The effect of lead free cap on the doses of ionizing radiation to the head of interventional cardiologists working in haemodynamic room

OBJECTIVES

The study aim was to analyse the influence of the lead free cap on doses received by interventional cardiologists. The impact of lead free cap on doses to the head were evaluated in number of studies. As different methods used to assess the attenuation properties of protective cap can lead to ambiguous results, a detailed study was performed.

MATERIAL AND METHODS

The effectiveness of a lead free cap in reducing the doses to the skin was assessed in clinic by performing measurements with thermoluminescent dosimeters attached inside and outside the cap first during individual coronary angiography (CA) or CA/percutaneous transluminal coronary angioplasty (CA/PTCA) procedures and then cumulated during few procedures of the same type. In order to investigate the effect of the cap on reducing the doses to the brain additional measurements were performed with a male Alderson Rando and polymethyl methacrylate (PMMA) phantoms representing the physician and the patient, respectively for different projections. The brain dose per procedure, annual and cumulated during entire working practice were estimated for both cases working with and without the cap.

RESULTS

The dose reduction factor (RF) for the skin (the quotient of doses outside and inside the cap) vary from 1.1 up to 4.0 in clinical conditions; on average 2.3-fold reduction is observed in the most exposed left temple. The RFs determined for the part of the head covered by the cap range from 1.4 to 1.8 while for the brain from 1.0 to 1.1 depending on the projection. The estimated annual brain dose for interventional cardiologist performing yearly 550 CA/PTCA procedures without any protective shields is 7.2 mGy and it is reduced with the lead free cap by an average factor of 1.1.

CONCLUSIONS

The study results proved the considerable effectiveness of lead free cap to protect the skin but very limited to protect the brain. Int J Occup Med Environ Health. 2022;35(5):549-60.

Platelet reactivity and mean platelet volume as risk markers of thrombogenesis in atrial fibrillation

Atrial fibrillation (AF) is associated with increased risk of thromboembolic complications. One of the markers of the increased risk of hypercoagulable state is platelet hyperreactivity. The aim of the study was to assess impact of arrhythmia on platelet reactivity.

METHODS

The study included 36 (mean age 48,3; range 21-60) male patients with lone atrial fibrillation, with exclusion of concomitant diseases known to trigger hypercoagulable state. The AF patients underwent cardioversion to restore sinus rhythm and were subsequently under observation for 1month. Echocardiography, ECG and blood collection was performed before cardioversion (T0) and 4weeks after successful cardioversion (T1). During the study period patients have been contacted and examined every week and 24h ECG monitoring was performed. Platelet reactivity was assessed based on changes of CD62 and CD42b expression on platelet surface after stimulation with thrombin. Also changes in MPV were assessed.

RESULTS

In all patients sinus rhythm was maintained at the end of the study period, however in 14 patients recurrences of AF were observed, confirmed by 24h ECG monitoring (atrial fibrillation recurrence group - AFR) and 22 patients maintained sinus rhythm throughout the whole study period (SR group). Mean fluorescence intensity (MFI) of CD62 on thrombin stimulated platelets decreased significantly 4weeks after electrical cardioversion as compared to T0 (48.04±22.42 vs 41.47±16.03; p<0.01). Also MFI of CD42b on thrombin stimulated platelets decreased significantly 4weeks after electrical cardioversion as compared to T0 (22.16±10.82 vs 12.06±5.99; p<0.0001). Platelets reactivity estimated by CD 62 expression in SR group decreased significantly after 4weeks observation (58.01±15.26 vs 46.57±13.44; p<0.001) opposite to AFR group 35.66±21.87 vs 34.54±16.4; p-ns). Moreover there were significant differences between basal reactivity during AF between SR and AFR groups (58.01±15.26 vs 35.66±21.87; p-0.01). MFI of CD42b on thrombin stimulated platelets decreased significantly both in AFR and SR groups (22.05±11.36 vs 13.8±6.03; p<0.001 and 21.87±14.18 vs 10.04±5.09; p<0005). MPV decreased significantly 4weeks after electrical cardioversion as compared to T0 (8.81±0.19 vs 8.42±0.14; p<0.0001).

