The usefulness of echocardiography in the diagnosis of myocarditis in a young man after sudden cardiac arrest.

The diagnosis of acute myocarditis (AM) remains challenging because of its diverse clinical manifestations. Thus, a wide range of diagnostic tests may be warranted. Although cardiac magnetic resonance (CMR) is the preferred imaging technique, it may not be applicable in the acute AM phase. Our case report highlights the usefulness and diagnostic accuracy of echocardiographic examination. In the first 2-dimensional echocardiography, the focal echobright was presented. A reduced value of global longitudinal strain and regional disturbances of segmental myocardial strain, both longitudinal and circumferential, in the epicardial layer, were detected with a good correlation with CMR results.

Electrocardiographic criteria for anterior STEMI - Does the cut-off point affect treatment delay?

BACKGROUND: Diagnostic criteria for anterior STEMI differ between the European Society of Cardiology (ESC) and the European Resuscitation Council (ERC). A greater degree of ST-segment elevation is required to meet ERC criteria compared to ESC criteria. This may potentially lead to discrepancies in management between emergency teams and cardiologists, subsequent delay in reperfusion therapy and worse prognosis. METHODS: We performed an observational study in patients with anterior STEMI routinely treated with primary PCI and assessed whether differing electrocardiographic diagnostic criteria could impact treatment and short-term prognosis. All patients in the study had anterior STEMI confirmed by electrocardiographic ESC criteria and subsequent coronary angiography. Patients were divided into two groups. Those who did not meet ERC criteria in the index ECG were assigned to the "non-ERC" group and were compared with those who met them - the "ERC" group. RESULTS: Out of 60 patients with anterior STEMI based on ESC criteria (mean age 66.9 ± 13.6 years, 70% males), 26 patients (44%) did not meet ERC criteria ("non-ERC" group) for STEMI. There were no significant differences in age, gender distribution or clinical characteristics between "ERC" and "non-ERC" patients. Total-Ischemic-Time, Patient-Delay, and System-Delay times were significantly longer in "non-ERC" group (433.1 ± 389.9 min vs. 264.2 ± 229.6 min, p = 0.03; 290.8 ± 337.6 min vs. 129.5 ± 144.9 min; p < 0.05 and 158.8 ± 158 vs 134.6 ± 191 min, p < 0.02 respectively). There were no differences in In-Hospital-Delay, procedure duration, and success rate of PCI. Proximal LAD occlusion (64.7%) and TIMI = 0 flow (73.5%) tended to be more frequently observed in "ERC" than in the "non-ERC" group (53.8% and 65.4%, respectively). Hospitalization time and LVEF (44.4 ± 8.7 vs 42.8 ± 9.5%, p = 0.53) were similar between groups. CONCLUSIONS: Differences in electrocardiographic criteria for anterior STEMI leave a significant proportion of patients undiagnosed. Patients with STEMI who failed to meet less strict ERC criteria had more distal LAD disease with better TIMI flow but received reperfusion therapy later. Thus, character of the disease may compensate for treatment delay but this needs to be further evaluated. Finally, lowering the cut-off point with stricter criteria compromises specificity and is expected to increase the false positive rate, however there were no false positives in this study as all patients were angiographically confirmed to have acute coronary obstruction.

Percutaneous Trans-Coronary Venous Mitral Annuloplasty in Patients With Functional Mitral Regurgitation: Analysis of Poznan Carillon Registry Data.

OBJECTIVES: The purpose of our study is to verify, whether percutaneous mitral annuloplasty results in reverse remodeling in patients with functional mitral regurgitation (FMR) and impaired ejection fraction (EF) and to investigate which echo parameters may help in prediction of the efficacy of the procedure. BACKGROUND: FMR exacerbates left ventricular (LV) dilatation and contributes to both LV remodeling and heart failure. METHODS: We analyzed baseline and 1 month follow-up data in 22 consecutive patients with FMR, who underwent successful percutaneous trans-coronary venous mitral annuloplasty with the Carillon device. RESULTS: Significant reduction of FMR echo parameters, including vena contracta (VC), effective regurgitant orifice area (EROA), and regurgitant volume (RV) were observed and maintained throughout 1 month follow up and did not correlate with baseline annular, LV or with the left atrial diameters. Baseline mitral tenting area correlated negatively with the relative improvement (% difference) of EROA (r = -0.5898) and RV (r = -0.4363), but not with VC (r = 0.1341). In addition, increased EF as well as a significant reduction in left ventricular diameters were noted. The increase in EF negatively correlated with the change in EROA (r = -0.50058), PISA (r = -0.5327), and RV (r = -0.5457). Baseline mitral tenting area significantly correlated with the 1 month change in EF (r = 0.5946) and stroke volume (r = 0.6913). CONCLUSIONS: The improvement of FMR after treatment with the Carillon device is associated with LV reverse remodeling and an increase in systolic performance, that correlates with the reduction in mitral regurgitation, being not dependent on baseline heart diameters. Mitral tenting area seems to be an important parameter in prediction of benefit from percutaneous mitral annuloplasty.

