RESUMEN

BACKGROUND: Multiple randomised clinical trials have proven that cardiac resynchronisation therapy (CRT) reduces morbidity and mortality in appropriately selected patients with congestive heart failure and is recommended for such patients as per the European Society of Cardiology guidelines. AIM: In this paper we compare the indications and demographics in cardiac resynchronisation recipients in Poland and other European countries. METHODS: In 2015 and 2016, physicians from 42 European countries participated in the second edition of the European Cardiac Resynchronisation Therapy Survey. For 14 months, 288 implanting centres gathered data regarding demography, indications, implanting methods, and guidance compatibility from 11,088 patients receiving CRT. RESULTS: The survey revealed that a vast group of patients were eligible for CRT implantation (although some of them with rela-tively weak guidance recommendations) and showed essential variety in clinical practice when national data were benchmarked. CONCLUSIONS: The population of CRT recipients in Poland and other European countries did not differ in terms of demographic and clinical characteristics. In most cases, indications for CRT were in accordance with the guidelines; however some devices were implanted in patients beyond the guideline recommendations. For these procedures, the decision regarding CRT im-plantation relies mainly on the physicians' experience.

Asunto(s)

RESUMEN

INTRODUCTION: Increased expression of interleukin-6 (IL-6) has been described in left ventricular dysfunction in the course of chronic heart failure. Cardiac resynchronization therapy (CRT) is a unique treatment method that may reverse the course of chronic heart failure (CHF) with reduced ejection fraction (HF-REF). We aimed to evaluate the IL-6 system, including soluble IL-6 receptor (sIL-6R) and soluble glycoprotein 130 (sgp130), in HF-REF patients, with particular emphasis on CRT effects. MATERIAL AND METHODS: The study enrolled 88 stable HF-REF patients (63.6 ±11.1 years, 12 females, EF < 35%) and 35 comorbidity-matched controls (63.5 ±9.8 years, 7 females). Forty-five HF-REF patients underwent CRT device implantation and were followed up after 6 months. Serum concentrations of IL-6, sIL-6R and sgp130 were determined using ELISA kits. RESULTS: The HF-REF patients had higher IL-6 (median: 2.6, IQR: 1.6-3.8 vs. 2.1, IQR: 1.4-3.1 pg/ml, p = 0.03) and lower sIL-6R concentrations compared to controls (median: 51, IQR: 36-64 vs. 53. IQR 44-76 ng/ml, p = 0.008). There was no significant difference between sgp130 concentrations. In the HF-REF group IL-6 correlated negatively with EF (r = -0.5, p = 0.001) and positively with BNP (r = 0.5, p = 0.008) and CRP concentrations (r = 0.4, p = 0.02). Patients who presented a positive response after CRT showed a smaller change of sIL-6R concentration compared to nonresponders (ΔsIL-6R: -0.2 ±7.1 vs. 7 ±14 ng/ml; p = 0.04). CONCLUSIONS: HF-REF patients present higher IL-6 and lower sIL-6R levels. IL-6 concentration reflects their clinical status. CRT-related improvement of patients' functional status is associated with a smaller change of sIL-6R concentration in time.

Asunto(s)