CONCLUSION

The changes of platelet reactivity to thrombin observed after restoration of sinus rhythm in patients prove that arrhythmia intrinsically leads to increased reactivity of platelets.

[The usefulness of complete blood count in predicting cardiac rehabilitation failure in post-NSTEMI patients]

ACS (acute coronary syndrome) NSTEMI is more prevalent than ACS STEMI. Within four years the mortality rate was twice higher in NSTEMI group than in the STEMI group. Studies have demonstrated that cardiac rehabilitation decreases the risk of all-cause mortality as well as the mortality related to cardiovascular events.

AIM

The aim of the study was to evaluate with the use of an index of own design the prognostic value of the complete blood count (CBC) in predicting cardiac rehabilitation failure in post-NSTEMI patients.

MATERIALS AND METHODS

The study comprised 116 post-NSTEMI patients, 81 men and 35 women, aged 64,12±11,29 years, admitted for cardiac rehabilitation to the Department of Internal Medicine and Cardiac Rehabilitation, MU in Lodz. On admission fasting blood cell count was performed, serum glucose and creatinine level was determined (GFR assessment). The following results were considered abnormal: glucose level ≥100 mg/dl, GFR<60 ml/min/1.73m2, RBC < 4x106 μl, WBC > 10x103/μl, PLT < 150x103/μl. Exercise test (cycloergometer) was performed twice in all patients - before and after the completion (4 weeks) of the II phase of the rehabilitation to assess its effects.

RESULTS

Basing on logistic regression analysis and the results of individual odds ratio (OR) of the tested blood parameters, their prognostic impact on the risk of cardiac rehabilitation failure was determined. This risk was defined on the basis of patient's inability to tolerate any workload increment (0 Watt) between the initial and final result of the exercise test despite the applied cardiac rehabilitation program. The most statistically significant risk factors were selected as the result of logistic regression model building on the basis of which cardiac rehabilitation failure index was determined. Anemia and leucocytosis determined most significantly the failure of cardiac rehabilitation (respectively OR=2,77 and OR=2,36; p=0,01). They were used to construct a rehabilitation failure index with the values ranging from 0 to 2, where 0 - corresponds to absence of anemia and leucocytosis, 1 - corresponds to the occurrence of anemia or leucocytosis in post-NSTEMI patients and was associated with 2,65-fold increase of the risk of cardiac rehabilitation failure, 2 - corresponds to simultaneous occurrence of anemia and leucocytosis and was associated with 7,02-fold increase of the risk of cardiac rehabilitation failure.

CONCLUSIONS

Complete blood count is useful in predicting cardiac rehabilitation failure. Anemia and leucocytosis are the most significant determinants of cardiac rehabilitation failure in post-NSTEMI patients. Cardiac rehabilitation failure index can be used for its individual programming. Then optimal rehabilitation effects can be obtained maintaining its safety in post-NSTEMI patients.

Asymptomatic atrial fibrillation in patients with atrial fibrillation and implanted pacemaker

INTRODUCTION

Atrial fibrillation is the most common chronic arrhythmia. Due to diagnostic difficulties, the exact prevalence of silent atrial fibrillation is not precisely defined.

AIM

The main aim of the present study was to assess the prevalence of asymptomatic atrial fibrillation and the relation between clinical status and presence of symptoms of atrial fibrillation.

MATERIAL AND METHODS

Fifty patients with implanted pacemaker with atrial fibrillation recording function and diagnosed paroxysmal atrial fibrillation were enrolled to the study in order to detect episodes of atrial fibrillation. Episodes lasting >1min were included into analysis. Patients were evaluated for presence of atrial fibrillation symptoms.