[Microbiological diagnostics of infective endocarditis in the light of the new guidelines of the European Society of Cardiology with particular focus on the molecular methods].

The authors describe the presentday possibilities of routine and molecular microbiologic diagnostics of infective endocarditis (IE). Routine diagnostics employs automated microbial growth and biochemical detection systems. Molecular methods are based on polymerase chain reaction (PCR) and matrix assisted laser desorption/ ionization time of flight mass spectrometry (MALDI-TOF MS). MALDI-TOF MS first appeared in the new guidelines for the management of IE of the European Society of Cardiology published in 2015. The greatest benefit of MALDITOF MS is the short time of pathogen identification. The main disadvantages are the necessity of routine agar cultures and lack of antimicrobial susceptibility estimation. So far, there has been no Polish literature report on MALDI-TOF MS used for pathogen identification in suspected IE. This may well result from scarce accessibility of the method in Poland. The paper aims to stress the importance of an up-todate technology in the diagnostics of difficult, blood culture negative cases of IE. It also takes into consideration the limitations of mass spectrometry in the ESC diagnostic scheme of IE.

Transseptal puncture from the jugular vein and balloon cryoablation for atrial fibrillation in a patient with azygos continuation of an interrupted inferior vena cava.

AIMS: Inferior vena cava (IVC) interruption is a rare anatomic variant where the azygos vein (AV) drains the blood from the IVC to the upper part of the right atrium via the superior vena cava. Here, we report balloon cryoablation of the pulmonary veins (PVs) via superior access in a patient with atrial fibrillation. METHODS AND RESULTS: After the first failed ablation attempt due to IVC interruption, balloon cryoablation with a 28-mm Arctic Front Advance cryoballoon (Medtronic CryoCath LP, Quebec, Canada) via superior access was performed; it requires only a single transseptal puncture (TP), and the patient had optimal PV anatomy. Deflectable electrodes were inserted into the right ventricle and coronary sinus from the right femoral vein. The right internal jugular vein was accessed using an SL0 transseptal sheath and BRK needle. The TP was performed under transoesophageal echocardiographic guidance with a Safe Sept wire because the septum was stiff. All PVs were engaged: the left using an ablation catheter before balloon insertion and the inferior following a 'push-up' technique because of a leak above the veins. Cryothermal energy was delivered after checking for occlusion. The procedure lasted 210 min, fluoroscopy time was 78 min, and air-kerma dose was 194 mGy. During the 6-month follow-up, no episodes of atrial fibrillation were detected on several Holter recordings. CONCLUSIONS: Successful PV isolation in patients with AV continuation of an interrupted IVC can be safely performed using superior access with balloon cryoablation, after several modifications of standard equipment.

[Smoking cessation during hospitalization on cardiology ward]. / Interwencje antynikotynowe u pacjentów hospitalizowanych na oddziale kardiologii.

Among the modifiable risk factors smoking has the most impact on cardiovascular mortality. Among patients with cardiovascular disease benefits of quitting smoking outweigh those associated with commonly prescribed drugs. Hospitalization in the ward seems to be a good time to motivate the patient to take this step. In our paper we present the effectiveness of different methods to achieve this goal.

Evaluation of early left-sided cardiac reverse remodeling under combined therapy of sacubitril-valsartan and spironolactone compared with angiotensin-converting enzyme inhibitors and spironolactone.

