Przez lata zaburzenia lipidowe w Polsce i na świecie nie były traktowane z należytą uwagą, a w wi... more Przez lata zaburzenia lipidowe w Polsce i na świecie nie były traktowane z należytą uwagą, a w wielu przypadkach ich występowania najczęściej zalecana była dieta i zmiana stylu życia. Pomimo wielu działań edukacyjnych towarzystw medycznych w Polsce, w tym także „sygnatariuszy” niniejszych wytycznych, wiedza pacjentów na temat tego niezależnego czynnika ryzyka jest także wciąż bardzo ograniczona. W efekcie tego w Polsce mamy prawie 20 milionów osób z hipercholesterolemią. Nie istnieją kliniki zaburzeń lipidowych, a funkcjonujące poradnie najczęściej nie są dedykowane temu problemowi, ale zaburzeniom metabolicznym i/lub chorobom endokrynologicznym, a sami pacjenci nierzadko leczeni są po prostu w poradniach kardiologicznych. Wynika to także z ograniczeń systemowych, które wcale nie ułatwiają stworzenia sieci poradni lipidowych, pomimo istnienia grupy prawie 70 lekarzy lipidologów certyfikowanych przez Polskie Towarzystwo Lipidologiczne. To właśnie dlatego przez lata w Polsce problem hipercholesterolemii rodzinnej (familial hypercholesterolemia– FH) nie był rozpoznawany jako istotny i mało kto potrafił skojarzyć stężenia cholesterolu LDL (low density lipoprotein) >190 mg/dl (4,9 mmol/l) czy cholesterolu całkowitego 290 mg/dl (7,5 mmol/l) i więcej jako takie, których przyczyną może być choroba uwarunkowana genetycznie, i idąc dalej – zakwalifikować takich pacjentów do grupy dużego i bardzo dużego ryzyka sercowo‑naczyniowego.To właśnie dlatego w Polsce leczenie aferezą pacjentów z najpoważniejszymi zaburzeniami lipidowymi praktycznie nie istnieje (tylko 3 ośrodki). Tymczasem za naszą zachodnią (Niemcy) czy południową (Czechy) granicą rejestr hipercholesterolemii rodzinnej tworzony jest od wielu lat, a w Niemczech liczba ośrodków wykonujących aferezy jest największa w Europie. Już kilkanaście lat temu zwrócono uwagę, że w ocenie ryzyka odległego (20‑letniego) lub tzw. lifetime risk zaburzenia lipidowe są niezależnym czynnikiem ryzyka wystąpienia incydentów sercowo‑naczyniowych, stąd ich optymalne i skuteczne leczenie jest równie ważne, jak terapia cukrzycy czy nadciśnienia tętniczego. Co więcej, nawet w przypadku podjęcia leczenia dyslipidemii stoją przed nami wyzwania pod postacią niestosowania / nieprzepisywania odpowiednich dawek statyn w odniesieniu do ryzyka sercowo‑naczyniowego (co może dotyczyć nawet 80% leczonych pacjentów) czy też dyskontynuacji leczenia, braku skutecznego leczenia skojarzonego mającego na celu redukcję ryzyka rezydualnego czy też właściwego postępowania w przypadku wystąpienia działań niepożądanych związanych z leczeniem. Dlatego właśnie Polskie Towarzystwo Lipidologiczne (PTL) wraz z Kolegium Lekarzy Rodzinnych w Polsce (KLRwP) oraz Polskim Towarzystwem Kardiologicznym (PTK) wspólnie zdecydowały o konieczności przygotowania pierwszych wytycznych dotyczących postępowania w zaburzeniach lipidowych, dedykowanych lekarzom rodzinnym, bo to właśnie oni najczęściej po raz pierwszy diagnozują zaburzenia lipidowe i to na nich w dużej mierze spoczywa odpowiedzialność za pierwsze decyzje terapeutyczne oraz kontynuację leczenia hipolipemizującego.
For many years, dyslipidaemias failed to receive the attention they deserve, both in Poland and a... more For many years, dyslipidaemias failed to receive the attention they deserve, both in Poland and across the world. In many cases, the most common recommendation given to patients suffering from lipid disorders was to change their diet and lifestyle. Despite multiple educational efforts undertaken by medical societies in Poland, including the signatories of the Guidelines, the knowledge of patients about this independent risk factor continues to be very limited even today. As a result, there are nearly 20 million hypercholesterolaemic patients in Poland. Furthermore, there are no medical (lipid) clinics specializing in the treatment of lipid disorders, and existing outpatient clinics are not usually dedicated specifically to dyslipidaemias, but metabolic disorders and/or endocrine conditions. Not uncommonly, patients receive treatment in cardiac outpatient clinics. The existing state of affairs stems partly from systemic constraints, which pose a hindrance to the establishment of a network of lipid outpatient clinics – even though a total of 70 lipidologists have already been certified by the Polish Lipid Association (PoLA). This is precisely why the problem of familial hypercholesterolaemia (FH) in Poland was not recognized as significant for many years. Few physicians were able to consider low density lipoprotein cholesterol (LDL-C) concentrations in excess of 190 mg/dl (4.9 mmol/l) or total cholesterol (TC) concentrations of 290 mg/dl (7.5 mmol/l) and more as potentially caused by genetically conditioned disease and, taking the matter further, classify patients presenting with such disorders into high and very high cardiovascular risk groups. This is why the treatment of patients with the most severe lipid disorders with apheresis is practically non-existent in Poland, with only three treatment centres available to patients. In contrast, in neighbouring countries (Germany, Czech Republic), nationwide FH registries have been kept for many years. Germany, in addition, has the largest number of medical centres offering apheresis treatment in Europe. It was first noted about a dozen years ago in the estimation of long-term (20-year) risk or lifetime risk that dyslipidaemias represented an independent risk factor for cardiovascular (CV) events. It thus follows that optimal effective treatment of lipid disorders is as important as the therapy of diabetes or arterial hypertension. What is more, even if dyslipidaemia treatment is undertaken, further challenges must be faced such as failure to use/prescribe statins at doses corresponding to the level of CV risk (the situation may affect as much as 80% of all treated patients), discontinuation of therapy, lack of effective combination treatment aimed at reducing residual risk or failure to ensure appropriate management of undesirable treatment-related effects.
