Search

Background: The Collaborative Outcome study on Health and Functioning during Infection Times (COH-FIT; www.coh-fit.com) is an anonymous and global online survey measuring health and functioning during the COVID-19 pandemic. The aim of this study was to test concurrently the validity of COH-FIT items and the internal validity of the co-primary outcome, a composite psychopathology "P-score"., Methods: The COH-FIT survey has been translated into 30 languages (two blind forward-translations, consensus, one independent English back-translation, final harmonization). To measure mental health, 1-4 items ("COH-FIT items") were extracted from validated questionnaires (e.g. Patient Health Questionnaire 9). COH-FIT items measured anxiety, depressive, post-traumatic, obsessive-compulsive, bipolar and psychotic symptoms, as well as stress, sleep and concentration. COH-FIT Items which correlated r ≥ 0.5 with validated companion questionnaires, were initially retained. A P-score factor structure was then identified from these items using exploratory factor analysis (EFA) and confirmatory factor analyses (CFA) on data split into training and validation sets. Consistency of results across languages, gender and age was assessed., Results: From >150,000 adult responses by May 6th, 2022, a subset of 22,456 completed both COH-FIT items and validated questionnaires. Concurrent validity was consistently demonstrated across different languages for COH-FIT items. CFA confirmed EFA results of five first-order factors (anxiety, depression, post-traumatic, psychotic, psychophysiologic symptoms) and revealed a single second-order factor P-score, with high internal reliability (ω = 0.95). Factor structure was consistent across age and sex., Conclusions: COH-FIT is a valid instrument to globally measure mental health during infection times. The P-score is a valid measure of multidimensional mental health., Competing Interests: Conflict of interest Conflict of interest statements of all authors are detailed in Supplementary Table 7., (Copyright © 2022 Elsevier B.V. All rights reserved.)

This study was conducted in a representative sample of area residents aged 20-80 years old. The aim of the study was to assess the prevalence of classic risk factors of atherosclerosis in the studied population and to search for new risk factors in these patient subpopulations. A total of 795 people (mean age 48.64 ± 15.24 years, 45.5% male) were included in the study group. Two independent data analyses were performed. In the first analysis, the study group was divided into two subgroups depending on the presence or absence of atherosclerotic plaques in carotid arteries (APCA). APCA were observed in 49.7% of the study group: in the population aged between 41 and 60 years in 49.3%, and those between 61 and 70 years in 86.3%. Patients with APCA were more often diagnosed with arterial hypertension, diabetes, and hypercholesterolemia. In the second analysis, the study group was divided into two subgroups depending on the presence of lower extremities atherosclerotic disease (LEAD). Patients with an ABI (ankle-brachial index) ≤ 0.9 constituted 8.5% of the study group, and they were significantly older, and more often diagnosed with diabetes and APCA. To identify the factors most strongly associated with APCA and an ABI ≤ 0.9, logistic regression was used, with stepwise elimination of variables. The strongest factors associated with APCA were current smoking and diastolic central pressure. We did not note such an association and did not find additional parameters to facilitate the diagnosis of LEAD in asymptomatic patients. The most important observation in our study was the high prevalence of APCA in the study population, especially in the group of young people under the age of 60.

Introduction: Diabetes remains one of the top public health care priorities. Over 6% of the world's population is affected by type 2 diabetes; however, a similar number of individuals may be unaware of this diagnosis., Objectives: Our population‑basedstudy aimed to investigate the true prevalence of diabetes and prediabetes in the general population of a medium‑sized city in Poland., Patients and Methods: The analysis included 1051 participants of the Bialystok PLUS population‑based cohort study. In those who did not report a history of diabetes, the oral glucose tolerance test (OGTT) was performed. Medical history data were gathered using standardized questionnaires, and anthropometric as well as body composition measurements were performed., Results: According to the medical history data, a total of 75 participants had diabetes (7.14%). Prediabetes (impaired fasting glycemia [IFG] or impaired glucose tolerance [IGT]) was identified in 410 individuals, including 241 participants with IFG (22.9%) and 169 patients with IGT (16.1%). Moreover, there were 71 individuals (6.75%) who were newly diagnosed with diabetes based on OGTT results. Overall, 146 patients with diabetes (13.8%) were identified. The ratio of lean mass to fat mass differed significantly between the patients with newly diagnosed diabetes and those without impaired glucose metabolism., Conclusions: Our cohort study demonstrated a high prevalence of undiagnosed diabetes in the Białystok population. In addition, we showed that a large group of patients still remains undiagnosed for other hyperglycemic disorders. Abdominal obesity as well as imbalance between the fat and lean mass may predispose to diabetes.

The outbreak of the COVID-19 pandemic caused the healthcare system to drastically reduce in-person visits and suddenly switch to telemedicine services to provide clinical care to patients. The implementation of teleconsultation in medical facilities was a novelty for most Polish patients. In Poland, the main telehealth services were provided in the form of telephone consultations. The aim of this study is to determine patients' perceptions of telemedicine in the context of their experiences with the healthcare system during the COVID-19 pandemic. In this study, we presented how the evaluation of telemedicine services from the perspective of patients in Poland changed in the context of the ongoing pandemic. We conducted two surveys (year by year) on a representative quota sample of the Polish population (N = 623). This ensured that our observations took into account the evolution of views on telemedicine over time. We confirmed the well-known relationship that innovations introduced in the healthcare sector require a longer period of adaptation. We also identified significant concerns that limit the positive perception of telemedicine and compared them with experiences described in other countries.

In recent years, the importance of the gut microbiome in human health and disease has increased. Growing evidence suggests that gut dysbiosis might be a crucial risk factor for coronary artery disease (CAD). Therefore, we conducted a systematic review and meta-analysis to determine whether or not CAD is associated with specific changes in the gut microbiome. The V3-V4 regions of the 16S rDNA from fecal samples were analyzed to compare the gut microbiome composition between CAD patients and controls. Our search yielded 1181 articles, of which 21 met inclusion criteria for systematic review and 7 for meta-analysis. The alpha-diversity, including observed OTUs, Shannon and Simpson indices, was significantly decreased in CAD, indicating the reduced richness of the gut microbiome. The most consistent results in a systematic review and meta-analysis pointed out the reduced abundance of Bacteroidetes and Lachnospiraceae in CAD patients. Moreover, Enterobacteriaceae , Lactobacillus , and Streptococcus taxa demonstrated an increased trend in CAD patients. The alterations in the gut microbiota composition are associated with qualitative and quantitative changes in bacterial metabolites, many of which have pro-atherogenic effects on endothelial cells, increasing the risk of developing and progressing CAD., Competing Interests: The authors have no conflicts of interest to declare. All co-authors have seen and agree with the manuscript’s contents, and there is no financial interest to report. We certify that the submission is original work and is not under review at any other publication. The authors have no competing interests to declare.

Psoriasis, vitiligo and lichen planus (LP) are autoimmune skin diseases associated with metabolic syndrome. Angiopoietin-like 4 (ANGPTL4) is a member of angiopoietin-like proteins, which play an important role in lipid metabolism, and its serum concentration has been proposed as a biomarker of cardiometabolic complications, especially coronary artery disease (CAD). The study involved 56 patients with abovementioned dermatoses and 29 sex- and age-matched volunteers without dermatoses. ANGPTL4 serum concentration was measured by ELISA. ANGPTL4 concentration was statistically significantly higher in patients with LP compared to the control group (p < 0.01); moreover, it was significantly higher than in patients with psoriasis and vitiligo (p < 0.001, p < 0.01, respectively). There was no statistically significant difference in ANGPTL4 concentration between patients with psoriasis or vitiligo and controls. There was no correlation between ANGPTL4 concentration and age or BMI in all study groups. There was a positive correlation between ANGPTL4 concentration and fasting glucose (R = 0.43) and AST activity (R = 0.39) in psoriatic patients and ALT activity in patients with vitiligo (R = 0.44). ANGPTL4 could be a potential marker of metabolic complications in patients with LP, especially CAD. Perhaps patients with LP are more prone to CAD compared to the other two dermatoses, which requires further research.

