Publications by authors named "Piotr Podolec"

331 Publications

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

Relationships between circulating galectin-3, extracellular matrix fibrosis and outcomes in dilated cardiomyopathy.

Adv Clin Exp Med 2021 Mar;30(3):245-253

Department of Cardiac and Vascular Disease, John Paul II Hospital, Jagiellonian University Medical College, Kraków, Poland.

Background: Galectin-3 is an emerging biomarker in cardiovascular disease. Myocardial galectin-3 is involved in the pathology of cardiac fibrosis; however, the role of circulating galectin-3 is not yet established.

Objectives: To assess the relationships between circulating galectin-3, fibrosis and outcomes in dilated cardiomyopathy (DCM).

Material And Methods: We included 70 patients (age: 48 ±12.1 years, ejection fraction (EF) 24.4 ±7.4%) with new-onset DCM (n = 35, ≤6 months). Galectin-3 and procollagen type I and III (PICP, PINP, PIIICP, and PIIINP), transforming growth factor β (TGF-β), connective tissue growth factor (CTGF), osteopontin (OPN), matrix metalloproteinases (MMP-2 and -9), and tissue inhibitor (TIMP-1) were determined in serum at baseline and after 3 and 12 months. Patients underwent endomyocardial biopsy. The endpoint was a combination of death and urgent hospitalization at 12 months.

Results: Galectin-3 did not correlate with biopsy-determined fibrosis. Baseline galectin-3 correlated with OPN,, TIMP-1, PIIICP, and MMP-2. In new-onset DCM, galectin-3 levels at baseline were higher than at 3 and 12 months, whereas in chronic DCM there was no difference. Galectin-3 was a predictor of the endpoint (hazard ratio (HR) = 1.115; 95% confidence interval (95% CI) = 1.009-1.231; p < 0.05). The best cut-off value was 14.54 ng/mL (area under the curve (AUC) = 0.67). Patients with galectin-3 ≥14.54 ng/mL had an increased risk of events (HR = 2.569; 95% CI = 1.098-6.009; p < 0.05).

Conclusions: Circulating galectin-3 is unrelated to fibrosis. Serial measurements of galectin-3 correlated with markers of fibrosis, including markers of collagen synthesis and OPN. Circulating galectin-3 was independently associated with cardiovascular (CV) outcomes in DCM.
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http://dx.doi.org/10.17219/acem/115081DOI Listing
March 2021

Chronotropic incompetence causes multiple organ complications in adults after the Fontan procedure.

Kardiol Pol 2021 04 2;79(4):410-417. Epub 2021 Mar 2.

Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland; John Paul II Hospital, Kraków, Poland.

Background: Although patients undergoing the Fontan procedure (FP) present a normal or close‑to‑‑normal function of the systemic ventricle, they cannot generate cardiac output or exhibit similar exercise capacity as their healthy peers. This can be attributed to chronotropic incompetence and multiple organ complications.

Aims: We evaluated the prevalence of chronotropic incompetence in adults after FP and assessed the relationship between heart rate reserve (HRR) and multiple organ complications.

Methods: Data were obtained from 50 post‑FP patients (mean [SD] age, 27 [6.6] years) and 30 healthy controls matched for age and sex. All patients were subjected to clinical examination, laboratory tests, echocardiography, cardiopulmonary exercise test, and chronotropic function evaluation.

Results: Cardiopulmonary exercise test parameters were impaired in the post‑FP group. Chronotropic incompetence was identified in 46 patients (92%), who also had a lower median (interquartile range) chronotropic index (0.55 [0.47-0.62] vs 0.93 [0.88-0.99]; P <0.001) and a greater median (interquartile range) HRR (32 [24-60] bpm vs 8 [1-14] bpm, P <0.001). A negative correlation was observed between HRR and peak oxygen uptake, and a positive one between HRR and the peak ventilatory equivalent for CO2 and mean platelet volume. The study revealed the diagnostic utility of HRR in detecting an abnormal peak ventilatory equivalent for O2, alkaline phosphatase levels, the ratio of aspartate transaminase to alanine transaminase levels, and mean platelet volume.

Conclusions: Chronotropic incompetence correlates with impaired exercise capacity, liver dysfunction, and platelet abnormalities in post‑FP patients. Heart rate reserve may be a promising indicator of organ complications as well as a sign of future bradyarrhythmia and the need for cardiac pacing.
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http://dx.doi.org/10.33963/KP.15853DOI Listing
April 2021

Temporal changes in the secondary prevention of coronary artery disease in patients following myocardial revascularization.

Postepy Kardiol Interwencyjnej 2020 Dec 29;16(4):422-428. Epub 2020 Dec 29.

First Department of Cardiology, Interventional Electrocardiology and Hypertension, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland.

Introduction: Well-organized, effective secondary prevention of coronary artery disease (CAD) has a potential to improve the patients' prognosis following myocardial revascularization procedures.

Aim: To evaluate overtime changes in the implementation of the ESC guidelines for secondary prevention by assessing control of the main risk factors and the rate of cardioprotective drug use in patients following myocardial revascularization procedures.

Material And Methods: Patients aged < 81 years who had been hospitalized for a myocardial revascularization procedure in five hospitals serving Krakow and surrounding districts were recruited and interviewed 6-18 months following discharge. Their personal medical history, medication use and control of the main cardiovascular risk factors were evaluated using a standard questionnaire in 2006-2007, 2011-2013, and 2016-2017. The same five hospitals took part in surveys on each occasion.

