Ocena choroby zastawkowej serca za pomocą elektrokardiografii wysiłkowej i echokardiografii obciążeniowej: czy te badania są nadal potrzebne?

The role of exercise electrocardiography (ECG) and stress echocardiography (SE) in the management of patients with valvular heart diseases (VHD) has been reviewed in this article relying on the recent evidence and the recommendations of the European Society of Cardiology/European Association of Cardio-Thoracic Surgery (ESC/EACTS) and the American College of Cardiology/American Heart Association (ACC/AHA) guidelines on the management of VHD. Both guidelines emphasise the role of exercise ECG to unmask objectively the occurrence of symptoms in patients, who deny symptoms or have doubtful symptoms; however, the role of SE to assess the haemodynamic component of VHD and unmask subclinical myocardial dysfunction is questioned. The above-mentioned guidelines strongly recommend deciding regarding valve surgery according to the presence of symptoms and the left ventricular (LV) morphological and functional parameters assessed at rest. SE can be useful in selected VHD patients for the determination of prognosis, clarification of symptoms and deciding on the timing of surgery. Despite existing evidence, there is still a need for randomised clinical outcome trials evaluating the role of stress imaging in the daily practise decision-making

Swoiste, związane z wiekiem i płcią, cechy u pacjentów ze stanem majaczeniowym na oddziale intensywnej opieki kardiologicznej

Background: The overall evidence base regarding delirium has been growing steadily over the past few decades. There has been considerable analysis of delirium concerning, for example, mechanically ventilated patients, patients in the general intensive care unit (ICU) setting, and patients with exclusively postoperative delirium. Nevertheless, there are few studies regarding delirium in a cardiovascular ICU (ICCU) setting and especially scarce literature about the particular features of delirium relating to patient age and gender. Aim: We aimed to determine particular features of delirium not induced by alcohol or other psychoactive substances, relating to patient age and gender in an ICCU setting. Methods: An observational cross-sectional study was conducted to evaluate patients with delirium in a Lithuanian ICCU. From a sample of 19,007 ICCU admissions, 337 (1.8%) had documented delirium diagnosed through liaison and consultation with a psychiatrist and were included in the final analysis. The obtained data was then evaluated and analysed according to patients’ gender and four categorised age groups: < 65 years, 65–74 years, 75–84 years, and ≥ 85 years. Results: Female patients who experienced delirium demonstrated a higher prevalence of hypertension, hyponatraemia, heart failure, cardiac rhythm and conduction disorders, myocardial infarction (MI), and dementia. The men, who were on average seven years younger than the women, significantly more often had hypokalaemia, double- or triple-vessel coronary artery disease, and sepsis. Furthermore, MI, ST-segment elevated MI, and Killip class 4 were most frequent amongst patients less than 65 years of age. Moreover, the youngest patient group demonstrated the highest mortality. Conclusions: Our investigation presented a number of associated peculiarities related to gender and age. It was shown that delirium is a severe complication that more often affects men amongst patients < 65 years old and more frequently affects women in the age group of ≥ 85 years. Male patients < 65 years old, who develop delirium should be treated with more caution because they tend to have more serious forms of disorder and a poorer prognosis.Wstęp: W ostatnich latach wzrosła liczba danych naukowych odnoszących się do stanu majaczeniowego (delirium). Przeprowadzono znaczące analizy delirium obejmujące na przykład pacjentów poddawanych mechanicznej wentylacji, przebywających na ogólnym oddziale intensywnej opieki medycznej (OIOM) i chorych, u których stan majaczeniowy występował wyłącznie w okresie pooperacyjnym. Niemniej niewiele jest badań dotyczących stanu majaczeniowego u pacjentów oddziału intensywnej opieki kardiologicznej (OIOK), a zwłaszcza brakuje prac na temat szczególnych cech stanu majaczeniowego w odniesieniu do wieku i płci chorych. Cel: Badanie przeprowadzono w celu ustalenia szczególnych właściwości substancji niealkoholowych i innych substancji o działaniu psychoaktywnym wywołujących delirium w odniesieniu do wieku i płci pacjentów przebywających na OIOK. Metody: Obserwacyjne badanie przekrojowe przeprowadzono w celu oceny pacjentów w stanie majaczeniowym hospitalizowanych na OIOK na Litwie. W próbie liczącej 19 007 przyjęć na OIOK było 337 (1,8%) chorych z udokumentowanym rozpoznaniem stanu majaczeniowego (poprzez współpracę i konsultacje z psychiatrami), których włączono do końcowej analizy. Uzyskane dane oceniano i analizowano w odniesieniu do płci chorych oraz czterech grup wiekowych: < 65 lat, 65–74 lat, 75–84 lat i ≥ 85 lat. Wyniki: U kobiet, u których występował stan majaczeniowy, częściej stwierdzano nadciśnienie tętnicze, hiponatremię, niewydolność serca, zaburzenia rytmu serca i przewodzenia, zawał serca (MI) oraz demencję. Natomiast u mężczyzn, których średnia wieku była o 7 lat wyższa niż u kobiet, istotnie częściej występowały hipokaliemia, dwu- lub trójnaczyniowa choroba wieńcowa oraz posocznica. Dodatkowo MI, MI z uniesieniem odcinka ST oraz IV klasa wg klasyfikacji Killipa występowały dużo częściej u chorych w wieku poniżej 65 lat. Ponadto w najmłodszej grupie pacjentów śmiertelność była najwyższa. Wnioski: W niniejszym badaniu zaobserwowano wiele szczególnych cech związanych z płcią i wiekiem. Wykazano, że stan majaczeniowy jest ciężkim powikłaniem, które dotyczy częściej mężczyzn niż kobiet w grupie chorych w wieku poniżej 65 lat, natomiast w grupie osób w wieku 85 lat i starszych częściej występuje u kobiet. Mężczyzn poniżej 65 lat, u których rozwinął się stan majaczeniowy, należy traktować ze szczególną uwagą, ponieważ ta grupa charakteryzuje się większym ryzykiem ciężkiego przebiegu choroby i gorszym rokowaniem

