Cardiac solitary fibrous tumor - an extremely rare but potentially fatal diagnosis

The background of this review is a description of the case of a 28-year-old man with an extremely rare cardiac solitary fibrous tumor (SFT). Although this tumor was removed surgically and in the 6-month follow-up examination no relapse was noted, recurrence was observed and confirmed in the magnetic resonance imaging 4 months later. SFT prevalence, symptoms and signs, treatment options and prognosis are reviewed.

The importance of the development of extracorporeal life support simulation centres for improving skills and knowledge during the COVID-19 pandemic

Introduction

Despite increasing implementation of sophisticated and logistically challenging techniques to support patients in life-threatening conditions in the last years, there were no devoted education centres, especially in coronavirus pandemic.

Aim

To assess the value of gaining evidence-based knowledge and improving the skills of physicians by means of simulation techniques in the safe use of extracorporeal technologies to support patients in the life-threatening conditions.

Material and methods

In 2019, the National Education Centre for Artificial Life Support and Patient Safety and the frame program of the course of "Artificial Life Support with ECMO". was created. In years 2019-2023, we managed to organise 34 such courses for 405 physicians, which were additionally endorsed by ELSO (Extracorporeal Life Support Organisation). The physicians' cognitive, behavioural, and technical skills were evaluated before and after the courses.

Results

The participants' gender was well balanced (54% men and 46% women). Most of them (mainly at the age between 31-40 years) presented more than 5 years of clinical experience, predominantly in anaesthesiology and intensive care (63%). Of note, 54% of them had no experience with ECMO application. In all detailed aspects of cognitive, behavioural, and technical assessment and knowledge scores, significant improvement was observed after the course.

Conclusions

The development of a simulation-based education centre was found to be an invaluable achievement that enabled not only successful standardised training and testing of novel or previously accepted procedures, but also the upgrading of technical skills, even in the challenging COVID-19 pandemic period.

Comprehensive proteomics of monocytes indicates oxidative imbalance functionally related to inflammatory response in chronic kidney disease-related atherosclerosis

Atherosclerosis-induced cardiovascular events are the leading cause of mortality in chronic kidney disease (CKD) patients. Monocytes are involved in the formation of atherosclerotic plaques and mediate in the overproduction of ROS, promoting inflammation and oxidative stress. However, the relationship between monocytes, inflammation, and oxidative status in CKD-associated atherosclerosis has not been thoroughly investigated. Monocytes and plasma derived from two groups of CKD patients with varying degrees of atherosclerosis and two groups of patients with cardiovascular disease (CVD) and non-CKD atherosclerosis were analyzed. This study was designed to perform a comprehensive proteomic analysis of monocytes in combination with functional bioinformatics. In addition, a targeted investigation of oxidative stress- and inflammatory-related factors to explore CKD-associated atherosclerosis was applied. Dysregulation of proteins involved in lipid oxidation, cell survival, ROS synthesis and metabolism, and inflammatory responses has been revealed. The characteristic disturbances in the monocyte proteome changed with the progression of CKD. A closer examination of oxidative stress's triggers, mediators, and effects on protein and lipid levels showed alterations in the oxidative imbalance between CKD and CVD. CKD monocytes demonstrated a significant increase of oxidized glutathione without changing the level of its reduced form. Evaluation of enzymatic antioxidants, sources of ROS, and modifications caused by ROS also revealed significant alterations between the study groups. In CKD, inflammation and oxidative imbalance correlated and drove each other. However, in CVD, oxidative stress-related factors were associated with each other but not to inflammatory proteins. Moreover, lipid abnormalities were more specific to classical CVD and unrelated to CKD. Such a comprehensive characterization of monocytes and oxidative stress in CKD and CVD patients has never been presented so far. Obtained results support the involvement of distinct mechanisms underlying the acceleration of atherosclerotic and non-atherosclerotic CKD.

Prognostic Impact of Residual Moderate Mitral Regurgitation Following Valve-in-Valve Transcatheter Aortic Valve Implantation

INTRODUCTION

The impact of mitral regurgitation (MR) on valve-in-valve transcatheter aortic valve implantation (VIV-TAVI) in patients with failed bioprostheses remains unclear. The purpose of this study was to assess the prognostic impact of residual moderate MR following VIV-TAVI.

METHODS

We retrospectively analyzed 127 patients who underwent VIV-TAVI between March 2010 and November 2021. At least moderate MR was observed in 51.2% of patients before the procedure, and MR improved in 42.1% of all patients. Patients with postoperative severe MR, previous mitral valve intervention, and patients who died before postoperative echocardiography were excluded from further analyses. The remaining 114 subjects were divided into two groups according to the degree of postprocedural MR: none-mild MR (73.7%) or moderate MR (26.3%). Propensity score matching yielded 23 pairs for final comparison.

RESULTS

No significant differences were found between groups before and after matching in early results. In the matched cohort, survival probabilities at one, three, and five years were 95.7% vs. 87.0%, 85.0% vs. 64.5%, and 85.0% vs. 29.0% in the none-mild MR group vs. moderate MR-group, respectively (log-rank P=0.035). Among survivors, patients with moderate MR had worse functional status according to New York Heart Association (NYHA) class at follow-up (P=0.006).

CONCLUSION

MR is common in patients with failed aortic bioprostheses, and improvement in MR-status was observed in over 40% of patients following VIV-TAVI. Residual moderate MR after VIV-TAVI is not associated with worse early outcomes, however, it was associated with increased mortality at five years of follow-up and worse NYHA class among survivors.

Do we correctly calculate doses of cardioplegia during aortic valve replacement procedures? A preliminary report

Introduction

Intraoperative myocardial protection during aortic valve replacement (AVR) for aortic stenosis (AS) is of paramount importance for outcomes. The dose of cardioplegia is usually calculated with reference to body mass.

Aim

To assess whether such a strategy should be applied to all AS patients undergoing AVR.

Material and methods

The study included 94 patients who underwent elective isolated AVR in cardiopulmonary bypass with cold cardioplegic arrest, with a mean age of 65.4 ±7.8 years. They were divided into two subgroup: A with an infusion of high (above median) and subgroup B with a low (below median) volume of cardioplegia indexed for left ventricular mass (LVM). Their doses were referred to the maximal postoperative release of cardiac troponin I (cTnI max). Eventually, it was examined whether the extent of intraoperative myocardial injury translated into long-term survival stratified according to the Kaplan-Meier method.

Results

The mean volume of cardioplegia was 1381 ±279 ml (4.9 ±1.6 ml/g of LV myocardium). cTnI max was much higher in group A than in group B (medians: 14.918 vs. 9.876 μg/l; p = 0.005). Moreover, a negative correlation between the index cardioplegia volume and cTnI max (r = 0.345) was noted. The five-year probability of survival in subgroup A (95.7%) was significantly better than that in subgroup B individuals (82.6%, p = 0.044).

Conclusions

Calculating cardioplegic doses during AVR solely based on body mass may be suboptimal and have a significant impact on postoperative outcomes.

