Czynniki warunkujące jakość życia po implantacji kardiostymulatora

Introduction. Health-related quality of life (HRQoL) after pacemaker (PM) implantation has been studied according to stimulation mode and indications, however these do not fully explain HRQoL changes. Aim of the study is to evaluate other factors.  Materials and methods. Single-center, prospective, observational study on 101 adult PM-recipients, with no periproce- dural complications was performed. The study group was surveyed twice: periprocedural and 18 month follow-up (FU). Nottingham Health Profile to evaluate general HRQoL was performed. 83 participants completed full study protocol. Comparative analysis (periprocedural vs. end-of-FU) was performed to measure relationship between HRQoL-change and gender, place of residence, disability level, physical activity, level of care and support, BMI, diet, percentage of atrial and ventricular pacing (Ap&Vp), symptoms associated with rhythm and conduction disorders, severity of coronary heart disease and heart failure.  Results. Total HRQoL improvement occurred for the rural residents, obese and Vp > 79%. The study group improved significantly in two HRQoL domains: emotional reactions (E.R.) and sleep disorders (S.D.). Analyzing specific HRQoL do- mains (energy, pain, E.R.S.D. social alienation, movement limitations) improved patients are: female, self-mobile, high level of care and support, eating habits — changers, without syncope and angina symptoms. Age and body mass index (BMI) were identified as factors changing HRQoL-improving domain.  Conclusions. The improvement of HRQoL after PM implantation seems to be mainly related to S.D. and E.R. Important factors influencing HRQoL change are: place of residence, BMI and Vp. This impact of PM implantation on HRQoL re- quires further study Wstęp. Jakość życia zależna od stanu zdrowia (HRQoL) po implantacji kardiostymulatora (PM) była przedmiotem wielu analiz, w których dominowała ocena zależności HRQoL od trybu stymulacji i wskazań do zabiegu. Czynniki te nie wyjaśniają jednak w pełni zmian HRQoL, co motywuje do poszukiwania innych uwarunkowań zmiany HRQoL po implantacji PM.  Materiał i metody. Przeprowadzono jednoośrodkowe, prospektywne badanie obserwacyjne u 101 dorosłych pacjentów, którym bez powikłań implantowano PM. Pacjentów ankietowano 2-krotnie — w okresie okołozabiegowym i na zakończenie 18-miesięcznej obserwacji (FU). Jakość życia zależną od stanu zdrowia oceniano za pomocą kwestionariusza Nottingham Health Profile. Pełen protokół badania ukończyło 83 pacjentów. W tej grupie przeprowadzono analizę porównawczą (okres okołozabiegowy v. FU) w celu pomiaru związku między zmianą HRQoL a: płcią, miejscem zamieszkania, poziomem niepełnosprawności, aktywnością fizyczną, poziomem opieki i wsparcia, wskaźnikiem masy ciała (BMI), dietą, odsetkiem stymulacji przedsionkowej i komorowej (Ap i Vp), objawami związanymi z zaburzeniami rytmu i przewodzenia, zaawansowaniem choroby wieńcowej i niewydolności serca.  Wyniki. Poprawa HRQoL po implantacji PM nastąpiła u mieszkańców wsi, osób otyłych i tych z Vp ponad 79%. W całej badanej grupie znaczną poprawę obserwowano w zakresie dwóch domen HRQoL — reakcji emocjonalnych (E.R.) i zaburzeń snu (S.D.). Analizując poszczególne domeny HRQoL (energia, ból, wyobcowanie społeczne, E.R.S.D. ograniczenia ruchowe), poprawę obserwowano u kobiet, osób zdolnych do samodzielnego poruszania się, osób z wysokim poziomem opieki i wsparcia, oraz tych, którzy po implantacji PM zmienili nawyki żywieniowe, a także tych, którzy nie doświadczyli omdlenia i dławicy piersiowej. Wiek i BMI zidentyfikowano jako czynniki zmieniające domenę HRQoL ulegającą poprawie po implantacji.  Wnioski. Poprawa HRQoL po implantacji PM wydaje się związana głównie z S.D. i E.R. Ważnymi czynnikami wpływającymi na zmianę HRQoL są miejsce zamieszkania, BMI i odsetek Vp. Wpływ implantacji PM na HRQoL wymaga dalszych badań.

