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Biomedical subjects

Walentyna Mazurek

Publications and source records attributed to Walentyna Mazurek.

At least 19 recordsLinked to original sources
PubMed2006

Aspirin failure course during exercise and its connection with soluble CD40L.

INTRODUCTION: The aspirin failure (resistance) is a still discussed and highly studied problem. This phenomenon is observed in rest, but could be precipitated by an exercise. The aspirin resistance was also linked with the inflammatory process which is a key event for the atherosclerosis development. Platelets seem to play an important role also in that setting, probably by the CD40-CD40L axis. The aim of the study was to assess the frequency of the aspirin failure induced by the exercise and the role of sCD40L in that regard. MATERIALS AND METHODS: The study included 40 patients with established coronary artery disease. The control group consisted of 10 patients without coronary artery disease matched for age. All patients and controls were on 75 mg of aspirin for at least 30 days and had treadmill testing and blood collected for measurement of sCD40L and optical platelet aggregation with ADP, collagen and arachidonic acid. Aspirin resistance was defined as a maximal aggregation with ADP and collagen exceeding 70%. RESULTS: There were 15 aspirin-resistant patients in the studied group (37%). There were significantly higher concentration of sCD40L (ng/ml) in aspirin-resistant patients in comparison with aspirin-sensitive ones before testing (7,9 +/- 2,5 vs. 5,1 +/- 3,5, p < 0,05) and on the top of it (8,1 +/- 2,9 vs. 4,5 +/- 3,9, p < 0,05). There were 3 persons who become resistant on the top of the exercise which was connected with the significant increase of sCD40L concentration in that group (from 7,6 +/- 1,9 before exercise to 10,1 +/- 2,9 on the top of the exercise, p < 0,05). There was also a positive correlation between the sCD40L level before and on the top of the exercise in an aspirin-resistant group (r = 0,48 for both, p < 0,05). Patients who were aspirin-resistant at rest had also significant elevation of platelet aggregation on the top of the exercise (ADP (%) from 90,5 +/- 8,6 to 95,0 +/- 6,5, p < 0,05 and collagen (%) from 87,8 +/- 8,7 to 92,1 +/- 8,0, p < 0,05). CONCLUSIONS: 1. Aspirin resistance phenomenon is present in about 37% patients on 75 mg aspirin daily.2. Aspirin-resistant patients have higher platelet aggregation during the exercise.3. Moderate physical exercise provokes 12% increase in the aspirin resistance phenomenon occurrence.4. Aspirin resistance is connected with higher sCD40L level at rest and exercise provoked aspirin resistance is connected with the sCD40L concentration increase.

Aged↗
PubMed2006

Abnormalities of pulmonary venous flow in patients with lone atrial fibrillation.

AIMS: Mechanisms underlying lone atrial fibrillation (LAF) are poorly defined. We sought to investigate indices of left atrial (LA) function in patients with recurrent LAF, in comparison with that in healthy subjects. METHODS AND RESULTS: Investigations were performed in 42 patients aged 51.8 +/- 8.7 at least 30 days after the last episode of LAF and in 38 healthy controls. Each subject underwent echocardiographic evaluation including left ventricular parameters and LA function indices. LA ejection fraction served as a measure of LA systolic performance, and acceleration (SAT) and deceleration time (SDT) of systolic phase of pulmonary venous flow (PVF) corresponded to LA relaxation and compliance, respectively. Patients with LAF showed significantly lower values of SAT (179.1 +/- 63.2 vs. 199.2 +/- 45.1 ms, P < 0.02) and higher values of SDT (250.8 +/- 81.6 vs. 211.7 +/- 57.3 ms, P < 0.01) when compared with controls. No significant differences were found with respect to other measured parameters. The combination of SAT < 185 ms and SDT > 239 ms showed a positive predictive value of 92% in the identification of patients prone to LAF. CONCLUSION: This study suggests that (i) patients with LAF have abnormalities of the systolic phase of PVF and (ii) Doppler estimation of PVF seems to be very valuable in the evaluation of patients with LAF.

Adult↗
PubMed2006

Influence of tilt training on activation of the autonomic nervous system in patients with vasovagal syncope.

