Brak wpływu stopnia zwężenia zastawki aortalnej na standardowe parametry płytek krwi — kluczowa rola innych czynników ryzyka sercowo-naczyniowego

Introduction. Calcification of the aortic valve, the main component of degenerative aortic stenosis (AS), results in turbulent blood flow, higher shear stress and may have an effect on the platelet (PLT) parameters. Platelet function and size, which are easily measured automatically during a complete blood count, are proposed as markers of platelet reactivity and risk factors for cardiovascular diseases. Material and methods. 143 patients with AS (mean age: 70 ± 13 y., males 76/53%) were enrolled into the study and divided according to the AS severity: severe AS (n = 89; males 43/48.3%; age IQR: 70 [63–75] y.) and non-severe AS (n = 54; males 63/61.1%; age IQR: 70 [62–76] y.). The clinical data were collected and analyzed with special attention being paid to the cardiovascular risk factors, concomitant diseases (coronary artery disease [CAD], diabetes mellitus, arterial hypertension, obesity). Laboratory tests and echocardiography were assessed in all subjects. Routine admission complete blood cell count was obtained — PLT count, mean PLT volume (MPV), PLT distribution width (PDW) and percentage of giant PLT (giant PLT%) were analyzed. Results. There were no differences between the PLT count, MPV, PDW and giant PLT% when comparing the group with severe AS to the non-severe AS group. Multivariate analysis showed a significant effect of CAD coincidence (β = –0.2, SE = 0.09, p = 0,03) and active smoking (β = –0.2, SE = 0.09, p = 0.03) on the PLT count; obesity (β = 0.2, SE = 0.09, p = 0.03) and CAD (β = –0.2, SE = 0.09, p = 0.03) on MPV; obesity (β = 0.21, SE = 0.09, p = 0.02), thienopyridines (β = 0.19, SE = 0.09, p = 0.03) and LMWH intake (β = 0.21, SE = 0.09, p = 0.02) on PDW; and similarly, obesity (β = 0.23, SE = 0.09, p = 0.01), thienopyridines (β = 0.18, SE = 0.09, p = 0.046) and LMWH intake (β = 0.23, SE = 0.09, p = 0.01) on giant PLT%. Conclusions. Aortic stenosis severity has no effect on PLT count and morphology that are automatically measured. The coincidence of standard cardiovascular risk factors and the CAD effects on the PLT parameters that are established during a standard complete blood count.Wstęp. Kalcyfikacje zastawki aortalnej, będące głównym komponentem degeneracyjnego zwężenia zastawki aortalnej (AS), skutkują turbulentnym przepływem krwi, co z kolei może wpływać na parametry płytek krwi (PLT). Funkcja i wielkość PLT, łatwo oznaczane podczas rutynowej morfologii krwi obwodowej, mogą być markerami aktywności PLT i potencjalnymi czynnikami ryzyka chorób układu sercowo-naczyniowego. Materiał i metody. Do badania włączono 143 pacjentów z AS (średni wiek: 70 ± 13 l., mężczyźni 76/53%) i podzielono na dwie podgrupy zależnie od ciężkości AS — z ciężką AS (mediana wieku: 70 [63–75] l., n = 89, mężczyźni 43/48,3%) oraz nieciężką AS (mediana wieku: 70 [62–76] l., n = 54, mężczyźni 63/61,1%). U wszystkich chorych wykonano przezklatkowe badanie echokardiograficzne oraz zebrano wywiad lekarski, ze szczególnym uwzględnieniem czynników ryzyka chorób układu sercowo-naczyniowego i schorzeń współistniejących (choroby wieńcowej [CAD], cukrzycy typu 2, nadciśnienia tętniczego, otyłości, palenia tytoniu). W wykonanej rutynowo morfologii krwi obwodowej analizie poddano następujące parametry płytkowe: liczbę płytek (PLT count), średnią objętość płytek (MPV), wskaźnik anizocytozy płytek (PDW), odsetek płytek olbrzymich (giant PLT%). Wyniki. Nie obserwowano istotnej różnicy pod względem PLT count, MPV, PDW ani giant PLT%, porównując grupy pod względem ciężkości AS. W przeprowadzonej analizie wieloczynnikowej wykazano istotny wpływ współwystępowania CAD (β = –0,2; SE = 0,09; p = 0,03) i palenia tytoniu (β = –0,2; SE = 0,09; p = 0,03) na PLT count; otyłości (β = 0,2; SE = 0,09; p = 0,03) i CAD (β = –0,2; SE = 0,09; p = 0,03) na MPV; otyłości (β = 0,21; SE = 0,09; p = 0,02), stosowania pochodnych tienopirydyn (β = 0,19; SE = 0,09; p = 0,03) oraz heparyn drobnocząsteczkowych (β = 0,21; SE = 0,09; p = 0,02) na PDW; i podobnie, otyłości (β = 0,23; SE = 0,09; p = 0,01), stosowania pochodnych tienopirydyn (β = 0,18; SE = 0,09; p = 0,046) oraz heparyn drobnocząsteczkowych (β = 0,23; SE = 0,09; p = 0,01) na giant PLT%. Wnioski. Stopień AS nie wpływa na automatycznie mierzoną liczbę i morfologię PLT. Współwystępowanie czynników ryzyka chorób układu sercowo-naczyniowego oraz CAD wpływa na rutynowo oznaczane w morfologii krwi obwodowej parametry płytkowe

