Hipotermia terapeutyczna — potężne narzędzie w zapobieganiu uszkodzeniu niedokrwienno-reperfuzyjnemu w sercach szczurów

Introduction. The aim of the experiment was to find the relationship between the extent of myocardial infarction and the internal body temperature of the rats. Our second goal was to investigate if mild hypothermia applied during myocardial ischemia and reperfusion brings cardioprotective effects. Materials and methods. The study was performed in vivo on rat hearts. Myocardial infarction was induced by 30 minutes of the left anterior descending artery occlusion followed by 60 min reperfusion. Thirteen rats were assigned to a group depending on the internal body temperature (t) ≤ 35.5°C (n = 5), 35.6 ≥ t ≥ 37.5°C (n = 4) and t ≥ 37.6°C (n = 4). The desired temperature was achieved during pre-ischemic procedures. The presence of the infarction scar and its size were assessed in planimetry. Infraction size was calculated as the infarct area relative to the area at risk (IA/RA). Results. The incidence of infarction scar in the groups of rats with body temperature ≥ 35.6°C was significantly higher (p &lt; 0.01) compared to the group with the temperature ≤ 35.5°C. There was statistically significant positive correlation (r = 0.787, p &lt; 0.01) between IA/RA and the internal body temperature of the rats. Conclusions. Any reduction in the body temperature during myocardial ischemia and reperfusion seems to be beneficial for the rat’s myocardium. Moreover, hypothermia ≤ 35.5ºC applied during ischemia and reperfusion fully prevents from myocardial infarction. We believe that there is a great need to intensify research on therapeutic hypothermia in humans, so that this method of treatment could be finally used in the course of myocardial infarction.  Wstęp. Celem doświadczenia było zbadanie zależności obszaru zawału (IA) od temperatury wewnętrznej szczurów oraz określenie, czy łagodna hipotermia zastosowana podczas niedokrwienia i reperfuzji działa kardioprotekcyjne. Materiały i metody. Badanie przeprowadzono in vivo na sercach szczurzych. Zawał serca wywoływano poprzez 30-minutowe zamknięcie gałęzi przedniej zstępującej (LAD), po czym następowała 60-minutowa reperfuzja. Trzynaście szczurów przydzielono do grup zależnie od wewnętrznej temperatury ciała (t) ≤ 35,5°C (n = 5), 35,6 ≥ t ≥ 37,5°C (n = 4) oraz t ≥ 37,6°C (n = 4). Pożądaną temperaturę wewnętrzną osiągano podczas czynności poprzedzających rozpoczęcie niedokrwienia. Obecność zawału i jego rozmiar oceniano planimetrycznie. Obszar blizny zawałowej określano jako procent obszaru zagrożonego martwicą (RA). Wyniki. Występowanie blizny zawałowej w ocenie planimetrycznej w grupach zwierząt z temperaturą ≥ 35,6°C było znacząco wyższe (p < 0,01) niż w grupie z temperaturą ≤ 35,5ºC. Wykazano istotną statystycznie pozytywną korelację (r = 0,787; p < 0,01) między IA/RA a wewnętrzną temperaturą ciała szczurów. Wnioski. Nawet niewielkie obniżenie temperatury ciała podczas niedokrwienia i reperfuzji wydaje się korzystne dla zmniejszenia uszkodzenia miokardium. Co więcej, zastosowanie hipotermii ≤ 35,5ºC podczas niedokrwienia i reperfuzji pozwala w pełni zapobiec wystąpieniu obszaru martwicy w sercach szczurzych. Autorzy niniejszej pracy wierzą, że istnieje duża potrzeba poszerzenia badań na temat hipotermii, tak aby metoda ta mogła ostatecznie znaleźć zastosowanie u chorych z ostrym zespołem wieńcowym. Słowa kluczowe: zawał serca w uniesieniem odcinka ST, temperatura ciała, kardioprotekcj

Evaluation and Comparison of the STIMUL Extended and Simplified Risk Scores for Predicting Two-Year Death in Patients Following ST-Segment Elevation Myocardial Infarction