Monocyte-to-lymphocyte ratio correlates with parathyroid hormone concentration in patients with severe symptomatic aortic stenosis

PURPOSE

The normal healthy valve is devoid of inflammatory cells, however background of aortic stenosis (AS) may include inflammatory processes. Moreover, the link between hyperparathyroidism and heart failure is postulated. Simple whole blood analysis with indices is a beneficial tool in cardiovascular diseases' assessment. The purpose of the study was to evaluate correlation between parathyroid hormone (PTH) and simple blood parameters in severe AS.

MATERIAL AND METHODS

The study included 62 patients with severe AS. Patients with inflammatory or autoimmune co-morbidities were excluded. Blood samples were collected, and clinical and demographic data were analyzed.

RESULTS

The final study group comprised 55 patients (31 females, 56.4%; mean age 77.13 (SD 6.76)). In 23 patients (41.8%), PTH concentration was markedly increased. The study group was divided into two subgroups according to the PTH concentration. Patients from both groups did not differ significantly in terms of age and co-morbidities. PTH concentration correlated positively with monocyte-lymphocyte ratio (MLR) (p ​= ​0.008, Spearman rho 0.356) and platelet-lymphocyte ratio (PLR) (p ​= ​0.047, Spearman rho 0.269), creatinine level (p ​= ​0.001, Spearman rho 0.425) and glomerular filtration rate (GFR-MDRD) (p ​= ​0.009, Spearman rho -0.349). The multivariable logistic regression with backward analysis revealed MLR (p ​= ​0.029) and GFR (p ​= ​0.028) as independent significant predictors of abnormal PTH values. The receiver operator characteristics (ROC) curve was performed for the model of MLR and GFR-MDRD (AUC ​= ​0.777), yielding the sensitivity of 60.9% and specificity of 90.6%.

CONCLUSIONS

PTH concentration correlates with monocyte-to-lymphocyte and platelet-to-lymphocyte ratios in calcified AS.

A comparative study of minimally invasive aortic valve replacement with sutureless biological versus mechanical prostheses

Introduction

The ministernotomy approach with sutureless aortic bioprosthesis may provide an attractive and safe option for aortic valve disease patients.

Aim

To assess the early and mid-term outcomes of minimally invasive aortic valve replacement (miniAVR) with sutureless vs. standard prostheses.

Material and methods

The study involved 76 consecutive patients (51 males and 25 females) with mean age of 63.2 years who were treated with miniAVR between 2015 and 2022. They were divided into 2 subgroups: group I (n = 40) subjects with sutureless bioprostheses and group II (n = 36) with standard prostheses implanted. Early and mid-term outcomes were evaluated. A probability of survival was estimated by means of the Kaplan-Meier method.

Results

No conversion to complete sternotomy was necessary. The median (minimum; maximum) aorta cross clamping and cardio-pulmonary bypass times were 49 (27; 84) and 70 (40; 188) minutes in group I whereas 69 (50; 103) and 95 (69; 170) minutes in group II, respectively (p < 0.001). In-hospital mortality was 5.0% (n = 2) and 2.8% (n = 1) in group I vs. II, respectively (ns). Permanent ICD implantation was performed in 8 (20.0%) in group I and in 3 (8.3%) subjects in group II. In the discharge echocardiography, the function of all prostheses was correct. Five-year probability of survival was much lower in group I (0.75 ±0.10) than in group II (0.94 ±0.04). No wound infection or sternum instability was noted.

Conclusions

Intraoperative advantages of miniAVR procedures for aortic valve patients with sutureless bioprostheses do not translate directly into improved early and middle-term outcomes.

Pre-operative systemic inflammatory response index influences long-term survival rate in off-pump surgical revascularization

Coronary artery bypass revascularization is still the optimal treatment for complex coronary artery disease with good long-term results. The relation between inflammatory activation in the post-operative period and the long-term prognosis was already postulated. The possible predictive role of preoperative inflammatory indexes after the off-pump coronary artery bypass grafting technique on long term survival was the aim of the study. Study population included 171 patients with a median age of 64 years (59-64) operated on using off-pump technique between January and December 2014. Patients enrolled in the current study were followed-up for 8 years. We conducted a multivariable analysis of pre-operative and post-operative inflammatory markers based on analysis of the whole blood count. The overall survival rate was 80% for the total follow-up period, while 34 deaths were reported (30-days mortality rate of 1%). In the multivariable analysis, a pre-operative value of systemic inflammatory response index (SIRI) >1.27 (HR = 6.16, 95% CI 2.17-17.48, p = 0.012) revealed a prognostic value for long-term mortality assessment after off-pump surgery. Preoperative inflammatory activation evaluated by systemic inflammatory reaction index (SIRI) possess a prognostic value for patients with complex coronary artery disease. The SIRI value above 1.27 indicates a worse late prognosis after off-pump coronary artery bypass (AUC = 0.682, p<0.001).

Serum copper concentration reflect inflammatory activation in the complex coronary artery disease - A pilot study

INTRODUCTION

Coronary artery disease possess inflammatory background related to enzymatic processes with trace elements involvements as co-factors. The aim of the study was to compare serum, urine and salivary copper, magnesium, calcium and zinc levels with inflammatory indices obtained from the whole blood count in patients with complex coronary artery disease.

MATERIAL AND METHOD

Fifty-two (42(81 %) males, 10 (19 %) females) consecutive patients (mean (SD) age 68 (9) years with symptomatic complex coronary artery disease were enrolled into prospective single center study in 2021. Serum, saliva and urine samples were collected at the day of admission for trace elements concentration (copper, zinc, magnesium, calcium) and compared with inflammatory indexes obtained from preoperative and perioperative period.

RESULTS

Multivariable regression analysis revealed relation between the copper serum concentration and neutrophil to lymphocyte ratio (NLR) and systemic inflammatory index (SII).

CONCLUSION

Serum copper concentration interplay with preoperative inflammatory activation in complex coronary disease measured by NLR and SII. The copper serum concentration possesses the strongest relation to preoperative inflammatory activation in patients reffered for off-pump coronary artery bypass grafting.

Changes in treatment of aortic valve diseases for acute and elective indications during the COVID-19 pandemic: A retrospective single-center analysis from 2019 to 2020

BACKGROUND

Coronavirus disease 2019 (COVID-19) pandemic had an impact on the quality of healthcare services and led to many changes in the treatment of cardiac pathologies.

OBJECTIVES

To assess the differences in the clinical manifestations, management and outcomes of patients with aortic valve diseases (AVDs) treated invasively before and during the pandemic.

MATERIAL AND METHODS

This retrospective single-center study involved patients with AVDs treated by means of balloon aortic valvuloplasty (BAV), transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR) in 2019 and 2020. They were divided into groups with respect to the year of intervention (2019 compared to 2020) and the priority of admission (urgent compared to elective). Preoperative characteristics, early outcomes and probability of annual survival were compared between the groups.

RESULTS

The number of patients admitted urgently increased from 37 in 2019 to 54 in 2020, with a higher prevalence of men in 2020 (83.3% compared to 56.8%, respectively). Elective cases, on the other hand, declined from 279 in 2019 to 256 in 2020. Among the latter, more subjects had manifestations of heart failure (p < 0.001), coronary artery disease (CAD; p = 0.002), hypertension (p = 0.006), as well as had a history of a stroke (p = 0.002). In the meantime, more TAVI and fewer SAVR procedures were performed in 2020 (86 compared to 127 and 192 compared to 125, respectively; p < 0.001). In 2020, TAVI individuals had risk of death (according to the EuroSCORE scale) than in 2019 (p < 0.001). The probability of annual survival was comparable (p = 0.769) among AVD patients treated before and during the coronavirus pandemic (91.3% compared to 88.3%, respectively).

