Clinical forms of infective endocarditis in Kaunas University of Medicine Hospital in 2002–2005

Objectives. To determine the incidence and distribution of clinical forms of infective endocarditis and to compare these data with data of 1983–1993. Material and methods. A retrospective analysis of clinical data of 116 patients with infective endocarditis treated in Kaunas University of Medicine Hospital in 2002–2005 was performed. The data were compared with analogical data of 1983–1993. Results. During 2002–2005, 55 (47.4%) patients presented with classic symptoms of infective endocarditis. In 61 cases, atypical clinical manifestations were observed: 19 patients presented with heart failure symptoms, 14 patients with embolic symptoms, 9 with pulmonary manifestations, and 5 patients with septic manifestations. There were three cases of nephritic form, three cases of rheumatic form, three cases of meningoencephalitic form, and two cases of ophthalmic form. In three cases, pacemaker endocarditis was seen. During the period of 1983–1993, 15 patients with infective endocarditis were treated annually in Kaunas University of Medicine Hospital; in 2002–2005, this number increased to 29 cases per year. More cases of embolic and pulmonic clinical forms of infective endocarditis were diagnosed as compared to the data of 1983–1993 (P<0.05). There were more cases of primary endocarditis in 2002–2005 than in 1983–1993 (36.2% and 23.8%, respectively, P<0.05). Conclusions. Typically, infective endocarditis manifests as classical symptoms, but in more than half of cases, atypical forms were observed, the most common of which were heart failure form and embolic form. Primary infective endocarditis was detected more frequently

Changes of electrophysiological parameters in patients with atrial flutter

Objectives. The aim of the study was to study some anatomic and electrophysiological features of the right atrium, related to the presence of atrial flutter. Materials and methods. A total 23 patients with type I atrial flutter and 22 patients without atrial flutter were studied. Right atrium size was assessed using echocardiography before intracardiac examination and radiofrequency ablation. Results. Effective refractory periods of coronary sinus, high right atrium, low right atrium were different comparing with the control group (P<0.05). A stimulus–response time between high right atrium and low right atrium positions in anterograde and retrograde ways, an impulse propagation speed along the lateral wall of the right atrium were statistically different comparing both groups (P<0.05). There was a significant correlation among effective refractory periods measured in different sites of the right atrium (r²=0.64, 0.44, 0.44, respectively). All measured effective refractory periods also correlated with stimulus–response time in anterograde way (P<0.05) and impulse propagation speed (P<0.05). Right atrium dimensions were significantly larger in atrial flutter group. There was no correlation between the right atrium dimensions and measured electrophysiological parameters in both groups.Conclusions. The presence of atrial flutter associates with diffuse alterations of the right atrium, but not the focal or single changes of refractoriness

Positron Emission Tomography in the Diagnosis and Management of Coronary Artery Disease

Cardiac positron emission tomography (PET) and positron emission tomography/computed tomography (PET/CT) are encouraging precise non-invasive imaging modalities that allow imaging of the cellular function of the heart, while other non-invasive cardiovascular imaging modalities are considered to be techniques for imaging the anatomy, morphology, structure, function and tissue characteristics. The role of cardiac PET has been growing rapidly and providing high diagnostic accuracy of coronary artery disease (CAD). Clinical cardiology has established PET as a criterion for the assessment of myocardial viability and is recommended for the proper management of reduced left ventricle (LV) function and ischemic cardiomyopathy. Hybrid PET/CT imaging has enabled simultaneous integration of the coronary anatomy with myocardial perfusion and metabolism and has improved characterization of dysfunctional areas in chronic CAD. Also, the availability of quantitative myocardial blood flow (MBF) evaluation with various PET perfusion tracers provides additional prognostic information and enhances the diagnostic performance of nuclear imaging

Components of Left Ventricular Ejection and Filling in Patients With Aortic Regurgitation Assessed by Speckle-Tracking Echocardiography

The aim of our study was to evaluate left ventricular (LV) longitudinal, radial, and rotational function and its relationship with conventional LV parameters of systolic and diastolic function in patients with aortic regurgitation (AR) by speckle-tracking echocardiography. Material and Methods. A total of 26 asymptomatic patients with moderate AR, 34 patients with severe AR, and 28 healthy controls were included into the study. LV rotation and longitudinal and radial strain were measured offline using speckle-tracking imaging. Results. The systolic longitudinal strain (–18.3% [SD, 2.18%] vs. –21.0% [SD, 2.52%], P<0.05) and strain rate (–1.08 s–1 [SD, 0.13 s–1] vs. –1.27 s–1 [SD, 0.15 s–1], P<0.05) were significantly lower and apical rotation (11.3° [SD, 4.99°] vs. 8.30° [SD, 4.34°], P<0.05) as well as rotation rate (82.72°/s [SD, 28.24 °/s] vs. 71.00°/s [SD, 28.04 °/s], P<0.05) were significantly higher in the patients with moderate AR compared with the control patients. The LV systolic basal rotation, systolic radial strain, and diastolic radial strain rate were significantly reduced in the patients with severe AR compared with the control patients. The global longitudinal, radial strain, and LV systolic diameter were the independent predictors of LV ejection fraction in the patients with AR (R2=0.77). The LV systolic basal rotation in the control patients, diastolic longitudinal strain rate and systolic longitudinal strain in the patients with moderate and severe AR, respectively, were independent predictors of LV diastolic filling. Conclusions. LV long-axis dysfunction with an increased apical rotation was present in the patients with moderate AR, while LV radial function and systolic basal rotation were found to be reduced in more advanced disease. LV diastolic filling depended on diastolic and systolic LV strain and rotation components in the patients with AR

