DOMINANCE OF CORONARY ARTERY DISEASE AMONG PATIENTS WITH ANEURYSM OF ABDOMINAL AORTA

Persons with aneurysm of the abdominal aorta have high prevalence of risk factors of cardiovascular disease. It cannot be stated with certainty whether these persons die in a large number due to the existence of risk factors or the genesis and complications of aneurysm itself. In patients with aneurysm of the abdominal aorta, there is a high correlation with the coronary artery disease; therefore, the aim of the study was to prove whether or not this is the case. The patients in preparation for the resection of the abdominal aorta aneurysm at the Institute of Cardiovascular Disease underwent the examination. The study included 377 examinees, of whom 341 males and 36 females, aged 45 to 83 years, during the three-year interval (from 2004 to 2006). The aim of the study was to determine the dominance of the coronary artery disease among the patients with aneurysm of the abdominal aorta. In the process of analyzing the data obtained from patients and medical evidence, it was found out that a large number of the abdominal aortic aneurysm patients were at the same time the coronary artery disease patients (55,2%; Hi=15,04; p<0,05). A large number of those who still have some other risk factors for the genesis of the disease belonged to the same group. Of the total patient number with the coronary artery disease, the percentage of males was larger (85%). The number of smokers with the coronary artery disease was larger (60%), while the number of former smokers (28%) was almost equal to the number of non-smokers (12%). The number of patients with increased body mass (>80 kg) was larger, as well as the percentage of patients with hypertension (89%) and increased levels of cholesterol and triglycerides (67%). There was a great number of those with the inherited factor (40%). It has been proven that the risk factors for the development of coronary artery disease are in direct association with the risk factors for the abdominal aortic aneurysm. Also, there is a great predominance of the coronary artery disease among the patients with aneurysm of the abdominal aorta. The coronary artery disease is one of the main risk factors. If we managed to prevent the appearance of this disease or achieve the timely diagnosing of it and eventual curing, we would be able to decrease the development of the abdominal aortic aneurysm well as the consequences and further complications

Histamine Blood Concentration in Ischemic Heart Disease Patients

The aim of this study was to investigate histamine blood concentration in subjects suffering from different types of ischemic heart diseases during the period of eight days. Our results showed that the histamine blood level was associated with different types of ischemic heart diseases. The blood histamine level in all investigated patients was significantly higher when compared to control subjects (44.87 ± 1.09 ng mL−1), indicating the increase of histamine release in patients suffering from coronary diseases. In patients suffering from ACS-UA and ACS-STEMI, the second day peak of histamine level occurs (90.85 ± 6.34 ng mL−1 and 121.7 ± 6.34 ng mL−1, resp.) probably as the reperfusion event. Furthermore, our data suggest that histamine can be additional parameter of myocardial ischemia along with cardiac specific enzymes and may prove to be an excellent single prognostic marker for multitude of ischemic heart diseases

The importance of combined NGS and MLPA genetic tests for differential diagnosis of maturity onset diabetes of the young

Introduction: Maturity onset diabetes of the young (MODY) is a rare form of monogenic diabetes. Being clinically and genetically heterogeneous, it is often misdiagnosed as type 1 or type 2 diabetes, leading to inappropriate therapy. MODY is caused by a single gene mutation. Thirteen genes, defining 13 subtypes, have been identified to cause MODY. A correct diagnosis is important for the right therapy, prognosis, and genetic counselling.Material and methods: Twenty-nine unrelated paediatric patients clinically suspected of having MODY diabetes were analysed using TruSight One panel for next-generation sequencing (NGS) and multiplex ligation-dependent probe amplification (MLPA) assay.Results: In this study we identified variants in MODY genes in 22 out of 29 patients (75.9%). Using two genetic tests, NGS and MLPA, we detected both single nucleotide variants and large deletions in patients. Most of the patients harboured a variant in the GCK gene (11/22), followed by HNF1B (5/22). The rest of the variants were found in the NEUROD1 and HNF1A genes. We identified one novel variant in the GCK gene: c.596T&gt;C, p.Val199Ala. The applied genetic tests excluded the suspected diagnosis of MODY in two patients and revealed variants in other genes possibly associated with the patient’s clinical phenotype.Conclusions: In our group of MODY patients most variants were found in the GCK gene, followed by variants in HNF1B, NEUROD1, and HNF1A genes. The combined NGS and MLPA-based genetic tests presented a comprehensive approach for analysing patients with suspected MODY diabetes and provided a successful differential diagnosis of MODY subtypes

Znaczenie stężenia NT-proBNP w określaniu rokowania i ocenie diagnostycznej u chorych z ostrymi zespołami wieńcowymi

