Subkliniczna przebudowa lewego przedsionka u chorego z częstymi przedwczesnymi skurczami komorowymi

Background: Premature ventricular contractions (PVCs) may cause subtle changes in left atrium (LA) structure and function which may not be readily detected by conventional parameters.Aim: To explore the relationship between PVCs and LA shape and size remodelling in patients without known structural heart disease.Methods: PVC frequency per 24 h was divided into tertiles. Echocardiographic measurements included left ventricular ejection fraction (LVEF) and volume, LA volume (LAV), mid-LA transverse diameter (LAt), and basal LA maximal transverse diameter (LAb). Trapezoidal LA shape was defined by LAt less than LAb. The association between PVCs and LA shape was explored bymultivariable adjusted logistic regression.Results: The 121 patients had a mean age of 43.1 years (63% male) and mean LVEF of 56%. Mean LAV was 57.7 mL in the lowest PVC tertile, 70.9 mL in the middle, and 87.1 mL in the highest PVC tertile (p < 0.001). Trapezoidal LA shape was documented in 32 patients. Five per cent of patients in the lowest and 65% in the highest PVC tertile had trapezoidal LA shape (p < 0.001). PVC frequency correlated with LAV (r = 0.87, p < 0.001) and LAb (r = 0.56, p < 0.001). Each 10% increase in PVCs was significantly associated with trapezoidal LA shape (OR = 1.32, 95% CI 1.17–1.48), after adjustment for age, sex, mean blood pressure, LVEF, and LV end-diastolic diameter.Conclusions: Frequent PVCs are associated with larger LAV and trapezoidal LA shape in otherwise healthy patients, suggesting LA remodelling in response to increased LV filling pressure. Wstęp: Przedwczesne skurcze komorowe (PVCs) mogą powodować subtelne zmiany w strukturze i czynności lewego przedsionka (LA), które mogą być trudne do wykrycia na podstawie analizy konwencjonalnych parametrów.Cel: Celem pracy była ocena zależności między występowaniem PVC a zmianą kształtu i wielkości LA u pacjentów bez stwierdzonej strukturalnej choroby serca.Metody: Częstość występowania PVC w ciągu 24 h podzielono na tercyle. Zmierzone parametry echokardiograficzne obejmowały frakcję wyrzutową lewej komory (LVEF), objętość lewej komory, objętość lewego przedsionka (LAV), wymiar poprzeczny LA w połowie wysokości (LAt, mid-LA transverse diameter) i maksymalny wymiar poprzeczny LA mierzony u jego podstawy (LAb, basal LA maximal transverse diameter). Trapezoidalny kształt LA definiowano jako wartość LAt mniejszą niż wartość LAb. Zależności między występowaniem PVC a kształtem LA analizowano, stosując wieloczynnikową regresję logistyczną (dane skorygowane).Wyniki: W badaniu uczestniczyło 121 chorych, których średnia wieku wynosiła 43,1 roku (63% mężczyzn), a średnia LVEF— 56%. Średnia LAV wynosiła 57,7 ml w najniższym tercylu PVC, 70,9 ml w środkowym tercylu i 87,1 ml w najwyższym tercylu (p < 0,001). Trapezoidalny kształt LA stwierdzono u 32 osób. U 5% chorych w najniższym tercylu i u 65% chorych w najwyższym tercylu kształt LA był trapezoidalny (p < 0,001). Częstość PVC wiązała się z LAV (r = 0,87; p < 0,001) i LAb(r = 0,56; p < 0,001). Każde zwiększenie PVC o 10% istotnie korelowało z trapezoidalnym kształtem LA (OR = 1,32; 95% CI 1,17–1,48) po skorygowaniu względem wieku, płci, średniego ciśnienia tętniczego, LVEF i wymiaru końcowo rozkurczowego LV.Wnioski: Częste przedwczesne PVC wiążą się z większymi wartościami LAV i trapezoidalnym kształtem LA u pacjentów bez żadnych innych chorób, co sugeruje przebudowę LA w odpowiedzi na zwiększone ciśnienie napełniania LV

Przywrócenie rytmu zatokowego w trzepotaniu lub migotaniu przedsionków: dabigatran jako bezpieczny lek niewymagający kontroli za pomocą echokardiografii przezprzełykowej