RESULTS

A total of 870 atrial fibrillation episodes were registered, the majority (93%) were asymptomatic. Episodes occurred more often during the day than during the night (p<0.001). Asymptomatic episodes occurred 13 times more frequently than symptomatic (p<0.001). Majority of episodes lasting up to 5min were asymptomatic, while episodes lasting over 24h were usually symptomatic (p<0.001). Furthermore, there were association between silent atrial fibrillation and lower HR (p=0.003), higher percentage of atrial (p=0.01) and ventricular pacing (p<0.001), male gender (p<0.001), presence of atrioventricular block (p<0.003), lower NYHA class (p<0.002), and calcium channel blockers (p=0.033) and diuretics intake (p<0.001).

CONCLUSION

In patients with bradycardia permanent pacemakers and paroxysmal atrial fibrillation, the proportion of asymptomatic episodes is very high. It was observed that shorter duration of the episodes, male gender, lower heart rate, presence of atrioventricular block, lower NYHA class, higher percentage of atrial and ventricular pacing, Ca²⁺ blockers, and diuretics intake predisposed to silent atrial fibrillation.

[Leukocytosis and decreased glomerular filtration rate increase the risk of cardiac rehabilitation failure in post-STEMI patients]

Recently, in the prognostic assessment of ACS patients attention has been paid to hyperglycemia, leukocytosis, decreased GFR, anemia and thrombocytopenia as they are believed to worsen the prognosis.

AIM

The aim of this study was to evaluate the results of basic laboratory blood tests in predicting the failure of in-hospital cardiac rehabilitation in post-STEMI patients - using an index of own design.

MATERIALS AND METHODS

The study comprised 100 post-STEMI patients, 70 men and 30 women, aged 60,1±10,3 years, admitted for cardiac rehabilitation (phase II) to the Department of Internal Medicine and Cardiac Rehabilitation, WAM University Hospital in Lodz. On admission fasting blood cell count and glucose and creatinine level was determined (for GFR assessment). The following results were considered abnormal: glucose level ≥100 mg/dl, GFR<60 ml/min/ 1,73m2, WBC> 10x103/μl, RBC<4x106/μl, PLT<150x103/μl. Exercise test was performed twice in all patients - before and after the completion of the II phase of cardiac rehabilitation to assess its effects.

RESULTS

Basing on logistic regression analysis and on the results of individual odds ratio (OR) of the tested blood parameters, their prognostic impact on the risk of cardiac rehabilitation failure was determined. This risk was defined on the basis of post-STEMI patients' inability to tolerate any workload increment (0 Watt) between the initial and final result of the exercise test despite the applied cardiac rehabilitation program. This concerned 54 out of 100 post- STEMI patients. Leukocytosis (WBC>10x103/μl) and GFR<60 ml/ min/1,73 m2 determined most significantly the failure of cardiac rehabilitation (respectively: OR=6,65 and OR=3,43; p=0,05). Thus, they were used to construct a cardiac rehabilitation index. The occurrence of leukocytosis or decreased GFR in post-STEMI patients was associated with a 4,5-fold increase of the risk of cardiac rehabilitation failure, whereas simultaneous occurrence of leukocytosis and decreased GFR was associated with over 20-fold increase of this risk.

CONCLUSIONS

The results of peripheral blood laboratory tests are useful in predicting cardiac rehabilitation effects. Leukocytosis and decreased GFR (<60 ml/min/1,73 m2) determine to the highest degree the risk of cardiac rehabilitation failure (phase II) in post-STEMI patients. Cardiac rehabilitation failure index can be useful in developing individualized rehabilitation program for post-STEMI patients.

[The prognostic value of basic laboratory blood tests in predicting the results of cardiac rehabilitation in post STEMI patients]

The possibility of complications and death from cardiovascular causes in patients with acute coronary syndromes (ACS) is an important element in the assessment of their clinical condition. It is believed that the prognosis of patients after ACS is affected, among others, by leukocytosis, anemia, hyperglycemia, thrombocytopenia, and increased volume of these cells and decreased GFR.

