Publications by authors named "Tomasz Jadczyk"

27 Publications

  • Page 1 of 1

Clinical Evidence behind Stereotactic Radiotherapy for the Treatment of Ventricular Tachycardia (STAR)-A Comprehensive Review.

J Clin Med 2021 Mar 17;10(6). Epub 2021 Mar 17.

Department of Radiotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, 44-102 Gliwice, Poland.

The electrophysiology-guided noninvasive cardiac radioablation, also known as STAR (stereotactic arrhythmia radioablation) is an emerging treatment method for persistent ventricular tachycardia. Since its first application in 2012 in Stanford Cancer Institute, and a year later in University Hospital Ostrava, Czech Republic, the authors from all around the world have published case reports and case series, and several prospective trials were established. In this article, we would like to discuss the available clinical evidence, analyze the potentially clinically relevant differences in methodology, and address some of the unique challenges that come with this treatment method.
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http://dx.doi.org/10.3390/jcm10061238DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8002399PMC
March 2021

Local electromechanical alterations determine the left ventricle rotational dynamics in CRT-eligible heart failure patients.

Sci Rep 2021 Feb 5;11(1):3267. Epub 2021 Feb 5.

Department of Cardiology and Structural Heart Disease, Medical University of Silesia, Ziołowa 45-47, Katowice, Poland.

Left ventricle, LV wringing wall motion relies on physiological muscle fiber orientation, fibrotic status, and electromechanics (EM). The loss of proper EM activation can lead to rigid-body-type (RBT) LV rotation, which is associated with advanced heart failure (HF) and challenges in resynchronization. To describe the EM coupling and scar tissue burden with respect to rotational patterns observed on the LV in patients with ischemic heart failure with reduced ejection fraction (HFrEF) left bundle branch block (LBBB). Thirty patients with HFrEF/LBBB underwent EM analysis of the left ventricle using an invasive electro-mechanical catheter mapping system (NOGA XP, Biosense Webster). The following parameters were evaluated: rotation angle; rotation velocity; unipolar/bipolar voltage; local activation time, LAT; local electro-mechanical delay, LEMD; total electro-mechanical delay, TEMD. Patients underwent late-gadolinium enhancement cMRI when possible. The different LV rotation pattern served as sole parameter for patients' grouping into two categories: wringing rotation (Group A, n = 6) and RBT rotation (Group B, n = 24). All parameters were aggregated into a nine segment, three sector and whole LV models, and compared at multiple scales. Segmental statistical analysis in Group B revealed significant inhomogeneities, across the LV, regarding voltage level, scar burdening, and LEMD changes: correlation analysis showed correspondently a loss of synchronization between electrical (LAT) and mechanical activation (TEMD). On contrary, Group A (relatively low number of patients) did not present significant differences in LEMD across LV segments, therefore electrical (LAT) and mechanical (TEMD) activation were well synchronized. Fibrosis burden was in general associated with areas of low voltage. The rotational behavior of LV in HF/LBBB patients is determined by the local alteration of EM coupling. These findings serve as a strong basic groundwork for a hypothesis that EM analysis may predict CRT response.Clinical trial registration: SUM No. KNW/0022/KB1/17/15.
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http://dx.doi.org/10.1038/s41598-021-82793-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7865069PMC
February 2021

AC Pulsed Field Ablation Is Feasible and Safe in Atrial and Ventricular Settings: A Proof-of-Concept Chronic Animal Study.

Front Bioeng Biotechnol 2020 3;8:552357. Epub 2020 Dec 3.

International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czechia.

Introduction: Pulsed field ablation (PFA) exploits the delivery of short high-voltage shocks to induce cells death via irreversible electroporation. The therapy offers a potential paradigm shift for catheter ablation of cardiac arrhythmia. We designed an AC-burst generator and therapeutic strategy, based on the existing knowledge between efficacy and safety among different pulses. We performed a proof-of-concept chronic animal trial to test the feasibility and safety of our method and technology.

Methods: We employed 6 female swine - weight 53.75 ± 4.77 kg - in this study. With fluoroscopic and electroanatomical mapping assistance, we performed ECG-gated AC-PFA in the following settings: in the left atrium with a decapolar loop catheter with electrodes connected in bipolar fashion; across the interventricular septum applying energy between the distal electrodes of two tip catheters. After procedure and 4-week follow-up, the animals were euthanized, and the hearts were inspected for tissue changes and characterized. We perform finite element method simulation of our AC-PFA scenarios to corroborate our method and better interpret our findings.

Results: We applied square, 50% duty cycle, AC bursts of 100 μs duration, 100 kHz internal frequency, 900 V for 60 pulses in the atrium and 1500 V for 120 pulses in the septum. The inter-burst interval was determined by the native heart rhythm - 69 ± 9 bpm. Acute changes in the atrial and ventricular electrograms were immediately visible at the sites of AC-PFA - signals were elongated and reduced in amplitude ( < 0.0001) and tissue impedance dropped ( = 0.011). No adverse event (e.g., esophageal temperature rises or gas bubble streams) was observed - while twitching was avoided by addition of electrosurgical return electrodes. The implemented numerical simulations confirmed the non-thermal nature of our AC-PFA and provided specific information on the estimated treated area and need of pulse trains. The postmortem chest inspection showed no peripheral damage, but epicardial and endocardial discolorations at sites of ablation. T1-weighted scans revealed specific tissue changes in atria and ventricles, confirmed to be fibrotic scars via trichrome staining. We found isolated, transmural and continuous scars. A surviving cardiomyocyte core was visible in basal ventricular lesions.