Competing Interests: The authors declare no conflict of interest.

Background: Obesity is a chronic disease with high prevalence in all age groups. Many overweight and obese people seem to be unaware of excess body weight., Aim: Analysis of people affected by the misperception of excess body weight and their eating behaviors simultaneously with selected health parameters., Methods: The study was conducted in 2017-2019 among 658 participants aged 20-79 from the population study-Bialystok PLUS (Poland). Results were based on clinical examinations and questionnaires., Results: Unawareness of overweight and obesity is common among adults (21.7%). Participants unaware of their overweight and obesity presented much higher risk factors. A high cardiovascular risk profile was observed more often among people not aware of overweight and obesity than among normal weight people (23.0% vs. 10.0%) as well as more common asymptomatic carotid artery atherosclerosis (49.7% vs. 31.3%). The subjective perception of overweight and obesity based on BMI (body mass index) was equal to 26.4 kg/m 2 in women and 27.9 kg/m 2 in men. The assessment of their diet was less favorable than that of people with normal weight., Conclusions: Unawareness of one's excessive weight and its health consequences may lead to hesitancy to apply a healthy lifestyle and hence increase the cardiovascular risk in a substantial part of society. Therefore, it should be considered a part of the cardiovascular disease risk spectrum. Measurement of BMI and discussion about its health implications should be a routine procedure during healthcare contacts.

In recent years, research has provided increasing evidence for the importance of inflammatory etiology in age-related macular degeneration (AMD) pathogenesis. This study assessed the profile of inflammatory cytokines in the serum of patients with AMD and coexisting glucose disturbances (GD). This prospective population-based cohort study addressed the determinants and occurrence of cardiovascular, neurological, ophthalmic, psychiatric, and endocrine diseases in residents of Bialystok, Poland. To make the group homogenous in terms of inflammatory markers, we analyzed only subjects with glucose disturbances (GD: diabetes or prediabetes). Four hundred fifty-six patients aged 50-80 were included. In the group of patients without macular degenerative changes, those with GD accounted for 71.7%, while among those with AMD, GD accounted for 89.45%. Increased serum levels of proinflammatory cytokines were observed in both AMD and GD groups. C1qTNF1 concentration was statistically significantly higher in the group of patients with AMD, with comparable levels of concentrations of other proinflammatory cytokines. C1qTNF1 may act as a key mediator in the integration of lipid metabolism and inflammatory responses in macrophages. Moreover, C1qTNF1 levels are increased after exposure to oxidized low-density lipoprotein (oxLDL), which plays a key role in atherosclerotic plaque formation and is also a major component of the drusen observed in AMD. C1qTNF1 may, therefore, prove to be a link between the accumulation of oxLDL and the induction of local inflammation in the development of AMD with concomitant GD.

BACKGROUND Ventricular electrical storm (VES) is a treatment-resistant ventricular arrhythmia associated with high mortality. This report is of a 39-year-old woman with VES treated with emergency cardiac defibrillation followed by multidisciplinary management. CASE REPORT A 39-year-old woman, previously diagnosed with eosinophilia of unknown origin and recurrent non-sustained ventricular tachycardias, was admitted to the Department of Invasive Cardiology with VES after an initial antiarrhythmic approach, analgesia, and defibrillation in the Emergency Department. The patient had a temporary pacing wire implanted, but overdrive therapy was not successful. The medical treatment and multiple defibrillations did not stop the arrythmia. Due to the hemodynamic instability, extracorporeal membrane oxygenation (ECMO) was performed at the Department of Cardiac Surgery. Consequently, the patient was stabilized and an electrophysiology exam and RF ablation of arrhythmogenic focus were conducted in the Department of Cardiology. One day after the procedure, the patient had pulmonary edema caused by pericardial tamponade. The patient was successfully operated on in the Department of Cardiac Surgery. Then, the next complication appeared - a femoral artery embolism - which was treated in the Department of Vascular Surgery. After patient stabilization and exclusion of serious neurological damage, an implantable cardioverter-defibrillator (ICD) was implanted for secondary prevention of sudden cardiac death (SCD). CONCLUSIONS This case has shown the importance of the rapid diagnosis of VES and emergency management with cardiac defibrillation. Multidisciplinary clinical follow-up is required to investigate and treat any reversible causes and to ensure long-term stabilization of cardiac rhythm.

Atherosclerosis remains the leading cause of cardiovascular diseases and represents a primary public health challenge. This chronic state may lead to a number of life-threatening conditions, such as myocardial infarction and stroke. Lipid metabolism alterations and inflammation remain at the forefront of the pathogenesis of atherosclerotic cardiovascular disease, but the overall mechanism is not yet fully understood. Recently, significant effects of trained immunity on atherosclerotic plaque formation and development have been reported. An increased reaction to restimulation with the same stimulator is a hallmark of the trained innate immune response. The impact of trained immunity is a prominent factor in both acute and chronic coronary syndrome, which we outline in this review.

To assess the frequency of persisting symptoms after SARS-CoV-2 infection and assessment of the effects of COVID-19 pandemic on selected parameters of self-reported health status and well-being half a year after the disease. The study population consisted of 3 groups: post-COVID-19 group I-172 patients; group II-172 patients with chronic disease, who have not suffered from COVID-19; group III-81 patients from a population study cohort-Bialystok PLUS. A standardized interview questionnaire was used to collect data in the three groups using the CATI (computer assisted telephone interviewing) technique. Interviews were conducted between October 2020 and January 2021, thus during the second wave of the pandemic in Poland. The subjective state of health in comparison with the state of health before the COVID-19 pandemic deteriorated in COVID-19 convalescents. Patients, who suffered from symptomatic COVID-19 were more prone to nervousness, anxiousness, tension than patients with oligosymptomatic course of the disease. Moreover, anxiety, fear and irritability were more frequent in Group I and II in comparison to Group III, whereas Group I and II did not differ significantly. The decrease in physical activity observed in COVID-19 patients mirrored the changes in general population. The most frequent persistent symptoms after COVID-19 are: general malaise, cough, smell and taste disorder, dyspnea. COVID-19 convalescents who experienced symptomatic disease are more prone to development of nervousness, anxiousness, tension and anxiety than patients with oligosymptomatic course of the disease. Females and younger patients who suffered from COVID-19 are more prone to development of mental distress than healthy population. No significant differences between COVID-19 convalescents and healthy population was observed as far as the attitude towards physical activity is concerned., (© 2022. The Author(s).)