OBJECTIVE: Tilt training is a new treatment for vasovagal syncope. Its therapeutic efficacy is thought to be the result of the desensitization of cardiopulmonary receptors, but it could be the influence of the tilt training on the activation of the autonomic nervous system as well. METHODS AND RESULTS: The study group consisted of 24 vasovagal patients (17 women and 7 men) aged 32.5 +/- 11.8 years. The diagnostic head-up tilt test was performed according to the Italian protocol with nitroglycerin if necessary. The monitoring head-up tilt test was performed according to the Westminster protocol without provocation, after 1 to 3 months of tilt training. Holter ECG recordings for HRV parameters (time and frequency domain) were obtained from selected 2-min intervals before, during and after the diagnostic and monitoring tilt test. The diagnostic test was positive in the passive phase in 6 and after provocation in 18 patients. During the training period no syncope occurred. Analysing the HRV parameters we demonstrated the following findings: I. mRR decreases immediately after assumption of a vertical position in both tests (diagnostic and monitoring) but in the diagnostic test its further decrease occurs earlier than in the monitoring test; 2. the absolute power of the HF component is greater in the early phase of tilt after tilt training than in the corresponding period in the diagnostic test. CONCLUSIONS: After a longer period of tilt training the activation of the sympathetic nervous system in response to the erect position is diminished.

Adolescent↗
PubMed2006

[Myocardial bridging of the left anterior descending coronary artery and dobutamine-induced left ventricular outflow tract gradient -- a case report].

We present a case of a 47-year-old patient with arterial hypertension and progressive ST segment changes with a T wave inversion during 2 years of observation. Coronary angiography showed myocardial bridging of LAD and no significant coronary artery stenosis. During subsequent two last years the patient was repeatedly hospitalised due to chest pain. During the last hospitalisation a dobutamine stress testing was performed which provoked an increased left ventricular outflow tract gradient. This finding may be attributed to an early phase of hypertrophic cardiomyopathy, or dobutamine specific phenomenon.

Atrioventricular Node↗
PubMed2006

Efficacy of tilt training in patients with vasovagal syncope.

BACKGROUND: Besides pharmacological therapy and pacemaker implantation, tilt training is a promising method of treatment in patients with vasovagal syncope (VVS). Tilt training is usually offered to patients with malignant or recurrent VVS which impairs their quality of life and carries a risk of injury. AIM: To assess the efficacy of tilt training in patients with VVS. METHODS: The study group consisted of 40 patients (29 females, 11 males, aged 36.6+/-14 years, range 18-57 years) who underwent tilt training using tilt table testing according to the Westminster protocol. The mean number of syncopal episodes prior to the initiation of tilt training was 6.5+/-4.9 (range 0-20); 3 patients had a history of very frequent faints. According to the VASIS classification, type I VVS (mixed) was diagnosed in 17 patients, type II (cardioinhibitory) in 22 subjects, and type III (vasodepressive) in one patient. Mean follow-up duration was 35.1+/-13.5 months. The control group, which did not undergo the tilt testing programme, consisted of 29 patients with VVS (25 females, 4 males, mean age 44.2+/-15.0 years) who had a mean of 3.3+/-3.2 (range 0-12) syncopal episodes in the past (p <0.05 vs study group); 6 of these patients had only pre-syncopal episodes. Type I VVS was diagnosed in 23 controls and type II VVS in 6 control subjects (syncope occurred during the passive phase of tilt testing in 7 subjects, whereas the remaining 22 fainted during NTG infusion). RESULTS: Of the patients from the study group, 3 underwent pacemaker implantation at the time of the initiation of tilt training. At the end of follow-up, 31 (77.5%) patients remained free from syncope recurrences, 5 had syncopal episodes during the initial phase of tilt training, whereas the remaining 4 continued to suffer from syncopal episodes. Out of 3 patients with presyncope, 2 had no syncope recurrences whereas 1 patient continued to have presyncopal attacks. Out of 3 patients with pacemakers, 1 reported activation of pacing in the interventional mode. During the follow-up period, in 5 patients from the study group the diagnosis of VVS was not confirmed and another condition was diagnosed. In the control group, syncope recurrences occurred in 13 (44.5%) patients (p <0.05 vs study group). CONCLUSIONS: In patients with VVS, tilt training is effective in the majority of patients. Syncopal or presyncopal episodes and positive results of tilt testing take place more frequently in the early rather than in the late phase of training. Cessation of tilt training causes a recurrence of positive results of tilt testing in spite of the lack of spontaneous syncopal episodes. During long-term observation, a proper diagnosis, different from VVS, can be established in some patients.

