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Introduction: Valvular heart diseases (VHD) are a significant problem in the Polish population. Coexistence of coronary artery disease (CAD) in patients with VHD increases the risk of death and affects the further therapeutic strategy. Aim: Analysis of atherosclerotic plaque burden distribution in coronary arteries and long-term prognosis among patients with VHD. Material and methods: Inclusion criteria were met by 1025 patients with moderate and severe VHD. Mean observation time was 2528 ±1454 days. Results: Severe aortic valve stenosis (AVS) occurred in 28.2%, severe mitral valve insufficiency (MVI) in 20%. CAD with severe angiographic stenoses was noted in 42.3% (n = 434). Among patients with severe MVI, CAD was noted in 47.1% of cases, and prior acute coronary syndromes (ACS) in 27.1% of patients (n = 58). In severe AVS patients, significant angiographic atherosclerotic changes were observed in 29.6% (n = 86), and prior ACS in 7.6% (n = 22) of patients. During the observation 52.7% of patients died, including 62.9% of patients with severe MVI and 51.6% of those with severe AVS. Age (OR = 1.038; 95% CI: 1.005-1.072; p = 0.022) and coexisting aortic valve insufficiency (AVI) (OR = 2.39, 95% CI: 5.370-11.065, p = 0.035) increased the mortality rate. Conclusions: Severe AVS is starting to be the most prevalent VHD. CAD is one of the most significant factors deteriorating prognosis of patients with VHD. AVI and age were significant risk factors for mortality. The worst prognosis was observed in severe MVI, which may result from more frequent occurrence of CAD in this group. A lesser burden of CAD and ACS in the group of patients with severe AVS did not affect survival. [ABSTRACT FROM AUTHOR]

Introduction: Stroke is the second leading cause of long-term disability and death worldwide. Diabetes and hyperglycemia may impact the outcome of stroke. We examined the impact of hyperglycemia and diabetes on in-hospital death among ischemic and hemorrhagic stroke patients.Material and Methods: Data from 766 consecutive patients with ischemic (83.15%) and hemorrhagic stroke were analyzed. Patients were classified into four groups: ischemic and diabetic; ischemic and non-diabetic; hemorrhagic and diabetic; and hemorrhagic and non-diabetic. Serum glucose was measured on admission at the emergency department together with biochemical and clinical parameters.Results: Mean admission glucose in ischemic stroke patients with diabetes was higher than in non-diabetic ones (p < 0.001) and in hemorrhagic stroke patients with diabetes than in those without diabetes (p < 0.05). Mean admission glucose in all patients who died was significantly higher than in patients who survived. In multivariate analysis, the risk factors for outcome in patients with ischemic stroke and without diabetes were age, admission glucose level and estimated glomerular filtration rate (eGFR), while in diabetics they were female gender, admission glucose level, and eGFR; in patients with hemorrhagic stroke and without diabetes they were age and admission glucose levels. The cut-off value in predicting death in patients with ischemic stroke and without diabetes was above 113.5 mg/dl, while in diabetics it was above 210.5 mg/dl.Conclusions: Hyperglycemia on admission is associated with worsened clinical outcome and increased risk of in-hospital death in ischemic and hemorrhagic stroke patients. Diabetes increased the risk of in-hospital death in hemorrhagic stroke patients, but not in ischemic ones. [ABSTRACT FROM AUTHOR]

Tako-tsubo syndrome is a transient cardiomyopathy, which is also known as the apical ballooning syndrome. Tako-tsubo is characterised by transient systolic dysfunction involving left ventricular apex and ischemic ECG findings with the absence of significant obstructive coronary artery disease. The clinical manifestation of tako-tsubo is similar to acute coronary syndrome. The most frequent finding on admission is ST-segment elevation in precordial leads in ECG. Tako-tsubo cardiomyopathy is also present in patients with diabetes. We present a case of a 66-year-old female patient with tako-tsubo cardiomyopathy, in whom apical ballooning syndrome was diagnosed despite of the absence of typical ECG findings. [ABSTRACT FROM AUTHOR]

Background: The most serious complication of the acute Takotsubo phase is a myocardial perforation, which is rare, but it usually results in the death of the patient. Methods: In the years 2008–2020, 265 patients were added to the Podlasie Takotsubo Registry. Cardiac rupture was observed in five patients (1.89%), referred to as the Takotsubo syndrome with complications of cardiac rupture (TS+CR) group. The control group consisted of 50 consecutive patients with uncomplicated TS. The diagnosis of TS was based on the Mayo Clinic Criteria. Results: Cardiac rupture was observed in women with TS aged 74–88 years. Patients with TS and CR were older (82.20 vs. 64.84; p = 0.011), than the control group, and had higher troponin, creatine kinase, aspartate aminotransferase, and blood glucose levels (168.40 vs. 120.67; p = 0.010). The TS+CR group demonstrated a higher heart rate (95.75 vs. 68.38; p < 0.0001) and the Global Registry of Acute Coronary Events (GRACE) scores (186.20 vs. 121.24; p < 0.0001) than the control group. In patients with CR, ST segment elevation was recorded significantly more often in the III, V4, V5 and V6 leads. Left ventricular free wall rupture was noted in four patients, and in one case, rupture of the ventricular septum. In a multivariate logistic regression, the factors that increase the risk of CR in TS were high GRACE scores, and the presence of ST segment elevation in lead III. Conclusions: Cardiac rupture in TS is rare but is the most severe mechanical complication and is associated with a very high risk of death. The main risk factors for left ventricular perforation are female gender, older age, a higher concentration of cardiac enzymes, higher GRACE scores, and ST elevations shown using electrocardiogram (ECG). [ABSTRACT FROM AUTHOR]

A case study of 74-year-old woman who was admitted to the hospital for issues regarding chest pain due to cardiac rupture. It mentions signs of cardiogenic shock such as skin pale and wet, blood pressure (BP) and heart rate (HR) undetectable shown by the patient. It also highlights treatment of the patient through takotsubo cardiomyopathy (TTC).

