Publications by authors named "Katarzyna Ptaszyńska-Kopczyńska"

22 Publications

  • Page 1 of 1

Characteristics and outcomes of patients with chronic thromboembolic pulmonary hypertension in the era of modern therapeutic approaches: data from the Polish multicenter registry (BNP-PL).

Ther Adv Chronic Dis 2021 25;12:20406223211002961. Epub 2021 Mar 25.

Pulmonary Circulation Centre Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland, Department of Medical Education, Center for Innovative Medical Education, Jagiellonian University Medical College, Krakow, Poland.

Background: Significant achievements in the treatment of chronic thromboembolic pulmonary hypertension (CTEPH) have provided effective therapeutic options for most patients. However, the true impact of the changed landscape of CTEPH therapies on patients' management and outcomes is poorly known. We aimed to characterize the incidence, clinical characteristics, and outcomes of CTEPH patients in the modern era of CTEPH therapies.

Methods: We analyzed the data of CTEPH adults enrolled in the prospective multicenter registry.

Results: We enrolled 516 patients aged 63.8 ± 15.4 years. The incidence rate of CTEPH was 3.96 per million adults per year. The group was burdened with several comorbidities. New oral anticoagulants ( = 301; 58.3%) were preferred over vitamin K antagonists ( = 159; 30.8%). Pulmonary endarterectomy (PEA) was performed in 120 (23.3%) patients and balloon pulmonary angioplasty (BPA) in 258 (50%) patients. PEA was pretreated with targeted pharmacotherapy in 19 (15.8%) patients, and BPA in 124 (48.1%) patients. Persistent CTEPH was present in 46% of PEA patients and in 65% of patients after completion of BPA. Persistent CTEPH after PEA was treated with targeted pharmacotherapy in 72% and with BPA in 27.7% of patients. At a mean time period of 14.3 ± 5.8 months, 26 patients had died. The use of PEA or BPA was associated with better survival than the use of solely medical treatment.

Conclusions: The modern population of CTEPH patients comprises mostly elderly people significantly burdened with comorbid conditions. This calls for treatment decisions that are tailored individually for every patient. The combination of two or three methods is currently a frequent approach in the treatment of CTEPH.

Clinical Trial Registration: clinicaltrials.gov/ct2/show/NCT03959748.
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http://dx.doi.org/10.1177/20406223211002961DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8010818PMC
March 2021

Impact of Pulse Wave Velocity and Parameters Reflecting Android Type Fat Distribution on Left Ventricular Diastolic Dysfunction in Patients with Chronic Coronary Syndromes.

J Clin Med 2020 Dec 3;9(12). Epub 2020 Dec 3.

Department of Population Medicine and Civilization Diseases Prevention, Medical University of Bialystok, 15-269 Bialystok, Poland.

Background: Left ventricular diastolic dysfunction (LVDD) is caused by a decreased left ventricle relaxation and is associated with an increased risk of symptomatic heart failure (HF) and excessive mortality.

Aim: To evaluate the frequency and factors related to LVDD in the population with chronic coronary syndromes (CCS).

Methods: 200 patients (mean age 63.18 ± 8.12 years, 75.5% male) with CCS were included. LVDD was diagnosed based on the recent echocardiography guidelines.

Results: LVDD was diagnosed in 38.5% of CCS population. From the studied factors, after adjustment for age, sex, and N-terminal pro-brain natriuretic peptide (NT-proBNP), LVDD associated positively with android/gynoid (A/G) fat mass ratio, left ventricular mass index (LVMI), and negatively with Z-score and left ventricular ejection fraction (LVEF). In stepwise backward logistic regression analysis, the strongest factors associated with LVDD were pulse wave velocity value, handgrip strength and waist to hip ratio (WHR).

Conclusions: LVDD is common among CCS patients and it is associated with parameters reflecting android type fat distribution regardless of NT-proBNP and high-sensitivity troponin T concentrations. Deterioration in diastolic dysfunction is linked with increased aortic stiffness independently of age and sex. Further studies evaluating the effects of increasing physical fitness and lowering abdominal fat accumulations on LVDD in CCS patients should be considered.
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http://dx.doi.org/10.3390/jcm9123924DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7761650PMC
December 2020

Defining right ventricular dysfunction by echocardiography in normotensive patients with pulmonary embolism.

Pol Arch Intern Med 2020 09 24;130(9):741-747. Epub 2020 Jun 24.

Center for Thrombosis and Hemostasis and Center for Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; Clinic of Cardiology and Pneumology, University Medical Center Goettingen, Goettingen, Germany; Department of Internal Medicine and Cardiology, Campus Virchow Klinikum, Charité – University Medicine, Berlin, Germany

Introduction: Although the prognostic value of various echocardiographic parameters of right ventricular dysfunction (RVD) was reported in normotensive patients with acute pulmonary embolism (PE), there is no generally accepted definition of RVD.

Objectives: The aim of the study was to compare echocardiographic parameters for the prediction of an adverse 30‑day outcome and create an optimal definition of RVD.                                     Patients and methods: Echocardiographic parameters including the right ventricular to left ventricular diameter ratio (RV to LV ratio) and tricuspid annular plane systolic excursion (TAPSE) to predict PE‑related mortality, hemodynamic collapse, or rescue thrombolysis within the first 30 days were directly compared in 490 normotensive patients with PE.

