Darius Palionis - Academia.edu (original) (raw)

Papers by Darius Palionis

Research paper thumbnail of Could careful patient selection for renal denervation warrant a positive effect on arterial stiffness and left ventricular mass reduction?

Acta Cardiologica, 2016

Hypertension is highly prevalent and one of the most frequently occurring chronic diseases worldw... more Hypertension is highly prevalent and one of the most frequently occurring chronic diseases worldwide. Globally, the overall prevalence of raised blood pressure (BP) in adults aged 25 and over was around 40% in 2008 1. The meta-analysis of large studies indicates the 12-15% prevalence of resistant arterial hypertension (RAH) among the treated patients 2. Furthermore, the prevalence

Research paper thumbnail of Tomographic volumetry of the right ventricle: redundancy of technologies or inescapable necessity for a multimodality approach?

Research paper thumbnail of Prediction of global left ventricular functional recovery in patients with heart failure undergoing revascularisation, based on late gadolinium enhancement and low dose dobutamine cardiovascular magnetic resonance

Research paper thumbnail of Isolated nasal amyloidosis: a case report

Medicina (Kaunas, Lithuania), 2013

Amyloidosis is a rare condition characterized by the deposition of abnormal protein filaments int... more Amyloidosis is a rare condition characterized by the deposition of abnormal protein filaments into the extracellular tissue. Only 16 cases of true primary idiopathic amyloidosis localized in the nose and the paranasal sinuses have previously been reported. We present a case of localized amyloidosis involving the sinonasal cavities and the nose in a 53-year-old woman. Our patient was operated on as a typical case of chronic rhinosinusitis with polyps, but after 2 years, the patient came back with severe symptoms of nasal obstruction and pain in the frontal and maxillary regions with proptosis of both eyes. Magnetic resonance imaging revealed sinonasal-intraorbital masses. Primary amyloidosis (AL type) was confirmed by tissue biopsy. A systemic workup for additional amyloid deposits revealed no evidence of other diseases. Extended surgery produced a symptomatic improvement.

Research paper thumbnail of Age-dependent heterogeneity of familiar hypertrophic cardiomyopathy phenotype: a role of cardiovascular magnetic resonance

Medicina (Kaunas, Lithuania), 2013

In this case report, we present familiar hypertrophic cardiomyopathy with age-dependent heterogen... more In this case report, we present familiar hypertrophic cardiomyopathy with age-dependent heterogeneity of the disease phenotype among the members of one family who carry the same mutation of the myosin-binding protein C gene. Phenotypic heterogeneity is common in patients with familial forms of hypertrophic cardiomyopathy, both in clinical expression and outcome. Compared with other noninvasive cardiac imaging modalities, cardiovascular magnetic resonance provides an opportunity to more accurately characterize the varying phenotypic presentations of hypertrophic cardiomyopathy.

Research paper thumbnail of Diagnostic methods, treatment modalities, and follow-up of extracranial arteriovenous malformations

Medicina (Kaunas, Lithuania), 2012

Arteriovenous malformations (AVMs) are an uncommon vascular pathology that remains challenging to... more Arteriovenous malformations (AVMs) are an uncommon vascular pathology that remains challenging to accurately diagnose and successfully treat. This study introduces a novel way to evaluate AVM treatment outcomes using transarterial lung perfusion scintigraphy (TLPS) and reports our treatment results. The patients treated for extracranial AVMs were studied retrospectively. Diagnosis and outcomes were based on clinical data, ultrasonography, magnetic resonance imaging, computed tomography, angiography, and TLPS studies. The influence of gender; location, form, and stage of AVMs; first attempt at treatment; and treatment modalities was analyzed. Outcomes were defined as positive (cure, improvement, and remission) or negative (no remission and aggravation). Of the 324 patients with congenital vascular malformations, 129 (39.8%) presented with AVMs, and the data of 56 treated patients with AVMs were analyzed. Of the 29 patients in the endovascularly treated group, 15 in the surgically tre...

