ABSTRACT
BACKGROUND: Data on sex differences in terms of action of antiarrhythmic agents (AADs) are limited. This study aimed to evaluate the clinical profile of patients with atrial fibrillation (AF), and efficacy and safety of AADs used for pharmacological cardioversion (PCV) of AF. METHODS: This research was a sub-analysis of the retrospective multicenter Cardioversion with ANTazoline II (CANT) registry, which comprised 1365 patients with short-duration AF referred for urgent PCV with the use of AAD. Patients were categorized according to and compared in terms of clinical parameters and PCV outcomes. The primary endpoint was return of sinus rhythm within 12 hours after drug infusion, and the composite safety endpoint involved bradycardia <45 bpm, hypotension, syncope, or death. RESULTS: The sex distribution of patients qualified for PCV was even (men, n = 725; 53.1%). Females were older and more symptomatic and had higher CHA2DS2-VASc scores, higher prevalence of tachyarrhythmia, and higher use of chronic anticoagulation. The overall efficacy (71.4% vs. 70.1%; P = 0.59) and safety (5.2% vs. 4.6%; P = 0.60) of PCV was comparable in men and women. Amiodarone (68.3% vs. 65.9%; P = 0.66) and antazoline (77.1% vs. 80.0%; P = 0.19) had similar efficacy in men and women, but propafenone had a lower rate of rhythm conversion in men (64.7% vs. 79.3%; P = 0.046). None of the assessed AADs differed in terms of safety profile in both sexes. CONCLUSION: Female patients with AF have different clinical profiles but similar efficacy and safety of AADs as compared to male participants. Propafenone has significantly lower efficacy in men, which requires further investigation.
Subject(s)
Anti-Arrhythmia Agents , Atrial Fibrillation , Female , Humans , Male , Amiodarone , Antazoline/adverse effects , Antazoline/pharmacology , Anti-Arrhythmia Agents/adverse effects , Anti-Arrhythmia Agents/pharmacology , Atrial Fibrillation/drug therapy , Electric Countershock , Propafenone/adverse effects , Propafenone/pharmacology , Treatment Outcome , Sex Factors , Multicenter Studies as TopicABSTRACT
INTRODUCTION: Most cardiac arrests in adults are related to coronary artery disease (CAD), and the role of early invasive cardiology procedures remains unclear. AIMS: We investigated the prognosis for patients hospitalized for out-of-hospital cardiac arrest (OHCA) or in-hospital cardiac arrest (IHCA) who were referred within 24 hours to a tertiary cardiology department, with a focus on the role of early coronary angiography (CA) and percutaneous coronary intervention (PCI). METHODS: This was an observational, single-center study using retrospective and prospective cohorts. Consecutive patients hospitalized for OHCA or IHCA and referred within 24 hours to a cardiology department were included in the study. Survival until hospital discharge was the primary outcome. RESULTS: One hundred and forty-eight patients aged 71 (14) years were included, 68 hospitalized for OHCA, and 80 patients after IHCA. Overall, in-hospital survival in the study group was 45% (66/148). In a multivariable logistic regression model, independent predictors of death were ejection fraction (EF) ≤30% (odds ratio [OR], 4.1; 95% confidence interval [CI], 1.69-10.03), blood oxygen saturation (SpO2) ≤90% (OR, 2.77; 95% CI, 1.19-6.46), non-ST-segement elevation myocardial infarction (NSTEMI) (OR, 2.71; 95% CI, 1.02-7.21). The risk of death was lower in patients who underwent early CA (OR, 0.28; 95% CI, 0.1-0.74) or received at least one defibrillation (OR, 0.11; 95% CI, 0.05-0.27), even after adjustment for other factors. CONCLUSIONS: In this series from a tertiary cardiac center, patients who underwent early CA had improved outcomes after cardiac arrest. In the multivariable logistic regression model, lower SpO2, lower EF, and NSTEMI were independent risk factors of death, whereas early CA and initial shockable rhythm improved survival.