In view of the situation outlined above, the PoLA, the College of Family Physicians in Poland (CFPiP) and the Polish Cardiac Society (PCS) have jointly identified a need to draft the first guidelines regulating the management of dyslipidaemias and addressed to family physicians, as they are usually the first to diagnose lipid disorders and they are largely responsible for the initial therapeutic decisions and for the continuation of lipid-lowering therapy (LLT).
Both in the European and Polish guidelines, the highest priority for preventive cardiology was gi... more Both in the European and Polish guidelines, the highest priority for preventive cardiology was given to patients with established coronary artery disease (CAD). The Cracovian Program for Secondary Prevention of Ischaemic Heart Disease was introduced in 1996 to assess and improve the quality of clinical care in secondary prevention. Departments of cardiology of five participating hospitals serving the area of the city of Kraków and surrounding districts (former Kraków Voivodship) inhabited by a population of 1 200 000 took part in the surveys. In 1999/2000 and 2006/2007 the same hospitals joined the EUROASPIRE (European Action on Secondary Prevention through Intervention to Reduce Events) II and III surveys. The goal of the EUROASPIRE surveys was to assess to what extent the recommendations of the Joint Task Force of International Scientific Societies were implemented into clinical practice. To compare the quality of secondary prevention in the post-discharge period in Kraków in 1997...
The effectiveness of revascularisation procedures of coronary chronic total occlusion (CTO) has b... more The effectiveness of revascularisation procedures of coronary chronic total occlusion (CTO) has been improved by the introduction of retrograde approach. This study compared the outcomes of CTO revascularisation in a single centre in Krakow, Poland using antegrade and retrograde approach. From January 2011 to September 2013, 150 patients underwent 159 procedures for percutaneous revascularisation of CTO of 153 vessels. Of the 159 procedures, 124 (78%) were performed using an antegrade approach and 35 (22%) using a retrograde approach. All patients were symptomatic, with mean CCS class (2.3 ± 0.6 vs. 2.1 ± 0.7, p = 0.9), mean age (59.2 ± 8.3 vs. 62.6 ± 9.9 years, p = 0.067), and mean number of males (81.3% vs. 81.8%, p = 0.9) similar in the retrograde and antegrade groups, respectively. Most patients in both groups had ejection fraction (EF) ≥ 50% (84.4% vs. 74.4%, respectively). Occlusions assessed according to the J-CTO score showed that 82.9% and 56.4%, respectively, were rated as difficult or very difficult (p < 0.01). Overall procedural success rate was 88.2%, 87.9% in the antegrade, and 74.3% in the retrograde group. Complication rates were low and similar in two groups. However, the retrograde approach was associated with a longer mean fluoroscopy time (47.8 ± 19.6 vs. 19.3 ± 10.0 min, p < 0.00001) and higher volume of contrast fluid (494.6 ± 142.4 vs. 291.9 ± 118.1 mL, p < 0.00001). Using novel equipment with adequate experience allowed high rates of successful revascularisation. The retrograde technique for CTO revascularisation showed good overall success and was safe.
... Podolec P, Kopeć G, Undas A, Pająk A, Godycki-Ćwirko M, Zdrojewski T, Jankowski P, Drygas W, ... more ... Podolec P, Kopeć G, Undas A, Pająk A, Godycki-Ćwirko M, Zdrojewski T, Jankowski P, Drygas W, Rynkiewicz A, Piotrowicz R, Czarnecka D, Naruszewicz M, Opala G, Stańczyk J, Kozek E, Windak A, Banasiak W, Guzik T. PMID: 21332073 [PubMed - in process].
