Ehokardiografska procjena bolesnika s mehaničkom potporom srcu Heart Mate II

Echocardiography plays an important role in evaluating patients both before and after the implantation of mechanical circulatory support devices. It consists of a standard examination expanded to specific aspects of ventricular assist devices. The scope of examination varies according to the type of the device, the method of implantation and the localization of the inflow and outflow cannulas. This article is focused on the echocardiographic examination of patients undergoing the implantation of the HeartMate II (Thoratec) – a continuous-flow ventricular assist device. It provides a review of all the important parts of the examination, including the preoperative, the intraoperative and the postoperative examination. The utilization of transthoracic and transesophageal echocardiography is presented. The methods of diagnosing the malfunction of the device are also discussed. The author emphasizes that the assessment of a patient with a mechanical assist device is a complex and an interdisciplinary challenge, where echocardiography is crucial in the assessment of the patients with mechanical circulatory support devices.Ehokardiografija igra ključnu ulogu u kliničkoj prognozi pacijenta prije i poslije ugradnje uređaja za mehaničku potporu srcu i cirkulaciji. Ova metoda uključuje standardni pregled sa specifičnim pogledom na ventrikularni potporni uređaj. Područje pregleda ovisi o vrsti uređaja, metodi implantacije i smještaju ulazne i izlazne kanile. Ovaj članak opisuje ehokardiografski pregled pacijenta te što je sve potrebno sagledati prilikom preoperativnog, intraoperativnog i postoperativnog pregleda. Prikazan je način upotrebe transtorakalnog i transezofagijskog ehokardiografa. Opisuju se i metode dijagnosticiranja nepravilnog rada uređaja za mehaničku potporu. Autor naglašava kompleksnost dijagnostike pacijenata s ugrađenom mehaničkom potporom srcu i cirkulaciji te prikazuje ehokardiografiju kao neophodnu dijagnostičku metodu kod ovih pacijenata

The effect of acetylsalicylic acid dosed at bedtime on the anti-aggregation effect in patients with coronary heart disease and arterial hypertension: A randomized, controlled trial

Background: Acetylsalicylic acid (ASA) is one of the basic drugs used in the secondary prevention ofcoronary artery disease (CAD), and in most cases it is taken in the morning in one daily dose. It is suggestedthat the morning peak of platelet aggregation is responsible for the occurrence of myocardial infarctionsand strokes. Hence, the aim of the study was to observe the effect of ASA (morning vs. evening)dosing on the anti-aggregative effect of platelets in patients with CAD and arterial hypertension (AH).Methods: The study involved 175 patients with CAD and AH. Patients were randomly assigned toone of two study groups, taking ASA in the morning or in the evening. The patients had two visits, onebaseline and another after 3 months from changing the time of ASA dosage. The platelet aggregationwas determined using the VerifyNow analyzer.Results: In the ASA evening group, a significant reduction in platelet aggregation was obtained. Inthe ASA morning group, a significant difference in response to ASA was observed, depending on sex. Inmen, the reactivity of platelets decreased, but in women it increased.Conclusions: In the group of patients with CAD and AH, bedtime ASA dosing is associated witha significant reduction in platelet aggregation. The response to ASA may differ between sexes. The benefitgained by changing the drug administration from the morning to the evening is greater in women

High proportion of genetic cases in patients with advanced cardiomyopathy including a novel homozygous Plakophilin 2-gene mutation

Cardiomyopathies might lead to end-stage heart disease with the requirement of drastic treatments like bridging up to transplant or heart transplantation. A not precisely known proportion of these diseases are genetically determined. We genotyped 43 index-patients (30 DCM, 10 ARVC, 3 RCM) with advanced or end stage cardiomyopathy using a gene panel which covered 46 known cardiomyopathy disease genes. Fifty-three variants with possible impact on disease in 33 patients were identified. Of these 27 (51%) were classified as likely pathogenic or pathogenic in the MYH7, MYL2, MYL3, NEXN, TNNC1, TNNI3, DES, LMNA, PKP2, PLN, RBM20, TTN, and CRYAB genes. Fifty-six percent (n = 24) of index-patients carried a likely pathogenic or pathogenic mutation. Of these 75% (n = 18) were familial and 25% (n = 6) sporadic cases. However, severe cardiomyopathy seemed to be not characterized by a specific mutation profile. Remarkably, we identified a novel homozygous PKP2-missense variant in a large consanguineous family with sudden death in early childhood and several members with heart transplantation in adolescent age

Clinical impact and 'natural' course of uncorrected tricuspid regurgitation after implantation of a left ventricular assist device: an analysis of the European Registry for Patients with Mechanical Circulatory Support (EUROMACS)

OBJECTIVES: Data on the impact and course of uncorrected tricuspid regurgitation (TR) during left ventricular assist device (LVAD) implantation are scarce and inconsistent. This study explores the clinical impact and natural course of uncorrected TR in patients after LVAD implantation. METHODS: The European Registry for Patients with Mechanical Circulatory Support was used to identify adult patients with LVAD implants without concomitant tricuspid valve surgery. A mediation model was developed to assess the association of TR with 30-day mortality via other risk factors. Generalized mixed models were used to model the course of post-LVAD TR. Joint models were used to perform sensitivity analyses. RESULTS: A total of 2496 procedures were included (median age: 56 years; men: 83%). TR was not directly associated with higher 30-day mortality, but mediation analyses suggested an indirect association via preoperative elevated right atrial pressure and creatinine (P = 0.035) and bilirubin (P = 0.027) levels. Post-LVAD TR was also associated with increased late mortality [hazard ratio 1.16 (1.06-1.3); P = 0.001]. On average, uncorrected TR diminished after LVAD implantation. The probability of having moderate-to-severe TR immediately after an implant in patients with none-to-mild TR pre-LVAD was 10%; in patients with moderate-to-severe TR pre-LVAD, it was 35% and continued to decrease in patients with moderate-to-severe TR pre-LVAD, regardless of pre-LVAD right ventricular failure or pulmonary hypertension. CONCLUSIONS: Uncorrected TR pre-LVAD and post-LVAD is associated with increased early and late mortality. Nevertheless, on average, TR diminishes progr

