PubMed Health⌕ Search

Biomedical subjects

Piotr Pieniazek

Publications and source records attributed to Piotr Pieniazek.

At least 19 recordsLinked to original sources
PubMed2006

Diagnostic value of carotid intima-media thickness in indicating multi-level atherosclerosis.

UNLABELLED: Carotid intima-media thickness (CIMT) is an indicator of atherosclerosis, but its association with multi-level involvement is sparsely investigated. Study aimed to examine interrelation between CIMT and number of arterial territories with significant (>50%) stenoses, including coronary, supraaortic, renal and iliac/femoral arteries. METHODS AND RESULTS: Study formed 415 patients (294 men), aged 62.9+/-9.3 years referred to coronary angiography. CIMT assessment was performed in common, bulb and internal carotid segments, and expressed as the mean aggregate value. In all patients, both coronary, renal angiography and supraaortic, iliac/femoral arteries ultrasound was performed. Group I formed 102 patients without significant lesions in any of investigated territories; group II formed 131 patients with single territory; group III formed 102 patients with two territory and group IV formed 80 patients with three to four territory involvements. CIMT correlated with increasing number of involved territories (r=0.751, p<0.001). Aggregate CIMT, previous myocardial infarction, creatinine level, hypertension, hs-CRP, smoking were independent predictors of multi-level involvement (p<0.001, R=0.768). ROC curves showed that CIMT cut-off value of 1.308 mm could distinguish 0-1 from two to three level involvement with sensitivity of 81.6%, specificity 88.8%, PPV 85.1%, NPV 86.3% (odds ratio 35.9, range 20-65). CONCLUSIONS: CIMT increases with number of involved territories. CIMT is an independent predictor of significant multi-level atherosclerosis, showing high sensitivity and specificity for indicating more advanced territorial atherosclerotic involvement.

Adult↗
PubMed2006

Determinants of immediate and long-term results of subclavian and innominate artery angioplasty.

BACKGROUND: Percutaneous angioplasty (PTA) is widely used in the treatment of subclavian/innominate artery obstruction, but factors of long-term PTA outcome are poorly understood. Our aim was to evaluate the efficiency of PTA on symptom resolution and identify determinants of long-term outcome. METHODS AND RESULTS: Seventy-six lesions were treated in 75 patients (58.7% men) aged 60 +/- 8.5 years. PTA was successful in 70 (93.3%) patients, including 58/58 (100%) stenotic lesions and 13/18 (72.2%) occlusions. The mean stenosis grade (QCA) was reduced from 78.9% +/- 16.6% to 13.5% +/- 10.7% (P < 0.01). A great majority of lesions (87.1%) were stented. In 5 (7.1%) high-risk lesions a proximal or distal neuroprotection system was used. There were no strokes or embolic events. Minor complications occurred in 7 (9.3%) cases. Fifty-seven (89%) of 64 symptomatic patients had complete symptom resolution. The mean follow-up was 24.4 +/- 15.5 months (up to 66 months). Ten restenoses (15.6%), including 9 (13.8%) in-stent restenoses and 1 (16.7%) restenosis after balloon angioplasty, were diagnosed in 64 patients and followed up for at least 6 months. Nine symptomatic restenoses were successfully treated with repeated angioplasty. Cox multivariable analysis revealed the following independent predictors of restenosis: implantation of more than one stent (P = 0.005), low stent diameter (P = 0.088), and postprocedural systolic blood pressure difference between upper extremities (P = 0.044). CONCLUSIONS: PTA is a safe and effective method for the treatment of the subclavian/innominate artery obstruction and leads to symptom resolution in majority of patients. Restenosis is not frequent and it can be effectively treated with repeat angioplasty. Low stent diameter, implantation of two stents, and upper limb systolic blood pressure difference are independent predictors of restenosis.

Adult↗
PubMed2006

Assessment of flow changes in the circle of Willis after stenting for severe internal carotid artery stenosis.

