Biomedical subjects
Publications and source records attributed to Zbigniew Gasior.
A case of 65 year old male with acute myocardial infarction is described. The patient underwent successful primary coronary angioplasty with the use of a distal embolic protection device.
UNLABELLED: The relation of stress dobutamine echocardiography test results to angiographic features was assessed in 551 patients with chest pain regarded as definite or probable stable angina pectoris. The indications for catheterization in each patient were determined at the discretion of the attending physician. All patients underwent diagnostic coronary angiography (clinically important coronary artery disease was defined as > 50 per cent narrowing of the diameter of at least one major vessel or > or = 50 per cent of the left main coronary artery) and stress dobutamine echocardiography (DSE): Ischemia was defined as new or worsening wall motion abnormalities using a 16-segment model. Sensitivity and specificity of DSE was calculated: 85% and 69% respectively for the entire group, 79% and 71% in women, 87% and 66% in men and compared with diagnostic value of the electrocardiographic exercise test (EE) in the same population. Sensitivity and specificity of the EE was respectively: 93% and 21% for the entire group, 91% and 16% in women, 94% and 27% in men. CONCLUSIONS: 1. DSE has comparable sensitivity but significantly higher specificity than EE. 2. Variables determining false positive result of DSE are as follows: mean maximal heart rate, reached % of the target heart rate and wall motion abnormalities present in single segment. 3. Variables determining false negative results are: sex (male) and one vessel disease. 4. Treatment with beta-adrenolytic agents increases incidence of nondiagnostic results of DSE.
Echocardiographic examination at rest is usually an adequate diagnostic method in evaluating patients with aortic stenosis and in assessing the severity of stenosis. However, in patients with aortic stenosis with coexisting coronary heart disease and in patients with poor left ventricular systolic function and low gradient aortic stenosis, dobutamine stress echocardiography should be performed. This test is helpful in differentiating between significant fixed aortic stenosis with secondary left ventricular dysfunction and severe left ventricular dysfunction coexisting with nonsignificant aortic valve stenosis. This examination is necessary to select the proper method of treatment and is helpful in risk stratification.
THE AIMS: The aim of the study was to assess the safety of dobutamine echocardiography (DE) in patients with aortic stenosis and left ventricular ejection fraction < or = 45%. METHODS: 162 patients (mean age 59 +/- 13, 64% males) with resting transvalvular peak gradient < 70 mmHg underwent standard DE (doses 5-40 micrograms/kg/min) in a multicenter study involving 10 centers from Poland and Hungary. This analysis involves a subset of 39 pts (34 M, 5 F, age 59 +/- 13) identified according to the criterion of EF < or = 45% and mean aortic gradient < or = 35 mmHg. Clinically indicated coronary arteriography was performed in all patients with left ventricular dysfunction. RESULTS: Peak dobutamine dose was 29 +/- 10 micrograms/kg/min. Peak heart rate was 112 +/- 26 bpm. Systolic arterial pressure was 148 +/- 20 mmHg and diastolic pressure 86 +/- 14 mmHg. Transaortic mean gradient and aortic valve area increased 35 +/- 34% and 19 +/- 15% during peak dobutamine dose, respectively. Ejection fraction improved 16 +/- 14%. The test was positive in 17 (43.6%) patients, negative in 11 (28.2%) patients and non diagnostic in 11 (28.2%) patients. There were no deaths, myocardial infarctions or episodes of sustained ventricular tachycardia as a result of DE. The test was terminated when the following conditions were met: Target heart rate (23.%). Left ventricular asynergy (46.2%). Maximal established dose achieved (7.7%). Side effects (20.5%). The most common side effects were ventricular arrhythmias (35.9%), dyspnea (20.5%) and hypotension < 20 mmHg (10.3%). CONCLUSION: Despite frequent side effects, DE can be safely performed in patients with aortic stenosis and depressed left ventricular contractility.
Transforming growth factor beta (TGF-beta) is a cytokine engaged in a wide range of diverse and often contradictory functions. Its effect on the cardiovascular system is also ambiguous; on the one hand, there is a strong evidence for so-called 'protective cytokine hypothesis'considering TGF-beta to be an anti-atherogenic and plaque-stabilizing factor, but on the other hand, TGF-beta has been proven to exert some proinflammatory effects. Moreover, besides the positive aspect of a profibrotic and reparative action of TGF-beta, there are also some disadvantages: TGF-beta plays a significant role in postangioplasty restenosis, post-infarction myocardial remodeling (resulting in the development of heart failure) and in numerous other circulatory disorders where fibrosis and vascular remodeling takes part in pathology. The aim of the paper was to review and discuss the unwanted effects of TGF-beta in the circulatory system, and to outline the possible pharmacological strategies to interfere with TGF-beta-dependent pathways and prevent these disturbances.