Conclusion: We proved that our method and technology of AC-PFA is feasible and safe for atrial and ventricular myocardial ablation, supporting their systematic investigation into effectiveness evaluation for the treatment of cardiac arrhythmia. Further optimization, with energy titration or longer follow-up, is required for a robust atrial and ventricular AC-PFA.
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http://dx.doi.org/10.3389/fbioe.2020.552357DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7744788PMC
December 2020

Readiness for Voice Technology in Patients With Cardiovascular Diseases: Cross-Sectional Study.

J Med Internet Res 2020 12 17;22(12):e20456. Epub 2020 Dec 17.

Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland.

Background: The clinical application of voice technology provides novel opportunities in the field of telehealth. However, patients' readiness for this solution has not been investigated among patients with cardiovascular diseases (CVD).

Objective: This paper aims to evaluate patients' anticipated experiences regarding telemedicine, including voice conversational agents combined with provider-driven support delivered by phone.

Methods: A cross-sectional study enrolled patients with chronic CVD who were surveyed using a validated investigator-designed questionnaire combining 19 questions (eg, demographic data, medical history, preferences for using telehealth services). Prior to the survey, respondents were educated on the telemedicine services presented in the questionnaire while being assisted by a medical doctor. Responses were then collected and analyzed, and multivariate logistic regression was used to identify predictors of willingness to use voice technology.

Results: In total, 249 patients (mean age 65.3, SD 13.8 years; 158 [63.5%] men) completed the questionnaire, which showed good repeatability in the validation procedure. Of the 249 total participants, 209 (83.9%) reported high readiness to receive services allowing for remote contact with a cardiologist (176/249, 70.7%) and telemonitoring of vital signs (168/249, 67.5%). The voice conversational agents combined with provider-driven support delivered by phone were shown to be highly anticipated by patients with CVD. The readiness to use telehealth was statistically higher in people with previous difficulties accessing health care (OR 2.920, 95% CI 1.377-6.192) and was most frequent in city residents and individuals reporting a higher education level. The age and sex of the respondents did not impact the intention to use voice technology (P=.20 and P=.50, respectively).

Conclusions: Patients with cardiovascular diseases, including both younger and older individuals, declared high readiness for voice technology.
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http://dx.doi.org/10.2196/20456DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7775197PMC
December 2020

Nanotechnology and stem cells in vascular biology.

Vasc Biol 2019 24;1(1):H103-H109. Epub 2019 Sep 24.

Interventional Cardiac Electrophysiology Group, International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic.

Nanotechnology and stem cells are one of the most promising strategies for clinical medicine applications. The article provides an up-to-date view on advances in the field of regenerative and targeted vascular therapies describing a molecular design (propulsion mechanism, composition, target identification) and applications of nanorobots. Stem cell paragraph presents current clinical application of various cell types involved in vascular biology including mesenchymal stem cells, very small embryonic-like stem cells, induced pluripotent stem cells, mononuclear stem cells, amniotic fluid-derived stem cells and endothelial progenitor cells. A possible bridging between the two fields is also envisioned, where bio-inspired, safe, long-lasting nanorobots can fully target the cellular specific cues and even drive vascular process in a timely manner.
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http://dx.doi.org/10.1530/VB-19-0021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7439937PMC
September 2019

Telemedicine in cardiology in the time of coronavirus disease 2019: a friend that everybody needs.

Pol Arch Intern Med 2020 06 16;130(6):559-561. Epub 2020 Jun 16.

Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland; Interventional Cardiac Electrophysiology Group, International Clinical Research Center, St. Anne’s University Hospital Brno, Brno, Czech Republic

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http://dx.doi.org/10.20452/pamw.15432DOI Listing
June 2020

The influence of scar on the spatio-temporal relationship between electrical and mechanical activation in heart failure patients.

Europace 2020 05;22(5):777-786

Center for Computational Medicine in Cardiology, Università della Svizzera italiana, Via G. Buffi 13, CH-6900 Lugano, Switzerland.

Aims: The aim of this study was to determine the relationship between electrical and mechanical activation in heart failure (HF) patients and whether electromechanical coupling is affected by scar.

Methods And Results: Seventy HF patients referred for cardiac resynchronization therapy or biological therapy underwent endocardial anatomo-electromechanical mapping (AEMM) and delayed-enhancement magnetic resonance (CMR) scans. Area strain and activation times were derived from AEMM data, allowing to correlate mechanical and electrical activation in time and space with unprecedented accuracy. Special attention was paid to the effect of presence of CMR-evidenced scar. Patients were divided into a scar (n = 43) and a non-scar group (n-27). Correlation between time of electrical and mechanical activation was stronger in the non-scar compared to the scar group [R = 0.84 (0.72-0.89) vs. 0.74 (0.52-0.88), respectively; P = 0.01]. The overlap between latest electrical and mechanical activation areas was larger in the absence than in presence of scar [72% (54-81) vs. 56% (36-73), respectively; P = 0.02], with smaller distance between the centroids of the two regions [10.7 (4.9-17.4) vs. 20.3 (6.9-29.4) % of left ventricular radius, P = 0.02].