Air pollution contributes to the premature death of approximately 428,000 citizens of Europe every year. The adverse effects of air pollution can be observed in respiratory, circulatory systems but also in renal function. We decide to investigate the hypothesis indicating that we can observe not only long- but also short-term impact of air pollution on kidney function. We used linear, log-linear, and logistic regression models to assess the association between renal function and NO2, SO2, and PMs. Results are reported as beta (β) coefficients and odds ratios (OR) for an increase in interquartile range (IQR) concentration. 3554 patients (median age 66, men 53.2%) were included into final analysis. Chronic kidney disease (CKD) was diagnosed in 21.5%. The odds of CKD increased with increase in annual concentration of PM2.5 (OR for IQR increase = 1.07; 95% CI 1.01–1.15, P = 0.037) and NO2 (OR for IQR increase = 1.05; 95% CI 1.01–1.10, P = 0.047). The IQR increase in weekly PM2.5 concentration was associated with 2% reduction in expected eGFR (β = 0.02, 95% CI − 0.03; − 0.01). Medium- and short-term exposure to elevated air pollution levels was associated with a decrease in eGFR and development CKD. The main pollutants affecting the kidneys were PM2.5 and NO2. [ABSTRACT FROM AUTHOR]

Families of deceased potential donors often object to organ harvesting on religious grounds. The aim of this study was to learn the attitudes and opinions of Judaism followers regarding organ donation. The study included 97 Judaism followers living in the northeastern part of Poland. The research used the diagnostic survey method. A fairly large percentage (approximately 92%) of respondents accepted treatment using organ transplantation. The removal of organs for transplantation from a loved one after his death was accepted by about 90%. After his death, 14.43% expressed opposition to organ removal. About one-third of respondents did not talk to the family about their organ donation attitude. The average age of people who talked to their family about their will to donate was 49.69 ± 13.95 years. In total, 91.75% of the respondents had a positive attitude toward organ transplantation, 6.19% negative, and 2.06% indifferent. According to respondents, the most common reasons for a family's refusal to collect organs from the deceased are death-related emotions (53.61%), religious beliefs (36.08%), and fear of misuse of organs (22.68%). Judaism believers mostly accept treatment with organs taken from living and deceased people. In a larger percentage, young people with higher and secondary education more often accepted organ donation. [ABSTRACT FROM AUTHOR]

Introduction: The clinical courses of takotsubo syndrome (TS) and of acute coronary syndromes (ACS) seem to be very similar. However, there is limited knowledge about risk factors of poor outcomes. Low body mass index worsens the prognosis of patients with cardiovascular diseases, especially those undergoing surgical treatment. The aim of the study was to evaluate the influence of the body mass index (BMI) on the prognosis in patients diagnosed with TS.Material and Methods: Eighty patients aged 15-89 (mean: 67.9 years), 74 women and 6 men with TS diagnosis according to Mayo Clinic diagnostic criteria were divided into 3 groups: low body mass (BMI < 18.5 kg/m2), normal body mass (18.5 ≥ BMI < 25 kg/m2) and excessive body mass (BMI ≥ 25 kg/m2).Results: Patients with low BMI were older, but with less prevalent risk factors such as hypertension, hypercholesterolemia and positive family history of coronary artery disease and more frequent risk factors such as cigarette smoking, chronic obstructive pulmonary disease (COPD), depressive and anxiety disorders as well as malignancy. They also had higher haemoglobin, lower troponin, creatine kinase, C-reactive protein and lipid fractions. The highest annual, 3-year and 5-year mortality was observed in the group with BMI < 18.5 kg/m2. None of the patients with low BMI survived the 5-year follow-up period (100% vs. 25% vs. 15.2%; p < 0.0001). In group III, mortality among overweight patients (25 ≥ BMI < 30 kg/m2) was 8.3%, and in obese people (BMI ≥ 30 kg/m2) 1 out 5 patients died during follow-up.Conclusions: The majority of typical cardiovascular risk factors are less frequently observed in patients with TS and low body mass. Early prognosis for TS patients and low BMI is relatively favourable, whereas the 5-year follow-up is associated with extremely high mortality. Overweight patients have the best prognosis in the long-term follow-up. [ABSTRACT FROM AUTHOR]

Background/Aims: We evaluated renal function and the impact of renal function on inhospital outcomes in patients with ischaemic and haemorrhagic stroke. Methods: We collected data from 766 patients with stroke; 637 (83.2 %) with ischaemic and 129 with haemorrhagic one. Results: The mean serum creatinine on admission in patients with both types of stroke, who died, was significantly higher than in those who survived. Multivariate analysis showed that independent predictors of mortality in patients with ischaemic stroke were: ischemic heart disease or prior myocardial infarction, diabetes, admission glucose and eGFR on admission. Also, multivariate analysis showed that independent predictors of mortality in patients with haemorrhagic stroke were: age and admission glucose. Conclusions: Patients with haemorrhagic stroke, in particular with acute kidney injury during hospitalisation had significantly worse outcomes than patients with ischaemic stroke. Assessment of kidney function is prerequisite to employ the necessary measures to decrease the risk of in-hospital mortality among patients with acute stroke. Appropriate approach to patients with renal dysfunction (adequate hydration, avoidance of nephrotoxic drugs, drug dose adjustment etc) should be considered as preventive and therapeutic strategies in the management of acute stroke. [ABSTRACT FROM AUTHOR]

