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Biomedical subjects

W Piwowarska

Publications and source records attributed to W Piwowarska.

At least 19 recordsLinked to original sources
PubMed2002

Relationship between hyperinsulinemia and angiographically defined coronary atherosclerosis in non-diabetic men.

BACKGROUND: Our aim was to estimate the relationship between hyperinsulinemia and angiographically validated coronary atherosclerosis. METHODS: 102 consecutive non-diabetic male subjects (age 48.9 +/- 9.6 years) with a body mass index 25.9 +/- 2.8 kg/m(2) referred to coronary angiography in our centre were studied. A 75-g oral glucose tolerance test (OGTT) was performed and the areas under the curve (AUC) of serum insulin and glucose were calculated. RESULTS: Discriminant analysis with stepwise forward variable selection revealed that in younger patients (<50 years), the following parameters affected positively the number of significant coronary lumen reductions: age (F=8.5, p=0.005), lnAUCinsulin (F=5.8, p=0.02), low HDL cholesterol (F=4.4, p=0.04), the smoking habit (F=4.1, p=0.05). In those >=50 years of age, exclusively age (F=5.8, p=0.02) and hyperuricemia (F=3.8, p=0.06) entered the final model. CONCLUSION: Our results indicate that in non-diabetic male subjects the association of hyperinsulinemia with the severity of coronary atherosclerosis is only seen in younger patients.

Area Under Curve↗
PubMed2000

[Evaluation of magnesium cation levels in serum of patients with mitral valve prolapse syndrome].

Magnesium deficiency has been suggested to be related to the mitral valve prolapse syndrome (MVPS). The aim of the present study was to analyse the concentration of magnesium in blood plasma of patients (pts) with MVPS. In the group of 80 subjects, including 50 pts with MVPS and 30 healthy people matched for age and gender, who comprised the control group (CG), concentration of magnesium in blood plasma was estimated. Magnesium levels were measured by atomic absorption spectrophotometry. Mean concentration of magnesium cation in plasma in pts with MVPS was 0.74 +/- 0.12 mmol/l (range 0.47-1.02 mmol/l). It was only 1.02% lower than in the CG (x = 0.76 +/- 0.07 mmol/l; range 0.67-0.97 mmol/l). However evaluation of the magnesium concentration in blood plasma did not prove magnesium deficiency in the mitral valve prolapse syndrome. Moreover the study revealed that histograms of magnesium concentration values in both investigated groups were divergent.

Adolescent↗
PubMed1999

[The clinical course of end stage heart disease in 152 patients qualified for heart transplantation in a four year observation].

UNLABELLED: The aim of the study was to analyse the clinical course of pts with end stage disease (ESD) in the period of four years. The study population consisted of 152 pts (132 males, 20 females) at the age of 17-66 years (mean = 48.8 year SD = 9.1) primarily qualified to the heart transplantation (HTX). We analysed the ethiology of cardiac failure, the NYHA class of circulation insufficiency, frequency of occurrence of cardiac arrhythmias and conduction system disturbances in 24-hour ecg monitoring, and the pharmacotherapy efficacy. An ischemic ethiology of cardiac failure we found in 102 pts, cardiomyopathy (idiopathic, hypertrophic or postinfectious) in 46 and unoperable valvular disease--in 4. Ten pts were in II NYHA class, 112 in III, and 30 in IV. Left ventricular ejection fraction (echo assessed) ranged from 11% to 40%(mean = 24.9%), LVEDd = 46-111 mm (mean = 80.9 mm), LVESd = 34-83.5 mm(mean = 63 mm). We found IVa class by Lown ventricular arrhythmias (in Holter monitoring) in 38 pts and IVb in 78. Fifty six pts were treated with amiodarone, 10--with beta-blockers and 11 with sotalol. 19 pts were treated by permanent cardiac pacing during the waiting period, 2 ones--by PTCA, 2--by CABG, three ones--by dynamic cardiomyoplasty, and one--by partial aneurysmectomy. One pt was treated by CABG and automatic cardioverter-defibrilator implantation. In 5 cases HTX was delayed because of the positive effect of pharmacotherapy. In assessed period HTX were performed in 64 cases, 31 pts died and 43 are still waiting for the procedure. CONCLUSIONS: During the 4-year period HTX were performed in 42% of waiting pts. Mortality in this group was 38.2%. In 9 pts (5.9%) the alternative methods of surgical treatment were applicable. In 5 pts (3.9) the decision about HTX was delayed because of the positive change of the clinical status. This fact confirms the necessity of the waiting list verification.