Balloon Pulmonary Angioplasty for Inoperable Chronic Thromboembolic Pulmonary Hypertension: Insights from a Pilot Low-Volume Centre Study and a Comparative Analysis with Other Centres

Background and Objectives: The aim of this study was to evaluate the effectiveness and safety of balloon pulmonary angioplasty (BPA) in patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH) in the Vilnius Pulmonary Hypertension (PH) Referral Centre and to provide a comparative analysis with other centres. Materials and Methods: This study included all BPA procedures performed between 2019 and 2024 in a single tertiary centre. Invasive haemodynamic parameters and clinical variables were assessed at baseline; at the end of invasive treatment; and at the conclusion of follow-up, an average of 8.6 months after the last BPA. A literature review was also performed. Results: Twenty-six patients with inoperable CTEPH were enrolled. The mean age of the patients was 61.6 (40–80) years. Each patient underwent a mean of 3.84 (1–9) procedures. Follow-up data were available for 12 patients with an average of 6.08 (3–9) procedures. Mean pulmonary arterial pressure decreased by 32% (p p = 0.001) at follow-up compared with the baseline measurements. There was also a significant 80% (p p = 0.04) increase in 6-min walk distance. The BPA procedures were generally safe in this low-volume centre setting, with only 17% of procedures having non-severe and non-fatal procedure-related complications. The most common complications included vessel dissection (10%), pulmonary vascular injury with haemoptysis (3%), and hyperperfusion pulmonary oedema (1%), which was successfully treated in all patients. Conclusions: The results of the present study demonstrate that the BPA procedure is an effective and safe treatment for individuals with inoperable CTEPH, being associated with significant improvements in hemodynamic parameters and functional capacity and a low risk of major complications in the low-volume tertiary PH centre setting

Value of scar imaging and inotropic reserve combination for the prediction of segmental and global left ventricular functional recovery after revascularisation

Abstract Background This study sought to prospectively and directly compare three cardiovascular magnetic resonance (CMR) viability parameters: inotropic reserve (IR) during low-dose dobutamine (LDD) administration, late gadolinium enhancement transmurality (LGE) and thickness of the non-contrast-enhanced myocardial rim surrounding the scar (RIM). These parameters were examined to evaluate their value as predictors of segmental left ventricular (LV) functional recovery in patients with LV systolic dysfunction undergoing surgical or percutaneous revascularisation. The second goal of the study was to determine the optimal LDD-CMR- and LGE-CMR-based predictor of significant (≥ 5%) LVEF improvement 6 months after revascularisation. Methods In 46 patients with chronic coronary artery disease (CAD) (63 ± 10 years of age, LVEF 35 ± 8%), wall motion and the above mentioned CMR parameters were evaluated before revascularisation. Wall motion and LGE were repeatedly assessed 6 months after revascularisation. Logistic regression analysis models were created using 333 dysfunctional segments at rest. Results An LGE threshold value of 50% (LGE50) and a RIM threshold value of 4 mm (RIM4) produced the best sensitivities and specificities for predicting segmental recovery. IR was superior to LGE50 for predicting segmental recovery. When the areas under the ROC curves is compared, the combined viability prediction model (LGE50 + IR) was significantly superior to IR alone in all analysed sets of segments, except the segments with an LGE from 26% to 75% (p = 0.08). The RIM4 model was not superior to the LGE50 model. A myocardial segment was considered viable if it had no LGE or had any LGE and produced IR during LDD stimulation. ROC analysis demonstrated that ≥ 50% of viable segments from all dysfunctional and revascularised segments in a patient predict significant improvement in LVEF with a 69% sensitivity and 70% specificity (AUC 0.7, p = 0.05). The cut-off of ≥ 3 viable segments was a less useful predictor of significant global LV recovery. Conclusions LDD-CMR is superior to LGE-CMR as a predictor of segmental recovery. The advantage is greatest in the segments with an LGE from 26% to 75%. The RIM cut-off value of 4 mm had no superiority over the LGE cut-off value of 50% in predicting the segmental recovery. Patients with ≥ 50% of viable segments from all dysfunctional and revascularised had a tendency to improve LVEF by ≥ 5% after revascularisation.</p