The aim of our study was to evaluate the importance of insulin-like growth-factor-binding protein 7 (IGFBP-7) as a potential marker of symptomatic peripheral artery disease (PAD) occurrence. The study group consisted of 145 patients with diagnosed PAD, who qualified for the invasive treatment. The control group consisted of 67 individuals representing the local population and an ischemic heart disease (IHD) group of 88 patients after myocardial infarction or percutaneous coronary intervention. Patients with PAD had significantly higher IGFBP-7 concentrations than control group (1.80 ± 1.62 vs. 1.41 ± 0.45 ng/mL, p = 0.04). No significant differences between PAD patients and IHD patients were found (1.80 ± 1.62 vs. 1.76 ± 1.04 ng/mL, p = 0.783). Patients with multilevel PAD presented significantly higher IGFBP-7 concentrations than patients with aortoiliac PAD-median 1.18 (IQR 0.48-2.23) vs. 1.42 ng/mL (0.71-2.63), p = 0.035. In the group of patients who died or had a major adverse cardiovascular event (MACE) during six months of follow-up, a statistically significant higher IGFBP-7 concentration was found (median 2.66 (IQR 1.80-4.93) vs. 1.36 ng/mL (IQR 0.65-2.34), p = 0.004). It seems that IGFBP-7 is elevated in patients with atherosclerotic lesions-regardless of their locations. Further research should be conducted to verify IGFBP-7 usefulness as a predictor of MACE or death.

Our goal was to assess the anti-SARS-CoV-2 antibodies presence in COVID-19 convalescents and assess the differences in anti-SARS-CoV-2 antibodies production regarding the disease severity, sex, vaccination, and assess the correlation between anti-SARS-CoV-2 antibodies production and inflammatory parameters. Three hundred twenty-two COVID-19 patients (282 hospitalized and 40 patients with oligosymptomatic COVID-19 isolated at homes) were included in the study. Blood was taken at 4 time points: during hospitalization, 1 month, 3 months, and 6 months. Detection of SARS-CoV-2 antibodies was performed with LIAISON SARS-CoV-2 S1/S2 IgG tests (DiaSorin, Italy). Clinical and laboratory parameters were compared. Significant differences between higher anti-SARS-CoV-2 antibodies titer in symptomatic patients 3 months after infection (III sample) and significantly higher ratio II/I in symptomatic patients were observed. Subgroup analysis based on sex showed differences only in laboratory tests, not in serological. Analysis of the results of serological tests showed significant differences in ratio IV/I and a significant increase in antibodies level after vaccination. The most significant rise was observed between the 3rd and 6th month when the patients received a vaccination. Immunological response after COVID-19 infection lasted over 6 months in all patients, although antibodies titers were significantly higher in patients with a history of severe COVID-19 and vaccinated patients. Immunological response after COVID-19 infection did not depend on sex. There was a significant correlation between anti-SARS-CoV-2 antibodies production and the degree of inflammation in the acute phase of the disease (inflammatory parameters in blood and severity of lung affection in CT). IMPORTANCE The results of our study confirm the knowledge on immune response in the Polish population and add new information regarding correlations with the severity of the disease. The data in the literature concerning the correlation between antibodies response and sex are ambiguous, and we did not observe differences between antibodies production and gender, which also adds new information.

Background: Insulin resistance is a risk factor for cardiovascular disease. Recently, we have developed a novel index, FLAIS (Fasting Laboratory Assessment of Insulin Sensitivity), which accurately reflects insulin sensitivity, measured with hyperinsulinemic-euglycemic clamp, in different groups of subjects. The aim of the present study was to assess the relationship of FLAIS with cardiovascular risk factors in a population-based study., Methods: The study group comprised 339 individuals from the ongoing Białystok Plus study, without previously known diabetes. Clinical examination, oral glucose tolerance test and the measurement of blood laboratory parameters were performed., Results: Prediabetes (impaired fasting glucose and/or impaired glucose tolerance) was diagnosed in 165 individuals whereas type 2 diabetes was diagnosed in 19 subjects. FLAIS was lower in individuals with prediabetes and diabetes in comparison with individuals with normal glucose tolerance. FLAIS was significantly related to waist circumference, systolic and diastolic blood pressure, triglycerides, HDL-cholesterol and LDL-cholesterol in the entire study group and in the subgroups with normal glucose tolerance and with prediabetes/diabetes. HOMA-IR, QUICKI and Matsuda index were not related to blood pressure and LDL-cholesterol in individuals with normal glucose tolerance. Majority of the adjusted models with FLAIS were characterized by better fit with the data in comparison with other indices for all cardiovascular risk factors except waist circumference., Conclusions: FLAIS represents useful index to assess the cluster of insulin resistance-associated cardiovascular risk factors in general population., (© 2022. The Author(s).)

Chronic low-grade inflammation has been proposed as a linking mechanism between obesity and the development of inflammation-related conditions such as insulin resistance and cardiovascular disease. Despite major advances in the last 2 decades, the complex relationship between inflammation and obesity remains poorly understood. Therefore, we aimed to identify novel inflammation-related proteins associated with adiposity. We investigated the association between BMI and waist circumference and 72 circulating inflammation-related proteins, measured using the Proximity Extension Assay (Olink Proteomics), in 3,308 participants of four independent European population-based studies (KORA-Fit, BVSII, ESTHER, and Bialystok PLUS). In addition, we used body fat mass measurements obtained by Dual-energy X-ray absorptiometry (DXA) in the Bialystok PLUS study to further validate our results and to explore the relationship between inflammation-related proteins and body fat distribution. We found 14 proteins associated with at least one measure of adiposity across all four studies, including four proteins for which the association is novel: DNER, SLAMF1, RANKL, and CSF-1. We confirmed previously reported associations with CCL19, CCL28, FGF-21, HGF, IL-10RB, IL-18, IL-18R1, IL-6, SCF, and VEGF-A. The majority of the identified inflammation-related proteins were associated with visceral fat as well as with the accumulation of adipose tissue in the abdomen and the trunk. In conclusion, our study provides new insights into the immune dysregulation observed in obesity that might help uncover pathophysiological mechanisms of disease development., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: . High-quality comprehensive data on short-/long-term physical/mental health effects of the COVID-19 pandemic are needed., Methods: . The Collaborative Outcomes study on Health and Functioning during Infection Times (COH-FIT) is an international, multi-language (n=30) project involving >230 investigators from 49 countries/territories/regions, endorsed by national/international professional associations. COH-FIT is a multi-wave, on-line anonymous, cross-sectional survey [wave 1: 04/2020 until the end of the pandemic, 12 months waves 2/3 starting 6/24 months threreafter] for adults, adolescents (14-17), and children (6-13), utilizing non-probability/snowball and representative sampling. COH-FIT aims to identify non-modifiable/modifiable risk factors/treatment targets to inform prevention/intervention programs to improve social/health outcomes in the general population/vulnerable subgrous during/after COVID-19. In adults, co-primary outcomes are change from pre-COVID-19 to intra-COVID-19 in well-being (WHO-5) and a composite psychopathology P-Score. Key secondary outcomes are a P-extended score, global mental and physical health. Secondary outcomes include health-service utilization/functioning, treatment adherence, functioning, symptoms/behaviors/emotions, substance use, violence, among others., Results: . Starting 04/26/2020, up to 14/07/2021 >151,000 people from 155 countries/territories/regions and six continents have participated. Representative samples of ≥1,000 adults have been collected in 15 countries. Overall, 43.0% had prior physical disorders, 16.3% had prior mental disorders, 26.5% were health care workers, 8.2% were aged ≥65 years, 19.3% were exposed to someone infected with COVID-19, 76.1% had been in quarantine, and 2.1% had been COVID 19-positive., Limitations: . Cross-sectional survey, preponderance of non-representative participants., Conclusions: . Results from COH-FIT will comprehensively quantify the impact of COVID-19, seeking to identify high-risk groups in need for acute and long-term intervention, and inform evidence-based health policies/strategies during this/future pandemics., (Copyright © 2021. Published by Elsevier B.V.)

