12-month patterns of serum markers of collagen synthesis, transforming growth factor and connective tissue growth factor are similar in new-onset and chronic dilated cardiomyopathy in patients both with and without cardiac fibrosis.

BACKGROUND: The dynamics of the extracellular matrix (ECM) fibrosis process in dilated cardiomyopathy (DCM) may be assessed non-invasively by means of serum markers of fibrosis. AIM: To explore the kinetics of serum markers of fibrosis during a 12-month follow-up in DCM. METHODS: We included 70 consecutive DCM patients (pts) (48±12.1years, EF 24.4±7.4%) with new-onset (n=35, duration <6months) and chronic DCM (n=35, >6months). Markers of collagen type I and III synthesis - procollagens type I and III carboxy- and amino-terminal peptides (PICP, PINP, PIIICP, PIIINP), and ECM metabolism controlling factors - tumor growth factor beta-1 (TGF1-ß), and connective tissue growth factor (CTGF) - were measured in serum at baseline, and at 3- and 12-month follow-up. All pts underwent endomyocardial biopsy to determine the presence and extent of ECM fibrosis. RESULTS: Markers of collagen type I synthesis (PICP and PINP) were almost homogenously increased over the 3- and 12-month period, whereas PIIINP values decreased and PIIICP levels were unchanged in new-onset and chronic DCM, and in pts with and without ECM fibrosis. Both TGF-ß and CTGF levels decreased over the observation period. Kinetics of serum markers of collagen synthesis and fibrosis controlling factors did not differ between DCM pts categorized according to disease duration and fibrosis status. CONCLUSIONS: The kinetics of collagen type I and III synthesis in DCM move in opposite directions, with production of collagen type I consistently increasing, and the synthesis of collagen type III decreasing. Levels of TGF and CTGF, which are proven fibrosis-stimulating factors, had a tendency to decrease. Regardless of disease duration or fibrosis status, the kinetics of serum markers of collagen synthesis, TGF and CTGF were similar in DCM. A better understanding of the kinetics of serum markers of fibrosis in DCM may help to develop more tailored therapeutic approaches to fibrosis.

Left ventricular reverse remodeling is not related to biopsy-detected extracellular matrix fibrosis and serum markers of fibrosis in dilated cardiomyopathy, regardless of the definition used for LVRR.

Left ventricular reverse remodeling (LVRR) is reported in dilated cardiomyopathy (DCM) patients (pts). However, numerous definitions of LVRR exist. Measurements of serum markers of fibrosis provide insight into myocardial fibrosis. The relationship between LVRR and fibrosis is poorly understood. From July 2014 until October 2015, we included 63 consecutive DCM pts (48 ± 12.1 years, EF 24.4 ± 7.4%) with completed baseline and 3-month follow-up echocardiograms. LVRR was assessed on the basis of four differing definitions. Procollagens type I and III carboxy- and amino-terminal peptides (PICP, PINP, PIIICP, and PIIINP), collagen 1, ostepontin, tumor growth factor beta-1, connective tissue growth factor, and matrix metalloproteinases (MMP-2, MMP-9), and their tissue inhibitor (TIMP-1) were measured in serum. In addition, all pts underwent right ventricular endomyocardial biopsy. Depending on the definition chosen, LVRR could be diagnosed in between 14.3 and 50.8% pts. Regardless of the LVRR definition used, the frequency of LVRR was similar in fibrosis negative and positive DCM. Minor differences of markers of fibrosis were detected between pts with and without LVRR. For every LVRR definition, adjusted and unadjusted models were constructed to evaluate the predictive value of serum fibrosis parameters. Only an increase of TIMP-1 by 1 ng/ml was found to independently increase the probability of LVRR by 0.016%. The choice of a particular definition of LVRR determines the final diagnosis, and this has a profound impact on subsequent management. LVRR is unrelated to biopsy-detected ECM fibrosis. Serum markers of fibrosis are only weakly related to LVRR, and are not of use in the prediction of LVRR.

Relation between cardiac magnetic resonance-assessed interstitial fibrosis and diastolic dysfunction in heart failure due to dilated cardiomyopathy.

