Ventricular Arrhythmias in Left Ventricular Assist Device Patients-Current Diagnostic and Therapeutic Considerations

Left ventricular assist devices (LVAD) are used in the treatment of advanced left ventricular heart failure. LVAD can serve as a bridge to orthotopic heart transplantation or as a destination therapy in cases where orthotopic heart transplantation is contraindicated. Ventricular arrhythmias are frequently observed in patients with LVAD. This problem is further compounded as a result of diagnostic difficulties arising from presently available electrocardiographic methods. Due to artifacts from LVAD-generated electromagnetic fields, it can be challenging to assess the origin of arrhythmias in standard ECG tracings. In this article, we will review and discuss common mechanisms, diagnostics methods, and therapeutic strategies for ventricular arrhythmia treatment, as well as numerous problems we face in LVAD implant patients.

Effects of exercise training after acute coronary syndromes in octogenarians - prospective 12-month evaluation

OBJECTIVE

Aim: To demonstrate the impact of individual exercise training on the course of the disease, exercise tolerance and quality of life (QoL) in patients over 75 years after acute coronary syndrome (ACS).

PATIENTS AND METHODS

Materials and methods: Study included octogenarians after ACS randomly assigned into two groups: a training group (ExT) subjected to individualized physical training and a control group (CG) with standard recommendations for activity. Patients underwent exercise tolerance test (ETT), 6-minute walk test (6-MWT), NHP and QoL questionnaires evaluation, lab tests, ECG, echocardiographic examination at the beginning and after 2, 6 and 12 months.

RESULTS

Results: Study included 51 patients, mean age 80 years, 50% men, all patients completed the study. Initial physical capacity was comparable in both groups. After 2-month training the average ETT exercise time increased by 12.5% (p=0.0004), the load increased by 13% (p=0.0005) and the 6-MWT results improved by 8.3% (p=0.0114). Among CG these changes were not significant. But 6 and 12 months after training cessation 6-MWT results returned to the initial values (p=0.069, p=0.062 respecitvely). Average ETT exercise time and average load decreased significantly after 12 months (p=0.0009, p=0.0006). Level of pain was significantly lower at the end of the training in ExT group (p=0.007), but it returned to initial 12 months later (p=0.48). QoL deteriorated significantly in the ExT group 12 months after training cessation (p=0.04).

CONCLUSION

Conclusions: Cardiac rehabilitation in octogenarians after ACS was safe and improved physical performance in a short period of time. Cessation of training resulted in a loss of achieved effects and deterioration of the QoL.

Plasma levels of chemokines CCL2 and CXCL12 in female dogs with malignant mammary gland tumours without and with metastases

The aim of this study was to evaluate the plasma levels of chemokines CCL2 and CXCL12 in female dogs with malignant mammary gland tumours without and with metastases. The concentrations of CCL2 and CXCL12 were determined in 25 female dogs with malignant mammary gland tumours (15 without metastases and 10 with metastases) and 10 healthy control animals using a specific canine ELISA assay. The mean plasma concentrations of CCL2 and CXCL12 were significantly higher (p<0.05) in the metastatic group compared to the control group. Moreover, the concentrations of these chemokines were markedly higher in the dogs with metastases than in those without metastases; however, a statistically significant difference was not found. The concentrations of both tested chemokines were numerically increased in the dogs with grade 2 and grade 3 carcinomas compared to the dogs with grade 1 carcinomas but the differences did not reach statistical significance. In conclusion, the results of our study demonstrate that plasma concentrations of chemokines CCL2 and CXCL12 are significantly increased in the dogs with metastatic malignant mammary gland tumours compared to the healthy dogs and show an upward trend compared to those without metastases. However, clarifying whether the increase of these chemokines is a cause or an effect of metastasis in female dogs with malignant mammary gland tumours as well as their potential role in metastatic process requires further research.

Short- and long-term survival of patients hospitalized for COVID-19 in relation to cardiovascular risk factors and established cardiovascular disease: the Cor-Cardio study

INTRODUCTION

The clinical presentation of COVID‑19 may range from asymptomatic infection to severe disease. Previous studies reported a relationship between the course of COVID‑19 and a history of cardiovascular (CV) disease (CVD).

OBJECTIVES

We aimed to analyze the influence of CV risk factors, established CVD, and treatment with CV drugs on short- and long‑term survival in patients hospitalized for COVID‑19.

PATIENTS AND METHODS

We retrospectively analyzed data of patients hospitalized in 13 COVID‑19 hospitals in Poland (between March and October 2020). Individual deaths during the follow‑up were recorded until March 2021.

RESULTS

Overall, 2346 patients with COVID‑19 were included (mean age, 61 years; 50.2% women). A total of 341 patients (14.5%) died during the hospitalization, and 95 (4.7%) died during the follow‑up. Independent predictors of in‑hospital death were older age, a history of established CVD, heart failure, and chronic kidney disease (CKD), while treatment with renin‑angiotensin‑aldosterone system blockers or statins was associated with a lower risk of death during hospitalization. Factors that independently predicted death during the follow‑up were older age, a history of established CVD, CKD, and a history of cancer. The presence of CV risk factors did not increase the odds of death either in the hospital or during the follow‑up. Of note, higher systolic blood pressure and oxygen blood saturation on admission were associated with better short- and long‑term prognosis.

CONCLUSION

Established CVD and CKD were the main predictors of mortality during both the hospitalization and the follow‑up in the patients hospitalized for COVID‑19, while the use of CV drugs during the hospitalization was associated with better prognosis. The presence of CV risk factors did not increase the odds of in‑hospital and postdischarge death.

