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Makowska K, Lech P, Gonkowski S. Bisphenol A Effects on Neurons' Neurochemical Character in the Urinary Bladder Intramural Ganglia of Domestic Pigs. Int J Mol Sci 2023; 24:16792. [PMID: 38069115 PMCID: PMC10706807 DOI: 10.3390/ijms242316792] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/14/2023] [Accepted: 11/25/2023] [Indexed: 12/18/2023] Open
Abstract
Bisphenol A (BPA), a substance globally used to produce plastics, is part of many everyday items, including bottles, food containers, electronic elements, and others. It may penetrate the environment and living organisms, negatively affecting, among others, the nervous, immune, endocrine, and cardiovascular systems. Knowledge of the impact of BPA on the urinary bladder is extremely scarce. This study investigated the influence of two doses of BPA (0.05 mg/kg body weight (b.w.)/day and 0.5 mg/kg b.w./day) given orally for 28 days on the neurons situated in the ganglia located in the urinary bladder trigone using the typical double immunofluorescence method. In the study, an increase in the percentage of neurons containing substance P (SP), galanin (GAL), a neuronal isoform of nitric oxide synthase (nNOS-used as the marker of nitrergic neurons), and/or cocaine- and amphetamine-regulated transcript (CART) peptide was noted after BPA administration. The severity of these changes depended on the dose of BPA and the type of neuronal factors studied. The most visible changes were noted in the cases of SP- and/or GAL-positive neurons after administering a higher dose of BPA. The results have shown that oral exposure to BPA, lasting even for a short time, affects the intramural neurons in the urinary bladder wall, and changes in the neurochemical characterisation of these neurons may be the first signs of BPA-induced pathological processes in this organ.
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Affiliation(s)
- Krystyna Makowska
- Department of Clinical Diagnostics, Faculty of Veterinary Medicine, University of Warmia and Mazury in Olsztyn, Oczapowskiego 14, 10-957 Olsztyn, Poland
| | - Piotr Lech
- Agri Plus sp. Z o.o., Marcelinska Street 92, 60-324 Pozan, Poland
| | - Sławomir Gonkowski
- Department of Clinical Physiology, Faculty of Veterinary Medicine, University of Warmia and Mazury in Olsztyn, Oczapowskiego 13, 10-957 Olsztyn, Poland
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Janssens SP, Bogaert J, Zalewski J, Toth A, Adriaenssens T, Belmans A, Bennett J, Claus P, Desmet W, Dubois C, Goetschalckx K, Sinnaeve P, Vandenberghe K, Vermeersch P, Lux A, Szelid Z, Durak M, Lech P, Zmudka K, Pokreisz P, Vranckx P, Merkely B, Bloch KD, Van de Werf F. Nitric oxide for inhalation in ST-elevation myocardial infarction (NOMI): a multicentre, double-blind, randomized controlled trial. Eur Heart J 2019; 39:2717-2725. [PMID: 29800130 DOI: 10.1093/eurheartj/ehy232] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 05/16/2018] [Indexed: 12/19/2022] Open
Abstract
Aims Inhalation of nitric oxide (iNO) during myocardial ischaemia and after reperfusion confers cardioprotection in preclinical studies via enhanced cyclic guanosine monophosphate (cGMP) signalling. We tested whether iNO reduces reperfusion injury in patients with ST-elevation myocardial infarction (STEMI; NCT01398384). Methods and results We randomized in a double-blind, placebo-controlled study 250 STEMI patients to inhale oxygen with (iNO) or without (CON) 80 parts-per-million NO for 4 h following percutaneous revascularization. Primary efficacy endpoint was infarct size as a fraction of left ventricular (LV) size (IS/LVmass), assessed by delayed enhancement contrast magnetic resonance imaging (MRI). Pre-specified subgroup analysis included thrombolysis-in-myocardial-infarction flow in the infarct-related artery, troponin T levels on admission, duration of symptoms, location of culprit lesion, and intra-arterial nitroglycerine (NTG) use. Secondary efficacy endpoints included IS relative to risk area (IS/AAR), myocardial salvage index, LV functional recovery, and clinical events at 4 and 12 months. In the overall population, IS/LVmass at 48-72 h was 18.0 ± 13.4% in iNO (n = 109) and 19.4 ± 15.4% in CON [n = 116, effect size -1.524%, 95% confidence interval (95% CI) -5.28, 2.24; P = 0.427]. Subgroup analysis indicated consistency across clinical confounders of IS but significant treatment interaction with NTG (P = 0.0093) resulting in smaller IS/LVmass after iNO in NTG-naïve patients (n = 140, P < 0.05). The secondary endpoint IS/AAR was 53 ± 26% with iNO vs. 60 ± 26% in CON (effect size -6.8%, 95% CI -14.8, 1.3, P = 0.09) corresponding to a myocardial salvage index of 47 ± 26% vs. 40 ± 26%, respectively, P = 0.09. Cine-MRI showed similar LV volumes at 48-72 h, with a tendency towards smaller increases in end-systolic and end-diastolic volumes at 4 months in iNO (P = 0.048 and P = 0.06, respectively, n = 197). Inhalation of nitric oxide was safe and significantly increased cGMP plasma levels during 4 h reperfusion. The Kaplan-Meier analysis for the composite of death, recurrent ischaemia, stroke, or rehospitalizations showed a tendency toward lower event rates with iNO at 4 months and 1 year (log-rank test P = 0.10 and P = 0.06, respectively). Conclusions Inhalation of NO at 80 ppm for 4 h in STEMI was safe but did not reduce infarct size relative to absolute LVmass at 48-72h. The observed functional recovery and clinical event rates at follow-up and possible interaction with nitroglycerine warrant further studies of iNO in STEMI.
