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Biomedical subjects

D Dudek

Publications and source records attributed to D Dudek.

At least 19 recordsLinked to original sources
PubMed2004

Comparison of dual-chamber pacing with nonsurgical septal reduction effect in patients with hypertrophic obstructive cardiomyopathy.

OBJECTIVES: The aim of the study was to compare the influence of dual-chamber pacing vs. nonsurgical septal reduction on hemodynamic and morphological parameters in patients with obstructive form of hypertrophic cardiomyopathy. METHODS: Nineteen patients with dual-chamber pacing (group I) and 9 patients who underwent nonsurgical septal reduction (group II) were studied at baseline and after a 6-month follow-up. The changes of left ventricular outflow tract gradient and posterior wall thickness (as an index of left ventricular hypertrophy regression) were compared. RESULTS: The baseline left ventricular outflow tract gradient was comparable between group I and group II (77+/-25 vs. 82+/-25 mm Hg, p>0.05). At 6-month follow-up, the left ventricular outflow tract gradient was reduced to a similar level in both groups (28+/-19 vs. 25+/-12 mm Hg, p>0.05). At baseline, posterior wall hypertrophy was comparable between groups (12.9+/-1.7 vs. 13.6+/-2.2 mm, p>0.05). During follow-up, the posterior wall thickness was unchanged in the pacing group (12.9+/-1.7 vs. 12.6+/-1.6 mm, p>0.05), whereas nonsurgical septal reduction induced regression of left ventricular hypertrophy in myocardial region remote from the infarcted septal segment (13.6+/-2.2 vs. 10.5+/-2.3 mm, p<0.003). CONCLUSION: Despite comparable reduction of instantaneous left ventricular outflow tract gradient, the nonsurgical septal reduction decreased posterior wall thickness, whereas pacing did not reduce left ventricular hypertrophy. Thus, regression of left ventricular hypertrophy that appeared solely after nonsurgical septal reduction may reflect the more permanent reduction of left ventricular pressure overload. Thus, not only hemodynamic but also morphological benefit from nonsurgical septal reduction seems to indicate the superiority of this method over dual-chamber pacing.

Cardiac Pacing, Artificial↗
PubMed2001

Circulating N-terminal brain natriuretic peptide precursor and endothelin levels in patients with syndrome X and left bundle branch block with preserved systolic function.

BACKGROUND: Deterioration of left ventricular function during follow-up was reported in some patients with syndrome X and concomitant left bundle branch block. The patients with syndrome X and left bundle branch block has been frequently presented with elevated Endothelin-1 (ET-1) level while brain natriuretic peptide (BNP) (a sensitive marker of left ventricular dysfunction) has not been measured in patients with syndrome X. METHODS: The purpose of the present study was to assess left ventricular diastolic function, levels of N-terminal Brain Natriuretic Peptide (NT-proBNP) precursor and biochemical parameters of endothelial function in patients with syndrome X complicated by left bundle branch block but preserved left ventricular systolic function (group A, n=8). The echocardiographic and neurohormonal measures in these patients were compared to those in patients with syndrome X without left bundle branch block (group B, n=13), and controls (group C, n=15). RESULTS: At rest and after exercise the serum concentration of NT-proBNP was significantly higher in group A than in the controls (at rest: 232+/-96 vs. 133+/-23 fmol/ml, P=0.03; after exercise: 313+/-96 vs. 180+/-33 fmol/ml, P=0.02). The highest concentration of endothelin-1 was also found in group A, being significantly higher than in the controls (6.81 vs. 4.52 pg/ml, P<0.05). Mitral flow abnormalities were detected in left bundle branch block patients. Accordingly, the lowest E/A ratio was in group A and it differed significantly from that in group C (0.85 vs. 1.1, P<0.05). E/A ratio inversely correlated with plasma NT-proBNP concentration in patients with left bundle branch block (r=-0.48, P=0.02). CONCLUSIONS: Elevated NT-proBNP and endothelin-1 plasma concentrations were demonstrated in patients with syndrome X complicated by left bundle branch block even when left ventricular systolic function was still preserved. In this subgroup the magnitude of left ventricular diastolic dysfunction correlated with the increase of BNP level which reflects neurohormonal activation.

Bundle-Branch Block↗
PubMed2001

[Direct stent implantation under control of intracoronary ultrasonography. Immediate and late results].

