Ocena aparatu zastawkowego zastawki mitralnej u chorych z ostrym zawałem ściany tylno-dolnej serca i niedokrwienną niedomykalnością zastawki mitralnej na podstawie echokardiografii dwuwymiarowej w odpowiednich płaszczyznach obrazowania anatomicznego

Background: Ischaemic mitral regurgitation (IMR) is associated with adverse prognosis after myocardial infarction (MI) as a result of left ventricular remodelling and geometric deformation of the mitral apparatus (MA). Aim: The aim of this study was to assess MA from anatomically correct imaging planes in acute inferoposterior MI and IMR. Methods: Ninety-three patients with no structural cardiac valve abnormalities and the first acute inferoposterior MI were prospectively enrolled into the study. Two-dimensional transthoracic echocardiography for MA assessment was performed within 48 h of presentation after reperfusion therapy. Based on the degree of mitral regurgitation (MR), patients were divided into either a no significant MR (NMR) group (n = 52 with no or mild, grade 0–I MR) or an IMR group (n = 41 with grade ≥ 2 MR). The control group consisted of 45 healthy individuals. Results: Ischaemic MR was related with dilatation of the left ventricle chambers, decrease in ejection fraction, increase in mitral annulus diameter and area, and changes in subvalvular apparatus when compared with the NMR group or healthy individuals. Conclusions: Ischaemic MR in acute inferoposterior MI is related with worse lesions in MA geometry that cause insufficiency of mitral valve function.Wstęp: Niedomykalność niedokrwienna zastawki mitralnej (IMR) w następstwie remodelingu lewej komory i geometrycznej deformacji aparatu zastawkowego (MA) wiąże się z niekorzystnym rokowaniem po zawale serca. Cel: Badanie przeprowadzono w celu oceny MA na podstawie badania echokardiograficznego w odpowiednich płaszczyznach obrazowania anatomicznego u chorych z ostrym zawałem tylno-dolnej ściany serca i niedomykalnością zastawki mitralnej. Metody: Do badania włączono prospektywnie 93 chorych bez strukturalnych zmian zastawek serca, u których stwierdzono po raz pierwszy w życiu zawał ściany tylno-dolnej. U pacjentów wykonano dwuwymiarową echokardiografię przezklatkową w celu oceny aparatu zastawkowego w ciągu 48 h od zgłoszenia się chorego po leczeniu reperfuzyjnym. Na podstawie stopnia niedomykalności zastawki mitralnej (MR) chorych podzielono na dwie grupy: osoby bez istotnej MR (NMR; n = 52; bez cech niedomykalności lub niedomykaloność łagodna [stopień 0–I] MR) oraz osoby z niedokrwienną MR (IMR; n = 41, z MR ≥ 2 stopnia). Grupę kontrolną stanowiło 45 zdrowych osób. Wyniki: Niedomykalność niedokrwienna zastawki mitralnej wiązała się z poszerzeniem lewej komory, obniżeniem frakcji wyrzutowej, zwiększeniem średnicy i powierzchni pierścienia zastawki mitralnej oraz zmianami w obrębie aparatu podzastawkowego w porównaniu z grupą NMR i osobami zdrowymi. Wnioski: Niedomykalność niedokrwienna zastawki mitralnej w ostrym zawale ściany tylno-dolnej wiąże się z większymi zmianami geometrii MA powodującymi nieprawidłową czynność zastawki mitralnej

Functional (ischemic) mitral regurgitation in acute phase of myocardial infarction: Associated clinical factors and in-hospital outcomes

Background and objective: Mitral regurgitation (MR) after myocardial infarction (MI) carries adverse prognosis. The objective of this study was to assess the impact of functional MR on adverse in-hospital outcomes in acute MI. Materials and methods: A total of 569 patients with first ever acute MI were divided into three groups: no MR, mild MR (regurgitant orifice area 0.2 cm2). Clinical profile and in-hospital outcomes were compared among the groups. Results: Patients with increasing grade of MR were elder (P < 0.001), more likely to be female (P = 0.003), have atrial fibrillation (P < 0.001), higher peak C-reactive protein values (P = 0.001), multivessel coronary artery disease (P < 0.001), and less likely to have dyslipidemia (P = 0.029). Ejection fraction, age, atrial fibrillation and left ventricular end diastolic diameter index were independent predictors of moderate and severe MR (P < 0.001). In hospital cardiac death and decompensated heart failure was more prevalent in moderate-severe MR group. Conclusions: Moderate and severe MR in acute MI is related to age, atrial fibrillation, increased left ventricular diastolic dimensions and decreased ejection fraction. Moderate and severe, but not mild MR is an important clinical contributor to in-hospital cardiac death