Czynniki warunkujące jakość życia po implantacji kardiostymulatora

Health-related quality of life (HRQoL) after pacemaker (PM) implantation has been studied according to stimulation mode and indications, however these do not fully explain HRQoL changes. Aim of the study is to evaluate other factors. Single-center, prospective, observational study on 101 adult PM-recipients, with no periproce- dural complications was performed. The study group was surveyed twice: periprocedural and 18 month follow-up (FU). Nottingham Health Pro le to evaluate general HRQoL was performed. 83 participants completed full study protocol. Comparative analysis (periprocedural vs. end-of-FU) was performed to measure relationship between HRQoL-change and gender, place of residence, disability level, physical activity, level of care and support, BMI, diet, percentage of atrial and ventricular pacing (Ap&Vp), symptoms associated with rhythm and conduction disorders, severity of coronary heart disease and heart failure. Total HRQoL improvement occurred for the rural residents, obese and Vp > 79%. The study group improved signi cantly in two HRQoL domains: emotional reactions (E.R.) and sleep disorders (S.D.). Analyzing speci c HRQoL do- mains (energy, pain, E.R.S.D. social alienation, movement limitations) improved patients are: female, self-mobile, high level of care and support, eating habits - changers, without syncope and angina symptoms. Age and body mass index (BMI) were identi ed as factors changing HRQoL-improving domain. The improvement of HRQoL after PM implantation seems to be mainly related to S.D. and E.R. Important factors in uencing HRQoL change are: place of residence, BMI and Vp. This impact of PM implantation on HRQoL re- quires further study

The prognostic value of normal myocardial perfusion spect with positive coronary angiography

BACKGROUND: Normal exercise SPECT studies are associatedwith a low event rate. The association of the negative SPECTand positive coronary angiography with the results for the longtime follow up was determined.MATERIAL AND METHODS: 45 patients were included intothe study. All patients had normal SPECT study and positiveangiography in the ≤ 6 months after SPECT. 20 of them werewomen.Six patients had diabetes mellitus, 8 was smokers. Twopatients had had left main coronary artery and 12 had multivesseldisease. Baseline clinical risk factors were recorded for eachpatients and compared to outcomes.RESULTS: There were no deaths in the study group in the followup period. One myocardial infarct occurred in patient withmultivessel disease and five more angioplasties with stentswere performed in the long term follow up due to progressionof coronary stenosis.CONCLUSIONS: We observed that the normal SPECT withpositive ECG pattern is infrequent and has a very good prognosticvalue However, the long-term survival among a patientcohort with a normal exercise SPECT study is influenced by thenumber of concomitant CAD risk factors. We conclude that there is an importance of modifying CAD risk factors among patientswith a normal SPECT

The prognostic value of normal myocardial perfusion spect with positive coronary angiography

BACKGROUND: Normal exercise SPECT studies are associated with a low event rate. The association of the negative SPECT and positive coronary angiography with the results for the long time follow up was determined. MATERIAL AND METHODS: 45 patients were included into the study. All patients had normal SPECT study and positive angiography in the ≤ 6 months after SPECT. 20 of them were women.Six patients had diabetes mellitus, 8 was smokers. Two patients had had left main coronary artery and 12 had multivessel disease. Baseline clinical risk factors were recorded for each patients and compared to outcomes. RESULTS: There were no deaths in the study group in the follow up period. One myocardial infarct occurred in patient with multivessel disease and five more angioplasties with stents were performed in the long term follow up due to progression of coronary stenosis. CONCLUSIONS: We observed that the normal SPECT with positive ECG pattern is infrequent and has a very good prognostic value However, the long-term survival among a patient cohort with a normal exercise SPECT study is influenced by the number of concomitant CAD risk factors. We conclude that there is an importance of modifying CAD risk factors among patients with a normal SPEC

Left coronary arteriovenous malformation with fistulous connections to the left and right ventricles

A 20-year-old man with right bundle branch block in recorded ECG was referred to our department. His physical examination was unremarkable. Transthoracic echocardiography showed a severe hypertrophy of the interventricular septum (22 mm) which contained multiple echo-free spaces of the vascular nature. A flow pattern suggestive to a coronary artery fistula into the left ventricle was recorded. The patient was referred for a coronary angiography, which revealed an arteriovenous malformation starting from the septal branch of the enlarged left anterior descending artery. The malformation communicated with the lumen of the left (arterial phase) and right ventricle (venous phase) as well. The posterior descending artery was fed exclusively from the described arteriovenous malformation. 99mTc MIBI SPECT images showed a moderately reversible perfusion defect in the inferior wall, suggesting non-critical ischemia of this region