Background: The COVID-19 pandemic has altered daily routines and family functioning, led to closing schools, and dramatically limited social interactions worldwide. Measuring its impact on mental health of vulnerable children and adolescents is crucial., Methods: The Collaborative Outcomes study on Health and Functioning during Infection Times (COH-FIT - www.coh-fit.com) is an on-line anonymous survey, available in 30 languages, involving >230 investigators from 49 countries supported by national/international professional associations. COH-FIT has thee waves (until the pandemic is declared over by the WHO, and 6-18 months plus 24-36 months after its end). In addition to adults, COH-FIT also includes adolescents (age 14-17 years), and children (age 6-13 years), recruited via non-probability/snowball and representative sampling and assessed via self-rating and parental rating. Non-modifiable/modifiable risk factors/treatment targets to inform prevention/intervention programs to promote health and prevent mental and physical illness in children and adolescents will be generated by COH-FIT. Co-primary outcomes are changes in well-being (WHO-5) and a composite psychopathology P-Score. Multiple behavioral, family, coping strategy and service utilization factors are also assessed, including functioning and quality of life., Results: Up to June 2021, over 13,000 children and adolescents from 59 countries have participated in the COH-FIT project, with representative samples from eleven countries., Limitations: Cross-sectional and anonymous design., Conclusions: Evidence generated by COH-FIT will provide an international estimate of the COVID-19 effect on children's, adolescents' and families', mental and physical health, well-being, functioning and quality of life, informing the formulation of present and future evidence-based interventions and policies to minimize adverse effects of the present and future pandemics on youth., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare complication of acute pulmonary embolism (APE). Both pharmacological and invasive treatments for CTEPH are available in Poland, and awareness of the disease among physicians is growing. It has been suggested that the COVID-19 pandemic may increase the incidence of CTEPH and facilitate disease detection during more advanced stages of the illness. Thus, the Polish Cardiac Society's Working Group on Pulmonary Circulation, in cooperation with independent experts in this field, launched the updated statement on the algorithm to guide a CTEPH diagnosis in patients with previous APE. CTEPH should be suspected in individuals after APE with dyspnea, despite at least 3 months of effective anticoagulation, particularly when specific risk factors are present. Echocardiography is the main screening tool for CTEPH. A diagnostic workup of patients with significant clinical suspicion of CTEPH and right ventricular overload evident on echocardiography should be performed in reference centers. Pulmonary scintigraphy is a safe and highly sensitive screening test for CTEPH. Computed tomography pulmonary angiography with precise detection of thromboembolic residues in the pulmonary circulation is important for the planning of a pulmonary thromboendarterectomy. Right heart catheterization definitively confirms the presence of pulmonary hypertension and direct pulmonary angiography allows for the identification of lesions suitable for thromboendarterectomy or balloon pulmonary angioplasty. In this document, we propose a diagnostic algorithm for patients with suspected CTEPH. With an individualized and sequential diagnostic strategy, each patient can be provided with suitable and tailored therapy provided by a dedicated CTEPH Heart Team.

While obesity has been correlated with welfare in the general population, there is not much data on the influence of body composition on welfare among the non-obese adult individuals. In this study, a total of 726 non-obese individuals from the general population were analyzed. The mean age was 46.8 ± 15.4 years and 42.1% of participants were male. The anthropometric measurements and dual energy X-ray absorptiometry (DEXA) were done. The mean value for the Satisfaction with Life Scale (SWLS) was 23.09 ± 5.43, for Euro Quality of Life Visual Analogue Scale (EQ-VAS) was 78.0 ± 14.5, and for the Beck Depression Inventory (BDI) was 6.7 ± 6.6. On the SWLS, the higher waist-hip ratio had a negative impact even after adjusting for age, gender, and concomitant diseases. EQ-VAS was inversely associated with android fat distribution and directly associated with muscle mass. BDI value was inversely associated with lower muscle mass, especially in lower limbs. The well-being of women was mainly associated with the distribution of adipose tissue and less with the distribution of muscle tissue-abdominal fat distribution has a particularly negative impact on well-being among women. In contrast, men's well-being depends more on muscle mass and to a lesser extent on the distribution of fat tissue-a positive significant effect has lean mass and a circumference of thigh below gluteal fold., (© 2021. The Author(s).)

Purpose: Dysfunction of the right ventricle (RV) is an important determinant of survival in patients with pulmonary arterial hypertension (PAH). The presence of late gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR) at RV insertion points (RVIPs) has been found in majority of PAH patients and was associated with parameters of RV dysfunction. We hypothesize, that more detailed quantification of LGE may provide additional prognostic information., Material and Methods: Twenty-eight stable PAH patients (mean age 49.9 ​± ​15.9 years) and 12 healthy subjects (control group, 44.8 ​± ​13.5 years) were enrolled into the study. Septal LGE mass was quantified at the RVIPs and subsequently indexed by subject's body surface area. Mean follow-up time of this study was 16.6 ​± ​7.5 months and the clinical end-point (CEP) was defined as death or clinical deterioration., Results: Median LGE mass index (LGEMI) at the RVIPs was 2.75 ​g/m2 [1.41-4.85]. We observed statistically significant correlations between LGEMI and hemodynamic parameters obtained from right heart catheterization - mPAP (r ​= ​0.61, p ​= ​0.001); PVR (r ​= ​0.52, p ​= ​0.007) and from CMR - RVEF (r ​= ​-0.54, p ​= ​0.005); RV global longitudinal strain (r ​= ​0.42, p ​= ​0.03). Patients who had CEP (n ​= ​16) had a significantly higher LGEMI (4.49 [2.75-6.17] vs 1.67 [0.74-2.7], p ​= ​0.01); univariate Cox analysis confirmed prognostic value of LGEMI. Furthermore, PAH patients with LGEMI higher than median had worse prognosis in Kaplan-Meier analysis (log-rank test, p ​= ​0.0006)., Conclusions: The body surface indexed mass of LGE at RV septal insertion points are suggestive of RV hemodynamic dysfunction and could be a useful non-invasive marker of PAH prognosis., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2020 Medical University of Bialystok. Published by Elsevier B.V. All rights reserved.)

Purpose: Exaggerated release of proinflammatory mediators during sepsis contributes to inadequate vasodilatation and depressed myocardial contractility, which lead to development of shock and circulatory collapse. The aim of the study was to evaluate the effect of IL-6 and aging on activation of intracellular signaling pathways in the myocardium induced by bacterial lipopolysaccharide (LPS) administration., Material/methods: LPS was injected intraperitoneally to male 3- and 24-month old mice with systemic IL-6 gene knock-out (IL-6KO) and the reference strain (WT). LPS was given intraperitoneally in single low (0.1 mg/kg) or high (10 mg/kg) dose, or in two doses (0.1 + 10 mg/kg) with 24-h delay. The expression and phosphorylation of STAT3, ERK1/2, Akt1/2/3 proteins in the left ventricular myocardium was evaluated after 24 h using Western blotting., Results: Low LPS dose induced higher STAT3 phosphorylation only in old IL-6KO mice, not affecting ERK1/2 and Akt1/2/3 phosphorylation in any group. High LPS dose upregulated STAT3 phosphorylation similarly in all groups, reduced ERK1/2 expression in young WT mice and upregulated Akt1/2/3 expression and phosphorylation in young IL-6KO mice. Pretreatment with low LPS dose attenuated phosphorylation of STAT3 in both old groups and phosphorylation of Akt1/2/3 in young IL-6KO group. Two-dose approach also significantly potentiated ERK1/2 phosphorylation in both old groups., Conclusions: Obtained results show that IL-6 deficiency alters the activity of intracellular signaling pathways: JAK/STAT in old and Akt in young LPS-treated mice. This may indicate that lack of IL-6 attenuates Akt-related cytoprotective effect of pretreatment with low LPS dose in young but not in aged animals., Competing Interests: Declaration of competing interest The authors declare no conflict of interests., (Copyright © 2020 Medical University of Bialystok. Published by Elsevier B.V. All rights reserved.)

