The impact of pulmonary regurgitation on right ventricular size and function in patients with repaired tetralogy of Fallot and additional haemodynamic abnormalities

Purpose: Right ventricular (RV) outflow tract obstruction (RVOTO) was demonstrated to be protective against RV dilatation in patients with repaired tetralogy of Fallot and chronic pulmonary regurgitation (PR). We hypothesised that the presence of additional haemodynamic abnormalities (more than mild tricuspid regurgitation, residual ventricular septal defect) reduces this protective association. Accordingly, we aimed to assess the impact of PR on RV size and function in this population. Material and methods: Consecutive patients with additional haemodynamic abnormalities after tetralogy of Fallot (TOF) repair, who had undergone cardiovascular magnetic resonance, were included. Results: Out of 90 patients studied, 18 individuals (mean age 32.5 ± 10.7 years, 72.2% males) met the inclusion criteria. There were no differences in RV volumes and ejection fraction between patients with and without RVOTO. Neither PR fraction (PRF) nor PR volume (PRV) correlated with RV end-diastolic volume (r = 0.36; p = 0.15 and r = 0.37; p = 0.14, respectively, for PRF and PRV) or RV end-systolic volume (r = 0.2; p = 0.42 and r = 0.19; p = 0.45, respectively, for PRF and PRV). Similarly, no significant correlations were observed between PRF or PRV and RV ejection fraction (r = –0.04; p = 0.87 and r = –0.03; p = 0.9, respectively). Conclusions: Additional haemodynamic abnormalities are associated with the abolition of the protective effect of RVOTO on RV size. There was no significant relationship between measures of PR and RV volumes in patients after TOF repair with concomitant haemodynamic abnormalities. These abnormalities acted as confounding factors in the assessment of the impact of pulmonary regurgitation on RV size and function

Pregnancy-related cardiac non-elective hospitalizations and pregnancy outcomes. A tertiary referral cardiac center experience

Background: Pregnant women with cardiovascular diseases (CVD) and their offspring are at higher risk of morbidity and mortality.Aims: To provide data on pregnancy outcomes among women with different types of CVD requiring non-elective cardiac hospitalization in a tertiary referral cardiac center.Methods: We identified all records of non-elective hospitalizations of pregnant women hospitalized between January 2009 through March 2018, at our institution — a tertiary referral cardiac center. The incidence and types of cardiac complications during pregnancy, as well as the pregnancy and offspring outcomes, were determined.Results: One hundred and sixty-one out of 328 pregnancy-related hospitalizations in 140 pregnancies were non-elective. Cardiac complications occurred in 62 (44%) pregnancies, with the most frequent being episodes of arrhythmia (22.1% pregnancies), followed by heart failure exacerbations (6.4% pregnancies). Maternal mortality reached 2.1% and affected only women with primary cardiomyopathies (CMP). Offspring mortality was 2.8%. Newborns of mothers with cardiac complications had significantly lower Apgar scores and gestational age at delivery, compared to mothers without cardiac complications.Conclusions: In our series mortality and morbidity among pregnant women with CVD hospitalizations were high. An unfavorable maternal outcome mainly affected women with CMP. Offspring of mothers with cardiovascular complications are prone to have a lower gestational age and Apgar score

Implantable cardioverter defibrillator use in arrhythmogenic right ventricular cardiomyopathy in North America and Europe

BACKGROUND AND AIMS: Implantable cardioverter-defibrillators (ICDs) are critical for preventing sudden cardiac death (SCD) in arrhythmogenic right ventricular cardiomyopathy (ARVC). This study aims to identify cross-continental differences in utilization of primary prevention ICDs and survival free from sustained ventricular arrhythmia (VA) in ARVC. METHODS: This was a retrospective analysis of ARVC patients without prior VA enrolled in clinical registries from 11 countries throughout Europe and North America. Patients were classified according to whether they received treatment in North America or Europe and were further stratified by baseline predicted VA risk into low- (25%/5 years) groups. Differences in ICD implantation and survival free from sustained VA events (including appropriate ICD therapy) were assessed. RESULTS: One thousand ninety-eight patients were followed for a median of 5.1 years; 554 (50.5%) received a primary prevention ICD, and 286 (26.0%) experienced a first VA event. After adjusting for baseline risk factors, North Americans were more than three times as likely to receive ICDs {hazard ratio (HR) 3.1 [95% confidence interval (CI) 2.5, 3.8]} but had only mildly increased risk for incident sustained VA [HR 1.4 (95% CI 1.1, 1.8)]. North Americans without ICDs were at higher risk for incident sustained VA [HR 2.1 (95% CI 1.3, 3.4)] than Europeans. CONCLUSIONS: North American ARVC patients were substantially more likely than Europeans to receive primary prevention ICDs across all arrhythmic risk strata. A lower rate of ICD implantation in Europe was not associated with a higher rate of VA events in those without ICDs

Nadwaga i otyłość a czynność systemowej prawej komory u osób dorosłych z wrodzonym skorygowanym przełożeniem pni tętniczych