Results: We examined 260 patients in 2006-2007, 200 in 2011-2013 and 190 in 2016-2017. We noted a significant difference in the management of surveys participants: 62% underwent percutaneous coronary intervention (PCI) and 38% coronary artery coronary artery bypass grafting (CABG) in 2006-2007 whereas the corresponding proportions in 2016-2017 were 90% and 10%. The proportion of patients who did not achieve target blood pressure (according to ESC guidelines valid at the time of each survey) in 2006-2007, 2011-2013 and 2016-2017 was 53.5%, 52.3%, and 38.9%, respectively, the proportion of those who did not achieve the LDL cholesterol target (according to ESC guidelines valid at the time of each survey) was 36.3%, 64.0%, and 61.7%, respectively, and the proportion of those with high fasting glucose was 12.6%, 14.6%, and 19.7%, respectively. The proportion of smokers was 16.2%, 19.5%, and 16.8%, whereas 30.5%, 28.6% and 40.5% of patients were obese in 2006-2007, 2011-2013 and 2016-2017, respectively. The proportion of patients taking antiplatelets (91.8% vs. 92.0% vs. 96.3%), β-blockers (90.3% vs. 87.5% vs. 92.6%), and lipid-lowering drugs (88.7% vs. 91.0% vs. 93.7%) did not change significantly.Conclusions: The analysis of three multicenter surveys provides evidence of the considerable potential for a further reduction in cardiovascular risk in patients following elective myocardial revascularization in Poland.
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http://dx.doi.org/10.5114/aic.2020.101767DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7863836PMC
December 2020

Obesity in patients with established coronary artery disease over a 20-year period (1997-2017).

Pol Arch Intern Med 2021 01 8;131(1):26-32. Epub 2021 Jan 8.

Background: Body mass reduction in overweight and obese people so as to reduce blood pressure, low‑density lipoprotein cholesterol level, and the risk of type 2 diabetes as well as to lower the risk of recurrent cardiovascular events is strongly recommended in current guidelines.

Objectives: To evaluate changes in body mass index (BMI) and waist circumference in patients with established coronary artery disease over a 20‑year period (1997-2017).

Patients And Methods: Consecutive patients younger than 71 years of age and hospitalized for acute coronary syndrome or myocardial revascularization procedures were recruited and interviewed 6 to 18 months after their discharge from hospital. Weight, height, and waist circumference were measured in 1997 to 1998, 1999 to 2000, 2006 to 2007, 2011 to 2013, and 2016 to 2017. The same 5 hospitals took part in the surveys each time.

Results: We examined 412 patients in 1997 to 1998 (survey 1), 427 in 1999 to 2000 (survey 2), 422 in 2006 to 2007 (survey 3), 462 in 2011 to 2013 (survey 4), and 272 in 2016 to 2017 (survey 5). The proportion of obese patients was 24.5% in survey 1, 27.2% in survey 2, 34.1% in survey 3, 35.9% in survey 4, and 40.4% in survey 5 (P <0.001). The proportion of patients with central obesity also increased significantly (32.5% in survey 1, 40.5% in survey 2, 51.4% in survey 3, 48.6% in survey 4, and 61.3% in survey 5; P <0.001). BMI increased significantly in men, but not in women, whereas the mean waist circumference increased in both sexes. BMI and waist circumference increased irrespective of age and education.

Conclusions: The analysis of 5 multicenter surveys showed a gradual increase in BMI and waist circumference in patients with established coronary artery disease over the course of 2 decades.
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http://dx.doi.org/10.20452/pamw.15742DOI Listing
January 2021

Flow Cytometric Assessment of Endothelial and Platelet Microparticles in Patients With Atrial Fibrillation Treated With Dabigatran.

Clin Appl Thromb Hemost 2020 Jan-Dec;26:1076029620972467

Department of Cardiac and Vascular Diseases, Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, John Paul II Hospital, Cracow, Poland.

The prothrombotic state in patients with atrial fibrillation (AF) is related to endothelial injury, the activation of platelets and the coagulation cascade. We evaluated the levels of platelet- (CD42b) and endothelial-derived (CD144) microparticles in the plasma patients with non-valvular AF treated with dabigatran at the time of expected minimum and maximum drug plasma concentrations. Following that, we determined the peak dabigatran plasma concentration (c ). CD42b increased after taking dabigatran (median [IQR] 36.7 [29.4-53.3] vs. 45.6 [32.3-59.5] cells/µL; p = 0.025). The concentration of dabigatran correlated negatively with the post-dabigatran change in CD42b (ΔCD42b, r = -0.47, p = 0.021). In the multivariate model, the independent predictors of ΔCD42b were: c (HR -0.55; with a 95% confidence interval, CI [-0.93, -0.16]; p = 0.007), coronary artery disease (CAD) (HR -0.41; 95% CI [-0.79, -0.02]; p = 0.037) and peripheral artery disease (PAD) (HR 0.42; 95% CI [0.07, 0.74]; p = 0.019). CD144 did not increase after dabigatran administration. These data suggest that low concentrations of dabigatran may be associated with platelet activation. PAD and CAD have distinct effects on CD42b levels during dabigatran treatment.
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http://dx.doi.org/10.1177/1076029620972467DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7787695PMC
November 2020

Hemodynamic Effects of Ultrasound-Assisted, Catheter-Directed, Very Low-Dose, Short-Time Duration Thrombolysis in Acute Intermediate-High Risk Pulmonary Embolism (from the EKOS-PL Study).

Am J Cardiol 2021 02 18;141:133-139. Epub 2020 Nov 18.

Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, Institute of Cardiology, John Paul II Hospital, Krakow, Poland.

Ultrasound-assisted, catheter-directed, low-dose thrombolysis (USAT) at an average alteplase dose of 20 mg infused over 12 to 24 hours reversed right ventricular disfunction and improved pulmonary hemodynamics in intermediate-high-risk pulmonary embolism patients. As bleeding risk increases with the thrombolytic dose, establishing a minimal effective USAT dosing regimen is of clinical importance. We aimed to investigate hemodynamic effects and safety of a very low-alteplase-dose USAT of 10 mg administered within 5 hours. We included 12 consecutive intermediate-high-risk pulmonary embolism patients with symptoms duration of <14 days and proximal thrombi location in pulmonary arteries. Pulmonary Embolism Response Team decision-based fixed, bilateral ultrasound-assisted alteplase infusions at the rate of 1mg/hour/catheter for 5 hours through EKOS system catheters were made. The primary efficacy measure was the change in invasive systolic and mean pulmonary arteries pressure, and in cardiac index from USAT start to termination. Safety measures were 180-day all-cause death or cardiopulmonary decompensation and bleeding complications. The systolic pulmonary arteries pressure and mean pulmonary arteries pressure decreased from 53 (45.5 to 59) to 37.5 (27.5 to 40.5) mm Hg (p = 0.02) and from 29.5 (27.5 to 32) to 21.5 (15.5 to 25) mm Hg (p = 0.02), respectively. The cardiac index increased from 1.6 (1.5 to 1.8) to 2.2 (1.9 to 2.4) l/min/m, (p = 0.02). No deaths, decompensations, or need for therapy intensification occurred. There was 1 episode of access-site bleeding, which subsided after conservative management. No intracranial hemorrhages appeared. In conclusion, reduced dose and duration USAT improved pulmonary hemodynamics and cardiac function leading to cardiopulmonary stabilization in intermediate-high risk pulmonary embolism patients at a low periprocedural risk.
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http://dx.doi.org/10.1016/j.amjcard.2020.11.004DOI Listing
February 2021

PERSONALITY TRAITS OF PATIENTS SUFFERING FROM PFO AND ASD AND INFLUENCE OF COVID-19 PANDEMIC TIME FOR PATIENTS SUFFERING FROM CONGENITAL HEART DEFECTS.

Wiad Lek 2020 ;73(9 cz. 2):1926-1933

CLINICAL DEPARTMENT OF CARDIAC AND VASCULAR DISEASES WITH THE INTENSIVE CARDIAC SUPERVISION SUBDIVISION, INSTITUTE OF CARDIOLOGY, COLLEGIUM MEDICUM OF THE JAGIELLONIAN UNIVERSITY IN CRACOW, JOHN PAUL II HOSPITAL, CRACOW, POLAND.

Objective: Introduction: The work presents a research project carried out in John Paul II Hospital in Cracow in Clinical Department of Cardiac and Vascular Diseases with the Intensive Cardiac Supervision Subdivision, with participation of 100 (50 F, 50 M) patients with congenital heart defects. The purpose of the work is to resolve the issue of personality specifics, and thus the different characteristics of people who suffer from congenital heart defects. Therefore, the following questions should be answered: Is there a relationship between personality traits and the occurrence of a congenital heart defect? What personality traits are characteristic for patients with congenital heart defects? The aim: We aimed to assess personality traits of clients suffering from PFO and ASD. The article also talks about how coronavirus pandemic affects patients with congenital heart disease.

Patients And Methods: Materials and methods: The research was conducted by psychologist Adrianna Skoczek. We performed a psychological clinical assessment and conducted the psychological tests like Eysenck Personality Questionnaire-Revised Short Version [EPQ-R(S)] and Eysenck's Impulsivity Inventory [IVE] by Hans J. Eysenck and Sybil G. Eysenck, the State-Trait Anxiety Inventory [STAI] by C. D. Spielberger, R. L. Gorsuch, R. E. Lushene describing personality traits of patients. Patients (F=50, M=50), with ASD (n=70) and with PFO (n=30).

Results: Results: In people suffering from ASD, the level of declared empathy was statistically significantly higher than the levels of impulsiveness and tendency to risk-taking. In people suffering from PFO, a statistically significant difference was observed only between the level of psychoticism and other variables. The level of declared empathy was statistically significantly higher than the levels of impulsiveness and tendency to risk-taking, a statistically significant difference was found between the analyzed variables - anxiety as a trait and anxiety as a condition.

Conclusion: Conclusions: The results of the study allowed us to isolate the specific personality traits of patients suffering from congenital heart defects.
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November 2020

Myocardial proteomic profile in pulmonary arterial hypertension.

Sci Rep 2020 09 1;10(1):14351. Epub 2020 Sep 1.

Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, Kraków, Poland.