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Affiliation(s)
- Stefan P Janssens
- The Department of Cardiovascular Diseases, University Hospitals Leuven, KU Leuven, Herestraat 49, Leuven, Belgium.,The Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Jan Bogaert
- Division of Radiology, University Hospitals Leuven and Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Jaroslaw Zalewski
- Department of Coronary Heart Disease, Jagiellonian University, Medical College, John Paul II Hospital, Pradnicka 80, Krakow, Poland
| | - Attila Toth
- Heart and Vascular Center, Semmelweis University, Varosmajor u. 68, Budapest, Hungary
| | - Tom Adriaenssens
- The Department of Cardiovascular Diseases, University Hospitals Leuven, KU Leuven, Herestraat 49, Leuven, Belgium.,The Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Ann Belmans
- The Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Johan Bennett
- The Department of Cardiovascular Diseases, University Hospitals Leuven, KU Leuven, Herestraat 49, Leuven, Belgium
| | - Piet Claus
- The Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Walter Desmet
- The Department of Cardiovascular Diseases, University Hospitals Leuven, KU Leuven, Herestraat 49, Leuven, Belgium.,The Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Christophe Dubois
- The Department of Cardiovascular Diseases, University Hospitals Leuven, KU Leuven, Herestraat 49, Leuven, Belgium.,The Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Kaatje Goetschalckx
- The Department of Cardiovascular Diseases, University Hospitals Leuven, KU Leuven, Herestraat 49, Leuven, Belgium
| | - Peter Sinnaeve
- The Department of Cardiovascular Diseases, University Hospitals Leuven, KU Leuven, Herestraat 49, Leuven, Belgium.,The Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | | | - Pieter Vermeersch
- The Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Arpad Lux
- Heart and Vascular Center, Semmelweis University, Varosmajor u. 68, Budapest, Hungary
| | - Zsolt Szelid
- Heart and Vascular Center, Semmelweis University, Varosmajor u. 68, Budapest, Hungary
| | - Monika Durak
- Department of Interventional Cardiology, Jagiellonian University, Medical College, John Paul II Hospital, Pradnicka 80, Krakow, Poland
| | - Piotr Lech
- Department of Interventional Cardiology, Jagiellonian University, Medical College, John Paul II Hospital, Pradnicka 80, Krakow, Poland
| | - Krzysztof Zmudka
- Department of Interventional Cardiology, Jagiellonian University, Medical College, John Paul II Hospital, Pradnicka 80, Krakow, Poland
| | - Peter Pokreisz
- The Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Pascal Vranckx
- Heart Center Hasselt, Jessa Hospital, Stadsomvaart 11, Hasselt, Belgium
| | - Bela Merkely
- Heart and Vascular Center, Semmelweis University, Varosmajor u. 68, Budapest, Hungary
| | - Kenneth D Bloch
- Department of Anesthesia, Critical Care, and Pain Medicine, and Cardiovascular Research Center, Department of Medicine, Massachusetts General Hospital, Fruit street 55, Boston, MA and Harvard Medical School, Boston, MA, USA
| | - Frans Van de Werf
- The Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
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Affiliation(s)
- Liliana Rytel
- Department of Internal Diseases with Clinic, Faculty of Veterinary Medicine, University of Warmia and Mazury, Oczapowskiego Str. 14, 10-718, Olsztyn, Poland.
