The impact of a previous history of ischaemic episodes on the occurrence of left ventricular free wall rupture in the setting of myocardial infarction

Wstęp: Epizody niedokrwienne poprzedzające zawał serca (MI) stanowią jeden z mechanizmów obronnych przed skutkami nagłego niedokrwienia. Pęknięcie wolnej ściany lewej komory (CR) jest rzadkim powikłaniem MI, prowadzącym w większości przypadków do nagłego zgonu sercowego. Cel: Celem pracy była ocena wpływu przebytych epizodów niedokrwiennych (IE) na wystąpienie CR u chorych z ostrym MI (AMI) leczonych metodą przezskórnej interwencji wieńcowej (PCI). Metody: Badaniem objęto populację 270 pacjentów, u których w okresie wewnątrzszpitalnym wystąpił zgon w przebiegu AMI; wszyscy chorzy byli poddani PCI. Grupa badana (grupa CR) składała się z 49 osób, u których w okresie wewnątrzszpitalnym wystąpiło CR, a grupę kontrolną (grupa non-CR) stanowiło 221 chorych, u których zgon wystąpił z innego powodu niż CR. U wszystkich pacjentów CR potwierdzono sekcyjnie. Dane dotyczące przebytego MI uzyskano z wywiadu bądź na podstawie dokumentacji medycznej, a informacje na temat IE na podstawie obecności dolegliwości zgłaszanych przez chorego w przeszłości lub poprzedzających bezpośrednio wystąpienie obecnego AMI lub na podstawie dokumentacji medycznej. Wyniki: Chorzy, u których doszło do CR, byli starsi (70,3 &#177; 3,2 v. 65,2 &#177; 9,9 roku; p < 0,001), częściej CR dotyczyło kobiet (w grupie CR kobiety stanowiły 75%, a w grupie non-CR 60,2%; p < 0,001). W grupie chorych z CR częściej obserwowano przebyte IE (61,2% v. 40,2%; p = 0,003), rzadziej przebyty MI (14,2% v. 33,4%; p = 0,004), częściej wielonaczyniową chorobę wieńcową (77,5% v. 61,5%; p = 0,03), dłuższy czas od początku objawów do PCI (9,0 &#177; 5,5 v. 4,5 &#177; 3,2 h; p < 0,001) oraz rzadziej przebyte IE bez przebytego MI (6,1% v. 23,9%; p < 0,001). Niezależnymi czynnikami ryzyka wystąpienia CR w przebiegu AMI był starszy wiek (OR 1,1; 95% Cl 1,02&#8211;1,19), płeć żeńska (OR 0,2 dla płci męskiej; 95% Cl 0,07&#8211;0,52) i dłuższy czas od wystąpienia objawów do PCI (OR 1,25; 95% Cl 1,07&#8211;1,47). Wnioski: Obecność uprzednich IE u chorych bez przebytego MI stanowiła czynnik ochronny przed wystąpieniem CR w przebiegu AMI.Background: Ischaemic episodes preceding myocardial infarction (MI) are one of the defence mechanisms protecting the body from the consequences of sudden ischaemia. Left ventricular free wall rupture (LVFWR) is a rare complication of MI but leading, in a majority of patients, to sudden cardiac death. Aim: To assess the impact of a previous history of ischaemic episodes (IEs) on the occurrence of LVFWR in patients with acute MI (AMI) managed by percutaneous coronary intervention (PCI). Methods: The study population consisted of 270 patients who had died during hospitalisation for AMI. All the patients were managed by PCI. The study group (the LVFWR group) consisted of 49 patients who developed LVFWR during hospitalisation and the control group (the non-LVFWR group) consisted of the remaining 221 patients who had died from causes other than LVFWR. In all the patients with LVFWR the rupture was confirmed by autopsy. The data on AMI was obtained from history or medical records. The data on IEs was obtained on the basis of the symptoms that were reported by the patients in the past that directly preceded the most recent AMI or on the basis of medical records. Results: Compared to the non-LVFWR group the LVFWR group was characterised by an older age (70.3 &#177; 3.4 vs. 65.2 &#177; 9.9 years, p < 0.001) and a higher percentage of females (75.0% vs. 60.2%, p < 0.001). The LVFWR group was also characterised by a higher percentage of IEs in the past (61.2% vs. 40.2%, p = 0.003), a lower percentage of patients with a history of MI (14.2% vs. 33.4%, p = 0.004), a higher percentage of patients with multivessel coronary artery disease (77.5% vs. 61.5%, p = 0.03), a longer interval from the onset of symptoms to PCI (9.0 &#177; 5.5 vs. 4.5 &#177; 3.2 h, p < 0.001) and a lower percentage of patients with IEs in the past but without an MI (6.1% vs. 23.9%, p < 0.001). Our study showed that independent risk factors for LVFWR in the setting of AMI were: older age (OR 1.1, 95% CI 1.02&#8211;1.19), male sex (OR 0.2, 95% CI 0.07&#8211;0.52) and a longer interval between the onset of symptoms and PCI (OR 1.25, 95% CI 1.07&#8211;1.47). Conclusions: A previous history of IEs in patients without a previous history of AMI was a protective factor against the development of LVFWR in the setting of AMI