Results: An adverse outcome (AO) was present in 31 patients (6.3%); 8 of them (1.6%) died due to PE. Systolic blood pressure, RV to LV ratio, and TAPSE were independent predictors of AO. The receiver operator characteristic yielded an area under the curve of 0.737 (0.654-0.819; P <0.001) for the RV to LV ratio and 0.75 (0.672-0.828; P <0.001) for TAPSE with regard to an AO. The hazard ratio for AO was 2.5 for the RV to LV ratio of more than 1 (95% CI, 1.2-5.7; P <0.03) and 3.8 for TAPSE of less than 16 mm (95% CI, 1.74-8.11; P = 0.001). A combined RVD criterion (TAPSE <16 mm and RV to LV ratio >1) was present in 60 patients (12%), and showed a positive predictive value of 23.3% with a high negative predictive value of 95.6% regarding an AO (HR, 6.5; 95% CI, 3.2-13.3; P <0.001).

Conclusions: Defining RVD on echocardiography by the RV to LV ratio of more than 1 combined with TAPSE of less than 16 mm identified patients with an increased risk of 30‑day PE‑related mortality, hemodynamic collapse, or rescue thrombolysis, while patients without this sign had a very good 30‑day prognosis.
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http://dx.doi.org/10.20452/pamw.15459DOI Listing
September 2020

Galectin-3 as the Prognostic Factor of Adverse Cardiovascular Events in Long-Term Follow up in Patients after Myocardial Infarction-A Pilot Study.

J Clin Med 2020 May 29;9(6). Epub 2020 May 29.

Department of Cardiology, Medical University of Białystok, 15-276 Białystok, Poland.

Galectin-3 (Gal-3) is a new independent risk factor in the development and severity of coronary artery disease (CAD). The aim of the study was to evaluate whether Gal-3 concentration has prognostic value and if it reflects the progression of atherosclerosis in carotid arteries in patients with CAD after acute myocardial infarction (AMI). The analysis included 110 patients who were hospitalized due to AMI, treated with primary coronary intervention (PCI) and further attended a follow-up visit, and 100 healthy volunteers. The Gal-3 concentration and carotid ultrasound were evaluated at baseline and on a follow-up visit. We found that the Gal-3 concentration in the group with hyperlipidemia decreased during the observation (10.7 vs. 7.9 ng/mL, = 0.00003). Patients rehospitalized during follow up had higher concentration of Gal-3 in the acute phase of myocardial infarction (MI) (10.7 vs. 7.2 ng/mL, = 0.02; 10.1 vs. 8.0 ng/mL, = 0.002, respectively). In the group of patients who had none of the following endpoints: subsequent MI, PCI, coronary artery bypass grafting (CABG) or stroke, there was a decrease in Gal-3 concentration at the follow-up visit. Parameters affecting the frequency of a composite endpoint occurrence are: the presence of atheromatous plaque in the carotid artery ( = 0.017), Gal-3 ( = 0.004) and haemoglobin ( = 0.03) concentration. In multivariate analysis, only Gal-3 concentration higher than 9.2 ng/mL at discharge was associated with a nine-fold increase of risk of composite endpoint occurrence ( = 0.0005, OR = 9.47, 95% CI 2.60-34.45). A significant decrease in Gal-3 concentration was observed in the group of patients after AMI without the endpoint occurrence during observation.
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http://dx.doi.org/10.3390/jcm9061640DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7355423PMC
May 2020

ECG Indices Poorly Predict Left Ventricular Hypertrophy and Are Applicable Only in Individuals With Low Cardiovascular Risk.

J Clin Med 2020 May 6;9(5). Epub 2020 May 6.

Department of Population Medicine and Civilization Diseases Prevention, Medical University of Bialystok, 15-269 Bialystok, Poland.

Background Left ventricular hypertrophy (LVH) is an important risk factor for cardiovascular events. The electrocardiography (ECG) has poor sensitivity, but it is commonly used to detect LVH.

Aim: To evaluate the diagnostic efficacy of known ECG indicators to recognize LVH in subgroups with different cardiovascular risk levels. Methods 676 volunteers were included.

Results: We found that 10.2% of the analyzed population had LVH based on echocardiography. Individuals with LVH were older, had a higher body mass index, higher systolic blood pressure, lower heart rate, higher parameters of insulin resistance, higher cardiovascular risk, and android-type obesity. Variables that remained independently associated with LVH were QRS duration, left atrial volume index, troponin T, and hemoglobin A1c. The receiver operating characteristics (ROC) curve analysis of the Sokolow-Lyon index did not show a significant predictive ability to diagnose LVH in the whole study population including all cardiovascular risk classes. The ROC curves analysis of Cornell and Lewis indices showed a modest predictive ability to diagnose LVH in the general population and in a low cardiovascular class.

Conclusions: There is a need for new, simple methods to diagnose LVH in the general population in order to properly evaluate cardiovascular risk and introduce optimal medical treatment of concomitant disease.
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http://dx.doi.org/10.3390/jcm9051364DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7290685PMC
May 2020

Characterization of Patients with Pulmonary Arterial Hypertension: Data from the Polish Registry of Pulmonary Hypertension (BNP-PL).

J Clin Med 2020 Jan 8;9(1). Epub 2020 Jan 8.

Department of Congenital Heart Disease Institute of Cardiology, 04-628 Warsaw, Poland.

