The prevalence of left atrial enlargement in Polish patients with atrial fibrillation — a single center study

Background. Atrial fibrillation (AF) remains one of the major causes of cardiovascular morbidity worldwide. Left atrial enlargement (LAE) is a common risk factor of AF. Left atrial enlargement is also connected with a higher prevalence of heart failure in AF patients. The aim of this study was to assess the prevalence of LAE in Polish patients with AF. Material and methods. Transthoracic echocardiography was performed in consecutive AF patients hospitalized in the Department of Heart Diseases. We assessed LAE using a two-dimensional method. Left atrial (LA) size was classified into the 4 categories: normal (LAE values < 39 mm in women and < 41 mm in men), mildly enlarged (39–42 mm in women and 41–46 mm in men), moderately enlarged (43–46 mm in women and 47–51 mm in men), and severely enlarged (≥ 47 mm in women and ≥ 52 mm in men). Results. We analyzed 113 individuals with AF (mean age 77.2 ± 9.8 years; 37.2% men). Of these, 71 (62.8%) patients had LAE (age 77.6 ± 9.9 years; 36.6% men). LA was mildly enlarged (39–42 mm in women and 41–46 mm in men) in 20 (28.2%) patients, moderately enlarged (43–46 mm in women and 47–51 mm in men) was observed in 30 (42.3%), and severely enlarged (≥ 47 mm in women and ≥ 52 mm in men) in 21 (29.6%) patients. The incidence of heart failure was significantly higher in AF patients with LAE [39 (54.9%) compared to the patients without LAE — 12 (28.6%) p = 0.01]. Conclusions. In patients with AF, LAE was highly prevalent. Patients with AF and LAE have more often HF compared to AF patients without LAE

Cardiac tumors : leiomyosarcoma - a case report

We present a case report of a 60-year-old woman with a long history of leiomyosarcoma in different locations. She was admitted to the clinic due to a left ventricular tumor diagnosed in ECHO examination. The patient was qualified for radical tumor resection. The early postoperative period was complicated due to low cardiac output syndrome and bradyarrhythmia requiring temporary cardiac pacing. Optimized pharmacological therapy resulted in a gradual reduction of symptoms and a clinical improvement of congestive heart failure (NYHA III – NYHA II). Due to the radical nature of the surgery, the patient was not referred for supplementary treatment. The follow-up currently exceeds 12 months – no new metastases have been found. This case provides an example of how to diagnose and treat heart tumors

Nagłe zatrzymanie krążenia u pacjentki z kardiomiopatią okołoporodową i zatorowością płucną

Peripartum cardiomyopathy is a type of dilatated cardiomyopathy, occuring with symptoms of heart failure (HF) during lastmonth of pregnancy or within 5 months after labour. Authors are presenting the case of patient admitted to hospital primarywith diagnosis of non-high risk pulmonary embolism 6 weeks after delivery, who developed episode of sudden cardiac deathfollowed by symptoms of cardiogenic shock. Peripartum cardiomyopathy was additionally diagnosed. After HF treatment withbromocriptine supply, gradual clinical improvement was achieved. The patient was discharged after 15 days of hospitalisationwith diagnosis of peripartum cardiomyopathy with non-high risk pulmonary embolism

Stroke in young diver with patent foramen ovale

Patent foramen ovale (PFO) is the most common cause of right-to-left shunt which carries a significant risk for stroke when associated with venous thrombosis, coagulation abnormalities or other conditions. We present a young male in whom diving was associated with stroke in a subject with otherwise clinically silent PFO. Kardiol Pol 2012; 70, 1: 55–5

Echocardiographic evaluation of cardiovascular system in adolescent athletes in view of physiological adaptation to physical training