UNLABELLED: Stents of a new generation have been developed, permitting immediate implantation without predilatation of the lesion site. Intracoronary ultrasound (ICUS) has been found useful in precise evaluation of stent expansion and in improvement of long-term therapeutic outcomes. The purpose of the study was to evaluate the safety and efficacy of direct stent implantation using intracoronary ultrasound. The study comprised 30 patients (8 women and 22 men) aged below 70 years with stable and unstable angina pectoris. ICUS was performed at baseline before making a decision about direct stent implantation and during the procedure to evaluate stent expansion. Direct stenting was performed in 26 patients achieving an angiographically and clinically optimal result (100% efficacy). In four patients direct stenting was abandoned because of massive calcifications in the affected artery detected by ICUS at baseline. During the 9-month follow-up recurrence of anginal pain requiring repeated intervention was observed in 3 patients (11.5%). CONCLUSIONS: The use of ICUS prior to direct stenting considerably improves the efficacy of the procedure and long-term therapeutic outcomes. Before wide popularisation of direct stenting under ICUS guidance it is necessary to carry out multicentre randomised clinical studies to verify the expected improvement of long-term results as compared with conventional stent implantation with pre-dilatation.

Adult↗
PubMed2001

[Personality patterns in coronary artery disease].

Relation of personality patterns and type A behaviour to the risk and prognosis of coronary artery disease was described. The particular interest of researchers was directed toward hostility, which correlated with the course of coronary artery disease. Finally, therapeutical implications, deriving from the holistic approach to cardiological patients, were proposed.

Coronary Artery Disease↗
PubMed2001

[Restenosis after coronary balloon angioplasty. Prevention and treatment].

The paper describes the mechanisms as well as clinical and angiographic risk factors for the development of restenosis after balloon coronary angioplasty. Based on literature findings and personal experience the ways of preventing restenosis were reviewed taking into account the optimisation of immediate angioplasty results based upon intracoronary ultrasound and physiological measurements of the coronary flow reserve. The paper also reviews the available techniques in the management of restenosis after balloon coronary angioplasty.

Cardiac Surgical Procedures↗
PubMed2001

[Clinical predictors of left ventricular function improvement after percutaneous coronary interventions in patients with ejection fraction below 45%].

BACKGROUND: The value of clinical predictors of left ventricle function recovery after surgical revascularization in patients with decreased ejection fraction is well documented. However, there are no clinical studies assessing factors which can influence left ventricle function in patients with coronary disease and low ejection fraction (LVEF) undergoing percutaneous coronary interventions (PCI). OBJECTIVE: We tried to assess clinical prognostic factors of left ventricle function improvement after PCI in patients with coronary artery disease and impaired LVEF. PATIENTS AND METHODS: We studied patients with LVEF < 45% undergoing PCI. We assessed duration and grade of symptoms of heart failure, angina class and echocardiographic parameters of LV systolic function. After 6 months follow-up LVEF was obtained again. We analyzed influence of baseline clinical factors on LVEF recovery after PCI. RESULTS: We studied 29 patients (mean age 54.4 +/- 11 years) before and after PCI. In the whole group of patients we found significant increase in EF (38.4 +/- 6% vs 50.4 +/- 15%, p = 0.005) at follow up examination. There was significant improvement of EF in patients with NYHA class I or II (from 40.4 +/- 5% to 58.1 +/- 9%, p < 0.0001) as compared to NYHA class III or IV (from 31.4% +/- 9% to 31.8 +/- 11, p = NS). In multivariate regression analysis correlation between NYHA class and LVEF at control examination (beta = -0.54, p = 0.03) was independent from epidemiological variables and baseline LVEF. There was significant increase in LVEF in patients with severe angina (CCS III or IV) as compared to patients without angina (DEF 21.3 +/- 5% vs 7.9 +/- 10%, p = 0.009). There was also higher increase in LVEF in patients with chest pain during balloon inflation (delta EF 17.4 +/- 9% vs 5.7 +/- 9%, p = 0.01). CONCLUSIONS: Mild symptoms of heart failure and independent predictors of left ventricle function recovery after PCI in patients with impaired LVEF. The lack of angina symptoms negatively influence LVEF recovery after PCI.

Adult↗
PubMed2001

[Intracoronary ultrasound assessment of balloon angioplasty with "stent-like' angiographic result].