Research paper thumbnail of Differentiation of acute myocarditis and acute myocardial infarction by the regional distribution of myocardial irreversible injury using cardiovascular magnetic resonance imaging

Medicina (Kaunas, Lithuania), 2012

In this study, we have sought for differences between cardiovascular magnetic resonance patterns ... more In this study, we have sought for differences between cardiovascular magnetic resonance patterns of acute myocarditis and acute myocardial infarction. A prospective analysis of 110 consecutive patients was performed. The presence, precise location, and pattern of late gadolinium enhancement (LGE) by cardiovascular magnetic resonance were investigated. The subendocardial LGE pattern was much more frequent in the myocardial infarction group (76.7%) than myocarditis group (10.0%) (P<0.001). Meanwhile, midmyocardial LGE was much more typical of myocarditis (65.0%) than acute myocardial infarction (1.1%) (P<0.001), and epicardial LGE was also much more typical of myocarditis (55.0%) than acute myocardial infarction (0.0%) (P<0.001). Midmyocardial and epicardial LGE patterns were defined as a nonischemic LGE pattern more typical of myocarditis. Logistic regression analysis revealed that the subendocardial and midmyocardial LGE locations played the greatest role in differentiation...

Research paper thumbnail of Cardiovascular magnetic resonance for visualization of myocardial ischemia at rest

Medicina (Kaunas, Lithuania), 2011

This article presents the case of a 54-year-old male with evidence of myocardial ischemia at rest... more This article presents the case of a 54-year-old male with evidence of myocardial ischemia at rest. In our case, by means of cardiovascular magnetic resonance, myocardial ischemia at rest in theoretical left anterior descending artery territory was proved, myocardial scar was excluded, and need for revascularization was validated.

Research paper thumbnail of Multimodality imaging in a rare case of tuberculous pericarditis

European Heart Journal - Cardiovascular Imaging, 2012

Research paper thumbnail of Prediction of long-term segmental and global functional recovery of hibernating myocardium after revascularisation based on low dose dobutamine and late gadolinium enhancement cardiovascular magnetic resonance

Journal of Cardiovascular Magnetic Resonance, 2014

This study sought to evaluate the relation between long-term segmental and global functional outc... more This study sought to evaluate the relation between long-term segmental and global functional outcome after revascularisation in patients with chronic ischaemic left ventricular dysfunction (LVD) and baseline markers of viability: late gadolinium enhancement (LGE) transmurality and contractile reserve (CR). Forty-two patients with chronic ischaemic LVD underwent low-dose dobutamine- (LDD) and late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) before surgical or percutaneous revascularisation. Regional and global left ventricular (LV) functions and LGE were repeatedly assessed 6 ± 1 and 35 ± 6 months after revascularisation. In total, 319 at baseline dysfunctional and successfully revascularised segments were available for statistical analysis. The likelihood of long-term functional improvement was directly related to the presence of CR and inversely related to both the LGE and the degree of contractile dysfunction at baseline. The time course of functional improvement was protracted, with significantly more delay in segments with more extensive LGE (p = 0.005) and more severe contractile dysfunction at baseline (p = 0.002). The presence of CR was the predictor of earlier functional improvement (p &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). Using a definition of viable segment as a segment without any LGE or with any LGE and producing CR during LDD stimulation, ≥55% of viable segments from all dysfunctional and revascularised segments in a patient was the only independent predictor of significant improvement (≥5%) in the left ventricular ejection fraction (LVEF) after revascularisation, with a 72% sensitivity and an 80% specificity (AUC 0.76, p = 0.014). Reverse LV remodelling was observed in patients who had a significant amount of viable myocardium successfully revascularised. In patients with chronic ischaemic LVD, improvement of dysfunctional but viable myocardium can be considerably delayed. Both the likelihood and the time course of functional improvement are related to the LGE, CR and the degree of contractile dysfunction at baseline. At 35 ± 6 months after revascularisation, patients with ≥55% of viable segments from all dysfunctional and revascularised segments significantly improve LVEF and experience reverse LV remodelling. A combination of LDD-CMR and LGE-CMR is a simple and powerful tool for identifying which patients with impaired LV function will benefit from revascularisation.

Research paper thumbnail of Complicated Congenital Gluteal Arteriovenous Malformation With Hemorrhage in Pregnancy

Annals of Vascular Surgery, 2013

Extracranial congenital arteriovenous malformations (AVMs) are rare clinical entities that can be... more Extracranial congenital arteriovenous malformations (AVMs) are rare clinical entities that can be progressive in nature. The influence of pregnancy on lesion progression has been discussed in the past. This report presents an unusual case of 23-year-old primigravida woman who presented at 36 weeks&amp;amp;amp;amp;amp;amp;amp;amp;#39; gestation with complicated necrotic ulceration and hemorrhage of the right gluteal region. A hyperpigmented mark with varicosities was initially noted at birth, but during pregnancy it showed remarkable progression and was first identified as an AVM. After hemorrhage control and induced delivery, the lesion was successfully treated with several embolizations. Complete wound healing was achieved, but because of partial recurrence at 3 years, repeat embolization was performed, with satisfactory clinical improvement and residual 25% arteriovenous shunting on transarterial lung perfusion scintigraphy study. AVM complications during pregnancy are uncommon, and this case supports the prior opinion that pregnancy can stimulate lesion progression. Especially in undiagnosed and previously untreated cases, this can lead to life-threatening complications for the mother and fetus. Long-term lesion management usually requires combined endovascular and surgical treatment.