Treatment of insomnia in older adults. Recommendations of the Polish Sleep Research Society, Polish Society of Family Medicine and the Polish Psychiatric Association

Insomnia is one of the most common health problems in developed countries. Its prevalence increases with age, with up to one in two people over the age of 65 experiencing symptoms of insomnia. The older people are also the patients who mostly commonly are among chronic sleep medication users. The aim of this article is to present the current recommendations for the management of insomnia in people over 65 years of age. The recommendations were prepared as a position of an expert panel, which included people from a number of clinical disciplines: family medicine, cardiology, psychiatry, sleep medicine and clinical psychopharmacology. The first step in treating sleep disorders is to establish proper diagnosis and, if possible, to initiate causal treatment. Moreover, cognitive and behavioural therapy for insomnia should also be used as the primary form of treatment, which can be supplemented, if not sufficiently effective, with pharmacological treatment. The main group of drugs used for treating insomnia are nonbenzodiazepine sedative hypnotics (zolpidem, zopiclone, eszopiclone, zaleplon). However, these drugs do not fully meet the needs of people over 65 years of age, primarily with regard to treatment safety. Therefore other classes of medicines, which are used for treatment of mental disorders, are prescribed off-label in this group of patients. Melatonin in a prolonged-release form is also indicated for this age group due to the high safety of the therapy. The management of insomnia in people over 65 years of age is a challenging task, given the need to seek compromise between treatment efficacy and safety. The treatment plan also has to take into account comorbidities as well as drugs used to treat them.

IMPACT OF EARLY EXERCISE-BASED CARDIAC REHABILITATION ON HOSTILITY, ITS BEHAVIORAL COMPONENTS AND DISEASE PERCEPTION IN PATIENTS AFTER MYOCARDIAL INFARCTION

OBJECTIVE

Aim: Hostility and its behavioral components, anger and aggression are psychosocial risk factors for coronary heart disease. The purpose of the study was to evaluate the effectiveness of physical training on the level of negative emotions, the cognitive aspect of adaptation to disease and physical capacity in patients after MI who participated in cardiac rehabilitation.

PATIENTS AND METHODS

Materials and Methods: We enrolled 60 post-MI men and women in the study. They underwent an 8-week training program. Before and after completion of trainings patients underwent exercise test and a psychological examination.The Buss-Perry Aggression Questionnaire and the Brief Illness Perception Questionnaire were performed with results analysis in the entire group and in subgroups of men, women, patients under 60 years of age (younger) and over 60 years of age (older).

RESULTS

Results: After rehabilitation a significant reduction in the general level of negative emotions was found in younger: 67.8±4.6 vs 63.9±3.7 points (p< 0.01). Similarly, a significant reduction in the sense of the impact of the disease on life was found only in younger 6.96±0.5 vs 5.48±0.5 points (p<0.01). There was a significant improvement in overall adaptation to the disease in women from 40.6±2.2 to 35.7±1.9 points (p < 0.05).Moreover,patients with higher levels of negative emotions had more difficulty adapting to the disease r=0.361, p<0.01. Physical capacity increased significantly in all groups.

CONCLUSION

Conclusions: Participating in cardiac rehabilitation improved physical capacity, beneficially contributed to a decrease in negative emotions and had a positive effect on disease adaptation but only in younger post -MI patients.

Cluster Analysis to Distinguish Patients Most Likely to Benefit from Outpatient Cardiac Rehabilitation-A Prospective, Multicenter Study

Offering cardiac rehabilitation to people who can benefit most could improve the outcomes in the context of limited availability. We used cluster analysis to distinguish three patient groups based on clinical and laboratory variables and then compared the outcomes of 6-month outpatient cardiac rehabilitation between these groups. The outcomes included blood pressure, blood lipids, fasting blood glucose, and uric acid concertation in serum. Group 1 consisted primarily of men with obesity, increased blood pressure, favourable lipid profiles and increased fasting glucose. Group 2 consisted of men or women with normal weight, normal blood pressure, favourable lipid profiles, and normal fasting glucose. Group 3 consisted primarily of women with overweight, normal blood pressure, unfavourable lipid profiles, and normal fasting glucose. After 6 months of cardiac rehabilitation, blood lipids improved in group 3, whereas blood pressure improved in groups 1 and 3, but the outcomes did not change significantly in group 2. We did not see any effect of cardiac rehabilitation on fasting blood glucose and serum uric acid concentration in any group. Concentrations of glucose and uric acid did not change significantly in any group. In conclusion, an adequate selection of patients should maximise the benefits of cardiac rehabilitation.

Plasma interleukin-1α and interleukin-8 in female dogs with non-metastatic and metastatic malignant mammary gland tumours

In this study plasma concentrations of IL-1α and IL-8 in 29 female dogs with malignant mammary gland tumours (19 without metastasis and 10 with metastasis) and in 10 healthy control animals were determined. Concentrations of IL-1α and IL-8 were analysed using a specific canine ELISA assay. Mean plasma concentrations of IL-1α and IL-8 were significantly higher (p⟨0.05) in female dogs with both non-metastatic and metastatic malignant tumours compared to the healthy animals. The concentrations of both tested cytokines were significantly increased (p⟨0.05) in the dogs with metastasis. In female dogs with mammary carcinomas, the plasma concentration of IL-1α was significantly higher (p⟨0.05) in the animals with grade 3 tumours compared to the dogs with grade 1 tumours. The concentration of IL-8 was significantly higher (p⟨0.05) in the dogs with grade 3 tumours compared to that found in the animals with grade 1 and grade 2 tumours. A moderate correlation (r=0.433) was found between IL-1α and IL-8 concentrations in the female dogs. These findings suggest that increased malignancy and invasiveness of canine mammary tumours is associated with an increased production of IL-1α and IL-8 in the tumour microenvironment, which, in turn, leads to an increase in their circulating levels. This may indicate that circulating levels of the cytokines investigated could be considered as diagnostic and prognostic markers in canine malignant mammary tumours. However, further studies in this fields are needed.