PURPOSE: To assess flow velocities in the cerebral arteries after carotid artery stenting (CAS) in patients with unilateral versus bilateral lesions and analyze velocities in patients with neurological complications after CAS. METHODS: Ninety-two patients (68 men; mean age 63.2 +/- 8.4 years, range 44-82) with internal carotid artery (ICA) stenoses were divided according to unilateral (group I, n = 72) or bilateral (group II, n = 20) disease. Fifty age- and gender-matched patients without lesions in the extra- or intracranial arteries served as a control group. Transcranial color-coded Doppler ultrasound was performed prior to and within 24 hours after CAS in the test groups; systolic velocities were assessed ipsilateral (i) and contralateral (c) to the CAS site in the middle cerebral artery (MCA) and anterior cerebral artery (ACA). RESULTS: Collateral flow via the anterior communicating artery (ACoA) was found in all group-II patients and 90% of group-I patients. After CAS, collateral flow through the ACoA ceased, and the velocity increased by 26% in the iMCA in group I compared to controls (p < 0.001). In group II, iMCA flow increased by 30% (p < 0.001) and flow via the ACoA (p < 0.001) increased, resulting in normalization of cMCA velocities (p = 0.928). In 89 (96.7%) subjects, CAS was uncomplicated. Hyperperfusion syndrome occurred in 2 (2.2%) patients, both with bilateral ICA stenoses; 1 (1.1%) transient ischemic attack was seen in a patient with unilateral disease. In the patients with hyperperfusion syndrome, the MCA velocities were 2.7- and 7.4-fold higher, respectively, versus before CAS and 2-fold higher than in controls. CONCLUSION: Uncomplicated CAS results in an iMCA velocity increase >25% compared to controls. MCA velocities in hyperperfusion syndrome were greatly increased versus before CAS and in controls.

Adult↗
PubMed2006

Transcoronary stem cell delivery using physiological endothelium-targeting perfusion technique: the rationale and a pilot study involving a comparison with conventional over-the-wire balloon coronary occlusions in patients after recent myocardial infarction.

INTRODUCTION: Recent evidence shows poor efficacy of over-the-wire balloon catheter (OTW) coronary occlusive technique adopted widely for intracoronary bone marrow stem cell (BMSC) delivery. The waterfall effect of OTW-balloon inflation/deflation with reactive > or = 2-fold flow velocity increase might be partly responsible for poor BMSC retention. AIM: To evaluate the safety, feasibility and tolerability of perfusion-infusion BMSC delivery with the facilitation of cell rolling in contact with the coronary endothelium (a pre-requisite for downstream transmigration). METHODS: We randomly assigned 11 patients (age 41-72 years) with first anterior myocardial infarction treated with PTCA+stent and LVEF < or =45% at 6-9 days to OTW in-stent occlusive (3 x 3 min.) BMSC delivery or cell infusion via a perfusion catheter with multiple side holes (SH-PC). RESULTS: OTW and SH-PC patients had a similar infarct size (mean peak CK 4361 vs 4717 U/L), LVEF (41.2% vs 40.3%), infused mononuclear cell number (2.99 x 108 range 0.61-7.48 x 108 vs 3.28 x 108 range 1.64-4.39 x 108), CD 34(+) number (1.79 x 106 vs 1.62 x 106), cell viability (91.5% vs 91.8%) and clonogenicity (CFU assay). None of the SH-PC, but 67% of OTW patients, had ST-segment elevation with chest pain (and nsVT in one) that limited OTW occlusion tolerance to 50-110 sec. At 6 months DLVEF in the OTW vs SH-PC patients was +4.2% (2-6) vs +8.8% (5-16) by MRI and +4.8 (2-7) vs +13.8% (2-24) by SPECT. CONCLUSIONS: Our work indicates that the SH-PC technique can be used safely for intracoronary BMSC transplantation. Further research is needed to determine whether the putative advantages of physiological SH-PC delivery translate into enhanced BMSC homing.

