Fusion of morphological data obtained by coronary computed tomography angiography with quantitative echocardiographic data on regional myocardial function

Background: Three-dimensional (3D) fusion of morphological data obtained by coronary computed tomography angiography (CCTA) with functional data from resting and stress echocardiography could potentially provide additional information compared to examination results analyzed separately and increase the diagnostic and prognostic value of non-invasive imaging in patients with suspected coronary artery disease (CAD). Using vendor-independent software developed in our institution, we aimed to assess the feasibility and reproducibility of 3D fusion of morphological CCTA data with echocardiographic data regarding regional myocardial function. Methods: Thirty patients with suspected CAD underwent CCTA and resting transthoracic echocardiography. From CCTA we obtained 3D reconstructions of coronary arteries and left ventricle (LV). Offline speckle-tracking analysis of the echocardiographic images provided parametric maps depicting myocardial longitudinal strain in 17 segments of the LV. Using our software, 3 independent investigators fused echocardiographic maps with CCTA reconstruc­tions in all patients. Based on the obtained fused models, each segment of the LV was assigned to one of the major coronary artery branches. Results: Mean time necessary for data fusion was 65 ± 7 s. Complete agreement between independent investigators in assignment of LV segments to coronary branches was obtained in 94% of the segments. The average coefficient of agreement (kappa) between the investigators was 0.950 and the intra-class correlation coefficient was 0.9329 (95% CI 0.9227–0.9420). Conclusions: Three-dimensional fusion of morphological CCTA data with quantitative echocardiographic data on regional myocardial function is feasible and allows highly repro­ducible assignment of myocardial segments to coronary artery branches

Conscious sedation for transcatheter implantation of atrial septal occluders with two- and three-dimensional transoesophageal echocardiography guidance — a feasibility and safety study

Background: General anaesthesia may have negative impact on patient mortality and morbidity, as well as overall procedure costs, in atrial septal occluder (ASO) implantation. Aim: We sought to evaluate the safety, efficacy, and feasibility of conscious sedation for transcatheter implantation of ASOs. Methods: A total of 122 patients referred for transcatheter implantation of ASO were included. Mean patient age was 51 ± 15 years, and 43 (35%) patients were male. The initial dose of midazolam was 2 mg and fentanyl dose was 25 μg. Additional doses of midazolam and fentanyl were administered, if necessary. Patient responsiveness was assessed every 10 min, and the sedatives doses were titrated in order not to exceed grade 3 sedation in the Ramsey scale. Results: Atrial septal occluders were successfully implanted in the majority of patients (98.4%). In two (1.6%) cases the proce­dure failed because of too small patent foramen ovale (PFO) diameter (n = 1, 0.8%) or device instability (n = 1, 0.8%). The mean duration of procedure was 47.6 ± 28.4 min and was similar for ASD and PFO closure (p = 0.522). The overall mean dose of midazolam was 4.7 ± 2.2 mg (63.9 ± 32.5 μg/kg) and fentanyl was 30.0 ± 11.9 μg (0.43 ± 0.17 μg/kg). Median entrance dose of radiation at the patient plane was 25 (interquartile range: 16–57) mGy, and did not differ between ASD and PFO procedures (p = 0.614). The majority of patients were free of complications (91.0%). The following early complications were observed: transient ischaemic attack (n = 2, 1.6%), supraventricular arrhythmias (n = 4, 3.3%), left atrial thrombus formation (n = 1, 0.8%), symptomatic bradycardia (n = 1, 0.8%), and femoral venous bleeding (n = 5, 4.1%). After mean follow-up of 386 days residual shunt was observed in eight (6.6%) patients. Conclusions: Conscious sedation for transcatheter implantation of ASO is a feasible, safe, and efficient technique, allowing successful PFO and ASD closure in the majority of patients.Background: General anaesthesia may have negative impact on patient mortality and morbidity, as well as overall procedure costs, in atrial septal occluder (ASO) implantation. Aim: We sought to evaluate the safety, efficacy, and feasibility of conscious sedation for transcatheter implantation of ASOs. Methods: A total of 122 patients referred for transcatheter implantation of ASO were included. Mean patient age was 51 ± 15 years, and 43 (35%) patients were male. The initial dose of midazolam was 2 mg and fentanyl dose was 25 μg. Additional doses of midazolam and fentanyl were administered, if necessary. Patient responsiveness was assessed every 10 min, and the sedatives doses were titrated in order not to exceed grade 3 sedation in the Ramsey scale. Results: Atrial septal occluders were successfully implanted in the majority of patients (98.4%). In two (1.6%) cases the proce­dure failed because of too small patent foramen ovale (PFO) diameter (n = 1, 0.8%) or device instability (n = 1, 0.8%). The mean duration of procedure was 47.6 ± 28.4 min and was similar for ASD and PFO closure (p = 0.522). The overall mean dose of midazolam was 4.7 ± 2.2 mg (63.9 ± 32.5 μg/kg) and fentanyl was 30.0 ± 11.9 μg (0.43 ± 0.17 μg/kg). Median entrance dose of radiation at the patient plane was 25 (interquartile range: 16–57) mGy, and did not differ between ASD and PFO procedures (p = 0.614). The majority of patients were free of complications (91.0%). The following early complications were observed: transient ischaemic attack (n = 2, 1.6%), supraventricular arrhythmias (n = 4, 3.3%), left atrial thrombus formation (n = 1, 0.8%), symptomatic bradycardia (n = 1, 0.8%), and femoral venous bleeding (n = 5, 4.1%). After mean follow-up of 386 days residual shunt was observed in eight (6.6%) patients. Conclusions: Conscious sedation for transcatheter implantation of ASO is a feasible, safe, and efficient technique, allowing successful PFO and ASD closure in the majority of patients