Background: Dilated cardiomyopathy (DCM) is distinguished by left ventricle (LV) dilation accompanied by systolic dysfunction. However, some studies suggested also a high prevalence of LV diastolic dysfunction (LVDD), similar to a general cohort of heart failure (HF) with reduced ejection fraction (LVEF). The bulk of evidence, mostly arising from basic studies, suggests a causative link between cardiac fibrosis (CF) and LVDD. However, still, there remains a scarcity of data on LVDD and CF. Therefore, the aim of the study was to investigate the association between CF and LVDD in DCM patients. Methods: The study population was composed of 102 DCM patients. Replacement CF was evaluated qualitatively (late gadolinium enhancement - LGE) and quantitively (LGE extent); interstitial cardiac fibrosis was assessed via extracellular volume (ECV). Based on echocardiography patients were divided into normal and elevated left atrial pressure (nLAP, eLAP) groups. Results: 42 % of patients had eLAP. They displayed higher troponin and NT-proBNP. Both groups did not differ in terms of LGE presence and extent; however, eLAP patients had larger ECV: 30.1 ± 5.6 % vs. 27.8 ± 3.9 %, p = 0.03. Moreover, ECV itself was found to be an independent predictor of LVDD (OR = 0.901; 95 %CI 0.810-0.999; p = 0.047; normalised for LVEF and RVOT diameter). Conclusions: More than two-in-five DCM patients had at least moderate LVDD. The mere presence or extent of replacement cardiac fibrosis is similar in patients with nLAP and eLAP. On the other hand, interstitial cardiac fibrosis is more pronounced in those with a higher grade of LVDD. ECV was found to be an independent predictor of LVDD in DCM.

[Echocardiographic assessment of left atrial volume in asymptomatic ambulatory patients with metabolic syndrome and/or arterial hypertension - is it parameter worth into considerate?]. / Echokardiograficzna ocena objetosci lewego przedsionka u pacjentów bezobjawowych z nadcisnieniem tetniczym i/lub z zespolem metabolicznym w opiece ambulatoryjnej - czy warto oceniac ten parametr?

INTRODUCTION: Early identification of high-risk patients, including those with arterial hypertension (AH) andlor metabolic syndrome (MS), have a positive effect on the treatment and the cost. Left atrial volume is a well-known, easy to examine prognostic factor in cardiovascular diseases. Impaired function and enlargement of the left atrium could be present in even when asymptomatic patients with AH, but in subjects with MS has not been well documented. OBJECTIVE: The aim of the study was to estimate the left atrial volume index (LAVI) among asymptomatic patients with AH and/or MS. PATIENTS AND METHODS: One hundred and fourteen consecutive patients were divided into three groups as follows: 54 patients with MS, 34 with AH and 26 in a control group; next they were underwent the echocardiographic examination. A statistical analysis of LAVI was carried out using the Whitney-Mann test. RESULTS: The mean LAVI was: 25.20 ml/m2 for the AH group (woman 24.90 ml/m2; men 25.49 ml/m2); 24.90 ml/m2 for the MS (woman 25.78 ml/m2; men 23.63 ml/m2) and 19.20 ml/m2 for the control group (woman 21.77 ml/m2; men 17.97 ml/m2). There was a positive correlation between increased LAVI and AH or/and MS presence. CONCLUSIONS: The results suggest that left atrial volume index enlargement is more common among even asymptomatic patients suffering from hypertension andlor metabolic syndrome. The estimation of LAVI is possible in a routine echocardiographic examination and seems to be an additional useful parameter in description of risk in cardiovascular diseases.

The burden of atrial fibrillation and its prognostic value in patients with dilated cardiomyopathy.

BACKGROUND: Atrial fibrillation (AF) is the most common arrhythmia in patients with dilated cardiomyopathy (DCM). However, the epidemiology as well as clinical and prognostic significance of AF in DCM are poorly defined. AIMS: We aimed to assess the impact and prognostic value of AF in DCM as well as to investigate the concept of AF­induced DCM. METHODS: Hospital records of 285 patients with DCM from 2012 to 2018 with follow-up were analyzed. RESULTS: Atrial fibrillation was present in 89 patients (31%). They were older, more frequently male, hadhigher body mass index, New York Heart Association class, heart rate (HR), creatinine levels, and larger atria (all P < 0.05) than patients without AF. During follow­up (mean [SD], 35 [24] months), death occurred in 20 of the 82 available patients with AF and 22 of the 188 patients without AF (24% and 12%, respectively; P = 0.007). Atrial fibrillation was independently associated with a worse outcome (hazard ratio, 2.4; 95% CI, 1.3-4.3) and was found to be the major cause of DCM in 21 patients (24%). The diagnostic accuracy of the most optimal predictive model for AF­induced DCM was 0.935 (95% CI, 0.903-0.967). Despite numerical differences, survival was similar in DCM patients with and without AF (P = 0.15). CONCLUSIONS: Almost one­third of patients with DCM had AF. Most of the parameters analyzed differed between patients with and without AF, and AF was found to be an independent prognostic factor of DCM. One­fourth of patients with DCM and AF met the diagnostic criteria for AF­induced DCM.