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

Mental stress, heart rate and endothelial function in patients with syndrome X

Background: The aim of the study was to determine whether the baseline heart rate (HR) and changes in HR after mental stress (MS) can influence endothelial function in syndrome X. Methods: Forty four patients with syndrome X (F/M: 21/23, mean age: 55.4 &#177; 10.7 years) were examined. The endothelium-dependent flow-mediated dilation (FMD) was defined as the percentage change in the brachial artery diameter during reactive hyperaemia related to baseline (%FMD). The %FMD was assessed before and after (at 10, 30, and 45 min) standardised three-minute MS. HR and blood pressure were monitored simultaneously. The %FMD values were compared between subgroups characterised by baseline HR, maximum HR and DHR, and HR after MS below and over the median values. Results: The values of %FMD measured at 10, 30 and 45 min after MS (4.39 &#177; 5.4%, 4.99 &#177; 3.9%, 4.03 &#177; 3.5%, respectively; p < 0.001) were significantly lower than baseline values (7.73 &#177; 4.9%). Impaired vasodilatation after MS was observed in the following subgroups of patients: those with baseline HR below the median (< 71.5 bpm; baseline: 8.35 &#177; 5.8%; 10 min: 2.87 &#177; 3.6%, 45 min: 4.56 &#177; 3.9%; p < 0.001); those with HR after MS below the median (< 76.5 bpm; baseline: 8.19 &#177; 5.5; 10 min: 3.88 &#177; 4.3%, 45 min: 4.59 &#177; 3.7%; p < 0.01); and those with maximum HR after MS below the median (< 84 bpm; baseline: 8.88 &#177; 5.6%; 10 min: 3.88 &#177; 3.8%, 30 min: 5.88 &#177; 3.9%, 45 min: 4.51 &#177; 3.8; p < 0.01). Conclusion: The stress-induced endothelial dysfunction syndrome X is related to the baseline HR and the changes in HR after MS, suggesting that the autonomic nervous system plays a part in its pathogenesis. (Cardiol J 2007; 14: 180-185

Severe degenerative aortic stenosis with preserved ejection fraction does not change adipokines serum levels

