Non-invasive myocardial work as an independent predictor of postprocedural NT-proBNP in elderly patients undergoing transcatheter aortic valve replacement.

Aortic stenosis has become the most prevalent valvular disease with increasing life expectancy and the ageing of the population, representing a significant clinical burden for health care providers. Its treatment has been revolutionized by transcatheter aortic valve replacement (TAVR) as a safe and minimally invasive option for elderly patients. Left ventricular (LV) functional measurement is of particular importance before TAVR, however, increased afterload significantly influences the conventional echocardiographic parameters. Non-invasive myocardial work examines myocardial deformation in the context of instantaneous LV pressure, thus, it might be a more reliable measure of LV function. Accordingly, we aimed to study non-invasive myocardial work and its relationship with functional outcome following TAVR.We enrolled 90 TAVR candidates (80 [75-84] years; 44% female). Using echocardiography, we quantified ejection fraction (EF), global longitudinal strain (GLS), global myocardial work index (GWI) and global constructive work (GCW) before and 12 months after the procedure. Serum NT-proBNP levels were also measured. EF did not change (52.6 ± 13.1 vs. 54.2 ± 10.5%; p = 0.199), while GLS increased (-13.5 ± 4.6 vs. -15.2 ± 3.8%; p < 0.001). GWI decreased (1913 ± 799 vs. 1654 ± 613 mmHg%; p < 0.001) and so did GCW (2365 ± 851 vs. 2177 ± 652 mmHg%; p = 0.018). History of atrial fibrillation (AF) (ß = 0.349) and preprocedural GCW (ß = -0.238) were independent predictors of postprocedural NT-proBNP (p < 0.001).GLS, GWI and GCW changed after TAVR while there was no alteration in EF. The preprocedural GCW and history of AF were independent predictors of postprocedural NT-proBNP. Accordingly, myocardial work indices may help patient selection and the prediction of the functional outcome in this population.

The application of landiolol in the cardiovascular and intensive care / A landiolol alkalmazási lehetoségei a kardiológiai és intenzív terápiás ellátásban.

Összefoglaló. A landiolol intravénásan alkalmazandó, kifejezetten cardioselectiv, gyors hatású és rövid felezési ideju béta-1-receptor-blokkoló, mely elsosorban negatív chronotrop és inotrop hatással bír, vérnyomáscsökkento hatása elhanyagolható. Foleg hemodinamikailag instabil állapotú, supraventricularis ritmuszavarban szenvedo betegek kamrafrekvenciájának csökkentésére használható. Nagy esetszámú, randomizált vizsgálatok igazolták hatékonyságát szívmutétek után jelentkezo pitvarfibrilláció megelozésében, valamint súlyos akut szívelégtelenségben és szívmutétek posztoperatív szakában jelentkezo pitvari tachyarrhythmiák kezelésében. Ezek mellett kisebb vizsgálatok alapján a használata biztonságosnak tunik akut myocardialis infarctusban, hatékony szeptikus állapotú, pitvarfibrillációban szenvedo betegek kamrafrekvencia- és ritmuskontrolljára, valamint nem cardialis mutétek esetén a pitvarfibrilláció prevenciójára és kezelésére. Sikerrel alkalmazható elektromos vihar esetén is, és jól használható angiográfiás coronaria-CT-vizsgálat elott az optimális szívfrekvencia elérésére. A gyógyszer 2016 óta Európában, 2018 óta Magyarországon is elérheto. Orv Hetil. 2022; 163(2): 53-62. Summary. Landiolol is an intravenous, selective beta-1-receptor blocking agent with rapid onset of action and ultra-short half-life that has a predominant negative chronotropic and only mild negative inotropic effect without significant reduction of blood pressure. Landiolol is indicated to control the ventricular heart rate predominantly in patients with hemodynamic instability due to supraventricular tachyarrhythmia. Large randomized controlled trials have proven the efficacy of landiolol in the prevention of atrial fibrillation and atrial tachyarrhythmias in severe acute heart failure or post-cardiac surgery. Based on lower case-number studies, the administration of landiolol has been proven to be efficient and safe in rhythm and rate control in atrial fibrillation complicating acute myocardial infarction, sepsis, and in the prevention of atrial fibrillation in non-cardiac surgery. Landiolol may be used in electrical storm, and even during coronary CT-angiography to achieve an optimal heart rate for imaging. The drug is available in Europe since 2016 and in Hungary since 2018. Orv Hetil. 2022; 163(2): 53-62.

[Clinical nutrition therapy in patients with short bowel syndrome in line with principles of personalized medicine]. / Klinikai táplálásterápia rövidbél-szindrómában a személyre szabott orvoslás elvei szerint.

Home parenteral nutrition administered in selected care centres has been financed in Hungary since January, 2013. The authors discuss diagnostic issues, treatment and nutrition therapy of short bowel syndrome patients in line with the principles of personalised medicine. The most severe form of short bowel syndrome occurs in patients having jejunostomy, whose treatment is discussed separately. The authors give a detailed overview of home parenteral feeding, its possible complications, outcomes and adaptation of the remaining bowel. They describe how their own care centre operates where they administer home parenteral nutrition to 12 patients with short bowel syndrome (5 females and 7 males aged 51.25±14.4 years). The body mass index was 19.07±5.08 kg/m2 and 20.87±3.3 kg/m2, skeletal muscle mass was 25.7±6.3 kg and 26.45±5.38 kg, and body fat mass was 14.25±8.55 kg and 11.77±2.71 kg at the start of home parenteral nutrition and presently, respectively. The underlying conditions of short bowel syndrome were tumours in 4 patients, bowel ischaemia in four patients, surgical complications in three patients, Crohn's disease in one patient, and Crohn's disease plus tumour in one patient.