It is well known that exceeded levels of particulate matter in the air and other air pollutants harmfully affect the cardiovascular system. Empirical analyses of the effects of these factors on stroke incidence and mortality are still limited. The main objective of our analyses was to determine the association between short-term exposure to air pollutants and stroke incidence in non-industrial areas, more specifically in north-eastern Poland. To achieve this aim, we used data from the National Health Fund on patients hospitalized for stroke between 2011 and 2020 in the largest city of the region described as the Green Lungs of Poland. The pollution levels and atmospheric conditions data were obtained from the Provincial Inspectorate for Environmental Protection and the Institute of Meteorology and Water Management. Using daily data on hospitalizations, atmospheric conditions, and pollution, as well as ordered logistic regression models the hypotheses on the impact of weather and air pollution conditions on ischemic strokes were tested. The study group included 4838 patients, 45.6% of whom were male; the average patient age was approximately 74 years. The average concentrations of PM2.5 were 19.09 µg/m3, PM10 26.66 µg/m3 and CO 0.35 µg/m3. Analyses showed that an increase in PM2.5 and PM10 concentrations by 10 µg/m3 was associated with an increase in the incidence of stroke on the day of exposure (OR = 1.075, 95% CI 0.999–1.157, P = 0.053; OR = 1.056, 95% CI 1.004–1.110, P = 0.035) and the effect was even several times greater on the occurrence of a stroke event in general (PM2.5: OR = 1.120, 95% CI 1.013–1.237, P = 0.026; PM10: OR = 1.103, 95% CI 1.028–1.182, P = 0.006). Furthermore, a short-term (up to 3 days) effect of CO on stroke incidence was observed in the study area. An increase of 1 μg/m3 CO was associated with a lower incidence of stroke 2 days after the exposure (OR = 0.976, 95% CI 0.953–0.998, P = 0.037) and a higher incidence 3 days after the exposure (OR = 1.026, 95% CI 1.004–1.049, P = 0.022). [ABSTRACT FROM AUTHOR]

Coronary artery disease in patients with end-stage renal disease occurs several dozen times more often than in the general population. Atherosclerotic changes in coronary arteries in dialysed patients are more diffused and calcified, which hampers the percutaneous coronary angioplasty. We present a case of an 84-year-old dialysed patient, in whom complex percutaneous coronary intervention of the left anterior descending artery was performed with the use of rotational atherectomy. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to assess the rate of hypertension and diabetes in patients with stable angina (CAD) admitted for coronary angiography and analyse other risk factors of CAD. Material and methods: In this retrospective study we enrolled 403 patients, age 65.41 ±9.6 years, with stable CAD admitted for coronary angiography. The patients were divided into 2 groups: patients with hypertension and diabetes and a group with hypertension. Results: Hypertension was diagnosed in 335 patients (83.10%). The majority of the patients were over 65 years old. There were 96 patients in the study group and 239 in the control group. Thirty-one patients had been using insulin and 65 patients oral agents. Blood pressure values in the patients with diabetes and without diabetes were similar - 135 mm Hg vs. 134 mm Hg for systolic blood pressure and 79 mm Hg vs. 80 mm Hg for diastolic (p = NS and p = NS). During hospitalization we observed a drop in systolic blood pressure in the patients without diabetes by 10 mm Hg. After 3 days of hospitalization blood pressure values were also significantly higher in patients with diabetes (p = 0.026). On admission patients using insulin had systolic blood pressure higher by 10 mm Hg than the patients using oral agents. During hospitalization the difference between systolic blood pressure in the patients using insulin and oral agents was 10 mm Hg. There was a significant correlation between systolic blood pressure and the kind of treatment of diabetes (p = 0.012). Results: Hypertension was diagnosed in 335 patients (83.10%). The majority of the patients were over 65 years old. There were 96 patients in the study group and 239 in the control group. Thirty-one patients had been using insulin and 65 patients oral agents. Blood pressure values in the patients with diabetes and without diabetes were similar - 135 mm Hg vs. 134 mm Hg for systolic blood pressure and 79 mm Hg vs. 80 mm Hg for diastolic (p = NS and p = NS). During hospitalization we observed a drop in systolic blood pressure in the patients without diabetes by 10 mm Hg. After 3 days of hospitalization blood pressure values were also significantly higher in patients with diabetes (p = 0.026). On admission patients using insulin had systolic blood pressure higher by 10 mm Hg than the patients using oral agents. During hospitalization the difference between systolic blood pressure in the patients using insulin and oral agents was 10 mm Hg. There was a significant correlation between systolic blood pressure and the kind of treatment of diabetes (p = 0.012). Conclusions: We observed a high rate of hypertension and diabetes among patients with stable CAD hospitalized due to coronary angiography. Both hypertension and diabetes were more frequent in patients over 65 years old. Values of blood pressure were similar in the group with and without diabetes. Patients treated with insulin had significantly higher blood pressure than patients treated with oral glucose lowering agents both on admission and during hospitalization. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to assess pharmacological treatment and qualification for invasive treatment after coronary angiography in patients with stable coronary artery disease (CAD) according to the presence of diabetes and the methods of treatment in diabetes. Material and methods: In this retrospective study we enrolled 403 patients with stable CAD. The patients were divided into 2 groups: patients with hypertension and diabetes and a control group with hypertension. Additionally the patients with diabetes were divided into 2 groups: one group treated with insulin and the second group treated with oral glucose lowering agents. Results: We enrolled 403 patients (mean age 65.4 ±9.6 years old). Hypertension was diagnosed in 335 patients (83.1%) and diabetes in 96 patients. β-Blockers were used by 92%, acetylsalicylic acid (ASA) by 94%, statins by 93.5%, angiotensin-converting enzyme inhibitors (ACEI) by 84%, diuretics by 46% and clopidogrel by 55.6% of the patients. One hundred and ninety-three patients (47.9%) were qualified for percutaneous coronary intervention (PCI) and 51 patients (12.7%) for coronary artery bypass grafts (CABG). Among patients with diabetes 31 (7.7%) were using insulin while 65 were using oral agents. 15.6% of the patients with diabetes and 13.3% without diabetes were scheduled for CABG, while 49.0% and 46.4%, respectively, were scheduled for PCI. 58.1% of the patients using insulin and 44.6% using oral agents were scheduled for PCI. Coronary artery bypass grafts was recommended for 16% and 15% of the patients (p = NS). Conclusions: Patients with hypertension and CAD are treated according to current guidelines. Qualification for invasive treatment in the group with and without diabetes was similar. In the group with diabetes patients treated with insulin were more often qualified for invasive treatment (especially PCI) as compared to patients treated with oral agents. [ABSTRACT FROM AUTHOR]

Patent foramen ovale (PFO) is associated with the occurrence of cryptogenic strokes in young patients. Transesophageal echocardiography with contrast is the established standard in PFO diagnostics. We present the case of a 44-year-old female patient after ischemic stroke, in whom PFO was not detected by echocardiography; the defect was ultimately diagnosed by right heart catheterization. [ABSTRACT FROM AUTHOR]

