Swietokrzyskie Cardiology Center

Kielce, Poland

Swietokrzyskie Cardiology Center

Kielce, Poland
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Undas A.,Jagiellonian University | Zalewski J.,John Paul II Hospital | Krochin M.,John Paul II Hospital | Siudak Z.,Jagiellonian University | And 6 more authors.
Arteriosclerosis, Thrombosis, and Vascular Biology | Year: 2010

OBJECTIVES-: We sought to investigate whether patients with in-stent thrombosis (IST) display altered plasma fibrin clot properties. METHODS AND RESULTS-: We studied 47 definite IST patients, including 15 with acute, 26 subacute and 6 late IST, and 48 controls matched for demographics, cardiovascular risk factors, concomitant treatment and angiographic/stent parameters. Plasma clot permeability (Ks), which indicates a pore size, turbidity (lag phase, indicating the rate of fibrin clot formation, ΔAbsmax, maximum absorbance of a fibrin gel, reflecting the fiber thickness), lysis time (t50%) and maximum rate of d-dimer release from clots (D-Drate) were determined 2 to 73 (median 14.7) months after IST. Patients with IST had 21% lower Ks, 14% higher ΔAbsmax, 11% lower D-Drate, 30% longer t50% (all P<0.0001) and 5% shorter lag phase compared to controls (P=0.042). There were no correlations between clot variables and the time of IST or that from IST to blood sampling. Multiple regression analysis showed that Ks (odds ratio=0.36 per 0.1 μm, P<0.001), D-Drate (odds ratio=0.16 per 0.01 mg/L/min, P<0.001) and stent length (odds ratio=1.1 per 1 mm, P=0.043) were independent predictors of IST (R=0.58, P<0.001). CONCLUSIONS-: IST patients tend to form dense fibrin clots resistant to lysis, and altered plasma fibrin clot features might contribute to the occurrence of IST. © 2010 American Heart Association, Inc.


Sadowski M.,Swietokrzyskie Cardiology Center | Janion-Sadowska A.,Swietokrzyskie Cardiology Center | Gasior M.,Silesian Center for Heart Diseases | Gierlotka M.,Silesian Center for Heart Diseases | And 3 more authors.
Archives of Medical Science | Year: 2013

Introduction: Data on mortality in young patients with ST-segment elevation myocardial infarction (STEMI) when compared to older people or regarding therapeutic strategies are contradictory. We investigate the prognosis of women under 40 after STEMI in a prospective nationwide acute coronary syndrome registry. Material and methods: We analyzed all 527 consecutive men and women (12.3% females) aged from 20 to 40 years (mean 35.7 ±4.5) presenting with STEMI, of all 26035 STEMI patients enrolled. Results: Differences between genders in the major cardiovascular risk factors, clinical presentation, extent of the disease and time to reperfusion were insignificant. The majority of patients (67%) underwent coronary angiography followed by primary percutaneous coronary intervention (PCI) in 79.9% of them. A 92% reperfusion success rate measured by post-procedural TIMI 3 flow was achieved. There were no significant differences between genders in the administration of modern pharmacotherapy both on admission and after discharge from hospital. In-hospital mortality was very low in both genders, but 12-month mortality was significantly higher in women (10.8% vs. 3.0%; p = 0.003). Killip class 3 or 4 on admission (95% CI 19.6-288.4), age per 5-year increase (95% CI 1.01-3.73) and primary PCI (95% CI 0.1-0.93) affected mortality. In patients who underwent reperfusion there was moderately higher mortality in women than in men (7.1% vs. 1.9%; p = 0.046). Conclusions: Despite little difference in the basic clinical characteristics and the management including a wide use of primary PCI, long-term mortality in women under forty after STEMI is significantly higher than in men. Copyright © 2013 Termedia & Banach.


Radomska E.,Swietokrzyskie Cardiology Center | Sadowski M.,Swietokrzyskie Cardiology Center | Kurzawski J.,Swietokrzyskie Cardiology Center | Gierlotka M.,Swietokrzyskie Cardiology Center | Polonski L.,Silesian Center for Heart Diseases
Diabetes Care | Year: 2013

