Relation between ascending aortic pressures and outcomes in patients with angiographically demonstrated coronary artery disease.
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Aorta↗
Biomedical subjects
Piotr Jankowski
Publications and source records attributed to Piotr Jankowski.
[Recurrent cardiac arrest due to electro-mechanical dissociation in a patient with variant angina -- a case report].
We present a case of a 44-year-old male with recurrent episodes of cardiac arrest in the course of Prinzmetal's angina. Episodes of variant angina can be life threatening due to episodes of advanced atrioventricular block, asystole, ventricular tachycardia or ventricular fibrillation. It has been suggested to implant an ICD in all patients with variant angina after cardiac arrest. This patient received an ICD, however, he died suddenly 6 months later. The possible mechanism of cardiac arrest was an electromechanical dissociation.
Adult↗
Asymmetric pulmonary oedema.
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Cardiomyopathy, Dilated↗
A new ab initio interaction energy surface and high-resolution spectra of the H2-CO van der Waals complex.
A new four-dimensional intermolecular potential-energy surface for the H(2)-CO complex is presented. The ab initio points have been computed on a five-dimensional grid including the dependence on the H-H separation (the C-O separation was fixed). The surface has then been obtained by averaging over the intramolecular vibration of H(2). The coupled-cluster supermolecular method with single, double, and noniterative triple excitations has been used to calculate the interaction energy. The correlation part of the interaction energy has been obtained from extrapolations based on calculations in a series of basis sets. An analytical fit of the ab initio potential-energy surface has the global minimum of -93.049 cm(-1) at the intermolecular separation of 7.92 bohr for the linear geometry with the C atom pointing toward the H(2) molecule. For the other linear geometry, with the O atom pointing toward H(2), the local minimum of -72.741 cm(-1) has been found for the intermolecular separation of 7.17 bohr. The potential has been used to calculate the rovibrational energy levels of the para-H(2)-CO complex. The results agree very well with those observed by McKellar [A. R. W. McKellar J. Chem. Phys. 108, 1811 (1998)]: the discrepancies are smaller than 0.1 cm(-1). The calculated dissociation energy is equal to 19.527 cm(-1) and significantly smaller than the value of 22 cm(-1) estimated from the experiment. Predictions of rovibrational energy levels for ortho-H(2)-CO have also been done and can serve as a guidance to assign recorded experimental spectra. The interaction second virial coefficient has been calculated and compared with the experimental data.
Journal Article↗
Ascending aortic blood pressure-derived indices are not correlated with the extent of coronary artery disease in patients with impaired left ventricular function.
BACKGROUND: Ascending aortic blood pressure-derived indices were shown to be related to coronary atherosclerosis. Unfortunately, most studies published so far included patients with preserved left ventricular function. Therefore, the aim of the present study was to investigate the relation between ascending aortic blood pressure-derived indices and the extent of coronary atherosclerosis in patients with impaired left ventricular function. METHODS: The study group consisted of 375 patients (302 men and 73 women; mean age: 59.0+/-10.1 years) with angiographically confirmed coronary artery disease and ejection fraction < or =55%. Invasive ascending aortic blood pressure during catheterization and conventional sphygmomanometer measurements were taken. RESULTS: None of the brachial or aortic blood pressure-derived indices differed between patients with one-, two- and three-vessel coronary artery disease. They were not independently related to the risk of having three-vessel coronary artery disease in none of the constructed models in logistic regression analysis. Moreover, none of the studied indices was correlated with Gensini or severity scores. We also did not find any significant correlation between blood pressure-derived indices and extent of coronary atherosclerosis in patients with ejection fraction < or =25%, 25-40% or >40%. CONCLUSION: Ascending aortic blood pressure-derived indices are not correlated with the severity of coronary atherosclerosis in patients with coronary artery disease and impaired left ventricular function.
Aorta, Thoracic↗
Relationship between reduced elasticity of extracardiac vessels and left main stem coronary artery disease.
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Aorta↗
Determinants of poor hypertension management in patients with ischaemic heart disease.