We aimed to compare therapies of sacubitril/valsartan + spironolactone (S/V + S) with angiotensin-converting enzyme inhibitors + spironolactone (ACEI + S) on the left-sided cardiac reverse remodeling (L-CRR). The second objective was to analyze the usefulness of GLS and LVEF in response to therapy. Methods: 78 patients (mean age 63.4 years, 20 females) with symptomatic heart failure with reduced ejection fraction were randomized to groups of equal numbers, i.e., 39 patients, and started on therapy of S/V + S or ACEI + S. Second evaluations were made after 6-8 weeks of therapy. Results: GLS changed from -7.4% to -9.4% (18% improvement) in both arms equally. More than 50% of patients, initially with very severe systolic dysfunction (GLS > -8%), were reclassified to severe (GLS -8% to -12%). LVEF did not improve in any of the groups. The quality of life measured by MLHFQ and walking distance by 6-MWT increased. Positive correlations between GLS and 6MWT (r = 0.41, p = 0.02) and GLS and MHFLQ (r = 0.42, p = 0.03) were found. The S/V + S subgroup demonstrated improvements in LVEDV (Δ16.7 vs. 4.5 ml), E/e ratio (Δ 2.8 vs. 1.4), and LAVI (Δ 9.4 vs. 8.4 ml/m2) as compared to ACEI + S. Conclusion: GLS, unlike LVEF, detects early changes in LV systolic function after 6-8 weeks of combined therapy, i.e., SV + S and ACE + S. GLS is more useful than LVEF in assessing early response to treatment. The effect of S/V + S and ACEI + S on LV systolic function was comparable, but the improvement in diastolic function as expressed by E/e', LAVI, and LVEDV was more pronounced with S/V + S.

The long-term benefit of a cardiac rehabilitation program after myocardial infarction in patients under the Managed Care for Acute Myocardial Infarction Survivors (MACAMIS) program in Poland: A single-center study.

BACKGROUND: The Managed Care for Acute Myocardial Infarction Survivors (MACAMIS) program introduced for patients after myocardial infarction (MI) consists of 4 modules including early cardiac rehabilitation (CR). AIMS: We compared the impact of CR on survival of patients after MI included in the MACAMIS program. METHODS: Patients in MACAMIS were divided into subgroups based on being qualified or not qual-ified for CR and on whether they completed or failed to complete CR. We evaluated one-, two-, and three-year mortality. RESULTS: Of 244 patients in MACAMIS, 174 patients were qualified for CR. They were younger, had less advanced coronary artery disease (CAD), higher ejection fraction (EF), and fewer comorbidities. Finally, 102 (58.6%) patients completed CR. These patients were younger and more likely to have STEMI; they were more often treated invasively, with no differences in comorbidity burden. The survival rates at one, two, and three years were 93.6%, 87.8%, and 65.0%, respectively. Patients who qualified for CR had a better prognosis. The mortality rates at one, two, and three years were 2.38% vs. 16.18% (P = 0.0003), 6.71% vs. 25.4% (P = 0.002), and 26.87% vs. 51.35% (P = 0.01), respectively. Patients who completed CR, again, had a significantly better prognosis. The mortality rate was 1% vs. 10.29% (P = 0.009), 4.17% vs. 17.56% (P = 0.002), and 23.33% vs. 40.54% (P = 0.09) in analyzed periods. The only independent factors related to survival were completion of CR and number of comorbidities. CONCLUSIONS: Patients with MI in the MACAMIS program had better prognosis when participating in CR. After completing the MACAMIS program, increased mortality was observed in the following years. Despite the flexibility of the CR program, the proportion of patients who qualified and completed CR remained low.

Echocardiography during the coronavirus disease 2019 pandemic - the impact of the vaccination program. A 2021 update of the expert opinion of the Working Group on Echocardiography of the Polish Cardiac Society.

The coronavirus disease 2019 (COVID-19) pandemic resulted in an urgent need to reorganize the work of echocardiography laboratories in order to ensure the safety of patients and the protection of physicians, technicians, and other staff members. In the previous Expert Opinion of the Working Group on Echocardiography of Polish Cardiac Society we provided recommendations for the echocardiographic services, in order to ensure maximum possible safety and efficiency of imagers facing epidemic threat. Now, with much better knowledge and larger experience in treating COVID-19 patients and with introduction of vaccination programs, we present updated recommendations for performing transthoracic and transesophageal examinations, including information on the potential impact of personnel and the patient vaccination program, and growing numbers of convalescents on performance of echocardiographic laboratories, with the goal of their ultimate reopening.

[Nicotine replacement therapy in cardiovascular disease]. / Nikotynowa terapia zastepcza w chorobach ukladu krazenia.

