New methods in laboratory diagnostics of dilated cardiomyopathy

Dilated cardiomyopathy (DCM) is a multifactorial heart disease in which there is enlargement and systolic dysfunction of one or both ventricles. The exhaustion of compensatory mechanisms leads to symptoms of congestive heart failure, which is a significant problem in contemporary cardiology. DCM is still diagnosed using clinical assessment; echocardiography is necessary, and in some clinical situations we need hemodynamic assessment in order to identify the etiology and progression of heart disease. These tests are necessary for choice of treatment and qualification for heart transplant. Investigators are looking for new, valuable, additional parameters which could be of use in screening and heart disease progression assessment, and which may be helpful in the management and risk stratification of patients with DCM. These monitoring and prognostic tools in patients with chronic heart failure can be biomarkers, such as natriuretic peptides: BNP and NT-proBNP, cardiac troponins or inflammatory cytokines and their receptors. Moreover, there are ongoing research projects concerning persistently elevated uric acid, Ca-125 and osteopontin concentrations for the identification of patients with DCM, as well as adverse prognoses

Malignancy-Associated Dyslipidemia

Cholesterol and triglycerides, important lipid constituents of cell, are essential to carry out several vital physiological functions. Lipids might be associated with cancers because they play a key role in the maintenance of cell integrity. The pathway for cholesterol synthesis may also produce various tumorigenic compounds and cholesterol serves as a precursor for the synthesis of many sex hormones linked to increased risk of various cancers. In some malignant diseases, blood cholesterol undergoes early and significant changes. The mechanism for the link between cancer and cholesterol remains controversial. The dates from studies are confusing because both hypolipidemia and hypercholesterolemia might be connected with malignancy. Not only cancers but also antineoplastic therapies have an influence on lipid profile. There are also dates suggesting that antihyperlipemic drugs might nfluenced malignancy

Established and potential echocardiographic markers of embolism and their therapeutic implications in patients with ischemic stroke

Cardiogenic strokes comprised 11% of all strokes and 25% of ischemic strokes. An accurate identificationof the cause of stroke is necessary in order to prepare an adequate preventive strategy. In this reviewthe confirmed and potential causes of embolic strokes are presented, which can be detected in echocardiography in the context of present treatment guidelines and gaps in evidence. There remains a need for further studies assessing the meaning of potential cardiac sources of embolism and establishment of rules for optimal medical prevention (antiplatelet therapy [APT] vs. oral anticoagulation [OAC]) andinterventional procedures to reduce the incidence of ischemic strokes. Currently available data does not provide definitive evidence on the comparative benefits of OAC vs. APT in patients with cryptogenic stroke or embolic stroke of undetermined source. There is a lack of antithrombotic treatment scheme in the time between stroke and the completed diagnosis of potential sources of thromboembolism

Influence of Co-Existing Atrial Fibrillation on the Efficacy of Atorvastatin Treatment in Patients With Dilated Cardiomyopathy: A Pilot Study

INTRODUCTION: The aim of the study was to assess the influence of co-existing atrial fibrillation (AF) on inflammatory condition factors, left ventricular function, clinical course and the efficacy of statin treatment of congestive heart failure in the course of dilated cardiomyopathy (DCM). MATERIAL AND METHODS: In a prospective, randomized, open-label study, 69 patients with DCM and left ventricular ejection fraction (LVEF) ≤40% were divided into two groups, with and without AF, who were treated according to the recommended standards. 68% of patients from the group with AF and 59% of patients from the group without AF were administered atorvastatin 40 mg daily for 8 weeks and 10 mg for next 4 months. Clinical examination with the assessment of body mass index (BMI) and waist size were followed by routine laboratory tests, measurement of concentration of tumor necrosis factor (TNF-α), interleukin-6 (IL-6), and IL-10 in blood plasma, N-terminal pro-brain natriuretic peptide (NT-proBNP) concentration in blood serum, echocardiographic examination, and the assessment of exercise capacity in 6-minute walk test (6-MWT). After six months, morbidity rate and the number of heart failure hospitalizations were also observed. RESULTS: In the whole population of patients, a significantly higher concentration of NT-proBNP was observed in the AF group (2669 ± 2192 vs 1540 ± 1067, p = 0.02). After statin treatment, in patients with DCM and co-existing AF, higher values of NT-proBNP and IL-6 were observed compared to non-AF patients (1530 ± 1054 vs 1006 ± 1195, p = 0.04 and (14.16 ± 13.40 vs 6.74 ± 5.45, p = 0.02, respectively). CONCLUSION: In patients with DCM and co-existing AF, a weaker effect of atorvastatin concerning the reduction of IL-6 and NT-proBNP concentration was observed than in patients without atrial fibrillation. TRIALS REGISTRATION: (ClinialTrial.gov No.: NCT01015144

