Search

In this review we try to answer the question whether and to what degree contemporary forensic pathology takes advantage of quantitative and qualitative troponin determinations. The report is simultaneously an introduction to discussing our results in this area. To perform this review we used the database "PubMed". Polish literature, concurrent with the objective of the study and not included in "PubMed" or included in "OLDMEDLINE" was also analyzed. The identified publications, which were concurrent with the aim of the study, were read and citations were checked. If among the cited papers we found one that was concurrent with the subject of the review, it was also included. While several studies support the use of post-mortem blood and body fluid levels of cardiac troponin T and I as a marker of sudden cardiac death, in our opinion, further research is required to determine the effects of post-mortem autolysis, microbial activity, metabolic derangement and the use of different sample matrices in autopsy cases.

Introduction: We determined retrospective analysis of the diagnostic value of virus serology in patients with non-ischemic systolic heart failure and parvovirus B19 infection., Material and Methods: Virus serology and endomyocardial biopsy were performed in 31 patients with non-ischemic systolic heart failure hospitalized from 2001 to 2006 in our clinic., Results: The serum specimens from 31 patients were tested for IgM and IgG antibody against parvovirus B19. IgM antibodies were identified in 3 patients and IgG antibodies were identified in 23 patients. All of the patients underwent endomyocardial biopsy which revealed chronic active myocarditis in 10 patients (32.4%), chronic persistent myocarditis in 14 patients (45.1%) and no myocarditis in 7 patients (22.5%)., Conclusions: Virus serology has no relevance for the diagnosis of non-ischemic systolic heart failure caused by parvovirus B19 infection. The result of serological tests are positive more frequently than the biopsy specimens results.

Objectives: The aim of the study was to evaluate the occurence of death and major adverse cardiac events (MACE) in patients with normal (group A) and elevated (group B) plasma bilirubin levels., Patients and Methods: We evaluated 124 patients (83% males, mean age 50.1 +/- 7.7 yrs) in New York Heart Association class II and III with hypertension-related chronic heart failure. We assessed the occurence of death and MACE (death, urgent heart transplantation and readmission to hospital)., Results: Groups A and B comprised 77 and 47 patients respectively. The independent predictors of death in group B were: N-terminal pro-brain natriuretic peptide (NT-proBNP) level (per 100 pg/ml difference; 95% CI: 1.29-4.76; p = 0.005) and physical component summary score (per 10 point difference; 95% CI: 0.66-0.99; p = 0.03). The independent predictors of MACE in group B were: age (per 10 yrs; 95% CI: 0.1-1.8; p = 0.04), NT-proBNP level (per 100 pg/ml difference; 95% CI: 1.02-3.69; p = 0.04) and the symptoms of depression (95% CI: 1.02-2.5; p = 0.01). The independent predictors of MACE in group A were: NT-proBNP level (per 100 pg/ml difference; 95% CI: 1.31-5.32; p = 0.006) and mental component summary (per 10 point difference; 95% CI: 0.85-0.98; p = 0.01). In a two-year follow-up the death rate was 5.2% in group A, and 23.4% in group B (p = 0.002) and frequency of MACE 18.2% and 42.6% in group A and B (p = 0.003), respectively., Conclusions: Elevated bilirubin levels are associated with higher incidence of death and MACE during a two-year follow-up in patients with hypertension-related chronic heart failure. Thus, it may be used as a simple prognostic factor in such of patients.

Unlabelled: We aimed at assessing the frequency of death, myocardial infarction, unstable angina, repeat revascularization, cardiovascular hospitalisation during 12 months in patients assigned to early invasive strategy., Material and Method: We analysed 658 consecutive patients with acute coronary syndrome (ACS) without ST-segment elevation hospitalized between January 2000 and February 2003. Patients had to fulfill the following criteria: 1) rest angina within 24 hours prior to admission, 2) at least one of the following: ST-segment depression (> or = 0,05 mV), transient (< 20 min) ST-segment elevation (> or = 0,05 mV), T-wave inversion (> or = 1 mV) in at least 2 contiguous leads, positive serum cardiac markers., Results: All patients underwent coronary angiography followed by PCI (percutaneous coronary interventions) in 71.8% of patients. 18.2% were assigned to CABG (coronary artery bypass graft) and 8.7% of patients were treated conservatively. 1.3% of patients underwent PCI followed by an elective CABG surgery. In-hospital mortality rate was.,3%. 3.3% patients died after hospital discharge. The frequency of myocardial infarction, unstable angina and repeat PCI at 12 months was 2.1%, 16.8% and 11.5% respectively. The rate of cardiovascular hospitalisation was 15.6%. Multivariate analysis identified two independent predictors ofdeath: diabetes mellitus (OR: 7.02, 95% CI: 1.5-13.8, p = 0.03) and heart failure (OR: 12.6, 95% CI: 2.86-16.6 p = 0.005)., Conclusions: Early invasive strategy in analysed group yields good long-term outcomes with low rate of adverse ischemic events. Independent predictors of deaths were diabetes mellitus and heart failure.