Pulmonary arterial hypertension (PAH) is a rare, fatal, and incurable disorder. Although advances in the understanding of the PAH pathobiology have been seen in recent years, molecular processes underlying heart remodelling over the course of PAH are still insufficiently understood. Therefore, the aim of this study was to investigate myocardial proteomic profile of rats at different stages of monocrotaline-induced PAH. Samples of left and right ventricle (LV and RV) free wall collected from 32 Wistar rats were subjected to proteomic analysis using an isobaric tag for relative quantitation method. Hemodynamic parameters indicated development of mild elevation of pulmonary artery pressure in the early PAH group (27.00 ± 4.93 mmHg) and severe elevation in the end-stage PAH group (50.50 ± 11.56 mmHg). In early PAH LV myocardium proteins that may be linked to an increase in inflammatory response, apoptosis, glycolytic process and decrease in myocardial structural proteins were differentially expressed compared to controls. During end-stage PAH an increase in proteins associated with apoptosis, fibrosis and cardiomyocyte Ca currents as well as decrease in myocardial structural proteins were observed in LV. In RV during early PAH, especially proteins associated with myocardial structural components and fatty acid beta-oxidation pathway were upregulated. During end-stage PAH significant changes in RV proteins abundance related to the increased myocardial structural components, intensified fibrosis and glycolytic processes as well as decreased proteins related to cardiomyocyte Ca currents were observed. At both PAH stages changes in RV proteins linked to apoptosis inhibition were observed. In conclusion, we identified changes of the levels of several proteins and thus of the metabolic pathways linked to the early and late remodelling of the left and right ventricle over the course of monocrotaline-induced PAH to delineate potential therapeutic targets for the treatment of this severe disease.
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http://dx.doi.org/10.1038/s41598-020-71264-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7462861PMC
September 2020

Mortality risk in dilated cardiomyopathy: the accuracy of heart failure prognostic models and dilated cardiomyopathy-tailored prognostic model.

ESC Heart Fail 2020 10 27;7(5):2455-2467. Epub 2020 Aug 27.

Department of Cardiac and Vascular Diseases, Jagiellonian University Collegium Medicum, John Paul II Hospital, Prądnicka Street 80, Kraków, 31-202, Poland.

Aims: The aims of this paper were to investigate the analytical performance of the nine prognostic scales commonly used in heart failure (HF), in patients with dilated cardiomyopathy (DCM), and to develop a unique prognostic model tailored to DCM patients.

Methods And Results: The hospital and outpatient records of 406 DCM patients were retrospectively analysed. The information on patient status was gathered after 48.2 ± 32.0 months. Tests were carried out to ascertain the prognostic accuracy in DCM using some of the most frequently applied HF prognostic scales (Barcelona Bio-Heart Failure, Candesartan in Heart Failure-Assessment of Reduction in Mortality and Morbidity, Studio della Streptochinasi nell'Infarto Miocardico-Heart Failure, Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure, Meta-Analysis Global Group in Chronic Heart Failure, MUerte Subita en Insuficiencia Cardiaca, Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure, Seattle Heart Failure Model) and one dedicated to DCM, that of Miura et al. At follow-up, 70 DCM patients (17.2%) died. Most analysed scores substantially overestimated the mortality risk, especially in survivors. The prognostic accuracy of the scales were suboptimal, varying between 60% and 80%, with the best performance from Barcelona Bio-Heart Failure and Seattle Heart Failure Model for 1-5 year mortality [areas under the receiver operating curve 0.792-0.890 (95% confidence interval 0.725-0.918) and 0.764-0.808 (95% confidence interval 0.682-0.934), respectively].Based on our accumulated data, a self-developed DCM prognostic model was constructed. The model consists of age, gender, body mass index, symptoms duration, New York Heart Association class, diabetes mellitus, prior stroke, abnormal liver function, dyslipidaemia, left bundle branch block, left ventricle end-diastolic diameter, ejection fraction, N terminal pro brain natriuretic peptide, haemoglobin, estimated glomerular filtration rate, and pharmacological and resynchronisation therapy. This newly created prognostic model outperformed the analysed HF scales.

Conclusions: An analysis of various HF prognostic models found them to be suboptimal for DCM patients. A self-developed DCM prognostic model showed improved performance over the nine other models studied. However, further validation of the prognostic model in different DCM populations is required.
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http://dx.doi.org/10.1002/ehf2.12809DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7524139PMC
October 2020

First experience with sodium-glucose co-transporter 2 inhibitors in Polish patients with cardiovascular diseases.

Cardiol J 2020 13;27(5):639-641. Epub 2020 Aug 13.

Collegium Medicum of Jagiellonian University, Department of Cardiac and Vascular Diseases, John Paul II Hospital, Kraków, Poland, ul.Prądnicka 80, 31-202 Cracow, Poland.

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http://dx.doi.org/10.5603/CJ.a2020.0100DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8078977PMC
August 2020

Spectrum of transthyretin gene mutations and clinical characteristics of Polish patients with cardiac transthyretin amyloidosis.

Cardiol J 2020 Aug 13. Epub 2020 Aug 13.

Department of Cardiomyopathy, Institute of Cardiology, Warsaw, Poland.

Background: Transthyretin amyloidosis (ATTR) is a rare, life-threatening systemic disorder. We present first findings on the cardiac hereditary ATTR in Poland.

Methods: Sixty-eight consecutive patients with suspected or known cardiac amyloidosis were evaluated, including blood tests, standard 12-lead electrocardiography (ECG) and transthoracic echocardiography. ATTR was confirmed histologically or non-invasively using 99mTc-DPD scintigraphy. Transthyretin (TTR) gene sequencing was performed.

Results: In 2017-2019, 10 unrelated male patients were diagnosed with hereditary ATTR. All patients had very uncommon TTR gene mutations: 7 patients had p.Phe53Leu mutation, 2 patients had p.Glu109Lys mutation and 1 patient had p.Ala101Val mutation. The age of onset ranged from 49 to 67 years (mean [SD] age, 58.7 [6.4] years). On ECG, most patients (70%) had pseudoinfarct pattern and/or low QRS voltage. The maximal wall thickness (MWT) on echocardiography varied considerably among the patients from moderate (16 mm) to massively increased (30 mm). Most patients (90%) had decreased LV ejection fraction (mean [SD], 43 [11] %). On follow-up, we observed progressive heart failure in almost all cases. The first patient with p.Phe53Leu mutation died of heart failure, the second died suddenly, the third successfully underwent combined heart and liver transplant with 15 months survival from the surgery. The patient with p.Ala101Val mutation died of stroke.

