Przepływ w gałęzi przedniej zstępującej lewej tętnicy wieńcowej u pacjentów z marskością wątroby

Introduction. Although cardiac function appears normal in patients with cirrhosis at rest, cardiac function deteriorates in these patients under stress conditions. Decreased cardiac function against stress may be due to coronary microvascular dysfunction in these patients. In this study, we aimed to evaluate coronary microvascular dysfunction in patients with cirrhosis by measuring coronary flow reserve (CFR) by transthoracic echocardiography. Materials and methods. Thirty-eight patients with cirrhosis and 32 healthy subjects (as control group) were examined. In addition to standard two-dimesional (2D) and Doppler echocardiography, coronary flow velocity was measured by pulsed-wave Doppler from the middle to the distal part of the left anterior descending artery at the beginning and after dipyridamole infusion in the hyperemic state. CFR was measured as the ratio of hyperemic peak diastolic flow rate to basal peak diastolic flow rate. Results. CFR was significantly lower in the cirrhosis group than in the control group (2.01 ± 0.31 and 2.84 ± 0.62; p < 0.0001). Increasing age, increasing myocardial mass, high aspartate aminotransferase and alanine aminotransferase, low hemoglobin, high C-reactive protein, decreased cholesterol and platelet levels were found to be associated with the reduction in CFR. Among all these factors only, the hemoglobin level and age were independent determinants of impaired CFR. Conclusions. Impaired CFR in patients with cirrhosis promotes coronary microvascular dysfunction. The coronary microvascular dysfunction can potentially contribute to the development of cirrhotic cardiomyopathy.Wstęp. Chociaż czynność serca u pacjentów z marskością wątroby oceniana w spoczynku wydaje się prawidłowa, to w warunkach wysiłku fizycznego lub obciążenia farmakologicznego ulega ona pogorszeniu. Zaburzenie czynności serca podczas obciążenia może być spowodowane dysfunkcją mikrokrążenia wieńcowego u tych chorych. Celem badania była ocena dysfunkcji mikrokrążenia wieńcowego u pacjentów z marskością wątroby przez pomiar rezerwy przepływu wieńcowego (CRF) za pomocą echokardiografii przezklatkowej. Materiał i metody. Do badania włączono 38 chorych z marskością wątroby i 32 osoby zdrowe (grupa kontrolna). Oprócz standardowej echokardiografii dwuwymiarowej (2D) i echokardiografii doplerowskiej prędkość przepływu wieńcowego w odcinkach środkowym i dystalnym gałęzi przedniej lewej tętnicy zstępującej zmierzono za pomocą badania dopplerowskiego metodą fali pulsacyjnej bezpośrednio przed wlewem dipirydamolu i po nim. Rezerwę przepływu wieńcowego mierzono jako stosunek maksymalnego przepływu rozkurczowego w obciążeniu do maksymalnego przepływu rozkurczowego w spoczynku. Wyniki. Rezerwa przepływu wieńcowego była istotnie niższa w grupie z marskością wątroby niż w grupie kontrolnej (2,01 ± 0,31 i 2,84 ± 0,62; p &lt; 0,0001). Stwierdzono, że ze zmniejszeniem CFR wiązały się: wiek, zwiększenie masy mięśnia sercowego, wysoka aktywność aminotransferaz asparaginianowej i alaninowej, niskie stężenie hemoglobiny, wysokie stężenie białka C-reaktywnego, obniżone stężenie cholesterolu i zmniejszona liczba płytek krwi. Jednak tylko stężenie hemoglobiny i wiek były niezależnymi determinantami zmniejszonej CFR. Wnioski. Zmniejszenie CFR u chorych z marskością wątroby sprzyja dysfunkcji mikrokrążenia wieńcowego, która może prowadzić do rozwoju kardiomiopatii wątrobowej (marskiej)

Three-dimensional transoesophageal echocardiography: how to use and when to use-a clinical consensus statement from the European Association of Cardiovascular Imaging of the European Society of Cardiology.

peer reviewedThree-dimensional transoesophageal echocardiography (3D TOE) has been rapidly developed in the last 15 years. Currently, 3D TOE is particularly useful as an additional imaging modality for the cardiac echocardiographers in the echo-lab, for cardiac interventionalists as a tool to guide complex catheter-based procedures cardiac, for surgeons to plan surgical strategies, and for cardiac anaesthesiologists and/or cardiologists, to assess intra-operative results. The authors of this document believe that acquiring 3D data set should become a 'standard part' of the TOE examination. This document provides (i) a basic understanding of the physic of 3D TOE technology which enables the echocardiographer to obtain new skills necessary to acquire, manipulate, and interpret 3D data sets, (ii) a description of valvular pathologies, and (iii) a description of non-valvular pathologies in which 3D TOE has shown to be a diagnostic tool particularly valuable. This document has a new format: instead of figures randomly positioned through the text, it has been organized in tables which include figures. We believe that this arrangement makes easier the lecture by clinical cardiologists and practising echocardiographers

The structural heart disease interventional imager rationale, skills and training: a position paper of the European Association of Cardiovascular Imaging

Percutaneous therapeutic options for an increasing variety of structural heart diseases (SHD) have grown dramatically. Within this context of continuous expansion of devices and procedures, there has been increased demand for physicians with specific knowledge, skills, and advanced training in multimodality cardiac imaging. As a consequence, a new subspecialty of 'Interventional Imaging' for SHD interventions and a new dedicated professional figure, the 'Interventional Imager' with specific competencies has emerged. The interventional imager is an integral part of the heart team and plays a central role in decision-making throughout the patient pathway, including the appropriateness and feasibility of a procedure, pre-procedural planning, intra-procedural guidance, and post-procedural follow-up. However, inherent challenges exist to develop a training programme for SHD imaging that differs from traditional cardiovascular imaging pathways. The purpose of this document is to provide the standard requirements for the training in SHD imaging, as well as a starting point for an official certification process for SHD interventional imager.Cardiolog

EHRA expert consensus statement on arrhythmic mitral valve prolapse and mitral annular disjunction complex in collaboration with the ESC Council on valvular heart disease and the European Association of Cardiovascular Imaging endorsed cby the Heart Rhythm Society, by the Asia Pacific Heart Rhythm Society, and by the Latin American Heart Rhythm Society.

peer reviewe

The atrium central part of a building-a definition, cardiologists should not forget

International audienc

Mitral regurgitation: not a single disease with systematic and identic functional and haemodynamic consequences

International audienceThis editorial refers to ‘Prevalence, distribution, and determinants of pulmonary venous systolic flow reversal in severe mitral regurgitation’ by K.U. Itakura et al., pp. 964--73

Haemodynamic evaluation: a key tool for heart failure management

International audienc