The aim of the study was to evaluate by intracoronary ultrasound (ICUS) the efficacy of optimal coronary balloon angioplasty (POBA) guided by quantitative coronary angiography (QCA). The study population included 40 patients who underwent conventional coronary balloon angioplasty, in whom a stent-like result was achieved (percent diameter stenosis (%DS) < 35% in QCA). In all patients diagnostic ICUS assessment was performed after the procedure. The site of stenosis and the proximal and distal reference segments were analysed with respect to residual plaque burden (RPB), true vessel dimension (the media-to-media diameter) and type of vascular remodelling. Despite an optimal angiographic result residual plaque burden was 70 +/- 6% at the site of stenosis, whereas in the reference segments it was around 45% indicating the severity of atherosclerosis in angiographically normal vascular segments. No significant differences were seen between averaged reference vessel diameter in QCA (Ref.D) and averaged luminal reference diameter in ICUS. In contrast, true vessel diameter in ICUS was significantly larger than Ref.D in QCA (p < 0.001). Positive vascular remodelling at the site of stenosis was observed in most patients. Optimal angiographic result of QCA-guided POBA does not indicate optimal dilatation of the lesion. In most patients ICUS reveals marked residual plaque burden, which is an independent predictor of restenosis after percutaneous coronary interventions.

Adult↗
PubMed2001

[Clinical outcome in patients after single vessel PTCA with multiple stent implantation].

Multiple stenting in a coronary artery may improve the angiographic result of unsatisfactory percutaneous coronary angioplasty (PTCA) but little is known about its clinical outcome. We evaluated 42 patients who underwent multiple contiguous stent implantation (2-4 stents) within a single coronary artery in order to achieve optimal vessel reconstruction. Procedural success rate was 95%. In-hospital events included myocardial infarction in 2 patients (5%) and acute stent thrombosis in 2 patients (5%). Acute stent thrombosis was successfully treated with repeated PTCA and abciximab infusion. The mean stented segment length was 33.5 +/- 9.9 mm. In 23 patients (54.8%) stents were implanted due to abrupt or threatened artery closure (bailout), in 9 (21.4%) following total chronic artery occlusion and in 10 (23.8%) due to a suboptimal result of angioplasty (i.e. provisional stenting). The bailout stent implantation was most frequent in the left anterior descending artery (15 out of 23 patients, i.e. 65.2%). Long-segment multiple stenting was performed mainly in the right coronary artery to maintain recanalization after the chronic artery occlusion (6 out of 9 patients, i.e. 66.7%). Mean data for all studied patients revealed a significant improvement in the exercise stress test parameters after the procedure (exercise time: 8.5 +/- 3.9 vs. 11.4 +/- 3.5 min, maximal load: 5.4 + 3.0 vs. 7.6 +/- 2.9 METS, percent of the maximal predicted effort 75.5 +/- 10.3 vs. 83.2 +/- 9.2%, p < 0.01 for all). Although the sub-group analysis showed a significant increase in exercise test parameters in patients treated with stent implantation due to the bailout (p < 0.05), the increase did not reach statistical significance in the group of patients who underwent multiple stent implantation to maintain recanalization after chronic artery occlusion or to improve the result of angioplasty. At 14.9 +/- 8.3 months follow-up restenosis was found in 14 (33%) patients. It was successfully treated either with re-PTCA (10 patients, i.e. 23%) or with bypass surgery (4 patients, i.e. 10%). Interestingly, the length of the stented segment was not significantly higher in those patients who developed restenosis. No patient died sustained myocardial infarction or subacute stent thrombosis. We conclude that multiple stent implantation is a safe procedure, with an insignificant complication rate. Best outcome is seen when multiple stent implantation is performed for the left anterior descending artery bailout. Reconstruction of the right coronary artery due to chronic total occlusion usually requires multiple stent implantation. When multiple contiguous stent implantation is performed due to the suboptimal PTCA result, it does not seem to improve the clinical outcome as evaluated by exercise stress test. Although the risk of restenosis is increased, subacute stent thrombosis seems rare with multiple one-vessel stenting.

Angioplasty, Balloon, Coronary↗
PubMed2001

[The assessment of safety of enoxaparin administration during percutaneous transluminal coronary angioplasty after ticlopidine pretreatment. Application of low molecular weigh heparins in prevention of coronary micro-embolization].

