Improvement of left ventricular function after percutaneous coronary intervention in patients with stable coronary artery disease and preserved ejection fraction: Impact of diabetes mellitus

Background: Many patients with stable coronary artery disease (CAD) have no visual segmental wall motion abnormalities and a left ventricular (LV) ejection fraction (LVEF) ≥ 50% at rest despite significant coronary artery stenosis. Here, the aim was to determine the impact of percutaneous coronary intervention (PCI) on LV function assessed by enhanced echocardiography in patients with stable CAD with or without diabetes mellitus type 2 and a preserved LVEF.Methods: Sixty-six consecutive patients with CAD and LVEF ≥ 50%, admitted to the hospital for planned coronary angiography, were prospectively assessed. PCI was performed for coronary artery stenosis > 70%. CAD extent was assessed using SYNTAX and EXTENT scores. To assess LV function, LVEF, global longitudinal strain (GLS), and LV peak systolic myocardial velocity (S’) were measured and Tei index was calculated before and 3 months after PCI.Results: Before PCI, LVEF, GLS, and Tei index were significantly worse in diabetic patients. LV functional indices improved significantly after PCI in all patients (p < 0.001). Multivariate linear regression analyses were performed to evaluate the impact of selected factors on LV function after PCI expressed as changes (D) of LVEF, GLS, S’, and Tei index. LV function improvement expressed as DGLS was associated only with SYNTAX score. Higher SYNTAX scores were related to greater GLS improvement (b = 0.003, 95% confidence interval: 0.0004–0.005; p = 0.02).Conclusions: Percutaneous coronary intervention significantly improved LV function in diabetic and non-diabetic CAD patients with preserved LVEF. Enhanced echocardiography allowed an assessment of subtle changes in LV function

Doksorubicyna liposomalna u chorych na raka piersi ze współistniejącymi chorobami sercowo-naczyniowymi — wielodyscyplinarne stanowisko ekspertów

The use of liposomal doxorubicin in place of conventional form can significantly reduce the risk of clinically important cardiovascular complications of chemotherapy. The use of liposomal doxorubicin-containing regimen seems to be the most justified in treatment of breast cancer patients with coexisting cardiovascular diseases. The document defines the possible clinical scenarios for the use of chemotherapy with liposomal doxorubicin and presents the optimal cardiac monitoring of this therapy.

Clinical application of stress echocardiography in valvular heart disease

ABSTRACT Valvular heart diseases (VHDs) constitute an increasing problem both as a consequence of population aging and as the sequelae of other heart diseases. Accurate diagnosis is essential for correct clinical decision‑making; however, in many patients, transthoracic and transesophageal echocardiography is insufficient. Stress echocardiography (SE) proved to be a useful tool allowing for simultaneous assessment of left ventricular contractile reserve and HVD hemodynamics under conditions of physiological or pharmacological stress. It is recommended for assessing the severity of VHD, guiding the choice of treatment, as well as for surgical risk stratification. It can be applied both in asymptomatic patients with severe VHD and in symptomatic individuals with moderate disease. In patients with VHD, SE can be performed either as exercise stress echocardiography (ESE) or dobutamine stress echocardiography (DSE). The first modality is recommended to unmask symptoms or abnormal blood pressure response in patients with aortic stenosis (AS) who report to be asymptomatic or in those with mitral stenosis with discordance between clinical symptoms and the severity of valve disease on transthoracic echocardiography. In asymptomatic patients with paradoxical low‑flow, low‑gradient (LFLG) AS, ESE can be used to assess the severity of stenosis. On the other hand, low‑dose DSE can be a useful diagnostic tool in classical LFLG AS, providing information on stenosis severity and contractile reserve. Moreover, SE is indicated in patients with prosthetic valve when there is discordance between symptoms and echocardiographic findings. It is also recommended in high‑risk surgical patients with VHD with poor functional capacity and more than 2 clinical risk factors. The present paper discusses in detail the use of SE in VHD

Long-term follow-up and comparison of techniques in radiofrequency ablation of ventricular arrhythmias originating from the aortic cusps (AVATAR Registry)

Introduction: Radiofrequency ablation (RFA) of outflow tract ventricular arrhythmia (VA) that originates from the aortic cusps can be challenging. Data on long-term efficacy and safety as well as optimal technique after aortic cusp ablation have not previously been reported. Objectives: This aim of the study was to determine the short- and long-term outcomes after RFA of aortic cusp VA, and to evaluate aortic valve injuries according to echocardiographic screening. Patients and methods: This was a prospective multicenter registry (AVATAR, Aortic Cusp Ventricular Arrhythmias: Long Term Safety and Outcome from a Multicenter Prospective Ablation Registry) study. A total of 103 patients at a mean age of 56 years (34–64) from the “Electra” Registry (2005–2017) undergoing RFA of aortic cusps VA were enrolled. The following 3 ablation techniques were used: zero-fluoroscopy (ZF; electroanatomical mapping [EAM] without fluoroscopy), EAM with fluoroscopy, and conventional fluoroscopy-based RFA. Data on clinical history, complications after RFA, echocardiography, and 24-hour Holter monitoring were collected. The follow-up was 12 months or longer. Results: There were no major acute cardiac complications after RFA. In one case, a vascular access complication required surgery. The median (interquartile range [IQR]) procedure time was 75 minutes (IQR, 58–95), median follow-up, 32 months (IQR, 12–70). Acute and long-term procedural success rates were 93% and 86%, respectively. The long-term RFA outcomes were observed in ZF technique (88%), EAM with fluoroscopy (86%), and conventional RFA (82%), without differences. During long-term follow-up, no abnormalities were found within the aortic root. Conclusions: Ablation of VA within the aortic cusps is safe and effective in long-term follow-up. The ZF approach is feasible, although it requires greater expertise and more imaging modalities