Research paper thumbnail of ClInICal InVestIgatIons Correspondence to Differentiation of acute Myocarditis and acute Myocardial Infarction by the Regional Distribution of Myocardial Irreversible Injury Using Cardiovascular Magnetic Resonance Imaging

Medicina (Kaunas, Lithuania)

Background and Objective. In this study, we have sought for differences between cardiovascular ma... more Background and Objective. In this study, we have sought for differences between cardiovascular magnetic resonance patterns of acute myocarditis and acute myocardial infarction. Material and Methods. A prospective analysis of 110 consecutive patients was performed. The presence, precise location, and pattern of late gadolinium enhancement (LGE) by cardiovascular magnetic resonance were investigated. Results. The subendocardial LGE pattern was much more frequent in the myocardial infarction group (76.7%) than myocarditis group (10.0%) (P<0.001). Meanwhile, midmyocardial LGE was much more typical of myocarditis (65.0%) than acute myocardial infarction (1.1%) (P<0.001), and epicardial LGE was also much more typical of myocarditis (55.0%) than acute myocardial infarc-tion (0.0%) (P<0.001). Midmyocardial and epicardial LGE patterns were defined as a nonischemic LGE pattern more typical of myocarditis. Logistic regression analysis revealed that the subendo-cardial and midmyocardia...

Research paper thumbnail of CLINICAL CASE REPORT Cardiovascular Magnetic Resonance for Visualization of Myocardial Ischemia at Rest

Medicina (Kaunas, Lithuania)

Key words: cardiovascular magnetic resonance; myocardial ischemia; coronary artery disease. Summa... more Key words: cardiovascular magnetic resonance; myocardial ischemia; coronary artery disease. Summary. This article presents the case of a 54-year-old male with evidence of myocardial is-chemia at rest. In our case, by means of cardiovascular magnetic resonance, myocardial ischemia at rest in theoretical left anterior descending artery territory was proved, myocardial scar was excluded, and need for revascularization was validated. Adresas susirašinėti: S. Glaveckaitė, VU MF Širdies ir kraujagys-lių ligų klinika, Introduction We present a case of resting myocardial ischemia and shortly discuss the value of cardiovascular mag-netic resonance (CMR) for the assessment of rest and stress ischemia especially in case when coronary artery stenosis is of unclear signifi cance.

Research paper thumbnail of ŠIRDIES AL AMILOIDOZĖ: KLINIKINIO ATVEJO APRAŠYMAS

Sveikatos mokslai, 2014

ABSTRACT Amiloidozė – tai grupė retų sisteminių ligų, kurioms būdingas sutrikęs baltyminių strukt... more ABSTRACT Amiloidozė – tai grupė retų sisteminių ligų, kurioms būdingas sutrikęs baltyminių struktūrų susidarymas ir fibrilių formavimasis. Amiloidozės atsiradimą lemia didelis amiloido pirmtako kiekis organizme, nevisiškas amiloido pirmtako suirimas makrofagų sistemoje bei tam tikri audinių ypatumai. Nors liga sukelia sisteminius pakitimus, tačiau amiloido depozicijos laipsnis įvairiuose organuose skiriasi ir lemia skirtingas klinikines amiloidozės išraiškas. Širdies amiloidozė – tai klinikinis susikaupusio amiloido širdyje pasireiškimas. Širdies amiloidozės metu pagrindinis patogenezinis elementas – intersticinė amiloido infiltracija, sukelianti infiltracinę kardiomiopatiją, kuri progresuoja iki restrikcinės kardiomiopatijos ir širdies nepakankamumo. Širdies pažeidimas amiloidozės metu lemia itin blogą prognozę ir didelį mirštamumą. Todėl labai svarbu kuo ankstyvesnė diagnostika, kuri užkirstų kelią amiloido depozicijai įvairiuose organuose. Vis dėlto širdies amiloidozės diagnostika dažnai būna atlikta procesui esant toli pažengus, nes nėra specifinio klinikinio ligos pasireiškimo, todėl instrumentiniai tyrimai, patvirtinantys ligos diagnozę, atliekami per vėlai. Pagrindinis amiloidozės gydymas nukreiptas į infiltracinio proceso sustabdymą, kurio metu siekiama blokuoti amiloido depoziciją įvairiuose organuose ir į amiloidozės sukeltų komplikacijų gydymą, kuris mažina simptomus ir pagerina bendrą paciento būklę.

