Transfermoral transcatheter aortic valve implantation using self-expanding Allegra bioprosthesis: One-year single-center outcomes

Background: The NAUTILUS study aimed to evaluate the safety and performance of the Allegra bioprosthesis in high-risk recipients undergoing transcatheter aortic valve implantation and were reported on 30-day outcomes. Hence, are the presented 1-year results of the trial. Methods: Twenty-seven recipients with severe, symptomatic aortic valve stenosis at high surgical risk, who underwent treatment using the next-generation self-expanding Allegra via transfemoral approach were prospectively enrolled. Clinical endpoints assessed were: mortality, stroke, permanent pacemaker implantation, New York Heart Association class and re-hospitalizations. Prosthetic valve performance evaluation comprised of: mean gradient, effective orifice area and paravalvular leak. Results: Patients were elderly (82.8 ± 4.2 years) and predominantly female (n = 19, 70.4%). All of them were deemed to be at high surgical risk with a mean logistic EuroSCORE of 12.5 ± 6.7. The bioprosthesis was successfully implanted in 92.6% of the cases (n = 25). At 1-year, all-cause mortality was 12.0% (n = 3) and stroke was 4.0% (n = 1). Three (12%) of patients developed complete atrioventricular block and received permanent pacemakers. 84% of patients were in New York Heart Association class II or lower. Need for subsequent hospitalization arose in 48% patients. The echocardiographic assessment confirmed an acceptable hemodynamic profile of the Allegra with low mean transprosthetic gradient (9.5 ± 3.4 mmHg), absence of severe paravalvular leak and a 20%-presence of moderate paravalvular leak. Conclusions: The current follow-up observation study shows that the Allegra was associated with a satisfactory safety profile and hemodynamic performance at 1-year after implantation

Transthoracic echocardiography in adults — guidelines of the Working Group on Echocardiography of the Polish Cardiac Society

This document presents current Polish guidelines on the clinical use of transthoracic echocardiography, including stress examinations, in adult patients. The examinations with pocket-size imaging devices are also discussed. The authors present recommendations regarding indications and contraindications, staff and equipment requirements, patient preparation and information, examination protocol, reporting and reimbursement.This document presents current Polish guidelines on the clinical use of transthoracic echocardiography, including stress examinations, in adult patients. The examinations with pocket-size imaging devices are also discussed. The authors present recommendations regarding indications and contraindications, staff and equipment requirements, patient preparation and information, examination protocol, reporting and reimbursement

Transesophageal echocardiography in adults — guidelines of the Working Group on Echocardiography of the Polish Cardiac Society

This document presents current Polish guidelines on the clinical use of transesophageal echocardiography, including guidance of percutaneous procedures and intraoperative echocardiography, in adult patients. The authors present recommendations regarding indications and contraindications, staff and equipment requirements, patient preparation and information, examination protocol, reporting and reimbursement.This document presents current Polish guidelines on the clinical use of transesophageal echocardiography, including guidance of percutaneous procedures and intraoperative echocardiography, in adult patients. The authors present recommendations regarding indications and contraindications, staff and equipment requirements, patient preparation and information, examination protocol, reporting and reimbursement

Być zdolnym – wspierać zdolnych

Praca recenzowana / peer-reviewed paperByć zdolnym – wspierać zdolnych to książka szczególna. Zawiera teksty napisane przez nauczycieli – uczestników studiów podyplomowych Praca z uczniem zdolnym. Stanowią oni pierwszą grupę specjalistów w zakresie rozpoznawania, opieki i wspierania uczniów zdolnych w województwie świętokrzyskim. Takie kadry są szczególnie potrzebne wobec zmian w systemie pracy ze zdolnymi, wdrażanych w szkołach i placówkach od roku szkolnego 2011/2012. Studia były realizowane w ramach projektu Benild – Doskonalenie Świętokrzyskich Kadr Oświaty, współfinansowanego ze środków Unii Europejskiej w ramach Europejskiego Funduszu Społecznego, na Uniwersytecie Jana Kochanowskiego w Kielcach. Celem studiów było nabywanie przez nauczycieli kompetencji w obszarze identyfikacji i wspierania uczniów zdolnych