Adult↗
PubMed2006

[Successful percutaneous angioplasty of renal artery in a patient with severe arterial hypertension and symptoms of hyperaldosteronism: a case report].

Arterial hypertension may result from renal artery stenosis. In this type of hypertension renin-angiotensin-aldosterone system is activated and patients often produce signs of hyperaldosteronism. It must be distinguished from primary hyperaldosteronism in order to chose a proper therapy. In this paper we describe a case of a 65-years-old man with severe arterial hypertension, which was difficult to control pharmacologically. The patient revealed symptoms which suggested primary hyperaldosteronism (except normal plasma renin activity). Only imaging techniques allowed diagnose of renal artery stenosis and carry out successful percutaneous angioplasty of renal artery.

Aged↗
PubMed2006

Platelet aggregation and P-selectin levels during exercise treadmill test in patients with ischaemic heart disease.

INTRODUCTION: Coronary artery disease (CAD) is associated with higher platelet activation sometimes despite aspirin use. There are conflicting data concerning platelet activation course during physical exercise in patients on aspirin with CAD. AIM: To assess platelet activation pattern during physical exercise in patients with CAD. METHODS: The study included 35 patients (20 men, 15 women) aged 64.7+/-10 years with CAD (CCS II) on aspirin treatment (75 mg daily) and a control group of 10 healthy subjects adjusted for age and gender. Treadmill testing was performed using the Bruce protocol. Platelet aggregation was measured with optical aggregation with the agonists ADP (10 microM), collagen (2 microg/ml) and arachidonic acid (0.5 mg/ml) before and at peak exercise; P-selectin platelet and soluble expression (basal and after stimulation with thrombin) was assessed with cytofluorometry before, at peak exercise and 1 hour after. RESULTS: There were no differences in collagen and ADP aggregation between patients and the control group. There was a significant increase of ADP aggregation at peak exercise in the control group (p <0.05). There was a positive correlation between platelet aggregation before exercise and at peak exercise with ADP (r=+0.86) and with collagen (r=+0.61). There was no difference in soluble P-selectin concentration between patients and the control group. Platelet P-selectin expression without stimulation with thrombin 1 hour after exercise was significantly higher in patients than in the control group (p <0.05). CONCLUSIONS: 1. Physical exercise does not intensify platelet aggregation in patients with CAD on 75 mg aspirin daily. 2. Despite taking aspirin, platelet activation measured with the expression of platelet P-selectin increases and there is further intensification during exercise testing. 3. The concentration of soluble P-selectin in patients with CAD does not reflect the expression of platelet P-selectin.

Aged↗
PubMed2006

[Life saving angioplasty of left main coronary artery in a high risk patient].

A case a of a life-saving angioplasty of left main coronary artery (LMCA) is presented. A 75 year old patient with a history of diabetes, previous CABG and carotid surgery was admitted to our hospital with symptoms of early post-infarct angina. Coronary angiography revealed significant stenosis of LMCA, in addition to previously known multi-vessel diffuse CAD. Taking into consideration a very high risk of repeat CABG surgery a decision was made to perform an angioplasty. The intervention was carried out with good angiographic effect and the patient was discharged home few days later, free from angina. In 9 month follow-up angiography there was no restenosis in LMCA. In patients to whom cardiac surgery presents very high risk, an angioplasty of LMCA can be life-saving, with good long term effects.

Aged↗
PubMed2005

Proinflammatory cytokines and myocardial viability in patients after acute myocardial infarction.