Smoking is well established and important risk factor for cardiovascular disease. Cessation of smoking clearly decreases the risk of cardiovascular events. Nicotine is known to be the addicting component of tobacco products. Nicotine replacement therapy (NRT) increases the probability of quitting smoking. Studies have indicating no increase in cardiovascular events in smokers with known cardiovascular disease.

Long-term results of irrigated bipolar radiofrequency ablation in patients with recurrent arrhythmia after failed unipolar ablation.

INTRODUCTION: The RF ablation of ventricular tachycardia (VT) or atrial flutter (AFl) can be unsuccessful due to lack of lesion transmurality. Bipolar ablation (BA) is more successful than unipolar ablation (UA). The purpose of our study was to investigate the long-term effect of BA ablation in patients after failed UA. METHODS: Patients with septal VT (5) or AFL (2) after 2 to 5 unsuccessful UA were prospectively analysed after BA. All patients presented with heart failure or had ICD interventions. RESULTS: BA was successful in 5 patients (1 failure each in the AFL and VT group). The follow-up duration was 10 to 26 months. In AFL group, BA was successful in 1 patient, unidirectional cavotricuspid block in was achieved in the other patient. All patients were asymptomatic for 12 months, but 1 had atrial fibrillation and the other had AFL reablation 19 months after BA. In VT group, all patients had several forms of septal VT. BA was successful in 4 patients. In 2 patients with high septal VT BA resulted in complete atrioventricular block. During follow-up, 1 patient had VT recurrence 26 months after BA and died after an unsuccessful reablation. Three patients had VT recurrences of different morphologies, which required reablation (UA in 2 and alcohol septal ablation in the other patient). CONCLUSION: BA was successful in patients with AFL and septal VT resistant to standard ablation. Relapses of clinical arrhythmia are rare; however, long-term follow-up is complicated by recurrences of different arrhythmias related to complex arrhythmogenic substrate.

Feasibility of Atrial Fibrillation Screening With Mobile Health Technologies at Pharmacies.

BACKGROUND: Atrial fibrillation (AF) is the most common cardiac arrhythmia. Thus, the aim of our study was to evaluate the smartphone-based electrocardiogram (ECG) recordings aimed at AF screening at Polish pharmacies. METHODS: Prospective AF screening among patients aged ≥65 years was conducted at 10 pharmacies using Kardia Mobile with a dedicated application (Kardia app). Prior AF was a study exclusion criterion. CHA2DS2-VASc score (congestive heart failure, hypertension, age, diabetes mellitus, previous stroke/transient ischemic attack, female sex, and vascular disease) has been collected from every patient. A single-lead ECG has been acquired by the placement of fingers from each hand on the pads. Kardia app diagnosis has been evaluated by the cardiologist. RESULTS: A total of 525 ECGs were performed. Kardia app diagnosis was provided in 490 cases. In 437 (89.18%) cases, it was "normal" rhythm, in 17 (3.47%) recordings "possible AF," in 23 (4.69%) ECGs "unreadable," and in 13 (2.65%) "unclassified". After the cardiologist reevaluation, the new AF was identified in 7 (1.33%) patients. Sensitivity and specificity of Kardia app in detecting AF was 100% (95% confidence interval [CI]: 71.5%-100%) and 98.7% (95% CI: 97.3%-99.5%), respectively. The positive predictive value was 64.7% (95% CI: 38.3%-85.7%) and the negative predictive value was 100% (95% CI: 99.2%-100%). CHA2DS2-VASc score was 2.14 ± 0.69 for those with new AF and 3.33 ± 1.26 in the non-AF group. CONCLUSION: Kardia app is capable of fast screening and detecting AF with high sensitivity and specificity. The possible diagnosis of AF deserves additional cardiological evaluation. The results obtained in patients with low CHA2DS2-VASc score and "silent" AF confirm the importance of routine AF screening. Cardiovascular screening with the use of mobile health technology is feasible at pharmacies.

Cardiovascular risk factors among cancer patients qualified for systemic treatment. Analysis of a cardiovascular disease-free cohort from the Polish multicentre study ONCOECHO.