The role of 99mTc-HMPAO-labelled white blood cell scintigraphy in the diagnosis of cardiac device-related infective endocarditis.

AIMS: The hybrid technique of single-photon emission tomography and computed tomography with technetium99m-hexamethylpropyleneamine oxime-labelled leucocytes (99mTc-HMPAO-SPECT/CT) is an emerging diagnostic technique in patients with cardiac device-related infective endocarditis (CDRIE). This prospective study assessed the 99mTc-HMPAO-SPECT/CT diagnostic profile and its added value to the modified Duke criteria (mDuke) in CDRIE diagnostic work-up. METHODS AND RESULTS: The study examined 103 consecutive patients with suspected CDRIE, who underwent 99mTc-HMPAO-SPECT/CT. Diagnostic accuracy was calculated based on a final clinical CDRIE diagnosis, including microbiology, echocardiography, and a 6-month follow-up. Subsequently, we compared the diagnostic value of the initial mDuke classification with a classification including 99mTc-HMPAO-SPECT/CT positive results as an additional major CDRIE criterion: mDuke-SPECT/CT.Overall, CDRIE was diagnosed in 31 (31%) patients, whereas 35 (34%) 99mTc-HMPAO-SPECT/CT were positive. 99mTc-HMPAO-SPECT/CT was characterized by 86% accuracy, 0.69 Cohen's kappa coefficient, 84% sensitivity, 88% specificity, 93% negative, and 74% positive predictive values. The original mDuke displayed 83% accuracy, 0.52 kappa, whereas mDuke-SPECT/CT had 88% accuracy, and 0.73 kappa. Compared with mDuke, mDuke-SPECT/CT showed significantly higher sensitivity (87% vs. 48%, P < 0.001). According to mDuke, 49.5% of patients had possible CDRIE, and after reclassification, that figure dropped to 37%. Furthermore, having assessed the diagnosis categorization improvement following the incorporation of 99mTc-HMPAO-SPECT/CT, the net reclassification index value was found to be 31.4%. CONCLUSION: In patients with CDRIE, 99mTc-HMPAO-SPECT/CT provides high diagnostic accuracy, whereas a negative scan excludes CDRIE with high probability. Inclusion of 99mTc-HMPAO-SPECT/CT into mDuke diagnostic criteria yields significantly higher sensitivity and a reduction in possible CDRIE diagnoses.

Kinetics of selected serum markers of fibrosis in patients with dilated cardiomyopathy and different grades of diastolic dysfunction of the left ventricle.

BACKGROUND: Fibrosis of the extracellular matrix (ECM) in dilated cardiomyopathy (DCM) is common and compromises both systolic and diastolic function. The aim of this study was to investigate the kinetics of ECM fibrosis markers over a 12 month follow-up in patients with DCM based on the severity of diastolic dysfunction (DD). METHODS: Seventy consecutive DCM patients (48 ± 12.1 years, ejection fraction 24.4 ± 7.4%) were included in the study. The grade of DD was determined using the ASE/EACVI algorithm. Markers of ECM fibrosis were measured at baseline and at 3 and 12 month follow-ups: collagen type I and III (PICP, PINP, PIIICP, PIIINP), transforming growth factor beta-1 (TGF1-b), connective tissue growth factor (CTGF) and galectin-3 were measured. RESULTS: Patients were divided into three groups according to DD severity: 30 patients with grade I, 18 with grade II and 22 with grade III of DD. Levels of PICP, PINP were increased over a 12-month period, while PIIINP decreased and PIIICP unchanged. Levels of TGF1-b decreased from the 3 to the 12-month points in grade I and II DD, and in grade III they remained unchanged. Levels of CTGF decreased over 12 months in grade III DD but were unchanged in grades I and II. Galectin-3 levels remained the same over all observation periods, irrespective of DD grade. CONCLUSIONS: Regardless of the DD grade, markers of collagen type I synthesis increased, markers of collagen type III decreased. Levels of TGF and CTGF had a tendency to decrease. Galectin-3 was revealed not to be a marker discriminating the severity of DD.