Background: The role of the adipokines in the pathogenesis of aortic stenosis (AS) is not well established. The aim was to evaluate the relationship between adipokines and clinical characteristics as well as echocardiographic indices and noninvasive markers of vascular remodeling in patients with severe AS with preserved ejection fraction (EF). Methods: Sixty-five patients (F/M: 38/27; age: 68.3 ± 9.0 years; body mass index [BMI]: 29.6 ± 4.3 kg/m2) with severe AS with preserved EF: 33 patients with paradoxical low-flow low-gradient AS (PLFLG AS) and 32 patients with normal flow high-gradient AS (NFHG AS) were prospectively enrolled into the study. Twenty-four subjects (F/M: 14/10; age: 65.4 ± 8.7 years; BMI: 29.6 ± 4.3 kg/m2) who matched as to age, sex, BMI and coronary artery disease (CAD) constituted the control group (CG). Clinical data and markers of vascular remodeling were related to the serum adipokines. Results: There were no differences in the adipokines concentrations in the AS/CG. Patients with AS and coexisting CAD were characterized by decreased serum adiponectin (9.9 ± 5.5 vs. 12.7 ± 5.8 μg/mL, p = 0.040) and leptin (8.3 ± 7.8 vs. 21.6 ± 17.1 ng/mL, p &lt; 0.001) levels compared to subjects without CAD. There were no differences in the serum adipokines concentrations between patients with PLFLG AS and NFHG AS. Systemic hypertension, diabetes, hyperlipidemia or markers of vascular remodeling did not discriminate adipokines concentrations. Multivariate regression analysis indicated that age (F = 3.02; p = 0.015) and E/E’ index (F = 0.87, p = 0.032) were independent predictors of the adiponectin level in the AS group. Conclusions: The presence of AS with preserved EF did not change the adipokine serum profile. Adipokines levels were modified by coexisting atherosclerosis but not the typical cardiovascular risk factors or the hemodynamic type of AS

Right ventricular thrombus successfully dissolved with novel oral anticoagulant therapy

Pacjentka w wieku 71 lat bez objawów podmiotowych została przyjęta na Oddział Kardiologii z powodu zmiany w obrębie koniuszka prawej komory, przypadkowo stwierdzonej w tomografii komputerowej jamy brzusznej. W przezklatkowym badaniu echokardiograficznym zaobserwowano hipoechogeniczną, przyścienną strukturę o morfologii skrzepliny w świetle prawej komory (o wymiarach 32 mm × 16 mm) z obecnością hipokinezy przyległych segmentów ściany serca. W trakcie hospitalizacji wykluczono obecność choroby wieńcowej, zatorowości płucnej i systemową chorobę tkanki łącznej. Za pomocą rezonansu magnetycznego serca uwidoczniono hipointensywną skrzeplinę w koniuszku prawej komory, a kontrolna tomografia komputerowa serca potwierdziła stabilne wymiary i charakter zmiany. Na podstawie powyższego obrazu klinicznego wdrożono przewlekłe leczenie przeciwkrzepliwie nowymi doustnymi antykoagulantami (NOAC). Kontrolne badanie echokardiograficzne wykonane po 3 miesiącach od wypisania ze szpitala wykazało całkowitą regresję skrzepliny i normalizację odcinkowych zaburzeń kurczliwości prawej komory. Niniejszy opis przypadku dokumentuje możliwość zastosowania NOAC w celu leczenia incydentalnej, przyściennej skrzepliny w prawej komorze.A 71-year-old asymptomatic female was admitted to the department of cardiology on account of incidental finding of a tumour- like mass located in the apex of right ventricle, which was revealed during contrast-enhanced computed tomography of the abdominal cavity. Transthoracic echocardiography showed hypoechogenic right ventricular mass (32 mm × 16 mm), suggestive of thrombus with hypokinesia of the surrounding right ventricular wall. Coronary artery disease, connective tissue disease and pulmonary embolism were excluded. Cardiac magnetic resonance imaging indicated the presence of hypo-intense mural thrombus, while repeated computed tomography confirmed stable size and character of the lesion. The anticoagulation therapy with novel oral anticoagulant (NOAC) was instituted. Following three months of treatment, the echocardiographic assessment confirmed complete disappearance of thrombus and resolution of regional wall motion abnormalities. The present case indicates that NOAC can be utilised as effective agents in case of incidental right ventricular mural thrombus, unrelated to pulmonary embolism

High doses of simvastatin in ACS decrease serum PDGF levels without influencing immune activation