INTRODUCTION: Cancer therapies are currently more efficient at increasing the survival of patients (pts) with cancer. Unfortunately, the cardiovascular (CV) complications of cancer therapies may adversely affect improving results of treatment. The aim of the study was to evaluate the prevalence of classical CV risk factors among pts with de novo diagnosis of cancer and thus identify the cohort of pts with potentially increased future risk of CV complications. MATERIAL AND METHODS: The analysis is based on the database of the multicentre ONCOECHO study. Pts before systemic treatment (chemotherapy or targeted therapy) were included. The diagnostic datasets of resting electrocardiogram, blood samples, and transthoracic echocardiogram were analysed in 343 consecutive pts who were free from any cardiovascular disease that could adversely affect the introduced treatment. RESULTS: Our cohort included 4.4% of pts with kidney cancer, 7.3% with colorectal cancer, 26.5% with haematological malignancies (HM), and 61.8% with breast cancer. The risk estimated by SCORE was 4.56 ±5.07%. Breast cancer pts had lower cardiovascular risk than those with HM (p = 0.001) and kidney cancer (p = 0.002). Additionally, the HM group had much higher levels of natriuretic peptides (p < 0.001) and creatinine (p = 0.008) than pts with breast cancer. The comparison with the NATPOL population data showed that our pts were more often smokers, hypertensives, and diabetics, but less frequently presented with hypercholesterolaemia. CONCLUSIONS: Patients with new diagnosis of cancer, who are candidates for potentially cardiotoxic medical treatment, have increased prevalence of significant cardiovascular risk factors and therefore should be followed by a multidisciplinary team during the therapeutic process.

[Cigarette smoking and cardiovascular disease]. / Palenie papierosów a choroby ukladu krazenia.

Clinical and experimental studies indicate that either active or passive cigarette smoke exposure promotes vasomotor dysfunction, atherogenesis, and thrombosis in multiple vascular beds. Although the precise mechanisms responsible remain undetermined, free radical-mediated oxidative stress appears to play a central role in cigarette smoking mediated athero-thrombotic diseases. These free radicals could potentially arise directly from cigarette smoke and indirectly from endogenous sources as well. Furthermore, potentiated by multiple prothrombotic and antifibrynolytic effects, intravascular thrombosis is the predominant cause of acute cardiovascular events. Epidemiologic, clinical, and experimental data also suggest that the pathophysiologic effects of cigarette smoke exposure on cardiovascular function may be nonlinear.

Transesophageal echocardiography.

Transthoracic and transesophageal examinations should be considered as mutually complementary. Transesophageal echocardiography is performed in cases of a justified need to visualize structures that are poorly visible or invisible on transthoracic echocardiogram. Primary indications for transesophageal echocardiography include an assessment of cardiac source of embolism, suspected endocarditis, suspected prosthetic valve dysfunction, an assessment of thoracic aorta and other vessels, an assessment prior to valvular repairs and closures of septal defects, intraoperative monitoring of cardiac or percutaneous interventions, ablation, non-diagnostic transthoracic examination, especially in patients after cardiac surgeries. Serious complications after transesophageal examination are very rare. This type of examination should not be performed in patients who consumed a meal 4-6 hours before the test, or when there is a risk of esophageal perforation and massive gastrointestinal bleeding. The test should be performed in an appropriately accredited laboratory and by a cardiologist with an individual accreditation. Transesophageal echocardiography may be performed in an outpatient setting. It should be recorded using the available media. The description should include comprehensive answers to questions in the referral. Transesophageal examination requires patient consent. It is performed using a multiplanar probe, which ensures the best conditions for imaging of the heart and the thoracic aorta. First of all, the reason for referral should be diagnosed. Depending on the setting depth, the following views may be distinguished: low transesophageal view (the probe is advanced approximately 30 cm from the teeth), mid transesophageal view (the probe is advanced approximately 30 cm from the teeth), high transesophageal view (the probe is advanced approximately 25-30 cm from the teeth), transgastric subcardiac view (the probe is advanced approximately 35-40 cm from the teeth), transgastric five-chamber view (the probe is advanced deeper than in the subcardiac view and with a stronger anterior flexion of the probe, aortic (the probe should be rotated at about 180°).Transthoracic and transesophageal examinations should be considered as mutually complementary. Transesophageal echocardiography is performed in cases of a justified need to visualize structures that are poorly visible or invisible on transthoracic echocardiogram. Primary indications for transesophageal echocardiography include an assessment of cardiac source of embolism, suspected endocarditis, suspected prosthetic valve dysfunction, an assessment of thoracic aorta and other vessels, an assessment prior to valvular repairs and closures of septal defects, intraoperative monitoring of cardiac or percutaneous interventions, ablation, non-diagnostic transthoracic examination, especially in patients after cardiac surgeries. Serious complications after transesophageal examination are very rare. This type of examination should not be performed in patients who consumed a meal 4­6 hours before the test, or when there is a risk of esophageal perforation and massive gastrointestinal bleeding. The test should be performed in an appropriately accredited laboratory and by a cardiologist with an individual accreditation. Transesophageal echocardiography may be performed in an outpatient setting. It should be recorded using the available media. The description should include comprehensive answers to questions in the referral. Transesophageal examination requires patient consent. It is performed using a multiplanar probe, which ensures the best conditions for imaging of the heart and the thoracic aorta. First of all, the reason for referral should be diagnosed. Depending on the setting depth, the following views may be distinguished: low transesophageal view (the probe is advanced approximately 30 cm from the teeth), mid transesophageal view (the probe is advanced approximately 30 cm from the teeth), high transesophageal view (the probe is advanced approximately 25­30 cm from the teeth), transgastric subcardiac view (the probe is advanced approximately 35­40 cm from the teeth), transgastric five-chamber view (the probe is advanced deeper than in the subcardiac view and with a stronger anterior flexion of the probe, aortic (the probe should be rotated at about 180°).