Adult↗
PubMed2006

[Alcohol ablation of the interventricular septum in a patient with hypertrophic obstructive cardiomyopathy complicated by an increase in the pressure gradient in the left ventricular outflow tract. A case report].

A case of a 70 year old female with hypertrophic obstructive cardiomyopathy who underwent alcohol ablation of the interventricular septum, is presented. Following the procedure, the pressure gradient decreased from 120 mmHg to 80 mmHg. However, 30 minutes after ablation the patients developed hypotension and pulmonary oedema. Echocardiography revealed a significant systolic anterior movement of the anterior leaflet of the mitral valve and elevated pressure gradient up to 200 mmHg. The patient underwent urgent surgery (myectomy), followed by the mitral valve replacement with a favourable outcome.

Aged↗
PubMed2005

Gender differences in carotid intima-media thickness in patients with suspected coronary artery disease.

Selecting patients who have suspected coronary artery disease (CAD) for coronary angiography remains difficult in some subgroups (e.g., women have often atypical symptoms and false-positive findings on noninvasive tests). This study evaluated gender differences and the clinical value of carotid intima-media thickness (IMT) in predicting CAD. We evaluated 558 patients who had symptoms and underwent coronary angiography: 91 women (61.2 +/- 9.5 years of age) had CAD (> or =1 lesion with a decrease >50% in luminal diameter of a coronary artery), 29 women (57.9 +/- 7.0 years of age) did not have CAD, 372 men (58.9 +/- 9.2 years of age) had CAD, and 66 men (54.6 +/- 8.7 years of age) did not have CAD. Maximal IMT was assessed bilaterally at the common carotid, bulb, and internal carotid arteries and expressed as mean IMT for each patient. Among patients who did not have CAD, women had lower mean IMT values than men (0.93 +/- 0.15 vs 1.05 +/- 0.19, p < 0.001). This gender difference was not seen in patients who had CAD (1.3 +/- 0.31 vs 1.31 +/- 0.31, p = 0.92). Among women and men, those with CAD had larger IMT values than those without CAD. Multivariable regression analysis showed that age, CAD, hypertension, smoking, and diabetes had the strongest effect on IMT values in women and men. Receiver-operator characteristic analysis showed that women had a significantly lower IMT threshold for likelihood of CAD (p < 0.001) and that a mean IMT of 1.069 mm was highly predictive of concomitant CAD (sensitivity 79%, specificity 90%, positive predictive value 96%); for men, the mean IMT threshold was 1.153 mm (sensitivity 66%, specificity 74%, positive predictive value 93%). In conclusion, carotid IMT assessment may be a valuable tool in selecting patients for coronary angiography to predict the likelihood of CAD. This particularly concerns women in whom sensitivity and specificity of mean IMT are high.

Adult↗
PubMed2005

Evaluation of cerebral circulation in patients with significant carotid artery stenosis.

