Znaczenie pomiaru prędkości ruchu pierścienia mitralnego za pomocą tkankowej echokardiografii dopplerowskiej w monitorowaniu czynności serca po zabiegach kardiochirurgicznych

Wstęp: Celem pracy było porównanie wartości nieinwazyjnej oceny ciśnienia zaklinowania w tętnicy płucnej za pomocą fali pulsacyjnej tkankowej echokardiografii dopplerowskiej z inwazyjnymi pomiarami warunków napełniania lewej komory oraz wybranymi innymi parametrami hemodynamicznymi czynności serca (pojemność minutowa, wskaźnik sercowy, objętość wyrzutowa, obwodowy i płucny opór naczyniowy, skurczowe, rozkurczowe i średnie ciśnienie w tętnicy płucnej) jeden dzień po zabiegu kardiochirurgicznym. Materiał i metody: Badaniem objęto 30 chorych (20 mężczyzn, 10 kobiet) w wieku 60,5 ± 7,2 roku zakwalifikowanych do zabiegu kardiochirurgicznego (29 chorych - CABG, 1 chory - CABG i aneuryzmektomia lewej komory). U wszystkich badanych wykonano echokardiograficzną ocenę prędkości fali E, E’, wskaźnika E/E’ oraz ciśnienia zaklinowania w tętnicy płucnej (PCWP), a następnie porównano uzyskane wartości z inwazyjnymi pomiarami warunków napełniania lewej komory oraz wybranymi parametrami hemodynamicznymi czynności serca. Wyniki: Prędkość fali E, E’, wartość wskaźnika E/E’ oraz PCWP w badaniu echokardiograficznym istotnie korelowały z inwazyjnymi pomiarami ciśnienia zaklinowania w tętnicy płucnej oraz z objętością wyrzutową lewej komory. Wnioski: Uzyskane wyniki badań potwierdziły istotność oceny parametrów hemodynamicznych lewej komory za pomocą fali pulsacyjnej tkankowej echokardiografii dopplerowskiej w celu monitorowania czynności serca wkrótce po zabiegu kardiochirurgicznym. (Folia Cardiol. 2004; 11: 669-675

Holocene fire activity during low-natural flammability periods reveals scale-dependent cultural human-fire relationships in Europe

Fire is a natural component of global biogeochemical cycles and closely related to changes in human land use. Whereas climate-fuel relationships seem to drive both global and subcontinental fire regimes, human-induced fires are prominent mainly on a local scale. Furthermore, the basic assumption that relates humans and fire regimes in terms of population densities, suggesting that few human-induced fires should occur in periods and areas of low population density, is currently debated. Here, we analyze human-fire relationships throughout the Holocene and discuss how and to what extent human driven fires affected the landscape transformation in the Central European Lowlands (CEL). We present sedimentary charcoal composites on three spatial scales and compare them with climate model output and land cover reconstructions from pollen records. Our findings indicate that widespread natural fires only occurred during the early Holocene. Natural conditions (climate and vegetation) limited the extent of wildfires beginning 8500 cal. BP, and diverging subregional charcoal composites suggest that Mesolithic hunter-gatherers maintained a culturally diverse use of fire. Divergence in regional charcoal composites marks the spread of sedentary cultures in the western and eastern CEL The intensification of human land use during the last millennium drove an increase in fire activity to early-Holocene levels across the CEL Hence, humans have significantly affected natural fire regimes beyond the local scale - even in periods of low population densities - depending on diverse cultural land-use strategies. We find that humans have strongly affected land-cover- and biogeochemical cycles since Mesolithic times

Fire hazard modulation by long-term dynamics in land cover and dominant forest type in eastern and central Europe