BACKGROUND: Administration of enoxaparin to patients with acute coronary syndromes can result in better outcomes in comparison to patients treated with unfractionated heparin. Use of enoxaparin during percutaneous coronary interventions (PCI) can also improve the outcome. Administration of ticlopidine and aspirin for a few days before PCI decreases frequency of ischaemic complications. There is lack of data about safety and efficacy of combined administration of enoxaparin, ticlo-pidine and aspirin during PCI. METHODS: 61 patients with coronary artery disease were involved in the study. All patients were pretreated with aspirin (75-325 mg/d) and ticlopidine (2 x 250 mg) for at least 3 days before PCI. PCI procedures were conducted after i.v. administration of 1 mg/kg of enoxaparin. After PCI bleeding and ischaemic complications were monitored. RESULTS: In the treated group, no major bleeding occurred, while minor bleeding was noted in 6.5% of patients. No periprocedural major adverse cardiac events (death, Q wave infarction, urgent revascularisation) were observed. Microembolisation was present in 4.9% patients (expressed as CK-MB > 3 times the reference level). CONCLUSIONS: Intravenous administration of enoxaparin 1 mg/kg during PCI in patients pretreated with aspirin and ticlopidine for at least 3 days before intervention appears to be safe. Safety and high efficacy of enoxapirine in this pilot trial justify initiating the randomized, multicenter trial comparing use of low molecular weight heparin to unfractionated heparin during PCI.

Administration, Topical↗
PubMed2001

[Therapeutic angiogenesis for coronary artery disease. Contemporary results and perspectives].

Therapeutic angiogenesis is referred to as development of new vasculature caused by various therapeutic measures such as: gene therapy, growth factors, percutaneous and transmyocardial laser revascularization. The scope of the current article is to provide review of performed clinical trials using therapeutic angiogenesis in patients with coronary artery disease.

Angiogenesis Inducing Agents↗
PubMed2001

[Percutaneous renal artery angioplasty--review of current indicators].

The most frequent cause of secondary arterial hypertension is renal artery stenosis. The aetiology of renal artery stenosis is mainly atherosclerotic (75-80%), in the remaining cases fibromuscular dysplasia is the causative factor. Renovascular hypertension has a poorer prognosis than spontaneous because it is more resistant to antihypertensive treatment, signifies an increased risk for the development and progression of malignant hypertension and may lead to irreversible renal dysfunction due to ischaemia. Renal revascularisation has been proved an effective treatment modality in patients with arterial hypertension or renal failure due to renal artery stenosis. However, surgical treatment is associated with the mortality rate of 6-9% due to the concomitant presence of ischaemic heart disease, cerebral and peripheral arteriosclerosis. Percutaneous transluminal renal angioplasty is equally effective in the treatment of arterial hypertension as surgical operation, leading to the improvement or stabilisation of renal function. The advent of renal stenting has markedly changed the efficacy and safety of procedures with PTRA becoming an alternative to surgery. The high efficacy of PTRA is associated with low mortality and relatively few complications as compared with surgical treatment. However, there is continuous discussion concerning the efficacy of percutaneous and surgical renal revascularisation in arterial hypertension. PTRA is currently increasingly frequently recommended in patients with renovascular hypertension not only to control blood pressure but also to protect renal function.

Angioplasty, Balloon↗
PubMed2000

Balloon positioning difficulties during nonsurgical septal reduction therapy in a patient with hypertrophic obstructive cardiomyopathy.

Dual chamber (DDD) pacing and catheter-based nonsurgical septal reduction therapy (NSRT) with ethanol are evaluated for treatment of patients with hypertrophic cardiomyopathy. This report describes a patient with hypertrophic cardiomyopathy and left ventricular outflow tract obstruction who had failed to respond to DDD pacing but showed benefit from subsequent NSRT. Procedural difficulties during NSRT due to massive septal hypertrophy are presented.

Adult↗
PubMed2000

The importance of ventricular septal morphology in the effectiveness of dual chamber pacing in hypertrophic obstructive cardiomyopathy.