Relationships between Pulmonary Hypertension Risk, Clinical Profiles, and Outcomes in Dilated Cardiomyopathy.

Pulmonary hypertension (PH) in patients with heart failure (HF) contributes to a poorer prognosis. However, in those with dilated cardiomyopathy (DCM), the true prevalence and role of PH is unclear. Therefore, this study aimed to analyze the profile of DCM patients at various levels of PH risk, determined via echocardiography, and its impact on outcomes. The 502 DCM in- and out-patient records were retrospectively analyzed. Information on patient status was gathered after 45.9 ± 31.3 months. Patients were divided into 3 PH-risk groups based on results from echocardiography measurements: low (L, n = 239, 47.6%), intermediate (I, n = 153, 30.5%), and high (H, n = 110, 21.9%). Symptom duration, atrial fibrillation, ventricular tachyarrhythmia, ejection fraction, right atrial area, and moderate or severe mitral regurgitation were found to be independently associated with PH risk. During the follow-up period, 83 (16.5%) DCM patients died: 29 (12.1%) in L, 31 (20.3%) in I, and 23 (20.9%) in H. L-patients had a significantly lower risk of all-cause death (L to H: HR 0.55 (95%CI 0.32-0.98), p = 0.01), while no differences in prognosis were found between I and H. In conclusion, over one in five DCM patients had a high PH risk, and low PH risk was associated with better prognoses.

Chronic mitral regurgitation--significance of the echocardiographic determinants in predicting severity.

UNLABELLED: The aim of study was to determine the significance of the best echocardiographic parameters for assessing the severity of mitral regurgitation (MR). METHODS: The study population consisted of 107 patients, mean age 52 +/- 7 y with chronic isolated non-ischaemic MR. Quantification of the MR was performed using echocardiography through the proximal isovelocity surface area method (regurgitant volume (RV) and the effective regurgitant orifice (ERO) were calculated) and the assessment of vena contracta width (VCW). RESULTS: The ROC curve analysis and Peto odds used to differentiate between the significant (III-IV grade) and non-significant (I-II grade) MR groups of patients indicated thatVCW, RV and ERO were the most powerful predictors of MR.The area under the ROC curve was 0.931, 0.944, 0.927, respectively.The cut-off values defining significant MR were: VCW > or =7 mm, RV > or =45 ml, ERO > or = 0.33 cm2. CONCLUSIONS: The most powerful predictors of severe MR are VCW, ERO and RV.

99mTc-HMPAO-labeled leukocyte SPECT/CT and transthoracic echocardiography diagnostic value in infective endocarditis.

Infective endocarditis (IE) is a life-threatening disease, establishing a diagnosis is often challenging. The aim of this prospective study was to evaluate and compare the diagnostic performance of the combined use of single photon emission tomography and computed tomography with technetium99m-hexamethylpropyleneamineoxime-labeled leukocytes (99mTc-HMPAO-SPECT/CT) with transthoracic echocardiography (TTE) in patients with suspected IE. We enrolled 40 consecutive patients (12 females, 28 males, mean age: 58.6 ± 18) with suspected IE in the years 2015-2016. All patients underwent clinical evaluation, TTE and 99mTc-HMPAO-SPECT/CT for the assessment of lesions typical for IE. Scans were evaluated for the presence and location of increased radioactivity foci, corresponding to the accumulation of radiolabeled leukocytes in inflammatory lesions. After 6 months, the patients were re-evaluated clinically and with TTE. Final IE diagnosis was established in 14 (35%) patients. Lesions typical for IE were shown in 28 (70%) TTEs and 16 (40%) 99mTc-HMPAO-SPECT/CTs. The latter tests were characterized by 90% accuracy, 93% sensitivity, 88% specificity, 96% negative predictive value (NPV), 81% positive predictive value (PPV). TTE demonstrated 60% accuracy, 93% sensitivity, 42% specificity, 92% NPV, and 46% PPV. 99mTc-HMPAO-SPECT/CT was characterized by a lower number of false-positive results compared to TTE (3 vs. 15). In patients with suspected IE, 99mTc-HMPAO-SPECT/CT yields a smaller number of false-positive results, significantly higher diagnostic accuracy, specificity and PPV than TTE. It helps to differentiate IE infectious and sterile echocardiographic lesions and reduces by 27% the number of misdiagnosed IE classified in the 'possible IE' category by modified Duke Criteria.