CONCLUSION

Although during the COVID-19 pandemic more nonelective and higher-risk AVD individuals received interventional treatment, the outcomes were comparable to the pre-pandemic era (2019). Our findings support highly valuable, less invasive therapeutic methods for treating aortic pathologies during the pandemic.

Pulmonary artery systolic pressure at 1-month predicts 1-year survival after transcatheter aortic valve implantation

BACKGROUND

Pulmonary hypertension related to left ventricle heart disease is a common finding in patients with severe aortic stenosis treated with transcatheter aortic valve implantation (TAVI) and is associated with a higher mortality rate.

AIMS

The study aimed to analyze the influence of pulmonary artery systolic pressure (PASP) changes after TAVI on long-term survival.

METHODS

TAVI was performed in 362 patients between January 2013 and December 2018. The study group comprised 210 patients who underwent a detailed 1-month follow-up.

RESULTS

At 1-month, 142 had a stable or decreased PASP value (Group 1), while in 68 patients an increase was observed (Group 2). During 1-year follow-up, 20 patients died (9.5%), 9 in Group 1 and 11 in Group 2 (P = 0.02). The receiver operating characteristic (ROC) curve analysis (area under the curve [AUC], 0.750) revealed a significant value of 1-month measurement for 1-year mortality prediction. The cutoff for the PASP value predictive of mortality was ≤41 mm Hg. A Kaplan-Meier analysis showed significantly higher mortality in patients without a 1-month PASP decrease. In the multivariable analysis, PASP measured at 1-month after TAVI (hazard ratio, 1.040; 95% confidence interval, 1.019-1.062; P < 0.001) was an independent predictor of 1-year mortality. Each 1 mm Hg increase in PASP predicts a 4% increase in the risk of death.

CONCLUSION

Decreased or stable value of PASP at 1-month follow-up may predict better 1-year survival after TAVI, while each 1 mm Hg increase in PASP confers a 4% greater risk of 1-year mortality.

Neutrophil-to-lymphocyte ratio as a predictor of inflammatory response in patients with acute kidney injury after transcatheter aortic valve implantation

BACKGROUND

Persistent inflammatory response after transcatheter aortic valve implantation (TAVI) is one of the possible causes of early and mid-term postprocedural adverse events.

OBJECTIVES

To establish the predictive role of whole blood parameters on inflammatory response characteristics within a 1-year follow-up.

MATERIAL AND METHODS

The study group comprised 163 consecutive patients (52.1% females), mean age 78.6 (±6.6) years (± standard deviation (SD)) who underwent TAVI and completed 1-year follow-up on-site examinations. Patients were retrospectively divided into acute kidney injury (AKI) and non-AKI subgroups. Clinical and laboratory data were collected. In-hospital and follow-up outcomes were assessed.

RESULTS

The clinical and procedural details did not show significant differences between AKI and non-AKI groups. Neutrophil-to-lymphocyte ratio (NLR) decreased from baseline to measurement after 1 year with a statistically significant decline in the whole study population and non-AKI subgroup (both p = 0.005). The baseline NLR cutoff value of 4.2 for the non-AKI group ((area under the curve (AUC) = 0.718, p < 0.0001; sensitivity 46.27%, specificity 92.31%) and of 3.8 for the AKI group (AUC = 0.673, p = 0.0174; sensitivity 59.25%, specificity 84%) had prognostic properties for persistent NLR elevation.

CONCLUSIONS

The NLR decreases after TAVI, and this phenomenon is more evident in patients without AKI. Furthermore, baseline NLR cutoff values may be considered predictors of persistence of inflammatory response.

Neutrophil Counts, Neutrophil-to-Lymphocyte Ratio, and Systemic Inflammatory Response Index (SIRI) Predict Mortality after Off-Pump Coronary Artery Bypass Surgery

Background: Several perioperative inflammatory markers are postulated to be significant factors for long-term survival after off-pump coronary artery bypass surgery (OPCAB). Hematological parameters, whether single or combined as indices, provide higher predictive values. Methods: The study group comprised 538 consecutive patients (125 (23%) females and 413 (77%) males) with a mean age of 65 ± 9 years, who underwent OPCAB with a mean follow-up time of 4.7 ± 1.7 years. This single-center retrospective analysis included perioperative inflammatory markers such as the neutrophil-to-lymphocyte ratio (NLR), systemic inflammatory response index (SIRI), aggregate index of systemic inflammation (AISI), and systemic inflammatory index (SII). Results: Multivariable analysis identified levels of neutrophils above 4.3 × 109/L (HR 13.44, 95% CI 1.05−3.68, p = 0.037), values of SIRI above 5.4 (HR 0.29, 95% CI 0.09−0.92, p = 0.036) and values of NLR above 3.5 (HR 2.21, 95% CI 1.48−3.32, p < 0.001) as being significant predictors of long-term mortality. The multifactorial models revealed the possibility of strong prediction by combining preoperative factors (COPD, stroke, PAD, and preoperative PLR) and postoperative neutrophil counts (p = 0.0136) or NLR (p = 0.0136) or SIRI (p = 0.0136). Conclusions: Among the postoperative inflammatory indices, the levels of neutrophils, NLR, and SIRI are the most prominent markers for long-term survival after off-pump coronary artery bypass surgery, when combined with preoperative characteristics.

The Significance of Systemic Immune-Inflammatory Index for Mortality Prediction in Diabetic Patients Treated with Off-Pump Coronary Artery Bypass Surgery

Diabetes mellitus (DM) represents a complex carbohydrate metabolism disorder characterized by inflammatory over-reactivity. The study aimed to investigate the potential influence of postoperative inflammatory activation on mortality risk after off-pump coronary artery bypass grafting in diabetic patients. There were 510 patients treated with off-pump coronary artery bypass grafting due to stable complex coronary artery disease, including 175 patients with type-2 DM (T2DM.) The mean follow-up time was 3.7 +/− 1.5 years with a 9% all-cause mortality rate in the diabetic group. In multivariable analysis, preoperative comorbidities (stroke, peripheral artery disease, postoperative systemic inflammatory index >952, and postoperative left ventricle ejection fraction (LVEF) < 45%) were revealed as prognostic factors. The receiver operator characteristics curve analysis for postoperative calculations of systemic immune-inflammatory index (SII) appeared significant (AUC = 0.698, p = 0.008), yielding sensitivity of 68.75% and specificity of 71.07%. Systemic immune-inflammatory index (SII) can be regarded as a predictive marker for long-term prognosis in diabetic patients after off-pump coronary artery bypass grafting. The role of perioperative inflammatory activation may play a crucial role in mortality prediction.