Over 1/3 of all patients treated for acute myocardial infarction are elderly (over 70 years of ag... more Over 1/3 of all patients treated for acute myocardial infarction are elderly (over 70 years of age). Blood flow restoration in the infarct-related artery is a fundamental therapeutic strategy, however reperfusion therapy is rarely used in the elderly as compared with younger groups. Mortality and complication rates are much higher in the elderly than in younger patients irrespective of the type of reperfusion therapy. Elderly patients are modestly represented in studies undertaken to analyze the efficacy of various types of reperfusion therapy. For this reason the choice of an optimal therapy in acute myocardial infarction in the elderly remains an open question. In the I Department of Cardiology PCI has been the strategy of choice in the treatment of acute myocardial infarction. This is a retrospective analysis of early and late outcomes of primary coronary angioplasty in elderly patients with myocardial infarction. Between June 2001 and December 2003 four hundred and five (405) co...
Two patients with acute myocardial infarction (MI) complicated by cardiogenic shock are described... more Two patients with acute myocardial infarction (MI) complicated by cardiogenic shock are described. Coronary angiography revealed subtotal left main stenosis. Both patients underwent successful primary coronary angioplasty. The role of coronary angioplasty in patients with acute MI complicated by cardiogenic shock is discussed.
Arterial pathology is a major contributor to cardiovascular disease, morbidity and mortality. Wom... more Arterial pathology is a major contributor to cardiovascular disease, morbidity and mortality. Women are at higher risk of cardiovascular disease after menopause. Arterial stiffness determined by pulse wave velocity, increases with age both in men and women, whereas arterial compliance in premenopausal women is greater than in men of similar age. This difference is lost in the postmenopausal years, with
In patients following a myocardial infarction, heart rate variability is an important prognostic ... more In patients following a myocardial infarction, heart rate variability is an important prognostic factor. Decreased heart rate variability is associated with a higher mortality rate. This study evaluated the influence of recanalisation by percutaneous coronary intervention (PCI) in totally occluded coronary arteries on the heart rate variability in patients with myocardial akinesis in the recanalised artery area. The study group included 22 men (average age 52.8 +/- 7.7) after successful PCI recanalization of the totally occluded artery. All patients had akinesis in the recanalised artery area. All patients underwent 24-hour continuous electrocardiographic Holter monitoring with HRV analysis and echocardiographic dobutamine tests both before the PCI and 6 months afterwards. The population was divided into two groups: group A (10 patients) had contractility adjustments in echocardiographic tests that were performed 6 months after the PCI. Group B (12 patients) did not have contractili...
ABSTRACT Background and Aims: Besides its known cardiac effects, cardiotrophin-1 (CT-1), a cytoki... more ABSTRACT Background and Aims: Besides its known cardiac effects, cardiotrophin-1 (CT-1), a cytokine belonging to the interleukin-6 family, exerts proliferative and secretory effects in vascular smooth muscle cells. We aimed to investigate the functional and morphological vascular changes induced by chronic CT-1 administration in rats and its involvement in the arterial phenotype of CT-1-null mice in vivo. Methods: A) Recombinant rat CT-1 (20 μg/Kg, IP) was administrated to Wistar rats for six weeks (n = 10/group). Blood pressure (BP) and heart rate were recorded by telemetry. Cardiac function was assessed using PET-scan. B) 2 year-old wild-type (WT) (n = 8) and CT-1-null mice (n = 3) were studied. Vascular structure and function were evaluated by an echo-tracking device. Circumferential wall stress, incremental elastic modulus (Einc), media cross-sectional area and pulse wave velocity (PWV) were measured. Aortic wall collagen and elastin contents were determined using immunohistochemistry, and the expression of collagen type I and III, elastin and fibronectin was quantified by RT-PCR and Western blot in aortic extracts. Results: A) Neither vehicle nor CT-1 treatment modified BP. CT-1-treated rats displayed decreased cardiac output (p < 0.01) as well as wall stress (p < 0.01), Einc (p < 0.01) and PWV (p < 0.05) as compared with vehicle group. CT-1-treated rats also showed increased media cross sectional area (p < 0.01) and collagen content (p < 0.01). CT-1-overloaded rats displayed increased expression of collagen type I (p < 0.05) and III (p < 0.01) and fibronectin (p < 0.01). B) CT-1-null mice presented an increased wall stress (p < 0.05) and Einc (p < 0.05) as compared with WT mice. Media cross sectional area and collagen content were reduced (p < 0.05) in mice lacking CT-1. Conclusions: Normotensive rats subjected to CT-1 overloading developed impaired cardiac and vascular functions, characterized by an increment in arterial stiffness accompanied by an augmented media thickness and extracellular matrix production. Accordingly, CT-1-null mice presented a reduced arterial stiffness and a reduced media thickness and collagen content. Our data show that CT-1 is a key player in arterial thickness and stiffness and in the cardiovascular coupling.
Ascending aortic fractional pulse pressure and fractional systolic pressure (FSP) were demonstrat... more Ascending aortic fractional pulse pressure and fractional systolic pressure (FSP) were demonstrated to differentiate patients with and without coronary artery disease. However, no study so far has analyzed the relationship between FSP and fractional diastolic pressure (FDP) and the ...
This case report concerns a 68 year old male with, type 2 diabetes, stage 3 hypertension, hyperch... more This case report concerns a 68 year old male with, type 2 diabetes, stage 3 hypertension, hypercholesterolemia, myocardial infarction (MI) 20 years ago. He was admitted to the catheterization laboratory with suspected acute inferior wall MI. Angiography of pulmonary arteries revealed massive thrombosis.