Conclusion: Scar decreases the association between electrical and mechanical activation, even when scar is remote from late activated regions.
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http://dx.doi.org/10.1093/europace/euz346DOI Listing
May 2020

Comparison of atrial fibrillation ablation efficacy using remote magnetic navigation vs. manual navigation with contact-force control.

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2020 Dec 10;164(4):387-393. Epub 2019 Oct 10.

International Clinical Research Center, Interventional Cardiac Electrophysiology, St. Anne's University Hospital Brno, Czech Republic.

Aims: This study aims to compare procedural parameters and clinical efficacy of remote magnetic navigation (RMN) vs. manual navigation (MAN) approach for radiofrequency ablation (RFA) in patients with atrial fibrillation (AF).

Methods: 146 patients with AF were enrolled in the study. In the RMN group (n=57), patients were treated with the CARTO® 3 in combination with the Niobe ES system. In the MAN group (n=89), ablation was performed with the EnSite Velocity and TactiCath™ Quartz catheter with direct contact force measurement. Procedural time, ablation time, fluoroscopy time, radiation dose and ablation counts were measured and compared between the groups. Recurrence of AF was evaluated after 6 months of follow-up.

Results: Mean procedure times (236.87±64.31 vs. 147.22±45.19 min, P<0.05), counts of RF applications (74.30±24.77 vs. 49.15±20.33, P<0.05) and total RFA times (4323.39±1426.69 vs. 2780.53±1157.85 s, P<0.05) were all significantly higher in the RMN than in the MAN group, respectively. In the same order, mean X-ray dose (9722.6±7507.4 vs. 8087.9±6051.5 mGy/cm, P=0.12) and mean total X-ray exposure time (8.07±4.20 vs. 9.54±5.47 min, P=0.08) were not statistically different. At 6-month follow-up, freedom from AF was similar in RMN and MAN group for paroxysmal (60.8% and 73%, respectively, P=0.42) and persistent AF (69.6% and 75.0%, respectively, P=0.77).

Conclusions: Due to the fact that mid-term clinical outcomes showed no significant differences in AF recurrences between groups and manual ablation strategy provided more favorable results regarding acute procedural parameters, we can conclude that the remote magnetic navigation is not superior to the manual approach.
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http://dx.doi.org/10.5507/bp.2019.045DOI Listing
December 2020

Remotely Navigated Ablations in Ventricle Myocardium Result in Acute Lesion Size Comparable to Force-Sensing Manual Navigation.

Circ Arrhythm Electrophysiol 2019 10 30;12(10):e007644. Epub 2019 Sep 30.

Interventional Cardiac Electrophysiology (J.J., G.C., T.J., F.L., M.P., T.K., Z.S.), International Clinical Research Center of St Anne's University Hospital, Brno, Czech Republic.

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http://dx.doi.org/10.1161/CIRCEP.119.007644DOI Listing
October 2019

Feasibility of a voice-enabled automated platform for medical data collection: CardioCube.

Int J Med Inform 2019 09 4;129:388-393. Epub 2019 Jul 4.

The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, Cincinnati, OH 45219, United States. Electronic address:

Aim: A feasibility study was conducted to evaluate implementation of a voice-enabled automated platform for collection of medical data from patients with cardiovascular disease: CardioCube.

Methods: The study enrolled 22 individuals (10 males, 45.5%) including 9 patients with cardiovascular disease and 13 healthy participants. Utilizing (1) voice-enabled patient registration software implemented on the Amazon Echo and (2) web-based electronic health record (EHR) system, study participants verbally answered a set of clinical questions. Primary endpoint: accuracy of ​the ​CardioCube system. Secondary endpoints: acceptability, usability and technical performance. The study was performed at the Outpatient Cardiology Clinic, Cedars-Sinai Medical Center, Los Angeles, CA, USA.

Results: The CardioCube system collected 432 data points with a high agreement level between verbally provided data and corresponding EHR information (accuracy 97.51%). The CardioCube was able to automatically generate a summarized medical report, which was instantly available for a doctor in the web-based EHR system. Patients reported CardioCube was "easy to use". Applicability of the system was graded excellent by the medical staff. A single session utilized less than 0.002% of available computational resources.

Conclusion: CardioCube can collect, index and document medical data using a voice interface. In this pilot study, CardioCube supported healthcare professionals by performing time-consuming paperwork during patient registration.
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http://dx.doi.org/10.1016/j.ijmedinf.2019.07.001DOI Listing
September 2019

Serum Concentrations of Osteogenesis/Osteolysis-Related Factors and Micro-RNA Expression in ST-Elevation Myocardial Infarction.

Cardiol Res Pract 2019 2;2019:1420717. Epub 2019 Jun 2.

Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland.

Background: Atherosclerosis and bone metabolism share similar molecular and cellular mechanisms. This study aims to evaluate (1) serum concentration of osteogenesis/osteolysis factors panel (Dickkopf-related protein 1 (DKK-1), TNF-, -terminal atrial natriuretic peptide (NT-proANP), thrombospondin-2 (TSP-2), osteoprotegerin (OPG), osteocalcin (OCN), osteopontin (OPN), fibroblast growth factor 23 (FGF-23), soluble receptor activator of nuclear factor-kappaB ligand (sRANKL), tumor necrosis factor-related apoptosis-inducing ligand (TRAIL), proprotein convertase subtilisin/kexin type 9 (PCSK9)), (2) serum expression levels of micro-RNA- (miR-) 24-1 and miR-6802, and (3) assess their correlation with myocardial injury and LV remodeling and function in the acute phase of STEMI and after 3 months.