AIM

The aim of the study was an attempt to use basic laboratory blood tests and an index of own design to predict the results of in-hospital cardiac rehabilitation (phase II) of post STEMI patients.

MATERIALS AND METHODS

The study included 100 post STEMI patients, 70 men and 30 women, aged 60,9±11,8 years, admitted for cardiac rehabilitation to the Department of Internal Diseases and Cardiac Rehabilitation, MU in Lodz. On admission fasting blood cell count was performed, serum glucose and creatinine level was determined (GFR assessment). The following results were considered abnormal: glucose level ≥100mg/dl, GFR <60 ml/min/1,73m(2), RBC <4x10(6)/μl, WBC >10x10(3)/μl, PLT <150x10(3)/μl. Exercise test was performed twice in all patients - before and after the completion of the II phase of rehabilitation to assess its effects.

RESULTS

Basing on logistic regression analysis and the results of individual odds ratio (OR) of the tested blood parameters, their prognostic impact on the risk of cardiac rehabilitation failure was determined. This risk was defined on the basis of patient's inability to tolerate workload increment ≥20 Watt despite the applied cardiac rehabilitation program. The most statistically significant risk factors were selected as the result of logistic regression model building on the basis of which cardiac rehabilitation failure index was determined. Leukocytosis and anemia determined most significantly the failure of cardiac rehabilitation (respectively: OR=6,4 and OR=2,9;p=0,01). They were used to construct a rehabilitation failure index with the values 0-2, as follows: 0 - corresponds to the situation of the absence of leukocytosis and anemia, 1 - corresponds to the situation of the occurrence of leucocytosis or anemia in post STEMI patients and was associated with 3,5-fold increase in the risk of not obtaining the full effect of cardiac rehabilitation, 2 - corresponds to the situation of the simultaneous occurrence of both parameters (leukocytosis and anemia) and was associated with 12,25-fold increase in the risk of not obtaining full effect of cardiac rehabilitation.

CONCLUSIONS

Peripheral blood cell count is essential in predicting cardiac rehabilitation effects. Leukocytosis and anemia determine to the greatest degree the failure of cardiac rehabilitation. Cardiac rehabilitation failure index may be useful in classifying post STEMI patients into an appropriate model of rehabilitation.

Clinical usefulness of baroreflex sensitivity test in the detection of cardiovascular autonomic neuropathy in patients with type 2 diabetes mellitus

Cardiovascular autonomic neuropathy (CAN) is one of the most common chronic complications of diabetes. It is defined as an impaired control of the cardiovascular system by the autonomic nervous system. The gold standard in detecting it is the Ewing test suite. The usefulness of other methods is still a subject of research.

AIM

The aim of this study was to assess the clinical usefulness of baroreflex sensitivity (BRS) test in the detection of CAN in patients with type 2 diabetes mellitus.

MATERIALS AND METHODS

The study included diabetic patients: 24 with CAN, diagnosed through the Ewing tests (the mean age 58 ± 7 years, BMI 33.6 ± 5 kg*m⁻², HbA1c% 8.3 ± 3, duration of diabetes 13.3 ± 7 years), and 24 without CAN (56 ± 8 years, BMI 32.2 ± 5 kg*m-2, HbA1c% 9.1 ± 2, 9.3 ± 9 years, respectively). The control group consisted of 12 patients without diabetes, homogeneous regarding gender and age. BRS was assessed in the supine (L-BRS), and in the standing position (S-BRS).

RESULTS

L-BRS was lower in the group with CAN vs the non-CAN group (6.2 ± 4 vs 9.6 ± 4 ms/mmHg; p=0,009); S-BRS respectively (4.4 ± 3 vs 6.9 ± 4 ms/mmHg; p=0.02). BRS well differentiates patients with and without polyneuropathy. The highest sensitivity of L-BRS and SBRS for detecting CAN is by cutoff ≤ 7 ms/mmHg.

CONCLUSIONS

The study confirms the value of baroreflex sensitivity in the early detection of CAN among patients with type 2 diabetes. We recommended cutoff points for BRS to detect CAN among patients with type 2 diabetes mellitus.