Coexistence of chronic kidney disease (CKD) in the case of acute coronary syndromes (ACS) significantly worsens the outcomes. The aim of our study was to assess renal function impact on mortality among patients with ACS. The study was based on records of 21,985 patients hospitalized in the Medical University of Bialystok in 2009–2015. Inclusion criteria were ACS. Exclusion criteria were: death within 24 h of admission, eGFR <15 ml/min/1.73 m2, hemodialysis. Mean observation time was 2296 days. Criteria were met by 2213 patients. CKD occurred in 24.1% (N = 533) and more often affected those with NSTEMI (26.2 (337) vs. 21.2 (196), p =.006). STEMI patients had higher incidence of post-contrast acute kidney injury (PC-AKI) (5 (46) vs. 4.1 (53), p <.001). During the study, 705 people died (31.9%), more often with NSTEMI (33.2% (428) vs. 29.95% (277), p <.001). However, from a group of patients suffering from PC-AKI 57.6% died. The risk of PC-AKI increased with creatinine concentration (RR: 2.990, 95%CI: 1.567–5.721, p <.001), occurrence of diabetes mellitus (RR: 2.143, 95%CI: 1.029–4.463, p =.042), atrial fibrillation (RR: 2.289, 95%CI: 1.056–4.959, p =.036). Risk of death was greater with an increase in postprocedural creatinine concentration (RR: 2.254, 95%CI: 1.481–3.424, p <.001). PC-AKI is a major complication in patients with ACS, occurs more frequently in STEMI and may be a prognostic marker of long-term mortality in patients undergoing percutaneous coronary intervention (PCI). More attention should be given to the prevention and diagnosis of PC-AKI but necessary PCI should not be withheld in fear of PC-AKI. [ABSTRACT FROM AUTHOR]

Aim of the study: In the case of atherosclerosis, therapeutic management depends on the advancement of the disease. The ever-present element of management in each clinical form of the disease is conservative treatment, including e.g. the elimination of risk factors for sclerosis, pharmacological treatment, and the treatment of comorbidities. The aim of the work was to evaluate the lifestyles of patients with lower extremity arterial disease and the patients' expectations concerning health education referring to the disease and the recommended lifestyle. Material and methods: The respondent group was composed of 50 patients with lower extremity arterial disease, of both sexes (including 61% of males), aged from 24 to 89 years. The research was carried out at the Invasive Cardiology Clinic of University Clinical Hospital in Bialystok and at the Nursing Home in Bialystok. A self-constructed survey questionnaire (including 44 questions) was used. Results: Most of the patients did not observe the recommendations about reducing consumption of saturated fats and increasing the consumption of complex carbohydrates and dietary fibre. They did not exercise regularly, and nearly half of them smoked. Only 16% of the patients had normal BMI. The respondents wanted, among others, information on foot care, complications, symptoms, risk factors for the disease, pharmacological treatment, and rehabilitation methods. Conclusions: Because of the high percentage of atherosclerosis complications occurring in the investigated group of patients and their failure to observe doctors' orders concerning an appropriate lifestyle, special attention should be given to educating patients and motivating them to observe therapeutic recommendations regarding non-pharmacological treatment. [ABSTRACT FROM AUTHOR]

Aim of the study: In the case of atherosclerosis, therapeutic management depends on the advancement of the disease. The ever-present element of management in each clinical form of the disease is conservative treatment, including e.g. the elimination of risk factors for sclerosis, pharmacological treatment, and the treatment of comorbidities. The aim of the work was to evaluate the lifestyles of patients with lower extremity arterial disease and the patients' expectations concerning health education referring to the disease and the recommended lifestyle. Material and methods: The respondent group was composed of 50 patients with lower extremity arterial disease, of both sexes (including 61% of males), aged from 24 to 89 years. The research was carried out at the Invasive Cardiology Clinic of University Clinical Hospital in Bialystok and at the Nursing Home in Bialystok. A self-constructed survey questionnaire (including 44 questions) was used. Results: Most of the patients did not observe the recommendations about reducing consumption of saturated fats and increasing the consumption of complex carbohydrates and dietary fibre. They did not exercise regularly, and nearly half of them smoked. Only 16% of the patients had normal BMI. The respondents wanted, among others, information on foot care, complications, symptoms, risk factors for the disease, pharmacological treatment, and rehabilitation methods. Conclusions: Because of the high percentage of atherosclerosis complications occurring in the investigated group of patients and their failure to observe doctors' orders concerning an appropriate lifestyle, special attention should be given to educating patients and motivating them to observe therapeutic recommendations regarding non-pharmacological treatment. [ABSTRACT FROM AUTHOR]

Introduction: Satisfaction with nursing care is the most important index of patients' general satisfaction. Aim of the study: To assess the expectations for nursing staff held by patients with cancer and cardiovascular disorders. Material and methods: Three groups of patients: group I - 120 with early-phase cancer diseases, group II - 150 with terminal-phase cancer diseases, and group III - 160 with cardiovascular disorders, completed a questionnaire involving the Social Support Scale that addressed their expectations of nurses. Results: Patients in group I regarded conscientiousness as the most desired quality of nurses, and 81.3% and 81.9% in groups II and III, respectively, agreed that it was at least important. Also comparably, 77.5% of patients in group I, 74.7% in group II, and 70.6% in group III reported having full trust in nursing staff. Concerning most important skill for nurses to have, patients in group I indicated an ability to pass medical information to patients (89.2%), those in group II indicated accuracy and gentleness in performing medical procedures (62.7%), and those in group III indicated humanitarian attitude toward patients (59.4%). Level of education of nurses did not matter to 50.8% of patients in group I, 54% in group II, and 35% in group III. Conclusions: The expectations of nursing staff concerning professional skills differed significantly depending on type and stage of disease. Patients in all groups esteemed informational and emotional support far more highly than instrumental and evaluating skills. [ABSTRACT FROM AUTHOR]