Neutrophil to Lymphocyte Ratio (NLR) as an Easily Accessible Parameter for Monitoring Tacrolimus Overdose after Heart Transplantation—Experimental Study

(1) Background: The combination of candidate selection, immunosuppressive therapy adjustment, and scrutinous monitoring is a cornerstone for optimizing long-term survival after a heart transplant. Neutrophil-to-lymphocyte ratio (NLR) is a simple marker of inflammatory reactions activation and may play a clinical role as a predictive marker in oncological and cardiovascular diseases. The aim of the study was to find simple hematologic indices available from whole blood count to help in immunosuppressive therapy monitoring. (2) Methods: Thirty patients (23 men and 7 women) with a mean age of 43 +/− 13 years who had undergone orthotopic heart transplantation were enrolled into the study. The blood samples for whole blood count and Tacrolimus level were collected during outpatient visits in heart transplant recipients every two months for 18 months after first year post transplantation. (3) Results: There was a significant correlation between Tacrolimus overdose (>15 ng/mL) and NLR (Spearman’s rho 0.99, p < 0.001) and mean platelet volume (Spearman’s rho 0.989, p < 0.001). The ROC analysis for NLR above 3.62 showed predictive properties for Tacrolimus overdose (over 15 ng/mL) (AUC =0.633, p = 0.008) with a sensitivity of 50% and specificity of 83.73%. (4) Conclusions: Our results suggest that NLR above 3.62 may be regarded as a simple indicator of tacrolimus overdose.

Diagnostic and Prognostic Value of miRNAs after Coronary Artery Bypass Grafting: A Review

MiRNAs are noncoding, 21-24 nucleotide-long RNA particles that control over 60% of genes. MiRNAs affect gene expression through binding to the 3'-untranslated region of messenger RNA (mRNA), thus inhibiting mRNA translation or inducing mRNA degradation. MiRNAs have been associated with various cardiovascular diseases, including heart failure, hypertension, left ventricular hypertrophy, or ischemic heart disease. In addition, miRNA expression alters during coronary artery bypass grafting (CABG) surgery, which could be used to predict perioperative outcomes. CABG is an operation in which complex coronary arteries stenosis is treated by bypassing atherosclerotic lesions with venous or arterial grafts. Despite a very low perioperative mortality rate and excellent long-term survival, CABG is associated with postoperative complications, including reperfusion injury, graft failure, atrial fibrillation and perioperative myocardial infarction. So far, no reliable diagnostic and prognostic tools to predict prognosis after CABG have been developed. Changes in the perioperative miRNA expression levels could improve the diagnosis of post-CABG myocardial infarction and atrial fibrillation and could be used to stratify risk after CABG. Herein, we describe the expression changes of different subtypes of miRNAs during CABG and review the diagnostic and prognostic utility of miRNAs in patients undergoing CABG.

Monocyte-to-Lymphocyte Ratio as a Predictor of Worse Long-Term Survival after Off-Pump Surgical Revascularization-Initial Report

Background and objective: Coronary artery disease is one of the leading causes of deaths nowadays and the trends in diagnosis and revascularization are still in plateau despite well-known factors. Simple whole blood count parameters may be used to measure inflammatory reactions that are involved in processes of atherosclerosis progression. The aim of our study was to analyse the association between simply available hematologic indices and long-term mortality following off-pump coronary artery bypass grafting (OPCAB). Material and Methods: The study group comprised 129 consecutive patients (16 females and 113 males, mean age 66 ± 6 years) who underwent surgical revascularization with off-pump technique between January 2014 and September 2019. The mean follow-up was 4.7 +/−1.9 years. A receiver operating characteristics curve was applied to estimate demographical and perioperative parameters including MLR for mortality. Results: Cox regression analysis revealed chronic pulmonary obstructive disease (HR = 2.86, 95%CI 1.05–7.78), MLR (HR = 3.81, 95%CI 1.45–10.06) and right coronary artery blood flow (HR = 1.06, 95%CI 1.00–1.10) as significant factors predicting increased mortality risk. In the presented model, the MLR > 1.44 on 1st postoperative day was a significant predictor of late mortality after the OPCAB procedure (HR = 3.82, 95%CI 1.45–10.06). Conclusions: Pronounced inflammatory reaction after off-pump surgery measured by MLR > 1.44 can be regarded as a worse long-term prognostic factor.

Increased neutrophil-to-lymphocyte ratio is associated with higher incidence of acute kidney injury and worse survival after transcatheter aortic valve implantation

BACKGROUND

Although considered a minimally invasive procedure, transcatheter aortic valve implantation (TAVI) generates an inflammatory response which is related to post-procedural complications including acute kidney injury (AKI). The aim of the present study was to analyse the association between simple, easily available post-operative morphological parameters of inflammatory status such as neutrophil-to-lymphocyte ratio (NLR) and AKI as well as post-discharge survival.

METHODS

The study group was comprised of 203 consecutive patients (102 females and 101 males, mean age 78 ± 6.9 years) who underwent TAVI between January 2013 and March 2017. Demographic and clinical data were collected. Baseline and subsequent post-procedural blood samples (8, 24, 48, 72 at discharge) were taken. Blood morphology (including NLR) and creatinine concentration were assessed. Long-term survival was also analyzed.

RESULTS

Seventy-four (36.5%) patients developed AKI. Baseline morphological parameters did not differ between subject with and without AKI. Those reflecting post-procedural inflammatory response, including leucocytes, neutrophils and NLR increased significantly following TAVI in both subgroups and the rise was more pronounced in AKI patients (p < 0.001). A comparison of Kaplan-Meier curves for patients with the lowest (NLR 1; below 25th percentile) and highest NLR (NLR 3; above 75th) revealed a significant difference in the log-rank test (p = 0.049). Estimated probability of 1-, 2- and 5-year survival were 100% vs. 79%, 94% vs. 77% and 75% vs. 46%, respectively in subgroup NLR 1 and NLR 3.

CONCLUSIONS

Inflammatory response after TAVI, estimated by means of NLR, is more pronounced in patients with AKI. A higher value of NLR is associated with a lower probability of long-term survival after TAVI.

Mean platelet volume-to-platelet count ratio after elective cardiac surgical procedures is superior in reflecting platelets metabolic hyperactivity compared to other routine morphological platelet indices: A preliminary report

BACKGROUND

Excessive metabolic excitation of platelets after cardiac procedures may be related to some adverse events but assessment of their metabolic activity is not routine. The purpose of this study was to evaluate which of the basic platelet morphological parameters best reflects their metabolic status.

METHODS

The blood samples of 22cardiac surgical patients (mean age of 62.3 ± 10.3 years) were taken before surgery (BS), and 1, 24 and 48 hours after the operation. Correlations between morphological platelet parameters (platelet count [PLT], mean platelet volume [MPV], platelet distribution width [PDW] and MPV/PLT) and their metabolic activity (total concentration of malondialdehyde [MDA] and MDA/PLT) were estimated.

RESULTS

Significant decline in PLT after operation (from 223 ± 44 × 10¹²/L to 166 ± 57 × 10¹²/L) was accompanied by marked increase in MPV (from 8.4 ± 0.9 fL to 9.1 ± 1.2 fL) and no change of PDW. Consequently, MPV/PLT index increased significantly after procedures from (median with IQR) 0.038 (0.030-0.043) to 0.053 (0.043-0.078). Simultaneously, a significant increase in total platelet MDA content and MDA/PLT was noted reaching peak levels soon after operation. The strongest correlation was observed between MPV/PLT and MDA/PLT (r = 0.56; p < 0.001), although the others were also found to be significant (MDA/PLT vs. MPV; r = 0.35; MDA/PLT vs. PDW; r = 0.34).