The effect of diabetic autonomic neuropathy on P-wave duration, dispersion and atrial fibrillation

INTRODUCTION

Atrial fibrillation (AF) is the most common sustained arrhythmia. Diabetic autonomic neuropathy (DAN) is a frequent complication of diabetes mellitus and has a negative impact on the cardiovascular system. There are no data about the occurrence of paroxysmal atrial fibrillation (PAF) in the population with DAN.

MATERIAL AND METHODS

We analysed the data of 100 patients with PAF. The study population was divided into three groups: group I: 28 patients with diabetes mellitus (DM) and DAN, group II: 34 patients with DM without DAN, and group III: 38 patients without DM. P-wave duration (FPD) and dispersion (PWD) were measured during sinus rhythm and AF episodes were counted during 12 months of follow-up.

RESULTS

Recurrence of PAF was higher in group I (47 episodes/year) compared to groups II and III (26 and 22 episodes/year) - p<0.01. The FPD was longer in group I (137.4 ±12.0 ms vs. 126 ±23.0 ms in II group and 129 ±18.3 ms in group III; p<0.001). The PWD was longer in patients with DAN (53 ±19 ms vs. 36 ±18 ms and 34 ± 20 ms, p<0.001).

CONCLUSIONS

The results showed that the presence of DAN caused a significant increase in P-wave duration and dispersion, which might be responsible for the recurrence of AF.

Prognostic value of plasma N-terminal pro-B-type natriuretic peptide concentration in patients with normal and impaired left ventricular systolic function undergoing surgery for abdominal aortic aneurysm

INTRODUCTION

Implantation of an aortic-bifemoral prosthesis is characterised by a high (> 5%) rate of perioperative cardiovascular events. The main aim of the study is to demonstrate the usefulness of the determination of NT-proBNP concentration as a method of risk stratification of left ventricular dysfunction in patients subjected to surgery for aortic-bifemoral prosthesis implantation.

MATERIAL AND METHODS

Forty consecutive patients were examined and subjected to aortic-bifemoral prosthesis implantation. The examined patients were divided into two groups: 1) with normal left ventricular systolic function and EF ≥ 58% (group I), 2) with left ventricular systolic dysfunction and EF < 58% (group II).

RESULTS

In group I the median EF before surgery was 69.5% and the concentration of NT-proBNP 141.5 pg/ml. On day 7 after surgery respective values were EF 65.5%, NT-proBNP 498.55 pg/ml. In group II the median EF before surgery was 54%, and NT-proBNP concentration 303.9 pg/ml.

CONCLUSIONS

The concentration of plasma NT-proBNP before surgery well correlated with left ventricular ejection fraction. The values of NT-proBNP > 303.9 pg/ml strongly correlated with increased risk of left ventricular systolic dysfunction after surgery and they seem to have high prognostic value for the occurrence of cardiovascular events in this group of patients. The determination of NT-proBNP level on day 7 after surgery strongly correlated with the decrease of left ventricular ejection fraction in patients after the prosthesis implantation. It is a valuable diagnostic and prognostic factor of circulatory system efficiency before making a decision to discontinue hospitalization.

Endothelial function and left ventricular remodeling in diabetic and non-diabetic patients after acute coronary syndrome

BACKGROUND

Endothelial dysfunction is an independent predictor of future cardiac events.

MATERIAL/METHODS

We evaluated the relationship between flow-mediated dilation (FMD) in brachial artery and coronary risk factors in 93 patients (70 males, mean age: 62 ± 8 years) with ACS treated with primary angioplasty (PCI). The patients were divided into 2 subgroups: 43 patients with diabetes mellitus type 2 (DM) and 50 non-diabetics (non-DM). Patients were examined on the 3rd day after ACS and after 6 months. FMD on the 3rd day were significantly lower in DM than in non-DM (5.8 ± 2.2% vs. 8.8 ± 4.9%, p=0.0007) and after 6 months (6.2 ± 2.6% vs. 9.4 ± 4.4%, p<0.0001). It was also observed that the improvement of FMD in both groups after a 6-month follow-up inversely correlated with the increase of left ventricular end-diastolic volume (LVEDV) (r=-0.41, p<0.001).