Clinical efficacy of potassium canreonate-canrenone in sinus rhythm restoration among patients with atrial fibrillation - a protocol of a pilot, randomized, double -blind, placebo-controlled study (CANREN-AF trial)

Background

Atrial fibrillation (AF) is the most frequent cardiac arrhythmia which increases the risk of thromboembolic complications and impairs quality of life. An important part of a therapeutic approach for AF is sinus rhythm restoration. Antiarrhythmic agents used in pharmacological cardioversion have limited efficacy and potential risk of proarrhythmia. Simultaneously, underlying conditions of AF should be treated (e.g. electrolyte imbalance, increased blood pressure, neurohormonal disturbances, atrial volume overload). There is still the need for an effective and safe approach to increase AF cardioversion efficacy. This randomized, double-blind, placebo-controlled, superiority clinical study is performed in patients with AF in order to evaluate the clinical efficacy of intravenous canrenone in sinus rhythm restoration.

Methods

Eighty eligible patients with an episode of AF lasting less than 48 h are randomized in a 1:1 ratio to receive canrenone or placebo. Patients randomized to a treatment intervention are receiving canrenone intravenously at a dose of 200 mg within 2–3 min. Subjects assigned to a control group obtain the same volume of 0.9% saline within the same time. The primary endpoint includes return of sinus rhythm documented in the electrocardiogram within 2 h after drug or placebo administration. Other endpoints and safety outcomes analyses, due to expected lack of statistical power, are exploratory.

Discussion

Current evidence supports renin–angiotensin–aldosterone system (RAAS) inhibition as an upstream therapy in AF management. Excess aldosterone secretion results in proarrhythmic effects. Among the RAAS inhibitors, only canrenone is administered intravenously. Canrenone additionally increases the plasma level of potassium, lowers blood pressure and reduces preload. It has been already used in primary and secondary hyperaldosteronism in the course of chronic liver dysfunction and in heart failure.

Trial registration

ClinicalTrials.gov, NCT03536806. Registered on 25 May 2018.

Elevated levels of d-dimer are associated with inflammation and disease activity rather than risk of venous thromboembolism in patients with granulomatosis with polyangiitis in long term observation

PURPOSE

Granulomatosis with polyangiitis (GPA) is one of antineutrophil cytoplasmic autoantibody (ANCA) - associated vasculitis. The disease is characterized by necrotizing inflammation of small vessels causing tissue ischemia in a variety of organs. The aim of the present study was an evaluation of inflammation, coagulation and fibrinolysis biomarkers, and their possible associations with various clinical and laboratory parameters in GPA patients.

METHODS

A group of 100 consecutive patients with GPA were prospectively followed in the study. In all patients, echocardiography and laboratory tests were performed.

RESULTS

The patients were followed-up for a median of 4.0 ± 1.9 years. Circulating d-dimer concentrations were elevated in a majority (56%) of GPA patients, and were significantly higher in GPA patients in the active stage compared to those in remission (median 652 vs. 405 ng/ml, p = 0.0002). In 23 patients (23%) venous thromboembolism (VTE) was diagnosed during observation. However, there were no differences in d-dimer concentrations between patients with and without VTE either in active stage or in remission. Correlation analysis showed that the levels of d-dimer correlated with hs-CRP (r = 0.42, p < 0.0001) and creatinine concentrations (r = 0.58; p < 0.0001), but not with ANCA levels.

CONCLUSIONS

In patients with GPA elevated levels of d-dimer are associated with disease activity and inflammation rather than with the risk of venous thromboembolism. The value of d-dimer as a biomarker of venous thromboembolism episodes in patients with small vessel vasculitis is low.

Uterine non-enzymatic antioxidant defence mechanisms (glutathione, vitamin C, copper and zinc) in diagnosis of canine pyometra

The aim of the present study was to determine the concentrations of glutathione (GSH), vitamin C, copper (Cu) and zinc (Zn) in the uterine tissues in diagnosis of canine pyometra. Fourteen samples of uterine tissues from female dogs with pyometra and twelve samples of healthy uteruses (control) were used. The concentrations of GSH and vitamin C were determined in the uterine tissue homogenates using spectrophotometric methods. The concentrations of Cu and Zn were measured using atomic absorption spectrometer. The results obtained showed the significantly lower (p⟨0.05) concentration of GSH and the trend towards lower concentration of vitamin C in the pyometra samples compared to the control. The concentrations of Cu and Zn were similar in the uterine tissues from female dogs with pyometra and those from healthy female dogs. The lower GSH and vitamin C concentrations in the uterine tissues of female dogs with pyometra indicate that the non-enzymatic antioxidant mechanisms are impaired in the uterus of dogs with pyometra. These findings suggest that the imbalance of oxidative-antioxidative can play an important role in pathogenesis of canine pyometra.

Differences in Symptomatology and Clinical Course of Acute Coronary Syndromes in Women ≤45 Years of Age Compared to Older Women

Acute coronary syndromes (ACS) in young people are rare. The data regarding differences in symptoms in relation to age are scarce, which may have an influence on outcomes. The aim of this study was to evaluate the differences in the clinical course of ACS between younger women (≤45 years old) and older women (63-64 years old). We compared 7481 women with ACS from the Polish Registry of ACS between 2007 and 2014 (1834 women aged ≤45 years and 5647 women aged 63-64 years). The predominant symptom of ACS in both groups was chest pain, with a higher incidence occurring in younger women (90.4% vs 88.5%, P = 0.025). Prehospital cardiac arrest occurred more often in younger women (2.1% vs 0.8%, P < 0.001), and onset-to-balloon time was shorter (8.9 vs 15.2 hours, P < 0.0001) in this group. Younger women presented with a lower Killip class at admission (class I at admission: 92.7% vs 86.2%, P < 0.001). The dominant type of ACS in the younger cohort was ST-segment elevation myocardial infarction (STEMI) (42% vs 26.1%), localized mainly in the anterior wall (47.7% vs 36.1%, P < 0.001), with a higher percentage of total occlusion of infarct-related artery (TIMI 0, 45.2% vs 36.1%) and left anterior descending artery engagement for all (33.5% vs 26.5%, P < 0.001). Drug-eluting stents were often used in the younger patients (43.3% vs 38.2%, P = 0.003) without significant differences in percutaneous coronary intervention numbers. Pharmacotherapy was used less in younger women. The 30-day and 2-year mortality in young women was lower than in the older cohort. The clinical course of ACS in younger women differed in comparison to older women. Younger women had a higher occurrence of typical chest pain, STEMI, and left anterior descending artery engagement. Except STEMI patients young women received faster revascularization, however with no significant differences in invasive treatment. Pharmacotherapy was inadequate in younger women and that resulted in a lower usage of the beta-blockers, angiotensin-converting enzyme inhibitors, and statins in that group. Short- and long-term mortality was low, regardless of the type of ACS.