Statistical investigation of the wavelet-based lossy medical image compression technique

Medical digital images have informational redundancy. Both the amount of memory for image storage and their transmission time could be reduced if image compression techniques are applied. The techniques are divided into two groups: lossless (compression ratio does not exceed 3 times) and lossy ones. Compression ratio of lossy techniques depends on visibility of distortions. It is a variable parameter and it can exceed 20 times. A compression study was performed to evaluate the compression schemes, which were based on the wavelet transform. The goal was to develop a set of recommendations for an acceptable compression ratio for different medical image modalities: ultrasound cardiac images and X-ray angiographic images. The acceptable image quality after compression was evaluated by physicians. Statistical analysis of the evaluation results was used to form a set of recommendations

Genotype-Phenotype Correlation in Familial <i>BAG3</i> Mutation Dilated Cardiomyopathy

We report the case of a 22-year-old male who visited a cardiologist after the first episode of atrial fibrillation (AF). Echocardiography and magnetic resonance imaging revealed decreased left ventricular (LV) systolic function with dilated LV. An intermittent second-degree AV (atrioventricular) block was detected during 24 h Holter monitoring. Genetic test revealed the pathogenic variant of the BAG3 (BLC2-associated athanogene 3) gene. Due to the high risk of heart failure (HF) progression and ventricular arrhythmias, an event recorder was implanted and a pathogenetic HF treatment was prescribed. The analysis of genealogy revealed that the patient’s father, at the age of 32, was diagnosed with dilated cardiomyopathy (DCM) and recurrent AF episodes. Genetic testing also confirmed a pathogenic variant of the BAG3 gene. Currently, with the optimal treatment of HF, the patient’s disease has been stable for three years and the condition is closely monitored on an outpatient basis. So, we demonstrate the importance of early detection for genetic testing and the unusual stability exhibited by the patient‘s optimal medical therapy for 3 years

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&lt;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&lt;0.05) were significantly lower and apical rotation (11.3° [SD, 4.99°] vs. 8.30° [SD, 4.34°], P&lt;0.05) as well as rotation rate (82.72°/s [SD, 28.24 °/s] vs. 71.00°/s [SD, 28.04 °/s], P&lt;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

Association of Whole-Heart Myocardial Mechanics by Transthoracic Echocardiography with Presence of Late Gadolinium Enhancement by CMR in Non-Ischemic Dilated Cardiomyopathy

Background: In patients with non-ischemic dilated cardiomyopathy (NIDCM), myocardial fibrosis (MF) is related to adverse cardiovascular outcomes. The purpose of this study was to evaluate the potential relationship between the myocardial mechanics of different chambers of the heart and the presence of MF and to determine the accuracy of the whole-heart myocardial strain parameters to predict MF in patients with NIDCM. Methods: We studied 101 patients (64% male; 50 &plusmn; 11 years) with a first-time diagnosis of NIDCM who were referred for a clinical cardiovascular magnetic resonance (CMR) and speckle tracking 2D echocardiography examination. We analyzed MF by late gadolinium enhancement (LGE), and the whole-heart myocardial mechanics were assessed by speckle tracking. The presence of MF was related to worse strain parameters in both ventricles and atria. The strongest correlations were found between MF and left ventricle (LV) global longitudinal strain (GLS) (r = &minus;0.586, p &lt; 0.001), global circumferential strain (GCS) (r = &minus;0.609, p &lt; 0.001), LV ejection fraction (LVEF) (r = 0.662, p &lt; 0.001), and left atrial strain during the reservoir phase (LASr) (r = 0.588, p &lt; 0.001). However, the binary logistic regression analysis revealed that only LV GLS, GCS, and LASr were independently associated with the presence of MF (area under the curves of 0.84, 0.85, and 0.64, respectively). None of the echocardiographic parameters correlated with fibrosis localization. Conclusions: In NIDCM patients, MF is correlated with reduced mechanical parameters in both ventricles and atria. LV GLS, LASr, and LV GCS are the most accurate 2D echocardiography predictive factors for the presence of MF