Purpose: The role of insulin-like growth factor-binding protein-7 (IGFBP-7) in atherosclerosis is still not well-known. The objective of this study was to find out the following: 1) whether IGFBP-7 may act as a biomarker of coronary artery disease (CAD) occurrence and extent; 2) whether IGFBP-7 is potentially related to the classical and new markers of cardiovascular risk (carotid intima-media thickness - cIMT); 3) whether IGFBP-7 may be a marker of mortality in the group of patients with myocardial infarction (MI)., Materials/methods: The study group consisted of 212 patients with MI and 75 patients with stable CAD, the control group included 100 healthy volunteers. IGFBP-7 serum concentration was measured., Results: IGFBP-7 value was considerably higher in the study group (MI and CAD patients - 35.1 ng/ml (P = 0.000001) and 32.7ng/ml (P = 0.0001), respectively), than in the controls - 25.2ng/ml. No statistically significant differences between IGFBP-7 concentrations in the MI and CAD group were found. No relationship between IGFBP-7 and the coronary lesions advancement in the study group was observed. No changes in IGFBP-7 concentration in the MI patients during hospitalization were observed. In the group of MI patients who died during follow-up, a considerably higher cIMT values were found whereas no statistically significant difference was observed in relation to IGFBP-7 (34.6 vs. 35.2 ng/ml)., Conclusions: IGFBP-7 is a good biomarker of CAD occurrence but not of its advancement. We demonstrated the existence of the relation between higher IGFBP-7 concentration and the selected classical risk factors of cardiovascular events as well as cIMT values. IGFBP-7 cannot serve as a marker of acute ischemia. Also, IGFBP-7 was not confirmed as a predictor of mortality in the MI patients., (Copyright © 2019 Medical University of Bialystok. Published by Elsevier B.V. All rights reserved.)

Pulmonary arterial hypertension is a multifactorial disease characterized by vasoconstriction, vascular remodeling, inflammation and thrombosis. Although an increasing number of research confirmed that pulmonary artery endothelial cells, pulmonary artery smooth muscle cells as well as platelets have a role in the pulmonary arterial hypertension pathogenesis, it is still unclear what integrates these factors. In this paper, we review the evidence that platelets through releasing a large variety of chemokines could actively impact the pulmonary arterial hypertension pathogenesis and development. A recent publication revealed that not only an excess of platelet derived cytokines, but also a deficiency may be associated with pulmonary arterial hypertension development and progression. Hence, a simple platelet blockade may not be a correct action to treat pulmonary arterial hypertension. Our review aims to analyse the interactions between the platelets and different types of cells involved in pulmonary arterial hypertension pathogenesis. This knowledge could help to find novel therapeutic options and improve prognosis in this devastating disease., (Copyright © 2018 Medical University of Bialystok. Published by Elsevier B.V. All rights reserved.)

Purpose: Pulmonary hypertension (PH) diagnosis requires invasive assessment by right heart catheterization (RHC), but screening and monitoring are performed using non-invasive methods: echocardiography and cardiopulmonary exercise testing (CPET). The aim of the study was to assess correlations between the parameters obtained in non-invasive testing and RHC in patients with PH of different etiologies., Material/methods: The study included 53 medical records of PH patients (32 women) aged 29-81 years. We analyzed correlations between RHC (systolic pulmonary artery pressure (sPAP), diastolic pulmonary artery pressure (dPAP), pulmonary vascular resistance (PVR), cardiac output (CO)) and echocardiographic (tricuspid annular plane systolic excursion (TAPSE), sPAP) and CPET parameters (end-tidal oxygen and carbon dioxide pressures (PetO 2 , PetCO 2 ), ventilation efficiency (VE/VCO 2 ) slope)., Results: Echocardiographic estimation correlated well with RHC measurement of sPAP (r=0.65, P<0.001). TAPSE correlated with PVR assessed with thermodilution method (r=-0.5, P=0.005), dPAP (r=-0.53, P=0.002) and CO (r=0.53, P=0.002). PVR assessed with thermodilution and Fick methods showed positive correlation with PetO 2 (r=0.74, P<0.001 and r=0.72, P<0.001) and negative correlation with PetCO 2 (r=-0.59, P=0.004 and r=-0.64, P=0.002) at the anaerobic threshold. VE/VCO 2 slope correlated with dPAP (r=0.43, P=0.04) and PVR calculated with both methods (r=0.52, P=0.01 and r=0.52, P=0.02)., Conclusions: Simple cardiac function indicators obtained by commonly used non-invasive methods allow only approximate estimation of the main hemodynamic RHC-derived parameters: sPAP, CO and PVR. Obtained results suggest the relationship between RV dysfunction and ventilation abnormalities in PH patients., (Copyright © 2016 Medical University of Bialystok. Published by Elsevier B.V. All rights reserved.)

