Prominent crista terminalis mimicking a right atrial mass: a systematic literature review and meta-analysis.

The crista terminalis is an anatomical structure localized on the posterolateral wall of the right atrium (RA). We performed a systematic review of the literature and meta-analysis concerning cases of unusual prominent crista terminalis mimicking RA mass. Moreover, we described the differential diagnosis of cardiac masses with the use of echocardiography, computed tomography, and cardiac magnetic resonance (CMR). We also emphasize the potential importance of this structure in electrophysiological procedures, including its role in exaggerated arrhythmias. Prominent crista terminalis may be a potential obstacle during invasive cardiac procedures or catheter ablation target. In analyzed cases, the crista terminalis was often erroneously interpreted as pathologic and at first confused with a thrombus or tumor during transthoracic echocardiography examination. The correct final diagnoses were mostly made with used transesophageal echocardiography or CMR. The most important imaging findings suggestive of prominent crista terminalis rather than tumor were a similar echogenicity/intensity with adjacent myocardium, the location on posterolateral wall of the RA, the phasic change in size, and no enhancement after contrast injection. We describe up to date and detailed imaging features for the differential diagnostics of selected intracardiac masses using various imaging techniques, including multimodality cardiac imaging. Familiarity with the anatomy and the imaging findings of the prominent crista terminalis will reduce misdiagnosis and avoid additional tests and unwarranted clinical interventions, while in patients considered for invasive cardiac procedures it might increase their efficacy and safety.

Coronary Slow-Flow Phenomenon in Takotsubo Syndrome: The Prevalence, Clinical Determinants, and Long-Term Prognostic Impact.

Patients with takotsubo syndrome (TTS) may present coronary slow flow (CSF) in angiography performed in the acute myocardial infarction (MI). However, the detailed clinical relevance and its long-term impact remain poorly understood. Among 7771 MI patients hospitalized between 2012 and 2019, TTS was identified in 82 (1.1%) subjects. The epicardial blood flow was assessed with thrombolysis in myocardial infarction (TIMI) scale and corrected TIMI frame count (TFC), whereas myocardial perfusion with TIMI myocardial perfusion grade (TMPG). CSF was defined as TIMI-2 or corrected TFC > 27 frames in at least one epicardial vessel. CSF was identified in 33 (40.2%) TTS patients. In the CSF-TTS versus normal-flow-TTS group, lower values of left ventricular ejection fraction on admission (33.5 (25-40) vs. 40 (35-45)%, p = 0.019), more frequent midventricular TTS (27.3 vs. 8.2%, p = 0.020) and the coexistence of both physical and emotional triggers (9.1 vs. 0%, p = 0.032) were noted. Within a median observation of 55 months, higher all-cause mortality was found in CSF-TTS compared with normal-flow TTS (30.3 vs. 10.2%, p = 0.024). CSF was identified as an independent predictor of long-term mortality (hazard ratio 10.09, 95% confidence interval 2.12-48.00, p = 0.004). CSF identified in two-fifths of TTS patients was associated with unfavorable long-term outcomes.

Associations between Pharmacotherapy for Cardiovascular Diseases and Periodontitis.

The goal of the study was to assess the relationship between cardioprotective medications, i.e., beta-blockers, angiotensin-converting enzyme inhibitors (ACEIs), calcium channel blockers (CCBs), angiotensin II receptor blockers (ARBs), statins, acetylsalicylic acid (ASA), and periodontitis (PD). BACKGROUND: Xerostomia increases the risk of PD and is a side effect of some pharmacotherapies. Information about the effect of cardioprotective treatment of periodontal status is scarce. METHODS: We studied 562 dentate residents of Krakow at the age of 50 to 70 years. Information about treatment was collected using a standardized questionnaire. The pocket depth and clinical attachment level (CAL) were used to ascertain PD. Multivariate logistic regression was applied to assess the relation between cardioprotective medications and PD. RESULTS: PD was found in 74% of participants. The range of cardioprotective drug use among participants was 7% (ARBs) to 32% (beta-blockers). After adjusting for age, sex, number of teeth, smoking, and education, ASA's use was related to a lower prevalence of PD in all dentate participants (odds ratio (OR) = 0.63, 95% confidence interval (CI): 0.40-0.99). The use of ARBs and statins was found to be associated with a higher prevalence of PD in persons having ≥6 teeth (odds ratio (OR) = 3.57, 95% CI: 1.06-11.99 and OR = 1.81, 95% CI: 1.03-3.16, respectively). Further adjustment for CVD risk factors, history of coronary heart disease, and other chronic diseases did not attenuate the results. There was no significant relation between PD and the use of other cardioprotective drugs.