OBJECTIVE-To evaluate the effect of type 2 diabetes on the clinical course and prognosis of women with ST-segment elevation myocardial infarction (STEMI) and diabetes. RESEARCH DESIGN AND METHODSdA total of 26,035 consecutive patients with STEMI who were hospitalized in 456 hospitals in Poland during 1 year were analyzed. The data were obtained from the Polish Registry of Acute Coronary Syndromes (PL-ACS). RESULTS-Type 2 diabetes occurred more frequently in women than in men (28 vs. 16.6%; P < 0.0001). The proportion of women was larger among patients with diabetes (47.1 vs. 31.3%; P < 0.0001), and compared with women without diabetes, diabetic women had worse clinical profiles. Women with diabetes were most frequently treated conservatively. Both women and men with diabetes had significantly more advanced atherosclerotic lesions than women without diabetes.Women with diabetes had the highest in-hospital, 6-month, and 1-year mortality rates. Multivariate analysis indicated that type 2 diabetes was a significant independent risk factor for in-hospital and 1-year mortality in women with STEMI. Primary percutaneous coronary intervention (pPCI) was a significant factor associated with the decreased 1-year mortality in women without diabetes. CONCLUSIONS-Type 2 diabetes was a significant independent risk factor for in-hospital and 1-year mortality in women with STEMI. Women with diabetes had the poorest early and 1-year prognoses after STEMI when compared with women without diabetes and men with diabetes. Although pPCI improves the long-term prognosis of women with diabetes, it is used less frequently than in women without diabetes or men with diabetes. © 2013 by the American Diabetes Association.


PubMed | Silesian Center for Heart Diseases, Intensive Cardiac Care Unit and Swietokrzyskie Cardiology Center
Type: Journal Article | Journal: Archives of medical science : AMS | Year: 2016

Gender-specific issues regarding ST-segment elevation (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) due to unprotected left main coronary artery (ULMCA) disease were not sufficiently studied. We assessed the value of STEMI/NSTEMI initial classification on the management of men and women with acute MI due to critical stenosis or occlusion of the ULMCA.The study group consisted of 643 consecutive patients with acute MI with the ULMCA as the infarct-related artery. Data derive from an ongoing, nationwide, multicenter, prospective, observational registry.Isolated ULMCA disease was more frequent in women and multivessel disease was more frequent in men in the NSTEMI group. The incidence of cardiogenic shock or pulmonary edema and cardiac arrest was higher in the STEMI group. Totally occluded ULMCA was more frequent in the STEMI group. Although the majority of patients underwent percutaneous coronary intervention (PCI), it was less frequently used in NSTEMI women and NSTEMI men. Although in-hospital and long-term mortality rates were higher in the STEMI group, there were no gender-related differences within groups. The initial ST-segment elevation was an independent predictor of in-hospital (OR = 2.37, 95% CI: 1.14-4.91, p = 0.02) and 12-month (OR = 1.52, 95% CI: 1.01-2.27, p = 0.045) mortality.There were no gender-related differences in the management within the STEMI or NSTEMI group. Although acute myocardial infarction due to ULMCA disease is associated with high mortality in both genders, STEMI was a negative prognostic factor of in-hospital and 12-month mortality. Despite poor baseline characteristics and clinical presentation in women, female gender itself did not influence mortality.


Sadowski M.,Swietokrzyskie Cardiology Center | Zabczyk M.,Jagiellonian University | Zabczyk M.,John Paul II Hospital | Undas A.,Jagiellonian University | Undas A.,John Paul II Hospital
Atherosclerosis | Year: 2014

Objectives: We investigated whether markers of platelet, neutrophil and endothelial activation, plasma fibrin clot properties and patient clinical profile may characterize coronary thrombus composition in ST-segment elevation myocardial infarction (STEMI) patients. Methods: A total of 40 intracoronary thrombi obtained 4.0-16.5h since chest pain onset by manual aspiration during primary coronary intervention (PCI) were assessed using scanning electron microscopy. Plasma fibrin clot permeation coefficient (Ks) and clot lysis time (CLT), together with platelet and endothelial activation, fibrinolysis, and inflammation markers, were measured exvivo in 16 patients on admission (pre-PCI group) and on the next morning in 24 patients (post-PCI group). Results: Fibrin, erythrocyte, platelet and white blood cell content in the thrombi were estimated at 49.1%, 24.2%, 11.6% and 3.7% respectively. In the pre-PCI group, in addition to fibrinogen, P-selectin and plasminogen activator inhibitor-1 were positively correlated with thrombus fibrin content. In the post-PCI group, in addition to von Willebrand factor antigen (vWF:Ag), soluble CD40 ligand and myeloperoxidase (MPO) were positively correlated with thrombus fibrin content. After adjustment for fibrinogen and onset-to-thrombectomy time circulating vWF:Ag in both groups, and MPO and P-selectin in the pre-PCI group were the independent predictors of fibrin-rich intracoronary thrombus presence. Other predictors were renal impairment, arterial hypertension and time from symptom onset to thrombus aspiration in all patients. Conclusions: In STEMI patients coronary thrombus composition is partly characterized by plasma markers of platelet, neutrophil and endothelial activation, with a varying contribution of these factors over time. © 2014 Elsevier Ireland Ltd.