Stress echocardiography. Part I: Stress echocardiography in coronary heart disease.

Stress echocardiography (stress echo) is a method in which various stimuli are used to elicit myocardial contractility or provoke cardiac ischemia with simultaneous echocardiographic image acquisition of left ventricular function and valvular flow, if needed. The technique is a well-recognized, safe and widely available stress test used for the diagnosis and assessment of prognosis in coronary heart disease, but may also prove valuable in valvular heart disease. The stressors used include physical exercise, pharmacological agents (dobutamine, vasodilators) and pacing stress, most often with the use of a permanent pacemaker. Two operators should perform the test: a physician experienced in stress echocardiography (at least 100 tests completed under supervision of an expert) and a trained nurse or another doctor. The laboratory should feature a defibrillator and a resuscitation kit with a set of pharmaceuticals, an intubation kit and an AMBU bag. Pacing stress echo requires an external programmer for the implanted permanent pacemaker. Exercise should be the preferred stressor for the diagnosis of ischemic heart disease with alternative of high-dose dobutamine test in cases of contraindications to physical stress. Pacing stress echo is recommended for patients with pacemakers, and dipyridamole test for the assessment of coronary flow reserve. Chest pain in patients with intermediate probability of coronary artery disease, inability to perform physical exercise and non-diagnostic resting or exercise electrocardiography are indications for stress echo. The test is also used in symptomatic patients after revascularization or patients qualified for revascularization for functional assessment of coronary artery stenosis. Low-dose dobutamine test is usually performed in patients after myocardial infarction or with moderate-to-severe left ventricular dysfunction to assess myocardial viability before potential revascularization.Stress echocardiography (stress echo) is a method in which various stimuli are used to elicit myocardial contractility or provoke cardiac ischemia with simultaneous echocardiographic image acquisition of left ventricular function and valvular flow, if needed. The technique is a well-recognized, safe and widely available stress test used for the diagnosis and assessment of prognosis in coronary heart disease, but may also prove valuable in valvular heart disease. The stressors used include physical exercise, pharmacological agents (dobutamine, vasodilators) and pacing stress, most often with the use of a permanent pacemaker. Two operators should perform the test: a physician experienced in stress echocardiography (at least 100 tests completed under supervision of an expert) and a trained nurse or another doctor. The laboratory should feature a defibrillator and a resuscitation kit with a set of pharmaceuticals, an intubation kit and an AMBU bag. Pacing stress echo requires an external programmer for the implanted permanent pacemaker. Exercise should be the preferred stressor for the diagnosis of ischemic heart disease with alternative of high-dose dobutamine test in cases of contraindications to physical stress. Pacing stress echo is recommended for patients with pacemakers, and dipyridamole test for the assessment of coronary flow reserve. Chest pain in patients with intermediate probability of coronary artery disease, inability to perform physical exercise and non-diagnostic resting or exercise electrocardiography are indications for stress echo. The test is also used in symptomatic patients after revascularization or patients qualified for revascularization for functional assessment of coronary artery stenosis. Low-dose dobutamine test is usually performed in patients after myocardial infarction or with moderate-to-severe left ventricular dysfunction to assess myocardial viability before potential revascularization.