Background and Objectives: The management of ST-segment elevation myocardial infarction (STEMI) requires a patient&rsquo;s long-term risk to be estimated. The objective of this study was to develop extended and simplified models of two-year death risk estimation following STEMI that include and exclude cardiac troponins as prognostic factors and to compare their performance with each other. Materials and Methods: Extended and simplified multivariable logistic regression models were elaborated using 1103 patients with STEMI enrolled and followed up in the STIMUL (ST-segment elevation Myocardial Infarctions in Ukraine and their Lethality) registry. Results: The extended STIMUL risk score includes seven independent risk factors: age; Killip class &ge; II at admission; resuscitated cardiac arrest; non-reperfused infarct-related artery; troponin I &ge; 150.0 ng/L; diabetes mellitus; and history of congestive heart failure. The exclusion of cardiac troponin in the simplified model did not influence the predictive value of each factor. Both models divide patients into low, moderate, and high risk groups with a C-statistic of 0.89 (95% CI 0.84&ndash;0.93; p &lt; 0.001) for the extended STIMUL model and a C-statistic of 0.86 (95% CI 0.83&ndash;0.99; p &lt; 0.001) for the simplified model. However, the addition of the level of troponin I to the model increased its prognostic value by 10.7%. Conclusions: The STIMUL extended and simplified risk estimation models perform well in the prediction of two-year death risk following STEMI. The simplified version may be useful when clinicians do not know the value of cardiac troponins among the population of STEMI patients

Biochemical and clinical evaluation of endothelial injury after distal or traditional transradial access in percutaneous interventions

Background: Distal transradial access (dTRA) has been proposed as an alternative to traditional transradial access (TRA) in cardiac catheterization.Aims: The study aimed to compare these two transradial approaches: TRA and dTRA in terms of clinical and biochemical aspects. Methods: Two hundred patients who qualified for the elective coronary procedure were included. The patients were assigned to one of the groups depending on their vascular access. The groups were compared in terms of perceived pain using the Visual Analogue Scale (VAS), time of gaining access, need for conversion, and local complications. Additionally, in forty patients circulating endothelial injury markers: endothelin 1 (ET-1), interleukin 8 (IL-8), and soluble vascular cell adhesion molecule-1 (sVCAM-1) were assessed.Results: Successful cannulation was obtained in 84 (100%) in the TRA group and in 98 (84%) subjects in the dTRA (P &lt;0.001). dTRA was associated with higher level of pain perceived at the time of gaining vascular approach than TRA; median VAS score (interquartile range [IQR]): 4 (2–5) vs. 2 (2–4) (P = 0.04). The mean time (standard deviation [SD]) needed to cannulate the artery in dTRA was longer than in TRA: 81 (8) seconds vs. 50 (4) seconds (P = 0.04). ET-1 concentration was (SD) 2.08 (0.19) pg/ml [dTRA] vs. 2.00 (0.29) [TRA] pg/ml (P = 0.83); sVCAM-1: 12.71 (3.97) ng/ml vs. 12.86 (4.29) ng/ml (P = 0.98); IL-8: 8.81 (0.42) ng/ml vs. 9.15 (0.52) ng/ml (P = 0.62). Th number of complications after procedures did not differ between these two approaches.Conclusions: Cannulation of dTRA is associated with a lower success rate and higher pain perceived. dTRA is not inferior to TRA when safety issues and vascular injury are considered.

Osoby z wysokim prawidłowym ciśnieniem tętniczym posiadają odmienną charakterystykę metaboliczną i hemodynamiczną względem osób z optymalnym ciśnieniem tętniczym

