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Janina Stepińska

Publications and source records attributed to Janina Stepińska.

18 recordsLinked to original sources
PubMed2006

Influence of pathogenetic factors on prognosis in patients with native valve infective endocarditis.

INTRODUCTION: Despite improvement in medical care the incidence of infective endocarditis (IE) has not decreased. Positive blood cultures are one of the most important diagnostic criteria of IE. There are no uniform data regarding the influence of pathogenetic factors on prognosis. AIM: To analyse the results of blood and valve cultures in patients with IE of native valves and evaluate their influence on the risk of early and late deaths as well as recurrence of IE. METHODS: The study group consisted of 152 patients with IE of native valves. The IE diagnosis was based on the Duke criteria. Early and late mortality as well as recurrence of IE were analysed in patients hospitalised at the Institute of Cardiology in Warsaw from 1988 to 1998. RESULTS: Positive blood cultures were found in 103 (67.8%) of patients. In-hospital mortality was 5.9% (9 deaths). The incidence of early deaths was significantly lower in surgically treated patients (p=0.01). Late deaths occurred in 23 (16%) patients. Results of blood and valve tissue cultures were not related to mortality. Recurrent IE was observed in 7 (4.9%) patients. Staphylococcus aureus was an independent risk factor for recurrent IE (p=0.04). Six-year survival was 79%. CONCLUSIONS: In patients with native valve infective endocarditis: 1. The risk of early and late death is not related to the results of blood and valve cultures. 2. Staphylococcus aureus aetiology increases the risk of disease recurrence. 3. The risk of early death is significantly lower in patients treated with surgery.

Adolescent↗
PubMed2005

[Intravascular hemolysis after multiple valvular replacement procedures--a case report].

A case of an intravascular hemolysis after multiple aortic and mitral valves replacement is described. Hemolysis was observed after second and third operation of mitral valve prosthesis due to prosthesis dysfunction -- paravalvular leak. We discuss the possibilities of treatment, difficulties in decision making in a patient who is in good condition but hemolysis is clinically significant, not amenable to conventional treatment and there is an increased risk of another operation.

Aortic Valve↗
PubMed2005

[Can the BNP be used as a biochemical marker for assessing severity of left ventricular hypertrophy in aortic stenosis?].

UNLABELLED: Plasma natriuretic peptide type B (BNP) concentration increases in aortic stenosis (AS) but relation to severity of left ventricle hypertrophy (LVH) is unknown. We analyze the relation between BNP and the LVH (left ventricle mass index (LVMI)), left ventricle thickness (LVTh) in pts with significant aortic stenosis (AS). MATERIAL AND METHODS: 58 pts with AS (32 male), aged 62 +/- 12, underwent echocardiographic study before aortic valve replacement. BNP level was measured using SHIONORIA BNP test (immunoradiometric method). Results were expressed as a mean (+/- standard deviation). Control group consisted of 26 healthy people. Correlation between BNP level and age, gender, EF, MGA and LVH were also tested. RESULTS: In pts with AS BNP level ranged from 11 to 2010 pg/ml. Mean BNP level was similar in men and women (mean level in whole group 344 +/- 480 pg/ml) and it was higher than in control group (6,1 +/- 3,9 pg/ml). BNP level was related with LVMI (r = 0,42; p<0,001), LVDD (r=0,61; p<0,0001), EF (r = -0,66; p<0,0001 - higher BNP level in lower EF) but not with LVTh (r = -0,08; p = ns), age (r = 0,06; p = ns) and MGA (r = -0,19; p = ns). BNP in 11 pts in eccentric type of hypertrophy was significantly higher (721 +/- 773 pg/ml) then in 47 cases with concentric type of remodeling (256 +/- 337; p = 0,04). CONCLUSIONS: 1. BNP level increased in relation to left ventricle mass index (increase in left ventricle diastolic diameter) but not to wall thickness 2. BNP measurement could potentially be used to monitor left ventricle remodeling in aortic stenosis.

Aged↗
PubMed2005

[Infective endocarditis in a patient with multiple myeloma. A case report].

A case of a 59 year old male with infective endocarditis is presented. Antibiotic therapy seemed effective, however, inflammation laboratory parameters increased two weeks after clinical improvement and body temperature normalisation. Subsequent extensive laboratory investigations revealed multiple myeloma. The patient underwent successful aortic valve replacement and received pharmacological therapy for multiple myeloma. Difficulties in diagnosing and treatment of patients with infective endocarditis who have other concomitant diseases, are discussed.

Diagnosis, Differential↗
PubMed2004

[Infective endocarditis caused by Erysipelothrix rhusiopathiae--case report].

Infective endocarditis (IE) is an infectious disease, which leads to death when is untreated. In most cases IE is caused by typical bacteria. IE caused by atypical bacteria is rare. In this paper, we describe a female patient with IE caused by Erysipelothrix rhusiopathiae (ER). Due to inflammation and leaflets' damage she underwent double-valve implantation (aortic and mitral ones). A long-term antibiotic therapy was given with good outcome. We also describe the organism, types of human diseases caused by ER and treatment options.