BACKGROUND: A significant proportion of ischaemic stroke episodes are caused by atherosclerotic lesions in extracranial arteries. Assessment of haemodynamical profile of cerebral arteries in both symptomatic and asymptomatic patients with carotid artery stenosis is of clinical importance. AIM: To assess haemodynamic changes in cerebral arteries in patients with significant internal carotid artery (ICA) stenosis. METHOD: Patients (n=109) were divided into the following groups: group I (GI) - 42 subjects (64.6+/-9.0 years) with asymptomatic ICA stenosis > or =70%; and group II (GII) - 67 subjects (63.4+/-7.1 years) after stroke. The control group consisted of 30 patients (60.3+/-8.9 years) without significant stenoses of extracranial arteries on USG and angiography. In all cases ultrasonographic evaluation of flow velocities and directions in cerebral arteries within the circle of Willis and collateral flow was performed. RESULTS: The severity of ICA stenosis did not differ significantly between GI and GII. Patients in GI had flow velocity in the middle cerebral artery (MCA) increased by 15.7% and by 40.8% in the anterior cerebral artery (ACA) contralateral to the ICA stenosis (p<0.001 and p<0.001), whereas in GII no significant changes in flow velocity in these arteries were observed in comparison with the control group. Patients in the groups I and II had lower flow velocities in MCA ipsilateral to the ICA stenosis, however values for GII patients were significantly lower than in GI patients (p<0.001). The presence of collateral circulation through the anterior and posterior communicating arteries (ACoA and PCoA) was similar in GI and GII; however, the flow velocities in the ipsilateral MCA and ACA were significantly higher in asymptomatic patients (GI). The frequency of active collateral circulation through both ACoA and PCoA increased along with the increase of ICA stenosis severity (p=0.003; p<0.001). CONCLUSIONS: Collateral flow in the circle of Willis in subjects with ICA stenosis occurs equally often in symptomatic and asymptomatic patients; however, it is more efficient in patients without symptoms. The rate of development of collateral circulation depends on ICA stenosis severity. The important role in maintaining collaterals within the circle of Willis is played by ACoA, although in some patients MCA may also be supplied by PCoA.

Adult↗
PubMed2005

[Systolic and diastolic left ventricle function assessment by tissue Doppler echocardiography in patients with perfusion defects in SPECT study].

INTRODUCTION: Tissue Doppler imaging (TDI) facilitates the quantitative assessment of the regional systolic and diastolic left ventricle function. Heart scintigraphy (SPECT) facilitates the assessment of regional perfusion of the myocardium. The aim of the study was the evaluation of the correlation between the regional myocardial perfusion defects observed in the SPECT study and the regional systolic and diastolic left ventricle function observed in TDI examination in the ischaemic heart disease patients. MATERIAL AND METHODS: In 40 patients (33 men and 7 women) aged 43-74 years (mean age 56 years) diagnosed of ischaemic heart disease on the basis of coronary angiography, rest TDI examination was performed. Maximal systolic and maximal early-diastolic myocardial velocities were assessed in 13 myocardial segments of the left ventricle, supplied by respective coronary arteries (left anterior descending artery--LAD, circumflex artery--Cx, right coronary artery--RCA). During rest and exercise perfusion scintigraphy of the heart (Tc99 MIBI SPECT) myocardial perfusion was evaluated in the segments analysed previously during TDI study. On the basis of the SPECT examination results the patients were divided into three groups: group I) patients with fixed perfusion defects, group II) patients with exercise-induced perfusion defects and normal rest perfusion, group III) patients with normal perfusion during rest and exercise. RESULTS: Systolic and diastolic myocardial velocity in LAD and Cx supplied segments were significantly higher in group II and group III as compared with group I. Systolic and diastolic velocities of myocardium supplied by LAD were significantly lower in group II as compared with group III. In Cx supplied region the diastolic myocardial velocity was significantly lower in group II as compared with group Ill. CONCLUSIONS: In the left ventricle myocardial regions with fixed perfusion defects, statistically significant decrease of systolic and diastolic myocardial velocities was observed. Moreover, the decrease of diastolic myocardial velocity in the rest TDI examination was found in patients with normal rest perfusion and exercise-induced perfusion defects.

Adult↗
PubMed2004

Detection of microvascular injury by evaluating epicardial blood flow in early reperfusion following primary angioplasty.

