IntroductionAtrial fibrillation (AF) is the most common sustained arrhythmia. Diabetic autonomic neuropathy (DAN) is a frequent complication of diabetes mellitus and has a negative impact on the cardiovascular system. There are no data about the occurrence of paroxysmal atrial fibrillation (PAF) in the population with DAN.Material and methodsWe analysed the data of 100 patients with PAF. The study population was divided into three groups: group I: 28 patients with diabetes mellitus (DM) and DAN, group II: 34 patients with DM without DAN, and group III: 38 patients without DM. P-wave duration (FPD) and dispersion (PWD) were measured during sinus rhythm and AF episodes were counted during 12 months of follow-up.ResultsRecurrence of PAF was higher in group I (47 episodes/year) compared to groups II and III (26 and 22 episodes/year) – p<0.01. The FPD was longer in group I (137.4 ±12.0 ms vs. 126 ±23.0 ms in II group and 129 ±18.3 ms in group III; p<0.001). The PWD was longer in patients with DAN (53 ±19 ms vs. 36 ±18 ms and 34 ± 20 ms, p<0.001).ConclusionsThe results showed that the presence of DAN caused a significant increase in P-wave duration and dispersion, which might be responsible for the recurrence of AF.

The aim of the study was to check, in clinical practice, the potential for the dose reduction of lead eyewear and a ceiling-suspended shield used to protect the eye lens of physicians working in interventional cardiology. To this end, for the lead eyewear, the dose reduction factors were derived to correct the readings from a dosimeter used routinely outside the glasses. Four types of lead eyewear with attached loose thermoluminescent dosimeters and EYE-D dosimeters were worn by physicians in two clinical centres, for two-month periods, during coronary angiography (CA), percutaneous coronary intervention (PCI), and pacemaker procedures. In order to analyse, separately, how a ceiling-suspended lead screen absorbs the scattered radiation, a series of measurements was carried out during single CA/PCI procedures performed with and without the protection. The lead eyewear may reduce the doses to the eye closest to the x-ray tube by a factor between 1.1 and 3.4, depending on its model and the physician's position. The effectiveness of the eyewear may, however, vary-even for the same model and physician-almost twofold between different working periods. The ceiling-suspended shield decreases the doses in clinical practice by a factor of 2.3. The annual eye lens doses without the eyewear estimated from routine measurements are high-above or close to the new eye lens dose limit established by the recent EU Basic Safety Standards, even though the ceiling-suspended shield was used. Therefore, to comply with the new dose limit that is set in the Directive, protection of the eyes of physicians with high workloads might require the use of both the eyewear and the ceiling-suspended shield.

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SummaryBackgroundEndothelial dysfunction is an independent predictor of future cardiac events.Material/MethodsWe evaluated the relationship between flow-mediated dilation (FMD) in brachial artery and coronary risk factors in 93 patients (70 males, mean age: 62±8 years) with ACS treated with primary angioplasty (PCI). The patients were divided into 2 subgroups: 43 patients with diabetes mellitus type 2 (DM) and 50 non-diabetics (non-DM). Patients were examined on the 3rd day after ACS and after 6 months. FMD on the 3rd day were significantly lower in DM than in non-DM (5.8±2.2% vs. 8.8±4.9%, p=0.0007) and after 6 months (6.2±2.6% vs. 9.4±4.4%, p<0.0001). It was also observed that the improvement of FMD in both groups after a 6-month follow-up inversely correlated with the increase of left ventricular end-diastolic volume (LVEDV) (r=−0.41, p<0.001).ResultsThere was an inverse relationship between FMD and age (r=−0.26, p<0.01), BMI (r=−0.26, p<0,005), total cholesterol (r=−0.56, p<0.001) and LDL cholesterol (r=−0.53, p<0.001). There was no relationship between triglycerides, hypertension and history of smoking. In the DM group, FMD negatively correlated with HbA1c (r=−0.68, p<0.001). Restenosis rate was significantly higher in the DM group (19% vs. 6%, p<0.001) but there was no relationship between FMD and restenosis.ConclusionsImpaired FMD is more significant in diabetics than in non-diabetic patients with ACS. Lack of improvement of FMD after acute coronary syndrome can be a predictor of detrimental left ventricular remodeling in patients with ACS.