Current knowledge of pulmonary arterial hypertension (PAH) epidemiology is based mainly on data from Western populations, and therefore we aimed to characterize a large group of Caucasian PAH adults of Central-Eastern European origin. We analyzed data of incident and prevalent PAH adults enrolled in a prospective national registry involving all Polish PAH centers. The estimated prevalence and annual incidence of PAH were 30.8/mln adults and 5.2/mln adults, respectively and they were the highest in females ≥65 years old. The most frequent type of PAH was idiopathic ( = 444; 46%) followed by PAH associated with congenital heart diseases (CHD-PAH, = 356; 36.7%), and PAH associated with connective tissue disease (CTD-PAH, = 132; 13.6%). At enrollment, most incident cases (71.9%) were at intermediate mortality risk and the prevalent cases had most of their risk factors in the intermediate or high risk range. The use of triple combination therapy was rare (4.7%). A high prevalence of PAH among older population confirms the changing demographics of PAH found in the Western countries. In contrast, we found: a female predominance across all age groups, a high proportion of patients with CHD-PAH as compared to patients with CTD-PAH and a low use of triple combination therapy.
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http://dx.doi.org/10.3390/jcm9010173DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7019268PMC
January 2020

Chemokines profile in patients with chronic heart failure treated with cardiac resynchronization therapy.

Adv Med Sci 2020 Mar 7;65(1):102-110. Epub 2020 Jan 7.

Department of Population Medicine and Civilization Diseases Prevention, Medical University of Bialystok, Bialystok, Poland. Electronic address:

Purpose: Inflammatory mechanisms have been suggested to play a role in the heart failure with reduced ejection fraction (HF-REF) development, but the role of chemokines is largely unknown. Cardiac resynchronization therapy (CRT) may reverse the HF-REF course. We aimed to evaluate selected chemokines concentrations in HF-REF patients and their relationship with disease severity and clinical response to CRT.

Materials And Methods: The study included 37 patients (64.1 ± 11.04 years, 6 females) with HF-REF subjected to CRT, controlled prior to implantation and after 6 months. The control population included 26 healthy volunteers (63.9 ± 8.1 years, 8 females). Serum chemokines concentrations were determined using multiplex method.

Results: HF-REF patients were characterized by the higher baseline MIF, NAP-2 and PF4 concentrations and lower Axl, BTC, IL-9, and IL-18 BPa concentrations comparing to controls. After 6 months of CRT only NAP-2 concentration decreased significantly in comparison to the baseline values.

Conclusions: HF-REF patients present altered chemokines profile compared to the control group. The CRT-related alleviation of HF-REF causes only slight changes in the chemokines concentrations especially in the platelet-associated ones. The precise chemokines role in the HF-REF pathogenesis and their prognostic value remains to be established.
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http://dx.doi.org/10.1016/j.advms.2019.11.007DOI Listing
March 2020

Treatment of chronic thromboembolic pulmonary hypertension in a multidisciplinary team.

Ther Adv Respir Dis 2019 Jan-Dec;13:1753466619891529

Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, European Health Centre Otwock, Centre of Postgraduate Medical Education, Poland.

Background: Chronic thromboembolic pulmonary hypertension (CTEPH) may be treated with pulmonary endarterectomy (PEA), balloon pulmonary angioplasty (BPA) and medical therapy (MT). Assessment in a multidisciplinary team of experts (CTEPH team) is currently recommended for treatment decision making. The aim of the present study was to report the effects of such an interdisciplinary concept.

Methods And Results: A total of 160 patients were consulted by the CTEPH team between December 2015 and September 2018. Patient baseline characteristics, CTEPH team decisions and implementation rates of diagnostic and therapeutic procedures were analysed. Change in World Health Organization (WHO) functional class and survival rates were evaluated by treatment strategy. A total of 51 (32%) patients were assessed as operable and 109 (68%) were deemed inoperable. Thirty-one (61% of operable patients) underwent PEA. Patients treated with PEA, BPA(+MT) and MT alone were 50.9 ± 14.7, 62.9 ± 15.1 and 68.9 ± 12.7 years old, respectively. At the follow-up, PEA patients had the highest WHO functional class improvement. Patients treated with BPA(+MT) had significantly better survival than PEA ( = 0.04) and MT patients ( = 0.04; 2-year survival of 92%, 79% and 79%, respectively).

Conclusions: The CTEPH team ensures that necessary diagnostic procedures are performed. A relatively low proportion of patients was assessed by the CTEPH team as operable and underwent surgery, which in survivors resulted in the best functional improvement. Although patients undergoing BPA(+MT) were older than patients treated with PEA, their survival was better than patients subjected to PEA or MT alone.
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http://dx.doi.org/10.1177/1753466619891529DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6935880PMC
June 2020

Atrial Fibrillation in Patients with Acute Pulmonary Embolism: Clinical Significance and Impact on Prognosis.

Biomed Res Int 2019 19;2019:7846291. Epub 2019 Aug 19.

Department of Cardiology, Medical University of Bialystok, Poland.