RESULTS

There was an inverse relationship between FMD and age (r=-0.26, p<0.01), BMI (r=-0.26, p<0,005), total cholesterol (r=-0.56, p<0.001) and LDL cholesterol (r=-0.53, p<0.001). There was no relationship between triglycerides, hypertension and history of smoking. In the DM group, FMD negatively correlated with HbA1c (r=-0.68, p<0.001). Restenosis rate was significantly higher in the DM group (19% vs. 6%, p<0.001) but there was no relationship between FMD and restenosis.

CONCLUSIONS

Impaired FMD is more significant in diabetics than in non-diabetic patients with ACS. Lack of improvement of FMD after acute coronary syndrome can be a predictor of detrimental left ventricular remodeling in patients with ACS.

[Right ventricle pacing site optimization guided by intracardiac echocardiography]

Right ventricle outflow tract (RVOT) is an alternative pacing site to right ventricle apex (RVA). Intracardiac echocardiography (ICE) is a new method for intracardiac structures visualization.

THE AIM

is comparison of functional effects of DDD permanent ventricular pacing in patients with lead implanted in RVA or in RVOT with the use of traditional fluoroscopy or in RVOT guided by ICE.

MATERIAL AND METHODS

33 patients with AV block grade I/III no older than 75 y (mean age 65,9+/-0,3 years). Group 1: 10 patients with RVA lead implantation. Group II: 12 patients with leads implanted in RVOT with the use of ICE. Group IlI: 11 patients with lead positioned in RVOT with the use of fluoroscopy. High septum was established as an target pacing site for RVOT implantation. On 3 day and 3 months after implantation the following parameters were collected: VO2 max, 6-minute walking test distance, level of NT-proBNP. The comparison of relative changes was done, 3 month vs. 3 day for each parameter.

RESULTS

Statistically significant greater decrease in NT-proBNP was found in Group II in comparison with both Group I and Ill (respectively p = 0.021 and p _ 0.034). Significantly greater increase in VO2 max was detected in patients Group II comparing to Group I (p = 0.047). Moreover it was found that ICE guided implantation is most effective in precise lead positioning.

CONCLUSION

ICE guided lead localization on high interventricular septum seems to have better functional characteristics than other right ventricle pacing sites.

[Glycosylated hemoglobin and left ventricular diastolic dysfunction in patients with type 2 diabetes mellitus]

Glycosylated hemoglobin (HbA1c) is a confirmed prognostic factor of cardiovascular complications in diabetic patients. The relative odds of cardiovascular disease (CD) increase by 20% for 1% increase of HbA1c above HbA1c 5%. The aim of the study was to assess relationship between diastolic dysfunction and HbA1c in patients with diabetes mellitus 2 (DM 2) without critical coronary stenosis in coronarography.

MATERIAL AND METHODS

The study comprised 57 subjects (35 men and 22 women) with DM 2, without coronary stenosis in coronarography, with normal and elevated HbA1c levels. The subjects were divided into two groups depending on HbA1c level: with HbA1c < or = 6.1% and HbA1c >6.1%. Parameters of left ventricular diastolic function were assessed in echocardiography according to criterions of European Society of Cardiology. Subjects with decreased systolic function (EF<50%) were excluded from the study.

RESULTS

Diastolic dysfunction of the left ventricle was observed in 43% of patients with HbA1c >6.1% comparing to 4.5% of patients in the group with HbA1 < or = 6.1%. In the group with HbA1c >6.1% in 38% of the patients abnormal relaxation in early filling phase and in 5% abnormal isovolumetric relaxation were observed. In the group with HbA1 < or = 6.1% in only 1 patient (4.5%) abnormal relaxation in early filling phase was observed.