Clinical experience with 12-month follow-up in patients after implantation of a novel long-tapered sirolimus drug-eluting stent.

INTRODUCTION: Long lesions contribute to a significant number of percutaneous coronary interventions. AIM: To assess the efficacy and safety of a novel long-tapered drug-eluting stent (DES) at a 12-month follow-up (FU) in patients with long coronary atherosclerotic lesions. MATERIAL AND METHODS: A prospective clinical cohort study was conducted in 32 patients who underwent percutaneous coronary intervention using a BioMime Morph tapered stent (Meril Life Sciences, India). The patients were followed for 3, 6, and 12 months. The safety endpoints were death, myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), and MACE and/or major bleeding. RESULTS: Mean lesion length was 48 mm (range: 35-70 mm) measured via quantitative coronary analysis (QCA). In most cases, the target lesion was located in the LAD (68.75%). A GuideLiner catheter (Vascular Solutions Inc., MN, USA) was used in 12.5% of procedures; buddy-wire technique in 9.4% of cases. Bifurcation lesions were treated in 40.6% of cases. Additional stent implantation was needed in 56% of the procedures (25% of cases due to proximal or distal dissection, or due to insufficient stent length in 31% of cases). On 12-month FU we observed 1 TLR (3.1%), 1 TVR (3.1%), and 1 non-cardiovascular death. CONCLUSIONS: The long sirolimus-eluting stent with tapered structure was characterized by good deliverability in long coronary lesions, although in some cases "buddy wire" or extension microcatheter use was necessary. Follow-up at 3, 6, and 12 months showed no significant major adverse cardiovascular events related to the device.

Association between carotid-femoral pulse wave velocity and overall cardiovascular risk score assessed by the SCORE system in urban Polish population.

BACKGROUND: The Systemic COronary Risk Estimation (SCORE) system is recommended for the assessment of cardiovascular disease (CVD) death risk in individuals free of CVD. AIM: We sought to determine the association between carotid-femoral pulse wave velocity (CFPWV) and SCORE. METHODS: The study involved 1008 Krakow residents, and a random subsample of 3424 men and 3205 women who participated in Wave 2 of the Polish part of the Health, Alcohol, and Psychosocial factors in Eastern Europe (HAPIEE) study. At baseline we performed a medical interview, physical examination, evaluation of present comorbidities, medications using standardised methods. A follow-up of 4.9 years included measurement of CFPWV using an automatic, computerised Complior® system. RESULTS: Final analysis included 720 patients (378 women), aged 58.5 ± 6.5 years at baseline. In 488 individuals without his- tory of CVD and/or diabetes, SCORE was calculated. Median CFPWV was higher (p = 0.002) in men (12.5 m/s; interquartile range [IQR] 10.3-15.7) than in women (11.7 m/s; IQR 10.1-13.7). High CFPWV (> 10 m/s) was observed in 270 men (78.9%) and in 285 women (75.4%). We observed a strong association between high CVD risk (SCORE ≥ 5%) and high CFPWV (odds ratio 2.29; 95% confidence interval 1.17-4.46). The CFPWV cut-off value to differentiate between patients with low and high CVD risk was 11.7 m/s (with 58.6% sensitivity and 71.3% specificity, AUC = 0.68). CONCLUSIONS: Our study is the first to describe the distribution of CFPWV in the adult Polish population. SCORE ≥ 5% pre- dicted high CFPWV in 4.9 years of follow-up, which was independent of other risk factors. CFPWV > 11.7 m/s was most valid in relation to high CVD risk.