Background: Interleukin 6 (IL-6) may be involved in regulation of cardiac lipid metabolism and mitochondrial function through its influence on peroxisome proliferator-activated receptors (PPARs). In this study we evaluated the impact of the physiological level of IL-6 on the expression of PPARα and PGC-1α in the heart and the effect of lack of this cytokine on high-fat diet (HFD) induced lipotoxicity., Methods: Male C57BL6/J wild type (WT) and IL-6 knock-out (IL-6KO) mice were used. 20 animals of each genotype were fed with HFD for 15-18weeks. Cardiac function was assessed using echocardiography and cardiomyocyte ultrastructure was examined using electron microscopy. QT-PCR and Western blotting were applied to estimate the expression of PPARα and PGC-1α at the transcriptional and protein levels., Results: At baseline WT and IL-6KO mice had similar size and function of the left ventricle. HFD induced similar left ventricular hypertrophic response in both groups without causing heart failure, but only WT animals had increased resting ejection fraction of the LV. Ultrastructure of HFD groups showed markers of lipotoxicity, that were more pronounced in IL-6KO group. In basal conditions IL-6KO animals had lower PPARα and similar PGC-1α expression as compared to WT. HFD induced downregulation of both PPARα and PGC-1α in WT animals, while in IL-6KO mice this effect was constrained., Conclusion: IL-6 is involved in basal regulation of PPARα and PGC-1α expression in cardiomyocytes. The lack of this cytokine promotes high-fat diet induced lipotoxicity but without overt manifestations of cardiac failure., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Objective: The role of Galectin-3(Gal-3) in atherosclerosis progression has not been definitely acknowledged. The aim of the study was to establish the following: whether Gal-3 may act as an independent risk factor of coronary artery disease (CAD) occurrence and its advancement, if Gal-3 has potential relations with classical and new markers of cardiovascular risk (carotid intima-media thickness (cIMT), and whether Gal-3 may be a marker of mortality in the group of patients with myocardial infarction (MI) during mid-term follow-up., Patients and Methods: The study group was composed of 233 patients with MI and 100 patients with a stable CAD. Selected risk factors were assessed, Gal-3 concentrations and cIMT were measured. The control group was composed of 100 healthy individuals., Results: In the study group (MI and CAD patients) Gal-3 concentration was significantly higher than in the controls--median 7.9 ng/ml (p = 0.0001) and 10.7 ng/ml (p = 0.00001) vs. 5.5 ng/ml, respectively. Patients with 3-vessel disease had higher levels of Gal-3 than patients with 1-or 2-vessel disease (9.2 ng/ml vs 7.4 ng/ml, p = 0.003). In the group of MI patients who died during the follow-up (average period - 2.8 years), we found a significantly higher concentration of Gal-3 (20.0 ng/ml vs 8.0 ng/ml, p = 0.0005) and cIMT values (common carotid artery(CCA): 1.4 ± 0.4 mm vs. 1.0 ± 0.3 mm, p = 0.03; carotid bulb(CB): 2.3 ± 0.5 mm vs. 1.9 ± 0.4 mm, p = 0.009). In the model of multivariate logistic regression analysis, the variables influencing the mortality after MI during follow-up were: age>65 years, Gal-3 concentration>8.7 ng/ml, IMT values and plaque occurrence in CB, previous MI and EF<40%., Conclusions: Gal-3 is an independent risk factor of CAD occurrence, but cIMT values are better markers of CAD advancement. Both Gal-3 concentration>8.7 ng/ml and IMT values in CB were an independent predictive indicators of increased risk of all-cause mortality in patients after MI during mid-term follow up., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Background: CCN family of proteins has been implicated in various processes in cardiovascular physiology and pathology, including angiogenesis, regeneration and fibrosis. In this study we assessed long term changes of CCN1 and CCN2 gene products abundance in the failing ventricular myocardium., Methods: Male, 12-14-weeks-old C57BL6/J and C57BL6/J (IL-6-/-) mice were used. To assess short term changes, a transient reversible ischemia model was utilized. Heart failure was caused by ligation of anterior descending coronary artery. The presence of systolic dysfunction was confirmed by echocardiography and left ventricular ANP RNA expression. Molecular analysis was performed on left ventricular samples from animals sacrificed 12-14 weeks after infarction. Western blotting and QT-PCR were used to investigate abundance of CCN proteins and RNAs, respectively., Results: Short ischemia resulted in marked increase of CCN1 transcript. However, three months after myocardial infarction (MI), remote myocardium showed a markedly increased expression of CCN1 protein, but not RNA. In the case of CCN2, the RNA was distinctly up-regulated, whereas the protein presented only modest, non-significant increase in failing myocardium. Expression of CCN2 RNA closely correlated with expression of ANP. Long-term telmisartan administration after infarction decreased the expression of CCN1 protein. Interleukin 6 (IL-6) deficiency caused increased CCN2 protein abundance in control animals, but the difference was absent after MI. Infarction did not increase CCN1 protein in the hearts of IL-6 deficient mice., Conclusion: CCN genes are activated in heart failure. Their regulation is multidimensional both transcriptional and posttranscriptional. The involved pathways include angiotensin II and IL-6., (Copyright © 2014 Institute of Pharmacology, Polish Academy of Sciences. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.)

Introduction: The CHA2DS2-VASc and R2CHA2DS2-VASc scoring systems were designed to stratify thromboembolic risk in patients with atrial fibrillation. The R2CHA2DS2-VASc score, compared with the CHA2DS2-VASc, was modified by adding reduced creatinine clearance., Objectives: The aim of the study was to assess the long-term predictive value of these scores in patients with acute coronary syndrome (ACS) and to compare their utility with TIMI and GRACE scores in this patient group., Patients and Methods: We performed a pooled analysis of 5 independent populations with ACS with a long-term follow-up available. The primary endpoint was defined as all-cause mortality. The following risk scores were calculated: TIMI-STEMI or TIMI-NSTEMI, GRACE, CHA2DS2-VASc, and R2CHA2DS2-VASc, Results: A total of 2557 patients were included in the final analysis with a median follow-up of about 5 years. The CHA2DS2-VASc and R2CHA2DS2 -VASc scores were significant predictors of total mortality in the pooled analysis. After correction for heart rate and systolic blood pressure on admission as well as previous myocardial infarction, the scores were still significantly predictive of mortality (hazard ratio [HR], 1.47; 95% confidence interval [CI], 1.39–1.54; P <0.0001 for CHA2DS2-VASc; and HR, 1.41; 95%CI, 1.35–1.47; P <0.0001 for R2CHA2DS2-VASc). At all time points (1, 3, and 5 years), the TIMI-STEMIscore was a significantly better predictor than the CHA2DS2-VASc and R2CHA2DS2-VASc scores. The predictive value of the R2CHA2DS2-VASc score was comparable to that of the GRACE score at 3 and 5 years., Conclusions: The CHA2DS2-VASc and R2CHA2DS2-VASc scores are significant predictors of all-cause mortality in a long-term follow-up in patients with ACS. These simple risk scores may be easily applied in clinical practice in this patient group.

Introduction:  rs9982601 (C>T) is a polymorphism of the noncoding region between the SLC5A3/MRPS6 and KCNE2 genes. It has been shown to be associated with early-onset myocardial infarction (MI) with T as a risk allele., Objectives:  The aim of our study was to investigate the association of the rs9982601 polymorphism with long-term overall mortality from MI and prevalence of MI in a Polish population., Patients and Methods:  The study involved patients with MI treated invasively. Individuals who underwent paternity testing served as a population group. Genotyping was performed by the TaqMan method. The analyzed endpoint was the overall long-term mortality., Results:  The study group comprised 981 patients (mean age, 62.8 ±12.1 years; 259 women [26.4%]). The percentages of TT, CT, and CC genotypes were 3.1%, 25.6%, and 71.3%, respectively, in the whole group, and 2.4%, 16.8%, and 80.8% (P = 0.01) in the population group (n = 167). During follow-up (median, 1826 days), 157 patients died (16%). No significant differences were observed between the genotypes either in clinical characteristics or in mortality. However, in a subgroup of high-risk patients (GRACE risk score of 155 points or higher, n = 428), low-risk CC homozygotes had a significantly better survival rate compared with the other genotypes (hazard ratio, 0.64; 95% confidence interval, 0.43-0.96; P = 0.03)., Conclusions:  We showed that the rs9982601 polymorphism of the region between SLC5A3/MRPS6 and KCNE2 genes is associated with long-term mortality in high-risk patients after MI. Additionally, our study supports the previous reports on the correlation of this polymorphism with the prevalence of MI.

Purpose: Cardiogenic shock (CS) is a severe complication of acute coronary syndromes (ACS). Intra-aortic balloon pump (IABP) is considered important mechanical therapy for acute CS. We aimed to analyze the natural history and possible prognostic factors in patients with CS complicating ACS., Patients/methods: All 126 patients (mean age 65.8 ± 12.5 years), who were hospitalized in single center due to an episode of CS in the course of ACS, had IABP and were scheduled for coronary angiography. The assessed end-point was 5-year death from any cause., Results: Median left ventricle ejection fraction (LVEF) 28% (interquartile range (IQR) 23-35%), 39 patients (31%) were female, in 91 (72%) the initial diagnosis was ST-elevation myocardial infarction (STEMI). Mean time on the IABP was 3.8 ± 3 days. During index hospitalization there were 56 deaths (44%). Other 27 patients (out of 70 discharged - 38.5%) died during 5-year follow-up. In univariate logistic regression, the significant effect on long term mortality had age, female gender, reduced ejection fraction below 31% and hypotension on admission. The out of hospital survival was also determined by age, gender and hypotension, while LVEF lost its predictive value The multivariate survival analysis both in whole group and in patients discharged from hospital was independently affected by age and hypotension on the admission., Conclusions: The mortality of patients with CS despite treatment with IABP remains very high, especially during the in-hospital period and early after discharge. Among assessed parameters age and hypotension on the admission are the most important predictors of adverse long term prognosis., (Copyright © 2014 Medical University of Bialystok. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.)

