Biomedical subjects
Publications and source records attributed to Wojciech Kosmala.
Explore the source record for details and available documents.
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.
Explore the source record for details and available documents.
In the population of hemodialysis patients the risk of ischemic heart disease and morbidity related to it, is considerably higher than in general population. In the group of elderly hemodialysed patients and in patients with diabetes this risk is even higher Additional risk factors of cardiovascular disease are those specific for renal insufficiency, including the presence of arterio-venous fistula, which is believed to be an independent risk factor for cardiovascular disease through the promotion of hyperkinetic circulation. In the study the impact of the arterio-venous fistula on heart function in Doppler USG in the group of 16 elderly hemodialysis patients (aged 79, 4 +/- 5,4), 10 diabetics with type 2 diabetes (aged 63,2 +/- 10,4) and 7 hemodialysis patients younger and without diabetes was examined. In all patients arterio-venous fistula was created on the forearm from native vessels. The following hemodynamic USG parameters of heart function were assessed: ejection fraction (EF), shortening fraction (FS), stroke volume (SV) and cardiac output (CO). We conclude that impact of native arterio-venous fistula created on forearm on circulation in the group of elderly and diabetic patients is of the same magnitude as in the group of younger, non diabetic patients.
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.
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.
BACKGROUND: In recent years QT dispersion (QTd) in post-infarct patients was estimated in many studies, but still little is known about its association with the presence of dysfunctional but viable myocardium. AIM: We investigated the relation between dispersion of QT interval and myocardial viability in patients after acute myocardial infarction (AMI). MATERIAL AND METHODS: In 52 patients (mean age 67.2+/-11.7) treated thrombolytically because of AMI 12-lead ECG and low dose-high dose dobutamine echocardiography was performed on 14th day after treatment. QTd and regional myocardial contractility were estimated three times: at baseline, low dose dobutamine (LDD) (10-15 microg/kg per min) and high dose dobutamine (HDD) infusion (up to 40 microg/kg per min). RESULTS: Patients with viable myocardium had lower baseline QTd than patients with only necrosis in infarct zone. Significant increase in QTd was shown during LDD and HDD both in patients with and without myocardial viability. During infusion of HDD QTd was significantly higher in patients with myocardial ischemia. The greatest percentage increase of QTd at HDD was shown in patients with biphasic response to dobutamine infusion i.e. with myocardial viability evidenced at LDD and myocardial ischemia at HDD. CONCLUSION: Patients with preserved myocardial viability had lower QTd values compared to those with similar left ventricular dysfunction but caused only by post-infarction necrosis. Ischemia evoked on 14th day after AMI was accompanied by greater increase in QTd in patients with myocardial viability in infarct region than in patients without. It may be one of the reasons of greater risk of serious ventricular arrhythmias in such patients during myocardial ischemia.
Explore the source record for details and available documents.
UNLABELLED: A prospective collection of clinical (history), electrocardiography (ECG), exercise electrocardiography (EE), dobutamine stress echocardiography (SE) and catheterization data was performed in 551 patients with chest pain regarded as definite or probable stable angina pectoris. All patients (65% male) without prior history of myocardial infarction undergone clinical evaluation: chest pain classification according to Diamond, ECG, EE (regarded as positive on the basis of > or = 1 mm ST-depression), SE (ischemia was defined as new or worsening wall motion abnormalities using a 16-segment model) and coronary angiography (CA):CAD was defined as > or = 50% narrowing of at least one major vessel. Sensitivity and specificity of ECG, EE, SE was calculated: and results are as follows respectively: 23% and 87%, 93% and 21%, 85% and 69%. On the basis of these results with implication of probability analysis two algorithms were developed by computer program. They incorporated pretest variables: age, gender, chest pain classification, ECG and results of one or two non-invasive tests: EE and (or) SE. The sensitivity and specificity of the algorithm is 96% and 44%. CONCLUSIONS: 1. Chest pain characteristics remains an effective tool for estimating probability of CAD. 2. The diagnostic value of resting electrocardiography in stable CAD is low. 3. SE has comparably sensitivity but significantly higher specificity than EE. 4. We demonstrated that when the likelihood of CAD is high on the basis of initial evaluation, diagnostic non-invasive testing is not indicated before CA. 5. When the probability is intermediate or low, implementation of first choice test should be different in women (SE) and men (EE).