| | - Piotr Lech
- Agri Plus sp. Z o.o, Marcelinska Str. 92, 60-324, Poznan, Poland
| | - Kamila Szymanska
- Department of Clinical Physiology, Faculty of Veterinary Medicine, University of Warmia and Mazury, Oczapowskiego Str. 13, 10-718, Olsztyn, Poland
| | - Slawomir Gonkowski
- Department of Clinical Physiology, Faculty of Veterinary Medicine, University of Warmia and Mazury, Oczapowskiego Str. 13, 10-718, Olsztyn, Poland
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Lech P, Vatan A, Modas Daniel P, Tsai HR, Vidal Perez RC, Anwer S, Gorriz Magana J, Giavarini A, Katbeh A, Lo Iudice F, Hayashida A, Lembo M, Jamiel AM, Peacock K, Wong CY, Ministeri M, Woolf A, Carbone A, Ma G, Lee AF, Ripley DP, Karabag T, Arslan C, Yakisan T, Sak D, Galrinho A, Ramos R, Aguiar Rosa S, Viveiros Monteiro A, Branco LM, Morais L, Rodrigues I, Figueiredo L, Ferreira RC, Lin CC, Wu HY, Chen TY, Tsai WC, Castineiras Busto M, Pena Gil C, Trillo Nouche R, Lopez Otero D, Bandin Dieguez MA, Martinez Monzonis A, Gonzalez-Juanatey JR, Atef M, Hassan N, Aboulfotouh Y, Moharem-Elgamal S, Katta A, Seleem M, Meshaal M, Lopez Pais J, Monjas Garcia S, Mata Caballero R, Molina Blazquez L, Alcon Duran B, Alcocer Ayuga M, Fraile Sanz A, Saavedra Falero J, Alonso Martin JJ, Barosi A, Vanelli P, Cerchiello M, Islas Ramirez F, De Agustin A, Marcos Alberca P, Nombela L, Jimenez P, Fernandez Ortiz A, Luis Rodrigo J, Perez De Isla L, Macaya C, Petitto M, Schiano Lomoriello V, Imbriaco M, Trimarco B, Galderisi M, Kagiyama N, Hirohata AH, Yamamoto K, Yoshida K, Santoro C, Esposito R, Gerardi D, Sellitto V, Trimarco B, Galderisi M, Ahmed AM, Alharbi AS, Savis A, Bellsham-Revell H, Salih C, Simpson JM, Uebing U, Gatzoulis M, Li WL, Jaber W, Salerno G, Rea G, D'andrea A, Di Maio M, Limongelli G, Muto M, Pacileo G. Clinical Case Poster session 1P501The incremental value of advanced cardiovascular multi-modality imaging in the investigation of a cardiac massP502Metastatic adenocarsinoma involving the right ventricle and pulmonary artery leading right heart failureP503A malignant cause of angina in hypertrophic cardiomyopathyP504Dyspnea in a severe mitral stenotic gentleman with hypereosinophiliaP505After transcatheter aortic valve implantation be aware of infections, a case of fistulization from left ventricular outflow track to left atriumP506Myocardial infarction masking infective endocarditisP507Subendocardial abscess by contiguity of a valvular vegetationP508Real-time three-dimensional transesophageal echocardiography as compared to in vivo anatomy in a case of Candida parapsilosis native mitral valve endocarditisP509TAVI in prosthetic heart valve failure : echocardiography guided transcatether percuntaneous valve in valve implantation (VIV) for failed TAVI corevalve bioprosthesisP510Functional-anatomic matching between longitudinal strain pattern and late gadolinium enhancement of cardiac amyloidosis at presentationP511Heart failure due to masked systolic atrial contraction detected by pulmonary venous flow in a patient with ventricular pacingP512The detection of early left ventricular dysfunction by global longitudinal strain is helpful to keep in adjuvant therapy breast cancer patients till completionP513Forgotten cause of known disease: pulmonary hypertension caused by schistosomiasisP515Single coronary origin delineation by echocardiography alone in a patient with tetralogy of fallot changing the surgical planP516A rare complication after multiple valve repairP517Unusual cause of cyanosis in a young adult with cavopulmonary connectionsP518Abnormal flow in the main pulmonary artery in adult patients: a tale of 2 shuntsP519Unexpected TEE finding: mediastinal lipomatosis can fake an aortic intramural haematoma. Eur Heart J Cardiovasc Imaging 2016. [DOI: 10.1093/ehjci/jew247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lech P, Ma G, Lee A, Ripley D. The incremental value of advanced cardiovascular multi-modality imaging in the investigation of cardiac masses. Int J Cardiol 2016; 222:714-716. [DOI: 10.1016/j.ijcard.2016.08.062] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 08/03/2016] [Indexed: 11/26/2022]
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Zalewski J, Zmudka K, Lech P, Durak M, Nessler J. Derivatives of enzymatic injury kinetics in acute ST-elevation myocardial infarction. Cardiac magnetic resonance imaging validation study. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.p433] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Zalewski J, Durak M, Lech P, Gajos G, Undas A, Nessler J, Rosławiecka A, Zmudka K. Platelet activation and microvascular injury in patients with ST-segment elevation myocardial infarction. Kardiol Pol 2012; 70:677-684. [PMID: 22825940] [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: 06/01/2023]