Stpien E.,Jagiellonian University | Fedak D.,Jagiellonian University | Klimeczek P.,John Paul II Hospital | Wilkosz T.,John Paul II Hospital | And 4 more authors.
Hypertension Research | Year: 2012

We conducted a cross-sectional observation study that included 500 asymptomatic subjects to investigate the relationship between bone metabolism and coronary artery calcification (CAC) in hypertensive conditions. Osteoprotegerin (OPG) and osteopontin (OPN) levels and their associations with hypertension were analyzed to predict CAC in 316 subjects. Multislice computed tomography was used to quantify CAC. Multivariate analysis of variance was used to test the non-interactive effects of hypertension, CAC severity and biomarker levels, and the logistic regression model was applied to predict the risk of CAC. OPG and OPN concentrations were significantly higher in the hypertensive than the normotensive subjects, at 3.0 (2.3-4.0) pmol l -1 and 51 (21-136) ng ml -1 vs. 2.4 (2.0-3.0) pmol l -1 and 41 (13-63) ng ml -1, respectively. The OPG level, but not OPN level, increased with age (r0.29; P=0.0001). Zero or minimal CAC (10 Agatston units (AU)) was observed in 63% of the subjects, mild (11-100 AU) in 17%, moderate (101-400 AU) in 12% and severe (401-1000 AU)-to-extensive (> 1000 AU) in 8%. In hypertensive subjects, only glomerular filtration rate (GFR) (Β=-0.67) and gender (Β=0.52) were significant predictors for CAC (R=0.68). In normotensive patients, GFR (Β=-0.81), gender (Β=0.48) and log-transformed OPG levels (Β=-0.15) were significant predictors for CAC. OPG levels were associated with an increased risk of CAC in normotensive subjects only (odds ratio: 3.37; 95% confidence interval (1.63-6.57); P=0.0002). OPG predicted a premature state of vascular calcification in asymptomatic normotensive individuals, and renal function significantly contributed to this process in both hypertensive and normotensive subjects. © 2012 The Japanese Society of Hypertension All rights reserved.


Polewczyk A.,Swietokrzyskie Cardiology Center | Janion M.,Swietokrzyskie Cardiology Center | Janion M.,Jan Kochanowski University | Podlaski R.,Jan Kochanowski University | Kutarski A.,Medical University of Lublin
European Journal of Clinical Microbiology and Infectious Diseases | Year: 2014

It is important to identify clinical manifestations of lead-dependent infective endocarditis (LDIE), as it begins insidiously with the slow development of nonspecific symptoms. Clinical data from 414 patients with the diagnosis of LDIE according to Modified Duke Lead Criteria (MDLC) were analyzed. Patients with LDIE had been identified in a population of 1,426 subjects submitted to transvenous lead extraction (TLE) in the Reference Clinical Cardiology Center in Lublin between 2006 and 2013. The symptoms of LDIE and pocket infection were detected in 62.1 % of patients. The mean duration of LDIE symptoms prior to referral for TLE was 6.7 months. Fever and shivers were found in 55.3 % of patients, and pulmonary infections in 24.9 %. Vegetations were detected in 67.6 % of patients, and positive cultures of blood, lead, and pocket in 34.5, 46.4, and 30.0 %, respectively. The most common pathogens in all type cultures were coagulase-negative staphylococci (CNS), with Staphylococcus epidermidis domination; the second most common organism was Staphylococcus aureus. 76.3 % of patients were treated with empirical antibiotic therapy before hospitalization due to TLE. In the laboratory tests, the mean white blood cell count was 9,671±5,212/μl, mean erythrocyte sedimentation rate 43 mm, C-reactive protein (CRP) 46.3 mg/dl±61, and procalcitonin 1.57±4.4 ng/ml. The multivariate analysis showed that the probability of LDIE increased with increasing CRP. The diagnosis of LDIE based on MDLC may be challenging because of a relatively low sensitivity of major criteria, which is associated with early antibiotic therapy and low usefulness of minor criteria. The important clinical symptoms of LDIE include fever with shivering and recurrent pulmonary infections. The most specific pathogens were Staphylococcus epidermidis and Staphylococcus aureus. Laboratory tests most frequently revealed normal white blood cell count, relatively rarely elevated procalcitonin level, and significantly increased erythrocyte sedimentation rate (ESR) and CRP. This constellation of signs should prompt a more thorough search for LDIE. © 2014 The Author(s).