Methods: Study enrolled 25 STEMI patients (mean age 55.4 ± 8.96 years). Blood samples were collected 4 days and 3 months after myocardial infarction. Serum concentrations of osteogenesis/osteolysis factors were measured using the Luminex assay. Analysis of miR-24-1, and miR-6802 expression was performed with qPCR. LV function and remodeling were assessed by MRI during index hospitalization and 3 months later.

Results: There were no significant differences in serum levels of osteogenesis/osteolysis factors and expression of miR-24-1 and miR-6802 between the acute phase and 3-month follow-up. The levels were similar in patients with at least ≥5% improvement of LVEF ( = 10) and those without improvement. There was a negative correlation between the OPG serum level and LVEF during the acute phase of myocardial infarction.

Conclusions: In STEMI patients, serum concentrations of osteogenesis/osteolysis factors, as well as miR-24-1 and miR-6802 expression, do not change significantly within the 3-month follow-up and are not correlated with LV remodeling and function.
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http://dx.doi.org/10.1155/2019/1420717DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6589187PMC
June 2019

Effects of trans-endocardial delivery of bone marrow-derived CD133+ cells on angina and quality of life in patients with refractory angina: A sub-analysis of the REGENT-VSEL trial.

Cardiol J 2018 ;25(4):521-529

Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Ziolowa 45/47, 40635 Katowice, Poland.

Background: The REGENT-VSEL trial demonstrated a neutral effect of transendocardial injection of autologous bone marrow (BM)-derived CD133+ in regard to myocardial ischemia. The current sub-analysis of the REGENT VSEL trial aims to assess the effect stem cell therapy has on quality of life (QoL) in patients with refractory angina.

Methods: Thirty-one patients (63.0 ± 6.4 years, 70% male) with recurrent CCS II-IV angina, despite optimal medical therapy, enrolled in the REGENT-VSEL single center, randomized, double-blinded, and placebo-controlled trial. Of the 31 patients, 16 individuals were randomly assigned to the active stem cell group and 15 individuals were randomly assigned to the placebo group on a 1:1 basis. The inducibility of ischemia, (≥ one myocardial segment) was confirmed for each patient using Tc-99m SPECT. QoL was measured using the Seattle Angina Questionnaire. Each patient completed the questionnaire prior to treatment and at the time of their outpatient follow-up visits at 1, 4, 6, and 12 months after cell/placebo treatment.

Results: The main finding of the REGENT-VSEL trial sub-analysis was that transendocardial injection of autologous BM-derived CD133+ stem cells in patients with chronic refractory angina did not show significant improvement in QoL in comparison to the control group. Moreover, there was no significant difference between cell therapy and placebo in a number of patients showing improvement of at least 1 Canadian Cardiovascular Society class during the follow-up period.

Conclusions: Intra-myocardial delivery of autologous CD133+ stem cells is safe and feasible but does not show a significant improvement in the QoL or angina pectoris symptoms in patients with chronic myocardial ischemia.
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http://dx.doi.org/10.5603/CJ.2018.0082DOI Listing
May 2019

ST segment elevation myocardial infarction caused by post-traumatic coronary artery perforation.

Kardiol Pol 2017 ;75(5):506

Department of Cardiology, Invasive Coronary Care Unit, District Hospital, Pszczyna, Poland.

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http://dx.doi.org/10.5603/KP.2017.0084DOI Listing
December 2017

Prevention of contrast-induced acute kidney injury in patients undergoing cardiovascular procedures-a systematic review and network meta-analysis.

PLoS One 2017 2;12(2):e0168726. Epub 2017 Feb 2.

Diaverum Medical Scientific Office, Diaverum Sweden AB, Lund, Sweden.

Background: Interventional diagnostic and therapeutic procedures requiring intravascular iodinated contrast steadily increase patient exposure to the risks of contrast-induced acute kidney injury (CIAKI), which is associated with death, nonfatal cardiovascular events, and prolonged hospitalization. The aim of this study was to investigate the efficacy of pharmacological and non-pharmacological treatments for CIAKI prevention in patients undergoing cardiovascular invasive procedures with iodinated contrast.

Methods And Findings: MEDLINE, Google Scholar, EMBASE and Cochrane databases as well as abstracts and presentations from major cardiovascular and nephrology meetings were searched, up to 22 April 2016. Eligible studies were randomized trials comparing strategies to prevent CIAKI (alone or in combination) when added to saline versus each other, saline, placebo, or no treatment in patients undergoing cardiovascular invasive procedures with administration of iodinated contrast. Two reviewers independently extracted trial-level data including number of patients, duration of follow-up, and outcomes. Eighteen strategies aimed at CIAKI prevention were identified. The primary outcome was the occurrence of CIAKI. Secondary outcomes were mortality, myocardial infarction, dialysis and heart failure. The data were pooled using network meta-analysis. Treatment estimates were calculated as odds ratios (ORs) with 95% credible intervals (CrI). 147 RCTs involving 33,463 patients were eligible. Saline plus N-acetylcysteine (OR 0.72, 95%CrI 0.57-0.88), ascorbic acid (0.59, 0.34-0.95), sodium bicarbonate plus N-acetylcysteine (0.59, 0.36-0.89), probucol (0.42, 0.15-0.91), methylxanthines (0.39, 0.20-0.66), statin (0.36, 0.21-0.59), device-guided matched hydration (0.35, 0.12-0.79), prostaglandins (0.26, 0.08-0.62) and trimetazidine (0.26, 0.09-0.59) were associated with lower odds of CIAKI compared to saline. Methylxanthines (0.12, 0.01-0.94) or left ventricular end-diastolic pressure-guided hydration (0.09, 0.01-0.59) were associated with lower mortality compared to saline.