Pulmonary embolism (PE) is one of the most common causes of cardiovascular death. The most often PE etiology is a deep vein thrombosis (DVT) of the lower extremities, but embolic material can arise in pelvic or upper extremity veins as well as in right heart chambers. There is growing number of evidences of atrial fibrillation (AF) involvement in PE. The presence of AF in patients with PE may be both the cause and the consequence of PE. The PE association with AF should be considered in patients without confirmed DVT and with history of AF, which itself is associated with prothrombotic state. The valuable diagnostic method is echocardiography that may bring the insight into source of embolic material. Another possible AF and PE association is the AF as a consequence of an abrupt increase in pulmonary vascular resistance due to the occlusion of the pulmonary vessels. Large-scale population-based studies have provided a considerable body of evidence on the involvement of PE in the onset of subsequent AF. Another important issue is the influence of AF on prognosis in patients with PE. Most investigators demonstrated a negative impact of AF on mortality. The main problem to resolve is whether AF is an independent mortality risk factor or whether it occurs as a result of comorbidities or the severity of a PE episode. Although the pathophysiological basis of this bidirectional relationship exists, many questions are still unresolved and require further studies, including the significance of paroxysmal AF accompanying an acute PE episode, the usefulness of PE risk scales in patients with concomitant AF, and the effect of anticoagulant treatment on PE and AF occurrence. Regardless of the type of AF, clinicians should be alert to the possibility of PE in patients with previous history of AF or presenting with new-onset AF.
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http://dx.doi.org/10.1155/2019/7846291DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6720355PMC
February 2020

Increased platelet content of SDF-1alpha is associated with worse prognosis in patients with pulmonary prterial hypertension.

Platelets 2019 4;30(4):445-451. Epub 2018 Apr 4.

a Department of Cardiology , Medical University of Bialystok , Bialystok , Poland.

Inflammatory processes and platelet activity play an important role in the pathophysiology of pulmonary arterial hypertension (PAH). Enhanced IL-6 signaling and higher concentration of stromal-derived factor alpha (SDF-1) have been previously shown to be linked with prognosis in PAH. We hypothesized that platelets of PAH patients have higher content of IL-6 and SDF-1 and thus are involved in disease progression. We enrolled into study 22 PAH patients and 18 healthy controls. Patients with PAH presented significantly higher plasma concentrations and platelet contents of IL-6, sIL-6R, and SDF-1 than healthy subjects (platelet content normalized to protein concentration: IL-6 (0.85*10 [0.29 - 1.37] vs. 0.45*10 [0.19-0.65], sIL-6R 1.54*10 [1.32-2.21] vs. 1.14*10 [1.01-1.28] and SDF-1 (2.72*10 [1.85-3.23] vs. 1.70*10 [1.43-2.60], all p < 0.05). Patients with disease progression (death, WHO class worsening, or therapy escalation, n = 10) had a significantly higher platelet SDF-1/total platelet protein ratio (3.68*10 [2.45-4.62] vs. 1.69*10 [1.04-2.28], p = 0.001), with no significant differences between plasma levels. Kaplan-Meier analysis revealed that patients with higher platelet SDF-1/total platelet protein ratio had more frequently deterioration of PAH in the follow-up (15.24 ± 4.26 months, log-rank test, p = 0.01). Concentrations of IL-6, sIL-6 receptor and SDF-1 in plasma and platelets are elevated in PAH patients. Higher content of SDF-1 in platelets is associated with poorer prognosis. Our study, despite of limitation due to small number of enrolled patients, suggests that activated platelets may be an important source of cytokines at the site of endothelial injury, but their exact role in the pathogenesis of PAH requires further investigation.
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http://dx.doi.org/10.1080/09537104.2018.1457780DOI Listing
May 2019

The significance of diminished sTWEAK and P-selectin content in platelets of patients with pulmonary arterial hypertension.

Cytokine 2018 07 2;107:52-58. Epub 2017 Dec 2.

Department of Cardiology, Medical University of Bialystok, Sklodowskiej 24a, 15-276 Bialystok, Poland; Department of Population Medicine and Civilization Diseases Prevention, Medical University of Bialystok, Sklodowskiej 24a, 15-276 Bialystok, Poland. Electronic address:

Pulmonary arterial hypertension (PAH) is a progressive disease characterized by proliferative changes in pulmonary arteries. There is growing evidence suggesting that soluble tumor necrosis factor-like weak inducer of apoptosis (sTWEAK) and P-selectin could be involved in PAH development and progression. Here we investigate whether circulating platelets may be a source of sTWEAK and contribute to diminished availability of sTWEAK and P-selectin in PAH patients. We have prospectively enrolled two independent study groups of stable patients with confirmed PAH and age matched controls: derivation (10 PAH; 15 controls) and validation (20 PAH; 12 controls). P-selectin and sTWEAK concentrations were measured in platelet-poor plasma and platelet lysate. To avoid procedural bias, in each group we employed different protocols for platelet isolation. Consistently, both in derivation and validation groups PAH patients presented significantly lower sTWEAK content in platelets than control group with no significant differences in plasma levels. Similarly, patients presented comparable to controls plasma P-selectin concentrations and lower concentration in platelet lysate. Kaplan-Meier analysis revealed that patients with low platelet sTWEAK/total protein concentration ratio had more frequently detoriation of PAH in the follow-up (16.51 ± 3.32 months), log-rank test, p = .03. Patients diagnosed with pulmonary arterial hypertension present diminished sTWEAK and P-selectin storage capacity in platelets. Thrombocytes appear to be a major source of sTWEAK that could be released upon local injury and its decreased availability could have an impact on pathophysiology and prognosis in PAH.
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http://dx.doi.org/10.1016/j.cyto.2017.11.014DOI Listing
July 2018

Interleukin-6 signaling in patients with chronic heart failure treated with cardiac resynchronization therapy.

Arch Med Sci 2017 Aug 17;13(5):1069-1077. Epub 2016 Mar 17.

Department of Cardiology, Medical University of Bialystok, Bialystok, Poland.