Subject(s)
Cardiopulmonary Resuscitation , Non-ST Elevated Myocardial Infarction , Out-of-Hospital Cardiac Arrest , Percutaneous Coronary Intervention , Adult , Humans , Coronary Angiography/methods , Percutaneous Coronary Intervention/adverse effects , Retrospective Studies , Prospective Studies , Non-ST Elevated Myocardial Infarction/complications , Out-of-Hospital Cardiac Arrest/therapy , SurvivorsABSTRACT
Pharmacological cardioversion (PCV) is commonly a primary option for termination of recent-onset atrial fibrillation (AF) in emergency departments (ED). This is a subanalysis of the CANT II study, evaluating the effectiveness and safety of antazoline in patients (n = 777) at three stages of chronic kidney disease (CKD): Group I > 60 mL/min (n = 531), Group II 45−59 mL/min (n = 149), and Group III < 45 mL/min (n = 97). Patients in Group III were older and with a higher prevalence of co-morbidities; however, we did not find statistically significant differences in the overall effectiveness of PCV in comparison with the other groups. In patients receiving amiodarone, the PCV success rate was similar in all the studied groups, but along with a renal function decline, it decreased in patients receiving antazoline (79.1 vs. 35%; p < 0.001), and it increased almost significantly in patients receiving propafenone (69.9 vs. 100%; p = 0.067). In patients in Group I, antazoline restored a sinus rhythm as effectively as propafenone and amiodarone; however, in patients in Group III, both antazoline and amiodarone became less effective in restoring a sinus rhythm than propafenone (p = 0.002 and p = 0.034, respectively). The rate of safety endpoint was the highest in patients in Group III (eGFR < 45 mL/min), and it was significantly higher than in patients in Groups I and II (p = 0.008 and p = 0.036, respectively). We did not observe antazoline-related adverse events in any of the studied groups of patients. This real-world registry analysis revealed a different influence of CKD on the effectiveness of individual drugs, and while propafenone and amiodarone maintained their AF termination efficacy, antazoline became significantly less effective in restoring sinus rhythm.
Subject(s)
Amiodarone , Antazoline , Atrial Fibrillation , Renal Insufficiency, Chronic , Amiodarone/therapeutic use , Antazoline/adverse effects , Anti-Arrhythmia Agents/therapeutic use , Atrial Fibrillation/chemically induced , Atrial Fibrillation/drug therapy , Atrial Fibrillation/epidemiology , Electric Countershock , Female , Humans , Male , Propafenone/adverse effects , Renal Insufficiency, Chronic/chemically induced , Renal Insufficiency, Chronic/drug therapy , Renal Insufficiency, Chronic/epidemiology , Treatment OutcomeABSTRACT
INTRODUCTION: Due to safety concerns about available antiarrhythmic drugs (AADs), reliable agents for termination of atrial fibrillation (AF) are requisite. OBJECTIVES: The aim of the study was to evaluate the efficacy and safety of antazoline, a firstgeneration antihistamine, for cardioversion of recentonset AF in the setting of an emergency department. PATIENTS AND METHODS: This multicenter, retrospective registry covered 1365 patients (median [interquartile range] age, 69.0 [61.0-76.0] years, 53.1% men) with newonset AF submitted to urgent pharmacological cardioversion. AAD allocation was performed by the attending physician: antazoline alone was utilized in 600 patients (44%), amiodarone in 287 (21%), propafenone in 150 (11%), and ≥2 AADs in 328 patients (24%). Antazoline in monotherapy or combination was administered to 897 patients (65.7%). Matched antazoline and nonantazoline groups were identified using propensity score matching (PSM, n = 330). The primary end point was return to sinus rhythm within 12 hours after initiation of the treatment. RESULTS: Before PSM, antazoline alone was superior to amiodarone (78.3% vs 66.9%; relative risk [RR], 1.17; 95% CI, 1.07-1.28; P <0.001) and comparable to propafenone (78.3% vs 72.7%; RR, 1.08; 95% CI, 0.97-1.20; P = 0.14) in terms of rhythm conversion rate. In the postPSM population, the rhythm conversion rate was higher among patients receiving antazoline alone than in the nonantazoline group (84.2% vs 66.7%; RR, 1.26; 95% CI, 1.11-1.43; P <0.001), and the risk of adverse events was comparable (P = 0.2). CONCLUSIONS: Antazoline appears to be an efficacious agent for termination of AF in realworld setting. Randomized controlled trials are required to evaluate its safety in specific patient populations.