CONCLUSION

Diastolic function of the left ventricle in patients with diabetes is dependent on HbA1c levels.

[Blood serum and neutrophil amino acid concentrations during hemodialysis]

The abnormal amino acid profile and altered distribution of some amino acids between the extra- and intracellular compartments is currently recognized as a part of metabolism abnormalities in hemodialyzed uremic patients associated with prognosis. The aim of this study was to investigate the pattern of HD influence on the extra- and intracellular amino acid concentrations in neutrophil homogenates and in blood serum. Before HD, the concentrations of arginine (64 vs 33 micromol/l) and cysteine (70 vs 40 micromol/l) were significantly higher in the uremic blood serum, but the concentrations of five amino acids, i.e. serine, threonine, alanine, proline, and valine, were significantly decreased in the uremic serum. The concentrations of arginine (7.95 vs 5.2 micromol/l), tyrosine (14.3 vs 12.5 micromol/l) and phenylalanine (10.7 vs 9.5 micromol/l) were significantly elevated in neutrophil homogenate from uremic patients before HD and after HD for arginine (8.73 micromol/l). We found a substantial increase of blood serum arginine concentration at all evaluated time points of HD from 64 to 191 micromol/l. The concentration of 8 amino acids were found to be significantly decreased in blood serum during HD. We may assume amino acid concentration changes in chronic uremia partly attributed to malnutrition, may be actually associated with inflammatory pathomechanisms, the hypothesis worth verifying in further studies.

Blood serum and neutrophil L-arginine concentrations and nitric oxide release by neutrophils in chronic uremic patients and healthy persons

BACKGROUND

Plasma levels of L-arginine have previously been evaluated in several studies to reveal either down- or up-regulation of the L-arginine/NO pathway in chronic uremia.

MATERIAL/METHODS

We studied L-arginine plasma levels along with intracellular neutrophil concentration and NO release by peripheral blood neutrophils in patients with chronic uremia.

RESULTS

The L-arginine plasma concentration was found to be significantly higher (64.4 +/- 12.0 micromol/L) in chronic uremic patients (n=25) than in healthy controls (33.0? +/- 10.0 micromol/L; n=25). Neutrophil homogenate L-arginine levels were substantially increased in uremic patients (7.95? +/- 1.10 nmol/10(8) cells) as compared with controls (5.22 +/- 0.46 nmol/10(8) cells). The in vitro release of NO by unstimulated neutrophils was lower in uremic patients (0.14? +/- 0.05? micromol s(-1)) than in healthy persons (0.48 +/- 0.20 micromol s-1). The NO release after uremic neutrophil stimulation with 10(-6) M fMLP was 21.42 +/- 2.13 micromol s(-1), while after PMA it was 31.01 +/- 1.99 micromol s(-1). NO release after normal neutrophil stimulation with 10(-7) M fMLP was 19.52 +/- 2.32 micromol s(-1), and after PMA was 28.63 +/- 3.06 micromol s(-1).

CONCLUSIONS

In chronic uremic patients plasma and neutrophil concentrations of L-arginine were significantly higher. However, there were no significant differences in NO release between normal and uremic neutrophils after stimulation. Our findings may have implications for the impact of the L-arginine-nitric oxide signaling pathway on the pathophysiological changes in the L-arginine: NO pathway seen in chronic uremia.

Adenosine-activated myocardial ischemia does not induce delayed preconditioning

BACKGROUND

Our objective was to determine whether adenosine-induced ischemia exerts a delayed cardiac protective effect in patients with stable effort angina ischemic heart disease.