Conclusions: According to available research, this is the first time types of TTR mutations and clinical characteristics of Polish patients with cardiac hereditary ATTR have been reported. Previous literature data about Polish background in families with p.Phe53Leu mutation and the present results, suggest that this TTR mutation might be endemic in the Polish population.
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http://dx.doi.org/10.5603/CJ.a2020.0104DOI Listing
August 2020

Psychological correlates of patients' identity suffering from atrial septal defect (ASD) and patent foramen ovale (PFO).

J Thorac Dis 2020 May;12(5):1999-2018

The Clinical Department of Cardiac and Vascular Diseases with the Intensive Cardiac Supervision Subdivision, John Paul II Hospital, Institute of Cardiology, Collegium Medicum of the Jagiellonian University in Cracow, Cracow, Poland.

Background: The work presents a research project carried out in hospital with participation of 100 (50 female, 50 male) patients with congenital heart defects [atrial septal defect (ASD) and patent foramen ovale (PFO)]. The aim of the study was to identify specific personality traits of patients with congenital heart defects and to check the psychological functioning of patients by examining: the level of anxiety, impulsiveness, tendency to risk-taking, empathy, neuroticism, extraversion, psychoticism and lying. The presented results and their statistical analyses showed specific personality traits of patients with congenital heart defects.

Methods: The research was conducted by psychologist Adrianna Skoczek. We performed a psychological clinical assessment and conducted the psychological tests like Eysenck Personality Questionnaire-Revised Short Version [EPQ-R(S)] and Eysenck's Impulsivity Inventory (IVE) by Hans J. Eysenck and Sybil G. Eystenck, the State-Trait Anxiety Inventory (STAI) by C. D. Spielberger, R. L. Gorsuch, R. E. Lushene describing personality traits of patients.

Results: The level of extraversion was statistically significantly higher than the level of all other variables. The level of lies was significantly different from the level of psychoticism, which in turn was statistically significantly lower than all other. In the case of the examined women, statistically significant differences were found only between the level of psychoticism and all other analyzed variables.

Conclusions: The conducted research shows that patients suffering from ASD or PFO have specific personality traits what allow to better understanding of suffering patients.
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http://dx.doi.org/10.21037/jtd-20-220DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7330417PMC
May 2020

The coronavirus disease 2019 pandemic prevents patients with pulmonary hypertension from seeking medical help.

Kardiol Pol 2020 09 6;78(9):916-918. Epub 2020 Jul 6.

Department of Cardiac and Vascular Diseases, Institute of Cardiology,Faculty of Medicine, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland

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http://dx.doi.org/10.33963/KP.15488DOI Listing
September 2020

Changes in heart morphometric parameters over the course of a monocrotaline-induced pulmonary arterial hypertension rat model.

J Transl Med 2020 06 30;18(1):262. Epub 2020 Jun 30.

Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, Kraków, Poland.

Background: Aim of this study was to assess changes in cardiac morphometric parameters at different stages of pulmonary arterial hypertension (PAH) using a monocrotaline-induced rat model.

Methods: Four groups were distinguished: I-control, non-PAH (n = 18); II-early PAH (n = 12); III-end-stage PAH (n = 23); and IV-end-stage PAH with myocarditis (n = 7).

Results: Performed over the course of PAH in vivo echocardiography showed significant thickening of the right ventricle free wall (end-diastolic dimension), tricuspid annular plane systolic excursion reduction and decrease in pulmonary artery acceleration time normalized to cycle length. No differences in end-diastolic left ventricle free wall thickness measured in echocardiography was observed between groups. Significant increase of right ventricle and decrease of left ventricle systolic pressure was observed over the development of PAH. Thickening and weight increase (241.2% increase) of the right ventricle free wall and significant dilatation of the right ventricle was observed over the course of PAH (p < 0.001). Reduction in the left ventricle free wall thickness was also observed in end-stage PAH (p < 0.001). Significant trend in the left ventricle free wall weight decrease was observed over the course of PAH (p < 0.001, 24.3% reduction). Calculated right/left ventricle free wall weight ratio gradually increased over PAH stages (p < 0.001). The reduction of left ventricle diameter was observed in rats with end-stage PAH both with and without myocarditis (p < 0.001).

Conclusions: PAH leads to multidimensional changes in morphometric cardiac parameters. Right ventricle morphological and functional failure develop gradually from early stage of PAH, while left ventricle changes develop at the end stages of PAH.
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http://dx.doi.org/10.1186/s12967-020-02440-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7325143PMC
June 2020

Relationships between Pulmonary Hypertension Risk, Clinical Profiles, and Outcomes in Dilated Cardiomyopathy.

J Clin Med 2020 Jun 1;9(6). Epub 2020 Jun 1.

Department of Cardiac and Vascular Diseases, Jagiellonian University Collegium Medicum, John Paul II Hospital, 31-202 Krakow, Poland.