Subject(s)
Amiodarone , Antazoline , Atrial Fibrillation , Aged , Amiodarone/adverse effects , Antazoline/adverse effects , Antazoline/therapeutic use , Anti-Arrhythmia Agents/adverse effects , Electric Countershock , Female , Humans , Male , Propafenone/therapeutic use , Propensity Score , Registries , Retrospective Studies , Treatment OutcomeABSTRACT
BACKGROUND: Fluoroscopy has been an essential part of every electrophysiological procedure since its inception. However, till now no clear standards regarding acceptable x-ray exposure nor recommendation how to achieve them have been proposed. HYPOTHESIS: Current norms and quality markers required for optimal clinical routine can be identified. METHODS: Centers participating in this Europe-wide multicenter, prospective registry were requested to provide characteristics of the center, operators, technical equipment as well as procedural settings of consecutive cases. RESULTS: Twenty-five centers (72% university clinics, with a mean volume of 526 ± 348 procedures yearly) from 14 European countries provided data on 1788 cases [9% diagnostic procedures (DP), 38% atrial fibrillation (AF) ablations, 44% other supraventricular (SVT) ablations, and 9% ventricular ablations (VT)] conducted by 95 operators (89% male, 41 ± 7 years old). Mean dose area product (DAP) and time was 304 ± 608 cGy*cm2 , 3.6 ± 4.8 minutes, 1937 ± 608 cGy*cm2 , 15.3 ± 15.5 minutes, 805 ± 1442 cGy*cm2 , 10.6 ± 10.7 minutes, and 1277 ± 1931 cGy*cm2 , 10.4 ± 12.3 minutes for DP, AF, SVT, and VT ablations, respectively. Seven percent of all procedures were conducted without any use of fluoroscopy. Procedures in the lower quartile of DAP were performed more frequently by female operators (OR 1.707, 95%CI 1.257-2.318, P = .001), in higher-volume center (OR 1.001 per one additional procedure, 95%CI 1.000-1.001, P = .002), with the use of 3D-mapping system (OR 2.622, 95%CI 2.053-3.347, P < .001) and monoplane x-ray system (OR 2.945, 95%CI 2.149-4.037, P < .001). CONCLUSION: Exposure to ionizing radiation varies widely in daily practice for all procedure. Significant opportunities for harmonization of exposure toward the lower range has been identified.