CONCLUSIONS

Among basic morphological parameters and indices, the MPV-to-PLT ratio reflects the best metabolic status of platelets in cardiac surgical patients.

Postoperative Neutrophil to Lymphocyte Ratio as an Overall Mortality Midterm Prognostic Factor following OPCAB Procedures

BACKGROUND

Off-pump coronary artery bypass grafting (OPCAB) is believed to limit inflammatory reaction. Neutrophil to lymphocyte ratio (NLR) is one of the more common and easily accessible markers of inflammatory response. The aim of the study was to compare postoperative results of NLR with mid-term OPCAB results.

METHODS

In total, 224 patients (198 (88%) men and 26 (12%) women) with mean age 65 +/- 9 years who underwent OPCAB though median full sternotomy in our department in 2018 enrolled into the study. We scrupulously collected the postoperative mid-term results, including survival rate, clinical status and risk for major adverse events, and compared them with perioperative laboratory results.

RESULTS

A three-year follow-up was completed by 198 individuals (90% survival rate) with 12 (5%) showing major adverse cardiovascular (MACE) events risk. In the multivariable analysis, the laboratory parameters noticed on the 1st postoperative day were statistically significantly predictive of survival, including neutrophils (HR 1.59, 1.33-1.89 95%CI, p < 0.0001), platelets (HR 1.01, 1.01-1.01 95%CI, p = 0.0065), NLR (HR 1.47, 1.3-1.65 95%CI, p < 0.0001) and postoperative ejection fraction (HR 0.9, 0.87-0.95 95%CI, p < 0.0001).

CONCLUSIONS

Postoperative NLR above 4.6, as an inflammatory reaction marker, is related to mid-term mortality in OPCAB patients.

Cardioprotective Effect of Low Level of LDL Cholesterol on Perioperative Myocardial Injury in Off-Pump Coronary Artery Bypass Grafting

Background and Objectives: Coronary artery disease is still a major cause of death in developed countries. Low-density lipoprotein cholesterol (LDL-C) lowering with statin therapy is a key strategy in major acute coronary events' prevention. The aim of the study was to establish if there is a cardioprotective effect of pre-operative LDL lowering therapy on perioperative myocaridal injury in patients undergoing off-pump coronary artery bypass grafting (CABG). Moreover, the impact of pre-operative LDL level on long term outcome was analysed. Materials and Methods: The retrospective single center analysis included 662 consecutive patients (431 (65%) males and 231 (35%) female, mean age of 65 ± 8) referred for cardiac surgery due to stable chronic coronary syndrome between 2012-2018. The follow up was 9 years. Results: A statistically significant difference was found in postoperative serum Troponin-I for LDL thresholds of 1.8 mmol/L (p = 0.009), 2.6 mmol/L (p = 0.03) and 3.0 mmol/L (p = 0.001). The results indicate that cardioprotective role of LDL is achieved within LDL concentration rate below 1.8 mmol/L (<70 mg/dL). Five patients died perioperatively, whereas 1-year and 9-year overall mortality rates were 4% (n = 28) and 18.6% (n = 123), respectively. Comparing the survival group with diseased, Mann-Whitney U test showed a statistically significant difference in HDL-C (p = 0.007), Troponin (p = 0.009), Castelli index (p = 0.001) and atherogenic index (p = 0.004). Preoperative levels of total cholesterol, LDL-C and HDL-C did not significantly differ between survivors and diseased. The 9-year mortality risk did not differ significantly between subgroups divided according to LDL-C thresholds of 1.4 mmol/L (55 mg/dL), 1.8 mmol/L (70 mg/dL), 2.6 mmol/L (100 mg/dL) and 3.0 mmol/L (116 mg/dL). Conclusions: Preoperative low level of LDL-C cholesterol (below 1.83 mmol/L, 70 mg/dL) has a cardioprotective effect on perioperative myocardial injury in off-pump coronary artery bypass grafting.

Expression Profile of Genes Encoding Proteins Involved in Regulation of Vasculature Development and Heart Muscle Morphogenesis-A Transcriptomic Approach Based on a Porcine Model

Despite significant advances in treatment of acute coronary syndromes (ACS) many subjects still develop heart failure due to significantly reduced ejection fraction. Currently, there are no commonly available treatment strategies that replace the infarcted/dysfunctional myocardium. Therefore, understanding the mechanisms that control the regeneration of the heart muscle is important. The development of new coronary vessels plays a pivotal role in cardiac regeneration. Employing microarray expression assays and RT-qPCR validation expression pattern of genes in long-term primary cultured cells isolated form the right atrial appendage (RAA) and right atrium (RA) was evaluated. After using DAVID software, it indicated the analysis expression profiles of genes involved in ontological groups such as: “angiogenesis”, “blood vessel morphogenesis”, “circulatory system development”, “regulation of vasculature development”, and “vasculature development” associated with the process of creation new blood vessels. The performed transcriptomic comparative analysis between two different compartments of the heart muscle allowed us to indicate the presence of differences in the expression of key transcripts depending on the cell source. Increases in culture intervals significantly increased expression of SFRP2, PRRX1 genes and some other genes involved in inflammatory process, such as: CCL2, IL6, and ROBO1. Moreover, the right atrial appendage gene encoding lysyl oxidase (LOX) showed much higher expression compared to the pre-cultivation state.

Exceptional life-threatening complication 19 years after Ravitch correction of pectus excavatum

BACKGROUND

Ravitch technique of chest correction has been considered, although invasive, as a safe and efficacious surgical method.

CASE

We describe a case of a 35-year-old woman with cardiac tamponade and in cardiogenic shock due to exceptional late complication after pectus excavatum reconstruction by means of classic Ravitch technique 19 years earlier. This very late adverse event was caused by a broken metal sternal wire that injured the wall of the ascending aorta. The patient underwent salvage repair of this segment of the aorta in cardiopulmonary bypass. Postoperative course and postdischarge 3-year follow-up have been uneventful.

CONCLUSION

Therefore, life-threatening cardiovascular complications may occur even many years after reconstructive surgery for chest deformity.

Management of High-Risk Atherosclerotic Patients by Statins May Be Supported by Logistic Model of Intima-Media Thickening

While the use of statins in treating patients with atherosclerosis is an undisputed success, the questions regarding an optimal starting time for treatment and its strength remain open. We proposed in our earlier paper published in Int. J. Mol. Sci. (2019, 20) that the growth of intima-media thickness of the carotid artery follows an S-shape (i.e., logistic) curve. In our subsequent paper in PLoS ONE (2020, 15), we incorporated this feature into a logistic control-theoretic model of atherosclerosis progression and showed that some combinations of patient age and intima-media thickness are better suited than others to start treatment. In this study, we perform a new and comprehensive calibration of our logistic model using a recent clinical database. This allows us to propose a procedure for inferring an optimal age to start statin treatment for a particular group of patients. We argue that a decrease in the slope of the IMT logistic growth curve, induced by statin treatment, is most efficient where the curve is at its steepest, whereby the efficiency means lowering the future IMT levels. Using the procedure on an aggregate group of severely sick men, 38 years of age is observed to correlate with the steepest point of the logistic curve, and, thus, it is the preferred time to start statin treatment. We believe that detecting the logistic curve’s steepest fragment and commencing statin administration on that fragment are courses of action that agree with clinician intuition and may support decision-making processes.