Širdies nepakankamumo biožymenų naudojimo gairės [elektroninis išteklius] : metodinė priemonė

Diagnozuoti ŠN, parinkti gydymą, įvertinti pacientų prognozę – sunki užduotis. Šiai užduočiai spręsti vis dažniau pasitelkiami biožymenys, taikytini tiek ūminiais, tiek planiniais atvejais, kai sprendimus priima ne tik gydytojai kardiologai, bet ir skubios pagalbos specialistai, vidaus ligų, šeimos ir kitų specializacijų gydytojai. Biožymenų įvertinimo tyrimus atlikti patogu, jie atliekami greitai. Tai padeda tinkamai planuoti ir organizuoti paciento, sergančio ŠN, gydymą ir priežiūrą. Pirmosios nacionalinių ekspertų rekomendacijos naudoti biožymenis – raktas į laiku diagnozuotą ŠN, ypač pirminėje sveikatos priežiūros grandyje, laiku skirtą hospitalizaciją ir pačių pažeidžiamiausių ŠN pacientų rizikos įvertinimą. ŠN biožymenų naudojimo metodika remiasi naujausiomis Europos, Jungtinių Amerikos Valstijų ir Jungtinės Karalystės kardiologų draugijų gairėmis, sveikatos technologijų įvertinimu. Šios priemonės paskirtis – paskatinti trijų labiausiai ištirtų biožymenų (natriuretinių peptidų, širdies troponinų ir tumorogenezės slopiklio) tyrimų racionalų taikymą visais paciento, sergančio ŠN, priežiūros etapaisBiologijos katedraLietuvos sveikatos mokslų universitetasLietuvos sveikatos mokslų universitetas. Medicinos akademijaVilniaus universitetasVytauto Didžiojo universiteta

Širdies nepakankamumo biožymenų naudojimo gairių santrauka. ST2 žymens vieta

Biologijos katedraLietuvos sveikatos mokslų universitetasLietuvos sveikatos mokslų universitetas. Medicinos akademijaVilniaus universitetasVytauto Didžiojo universiteta

Širdies nepakankamumo biožymenų naudojimo gairės

Biologijos katedraLietuvos sveikatos mokslų universitetasLietuvos sveikatos mokslų universitetas. Medicinos akademijaVilniaus universitetasVytauto Didžiojo universiteta

Dobutamine-stress echocardiography speckle-tracking imaging in the assessment of hemodynamic significance of coronary artery stenosis in patients with moderate and high probability of coronary artery disease

Background and objective: Myocardial deformation indices are considered as sensitive markers of ischemia and may be useful in the quantification of hemodynamic significance of coronary artery disease (CAD). We sought to determine the diagnostic value of speckletracking echocardiography derived myocardial deformation parameters at rest and during stress to determine hemodynamically significance coronary artery stenosis in patients with moderate and high probability of CAD. Materials and methods: In 81 patients (mean age, 64 ± 8.6 years) with stable CAD inducible myocardial ischemia was evaluated by dobutamine stress echocardiography (DSE) and adenosine magnetic resonance imaging (AMRI). Based on AMRI patients were divided into two groups: nonpathologic (n = 41) and pathologic (n = 40). Strain and strain rate (SR) parameters and their changes from the rest (BASE) to low stress (MIN), peak stress (MAX), and recovery (REC) were analyzed using 2D speckle-tracking imaging (STI). Results: In the nonpathologic group, systolic longitudinal and circumferential strain increased significantly from BASE to MIN, as well as systolic SR from BASE to MIN and from MIN to MAX in longitudinal plane. In contrast, in the pathologic group, insignificant longitudinal systolic SR increase and radial and circumferential systolic SR decrease from MIN to MAX was observed. Discriminant function analysis revealed that select STI derived parameters best classify patients into predefined AMRI groups (pathologic and nonpathologic) with the accuracy respectively 90.9% and 83.3%. According to ROC analysis these myocardial deformation parameters had the greatest predictive value of significant coronary artery stenoses: longitudinal strain at high dose (AUC 0.811, sensitivity 89.4%, specificity 64.7%), longitudinal strain rate at high dose (AUC 0.855, sensitivity 88.1%, specificity 71.0% at high doses). The sensitivity and specificity of inducible wall motion abnormalities were 74.0% and 85.0% (AUC 0.798) and was lower compared with the diagnostic value of longitudinal myocardial deformation parameters. Conclusions: Left ventricular strain and strain rate analyses during DSE can be used in the assessment of hemodynamic significance of coronary artery stenosis in patients with moderate and high risk for CAD