Skin Autofluorescence in Systemic Sclerosis Is Related to the Disease and Vascular Damage: A Cross-Sectional Analytic Study of Comparative Groups

Skin autofluorescence (AF), a relatively simple and time saving procedure, measures the accumulation of advanced glycation end (AGE) products. The importance in autoimmune rheumatic diseases, particularly, systemic sclerosis (SSc), has not been evaluated yet. The aim of our study was to examine the skin AF in the context of SSc patients and to analyse the relations between skin AF and other surrogate measures of atherosclerosis. Forty-seven patients with SSc and 47 healthy volunteers were included in this study as controls. Patients and controls underwent common carotid artery wall assessment, arterial stiffness and wave reflection measurements, laser Doppler measurements of capillary flow, assessment of endothelial function by brachial ultrasound, peripheral arterial tonometry, and AGE measurement by skin AF. Wall properties of the common carotid arteries and wave reflection measurements were not affected in these study patients compared to controls while measures reflecting small capillary flow were altered. The accumulation of AGE products measured by skin AF was more prominent in SSc patients than in healthy controls. AGE products’ score was significantly associated with carotid radial pulse wave velocity, intima media/carotid artery diameter ratio, capillary flow percentage change during occlusion, and the disease itself in a multivariate linear analysis model

Širdies resinchronizacijos terapijos šiuolaikinės rekomendacijos: Vilniaus kardiologijos ir angiologijos centro patirtis

Vytė Maneikienė, Germanas Marinskis, Audrius Aidietis, Sigita Aidietienė, Jelena Čelutkienė, Kęstutis Ručinskas, Vytautas Sirvydis, Aleksandras Laucevičius Vilniaus universiteto Širdies ir kraujagyslių ligų klinika, Santariškių g. 2, LT-08661 Vilnius El. paštas: [email protected] Įvadas / tikslas: Širdies resinchronizavimo terapijos metodas sumažina širdies nepakankamumo simptomus, pagerina širdies sistolinę funkciją ir išgyvenamumą pacientų, sergančių toli pažengusiu širdies nepakankamumu, atspariu optimaliam medikamentiniam gydymui, ir turinčių elektrinio širdies asinchroniškumo požymį – plačius QRS kompleksus, tačiau vėlyvieji ilgo stebėjimo rezultatai dar nėra iki galo aiškūs ir plačiai tyrinėjami. Darbo tikslas – apžvelgti pagrindines šiuolaikines resinchronizacijos taikymo nuorodas, papildomų atrankos kriterijų paieškų rezultatus; pateikti Vilniaus universitetinės ligoninės Santariškių klinikų Kardiologijos ir angiologijos centro patirties apžvalgą. Ligoniai ir metodai: Analizuojami pacientų, gydytų resinchronizacine terapija nuo 2002 metų vidurio iki 2009 metų pabaigos, atvejai. Klinikinė informacija renkama iš pacientų ligos istorijų, ambulatorinio stebėjimo kortelių. Visi iki šiol gyvenantys pacientai periodiškai kviečiami nuodugniai klinikinei patikrai. Prieš ir po resinchronizacijos procedūros atliekami išplėstiniai širdies echoskopijos tyrimai įvertinant mechaninį asinchroniškumą, spiroergometrijos tyrimai, nustatomas smegenų natriurezinio peptido kiekis kraujyje. Rezultatai: Per aštuonerius metus, nuo 2002 iki 2009 metų pabaigos, implantuoti 92 resinchronizacijos prietaisai. Darbų apimtis gerokai padidėjo per pastaruosius dvejus metus. Šių pacientų, priklausančių III–IV NYHA funkcinei klasei, išgyvenamumo rodikliai yra geri (mirštamumas per 8 metus – tik 10,8 %). Daliai pacientų (4 %) biventrikuliniai stimuliatoriai tapo tiltu į sėkmingą širdies transplantaciją. Išvados: Širdies resinchronizavimo terapija saugiai ir gana veiksmingai pagerina pacientų, sergančių širdies nepakankamumu ir priklausančių III–IV NYHA funkcinei klasei, gyvenimo kokybę. Atrenkant pacientus gydyti šiuo būdu pagal šiuolaikines rekomendacijas, išlieka didelis procentas nepakankamai gerų rezultatų, nors tokios toli pažengusio širdies nepakankamumo grupės ligonių išgyvenamumas yra daug geresnis nei tikėtinas. Reikšminiai žodžiai: resinchronizacija, širdies nepakankamumas, klinikinės studijos Current clinical guidelines for cardiac resynchronization therapy: the experience of vilnius cardiology-angiology center Vytė Maneikienė, Germanas Marinskis, Audrius Aidietis, Sigita Aidietienė, Jelena Čelutkienė, Kęstutis Ručinskas, Vytautas Sirvydis, Aleksandras Laucevičius Vilnius University, Clinic of Cardiovascular Diseases, Santariškių str. 2, LT-08661 Vilnius, Lithuania El. paštas: [email protected] Background /objective: Cardiac resynchronisation therapy improves cardiac function and clinical outcomes for patients suffering from congestive heart failure due to systolic dysfunction associated with ventricular dyssinchrony, who are already optimized with medical therapy. The aim of the study was to present the current clinical guidelines of cardiac resynchronization therapy and the results of current clinical trials, as well as to overview the experience of the Vilnius cCardiology-aAngiology Center. Patients and Methods: We analyse patients who underwent cardiac resynchronisation therapy in 2002–2009. Their in- and outpatient histories were studied. The patients were tested before and after the procedure. eEchocardiography was performed to assess mechanical dyssinchrony, cardiopulmonary exercise testing, B-type natriuretic peptide level. Results: Between June 2002 and December 2009 92 resynchronisation devices, were implanted. Cardiac resynchronisation therapy resulted in a higher survival of patients with NYHA III–IV. For four patients, resynchronisation therapy was a bridge to successful transplantation. Conclusions: Cardiac resynchronization therapy safely improved the quality of life in patients with moderate to severe chronic heart failure (New York Heart Association class III–IV). The present criteria for patient selection have some percent age of no responders, but the survival rate in this group of patients is significantly higher than could be expected. Keywords: resynchronization, heart failure, clinical trial