Pulmonary hypertension (PH) in patients with heart failure (HF) contributes to a poorer prognosis. However, in those with dilated cardiomyopathy (DCM), the true prevalence and role of PH is unclear. Therefore, this study aimed to analyze the profile of DCM patients at various levels of PH risk, determined via echocardiography, and its impact on outcomes. The 502 DCM in- and out-patient records were retrospectively analyzed. Information on patient status was gathered after 45.9 ± 31.3 months. Patients were divided into 3 PH-risk groups based on results from echocardiography measurements: low (L, = 239, 47.6%), intermediate (I, = 153, 30.5%), and high (H, = 110, 21.9%). Symptom duration, atrial fibrillation, ventricular tachyarrhythmia, ejection fraction, right atrial area, and moderate or severe mitral regurgitation were found to be independently associated with PH risk. During the follow-up period, 83 (16.5%) DCM patients died: 29 (12.1%) in L, 31 (20.3%) in I, and 23 (20.9%) in H. L-patients had a significantly lower risk of all-cause death (L to H: HR 0.55 (95%CI 0.32-0.98), = 0.01), while no differences in prognosis were found between I and H. In conclusion, over one in five DCM patients had a high PH risk, and low PH risk was associated with better prognoses.
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http://dx.doi.org/10.3390/jcm9061660DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7355437PMC
June 2020

Virtual Histology to Evaluate Mechanisms of Pulmonary Artery Lumen Enlargement in Response to Balloon Pulmonary Angioplasty in Chronic Thromboembolic Pulmonary Hypertension.

J Clin Med 2020 Jun 1;9(6). Epub 2020 Jun 1.

Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Prądnicka 80, 31-202 Krakow, Poland.

Chronic thromboembolic pulmonary hypertension (CTEPH) results from an obstruction of pulmonary arteries (PAs) by organized thrombi. The stenosed PAs are targeted during balloon pulmonary angioplasty (BPA). We aimed to evaluate the mechanism of BPA in inoperable patients with CTEPH. We analyzed stenosed PAs with intravascular grey-scale ultrasound (IVUS) to determine the cross-sectional area (CSA) of arterial lumen and of organized thrombi. The composition of organized thrombi was assessed using virtual histology. We distinguished two mechanisms of BPA: Type A with dominant vessel stretching, and type B with dominant thrombus compression. PAs were assessed before ( = 159) and after ( = 98) BPA in 20 consecutive patients. Organized thrombi were composed of dark-green (57.1 (48.0-64.0)%), light-green (34.0 (21.4-46.4)%), red (6.4 (2.9-11.7)%;) and white (0.2 (0.0-0.9)%) components. The mechanism type depended on vessel diameter (OR = 1.09(1.01-1.17); = 0.03). In type B mechanism, decrease in the amount of light-green component positively correlated with an increase in lumen area after BPA ( = 0.50; = 0.001). The mechanism of BPA depends on the diameter of the vessel. Dilation of more proximal PAs depends mainly on stretching of the vessel wall while dilation of smaller PAs depends on compression of the organized thrombi. The composition of the organized thrombi contributes to the effect of BPA.
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http://dx.doi.org/10.3390/jcm9061655DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7355673PMC
June 2020

Time from symptom onset to final diagnosis of pulmonary arterial hypertension in Polish patients.

Kardiol Pol 2020 08 7;78(7-8):750-752. Epub 2020 May 7.

Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland.

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http://dx.doi.org/10.33963/KP.15344DOI Listing
August 2020

The Prognostic Value of mTc-HMPAO-Labeled Leucocyte SPECT/CT in Cardiac Device-Related Infective Endocarditis.

JACC Cardiovasc Imaging 2020 08 15;13(8):1739-1751. Epub 2020 Apr 15.

Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland; Department of Nuclear Medicine, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland.

Objectives: This was a prospective, single-center study designed to assess the prognostic value of the hybrid technique of single photon emission tomography and computed tomography with the application of technetiumm-hexamethylpropyleneamine oxime-labelled autologous leukocytes (mTc-HMPAO-SPECT/CT) in patients with cardiac device-related infective endocarditis (CDRIE).

Background: CDRIE entails the risk of complications and an increase in mortality rates, both in-hospital and long-term. The prognostic value of mTc-HMPAO-SPECT/CT in the course of CDRIE has not been evaluated so far.

Methods: The project enrolled 103 consecutive patients with suspected CDRIE, all of whom underwent Tc-HMPAO-SPECT/CT. The resulting scans were then classified as positive if the presence of abnormal tracer uptake involving cardiac and intravascular sections of the device electrodes was found. Patients were prospectively observed for a mean time of 17.48 ± 11.9 months. All-cause mortality, in-hospital mortality, and complete hardware removal were assessed, followed by a composite endpoint including complications, namely embolic events, new onset heart failure, uncontrolled infection, renal replacement therapy, reoperation, new heart rhythm, and conduction disturbances.

Results: In the analysis, despite a noticeable trend, all-cause mortality rates were not found to be statistically significantly higher among the 35 patients who registered positive results using Tc-HMPAO-SPECT/CT for CDRIE (group 1) than among the 68 patients from group 2 whose Tc-HMPAO-SPECT/CT results were negative (20% vs. 10.3%, respectively; p = 0.14). However, group 1 did present higher in-hospital mortality (11.4% vs. 0%, respectively; odds ratio: 19.6; 95% confidence interval [CI]: 1.02 to 374.70), an increased rate of complications (43% vs. 9%, respectively; hazard ratio [HR]: 5.9; 95% CI: 2.27 to 15.20), and underwent hardware removal more frequently (57% vs. 16%, respectively; HR: 4.3; 95% CI: 2.07 to 19.08).