Conclusions: Currently recommended treatment with saline as the only measure to prevent CIAKI during cardiovascular procedures may not represent the optimal strategy. Vasodilators, when added to saline, may significantly reduce the odds of CIAKI following cardiovascular procedures.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0168726PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5289438PMC
August 2017

Effects of Transendocardial Delivery of Bone Marrow-Derived CD133 Cells on Left Ventricle Perfusion and Function in Patients With Refractory Angina: Final Results of Randomized, Double-Blinded, Placebo-Controlled REGENT-VSEL Trial.

Circ Res 2017 Feb 30;120(4):670-680. Epub 2016 Nov 30.

From the Third Division of Cardiology (W.W., T.J., A.M.-W., Z.P., W.R., A.B., W.W., J.C., B.O., W.C., W.W., S.D., G.S., T.P., A.O., M.T.), Department of Hematology and Bone Marrow Transplantation (M.M., M.D.-M.), and Division of Diagnostic Imaging (K.G.), Medical University of Silesia, Katowice, Poland; Department of Nuclear Medicine Hospital John Paul II, Kraków, Poland (M.K.); 2nd Department of Cardiology and Cardiovascular Interventions (Ł.R., W.Z.) and Department of Angiology (Ł.P.), University Hospital, Krakow, Poland; Krakow Cardiovascular Research Institute, Kraków, Poland (Ł.P., W.Z.); and Department of Vascular Surgery, Medical University of Silesia, Katowice, Poland (W.K.).

Rationale: New therapies for refractory angina are needed.

Objective: Assessment of transendocardial delivery of bone marrow CD133 cells in patients with refractory angina.

Methods And Results: Randomized, double-blinded, placebo-controlled trial enrolled 31 patients with recurrent Canadian Cardiovascular Society II-IV angina, despite optimal medical therapy, ≥1 myocardial segment with inducible ischemia in Tc-99m SPECT who underwent bone marrow biopsy and were allocated to cells (n=16) or placebo (n=15). Primary end point was absolute change in myocardial ischemia by SPECT. Secondary end points were left ventricular function and volumes by magnetic resonance imaging and angina severity. After 4 months, there were no significant differences in extent of inducible ischemia between groups (summed difference score mean [±SD]: 2.60 [2.6] versus 3.63 [3.6], =0.52; total perfusion deficit: 3.60 [3.6] versus 5.01 [4.3], =0.32; absolute changes of summed difference score: -1.38 [5.2] versus -0.73 [1.9], =0.65; and total perfusion deficit: -1.33 [3.3] versus -2.19 [6.6], =0.65). There was a significant reduction of left ventricular volumes (end-systolic volume: -4.3 [11.3] versus 7.4 [11.8], =0.02; end-diastolic volume: -9.1 [14.9] versus 7.4 [15.8], =0.02) and no significant change of left ventricular ejection fraction in the cell group. There was no difference in number of patients showing improvement of ≥1 Canadian Cardiovascular Society class after 1 (41.7% versus 58.3%; =0.68), 4 (50% versus 33.3%; =0.63), 6 (70% versus 50.0%; =0.42), and 12 months (55.6% versus 81.8%; =0.33) and use of nitrates after 12 months.

Conclusion: Transendocardial CD133 cell therapy was safe. Study was underpowered to conclusively validate the efficacy, but it did not show a significant reduction of myocardial ischemia and angina versus placebo.

Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01660581.
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http://dx.doi.org/10.1161/CIRCRESAHA.116.309009DOI Listing
February 2017

Second-generation drug-eluting stents in the elderly patients with acute coronary syndrome: the in-hospital and 12-month follow-up of the all-comer registry.

Aging Clin Exp Res 2017 Oct 10;29(5):885-893. Epub 2016 Nov 10.

Third Division of Cardiology, Medical University of Silesia, Katowice, Poland.

Background: Katowice-Zabrze registry provides data that can be used to evaluate clinical outcomes of percutaneous coronary interventions in elderly patients (≥70 y/o) treated with either first- (DES-I) or second-generation (DES-II) drug-eluting stents (DES).

Methods: The registry consisted of data from 1916 patients treated with coronary interventions using either DES-I or DES-II stents. For our study, we defined patients ≥70 years of age as elderly. We evaluated any major adverse cardiac and cerebral events (MACCE) at 12-month follow-up.

Results: Coronary angiography revealed a higher incidence of multivessel coronary artery disease in this elderly patient population. There were no differences in acute and subacute stent thrombosis (0.4 vs. 0.6%, p = 0.760; 0.4 vs. 0.4%; p = 0.712). Elderly patients experienced more in-hospital bleeding complications requiring blood transfusion (2.0 vs. 0.9%; p = 0.003). Resuscitated cardiac arrests (2.0 vs. 0.9%; p = 0.084) were observed more often in this elderly patients during hospitalization. The composite in-hospital MACCE rates did not differ statistically between both groups (1.4 vs. 1.1%; p = 0.567). Data from a twelve-month follow-up disclosed that mortality was higher (7.1 vs. 1.8%; p < 0.001) in the elderly, with no difference in TVR (7.2 vs. 9.9%, p = 0.075), MI (6.0 vs. 4.8%, p = 0.300), stroke (0.8 vs. 0.6%, p = 0.600) and composite MACCE (15.0 vs. 13.4%, p = 0.324). The age of 70 years or over was an independent predictor of death [HR = 2.55 (95% CI 1.49-4.37); p < 0.001]. The use of DES-II reduced the risk of MI [HR = 0.40 (95% CI 0.19-0.82); p = 0.012] in the elderly.