[Percutaneous transluminal septal myocardial ablation: early results and long-term follow-up]. / Bezposrednie i odlegle wyniki przezskórnej ablacji alkoholowej przegrody miedzykomorowej u chorych z kardiomiopatia przerostowa zawezajaca droge wyplywu.

BACKGROUND: Percutaneous transluminal septal myocardial ablation (PTSMA) is becoming an alternative to surgical myectomy in the treatment of severe, drug refractory, hypertrophic obstructive cardiomyopathy (HOCM). The aim of our study was to analyze early results, complications and long-term follow-up in patients after PTSMA. METHODS: Out of eighteen patients [11 M] initially accepted for PTSMA, the procedure was performed in 12 patients [6 M] age from 22 to 70 y. All the patients underwent clinical evaluation, echocardiography and cardiopulmonary exercise testing (CPX) before the procedure, and after a median of 38 months of observation. In echo-cardiography left ventricle outflow tract gradient (LVOTG) and intraventricular septum diastolic diameter were assessed. The following parameters of CPX were analyzed: exercise duration, anaerobic threshold, peak oxygen consumption, peak exercise heart rate and carbon dioxide ventilating equivalent. RESULTS: The procedure was successful in 11 patient. There were 2 acute complications: 3rd degree AV block requiring peacemaker implantation and LVOTG increase with SAM exacerbation requiring urgent cardiosurgical intervention. During long-term follow-up 1 cerebral stroke and 1 death occurred. PTSMA resulted in significant reduction of left ventricle outflow tract gradient (89 +/- 44 vs. 17 +/- 17 mmHg) and intraventricular septum diastolic diameter (24 +/- 4 vs 18 +/- 5 mm) (p < or = 0.01 for both). We also observed improvement of CPX parameters: exercise duration (487 +/- 268 vs. 730 +/- 292 sec), anaerobic threshold (34.3 +/- 8.9 vs. 53.2 +/- 13.4% VO2max predicted), peak oxygen consumption (18.5 +/- 6 vs. 26.8 +/- 10.1 ml/kg/min), peak exercise heart rate (70.3 +/- 8.3 vs. 83.6 +/- 11.7%) and carbon dioxide ventilating equivalent (31 +/- 6.1 vs. 28 +/- 4.8); (p < or = 0.01 for all). CONCLUSIONS: PTSMA is an effective method of treatment in patients with severe, drug refractory HOCM. PTSMA is safe and is associated with a low percentage of severe complications.

Novel PARADIGM in carotid revascularisation: Prospective evaluation of All-comer peRcutaneous cArotiD revascularisation in symptomatic and Increased-risk asymptomatic carotid artery stenosis using CGuard™ MicroNet-covered embolic prevention stent system.

AIMS: Our aim was to determine (1) periprocedural and 30-day clinical safety and efficacy of the CGuard MicroNet-covered embolic prevention carotid stent system (MN-EPS) in routine use for unselected carotid stenosis (CS) patients undergoing CAS, as well as (2) feasibility of MN-EPS post-dilatation optimisation to minimise residual stenosis after CAS. METHODS AND RESULTS: This was a non-industry-funded, prospective academic study in all-referrals-tracked symptomatic and asymptomatic CS. In asymptomatic lesions, intervention was mandated only in case of increased stroke risk CS features. There was independent neurologist evaluation before CAS, at 48 hours and 30 days. There was external source data verification, angiographic core lab, and statistical analysis. Over 11 months, 108 referrals were recommended by the NeuroVascular Team for revascularisation: 101 (51-86 years, 55 symptomatic, evolving stroke in nine) underwent 106 (100% MN-EPS use) neuroprotection device-assisted (46% proximal, 54% distal) CAS; CEA was performed in seven. MN-EPS device success was 99.1%. Angiographic diameter stenosis was reduced from 83±9% to 6.7±5% (p<0.001). No MN-EPS foreshortening/elongation occurred (30 mm long was 29.82±0.68 mm; 40 mm long was 39.89±0.59 mm). The periprocedural death/major stroke/MI rate was 0%. One event, with no change in NIHSS or modified Rankin Scale and no clinical sequel, was adjudicated by the clinical events committee as minor stroke (0.9%). By 30 days there were no new events (0%). CONCLUSIONS: These increased risk consecutive patient data (1) indicate safety and efficacy of routine MN-EPS use in achieving endovascular reconstruction across all-comer CS lesion subsets, and (2) are consistent with MN-EPS protection against cerebral events extending throughout the stent healing period.