Anti-Bacterial Agents↗
PubMed2004

[Plethysmographic assessment of pulse wave may be helpful in the detection of prosthetic valve dysfunction--a case report].

A case of a 63-year-old female with prosthetic mitral and aortic valves is described. The long-term post-operative period was complicated by infective endocarditis, persistent atrial fibrillation requiring pacemaker implantation and total a-v node ablation as well as ischaemic stroke which occurred one year before present hospitalisation. This time the patient was admitted to the hospital due to progressive heart failure. Transesophageal echocardiography showed a cyclic intermittent opening of both prosthetic valves full opening was present during every second cardiac cycle. The same phenomenon was documented using plethysmographic recording of a pulse wave from a finger. The patient underwent prosthetic valve replacement. Intraoperatively, a fibrous tissue ingrowth was detected.

Aortic Valve↗
PubMed2004

Is the assessment of lipid profile performed up to seventy two hours from hospital admission due to acute coronary syndrome still valid?

BACKGROUND: Serum concentration of lipids and lipoproteins changes during the course of acute coronary syndrome (ACS). Total cholesterol and LDL-cholesterol levels decrease. Also HDL-cholesterol and triglyceride levels are not stable. Therefore, it has been suggested that reliable assessment of lipid profile can be performed either during the first 24 hours or after 6 weeks or even 3 months from the onset of ACS. AIM: To examine whether lipid parameters remain stable during the first 72 hours of hospitalisation due to ACS. METHODS: The study group consisted of 84 patients, aged 30-88 years, hospitalised due to ACS, of whom 90% underwent primary percutaneous coronary intervention (PCI). In all patients lipid profile was assessed twice. The first measurement was performed as soon as possible, within 24 hours from hospital admission. The second measurement was obtained within 24 hours from the first sample (group I, n=42), between 24 and 48 hours (group II, n=28), or between 48 and 72 hours (group III, n=15) from the first measurement. Lipid parameters obtained from the first measurement were compared with those obtained during the second assessment. RESULTS: There were no significant differences between lipid parameters measured during the first and second measurement within all three investigated groups nor were there any significant inter-group differences. CONCLUSIONS: Lipid profile assessed within 72 hours from the hospital admission due to ACS is as valid as the measurement performed within the first 24 hours.

Acute Disease↗
PubMed2004

[Favorable reverse remodelling of the left ventricle in elderly patients following aortic valve replacement].

UNLABELLED: Progress of surgical technique and anaesthesia enabled aortic valve replacement in the very elderly patients. However both valvular heart disease and ageing are associated with myocardial fibrosis. It is not known whether reverse remodelling and regression of hypertrophy, observed in the young patients after aortic valve surgery is possible also in the elderly. The aim of the study was to evaluate the changes of left ventricular structure and function in the elderly patients subjected to aortic valve replacement for aortic stenosis. Echocardiographic examinations were performed prior to surgery, approximately 4 weeks after the procedure and after an average of 32 months of follow-up. Left ventricular end-systolic (LVESV) and end-diastolic volumes (LVEDV) and ejection fraction (LVEF) were measured, as well as interventricular septum (IVSD) and posterior wall thickness (PWD). 43 patients over 74 years old (range 74-83), with aortic stenosis and transvalvular aortic gradient of 60-150 mmHg (mean 104 mm Hg), were included in the analysis. 17 patients received biological and 26 mechanical prosthesis. During the long term follow up LVEDV decreased from 143 ml to 114 ml, LVESV from 59 ml to 36 ml and EF increased from 59% to 68% (all p<0.05). Significant regression of left ventricular wall hypertrophy was observed (IVSD from 1.53 cm to 1.32 cm and PWD from 1.4 cm to 1.28 cm, all p<0.05). IN CONCLUSION: the improvement of physical efficiency were observed. Favorable reverse remodelling of the left ventricle is observed also in elderly patients following valve replacement.

Aged↗
PubMed2003

Acute myocardial infarction complicated by cardiogenic shock. In-hospital and mid-term results of invasive treatment in the National Institute of Cardiology, Warsaw-Anin.

BACKGROUND: Mortality in acute myocardial infarction (MI) complicated by cardiogenic shock approaches 90%, regardless of the type of pharmacological treatment. AIM: To assess in-hospital and mid-term results of invasive treatment of patients with acute MI with ST segment elevation (STEMI) complicated by cardiogenic shock. METHODS: From a prospective registry of all patients admitted to our institution for urgent coronary angiography due to acute coronary syndrome between February 2001 and June 2002, patients with STEMI, symptom duration up to 12 hours and cardiogenic shock diagnosed on admission were identified. The in-hospital and mid-term outcome of 37 patients (mean age 65 years, range 54-77, 68% of males) treated with primary percutaneous coronary intervention (PCI) was analysed. RESULTS: Of the 41 patients with STEMI and cardiogenic shock, total occlusion or critical stenosis of a coronary artery were found in 38 patients. One patient with the occlusion of three main coronary arteries underwent urgent surgical revascularisation and remains alive after an 18-month follow-up. In the remaining 37 patients primary PCI of an infarct-related artery was performed (stent implantation in 70%, abciximab administration in 54%) which restored normal blood flow (TIMI grade 3 flow) in 54% of subjects. In patients with TIMI grade 3 flow the in-hospital mortality was 25%. Of the whole PCI-treated group, 18 (48.6%) patients died during stay in our institution, an additional two - after transfer to another hospital, and one - during a 19-month follow-up period. The remaining 16 patients remain alive (median follow-up of 8 months). CONCLUSIONS: Invasive treatment of patients with STEMI complicated by cardiogenic shock significantly reduces mortality in this high-risk population. The mid-term results in patients discharged from hospital are good. Invasive treatment of acute MI should be accessible for all patients with extensive acute MI.