Background and aim: To assess the safety of dabigatran in converting persistent atrial fibrillation (PAF) and atrial flutter (AFL) to sinus rhythm (SR) without transoesophageal echocardiography (TEE) evaluation. Methods: Consecutive patients with PAF or AFL were included between 2012 and 2015. Dabigatran was used for three weeks before and six months after cardioversion. Left atrium area (LAA) and left atrium volume (LAV) were assessed in all patients. Follow-up visits for major cardiac events occurred at 1, 3, 6, and 12 months. Results: The study included 82 patients (56 male, mean age 63.1 ± 10.4 years), of which 45 had PAF and 37 AFL. In patients with PAF, mean LAA was 30.3 ± 5.3 cm2 and LAV 114.4 ± 31.5 mL; in those with AFL mean LAA was 26.5 ± 4.2 cm2 and LAV 97 ± 24.9 mL at baseline. Forty-nine patients underwent uncomplicated electric cardioversion (38 with PAF and 11 with AFL), 11 patients were pharmacologically converted to SR (7 with PAF and 4 with AFL), and 22 patients with AFL underwent successful radiofrequency ablation. The mean CHA2DS2-VASc score was 2.96 ± 1.39 (score > 3, 58.6%). No major cardiac events occurred during the follow-up period of 19.4 ± 9.5 months. Conclusions: Safe cardioversion using dabigatran was achieved in this small group of patients without the need for TEE.Wstęp i cel: Badanie przeprowadzono, aby przeanalizować bezpieczeństwo stosowania daibatranu w przywracaniu rytmu zatokowego (SR) u chorych z przetrwałym migotaniem przedsionków (PAF) i trzepotaniem przedsionków (AFL) bez oceny za pomocą echokardiografii przezprzełykowej (TEE). Metody: Do badania włączono kolejnych chorych z PAF lub AFL w okresie od 2012 do 2015 r. Dabigatran stosowano 3 tygodnie przed kardiowersją i 6 miesięcy po kardiowersji. U wszystkich pacjentów zmierzono pole powierzchni (LAA) i objętość (LAV) lewego przedsionka. Wizyty kontrolne w celu oceny występowania poważnych zdarzeń sercowych odbywały się po 1, 3, 6 i 12 miesiącach. Wyniki: Badanie obejmowało 82 chorych (56 mężczyzn, średnia wieku 63,1 ± 10,4 roku), w tym 45 osób z PAF i 37 z AFL. Na początku badania u pacjentów z PAF średnie LAA wynosiło 30,3 ± 5,3 cm2, a średnia LAV — 114,4 ± 31,5 ml, natomiast u chorych z AFL średnie LAA wynosiło 26,5 ± 4,2 cm2, a średnia LAV — 97 ± 24,9 ml. Czterdziestu dziewięciu chorych poddano niepowikłanej kardiowersji elektrycznej (38 osób z PAF i 11 osób z AFL), u 11 pacjentów przywrócono SR, stosując kardiowersję farmakologiczną (7 osób z PAF i 4 osób z AFL), a u 22 chorych z AFL wykonano skuteczną ablację prądem o wysokiej częstotliwości. Średnia punktacja w skali CHA2DS2-VASc wynosiła 2,6 ± 1,39 (58,6% chorych z punktacją > 3). W trwającej 19,4 ± 9,5 miesiąca obserwacji nie odnotowano poważnych zdarzeń sercowych. Wnioski: Stosowanie dabigatranu pozwoliło uzyskać w tej niewielkiej grupie pacjentów skuteczną kardiowersję bez konieczności wykonania TEE

An Insight into the Structural Diversity and Clinical Applicability of Polyurethanes in Biomedicine

Due to their mechanical properties, ranging from flexible to hard materials, polyurethanes (PUs) have been widely used in many industrial and biomedical applications. PUs’ characteristics, along with their biocompatibility, make them successful biomaterials for short and medium-duration applications. The morphology of PUs includes two structural phases: hard and soft segments. Their high mechanical resistance featuresare determined by the hard segment, while the elastomeric behaviour is established by the soft segment. The most important biomedical applications of PUs include antibacterial surfaces and catheters, blood oxygenators, dialysis devices, stents, cardiac valves, vascular prostheses, bioadhesives/surgical dressings/pressure-sensitive adhesives, drug delivery systems, tissue engineering scaffolds and electrospinning, nerve generation, pacemaker lead insulation and coatings for breast implants. The diversity of polyurethane properties, due to the ease of bulk and surface modification, plays a vital role in their applications

Morphological Study of Fossa Ovalis in Formalin-Fixed Human Hearts and Its Clinical Importance

Background and Objectives: Our study aimed to investigate the gross anatomy aspects of the fossa ovalis (FO) and the presence of some anatomical variation resulting from the incomplete fusion of septum primum and septum secundum, such as an atrial septal pouch (SP) and left atrial septal ridge. Materials and Methods: Thirty-one adult human hearts removed from formalin-fixed specimens were examined to provide information about the morphology of the FO. The organs were free of any gross anatomically visible pathological conditions. Results: The most common variants were the FO located in the inferior part of the interatrial septum (64.51%), circular (61.3%), with a net-like structure (51.62%), prominent limbus (93.55%), and patent foramen ovale (PFO) (25.8%). The right SP was observed in 9.67% of specimens, the left SP was observed in 29.03% of cases, and in 51.61% of cases, a double SP was observed. One sample presented a right SP and a double left SP, and one case showed a triple left SP, which was not reported previously to our knowledge. Conclusions: Knowledge of the interatrial septal anatomy becomes important for interventional cardiologists and should be documented before transeptal puncture

Metformin Acutely Mitigates Oxidative Stress in Human Atrial Tissue: A Pilot Study in Overweight Non-Diabetic Cardiac Patients