Stress echocardiography. Part II: Stress echocardiography in conditions other than coronary heart disease.

Stress echocardiography (stress echo), with use of both old and new ultrasonographic cardiac function imaging techniques, has nowadays become a widely available, safe and inexpensive diagnostic method. Cardiac stress, such as exercise or an inotropic agent, allows for dynamic assessment of a wide range of functional parameters describing ventricles, heart valves and pulmonary circulation. In addition to diagnosis of ischemic heart disease, stress echocardiography is also used in patients with acquired and congenital valvular defects, hypertrophic cardiomyopathy, dilated cardiomyopathy as well as diastolic and systolic heart failure. Physical exercise is the recommended stressor in patients with aortic and especially mitral valvular disease. Nevertheless, dobutamine stress echo is useful for the assessment of contractile and flow reserve in aortic stenosis with reduced left ventricular ejection fraction. Stress echo should always be performed by an appropriately trained cardiologist assisted by a nurse or another doctor, in the settings of an adequately equipped echocardiographic laboratory and with compliance to safety requirements. Moreover, continuous education of cardiologists performing stress echo is needed.Stress echocardiography (stress echo), with use of both old and new ultrasonographic cardiac function imaging techniques, has nowadays become a widely available, safe and inexpensive diagnostic method. Cardiac stress, such as exercise or an inotropic agent, allows for dynamic assessment of a wide range of functional parameters describing ventricles, heart valves and pulmonary circulation. In addition to diagnosis of ischemic heart disease, stress echocardiography is also used in patients with acquired and congenital valvular defects, hypertrophic cardiomyopathy, dilated cardiomyopathy as well as diastolic and systolic heart failure. Physical exercise is the recommended stressor in patients with aortic and especially mitral valvular disease. Nevertheless, dobutamine stress echo is useful for the assessment of contractile and flow reserve in aortic stenosis with reduced left ventricular ejection fraction. Stress echo should always be performed by an appropriately trained cardiologist assisted by a nurse or another doctor, in the settings of an adequately equipped echocardiographic laboratory and with compliance to safety requirements. Moreover, continuous education of cardiologists performing stress echo is needed.

Echocardiography in adults.

Transthoracic echocardiography is the primary non-invasive modality for anatomical and functional cardiac assessment. All one-, two-dimensional and Doppler modes use the same phenomenon, i.e. the piezoelectric effect, to visualize mobile cardiac structures and blood flow in cardiac cavities. Novel techniques for myocardial imaging, such as tissue Doppler and acoustic marker tracing, allow for the assessment of regional myocardial contractility of the left and the right ventricle. Cardiac assessment is performed in standard views characterized by an optimal acoustic window. The goal of each cardiac echo is to assess cardiac function and morphology using all available imaging modes. The evaluation of acquired valvular heart diseases should include morphological and functional changes indicative of the type (stenosis, regurgitation, complex defect) and the mechanism (Carpentier's classification of mitral regurgitation) of the defect, as well as its stage (mild, moderate, severe). The assessment of left and right ventricular function should involve the measurement of global and regional parameters. An echocardiographic report should also include information on septal continuity and the presence of additional structures or intracardiac masses.Transthoracic echocardiography is the primary non-invasive modality for anatomical and functional cardiac assessment. All one-, two-dimensional and Doppler modes use the same phenomenon, i.e. the piezoelectric effect, to visualize mobile cardiac structures and blood flow in cardiac cavities. Novel techniques for myocardial imaging, such as tissue Doppler and acoustic marker tracing, allow for the assessment of regional myocardial contractility of the left and the right ventricle. Cardiac assessment is performed in standard views characterized by an optimal acoustic window. The goal of each cardiac echo is to assess cardiac function and morphology using all available imaging modes. The evaluation of acquired valvular heart diseases should include morphological and functional changes indicative of the type (stenosis, regurgitation, complex defect) and the mechanism (Carpentier's classification of mitral regurgitation) of the defect, as well as its stage (mild, moderate, severe). The assessment of left and right ventricular function should involve the measurement of global and regional parameters. An echocardiographic report should also include information on septal continuity and the presence of additional structures or intracardiac masses.