MATERIAL/METHODS

The study group was comprised of 32 patients (men) with symptoms of stable effort angina, aged 38-65 years (Group 1), and 18 clinically healthy subjects (3 women, 15 men), aged 35-55 years (Control group). The study protocol included baseline ECG and treadmill echocardiogram (ET1); ECG and adenosine echocardiogram performed 7 days after ET1; repeated exercise test exactly 24 h after adenosine infusion (ET2). Increases in heart rate (HR), systolic (SBP) and diastolic (DBP) blood pressure, maximum ST-segment depression (max IST) and total ST-segment depression (SIST) on ECG were compared, as well as left ventricular end-diastolic volume (LVEDV), end-systolic (LVESV) volume, ejection fraction (EF), and wall motion synergy index (WMSI).

RESULTS

No statistically significant differences were found in the increased values of the investigated electrocardiographic and echocardiographic parameters in either group on either exercise test. The only positive trend was observed in LVEDV. In Group 1 LVEDV increased significantly from rest values during ET1, whereas during ET2 LVEDV did not change.

CONCLUSIONS

Adenosine-induced ischemia does not exert a delayed protective effect in respect to cardiac bioelectrical and mechanical functions in patients with ischemic heart disease in the form of stable effort angina.

Left atrial function in patients with renal transplantation

BACKGROUND

Chronic renal failure leads to structural changes and cardiac functional abnormalities known as uremic cardiomyopathy. Eliminating excess water and improving the composition of the inner environment leads to at least partial cardiac function improvement, which is reflected primarily in favorable changes in left ventricular indices. The aim of our study was to evaluate left atrial function in patients after renal transplantation and compare them with clinically healthy subjects.

MATERIAL/METHODS

10 renal transplant patients (2 women, 8 men; mean age 47.8 +/- 6.4 years), treated before transplantation with repeated hemodialysis, were subjected to standard transthoracic echocardiographic examination. Atrial function was evaluated in M-mode and 2D projections and by cross-sectional Doppler echocardiography. The results obtained were compared with 16 healthy controls (9 women, 7 men; mean age 39.7 +/- 9.4 years).

RESULTS

Maximal left atrial dimension (LAmax), left atrial dimension obtained in M-mode of the long axis in parasternal projection (LAa), ejection time (ETlp) and pre-ejection period (PEPlp) were significantly higher in renal transplant patients than in healthy subjects. In both investigated groups there were no differences in minimal left atrial dimensions (LAmin), PEPlp/Etlp ratio, P wave time (P), left atrial fiber shortening fraction (FS%lp), passive evacuate fraction (FBOlp), total left atrial fraction (FClp), or IElp ratio.

CONCLUSIONS

Abnormal function of the left atrium in the course of uremia treated with repeated hemodialysis is not fully corrected after renal transplantation despite the elimination of many cardiovascular complications observed in chronic renal disease.

[The significance of scintigraphic, echocardiographic and electrocardiographic left atrial transesophageal pacing in diagnosis of ischemic heart disease]

The aim of the study was to compare the perfusion scintigraphy (using SPECT method with Tc-99-MIBI) during left atrial transoesophageal pacing test (LAPT) with pacing electrocardiography (ECG), echocardiography (ECHO) and electrocardiography exercise test (ExT) in ischaemic heart disease (IHD) diagnostics. The effect of LATP on heart haemodynamic parameters and the correlation between scintigraphic, echocardiographic and electrocardiographic parameters during LAPT test have been also assessed. Investigations were carried out in 55 subjects (Group I: 36 patients with effort angina pectoris; group II: controls: 19 clinically healthy subjects). Coronarography was performed in 24 patients 6 weeks before or after examinations. LATP test was analyzed with ECG, ECHO and SPECT. Echocardiography did not increase significantly the LATP test diagnostic value. Perfusion scintigraphy enhanced sensitivity and predictive excluding value LATP test. These values were 93.3% v 62.9% and 90% v 59.3% respectively. LATP test assessed with ECG, ECHO and perfusion scintigraphy expressed significantly higher sensitivity and predicting excluding value in comparison to ExT. LATP test analyzed in such way was characterized by 100% sensitivity and 100% predicting excluding value.

CONCLUSION

Combination of LATP with electrocardiography, echocardiography and SPECT is a non-invasive high quality method for ischaemic heart disease diagnostics.