Previous studies conducted in highly polluted areas have reported associations between air pollution and daily mortality. The Green Lungs of Poland are characterized by unique natural features and a moderate pollution level. We aimed to assess the short-term impact of air pollution on cardiovascular (CVD)-, acute coronary syndrome (ACS)-, and cerebrovascular-related (CbVD) mortality. An analysis with 4,500,000 person-years and a time-stratified case-crossover design was performed. The interquartile range increase in the PM2.5 (OR 1.036, 95% CI 1.016–1.056, p < 0.001) and PM10 concentration (OR 1.034, 95% CI 1.015–1.053, p < 0.001) was associated with increased CVD mortality on lag 0, and this effect persisted on the following days. The effects of PMs were expressed more in association with ACS-related mortality (PM2.5-OR = 1.045, 95% CI 1.012–1.080, p = 0.01; PM10-OR = 1.044, 95% CI 1.010–1.078, p = 0.01) and CbVD mortality (PM10-OR = 1.099, 95% CI 1.019–1.343, p = 0.02). We also noted a higher CVD mortality OR in the cold season for PM10 in cities with area-source domination: Białystok (p = 0.001) and Suwałki (p = 0.047). The short-term impact of PMs on cardiovascular mortality is also observed in moderately polluted areas. This adverse health effect was more apparent in CbVD- and ACS-related mortality, and in the cold season. Further research focusing on the adverse health effects of "Polish smog" is sorely needed. [ABSTRACT FROM AUTHOR]

Introduction: The influence of moderate and severe renal disease on the outcome in patients with acute coronary syndromes (ACS) is well established. However, the association with mild renal disease is less well defined. Aim of the study: The aim of the present study was to assess the prognostic significance of estimated glomerular filtration rate (eGFR) in patients with ACS treated with primary PCI and preserved renal function on a 2-year follow-up. We also investigated whether eGFR value within limits of normal influences the success of primary PCI. Material and methods: We retrospectively studied 770 patients with ACS (ST-segment elevation myocardial infarction [STEMI], non-ST-segment elevation myocardial infarction [NSTEMI], unstable angina [UA]) consecutively referred to the catheterization laboratory of our hospital for emergency primary PCI in the year 2005. The cutoff value of eGFR was 60 ml/min/1.73 m2. The patients were subsequently divided into 2 groups according to their renal function, as assessed by eGFR: 1st group with eGFR 60-90 ml/min/1.73 m2 and 2nd with eGFR>90 ml/min/1.73 m2. The primary end-point was all-cause mortality on a 2-year follow-up. Results: A total of 770 patients (187 women, 24%; mean age 62±11 years) were included in the analysis. The mean eGFR was 86±18 ml/min/1.73 m2. Renal function with eGFR>90 ml/min/1.73 m2 was present in 262 patients (34%) and eGFR value 60-90 ml/min/1.73 m2 was found in 508 patients (66%). Lower eGFR values were associated with older age (p<0.0001), female gender (p<0.0001), hypertension (p=0.0008), impaired glucose tolerance (IGT) or impaired fasting glucose (IFG) (p=0.02) and lower LVEF (p<0.0001). There was a higher rate of unstable angina (p=0.0048) among patients with eGFR 60-90 ml/min/1.73 m2. During the 2-year follow-up, 7% (n=55) of the patients died. All-cause mortality was significantly higher in patients with lower eGFR (60-90 ml/min/1.73 m2) (p=0.01), lower LVEF (p=0.00), diabetes (p=0.03), hyperlipidemia (p=0.0001) and higher heart rate on admission (p=0.007). Long-term mortality significantly correlated with unsuccessful PCI (p=0.03) and the stenosis apart from the IRA (p=0.01). The mortality rates in patients with eGFR 60-90 ml/min/1.73 m2 were significantly higher than in eGFR>90 ml/min/1.73 m2 group (9% vs 4% respectively, p=0.02). Conclusions: In patients with ACS and preserved renal function the value of eGFR correlates with all-cause mortality on a 2-year follow-up. Mild renal disease may be used in risk stratification in ACS patients treated invasively. Values of eGFR in population with preserved renal function do not influence the rate of successful coronary interventions. [ABSTRACT FROM AUTHOR]

Introduction: Transcatheter aortic valve implantation (TAVI) is alternative treatment for high risk patients with severe, symptomatic aortic stenosis. The TAVI procedures are associated with good immediate and long-term outcomes. Aim: To determine the success, complications, and survival of patients after TAVI during hospitalization in single center. Material and methods: A cohort of 22 patients (age 79.7 years, logistic EuroSCORE 23.2) with severe aortic stenosis underwent TAVI procedures. The approach was femoral in 16 patients and transapical in 6 patients. Results: Procedural success was achieved in 21 patients (95%). AVA and Pmax before and after the procedure were respectively: 0.65 ±0.1 cm2, 99.1 ±27.1 mm Hg and 2.5 ±0.4 cm2, 15.8 ±4.4 mm Hg. Hospital mortality was 9% (2/22). One patient (with biscupid valve) died on 27 day after cardiosurgery due to aortic dissection resulting from shifting CoreValve to ascending aorta. One patient died after tamponade and multi-organ failure 4 days after procedure. During hospitalization there was no severe aortic regurgitations, strokes, myocardial infarctions and contrast induced nephropathies (excluding patients who died, nephropathy as a component of multi-organ failure). Conclusions: Transcatheter aortic valve implantation procedures in high risk patients not qualified for surgery is efficacious method of treatment for severe, symptomatical aortic stenosis. [ABSTRACT FROM AUTHOR]

A growing number of percutaneous coronary interventions to treat coronary artery disease carries the risk of vascular complications. The percutaneous transfemoral approach has been routinely used for cardiac catheterization and coronary angioplasty. Transfemoral arteriography is associated with significant risk of local vascular complications, so the transradial approach for coronary interventions is widely accepted among interventional cardiologists in everyday practice. The coronary interventions via radial artery are relatively safe but despite the numerous benefits of transradial intervention it also has its limitations due to the anatomy of the radial artery. The radial artery is easily compressible, thus bleeding is controllable and hemorrhagic complications are significantly reduced. Despite the effective application of pressure device and lack of early local complications, transradial intervention is not free of late vascular complications, such as arteriovenous fistula. They occur occasionally, do not threaten the life of patients but often require the intervention of vascular surgeons. We report a rare case of iatrogenic arteriovenous fistula, which developed after coronary angiography performed using the right radial approach. [ABSTRACT FROM AUTHOR]