BACKGROUND: In a significant proportion of patients with acute myocardial infarction (AMI), successful opening of the infarct related artery (IRA) does not translate into adequate perfusion at the tissue level. We hypothesised that deterioration of epicardial blood flow in early reperfusion may identify early signs of coronary microvascular injury. METHODS: In 272 consecutive patients (age 56.9+/-10.4 years) with AMI treated by primary angioplasty (PCI), coronary blood flow (Trombolysis in Myocardial Infarction (TIMI) scale and corrected TIMI frame count (cTFC)) was evaluated before [B], immediately after [O] and 15 min after [O15] opening of the IRA. The sum of ST-segment elevation in standard ECG leads (sigmaST) was measured at [B], at [O15] and 24 h after [C24]. Microvascular injury was assessed by indexes STi(O15)=sigmaST(O15)/sigmaST(B), STi(C24)=sigmaST(C24)/sigmaST(B), and by peak CK-MB release. Coronary flow deterioration (cTFC(DET)) was defined as the difference between cTFC(O15) and cTFC(O). RESULTS: TIMI-3 flow was achieved in 236 (90.8%) patients at [O]. In the early phase of reperfusion (between [O] and [O15]), TIMI flow deteriorated by >/=1 point in 19 (7.3%) patients despite angiographic optimisation of the PCI result. At [O15] 224 (86.2%) patients had TIMI-3 flow (reflow), 36 (13.8%) patients had TIMI</=2 flow (no-reflow). cTFC(DET) was 30.2+/-16.5 in the no-reflow group but only 7.5+/-4.0 in the reflow group (p<0.001). cTFC(DET) showed a significant correlation with STi(O15) (r=0.63; p<0.001), STi(C24) (r=0.62; p<0.001) and peak CK-MB (r=0.36; p=0.001). In conclusion, we found that an increase in corrected TIMI frame count following successful IRA opening in AMI is an early angiographic indicator of coronary microvascular injury.

Adult↗
PubMed2004

Use of the Parodi Anti-Emboli System and transient subclavian steal for cerebral protection during emergent vertebral artery recanalization.

PURPOSE: To report the use of the Parodi Anti-Emboli System (PAES) for cerebral protection during emergent vertebral artery recanalization. CASE REPORT: A 56-year-old chimney sweep was referred with recurrent episodes of vertigo and gait ataxia. Left vertebral artery (LVA) flow was barely detectable on duplex Doppler, and brain computed tomography revealed a small infarct in the posterior inferior cerebellar artery territory. Angiography showed subtotal ostial stenosis of the LVA with poor distal flow and possible thrombus. Due to a high risk of distal embolization with percutaneous treatment, anticoagulation was initiated, and the lesion was to be re-evaluated in 2 to 3 weeks. However, 2 days later, the patient developed severe, aggravating headache, gait and left-limb ataxia, horizontal nystagmus, and vomiting. Emergent angiography showed a total ostial LVA occlusion. The PAES was employed to elicit a temporary subclavian steal during percutaneous LVA recanalization, thus protecting the brain from embolization. The ostial LVA was successfully recanalized and stented, with immediate symptom cessation. CONCLUSIONS: The PAES can be successfully applied in the subclavian artery to prevent distal embolization during emergent vertebral artery recanalization. Since a significant proportion of vertebral strokes are embolic, PAES may play a novel role in the treatment of acute cerebellar stroke.

Angioplasty, Balloon↗
PubMed2004

[Morphology and location of atherosclerotic lesions in coronary vessels depending on gender and age].

Coronary artery disease is a major social problem. However, its epidemiology, pathophysiology, clinical course, diagnostic efficiency and therapeutic potential differ significantly with regard to gender and age. There are few comparative data available on morphological differences and immediate results of direct percutaneous interventions, aorto-coronary bypass grafting, complication rate, risk factors for developing complications after invasive procedures in CAD patients of both sexes and in various age groups. The aim of the study was to identify differences in the location and morphology of coronary plaque and left ventricular function in CAD patients with regard to gender and age. The study included consecutive patients with coronary artery disease diagnosed and treated in the Department of Hemodynamics and Angiocardiography Jagiellonian University Medical College from June 1997 to June 1998. Coronary angiography group, consisting of 1374 patients, 1004 men (73.1%) and 370 women (26.9%), of whom 1146 (83.4%), 890 men (77.7%) and 256 women (22.3%), were included in the final morphological and clinical analysis and in whom coronary angiography confirmed the presence of coronary plaque. The subgroups were further subdivided into two age groups: below and over 50 years of age. Clinical, angiographic and hemodynamic data were analysed retrospectively. Analysis revealed that among patients after invasive diagnosis because of suspected coronary artery disease atherosclerotic lesions in epicardial coronary vessels were significantly more frequently confirmed in men. In patients of both sexes the proportion of patients with angiographically confirmed lesions rises with age. In patients with angiographically documented coronary artery diseases the location and morphology of stenosis in epicardial coronary vessels differs between sexes in the corresponding age groups. Left ventricular function is better preserved in women.