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

Journal of Cardiovascular Magnetic Resonance, 2011

This study sought to prospectively and directly compare three cardiovascular magnetic resonance (... more 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. 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. 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. 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.

Research paper thumbnail of An assessment of iron overload in children treated for cancer and nonmalignant hematologic disorders

European Journal of Pediatrics, 2014

Our goal was to assess the natural fate of iron overload (IO) following transfusions of packed re... more Our goal was to assess the natural fate of iron overload (IO) following transfusions of packed red blood cells (PRBCs) in children treated for cancer and nonmalignant disorders according to the intensity level of their treatment. Sixty-six children were followed up from February 2010 to March 2013. The transfusion burden was compared between three treatment intensity groups assigned according to the Intensity of Treatment Rating Scale 3.0 (ITR-3). IO was assessed by serial measurements of serum ferritin (SF) (n= 66) and quantification of tissue iron by magnetic resonance imaging (MRI) (n=12). Of the children studied, 36 % (24/66) received moderately intensive treatment (level 2), 21 % (14/ 66) received very intensive treatment (level 3), and 42 % (28/ 66) received the most intensive treatment (level 4). The number of PRBC (p=0.016), the total transfused volume (p= 0.026), and transfused volume adjusted to body weight (p= 0.004) were significantly higher in the level 4 group. By the median follow-up time of 35.5 months (range 8–133), 21– 29 % of patients (including level 2 and level 3 children) had SF &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;1,000 μg/l 1 year after cessation of transfusions. The slowest decrease of SF was observed in the level 4 group. Initial MRI examination demonstrated either mild or moderate IO in the liver and spleen. Repetitive MRI showed significant improvement in relaxation time between the initial and follow-up MRI performances in the liver (5.9 vs. 8.6 ms, p= 0.03) and the spleen (4.3 vs. 8.8 ms, p=0.03). IO diminished over time, but in the level 4 patients, it was detectable for years after cessation of transfusions.

Research paper thumbnail of Neurovascular intervention

Cardiovascular Revascularization Medicine, 2010

Research paper thumbnail of Early ischemic brain lesions after carotid angioplasty and stenting on diffusion-weighted magnetic resonance imaging study

Seminars in Cardiovascular Medicine, 2000

The aim of the paper is to evaluate the appearance of the new early ischemic lesions in the brain... more The aim of the paper is to evaluate the appearance of the new early ischemic lesions in the brain after carotid angioplasty and stenting on diffusion-weighted magnetic resonance imaging, and their relationship with clinical and procedural factors.

Research paper thumbnail of Could careful patient selection for renal denervation warrant a positive effect on arterial stiffness and left ventricular mass reduction?

Acta Cardiologica, 2016

Hypertension is highly prevalent and one of the most frequently occurring chronic diseases worldw... more Hypertension is highly prevalent and one of the most frequently occurring chronic diseases worldwide. Globally, the overall prevalence of raised blood pressure (BP) in adults aged 25 and over was around 40% in 2008 1. The meta-analysis of large studies indicates the 12-15% prevalence of resistant arterial hypertension (RAH) among the treated patients 2. Furthermore, the prevalence

Research paper thumbnail of Tomographic volumetry of the right ventricle: redundancy of technologies or inescapable necessity for a multimodality approach?

Research paper thumbnail of Prediction of global left ventricular functional recovery in patients with heart failure undergoing revascularisation, based on late gadolinium enhancement and low dose dobutamine cardiovascular magnetic resonance

Research paper thumbnail of Isolated nasal amyloidosis: a case report

Medicina (Kaunas, Lithuania), 2013

Amyloidosis is a rare condition characterized by the deposition of abnormal protein filaments int... more Amyloidosis is a rare condition characterized by the deposition of abnormal protein filaments into the extracellular tissue. Only 16 cases of true primary idiopathic amyloidosis localized in the nose and the paranasal sinuses have previously been reported. We present a case of localized amyloidosis involving the sinonasal cavities and the nose in a 53-year-old woman. Our patient was operated on as a typical case of chronic rhinosinusitis with polyps, but after 2 years, the patient came back with severe symptoms of nasal obstruction and pain in the frontal and maxillary regions with proptosis of both eyes. Magnetic resonance imaging revealed sinonasal-intraorbital masses. Primary amyloidosis (AL type) was confirmed by tissue biopsy. A systemic workup for additional amyloid deposits revealed no evidence of other diseases. Extended surgery produced a symptomatic improvement.