Introduction: Acute coronary syndromes (ACS) are still the most common reason of death in Poland. Mortality rates in Poland are two times highier than in other EU countries. Analysis of mortality in Poland presents differentiation in various socio-economic groups or patients inhabiting different regions. Morality rates for rural and urban areas are: 483.5/100 000, and 415.6/100 000. Aim: To compare of prevalence of selected coronary heart disease risk factors among patients with STEMI and NSTEMI from Bialystok and Bialystok region hospitalized in the Department of Invasive Cardiology of Medical University of Bialystok. Material and methods: Four hundred and forty consecutive patients with troponin postive ACS from Bialystok and Bialystok region were included in the study. Both populations were divided into ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) groups depending on ECG changes. Results: ST-elevation myocardial infarction were more common among patients under 50 years of age from Bialystok region in compared to patients from Bialystok. Non-ST-elevation myocardial infarction were more common among patients between 50-59 years of age from Bialystok region. The most common ACS risk factors in both populations were overweight and obesity. Severe hypertension was more frequent in the population from Bialystok region compared to the population from Bialystok. Patients from Bialystok had worse lipid profile compared to patients from Bialystok region. Conclusions: Insufficient prevention of coronary heart disease and myocardial infarction suggests urgent necessity of educational programs implementation. Heart disease and myocardial infarction suggests urgent necessity of implementations of educational programs. [ABSTRACT FROM AUTHOR]

Introduction: Heart defects are congenital or acquired abnormalitites of heart anatomy. Most frequent valve abnormalities i.e. aortic valve stenosis and mitral valve insufficiency have recently been the third most common heart diseases after ischaemic heart disease and hypertension. Aim: Clinical, biochemical and echocardiographic assessment of patients with aortic valve stenosis. The analysis of comorbidities and pharmacological treatment. Material and methods: Epidemiological analysis of patients with aortic valve stenosis hospitalized in the Department of Invasive Cardiology of the University Hospital in Bialystok between 2006-2010. Patients were divided into three groups with benign, moderate and significant aortic valve stenosis. Results and conclusions: Among 226 patients 48% had significant aortic valve stenosis. Aortic valve stenosis was more frequent in men, however it was mainly at benign and moderate stage. With increasing severity of the defect, number of women in the study group have risen. The severity of the defect, assessed by echocardiography, was associated with changing parameters such as left ventricular wall hypertrophy and left ventricle size. Comorbidities such as ischaemic heart disease, a history of myocardial infarction, atrial fibrillation presented higher prevalence in the group with benign aortic valve stenosis while chronic kidney disease was significantly more frequent among patients with severe aortic valve stenosis. Drugs such as ACE inhibitors, antiplatelet drugs, anticoagulants, cardiac glycosides were administered according to the severity of the defect. [ABSTRACT FROM AUTHOR]

Introduction: Invasive diagnosis and treatment of cardiovascular disease is now widely available. Constantly growing number of procedures promotes the increasing number of adverse events, therefore the records of complications have been introduced to improve the quality of procedures performing in catheterization laboratories (cathlab). Aim: Analyze the complications of invasive procedures that occurred at our Department in patients between January 2011 to May 2012. Material and methods: Among 3935 invasive diagnostic and therapeutic procedures performed at the period, 860 patients had diabetes (21.85%). Results: We reported 62 complications, 28 in diabetic patients (study group). Complication rate in the general population was 1.57%, while in the study group -- 3.26%. Among patients with diabetes the most common adverse event was local hematoma in the area of vascular access -- 32.13%, followed by myocardial infarction associated with percutaneous coronary intervention (PCI) type IVa -- 28.5%, and contrast-induced nephropathy -- 10.7%. Other complications which amounted to 21.42% included a stroke, coronary vessel perforation with cardiac tamponade, allergy to the contrast agent (7.14% for each of the complication). Conclusions: The risk of adverse consequences of invasive diagnostic and therapeutic procedures in patients with diabetes is more than twice compared to general population. Special attention should be paid to such patients in order to minimize the risk of adverse events. [ABSTRACT FROM AUTHOR]

Patients with diabetes mellitus have much higher risk of developing cardiovascular disease. Diabetic patients with an acute coronary syndrome (ACS) have worse prognosis related to higher progression of atherosclerosis and blood hypercoagulability contributed by platelet hyperreactivity, increased coagulation marker and decreased fibrinolytic potential. Diabetic patients who present ACS derive greater benefit from complex antithrombotic therapy, particularly platelet-inhibiting therapies. Beneficial effects of antithrombotic drugs in diabetic patients with ACS have been demonstrated only for: prasugrel in ST-elevated myocardial infarction (STEMI) patients, glycoprotein IIb/IIIa receptor inhibitors in high-risk non-ST elevated myocardial infarction (NSTEMI) and STEMI patients undergoing PCI and for bivalirudin in STEMI patients. Taking into consideration available facts individualized treatment of patients with diabetes mellitus and coronary artery disease is crucial. [ABSTRACT FROM AUTHOR]

Diabetes mellitus type 2 affects the outcome of patients with coronary artery disease. Due to augmentation of atherogenesis it leads to diffuse, multivessel coronary artery disease, including lesions located in the left main. Optimal treatment strategy is linked to multidisciplinary proceedings. Presented case relates to 65-years old patient with acute myocardial infarction without ST segment elevation with multivessel disease and long history of diabetes mellitus type 2. [ABSTRACT FROM AUTHOR]