UNLABELLED: Endothelium dysfunction is one of the first signs of atherosclerotic process. There are many factors known, which provoke such a dysfunction; many are still to be revealed. One of them may be a heavy metal ion. The aim of the study was to establish the link between heavy metal ions concentrations in blood and the endothelium dysfunction measured with the nitric oxide blood concentration in a population of patients with ischemic heart disease, not exposed occupationally to high concentrations of heavy metal ions. The study included 42 patients (24 men and 18 women, age 63.7 +/- 9.9 years) with angiography confirmed coronary artery disease. The study group was subdivided according to coronary artery atherosclerosis extent. Control included 18 patients (10 men and 8 women, age 58.7 +/- 9.4 years), where coronarography revealed no significant lesions in coronary arteries. In all persons blood for nitric oxide and heavy metal ions was collected. Heavy metal ions studied included: lead, copper, manganese, zinc, selenium, and cadmium. Heavy metal ions concentrations in studied and control group was within normal range for not exposed population and did not differ significantly with each other. No significant difference was observed between groups for nitric oxide concentration. Nitric oxide concentration correlated positively with zinc concentration in control group (p<0.001, Pearson r=0.70). Such a correlations was not present in studied group. After regression analysis there was still strong correlation between zinc and nitric oxide in control group (beta=0.43, p<0.01), the phenomenon not present in studied group. CONCLUSIONS: 1. In the group of patients with angiography confirmed ischemic heart disease heavy metal ions concentrations are within normal range for not exposed population and is not connected with coronary atherosclerosis extent. 2. From all heavy metal ions studied only zinc seams to have protective influence on endothelial function measured by nitric oxide production 3. No such a protective effect is observed in the group of patients with ischemic heart disease, which may be due to the relative zinc deficiency.
Stress echocardiography is valuable, non-invasive method useful for detection of coronary artery disease. In stress echocardiography myocardial ischemia is most commonly induced by exercise or pharmacological agents like dobutamine, dypiridamole, arbutamine or adenosine. The aim of the study was to compare usefulness of dobutamine-atropine stress echocardiography (DATR) with dobutamine-adenosine stress echocardiography (DADE) in detection of coronary artery disease. Studies were carried out in 23 patients, 11 women and 12 men, with suspected coronary artery disease. Both DATR and DADE were performed in all patients. In DATR left ventricular segmental contractility was estimating during intravenous infusion of dobutamine in increasing doses from 5 to 40 microg/kg/min and after intravenous administration of 1 mg of atropine. In DADE regional left ventricular systolic function was analyzed during intravenous infusion of dobutamine in increasing doses from 5 to 40 microg/kg/min and adenosine in dose of 0.14 mg/kg/min. The sensitivity of DATR in detection of coronary artery disease was 87% and specificity was 85%, whereas DADE 87% and 100% respectively. The sensitivity of DATR and DADE in subgroups of patients with one-vessel and multivessel disease was equal: 83% and 90% respectively. There were no significant differences between DADE and DATR in respect of sensitivity and specificity in detection of coronary artery disease. The results of this study suggest that dobutamine-adenosine stress echocardiography is highly sensitive and specific diagnostic test for detection both one-vessel and multivessel coronary artery disease. Moreover, there is no statistically important difference between dobutamine-adenosine stress echocardiography and dobutamine-atropine echocardiography in respect of sensitivity and specificity in detection of coronary artery disease.
Left ventricular hypertrophy, in particular concentric, accompanying hypertension is an independent risk factor of sudden death and other serious cardiovascular complications. It is still not clear how ANP and BNP are related to various types of left ventricular geometry and whether BNP is a better predictor of left ventricular hypertrophy and dysfunction than ANP. The aim of the study was estimation of plasma ANP and BNP levels in patients with hypertension in relation to the changes of left ventricular geometry. Investigations were carried out in 80 patients aged 52.5 +/- 12.6. In every patient plasma levels of ANP and BNP were estimated, blood pressure was measured and echocardiographic study was performed. Based on echocardiographic measurements every patient was classified into one of four left ventricular geometric patterns. It was found that in patients with left ventricular concentric hypertrophy plasma level of ANP and BNP was increased whereas in patients with concentric remodeling and eccentric hypertrophy only plasma level of ANP was elevated. In patients with concentric hypertrophy higher levels of ANP and BNP were found compared to patients with concentric remodeling and eccentric hypertrophy.