It has been reported that older patients with hypertrophic obstructive cardiomyopathy (HOCM) benefited the most from dual chamber (DDD) pacing. Since in older patients the distribution of septal hypertrophy and left ventricular (LV) cavity shape differs from that in younger patients, we decided to study the efficacy of DDD pacing on the reduction of LV outflow tract (LVOT) gradient in different patterns of septal hypertrophy. We compared HOCM patients with nonreversed septal curvature, thus preserving the elliptical LV cavity contour (common in the elderly), (group I) versus patients with reversed septal curvature, deforming the LV cavity to a crescent shape (common in the young), (group II). Eighteen HOCM patients were studied (11 patients in group I and 7 patients in group II). After implantation of a DDD pacemaker, the LVOT gradient was measured using Doppler echocardiography at various programmed AV delay intervals to determine the maximal percentage decrease of LVOT gradient from baseline. The measurement was repeated after at least a 6-month follow-up (chronic DDD pacing). The baseline LVOT gradient was comparable between groups (79 +/- 28 vs 81 +/- 25 mmHg, P = 0.92). The LVOT gradient reduction at acute DDD pacing was significantly greater in group I than group II (61 +/- 18% vs 23 +/- 10%, P = 0.0001). This difference in favor of the patients from group I was maintained at midterm follow-up (69 +/- 17% vs 40 +/- 17% P = 0.0076). In conclusion, patients with normal septal curvature and preserved elliptical LV cavity shape had a greater reduction of LVOT gradient after DDD pacing than patients with reversed septal curvature deforming LV cavity. The proposed criterion assessing the septal curvature may be useful to predict the efficacy of DDD pacing in the reduction of LVOT gradient.

Adult↗
PubMed2000

[Personality and restenosis after percutaneous transluminal coronary angioplasty].

The paper is an attempt to find out which personality traits predispose to increased risk of restenosis in patients after first percutaneous transluminal coronary angioplasty (PTCA). The Eysenck Personality Questionnaire-Revised (EPQ-R) was used in 87 consecutive men (31 persons with university education, 26 secondary, and 20 occupational education; mean age 50 years, range from 32 to 72) on the second day after PTCA. Raw data were used in statistical analysis of EPQ-R. Restenosis was identified in coronary angiography within several weeks to 6 months after PTCA. Restenosis was detected in 25 patients. Groups with and without restenosis were compared with respect to EPQ-R parameters referring to neurotism (14.8 +/- 3.26 vs. 12.4 +/- 5.63; p < 0.01), extroversion (13.7 +/- 3.82 vs. 13.7 +/- 3.95; NS) and psychotism (5.7 +/- 3.20 vs. 7.2 +/- 4.8; p = 0.08). There was positive correlation between the level of neurotism and the frequency of restenosis (logistic regression coefficient = 0.225; OR = 1.252; p = 0.03), but not with age and the level of education. In contrast, psychotism did not correlate significantly with frequency of restenosis. In conclusion, neurotism appears to affect the frequency of restenosis, which means that emotional imbalance through reducing immunity to stress and skills of effective coping with it increases the risk of restenosis. Psychological intervention directed at developing the skills of coping with stress should be a part of the therapy in patients after PTCA.

Adaptation, Psychological↗
PubMed2000

[Sexual dysfunction during treatment of depression].

Sexual dysfunction in depressed patients is an important clinical problem. Its etiology is complex, however pharmacotherapy is one of the most important factors. It is important for therapists to consider effects of antidepressants on sexual functions in planning treatment strategy.

Adult↗
PubMed1999

[Depression in coronary artery disease].

Comorbidity of major depression and cardiac disorders is an important, however undervalued clinical problem. Cardiac mortality in patients with affective disorders is higher in comparison to general population. On the other hand, in people with coronary artery disease coexistence of depressive syndrome significantly worsens mortality rate as well as quality of life. Major depression in cardiological patients is rarely adequately diagnosed and even more seldom treated. It could be suggested that adequate treatment of major depression could improve long-term prognosis in coronary artery disease.

Comorbidity↗
PubMed1998

Successful coronary stent implantation in a patient with primary antiphospholipid syndrome.

We report a 22-year-old man who successfully underwent coronary stent implantation after an acute myocardial infarction. Lupus anticoagulant and antibodies against cardiolipin and prothrombin were detected despite the absence of any underlying disease. Therefore, long-term oral anticoagulation was instituted and appeared to be effective. To our knowledge this is the first report on coronary stenting in primary antiphospholipid syndrome.

Adult↗