Wpływ przezcewnikowego zamknięcia przetrwałego otworu owalnego u pacjentów z udarem kryptogennym na zaburzenia rytmu serca- obserwacja 3-miesięczna

Background: Patent foramen ovale (PFO) is a common abnormality, occurring in about 25% of the population. Percutaneous PFO closure is recommended for selected patients in the prevention of recurrent thromboembolic events. Although transcatheter closure of PFO is recognized as a safe procedure, potential complications, such as atrial fibrillation, may occur. The purpose of this study was to assess the prevalence of arrhythmia in patients before and after PFO closure. Methods: We retrospectively reviewed the medical records of 45 patients (median age, 45 [IQR, 35–61] years; 80% female) who underwent percutaneous PFO closure. 24‑hour Holter electrocardiograms were done both before and 3 months after the procedure in 21 patients (median age, 49 [38–65] years; 81% female), however data of predominant underlying rhythm was available for all 45 patients. Results: There were no statistically significant differences in maximal and minimal heart rate, number of supraventricular and ventricular extrasystolic beats, pauses, episodes of supraventricular and ventricular tachycardia in patients before and after the PFO closure procedure. Median average heart rate was significantly higher before the procedure (70 [67–78] bpm vs 69 [62–77] bpm; p = 0,03). Among the 45 patients, one had a history of paroxysmal atrial fibrillation (AF) before the procedure. During the follow‑up, no AF was found. Conclusions: 1) Transcatheter closure of PFO did not affect arrhythmias observed in 24‑hour Holter ECG monitoring of our patients. 2) The procedure has a low risk of complications if performed in selected patients by an adequately trained operator in an experienced center.Wstęp: Przetrwały otwór owalny (PFO) to częsta anomalia, występująca u około 25% populacji. Zabieg przezskórnego zamykania PFO jest zalecany u wybranych pacjentów w celu zapobiegania nawrotom incydentów zakrzepowo-zatorowych. Mimo, że przezcewnikowe zamykanie PFO uznawane jest za zabieg bezpieczny, może być przyczyną potencjalnych powikłań, takich jak migotanie przedsionków. Celem pracy była ocena występowania arytmii u pacjentów przed i po zabiegu zamknięcia PFO. Metody: Retrospektywnie przeanalizowaliśmy dokumentację medyczną 45 pacjentów (mediana wieku, 45 [IQR, 35–61] lat; 80% kobiet), którzy przebyli zabieg przezskórnego zamknięcia PFO. 24-godzinne monitorowanie EKG metodą Holtera wykonano przed oraz 3 miesiące po zabiegu u 21 pacjentów (mediana wieku, 49 [38–65] lat; 81% kobiet), jednak dane o rytmie prowadzącym były dostępne dla wszystkich 45 pacjentów. Wyniki: Nie wykazano istotnych statystycznie różnic w zakresie maksymalnej i minimalnej częstości pracy serca, liczby nadkomorowych i komorowych pobudzeń dodatkowych, liczby pauz, liczby epizodów częstoskurczów nadkomorowych lub komorowych u pacjentów przed i po zabiegu zamknięcia PFO. Mediana średnich częstości pracy serca była istotnie wyższa przed zabiegiem (70 [67–78] bpm vs 69 [62–77] bpm; p = 0,03). Wśród 45 pacjentów u jednej osoby stwierdzano napadowe migotanie przedsionków (AF) przed zabiegiem. Podczas 3 miesięcznej obserwacji nie wykryto żadnego epizodu AF. Wnioski: 1) Zabieg przezcewnikowego zamknięcia PFO nie wpłynął na arytmie obserwowane w 24-godzinnym monitorowaniu EKG metodą Holtera w badanej grupie. 2) Zabieg ma niskie ryzyko powikłań, o ile wykonywany jest u właściwie zakwalifikowanych pacjentów, przez odpowiednio wyszkolonego operatora i w doświadczonym ośrodku