Implementation of the modified four-step approach method for teaching echocardiography using the FATE protocol-A pilot study.

INTRODUCTION: Peyton's four-step approach is well-known and commonly used in medical education. It is a practical and useful method which is simple to apply. The study presents the implementation of the modified four-step approach method to teach how to perform the emergency echocardiographic assessment according to FATE (Focus-Assessed Transthoracic Echo) protocol. The aim of the study was to determine the feasibility and utility of this method FATE protocol teaching. DESIGN: We collected students' feedback relating to perception of this way of teaching. Based on a semistructured interview conducted with the students, as well as an evaluation of the electronic survey, it has been demonstrated that the four-step method is useful for teaching emergency echocardiographic assessment. SETTING: One Polish medical school. PARTICIPANTS: The classes were run in small groups as part of an elective ultrasound course for the fourth- and fifth-year students of the Faculty of Medicine of the Medical College. Twenty-two students were trained. RESULTS: Based on the opinions of the participants of the elective course and the teacher conducting the classes, which involved the use of the modified Peyton's four-step method in teaching echocardiography in emergency cases according to the FATE protocol, it has been determined that the four-step method is effective in imaging training. All participants claim that this method is clear and understandable. Advantages of the methodological approach: a slow-motion demonstration by the instructor, accompanied by the commentary on the activities undertaken and practical exercises performed by the participants, learning through repetition, requirement of constant concentration. CONCLUSIONS: Peyton's approach allows to use of the class time in maximal extend by consolidating new information and facilitating memorization through adequate instructor guidance and observation of the training of the peer students and repetition of the skills acquired.

Effectiveness of single medical advice on emergency phone number knowledge in urban adult population--"Health, Alcohol and Psychosocial Factors in Eastern Europe" substudy.

INTRODUCTION: Early access to Emergency Medical Services determines survival in out-of-hospital cardiac arrest. However, a significant proportion of adults do not know the emergency phone number (EN) and no intervention has been proposed to improve it. Therefore, we aimed to assess prospectively the effectiveness of single advice from a physician on knowledge of the EN in adult population. MATERIALS AND METHODS: The study was conducted among participants of "Health, Alcohol and Psychosocial Factors in Eastern Europe" study. A total of 942 persons (aged 48-82 years) randomly selected from an urban population registry were interviewed and then instructed about the correct EN (the intervention group). After 12 months knowledge of the EN was assessed in the intervention group (n=716) and in matched control group (n=435). RESULTS: The correct EN was given by 498 (69.6%) participants at baseline and in 550 (76.8%) participants 12 months afterwards (p<0.001). At follow-up the knowledge of EN was higher by in intervention group than in controls (76.8% vs 70.6%, p=0.02). Factors associated with better educational effect were male sex (OR 1.49; 95% CI 1.04-2.1) and secondary or higher level of education (OR 1.44; 95% CI 1.08-1.91). CONCLUSIONS: We concluded that a single instruction about the EN from a physician increases its long-term knowledge and should be offered during medical visits.

Model of the distribution of diastolic left ventricular posterior wall thickness in healthy adults and its impact on the behavior of a string of virtual cardiomyocytes.

Correlation of the thickness of the left ventricular posterior wall (LVPWd) with various parameters, including age, gender, weight and height, was investigated in this study using regression models. Multicenter derived database comprised over 4,000 healthy individuals. The developed models were further utilized in the in vitro-in vivo (IVIV) translation of the drug cardiac safety data with use of the mathematical model of human cardiomyocytes operating at the virtual healthy population level. LVPWd was assumed to be equivalent to the length of one-dimensional string of virtual cardiomyocyte cells which was presented, as other physiological factors, to be a parameter influencing the simulated pseudo-ECG (pseudoelectrocardiogram), QTcF and ∆QTcF, both native and modified by exemplar drug (disopyramide) after I Kr current disruption. Simulation results support positive correlation between the LVPWd and QTcF/∆QTc. Developed models allow more detailed description of the virtual population and thus inter-individual variability influence on the drug cardiac safety.