Pacientų atranka širdies transplantacijai: šiuolaikiniai kriterijai

Vytė Valerija Maneikienė1, Jelena Čelutkienė2, Gitana Žemaitaitytė1, Kęstutis Ručinskas3, Saulius Miniauskas3, Sigitas Čibiras2, Vytautas Jonas Sirvydis3, Aleksandras Laucevičius2 1 Vilniaus universiteto ligoninės Santariškių klinikų Širdies chirurgijos centras, Santariškių g. 2, LT-08661 Vilnius 2 Vilniaus universiteto Širdies ir kraujagyslių ligų klinika, Santariškių g. 2, LT-08661 Vilnius 3Vilniaus universiteto Širdies chirurgijos centras, Santariškių g. 2, LT-08661 Vilnius El paštas: [email protected] Vilniaus universiteto Širdies chirurgijos centre nuo 1987 metų atliekamos širdies transplantacijos operacijos. Per šį laikotarpį recipientų sąrašuose buvo įrašyti 268 pacientai, atliktos 47 širdies transplantacijos. Šiuolaikiniai medikamentinio, elektrofiziologinio ir chirurginio gydymo metodai gerokai padidino pacientų, laukiančių širdies transplantacijos, išgyvenimą, tačiau širdies transplantacija tebėra veiksmingiausias gydymo metodas terminalinėmis širdies nepakankamumo stadijomis. Pastaraisiais metais Vilniaus universiteto Širdies chirurgijos klinikoje įdiegti nauji diagnostikos metodai (spiroergometrija, NT-pro-BNP nustatymas) leidžia praktiškai pritaikyti šiuolaikinius atrankos kriterijus. Šiame straipsnyje remiantis literatūros apžvalga įvardyti pagrindiniai recipientų atrankos širdies transplantacijai kriterijai, taikomi ir Vilniaus universiteto Širdies chirurgijos centre. Pagrindiniai žodžiai: širdies nepakankamumas, recipientų atranka, transplantacija Evaluation at selection of patients for heart transplantation: current criteria Vytė Valerija Maneikienė1, Jelena Čelutkienė2, Gitana Žemaitaitytė1, Kęstutis Ručinskas3, Saulius Miniauskas3, Sigitas Čibiras2, Vytautas Jonas Sirvydis3, Aleksandras Laucevičius2 1 Vilnius University Hospital „Santariškių klinikos“, Heart Surgery Centre, Santariškių str. 2, LT-08661 Vilnius, Lithuania 2 Vilnius University, Heart and Cardiovascular Diseases Clinic, Santariškių str. 2, LT-08661 Vilnius, Lithuania 3 Vilnius University, Heart Surgery Centre, Santariškių str. 2, LT-08661 Vilnius, Lithuania E-mail: [email protected] Heart transplantations at Vilnius University Heart Surgery Centre have been performed since 1987. During all this period, 268 patients were included into the recipients’ list and 47 heart transplantations were performed. The current medical, electrophysiological and surgical methods have obviously increased the survival of patients who are waiting for heart transplantation. However, heart transplantation is still the most effective method in the end-stage heart failure. In recent years, the new diagnostic methods (spiroergometry, NT-pro-BNP) implemented at Vilnius University Heart Surgery Center enable using current selection criteria in practice. In the article, according to a literature review, all the basic criteria of evaluating and selecting recipients for heart transplantation mentioned above are used at our Center. Key words: heart failure, recipients’ selection, transplantatio