Global cardiac risk assessment in the Registry Of Pregnancy And Cardiac disease: results of a registry from the European Society of Cardiology.

AIMS: To validate the modified World Health Organization (mWHO) risk classification in advanced and emerging countries, and to identify additional risk factors for cardiac events during pregnancy. METHODS AND RESULTS: The ongoing prospective worldwide Registry Of Pregnancy And Cardiac disease (ROPAC) included 2742 pregnant women (mean age ± standard deviation, 29.2 ± 5.5 years) with established cardiac disease: 1827 from advanced countries and 915 from emerging countries. In patients from advanced countries, congenital heart disease was the most prevalent diagnosis (70%) while in emerging countries valvular heart disease was more common (55%). A cardiac event occurred in 566 patients (20.6%) during pregnancy: 234 (12.8%) in advanced countries and 332 (36.3%) in emerging countries. The mWHO classification had a moderate performance to discriminate between women with and without cardiac events (c-statistic 0.711 and 95% confidence interval (CI) 0.686-0.735). However, its performance in advanced countries (0.726) was better than in emerging countries (0.633). The best performance was found in patients with acquired heart disease from developed countries (0.712). Pre-pregnancy signs of heart failure and, in advanced countries, atrial fibrillation and no previous cardiac intervention added prognostic value to the mWHO classification, with a c-statistic of 0.751 (95% CI 0.715-0.786) in advanced countries and of 0.724 (95% CI 0.691-0.758) in emerging countries. CONCLUSION: The mWHO risk classification is a useful tool for predicting cardiac events during pregnancy in women with established cardiac disease in advanced countries, but seems less effective in emerging countries. Data on pre-pregnancy cardiac condition including signs of heart failure and atrial fibrillation, may help to improve preconception counselling in advanced and emerging countries.

Clinical and echocardiographic assessment of pregnant women with valvular heart diseases--maternal and fetal outcome.

UNLABELLED: The study aimed to compare the outcome of pregnancy in women with valvular heart diseases. MATERIAL: Two hundred and fifty-nine pregnant women with cardiac diseases, aged 18-42, were observed. Group I-158 patients with mitral valve disease: 30 patients with mitral stenosis; 44 patients with mitral regurgitation, 33 patients with combined mitral valve disease, 51 patients with mitral valve prolapse; Group II-54 patients with aortic valve disease: 32 patients with aortic stenosis, 22 with aortic regurgitation; Group III-47 patients after valve replacement (36 mechanical; 11 homograft valves). Medical history and physical examination, NYHA class assessment, ECG, and echocardiography were performed during consecutive trimesters of pregnancy and after delivery. RESULTS: Clinical deterioration was observed in 38 patients-in 25 women of Group I, 6 women of Group II, and 7 women of Group III. Newborns outcome : 250 healthy (10 prematures, 12 with intrauterine growth retardation), 6 aborted, 2 stillbirths, 1 neonatal death. Method of delivery : 200 vaginally, 53 cesarean sections. CONCLUSIONS: (1). Pregnants with critical mitral valve stenosis form a high-risk group of life-threatening complications. (2) In women with severe aortic stenosis, pregnancy could lead to sudden clinical status deterioration. (3) Cardiac complications can be expected in patients with left ventricular enlargement and its depressed function. (4) Key factors influencing successful course of pregnancy and labour in patients with prosthetic valves: adequate left ventricular function, properly functioning valves, and effective anticoagulation.

Vena contracta width as a simple method of assessing mitral valve regurgitation. Comparison with Doppler quantitative methods.