Subject(s)
Atrial Fibrillation/surgery , Catheter Ablation/methods , Electrophysiologic Techniques, Cardiac/methods , Fluoroscopy/methods , Registries , Surgery, Computer-Assisted/methods , Adult , Atrial Fibrillation/diagnosis , Europe , Female , Humans , Male , Prospective StudiesABSTRACT
BACKGROUND: The rotation and twist of the left ventricle (LV) have been comprehensively evaluated at rest. However, little is known about rotational mechanics during dobutamine stress echocardiography (DSE). AIMS: We aimed to quantify and compare the basal and apical rotation and twist of the LV at rest as well as at the peak and recovery stages of DSE in patients with and without coronary artery disease (CAD). METHODS: We enrolled 91 patients, including 48 patients with CAD and 43 patients without CAD (mean [SD] age, 62 [9] years and 61 [10] years, respectively). Coronary artery disease was defined as the presence of stenoses of 50% or more in the left main coronary artery and/or stenoses of 70% or more in other epicardial arteries. Rotation was measured by 2dimensional speckletracking echocardiography, and twist was calculated as the difference between the basal and apical rotation. RESULTS: Neither rotation nor twist differed between patients with and without CAD at rest, although apical rotation was significantly greater in the CAD group at peak DSE (mean [SD], 5.43° [3.45°] vs 3.71° [3.52°], P = 0.01) and at recovery (mean [SD], 5.05° [3.65°] vs 2.87° [2.73°], P <0.01). On the contrary, the absolute value for basal rotation at recovery was higher in patients without CAD (mean [SD], 3.87° [3.37°] vs 2.63° [2.43°], P = 0.03). In both groups, the rotation and twist did not change significantly during the dobutamine challenge. CONCLUSIONS: During DSE, we observed differences in LV rotation between patients with and without CAD, revealing the effect of ischemia on deformation parameters.
Subject(s)
Coronary Artery Disease/diagnostic imaging , Heart Ventricles/diagnostic imaging , Aged , Coronary Artery Disease/physiopathology , Echocardiography, Stress , Female , Heart Ventricles/physiopathology , Humans , Male , Middle Aged , Rotation , Ventricular Function, LeftABSTRACT
BACKGROUND: A 53-year-old male with heart failure secondary to anterior wall myocardial infarction treated with cardiac resynchronization-defibrillator (CRT-D) device presented with ventricular arrhythmia: repetitive incessant slow ventricular tachycardias (VT) below the CRT-D detection zone, accelerated ventricular rhythm, and numerous premature ventricular ectopic beats (ExV), resulting in loss of biventricular pacing. METHODS AND RESULTS: Nonsustained monomorphic VT (nsVT) and ExV were observed in an electrocardiogram under biventricular stimulation. During noninvasive CRT-D programming, ventricular bigeminy reproducibly recurred only at right ventricular (RV) pacing and its morphology was almost identical to the stimulated beats. The left ventricular (LV) pacing failed to induce ventricular ectopy or tachycardia. CONCLUSIONS: This unusual case shows a rare phenomenon of late proarrhythmic effect due to the RV lead pacing-a new finding reported only in a few publications. Here we present our approach to CRT programming that suppressed the clinical arrhythmia without the need of catheter ablation and achieving the high biventricular pacing capture rate along with optimal hemodynamic CRT-D performance.
Subject(s)
Cardiac Resynchronization Therapy Devices/adverse effects , Tachycardia, Ventricular/etiology , Heart Failure/therapy , Humans , Male , Middle AgedABSTRACT
PURPOSE: A microUSB ultrasound probe, which can be connected to a personal mobile device constitutes a new class of diagnostic pocket-size imaging devices (PSID). The aim of this study was to assess the feasibility and diagnostic value of brief transthoracic echocardiographic examination (bTTE) performed with the use of such equipment. MATERIAL AND METHODS: The study population comprised 87 consecutive patients (58 men, mean age 61 ± 16 years), 53 of whom were admitted to intensive cardiac care unit and 34 patients, who were referred for transthoracic echocardiography from outpatient clinic. All patients underwent bTTE performed by cardiologist with the use of personal mobile device-based PSID. Within 18 h of bTTE all subjects underwent a standard TTE (sTTE) using a full sized echocardiograph by expert echocardiographer. RESULTS: In all patients, PSID imaging provided sufficient diagnostic image quality. Echocardiographic measurements were completed for both bTTE and sTTE in 98% of patients. The linear measurements obtained during bTTE showed good to excellent correlation with sTTE results (r = 0.65-0.98; p < 0.001). The agreement in detection of various pathologies between the bTTE and sTTE examination was very good (k = 0.62-0.97; p < 0.01). CONCLUSION: Personal mobile device-based PSID allows for performing bTTE. The diagnostic value of such PSID in basic assessment of cardiac morphology and function as compared to standard echocardiography is very good.
