Myocardial infarction differentially alters sphingolipid levels in plasma, erythrocytes and platelets of the rat

Three bioactive sphingolipids, namely sphingosine-1-phosphate (S1P), ceramide (CER) and sphingosine (SPH) were shown to be involved in ischemia/reperfusion injury of the heart. S1P is a powerful cardioprotectant, CER activates apoptosis and SPH in a low dose is cardioprotective whereas in a high dose is cardiotoxic. The aim of the present study was to examine effects of experimental myocardial infarction on the level of selected sphingolipids in plasma, erythrocytes and platelets in the rat. Myocardial infarction was produced in male Wistar rats by ligation of the left coronary artery. Blood was taken from the abdominal aorta at 1, 6 and 24 h after the ligation. Plasma, erythrocytes and platelets were isolated and S1P, dihydrosphingosine-1-phosphate (DHS1P), SPH, dihydrosphingosine (DHS) and CER were quantified by means of an Agilent 6460 triple quadrupole mass spectrometer using positive ion electrospray ionization source with multiple reaction monitoring. The infarction reduced the plasma level of S1P, DHS1P, SPH and DHS but increased the level of total CER. In erythrocytes, there was a sharp elevation in the level of SPH and DHS early after the infarction and a reduction after 24 h whereas the level of S1P, DHS1P and total CER gradually increased. In platelets, the level of each of the examined compounds profoundly decreased 1 and 6 h after the infarction and partially normalized in 24 h. The results obtained clearly show that experimental heart infarction in rats produces deep changes in metabolism of sphingolipids in the plasma, platelets and erythrocytes

Myocardial contractility improvement after coronary artery by-pass grafting in a 1-year observation: The role of myocardial viability assessment

Background: Left ventricular (LV) contractility impairment in coronary artery disease patients may be the effect of heart muscle hibernation due to chronic ischemia. Revascularization is the only method to restore contractile function in these patients. The time and degree of LV function improvement have not been precisely determined, and the published data are discordant. The aim of our study was to evaluate the time of myocardial contractility recovery after surgical revascularization in patients with systolic LV dysfunction in relation to the results of echocardiography stress tests. Methods: The study included 50 patients with multivessel coronary artery disease and decreased left ventricular ejection fraction (LVEF < 40%) qualified for coronary artery by-pass grafting. The intervention was preceded by rest echocardiography, low dose dobutamine stress test (5-10 &#181;g/kg/min) and by low dose dipyridamole stress test (0.24 mg/kg during 4 min) performed on the next day. Consecutive rest echocardiograms were performed immediately after the intervention and after 3, 6 and 12 months. LVEF and the index of left ventricular contractility (WMSI, wall motion score index) were evaluated at each examination. Results: During 1-year follow-up after coronary artery by-pass grafting (CABG), significant improvement in LV systolic function was observed (LVEF increased, WSMI reduced), with major changes occurring over the first 6 months. The correlation of echocardiography parameters (EF, WMSI) at stress tests and during 1-year follow-up showed that the strongest relationship exists between the change in WMSI both in dobutamine and dipyridamole stress tests and the improvement in WMSI observed after 6 months. Conclusions: LV function improvement after CABG in patients with systolic LV dysfunction was most pronounced 3 to 6 months after the intervention. Both types of stress tests are characterized by similar diagnostic value for assessing LV myocardial viability. WMSI calculated during stress was identified to have the strongest prognostic value. (Cardiol J 2007; 14: 246-251

The value of dobutamine stress echocardiography in predicting clinical improvement following coronary artery bypass grafting in patients with left ventricular systolic dysfunction

Background: Recent years have seen an increasing number of patients with multivessel coronary artery disease and left ventricular systolic dysfunction being qualified for cardiac surgery. Identification of patients who are likely to benefit most from revascularisation procedures poses a considerable problem. The aim of the study was to assess the value of dobutamine stress echocardiography in predicting the clinical course following coronary artery bypass grafting (CABG) in patients with ischaemic left ventricular dysfunction. Methods: Fifty patients with multivessel coronary artery disease and reduced left ventricular ejection fraction (LVEF < 40%) who were qualified for CABG were included in the study. Resting echocardiography and a small-dose (5&#8211;10 &#181;g/kg/min) dobutamine test were performed before the procedure. Subsequent tests were repeated after the procedure and at 3.6 and 12 months. A combined endpoint of death, repeat hospitalisations, NYHA stage, severity of angina and left ventricular systolic function was evaluated. Results: Two factors were found to affect the prognosis adversely following CABG in both univariate and multivariate analysis: a history of hypertension (p = 0.039, OR 4.9, 95% CI 1.4-17.1) and lack of improvement in contractility in at least 4 segments during the dobutamine test (p = 0.0003, OR 37.2, 95% CI 6.3-218.4). An improvement in contractility in at least 4 segments of the left ventricle is the most important prognostic factor. Conclusions: The results of the dobutamine stress test have a more potent prognostic value than clinical or demographic parameters in predicting clinical improvement. Patients with negative results of the test represent the group with the gravest prognosis. (Cardiol J 2007; 14: 174-179

