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INTRODUCTION    The response to Cardiac Resynchronisation Therapy (CRT) varies significantly, resulting in lack of improvement among the substantial patients proportion.  OBJECTIVES    To identify mechanical dyssynchrony indices with combination of myocardial viability characteristics for predicting long-term response to CRT.  PATIENTS AND METHODS    ViaCRT was a multicentre study coordinated by the Working Group on Echocardiography of  Polish Cardiac Society. 127 patients with heart failure were assessed prospectively. Cardiac dyssynchrony indices and low-dose dobutamine response were determined by echocardiography prior to CRT. Improvement in Wall Motion Score Index (WMSI) or LVEF exceeding 20% at peak stress identified preserved contractile reserve.  RESULTS    After 12 months there was significantly different survival between subsets with and without viability characterised by WMSI decrease, corresponding to 1 (4.4%) and 20 (19.4%) fatal events respectively (p=0.048). The predictive value of LVEF gain at Dobutamine Stress Echocardiography (DSE) study was only significant at 6 months, with all-cause death occurring in 1 (1.6%) and 7 (12.1%) of patients with viable and non-viable myocardium respectively (p=0.029). Multivariate regression analysis identified the presence of septal flash and interventricular dyssynchrony as independent indices with the ability to predict echocardiographic response alone at 12 months. CONCLUSIONS    The study demonstrated a significant relationship between left ventricular contractile reserve at DSE and long-term all-cause mortality following CRT device implantation. Conversely, the presence of septal flash and interventricular dyssynchrony but not myocardial viability were predictive of the response to resynchronisation. The results indicate that interference of multiple different mechanisms may be responsible for the general effect following CRT.

Introduction: Obesity is a cluster of medical conditions affecting several pathophysiological processes, including platelet (PLT) function., Objectives: We evaluated the association between obesity and PLT response to dual antiplatelet therapy over 1 month in patients with stable angina pectoris after percutaneous coronary intervention (PCI). , Patients and Methods: Patients with stable angina pectoris (n = 130) and prior therapy with acetylsalicylic acid (ASA, 75 mg/d) after PCI were enrolled into the study and divided based on a body mass index (BMI): BMI <25 kg/m² (group A); BMI = 25-29.9 kg/m² (group B); and BMI ≥30 kg/m² (group C). PLT function was assessed by impedance aggregometry 24 hours after PCI and a loading dose (LD) of clopidogrel (CLO, 600 mg) and after 30 days of a maintenance dose (MD) of CLO and ASA of 75 mg/d. The delta values were calculated as the difference between the tests performed 30 days and 24 hours after PCI., Results: The PLT function changed significantly over a 30-day follow-up. The initial PLT reactivity to adenosine diphosphate (ADP1) was lower in group A and was the highest in group C (P <0.05). The PLT reactivity to collagen (COL1) and arachidonic acid was lower in group A (P <0.05) with no differences between groups B and C. There were no differences among the subgroups in PLT reactivity assessed after 30 days. A multivariate regression analysis showed that BMI (P = 0.03), creatinine serum concentration (P <0.01), male sex (P <0.01), and active smoking (P <0.001) are the independent predictors of ΔADP. CONCLUSIONS Obesity is associated with a lower response to CLO LD but PLT function after 30 days of CLO MD is similar in patients with obesity and normal-weight.

Obesity is a significant public health problem, associated with several comorbidities and complications. At the same time, the results of studies suggest that the relationship between obesity and survival in subjects diagnosed with cardiovascular disease is a U-shaped curve with a significantly worse prognosis among underweight and morbidly obese individuals. The association between overweight or grade I obesity and cardiovascular mortality is not clear, and numerous studies have shown an unexpected and paradoxical inverse relationship with better prognosis in this patient group, the so-called "obesity paradox". In the current review, we discuss the most important and most reliable studies regarding the prognosis and clinical course in patients with overweight or grade I obesity and essential hypertension, coronary artery disease, or heart failure, focusing on data for and against the obesity paradox.

Introduction: About 90% of Polish adults with hypercholesterolemia are not aware of their disease or are not treated., Objectives: The aim of the study was to evaluate hypercholesterolemia control in general practice and to assess the implications of introducing the nationwide Program of Cardiovascular Disease Prevention (PCVDP)., Patients and Methods: Sixty-six primary care clinics were scheduled to participate in the study. In half of them, PCVDP was implemented (active clinics), the remaining 33 constituted the control group. Study participants were selected from a group of persons aged 35-55 years with medical records established before January 1, 2005. Patients with coronary heart disease, stroke, or peripheral atherosclerosis were excluded. In a random sample of patients scheduled for the study, medical records were reviewed followed by an interview, physical examination, and blood lipid tests., Results: The availability of data on total cholesterol (TC) levels increased from 19.2% to 40.5% in patients from the active clinics and did not change in the control group. Hypercholesterolemia treatment was reported more often in the active clinics than in the control group (4.4% and 3.3%, respectively, P <0.01). Patients from the active clinics more often reported that a physician informed them about increased TC levels compared with the control group (29.1% and 24.1%, respectively, P <0.01). However, the percentage of patients with increased TC or low-density lipoprotein cholesterol levels and those using statins did not differ between the study groups., Conclusions: PCVDP is an effective tool to identify subjects with hypercholesterolemia but has no effect on the rate of achieving the recommended treatment targets.

Introduction: There is an ongoing debate regarding aortic valve degenerative processes. Some markers of calcification and atherosclerosis may be potentially useful in establishing their etiology., Objectives: The aim of the study was to assess the biochemical markers of calcification and atherosclerosis in patients with degenerative aortic stenosis (AS) in relation to the aortic valve calcium score (AVCS) and concomitant coronary artery disease (CAD)., Patients and Methods: The study involved 88 patients: 68 patients with degenerative AS (group A), including 44 patients with severe AS (A1; 25 patients with CAD) and 24 patients with moderate AS (A2; 13 patients with CAD) and 20 matched subjects as controls (18 patients with CAD). In all patients, clinical data were assessed, laboratory tests were done (including the analysis of serum interleukin4 [IL-4], osteoprotegerin [OPG], and fetuin-A levels), coronary angiography was performed, and the AVCS was measured., Results: Study groups and subgroups had comparable serum IL-4, OPG, and fetuin-A levels. There were significant differences in the AVCS between patients with severe AS, moderate AS, and controls (3605 ± 2542 Agatston units [AU], 1390 ± 1143 AU, 100 ± 194 AU, respectively; P <0.001). There were no significant correlations between the AVCS and serum IL-4, OPG, or fetuin-A levels. In moderate AS, serum OPG levels were higher in subjects with concomitant CAD (5.84 ± 1.4 vs. 4.03 ± 1.3 pmol/l, P = 0.036). In severe AS, the mean AVCS was similar in patients with and without CAD. Higher AVCS was observed only in patients with moderate AS and coexisting CAD compared with patients without CAD (1644 ± 1285 vs. 902 ± 789 AU, P = 0.038)., Conclusions: There were no significant differences between patients with and without degenerative AS in selected biochemical markers. The presence of CAD in moderate AS was associated with increased AVCS and serum OPG levels suggesting the effect of atherosclerosis on early valve calcification. In patients with severe AS, there were no correlations between calcification and atherosclerotic markers.