Subject(s)
Cell Phone , Echocardiography/instrumentation , Adolescent , Adult , Aged, 80 and over , Female , Humans , Intensive Care Units , Male , Middle Aged , ROC Curve , Young AdultSubject(s)
Kidney Transplantation , Dilatation , Humans , Immunosuppression Therapy , Kidney , Transplant RecipientsABSTRACT
PURPOSE: To assess the potential ability of two-dimensional speckle tracking analysis (STE) during atrial fibrillation (AF) to identify patients with LA appendage thrombi (LAAT). METHODS: This study involved 93 patients with AF (39% female, 67.1 ± 9.5 years) who were referred for a clinical indication for transesophageal echocardiography (TEE). TEE revealed LAAT in 39 (42%) patients. We analyzed standard parameters of the left ventricle (LV) and LA in transthoracic echocardiography. Using STE, we assessed LV global longitudinal strain (LVGLS), peak atrial longitudinal strain (PALS), and intra-atrial asynchrony. The PALS was calculated using the global strain curve (GPALS) and as the mean of peaks derived from segmental strain curves (MPALS). RESULTS: Patients were comparable with regard to the clinical data. A subgroup with LAAT had lower LV ejection fraction (LVEF) and a lower absolute value of the LVGLS, as well as greater impairment in the LA standard parameters, PALS, and asynchrony. Receiver operating characteristic curve analysis revealed that the LVEF of 30% (P < .001), the LVGLS of -7% (P < .0001), the GPALS of 11% (P < .005), and the LA asynchrony of 22% (P < .01) were the optimal cutoff values for distinguishing both subgroups. LA asynchrony, LVEF, and LVGLS were independently associated with the presence of LAAT in multivariate analyses, and PALS had additional significance over the CHA2 DS2 -VASc score. CONCLUSIONS: Left ventricular systolic dysfunction characterized by both LVEF and LVGLS is an independent factor for LAAT. LA asynchrony provides additional diagnostic value for discriminating between patients with and without LAAT.
Subject(s)
Atrial Appendage , Atrial Fibrillation/complications , Echocardiography, Transesophageal/methods , Heart Ventricles/diagnostic imaging , Stroke Volume/physiology , Thrombosis/etiology , Ventricular Function, Left/physiology , Aged , Atrial Fibrillation/diagnosis , Atrial Fibrillation/physiopathology , Female , Heart Atria/diagnostic imaging , Heart Atria/physiopathology , Heart Diseases/diagnosis , Heart Diseases/etiology , Heart Ventricles/physiopathology , Humans , Male , Predictive Value of Tests , Risk Factors , Thrombosis/diagnosisABSTRACT
AIM: To evaluate the impact of the 2 most common bicuspid aortic valve (BAV) morphology patterns [right-left (RL) vs right-noncoronary (RN) cusp fusion] on the aortic diameters and the impact of gender, aortic stenosis (AS), aortic regurgitation (AR), and age on the observed effects. METHODS: The PubMed databases was searched up to December 31, 2016 to identify studies investigating the morphology of BAV and aortic diameters. Inclusion criteria were as follows: the data on diameter of sinuses of Valsalva (SVD) and/or ascending aorta (AAD) and BAV morphology. The additional characteristics [gender, AS and AR (% of patients with moderate or severe AS/AR) and mean age] were collected to perform a meta-regression analysis. RESULTS: A total of 12 studies with 2192 patients with indexed AAD, 15 studies with 3104 patients with nonindexed AAD and 8 studies with 1271 patients with indexed SVD, and 16 studies with 3454 patients with nonindexed SVD were included. There was no difference between RL and RN group in indexed/nonindexed AAD-mean difference (MD): 0.06 mm/m2 (95% CI: -0.65 to 0.77 mm/m2 , P = .87) and -0.06 mm (95% CI: 1.10-0.97 mm, P = .91). Differently, the RL BAV was associated with larger indexed/nonindexed SVD than RN phenotype-MD: 1.66 mm/m2 (95% CI: 0.83-2.49 mm/m2 , P < .001) and 2.03 mm (95% CI: 0.97-3.09 mm, P < .001). Age, gender, AS, and AR had no influence on observed differences. CONCLUSIONS: RL BAV phenotype is associated with larger SVD than RN BAV, and the observed differences are independent from aortic valve dysfunction degree, age, and gender.