Przez lata zaburzenia lipidowe w Polsce i na świecie nie były traktowane z należytą uwagą, a w wi... more Przez lata zaburzenia lipidowe w Polsce i na świecie nie były traktowane z należytą uwagą, a w wielu przypadkach ich występowania najczęściej zalecana była dieta i zmiana stylu życia. Pomimo wielu działań edukacyjnych towarzystw medycznych w Polsce, w tym także „sygnatariuszy” niniejszych wytycznych, wiedza pacjentów na temat tego niezależnego czynnika ryzyka jest także wciąż bardzo ograniczona. W efekcie tego w Polsce mamy prawie 20 milionów osób z hipercholesterolemią. Nie istnieją kliniki zaburzeń lipidowych, a funkcjonujące poradnie najczęściej nie są dedykowane temu problemowi, ale zaburzeniom metabolicznym i/lub chorobom endokrynologicznym, a sami pacjenci nierzadko leczeni są po prostu w poradniach kardiologicznych. Wynika to także z ograniczeń systemowych, które wcale nie ułatwiają stworzenia sieci poradni lipidowych, pomimo istnienia grupy prawie 70 lekarzy lipidologów certyfikowanych przez Polskie Towarzystwo Lipidologiczne. To właśnie dlatego przez lata w Polsce problem hipercholesterolemii rodzinnej (familial hypercholesterolemia– FH) nie był rozpoznawany jako istotny i mało kto potrafił skojarzyć stężenia cholesterolu LDL (low density lipoprotein) >190 mg/dl (4,9 mmol/l) czy cholesterolu całkowitego 290 mg/dl (7,5 mmol/l) i więcej jako takie, których przyczyną może być choroba uwarunkowana genetycznie, i idąc dalej – zakwalifikować takich pacjentów do grupy dużego i bardzo dużego ryzyka sercowo‑naczyniowego.To właśnie dlatego w Polsce leczenie aferezą pacjentów z najpoważniejszymi zaburzeniami lipidowymi praktycznie nie istnieje (tylko 3 ośrodki). Tymczasem za naszą zachodnią (Niemcy) czy południową (Czechy) granicą rejestr hipercholesterolemii rodzinnej tworzony jest od wielu lat, a w Niemczech liczba ośrodków wykonujących aferezy jest największa w Europie. Już kilkanaście lat temu zwrócono uwagę, że w ocenie ryzyka odległego (20‑letniego) lub tzw. lifetime risk zaburzenia lipidowe są niezależnym czynnikiem ryzyka wystąpienia incydentów sercowo‑naczyniowych, stąd ich optymalne i skuteczne leczenie jest równie ważne, jak terapia cukrzycy czy nadciśnienia tętniczego. Co więcej, nawet w przypadku podjęcia leczenia dyslipidemii stoją przed nami wyzwania pod postacią niestosowania / nieprzepisywania odpowiednich dawek statyn w odniesieniu do ryzyka sercowo‑naczyniowego (co może dotyczyć nawet 80% leczonych pacjentów) czy też dyskontynuacji leczenia, braku skutecznego leczenia skojarzonego mającego na celu redukcję ryzyka rezydualnego czy też właściwego postępowania w przypadku wystąpienia działań niepożądanych związanych z leczeniem. Dlatego właśnie Polskie Towarzystwo Lipidologiczne (PTL) wraz z Kolegium Lekarzy Rodzinnych w Polsce (KLRwP) oraz Polskim Towarzystwem Kardiologicznym (PTK) wspólnie zdecydowały o konieczności przygotowania pierwszych wytycznych dotyczących postępowania w zaburzeniach lipidowych, dedykowanych lekarzom rodzinnym, bo to właśnie oni najczęściej po raz pierwszy diagnozują zaburzenia lipidowe i to na nich w dużej mierze spoczywa odpowiedzialność za pierwsze decyzje terapeutyczne oraz kontynuację leczenia hipolipemizującego.