RESUMEN

UNLABELLED: Inflammatory activation plays a pivotal role in chronic heart failure with reduced ejection fraction (HF-REF). A novel mediator from TNF family: soluble tumor necrosis factor-like weak inducer of apoptosis (sTWEAK) along its soluble decoy receptor CD163 (sCD163) recently has been investigated in other cardiovascular pathologies. We aimed to evaluate sTWEAK and sCD163 concentrations in HF-REF patients. The study enrolled 79 patients with stable HF-REF, EF < 35%. The control population without history of heart failure included two groups: 26 comorbidities matched patients and 27 healthy volunteers. sTWEAK and sCD163 serum concentrations were determined using ELISA kits. Univariate and multivariate analysis was performed to assess variables affecting concentration of sTWEAK and sCD163. HF-REF patients were characterized by higher sTWEAK (median 374 IQR: 321-429 vs 201 IQR: 145-412pg/ml, P=0.005), sCD163 (median 744 IQR: 570-1068 vs 584 IQR: 483-665pg/ml, P=0.03) concentrations and sTWEAK/sCD163 ratio (median 0.53 IQR: 0.32-0.7 vs 0.3 IQR: 0.22-0.37, P=0.001) comparing to healthy volunteers. Comparing to comorbidities matched controls, HF-REF patients had lower sTWEAK levels (median 374 IQR: 321-429 vs 524 IQR: 384-652pg/ml; P=0.002), while sCD163 and sTWEAK/sCD163 ratio didn't differ. Concentration of sTWEAK in HF-REF was affected by white blood cell count and aspirin intake, while sCD163 by exercise capacity, LV diastolic volume, CRP and presence of arterial hypertension. CONCLUSIONS: HF-REF patients present increased sTWEAK and sCD163 levels as well as sTWEAK/sCD163 ratio when compared to healthy subjects, however CHF itself appears to be associated with down-regulation of sTWEAK.

Asunto(s)

RESUMEN

We describe a case of a 45-year-old man admitted with symptoms of infective endocarditis on tricuspid valve. At this time complex congenital heart disease was first time diagnosed. Differential diagnosis between tetralogy of Fallot and double-chambered right ventricle is discussed. At surgical exploration tetralogy of Fallot was confirmed. The patient underwent successful total surgical correction.

Asunto(s)

RESUMEN

BACKGROUND: Acute coronary syndromes are caused by the rupture or erosion of an atherosclerotic plaque which by secreting a variety of proteases is capable of degrading pericellular matrix components induces death of endothelial cells. This mechanism plays the main role in apoptosis. AIM: To estimate expression of apoptotic Fas/FasL (CD95/CD95L) on lymphocytes in the peripheral blood. METHODS: We examined patients with acute myocardial infarction (n=18, mean age 62+/-8 years), in unstable angina pectoris (n=31, mean age 62+/-10 years) and in a control group (n=20, mean age 62+/-9 years) without coronary risk factors and inflammatory condition. All investigations of Fas/FasL were performed by flow cytometry. Inflammatory parameters and standard risk factors were investigated by standard methods (ELISA). RESULTS: The analysis revealed a higher expression of Fas and FasL molecules on the lymphocytes from patients with acute myocardial infarction (p<0.001, p<0.002) and unstable angina (p<0.01, p<0.02) compared to the control group. Moreover we found a statistically significant positive correlation between the level of LDL cholesterol and hypertension and prevalence of CD95 (p<0.001, p<0.01) and CD95L (p<0.02, p<0.03) in patients with acute myocardial infarction. CONCLUSIONS: A higher expression of apoptotic molecules (Fas and FasL) on lymphocytes occurs before the onset of acute ischaemia and contributes to the plaque rupture and acute coronary syndrome. Furthermore, antiapoptotic therapy leads to plaque stabilisation.

Asunto(s)

RESUMEN

Hepatocyte growth factor (HGF) takes part in tissue regeneration after injury. It is a potent survival and regeneration factor after severe tissue damage. It promotes cell growth and protection from apoptosis, regulates the cell migration and differentiation. HGF is a subject of intensive investigations in order to apply it in the future in gene therapy to improve treatment of angina pectoris or intermittent claudication. The aim of this review is discussion about the role of HGF in pathogenesis and treatment of atherosclerosis. Angiogenetic activity of HGF was proven in vivo as well as in vitro. In patients with collaterals increased HGF plasma concentration was revealed. It is possible to determine with high probability the risk of cardiovascular event on the basis of HGF concentration. Plasma concentration of this factor increases dramatically after heparin injection, particularly after unfractionated heparin. Also other drugs (ACE-inhibitors) may take part in regulation of HGF synthesis.