Subject(s)
Aorta/diagnostic imaging , Aortic Valve/abnormalities , Aortic Valve/diagnostic imaging , Echocardiography/methods , Heart Valve Diseases/diagnosis , Bicuspid Aortic Valve Disease , HumansABSTRACT
INTRODUCTION: The latest recommendations for echocardiographic chamber quantification have implemented updated normal values for all cardiac chambers. PURPOSE: To evaluate the incidence of normal and abnormal values of routine echocardiographic parameters such as left ventricular ejection fraction (LVEF) and left atrial volume indexed to body surface area (LAVi) in patients with non-valvular atrial fibrillation (AF) and to determine the influence of LVEF and LAVi reclassification on the prediction of LAAT by transthoracic echocardiography. METHODS: We retrospectively analysed the database of 1674 transesophageal echocardiograms performed between 2012 and 2015 in our echo lab. The study involved patients (mean age 70 ± 7 years, 80% men) with paroxysmal or persistent AF (35 patients with left atrial appendage thrombus [LAAT] and 35 sex- and age-matched controls without LAAT). LVEF and LAVi were categorised in two ways: semi-quantitative using four-degree scale (normal or abnormal graded from mild and moderate to severe) and qualitative (normal vs. abnormal). RESULTS: We reclassified 6 (9%) and 4 (6%) patients with regard to LVEF as well as 38 (54%) and 16 (23%) with regard to LAVi on semi-quantitative and qualitative scale, respectively. After adjustment for effective anticoagulation and approved risk factors in the multivariate models, we identified LVEF categorised in semi-quantitative manner according to both documents, LAVi categorised in a binary manner by new guidelines and semi-quantitative scale by both recommendations as independently associated with LAAT. CONCLUSIONS: Differentiation between normal and abnormal value enhanced the diagnostic meaning of LAVi in the aspect of higher LAAT risk. LVEF reclassification had no significant influence.
Subject(s)
Atrial Appendage/diagnostic imaging , Echocardiography/methods , Heart Diseases/diagnosis , Thrombosis/diagnosis , Ventricular Function, Left/physiology , Aged , Case-Control Studies , Diagnosis, Differential , Female , Follow-Up Studies , Heart Diseases/physiopathology , Humans , Male , Reproducibility of Results , Retrospective Studies , Stroke Volume/physiology , Thrombosis/physiopathologyABSTRACT
BACKGROUND: Cryoballoon ablation for atrial fibrillation (cryoAF) is relatively simple, cost-effective and easy procedure. However, general anesthesia during this procedure may have negative impact on patients' mortality and morbidity, as well as procedure costs. We sought to assess the feasibility and safety of conscious sedation during cryoAF. METHODS: Patients with paroxysmal or persistent, drug-refractory AF who underwent a first procedure of cryoAF were included in our single-center, retrospective study. The loading dose of midazolam was 2 mg and loading fentanyl dose was 25 µg intravenously. Additional doses of midazolam and fentanyl were administered, if necessary. Midazolam and fentanyl were administered to maintain amnesia and analgesia, and patients' responsiveness in Ramsay Sedation Score was assessed every 10 minutes with sedation kept at the Ramsey Sedation Scale not exceeding Ramsey 3 Grade. RESULTS: A total of 71 patients with mean age 59.5±11.1 years were enrolled (48 males, 68%). The TEE and the TEE-guided transseptal puncture was feasible in all patients. The mean duration of cryoAF procedure was 136.3±36.0 minutes. The overall mean midazolam and fentanyl used doses were: 5.1±3.1 mg (55.7±35.1 µg/kg) and 98.9±51.1 µg (1.13±0.60 µg/kg). In 3 patients (4.2%), vascular complications occurred (femoral vein bleeding with hematoma formation without communication with femoral artery). In 1 case (1.4%) transient right phrenic palsy was observed; symptoms disappeared completely within 12 hours after procedure. The overall acute procedural success rate of cryoAF (defined as electrical isolation of all pulmonary veins) was 68/71 (95.8%). CONCLUSIONS: Conscious sedation is a safe, efficacious and feasible during cryoablation of pulmonary veins for AF.