Background: The positive effects of statin therapy in acute coronary syndromes (ACS) may result from their anti-inflammatory and anti-thrombotic effects. The aim of the study was to compare the influence of standard and high-dose statin therapies in ACS on the serum markers of immune and platelet activation. Material and methods: We examined 44 patients with ACS randomised into two groups: Group S(+) - 22 patients with ACS who were administered high doses of simvastatin (80 mg per day) over a period of one month from a cardiac event; Group S(&#8211;) - 22 patients with ACS treated by standard doses of statins. In all patients successful percutaneous coronary interventions (PCI) were performed. Laboratory analyses were performed at the baseline on the 7th and 30th days from an ACS and involved the following: platelet-derived growth factor (PDGF), tumour necrosis factor (TNF) alpha, soluble forms of TNF receptor (sTNFR 1 and 2), Interleukin-2 (IL-2), and IL-10. Results: During a one-month follow-up we found no difference between clinical data and the baseline levels of the assessed markers in the groups examined. There were no differences in the consecutive measurements of TNF-a, sTNFR1, sTNFR 2, IL-2, and IL-10 levels. Serum concentrations of PDGF were significantly lower on the 7th and 30th days in group S(+) (7th: 6111 &#177; 1834 pg/ml, p = 0.037; 30th: 5735 &#177; 1089 pg/ml, p = 0.016, respectively) in comparison to group S(&#8211;) (7th: 7292 &#177; 1952 pg/ml; 30th: 7034 &#177; 2008 pg/ml, respectively). Conclusions: High doses of simvastatin administered over a period of one month following an acute coronary syndrome were associated with a significant decrease in serum PDGF levels without influence on the activation of serum immune markers

Can CD34+CD38− lymphoblasts, as likely leukemia stem cells, be a prognostic factor in B-cell precursor acute lymphoblastic leukemia in children?

BackgroundCD34+CD38− lymphoblasts as likely leukemia stem cells (LSCs) may be responsible for a worse response to treatment and may be a risk factor for recurrence in B-cell precursor acute lymphoblastic leukemia (BCP-ALL).ObjectiveThe study objective was to assess the prognostic role of CD34+CD38− lymphoblasts in bone marrow on the day of BCP-ALL diagnosis.Methods115 patients with BCP-ALL, the median age of 4.5 years (range 1.5–17.9 years), gender: female 63 (54.8%) with BCP-ALL were enrolled; Group I (n = 90)—patients with CD34+CD38+ antigens and Group II (n = 20)—patients with CD34+CD38− antigens on the lymphoblast surface.ResultsA worse response on Days 8, 15, and 33 of therapy and at the end of treatment in Group II (CD34+CD38−) was more often observed but these differences were not statistically significant. A significantly higher incidence of BCP-ALL recurrence was in Group II.Conclusions1.In BCP-ALL in children, the presence of CD34+CD38− lymphoblasts at the diagnosis does not affect the first remission.2.In BCP-ALL in children, the presence of CD34+CD38− lymphoblasts at the diagnosis may be considered an unfavorable prognostic factor for disease recurrence.3.It is necessary to further search for prognostic factors in BCP-ALL in children

Wpływ otyłości na skuteczność kardiowersji elektrycznej u pacjentów z przetrwałym migotaniem przedsionków