Introduction: Increased expression of interleukin-6 (IL-6) has been described in left ventricular dysfunction in the course of chronic heart failure. Cardiac resynchronization therapy (CRT) is a unique treatment method that may reverse the course of chronic heart failure (CHF) with reduced ejection fraction (HF-REF). We aimed to evaluate the IL-6 system, including soluble IL-6 receptor (sIL-6R) and soluble glycoprotein 130 (sgp130), in HF-REF patients, with particular emphasis on CRT effects.

Material And Methods: The study enrolled 88 stable HF-REF patients (63.6 ±11.1 years, 12 females, EF < 35%) and 35 comorbidity-matched controls (63.5 ±9.8 years, 7 females). Forty-five HF-REF patients underwent CRT device implantation and were followed up after 6 months. Serum concentrations of IL-6, sIL-6R and sgp130 were determined using ELISA kits.

Results: The HF-REF patients had higher IL-6 (median: 2.6, IQR: 1.6-3.8 vs. 2.1, IQR: 1.4-3.1 pg/ml, = 0.03) and lower sIL-6R concentrations compared to controls (median: 51, IQR: 36-64 vs. 53. IQR 44-76 ng/ml, = 0.008). There was no significant difference between sgp130 concentrations. In the HF-REF group IL-6 correlated negatively with EF ( = -0.5, = 0.001) and positively with BNP ( = 0.5, = 0.008) and CRP concentrations ( = 0.4, = 0.02). Patients who presented a positive response after CRT showed a smaller change of sIL-6R concentration compared to nonresponders (ΔsIL-6R: -0.2 ±7.1 vs. 7 ±14 ng/ml; = 0.04).

Conclusions: HF-REF patients present higher IL-6 and lower sIL-6R levels. IL-6 concentration reflects their clinical status. CRT-related improvement of patients' functional status is associated with a smaller change of sIL-6R concentration in time.
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http://dx.doi.org/10.5114/aoms.2016.58635DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5575204PMC
August 2017

Paroxysmal Atrial Fibrillation in the Course of Acute Pulmonary Embolism: Clinical Significance and Impact on Prognosis.

Biomed Res Int 2017 9;2017:5049802. Epub 2017 Feb 9.

Department of Cardiology, Medical University of Białystok, Białystok, Poland.

The relationship and clinical implications of atrial fibrillation (AF) in acute pulmonary embolism (PE) are poorly investigated. We aimed to analyze clinical characteristics and prognosis in PE patients with paroxysmal AF episode. . From the 391 patients with PE 31 subjects with paroxysmal AF were selected. This group was compared with patients with PE and sinus rhythm (SR) and 32 patients with PE and permanent AF. . Paroxysmal AF patients were the oldest. Concomitant DVT varies between groups: paroxysmal AF 32.3%, SR 49.5%, and permanent AF 28.1% ( = 0.02). The stroke history frequency was 4.6% SR, 12.9% paroxysmal AF, and 21.9% permanent AF ( < 0.001). Paroxysmal AF comparing to permanent AF and SR individuals had higher estimated SPAP (56 versus 48 versus 47 mmHg, = 0.01) and shorter ACT (58 versus 65 versus 70 ms, = 0.04). Patients with AF were more often classified into high-risk group according to revised Geneva score and sPESI than SR patients. In-hospital mortality was lower in SR (5%) and paroxysmal AF (6.5%) compared to permanent AF group (25%) ( < 0.001). . Patients with PE-associated paroxysmal AF constitute a separate population. More severe impairment of the parameters reflecting RV afterload may indicate relation between PE severity and paroxysmal AF episode. Paroxysmal AF has no impact on short-term mortality.
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http://dx.doi.org/10.1155/2017/5049802DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5322430PMC
March 2017

Correlations between electrocardiogram and biomarkers in acute pulmonary embolism: Analysis of ZATPOL-2 Registry.

Ann Noninvasive Electrocardiol 2017 Jul 18;22(4). Epub 2017 Feb 18.

Department of Pulmonary Circulation and Thromboembolic Diseases, The Medical Centre of Postgraduate Medication, European Health Centre Otwock, Otwock, Poland.

Background: Electrocardiography (ECG) is still one of the first tests performed at admission, mostly in patients (pts) with chest pain or dyspnea. The aim of this study was to assess the correlation between electrocardiographic abnormalities and cardiac biomarkers as well as echocardiographic parameter in patients with acute pulmonary embolism.

Methods: We performed a retrospective analysis of 614 pts. (F/M 334/280; mean age of 67.9 ± 16.6 years) with confirmed acute pulmonary embolism (APE) who were enrolled to the ZATPOL-2 Registry between 2012 and 2014.

Results: Elevated cardiac biomarkers were observed in 358 pts (74.4%). In this group the presence of atrial fibrillation (p = .008), right axis deviation (p = .004), S Q T sign (p < .001), RBBB (p = .006), ST segment depression in leads V -V (p < .001), ST segment depression in lead I (p = .01), negative T waves in leads V -V (p < .001), negative T waves in leads V -V (p = .005), negative T waves in leads II, III and aVF (p = .005), ST segment elevation in lead aVR (p = .002), ST segment elevation in lead III (p = .0038) was significantly more frequent in comparison to subjects with normal serum level of cardiac biomarkers. In multivariate regression analysis, clinical predictors of "abnormal electrocardiogram" were as follows: increased heart rate (OR 1.09, 95% CI 1.02-1.17, p = .012), elevated troponin concentration (OR 3.33, 95% CI 1.94-5.72, p = .000), and right ventricular overload (OR 2.30, 95% CI 1.17-4.53, p = .016).