The prevalence of abnormal echocardiographic findings in a sample of urban adult population.

BACKGROUND: Echocardiography has emerged as the test of choice for the evaluation of cardiac diseases. AIM: To assess the prevalence of a spectrum of cardiac abnormalities detected by echocardiography in a representative sample of an urban adult population. METHODS: Transthoracic echocardiography was performed in a random sample of 511 men (47%) and women (53%) aged 48-76 years selected from population registers in Krakow. Body surface area (BSA) was used to adjust echocardiographic parameters for variations in body size. Disease history and cardiovascular risk factors were assessed in all patients. RESULTS: Men smoked more frequently than women and had higher blood pressure and triglycerides and lower high density lipoprotein cholesterol. The most common finding was increased left ventricular (LV) end-diastolic diameter (EDd) (37%), followed by mitral (32%), aortic (24%), or tricuspid (17%) regurgitations, LV posterior wall (24.1%) and interventricular septum (17.5%) thickening, increased indexed LVEDd (23%), increased left atrial diameter (LAd; 15.7%), reduced LV ejection fraction (LVEF; 15.3%), segmental wall motion abnormalities (13.9%), increased indexed LAd (8.8%), dilation of the ascending aorta (8%), enlargement of the right ventricle (RV) (2%) and elevation of RV systolic pressure (0.6%). When adjusted for main cardiovascular risk factors and the presence of coronary artery disease, male sex was associated with a higher prevalence of enlargement of LV (LVEDd/BSA): OR = 1.8 (1.1-2.9), dilation of ascending aorta (aortic diameter/BSA): OR = 2.7 (1.3-5.8), and LA (LA/BSA) = OR 2.7 (1.3-5.6), as well as a decrease of LVEF: OR = 3.6 (1.9-6.5). CONCLUSIONS: Approximately a quarter of urban adults aged 48 to 76 can be expected to have some abnormalities on echocardiographic examination. Some of these abnormalities such as aortic dilation, LA enlargement, LV enlargement and decreased LVEF are more frequently found in males than in females, even after adjustment for BSA, main cardiovascular disease risk factors, and the presence of coronary artery disease. The use of raw instead of indexed LAd and LVEDd over estimates the prevalence of LA and LV enlargement.

Knowledge of a patient-dependant phase of acute myocardial infarction in Polish adults: the role of physician's advice.

BACKGROUND: Effective management of acute myocardial infarction (AMI) is limited by patient delay in calling an ambulance. We aimed to assess knowledge related to a patient-dependant phase of AMI and its determinants in adults. METHODS: Questionnaire survey was conducted among a random sample of 942 men (48%) and women (52%) aged 63.50 ± 6.50 selected from population registers in Cracow (Poland). Questions from the Behavioral Risk Factor Surveillance System were used to assess knowledge of AMI symptoms. The respondents were further asked about the first thing they would do in response to AMI symptoms, the emergency phone number and whether a doctor advised them about AMI. RESULTS: All suggested AMI symptoms were recognized by 51 (5.4%) respondents. More persons would call an ambulance in response to AMI symptoms in another person than if they appear in themselves (87.4% vs. 74.4%, P = 0.02). Only 644 (68%) participants knew the emergency phone number and 104 (11%) were advised about AMI by their doctors. Such advice was associated with higher rates of knowledge of AMI symptoms and the emergency phone number but not with a declaration of the appropriate reaction to AMI symptoms. Participants after AMI did not represent better knowledge of a patient-dependant phase of AMI but paradoxically less frequently than other persons declared calling an ambulance in response to AMI symptoms. CONCLUSION: Improvement in knowledge and attitudes related to a patient-dependant phase of AMI is needed in adults even if they experienced AMI before. A routine advice from a doctor may contribute significantly to this improvement.