For many years, dyslipidaemias failed to receive the attention they deserve, both in Poland and a... more For many years, dyslipidaemias failed to receive the attention they deserve, both in Poland and across the world. In many cases, the most common recommendation given to patients suffering from lipid disorders was to change their diet and lifestyle. Despite multiple educational efforts undertaken by medical societies in Poland, including the signatories of the Guidelines, the knowledge of patients about this independent risk factor continues to be very limited even today. As a result, there are nearly 20 million hypercholesterolaemic patients in Poland. Furthermore, there are no medical (lipid) clinics specializing in the treatment of lipid disorders, and existing outpatient clinics are not usually dedicated specifically to dyslipidaemias, but metabolic disorders and/or endocrine conditions. Not uncommonly, patients receive treatment in cardiac outpatient clinics. The existing state of affairs stems partly from systemic constraints, which pose a hindrance to the establishment of a network of lipid outpatient clinics – even though a total of 70 lipidologists have already been certified by the Polish Lipid Association (PoLA). This is precisely why the problem of familial hypercholesterolaemia (FH) in Poland was not recognized as significant for many years. Few physicians were able to consider low density lipoprotein cholesterol (LDL-C) concentrations in excess of 190 mg/dl (4.9 mmol/l) or total cholesterol (TC) concentrations of 290 mg/dl (7.5 mmol/l) and more as potentially caused by genetically conditioned disease and, taking the matter further, classify patients presenting with such disorders into high and very high cardiovascular risk groups. This is why the treatment of patients with the most severe lipid disorders with apheresis is practically non-existent in Poland, with only three treatment centres available to patients. In contrast, in neighbouring countries (Germany, Czech Republic), nationwide FH registries have been kept for many years. Germany, in addition, has the largest number of medical centres offering apheresis treatment in Europe. It was first noted about a dozen years ago in the estimation of long-term (20-year) risk or lifetime risk that dyslipidaemias represented an independent risk factor for cardiovascular (CV) events. It thus follows that optimal effective treatment of lipid disorders is as important as the therapy of diabetes or arterial hypertension. What is more, even if dyslipidaemia treatment is undertaken, further challenges must be faced such as failure to use/prescribe statins at doses corresponding to the level of CV risk (the situation may affect as much as 80% of all treated patients), discontinuation of therapy, lack of effective combination treatment aimed at reducing residual risk or failure to ensure appropriate management of undesirable treatment-related effects.
In view of the situation outlined above, the PoLA, the College of Family Physicians in Poland (CFPiP) and the Polish Cardiac Society (PCS) have jointly identified a need to draft the first guidelines regulating the management of dyslipidaemias and addressed to family physicians, as they are usually the first to diagnose lipid disorders and they are largely responsible for the initial therapeutic decisions and for the continuation of lipid-lowering therapy (LLT).
Both in the European and Polish guidelines, the highest priority for preventive cardiology was gi... more Both in the European and Polish guidelines, the highest priority for preventive cardiology was given to patients with established coronary artery disease (CAD). The Cracovian Program for Secondary Prevention of Ischaemic Heart Disease was introduced in 1996 to assess and improve the quality of clinical care in secondary prevention. Departments of cardiology of five participating hospitals serving the area of the city of Kraków and surrounding districts (former Kraków Voivodship) inhabited by a population of 1 200 000 took part in the surveys. In 1999/2000 and 2006/2007 the same hospitals joined the EUROASPIRE (European Action on Secondary Prevention through Intervention to Reduce Events) II and III surveys. The goal of the EUROASPIRE surveys was to assess to what extent the recommendations of the Joint Task Force of International Scientific Societies were implemented into clinical practice. To compare the quality of secondary prevention in the post-discharge period in Kraków in 1997...
The effectiveness of revascularisation procedures of coronary chronic total occlusion (CTO) has b... more The effectiveness of revascularisation procedures of coronary chronic total occlusion (CTO) has been improved by the introduction of retrograde approach. This study compared the outcomes of CTO revascularisation in a single centre in Krakow, Poland using antegrade and retrograde approach. From January 2011 to September 2013, 150 patients underwent 159 procedures for percutaneous revascularisation of CTO of 153 vessels. Of the 159 procedures, 124 (78%) were performed using an antegrade approach and 35 (22%) using a retrograde approach. All patients were symptomatic, with mean CCS class (2.3 ± 0.6 vs. 2.1 ± 0.7, p = 0.9), mean age (59.2 ± 8.3 vs. 62.6 ± 9.9 years, p = 0.067), and mean number of males (81.3% vs. 81.8%, p = 0.9) similar in the retrograde and antegrade groups, respectively. Most patients in both groups had ejection fraction (EF) ≥ 50% (84.4% vs. 74.4%, respectively). Occlusions assessed according to the J-CTO score showed that 82.9% and 56.4%, respectively, were rated as difficult or very difficult (p < 0.01). Overall procedural success rate was 88.2%, 87.9% in the antegrade, and 74.3% in the retrograde group. Complication rates were low and similar in two groups. However, the retrograde approach was associated with a longer mean fluoroscopy time (47.8 ± 19.6 vs. 19.3 ± 10.0 min, p < 0.00001) and higher volume of contrast fluid (494.6 ± 142.4 vs. 291.9 ± 118.1 mL, p < 0.00001). Using novel equipment with adequate experience allowed high rates of successful revascularisation. The retrograde technique for CTO revascularisation showed good overall success and was safe.
... Podolec P, Kopeć G, Undas A, Pająk A, Godycki-Ćwirko M, Zdrojewski T, Jankowski P, Drygas W, ... more ... Podolec P, Kopeć G, Undas A, Pająk A, Godycki-Ćwirko M, Zdrojewski T, Jankowski P, Drygas W, Rynkiewicz A, Piotrowicz R, Czarnecka D, Naruszewicz M, Opala G, Stańczyk J, Kozek E, Windak A, Banasiak W, Guzik T. PMID: 21332073 [PubMed - in process].