Readmission following both cardiac and non-cardiac acute dyspnoea is associated with a striking risk of death

Readmission and mortality are the most common and often combined endpoints in acute heart failure (AHF) trials, but an association between these two outcomes is poorly investigated. The aim of this study was to determine whether unplanned readmission is associated with a greater subsequent risk of death in patients with acute dyspnoea due to cardiac and non-cardiac causes.; Derivation cohort (1371 patients from the LEDA study) and validation cohort (1986 patients from the BASEL V study) included acute dyspnoea patients admitted to the emergency department. Cox regression analysis was used to determine the association of 6 month readmission and the risk of 1 year all-cause mortality in AHF and non-AHF patients and those readmitted due to cardiovascular and non-cardiovascular causes. In the derivation cohort, 666 (49%) of patients were readmitted at 6 months and 282 (21%) died within 1 year. Six month readmission was associated with an increased 1 year mortality risk in both the derivation cohort [adjusted hazard ratio (aHR) 3.0 (95% confidence interval, CI 2.2-4.0), P < 0.001] and the validation cohort (aHR 1.8, 95% CI 1.4-2.2, P < 0.001). The significant association was similarly observed in AHF (aHR 3.2, 95% CI 2.1-4.9, P < 0.001) and other causes of acute dyspnoea (aHR 2.9, 95% CI 1.9-4.5, P < 0.001), and it did not depend on the aetiology [aHR 2.2, 95% CI 1.6-3.1 for cardiovascular readmissions; aHR 4.1, 95% CI 2.9-5.7 for non-cardiovascular readmissions (P < 0.001 for both)] or timing of readmission. CONCLUSION​S: Our study demonstrated a long-lasting detrimental association between readmission and death in AHF and non-AHF patients with acute dyspnoea. These patients should be considered 'vulnerable patients' that require personalized follow-up for an extended period

Identifying differential miR and gene consensus patterns in peripheral blood of patients with cardiovascular diseases from literature data

Abstract Background Numerous recent studies suggest the potential of circulating MicroRNAs (miRs) in peripheral blood samples as diagnostic or prognostic markers for coronary artery disease (CAD), acute coronary syndrome (ACS) and heart failure (HF). However, literature often remains inconclusive regarding as to which markers are most indicative for which of the above diseases. This shortcoming is mainly due to the lack of a systematic analyses and absence of information on the functional pathophysiological role of these miRs and their target genes. Methods We here provide an-easy-to-use scoring approach to investigate the likelihood of regulation of several miRs and their target genes from literature by identifying consensus patterns of regulation. We therefore have screened over 1000 articles that study mRNA markers in cardiovascular and metabolic diseases, and devised a scoring algorithm to identify consensus means for miRs and genes regulation across several studies. We then aimed to identify differential markers between CAD, ACS and HF. Results We first identified miRs (miR-122, −126, −223, −138 and −370) as commonly regulated within a group of metabolic disease, while investigating cardiac-related pathologies (CAD, ACS, HF) revealed a decisive role of miR-1, −499, −208b, and -133a. Looking at differential markers between cardiovascular disease revealed miR-1, miR-208a and miR-133a to distinguish ACS and CAD to HF. Relating differentially expressed miRs to their putative gene targets using MirTarBase, we further identified HCN2/4 and LASP1 as potential markers of CAD and ACS, but not in HF. Likewise, BLC-2 was found oppositely regulated between CAD and HF. Interestingly, while studying overlap in target genes between CAD, ACS and HF only revealed little similarities, mapping these genes to gene ontology terms revealed a surprising similarity between CAD and ACS compared to HF. Conclusion We conclude that our analysis using gene and miR scores allows the extraction of meaningful markers and the elucidation of differential pathological functions between cardiac diseases and provides a novel approach for literature screening for miR and gene consensus patterns. The analysis is easy to use and extendable upon further emergent literature as we provide an Excel sheet for this analysis to the community

