1
|
Lis P, Rajzer M, Klima Ł. The Significance of Coronary Artery Calcification for Percutaneous Coronary Interventions. Healthcare (Basel) 2024; 12:520. [PMID: 38470631 PMCID: PMC10931248 DOI: 10.3390/healthcare12050520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 03/14/2024] Open
Abstract
The prevalence of calcium deposits in coronary arteries grows with age. Risk factors include, e.g., diabetes and chronic kidney disease. There are several underlying pathophysiological mechanisms of calcium deposition. Severe calcification increases the complexity of percutaneous coronary interventions. Invasive techniques to modify the calcified atherosclerotic plaque before stenting have been developed over the last years. They include balloon- and non-balloon-based techniques. Rotational atherectomy has been the most common technique to treat calcified lesions but new techniques are emerging (orbital atherectomy, intravascular lithotripsy, laser atherectomy). The use of intravascular imaging (intravascular ultrasound and optical coherence tomography) is especially important during the procedures in order to choose the optimal strategy and to assess the final effect of the procedure. This review provides an overview of the role of coronary calcification for percutaneous coronary interventions.
Collapse
Affiliation(s)
| | | | - Łukasz Klima
- 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, 30-688 Kraków, Poland; (P.L.); (M.R.)
| |
Collapse
|
2
|
Terlecki M, Kocowska-Trytko M, Plens K, Drożdż T, Pavlinec C, Gruszka K, Klima Ł, Wojciechowska W, Wordliczek J, Stolarz-Skrzypek K, Rajzer M. Prognostic value of acid-base balance parameters obtained from peripheral venous blood sample on admission in patients with myocardial infarction treated with percutaneous coronary intervention. Pol Arch Intern Med 2022; 132. [PMID: 35289158 DOI: 10.20452/pamw.16229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Peripheral venous blood sample may be used to obtain acid-base balance parameters (PVA-BP) measured in rapid point-of-care test analyzers (POCT) on admission to emergency department (ED). Thus, lactates, anion gap (AG) and base excess (BE) may be early prognostic markers in patients with myocardial infarction (MI). OBJECTIVES We aimed to confirm the relationship between PVA-BP on admission and the outcome in patients with MI treated by percutaneous coronary intervention (PCI). PATIENTS AND METHODS A retrospective, observational analysis of MI patients admitted primarily to ED and secondly transferred to PCI department. RESULTS 336 patients (41.1% STEMI, 58.9% NSTEMI) were divided according to lactates level: G1:≤2.0 mmol/l (n = 207), G2:>2.0 mmol/l (n = 129). G2 patients had higher values of AG (mean (SD), 9.6 (4.3) vs 6.8 (3.2) mEq/l; P <0.001) and lower BE (median [interquartile range (IQR)], -0.7 [-3.9;0.8] vs 1.0 [-0.2;2.4] mEq/l; P <0.001). In-hospital non-survivors had higher values of lactates (4.0 [2.0;8.7] vs 1.7 [1.3;2.4] mmol/l; P <0.001), AG (10.5 (4.6) vs 7.7 (3.8) mEq/l; P <0.001) and lower BE (-4.8 [-10.6;-1.8] vs 1.5 [-0.8;2.3] mEq/l; P <0.001) compared to survivors. Lactates, AG and BE correlated with GRACE score (r = 0.361; P <0.001, r = 0.158; P = 0.004, r = -0.383; P <0.001, respectively). Only BE independently predicted both 30- and 365-days mortality in whole group (HR 0.79, 95%CI 0.65-0.95; P = 0.01, HR 0.89, 95%CI 0.76-0.99; P = 0.04, respectively) as well as in-hospital mortality among patients without infarct-related out-of-hospital cardiac arrest (OR 0.74, 95%CI 0.57-0.97; P = 0.03). CONCLUSIONS In patients admitted to ED with MI treated with PCI the evaluation of PVA-BP assessed in POCT analyzers may be a reliable tool for early risk stratification.
Collapse
Affiliation(s)
- Michał Terlecki
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Institute of Cardiology, Kraków, Poland
| | - Maryla Kocowska-Trytko
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Institute of Cardiology, Kraków, Poland
| | | | - Tomasz Drożdż
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Institute of Cardiology, Kraków, Poland
| | - Christopher Pavlinec
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Institute of Cardiology, Kraków, Poland
| | - Krystian Gruszka
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Institute of Cardiology, Kraków, Poland
| | - Łukasz Klima
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Institute of Cardiology, Kraków, Poland
| | - Wiktoria Wojciechowska
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Institute of Cardiology, Kraków, Poland
| | - Jerzy Wordliczek
- Department of Interdisciplinary Intensive Care, Jagiellonian University Medical College, Kraków, Poland
| | - Katarzyna Stolarz-Skrzypek
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Institute of Cardiology, Kraków, Poland
| | - Marek Rajzer
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Institute of Cardiology, Kraków, Poland.