BACKGROUND AND AIM OF THE STUDY: Quantitative Doppler echocardiography and proximal flow convergence methods facilitate quantification of regurgitant volume (RV), regurgitant fraction (RF) and the measurement of effective regurgitant orifice (ERO) to define mitral regurgitation (MR) severity. Vena contracta width (VCW) has been proposed as a simple, accurate marker of MR, and is instrumental in predicting the angiographic severity of valvular regurgitation. The study aim was to compare VCW with quantitative Doppler methods and angiography for assessing MR. METHODS: Sixty-four patients with MR (50 males; mean age 54 +/- 8 years; range: 34-84 years) were included. The etiology of MR was coronary artery disease, infective endocarditis, rheumatic disease, dilated cardiomyopathy or mitral valve prolapse. Exclusion criteria included aortic stenosis and/or aortic insufficiency, mitral stenosis, mechanical prostheses and atrial fibrillation. RV and ERO estimated by the proximal isovelocity surface area method (PISA), and RF calculated by Doppler, were compared with VCW measured by color Doppler. The angiographic severity of MR was classified on a four-point scale, in compliance with Sellers' criteria. RESULTS: A good correlation was found between VCW and ERO (r2 = 0.70, p <0.001), RV (r2 = 0.73, p <0.001), RF (r2 = 0.71, p <0.001) and angiographic grade (r2 = 0.72, p <0.001). CONCLUSION: VCW measured by color Doppler correlates well with MR severity. In addition, VCW is a simple, reproducible quantitative measurement of MR, and is recommended for use in the non-invasive assessment of the condition.

[Carotid artery stenting with proximal or distal brain protection: early outcome]. / Wczesne wyniki stentowania tetnic szyjnych z zastosowaniem systemów czasowej protekcji mózgu.

BACKGROUND: Stroke is the third cause of death and a leading cause of disability. Significant atherosclerotic carotid artery stenosis is associated with as many as one in five strokes. Recent randomized trials have shown that percutaneous carotid artery stenting (CAS) is at least as effective and safe as surgery. AIM: To evaluate the early outcome of CAS performed with brain protection systems in a large series of consecutive patients. METHODS: From January 2001 to April 2004, 132 patients (age 63 +/- 8 years, 99 symptomatic and 90 with co-existing coronary artery disease, 36 women) with carotid artery stenosis were treated in our Institution. All patients underwent independent neurological assessment and non-invasive imaging (extra- and intracranial duplex Doppler and CT angiography, brain CT) before the procedure to tailor the brain protection system to the patient and lesion. Proximal (Parodi Anti-Emboli System, Mo.Ma) or distal (Percusurge/Guardwire, filters i.e. Angioguard, EPI FilterWire, Accunet, Spider, NeuroShield) neuroprotection was applied respectively in 42 (31%) and 93 (69%) cases. Clinical evaluation was performed on discharge and at 30 days. RESULTS: Procedural success rate was 130/132 (98.6%). The degree of stenosis (expressed as % diameter reduction, QCA) decreased from 76.3 +/- 10.6 to 16.9 +/- 9.1 (p < 0.001) while the minimal lumen diameter increased from 1.48 +/- 0.67 to 3.72 +/- 0.71 mm (p < 0.001). In the peri-procedural period, 5 (3.7%) patients had TIA and 1 (0.7%) had hyperperfusion syndrome with a small haemorrhagic stroke, but with a complete clinical recovery. There were no deaths, myocardial infarctions nor any major strokes. On discharge no patients had neurological deterioration as compared to the admission status. At 30 days there were no new cardiac or neurological events. CONCLUSIONS: Our results show that percu-taneous CAS--when performed with brain protection--has a high success rate and a very low complication rate. It is conceivable that the patient/lesion-tailored application of a particular neuroprotection system importantly contributes to the favourable early outcome of CAS.

[Comparison of quantitative echocardiographic methods with angiography for assessment of mitral regulation]. / Ilosciowa ocena niedomykalnosci mitralnej--porównanie metody echokardiograficznej i angiograficznej.

UNLABELLED: The aim of this study was to compare echocardiographic assessment of the severity of mitral regurgitation (MR) with angiographic grading. MATERIAL: 51 patients (patients) with MR (43 men and 8 women), aged from 38 to 75 (mean 56 +/- 9 years), were used in the study. The etiology of MR was: Coronary artery disease (28 pts), infective endocarditis (3 patients), rheumatic disease (5 patients), dilated cardiomyopathy (7 patients), mitral valve prolapse (8 patients). EXCLUSION CRITERIA: Aortic stenosis and/or aortic insufficiency, mitral stenosis, mechanical prostheses and atrial fibrillation. METHODS: The mitral regurgitant volume (RV) and effective regurgitant orifice (ERO) were estimated by the proximal convergence method (PISA), regurgitant fraction (RF) and vena contracta width (VCW) by color Doppler quantitative method and compared to the cine ventriculographic grades. The angio-graphic severity of MR was classified as 1 to 4 grades according to the Sellers criteria. RESULTS: There was a good correlation between the angiographic grading and ERO (r = 0.855, p < 0.001), RV (r = 0.868, p < 0.001), RF (r = 0.923, p < 0.001) and VCW (r = 0.846, p < 0.001). CONCLUSIONS: 1. PISA method is clinically useful in routine evaluation of the severity of MR. 2. VCW provides a simple method for the identification of patients with severe MR. 3. These methods offer an alternative approach in quantifying MR noninvasively.