Conclusions: Electrocardiographic signs of right ventricular strain are strongly related to elevated cardiac biomarkers and echocardiographic signs of right ventricular overload. ECG may be used in preliminary risk stratification of patient with intermediate- or high-risk forms of APE.
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http://dx.doi.org/10.1111/anec.12439DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6931873PMC
July 2017

The strengths and weaknesses of non-invasive parameters obtained by echocardiography and cardiopulmonary exercise testing in comparison with the hemodynamic assessment by the right heart catheterization in patients with pulmonary hypertension.

Adv Med Sci 2017 Mar 14;62(1):39-44. Epub 2016 Jun 14.

Department of Cardiology, Medical University of Bialystok, Bialystok, Poland; Department of Community Medicine and Civilization Disease Prevention, Medical University of Bialystok, Bialystok, Poland. Electronic address:

Purpose: Pulmonary hypertension (PH) diagnosis requires invasive assessment by right heart catheterization (RHC), but screening and monitoring are performed using non-invasive methods: echocardiography and cardiopulmonary exercise testing (CPET). The aim of the study was to assess correlations between the parameters obtained in non-invasive testing and RHC in patients with PH of different etiologies.

Material/methods: The study included 53 medical records of PH patients (32 women) aged 29-81 years. We analyzed correlations between RHC (systolic pulmonary artery pressure (sPAP), diastolic pulmonary artery pressure (dPAP), pulmonary vascular resistance (PVR), cardiac output (CO)) and echocardiographic (tricuspid annular plane systolic excursion (TAPSE), sPAP) and CPET parameters (end-tidal oxygen and carbon dioxide pressures (PetO, PetCO), ventilation efficiency (VE/VCO) slope).

Results: Echocardiographic estimation correlated well with RHC measurement of sPAP (r=0.65, P<0.001). TAPSE correlated with PVR assessed with thermodilution method (r=-0.5, P=0.005), dPAP (r=-0.53, P=0.002) and CO (r=0.53, P=0.002). PVR assessed with thermodilution and Fick methods showed positive correlation with PetO (r=0.74, P<0.001 and r=0.72, P<0.001) and negative correlation with PetCO (r=-0.59, P=0.004 and r=-0.64, P=0.002) at the anaerobic threshold. VE/VCO slope correlated with dPAP (r=0.43, P=0.04) and PVR calculated with both methods (r=0.52, P=0.01 and r=0.52, P=0.02).

Conclusions: Simple cardiac function indicators obtained by commonly used non-invasive methods allow only approximate estimation of the main hemodynamic RHC-derived parameters: sPAP, CO and PVR. Obtained results suggest the relationship between RV dysfunction and ventilation abnormalities in PH patients.
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http://dx.doi.org/10.1016/j.advms.2016.06.001DOI Listing
March 2017

Differences of psychological features in patients with heart failure with regard to gender and aetiology - Results of a CAPS-LOCK-HF (Complex Assessment of Psychological Status Located in Heart Failure) study.

Int J Cardiol 2016 Sep 15;219:380-6. Epub 2016 Jun 15.

Laboratory for Applied Research on Cardiovascular System, Wroclaw Medical University, Wroclaw, Poland; Department of Cardiology, Center for Heart Diseases, Military Hospital in Wroclaw, Wroclaw, Poland;

Objective: Objective of the study was to assess the psychological state of HF patients with reduced ejection fraction (HFrEF) with regard to gender and aetiology.

Methods: 758 patients with HFrEF (mean age - 64±11years, men - 79%, NYHA class III-IV - 40%, ischemic aetiology - 61%) in a prospective Polish multicenter Caps-Lock-HF study. Scores on five different self-report inventories: CISS, MHLC, GSES, BDI and modified Mini-MAC were compared between the sexes taking into account the aetiology of HFrEF.

Results: There were differences in the CISS and BDI score between the genders - women had higher CISS (emotion- and avoidance-oriented) and BDI (general score - 14.2±8.7 vs 12.3±8.6, P<0.05; subscale - somatic score - 7.3±3.7 vs 6.1±3.7, P<0.05). In the ischemic subpopulation, women had higher BDI (general and subscales) than men. In the non-ischemic subpopulation the differences between genders were limited to CISS scale. In a multivariable analysis with demographic and clinical data female sex, NYHA class, atrial fibrillation and diabetes mellitus determined BDI score. Similarly, in the ischemic subpopulation, the female sex, NYHA class and atrial fibrillation determined the BDI, while in the non-ischemic population NYHA class was the only factor that influenced the BDI score. Adding the psychological data made a significant additional contribution to the prediction of depression status.

Conclusions: There are distinct differences in psychological features with regard to gender in patients with HFrEF. Women demonstrate less favourable psychological characteristics. Gender-related differences in BDI score are especially explicit in patients with ischemic aetiology of HF. The BDI score is related to psychological predisposition.
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http://dx.doi.org/10.1016/j.ijcard.2016.06.036DOI Listing
September 2016

Alterations of soluble TWEAK and CD163 concentrations in patients with chronic heart failure.

Cytokine 2016 Apr 22;80:7-12. Epub 2016 Feb 22.