Current possibilities of examination and preservative treatment in endometrial hyperplasia

Abstract Endometrial hyperplasia is one of the most frequent reasons of pre- and menopausal bleeding. In recent years, knowledge of biology of hyperplastic endometrium has changed some medical guidelines in a group of patients diagnosed with endometrial lesions. In many cases radical procedures have been replaced with preservative treatment, especially for those women who wished to spare their uterus. Also, in many high-risk surgical procedures there are a number of algorithms which allow to perform non-radical treatment in those cases. Enforcement of those strategy should be linked to precise examination of endometrium morphology. Summarizing, a preservative treatment in case of endometrial hyperplasia needs sensitive and specific tests which determine safety limits of the procedure. This paper has presented current possibilities of examination and non-radical treatment of endometrial hyperplasia

Rola galektyny 3 jako markera diagnostycznego i prognostycznego w kardiologii

Galectin 3 (Gal-3) is a protein belonging to family lectins. Gal-3 is produced as a response to inflammatory mediatorsby several types of cells directly associated with atherosclerosis such as macrophages and endothelial cells. Galectin3 represents a link between inflammation and fibrosis. Gal-3 is a biomarker associated with inflammation and cardiacfibrosis in patients with heart failure. Association of galectin 3 with cardiovascular risk factors suggest that it can bea promising marker of subclinical and symptomatic atherosclerosis. Previous research suggest that Gal-3 may be a usefuldiagnostics marker and prognostic factor in ischaemic heart disease and heart failure.Galektyna-3 (Gal-3) jest białkiem należącym do rodziny lektyn. Produkowana jest pod wpływem czynników zapalnych przez różnego rodzaju komórki, m.in. związane bezpośrednio z rozwojem miażdżycy jak np. makrofagi i komórki śródbłonka naczyniowego. Galektyna-3 jest biomarkerem związanym z zapaleniem i włóknieniem mięśnia sercowego u chorych z niewydolnością serca. Związek Gal-3 z czynnikami ryzyka sercowo-naczyniowego pozwala sądzić, że jest ona również obiecującym parametrem w ocenie rozwoju miażdżycy. Dotychczasowe badania sugerują, że może być ona przydatnym markerem w diagnostyce oraz ocenie rokowania zarówno w chorobie niedokrwiennej serca jak i niewydolności serca

Powikłania przezskórnej interwencji wieńcowej u 70-letniego pacjenta z wielonaczyniową chorobą wieńcową i rakiem prostaty

A 70-year-old man with chronic coronary artery disease (CAD), disseminated atherosclerosis, heart failure with mildly reduced ejection fraction, hypertension, diabetes mellitus type 2 and prostate cancer was admitted to the Department of Cardiology because of low effort tolerance for further cardiological assessment before chemotherapy of prostate cancer. Due to the progression of CAD in coronarography, he was consulted at the Heart Team meeting and classified for two-step percutaneous coronary intervention (PCI). After PCI of the left anterior descending artery, he had a myocardial infarction with the ejection fraction decreased from 43% to 28%.70-letni mężczyzna z przewlekłą chorobą wieńcową, rozsianą miażdżycą, niewydolnością serca z umiarkowanie obniżoną frakcją wyrzutową, nadciśnieniem tętniczym, cukrzycą typu 2 i rakiem prostaty został przyjęty do Kliniki Kardiologii z powodu niskiej tolerancji wysiłku celem dalszej oceny kardiologicznej przed chemioterapią raka prostaty. Po wykonaniu koronarografii, która ujawniła progresję choroby wieńcowej, pacjent został skonsultowany na spotkaniu "Heart Team" i zakwalifikowany do dwuetapowej przezskórnej interwencji wieńcowej (PCI). Po PCI gałęzi przedniej zstępującej lewej tętnicy wieńcowej wystąpił zawał mięśnia sercowego oraz obniżenie frakcji wyrzutowej lewej komory z 43% do 28%