Background and aim: N terminal-proB-type natriuretic peptide (NT-proBNP) is synthesised and secreted from the ventricularmyocardium. This marker is known to be elevated in patients with acute coronary syndromes (ACS). We evaluated NT-proBNP asa significant diagnostic marker and an important independent predictor of short-term mortality (one month) in patients with ACS.Methods: NT-proBNP and cardiac troponin I (cTI) were assessed in 134 consecutive patients (median age 66 years, 73% male)hospitalised for ACS in a cardiological university department. The patients were classified into ST-elevation ACS (STE-ACS, n = 74) and non-ST-elevation ACS (NSTE-ACS, n = 60) groups based on the ECG findings on admission. Patients with Killipclass ≥ II were excluded.Results: The serum level of NT-proBNP on admission was significantly higher (p &lt; 0.0005), while there was no differencein cTI serum level in the NSTE-ACS patients compared to STE-ACS patients. There was a significant positive correlation betweenNT-proBNP and cTI in the NSTE-ACS (r = 0.338, p = 0.008) and STE-ACS (r = 0.441, p &lt; 0.0005) patients. Therewas a significant difference in NT-proBNP (p &lt; 0.0005) and cTI (p &lt; 0.0005) serum level between ACS patients who diedwithin 30 days or who survived after one month. The increased NT-proBNP level is the strongest predictor of mortality in ACSpatients, also NT-proBNP cut-point level of 1,490 pg/mL is a significant independent predictor of mortality.Conclusions: We demonstrated the differences and the correlation in the secretion of NT-proBNP and cTI in patients withSTE-ACS vs. NSTE-ACS. Our results provide evidence that NT-proBNP is a significant diagnostic marker and an importantindependent predictor of short-term mortality in patients with ACS.Wstęp i cel: N-końcowy fragment propeptydu natriuretycznego typu B (NT-proBNP) jest syntetyzowany i wydzielany przezmiokardium komór serca. Wiadomo, że stężenie tego wskaźnika jest podwyższone u chorych z ostrymi zespołami wieńcowymi (ACS). Autorzy ocenili znaczenie stężenia NT-proBNP jako istotnego wskaźnika diagnostycznego i ważnego niezależnegoczynnika prognostycznego śmiertelności krótkoterminowej (w ciągu 1 miesiąca) u chorych z ACS.Metody: Oznaczono stężenia NT-proBNP i sercowej troponiny I (cTI) u 134 kolejnych chorych (mediana wieku 66 lat, 73%mężczyzn) hospitalizowanych z powodu ACS na oddziale kardiologicznym szpitala uniwersyteckiego. Pacjentów przydzielanodo grupy ACS z uniesieniem odcinka ST (STE-ACS, n = 74) lub do grupy ACS bez uniesienia odcinka ST (NSTE-ACS, n = 60)na podstawie EKG wykonanego przy przyjęciu. Chorych w klasie Killipa ≥ II wykluczono z badania.Wyniki: Stężenie NT-proBNP w surowicy przy przyjęciu do szpitala było istotnie wyższe (p &lt; 0,0005) u pacjentów z NSTE--ACS niż u osób z STE-ACS, natomiast surowicze stężenia cTI były podobne w obu grupach. Stwierdzono istotną dodatniąkorelację między stężeniami NT-proBNP i cTI u chorych z NSTE-ACS (r = 0,338; p = 0,008) i u osób z STE-ACS (r = 0,441;p &lt; 0,0005). Stężenia NT-proBNP (p &lt; 0,0005) i cTI (p &lt; 0,0005) w surowicy różniły się istotnie między chorymi z ACS,którzy zmarli w ciągu 30 dni, a pacjentami, którzy żyli dłużej niż miesiąc. Zwiększone stężenie NT-proBNP jest najsilniejszymczynnikiem prognostycznym zgonu u chorych z ACS. Ponadto stężenie NT-proBNP powyżej progowej wartości 1490 pg/mL jest istotnym niezależnym czynnikiem prognostycznym zgonu.Wnioski: Autorzy wykazali różnice w wydzielaniu NT-proBNP i cTI między chorymi ze STE-ACS i chorymi z NSTE-ACS orazkorelacje między tymi wskaźnikami. Uzyskane przez nich wyniki dowodzą, że NT-proBNP jest istotnym niezależnym wskaźnikiemdiagnostycznym i ważnym niezależnym czynnikiem prognostycznym śmiertelności krótkoterminowej u chorych z ACS

Cardiac Magnetic Resonance in Hypertensive Heart Disease: Time for a New Chapter

Hypertension is one of the most important cardiovascular risk factors, associated with significant morbidity and mortality. Chronic high blood pressure leads to various structural and functional changes in the myocardium. Different sophisticated imaging methods are developed to properly estimate the severity of the disease and to prevent possible complications. Cardiac magnetic resonance can provide a comprehensive assessment of patients with hypertensive heart disease, including accurate and reproducible measurement of left and right ventricle volumes and function, tissue characterization, and scar quantification. It is important in the proper evaluation of different left ventricle hypertrophy patterns to estimate the presence and severity of myocardial fibrosis, as well as to give more information about the benefits of different therapeutic modalities. Hypertensive heart disease often manifests as a subclinical condition, giving exceptional value to cardiac magnetic resonance as an imaging modality capable to detect subtle changes. In this article, we are giving a comprehensive review of all the possibilities of cardiac magnetic resonance in patients with hypertensive heart disease

Cardiac Magnetic Resonance in Hypertensive Heart Disease: Time for a New Chapter

Hypertension is one of the most important cardiovascular risk factors, associated with significant morbidity and mortality. Chronic high blood pressure leads to various structural and functional changes in the myocardium. Different sophisticated imaging methods are developed to properly estimate the severity of the disease and to prevent possible complications. Cardiac magnetic resonance can provide a comprehensive assessment of patients with hypertensive heart disease, including accurate and reproducible measurement of left and right ventricle volumes and function, tissue characterization, and scar quantification. It is important in the proper evaluation of different left ventricle hypertrophy patterns to estimate the presence and severity of myocardial fibrosis, as well as to give more information about the benefits of different therapeutic modalities. Hypertensive heart disease often manifests as a subclinical condition, giving exceptional value to cardiac magnetic resonance as an imaging modality capable to detect subtle changes. In this article, we are giving a comprehensive review of all the possibilities of cardiac magnetic resonance in patients with hypertensive heart disease

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P &lt; 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)