Assessment of the intima-media thickness and pulse-wave velocity in peripheral arteries in patients with angiographically confirmed coronary artery disease

Background: Non-invasive methods of assessment of the vascular wall have become of significant interest in recent years. They allow better prediction of cardiovascular lesions when combined with evaluation of established cardiovascular risk factors. The aim of the study was to evaluate whether the combination of ultrasonographic assessment of intima-media thickness (IMT) and pulse-wave velocity (PWV) measurement in peripheral arteries results in an increased predictive value for the presence of atherosclerotic coronary lesions. In addition, selected established risk factors for atherosclerosis were analysed for their association with IMT and PWV. Methods: Fifty patients with angiographically confirmed coronary artery disease were included in the study. In all patients ultrasonographic assessment of IMT was performed in the common carotid artery (CCA), the carotid artery bulb (CB) and the common femoral artery (CFA). Simultaneously PWV was recorded between CCA and the brachial and femoral arteries. Results: A higher IMT was noted both in CB and CFA as compared to CCA. Carotid-brachial PWV was higher compared to carotid-femoral PWV. Carotid-femoral PWV correlated with IMT (p = 0.015) and the presence of atherosclerotic plaques (p = 0.04) in CB. No similar relation was found for carotid-brachial PWV. IMT in CCA, CB, and CFA was significantly higher in subjects with triple-vessel disease compared to patients with single-vessel or doublevessel disease. We also found a trend for higher PWV values in patients with multivessel disease but these differences did not reach statistical significance. Conclusions: Combining ultrasonographic assessment of IMT and PWV measurements in peripheral arteries results in an increased predictive value for the presence of atherosclerotic coronary lesions. Isolated PWV measurements are less useful for non-invasive coronary risk assessment than IMT measurements

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

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

Testing the 2017 PHC reform through pilots: strengthening prevention and chronic care coordination

Numerous official reports have highlighted insufficient provision of preventive services within primary health care (PHC) in Poland. Other identified weaknesses include inappropriate referrals to ambulatory care that contribute to long waiting times for specialist consultations. Since mid-2018, a new model of PHC organization has been piloted and can be seen as an attempt to address some of these weaknesses. It draws on the Primary Health Care Act of 2017 and puts much more emphasis on disease prevention and health promotion within PHC as well as shifts management of common chronic conditions to multidisciplinary PHC teams. The implementation of this model has been supported by a range of financial and non-financial measures, including a special grant that helps PHC practices to adapt their IT systems to the requirements of the pilot. Yet, the overall requirements were prohibitive to most PHC practices and only 42 were eventually included in the pilot. In this paper, we describe the content of this model, the difficulties in its implementation and how they were addressed and discuss its possible effects on PHC and the health system more broadly

Clinical study on single-organ cutaneous small vessels vasculitis (SoCSVV)

Leukocytoclastic vasculitis (LCV) is a heterogenous group of disorders that may manifest as a mild disease isolated to the skin or be a part of life-threatening systemic vasculitis. According to the 2012 Chapel Hill Consensus Conference nomenclature, patients presenting symptoms of LCV confined only to the skin should be defined as suffering from a single-organ cutaneous small vessel vasculitis (SoCSVV). SoCSVV is a benign disease with a good clinical outcome but with a significant risk of relapse and skin ulcer formation. The aim of the current study was to characterize SoCSVV and to identify factors that may be associated with the risk of recurrence and skin ulcers. Medical records of patients with LCV hospitalized at the Department of Dermatology at University Hospital in Cracow in the years 2010 to 2015 were analyzed. A total of 24 patients fulfilled criteria of SoCSVV. Drugs and preceding infections were identified as precipitating factors in 40% and 20% of cases, respectively. Skin lesions other than palpable purpura (i.e., macules, urticarial vasculitis, or ulcers) were identified in almost half of the patients. Interestingly, the presence of macules independently increased the risk of skin ulcer formation (odds ratio = 16; 95% confidence interval: 1.5–176.6; P = 0.0075) in the multivariate logistic regression analysis. One-quarter of patients with SoCSVV experienced relapse during the 6-month follow-up. The greater number of affected skin areas was an independent risk factor of recurrence (odds ratio = 5; 95% confidence interval: 2–45; P = 0.02). SoCSVV was usually associated with drugs and preceding infections. The disease relapses in approximately one-quarter of the patients. The more severe the skin involvement in the course of SoCSVV, the higher is the risk of recurrence

Hypertension in children from a nephrological perspective - are there any differences between younger children and adolescents ?

Background. Hypertension (HTN) affects about 5% of children. Renal diseases are the major cause of HTN inpediatric patients, but the incidence of primary HTN is increasing. The aim of the study was to analyze the potentialdifferences between etiology of HTN, type of renal disease leading to HTN, clinical picture, laboratory test resultsor family history, with reference to patients’ age. Material and methods. Medical records of 112 patients (27 children &lt; 11 years and 85 adolescents &gt; 11 years),diagnosed with hypertension in the Department of Pediatric Nephrology, were analyzed. Family history, aetiologyof HTN, clinical course and laboratory results were compared, regarding the patients’ age. Results. HTN secondary to renal disease prevailed over the primary one in younger children. Major causes of renalHTN differed with age. In children under 11 anomalies in the urinary tract were dominant, in teenagers — glomerulopathies. In adolescents, the incidence of primary HTN was higher than in the younger patients and becamecomparable to that of secondary HTN. Patients with primary HTN, irrespective of their age, had higher BMI andmore frequent positive family history of HTN. Clinical symptoms, except for headaches prevalent in adolescents,did not depend on age. Conclusions. In paediatric patients, hypertension secondary to renal diseases is more frequent than the primaryone. The incidence of primary HTN is increasing with age and occurs in adolescents more often than in youngerchildren. The clinical course is usually asymptomatic and may delay the diagnosis, especially in the youngest patients.Introduction: Hypertension (HTN) affects about 5% of children. Renal diseases are the major cause of HTN in pediatric patients, but the incidence of primary HTN is increasing. The aim of study was to analyze the potential differences between etiology of HTN, type of renal disease leading to HTN, clinical picture, laboratory test results or family history, with reference to patients’ age. Material and methods: Medical records of 112 patients (27 children 11 years), diagnosed for hypertension in the Department of Pediatric Nephrology, were analyzed. Family history, etiology of HTN, clinical course and laboratory results were compared, regarding the patients’ age. Results: HTN secondary to renal disease prevailed over the primary one in younger children. Major causes for renal HTN differed with age. In children under 11 anomalies in the urinary tract were dominant, in teenagers – glomerulopathies. In adolescents, the incidence of primary HTN was higher than in the younger patients and became comparable to that of secondary HTN. Patients with primary HTN, irrespective of their age, had higher BMI and more frequent positive family history of HTN. Clinical symptoms, except for headaches prevalent in adolescents, did not depend on age. Conclusions: In pediatric patients, hypertension secondary to renal diseases is more frequent that the primary one. The incidence of primary HTN is increasing with age and occurs in adolescents more often than in younger children. The clinical course is usually asymptomatic and may delay the diagnosis, especially in the youngest patients