The effect of sacubitril / valsartan on the occurrence of ventricular arrhythmia and the risk of sudden cardiac death in patients with chronic heart failure with reduced left ventricular ejection fraction. Expert opinion of the Heart Rhythm and Heart Failure Sections of the Polish Cardiac Society

Exacerbation of chronic heart failure (HF) is the most common cause of hospitalization in adults, which is associated with high morbidity and mortality rates, mainly due to HF exacerbation or sudden cardiac death (SCD). A novelty in the treatment of HF with reduced left ventricular ejection fraction (HFrEF) in recent years has been the approval of sacubitril / valsartan, a drug belonging to angiotensin receptor-neprilysin inhibitors (ARNIs). Sacubitril / valsartan significantly reduces the severity of HF symptoms as well as the risk of hospitalization and death and is characterized by a good safety profile. Therefore, it has a strong position in the guidelines of international cardiac societies. However, the precise mechanism underlying the beneficial effects of ARNIs on cardiovascular mortality is unknown. The advantages of ARNIs are likely to result from improved left ventricular ejection fraction, reduced myocardial remodeling, and increased natriuretic peptide availability. Therefore, sacubitril / valsartan may exhibit antiarrhythmic properties and reduce the risk of ventricular arrhythmias and SCD in patients with HFrEF. Importantly, the improvement of the function and electrical stabilization of cardiomyocytes may translate into a reduced risk of appropriate and inappropriate implantable cardioverter‑defibrillator interventions and improvement in the percentage of biventricular pacing. In this expert opinion of the Heart Rhythm and Heart Failure Sections of the Polish Cardiac Society, we summarize and discuss the current knowledge on the effect of sacubitril / valsartan on the occurrence of ventricular arrhythmias and the risk of SCD in patients with chronic HFrEF.

Exercise training program in patients with NYHA III class systolic heart failure - Parallel comparison to the effects of resynchronization therapy

PURPOSE

The aim of this study was to assess exercise capacity and echocardiographic parameters in patients with heart failure with reduced ejection fraction (HFrEF) in NYHA III functional class, after cardiac resynchronization therapy (CRT) or implantable cardioverter-defibrillator (ICD) implantation followed by 6 months of supervised rehabilitation in ICD patients.

MATERIALS AND METHODS

The study included patients with HFrEF and impaired left ventricle systolic function (LVEF ≤ 35%), divided into two groups: CRT group - patients after CRT-D implantation > six weeks, and ICD-rehab group - patients after ICD implantation > six weeks, followed by 6 months of supervised aerobic interval training and the conditioning exercises. At baseline and after 6 months in all the patients cardiopulmonary exercise tests (CPX) and standard echocardiographic examinations were performed.

RESULTS

The study included 61 patients (49-77 years) with HFrEF. At baseline, the values of CPX parameters were similar in both groups. After completing training almost all CPX parameters in the ICD-rehab group significantly improved, except for anaerobic threshold (AT). In the CRT group significant improvements were found in 2 parameters: peak oxygen uptake (VO₂) and exercise tolerance (metabolic equivalents, METs). Significant reductions in left and right ventricle diameters and an increase in LVEF were observed in both groups after 6 months.

CONCLUSIONS

Significant improvement in exercise tolerance capacity and increase of LVEF were observed in similar extent both in heart failure patients with CRT and with ICD undergoing the rehabilitation program. Regular, controlled exercise trainings provided additional, safe and easy to conduct therapeutic option for heart failure patients with no indications for CRT.

Factors Affecting Early Mortality and 1-Year Outcomes in Young Women With ST-Segment-Elevation Myocardial Infarction Aged Less Than or Equal to 45 Years

Given that up to 2% of patients with myocardial infarction (MI) are young women, the purpose of this study was to evaluate factors affecting outcomes in young women with ST-segment-elevation myocardial infarction (STEMI) aged less than or equal to 45 years. We evaluated 796 women with STEMI aged less than or equal to 45 years between 2007 and 2014, and mortality was 4.0%. Death occurred more often in women with prehospital sudden cardiac arrest, and severe symptoms of heart failure; less commonly, the women were subjected to percutaneous coronary intervention (PCI), with a higher rate of incomplete revascularization. Beta blockers (BB) and angiotensin converting enzyme inhibitors were frequently used in the survivor group. The independent predictor of 30-day mortality was as follows: inability to undergo PCI (odds ratio [OR] 4.6, 95% confidence interval [CI] 1.45-14.76, P = 0.009), sudden cardiac arrest (OR 4.5, 95% CI 1.5-18.3, P = 0.04). An increase in systolic blood pressure for every 5 mm Hg was associated with lower mortality, OR 0.90, 95% CI 0.76-0.97 in patients without cardiogenic shock (CS) and OR 0.69, 95% CI 0.61-0.78, P < 0.0001 in the group with CS. Predictors for 1-year mortality were the inability to undergo PCI (hazard ratio [HR] 84, 95% CI 1.6-43.1, P = 0.01) and CS (HR 6.97, 95% CI 1.39-34.7, P = 0.01). An increase of 5% in left ventricular ejection fraction reduced the mortality rate for 60% (HR 0.40, 95% CI 0.26-0.63, P < 0.0001) and an increase in systolic blood pressure for every 5 mm Hg reduced mortality for 34% (HR 0.66, 95% CI 0.52-0.84, P = 0.02). Both short- and long-term outcomes in young women aged less than or equal to 45 years with STEMI are good. The strongest predictor for both 30-day and 1-year mortality was the inability to undergo PCI. Suboptimal use of beta blockers and angiotensin converting enzyme inhibitors affect the outcomes in young women. Hypotension in the acute phase of MI increased mortality in young women, independent of coexisting CS.