Conclusions: In patients with suspected CDRIE, positive Tc-HMPAO-SPECT/CT results were associated with increased rates of in-hospital mortality and complications.
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http://dx.doi.org/10.1016/j.jcmg.2020.01.025DOI Listing
August 2020

Relations between circulating and myocardial fibrosis-linked microRNAs with left ventricular reverse remodeling in dilated cardiomyopathy.

Adv Clin Exp Med 2020 Mar;29(3):285-293

Department of Cardiac and Vascular Diseases, John Paul II Hospital, Kraków, Poland.

Background: Left ventricular reverse remodeling (LVRR) determines clinical status and outcomes in dilated cardiomyopathy (DCM). The extent of myocardial fibrosis is connected to the systolic function of the heart. The recent discovery of the contribution of microRNAs (miRs) to the regulation of cardiac remodeling, LVRR and fibrosis warrants exploration.

Objectives: The aim of the study was to examine the predictive value of circulating and myocardial miR expression for LVRR in DCM.

Material And Methods: Seventy consecutive DCM patients (age 48 ±12.1 years, 90% male, ejection fraction (EF) 24.4% ±7.4%) were included in the study. At baseline, all patients underwent clinical assessment, echocardiography, venous blood sampling, and right ventricular endomyocardial biopsy. Circulating and myocardial miRs (miR-21, -26, -29, -30, -133a, and -423) were measured with quantitative real-time polymerase chain reaction (qRT-PCR). LVRR was defined as an increase in EF ≥ 10%, accompanied by a decrease in left ventricle end-diastolic diameter (LVEDd) ≥10% or LVEDd ≤ 33 mm/m2 between baseline and 3-month follow-up.

Results: At the 3-month follow-up, 4 patients had died and 3 patients had incomplete data. The remaining patients were divided according to the presence of LVRR into LVRR-present (n = 32, 51%) and LVRR-absent (n = 31, 49%) groups. Out of all the circulating and tissue miRs under study, only myocardial expression of miR-133a significantly differed between the LVRR-present and LVRR-absent group (1.22 (0.47-1.90) vs 0.61 (0.25-0.99) ΔCq, respectively, p < 0.01). miR-133a was found to be a significant LVRR predictor in unadjusted (odds ratio (OR) = 2.81 (1.23-6.40), p < 0.05) and adjusted for duration of disease, left ventricle end-diastolic (LVED) volume (LVEDvol), hs-troponin-T, and NT-proBNP (OR = 5.20 (1.13-24.050, p < 0.05) models.

Conclusions: From all of the circulating and tissue miRs, only myocardial miR-133a showed increased expression in LVRR-present patients and was found an independent LVRR predictor. This indicates a link between miR-133 and cardiac remodeling in DCM.
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http://dx.doi.org/10.17219/acem/115088DOI Listing
March 2020

Pregnancy in a Patient With Chronic Thromboembolic Pulmonary Hypertension After Successful Treatment with Balloon Pulmonary Angioplasty.

Can J Cardiol 2020 04 1;36(4):589.e13-589.e16. Epub 2019 Nov 1.

Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland.

Pulmonary hypertension has been recognized as a contraindication to pregnancy. Recently, several groups have shown promising results with the use of balloon pulmonary angioplasty (BPA) in the treatment of chronic thromboembolic pulmonary hypertension (CTEPH) patients with distally located organized thrombi who were not candidates for pulmonary endarterectomy. We present the case report of a 26-year-old woman who became pregnant after successful treatment of severe CTEPH with the use of BPA. We conclude that patients undergoing effective BPA for CTEPH can consider becoming pregnant if followed closely by a multidisciplinary team, including experts in thrombosis, pulmonary hypertension, and obstetrics.
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http://dx.doi.org/10.1016/j.cjca.2019.10.029DOI Listing
April 2020

Percutaneous left atrial appendage closure in a patient with atrial fibrillation and osler-weber-rendu disease

Wiad Lek 2019 Oct;72(10):2060-2062

Klinika Chorób Serca i Naczyń, Instytut Kardiologii UJ CM, Krakowski Szpital Specjalistyczny Im. Jana Pawła II, Kraków, Polska

We present a case report of a 79-year-old woman with permanent atrial fibrillation and Osler-Weber-Rendu disease who underwent percutaneous closure of left atrial appendage. The patient had a history of small bowel resection due to mesenteric embolism and recurrent episodes of gastrointestinal bleeding, epistaxis and hemarthrosis. Bleeding episodes were exacerbated by anticoagulation therapy causing severe anemia that required repeated red blood cells transfusions. Left atrial appendage occlusion with Watchman 30 mm LAA Device was successfully performed. In long-term observation no thromboembolic event, epistaxis or severe bleeding have occurred.
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October 2019

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

Long-term observation of adults after successful repair of aortic coarctation.

Postepy Kardiol Interwencyjnej 2019 8;15(4):455-464. Epub 2019 Dec 8.

Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland.

Introduction: Despite successful repair of aortic coarctation, cardiovascular complications occur.

Aim: To analyse type and frequency of late complications and their impact on exercise capacity in adults after aortic coarctation repair.

Material And Methods: Fifty-eight adults after aortic coarctation repair, 36 male, median age 27.46 ±10.57, were compared to 30 healthy volunteers. Physical examination, transthoracic echocardiography, carotid intima-media thickness measurement, cardiopulmonary exercise test and 24-hour ambulatory blood pressure monitoring were performed.