Metformin, the first-line drug in type 2 diabetes mellitus, elicits cardiovascular protection also in obese patients via pleiotropic effects, among which the anti-oxidant is one of the most investigated. The aim of the present study was to assess whether metformin can acutely mitigate oxidative stress in atrial tissue harvested from overweight non-diabetic patients. Right atrial appendage samples were harvested during open-heart surgery and used for the evaluation of reactive oxygen species (ROS) production by means of confocal microscopy (superoxide anion) and spectrophotometry (hydrogen peroxide). Experiments were performed after acute incubation with metformin (10 µM) in the presence vs. absence of angiotensin II (AII, 100 nM), lipopolysaccharide (LPS, 1 μg/mL), and high glucose (Gluc, 400 mg/dL). Stimulation with AII, LPS, and high Gluc increased ROS production. The magnitude of oxidative stress correlated with several echocardiographic parameters. Metformin applied in the lowest therapeutic concentration (10 µM) was able to decrease ROS generation in stimulated but also non-stimulated atrial samples. In conclusion, in a pilot group of overweight non-diabetic cardiac patients, acute incubation with metformin at a clinically relevant dose alleviated oxidative stress both in basal conditions and conditions that mimicked the activation of the renin–angiotensin–aldosterone system, acute inflammation, and uncontrolled hyperglycemia

The Importance of DS-14 and HADS Questionnaires in Quantifying Psychological Stress in Type 2 Diabetes Mellitus

Background and Objectives: The comorbid association between type 2 diabetes mellitus (T2DM) and a psychological profile characterized by depression and/or anxiety has been reported to increase the risk of coronary heart disease (CAD), the most striking macrovascular complication of diabetes. The purpose of the present study was to quantify anxiety, depression and the presence of type D personality, and to correlate the scores obtained with cardiovascular risk factors and disease severity in diabetic patients. Materials and methods: The retrospective study included 169 clinically stable diabetic patients divided into two groups: group 1 without macrovascular complications (n = 107) and group 2 with CAD, stroke and/or peripheral vascular disease (n = 62). A biochemical analysis and an assessment of psychic stress by applying the Hospital Anxiety and Depression Scale (HADS)and the Type D scale (DS-14) to determine anxiety, depression and D personality scores were done in all patients. Statistical analysis was made using SPSSv17 and Microsoft Excel, non-parametric Kruskal–Wallis and Mann–Whitney tests. Results: Following application of the HAD questionnaire for the entire group (n = 169), anxiety was present in 105 patients (62.2%), and depression in 96 patients (56.8%). Group 2 showed significantly higher anxiety scores compared to group 1 (p = 0.014), while depression scores were not significantly different. Per entire group, analysis of DS-14 scores revealed social inhibition (SI) present in 56 patients (33%) and negative affectivity (NA) in 105 patients (62%). TheDS-14 SI score was significantly higher in group 2 compared to group 1 (p = 0.036). Type D personality, resulting from scores above 10 in both DS-14 parameter categories, was present in 51 patients of the study group (30%). There was a direct and significant correlation (r = 0.133, p = 0.025) between the Hospital Anxiety and Depression Scale-Anxiety (HAD-A) score and the LDL-c values. Conclusions: The results of this study demonstrated that more than a half of patients with diabetes had anxiety and/or depression and one third had Type D personality, sustaining that monitoring of emotional state and depression should be included in the therapeutic plan of these patients. New treatment strategies are needed to improve the well-being of diabetic patients with psychological comorbidities

Betablockers and Ivabradine Titration According to Exercise Test in LV Only Fusion CRT Pacing

Background: Betablockers (BB)/ivabradine titration in fusion CRT pacing (CRTP) is understudied. Aim: To assess drug optimization using systematic exercise tests (ET) in fusion CRTP with preserved atrioventricular conduction (AVc). Methods: Changes in drug management were assessed during systematic follow-ups in CRTP patients without right ventricle lead. Shorter AVc (PR interval) allowed BB up-titration, while longer AVc needed BB down-titration, favoring ivabradine. Constant fusion pacing was the goal to improve outcomes. Results: 64 patients, 62.5 ± 9.5 y.o divided into three groups: shorter PR (<160 ms), normal (160–200 ms), longer (200–240 ms); follow-up 59 ± 26 months. Drugs were titrated in case of: capture loss due to AVc shortening (14%), AVc lengthening (5%), chronotropic incompetence (11%), maximum tracking rate issues (9%), brady/tachyarrhythmias (8%). Interventions: BB up-titration (78% shorter PR, 19% normal PR, 5% longer PR), BB down-titration (22% shorter PR, 14% normal PR), BB exclusion (16% longer PR), adding/up-titration ivabradine (22% shorter PR, 19% normal PR, 5% longer PR), ivabradine down-titration (22% shorter PR, 3% normal PR), ivabradine exclusion (11% normal PR, 5% longer PR). Drug strategy was changed in 165 follow-ups from 371 recorded (42% patients). Conclusions: BBs/ivabradine titration and routine ET during follow-ups in patients with fusion CRTP should be a standard approach to maximize resynchronization response. Fusion CRTP showed a positive outcome with important LV reverse remodeling and significant LVEF improvement in carefully selected patients