Selective apheresis of low-density lipoproteins in a child

The case of rear complicated homozygous hypercholesterolemia treated by a direct adsorption of lipoprotein apheresis procedure is presented in this article. In total, 30 sessions of direct adsorption of lipoprotein apheresis were performed on a 14–16-year-old patient from June 2004 to December 2006. Blood flow rate was 30–70 mL/min. Central and ulnar veins were punctured. Lipid levels were measured before and after lipid apheresis during each session throughout the study period. The mean decrease in total cholesterol level was 26.4–71.2% compared to baseline, low-density lipoprotein cholesterol – 31.9–72.2%, lipoprotein (a) – 56.6–90.9%, apolipoprotein B – 26.4–60.0%. Clinical procedures were completely uneventful. The last 26 sessions were performed in a day unit

Delayed diagnosis of an isolated partial anomalous pulmonary venous connection

In this case report we describe the delayed diagnosis of a very rare congenital anomaly — isolated partial anomalous pulmonary venous connection. This congenital anomaly should be suspected at any age in the clinical setting of right heart volume overload, especially in the absence of a large atrial septal defect. Tomographic imaging modalities (computed tomography or cardiovascular magnetic resonance) not only allow the comprehensive structural and functional assessment of this anomaly, but also help assess the patient’s suitability for surgical treatment. Surgery is the definitive treatment of a patient with a significant left-to-right shunt due to partial anomalous pulmonary venous connection

Ilgų vainikinių arterijų susiaurėjimų PKI vadovaujantis frakcijinio tėkmės rezervo tyrimu: dvejų metų klinikiniai rezultatai naudojant antros ir naujesnės kartos vaistais dengtus stentus

Background. Despite improvements in drug-eluting stent (DES) technology, treatment strategies for long coronary artery lesions remain a controversial issue. The aim of our study was to evaluate the long-term clinical results after FFR guided PCI on long coronary lesions. Materials and methods. A total of 74 consecutive patients with significant (mean FFR 0.61 ± 0.11) coronary artery lesions ≥30 mm in length were included in the prospective study. All patients were treated with FFR guided PCI implanting newer generation Biolimus, Everolimus or Zotarolimus eluting stents. Clinical endpoints – target vessel revascularization (TVR) and major adverse cardiac events (MACE) – were recorded at 1 and 2 years. Results. 100% angiographic procedure success was achieved, the mean post procedural FFR was 0.88 ± 0.06. At 2-year follow-up, 6 (8.1%) patients had ischemia driven TVR, all within the first 12 months. There were no target vessel related acute coronary syndromes and definite stent thromboses in the study group. At 2 years, the total MACE rate was 29.7%. There was a trend towards a higher TVR rate in patients with overlapping DES vs single DES implanted (9.6 vs 4.5%, p = 0.6). On regression analysis, the total stent length had no influence on the TVR rate. Conclusions. At 2 years after stenting long coronary lesions with newer generation DES the TVR rate was 8.1%, which is acceptable in the high cardiovascular risk population with diffuse coronary artery disease. The total stent length did not affect the long-term clinical outcomes

Vitamin D, cardiovascular and bone health in postmenopausal women with metabolic syndrome

Background. The evidence highlights the importance of improving vitamin D levels in the general population for the prevention of adverse long-term health risks, including cardiovascular events, metabolic syndrome, cancer, anxiety and depression, and overall mortality, although controversies in the research are common. Objectives. The purpose of this study was to investigate the relationship between vitamin D and vascular and bone health among postmenopausal metabolic women, controlling for traditional cardiovascular factors, and thus seeking to explore their plausible relation. The secondary aim was to look specifically for the relation between artery stiffness and bone health. Material and methods. This is a cross-sectional study designed to evaluate the relation between vitamin D level and vascular and bone health among women with metabolic syndrome. Two hundred and ten women visiting a cardiologist were recruited consecutively into the study. The study variables included clinical examination, laboratory findings, measurements of vascular stiffness, and bone turnover markers. Results. We found 126 (60%) metabolic women with a vitamin D deficiency (50 nmol/L) among the study group. We discovered no statistically significant correlation between vitamin D and vascular stiffness. Vitamin D was not associated neither with femoral neck bone mineral density (BMD) and T score, nor with lumbar spine BMD and T score. Nevertheless, there was an indirect weak correlation between vascular stiffness, in particular the augmentation index (AIx), and all bone health markers, including BMD and T score in both the femur head and lumbar spine. Conclusions. We showed a high proportion of postmenopausal metabolic women with a vitamin D deficiency, but there was no relation between vitamin D and vascular health or vitamin D and bone health. Nevertheless, the relation between vascular health and bone health exists, although the role of vitamin D in this link has not yet been established