Aim: To assess whether combination of admission hyperglycaemia and diabetes mellitus (DM) has better prognostic value than DM alone in patients with acute coronary syndrome (ACS) treated with primary percutaneous coronary intervention (PCI). Material and methods: Patients were stratified based on the history of DM and admission blood glucose concentration. Hyperglycaemia was defined as an admission plasma glucose level of > 140 mg/dl. Total mortality was evaluated during 591 ±187 days of follow-up. Results: A total of 704 patients with ACS were included in the analysis. The mean age was 63 ±11 years. During follow-up, 8% (n = 56) of the patients died. Mortality rate in normoglycaemic DM patients in relation to normoglycaemic non-DM patients was similar (9% vs. 7%, p = 0.4). In the multivariable model of Cox regression analysis DM was not an independent predictor of mortality (HR = 1.36, 95% CI 0.66-2.80, p = 0.40). Increased mortality was observed in DM hyperglycaemic patients in relation to normoglycaemic non- DM patients (21% vs. 7%, p = 0.0005). In the model of Cox regression analysis the adjusted relative risk of death in the patients with DM and hyperglycaemia was two times higher than in the non-diabetic normoglycaemic patients (HR = 2.28, 95% CI 1.15-4.52, p = 0.02). For the multivariable modelling, DM with hyperglycaemia remained an independent predictor of mortality (HR = 2.40, 95% CI 1.20-4.82, p = 0.01). Conclusions: Admission hyperglycaemia together with history of diabetes is a strong predictor of mortality in ACS patients treated with PCI, while diabetes alone is not. Elevated glucose levels can be integrated along with diabetes into the risk stratification in ACS patients. [ABSTRACT FROM AUTHOR]

Atrial fibrillation (AF) symptoms may mimic coronary artery disease (CAD) which reflects the difficulties in qualifying AF patients for invasive diagnostics. A substantial number of coronary angiographies may be unnecessary or even put patients at risk of post-contrast acute kidney injury (PC-AKI), especially patients with chronic kidney disease (CKD). We aimed to investigate the hypothesis indicating higher prevalence of PC-AKI in patients with AF scheduled for coronary angiography. The study population comprised of 8026 patients referred for elective coronarography including 1621 with AF. In the comparison of prevalence of PC-AKI in distinguished groups we can see that kidney impairment was twice more frequent in patients with AF in both groups with CKD (CKD (+)/AF (+) 6.24% vs. CKD (+)/AF (−) 3.04%) and without CKD (CKD (−)/AF (+) 2.32% vs. CKD (−)/AF (−) 1.22%). In our study, post-contrast acute kidney disease is twice more frequent in patients with AF, especially in subgroup with chronic kidney disease scheduled for coronary angiography. Additionally, having in mind results of previous studies stating that AF is associated with non-obstructive coronary lesions on angiography, patients with AF and CKD may be unnecessarily exposed to contrast agent and possible complications. [ABSTRACT FROM AUTHOR]

Abstract: Background: Gastro-esophageal reflux disease (GERD) may cause chest pain. The aim was to determine the correlation between ischemia and gastro-esophageal reflux in patients with CAD and to assess the influence of short-term “anti-reflux” therapy on the ischemia in patients with GERD and CAD. Methods: Fifty patients with angiographically proven CAD underwent simultaneous 24-h continuous ECG and esophageal pH monitoring. We assessed the number of ST-segment depression episodes (ST dep.) and total duration of ischemic episodes, expressed as total ischemic burden (TIB). In pH-metry, we assessed: time percentage of pH lower than 4, total time of pH lower than 4 and the number of pathological refluxes (PR). Patients fulfilling the GERD criteria received a 7-day therapy with omeprazol 20 mg bid. On the 7th day of therapy, simultaneous Holter and esophageal pH monitoring was repeated. Results: Total number of 224 PRs in 42 patients (84%) was recorded during esophageal pH-metry. GERD criteria were fulfilled in 23 patients (46%). Out of 218 episodes of ST dep., 45 (20.6%) correlated with PR. GERD patients had larger TIB and higher number of ST dep. (p&#60;0.015 and p&#60;0.035, respectively). The anti-reflux therapy reduced all analyzed parameters of esophageal pH monitoring (p&#60;0.0022) as well as the number of ST dep. (p&#60;0.012) and TIB (p&#60;0.05). Conclusions: Gastro-esophageal reflux disease is common in patients with CAD and may provoke myocardial ischemia. Short-term proton pump inhibitors therapy that restores normal esophageal pH significantly reduces myocardial ischemia, possibly due to elimination of acid-derived esophago-cardiac reflex compromising coronary perfusion—the phenomenon known as “linked angina”. [Copyright &y& Elsevier]

There is a lack of studies directly comparing the effect of air pollution on acute coronary syndrome (ACS) occurrence in industrial and non-industrial areas. A comparison of association of air pollution exposure with ACS in two cohorts of industrially different areas. The study covered 6,000,000 person-years of follow-up and five pollutants between 2008 and 2017. A time series regression analysis with 7-lag was used to assess the effects air pollution on ACS. A total of 9046 patients with ACS were included in the analysis, of whom 3895 (43.06%) had ST-elevation myocardial infarction (STEMI) - 45.39% from non-industrial area, and 42.37% from industrial area; and 5151 (56.94%) had non-ST-elevation myocardial infarction (NSTEMI) - 54.61% from non-industrial area and 57.63% from industrial area. The daily concentrations of PM 2.5 , PM 10 , NO 2 , SO 2 , CO were higher in industrial than in non-industrial area (P < 0.001). In non-industrial area, an increase of 10 μg/m3 of NO 2 concentration (Odds Ratio (OR) = 1.126, 95%CI = 1.009–1.257; P = 0.034, lag-0) and an increase of 1 mg/m3 in CO concentration (RR = 1.055, 95%CI = 1.010–1.103; P = 0.017, lag-0) were associated with an increase in the number of hospitalization due to NSTEMI (for industrial area increase of 10 μg/m3 in NO 2 (OR = 1.062, 95%CI = 1.020–1.094; P = 0.005, lag-0), SO 2 (OR = 1.061, 95%CI = 1.010–1.116; P = 0.018, lag-4), PM 10 (OR = 1.010, 95%CI = 1.001–1.030; P = 0.047, lag-6). In STEMI patients in industrial area, an increased hospitalization was found to be associated with an increase of 10 μg/m3 in SO 2 (OR = 1.094, 95%CI = 1.030–1.162; P = 0.002, lag-1), PM 2.5 (OR = 1.041, 95%CI = 1.020–1.073; P < 0.001, lag-1), PM 10 (OR = 1.030, 95%CI = 1.010–1.051; P < 0.001, lag-1). No effects of air pollution on the number of hospitalization due to STEMI were noted from non-industrial area. The risk of air pollution-related ACS was higher in industrial over non-industrial area. The effect of NO 2 on the incidence of NSTEMI was observed in both areas. In industrial area, the effect of PMs and SO 2 on NSTEMI and STEMI were also observed. A clinical effect was more delayed in time in patients with NSTEMI, especially after exposure to PM 10. Chronic exposure to air pollution may underlie the differences in the short-term effect between particulate air pollution impact on the incidence of STEMI. [Display omitted] • The first study with 6,000,000 person-years and seven-lag design in central Europe. • Comparison of pollution impact on ACS in areas of notably different air quality. • Short-term exposure to NO 2 influenced the prevalence of ACS in both areas. • In severely polluted area concentrations of PMs, SO 2 , NO 2 affected STEMI and NSTEMI. • No effect of air pollution on STEMI was noted in non-industrial area. [ABSTRACT FROM AUTHOR]