Background: Early invasive strategy is one of alternative methods for management of acute coronary syndromes (ACS) without persistent ST-segment elevation., Hypothesis: The aim of the study was analysis of clinical characteristics, in-hospital outcome and factors of in-hospital mortality., Methods: The study group comprised 853 patients who were defined as high-risk, based on resting pain episodes within previous 24 hours, changes of ST-T segment in ECG, and elevated serum cardiac markers. All patients underwent coronary angiography followed by PCI (percutaneous coronary interventions) in 73.1% of patients. 16.7% were assigned to CABG (coronary artery bypass graft), 1.6% of patients underwent PCI and CABG and 8.6% of patients were treated conservatively., Results: Overall in-hospital mortality was 3%; 1.4% in the PCI group, 8.4% in the CABG group and 6.8% in conservatively treated patients. The independent risk factors of in-hospital deaths were: Braunwald's IIIC class angina (OR 7.8; 95%CI 3.6-12.37 p=0.004), recurrent angina after revascularization (OR 13.04; 95%CI 7.62-29.23 p=0.002), congestive heart failure (OR 11.45; 95%CI 8.01-18,38 p=0.00001) and evolving myocardial infarction with ST-segment elevation (OR 12.77; 95%CI 8.35-27.35 p=0.0001). Stent implantation was associated with decreased risk of in-hospital death (OR 0.12; 95%CI 0.07-0.41; p=0.003)., Conclusions: Early invasive strategy in patients with ACS without ST-segment elevation is efficacious method of treatment. Independent predictors of in-hospital deaths are: Braunwald's IIIC class angina, congestive heart failure, recurrent angina after revascularization, myocardial infarction complicating hospital course. Stent implantation improves in-hospital prognosis.

Unlabelled: Cardiogenic shock develops in 5-15% of patients hospitalised with acute myocardial infarction. It is responsible for more than a half of all hospital deaths with survival rate of about 20%. Conventional medical therapy with use of adrenergic, vasoactive, inotropic and thrombolytic agents has failed to improve survival. Treatment strategy combine hemodynamic stabilisation with restoration of coronary blood flow. The aim of the study was evaluation of mechanical restoration of coronary blood flow in infarction related artery and to assess its influence on mortality in patients with myocardial infarction complicated by cardiogenic shock. We retrospectively analysed 58 subjects: 26 patients treated by primary angioplasty, 25 patients with PTCA angioplasty after streptokinase treatment and 7 ones treated conservatively. TIMI 3 flow in angioplasty treated patients was achieved in 70.6% with in hospital mortality rate 14%, however, when reperfusion was unsuccessful the mortality was high (80%). 12 months follow-up mortality rate was 41.8%., Conclusion: Successful reperfusion with coronary angioplasty of the infarct-related artery can significantly reduce mortality rate in patients with cardiogenic shock. Patients who survived in-hospital period have favourable one-year prognosis.

Unlabelled: The inflammatory process in chronic heart failure (CHF) is the result of dysbalance between the function of inflammatory and natural antiinflammatory mediators. Tumor necrosis factor alpha (TNF-alpha) is increased in patients with severe CHF. Two soluble proteins, the extracellular domains of the TNF receptors (sTNF-RI and sTNF-RII) inhibit the TNF-alpha biological effect. The aim of the study was to examine the plasma levels of sTNF-RI and sTNF-RII in patients with CHF and its relation to clinical, biochemical parameters of CHF severity. 41 patients with CHF (NYHA III and NYHA IV) and 18 control subjects were enrolled in this study. Plasma levels of sTNF-RI and sTNF-RII were analyzed by immunosorbent assay (ELISA) kits R&D (Research and Diagnostics Systems) (pg/ml)., Results: CHF patients had significantly increased receptor plasma levels compared to controls (p < 0.001). Soluble sTNF-RI and sTNF-RII receptors levels were similar in class NYHA III and NYHA IV. Receptor sTNF-RII correlated negatively with sodium plasma levels (p < 0.001), and sTNF-RI positively correlated with urice acid plasma level (p < 0.05). No statistically significant correlations were found between those receptors and age and gender etiology and severity of CHF, body weight (BMI) or other examined parameters (clinical, hemodynamic, echocardiographic, holter)., Conclusions: Plasma level of sTNF-RI and sTNF-RII are increased in patients with CHF.