UNLABELLED: Not much is known about factors influencing hypertension management in patients with ischaemic heart disease (IHD). Therefore, the aim of the study was to assess factors influencing hypertension management in patients hospitalized due to IHD. We reviewed hospital records of 1051 consecutive patients with a discharge diagnosis of myocardial infarction (MI; n = 290), unstable angina (n = 247), percutaneous coronary intervention (PCI; n = 259) or coronary artery bypass grafting (CABG; n = 255) who were hospitalized at three university (n = 533) or three community (n = 518) cardiac departments. During the follow-up interview (6-18 months after discharge) 70.2% of study participants fulfilled the criteria for a diagnosis of hypertension. Hypertension had not been diagnosed during index hospitalization in 17.5% of hypertensive participants. Overall, 7.1% of hypertensives were not treated with any blood pressure lowering agent. Irregular health checks (odds ratio, OR, 16.3, 95% confidence interval, CI, 4.1-64.0), alcohol drinking (OR 3.3, 95% CI 1.5-7.0), unstable angina (OR 2.7, 95% CI 1.3-5.8), hypertension awareness (OR 0.2, 95% CI 0.1-0.5) and blood pressure lowering drugs prescribed at discharge (OR 0.08, 95% CI 0.03-0.19) were significantly related to the probability of not being on antihypertensive medication. High blood pressure (>or=140/90 mmHg) was found in 68.9% of hypertensives; older age (OR 1.3, 95% CI 1.0-1.6) and hypertension awareness (OR 0.6, 95% 0.3-1.0) were the only significant predictors of uncontrolled hypertension. Among treated participants with uncontrolled hypertension, 33.4% were on monotherapy, 66.6% were on combination therapy, 25.5% were on three or more drugs and 14.7% were on combination of three or more drugs with diuretic. CONCLUSIONS: Hypertension management in the secondary prevention of IHD is not satisfactory. Age and hypertension awareness are the main factors related to the quality of blood pressure control in the post-discharge period.
Aged↗
The challenge of blood pressure control in patients with ischaemic heart disease in Europe.
The goal of the paper is to summarize the current status of blood pressure management in patients with ischaemic heart disease. Recently published results from Europe and North America showed that about half of ischaemic heart disease patients have their blood pressure over 140/90 mmHg. Moreover, these data provide further evidence that poor hypertension management is common in a variety of healthcare settings. Although most ischaemic heart disease patients receive blood pressure-lowering drugs, still a large proportion of them does not reach the recommended treatment goals. During recent years, several attempts were made to improve the control of risk factors (among them blood pressure) in patients with ischaemic heart disease; however, none of them was definitively successful.
Antihypertensive Agents↗
Approximate generation of full-dimensional ab initio van der Waals surfaces for high-resolution spectroscopy.
A method for the generation of highly accurate, nearly-exact, full-dimensional interaction energy surfaces for weakly interacting subsystems is proposed. The method is based on the local expansion of the exact interaction energy surface in the Taylor series with respect to intramolecular coordinates. It is shown that without any significant loss of accuracy this expansion can be limited to a few low-order terms. This leads to significant savings in computations of the full-dimensional interaction energy surfaces. Also a method for the direct calculation of the interaction energy surface of reduced dimensionality, corresponding to averaging over the intramolecular vibrations, without explicit knowledge of the full-dimensional surface, is presented. The main ideas and computational features of the proposed scheme are comprehensively tested for the Ar-HF system.
Journal Article↗
Fractional diastolic and systolic pressure in the ascending aorta are related to the extent of coronary artery disease.