Adolescent↗
PubMed1999

[Endogenous mechanisms for protection in myocardium].

New opinions about myocardial adaptation during ischaemia are described in presented article. Myocardial preservation mechanisms in response to ischaemia are divided into metabolic adaptation like preconditioning and hibernation and anatomic mechanisms of adaptation like development of collateral circulation. Adaptation in clinical conditions can be observed in few situations. 1) During repeated in short period of time exercise tests (warm up). Adaptation may express through increasing tolerated ischemic burden, lenghtening time of exercise, increasing of ischaemic threshold and double product during successive exercise tests (predominately second). This phenomenon called warm up is a clinical counterpart of myocardial preconditioning. 2) In study during coronary angioplasty demonstrated that decrease of ST-segment, intensity of thoracic pain and serum lactacidaemia was lower during the second balloon inflation than the first. 4) The example of myocardial adaptation is repeated atrial stimulation. Ischaemic myocardium should be treated like some kind of mosaic of necrosis, hibernation, stunning and normal viability.

Adaptation, Physiological↗
PubMed1999

[Variability of heart auscultation in patients with mitral valve prolapse].

The aim of the study was to analyze the auscultatory findings and its variability in 84 patients (pts) with mitral valve prolapse syndrome (MVPS) who were examined in the different body positions. All the pts underwent the echocardiographical examination and in 32 subjects (38%) prolapse of the anterior mitral leaflet was found, in 40 pts (48%) prolapse of the posterior mitral leaflet and in 12 (14%) pts prolapse of the both mitral leaflets. The auscultation of the heart was done in the supine position, in the lying position on the left side and in the upright position of the patient's body. Characteristic for the mitral valve prolapse (MVP) auscultatory findings (midsystolic murmur, late-systolic murmur and/or mid-systolic "non ejection" click) were demonstrated by 43 pts (51%) in the supine position. During the auscultation in the lying position of the pts on the left side, the auscultatory findings were found in 57 pts (68%) while in the upright position in 64 pts with MVPS (76%). The study showed that the auscultatory findings in pts with MVPS were demonstrated more frequently in the lying position of the body on the left side or in the upright position compared with the supine position. Moreover we found that 20 pts with MVPS (24%) did not demonstrate the characteristic auscultatory findings of MVP.

Adolescent↗
PubMed1998

Evaluation of plasma cyclic GMP assay as a screening test for detection of acute cardiac allograft rejection.

Our aim was to assess the value of a single determination of plasma cyclic guanosine 3',5'-monophosphate (cGMP) in noninvasive screening for acute cardiac allograft rejection warranting augmentation of immunosuppression. Plasma cGMP levels were measured in 26 patients 1 to 13 months after heart transplantation on the same day the endomyocardial biopsies were performed. Acute moderate rejection (ISHLT 3A or 3B) was found in 10 out of 17 subjects (59%) with plasma cGMP >5 nmol/L, whereas there was mild or no rejection (ISHLT 0 to 1) in 8 from among 9 subjects (89%) with cGMP <5 nmol/L. Because cGMP levels <5 nmol/L appear to argue against the presence of acute rejection requiring therapy modification, our preliminary results suggest that a single plasma cGMP assay might be helpful in establishing indications for endomyocardial biopsy in heart transplant recipients.

Acute Disease↗
PubMed1997

[Fungal infections in heart transplant patient].

Considering imparied immunity in heart transplant patients as a result of immunosuppressive therapy, they are often exposed to the fungal infections. These infections are especially important because they still stay the main reason of death in transplant patients. Besides immunosuppressive therapy also antibiotics therapy, prolonged artificial ventilation of lungs, passed infections for example tuberculosis, or cytomegalovirus infection and Diabetes mellitus are the factors, which increase possibility of fungal infections in heart transplant patients. Fungal infections are the most often between first and sixth month after heart transplantation. They are caused mostly by species of Candida and Aspergillus fungi. Later than six months after heart transplantation also Cryptococcus fungi can develop fungal infection. The most often fungal infections in heart transplant patients is candidiasis. These kind of fungi colonize a skin and a mucose membrane and can very easy cause infection in friendly conditions. Infections caused by Aspergillus proceed as invasive aspergillosis, allergic, bronchopulmonary aspergillosis and aspergilloma. Depend on kind of infection we use pharmacologic or surgical therapy.

Heart Transplantation↗
PubMed1997

[The role of calcium antagonists on coronary artery spasm and prevention of restenosis after angioplasty].