Subject(s)
Anesthetics, Intravenous/administration & dosage , Atrial Fibrillation/surgery , Conscious Sedation/methods , Cryosurgery/methods , Administration, Intravenous , Aged , Anesthetics, Intravenous/adverse effects , Conscious Sedation/adverse effects , Feasibility Studies , Female , Fentanyl/administration & dosage , Fentanyl/adverse effects , Humans , Male , Midazolam/administration & dosage , Midazolam/adverse effects , Middle Aged , Pulmonary Veins , Retrospective StudiesABSTRACT
BACKGROUND: General anaesthesia may have negative impact on patient mortality and morbidity, as well as overall procedure costs, in atrial septal occluder (ASO) implantation. AIM: We sought to evaluate the safety, efficacy, and feasibility of conscious sedation for transcatheter implantation of ASOs. METHODS: A total of 122 patients referred for transcatheter implantation of ASO were included. Mean patient age was 51 ± 15 years, and 43 (35%) patients were male. The initial dose of midazolam was 2 mg and fentanyl dose was 25 µg. Additional doses of midazolam and fentanyl were administered, if necessary. Patient responsiveness was assessed every 10 min, and the sedatives doses were titrated in order not to exceed grade 3 sedation in the Ramsey scale. RESULTS: Atrial septal occluders were successfully implanted in the majority of patients (98.4%). In two (1.6%) cases the proce-dure failed because of too small patent foramen ovale (PFO) diameter (n = 1, 0.8%) or device instability (n = 1, 0.8%). The mean duration of procedure was 47.6 ± 28.4 min and was similar for ASD and PFO closure (p = 0.522). The overall mean dose of midazolam was 4.7 ± 2.2 mg (63.9 ± 32.5 µg/kg) and fentanyl was 30.0 ± 11.9 µg (0.43 ± 0.17 µg/kg). Median entrance dose of radiation at the patient plane was 25 (interquartile range: 16-57) mGy, and did not differ between ASD and PFO procedures (p = 0.614). The majority of patients were free of complications (91.0%). The following early complications were observed: transient ischaemic attack (n = 2, 1.6%), supraventricular arrhythmias (n = 4, 3.3%), left atrial thrombus formation (n = 1, 0.8%), symptomatic bradycardia (n = 1, 0.8%), and femoral venous bleeding (n = 5, 4.1%). After mean follow-up of 386 days residual shunt was observed in eight (6.6%) patients. CONCLUSIONS: Conscious sedation for transcatheter implantation of ASO is a feasible, safe, and efficient technique, allowing successful PFO and ASD closure in the majority of patients.