[Implants with aortic valve homografts in patients with critical left aortic stenosis]. / Przyklady zastosowania zastawek homogennych u chorych z krytycznym zwezeniem lewego ujscia tetniczego.

This case study presents two patients with aortic stenosis and infective endocarditis (IE) who underwent homograft aortic valve replacement. The first patient is a 67 year old practicing surgeon. Twenty one years ago, he was admitted to our department for critical aortic stenosis, infective endocarditis (IE) and heart failure. He underwent homograft aortic valve replacement. After the surgery his condition improved dramatically and he returned to his practice. Current echocardiographic study shows normal function of the left ventricle and normal gradient across homograft aortic valve. The next case, a 33-year old happy mother of 5 children, is particularly interesting. When she was 15 years old, she was referred to surgery, diagnosed with bicuspid aortic valve stenosis, subaortic muscular stenosis and aneurysm of aortic sinus of Valsalva. She underwent homograft aortic valve and root replacement and excision of the sub-aortic muscle bulge. Eleven months later, she required another operation due to active IE. The St. Jude Medical aortic valve was implanted. Two months after the surgery a dysfunction of the implanted artificial valve was diagnosed. She again underwent the homograft aortic valve and root replacement with good long-term results. In the period spanning 1987-1997, she managed to deliver five babies without any complications whatsoever. Seventeen years later, the homograft aortic valve is still functioning fairly well. The homograft aortic valve replacement may be regarded as a viable option for patients with aortic stenosis and IE and for young women suffering from aortic valve disease who intend to be prospective mothers.

[Echocardiographic prediction of outcome in patients with congestive heart failure and mitral regurgitation]. / Ocena rokowania u chorych z zastoinowa niewydolnoscia serca na podstawie echokardiograficznego wskaznika dP/dt.

BACKGROUND: Congestive heart failure is associated with the increase risk of death or cardiac transplantation. The ability of current techniques to predict outcome in heart failure is rather limited. Identification of the patients at risk of cardiac death or requiring heart transplantation is clinically important. The changing rate of left ventricular pressure during the cardiac cycle is an important parameter in the assessment of myocardial systolic function. Non-invasive echocardiographic method--dP/dt has been proposed to determine the isovolumic phase of cardiac function. The aim of this study was to evaluate the ability of Doppler-derived dP/dt to predict survival in patients with congestive heart failure. MATERIAL AND METHODS: Thirty one patients (22M, 9W), mean age 55 +/- 11.2 years, with CHF (LVEF < 45%, NYHA II-IV class) and chronic mitral regurgitation were analyzed. The echocardiography, cardiopulmonary exercise test and clinical follow-up were performed in all of them. The ejection fraction was calculated using the Simpson's method from apical 4-chamber view. The dP/dt index was derived from the continuous-wave Doppler spectrum. The mean follow-up period was 28.5 +/- 12 months. According to the clinical status the patients were divided into two groups: group I--21 event-free patients and group II--10 patients who experienced primary events (5 died and 5 underwent heart transplantation). RESULTS: In the group of primary events patients there was noted a significant decrease of the dP/dt index in comparison to the event-free patients: 463 mmHg/s vs 839 mmHg/s (p=0.0001). The correlation between dP/dt and ejection fraction, left ventricular end-diastolic diameter as well as between the parameters of cardiopulmonary exercise test VO2peak, VO2AT, VE/VCO2peak was found. CONCLUSIONS: Doppler echocardiographic index of dP/dt can predict the outcome in patients with congestive heart failure. Dp/dt can be useful as a prognostic factor in patients with CHF. A significant correlation was observed between dP/dt and VO2peak as well as VE/VCO2peak which are independent prognostic predictors.