Molecular Mechanisms Associated with ROS-Dependent Angiogenesis in Lower Extremity Artery Disease

Currently, atherosclerosis, which affects the vascular bed of all vital organs and tissues, is considered as a leading cause of death. Most commonly, atherosclerosis involves coronary and peripheral arteries, which results in acute (e.g., myocardial infarction, lower extremities ischemia) or chronic (persistent ischemia leading to severe heart failure) consequences. All of them have a marked unfavorable impact on the quality of life and are associated with increased mortality and morbidity in human populations. Lower extremity artery disease (LEAD, also defined as peripheral artery disease, PAD) refers to atherosclerotic occlusive disease of the lower extremities, where partial or complete obstruction of peripheral arteries is observed. Decreased perfusion can result in ischemic pain, non-healing wounds, and ischemic ulcers, and significantly reduce the quality of life. However, the progressive atherosclerotic changes cause stimulation of tissue response processes, like vessel wall remodeling and neovascularization. These mechanisms of adapting the vascular network to pathological conditions seem to play a key role in reducing the impact of the changes limiting the flow of blood. Neovascularization as a response to ischemia induces sprouting and expansion of the endothelium to repair and grow the vessels of the circulatory system. Neovascularization consists of three different biological processes: vasculogenesis, angiogenesis, and arteriogenesis. Both molecular and environmental factors that may affect the process of development and growth of blood vessels were analyzed. Particular attention was paid to the changes taking place during LEAD. It is important to consider the molecular mechanisms underpinning vessel growth. These mechanisms will also be examined in the context of diseases commonly affecting blood vessel function, or those treatable in part by manipulation of angiogenesis. Furthermore, it may be possible to induce the process of blood vessel development and growth to treat peripheral vascular disease and wound healing. Reactive oxygen species (ROS) play an important role in regulation of essential cellular signaling pathways such as cell differentiation, proliferation, migration and apoptosis. With regard to the repair processes taking place during diseases such as LEAD, prospective therapeutic methods have been described that could significantly improve the treatment of vessel diseases in the future. Summarizing, regenerative medicine holds the potential to transform the therapeutic methods in heart and vessel diseases treatment.

Proteomic Profiling of Leukocytes Reveals Dysregulation of Adhesion and Integrin Proteins in Chronic Kidney Disease-Related Atherosclerosis

A progressive loss of functional nephrons defines chronic kidney disease (CKD). Complications related to cardiovascular disease (CVD) are the principal causes of mortality in CKD; however, the acceleration of CVD in CKD remains unresolved. Our study used a complementary proteomic approach to assess mild and advanced CKD patients with different atherosclerosis stages and two groups of patients with different classical CVD progression but without renal dysfunction. We utilized a label-free approach based on LC-MS/MS and functional bioinformatic analyses to profile CKD and CVD leukocyte proteins. We revealed dysregulation of proteins involved in different phases of leukocytes' diapedesis process that is very pronounced in CKD's advanced stage. We also showed an upregulation of apoptosis-related proteins in CKD as compared to CVD. The differential abundance of selected proteins was validated by multiple reaction monitoring, ELISA, Western blotting, and at the mRNA level by ddPCR. An increased rate of apoptosis was then functionally confirmed on the cellular level. Hence, we suggest that the disturbances in leukocyte extravasation proteins may alter cell integrity and trigger cell death, as demonstrated by flow cytometry and microscopy analyses. Our proteomics data set has been deposited to the ProteomeXchange Consortium via the PRIDE repository with the data set identifier PXD018596.

Mass Spectrometry-Based Lipidomics Reveals Differential Changes in the Accumulated Lipid Classes in Chronic Kidney Disease

Chronic kidney disease (CKD) is characterized by the progressive loss of functional nephrons. Although cardiovascular disease (CVD) complications and atherosclerosis are the leading causes of morbidity and mortality in CKD, the mechanism by which the progression of CVD accelerates remains unclear. To reveal the molecular mechanisms associated with atherosclerosis linked to CKD, we applied a shotgun lipidomics approach fortified with standard laboratory analytical methods and gas chromatography-mass spectrometry technique on selected lipid components and precursors to analyze the plasma lipidome in CKD and classical CVD patients. The MS-based lipidome profiling revealed the upregulation of triacylglycerols in CKD and downregulation of cholesterol/cholesteryl esters, sphingomyelins, phosphatidylcholines, phosphatidylethanolamines and ceramides as compared to CVD group and controls. We have further observed a decreased abundance of seven fatty acids in CKD with strong inter-correlation. In contrast, the level of glycerol was elevated in CKD in comparison to all analyzed groups. Our results revealed the putative existence of a functional causative link-the low cholesterol level correlated with lower estimated glomerular filtration rate and kidney dysfunction that supports the postulated "reverse epidemiology" theory and suggest that the lipidomic background of atherosclerosis-related to CKD is unique and might be associated with other cellular factors, i.e., inflammation.

Cardiac conduction abnormalities in patients with degenerated bioprostheses undergoing transcatheter aortic valve-in-valve implantations and their impact on long-term outcomes

BACKGROUND

The relationship between preoperative cardiac conduction abnormalities (CCA) and long-term outcomes after transcatheter aortic valve-in-valve implantation (TAVI-VIV) remains unclear. The aim of the study was to evaluate the effects of preoperative CCA on mortality and morbidity after TAVI-VIV and to estimate the impact of new-onset CCA on postoperative outcomes.

METHODS

Between 2011 and 2020, 201 patients with degenerated aortic bioprostheses were qualified for TAVI-VIV procedures in two German heart centers. Cases with previously implanted permanent rhythm-controlling devices were excluded (n = 53). A total of 148 subjects met the eligibility criteria and were divided into 2 study groups according to the presence of preexisting CCA (CCA (n = 84) and non-CCA (n = 64), respectively). Early and late mortality and morbidity were evaluated. Follow-up functional status was assessed according to New York Heart Association (NYHA) classification.

RESULTS

There were no procedural deaths. TAVI-VIV related new-onset CCAs were observed in 35.8% patients. The 30-day permanent pacemaker implantation rate was 1.6% in non-CCA vs 9.5% in CCA group (p = 0.045). Preexisting right bundle-branch block (OR:5.01; 95%CI, 1.05-23.84) and first-degree atrioventricular block (OR:4.55; 95%CI, 1.10-18.73) were independent predictors of new pacemaker implantation. One-year and five-year probability of survival were comparable in CCA and non-CCA groups: 90.3% vs 91.8% and 68.2% vs 74.3%, respectively. Surviving patients with preexisting and new-onset CCA had a worse functional status according to NYHA classification at follow-up.