Clinical factors affecting long term survival in patients with systolic heart failure and cardiac resynchronization therapy in advanced age

Identification of demographic and clinical factors which influence prognosis is crucial in patients with heart failure and cardiac resynchronization therapy (CRT).

MATERIALS AND METHODS

The study included 223 patients with CRT (177 males), mean age 64.6±9.7 years, including 98 patients (43.9%) with defibrillation function (CRT-D) and 58 (26.0%) with permanent atrial fibrillation (AF). Of 223, n=72 patients (32.3%) had CRT implanted after the age of 70. The mean follow-up was 37±19 months. Mortality rates and other clinical factors according to age were assessed in multivariable analysis of CRT patients follow-up.

RESULTS

Total mortality was 30.9%. Mortality rate was similar in subjects aged ≤70 and >70 (HR:1.41, 95%CI:0.70-2.82). The female gender was the strongest clinical factor of best prognosis (HR:0.12,95%CI:0.03-0.59, p=0.0088). Lower mortality was also associated with higher left ventricular ejection fraction (HR:0.94,95%CI:0.90-0.98, p=0.0031). Coronary disease (HR:2.09,95%CI:1.10-3.99, p=0.0245), chronic kidney disease (HR:3.00, 95%CI:1.47-6.12, p=0.0024)and higher NYHA class (HR:2.28, 95%CI:1.18-4.40, p=0.0137) were factors of increased mortality. For patients >70 years old, gender was not a survival determining factor and mortality was lower in regard to hypertension or permanent AF. Only chronic kidney disease was significantly associated with higher mortality in patients >70 years old (HR:6.74, 95%CI:1.90-23.9). The use of defibrillation function had no influence on survival rate at any age.

CONCLUSIONS

In patients with cardiac resynchronization therapy female gender was not associated with mortality and was the factor of better prognosis. For subjects aged >70 a worse prognosis was related to renal insufficiency.

Evaluation of adenosine deaminase in saliva and serum, and salivary α-amylase, in canine pyometra at diagnosis and after ovariohysterectomy

An assay for adenosine deaminase (ADA) was validated in serum and saliva in dogs. Changes in ADA and salivary α-amylase activities were analysed in 26 bitches diagnosed with pyometra and compared with activities in 19 healthy bitches. All animals were classified according to the American Society of Anaesthesiologists (ASA) scoring for physical status. In the validation study, the ADA assay had an imprecision<12% and determination coefficients>0.90 in linearity under dilution experiments, with recoveries of 99.2-114.4%. On the day of presentation, salivary ADA activity was significantly higher in dogs with pyometra than in healthy dogs (median values 7.1IU/L vs. 0.8IU/L, respectively; P<0.01). ADA had a moderate positive correlation with leucocyte and band neutrophil counts, haptoglobin, salivary α-amylase and ASA score, and a low positive correlation with C-reactive protein. There were no significant differences in salivary α-amylase activity between dogs with pyometra and healthy dogs (57.3IU/L vs. 27.4IU/L, respectively). Salivary α-amylase had a low correlation with ASA grade, and leucocyte and band neutrophil counts. In 7/26 bitches with pyometra that were sampled 3 and 10days after ovariohysterectomy, there were no significant changes in α-amylase or ADA activities. These results indicate that ADA activity is increased in the saliva of bitches with pyometra, probably related to systemic inflammation.

Risk factors predisposing to acute coronary syndromes in young women ≤45 years of age

BACKGROUND

Acute coronary syndromes (ACS) are rare in young women. The purpose of this study was to characterize risk factors (RF) predisposing to ACS in young women and evaluate possible age-related differences.

METHODS AND RESULTS

We studied 1941 young women with ACS aged ≤45 years (≤45ACS) from the PL-ACS registry and compared them with two control groups: 4275 women aged 63-64 years with ACS (63-64ACS) from the PL-ACS registry and 1170 young healthy women aged ≤45 years (≤45H) without confirmed coronary artery disease (CAD), from two national, representative, cross-sectional population health surveys, NATPOL 2011 and WOBASZ. The prevalence of major RF in these three groups was as follows, respectively: (≤45 ACS vs. 63-64ACS vs. ≤45H, for all P < 0.0001): hypertension 49.8% vs. 78.1% vs. 16.8%; hypercholesterolemia 36.1% vs. 44.3% vs. 12.9%; obesity 22.3% vs. 28.1% vs. 15.6%; diabetes 10.6% vs. 29.9% vs. 1.8% and smoking 48.7% vs. 22.2% vs. 39%. Healthy women had the lowest number of major RF (1.7 ± 1.2 vs. 2.0 ± 1.1 vs. 1.1 ± 1.0). No RF was found in 16.7% vs. 8.2% vs. 34.4% women, respectively. Independent predictors of ACS in the ≤45ACS group included diabetes [odds ratio (OR) 6.66, 95% confidence interval (CI) 3.47-12.74]*, hypertension (OR 4.30, 95% CI 3.42-5.38)*, hypercholesterolemia (OR 3.45; 95% CI 2.60-4.29)*, and smoking (OR 1.63, 95% CI 1.34-1.98)*, *(P < 0.0001 for all).

CONCLUSIONS

The prevalence of risk factors for acute coronary syndromes in young women with ACS is different to those in healthy women and to those in older women. The prevalence of smoking was higher. The strongest predictor of ACS in women ≤45 years of age was diabetes, with a 6-fold increase in risk. There is still need to improve the cardio-vascular primary prevention and health promotion in the population of young women.