BACKGROUND: Proinflammatory cytokines such as tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) can potentiate heart muscle damage during acute myocardial infarction (AMI). Whether changes in their plasma levels after AMI are dependent on the presence of myocardial viability is unclear. The aim of the study was to estimate the relation of time course of plasma TNF-alpha and IL-6 and the presence of reversible and irreversible myocardial dysfunction in patients early after AMI treated thrombolytically. MATERIAL AND METHODS: Patients (54; mean age 60.4 +/- 11.7 years) with AMI plasma TNF-alpha and IL-6 were evaluated on the 2nd, 10th and 30th day after thrombolysis. Based on the response of dysfunctional segments of myocardium during dobutamine stress echocardiography performed on the 10th day, patients were divided into four groups: A, sustained improvement in contractility; B, biphasic (improvement followed by worsening); C, only worsening; D, no change. Twenty-two healthy persons served as controls. RESULTS: On the 2nd day, all four groups of patients demonstrated increased levels of TNF-alpha and IL-6 and did not differ among one another regarding both cytokines. On the 10th day, plasma TNF-alpha and IL-6 decreased in each group and were the lowest in group A, intermediate in group B and the highest in groups C and D. On the 30th day, both cytokines were not different among all studied groups. CONCLUSION: Elevated plasma TNF-alpha and IL-6 early after AMI decreased more quickly in patients with dysfunctional myocardium comprising not only necrotic but also viable segments. This decline is attenuated by the presence of residual ischemia.

Biomarkers↗
PubMed2005

Aspirin resistance in ischaemic heart disease.

BACKGROUND: In spite of the usage of acetylsalicylic acid (aspirin) in the secondary prevention of ischaemic heart disease (IHD), new thrombo-embolic events occur in more than half of patients. Aspirin resistance may be partially responsible for this phenomenon. AIM: To assess the prevalence of aspirin resistance in patients with IHD and to correlate this phenomenon with the progression of atherosclerosis, concomitant diseases and other medication. METHODS: The study group consisted of 205 patients (mean age 65.8 years, 95 females) with stable angina, recent coronary angiography and positive result of non-invasive stress tests, treated with 75 mg of aspirin for at least one week. Platelet aggregation was measured using the optical aggregation method. Aspirin resistance was defined as a mean collagen and ATP-induced platelet aggregation >70%. RESULTS: Aspirin resistance was found in 41 (20%) patients and was significantly associated with previous coronary artery bypass grafting (CABG) (p<0.01) and three-vessel disease (p<0.05). Previous CABG was the only independent risk factor for the presence of aspirin resistance (OR 5.6; 95% CI 2.0-15.4; p<0.01). CONCLUSIONS: Aspirin resistance is present in 20% of patients with stable angina. Previous CABG is an independent risk factor of this phenomenon.

Aged↗
PubMed2005

Kinetics of chemokines in acute myocardial infarction.

BACKGROUND: Chemokines are supposed to play an important role in the activation of monocytes and in the development of atherosclerosis. There are also suggestions that chemokine-mediated enhanced coagulability may be related to the pathogenesis of acute coronary syndromes.Aim. To assess the kinetics of 3 chemokines: Monocyte Chemoattractant Protein-1 (MCP-1), Macrophage Inflammatory Protein-1alfa (MIP-1alpha) and Regulated on Activation Normal T cell Expressed and Secreted (RANTES) in patients with ST-elevation myocardial infarction (STEMI). METHODS: The study group consisted of 40 patients (pts) with STEMI who were divided into 2 groups -- 16 pts with anterior MI (AMI) and 24 pts with inferior or lateral MI (IMI). According to the type of received therapy, the pts were divided into 2 other groups: group A -- 30 pts treated with thrombolytic agents or primary angioplasty and group B -- 10 pts without recanalisation therapy. The control group consisted of 10 healthy volunteers. Blood samples for MCP-1, MIP-1alpha and RANTES serum levels was taken on admission and 3 h, 24 h, 48 h, 72 h and 7 days afterwards. RESULTS: The baseline MCP-1 and RANTES levels were significantly higher in pts with STEMI than in controls (1068.9 vs 880.9 pg/ml, p<0.05; 50.8 vs 33.9 pg/ml, p<0.005). In pts with STEMI, peak levels of MCP-1 and MIP-1alpha were significantly higher 3h than 24h from admission (MCP-1 1274.4 vs 1097.4 pg/ml, p<0.02; MIP-1alpha 39.2 vs 22.0 pg/ml, p<0.01). In all STEMI pts there was a positive correlation between MIP-1alpha 3h and left ventricular ejection fraction (LVEF) (r=0.455, p<0.05) and a negative correlation between MIP-1alpha 3h and LV end-diastolic diameter (LVEED) (r=-0.453, p<0.05). A significant positive correlation between TnI level and chemokines in both AMI and IMI patients was detected, being the highest in AMI and IMI groups when MIP-1alpha 24 h and TnI were compared (R=0.852, p<0.003 and R=0.646, p<0.0001). In pts with IMI, a positive correlation between RANTES, MIP-1alpha 3h and LVEF was found (R=0.322, p<0.03 and R=0.399, p<0.008). In group A, all MIP-1alpha values were significantly higher than in group B. Also, peak MIP-1alpha levels significantly differed between groups A and B (44.8 vs 8.3 pg/ml, p<0.006). In pts from group B, a negative correlation between MCP-1 measured an admission and LVEF was found (R=-0.690, p<0.05). CONCLUSIONS: We found a significant elevation of chemokines in the early period of acute MI. The correlations between different parameters suggest, that chemokines may serve as new parameters of immune activation in STEMI and also may play the dominant role in the cardiac inflammatory response and subsequent repair processes.