Echocardiographic predictors of thrombus in left atrial appendage-The role of novel transthoracic parameters

INTRODUCTION: The left atrium appendage thrombus (LAAT) formation is a complex process. A CHA2DS2-VASc scale is an established tool for determining the thromboembolic risk and initiation of anticoagulation treatment in patients with atrial fibrillation or flutter (AF/AFL). We aimed to identify whether any transthoracic echocardiography (TTE) parameters could have an additional impact on LAAT detection. METHODS: That is a sub-study of multicenter, prospective, observational study LATTEE (NCT03591627), which enrolled 3,109 consecutive patients with AF/AFL referred for transesophageal echocardiography (TEE) before cardioversion or ablation. RESULTS: LAAT was diagnosed in 8.0% of patients. The univariate logistic regression analysis [based on pre-specified in the receiver operating characteristic (ROC) analysis cut-off values with AUC ≥ 0.7] identified left ventricular ejection fraction (LVEF) ≤ 48% and novel TTE parameters i.e., the ratios of LVEF and left atrial diameter (LAD) ≤ 1.1 (AUC 0.75; OR 5.64; 95% CI 4.03-7.9; p < 0.001), LVEF to left atrial area (LAA) ≤ 1.7 (AUC 0.75; OR 5.64; 95% CI 4.02-7.9; p < 0.001), and LVEF to indexed left atrial volume (LAVI) ≤ 1.1 (AUC 0.75, OR 6.77; 95% CI 4.25-10.8; p < 0.001) as significant predictors of LAAT. In a multivariate logistic regression analysis, LVEF/LAVI and LVEF/LAA maintained statistical significance. Calculating the accuracy of the abovementioned ratios according to the CHA2DS2-VASc scale values revealed their highest predictive power for LAAT in a setting with low thromboembolic risk. CONCLUSION: Novel TTE indices could help identify patients with increased probability of the LAAT, with particular applicability for patients at low thromboembolic risk

Left Atrial Thrombus in Atrial Fibrillation/Flutter Patients in Relation to Anticoagulation Strategy: LATTEE Registry

BACKGROUND: Atrial fibrillation (AF) and flutter (AFl) increase the risk of thromboembolism. The aim of the study was to assess the prevalence of left atrial thrombus (LAT) in AF/AFl in relation to oral anticoagulation (OAC). METHODS: LATTEE (NCT03591627) was a multicenter, prospective, observational study enrolling consecutive patients with AF/AFl referred for transesophageal echocardiography before cardioversion or ablation. RESULTS: Of 3109 patients enrolled, 88% were on chronic, 1.5% on transient OAC and 10% without OAC. Of patients on chronic OAC, 39% received rivaroxaban, 30% dabigatran, 14% apixaban and 18% vitamin K antagonists (VKA). Patients on apixaban were oldest, had the worst renal function and were highest in both bleeding and thromboembolic risk, and more often received reduced doses. Prevalence of LAT was 8.0% (7.3% on chronic OAC vs. 15% without OAC; p &lt; 0.01). In patients on VKA, prevalence of LAT was doubled compared to patients on non-VKA-OACs (NOACs) (13% vs. 6.0%; p &lt; 0.01), even after propensity score weighting (13% vs. 7.5%; p &lt; 0.01). Prevalence of LAT in patients on apixaban was higher (9.8%) than in those on rivaroxaban (5.7%) and dabigatran (4.7%; p &lt; 0.01 for both comparisons), however, not after propensity score weighting. CONCLUSIONS: The prevalence of LAT in AF is non-negligible even on chronic OAC. The risk of LAT seems higher on VKA compared to NOAC, and similar between different NOACs