Background: In congenitally corrected transposition of the great arteries the right ventricle (RV) supports systemic circulation, and patients are prone to develop heart failure over time. Chronic volume overload secondary to obesity may contribute to premature dysfunction of the systemic RV. Aim: The aim of our study was to assess the systemic RV function in overweight/obese adult patients with congenitally corrected transposition of the great arteries. Methods: Transthoracic echocardiographic studies and laboratory testing (N-terminal pro-B-type natriuretic peptide [NT-proBNP] assessment) were performed in patients with congenitally corrected transposition, who were scheduled for a routine examination, and the body mass index was calculated for each patient. Results: We studied 56 adults (31 men; mean age 33.9 years); 22 of whom were overweight (body mass index [BMI] of 25–29.9 kg/m2) or obese (BMI of 30 kg/m2 or more), and 34 of whom were normal weight (BMI below 25 kg/m2). Age, gender, heart rate, and blood pressure were similar in both groups. The mean NT-proBNP levels were not significantly different. On echocardiography, the overweight/obese patients had a decreased systemic RV fractional area change (0.38) compared to normal weight patients (0.43); p = 0.02. Moreover, a significant reduction in the global longitudinal strain in the overweight/obese group was observed (–15.3% vs. –18.3%; p = 0.01). Conclusions: Overweight/obesity in adult patients with congenitally corrected transposition of the great arteries is associated with impaired systemic RV function.Wstęp: U chorych z wrodzonym skorygowanym przełożeniem pni tętniczych komora morfologicznie prawa pełni rolę komory systemowej, co sprzyja rozwojowi niewydolności serca w długim okresie obserwacji. Dodatkowe przewlekłe przeciążenie objętościowe komory systemowej wtórne do nadwagi/otyłości może prowadzić do wcześniejszego upośledzenia jej czynności. Cel: Celem pracy była ocena czynności systemowej prawej komory u dorosłych chorych z wrodzonym skorygowanym przełożeniem pni tętniczych i nadwagą/otyłością. Metody: Do badania włączono 56 dorosłych osób z wrodzonym skorygowanym przełożeniem pni tętniczych, którzy zgłosili się na rutynową wizytę kontrolną w Instytucie Kardiologii. U każdego chorego wykonano przezklatkowe badanie echokar­diograficzne, oznaczono stężenie N-końcowego propeptydu natriuretycznego typu B (NT-proBNP) i wyliczono wskaźnik masy ciała (BMI). Wyniki: Średni wiek w badanej grupie wyniósł 33,9 ± 12,9 roku, 55% stanowili mężczyźni. U 22 chorych stwierdzono nadwagę (BMI 25–29.9 kg/m2) lub otyłość (BMI ≥ 30 kg/m2), a u 34 chorych — prawidłową masę ciała (BMI < 25 kg/m2). Wiek, płeć, częstość rytmu serca i wartości ciśnienia tętniczego były zbliżone w analizowanych grupach. Nie stwierdzono także istotnych różnic w zakresie stężeń NT-proBNP. W badaniu echokardiograficznym u chorych z nadwagą/otyłością zarejestrowano natomiast niższe wartości skurczowej zmiany pola powierzchni systemowej prawej komory w porównaniu z pacjentami z prawidłową masą ciała (0,38 ± 0,08 vs. 0,43 ± 0,06; p = 0,02). Wartości globalnego odkształcenia podłużnego mięśnia systemowej prawej komory były również istotnie niższe w grupie chorych z nadwagą/otyłością (–15,3% ± 3,4% vs. –18,3% ± 3,6%; p = 0,01). Wnioski: Nadwaga/otyłość u dorosłych pacjentów z wrodzonym skorygowanym przełożeniem pni tętniczych dodatkowo upośledza czynność systemowej prawej komory

Bezpieczeństwo stosowania leków przeciwwirusowych i przeciwzapalnych wydłużających odstęp QT u pacjentów z COVID‑19

Celem dokumentu nie jest ocena skuteczności leczenia lekami przeciwwirusowymi i przeciwmalarycznymi u chorych z COVID‑19 ani próba wpłynięcia na decyzje o rodzaju wdrażanego leczenia. Celem opracowania jest zwrócenie uwagi na możliwości ograniczenia ryzyka nagłego zgonu sercowego związanego ze stosowaniem tych leków i zapewnienie maksymalnego bezpieczeństwa pacjentom, którzy takiego leczenia wymagają.Celem dokumentu nie jest ocena skuteczności leczenia lekami przeciwwirusowymi i przeciwmalarycznymi u chorych z COVID‑19 ani próba wpłynięcia na decyzje o rodzaju wdrażanego leczenia. Celem opracowania jest zwrócenie uwagi na możliwości ograniczenia ryzyka nagłego zgonu sercowego związanego ze stosowaniem tych leków i zapewnienie maksymalnego bezpieczeństwa pacjentom, którzy takiego leczenia wymagają

Predictors of COVID-19 outcomes in adult congenital heart disease patients — anatomy versus function

Background: It is unclear whether patients with adult congenital heart disease (ACHD) should be considered as an increased risk population with poor outcomes when suffering from COVID-19.Aims: This study aimed to collect clinical outcome data and to identify risk factors of a complicated course of COVID-19  among ACHD patients.Methods: Among all outpatients who came to medical attention via telemedicine or direct physician contact at our institution between September 1, 2020 and March 31, 2021, we included all with a COVID-19 diagnosis. The incidence of COVID-19, a clinical course of the disease, and outcome were determined. Results: One hundred and four (8.7%) out of 1 197 patients who were seen at our outpatient clinic for ACHD patients met the definition of COVID-19. Most of them reported a mild course of COVID-19 (99 [95.5%]). Five patients (4.5%) experienced severe symptoms and needed hospitalization. Two patients (1.9% of all with a confirmed diagnosis, 40% with severe infection) died. In the multivariable analysis, decreased systemic ventricular systolic function and any significant valve stenosis were predictors of a complicated disease course. Conclusions: Our study confirmed previous results showing that a physiology-based model, rather than an anatomy-based model, better predicted COVID-19 outcomes among ACHD patients, which is of importance for patients and healthcare providers during the COVID-19 pandemic