Classification, mechanism of action, hemodynamic and electrophysiological effects of calcium antagonists also structure of L-type calcium channel (cell receptor for this group of drugs) have been presented. Current views about the role of calcium channel antagonists in treatment of vasospastic angina pectoris, in particular Prinzmetal's angina, have been discussed. The use of calcium antagonists for the prevention of coronary restenosis after successful percutaneous transluminal coronary angioplasty have been analysed. Beneficial effects of calcium channel blockers (diltiazem 180 mg per day and verapamil 480 mg per day) for the prevention of restenosis after coronary angioplasty in a group of patients with stable angina pectoris have been demonstrated. Future directions in the trials on the calcium antagonists were been also presented.

Angina Pectoris↗
PubMed1997

[Myocardial bridge of the coronary arteries and its clinical significance].

Myocardial bridge is a congenital anomaly of the coronary artery and appears on an angiogram as a systolic narrowing. Major coronary veins are rarely covered by myocardial bridges. The functional significance of coronary bridging remains controversial. Generally, bridging is not though to result in symptoms, as the coronary narrowing occurs during systole and most coronary flow occurs during diastole. Some authors reported this condition in association with angina pectoris, myocardial infarction, cardiac arrhythmias and sudden cardiac death. The mechanism of ischemia, connection with atherosclerosis are not clear. The symptomatic compressive myocardial bridge is in itself an indication for operation by simple section of the bridge. But if there exist associated atheromatous lesions, the surgeon should combine aortocoronary bypass with section or coronary angioplasty.

Angina Pectoris↗
PubMed1997

[Qualification of patients for heart transplantation in light of current views and personal observations].

Development of new diagnostic and therapeutic techniques along with increasing experience brought a great progress in heart transplantation over last 30 years. Changes occurred not only in the management of posttransplant patients but also in the subject of recipient selection, management and quantification. As there is insufficient number of potential donors to make heart transplantation in all candidates the problem of proper selection is very important. We discussed current approach to the potential candidates for heart transplantation: methods of patient quantification, indications and contraindications to transplantation, recipient selection criteria. Management of the potential recipients, who are on the waiting list is also discussed. Better knowledge, careful recipient selection and management bring significant improvement in posttransplant prognosis.

Contraindications↗
PubMed1997

[Clinical usefulness of cardiopulmonary exercise testing in patients with cardiac failure waiting heart transplantation].

Heart transplantation has recently become an accepted method of treating heart failure patients, also in Poland. Criteria of patient selection to heart transplantation and follow-up was based (and in some centers still is) on the assessment of the patients' clinical status according to NYHA classification and on the data on the extend of myocardial damage obtained from echocardiography or ventriculography at rest. However, examinations performed in the resting state do not provide complete information on the patient's clinical status, especially during increased oxygen demand. Recently cardiopulmonary exercise testing (CPX-to measure maximal oxygen consumption) has been increasing used to establish the prognosis in patients with severe heart failure and to define indications to heart transplantation. CPX combines exercise testing with monitoring the air flow and gas exchange. The measurement of oxygen uptake and anaerobic threshold during exercise is an objective, reproducible, safe and non-invasive method to assess cardiac reserve. There is evidence implying that in heart failure patients VO2max is a good short-term indicator of mortality and that its deterioration frequently precedes clinical decompensation. Thus, the parameter may be useful not only in defining the indications, but also in the monitoring the patient's clinical state and timing of heart transplantation.

Exercise Test↗
PubMed1996

Heterogeneity of high-density lipoprotein particles and insulin output during oral glucose tolerance test in men with coronary artery disease.

We compared the high-density lipoprotein (HDL) composition and particle heterogeneity in 60 nonobese (normal body mass index, BMI) men suffering from coronary artery disease (CAD) with normolipemia and normoinsulinemia with lower and higher insulin output during the oral glucose tolerance test (silent hyperinsulinemia). The apolipoprotein apoAI, apoAII, and apoE levels were higher in the high insulin response (HI) group than in low insulin response (LI) group. The ratio of apoAI versus total protein and the ratio of apoAI versus total cholesterol were increased in HI compared with LI. The lipid components in HDL were higher in LI than in HI, while for HDL2 they were higher in HI. The fractioning of HDL by gradient gel electrophoresis revealed a different pattern of HDL particles in both groups. The larger particles, HDL2b and HDL2a (mean particle diameters 10.6 and 9.2 nm, respectively), occur more frequently in HI patients (up to 60%) than in LI patients, whereas the smaller particles, HDL3a and HDL3b (mean particle diameters 8.6 and 7.8 nm, respectively), predominate in LI patients. Our results demonstrate that even in the normoglycemic, normocholesterolemic CAD patients, a high insulin output observed during the oral glucose tolerance test may be connected with a different HDL particle pattern, which suggests changes in the reverse cholesterol transport.