Wildfire occurrence is influenced by climate, vegetation and human activities. A key challenge for understanding the risk of fires is quantifying the mediating effect of vegetation on fire regimes. Here, we explore the relative importance of Holocene land cover, land use, dominant functional forest type, and climate dynamics on biomass burning in temperate and boreo-nemoral regions of central and eastern Europe over the past 12 kyr. We used an extensive data set of Holocene pollen and sedimentary charcoal records, in combination with climate simulations and statistical modelling. Biomass burning was highest during the early Holocene and lowest during the mid-Holocene in all three ecoregions (Atlantic, continental and boreo-nemoral) but was more spatially variable over the past 3–4 kyr. Although climate explained a significant variance in biomass burning during the early Holocene, tree cover was consistently the highest predictor of past biomass burning over the past 8 kyr. In temperate forests, biomass burning was high at ~ 45% tree cover and decreased to a minimum at between 60% and 70% tree cover. In needleleaf-dominated forests, biomass burning was highest at ~60 %–65%tree cover and steeply declined at > 65% tree cover. Biomass burning also increased when arable lands and grasslands reached ~15 %–20 %, although this relationship was variable depending on land use practice via ignition sources, fuel type and quantities. Higher tree cover reduced the amount of solar radiation reaching the forest floor and could provide moister, more wind-protected microclimates underneath canopies, thereby decreasing fuel flammability. Tree cover at which biomass burning increased appears to be driven by warmer and drier summer conditions during the early Holocene and by increasing human influence on land cover during the late Holocene. We suggest that longterm fire hazard may be effectively reduced through land cover management, given that land cover has controlled fire regimes under the dynamic climates of the Holocene

Chorzy trudni nietypowiNiedokrwistość hemolityczna jako powikłanie po zabiegu wszczepienia pierścienia mitralnego

Haemolytic anaemia following mitral annuloplasty is uncommon as compared with mitral valve replacement procedures. A 67-year-old woman, who underwent mitral annuloplasty and CABG, developed haemolytic anaemia. Echocardiographic examination revealed mitral regurgitation jet colliding with mitral ring. The management of these cases usually demands redo surgery. In the presented case, the direction of mild mitral regurgitant jet with respectably high velocity contributed significantly to the early postoperative haemolysis. Redo surgery with implantation of bioprosthesis caused withdrawal of intravascular haemolysis

Chorzy trudni typowiRatująca życie angioplastyka pnia lewej tętnicy wieńcowej u chorego wysokiego ryzyka

A case a of a life-saving angioplasty of left main coronary artery (LMCA) is presented. A 75 year old patient with a history of diabetes, previous CABG and carotid surgery was admitted to our hospital with symptoms of early post-infarct angina. Coronary angiography revealed significant stenosis of LMCA, in addition to previously known multi-vessel diffuse CAD. Taking into consideration a very high risk of repeat CABG surgery a decision was made to perform an angioplasty. The intervention was carried out with good angiographic effect and the patient was discharged home few days later, free from angina. In 9 month follow-up angiography there was no restenosis in LMCA. In patients to whom cardiac surgery presents very high risk, an angioplasty of LMCA can be life-saving, with good long term effects

Choroba Takayasu czynnikiem ryzyka progresji miażdżycy? Skuteczny zabieg angioplastyki wieńcowej u pacjentki z oboma schorzeniami

Abstract: Takayasu arteritis is a rare, inflammatory disease affecting mainly young women and is more prevalent in Asia and Latin America. Its etiology is obscure. It involves the aorta and its main branches. The typical lesions are represented by obliteration and aneurysmatic dilatation of arteries and ostial stenosis. We report a case of a 51-year-old women with Takayasu arteritis and coronary disease, complaining from angina pectoris CCS class IV. The patient underwent successful angioplasty of LAD. During 6-month follow-up she remained asymptomatic. Various therapeutic options of revascularization are reviewed

Personal experiences in direct ultrasound-guided injection of thrombin into the lumen of pseudoaneurysm as a method of treatment in case of iatrogenic femoral artery damage