Echokardiograficzna ocena złożonego mechanizmu ciężkiej niedomykalności mitralnej u pacjentki 59-letniej — współistnienie wypadania segmentu P2 z częściowym rozszczepem tylnego płatka zastawki mitralnej

Pacjentka 59-letnia z nadciśnieniem tętniczym i hipercholesterolemią została przyjęta do kliniki kardiologii z powodu znacznego pogorszenia tolerancji wysiłku (do IV klasy wg NYHA), narastającej duszności (do spoczynkowej włącznie) oraz znacznego stopnia obrzęków obwodowych i cech retencji płynów. W EKG stwierdzono rytm zatokowy, miarowy o częstości 72/min, zespoły QS w odprowadzeniach I i aVL, ujemne załamki T w odprowadzeniach III i aVF oraz pojedyncze monomorficzne pobudzenia dodatkowe pochodzenia komorowego

Flow-mediated skin fluorescence: A novel method for the estimation of sleep apnea risk in healthy persons and cardiac patients

Background: This pilot study revealed a relationship between the results of flow mediated skin fluorescence (FMSF) and of ECG-Holter-based estimated apnea/hypopnea index (eAHI) in asymptomatic individuals. The aim was to test whether the results of FMSF show a relationship with the eAHI in patients with coronary artery disease or aortic stenosis. Methods: Twenty-one patients (12 coronary disease, 9 aortic stenosis) and 37 healthy volunteers were included in this study. FMSF was assessed before, during and after the pressure occlusion of the brachial artery, using a prototype device allowing the quantification of skin fluorescence. The values of FMSF expressed as baseline (BASE), maximum (MAX), and minimum (MIN) were analyzed. The percentages of ischemic response (IR) and hyperemic response (HR) were calculated. The eAHI was assessed from night ECG-Holter recordings. Differences between the groups and the relationships between the parameters were analyzed statistically. Results: Mean ± standard deviation of BASE, MAX, MIN and IR were not significantly different in both groups (p > 0.05). HR was significantly lower in cardiac patients (14.7 ± 7.5 vs. 11.8 ± 5.1; p = 0.048), whose eAHI was significantly higher (11.0 ± 7.4 vs. 36.3 ± 16.5; p < 0.01). Negative correlation for MAX and eAHI was found in volunteers and patients: r = –0.38, p = 0.02 and r = –0.47, p = 0.03, respectively. In volunteers, HR had a negative correlation with eAHI: r = –0.34, p = 0.04. Conclusions: This pioneer study confirms that FMSF can be used to detect the negative correlation between MAX fluorescence and eAHI not only among healthy volunteers, but also among cardiac patients with coronary artery disease or aortic stenosis