Introduction: Inflammation plays a significant role in the pathogenesis of pulmonary arterial hypertension (PAH). Soluble receptor activator of nuclear factor-ĸB ligand (sRANKL) and osteoprotegerin (OPG) are tumor necrosis factor α family members of immunomodulatory activity., Objectives: The aim of the study was to evaluate sRANKL and OPG concentrations in patients with PAH as potential factors contributing to the development of the disease., Patients and Methods: We studied 26 patients with PAH, 31 volunteers, and 24 stable patients with chronic systolic left ventricular heart failure (LVHF) without pulmonary hypertension. The PAH group was followed up for 6 months for clinical deterioration or death., Results: sRANKL levels were higher in the PAH group compared with controls and the LVHF group (5.6 [interquartile range, 3.9-7.9) vs. 2.0 [0.9-4.4] pmol/l; P = 0.0001, and 2.4 [1.3-4.2] pmol/l; P = 0.001, respectively). OPG levels were higher in PAH patients compared with controls (4.07 ±1.9 vs. 3.27 ±0.95 pmol/l; P = 0.048). We found significant correlations between sRANKL levels and parameters of ventilatory efficiency during exercise in the PAH group. OPG levels correlated with brain natriuretic peptide levels and with invasive hemodynamic parameters. Patients with clinical deterioration during 6-month follow-up (n = 9) showed higher baseline OPG levels compared with stable patients (n = 17, 5.09 ±2.6 vs. 3.52 ±1.19 pmol/l; P = 0.043). In the univariate analysis, the elevated OPG concentration at baseline was associated with an increased risk and earlier occurrence of clinical deterioration (hazard ratio, 1.43; 95% confidence interval, 1.06-1.9; P = 0.017)., Conclusions: Concentrations of sRANKL and OPG are elevated in patients with PAH and are associated with indicators of disease severity and prognosis. sRANKL is a better discriminant between PAH and LVHF than OPG. The baseline OPG concentration is significantly associated with adverse outcomes in patients with PAH.

Introduction: MicroRNAs (miRNAs) are small RNAs that play an important role in the regulation of gene expression. miRNA dysregulation has been associated with phenotypic changes, including cardiovascular diseases (CVDs)., Objectives: The aim of the study was to obtain a list of single nucleotide polymorphisms (SNPs) related to CVDs, with computationally predicted effect on miRNA binding sites, which would verify the hypothesis that miRNA dysregulation can lead to the development of CVDs., Materials and Methods: SNPs, CVDs, and miRNAs were the 3 factors subjected to analysis. Based on the publicly available databases, we created a set of SNPs associated with the phenotype of interest and of SNPs located in known miRNA binding sites. We then merged the records assigned by the same SNP, which allowed us to indicate miRNA target sites, whose variants may be associated with CVDs. The results were supplemented with the additional data such as miRNA and mRNA coexpression, differences in the expression between various tissues, and Expression Quantitative Trait Locus analysis. Only in-silico methods, on the basis of publically available information tools and databases, were used., Results: We obtained a list of 47 entries, constituting unique miRNA-SNP allele-phenotype linkages., Conclusions: Computational approach supports the hypothesis of the linkage between alterations in miRNA function and numerous CVDs. Given the high frequency of SNP incidence, this pathomechanism may be common in the population. Although the obtained results need to be further experimentally validated, limiting the number of interactions to the most probable ones will facilitate the identification of clinically significant associations.

Constrictive pericarditis (CP) is a rare disease which can be easily overlooked in the absence of typical pericardial calcification. One of its most frequent manifestations is pleural effusion. We present a case report of a patient with unrecognised CP in whom plerocentesis led to haemodynamic collapse, and we speculate about the potential pathomechanism. No obvious criterion of CP or severe systolic dysfunction was found in baseline echocardiography. We consider that patients with advanced CP are remarkably prone to haemodynamic decompensation secondary to pleural drain.

Background: Cardiac rupture is a rare but potentially lethal complication of acute myocardial infarction with ST-elevation (STEMI). Primary percutaneous coronary intervention (pPCI) is a preferable treatment method of acute STEMI. Reperfusion at vascular and myocardial levels may be the key parameters determining probability of cardiac rupture., Aim: To analyse the relationship between reperfusion parameters and cardiac rupture occurrence in a group of patients with STEMI treated with pPCI., Methods: Twenty three patients with cardiac rupture were selected out of 2800 patients with acute STEMI hospitalised and treated with pPCI from 2000 to 2007. Free wall or interventricular septum rupture was diagnosed on echocardiography or autopsy. The control group consisted of 255 patients with STEMI and pPCI treatment, but without cardiac rupture. The TIMI flow score was used to assess blood flow in an infarct-related artery (IRA). Myocardial perfusion was evaluated with the use of the myocardial blush grade (MBG) score., Results: Female gender accounted for 47.8% of patients with cardiac rupture. Mean age was 72.9 ± 4.8 years for women and 64.3 ± 11.5 years for men. In 12 (52%) patients anterior descending artery was the IRA. Before the pPCI, the average blood flow in IRA was significantly lower in patients with subsequent cardiac rupture (0.41 ± 0.59) than in the reference group (0.81 ± 1.15; p < 0.05), and remained lower after pPCI (1.96 ± 0.93 in comparison to 2.93 ± 0.36; p < 0.05). Adequate blood flow (TIMI 3) was achieved only in 30.4% (7) of patients with cardiac rupture and in 95.3% (243) of the control group (p < 0.05). Myocardial tissue perfusion, assessed by MBG, was also lower (0.76 ± 1 vs 1.92 ± 1.13; p < 0.05). In-hospital mortality in patients with cardiac rupture reached 56.5% (13 subjects) compared to 3 (1.2%) patients in the reference group (p < 0.05). Multivariable analysis confirmed independent effects of lower TIMI and MBG after PCI as well as female gender on the occurrence of cardiac rupture., Conclusions: Poorer blood flow in IRA and worse tissue microvascular perfusion after pPCI are important risk factors of cardiac rupture occurrence in patients with STEMI.