Wtórny nowotwór złośliwy serca

We present a case of a 58 year-old patient with metastatic malignant cardiac tumour in whom the first manifestation of heart involvement was cardiac tamponade. Kardiol Pol 2010; 68, 12: 1402-140

Wartość echokardiograficznej próby dobutaminowej w przewidywaniu poprawy klinicznej po pomostowaniu aortalno-wieńcowym u pacjentów z upośledzoną funkcją skurczową lewej komory

Wstęp: W ostatnich latach coraz więcej pacjentów z wielonaczyniową chorobą wieńcową oraz dysfunkcją skurczową lewej komory kwalifikuje się do leczenia kardiochirurgicznego. Identyfikacja chorych odnoszących największe korzy&#339;ci z zabiegów rewaskularyzacji stanowi istotny problem. Celem niniejszego badania była ocena wartości testu obciążeniowego z dobutaminą w prognozowaniu przebiegu klinicznego po pomostowaniu aortalno-wieńcowym (CABG) w grupie pacjentów z dysfunkcją niedokrwienną lewej komory. Metody: Badaniem objęto 50 pacjentów z wielonaczyniową chorobą wieńcową oraz obniżoną frakcją wyrzutową lewej komory (LVEF < 40%) zakwalifikowanych do CABG. Przed zabiegiem wykonywano spoczynkowe badanie echokardiograficzne oraz próbę z małą dawką dobutaminy (5-10 &#181;g/kg/min). Kolejne badania powtarzano po zabiegu oraz po 3, 6 i 12 miesiącach. Oceniano złożony punkt końcowy, na który składały się: zgony, powtórne hospitalizacje, stopień wydolności krążenia według NYHA, nasilenie dolegliwości dławicowych oraz funkcja skurczowa lewej komory. Wyniki: W analizie zarówno jedno-, jak i wieloczynnikowej na niekorzystne rokowanie po zabiegu CABG wpływały 2 czynniki: wywiad w kierunku nadciśnienia tętniczego (p = 0,039; OR: 4,9; 95% CI: 1,4-17,1) oraz brak poprawy kurczliwości w próbie dobutaminowej w przynajmniej 4 segmentach (p = 0,0003; OR 37,2; 95% CI: 6,3-218,4). Poprawa kurczliwości przynajmniej 4 segmentów lewej komory jest czynnikiem o najistotniejszym znaczeniu prognostycznym. Wnioski: Wynik próby obciążeniowej z dobutaminą ma większą moc prognostyczną od parametrów klinicznych i demograficznych w przewidywaniu poprawy klinicznej. Pacjenci z negatywnymi rezultatem testu reprezentują grupę charakteryzującą się najgorszym rokowaniem. (Folia Cardiologica Excerpta 2007; 2: 201-206

The influence of renal function and selected cardiovascular risk factors on the thickness of the intima-media complex in the peripheral arteries

Background: Measurement of the intima-media thickness (IMT) in the peripheral arteries leads to better stratification of cardiovascular risk. This is of great importance in patients with chronic renal insufficiency, who are particularly vulnerable to developing atherosclerotic lesions. The aim of the study was to evaluate whether parameters of renal insufficiency and selected risk factors of atherosclerosis influence IMT in the peripheral arteries. Methods: The study population comprised 231 patients submitted to coronary angiography with ultrasonographic assessment of the common carotid artery (CCA), carotid artery bulb (CB) and common femoral artery (CFA) made contemporaneously with evaluation of IMT and atherosclerotic plaques. Renal function as well as selected clinical and biochemical risk factors of atherosclerosis were assessed. Two subgroups were analysed: 200 patients with coronary heart disease confirmed angiographically (study group) and 31 patients without coronary lesions (control group). Results: Significant negative correlation was found between glomerular filtration rate and IMT values in CCA (p < 0.001) as well as in CB (p < 0.05). Patients with abnormal glucose metabolism had significantly higher IMT values in CCA (0.95 &plusmn; 0.30 vs. 0.87 &plusmn; 0.20; p = 0.034). Hypercholesterolaemia did not influence the IMT values in CCA and CFA. There was no correlation between body mass index and IMT. Conclusions: Patients with chronic renal insufficiency presented higher values of IMT in CCA. The measurement of IMT appears to be a valuable non-invasive method of diagnosing preclinical stages of atherosclerosis in the described group of patients. (Cardiol J 2007; 14: 59&#8211;66