Background: The ESH classification of blood pressure includes the high-normal blood pressure (HNBP) category, which is within normal limits but associated with increased cardiovascular (CV) risk. Aim: To identify additional CV risk factors and early signs of target organ damage in healthy individuals with HNBP. Methods: Healthy volunteers (n = 74) with optimal blood pressure or HNBP were compared with respect to metabolic and haemodynamic parameters. Results: The HNBP was associated with higher serum uric acid (333.1 &#177; 65.4 vs 267.7 &#177; 65.4 &mu;mol/L, p < 0.05) and glucose (4.7 &#177; 0.3 vs 4.5 &#177; 0.3 mmol/L, p < 0.01) concentrations, intima-media thickness (0.39 &#177; 0.06 vs 0.36 &#177; 0.04 mm, p < 0.05), systemic vascular resistance index (2,678.2 &#177; 955.9 vs 1,930.2 &#177; 625.5 dyn x s x m2/cm5, p < 0.001), lower total arterial compliance index (1.04 &#177; 0.42 vs 1.44 &#177; 0.48 mL/[mm Hg x m2], p < 0.01) and baroreflex sensitivity (14.2 &#177; 3.8 vs 18.0 &#177; 8.8 mm Hg2/Hz, p = 0.05). Conclusions: The observed differences in metabolic and haemodynamic profile in HNBP may adversely affect CV risk in these individuals.Wstęp: Klasyfikacja ciśnienia tętniczego wg ESH wyróżnia ciśnienie &#8222;wysokie prawidłowe&#8220; (HNBP), które mieści się w granicach normy, lecz wiąże się z wyższym ryzykiem sercowo-naczyniowym. Cel: Celem pracy było określenie dodatkowych czynników ryzyka sercowo-naczyniowego i wczesnych zmian narządowych u zdrowych osób z HNBP. Metody: Porównano zdrowych ochotników (n = 74) z ciśnieniem optymalnym lub HNBP pod względem czynników metabolicznych i hemodynamicznych. Wyniki: Osoby z HNBP wykazywały wyższe stężenia kwasu moczowego (333,1 &#177; 65,4 v. 267,7 &#177; 65,4 &#956;mol/l, p < 0,05) i glukozy (4,7 &#177; 0,3 v. 4,5 &#177; 0,3 mmol/l, p < 0,01), wyższy wskaźnik intima-media (0,39 &#177; 0,06 v. 0,36 &#177; 0,04 mm, p < 0,05), wyższy wskaźnik obwodowego oporu naczyniowego (2678,2 &#177; 955,9 v. 1930,2 &#177; 625,5 dyn x s x m2/cm5, p < 0,001) oraz niższy wskaźnik całkowitej podatności naczyniowej (1,04 &#177; 0,42 v. 1,44 &#177; 0,48 ml/[mm Hg x m2], p < 0,01) i niższą czułość odruchu z baroreceptorów (14,2 &#177; 3,8 v. 18,0 &#177; 8,8 mm Hg2/Hz, p = 0,05). Wnioski: Różnice w profilu metabolicznym i hemodynamicznym wykazane u osób z HNBP mogą się wiązać ze zwiększonym ryzykiem sercowo-naczyniowym w tej grupie pacjentów

Gestational Endotheliopathy as Trigger Disorder of Haemodynamics Pregnancy Supply

The idea for this study is based on endothelial-dependent adaptation of hemodynamic circulation in pregnancy. The optimization of the circulatory component of the cardiovascular system (CVS) during pregnancy via blood pressure (BP), especially in physiological pregnancy (PhP), is accompanied by a clear overall increase in systolic characteristics of the pumping function of the heart. This orientation in cardiac output (CO) is unambiguously manifested throughout all three trimesters as with PhP—in a prone and standing position in total according to 24 characteristics out of 24 (P < 0.01), while for gestational endotheliopathy (PaP)—by 18 out of 24 (P < 0.05) clear restructuring of the dynamic organization of the circulatory state according to the anthropophysiological ratio to the hyperkinetic state according to CO in a standing position (type III) was noted with all blood pressure (BP) regimes. If the manifestation of type III under hypotonic, normotonic, and hypertonic regimes in BP was 8, 12, and 6%, respectively, then in the case of PhP, it was 21, 36, and 50%, respectively (P < 0.01), and for PaP, it was 48, 66, and 76% (P < 0.01). Hemodynamically identified heart failure (HF) syndrome, as the earliest preclinical circulatory endothelial-dependent form, is examined as a trigger of formation of perinatal pathology corresponding to preeclampsia

Effect of Chronic Kidney Disease on Changes in Vasopressin System Expression in the Kidney Cortex in Rats with Nephrectomy

It is believed that the vasopressinergic system plays an important role in the pathogenesis of chronic kidney disease (CKD). The aim of this study was to evaluate the effect of CKD on changes in vasopressin system expression in the kidney cortex in rats with nephrectomy. The study was performed on 4 groups of Sprague Dawley (SPRD) rats: a control group (CN), 1/2 nephrectomy (N1/2), 2/3 nephrectomy (N2/3), and 5/6 nephrectomy (N5/6). Blood and the kidney cortex were collected to evaluate plasma copeptin concentrations and mRNA expressions of V1a vasopressin receptors (V1aR) and V2 vasopressin receptors (V2R) and V1aR, V2R, and aquaporin 2 (AQP2) protein levels. V1aR and V2R mRNA expression in the kidney cortex was significantly lower in the CN group compared with the other groups. In contrast, the V1aR, V2R, and AQP2 protein levels were significantly higher in the CN group compared with all of the nephrectomized groups. Plasma copeptin concentration was significantly lower in the CN group than in the nephrectomized groups. CKD caused significant changes in the expression of the vasopressinergic system. Further research is needed to explain the mechanisms of the impact of the vasopressinergic system on the kidney in CKD