Background: TIMI Risk Score for ST-elevation myocardial infarction (STEMI) was developed in a cohort of patients treated with fibrinolysis. It was though to predict in-hospital and short-term prognosis. Later studies validated this approach in large cohorts of patients, regardless of the applied treatment and presented its good power to predict 30-day mortality., Aim: We applied the TIMI Risk Score to our registry of STEMI patients treated with primary percutaneous intervention (pPCI) to validate the possibility to predict one-year survival., Methods: Our registry comprised 494 consecutive patients (mean age 58.5+/-11.3 years) with STEMI treated with pPCI who were followed for approximately one year. STEMI was diagnosed based on typical criteria: chest pain, ECG changes and rise in myocardial necrosis markers. In all patients TIMI Risk Score for STEMI was calculated and they were divided into three groups: low risk (0-5 points), medium risk (6-7) and high risk (>7 points). Multivariate logistic regression analysis, Kaplan-Meier survival analysis with Cox and log-rank tests as well as c statistics from receiver-operator curves (ROC) were used for statistical analysis., Results: TIMI 3 flow was obtained in 95.5% of patients. Median TIMI risk score was 4 (ranging from 0 to 10). During follow-up there were 47 deaths (9.5%). There was a statistically significant difference in survival between all risk groups both in 30-day and one-year follow-up (p <0.001 log-rank test). TIMI Risk Score had good power to predict 30-day (c statistic 0.834, 95% CI 0.757-0.91, p <0.0001) as well as one-year mortality (c statistic 0.809, 95% CI 0.739-0.878, p <0.0001). Interestingly, when we excluded from the analysis all patients who died during the first 30 days, TIMI Risk score maintained its very good prognostic value. All analysed risk groups significantly differed between each other with respect to mortality (p <0.05, log-rank test) and the c statistic was 0.745 (95% CI 0.612-0.879, p <0.0002). In multivariate logistic regression analysis TIMI Risk Score was one of the independent risk factors of death during one-year follow-up (OR 1.59, p <0.001)., Conclusions: TIMI Risk Score accurately defines the population of STEMI patients who are at high risk of death not only during the first 30 days, but also during a long-term follow-up. This simple score should be included in the discharge letters because it contains very useful information for further care.

Coronary heart disease remains one of the main problems in healthcare systems in western countries. Despite a vast improvement in revascularisation techniques in recent years, we still encounter many patients, who are not suitable for conventional revasularisation methods. A delivery of proangiogenic substances like VEGF or FGF to cardiac muscle was thought to help these patients. Nevertheless, in order to induce angiogenesis in heart in safe and efficient manner further studies of mechanism regulating vessel growth are necessary. This interest resulted in still increasing number of papers dealing with angiogenesis in heart. Still, the results of clinical studies were in large part discouraging. Therefore novel angiogenic substances are currently under investigation. The great expectations are associated with proteins affecting multiple levels and processes involved in vessel growth and maturation. These include among others PIGF and CYR61. Other promising approach is the induction of angiogenesis by stem cells and endothelial progenitor cells. Hopefully these efforts will soon reveal therapeutic methods, which will be applicable in patients with severe ischemic heart disease disqualified from conventional revascularisation procedures.

Introduction: Glycoprotein IIb/IIIa (GP IIb/IIIa) is a platelet receptor composed of two subunits coded by individual genes. GP IIIa gene has two alleles: A1 and A2. The A2 allele determines higher platelet activity and was investigated many times as a potential risk factor of ACS. The influence of A1/A2 polymorphism on the prognosis in patients with ST-segment elevation myocardial infarction (STEMI) has not been analysed so far., Aim: Evaluation of the relationship between GP IIb/IIIa A1/A2 gene polymorphism and one-year prognosis in patients with STEMI treated with primary percutaneous coronary intervention (pPCI)., Methods: 171 patients (23.9%--women, 39.7%--anterior MI) with STEMI treated successfully with pPCI as well as 121 healthy subjects from a reference group were enrolled in the study. Genotyping was performed using restriction fragment length polymorphism analysis (RFLP). In one-year follow-up the primary end point included deaths and infarctions. The following methods were used in statistical analysis: chi(2) as well as Mann-Whitney test, Kaplan-Meier survival analysis, Cox regression model and multivariate analysis., Results: The percentage of A2 allele carriers was similar in STEMI patients and in subjects from the reference group (27.4% vs. 21.5%, p=0.24). No statistically significant difference in the incidence of primary end point between the A1A1 homozygotes and A2 allele carriers (A1A2/A2A2 genotype) was observed among STEMI patients. In Cox regression analysis, the variables associated with death or MI were: ejection fraction (RR 0.912, p=0.01) and systolic blood pressure on admission (RR 0.97, p=0.049). The variables categorised as unfavourable predictors included: Killip class >2 and heart ratio on admission >100/min (p <0.05, log-rank test)., Conclusion: No relationship between GP IIb/IIIa A1/A2 gene polymorphism and STEMI incidence as well as one-year prognosis in patients with STEMI treated with pPCI was documented.

The case of a 73-year-old female with an acute myocardial infarction, treated successfully with primary percutaneous coronary intervention who developed subacute left ventricular free wall rupture, is presented. The diagnosis was established by echocardiography at bedside. She underwent urgent cardiac surgery with patch glue repair of left ventricular free wall rupture and selective revascularisation. The recovery was uneventful and the patient was discharged from the hospital on the 11th postoperative day in good condition. At 6 month follow-up, the patient remained well, without any symptoms.

The number of patients suffering from heart failure is constantly increasing. One of its main causes is coronary artery disease, especially myocardial infarction. Progression of heart failure depends both on the extent of ischaemic injury and the course of subsequent adaptive processes. Genetic methods may help to find individuals at high risk of developing heart failure. There are multiple genes influencing circulatory system, some of their alleles may potentially affect progression of the disease. Among the most promising targets are genes of the renin-angiotensin-aldosterone system: insertion/deletion (L/D) polymorphism of angiotensin converting enzyme gene, polymorphisms of angiotensinogen, angiotensin receptors (AT1 and AT2) and aldosterone syntase genes. Other genetic factors, which may affect are different gene variants of adrenergic receptors (beta1, beta2, alpha2C), AMP deaminase-1, endothelin-1, endothelial nitric oxide syntase, precursors of natriuretic peptides and inflammatory factors (TNF-alpha, IL-6, MCP-1, TGF, MMP-2). Furthermore, the response to drugs may depend on genetic background, that is why pharmacogenetics creates new possibilities to tailor the best therapy for each patients with heart failure. Therefore research in the field of genetic factors affecting the development of heart failure has not only scientific, but also practical value.

Introduction: Impaired microvascular flow, despite patent epicardial artery (no-reflow phenomenon), leads to greater left ventricular dysfunction after myocardial infarction (MI). Predictive factors associated with no-reflow remain largely unexplored. Q-wave on admission (Q(A)) is a sign of extensive ischemia probably predisposing to no-reflow. The aim of the study was to explore possible relation between Q(A) and electrocardiographic signs of no-reflow in patients with first MI., Material and Methods: The study group was composed of 108 patients (81 men; mean age 60+/-11 years), with first ST-segment elevation MI, treated successfully with primary angioplasty (p-PTCA). ECG tracings were obtained before and 30 minutes after p-PTCA. The sum of ST-segment elevations (sum(ST(el))) in 3 contiguous leads with the highest ST(el) was calculated. Lack of 50% reduction of the sum(ST(el)) 30 minutes after angioplasty was defined as ECG sign of no-reflow. Presence of Q(A) was estimated in leads with ST(el)., Results: Q(A) was found in 42 (39%) patients. Q(A) was more often observed in patients with ECG signs of no-reflow (38% vs. 18%; p<0.05). Group with Q(A) showed larger damage of left ventricle estimated with ECG QRS score (7.7+/-4.4 vs. 6.1+/-3.4; p<0.05) as well as worse ejection fraction (42% vs. 46%; p=0.05)., Conclusions: Patients with Q(A) have more often ECG signs of no-reflow than other patients with MI. Previously described worse function of left ventricle in this group, may be partially caused by more frequent no-reflow occurring in those patients. This fact suggests that adjunctive therapy preventing no-reflow could be beneficial in this group of patients.