An impaired exercise capacity is common in hypertensive patients (pts) and factors affecting exercise capacity are not completely elucidated. The aim of the study was to investigate factors influencing exercise capacity in hypertensive pts Studied group consisted of 41 pts (18 males, 23 females) mean age 54.2 +/- 11.9 with essential hypertension and without coronary artery disease. Each patient underwent an echocardiographic examination followed by treadmill exercise test. Echocardiographic assessment comprised estimation of left ventricular (LV) mass index (LVMI), pattern of LV geometry, ejection fraction (LVEF), fractional shortening (LVFS), peak and integral velocities of early (E, Ei) and late (A, Ai) transmitral flow, deceleration time of E wave (DT), isovolumic relaxation time (IVRT), duration of A wave (A-dur), total ejection isovolume index (TEI), E (ETT) and A (ATT) wave transit time to the LV outflow tract, flow propagation velocity of E wave (EP), peak and integral velocities of systolic (S, Si), diastolic (D, Di) and atrial reversal (AR, ARi) pulmonary venous flow, duration of AR wave (AR-dur), acceleration (SAT) and deceleration (SDT) of systolic pulmonary venous flow, systolic forward fraction of pulmonary venous flow (SFF). Exercise capacity was assessed by exercise time and total workload expressed in MET. Significant correlations were found for MET and: age (r = -0.49, p < 0.001), A (r = -0.62, p < 0.001), E/A ratio (r = 0.55, p < 0.004), Di (r = 0.55), p < 0.004), ARi (r = -0.38, p < 0.01), SFF (r = 0.46, p < 0.002). Exercise time correlated with A (r = -0.61, p < 0.001), E/A ratio (r = 0.41, p < 0.04), Di (r = 0.51, p < 0.009), ARi (r = -0.35, p < 0.02), SFF (r = -0.51, p < 0.008), S/D ratio (r = -0.47, p < 0.01). Other investigated parameters did not correlate with both MET and exercise time. By stepwise multiple linear regression analysis Di and ARi were the only determinants of MET (multiple r = 0.85, p < 0.0001) whereas A and Di turn out to be the only independent predictors of exercise time (multiple r = 0.76, p < 0.0004). In hypertensive pts: 1. diastolic function of LV is a principle determinant of exercise capacity, 2. integral velocity of diastolic and atrial reversal pulmonary venous flow and peak velocity of late transmitral flow are the best predictors of exercise tolerance.
UNLABELLED: It has been shown that increased QT dispersion (QTd) reflects electrical inhomogeneity of the myocardium and is associated with high incidence of ventricular arrhythmias. In some cases increased QTd has also been found in some hypertensive patients with left ventricular hypertrophy. The aim of the study was to investigate the relation between QTd and left ventricular (LV) geometry in hypertensive patients (pts). Studied group consisted of 80 pts aged 52.5 +/- 12.6 yrs with mild, moderate and severe hypertension. Nineteen healthy subjects aged 50.5 +/- 9.6 yrs served as control group. QTd was calculated as a difference between the longest QT and shortest QT from the 12-leads of the standard electrocardiogram. Each subject underwent echocardiographic study to determine the pattern of LV geometry divided into: normal (NG), concentric remodeling (CR), excentric hypertrophy (EH) and concentric hypertrophy (CH). Significantly higher QTd was found out in pts with CH and EH as compared to CG (respectively 61 +/- 10 ms, 69 +/- 15 ms vs 46 +/- 14 ms, p < 0.01). Moreover, pts with CH had higher QTd than NG (69 +/- 15 ms vs 55 +/- 15 ms, p < 0.01). CONCLUSION: QTd is related to the pattern of LV geometry. As compared to healthy subjects it is increased in hypertensive pts with concentric and eccentric hypertrophy. In pts with CH QTd is significantly greater than in hypertensive pts with normal geometry.
A case of a 47-year-old man, a Jehovah's Witness, with left atrial myxoma is presented. Clinical presentation included several months of thrombocytopenia and disseminated intravascular coagulation. Deterioration of heart failure was complicated by pneumonia and worsening of disseminated intravascular coagulation. Therapeutic challenges related to patient's religious beliefs are discussed.
Endothelial cells produce both vasodilatating compounds as nitric oxide, prostacycline, endothelial derived hyperpolarising factor and counteracting substances known as endothelial derived contracting factors: endothelin, tromboxan A2, prostaglandin H2, free oxygen radicals. Natural balance between both groups affects blood perfusion of various tissues and constitutes important element in blood pressure control. More and more attention is paid to endothelial dysfunction in patogenesis of hypertension. In a number of studies endothelial dysfunction in hypertensive patients was found out as decreased release of nitric oxide or increased production of endothelin. Principle mechanism of impaired function of endothelium in hypertension seems to be decreased production and increased degradation of nitric oxide mainly due to free oxygen radicals. Favorable effects in improvement of endothelial function were achieved by using ACE inhibitors, AT1 receptor blockers and calcium channel antagonists.
Acute right ventricular ischemia accompanies 40-80% of cases of infero-posterior myocardial infarction. Approximately one half of these patients present with hemodynamic compromise consisting of acute right ventricular failure, clear lungs and low cardiac output in spite of preserved left ventricular systolic function. The ischemic right ventricle appears to be relatively resistant to infarction and has remarkable ability to recover. Right ventricular performance improves spontaneously even in the absence of reperfusion, however reperfusion enhances this recovery and improves the clinical course of right ventricular infarction.
Explore the source record for details and available documents.