Abstract
BACKGROUND Dual antiplatelet therapy reduces the risk of thrombotic complications after primary percutaneous coronary intervention (PCI). AIM To assess whether inhibition of platelet function attenuates microvascular damage in patients with ST-segment elevation myocardial infarction (STEMI). METHODS We studied 83 STEMI patients treated with primary PCI. Platelet aggregation was measured on admission (ADM) and 4 days later (D4) by light transmission aggregometry after stimulation with 0.5 mM of arachidonic acid and after stimulation with 5 and 20 μM of adenosine diphosphate (ADP) on treatment with dual antiplatelet therapy with aspirin and clopidogrel. Platelet-neutrophil aggregate (PNA) and platelet-monocyte aggregate (PMA) were analysed by flow cytometry. Contrast-enhanced magnetic resonance imaging was performed 2-4 days after STEMI to detect the area of perfusion defect at rest and to determine the size of microvascular obstruction. Microvascular obstruction was expressed as a percentage of infarct area. RESULTS Perfusion defect at rest was found in 56 (67.5%) patients whereas microvascular obstruction in 63 (75.9%) patients. Patients with perfusion defect at rest had on admission a significantly higher level of both PMA (7.0 vs. 4.5%, p = 0.004) and PNA (4.1 vs. 2.2%, p = 0.016), however there were no significant differences at D4. Platelet aggregation after stimulation with 5 μM of ADP on ADM was correlated (r = 0.37, p = 0.004) with microvascular obstruction area. Moreover, the higher the concentration of PMA(ADM) (r = 0.31, p = 0.016), PNA(ADM) (r = 0.34, p = 0.006) and PM(AD4) (r = 0.35, p = 0.005) the larger the size of microvascular obstruction. Infarct size (β = 0.43, 95% CI 0.19 to 0.67, p 〈 0.0001), TIMI < 3 after PCI (β = -0.27, 95% CI -1.90 to -0.11, p = 0.015) and PMA(D4) (β = 0.21, 95% CI 0.13 to 1.86, p = 0.032) independently influenced the size of microvascular obstruction (R2 = 0.60, p 〈 0.0001). CONCLUSIONS Excessive platelet activation during reperfusion in STEMI patients despite dual antiplatelet therapy is associated with greater microvascular impairment.
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Affiliation(s)
- Jarosław Zalewski
- Centre for Interventional Treatment of Cardiovascular Diseases, The John Paul II Hospital, Kraków, Poland.
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Gasior M, Pres D, Stasik-Pres G, Lech P, Gierlotka M, Hawranek M, Wilczek K, Szyguła-Jurkiewicz B, Lekston A, Kalarus Z, Strojek K, Gumprecht J, Poloński L. Effect of blood glucose levels on prognosis in acute myocardial infarction in patients with and without diabetes, undergoing percutaneous coronary intervention. Cardiol J 2008; 15:422-430. [PMID: 18810716] [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: 05/26/2023] Open
Abstract
BACKGROUND Diabetes mellitus (DM) is a significant factor regarding poor outcome in patients with myocardial infarction. Recently a new prognostic factor is under consideration - a baseline glucose level on admission. We sought to assess the influence of blood glucose levels on admission on prognosis of patients with acute ST-segment elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention (PCI). METHODS AND RESULTS Consecutive patients treated with PCI for STEMI were analyzed. Presence or absence of DM was the first grouping criterion. The secondary criterion was the blood glucose level on admission [threshold >or= 7.8 mmol/L (140 mg/dL)]. Hyperglycemic and non-hyperglycemic subgroups were selected within both DM and non-DM groups according to the threshold. One-year mortality of diabetics was 16.0%. There was no significant difference in 1-year mortality between hyperglycemic and non-hyperglycemic patients with DM. One-year mortality in the non-DM group was 5.6%. Patients without DM but with hyperglycemia showed a higher 1-year mortality rate than non-hyperglycemic patients (8.51% vs. 3.68%, p = 0.001). Multivariate analysis revealed that in the non-DM group blood glucose level (per 1 mmol/L) on admission was a factor affecting 1-year mortality [HR = 1.09 (1.01-1.17)]. CONCLUSIONS Elevated blood glucose levels in STEMI affect the prognosis of patients without DM; however, it is not an independent death risk factor of patients with DM treated with PCI.