Left coronary arteriovenous malformation with fistulous connections to the left and right ventricles

A 20-year-old man with right bundle branch block in recordedECG was referred to our department. His physical examinationwas unremarkable. Transthoracic echocardiography showeda severe hypertrophy of the interventricular septum (22 mm)which contained multiple echo-free spaces of the vascularnature. A flow pattern suggestive to a coronary artery fistulainto the left ventricle was recorded. The patient was referredfor a coronary angiography, which revealed an arteriovenousmalformation starting from the septal branch of the enlarged leftanterior descending artery. The malformation communicatedwith the lumen of the left (arterial phase) and right ventricle(venous phase) as well. The posterior descending artery wasfed exclusively from the described arteriovenous malformation.99mTc MIBI SPECT images showed a moderately reversible perfusiondefect in the inferior wall, suggesting non-critical ischemiaof this region

Amyloidoza serca — właściwe rozpoznanie i nowe terapie na horyzoncie

Cardiac amyloidosis (CA), which used to be considered a rare disease, is now increasingly recognised due to increased clinical awareness and the availability of advanced diagnostic techniques. CA can occur unexpectedly frequently in particular patient populations: among patients with heart failure with preserved left ventricular ejection fraction, as a phenocopy of hypertrophic cardiomyopathy, and among older patients with severe aortic stenosis. The deposition of abnormally folded, insoluble proteins in the extracellular matrix of tissues and organs plays a key role in the pathogenesis of amyloidosis. Despite the large number of pathogenic molecules, two types account for more than 95% of CA cases: immunoglobulin light chain amyloidosis (AL) and transthyretin amyloidosis (ATTR). A recent paradigm shift in the diagnosis of CA, without the need for performing endomyocardial biopsy, has occurred as a result of technological advances in imaging and the development of new scintigraphy protocols. A combination of positive scintigraphic examination performed with bone-avid tracers and the absence of detectable monoclonal protein in serum or urine justifies a non-invasive diagnosis of ATTR. Early identification of affected patients remains crucial in order to improve prognosis, especially in patients with AL, in whom progression of the disease from the moment of heart involvement is extremely swift without causal treatment. There has recently been an exponential development of novel agents designed for patients with cardiomyopathy in the course of ATTR, which as a result, hopefully, in the future could become a curable disease. In the following article we present recent advances in the diagnosis and treatment of CA.Amyloidoza serca (CA), uważana w przeszłości za chorobę rzadką, obecnie jest coraz częściej rozpoznawana dzięki zwiększonej świadomości klinicznej oraz dostępnym zaawansowanym metodom diagnostycznym. Może ona występować zaskakująco często w szczególnych populacjach pacjentów — wśród osób z niewydolnością serca z zachowaną frakcją wyrzutową, jako fenokopia kardiomiopatii przerostowej (HCM) oraz wśród starszych pacjentów z ciężką stenozą aortalną. Kluczową rolę w patogenezie amyloidozy odgrywa odkładanie się w macierzy pozakomórkowej tkanek i narządów depozytów nieprawidłowo sfałdowanych, nierozpuszczalnych białek. Mimo dużej liczby patogennych cząsteczek, to dwa ich rodzaje odpowiadają za ponad 95% przypadków CA — amyloidozę łańcuchów lekkich immunoglobulin (AL) i amyloidozę transtyretynową (ATTR). Niedawna zmiana paradygmatu w diagnozowaniu CA bez konieczności wykonywania biopsji endomiokardialnej dokonała się wraz z postępem technologicznym w obrazowaniu i rozwoju nowych protokołów badania scyntygraficznego. Pozytywne obrazowanie scyntygraficzne z użyciem znaczników klasycznie stosowanych w obrazowaniu układu kostnego, w przypadku braku wykrywalnego białka monoklonalnego w surowicy lub moczu, pozwala na nieinwazyjną diagnozę ATTR. Wczesna identyfikacja chorych jest kluczowa w kontekście poprawy rokowania, zwłaszcza pacjentów z AL, u których postęp choroby podstawowej od czasu zajęcia serca jest dramatycznie szybki. Obserwuje się ogromny rozwój nowych leków przeznaczonych dla pacjentów z kardiomiopatią w przebiegu ATTR, która w przyszłości ma szansę stać się chorobą uleczalną. W poniższym artykule przedstawiono ostatnie postępy w diagnostyce i leczeniu CA