Dorosła z Tetralogią Fallota, anomalią odejścia tętnicy wieńcowej, niescaleniem lewej komory, ubytkiem w przegrodzie międzyprzedsionkowej i nawracającym zwężeniem w drodze odpływu prawej komory

Advances in therapeutical possibilities for patients with complex congenital heart defects are unquestionable. Nonetheless, it is still probable to encounter unique challenges. The study presents a case of a symptomatic 25-year-old female patient with uncorrected Tetralogy of Fallot who has never been qualified for surgery due to an unusual constellation of cardiac congenital comorbidities: anomalous coronary artery origin and non-compaction of the left ventricle.Postępy w możliwościach terapeutycznych dla pacjentów ze złożonymi wrodzonymi wadami serca są nie do zakwestionowania. Jednakże wciąż istnieje prawdopodobieństwo napotkania wyjątkowych wyzwań. W niniejszej pracy zaprezentowano przypadek objawowej 25-letniej pacjentki z nieskorygowaną Tetralogią Fallota, która nigdy nie była zakwalifikowana do operacji z powodu unikatowej konstelacji wrodzonych schorzeń serca: anomalii odejścia tętnicy wieńcowej i kardiomiopatii z niescalenia lewej komory

Complex percutaneous intervention on pulmonary arteries in an adult patient with a corrected Taussig-Bing anomaly

W niniejszej pracy przedstawiono przypadek udanej złożonej interwencji przezskórnej na tętnicach płucnych u 23-letniego dorosłego pacjenta ze skorygowaną anomalią Taussiga–Binga. Wada skorygowana była zabiegiem typu arterial switch; ponadto w wywiadzie odnotowano przebytą operację Bentalla i wymianę zastawki mitralnej. Przy przyjęciu pacjent był bezobjawowy, jednak wykryto istotne zwężenie tętnic płucnych. Pacjent został zakwalifikowany do cewnikowania serca. Złożony zabieg wysokiego ryzyka z implantacją trzech stentów poprawił morfologię prawej tętnicy płucnej, a w konsekwencji funkcję prawej komory. Podsumowując, dzięki niezwykłemu rozwojowi technik przezskórnych, coraz więcej pacjentów otrzymuje optymalne, spersonalizowane leczenie.This study reports a case of a successful complex percutaneous intervention on pulmonary arteries in a 23-year-old adult patient with a corrected Taussig-Bing anomaly. The patient had a history of multiple surgeries, including an arterial switch operation, the Bentall procedure, and mitral valve replacement. On admission, the patient was asymptomatic, however significant stenosis of the pulmonary arteries was detected. The patient was qualified for cardiac catheterization. The complex, high-risk procedure with the implantation of three stents improved the morphology of the right pulmonary artery and consequently the function of the right ventricle. It is concluded that with the remarkable development of percutaneous techniques, more and more patients are receiving optimal, personalised treatment

Familial hypercholesterolaemia in children and adolescents from 48 countries: a cross-sectional study