Doksorubicyna liposomalna u chorych na raka piersi ze współistniejącymi chorobami sercowo-naczyniowymi — wielodyscyplinarne stanowisko ekspertów

Zastosowanie liposomalnej formy doksorubicyny zamiast konwencjonalnej istotnie zmniejsza ryzyko poważnych klinicznie powikłań sercowo-naczyniowych chemioterapii. Wykorzystanie schematu z doksorubicyną liposomalną wydaje się najbardziej uzasadnione w leczeniu chorych na raka piersi ze współistniejącymi chorobami sercowo-naczyniowymi. Dokument definiuje możliwe scenariusze kliniczne zastosowania chemioterapii z doksorubicyną liposomalną oraz przedstawia zasady optymalnego monitorowania tego leczenia

Tissue Doppler echocardiography detects subclinical left ventricular dysfunction in patients undergoing chemotherapy for colon cancer: insights from ONCOECHO multicentre study

Wstęp: Rak jelita grubego (CRC) jest jednym z najczęściej występujących nowotworów na świecie. W Polsce znajduje się na trzeciej pozycji wśród mężczyzn oraz na drugiej pozycji wśród kobiet pod względem zachorowań na nowotwory. Rola chemioterapii w leczeniu CRC zależy od stopnia zaawansowania nowotworu. Chemioterapię uzupełniającą stosuje się zawsze w III stopniu zaawansowania, a także w II stadium zaawansowania klinicznego przy obecności czynników ryzyka. Cel: Celem niniejszej pracy była ocena występowania wczesnych powikłań sercowych u chorych włączonych do badania ONCOECHO w latach 2012–2014, leczonych chemioterapią z powodu CRC. W ramach badania potencjalnej kardiotoksyczności chemioterapii oceniano funkcję skurczową i rozkurczową mięśnia sercowego, zaburzenia rytmu i przewodzenia oraz występowanie niekorzystnych zdarzeń sercowo-naczyniowych. Metody: Do 12-miesięcznej obserwacji włączono 25 pacjentów z CRC (12 kobiet, średnia wieku 61,3 roku [35–76 lat]), poddanych 6-miesięcznej chemioterapii adjuwantowej. Spośród badanych 13 chorych stosowało chemioterapię opartą na 5-fluorouracylu (5-FU), a pozostałych 12 pacjentów — terapię w schemacie opartym na kapecytabinie. Ocenę przepro­wadzono wyjściowo oraz w 3., 6. i 12. miesiącu od rozpoczęcia leczenia. Analiza obejmowała obecność zaburzeń rytmu i przewodzenia, funkcję skurczową i rozkurczową mięśnia sercowego oraz występowanie zdarzeń sercowo-naczyniowych. Wyniki: Po 12 miesiącach obserwacji niektóre parametry czynności lewej komory (LV) (S’IVS, S’lat i E’sept) uległy pogorszeniu. Frakcja wyrzutowa (EF) i wymiary jam serca pozostały niezmienione. Zmiany parametrów LV uwidocznione metodą doplera tkankowego po 12 miesiącach były niezależne od stosowanego schematu chemioterapii; nie wykazano również zależności między zmianami tych parametrów a stosowaniem inhibitorów konwertazy angiotensyny i beta-adrenolityków. Wnioski: Stosowanie chemioterapii w CRC nie wpływa na parametry strukturalne ani klasyczne parametry czynności skurczowej LV (LVEF). Może jednak wywoływać subtelne pogorszenie zarówno czynności skurczowej, jak i rozkurczowej mięśnia sercowego wykrywalne przy użyciu doplera tkanowego po 12 miesiącach obserwacji, a także przejściowe wydłużenie odcinka QT ustępujące po zakończeniu chemioterapii.Background: Colorectal cancer (CRC) is the second most common cancer in women and the third in men in Poland. The role of chemotherapy (CTX) depends on the stage of CRC: adjuvant CTX is a standard treatment in stage III and should also be considered in stage II with risk factors. Aim: The aim of the paper was to assess the cardiovascular consequences of CTX in CRC enrolled to the ONCOECHO multicentre study (2012–2014). To identify potential cardiotoxicity, we focused on myocardial function, heart rhythm and conduction disorders, and adverse cardiovascular events. Methods: Twenty-five CRC patients (12 women, mean age 61.3 [35–76] years), all receiving six-month adjuvant CTX were included. Thirteen patients received 5-fluorouracil (5FU)-based CTX, and 12 patients received a capecitabine-based scheme. Subjects were assessed at baseline and followed-up three, six, and 12 months after the onset of treatment. In this analysis we focused on conduction abnormalities, systolic and diastolic function of the left ventricle (LV), and cardiovascular events. Results: In 12-month follow-up a decrease of selected tissue Doppler parameters (e.g. S’IVS, S’lat, and E’sept) was observed, and it was significant. LV structural parameters and ejection fraction (EF) remained unaffected. Changes in myocardial performance were not influenced by CTX regimen or treatment with beta-blockers or angiotensin-converting enzyme inhibitors. CTX did not affect LV structural parameters, EF, or conduction system, nor was it associated with cardiovascular events during the 12-month follow-up. Conclusions: CTX in CRC patients does not affect LV structural parameters and EF. It may, however, trigger subtle changes in myocardial performance detectable by tissue Doppler echocardiography after 12 months. Moreover, it causes a transient increase of QT, which resolves after CTX cessation