Results: The main complications were: arterial hypertension 48.3%, myocardial hypertrophy in echocardiography 29.34%, recoarctation 25.86%, aortic dilation 13.79% and coronary artery disease 6.89%. Exercise tolerance was reduced in the cardiopulmonary exercise test. The VO/kg peak was lower, 29.01 ±8.79 vs. 49.16 ±7.38 ml/kg/min, < 0.001, VE/VCO peak higher 28.18 ±4.69 vs. 26.78 ±3.13, = 0.017. The peak heart rate was reduced, 157.28 ±22.22 vs. 177.93 ±23.08 bpm, < 0.001, peak systolic blood pressure was higher, 174.79 ±17.62 vs. 153.33 ±4.79 mm Hg, < 0.001. Systolic blood pressure in 24-hour ambulatory monitoring correlated with left ventricle mass index, = 0.29, = 0.025, wall thickness, = 0.31, = 0.039. Age at operation was related to left ventricle wall thickness, = 0.27, = 0.041, and carotid intima-media thickness, = 0.26, = 0.046. There was no association of any cardio-pulmonary parameters with time from surgery, type of operation or echocardiography results.

Conclusions: Adults after aortic coarctation repair suffer from arterial hypertension, recurrent aortic stenosis, aortic aneurysms, and coronary artery disease. Reduced exercise capacity in cardio-pulmonary exercise test is related to hypertensive reaction and chronotropic incompetence.
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http://dx.doi.org/10.5114/aic.2019.90220DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6956463PMC
December 2019

Personality traits of patients suffering from congenital heart defects.

Wiad Lek 2019 ;72(11 cz 1):2135-2144

The Clinical Department of Cardiac and Vascular Diseases with the Intensive Cardiac Supervision Subdivision, Institute of Cardiology, Collegium Medicum of the Jagiellonian University in Cracow, John Paul II Hospital.

Objective: Introduction: Personality traits of patients suffering from congenital heart defects The work presents a research project carried out in John Paul II Hospital, The Clinical Department of Cardiac and Vascular Diseases with the Intensive Cardiac Surgeon Division Institute of Cardiology, Collegium Medicum of the Jagiellonian University in Cracow, with participation of patients with congenital heart defects. We aimed to assess personality traits of clients suffering from congenital heart defects, in a group of women and men, younger, under 40 years old and older than 40 years old, with PFO and ASD before and after surgery. The aim: identify specific personality traits of patients with congenital heart defects and to check the psychological functioning of patients by examining: the level of anxiety, impulsiveness, tendency to risk-taking, empathy, neuroticism, extraversion, psychoticism and lying.

Patients And Methods: Material and methods: We performed a psychological clinical assessment and conducted the psychological tests like EPQ-R(S) by Hans J. Eysenck and Sybil G. Eysenck, IVE by Hans J. Eysenck and Sybil G. Eystenck, STAI by C. D. Spielberger, R. L. Gorsuch, R. E. Lushene describing personality traits of patients.

Results: Results: Patients (F=29, M=21), adult, with ASD and with PFO, with the level of education: basic, vocational, secondary, incomplete higher, higher; inhabiting: village, city up to 40 thousand residents, a city with a population of 41-61 thousand, and a city with a population of 60 thousand; civil status: single, married, divorced, widow/widower, separated; being: students, unemployed persons, working persons, pensioners, retirees.

Conclusion: Conclusions: The presented results and their statistical analyses showed specific personality traits of patients with congenital heart defects.
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January 2020

Prognostic role of traditional cardiovascular risk factors in patients with idiopathic pulmonary arterial hypertension.

Arch Med Sci 2019 Oct 25;15(6):1397-1406. Epub 2018 Oct 25.

Department of Cardiac and Vascular Diseases, Faculty of Medicine, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland.

Introduction: Metabolic alterations have been recently associated with onset and progression of idiopathic pulmonary arterial hypertension (IPAH). We aimed to determine the prevalence and prognostic role of cardiovascular risk factors in patients with IPAH.

Material And Methods: Between February 2009 and January 2015 we recruited consecutive IPAH patients. Clinical assessment included medical history, fasting glucose, lipid profile, N-terminal pro-brain natriuretic peptide concentration, 6-minute walk test distance, WHO functional class and hemodynamic evaluation. Patients' risk was estimated based on the Swedish PAH Register grading system.

Results: The study group included 61 IPAH patients, and the control group included 2413 Polish residents. When compared to the general population, IPAH patients had lower low-density lipoprotein cholesterol (LDL-C) and a higher triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio. Female patients were characterized by elevated glucose level, higher prevalence of diabetes and lower HDL-C than controls. PAH severity grade correlated positively with age and TG/HDL-C ratio ( = 0.29, = 0.02) and inversely with LDL-C ( = -0.28, = 0.03) and HDL-C ( = -0.39, = 0.02) concentrations. After a follow-up of 48 (23-79) months we recorded 28 deaths in the IPAH group. In the regression analysis lower LDL-C ( = 0.002) and HDL-C ( = 0.0002) levels, and higher TG/HDL-C ratio ( = 0.003) and glucose level ( = 0.003) were associated with all-cause mortality after adjustment for age, sex or PAH severity grade.

Conclusions: Patients with IPAH are characterized by an altered profile of lipid and glucose metabolism. Lowered levels of LDL-C and HDL-C and increased TG/HDL-C ratio correlate with disease severity and together with elevated plasma glucose level predict poor survival in IPAH.
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http://dx.doi.org/10.5114/aoms.2018.79242DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6855165PMC
October 2019