Background: Approximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2·1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches, which are derived from observations in adults. We aimed to characterise children and adolescents with heterozygous familial hypercholesterolaemia (HeFH) and understand current approaches to the identification and management of familial hypercholesterolaemia to inform future public health strategies. Methods: For this cross-sectional study, we assessed children and adolescents younger than 18 years with a clinical or genetic diagnosis of HeFH at the time of entry into the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry between Oct 1, 2015, and Jan 31, 2021. Data in the registry were collected from 55 regional or national registries in 48 countries. Diagnoses relying on self-reported history of familial hypercholesterolaemia and suspected secondary hypercholesterolaemia were excluded from the registry; people with untreated LDL cholesterol (LDL-C) of at least 13·0 mmol/L were excluded from this study. Data were assessed overall and by WHO region, World Bank country income status, age, diagnostic criteria, and index-case status. The main outcome of this study was to assess current identification and management of children and adolescents with familial hypercholesterolaemia. Findings: Of 63 093 individuals in the FHSC registry, 11 848 (18·8%) were children or adolescents younger than 18 years with HeFH and were included in this study; 5756 (50·2%) of 11 476 included individuals were female and 5720 (49·8%) were male. Sex data were missing for 372 (3·1%) of 11 848 individuals. Median age at registry entry was 9·6 years (IQR 5·8-13·2). 10 099 (89·9%) of 11 235 included individuals had a final genetically confirmed diagnosis of familial hypercholesterolaemia and 1136 (10·1%) had a clinical diagnosis. Genetically confirmed diagnosis data or clinical diagnosis data were missing for 613 (5·2%) of 11 848 individuals. Genetic diagnosis was more common in children and adolescents from high-income countries (9427 [92·4%] of 10 202) than in children and adolescents from non-high-income countries (199 [48·0%] of 415). 3414 (31·6%) of 10 804 children or adolescents were index cases. Familial-hypercholesterolaemia-related physical signs, cardiovascular risk factors, and cardiovascular disease were uncommon, but were more common in non-high-income countries. 7557 (72·4%) of 10 428 included children or adolescents were not taking lipid-lowering medication (LLM) and had a median LDL-C of 5·00 mmol/L (IQR 4·05-6·08). Compared with genetic diagnosis, the use of unadapted clinical criteria intended for use in adults and reliant on more extreme phenotypes could result in 50-75% of children and adolescents with familial hypercholesterolaemia not being identified. Interpretation: Clinical characteristics observed in adults with familial hypercholesterolaemia are uncommon in children and adolescents with familial hypercholesterolaemia, hence detection in this age group relies on measurement of LDL-C and genetic confirmation. Where genetic testing is unavailable, increased availability and use of LDL-C measurements in the first few years of life could help reduce the current gap between prevalence and detection, enabling increased use of combination LLM to reach recommended LDL-C targets early in life

A case of pregnant patient with stenotic bicuspid aortic valve

Key Clinical Message Asymptomatic severe aortic stenosis (AS) during pregnancy remains challenging; however, the postponement of surgery with the possibility of valvuloplasty as a bridge therapy seems reasonable. Our case showed that despite physiological changes during pregnancy, the aortic valve defect did not worsen, which allowed us to avoid dilemmas related to anticoagulation on artificial valve. Abstract A 31‐year‐old woman, with a bicuspid aortic aorta, post‐aortic valvulotomy, was listed for cardiac surgery because of severe aortic stenosis. However, the operation was postponed due to procreation plans. During the pregnancy and delivery, we did not observe neither deterioration of symptoms nor changes of echocardiographic parameters. Subsequent monthly echocardiographic studies did not reveal a significant increase of peak and mean aortic gradient. Presented case reports showed that despite physiological changes associated with pregnancy, the aortic valve defect did not worsen, which allowed to avoid dilemmas related to anticoagulation on artificial valves