BACKGROUND: Ascending aortic fractional pulse pressure and fractional systolic pressure (FSP) were demonstrated to differentiate patients with and without coronary artery disease. However, no study so far has analyzed the relationship between FSP and fractional diastolic pressure (FDP) and the extent of coronary artery disease. Therefore, we investigated the relationship between ascending aortic FSP and FDP and the extent of coronary atherosclerosis in unselected patients with angiographically confirmed coronary artery disease. METHODS: The study group consisted of 445 patients (350 men and 95 women, mean age 58.5 +/- 9.7 years) with angiographically confirmed coronary artery disease and ejection fraction > 55%. Invasive ascending aortic blood pressure during catheterization and conventional sphygmomanometer measurements were taken. RESULTS: Pulse pressure (PP), FSP, and FDP derived from intraaortic measurements differentiated patients with one-, two-, and three-vessel coronary artery disease (PP, 62.8 +/- 15.8 v 64.8 +/- 17.9 v 71.7 +/- 19.1 [P < .0001]; FSP, 1.45 +/- 0.09 v 1.46 +/- 0.10 v 1.51 +/- 0.12 [P < .0001]; FDP 0.77 +/- 0.05 v 0.77 +/- 0.05 v 0.75 +/-0.06 [P < .0001]). After multivariate stepwise adjustment, the odds ratio (OR) and confidence interval (CI) of having three-vessel disease was as follows: PP per 10 mm Hg, OR = 1.15, 95% CI = 1.01 to 1.30; FSP per 0.1, OR = 1.28, 95% CI = 1.03 to 1.60; and FDP per 0.1, OR = 0.61, 95% CI = 0.39 to 0.95. None of the brachial pressure indices was independently related to the extent of coronary atherosclerosis. CONCLUSIONS: Pulse pressure (PP), FSP, and FDP of the ascending aorta are related to the risk of three-vessel disease in patients with coronary artery disease and preserved left ventricular function.
Aged↗
Lipid-lowering drugs and homocysteine. A comparison between statins and other lipid-lowering drugs.
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Homocysteine↗
Ascending aortic, but not brachial blood pressure-derived indices are related to coronary atherosclerosis.
UNLABELLED: A recent study has demonstrated that pulse pressure (PP) measured in the ascending aorta is related to the extent of coronary artery disease in patients undergoing coronary angioplasty. However, no study so far has analyzed the relation between pulsatility of the ascending aorta and the extent of coronary artery disease in consecutive patients undergoing coronary angiography. Therefore, we investigated the relation between ascending aorta pulsatility and the extent of coronary atherosclerosis in unselected patients with angiographically confirmed coronary artery disease. The study group consisted of 423 consecutive patients (334 men and 89 women; mean age: 58.6+/-9.7 years) with angiographically confirmed coronary artery disease and ejection fraction < or =60% PP, fractional pulse pressure (the ratio of pulse pressure to mean pressure, FPP), and the ratio of pulse pressure to diastolic pressure (pulsatility index, PI) derived from intraaortic measurements differentiated patients with one-, two- and three-vessel coronary artery disease (PP, 63.0+/-16.0 versus 64.2+/-18.3 versus 71.8+/-19.1 mmHg (P < 0.0001); FPP, 0.68+/-0.14 versus 0.69+/-0.15 versus 0.76+/-0.17 (P < 0.0001); PI 0.89+/-0.25 versus 0.92+/-0.27 versus 1.04+/-0.32 (P < 0.0001)). After multivariate stepwise adjustment, the odds ratio (OR) and confidence interval (CI) of having three-vessel disease was: PP per 10 mmHg OR 1.15 (95% CI 1.02-1.31); FPP per 0.1 OR 1.18 (95% CI 1.02-1.37); and PI per 0.1 OR 1.11 (95% CI 1.03-1.21). None of brachial blood pressure indices was independently related to the extent of coronary atherosclerosis. CONCLUSION: Pulse pressure, fractional pulse pressure, and pulsatility index of the ascending aorta are related to the risk of three-vessel disease in patients with coronary artery disease and preserved left ventricular function.
Aged↗
[Pheochromocytoma mimicking acute myocarditis].
Pheochromocytoma, a relatively rare (0.1-0.8% of hypertensives), catecholamine-secreting tumor, is almost always lethal unless recognised and appropriately treated. Histological changes in myocardium can be often found in patients with hypertension crisis due to pheochromocytoma, however, only a few patients with clinical manifestations of acute myocarditis were described. We report a 18-year-old man hospitalised with symptoms of acute myocarditis. Precise clinical assessment allowed to diagnose pheochromocytoma.
Acute Disease↗
[Intracoronary thrombolysis combined with platelet receptor IIb/IIIa inhibitor and followed by percutaneous coronary intervention for the treatment of acute myocardial infarction: two case reports].