Ocena funkcji prawego przedsionka za pomocą echokardiografii metodą śledzenia markerów akustycznych

Introduction. Speckle tracking echocardiography (STE) is a well-established tool to assess cardiac function parameters, however, the value of this tool in the assessment of right atrial (RA) function is still largely unknown. The aim of the study is to investigate the feasibility of RA function assessment by STE and the relationship between right ventricular (RV) deformation and the function of the RA. Material and methods. 94 patients with various cardiovascular pathologies have been included in the study group. All patients underwent transthoracic echocardiography with subsequent off-line analysis using speckle tracking technique and measurement of numerous RA deformation parameters, including peak atrial longitudinal strain (PALS) and peak atrial contraction strain (PACS), as well as established indices of RV function, such as tricuspid annular peak systolic excursion (TAPSE) and global longitudinal strain (GLS). Results. RA function assessment by STE was feasible in all patients. A statistically significant correlation was observed between RA strain (PACS and PALS) and RV parameters. RV-GLS showed weak correlation with PALS (r = –0.38; p = 0.0015) and PACS (r = –0.30; p = 0.013). Similarly, TAPSE correlated with PALS and PACS (r = 0.34; p = 0.02) and (r = 0.23; p = 0.04) respectively. Conclusion. RA function assessment by STE is feasible. The RA deformation parameters weakly correlate with RV function indices, indicating that other factors significantly influence RA function. Therefore, the RA function cannot be regarded as a direct barometer of the RV function.Wstęp. Echokardiografia metodą śledzenia markerów akustycznych (STE) jest uznanym narzędziem oceny parametrów czynności serca, jednak wartość tego narzędzia w ocenie czynności prawego przedsionka (RA) jest nadal w dużej mierze nieznana. Celem pracy jest zbadanie możliwości oceny funkcji RA za pomocą STE oraz związku między deformacją prawej komory (RV) a funkcją RA. Materiał i metody. Do badanej grupy włączono 94 osoby z różnymi patologiami sercowo-naczyniowymi. U wszystkich pacjentów wykonano echokardiografię przezklatkową z późniejszą analizą off-line z wykorzystaniem techniki śledzenia markerów akustycznych i pomiarem licznych parametrów deformacji RA, w tym szczytowe odkształcenie podłużne przedsionków (PALS) i szczytowe napięcie skurczowe przedsionków (PACS), a także ustalonych wskaźników funkcji RV, takich jak: wychylenie skurczowe pierścienia trójdzielnego (TAPSE) i globalne odkształcenie podłużne (GLS). Wyniki. Ocena funkcji RA za pomocą echokardiografii śladowej plamki była możliwa u wszystkich pacjentów. Zaobserwowano statystycznie istotną korelację między odkształceniem prawej komory (PACS i PALS) a parametrami RV. RV-GLS wykazało słabą korelację z PALS (r = –0,38; p = 0,0015) i PACS (r = –0,30; p = 0,013). Podobnie TAPSE korelowało z PALS i PACS (r = 0,34; p = 0,02) i (r = 0,23; p = 0,04). Wnioski. Ocena funkcji RA za pomocą echokardiografii metodą śledzenia markerów akustycznych jest możliwa. Parametry deformacji RA słabo korelują ze wskaźnikami funkcji RV, co wskazuje, że inne czynniki mają istotny wpływ na funkcję RA. Dlatego funkcja RA nie może być traktowana jako bezpośredni barometr funkcji RV

Tętniak prawdziwy po bezobjawowym zawale dolnej ściany lewej komory jako podłoże ciężkiej wtórnej niedomykalności mitralnej

Przedstawiony opis przypadku ukazuje nietypowy, bezobjawowy przebieg choroby wieńcowej z wytworzeniem tętniaka prawdziwego lewej komory, powodującego ciężką, przez długi czas skąpoobjawową, niedomykalność zastawki mitralnej