Adult↗
PubMed2005

[Renin-angiotensin-aldosterone system activity during head-up tilt testing in patients with vasovagal syncope].

UNLABELLED: The stimulation of renin-angiotensin-aldosterone (RAA) system during tilt table test is caused by sympathetic nervous system activation by orthostatic stress and a serotonin release as well. In healthy individuals increase of plasma renin activity during test with maximal values on the peak of the test was described. OBJECTIVE: The aim of the study was to assess the activation of RAAS in patients with neurally mediated syncope during the tilt table test by means of plasma renin activity and serum aldosterone levels. MATERIAL AND METHODS: The study was carried out in 31 patients aged 39.4 +/- 15.0 years (18 women and 13 men) with neurally mediated syncope during tilt test. Plasma renin activity was assessed in the baseline conditions, immediately after the test and 10 minutes after the test using radioenzymatic assay. Aldosterone concentrations were measured radioimmunologically, twice: after 30 minutes supine rest and after the syncope. RESULTS: Plasma renin activity during supine rest was 2.2 +/- 2.4 ng/ml/h, rose after the syncope 2.5-fold to 5.2 +/- 4.5 ng/ml/h (p < 0.001 comparing to baseline) stayed on similar level approximately for the next 10 minutes--4.9 +/- 5.5 ng/ml/h (p = n.s.). In 11 patients (35%) 10 minutes after the test even further increase of PRA was observed. Serum aldosterone level increased significantly immediately after tilt test (90.0 +/- 72.9 vs 178.8 +/- 150.1 pg/ml, p < 0.01). CONCLUSION: Authors showed, that in patients with NMS plasma renin activity increases and this increase lasts for 10 minutes after the syncope and the concentration of aldosterone increases immediately after tilt test.

Adult↗
PubMed2005

[The influence of deterioration of clinical condition on the change of revascularisation method in coronary artery disease].

A case of a 52-year old woman with diabetes mellitus and symptomatic, multivessel coronary disease is presented. The patient underwent coronary angiography. Taking in consideration the intensity of atherosclerotic lesions and vessels diameter, she was initially selected for cardiovascular surgery. However, because of sudden deterioration of clinical condition caused by myocardial infarction the strategy of cardiac revascularisation was changed. The patient underwent multivessel percutaneous coronary intervention with good result in short- and 6-month observation.

Angioplasty, Balloon, Coronary↗
PubMed2004

Comparison of left ventricular function by tissue Doppler imaging in patients with diabetes mellitus without systemic hypertension versus diabetes mellitus with systemic hypertension.

Because diabetes mellitus substantially increases the risk of development of heart failure, we sought to establish early alterations in left ventricular systolic and diastolic function in patients with diabetes mellitus with and without coexisting systemic hypertension. We studied 134 subjects using echocardiography comprising standard 2-dimensional and conventional Doppler as well as tissue Doppler imaging. Our study demonstrated the early appearance of both left ventricular systolic and diastolic dysfunction in diabetic patients at rest and the contributory effects of diabetes to myocardial impairment produced by hypertension, as well as the high usefulness of tissue Doppler imaging in detection and quantitation of myocardial dysfunction in diabetics. This method was superior to other echocardiographic techniques and plasma brain natriuretic peptide evaluation.

Age Distribution↗