Over 1/3 of all patients treated for acute myocardial infarction are elderly (over 70 years of ag... more Over 1/3 of all patients treated for acute myocardial infarction are elderly (over 70 years of age). Blood flow restoration in the infarct-related artery is a fundamental therapeutic strategy, however reperfusion therapy is rarely used in the elderly as compared with younger groups. Mortality and complication rates are much higher in the elderly than in younger patients irrespective of the type of reperfusion therapy. Elderly patients are modestly represented in studies undertaken to analyze the efficacy of various types of reperfusion therapy. For this reason the choice of an optimal therapy in acute myocardial infarction in the elderly remains an open question. In the I Department of Cardiology PCI has been the strategy of choice in the treatment of acute myocardial infarction. This is a retrospective analysis of early and late outcomes of primary coronary angioplasty in elderly patients with myocardial infarction. Between June 2001 and December 2003 four hundred and five (405) co...
Two patients with acute myocardial infarction (MI) complicated by cardiogenic shock are described... more Two patients with acute myocardial infarction (MI) complicated by cardiogenic shock are described. Coronary angiography revealed subtotal left main stenosis. Both patients underwent successful primary coronary angioplasty. The role of coronary angioplasty in patients with acute MI complicated by cardiogenic shock is discussed.
Arterial pathology is a major contributor to cardiovascular disease, morbidity and mortality. Wom... more Arterial pathology is a major contributor to cardiovascular disease, morbidity and mortality. Women are at higher risk of cardiovascular disease after menopause. Arterial stiffness determined by pulse wave velocity, increases with age both in men and women, whereas arterial compliance in premenopausal women is greater than in men of similar age. This difference is lost in the postmenopausal years, with
In patients following a myocardial infarction, heart rate variability is an important prognostic ... more In patients following a myocardial infarction, heart rate variability is an important prognostic factor. Decreased heart rate variability is associated with a higher mortality rate. This study evaluated the influence of recanalisation by percutaneous coronary intervention (PCI) in totally occluded coronary arteries on the heart rate variability in patients with myocardial akinesis in the recanalised artery area. The study group included 22 men (average age 52.8 +/- 7.7) after successful PCI recanalization of the totally occluded artery. All patients had akinesis in the recanalised artery area. All patients underwent 24-hour continuous electrocardiographic Holter monitoring with HRV analysis and echocardiographic dobutamine tests both before the PCI and 6 months afterwards. The population was divided into two groups: group A (10 patients) had contractility adjustments in echocardiographic tests that were performed 6 months after the PCI. Group B (12 patients) did not have contractili...
ABSTRACT Background and Aims: Besides its known cardiac effects, cardiotrophin-1 (CT-1), a cytoki... more ABSTRACT Background and Aims: Besides its known cardiac effects, cardiotrophin-1 (CT-1), a cytokine belonging to the interleukin-6 family, exerts proliferative and secretory effects in vascular smooth muscle cells. We aimed to investigate the functional and morphological vascular changes induced by chronic CT-1 administration in rats and its involvement in the arterial phenotype of CT-1-null mice in vivo. Methods: A) Recombinant rat CT-1 (20 μg/Kg, IP) was administrated to Wistar rats for six weeks (n = 10/group). Blood pressure (BP) and heart rate were recorded by telemetry. Cardiac function was assessed using PET-scan. B) 2 year-old wild-type (WT) (n = 8) and CT-1-null mice (n = 3) were studied. Vascular structure and function were evaluated by an echo-tracking device. Circumferential wall stress, incremental elastic modulus (Einc), media cross-sectional area and pulse wave velocity (PWV) were measured. Aortic wall collagen and elastin contents were determined using immunohistochemistry, and the expression of collagen type I and III, elastin and fibronectin was quantified by RT-PCR and Western blot in aortic extracts. Results: A) Neither vehicle nor CT-1 treatment modified BP. CT-1-treated rats displayed decreased cardiac output (p < 0.01) as well as wall stress (p < 0.01), Einc (p < 0.01) and PWV (p < 0.05) as compared with vehicle group. CT-1-treated rats also showed increased media cross sectional area (p < 0.01) and collagen content (p < 0.01). CT-1-overloaded rats displayed increased expression of collagen type I (p < 0.05) and III (p < 0.01) and fibronectin (p < 0.01). B) CT-1-null mice presented an increased wall stress (p < 0.05) and Einc (p < 0.05) as compared with WT mice. Media cross sectional area and collagen content were reduced (p < 0.05) in mice lacking CT-1. Conclusions: Normotensive rats subjected to CT-1 overloading developed impaired cardiac and vascular functions, characterized by an increment in arterial stiffness accompanied by an augmented media thickness and extracellular matrix production. Accordingly, CT-1-null mice presented a reduced arterial stiffness and a reduced media thickness and collagen content. Our data show that CT-1 is a key player in arterial thickness and stiffness and in the cardiovascular coupling.
Ascending aortic fractional pulse pressure and fractional systolic pressure (FSP) were demonstrat... more Ascending aortic fractional pulse pressure and fractional systolic pressure (FSP) were demonstrated to differentiate patients with and without coronary artery disease. However, no study so far has analyzed the relationship between FSP and fractional diastolic pressure (FDP) and the ...