Stable coronary artery disease - medical treatment

The crucial issues in optimal medical therapy to improve prognosis and reduce angina symptoms are secondary prevention, effective control of concomitant diseases, risk factors and medical treatment. In spite of successful percutaneous coronary interventions (PCI) and medical treatment with beta-blockers, ACE-inhibitors or angiotensin receptor blockers, statins and antiplatelet drugs, some patients are still symptomatic. In the era of PCI not sufficient attention is paid to other drugs reducing the incidence of angina episodes: calcium antagonists, long-acting nitrates, metabolic agents and novel antianginal drugs. Substantial part of secondary coronary interventions may be avoided if angina pectoris would be properly treated. In the light of the Courage and BARI trials' results, optimal medical therapy of angina pectoris remains important part of treatment.

Improvement of exercise tolerance in cardiopulmonary testing with sustained safety after regular training in outpatients with systolic heart failure (NYHA III) and an implantable cardioverter-defibrillator. Prospective 18-month randomized study

INTRODUCTION

The aim of the study was to evaluate the impact of individual training on the level of physical capacity and echocardiographic parameters in patients with systolic heart failure (SHF), NYHA III and an implantable cardioverter-defibrillator (ICD).

MATERIAL AND METHODS

The study included 84 patients with SHF, randomly assigned to one of two groups: with regular training (ICD-Ex) and a control group (ICD-control). The ICD-Ex group participated in a hospital rehabilitation program which after discharge was individually continued for 6 months in an outpatient setting. The ICD-control group participated in a training program during hospitalization, but after discharge did not perform any controlled activities. Prior to discharge, at 6 and 18 months cardiopulmonary exercise testing (CPX), standard echocardiographic examination and the 6-minute walk test (6-MWT) were performed in all patients.

RESULTS

After 18 months in the ICD-Ex group most of the CPX parameters improved significantly (VO₂ peak, ml/kg/min: 13.0 ±4.1 vs. 15.9 ±6.1, p < 0.0017; VCO₂ peak, l/min: 1.14 ±0.34 vs. 1.58 ±0.65, p < 0.0008; Watt: 74.5 ±29.7 vs. 92.6 ±39.1, p < 0.0006; METs 3.72 ±1.81 vs. 4.35 ±1.46, p < 0.0131). In the ICD-control group no significant improvement of any parameter was observed. Left ventricular systolic dimensions remained significantly lower at 18 months only in the ICD-Ex group (49.5 ±11.0 vs. 43.4 ±10.0, p < 0.011). Left ventricular ejection fraction in both groups significantly increased at 6 and 18 months compared to baseline (ICD-Ex: 25.07 ±5.4 vs. 31.4 ±9.2, p < 0.001, vs. 30.9 ±8.9, p < 0.002, ICD-C: 25.1 ±8.3 vs. 29.2 ±7.7, p < 0.012 vs. 30.1 ±9.1, p < 0.005). Distance of the 6-MWT was significantly improved after 6 and 18 months in the ICD-Ex group and was overall longer than in the ICD-control group (491 ±127 vs. 423 ±114 m, p < 0.04).

CONCLUSIONS

An individual, 6-month training program, properly controlled in patients with SHF and an implanted ICD, was safe and resulted in a significant improvement of exercise tolerance and capacity and echocardiographic parameters.

Factors responsible for subclinical mastitis in cows caused by Staphylococcus chromogenes and its susceptibility to antibiotics based on bap, fnbA, eno, mecA, tetK, and ermA genes

The aim of this study was to recognize selected factors of virulence determining the adhesion of Staphylococcus chromogenes to cows' udder tissues in subclinical mastitis and to evaluate the susceptibility of this pathogen to antibiotics. The subjects of the study were 38 isolates of Staph. chromogenes from 335 samples of milk from cows with subclinical coagulase-negative staphylococci mastitis. Somatic cell count ranged between 216,000 and 568,000/mL of milk (average 356,000/mL of milk). We confirmed the ability to produce slime in 24 isolates (63.2%), and the ability to produce protease in 29 isolates (76.3%). In each slime-producing isolate, the bap gene was not found, and the fnbA and eno genes were not detected. In vitro tests showed that ceftiofur had the highest effectiveness against Staph. chromogenes (89.5% of susceptible isolates). Minimum inhibitory concentrations ranged from 0.06 to 2µg/mL for susceptible isolates. The minimum concentrations required to inhibit growth of 90 and 50% of the isolates for ceftiofur were at or below the cutoffs recommended by the Clinical and Laboratory Standards Institute (2 and 0.06µg/mL, respectively). A significant percentage of the isolates were susceptible to other β-lactam antibiotics: amoxicillin with clavulanic acid (84.2%) and ampicillin (81.6%). The lowest effectiveness among β-lactams was for penicillin (73.7% of susceptible isolates), and the minimum inhibitory concentration for penicillin ranged from <0.06 to 8µg/mL. None of the examined isolates had the mecA gene, but β-lactamase was detected in 4 isolates (10.5%). Erythromycin and oxytetracycline exhibited the lowest activity against Staph. chromogenes (71.1 and 63.2% of susceptible isolates, respectively). The genes tetK (6 isolates) and ermA (1 isolate) were also detected.

Osteoprotegerin in patients with degenerative aortic stenosis and preserved left-ventricular ejection fraction

OBJECTIVES

The aim of the present study was to evaluate value of osteoprotegerin (OPG) in patients with degenerative aortic stenosis and preserved left-ventricular ejection fraction.

METHODS

We have prospectively followed 70 patients with aortic stenosis (mean aortic gradient ≥15 mmHg) and preserved left-ventricular ejection fraction for 1 year. In all patients, echocardiography and blood tests (OPG, lipids, high-sensitivity C-reactive protein) were performed at baseline and after 1 year of follow-up. Detailed medical history including atherosclerotic risk factors was obtained. The control group consisted of 20 healthy individuals with normal echocardiographic findings. Rapid progression of aortic stenosis was defined as more than 7 mmHg increase in mean aortic gradient per year.