Adult↗
PubMed2004

[Adaptation of different neuroprotection devices during carotid stenting procedures].

Carotid artery stenting (CAS) is, apart from surgical endarterectomy, a common method of treatment of atherosclerosis in carotid arteries. Percutaneous angioplasty of carotid artery narrowings has been developing in recent years due to introduction of neuroprotection systems, which significantly reduced number of complications. Nowadays three neuroprotection systems are in common use: filters, temporary occlusion and aspiration systems and flow reversal systems. We present three cases of successful CAS with application of three different neuroprotection systems. We discuss indications, contraindications and limitations of every device.

Aged↗
PubMed2004

"Saba"--application of knowledge and state-of-the-art technologies in the field of psychiatry for development of new diagnostics prevention and therapeutic tools for schizophrenia.

The aim of project is to build a European network, which will integrate the research capabilities of a group of research institutes and university departments to provide an infrastructure for the highest quality research in psychiatric disorders, particularly in schizophrenia and schizoaffective disturbances. This network will integrate original computer expert advisory system called "Saba" with modern brain imaging techniques and neurophysiological methods, which allows for the delineation of specific subtypes and particular episodes of mental disorders and their neural bases will be studied by state-of-the art (high tech) imaging techniques. This approach will lead to new investigatory, diagnostic and therapeutic techniques. Together the members of this network will comprise an unmatched critical mass of human and other resources aimed at fundamental and applied research into a group of disorders, which impose a huge burden on social and material capital. The relationships and mutual responsibilities between neuroscience and the society it serves will be addressed specifically. Top brain research is performed at several locations in Europe. In particular, in the area of linking classical psychiatric and psychological assessment methods and the newest brain imaging techniques in mental disorders, major progress can only be made when various research groups join their efforts. Large-scale studies using different databases are critically required, which demands standardization of the description of mental disorders and of the applied techniques and methods of analysis. Imaging techniques, including functional MRI (fMRI), Evoked Potentials (EPs), brain mapping, and the computer gathered information will be shared, standardized and further developed within the network. Developing new information technology tools for simulation, visualization and data-mining will be required to enable effective search for links between mental disorders and brain characteristics (function, structure) in very large scale data-sets acquired and stored in various research facilities.

Brain↗
PubMed2004

The integration of the computer advisory system together with neuroimaging procedures, neurophysiological markers and psychological cognitive tests in order to obtain evidence based system for the physician treating affective disturbance.

WHO has classified depression disturbances--due to widespread existence and serious medical consequences and resulting social and economic effects--as a priority health problem in all the developed countries. The significance of the depression disturbances is fully comparable to such illnesses as heart diseases, cancer and HIV infection. The research made in the USA (NIMH programmer) shows that first contact doctors are not able to detect depression in relation to 50-70% of the people ill with it. Also the research made in other countries shows that a doctor properly identifies only one out of four persons with clear indications of depression. The wrong choice of the antidepressant drug may result in inefficient therapy and in growing risk of suicide. In 1993 the analysis of 50 best selling medicines in the EU made by two Italian pharmacologists showed that in France and Italy in over 45% of the cases the medicines with doubtful efficiency are applied. The aim of our project is to build a European network, which will integrate the research capabilities of a group of research institutes and university departments to provide an infrastructure for creation of the computer advisory system for diagnostics of affective disorders. This network will integrate our original computer expert advisory system called "Salomon" with modem brain imaging techniques and neurophysiological methods, which allows for the delineation of specific subtypes and particular episodes of mental disorders and their neural bases will be studied by state-of-the art (high tech) imaging techniques. This approach will lead to new investigatory, diagnostic and therapeutic techniques.