Cardiac rupture risk estimation in patients with acute myocardial infarction treated with percutaneous coronary intervention

Background: Cardiac rupture (CR) is a common cause of death following acute myocardial infarction (AMI). Despite improvements in AMI treatment, the frequency of CR remains considerable and in most cases leads to death. The aim of the study was to define the independent prognostic CR risk factors of AMI in patients treated with percutaneous coronary intervention (PCI). Methods: A total of 4,200 AMI patients treated by PCI were studied retrospectively. Two hundred and seventy patients who had died of AMI were examined. In all cases CR was confirmed in post-mortem examination. Results: Cardiac rupture occurred in 49 patients (18.1%). In the CR group, 24.4% patients received thrombolysis and 22.6% in the non-CR group (p = NS). The following characteristics were associated with a higher rate of CR in univariable analysis: age (70.3 &#177; 3.2 vs. 65.2 &#177; &#177; 9.9; p < 0.001), female (75.0% vs. 60.2%; p < 0.001), prior cardiac event and absence of myocardial infarction history (61.2% vs. 40.2%; p < 0.05 and 14.2% vs. 33.4%; p < 0.05), presence of QS complex in first ECG (75.5% vs. 52.0%, p < 0.05) and multiple coronary heart disease (75.5% vs. 61.5%, p < 0.05), and long time from onset of symptoms to thrombolysis and to PCI (8.1 &#177; 2.8 vs. 4.7 &#177; 2.3 hours, p < 0.001 and 9.0 &#177; 5.5 vs. 4.5 &#177; 3.2 hours, p < 0.001). In the multivariable analysis, independent predictors of CR were: age (OR: 1.1; 95% CI: 1.02-1.19; p = 0.01); female gender (OR: 0.2; 95% CI: 0.07-0.52; p = 0.001); time from onset of symptoms to PCI (OR: 1.15; 95% CI: 1.07-1.47; p = 0.003). Conclusions: Old age, female gender and long time from onset of symptoms to AMI treatment (independent of previous fibrinolysis) are independent factors of CR in PCI patients. (Cardiol J 2007; 14: 538-543)

Technika angiografii tętnic wieńcowych szczura

Background: Experimental cardiology investigations carried out on rat hearts involve problems with the anatomy and physiology of the coronary arteries. Coronarography is an imaging method of the coronary arteries which can be performed intravitaly as well as postmortem. The aim of the study was to present our own radiological method of postmortem imaging of the rat's coronary arteries. Material/Method: The investigation was done on anatomical preparations of the hearts of rats of the Sprague-Dawley® and Wistar® strains. In total, 69 arteriograms were obtained. The coronary arteries were filled with contrast medium consisting of 60% barium sulfate and a 10% solution of gelatin in a proportion of 3:2. Images of contrasted arteries were presented on X-ray film and, in some groups of rats, by a digital image converter. X-rays were performed using an apparatus we designed ourselves. This enabled image fixing of the arteries during full rotation of the heart about its axis. Results: The described method of contrasting and image presentation of the rat's coronary arteries was able to show consecutively the shape and topography of the arteries in a precise, spatial way in repeatable experiments. The authors demonstrated the existence of anatomical and topographic differences in the images of the investigated arteries in the rat compared with the human heart. They pointed out the presence of arterioarterial anastomoses. Conclusions: The authors suggest further research to gain a better understanding of the anatomy and physiology of the coronary circulation of the rat

Ocena ryzyka pęknięcia serca u pacjentów z ostrym zawałem serca poddanych przezskórnej interwencji wieńcowej