Department of Cardiology, Medical University of Bialystok, Poland; Department of Community Medicine and Civilization Disease Prevention, Medical University of Bialystok, Poland. Electronic address:

Unlabelled: Inflammatory activation plays a pivotal role in chronic heart failure with reduced ejection fraction (HF-REF). A novel mediator from TNF family: soluble tumor necrosis factor-like weak inducer of apoptosis (sTWEAK) along its soluble decoy receptor CD163 (sCD163) recently has been investigated in other cardiovascular pathologies. We aimed to evaluate sTWEAK and sCD163 concentrations in HF-REF patients. The study enrolled 79 patients with stable HF-REF, EF < 35%. The control population without history of heart failure included two groups: 26 comorbidities matched patients and 27 healthy volunteers. sTWEAK and sCD163 serum concentrations were determined using ELISA kits. Univariate and multivariate analysis was performed to assess variables affecting concentration of sTWEAK and sCD163. HF-REF patients were characterized by higher sTWEAK (median 374 IQR: 321-429 vs 201 IQR: 145-412pg/ml, P=0.005), sCD163 (median 744 IQR: 570-1068 vs 584 IQR: 483-665pg/ml, P=0.03) concentrations and sTWEAK/sCD163 ratio (median 0.53 IQR: 0.32-0.7 vs 0.3 IQR: 0.22-0.37, P=0.001) comparing to healthy volunteers. Comparing to comorbidities matched controls, HF-REF patients had lower sTWEAK levels (median 374 IQR: 321-429 vs 524 IQR: 384-652pg/ml; P=0.002), while sCD163 and sTWEAK/sCD163 ratio didn't differ. Concentration of sTWEAK in HF-REF was affected by white blood cell count and aspirin intake, while sCD163 by exercise capacity, LV diastolic volume, CRP and presence of arterial hypertension.

Conclusions: HF-REF patients present increased sTWEAK and sCD163 levels as well as sTWEAK/sCD163 ratio when compared to healthy subjects, however CHF itself appears to be associated with down-regulation of sTWEAK.
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http://dx.doi.org/10.1016/j.cyto.2016.02.005DOI Listing
April 2016

Perception of health control and self-efficacy in heart failure.

Kardiol Pol 2016 ;74(2):168-178

Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland Department of Physiology, Wroclaw Medical University, Wroclaw, Poland Department of Cardiology, Centre for Heart Disease, Military Hospital, Wroclaw, Poland.

Background: The issue of self-perceived health control and related sense of self-efficacy has not received any attention in patients with heart failure (HF), although these psychological features have been established to determine the patients' approach towards healthcare professionals and their recommendations, which strongly affects compliance.

Methods: A total of 758 patients with systolic HF (age: 64 ± 11 years, men: 79%, NYHA class III–IV: 40%, ischaemic aetiology: 61%) were included in a prospective Polish multicentre Caps-Lock-HF study. A Multidimensional Health Locus of Control (MHLC) scale was used to assess subjective perception of health control in three dimensions (internal control, external control by the others, and by chance); the Generalised Self Efficacy scale (GSES) was used to estimate subjective sense of self-efficacy; and the Beck Depression Inventory (BDI) was used to determine depressive symptoms.

Results: The majority of patients perceived the external control (by the others) and internal control of their health as high (77% and 63%, respectively) or moderate (22% and 36%, respectively), whereas self-efficacy was perceived as high or moderate (63% and 27%), which was homogenous across the whole spectrum of the HF cohort, being unrelated to HF severity, HF duration, the presence of co-morbidities, and the applied treatment. The stronger the perception of internal health control, the higher the self-efficacy (p < 0.05); both features were related to less pronounced depressive symptoms (p < 0.05).

Conclusions: The established pattern of self-perceived control of own health and self-efficacy indicates that patients with HF acknowledge the role of others (i.e. healthcare providers) and themselves in the process of the management of HF, and are convinced about the high efficacy of their undertaken efforts. Such evidence supports implementation of a partnership model of specialists’ care of patients with HF.
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http://dx.doi.org/10.5603/KP.a2015.0137DOI Listing
February 2017

Enhanced IL-6 trans-signaling in pulmonary arterial hypertension and its potential role in disease-related systemic damage.

Cytokine 2015 Dec 9;76(2):187-192. Epub 2015 Jul 9.

Department of Cardiology, Medical University of Bialystok, ul. M. Sklodowskiej-Curie 24 A, 15-276 Bialystok, Poland. Electronic address:

Background: The role of IL-6 in pulmonary arterial hypertension (PAH) has been reported but the prevalence of soluble receptors for IL-6: sIL-6R and sgp130 and its potential role in PAH have not been studied.Our aim was to examine the IL-6 together with the soluble receptors and to assess its relationship with clinical status of PAH patients as well as to assess its potential prognostic significance.

Methods: Serum concentrations of IL-6, sIL-6R and sgp130 were quantified by ELISA in 26 patients with PAH and 27 healthy controls and related to functional and biochemical parameters and clinical outcome in PAH group. The PAH patients were followed up for 1 year, noting the end point of clinical deterioration (WHO class change, the need for escalation of therapy) or death.