The detrimental influence of air pollution on mortality has been established in a series of studies. The majority of them were conducted in large, highly polluted cities—there is a lack of studies from small, relatively clean regions. The aim was to analyze the short-term impact of particulate matters (PMs) on mortality in north-eastern Poland. Time-stratified case-crossover design was performed for mortality in years 2008–2017. Daily concentrations of PM2.5 (28.4 µg/m3, interquartile range (IQR) = 25.2) vs. (12.6 µg/m3, IQR = 9.0) and PM10 (29.0 µg/m3, IQR = 18.0) vs. (21.7 µg/m3, IQR = 14.5) were higher in Łomża than Suwałki (p < 0.001). Impact of PM2.5 on mortality was recorded in Łomża (odds ratio (OR) for IQR increase 1.061, 1.017–1.105, p = 0.06, lag 0) and Suwałki (OR for IQR increase 1.044, 1.001–1.089, p = 0.004, lag 0). PM10 had an impact on mortality in Łomża (OR for IQR increase 1.028, 1.000–1.058, p = 0.049, lag 1). Cardiovascular mortality was affected by increase of PM2.5 in Łomża (1.086, 1.020–1.156, p = 0.01) and Suwałki (1.085, 1.005–1.171, p = 0.04). PM2.5 had an influence on respiratory mortality in Łomża (1.163, 1.021–1.380, p = 0.03, lag 1). In the whole studied region, despite differences in the air quality, the influence of PMs on mortality was observed. [ABSTRACT FROM AUTHOR]

(1) Introduction: air pollution is considered to be one of the main risk factors for public health. According to the European Environment Agency (EEA), air pollution contributes to the premature deaths of approximately 500,000 citizens of the European Union (EU), including almost 5000 inhabitants of Poland every year. (2) Purpose: to assess the gender differences in the impact of air pollution on the mortality in the population of the city of Bialystok—the capital of the Green Lungs of Poland. (3) Materials and Methods: based on the data from the Central Statistical Office, the number—and causes of death—of Białystok residents in the period 2008–2017 were analyzed. The study utilized the data recorded by the Provincial Inspectorate for Environmental Protection station and the Institute of Meteorology and Water Management during the analysis period. Time series regression with Poisson distribution was used in statistical analysis. (4) Results: A total of 34,005 deaths had been recorded, in which women accounted for 47.5%. The proportion of cardiovascular-related deaths was 48% (n = 16,370). An increase of SO2 concentration by 1-µg/m3 (relative risk (RR) 1.07, 95% confidence interval (CI) 1.02–1.12; p = 0.005) and a 10 °C decrease of temperature (RR 1.03, 95% CI 1.01–1.05; p = 0.005) were related to an increase in the number of daily deaths. No gender differences in the impact of air pollution on mortality were observed. In the analysis of the subgroup of cardiovascular deaths, the main pollutant that was found to have an effect on daily mortality was particulate matter with a diameter of 2.5 μm or less (PM2.5); the RR for 10-µg/m3 increase of PM2.5 was 1.07 (95% CI 1.02–1.12; p = 0.01), and this effect was noted only in the male population. (5) Conclusions: air quality and atmospheric conditions had an impact on the mortality of Bialystok residents. The main air pollutant that influenced the mortality rate was SO2, and there were no gender differences in the impact of this pollutant. In the male population, an increased exposure to PM2.5 concentration was associated with significantly higher cardiovascular mortality. These findings suggest that improving air quality, in particular, even with lower SO2 levels than currently allowed by the World Health Organization (WHO) guidelines, may benefit public health. Further studies on this topic are needed, but our results bring questions whether the recommendations concerning acceptable concentrations of air pollutants should be stricter, or is there a safe concentration of SO2 in the air at all. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to assess the effect of air pollution and weather conditions on the frequency of hospital admissions due to acute coronary syndrome (ACS) in the population of Bialystok, known as the capital of the Green Lungs of Poland.Materials and Methods: The study analyzed the medical records of 2,645 patients living within the borders of Bialystok who were treated for ACS between 2009 and 2017 and the data on air pollutants-nitrogen dioxide (NO2), sulfur dioxide (SO2), and particulate matter with a diameter of 2.5 μm or less (PM2.5) and 10 μm or less (PM10)-and the basic meteorological factors (temperature, humidity, and atmospheric pressure). A time-stratified case-crossover study design was applied to assess the effects of particulate matter, the concentration of gases, and weather conditions on ACS.Results: The number of patients admitted for ST-segment elevation myocardial infarction, non-ST-segment elevation myocardial infarction (NSTEMI), and unstable angina (UA) was 791, 999, and 855, respectively. The daily concentration norm for PM2.5 recommended by the World Health Organization (WHO) was exceeded in 692 days (i.e., 24.58% of the observation period). The significant increase in the number of ACS hospitalizations was associated with an interquartile-range increase in NO2 concentration, with an odds ratio of 1.08 (95% confidence interval (CI): 1.02-1.15, P = 0.01), 1.09 (95% CI: 1.01-1.18, P = 0.03), and 1.11 (95% CI: 1.00-1.22, P = 0.048) for patients with ACS, NSTEMI, and UA, respectively.Conclusion: The study showed that the effects of air pollution and weather conditions on the number of ACS hospitalizations are also observed in cities with moderately polluted or good air quality. NO2 was identified as the main air pollutant affecting the incidence of ACS. [ABSTRACT FROM AUTHOR]