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Affiliation(s)
- Mariusz Gasior
- Department of Cardiology, Medical University of Silesia, Silesian Centre for Heart Diseases, Zabrze, Poland.
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Gasior M, Pres D, Stasik-Pres G, Lech P, Gierlotka M, Lekston A, Hawranek M, Tajstra M, Kalarus Z, Poloński L. Does glucose level at hospital discharge predict one-year mortality in patients with diabetes mellitus treated with percutaneous coronary intervention for ST-segment elevation myocardial infarction? Kardiol Pol 2008; 66:1-11. [PMID: 18266182] [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: 05/25/2023]
Abstract
BACKGROUND It has been shown that diabetes mellitus (DM) is an independent prognostic factor in patients with myocardial infarction (MI). In addition to that fact the prognostic significance of blood glucose (BG) abnormalities in the acute phase of MI has also been suggested. Recently, a new prognostic factor has been evaluated - the glucose level at hospital discharge. AIM To assess whether the glucose level at hospital discharge is associated with one-year mortality in patients with DM treated with percutaneous coronary intervention (PCI) for ST-segment elevation MI (STEMI), taking into account hypoglycaemic treatment. METHODS Consecutive patients with STEMI and DM treated with PCI, who survived hospitalisation, were included in the analysis. Patients were assumed to have DM if previous diagnosis of DM or newly diagnosed DM during hospital stay was noted. Criteria of newly diagnosed DM were as follows: fasting BG >or=7 mmol/l at least twice after acute phase of STEMI, BG >or=11.1 mmol/l in a 2-hour glucose tolerance test performed before discharge. Fasting plasma glucose at hospital discharge was used for analysis. RESULTS Out of 2762 consecutive patients with STEMI, 565 had DM. In-hospital mortality in this group was 9.4% (53 patients), so the final DM group consisted of 512 patients. After discharge 59 (11.5%) patients died during one-year follow-up. The glucose level at discharge was not an independent prognostic factor of one-year mortality in the whole analysed group, however insulin treatment at discharge was (HR 2.61, 95% CI 1.29-5.29; p=0.008). Afterwards, we undertook multivariate analysis separately in the group treated with insulin (253 patients) and in the group treated with oral drugs or diet only (259 patients). This analysis showed that in the group treated with insulin the glucose level at discharge was not an independent prognostic factor of one-year mortality (HR 1.07, 95% CI 0.95-1.22; p=0.27), whereas in patients treated with hypoglycaemic agents or diet it was significantly associated with a one-year mortality (HR 1.30, 95% CI 1.01-1.68; p=0.049). CONCLUSIONS 1. Patients with STEMI and DM treated with insulin at hospital discharge have higher risk of death, probably because of more advanced DM and more severe complications, than patients treated with oral drugs or diet. 2. Elevated glucose level at hospital discharge predict one-year mortality only in patients with MI and DM treated with oral drugs or diet.
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Affiliation(s)
- Mariusz Gasior
- III Katedra i Oddział Kliniczny Kardiologii SUM, Slaskie Centrum Chorób Serca, ul. Szpitalna 2, 41-800 Zabrze.