Introduction: Obesity’s influence on the effectiveness of electrical cardioversion (CVE) still requires more studies. The study aimed to evaluate the impact of obesity on the efficacy of CVE in atrial fibrillation (AF). Material and methods: Eighty-nine patients [female/male (F/M): 33/56; mean age: 64.66 ± 9.7 years) with persistent symptomatic AF qualified for CVE were prospectively enrolled in the study. CVE efficacy was analyzed immediately after the procedure and in a one-month follow-up. Patients with immediately efficient CVE were divided into obese group [OG; body mass index) BMI ≥ 30 kg/m2, 49 patients, F/M: 21/28, mean age: 64 ± 10 y.) and non-obese group (NOG; BMI &lt; 30 kg/m2, 33 patients, F/M: 9/24, mean age: 66 ± 10 y.). Results: Immediate CVE efficacy was 92%. Sinus rhythm restoration was not BMI-dependent, but BMI had an impact on the amount of energy needed for sinus rhythm restoration (150 J in NOG vs. 200 J in OG, p &lt; 0.05). One-month CVE efficacy was 47%: 38.8% in OG and 60.6% in NOG (p &lt; 0.05). Patients in OG had greater left atrium (LA) and left ventricle (LV) diameters (p &lt; 0.05) and lower left ventricle ejection fraction (LVEF) (p &lt; 0.05) as compared to NOG subjects. Logistic regression analysis revealed LVEF [odds ratio (OR): 1.107, 95% CI: 1.015–1.207, p &lt; 0.05] as a factor influencing one-month CVE efficacy. Conclusions: Immediate high efficacy of CVE in persistent AF seems to be independent of coexisting obesity, however, obesity has an impact on the amount of energy needed for sinus rhythm restoration. One-month efficacy of CVE is low and modified by coexisting obesity.Wprowadzenie: Znaczenie otyłości dla efektywności procedur przywracających rytm zatokowy nie zostało nadal jednoznacznie określone. Celem przeprowadzonego badania była ocena wpływu otyłości na skuteczność kardiowersji elektrycznej (CVE) w migotaniu przedsionków (AF). Materiały i metody: Do badania włączono 89 pacjentów zakwalifikowanych do CVE z powodu objawowego przetrwałego AF. Pacjentów, u których przywrócono rytm zatokowy, podzielono na 2 grupy uwzględniając ich wskaźnik masy ciała (BMI): grupę z otyłością (OG: BMI ≥ 30 kg/m2) i bez otyłości (NOG: < 30 kg/m2). W obu grupach ponownie oceniono skuteczność CVE po miesiącu obserwacji. Wyniki: Natychmiastowa skuteczność CVEwyniosła 92% i była niezależna od BMI. Otyłość miała jednak wpływ na ilość energii potrzebnej do przywrócenia rytmu zatokowego (150 J w NOG vs. 200 J w OG; p < 0,05). Skuteczność CVE oceniania po miesiącu wyniosła 47%: 38,8% w OG i 60,6% w NOG (p < 0,05). Pacjenci w OG charakteryzowali się większymi wymiarami lewego przedsionka, lewej komory i niższą frakcją wyrzutową lewej komory w porównaniu z NOG (p < 0,05). Analiza regresji wykazała, że LVEF istotnie wpływa na skuteczność CVE ocenianej po miesiącu obserwacji (iloraz szans [OR]: 1,107, 95% CI: 1,015–1,207; p < 0,05). Wnioski: Otyłość wydaje się nie wpływać na natychmiastową skuteczność CVE, jednak rzutuje na wartość energii koniecznej do przywrócenia rytmu zatokowego. Skuteczność CVE oceniania po miesiącu jest niska, a współistnienie otyłości dodatkowo zmniejsza szanse na utrzymanie rytmu zatokowego

N-3 polyunsaturated fatty acids do not influence the efficacy of dual antiplatelet therapy in stable angina pectoris patients after percutaneous coronary intervention

Background: We aimed to prospectively assess the influence of the recommended dose, 1.0 g of polyunsaturated fatty acids (N-3 PUFA) daily, on platelet reactivity in patients with stable angina pectoris (SAP) after elective percutaneous coronary intervention (PCI).Methods: Forty consecutive patients with SAP and successful PCI were randomized to the study group (group PUFA: n = 20; age 65 ± 8; standard therapy + 75 mg acetylsalicylic acid + 75 mgclopidogrel + N-3 PUFA/Omacor 1 g daily) and the control group (group C: n = 20; age 65 ± 9; standard therapy + 75 mg acetylsalicylic acid + 75 mg clopidogrel). Platelet reactivity tests (COL, TRAP, ASPI, ADP) were performed using whole blood aggregometry (multiplate platelet [PLT] function analysis) on the 2,nd and 30th day after PCI.Results: Baseline patients’ characteristics and clinical outcomes were comparable between the groups. There were no differences between both groups in the mean values of the PTL tests measured 30 days after PCI (PUFA vs. C: ASPI: 18.5 ± 17 vs. 27 ± 29 U, COL: 30.4 ± 14.3 vs. 30.3 ± 13.4 U, ADP: 25.4 ± 16.1 vs. 20 ± 10.7 U, TRAP: 65.8 ± 25.6 vs. 57.1 ± 20.4 U, p = NS). The mean delta values of the PTL tests (18–24 h post-PCI/30 days post-PCI) were also comparable between the groups. The PTL aggregometry results were related to time — the baseline values of the ADP (p = 0.003), COL (p = 0.037) and TRAP (p &lt; 0.001) tests were smaller and the ASPI (p = 0.027) test was higher than those measured after 1-month.Conclusions: N-3 PUFA supplementation does not affect the efficacy of dual antiplatelettherapy in patients with SAP after PCI