Polewczyk A.,Swietokrzyskie Cardiology Center | Polewczyk A.,Jan Kochanowski University | Janion M.,Swietokrzyskie Cardiology Center | Janion M.,Jan Kochanowski University | Kutarski A.,Medical University of Lublin
Polskie Archiwum Medycyny Wewnetrznej | Year: 2016

Cardiac device infections (CDIs) continue to be a serious clinical problem, with varying terminology and different classifications constituting one of the major diagnostic and therapeutic challenges in routine clinical practice. The problem invariably arises during an attempt to estimate the extent of the infection, which in consequence determines the choice of treatment strategy (duration of antibiotic therapy). The most serious form of CDI is lead-related infective endocarditis (LRIE). There are no clearly established diagnostic criteria for this disease; the available Duke University criteria are difficult to apply in patients with a suspicion of LRIE because of low sensitivity. As the treatment of LRIE is expensive and troublesome, there is a tendency to underdiagnose this condition and seek any intermediary forms between local pocket infection and definite LRIE. The present review includes suggestions for the systematization of CDIs with a clear definition of LRIE as a separate and most severe entity among CDIs. Copyright © 2016 Medycyna Praktyczna. All rights reserved.


Kurzawski J.,Swietokrzyskie Cardiology Center | Sadowski M.,Swietokrzyskie Cardiology Center | Janion-Sadowska A.,Swietokrzyskie Cardiology Center
Journal of Clinical Ultrasound | Year: 2016

Purpose: To study the complications of ultrasound-guided thrombin injection of pseudo-aneurysms occurring after interventional cardiovascular procedures. Method: We prospectively studied 353 patients who developed post-catheterization femoral artery pseudo-aneurysms and were treated with ultrasound-guided thrombin injection. Results: Arterial micro-embolization occurred in 53 patients (15%) and pulmonary embolism in 1 patient (0.3%). None of the patients developed significant peripheral arterial embolism. The length of the communicating channel between the arterial lumen and the pseudo-aneurysm was inversely correlated with the risk of embolization (p < 0.0001). A 4.6 mm increase in channel length decreased the odds of embolization by 14%, and patients with a channel less than 2 mm long were at greater risk. Repeated thrombin injection also increased the risk of embolization (p = 0.02). Conclusion: Thrombin injection for the treatment of post-catheterization femoral pseudo-aneurysm is feasible and safe, but it must be performed with caution, especially when the sac is directly communicating with the artery, or when success cannot be achieved with a single injection. © 2015 Wiley Periodicals, Inc.


Clinical evaluation of patients with diabetes or after myocardial infarction (MI) with preserved left ventricular (LV) systolic function is not very precise in isolating patients at particularly high risk of developing manifest cardiac failure and associated cardiovascular incident. Early diagnosis of LV diastolic dysfunction is essential because implementation of the appropriate treatment can positively affect the course of the disease.To assess the impact of LV diastolic function on B-type natriuretic peptide (BNP) concentration at rest and immediately after exercise test, and to search for the relationship between LV diastolic function and BNP secretion, tolerance, and duration of exercise in the studied groups of patients.Ninety-nine consecutive patients were qualified for the study: in Group 1 - patients with type 2 diabetes without a history of MI, and in Group 2 - patients after MI with preserved LV systolic function (ejection fraction 40%), without diabetes. The studied patients had echocardiography with LV systolic and diastolic function evaluation, an electrocardiographic exercise test and blood sampling for BNP determination before and immediately after exercise test.The study included 99 patients aged 40-75 years (60 patients after MI and 39 patients with diabetes). The study group included 62 patients who were diagnosed with diastolic dysfunction. Diastolic dysfunction occurred in 41 (68.4%) patients in the group after MI, and in 21 (53.8%) patients in the group with diabetes, severe disorders in the form of pseudonormal and restrictive mitral valve inflow occurred in 13 (21.7%) and five (12.8%), respectively. The average BNP concentration in patients with severe diastolic dysfunction at rest was 188.3 vs. 25.2 pg/mL in patients with normal diastolic function (p < 0.001). In all patients with severe diastolic dysfunction BNP after exercise was 285.2 vs. 37.5 pg/mL in patients with normal diastolic function, and the increase in BNP during exercise was 96.9 vs. 12.4 pg/mL, respectively. Duration of exercise and exercise tolerance in patients with normal diastolic function was better in comparison with the studied patients with disturbed diastolic function, but did not reach statistical significance.The BNP initial concentration and its value immediately after exercise were significantly higher in subjects with severe diastolic disorders than those in subjects with normal LV diastolic function and in subjects with impaired LV relaxation.

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