Background: Pseudoaneurysms constitute a quite common complication of procedures requiring puncture of the common femoral artery. The risk factors of the condition include: obesity, arterial hypertension, sex (more prevalent in males) as well as antithrombotic therapy. Material/Methods: The US-guided injection of thrombin into the pseudoaneurysm lumen was performed in patients referred from the Department of Invasive Cardiology who had undergone coronarography or coronary angioplasty. Pseudoaneurysms constituted the complication of common femoral artery canulation. After setting the diagnosis of pseudoaneurysm by means of Doppler ultrasound, patients with large pseudoaneurysms of volume exceeding 10 mm were qualified for thrombin injection. Generally, 33 patients underwent the treatment. In 3 cases - due to the presence of multiocular pseudoaneurysm - thrombin was administered twice. Results: Taking into account the safety of the procedure, ultimately 33 patients were qualified for thrombin administration, in whom aneurism of diameter exceeding 10 mm was diagnosed. In 3 patients with aneurysm of less than 10mm, only a compression band was used prophylactically. In one case, because of a considerable oedema surrounding the tissue, as well as deep location of the aneurysm in the groin, thrombin treatment was not given due to technical reasons. In 30 cases, single administration of thrombin was effective and resulted in a complete thrombosis of the pseudoaneurism lumen within a couple of seconds following thrombin injection. In 3 patients with multicellular aneurysm, thrombin was given twice, resulting in a total obliteration of the pseudoaneurysm in two cases only. No complications were observed after the performed procedures. No recanalisation of pseudoaneurysms was demonstrated in follow-up examinations. Conclusions: 1. Direct thrombin injection into the pseudoaneurysm lumen can constitute an alternative method of treatment for open surgical techniques. 2. The procedure is highly effective, cheap and minimally invasive

The importance of the longest R-R interval on 24-hour electrocardiography in mortality prediction in patients with atrial fibrillation

BACKGROUND: Heart rate control in atrial fibrillation (AF) is typically assessed by 24-hour electrocardiography (ECG). There are scarce data on the use of 24-hour ECG parameters to predict mortality in AF.AIMS: We aimed to identify 24-hour ECG parameters that predict mortality in AF.METHODS: We enrolled 280 ambulatory patients (mean [SD] age, 72.0 [8.7] years; 57.9% men) with permanent or persistent AF. Data on mortality and pacemaker or defibrillator implantation during follow-up were collected. Predictors of mortality were assessed using the Cox proportional hazards model and C-statistic.RESULTS: Compared with survivors, 78 (28%) patients who died were older, more often had comorbidities, left bundle branch block (LBBB), reduced left ventricular ejection fraction, lower maximum heart rate, a higher number of ventricular extrasystoles, and the longest R-R interval below 2 seconds. Univariate analysis revealed higher mortality in patients with the longest R-R intervals below 2 seconds compared with those with the R-R intervals of 2 seconds or longer (P <0.001). Independent mortality predictors in the regression model included older age, renal failure, history of coronary intervention, chronic obstructive pulmonary disease, LBBB, and a high number (≥770) or absence of R-R intervals of at least 2 seconds. The area under curve (AUC) for mortality prediction increased after inclusion of ECG parameters 0.748 [95% CI, 0.686-0.810] vs 0.688 [95% CI, 0.618-0.758]; P = 0.02).CONCLUSIONS: A high number of R-R intervals longer than 2 seconds or their absence on 24-hour ECG may predict mortality in AF

Analysis of out-of-hospital cardiac arrest in Poland in a 1-year period: data from the POL-OHCA registry

Background: Out‑of‑hospital cardiac arrest (OHCA) is a severe medical condition. Prehospital care plays an essential role in patient survival. Aims:  First, the study aimed to evaluate cases of OHCA managed by cardiopulmonary resuscitation (CPR) attempts in Poland in 2018, including their frequency and patient outcomes in terms of survival until hospital admission or transport to the hospital by helicopter emergency medical service (HEMS). Second, the study was performed to identify the predictors of patient survival until hospital admission or transport by HEMS. Methods:  It was a case‑control study based on medical records. In 2018, 3 400 000 emergency visits were registered. Patients who were treated by emergency medical service (EMS) ambulance staff using defibrillation and / or administering at least 1 dose of 1 mg of epinephrine were considered to have OHCA managed by CPR attempts. Results:  A total of 26 783 CPR attempts were reported by EMS in Poland in 2018. The incidence of OHCA with CPR attempts in 2018 was 69.7 per 100 000 inhabitants and it varied from 58.9 per 100 000 to 84.5 per 100 000 inhabitants in 16 Polish provinces. The mean survival rate until hospital admission or transport by HEMS was 36.3% and it ranged from 34.5% to 38.3%. Patient survival until hospital admission or transport by HEMS was related to age, sex, emergency site, defibrillation during CPR, the first recorded rhythm, and procedures performed by the EMS personnel. Conclusions: The rate of OHCA with CPR attempts was similar to that reported in other European countries. Patient survival until hospital admission or transport by HEMS was associated with many well‑‑known, identified nonmodifiable and modifiable factors