Results: The PAH group was characterized by higher median serum IL-6 [2.38 (IQR 1.56-3.75) vs 0.87 (0.63-1.3) pg/ml, p=0.000003] and sIL-6R concentrations [69.7 (IQR 60.4-84.4 vs 45.7 (34.6-70.3) ng/ml, p=0.0036] compared to control subjects. Both groups did not differ in sgp130 concentrations. There were significant correlations in PAH group between IL-6 levels and uric acid, parameters of ventilatory efficiency in cardiopulmonary exercise testing: VE/VO2, VE/VCO2, VE/VCO2 slope and peak PetCO2. sIL-6R levels inversely correlated with LDL cholesterol. After 1 year the clinical deterioration occurred in 11 patients, 15 remained stable. Patients in whom the clinical deterioration occurred showed significantly higher baseline concentrations of IL-6 [3.25 (IQR 2.46-5.4) pg/ml vs 1.68 (1.38-2.78) pg/ml, p=0.004], but not sIL-6R. Median IL-6 ⩾ 2.3 pg/ml (91% sensitivity, 73% specificity) identified subjects with worse clinical course. In the univariate analysis, higher IL-6 level at baseline was associated with increased risk and earlier occurrence of clinical deterioration (HR 1.42, 95%CI 1.08-1.85, p=0.015).

Conclusions: IL-6 trans-signaling is enhanced in PAH. Elevated concentration of sIL-6R suggests its potential unfavorable role in systemic amplification of IL-6 signaling in PAH. Levels of IL-6 are associated with clinical indicators of disease severity as well as indirectly with systemic metabolic alterations. IL-6 shows prognostic value regarding predicting clinical deterioration.
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http://dx.doi.org/10.1016/j.cyto.2015.06.018DOI Listing
December 2015

Circulating classical CD14++CD16- monocytes predict shorter time to initial treatment in chronic lymphocytic leukemia patients: Differential effects of immune chemotherapy on monocyte-related membrane and soluble forms of CD163.

Oncol Rep 2015 Sep 26;34(3):1269-78. Epub 2015 Jun 26.

Department of Regenerative Medicine and Immune Regulation, Medical University of Bialystok, Bialystok, Poland.

Three main monocyte subsets: classical CD14++CD16-, intermediate CD14++CD16+ and non-classical CD14+CD16++, differentially regulate tumor growth and survival. Thereby, in the present study we aimed to determine the role of distinct monocyte subsets in the prognostication of chronic lymphocytic leukemia (CLL). Moreover, we set out to analyze the effects of standard immune chemotherapy on different monocyte subsets and levels of membrane-associated and soluble forms of CD163, a monocyte/macrophage-related immunomodulatory protein. We demonstrated that the number of peripheral blood classical CD14++CD16- monocytes assessed at the time of diagnosis was negatively correlated with lymphocytosis and was decreased in the CLL patients who required immediate treatment as opposed to patients who qualified to 'watch and wait' strategy. Notably, lower baseline levels of classical CD14++CD16- monocytes in CLL patients who were qualified for 'watch and wait' therapy were associated with shorter time to initial treatment. Notably, therapy with rituximab, cyclophosphamide and fludarabine resulted in a significant reduction in the number of non-classical CD14+CD16++ monocytes and soluble form of CD163 but upregulation of membrane-associated monocyte CD163. Our data indicate that distinct monocyte subsets and two forms of CD163 are differentially modulated by both CLL and immune chemotherapy. Moreover, we proposed that quantification of classical monocytes at the time of diagnosis contributes to better prognostication of CLL patients.
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http://dx.doi.org/10.3892/or.2015.4088DOI Listing
September 2015

Efficacy of invasive treatment and the occurrence of cardiac rupture in acute ST-elevation myocardial infarction.

Kardiol Pol 2011 ;69(8):795-800

Department of Cardiology, Medical University of Bialystok, Poland.

Background: Cardiac rupture is a rare but potentially lethal complication of acute myocardial infarction with ST-elevation (STEMI). Primary percutaneous coronary intervention (pPCI) is a preferable treatment method of acute STEMI. Reperfusion at vascular and myocardial levels may be the key parameters determining probability of cardiac rupture.

Aim: To analyse the relationship between reperfusion parameters and cardiac rupture occurrence in a group of patients with STEMI treated with pPCI.

Methods: Twenty three patients with cardiac rupture were selected out of 2800 patients with acute STEMI hospitalised and treated with pPCI from 2000 to 2007. Free wall or interventricular septum rupture was diagnosed on echocardiography or autopsy. The control group consisted of 255 patients with STEMI and pPCI treatment, but without cardiac rupture. The TIMI flow score was used to assess blood flow in an infarct-related artery (IRA). Myocardial perfusion was evaluated with the use of the myocardial blush grade (MBG) score.

Results: Female gender accounted for 47.8% of patients with cardiac rupture. Mean age was 72.9 ± 4.8 years for women and 64.3 ± 11.5 years for men. In 12 (52%) patients anterior descending artery was the IRA. Before the pPCI, the average blood flow in IRA was significantly lower in patients with subsequent cardiac rupture (0.41 ± 0.59) than in the reference group (0.81 ± 1.15; p < 0.05), and remained lower after pPCI (1.96 ± 0.93 in comparison to 2.93 ± 0.36; p < 0.05). Adequate blood flow (TIMI 3) was achieved only in 30.4% (7) of patients with cardiac rupture and in 95.3% (243) of the control group (p < 0.05). Myocardial tissue perfusion, assessed by MBG, was also lower (0.76 ± 1 vs 1.92 ± 1.13; p < 0.05). In-hospital mortality in patients with cardiac rupture reached 56.5% (13 subjects) compared to 3 (1.2%) patients in the reference group (p < 0.05). Multivariable analysis confirmed independent effects of lower TIMI and MBG after PCI as well as female gender on the occurrence of cardiac rupture.

Conclusions: Poorer blood flow in IRA and worse tissue microvascular perfusion after pPCI are important risk factors of cardiac rupture occurrence in patients with STEMI.
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February 2012