By using classical thrombolytic treatment in acute myocardial infarction, reperfusion can be obtained in 60-80% of patients. However, in only 30-55% of cases TIMI grade 3 flow is achieved. Primary percutaneous coronary intervention (PCI) offers the potential for a higher rate of reperfusion and a lower rate of bleeding events. Recently, advances in platelet inhibition and PCI procedures have led to the combination of all the approaches. Facilitated PCI or the use of elective PCI after pharmacological reperfusion therapy can combine the best aspects of thrombolysis and mechanical revascularization in acute myocardial infarction. We report two cases with acute myocardial infarction successfully treated with PCI following thrombolytic treatment combined with platelet receptor IIb/IIIa inhibitor.
Aged↗
[Primary percutaneous coronary interventions in acute myocardial infraction with ST-segment elevation. Experience in a heart catheterization unit without surgical backup].
BACKGROUND: Primary percutaneous coronary intervention (PCI) in patients (pts) with ST-segment elevation myocardial infarction is regarded as treatment superior to thrombolysis. Coronary stents and GP IIb/IIIa receptor inhibitors improved safety and clinical outcome of interventional procedures. Safety of primary PCI procedure in catheterisation laboratories which do not have on-site surgical backup is still under evaluation. METHODS: In a cohort of 249 consecutive patients we analysed short and long-term clinical outcome of primary PCI performed in catheterisation laboratory which is located several kilometres from a cardiac surgery department, with an effective transfer time < 30 minutes. RESULTS: Coronary stents were implanted in 43% pts. GP IIb/IIIa receptor inhibitors were used in 54.2% pts. Cardiogenic shock on admission was diagnosed in 7.2% pts. Intra-aortic balloon counterpulsation usage was necessary in 6.4% pts. In-hospital mortality was 6% (3.5% in non-shock pts). In two pts (0.8%) during hospitalization repeat PCI was performed--in one case due to reinfarction. No urgent cardiosurgery intervention was necessary. Mortality and myocardial infarction rate after hospital discharge during 6 month follow up was 2.4% and 2.8% respectively. In 4% pts repeated PCI was performed due to restensosis. Cumulative event free survival was 84%. CONCLUSION: Primary PCI procedure for acute myocardial infarction seems to be feasible and safe in catheterisation laboratories without on-site surgical backup provided usage of stents, GPIIb/IIIa receptor inhibitors and intraaortic balloon counterpulsation and cooperation with a nearby cardiosurgery department with short transfer time.
Aged↗
[Secondary prevention of ischemic heart disease in diabetics in clinical practice].
BACKGROUND: Diabetes is an indication for particularly careful risk factors management in ischaemic heart disease patients. AIM: The aim of the study was to assess the implementation of guidelines on secondary prevention of ischaemic heart disease in diabetics. METHODS: We reviewed hospital records of 1051 consecutive patients at age < or = 70 years with discharge diagnosis of acute myocardial infarction, unstable angina, percutaneous coronary intervention or coronary artery bypass surgery who were hospitalized in three university and in three community cardiac departments serving the area of the city. The follow-up interview took place 6-18 months after discharge. RESULTS: Out of 1051 (754 men and 297 women; mean age 57.1 +/- 8.4 years) study participants 160 (15.2%) were diagnosed as having diabetes. ACE inhibitors were prescribed at discharge more often (73.1% vs 47.6%; p < 0.0001) whereas beta-blockers (54.4% vs 66,0%; p < 0.01) and lipid-lowering drugs (25.0% vs 35.9%; p < 0.01) less often in diabetics compared to non-diabetics. One year after discharge diabetics smoked less frequently compared to non-diabetics (9.8% vs 17.2%; p < 0.05). No significant difference was found in the prevalence of high blood pressure, high total and LDL cholesterol levels, low HDL cholesterol level and high triglycerides level in diabetic and non-diabetic patients. The prevalence of obesity increased after hospitalization in both groups. ACE inhibitors were used more often (61.5% vs 44.3%; p < 0.001) whereas lipid-lowering drugs less often (27.1% vs 39.8%; p < 0.01) in diabetics compared to non-diabetics. Diabetes was not independently related to the frequency of lipid-lowering drug use in patients with hypercholesterolemia. CONCLUSIONS: Insufficient control of risk factors and too low prescription rate of secondary prevention drugs were found both in diabetic and non-diabetic patients. There is a need to intensify secondary prevention, especially in patients with diabetes.