This case report concerns a 68 year old male with, type 2 diabetes, stage 3 hypertension, hyperch... more This case report concerns a 68 year old male with, type 2 diabetes, stage 3 hypertension, hypercholesterolemia, myocardial infarction (MI) 20 years ago. He was admitted to the catheterization laboratory with suspected acute inferior wall MI. Angiography of pulmonary arteries revealed massive thrombosis.
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Papers by P. Jankowski
właśnie dlatego przez lata w Polsce problem hipercholesterolemii rodzinnej (familial hypercholesterolemia– FH) nie był rozpoznawany
jako istotny i mało kto potrafił skojarzyć stężenia cholesterolu LDL (low density lipoprotein) >190 mg/dl (4,9 mmol/l) czy cholesterolu całkowitego 290 mg/dl (7,5 mmol/l) i więcej jako takie, których przyczyną może być choroba uwarunkowana genetycznie, i idąc dalej
– zakwalifikować takich pacjentów do grupy dużego i bardzo dużego ryzyka sercowo‑naczyniowego.To właśnie dlatego w Polsce leczenie
aferezą pacjentów z najpoważniejszymi zaburzeniami lipidowymi praktycznie nie istnieje (tylko 3 ośrodki). Tymczasem za naszą
zachodnią (Niemcy) czy południową (Czechy) granicą rejestr hipercholesterolemii rodzinnej tworzony jest od wielu lat, a w Niemczech liczba ośrodków wykonujących aferezy jest największa w Europie. Już kilkanaście lat temu zwrócono uwagę, że w ocenie ryzyka odległego (20‑letniego) lub tzw. lifetime risk zaburzenia lipidowe są niezależnym czynnikiem ryzyka wystąpienia incydentów sercowo‑naczyniowych, stąd ich optymalne i skuteczne leczenie jest równie ważne, jak terapia cukrzycy czy nadciśnienia tętniczego. Co więcej, nawet w przypadku
podjęcia leczenia dyslipidemii stoją przed nami wyzwania pod postacią niestosowania / nieprzepisywania odpowiednich dawek statyn w odniesieniu do ryzyka sercowo‑naczyniowego (co może dotyczyć nawet 80% leczonych pacjentów) czy też dyskontynuacji leczenia, braku skutecznego leczenia skojarzonego mającego na celu redukcję ryzyka rezydualnego czy też właściwego postępowania w przypadku wystąpienia działań niepożądanych związanych z leczeniem. Dlatego właśnie Polskie Towarzystwo Lipidologiczne (PTL) wraz z Kolegium Lekarzy Rodzinnych w Polsce (KLRwP) oraz Polskim Towarzystwem
Kardiologicznym (PTK) wspólnie zdecydowały o konieczności przygotowania pierwszych wytycznych dotyczących postępowania
w zaburzeniach lipidowych, dedykowanych lekarzom rodzinnym, bo to właśnie oni najczęściej po raz pierwszy diagnozują zaburzenia
lipidowe i to na nich w dużej mierze spoczywa odpowiedzialność za pierwsze decyzje terapeutyczne oraz kontynuację leczenia hipolipemizującego.
the treatment of lipid disorders, and existing outpatient clinics are not usually dedicated specifically to dyslipidaemias, but metabolic disorders
and/or endocrine conditions. Not uncommonly, patients receive treatment in cardiac outpatient clinics. The existing state of affairs stems partly from systemic constraints, which pose a hindrance to the establishment of a network of lipid outpatient clinics – even though a total of 70 lipidologists have already been certified by the Polish Lipid Association (PoLA). This is precisely why the problem of familial hypercholesterolaemia (FH) in Poland was not recognized as significant for many years. Few physicians were able to consider low density lipoprotein cholesterol (LDL-C) concentrations in excess of 190 mg/dl (4.9 mmol/l) or total cholesterol (TC) concentrations of 290 mg/dl (7.5
mmol/l) and more as potentially caused by genetically conditioned disease and, taking the matter further, classify patients presenting with such disorders into high and very high cardiovascular risk groups. This is why the treatment of patients with the most severe lipid disorders with apheresis is practically non-existent in Poland, with only three treatment centres available to patients. In contrast, in neighbouring countries (Germany, Czech Republic), nationwide FH registries have been kept for many years. Germany, in addition, has the largest number of medical centres offering apheresis treatment in Europe. It was first noted about a dozen years ago in the estimation of long-term (20-year) risk or lifetime
risk that dyslipidaemias represented an independent risk factor for cardiovascular (CV) events. It thus follows that optimal effective treatment of lipid disorders is as important as the therapy of diabetes
or arterial hypertension. What is more, even if dyslipidaemia treatment is undertaken, further challenges must be faced such as failure to use/prescribe statins at doses corresponding to the level of CV risk (the situation may affect as much as 80% of all treated patients), discontinuation of therapy, lack of effective combination treatment aimed at reducing residual risk or failure to ensure appropriate management of undesirable treatment-related effects.