CONCLUSION

Preexisting and new-onset postoperative CCAs did not affect early and late mortality after TAVI-VIV procedures, however, they may have a negative impact on late functional status.

Platelet function in patients undergoing surgical and transcatheter aortic valve replacement: a comparative study

BACKGROUND

Intervention-induced platelet hypercoagulability may pose a risk of serious adverse events for patients.

AIMS

This study aimed to assess whether surgical and transcatheter aortic valve replacement (SAVR and TAVR) differ in periprocedural platelet activity.

METHODS

The total number of 24 patients with a mean age (SD) of 71 (13) years who underwent SAVR (n = 12) or TAVR (n = 12) were recruited for the study. The following parameters were evaluated at 4 time-points: (i) platelet indices: total platelet count (PLT), platelet distribution width (PDW) and mean platelet volume (MPV), (ii) MPV/PLT ratio, (iii) platelet level of lipid peroxidation: malondialdehyde (MDA) content and MDA/PLT ratio. Eventually, percentage variations of PLT, PDW, and MPV in relation to the baseline values were determined.

RESULTS

MPV/PLT ratio increased significantly after procedures in both groups (P = 0.01 in TAVI and P = 0.01 in SAVR). MDA concentrations were significantly higher when assessed directly post-procedure (P = 0.04) as well as 24 hours later (P = 0.01) in the SAVR and TAVI groups. The indirect parameter of platelet activity indexed for platelet counts (MDA/PLT) was comparable between both groups before and 48 hours after procedures, but was significantly higher in SAVR patients, particularly after 24 hours after interventions (P = 0.04; medians TAVR vs SAVR, respectively).

CONCLUSIONS

Standard surgical aortic valve replacement is associated with a more pronounced platelet reaction to intervention-induced injury, as compared to the transcatheter-based procedure. The importance of these laboratory findings requires further investigation focused on early and late clinical outcomes.

Extended cardiopulmonary resuscitation: from high fidelity simulation scenario to the first clinical applications in Poznan out-of-hospital cardiac arrest program

BACKGROUND

The outcomes of out-of-hospital cardiac arrest (OHCA) patients are poor. In some OHCA cases, the reason is potentially reversible cardiac or aortic disease. It was suggested previously that high-quality cardiopulmonary resuscitation (CPR) followed by extracorporeal membrane oxygenation (ECMO) support may improve the grave prognosis of OHCA. However, extended CPR (ECPR) with ECMO application is an extremely invasive and cutting-edge procedure. The purpose of this article is to describe how high-fidelity medical simulation as a safe tool enabled implementation of the complex, multi-stage ECPR procedure.

METHOD

A high fidelity simulation of OHCA in street conditions was prepared and carried out as part of a ECPR procedure implemented in an in-hospital area. The simulation tested communication and collaboration of several medical teams from the pre-hospital to in-hospital phases along with optimal use of equipment in management of a sudden cardiac arrest (SCA) patient.

RESULTS

The critical and weak points of an earlier created scenario were collected into a simulation scenario checklist of ECPR algorithm architecture. A few days later, two ECPR procedures followed by cardiologic interventions for OHCA patients (one pulmonary artery embolectomy for acute pulmonary thrombosis and one percutaneous coronary artery angioplasty with drug eluting stent implantation for acute occlusion of the left anterior descending artery), were performed for the first time in Poland. The protocol was activated five times in the first 2 months of the POHCA Program.

CONCLUSION

High fidelity medical simulation in real-life conditions was confirmed to be a safe, useful tool to test and then implement the novel and complex medical procedures. It enabled to find, analyze and solve the weakest points of the earlier developed theoretical protocol and eventually succeed in clinical application of complete ECPR procedure.

Impact of Application of Multifunction Electrode (MFE) Pads on Cardiopulmonary Resuscitation Quality

BACKGROUND

Early defibrillation and high-quality chest compressions are crucial in treatment of sudden cardiac arrest (SCA) subjects. The aim of this study was to assess an impact of defibrillation methods on cardiopulmonary resuscitation (CPR) quality.

METHODS

A randomized simulation cross-study was designed, in which 100 two-person paramedical teams participated. Two 10-minute scenarios of SCA in the mechanism of ventricular fibrillation were analysed. In the first one, teams had at their disposal defibrillator with hard paddles (group C), whereas in the second one, adhesive electrodes were used (group MFE). The CPR quality was evaluated on the basis of the chest compression parameters (rate, depth, recoil, compression fraction (CCF), and no-flow time), airways patency achievement, and successful emergency drug administration.

RESULTS

Substituting standard hard paddles with adhesive electrodes led to an increase in CCF (77% vs 73%; p < 0.05), higher rate of complete chest recoil, and a decrease in no-flow time (6.0 ± 1.1 vs. 7.3 ± 1.1; p < 0.001). The airway patency was ensured sooner in group MFE (271 ± 118 s vs. 322 ± 106 s in group C; p < 0.001). All teams in scenario with adhesive electrodes were able to administer two doses of adrenaline, meanwhile only 74% of them in group C (p < 0.001). Moreover, in 8% of group C scenarios, paramedics did not have enough time to administer amiodarone.

CONCLUSION

Our simulation-based analysis revealed that use of adhesive electrodes during defibrillation instead of standard hard paddles may improve the quality of CPR performed by two-person emergency team.

Off-pump versus on-pump coronary artery surgery in octogenarians (from the KROK Registry)

Background

According to the medical literature, both on-pump and off-pump coronary artery surgery is safe and effective in octogenarians.

Objectives

The aim of our study was to examine the epidemiology, in-hospital outcomes and long-term follow-up results in octogenarians undergoing off-pump and on-pump coronary artery surgery utilizing nationwide registry data.

Methods

All octogenarians (≥ 80 years) enrolled in the Polish National Registry of Cardiac Surgical Procedures (KROK Registry), who underwent isolated coronary surgery between January 2006 and September 2017 were identified. Preoperative data, perioperative complications, hospital mortality and long-term mortality were analyzed. Unadjusted and propensity-matched comparisons were performed between octogenarians undergoing off-pump and on-pump coronary artery bypass surgery.

Results

Octogenarians accounted for 4.1% of the total population undergoing coronary artery surgery in Poland during the analyzed period (n = 152,631) and this percentage is increasing. Among 6,006 analyzed patients, 2,744 (45.7%) were operated on-pump and 3,262 (54.3%) were operated off-pump. Propensity-matched analysis revealed that patients operated on-pump were more often reoperated due to postoperative bleeding and their in-hospital mortality was higher (6.6% vs 4.5%, p = 0.006 and 8.7% vs 5.8%, p = 0.001, respectively). Long-term all-cause mortality was lower among patients operated off-pump (p = 0.013).

Conclusion

On the basis of our findings we suggest that off pump technique should be considered as perfectly acceptable in octogenarians.

Impact of automatic chest compression devices in out-of-hospital cardiac arrest

Background

High quality chest compressions (CCs) are of crucial importance during cardio-pulmonary resuscitation (CPR). Currently, there are no clear evidences that the use of automatic chest compression devices (ACCD) are superior to manual CCs during out-of-hospital CPR. This study aimed to estimate if availability of ACCDs for two-man rescue teams had any impact on CPR efficiency and a rate of successful transport of patients after out-of-hospital cardiac arrest (OHCA) to emergency departments.