RESULTS

Osteoprotegerin concentrations were significantly higher in patients with aortic stenosis (P < 0.0001) and correlated with the degree of aortic stenosis. In multivariable regression model analysis, age (β = 0.015, P < 0.0001), mean aortic gradient (β = 0.04, P = 0.0078) and presence of coronary artery disease (β = 0.111, P = 0.0408) were the only independent determinants of plasma OPG concentrations. There was no association between OPG concentrations and coronary artery disease risk factors: male sex, smoking, hypertension and hypercholesterolemia. Concentrations of high-sensitivity C-reactive protein correlated positively with OPG levels only in nonsurgical patients (with lower degree of stenosis) (r = 0.34, P = 0.01). Aortic stenosis progression was related to body mass, diabetes, triglyceride concentrations, metabolic syndrome and left-ventricular systolic volume. In multivariate analysis, only metabolic syndrome was an independent predictor of aortic stenosis progression.

CONCLUSION

Osteoprotegerin concentrations are linked to the presence and severity of aortic stenosis. Metabolic syndrome was the only independent predictor of degenerative aortic stenosis progression.

Induction of a room temperature ferroelectric SmC* phase in binary mixtures with moderate spontaneous polarization and sub-millisecond switching time

Induction of room temperature SmC* phase in binary mixture.

Hospital-based and telemonitoring guided home-based training programs: effects on exercise tolerance and quality of life in patients with heart failure (NYHA class III) and cardiac resynchronization therapy. A randomized, prospective observation

Cardiac resynchronization therapy with defibrillator function (CRT-D) along with an optimal medical therapy improves symptoms, cardiac efficiency, quality of life (QoL) and prognosis in patients with heart failure (CHF). The aim of the study was to assess effects of hospital-based and home-based/telemonitoring exercise training.

METHODS

The prospective, randomized study was conducted in 52 patients (pts), aged 45-75years (mean 62±9.3), with CHF of ischemic or another etiology, NYHA class III and implanted CRT-D. Group CRT-Ex (n=26) underwent initial exercise training in the hospital setting and continued training program at home with telemonitoring 5 times a week for 8weeks. The CRT-control group (n=26) consisted of patients who had hospital rehabilitation, but no training program after discharge.

RESULTS

No differences between the groups in CHF etiology, comorbidities, medical therapy and in any of spiroergometry (CPX) parameters at baseline were observed. After 3-4months the CRT-Ex group achieved better results in VO2 peak, VCO2 peak and treadmill test duration. But after 12months the measurements returned to the baseline values. No significant differences were observed directly between two groups in distances of 6-MWT at baseline, at 3-4months and at 12months. Echocardiographic evaluation showed significant reduction of left ventricular dimensions and improvement in the left ventricular ejection fraction (EF), in both groups (25.3±7.4% to 28.9±9.1%, CRT-Ex group, p=0.0213 and 24.9±7.2% to 31.7±10.6%, CRT-Control group, p=0.0001). Significant improvement in all domains of QoL was observed in the CRT-Ex group, while the CRT-Control pts declared only higher energy levels and less pain. Intensity of telemonitoring guided home-based exercise training was low. In the 12- and 18-months follow-up there were no differences in the ICD-interventions, mortality or hospitalization rates between the groups.

CONCLUSIONS

A structured exercise training program in the hospital and home-based with telemonitoring was safe option of additional treatment and improved directly physical fitness and, quality of life in patients with NYHA III CHF and CRT-D. However these effects haven't been sustained in longer period of time and had no impact on prognosis.

Assessment of lipid and protein peroxidation markers in non-pregnant and pregnant female dogs

The aim of the study was to investigate oxidative stress during normal pregnancy in female dogs based on an evaluation of plasma markers for lipid and protein peroxidation. Twenty clinically healthy female dogs (10 non-pregnant and 10 pregnant) were used in the study. Blood samples from the pregnant animals were collected at 19-21, 38-40, and 56-58 days of pregnancy. Blood samples from non-pregnant female dogs were obtained between 20 and 35 days after ineffective breeding. As indicators of oxidative stress, we measured the following using spectrophotometric and spectrof- luorimetric methods: thiobarbituric acid reactive substances (TBARS), radical cations of N,N, diethylparaphenylene diamine (RC-DEPPD), sulfhydryl groups (SH groups), bityrosine and formylkynurenine. The mean plasma TBARS concentration in the pregnant dogs (0.486 ± 0.071-0.581 ± 0.191 μmol/g protein) was significantly higher (p < 0.05) than that found in the non-pregnant animals (0.274 ± 0.111 μmol/g protein). A marked, although not significant, decrease in SH group content, as well as an increase in bityrosine and formylkynurenine concentration were concurrently observed in the pregnant dogs. No significant differences were found in terms of the studied markers in the pregnant animals when comparing the values obtained during the investigated periods of pregnancy, although there was a progressive decrease in TBARS concentration and a progressive increase in RC-DEPPD, bityrosine and formylkynurenine contents. Our findings suggest that normal pregnancy in female dogs is associated with oxidative stress. Further studies are necessary to establish the physiological ranges of antioxidative/oxidative profiles in pregnant dogs and to explain if and how the intensity of oxidative stress might contribute to the risk of the complications of pregnancy.