Conclusion: This elderly patient population had an increased risk of in-hospital bleeding complications requiring blood transfusion and a higher risk of death at 12-month follow-up. The use of new-generation DES reduced the risk of MI in the elderly population.
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http://dx.doi.org/10.1007/s40520-016-0649-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5590486PMC
October 2017

Optical Coherence Tomography of De Novo Lesions and In-Stent Restenosis in Coronary Saphenous Vein Grafts (OCTOPUS Study).

Circ J 2016 Jul 21;80(8):1804-11. Epub 2016 Jun 21.

Third Department of Cardiology, Medical University of Silesia.

Background: The OCTOPUS registry prospectively evaluates the procedural and long-term outcomes of saphenous vein graft (SVG) PCI. The current study assessed the morphology of de novo lesions and in-stent restenosis (ISR) in patients undergoing PCI of SVG.

Methods and results: Optical coherence tomography (OCT) of SVG lesions in consecutive patients presenting with stable CAD and ACS was carried out. Thirty-nine patients (32 de novo and 10 ISR lesions) were included in the registry. ISR occurred in 5 BMS and 5 DES. There were no differences in the presence of plaque rupture and thrombus between de novo lesions and ISR. Lipid-rich tissue was identified in both de novo lesions and in ISR (75% vs. 50%, P=0.071) with a higher prevalence in BMS than in DES (23% vs. 7.5%; P=0.048). Calcific de novo lesions were detected in older grafts as compared with non-calcific atheromas (159±57 vs. 90±62 months after CABG, P=0.001). Heterogeneous neointima was found only in ISR (70% vs. 0, P<0.001) and was observed with similar frequency in both BMS and DES (24% vs. 30%, P=0.657). ISR was detected earlier in DES than BMS (median, 50 months; IQR, 18-96 months vs. 27 months; IQR, 13-29 months, P<0.001).

Conclusions: OCT-based characteristics of de novo and ISR lesions in SVG were similar except for heterogeneous tissue, which was observed only in ISR. (Circ J 2016; 80: 1804-1811).
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http://dx.doi.org/10.1253/circj.CJ-16-0332DOI Listing
July 2016

Long-term follow-up of renal arteries after radio-frequency catheter-based denervation using optical coherence tomography and angiography.

Int J Cardiovasc Imaging 2016 Jun 16;32(6):855-62. Epub 2016 Feb 16.

Third Department of Cardiology, Medical University of Silesia, 45/47 Ziolowa Street, 40-635, Katowice, Poland.

Optical coherence tomography (OCT) imaging at the time of renal denervation (RDN) showed that procedure might cause spasm, intimal injury or thrombus formation. In the present study, we assessed the healing of renal arteries after RDN using OCT and renal angiography in long-term follow-up. OCT and renal angiography were performed in 12 patients (22 arteries) 18.41 ± 5.83 months after RNS. There were no adverse events or complications during the long-term follow-up. In ten patients (83 %), significant reductions of blood pressure was achieved without a change of the antihypertensive medications. We demonstrated the presence of 26 areas of focal intimal thickening identified by OCT in 10 (83 %) patients and in 14 (63 %) arteries. The mean area of focal intimal thickening was 0.054 ± 0.033 mm(2). No vessel dissection, thrombus, intimal tear or acute vasospasm were observed during the OCT analysis. Also, the quantitative angiography analysis revealed a significant reduction of the minimal and proximal lumen diameters at follow-up as compared to measurements obtained before RDN. Renal arteries have a favorable "long-term" vessel healing response after RDN. Focal intimal thickening and a modest reduction of the minimal lumen diameter may be observed after RF denervation. Further studies are needed to determine whether intravascular imaging may be helpful in evaluating the vessel healing of RF RDN.
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http://dx.doi.org/10.1007/s10554-016-0853-9DOI Listing
June 2016

Electromechanical mapping of the left ventricle for stem cell injection in a patient with permanent atrial fibrillation.

Kardiol Pol 2015 ;73(8):665

1st Department of Cardiology, Medical University of Silesia, Katowice, Poland.

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http://dx.doi.org/10.5603/KP.2015.0149DOI Listing
February 2017

New advances in stem cell research: practical implications for regenerative medicine.

Pol Arch Med Wewn 2014 11;124(7-8):417-26. Epub 2014 Jun 11.