Methods

The study was designed as a retrospective cohort study. The research tool was the analysis of medical charts of Emergency Medical Service (EMS) in one million agglomeration in Poland in 2018. ACCDs were available for two-man paramedical teams in a half of ambulances and this fact was criterion of group division [ACCD (n=181) and manual CC (MCC) (n=303)]. The following variables such as gender (male/female), age, area of intervention (town/countryside), return of spontaneous circulation (ROSC) followed by successful transport to hospital were compared between subgroups.

Results

Among 71,282 interventions in 2018, there were 484 resuscitations undertaken with complete medical data. ROSC and transport to hospital was achieved in 54.9% of individuals, statistically more often among ACCD subjects (63.5%) than those compressed manually (49.8%) (P=0.003). Moreover, the use of ACCD was associated with higher chances of ROSC in younger patients (P=0.027) and if cardiac arrest had place in the town centre (P=0.002).

Conclusions

Our observation revealed that the use of ACCD in the pre-hospital emergency care involving two-man rescue teams may increase the prevalence of ROSC among OHCA patients.

The Proliferation and Differentiation of Adipose-Derived Stem Cells in Neovascularization and Angiogenesis

Neovascularization and angiogenesis are vital processes in the repair of damaged tissue, creating new blood vessel networks and increasing oxygen and nutrient supply for regeneration. The importance of Adipose-derived Mesenchymal Stem Cells (ASCs) contained in the adipose tissue surrounding blood vessel networks to these processes remains unknown and the exact mechanisms responsible for directing adipogenic cell fate remain to be discovered. As adipose tissue contains a heterogenous population of partially differentiated cells of adipocyte lineage; tissue repair, angiogenesis and neovascularization may be closely linked to the function of ASCs in a complex relationship. This review aims to investigate the link between ASCs and angiogenesis/neovascularization, with references to current studies. The molecular mechanisms of these processes, as well as ASC differentiation and proliferation are described in detail. ASCs may differentiate into endothelial cells during neovascularization; however, recent clinical trials have suggested that ASCs may also stimulate angiogenesis and neovascularization indirectly through the release of paracrine factors.

The use of prefilled adrenaline syringes improves cardiopulmonary resuscitation quality-high-fidelity simulator-based study

BACKGROUND

In some countries, adrenaline is available only in glass ampoules. However, simplification of cardiopulmonary resuscitation (CPR) by introducing prefilled syringes may ensure more efficient CPR. The aim of this study was to investigate the impact of different forms of adrenaline on the CPR quality.

METHODS

In a randomized cross-examination simulation study, 100 two-person paramedical teams took part in two 10-minute scenarios of sudden cardiac arrest (SCA) in a pulseless electrical activity mechanism (PEA). In the first scenario the set of medicines contained glass ampoules (group ST) with adrenaline, in the second prefilled syringes (group AMPS). The parameters of the CPR quality [correct number and depth of chest compressions (CC), no flow time, chest recoil, time to apply supraglottic airways device (SAD)] were compared.

RESULTS

In group AMPS the first dose of adrenaline was administered after 114.2±28.3 seconds after the initiation of CPR whereas after 178.1±62.6 seconds in group ST (P<0.001). Chest compression fraction (CCF) was higher (81.8%±6.1%) in group AMPS than in group ST (71.2%±7.5%). Paramedics performed CC at better frequency, to a preferred depth and in an appropriate place in group AMPS. Faster decision to apply SAD (131.7±34.0 s in group AMPS and 220.3±81.5 s in group ST) ensured faster achievement of airway patency in this group (181.5±48.7 vs. 271.2±101.5 s).

CONCLUSIONS

Prefilled syringes with crucial drugs during CPR may significantly improve the quality of CPR performed by two-person teams.

Differences in Expression of Genes Involved in Bone Development and Morphogenesis in the Walls of Internal Thoracic Artery and Saphenous Vein Conduits May Provide Markers Useful for Evaluation Graft Patency

Coronary artery bypass grafting (CABG) is one of the most efficient procedures for patients with advanced coronary artery disease. From all the blood vessels with the potential to be used in this procedure, the internal thoracic artery (ITA) and the saphenous vein (SV) are the most commonly applied as aortocoronary conduits. Nevertheless, in order to evaluate the graft patency and efficiency effectively, basic knowledge should be constantly expanding at the molecular level as well, as the understanding of predictive factors is still limited. In this study, we have employed the expressive microarray approach, validated with Real-Time Quantitative Polymerase Chain Reaction (RT-qPCR), to analyze the transcriptome of both venous and arterial grafts. Searching for potential molecular factors, we analyzed differentially expressed gene ontologies involved in bone development and morphogenesis, for the possibility of discovery of new markers for the evaluation of ITA and SV segment quality. Among three ontological groups of interest—“endochondral bone morphogenesis”, “ossification”, and “skeletal system development”—we found six genes common to all of them. BMP6, SHOX2, COL13A1, CSGALNACT1, RUNX2, and STC1 showed differential expression patterns in both analyzed vessels. STC1 and COL13A1 were upregulated in ITA samples, whereas others were upregulated in SV. With regard to the Runx2 protein function in osteogenic phenotype regulation, the RUNX2 gene seems to be of paramount importance in assessing the potential of ITA, SV, and other vessels used in the CABG procedure. Overall, the presented study provided valuable insight into the molecular background of conduit characterization, and thus indicated genes that may be the target of subsequent studies, also at the protein level. Moreover, it has been suggested that RUNX2 may be recognized as a molecular marker of osteogenic changes in human blood vessels.

Infiltration of CD68+ cells correlates positively with matrix metalloproteinase 2 expression in the arteries used as aortocoronary bypass grafts. Possible clinical implications

BACKGROUND

Late failure of arterial aortocoronary conduits may result from abnormal activity of cells found in the vessel wall, including macrophages. The purpose of this study was to assess if there are any associations between the number of macrophages and overexpression of matrix metalloproteinases (MMPs) in the wall of arterial grafts, as well as their clinical significance.

METHODS

This study involved 128 consecutive patients with a mean age of 64.9 ± 9.7 years who underwent elective surgery for coronary artery disease (CAD). The surplus segments of internal thoracic artery (ITA) and radial arteries (RA) were taken for immunohistochemical analysis of macrophage numbers and MMPs expression. The participants who reached the clinical primary end-point (cardiacrelated death, acute coronary syndrome or progression of CAD) had a follow-up angiography.

RESULTS

The mean numbers of macrophages were higher on RA (70 [24; 112]) than ITA cross-sections (44 [24; 59]; p < 0.001). Median expression of both MMP2 and MMP9 were stronger in the ITA than RA cross-sections (p < 0.001). A significant positive correlation of MMP2 expression and a number of macrophages infiltrating the tunica media of arterial segments were noted on both ITA and RA cross-sections. In addition, the arterial segments of the 6 patients who reached clinical end-point had higher numbers of macrophages and stronger MMP2 expression when compared to the rest of the participants.

CONCLUSIONS

Macrophage infiltration of arterial wall grafts prior to harvesting may be associated with higher risk of late occlusion and MMP2 might be facilitating this process.