Age Distribution↗
PubMed2003

Early and long-term results of non-surgical septal reduction in patients with hypertrophic cardiomyopathy.

BACKGROUND: Non-surgical septal reduction (NSMR) is a new method of treatment in patients with hypertrophic obstructive cardiomyopathy (HOCM). The long-term outcome of patients undergoing this procedure has not yet been well established. AIM: To assess the short- and long-term results of NSMR in HOCM. METHODS: Early and late (3-year) outcome after NSMR was assessed in 59 and 44 consecutive patients with HOCM, respectively. Control out-patient visits were scheduled 3, 6, and 12 months after NSMR, and annually thereafter. All patients had repeated ECG, echocardiography, 24-hour ambulatory ECG monitoring and spiro-ergometric tests. RESULTS: Left ventricular outflow tract (LVOT) gradient, measured invasively directly after the procedure, decreased from 79.5+/-29.6 to 26.2+/-18.5 mmHg (p<0.0001). A significant LVOT gradient reduction was achieved in 51 (86%) patients. A complete a-v block occurred in 17 (29%) patients, of whom 7 (12%) underwent dual-chamber pacemaker implantation. A significant decrease in exertional dyspnea and angina was observed three months after NSMR (NYHA class reduction from 2.9+/-0.2 to 1.4+/-0.7, p=0.001 and CCS class reduction from 2.3+/-0.3 to 0.5+/-0.7, p=0.001, respectively). Of the 45 patients who were followed for > or =3 years, one patient died due to lung disease whereas no sudden deaths or life-threatening ventricular arrhythmias were observed. LVOT gradient was further reduced, and three years after NMSR disappeared in 35 (59%) patients. A significant improvement in physical capacity was noted (peakVO(2) increased from 14.1+/-3.8 ml/kg/min before NSMR to 23.2+/-6.2 three years later, p=0.02). Favourable LV remodelling was observed, causing LVOT dilatation and an increase in LV diastolic volume. CONCLUSIONS: Because NSMR causes a significant reduction of LVOT gradient, an increase in physical capacity in >80% of patients and the long-term follow-up is uneventful, it may be regarded as an alternative procedure to myectomy in the treatment of patients with HOCM.

Cardiomyopathy, Hypertrophic↗
PubMed2002

Calcium blocker therapy before myocardial infarction increases post-infarction short- and long-term mortality. Data from the INJECT trial.

BACKGROUND: Short-acting calcium channel blockers (Ca-blockers) have been shown in some studies to increase the risk of myocardial infarction (MI) and post-MI complications. Data from large, international, randomised studies such as the INJECT trial may bring new important information on the effects of medication used before MI, on the course of MI and post-MI complications. AIM: To assess the effects of beta-blocker and Ca-blocker therapy administered prior to MI on the early and late outcome after MI. METHODS: The study group consisted of 6001 patients with acute MI treated according to the INJECT protocol. The patients were divided into four groups according to the type of treatment before the index MI: Group I (n=580) - patients treated with beta-blockers; Group II (n=831) - patients treated with Ca-blockers; Group III (n=277) - patients treated with both beta-blockers and Ca-blockers; and Group IV (n=4313) - no beta-blocker or Ca-blocker treatment. The analysed end-points were 35- and 180-day mortality as well as angina recurrences, occurrence of heart failure, atrial fibrillation/flutter and asystole. RESULTS: During hospital stay, supraventricular arrhythmias, asystole, recurrent ischaemia and heart failure occurred more frequently in patients from groups II and III than in other groups. Early mortality was significantly higher in group II (p<0.001) and group III (p<0.002) than in group IV. Late mortality was the lowest in group IV, followed by group I. Cox proportional hazards multivariable analysis revealed that hypotension, Killip class IV (p<0.001), previous Ca-blocker (p<0.01) or Ca- and beta-blocker treatment (p<0.01) as well as previous MI (p<0.05) were the independent predictors of death. CONCLUSIONS: Compared with beta-blocker therapy or no treatment, previous use of Ca-blockers increases both early and long-term complication rates in patients with MI.

Journal Article↗
PubMed2002

[Benign tumour of aortic valve in a patient with tight aortic stenosis - a case report].

A case of 58-year-old male with aortic stenosis who was admitted due to chest pain suggesting acute myocardial infarction, is presented. Transthoracic and transesophageal echocardiography revealed the presence of aortic valve tumour and the patient underwent successful surgery. Symptomatology and treatment of cardiac tumours are discussed.

English Abstract↗