Regenerative medicine is searching for stem cells that can be safely and efficiently employed for regeneration of damaged solid organs (e.g., the heart, brain, or liver). Ideal for this purpose would be pluripotent stem cells, which, according to their definition, have broad potential to differentiate into all types of adult cells. For almost 20 years, there have been unsuccessful attempts to harness controversial embryonic stem cells (ESCs) isolated from embryos. Induced pluripotent stem cells (iPSCs), generated by genetic modification of adult somatic cells, are a more promising source. However, both iPSC and ESCs are associated with a risk of teratoma formation. At the same time, various types of more‑differentiated adult stem and progenitor cells derived from the bone marrow, umbilical cord blood, mobilized peripheral blood, or fat tissue are being employed in clinical trials to regenerate damaged solid organs. However, for most of these cells, there is a lack of convincing documentation for successful regeneration of the treated organs. Beneficial effects of those cells might be explained by paracrine effects of growth factors, cytokines, chemokines, bioactive lipids, and extracellular microvesicles, which are released from the cells and have trophic, antiapoptotic, and angiopoietic effects. Nevertheless, there is evidence that adult tissues harbor a promising population of very rare dormant stem cells with broad differentiation potential. In this review, we will discuss various potential sources of stem cells for regenerative medicine and the mechanisms that explain some of their beneficial effects as well as highlight the results of the first clinical trials.  
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http://dx.doi.org/10.20452/pamw.2355DOI Listing
October 2016

Induction of a tumor-metastasis-receptive microenvironment as an unwanted and underestimated side effect of treatment by chemotherapy or radiotherapy.

J Ovarian Res 2013 Dec 27;6(1):95. Epub 2013 Dec 27.

Stem Cell Institute at the James Graham Brown Cancer Center, University of Louisville, 500 S, Floyd Street, Rm, 107, Louisville, KY 40202, USA.

There are well-known side effects of chemotherapy and radiotherapy that are mainly related to the toxicity and impaired function of vital organs; however, the induction by these therapies of expression of several pro-metastatic factors in various tissues and organs that in toto create a pro-metastatic microenvironment is still, surprisingly, not widely acknowledged. In this review, we support the novel concept that toxic damage in various organs leads to upregulation in "bystander" tissues of several factors such as chemokines, growth factors, alarmines, and bioactive phosphosphingolipids, which attract circulating normal stem cells for regeneration but unfortunately also provide chemotactic signals to cancer cells that survived the initial treatment. We propose that this mechanism plays an important role in the metastasis of cancer cells to organs such as bones, lungs, and liver, which are highly susceptible to chemotherapeutic agents as well as ionizing irradiation. This problem indicates the need to develop efficient anti-metastatic drugs that will work in combination with, or follow, standard therapies in order to prevent the possibility of therapy-induced spread of tumor cells.
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http://dx.doi.org/10.1186/1757-2215-6-95DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3880975PMC
December 2013

Mobilization of CD34+CXCR4+ stem/progenitor cells and the parameters of left ventricular function and remodeling in 1-year follow-up of patients with acute myocardial infarction.

Mediators Inflamm 2012 28;2012:564027. Epub 2012 Mar 28.

Third Division of Cardiology, Medical University of Silesia, 45-47 Ziołowa Street, 40-635 Katowice, Poland.

Mobilization of stem cells in acute MI might signify the reparatory response. Aim of the Study. Prospective evaluation of correlation between CD34+CXCR4+ cell mobilization and improvement of LVEF and remodeling in patients with acute MI in 1-year followup. Methods. 50 patients with MI, 28 with stable angina (SAP), and 20 individuals with no CAD (CTRL). CD34+CXCR4+ cells, SDF-1, G-CSF, troponin I (TnI) and NT-proBNP were measured on admission and 1 year after MI. Echocardiography and ergospirometry were carried out after 1 year. Results. Number of CD34+CXCR4+ cells in acute MI was significantly higher in comparison with SAP and CTRL, but lower in patients with decreased LVEF ≤40%. In patients who had significant LVEF increase ≥5% in 1 year FU the number of cells in acute MI was significantly higher versus patients with no LVEF improvement. Number of cells was positively correlated (r = 0,41, P = 0,031) with absolute LVEF change and inversely with absolute change of ESD and EDD in 1-year FU. Mobilization of CD34+CXCR4+ cells in acute MI was negatively correlated with maximum TnI and NT-proBNP levels. Conclusion. Mobilization of CD34+CXCR4+ cells in acute MI shows significant positive correlation with improvement of LVEF after 1 year.
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http://dx.doi.org/10.1155/2012/564027DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3321738PMC
September 2012

Circulating very small embryonic-like stem cells in cardiovascular disease.

J Cardiovasc Transl Res 2011 Apr 17;4(2):138-44. Epub 2010 Dec 17.

Third Division of Cardiology, Medical University of Silesia, 45-47 Ziołowa Street, Katowice, Poland.

Very small embryonic-like cells (VSELs) are a population of stem cells residing in the bone marrow (BM) and several organs, which undergo mobilization into peripheral blood (PB) following acute myocardial infarction and stroke. These cells express markers of pluripotent stem cells (PSCs), such as Oct-4, Nanog, and SSEA-1, as well as early cardiac, endothelial, and neural tissue developmental markers. VSELs can be effectively isolated from the BM, umbilical cord blood, and PB. Peripheral blood and BM-derived VSELs can be expanded in co-culture with C2C12 myoblast feeder layer and undergo differentiation into cells from all three germ layers, including cardiomyocytes and vascular endothelial cells. Isolation of VSLEs using fluorescence-activated cell sorting multiparameter live cell sorting system is dependent on gating strategy based on their small size and expression of PSC and absence of hematopoietic lineage markers. VSELs express early cardiac and endothelial lineages markers (GATA-4, Nkx2.5/Csx, VE-cadherin, and von Willebrand factor), SDF-1 chemokine receptor CXCR4, and undergo rapid mobilization in acute MI and ischemic stroke. Experiments in mice showed differentiation of BM-derived VSELs into cardiac myocytes and effectiveness of expanded and pre-differentiated VSLEs in improvement of left ventricular ejection fraction after myocardial infarction.
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http://dx.doi.org/10.1007/s12265-010-9254-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3047714PMC
April 2011

Catalytic residues in hydrolases: analysis of methods designed for ligand-binding site prediction.