Wstęp. Ocena układu krążenia u młodych sportowców pozostaje tematem aktywnych badań. Duże trudności pojawiają się w zakresie oceny wielkości i grubości jam serca ze względu na istotne różnice antropometryczne między poszczególnymi zawodnikami gdzie trening fizyczny (nierzadko bardzo intensywny) nakłada się na okres dojrzewania i szybkiego wzrostu. Celem pracy była ocena wpływu regularnego wysiłku fizycznego na układ krążenia u dorastających sportowców. Materiał i metody. W badaniu oceniano 89 sportowców — 41 jeden piłkarzy oraz tenisistów (grupa 1.) oraz 48 rozpoczynających karierę sportową wioślarzy (grupa 2.). U wszystkich kwalifikujących się zawodników wykonano badanie ergospirometryczne z oceną szczytowego pochłaniania tlenu (VO2max) oraz badania elektrokardiograficzne i echokardiograficzne. Wyniki. Porównano sportowców z obu grup, tj. piłkarzy i tenisistów (grupa 1.) z grupą wioślarzy (grupa 2.). Obie grupy nie różniły się wiekiem (14,2 ± 1,1 v. 14,3 ± 1,2 roku; p = NS) oraz płcią (dziewczęta: 6 [7,6%] v. 8 [10,2%]; p = NS]. Dłużej trenujący piłkarze i tenisiści, w porównaniu z grupą wioślarzy, różnili się pod względem parametrów antropometrycznych, parametrów wydolności fizycznej oraz spoczynkowej częstości rytmu serca. Większość wymiarów jam serca indeksowanych względem pola powierzchni ciała była większa w grupie osób dłużej trenujących piłkarzy i tenisistów (końcoworozkurczowy wymiar lewej komory: 29,1 ± 2,5 v. 26,8 ± 2,7 mm/m2; p < 0,001; grubość przegrody międzykomorowej: 6,0 ± 0,7 v. 5,4 ± 0,8 mm; p = 0,001; grubość ściany tylnej: 0,8 ± 0,6 v. 5,2 ± 0,6; p < 0,001; proksymalny fragment drogi odpływu prawej komory: 16,1 ± 2,2 v. 14,5 ± 2,0 mm/m2; p = 0,001; wymiar drogi napływu prawej komory: 19,9 ± 2,1 v. 18,5 ± 2,6 mm/m2; p = 0,01). Po zastosowaniu indeksacji allometrycznej większość oberwanych różnic przestała mieć znaczenie istotne statystycznie, z wyjątkiem indeksowanej masy lewej komory (87,0 ± 13,9 v. 76,8 ± 12,2 g/(m2)1,5; p = 0,001). Wnioski. 1. Zastosowanie indeksacji allometrycznej w stosunku do parametrów echokardiograficznych u dorastających sportowców wydaje się właściwe ze względu na nieliniową zależność pomiędzy tempem wzrostu, a szybkością zwiększania się narządów wewnętrznych w tej grupie wiekowej. 2. Nawet krótki trening fizyczny u dorastających sportowców ma istotny wpływ na poprawę parametrów wydolności fizycznej, bez znaczącego wpływu na większość parametrów morfologicznych serca.Introduction. Assessment of cardiovascular system in young athletes is a subject of active research. Cardiac morphology is difficult to evaluate due to significant anthropometric differences between individuals, especially during puberty and growth spurt. The aim of this paper was an assessment of systematic physical training’s impact on cardiovascular system and cardiac remodeling in young athletes. Material and methods. Study involved 89 adolescent athletes, including 41 football players and tennis players (group 1) and 48 beginner rowers (group 2). All athletes included in the study underwent ergospirometric tests with evaluation of peak oxygen uptake (VO2max) as well as a 12-lead electrocardiographic and echocardiographic evaluation. Results. Athletes in group 1 (football/tennis players) were compared to group 2 (rowers). There were no significant differences in age (14.2 ± 1.1 vs. 14.3 ± 1.2 years, p = NS) or sex (6 [7.6%] vs. 8 women [10.2%], respectively, p = NS). Differences were observed in anthropometric parameters, cardiopulmonary fitness, and resting heart rate. Most parameters of cardiac morphology indexed to body area (indexed value: raw data/bodu surface area) were greater in group 1 (left ventricular end-diastolic dimension 29.1 ± 2.5 vs. 26.8 ± 2.7 mm/m2, p < 0.001; septal thickness: 6.0 ± 0.7 vs. 5.4 ± 0.8 mm, p = 0.001; posterior wall thickness: 0.8 ± 0.6 vs. 5.2 ± 0.6, p < 0.001; proximal part of right ventricle outflow tract: 16.1 ± 2.2 vs. 14.5 ± 2.0 mm/m2, p = 0.001; right ventricle inflow tract: 19.9 ± 2.1 vs. 18.5 ± 2.6 mm/m2, p = 0.01). When allometric scaling was employed, most differences were insignificant, apart from indexed left ventricle mass (87.0 ± 13.9 vs. 76.8 ± 12.2 g/(m2)1.5, p = 0.001). Conclusions. 1. Allometric indexation of echocardiographic parameters in young athletes is appropriate since relationship between body height increase and the rate of internal organ growth in these subjects is non-linear. 2. Even a short physical training in young athletes has impact on their condition but does not significantly affect parameters of cardiac morphology

Ubytek przegrody międzykomorowej u sportowca wyczynowego

The ventricular septum defect (VSD) is one of the congenital heart diseases that in developed countries can be rarely found in adults. We present a case of young athlete, member of the Polish Olympic Team, diagnosed with VSD during medical check-up. The congenital heart disease did not prevent the athlete from participating in sport on world-class level. Kardiol Pol 2010; 68; 9: 1067-106

Left atrial appendage thrombus in patients with atrial fibrillation who underwent oral anticoagulation

Background: Electric cardioversion of atrial fibrillation (AF) is associated with an increased risk of embolism, with embolic material existing in the heart cavities. The initiation of oral anticoagulation therapy reduces the risk of thromboembolic events. The aims of this study were to evaluate the prevalence of left atrial appendage (LAA) thrombi in non-valvular AF, to compare vitamin K antagonists (VKAs) and non-vitamin K oral anticoagulants (NOACs) with respect to thrombus prevalence, and to evaluate the rate of LAA thrombus persistence on repeat transesophageal echocardiography (TEE) after treatment change. Methods: We enrolled 160 consecutive AF patients who presented with an AF duration > 48 h and had undergone TEE before cardioversion. Results: Left atrial appendage thrombus was observed in 12 (7.5%) patients, and spontaneous echo contrast 4 was observed in 19 (11.8%) patients; the incidence was similar between the NOAC and VKA groups (8.9% vs. 3.6% and 12.4% vs. 18.5 %, respectively). Among patients on NOAC, thrombus prevalence was detected in 8.4% of users of rivaroxaban, 8% of users of dabigatran, and 12.5% of users of apixaban. Conclusions: The LAA thrombus developed in 7.5% of patients despite anticoagulation therapy, demonstrating similar prevalence rates among patients either on NOAC or VKA. Lower mean LAA flow velocity and a history of vascular disease were independent predictors of embolic material in the LAA. It seems that in the case of embolic materials in LAA under NOAC treatment, switching to VKA provides additional clinical benefit to the patients