Asunto(s)

RESUMEN

BACKGROUND: Cytokines are responsible for the modulation of immunological and inflammatory processes as well as proliferative responses and apoptosis. It has been recently suggested that such cytokines as interleukin 6 (IL-6), soluble interleukin 6 receptor (sIL-6R) and anti-inflammatory cytokines such as interleukin 10 (IL-10) may play a significant role in the pathogenesis of acute coronary syndromes. AIM: To assess serum concentration of IL-6, sIL-6R and IL-10 in patients with ischaemic heart disease or acute myocardial infarction (AMI). METHODS: The study group consisted of 74 patients (25 females, 49 males, aged 40-69 years) divided into three groups; group I - 18 patients with AMI (up to 12 hours from the onset of symptoms), group II - 31 patients with unstable angina and group III - 25 patients with stable angina. The control group consisted of 20 healthy subjects. RESULTS: The IL-6 and sIL-6R serum levels were significantly higher in patients from groups I and II compared with patients from group III and controls, whereas the IL-10 serum concentration was similar in all studied groups. In patients with acute coronary syndromes serum concentrations of examined cytokines were positively correlated with acute inflammatory phase parameters and classical risk factors such as body mass index, blood pressure and lipid levels. CONCLUSIONS: IL-6 and sIL-6R are markers of acute coronary syndromes and may be used for the identification of high-risk patients with unstable angina or AMI.

Asunto(s)

RESUMEN

A case of a 51-year-old male with dilated cardiomyopathy and left atrial mass detected by echocardiography is described. Differential diagnosis between thrombus and myoxoma was difficult. Anticoagulation therapy was initiated and no intra-atrial mass was detected during the control echocardiographic examination. Thus, the diagnosis of intracardiac thrombus was established ex iuvantibus. Difficulties in the diagnosis and treatment of intracardiac masses are discussed.

Asunto(s)

RESUMEN

The targeting and recruitment of inflammatory cells to vascular endothelium in ischaemic heart diseases is mediated by Intercellular Adhesion Molecule-1 (ICAM-1), Vascular Cell Adhesion Molecule (VCAM-1) and E-selectin and proinflammatory cytokines. Accumulation of mononuclear cells to the endothelium is one of the earliest events in the formation of an atherosclerotic lesion. The aim of this study was to estimate the serum concentrations of soluble intercellular adhesion molecule-1 (sICAM-1), vascular adhesion molecule-1 (sVCAM-1), selectin E (sE-selectin) in patients with acute myocardial infarction (Group 1--n = 18 patients: 3 women and 15 men, mean age--60 years), unstable angina pectoris (Grupa 2--n = 31 patients: 8 women and 23 men, mean age--62 years and stable heart disease (Grupa 3--n = 25 patients: 14 women and 11 men, mean age--61 years. The control group (Group 4--n = 20) consist of twenty healthy patient without coronary risk factors. ELISA method was used to determine the concentration of adhesion molecules of acute inflammation parameters, and traditional risk factors with using standard methods. The serum levels of sICAM-1, sVCAM-1 were markedly elevated in patients with acute myocardial infarction, unstable angina pectoris and stable heart disease compared to control group (p < 0.001, p < 0.004, p < 0.0002 for sICAM-1, p < 0.007, p < 0.003, p < 0.004 for sVCAM-1). Serum concentration of sE-selectin in three groups was similar, we did not find statistically significant differences between them. Furthermore, serum concentrations of adhesion molecules correlated with serum concentrations of acute inflammation parameters and traditional coronary risk factor for example BMI, systolic and diastolic blood pressure and lipid concentration. Additional serum concentration of sICAM-1 was elevated in smoking patients compared to non-smokers. We conclude that evaluation of adhesion molecules (sICAM-1 and sVCAM-1 in patients with heart diseases can be unspecific markers of activity of inflammatory process in coronary vascular endothelium.

Asunto(s)

Asunto(s)