Adrenergic beta-Antagonists↗
[New beta-blockers in the treatment of chronic ischaemic heart disease].
Beta-blockers are routinely used in all forms of ischaemic heart disease except variant angina. Recently, III generation beta-blockers were introduced into practice. New beta-blockers often have ancillary properties like vaso-dilating or antioxidant properties. Also slow-release formulas of old beta-blockers are now available. Several studies show that these new agents are more efficient when compared with old beta-blockers. Moreover, adverse effects of new beta-blockers are often less severe than in the case of older agents. Especially the influence on bronchi, peripheral arteries and lipid and glucose metabolism is less pronounced. The frequency of beta-blockers use is too low in Poland as well as in other European countries, despite overwhelming evidence that these agents improve prognosis. The results of Cracovian Program for Secondary Prevention of Ischaemic Heart Disease showed that the proportions of patients after myocardial infarction or myocardial revascularization prescribed beta-blockers are too low. One of the reasons is probably the doctors' concern about side effects of beta-blockers. Widespread use of new beta-blockers in everyday clinical practice may increase beta-blocker use in general and in this way improve prognosis of ischaemic heart disease patients in Europe.
Adrenergic beta-Antagonists↗
Determinants of appropriate lipid management in patients with ischaemic heart disease. Cracovian Program for Secondary Prevention of Ischaemic Heart Disease.
UNLABELLED: Although several randomised clinical trials have documented the efficacy of lipid-lowering therapy in improving clinical outcomes in hyperlipidemic subjects with ischaemic heart disease (IHD), such therapy is underutilized worldwide. Not much is known about the effects of the hospital setting (university vs. community) on lipid management in patients after hospitalization due to ischaemic heart disease. The combined effect of age, sex, education, risk factors, hospital as well as practice setting in the post-discharge period on lipid management in IHD patients is also unknown. Therefore the aim of this study was to evaluate factors influencing lipid management during and after hospitalization due to IHD. The primary outcome measure was "appropriate lipid management", defined as: (a) being discharged on lipid-lowering medication or having a documented LDL cholesterol level <3.4 microM/l within the first 24 h of hospitalization, and (b) (for patients with hypercholesterolemia) being prescribed a lipid-lowering drug at the time of the interview 6-18 months after discharge. METHODS AND RESULTS: We reviewed the hospital records of 1051 consecutive patients with a discharge diagnosis of acute myocardial infarction (N=290), unstable angina (N=247), percutaneous coronary intervention (N=259) or coronary artery bypass surgery (N=255) who were hospitalized at three university (N=533) or three community (N=518) cardiac departments. Overall, 42.2% of the study population met the criteria for appropriate lipid management during hospitalization. Admission to the university hospital, percutaneous coronary intervention, a history of myocardial infarction, the presence of hypertension, the absence of diabetes mellitus, and younger age were all associated with an increased probability of receiving proper treatment during hospitalization. During the follow-up interview (6-18 months after discharge), 10.4% patients had a LDL cholesterol level of <2.6 microM/l. The use of lipid-lowering agents in the group with hypercholesterolemia was 40.8%. Patients who met the criteria for appropriate lipid management during hospitalization were more often prescribed a lipid-lowering drug at the time of interview compared with persons who did not meet those criteria (62.5% vs. 23.5%; P<0.0001). Patients undergoing percutaneous coronary interventions, treated in hospital outpatient clinics, obese patients as well as those better educated were more likely to be treated appropriately than the other groups. CONCLUSIONS: Proper lipid management during hospitalization is the most important factor related to lipid management in the post-discharge period. There is the potential for a further reduction of coronary risk, especially in patients hospitalized in community hospitals, not undergoing coronary interventions and those being under the care of general practitioners.
Comorbidity↗