Wstęp: Pęknięcie serca jest częstą przyczyną śmierci pacjentów z ostrym zawałem serca (AMI). Pomimo postępu w leczeniu AMI do pęknięcia serca dochodzi dość często, a powikłanie to w większości przypadków prowadzi do śmierci. Celem tego badania było określenie niezależnych wskaźników predykcyjnych pęknięcia serca w przebiegu AMI u pacjentów poddanych przezskórnej interwencji wieńcowej (PCI). Metody: Zbadano retrospektywnie 4200 pacjentów z AMI leczonych za pomocą PCI. Analizą objęto 217 osób, które zmarły z powodu AMI. We wszystkich przypadkach pęknięcie serca potwierdzono w badaniu pośmiertnym. Wyniki: Pęknięcie serca wystąpiło u 49 pacjentów (18,1%). W grupie osób z pęknięciem serca leczenie trombolityczne zastosowano u 24,4% chorych, w porównaniu z 22,6% pacjentów, u których nie doszło do pęknięcia serca (p = NS). Z większym ryzykiem pęknięcia serca w analizie jednozmiennej wiązały się następujące cechy: wiek (70,3 &#177; 3,2 vs. 65,2 &#177; 9,9 roku; p < 0,001), płeć żeńska (75,0% vs. 60,2%; p < 0,001); wcześniejszy incydent sercowy (61,2% vs. 40,2%; p < 0,05), negatywne wywiady w kierunku uprzednio przebytego zawału (częstość występowania uprzednio przebytego zawału: 14,2% vs. 33,4%; p < 0,05), obecność zespołów QS w pierwszym elektrokardiogramie (75,5% vs. 52,0%; p < 0,05), choroba wielu tętnic wieńcowych (75,5% vs. 61,5%; p < 0,05) oraz długi czas od początku wystąpienia objawów do trombolizy lub PCI (odpowiednio 8,1 &#177; 2,8 vs. 4,7 &#177; 2,3 h, p < 0,001 oraz 9,0 &#177; 5,5 vs. 4,5 &#177; &#177; 3,2 h; p < 0,001). W analizie wielozmiennej niezależnymi wskaźnikami predykcyjnymi pęknięcia serca były: wiek [iloraz szans (OR) 1,1; 95-procentowy przedział ufności (CI) 1,02-1,19; p = 0,01], płeć żeńska (OR 0,2 dla płci męskiej w porównaniu z żeńską; 95% CI 0,07-0,52; p = 0,001) oraz czas od początku objawów do PCI (OR 1,15; 95% CI 1,07-1,47; p = 0,003). Wnioski: Starszy wiek, płeć żeńska i długi czas od początku wystąpienia objawów do leczenia AMI (niezależnie od wcześniejszej trombolizy) są niezależnymi czynnikami ryzyka pęknięcia serca u pacjentów poddawanych PCI. (Folia Cardiologica Excerpta 2008; 3: 79-84)

State-of-the-art of transcatheter treatment of aortic valve stenosis and the overview of the InFlow project aiming at developing the first Polish TAVI system

Initial experience of transcatheter aortic valve implantation (TAVI) or replacement (TAVR) has ap-peared as a promising minimally invasive technology for patients disqualified from surgical treatment (SAVR). Safety and efficacy of TAVI has been analyzed and assessed through numerous registries and trials. Furthermore, results obtained from comparative TAVI vs. SAVR trials proved that both treat¬ments can be considered equal in terms of post-procedural mortality and morbidity in high-risk, as well as lower risk patients. However, there are still some issues that have to be addressed, such as higher chance of paravalvular leakage, vascular injuries, conduction disturbances, malpositioning and the yet unmet problem of insufficient biological valves durability. Recent technological developments along with the learning curve of operators prove a great potential for improvement of TAVI and a chance of surpassing SAVR in various groups of patients in the near future. In pursuit of finding new solutions, the CardValve Consortium consisting of leading scientific and research institutions in Poland has been created. Under the name of InFlow and financial support from the National Center for Research and Development, they have started a project with the aim to design, create and implement into clinical practice the first, Polish, low-profile TAVI valve system, utilizing not only biological but also artificial, polymeric-based prosthesis. This review focuses on current developments in TAVI technologies including the InFlow project

Long-term bio-functional performance of a novel, self-positioning balloon expandable transcatheter biological aortic valve system in the ovine aortic banding model

Background: The aim of the study was to evaluate bio-functionality of a novel, proprietary balloon-expandable biological transcatheter aortic valve implantation (TAVI) system (InFlow, CardValve Consortium, Poland) in an ovine model of aortic banding. Methods: Surgical ascending aorta banding was created in 21 sheep. Two weeks later, 18 biological valves were implanted within the model using 15–16 F InFlow TAVI systems and carotid cut-down approach. Follow-up transthoracic echocardiography was performed at 30, 90, and 180-day. At designated time, animals were euthanized and valves harvested for analysis. Results: All sheep survived the banding procedure. There were 4 (22%) procedure related deaths within a 7-day period. During the observation an additional 2 sheep died. In one, the valve dislocated after the procedure — the animal was excluded. Two animals completed 30-day follow up, five 90-day follow-up and four terminal follow-up of 180 days. Valves examined via transesophageal echocardiography showed proper hemodynamic parameters without evidence of structural valve deterioration. The maximum and average flow gradients at 180 days were 31.4 (23.3–37.7) and 17.5 (13.1–20.2) mmHg, respectively. There was one case of moderate insufficiency and no case of perivalvular leaks. By histopathology, there were no inflammation, thrombosis, nor calcifications in any tested valves at long-term follow-up. Neointimal coverage of stent struts increased with time from basal part in “early” groups to nearly 3/4 of stent length in the 180-day group. The pannus tissue showed maturation that increased with time with no stenotic “collar” visible in orthotopically implanted valves. Conclusions: The study showed good hemodynamic performance, durability and biocompatibility of the novel biological THV