In view of the situation outlined above, the PoLA, the College of Family Physicians in Poland (CFPiP) and the Polish Cardiac Society (PCS) have
jointly identified a need to draft the first guidelines regulating the management of dyslipidaemias and addressed to family physicians, as they are usually the first to diagnose lipid disorders and they are largely responsible for the initial therapeutic decisions and for the continuation of lipid-lowering therapy (LLT).
właśnie dlatego przez lata w Polsce problem hipercholesterolemii rodzinnej (familial hypercholesterolemia– FH) nie był rozpoznawany
jako istotny i mało kto potrafił skojarzyć stężenia cholesterolu LDL (low density lipoprotein) >190 mg/dl (4,9 mmol/l) czy cholesterolu całkowitego 290 mg/dl (7,5 mmol/l) i więcej jako takie, których przyczyną może być choroba uwarunkowana genetycznie, i idąc dalej
– zakwalifikować takich pacjentów do grupy dużego i bardzo dużego ryzyka sercowo‑naczyniowego.To właśnie dlatego w Polsce leczenie
aferezą pacjentów z najpoważniejszymi zaburzeniami lipidowymi praktycznie nie istnieje (tylko 3 ośrodki). Tymczasem za naszą
zachodnią (Niemcy) czy południową (Czechy) granicą rejestr hipercholesterolemii rodzinnej tworzony jest od wielu lat, a w Niemczech liczba ośrodków wykonujących aferezy jest największa w Europie. Już kilkanaście lat temu zwrócono uwagę, że w ocenie ryzyka odległego (20‑letniego) lub tzw. lifetime risk zaburzenia lipidowe są niezależnym czynnikiem ryzyka wystąpienia incydentów sercowo‑naczyniowych, stąd ich optymalne i skuteczne leczenie jest równie ważne, jak terapia cukrzycy czy nadciśnienia tętniczego. Co więcej, nawet w przypadku
podjęcia leczenia dyslipidemii stoją przed nami wyzwania pod postacią niestosowania / nieprzepisywania odpowiednich dawek statyn w odniesieniu do ryzyka sercowo‑naczyniowego (co może dotyczyć nawet 80% leczonych pacjentów) czy też dyskontynuacji leczenia, braku skutecznego leczenia skojarzonego mającego na celu redukcję ryzyka rezydualnego czy też właściwego postępowania w przypadku wystąpienia działań niepożądanych związanych z leczeniem. Dlatego właśnie Polskie Towarzystwo Lipidologiczne (PTL) wraz z Kolegium Lekarzy Rodzinnych w Polsce (KLRwP) oraz Polskim Towarzystwem
Kardiologicznym (PTK) wspólnie zdecydowały o konieczności przygotowania pierwszych wytycznych dotyczących postępowania
w zaburzeniach lipidowych, dedykowanych lekarzom rodzinnym, bo to właśnie oni najczęściej po raz pierwszy diagnozują zaburzenia
lipidowe i to na nich w dużej mierze spoczywa odpowiedzialność za pierwsze decyzje terapeutyczne oraz kontynuację leczenia hipolipemizującego.
the treatment of lipid disorders, and existing outpatient clinics are not usually dedicated specifically to dyslipidaemias, but metabolic disorders
and/or endocrine conditions. Not uncommonly, patients receive treatment in cardiac outpatient clinics. The existing state of affairs stems partly from systemic constraints, which pose a hindrance to the establishment of a network of lipid outpatient clinics – even though a total of 70 lipidologists have already been certified by the Polish Lipid Association (PoLA). This is precisely why the problem of familial hypercholesterolaemia (FH) in Poland was not recognized as significant for many years. Few physicians were able to consider low density lipoprotein cholesterol (LDL-C) concentrations in excess of 190 mg/dl (4.9 mmol/l) or total cholesterol (TC) concentrations of 290 mg/dl (7.5
mmol/l) and more as potentially caused by genetically conditioned disease and, taking the matter further, classify patients presenting with such disorders into high and very high cardiovascular risk groups. This is why the treatment of patients with the most severe lipid disorders with apheresis is practically non-existent in Poland, with only three treatment centres available to patients. In contrast, in neighbouring countries (Germany, Czech Republic), nationwide FH registries have been kept for many years. Germany, in addition, has the largest number of medical centres offering apheresis treatment in Europe. It was first noted about a dozen years ago in the estimation of long-term (20-year) risk or lifetime
risk that dyslipidaemias represented an independent risk factor for cardiovascular (CV) events. It thus follows that optimal effective treatment of lipid disorders is as important as the therapy of diabetes
or arterial hypertension. What is more, even if dyslipidaemia treatment is undertaken, further challenges must be faced such as failure to use/prescribe statins at doses corresponding to the level of CV risk (the situation may affect as much as 80% of all treated patients), discontinuation of therapy, lack of effective combination treatment aimed at reducing residual risk or failure to ensure appropriate management of undesirable treatment-related effects.
In view of the situation outlined above, the PoLA, the College of Family Physicians in Poland (CFPiP) and the Polish Cardiac Society (PCS) have
jointly identified a need to draft the first guidelines regulating the management of dyslipidaemias and addressed to family physicians, as they are usually the first to diagnose lipid disorders and they are largely responsible for the initial therapeutic decisions and for the continuation of lipid-lowering therapy (LLT).