Effects of ovariohysterectomy on oxidative stress markers in female dogs

Numerous studies reported an increase of oxidative stress increases in both women and female laboratory animals after ovariectomy. However, there is little information about the evaluation of antioxidative/oxidative status in ovariectomized dogs. The purpose of this study was to examine the changes in oxidative stress markers after ovariohysterectomy (OHE) in female dogs. The study included eighteen healthy mongrel female dogs. Blood samples were collected immediately before surgery and 14 and 30 days after surgery. Following parameters of oxidative stress intensity were determined: the erythrocyte activity of glutathione peroxidase (GSH-Px) and superoxide dismutase (SOD) as well as the plasma concentrations of thiobarbituric acid reactive substances (TBARS), radical cations of N,N, diethylpara-phenylene diamine (RC-DEPPD), sulfhydryl groups (SH groups), bityrosine and formylkynurenine. The activity of GSH-Px increased markedly, although not significantly, 14 days after OHE and then significantly decreased at 30 days after OHE. A significant increase in plasma TBARS, bityrosine and formylkynurenine concentrations and a decrease in SH group content were concurrently noted at 30 days after surgery. Acquired results suggested that a loss of control over ROS production occurred in female dogs after OHE, which could lead to oxidative stress in the late post-operative period. In conclusion, our findings indicated that OHE is related with the risk of oxidative stress in the late period after operations. Given that oxidative stress contributes to the pathogenesis of various diseases, this may suggest an increased risk of disorders in ovariectomized female dogs; however, further studies are necessary to confirm this hypothesis.

Prognostic importance of the extent of coronary revascularisation in patients with acute coronary syndromes and multivessel disease: one-year prospective follow-up

BACKGROUND

Interventional treatment improves prognosis in patients with acute coronary syndromes (ACS). However, despite introduction of percutaneous coronary intervention (PCI), the risk of cardiovascular events in patients with multivessel coronary artery disease (MVD) remains significant.

AIM

To evaluate the risk of complications and the prognostic value of MVD in patients with ACS during 1-year follow-up.

METHODS

A group of 153 patients with ACS was followed up at a single cardiology unit with round-the-clock PCI capability. Treatment of ACS, the extent of revascularisation, and complications occurring during hospitalisation and 1-year follow-up were analysed. The end points of the study were defined as death from all causes, cardiac death, recurrent ACS and a composite end point (deaths from cardiac causes and recurrent ACS).

RESULTS

During 1-year follow-up, 11 (7.2%) patients died, including 10 patients with MVD without complete revascularisation. Recurrent ACS occurred in 18 (12%) patients, including 13 patients with MVD without complete revascularisation. Presence of a residual significant coronary stenosis in incompletely revascularised patients with MVD was an important risk factor for all-cause mortality and occurrence of a composite endpoint in comparison to MVD patients who underwent complete revascularisation (p = 0.028 and p = 0.046, respectively) and patients with single-vessel disease (p = 0.006 and p = 0.003, respectively).

CONCLUSIONS

Incomplete revascularisation during the acute phase of ACS was associated with an increased risk of complications and a significantly increased risk of all-cause mortality and the combined rate of cardiovascular deaths and recurrent ACS. Single-stage PCI of all significant stenoses in MVD patients resulted in better outcomes.

The right ventricle in patients with chronic heart failure and atrial fibrillation

Under normal conditions function of the right ventricle (RV) is determined by the heart rhythm, RV filling time, RV systolic synchrony and interdependence between both ventricles. Failure of the left ventricle (LV) can lead to RV failure. Impaired function of the RV significantly worsens the prognosis in patients after myocardial infarction and with LV failure. Permanent atrial fibrillation (AF) is one of the most common arrhythmia in patients with depressed RV function. Frequent coexistence of chronic heart failure (CHF) and AF causes overlapping of the arrhythmia and RV dysfunction in the setting of CHF. They may lead to hemodynamic compromise and worsen prognosis in patients with chronic RV failure of various etiologies. RV structure and function can be assessed in 2D, 3D echocardiography, cardiac magnetic resonance imagingand computed tomography.

Dielectric Relaxation Studies of 4-n-Alkyloxy-4’-Cyanobiphenyls (nOCB, n= 5÷8)

The results of dielectric relaxation studies of series of four n-alkyloxy cyanobiphenyl (nOCB) compounds with n ranging from 5 to 8 are presented. The complex dielectric permittivity, ε*(ω) - ε’(ω) - i ε’’(ω), was measured in the frequency range 1 kHz - 3 GHz, with the use of an impedance analyzer and a time domain spectroscopy (TDS) set-up. The relaxation times: longitudinal τ|| in the nematic and smectic A phase (80CB), transverse τ⊥ in the nematic phase, and τis in the isotropic phase, were obtained as functions of the temperature. This allowed the calculation of activation barriers for different molecular relaxation processes occurring in particular phases. More-over, the retardation factors g|| and g⊥ and the nematic potential q according to two theoretical models were calculated. The analysis of q(T) and its relation to the order parameter S is done taking into account the results of NMR studies of the compounds under consideration. Finally, the dependencies of the obtained quantities on the number of carbon atoms in the alkyloxy chains are analyzed.

Cardioversion of Atrial Fibrillation (RHYTHM-AF) International Registry in Poland

BACKGROUND

A key procedure of the rhythm control strategy in atrial fibrillation (AF) is cardioversion to normal sinus rhythm. The aim of the present study was to provide a review of treatment patterns for the cardioversion of patients with AF in a hospital setting in Poland and document the success rate of various cardioversion procedures.

METHODS

We herein present the results from Poland of a prospective observational study to characterize patients with recent onset episodes of AF for whom cardioversion is one of the planned therapeutic options - the RHYTHM-AF registry. Consecutive patients in the hospital setting, age > 18 years, with documented AF at the time of enrollment, excluding those with atrial flutter and those treated with vernakalant, were recruited. No treatment was recommended nor discouraged.

RESULTS

Five hundred and one patients were recruited (mean age 64.2 ± 12.1), with 294 (58.7%) patients finally undergoing cardioversion. Primary electrical cardioversion (ECV) was successful in 131 (88.5%) patients. Primary pharmacological cardioversion (PCV) was successful in 110 (75.3%) patients. Amiodarone and propafenone were most commonly used (52.1% and 24.7%, respectively). Fourteen complications and adverse events were recorded (no stroke was observed).

CONCLUSIONS

Conversion to sinus rhythm was attempted in < 60% of the patients with AF admitted to the hospital with an intention to terminate arrhythmia. ECV was successful in ~90% of the patients, while PCV in ~75% of the patients (amiodarone and propafenone were most commonly used). The rate of complications was low (2.8%).