| |
Collapse
|
3
|
Moskal P, Klima Ł, Jastrzębski M, Czarnecka D. Arteriovenous fistula imitating myocardial ischaemia on electrocardiogram. Kardiol Pol 2018; 76:1376. [DOI: 10.5603/kp.2018.0185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 04/23/2018] [Accepted: 05/08/2018] [Indexed: 11/25/2022]
|
4
|
Wojciechowska W, Stolarz-Skrzypek K, Olszanecka A, Klima Ł, Gąsowski J, Grodzicki T, Kawecka-Jaszcz K, Czarnecka D. Subclinical arterial and cardiac damage in white-coat and masked hypertension. Blood Press 2016; 25:249-56. [DOI: 10.3109/08037051.2016.1150563] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Wiktoria Wojciechowska
- The First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Katarzyna Stolarz-Skrzypek
- The First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Agnieszka Olszanecka
- The First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Łukasz Klima
- The First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Jerzy Gąsowski
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Kraków, Poland
| | - Tomasz Grodzicki
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Kraków, Poland
| | - Kalina Kawecka-Jaszcz
- The First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Danuta Czarnecka
- The First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| |
Collapse
|
5
|
Bryniarski L, Surowiec S, Klima Ł, Terlecki M, Jankowski P, Rajzer M, Kusak P, Królikowski T, Curyło A, Żmudka K, Dudek D, Czarnecka D. Recanalisation of coronary chronic total occlusion by retrograde approach: the first experience in Poland. Kardiol Pol 2014; 73:167-76. [PMID: 25179481 DOI: 10.5603/kp.a2014.0167] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Revised: 05/16/2014] [Accepted: 06/12/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND The effectiveness of revascularisation procedures of coronary chronic total occlusion (CTO) has been improved by the introduction of retrograde approach. AIM This study compared the outcomes of CTO revascularisation in a single centre in Krakow, Poland using antegrade and retrograde approach. METHODS From January 2011 to September 2013, 150 patients underwent 159 procedures for percutaneous revascularisation of CTO of 153 vessels. Of the 159 procedures, 124 (78%) were performed using an antegrade approach and 35 (22%) using a retrograde approach. RESULTS All patients were symptomatic, with mean CCS class (2.3 ± 0.6 vs. 2.1 ± 0.7, p = 0.9), mean age (59.2 ± 8.3 vs. 62.6 ± 9.9 years, p = 0.067), and mean number of males (81.3% vs. 81.8%, p = 0.9) similar in the retrograde and antegrade groups, respectively. Most patients in both groups had ejection fraction (EF) ≥ 50% (84.4% vs. 74.4%, respectively). Occlusions assessed according to the J-CTO score showed that 82.9% and 56.4%, respectively, were rated as difficult or very difficult (p < 0.01). Overall procedural success rate was 88.2%, 87.9% in the antegrade, and 74.3% in the retrograde group. Complication rates were low and similar in two groups. However, the retrograde approach was associated with a longer mean fluoroscopy time (47.8 ± 19.6 vs. 19.3 ± 10.0 min, p < 0.00001) and higher volume of contrast fluid (494.6 ± 142.4 vs. 291.9 ± 118.1 mL, p < 0.00001). CONCLUSIONS Using novel equipment with adequate experience allowed high rates of successful revascularisation. The retrograde technique for CTO revascularisation showed good overall success and was safe.
Collapse
Affiliation(s)
- Leszek Bryniarski
- 1st Department of Cardiology, Interventional Electrocardiology, and Arterial Hypertension, Jagiellonian University, Medical College, University Hospital, Krakow, Poland.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Klima Ł, Kawecka-Jaszcz K, Stolarz-Skrzypek K, Menne J, Fijorek K, Olszanecka A, Wojciechowska W, Bilo G, Czarnecka D. Structure and function of large arteries in hypertension in relation to oxidative stress markers. Kardiol Pol 2013; 71:917-23. [DOI: 10.5603/kp.2013.0226] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Indexed: 11/25/2022]
|
7
|
Fijorek K, Patel N, Klima Ł, Stolarz-Skrzypek K, Kawecka-Jaszcz K, Polak S. Age and gender dependent heart rate circadian model development and performance verification on the proarrhythmic drug case study. Theor Biol Med Model 2013; 10:7. [PMID: 23394137 PMCID: PMC3598978 DOI: 10.1186/1742-4682-10-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2012] [Accepted: 02/06/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are two main reasons for drug withdrawals at the various levels of the development path - hepatic and cardiac toxicity. The latter one is mainly connected with the proarrhythmic potency and according to the present practice is supposed to be recognized at the pre-clinical (in vitro and animal in vivo) or clinical level (human in vivo studies). There are, although, some limitations to all the above mentioned methods which have led to novel in vitro - in vivo extrapolation methods being introduced. With the use of in silico implemented mathematical and statistical modelling it is possible to translate the in vitro findings into the human in vivo situation at the population level. Human physiology is influenced by many parameters and one of them which needs to be properly accounted for is a heart rate which follows the circadian rhythm. We described such phenomenon statistically which enabled the improved assessment of the drug proarrhythmic potency. METHODS A publicly available data set describing the circadian changes of the heart rate of 18 healthy subjects, 5 males (average age 36, range 26-45) and 13 females (average age 34, range 20-50) was used for the heart rate model development. External validation was done with the use of a clinical research database containing heart rate measurements derived from 67 healthy subjects, 34 males and 33 females (average age 33, range 17-72). The developed heart rate model was then incorporated into the ToxComp platform to simulate the impact of circadian variation in the heart rate on QTc interval. The usability of the combined models was assessed with moxifloxacin (MOXI) as a model drug. RESULTS The developed heart rate model fitted well, both to the training data set (RMSE = 128 ms and MAPE = 12.3%) and the validation data set (RMSE = 165 ms and MAPE = 17.1%). Simulations performed at the population level proved that the combination of the IVIVE platform and the population variability description allows for the precise prediction of the circadian variation of drugs proarrhythmic effect. CONCLUSIONS It can be concluded that a flexible and practically useful model describing the heart rate circadian variation has been developed and its performance was verified.