The aim of the present study is to analyse quantitatively the potential reduction of doses to the eye lens and the hands of an operator and a nurse by the use of a pelvic lead blanket during coronary angiography (CA) and percutaneous transluminal coronary angioplasty (PTCA) procedures. Thermoluminescent dosimeters were used to assess dose levels to the left eye lens and fingers on both hands of both physician and nurses during single procedures performed with or without the lead blanket. The measurements were carried out at one medical centre and include dosimetric data from 100 procedures. Additional measurements including physician's and patient's doses were made on phantoms in the laboratory. In order to determine the reduction potential of the lead blanket, the doses normalized to DAP (Dose-Area Product) corresponding to the same position of dosimeter were compared against each other for both procedure categories (with and without protection). There was no statistically significant decrease observed in physicians' and nurses' eye lens doses, nor in doses normalized to DAP due to the use of the lead pelvic shield in clinic. However, some trend in reducing the eye lens doses by this shield can be observed. Regarding finger doses, the differences are statistically significant but only for physicians. The mean DAP-normalised doses to the eye lens and left and right finger of physicians, in the presence of a ceiling-suspended transparent lead shield, were 2.24e-5 ± 1.41e-5 mSv/μGym, 2.31e-4 ± 1.21e-4 mSv/μGym, and 2.60e-5 ± 1.57e-5 mSv/μGym for standard procedures performed without the lead blanket, and 1.77e-5 ± 1.17e-5 mSv/μGym, 1.70e-4 ± 1.01e-4 mSv/μGym, and 1.86e-5 ± 1.13e-5 mSv/μGym for procedures performed with it. A comparison of the results from the laboratory and the clinic shows that they are consistent regarding the eye lens, while for fingers it suggests that the dose reduction properties of the lead shield are related to the physician's work technique and both patient and lead blanket sizes or its positioning. The highest degree of reduction is observed for cranial and caudal projections together with the use of a patient-adjustable lead blanket; about a 2-fold decrease in finger doses is expected for optimum conditions. However, the laboratory measurements suggest that the use of lead blanket might slightly increase the patient dose, but only when specific projections are constantly used. This limitation should be considered by cardiologists during clinical work if this protection is used. In the light of the presented results, the ceiling-suspended transparent lead shield and the lead glasses seem to be the preferred way to reduce the doses to the eye lens, compared to the lead blanket.

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Objectives:The study aim was to analyse the influence of the lead free cap on doses received by interventional cardiologists. The impact of lead free cap on doses to the head were evaluated in number of studies. As different methods used to assess the attenuation properties of protective cap can lead to ambiguous results, a detailed study was performed. Material and Methods: The effectiveness of a lead free cap in reducing the doses to the skin was assessed in clinic by performing measurements with thermoluminescent dosimeters attached inside and outside the cap first during individual coronary angiography (CA) or CA/percutaneous transluminal coronary angioplasty (CA/PTCA) procedures and then cumulated during few procedures of the same type. In order to investigate the effect of the cap on reducing the doses to the brain additional measurements were performed with a male Alderson Rando and polymethyl methacrylate (PMMA) phantoms representing the physician and the patient, respectively for different projections. The brain dose per procedure, annual and cumulated during entire working practice were estimated for both cases working with and without the cap. Results: The dose reduction factor (RF) for the skin (the quotient of doses outside and inside the cap) vary from 1.1 up to 4.0 in clinical conditions; on average 2.3-fold reduction is observed in the most exposed left temple. The RFs determined for the part of the head covered by the cap range from 1.4 to 1.8 while for the brain from 1.0 to 1.1 depending on the projection. The estimated annual brain dose for interventional cardiologist performing yearly 550 CA/PTCA procedures without any protective shields is 7.2 mGy and it is reduced with the lead free cap by an average factor of 1.1. Conclusions: The study results proved the considerable effectiveness of lead free cap to protect the skin but very limited to protect the brain.