The role of long-term mechanical circulatory support in the treatment of end-stage heart failure

Heart failure is a clinical syndrome of multifactorial aetiology with typical symptoms and diverse prevalence depending on the world region, reaching more than 10% in the population over 70 years of age. The prognosis, in spite of a dynamic improve- ment in medical therapy, remains poor. The only treatment for these patients is heart transplantation, however, its availability is highly limited because of the shortage of donor organs. Mechanical circulatory support can offer an alternative treatment for this patient cohort. In this review the authors discuss the present indications for, as well as results and complications of different types of long-term mechanical circulatory support. The long-term survival in patients receiving this therapy, in spite of many complication, is much better than in those receiving medical treatment. The use of mechanical circulatory support is an established treatment option for many patients with end-stage heart failure. The most important issue for the cardiologist is to identify patients eligible for this therapy in order to give them a chance for a longer life and better quality of life

Multi-parametric analyses to investigate dependencies of normal left atrial strain by cardiovascular magnetic resonance feature tracking

Abstract Left-atrial (LA) strain is the result of complex hemodynamics, which may be better characterized using a multiparametric approach. Cardiovascular magnetic resonance (CMR) feature tracking was used to perform a comprehensive LA strain assessment of 183 enrolled healthy volunteers (11–70 years, 97 females, median 32.9 ± 28.3 years). Novel strain dependencies were assessed using multi-parametric regression (MPR) analyses. LA volumetric data, left ventricular strain, transmitral and pulmonary venous blood flow parameters were utilized to create clusters for MPR of all subjects and a heart rate controlled subgroup (pulse: 60–75/min, N = 106). The LA reservoir(r) and conduit(c) strains of the total cohort were significantly elevated (p ≤ 0.001) in women (r: 49.7 ± 12.9%, c: 32.0 ± 11.0%) compared to men (r: 42.9 ± 11.4%, c: 26.1 IQ 10.5%). In contrast, there were no gender-specific differences (p > 0.05) for subgroup LA reservoir, conduit and booster(b) strains (all, r: 47.3 ± 12.7%; c: 29.0 IQ 15.5%; b: 17.6 ± 5.4%) and strain rates (all, 2.1 IQ 1.0 s−1; − 2.9 IQ 1.5 s−1; − 2.3 IQ 1.0 s−1). MPR found large effect sizes (|R2|≥ 0.26) for correlations between strain and various cardiac functional parameters. Largest effect size was found for the association between LA conduit strain and LA indexed booster volume, LA total ejection fraction, left ventricular global radial strain and E-wave (|R2|= 0.437). In addition to providing normal values for sex-dependent LA strain and strain rate, no gender differences were found with modified heart rate. MPR analyses of LA strain/strain rate and various cardiac functional parameters revealed that heart rate control improved goodness-of-fit for the overall model

Original articleUsefulness of ambulatory ECG in the diagnosis of sleep-related breathing disorders

Background: Sleep-related breathing disorders (SRBD) are the additional factor related to poor prognosis in patients with cardiovascular disorders. The apnoea/hypopnoea index (AHI), describing the number of apnoea and hypopnoea episodes per one hour of sleep, has been used as a marker of severity of the disorder. The disease is present in 4% of men and 2% of women above 40 years of age. However, SRBD are diagnosed in less than 3% of patients with this syndrome due to lack of awareness of the disease among health care practitioners and patients. Polysomnography (PSG) has been used as a golden standard for detecting SRBD, however this test is available only in selected centres. Therefore, a simple, fast and inexpensive test for screening for SRBD is necessary. Respiratory activity influences the amplitude of ECG signal whereas heart rate variability (HRV) depicts the activity of the autonomic nervous system. These associations have been used to develop a new method for detection of SRBD involving analysis of HRV and morphology of ECG signal in ECG monitoring. Aim: Assessment of accuracy of SRBD detection using estimated AHI (Est.AHI), calculated from Holter ECG recordings. Methods: In a study group consisting of 74 patients tested for SRBD, simultaneous PSG and 24-hour ECG monitoring were performed. Following PSG, AHI for each patient was calculated. According to the AHI values patients were classified as SRBD patients (AHI >15), non-SRBD patients (AHIWstęp: Zaburzenia oddychania podczas snu (ZOPS) są czynnikiem obciążającym rokowanie w wielu chorobach układu sercowo-naczyniowego. Wykładnikiem ZOPS jest wskaźnik bezdechów i spłyceń oddychania przypadający na godzinę snu, zwany AHI (ang. apnoe/hypopnoe index). Na ZOPS cierpi ok. 4% mężczyzn i 2% kobiet w wieku >40 lat. Z powodu niskiej świadomości problemu zarówno wśród chorych, jak i lekarzy zdiagnozowanych jest 15) zakwalifikowano 34 chorych. W grupie bez ZOPS (AH