Collapse
Affiliation(s)
- Kamil Fijorek
- Department of Statistics, Cracow University of Economics, Krakow, Poland.
| | | | | | | | | | | |
Collapse
|
8
|
Wiliński J, Kusiak A, Wiliński B, Smolik P, Klima Ł, Chmielewska J, Czarnecka D. [Selection and maintenance of the blood pressure monitor for self-blood pressure monitoring (SBPM)]. Przegl Lek 2013; 70:900-903. [PMID: 24697026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND AND PURPOSE The choice of an attested blood pressure (BP) monitor with an adequate arm cuff size and its proper maintenance are crucial for obtaining reliable results in Self-Blood Pressure Monitoring (SBPM) practice. The aim of the study was to assess the factors determining the BP monitor selection, its purchase place and technical use aspects. MATERIAL AND METHODS Two hun. dred consecutive patients with arte. rial hypertension regularly performing SBPM (100 individuals from a munici. pal primary health care centre and 100 from a specialized hypertension office at a university cardiology clinic, aged 57.7 +/-12.4 years, 54.0% female) have undergone an inquiry study based on the European Society of Hyperten. sion (ESH) guidelines for home BP monitoring. RESULTS Almost half of the re. spondents are utilizing BP monitors that are not routinely recommended for SBPM: wrist devices - 22.0%, aneroid appliances -15.0%, mercury monitors - 7.0% and finger monitors - 1.0%. Only 45.0% of the study participants have checked if the cuff size is ap. propriate, whereas arm circumference in 26.0% of the patients exceeded 34 cm and in 3.5% of the individuals was below 24 cm. As few as 2.5% of SBPM practitioners perform regular techni. cal checkups of their BP monitors. Patients of a specialized hypertension office have significantly more often chosen their BP apparatus according to the doctor's recommendation than primary health care patients (27.0% vs 12.0%, p=0.007, respectively). CONCLUSIONS Sphygmomanometer type and appropriate arm cuff size selections for SBPM is random. The aspects of BP monitor attest and its proper maintenance are neglected. Physicians recommend an adequate BP apparatus choice too rarely.
Collapse
|
9
|
Neisius U, Bilo G, Taurino C, McClure JD, Schneider MP, Kawecka-Jaszcz K, Stolarz-Skrzypek K, Klima Ł, Staessen JA, Kuznetsova T, Redon J, Martinez F, Rosei EA, Muiesan ML, Melander O, Zannad F, Rossignol P, Laurent S, Collin C, Lonati L, Zanchetti A, Dominiczak AF, Delles C. Association of central and peripheral pulse pressure with intermediate cardiovascular phenotypes. J Hypertens 2012; 30:67-74. [DOI: 10.1097/hjh.0b013e32834e12d8] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
|
10
|
Klima Ł, Stolarz Skrzypek K, Olszanecki R, Kawecka Jaszcz K. [The oxidative stress in pathogenesis of arterial hypertension - role of methylated arginines]. Kardiol Pol 2011; 69 Suppl 3:94-99. [PMID: 22125211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Oxidative stress plays significant role in pathogenesis of cardiovascular diseases. Imbalance of antioxidants and reactive oxygen species contributes to endothelium damage and leads to hypertension. The knowledge on these processes may contribute to prevention and therapy of cardiovascular diseases. This paper describes the role of methylated arginines in pathogenesis of arterial hypertension, which are nowadays object of wide research and pathways involved in their formation and metabolism are often recognised as potential targets for cardiovascular drugs.
Collapse
Affiliation(s)
- Łukasz Klima
- I Klinika Kardiologii i Nadciśnienia Tętniczego, Collegium Medicum, Uniwersytet Jagielloński, Kraków
| | | | | | | |
Collapse
|