Apolipoprotein A-I↗
PubMed1996

Inhibition of thrombin generation by aspirin is blunted in hypercholesterolemia.

Recent evidence indicates that aspirin inhibits thrombin generation in clotting blood. We noticed that this effect was less pronounced in patients with hypercholesterolemia. The aim of the study was to prove this observation. The effects of aspirin on thrombin generation were evaluated in (1) 46 healthy volunteers, 2 hours after ingestion of a single, 500-mg dose and (2) 28 survivors of myocardial infarction who took 300 mg aspirin/d for 2 weeks. In both populations, two well-matched subgroups were distinguished, using a serum cholesterol level of 6.2 mmol/L (240 mg/dL) and an LDL cholesterol level of 4.0 mmol/L (155 mg/dL) as borderline. Thrombin generation was monitored ex vivo in blood emerging from a skin microvasculature injury and additionally, in a single-dose study in vitro in recalcified plasma. Aspirin depressed thrombin generation in the group of subjects with serum cholesterol < 6.2 mmol/L and LDL cholesterol < 4.0 mmol/L but not in the group with high blood cholesterol levels. Inhibitory effects of aspirin were more pronounced after the 2-week treatment than after a single dose. There was a significant correlation between total serum cholesterol or LDL cholesterol and total amount of thrombin generated after aspirin treatment. In subjects with high blood cholesterol levels, thrombin generation was not affected by aspirin. Blunting of aspirin action in hypercholesterolemia might be explained by (1) alterations in platelet lipid-protein matrix that render their membrane proteins less accessible for acetylation by aspirin and (2) changes in composition and structure of plasma lipoproteins that diminish the chance of aspirin to interact with prothrombin.

Adult↗
PubMed1996

[Stress echocardiography in diagnosis of coronary artery disease].

Diagnostic value of stress echocardiography is discussed. Different stress modalities such as exercise, pharmacological tests (dipyridamole, adenosine, dobutamine), and atrial pacing are characterized and compared. Stress echo protocols are also described. A value of stress echocardiography is discussed in comparison with ECG stress testing and thalium perfusion scintigraphy. Stress echocardiography is a valuable, safe, inexpensive diagnostic technique in case of the coronary artery disease. It is time-consuming and has limited efficiency in patients with poor echocardiographic conditions. The test requires skills and experience of the performing physician.

Adenosine↗
PubMed1996

[Remodeling of the left ventricle after myocardial infarction].

Cardiac remodeling following myocardial infarction denotes changes of left ventricular shape, chamber size and wall thickness. It involves both the infarcted and the noninfarcted segments. This process begins at the time of acute myocardial infarction, progresses by stages, and can lead to congestive heart failure. The major determinants of lest ventricular remodeling are infarct size and transmural, adequacy of the healing process, mechanical deformation forces, and progressive ventricular dilation. Infarct expansion is a relatively frequent, early occurring alteration of the ventricular shape. It denotes thinning and lengthening of the infarct segment. The progressive ventricular remodeling can be halted by reactive hypertrophy of the viable myocytes, on condition that it is appropriate. The left ventricular increase results from myocytes hypertrophy, partly their hyperplasia, and increase of fibrosis. Major ways of action in order to limit the cardiac remodeling after myocardial infarction are: reperfusion of the infarct-related vessel by thrombolysis, nitrate therapy, and angiotensin-converting enzyme inhibitors administration. Maximum benefit is when therapy is begun very early.

Adaptation, Physiological↗
PubMed1996

Successful full-term pregnancy in a patient three and a half years after a heart transplant.

The patient is a 28 year old woman who received a heart transplant in 1992 secondary to hypertrophic cardiomyopathy with unremarkable post-operative course. In the period immediately post transplantation the patient was on a four-drug immunosuppressive regimen which was subsequently changed to standard three-agent therapy. This therapy was continued until the patient became pregnant. In the first trimester only Cyclosporine (CsA) was used, and thereafter, the patient was continued on the previous three agent regimen. Toward the end of pregnancy a rise in systolic pressure was observed, but the child was delivered by spontaneous vaginal delivery without complications in the 38th week of pregnancy. The newborn weighed 3320 g and was in good health. A sharp fall in the newborn CsA blood levels was observed post delivery reaching zero level on the third day of life. At the present time, both mother and baby are in good health, 6 weeks after delivery.

Adult↗