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Gasior M, Stasik-Pres G, Pres D, Lech P, Gierlotka M, Lekston A, Hawranek M, Tajstra M, Kalarus Z, Poloński L. Relationship between blood glucose on admission and prognosis in patients with acute myocardial infarction treated with percutaneous coronary intervention. Kardiol Pol 2007; 65:1031-1040. [PMID: 17975750] [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: 05/25/2023]
Abstract
BACKGROUND Diabetes mellitus in patients with myocardial infarction affects in-hospital and late mortality. It has been shown that the glucose level on admission can also affect prognosis. This conclusion was based on an analysis performed on a heterogeneous group of patients, treated not only with percutaneous coronary intervention (PCI) but also with fibrinolysis. Moreover, the threshold values hyperglycaemia for the diagnosis of were also variable. AIM To assess whether glucose level on admission affects in-hospital and one-year prognosis in patients with ST-segment elevation myocardial infarction (STEMI) treated with PCI. METHODS Consecutive patients with STEMI treated with PCI were included in the analysis. Patients with STEMI complicated by cardiogenic shock were also included. Three groups according to the glucose level on admission were analysed: group I - <7.8 mmol/l (140 mg/dl), group II - 7.8-11.1 mmol/l (140-200 mg/dl), and group III - > or = 11.1 mmol/l (200 mg/dl). RESULTS The incidence of diabetes mellitus in the total group (1027 patients) was 26.1%, and of cardiogenic shock - 9.2%. Group I consisted of 472 patients, group II - 307 patients, and group III - 248 patients. Compared with normoglycaemic patients, those with elevated glucose level were older, more often female, had more often hypertension, diabetes mellitus, cardiogenic shock, were more often treated with fibrinolysis before PCI but were less often smokers. Multivessel disease and initial patency of the infarct-related artery (TIMI 0-1) were more often observed in patients with higher glucose level. A trend towards a higher incidence of reocclusion was also more often present in patients with increased glucose level. Moreover, mean creatine kinase concentration was the highest and the left ventricular ejection fraction was the lowest in group III. During the in-hospital stay, the complication rate was as follows: stroke (1.1% vs. 1.3% vs. 4.4%), and mortality (2.8 vs. 4.9 vs. 13.3%) in groups I, II, and III, respectively. The same tendency was observed during the one-year follow-up period: stroke (1.3 vs. 2.9 vs. 6.9%), mortality (6.4 vs. 9.1 vs. 22.6%). The 1 mmol/l (18 mg/dl) increase of the baseline glucose level among various risk factors was an independent prognostic factor of higher -year mortality (HR=1.06; 95% CI 1.02-1.09). Diabetes mellitus did not affect prognosis among patients included in the analysis. CONCLUSION Elevated glucose level on admission is associated with adverse prognosis in patients with STEMI treated with PCI.
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Affiliation(s)
- Mariusz Gasior
- 3rd Chair and Department of Cardiology, Silesian Medical University, Silesian Centre for Heart Diseases, Zabrze, Poland.
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Elzbieta J, Jan W, Lech P. [Evaluation of the prognostic value of chosen maternal risk factors of complications existing among newborns of GDM mothers]. Ginekol Pol 1999; 70:689-99. [PMID: 10615809] [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: 02/15/2023] Open
Abstract
OBJECTIVES According to WHO definition, gestational diabetes mellitus (GDM) is a disorder of carbohydrates tolerance during pregnancy. The incidence of GDM is about 2-4% in the population at pregnant women. Prematurity, neonatal dystrophy (particularly hypertrophy), hypoglycemia and other clinical abnormalities are more frequent in the group of the neonates of diabetic mothers. DESIGN The aim of this study was to separate the maternal risk factors of complications existing among neonates of diabetic mothers as well as the statistical analysis of their prognostic values. MATERIAL AND METHODS 260 newborns of GDM mothers, born at Polish Mothers Health Center were observed. The group of pregnant women was divided into two subgroups according to GDM class--G1 or G2. At 116 (44.6%) pregnant women glycemia was regulated dietetic treatment (G1 class). 144 women (55.4%) were treated with insulin (G2 class). The control group were 153 newborns from pregnant women with excluded GDM after carbohydrates tolerance screening test provide between 24-28 week. Estimation of the newborns status after birth was based on Apgar Score and umbilical blood pH. Basic laboratory tests were done in umbilical blood. Blood glucose concentration were monitored in all cases. Bilirubin concentration, infection screening tests were provided due to clinical status. Statistic evaluation was performed using special computer programs. CONCLUSIONS G2 class of the Gestational Diabetes Mellitus significantly increases the frequency of newborn macrosomia, LGA, birth trauma, hypoglycemia, hyperbilirubinemia, cardiomyopathy and respiratory disorders. Prematurity is more frequent among newborns from GDM mothers group and it determines a potent risk factor of low Apgar Score, hypoglycemia and respiratory disorders. The following risk factors are unimportant for the frequency of complications existing among newborns of diabetic mothers: mothers age, number of delivers, obstetric complications and delivery of newborn with a congenital malformation in an anamnesis.
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Affiliation(s)
- J Elzbieta
- Kliniki Neonatologii Instytutu Centrum Zdrowia Matki Polki w Lodzi
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