Subject(s)
Conscious Sedation/adverse effects , Heart Septal Defects, Atrial/surgery , Patient Safety , Septal Occluder Device , Adult , Aged , Echocardiography, Transesophageal , Female , Heart Atria/surgery , Humans , Male , Middle AgedABSTRACT
Aims: Diabetes (DM) is a strong cardiovascular risk factor modifying also the left ventricular (LV) function that may be objectively assessed with echocardiographic strain analysis. Although the impact of isolated DM on myocardial deformation has been already studied, few data concern diabetics with coronary artery disease (CAD), especially in all stages of dobutamine stress echocardiography (DSE). We compared LV systolic function during DSE in CAD with and without DM using state-of-the art speckle-tracking quantification and assessed the impact of DM on LV systolic strain. Methods and results: DSE was performed in 250 patients with angina who afterwards had coronarography with ≥50% stenosis in the left main artery and ≥70% in other arteries considered as significant. In this analysis, we included 127 patients with confirmed CAD: 42 with DM [DM(+); mean age 64 ± 9 years] and 85 patients without DM [DM(-); mean age 63 ± 9 years]. The severity of CAD and LV ejection fraction (EF) were similar in both groups. Global and regional LV peak systolic longitudinal strain (PSLS) revealed in all DSE phases lower values in DM(+) group: 14.5 ± 3.6% vs. 17.4 ± 4.0% at rest; P = 0.0001, 13.8 ± 3.9% vs. 16.7 ± 4.0% at peak stress; P = 0.0002, and 14.2 ± 3.1% vs. 15.5 ± 3.5% at recovery; P = 0.0432 for global parameters, although dobutamine challenge did not enhance further resting differences. LV EF, body surface area, and diabetes were independent predictors for strain in 16-variable model (R2 = 0, 51, P < 0.001). Conclusion: PSLS although diminished in both groups with CAD was lower in diabetics at all DSE stages, and DM was an independent predictor of this impairment. However, the dobutamine challenge did not deepen the resting differences, suggesting that the direct impact of coronary stenoses effaces the influence of DM during DSE. The comparison with our previous data revealed synergistic, detrimental effect of coexisting CAD and DM on myocardial strain.
Subject(s)
Coronary Artery Disease/epidemiology , Diabetes Mellitus/epidemiology , Echocardiography, Stress/methods , Image Interpretation, Computer-Assisted , Ventricular Dysfunction, Left/diagnosis , Age Factors , Aged , Angina Pectoris/diagnosis , Angina Pectoris/etiology , Case-Control Studies , Coronary Artery Disease/diagnosis , Diabetes Mellitus/diagnosis , Female , Humans , Incidence , Male , Middle Aged , Multivariate Analysis , Observer Variation , Reference Values , Retrospective Studies , Risk Assessment , Sex Factors , Stroke Volume/physiology , Ventricular Dysfunction, Left/epidemiologyABSTRACT
BACKGROUND: The relationship between visual and strain assessment of left ventricular (LV) function during dobutamine stress echocardiography (DSE) remains poorly investigated. We assessed systolic longitudinal strain (SLS) and strain rate (SLSR) in segments visually graded as normokinetic, hypokinetic, or akinetic at baseline (0) and peak stage (1) of DSE and compared deformation changes between segments with and without induced contractility worsening. METHODS: From 250 patients examined by DSE, 238 patients with diagnostic test were included, mean age of 62±9 years (105 females). Regional LV contractility was assessed visually and measured using SLS and SLSR in 4284 segments. RESULTS: The LV segments during baseline and peak stage of DSE revealed gradual decrease in absolute values of SLS (from 17.7±6.4% in normokinetic to 11.7±8.4% in akinetic segments at rest, and from 17.2±8.5% to 14.4±7.8% at peak, P<.001), as measured by automated function imaging (AFI) and SLSR (from 1.1±0.37 s-1 in normokinetic to 0.9±0.29 s-1 in akinetic at rest, and from 2.32±0.92 to 2.13±0.85 s-1 at peak). The decrease in SLS in segments with contractility worsening was higher than in segments without induced impairment (ΔSLS 2% vs 0%, P<.0001 for all LV segments and 2% vs 1%, P=.02 in mid-LV segments). Absolute value of regional SLS <23% at peak DSE and decrease in SLS >2% from baseline showed 90% and 76% sensitivity for the detection of contractility impairment. CONCLUSION: Strain analysis quantifies segmental LV contractility not only at rest and peak DSE but may be helpful in detection of stress-induced contractility worsening.