Low levels of total testosterone, testosterone/estradiol ratio and free androgen index and higher levels of estrone in men with coronary artery disease appear together with many features of metabolic syndrome and may be involved in the pathogenesis of coronary atherosclerosis.

Our data suggest that low plasma adiponectin level is connected with insulin resistance syndrome and atherogenic lipid profile. It seems that adiponectin plays a role in pathogenesis of coronary atherosclerosis, especially in obese and insulin-resistant subjects.

Angioplastyka tętnicy nerkowej pod kontrolą cząstkowej rezerwy przepływu -metoda optymalnego doboru pacjentów do zabiegu rewaskularyzacji?M Ma ar rc ci in n P Pr ro ot ta as si ie ew wi ic cz z 1 1 , , K Ka ar ro ol l P Po oc cz zą ąt te ek k 1 1 , , M Ma ar rt ta a N Ne eg gr ru us sz z--K Ka aw we ec ck ka a 1 1 , , P Pr rz ze em my ys sł ła aw w N No ow wi ic ck ki i 1 1 , , P Pa aw we eł ł S Sz zy ym mk ki ie ew wi ic cz z 1 1 , , J Jo oa an nn na a S Sł ło on ni in na a 2 2 , , A Ar rk ka ad di iu us sz z D De er rk ka ac cz z 3 3 , , M Ma ac ci ie ej j P Po od dg gó ór rs sk ki i 3 3 , , A An nd dr rz ze ej j M My ys si ia ak k A b s t r a c tRandomised trials show that renal artery angioplasty based on angiographic qualification is not beneficial in improving blood pressure, renal function or mortality. At the same time, recent studies have indicated that trans-lesional pressure gradient measurement might help to identify patients in whom percutaneous renal revascularisation would have a favourable effect in terms of hypertension improvement. We present a case of a 53-year-old woman with unilateral renal artery stenosis and resistant hypertension in whom successful fractional flow reserve guided renal artery stenting was performed.K Ke ey y w wo or rd ds s: : renal angioplasty, fractional flow reserve, hyperaemia, hypertension S t r e s z c z e n i ePrzeprowadzone badania kliniczne z randomizacją wykazały, że kwalifikacja do zabiegu angioplastyki tętnicy nerkowej na podstawie angiograficznej oceny istotności zwężenia nie przynosi poprawy w rokowaniu pacjentów, kontroli nadciśnienia tętniczego czy funkcji wydalniczej nerek. Ostatnio pojawiły się doniesienia, że ocena gradientu ciśnień powodowanego zwężeniem tętnicy nerkowej może być pomocna w identyfikacji pacjentów odnoszących korzyść (w postaci lepszej kontroli ciśnienia tętniczego) z zabiegu przezskórnej rewaskularyzacji. Prezentujemy przypadek 53-letniej pacjentki z jednostronnym zwężeniem tętnicy nerkowej i opornym nadciśnieniem tętniczym, u której przeprowadzono długookresowo skuteczny zabieg angioplastyki tętnicy nerkowej pod kontrolą cząstkowej rezerwy przepływu. S Sł ło ow wa a k kl lu uc cz zo ow we e: : angioplastyka tętnicy nerkowej, cząstkowa rezerwa przepływu, hiperemia, nadciśnienie tętnicze Corresponding autor/Adres do korespondencji:

The objective of this case report is to present how the chronic condition significantly complicates life-saving procedures and influences further treatment decisions. A 64-year-old man suffering from arterial hypertension and immune thrombocytopenic purpura presented to the Emergency Department with anterior ST-elevation myocardial infarction. An immediate coronary angiography was performed where critical stenosis of the proximal left anterior descending was found. It was followed by primary percutaneous intervention with bare metal stent. In first laboratory results, extremely low platelet count was found (13 × 10 9 /L). Consulting haematologist advised the use of single antiplatelet therapy and from the second day of hospitalisation only clopidogrel was prescribed. On the sixth day of hospital stay, patient presented acute chest pain with ST elevation in anterior leads. Emergency coronary angiography confirmed acute stent thrombosis and aspiration thrombectomy was performed. It was therefore agreed to continue dual antiplatelet therapy for 4 weeks. As there are no clinical trials where patients with low platelet count are included, all therapeutic decisions must be made based on clinician’s experience and experts’ consensus. Both the risk of haemorrhagic complications and increased risk of thrombosis must be taken into consideration when deciding on patient’s treatment.

Perforations of saphenous venous grafts during coronary angioplasty are rare and potentially lethal. The objective of this clinical case report is to highlight this unusual complication and necessary treatment. A 76-year-old woman, 3 months after coronary artery bypass grafting (left internal mammary artery to left anterior descendant artery, saphenous vein graft to obtuse marginal, saphenous vein graft to right coronary artery), demonstrated typical signs of acute coronary syndrome. Coronary angiogram revealed, inter alia, two critical lesions in saphenous vein graft to right coronary artery. Percutaneous coronary intervention was performed with placement of two drug-eluting stents, complicated by a vessel rupture and heavy extravasation of contrast. A polyurethane-covered stent was then deployed and successfully sealed the vascular wall. In a computed tomography of the chest, a mediastinal haematoma near the heart base and right heart margin was found. Subsequently, this intrathoracic bleeding caused external impression on saphenous vein graft to right coronary artery, leading to near occlusion of the vessel with recurrence of chest pain and ST-segment elevation in inferior wall electrocardiogram leads. Immediate coronary angiography and drug-eluting stent implantation was performed. During, further, in-hospital follow-up, patient was free of chest pain; computed tomography scan performed after 10 days revealed regression of haematoma. Clinicians must remain alert to the potential of life-threatening complications associated with saphenous venous graft angioplasty, as their recognition is critical to institution of prompt, appropriate therapy.