Antidepressive Agents↗
PubMed2004

Evaluation of contrast-enhanced FLAIR sequence in MR assessment of intracranial tumours.

BACKGROUND: Magnetic resonance (MR) has become the most important imaging method in the diagnosis of intracranial tumours. However, conventional MR protocol often fails to obtain all morphological details which are necessary for precise planning of the treatment. Therefore, there are attempts of introducing other MR techniques, to gain new information concerning tumour morphology. One such technique is FLAIR sequence. In previous papers we presented the value of plain FLAIR in patients with intracranial tumours. The aim of the present study was evaluation of contrast enhanced FLAIR (CE FLAIR) in assessment of intracranial tumours. MATERIAL/METHODS: MR examinations, including conventional T1 (pre-and postcontrast) and T2 images, as well as plain and contrast-enhanced FLAIR sequences were performed in 27 patients with intracranial tumours. In all patients the degree and localization of contrast enhancement in post-contrast T1-weighted sequence (CE T1w) and CE FLAIR images have been compared. RESULTS: Contrast enhancement of the tumour in both CE T1-w and CE FLAIR sequences was found in 18 patients. In 5 patients the enhancement was visible only on T1-weighted images, while in 2 cases only on FLAIR images. Among 18 patients, who demonstrated enhancement both in T1-weighted and FLAIR sequences, in 9 cases the effect of enhancement was better on T1-weighted images, in 7-CE FLAIR gave superior results, and in 2 patients - both methods were equivalent. In the whole material in 9 cases CE-FLAIR was superior in 14-inferior and in 4-equal to CE-T1-w. Among 9 cases in which CE- FLAIR was superior, in 7 patients the enhancement concerned the border of the tumour or postoperative cave. CONCLUSIONS: Contrast-enhanced FLAIR has limited value in assessment of intracranial tumours and should be used as a supplementary technique if there are difficulties in evaluation of tumour morphology in other sequences.

Adolescent↗
PubMed2003

Impact of Chlamydia pneumoniae infection on survival rate after heart transplantation.

BACKGROUND: As Chlamydia pneumoniae (Cp), a common cause of respiratory infection, is of vasotropic character, chronic infection may be associated with the development of coronary disease, although there have been few reports on the impact of Cp infection on the post-orthotopic heart transplantation (OHT) survival rate. MATERIAL/METHODS: A total of 41 patients (4 females) were followed up for one year after OHT. Serology investigations for IgM, IgG and IgA antibodies against Cp were performed using the enzyme immunoassay (EIA) method. Univariate and multivariate analyses were carried out with respect to IgA, IgG, gender and type of cardiomyopathy. The IgA-IgG joint effect was also studied. RESULTS: The one-year survival rate was reported for patients with IgA < 8 EIU to be 72.2%, whereas those with IgA >or= 8 EIU accounted for only 43.5% (Kaplan-Meier analysis, p = 0.0548). In multivariate analysis IgA /IgG status proved to be a highly significant factor in survival. IgA positive outcome combined with IgG negative outcome showed that the relative risk of death equaled 12.08 versus other combinations of IgA/IgG status. In the Cox multivariate model ischemic cardiomyopathy showed a relative risk of 2.79 (p=0.0594), although it was not significant in univariate CONCLUSIONS: Chronic Cp infection, as expressed through a high IgA level, seems to have adverse impact on the survival rate in one-year follow-up after OHT. IgA titers against Cp in heart transplant recipients should therefore be assessed, as the high values might be a predictive risk factor within the first post-operative year.

Adult↗