral extraction of dropped-in atrial lead with Evolution system

We present a case of an 82-year-old patient who underwent transvenous lead extraction of a broken atrial lead, a functional ventricular lead and an abandoned ventricular lead due to suspicion of lead dependent infective endocarditis. The atrial lead was implanted 18 years ago, and 10 years ago it dislodged into the subclavian vein following a fracture. The lead was removed via the femoral vein approach using a pigtail catheter, lasso, Dotter basket, Needle’s Eye Snare and finally the Evolution system

Adiposity, fat depots and the prediction of stroke

Background: Despite the progress in research, the utility of clinical assessment for the prediction of stroke is limited. The aim herein, was to evaluate the predictive values of major ultrasound indexes of carotid artery and fat depots for stroke in patients with high and  very high cardiovascular (CV) risk. Methods: The study group included 364 patients (age: 61.3 ± 7.2 years old) with typical CV risk factors scheduled for elective coronary angiography (2012–2013). A comprehensive baseline assessment included the following ultrasound indexes: carotid artery intima-media thickness (IMT), extra-media thickness (EMT), epicardial (EFT) and pericardial fat thickness (PFT), abdominal subcutaneous (ASF) and visceral fat (AVF) and combined Periarterial Adipose Tissue Intima Media Adventitia (PATIMA) index. Afterwards, all patients were followed for 80.9 ± 7.1 months. Results: There were 23 strokes and 25 cases with new-onset atrial fibrillation during follow-up. Receiver operating characteristics (ROC) analysis showed, that selected clinical parameters (age, waist circumference [WC], waist hip ratio [WHR]) and ultrasound indexes (EFT: area under curve [AUC] 0.672, p < 0.01 and PATIMA index: AUC 0.658, p < 0.01) were predictive for stroke. However, their predictive values showed no significant differences (p = NS). The baseline body mass index (BMI) was the only parameter, which showed a prediction for new-onset atrial fibrillation (BMI > 33 kg/m2: sensitivity 65%, specificity 76%).   Conclusions: It was found that age, WC and echocardiographic EFT revealed significant predictive values for stroke. Both WC and EFT showed a very high NPV suggesting that they should be implemented into the clinical practice as a tool affirming a very low risk of stroke

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

Association of selected factors with long-term prognosis and mortality after dual-chamber pacemaker implant

Background: Dual-chamber (DDD) pacing is the most widely utilised pacing modality in many parts of the world. The present study aimed to evaluate life expectancy of DDD pacemaker patients in comparison to the age- and sex-matched general population, assess changes in baseline characteristics over three decades of the inclusion period and determine the association between selected variables and patient survival. Methods: This longitudinal study of consecutive de novo DDD pacemaker implantations performed between 1984 and 2014, with all-cause mortality until 2016 as the endpoint, was conducted at a singlecenter university hospital. Results: Under assessment were 3928 patients with a total of 30,087 patient-years of survival time. Compared to the general population, the observed survival was significantly inferior until 12 years post DDD pacemaker implant (HR = 1.499, p < 0.001), whereas after 12 years of follow-up the observed survival was significantly superior (HR = 0.555, p < 0.001). A comparison of patient baseline characteristics over three decades revealed the following significant changes: more elderly patients, more female patients, less patients with atrioventricular block, more patients with atrial fibrillation/atrial flutter (AF/AFL) and fewer patients with an apical right ventricular (RV) lead position in the later decades. In multivariate analysis male sex and higher age were the only variables significantly associated with shorter survival time. Indication for pacing, history of pre-implant AF/AFL, RV lead position and device infection were not associated with survival. Conclusions: In the very-long-term follow-up of DDD pacemaker patients, the parameters associated with survival were sex and baseline age at first implantation

Association of selected factors with long-term prognosis and mortality after dual-chamber pacemaker implant

Background: Dual-chamber (DDD) pacing is the most widely utilised pacing modality in manyparts of the world. The present study aimed to evaluate life expectancy of DDD pacemaker patients incomparison to the age- and sex-matched general population, assess changes in baseline characteristicsover three decades of the inclusion period and determine the association between selected variables andpatient survival.Methods: This longitudinal study of consecutive de novo DDD pacemaker implantations performedbetween 1984 and 2014, with all-cause mortality until 2016 as the endpoint, was conducted at a singlecenteruniversity hospital.Results: Under assessment were 3928 patients with a total of 30,087 patient-years of survival time.Compared to the general population, the observed survival was significantly inferior until 12 years postDDD pacemaker implant (HR = 1.499, p &lt; 0.001), whereas after 12 years of follow-up the observedsurvival was significantly superior (HR = 0.555, p &lt; 0.001). A comparison of patient baseline characteristicsover three decades revealed the following significant changes: more elderly patients, more femalepatients, less patients with atrioventricular block, more patients with atrial fibrillation/atrial flutter(AF/AFL) and fewer patients with an apical right ventricular (RV) lead position in the later decades.In multivariate analysis male sex and higher age were the only variables significantly associated withshorter survival time. Indication for pacing, history of pre-implant AF/AFL, RV lead position and deviceinfection were not associated with survival.Conclusions: In the very-long-term follow-up of DDD pacemaker patients, the parameters associatedwith survival were sex and baseline age at first implantation