J Comput Aided Mol Des 2011 Feb 21;25(2):117-33. Epub 2010 Nov 21.

Faculty of Chemistry, Jagiellonian University, 3 Ingardena Street, 30-060 Krakow, Poland.

The comparison of eight tools applicable to ligand-binding site prediction is presented. The methods examined cover three types of approaches: the geometrical (CASTp, PASS, Pocket-Finder), the physicochemical (Q-SiteFinder, FOD) and the knowledge-based (ConSurf, SuMo, WebFEATURE). The accuracy of predictions was measured in reference to the catalytic residues documented in the Catalytic Site Atlas. The test was performed on a set comprising selected chains of hydrolases. The results were analysed with regard to size, polarity, secondary structure, accessible solvent area of predicted sites as well as parameters commonly used in machine learning (F-measure, MCC). The relative accuracies of predictions are presented in the ROC space, allowing determination of the optimal methods by means of the ROC convex hull. Additionally the minimum expected cost analysis was performed. Both advantages and disadvantages of the eight methods are presented. Characterization of protein chains in respect to the level of difficulty in the active site prediction is introduced. The main reasons for failures are discussed. Overall, the best performance offers SuMo followed by FOD, while Pocket-Finder is the best method among the geometrical approaches.
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http://dx.doi.org/10.1007/s10822-010-9402-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3032897PMC
February 2011

Very small embryonic-like stem cells in cardiovascular repair.

Pharmacol Ther 2011 Jan 31;129(1):21-8. Epub 2010 Oct 31.

Third Division of Cardiology, Medical University of Silesia, Katowice, Poland.

Adult bone marrow (BM) harbors several small populations of cells which may contribute to cardiac and endothelial repair, such as endothelial progenitor cells (EPCs), mesenchymal stromal cells (MSCs) and very small embryonic-like cells (VSELs) expressing several markers of pluripotent stem cells (PSCs), such as Oct-4, Nanog and SSEA-1. Such cells were identified in mice bone marrow, peripheral blood and solid organs as well as in umbilical cord blood (UCB) and peripheral blood (PB) in humans. The adult BM-derived VSELs may undergo differentiation into cells derived for all three germ layers, including cardiomyocytes and vascular endothelial cells. VSELs can be isolated using a multiparameter live cell sorting technique with special gating strategy based on their small size, expression of stem cell markers (Sca-1 in mice, CXCR4 and CD133 in humans) and absence of hematopoietic lineage markers (CD45(-) Lin(-)). Experiments in murine models of myocardial infarction (MI) demonstrated population of VSELs expressed also early markers of cardiac and endothelial lineages (GATA-4, Nkx2.5/Csx, VE-cadherin, von Willebrand factor) which migrated to stromal-derived factor-1 (SDF-1) and other chemoattractant gradient and underwent rapid mobilization into peripheral blood in experimental MI mice models. Recently, we demonstrated the mobilization of VSELs expressing PSC, early cardiac and endothelial markers in patients with acute MI. In addition to BM, VSELs were also identified in several murine solid organs including the heart and brain, as well as in umbilical cord blood and peripheral blood in adult humans. We hypothesized that VSELs are quiescent progeny of epiblast-derived PSCs that are deposited during organogenesis in developing organs. In experimental MI intramyocardial injection of VSELs was more efficient than that of HSCs at improving left ventricular ejection fraction and attenuation of myocardial hypertrophy. VSELs can be useful in translational studies of cardiovascular repair.
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http://dx.doi.org/10.1016/j.pharmthera.2010.09.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3005032PMC
January 2011

[Cardiac stem cells].

Kardiol Pol 2010 Oct;68(10):1163-7

III Katedra Kardiologii, Śląski Uniwersytet Medyczny, Katowice.

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October 2010

[Selected problems concerning anaemia in systemic lupus erythematosus patients].

Pol Merkur Lekarski 2009 Dec;27(162):503-7

Slaski Uniwersytet Medyczny w Katowicach, Katedra i Klinika Chorób Wewnetrznych, Autoimmunologicznych i Metabolicznych.

Haematological abnormalities are common in systemic lupus erythematosus (SLE) and may be manifested by anaemia of different pathogenesis. The objective of this article was to describe some data concerning autoimmune haemolytic anaemia, aplastic and megaloblastic ones accompanying SLE and also to present erythropoietin (EPO) function in the above mentioned diseases. In SLE many factors are produced which disturb the organism haematological balance both on the peripheral level and in the bone marrow. It is assumed that the autoantibodies produced in SLE are the main cause of anaemia. However it should be considered that quantitative changes in the number of erythrocytes observed in this disease are also caused by chronic inflammatory condition, which as the element of autoimmune disease impairs the endocrine function of the kidneys in EPO production. It influences bone marrow, iron metabolism and then haemopoiesis. Apart from humoral factors the role of mechanisms connected with immune cellular response is also considered.
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December 2009