Research paper thumbnail of Age-dependent heterogeneity of familiar hypertrophic cardiomyopathy phenotype: a role of cardiovascular magnetic resonance

Medicina (Kaunas, Lithuania), 2013

In this case report, we present familiar hypertrophic cardiomyopathy with age-dependent heterogen... more In this case report, we present familiar hypertrophic cardiomyopathy with age-dependent heterogeneity of the disease phenotype among the members of one family who carry the same mutation of the myosin-binding protein C gene. Phenotypic heterogeneity is common in patients with familial forms of hypertrophic cardiomyopathy, both in clinical expression and outcome. Compared with other noninvasive cardiac imaging modalities, cardiovascular magnetic resonance provides an opportunity to more accurately characterize the varying phenotypic presentations of hypertrophic cardiomyopathy.

Research paper thumbnail of Diagnostic methods, treatment modalities, and follow-up of extracranial arteriovenous malformations

Medicina (Kaunas, Lithuania), 2012

Arteriovenous malformations (AVMs) are an uncommon vascular pathology that remains challenging to... more Arteriovenous malformations (AVMs) are an uncommon vascular pathology that remains challenging to accurately diagnose and successfully treat. This study introduces a novel way to evaluate AVM treatment outcomes using transarterial lung perfusion scintigraphy (TLPS) and reports our treatment results. The patients treated for extracranial AVMs were studied retrospectively. Diagnosis and outcomes were based on clinical data, ultrasonography, magnetic resonance imaging, computed tomography, angiography, and TLPS studies. The influence of gender; location, form, and stage of AVMs; first attempt at treatment; and treatment modalities was analyzed. Outcomes were defined as positive (cure, improvement, and remission) or negative (no remission and aggravation). Of the 324 patients with congenital vascular malformations, 129 (39.8%) presented with AVMs, and the data of 56 treated patients with AVMs were analyzed. Of the 29 patients in the endovascularly treated group, 15 in the surgically tre...

Research paper thumbnail of Differentiation of acute myocarditis and acute myocardial infarction by the regional distribution of myocardial irreversible injury using cardiovascular magnetic resonance imaging

Medicina (Kaunas, Lithuania), 2012

In this study, we have sought for differences between cardiovascular magnetic resonance patterns ... more In this study, we have sought for differences between cardiovascular magnetic resonance patterns of acute myocarditis and acute myocardial infarction. A prospective analysis of 110 consecutive patients was performed. The presence, precise location, and pattern of late gadolinium enhancement (LGE) by cardiovascular magnetic resonance were investigated. The subendocardial LGE pattern was much more frequent in the myocardial infarction group (76.7%) than myocarditis group (10.0%) (P<0.001). Meanwhile, midmyocardial LGE was much more typical of myocarditis (65.0%) than acute myocardial infarction (1.1%) (P<0.001), and epicardial LGE was also much more typical of myocarditis (55.0%) than acute myocardial infarction (0.0%) (P<0.001). Midmyocardial and epicardial LGE patterns were defined as a nonischemic LGE pattern more typical of myocarditis. Logistic regression analysis revealed that the subendocardial and midmyocardial LGE locations played the greatest role in differentiation...

Research paper thumbnail of Cardiovascular magnetic resonance for visualization of myocardial ischemia at rest

Medicina (Kaunas, Lithuania), 2011

This article presents the case of a 54-year-old male with evidence of myocardial ischemia at rest... more This article presents the case of a 54-year-old male with evidence of myocardial ischemia at rest. In our case, by means of cardiovascular magnetic resonance, myocardial ischemia at rest in theoretical left anterior descending artery territory was proved, myocardial scar was excluded, and need for revascularization was validated.

Research paper thumbnail of Multimodality imaging in a rare case of tuberculous pericarditis

European Heart Journal - Cardiovascular Imaging, 2012

Research paper thumbnail of Prediction of long-term segmental and global functional recovery of hibernating myocardium after revascularisation based on low dose dobutamine and late gadolinium enhancement cardiovascular magnetic resonance

Journal of Cardiovascular Magnetic Resonance, 2014

This study sought to evaluate the relation between long-term segmental and global functional outc... more This study sought to evaluate the relation between long-term segmental and global functional outcome after revascularisation in patients with chronic ischaemic left ventricular dysfunction (LVD) and baseline markers of viability: late gadolinium enhancement (LGE) transmurality and contractile reserve (CR). Forty-two patients with chronic ischaemic LVD underwent low-dose dobutamine- (LDD) and late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) before surgical or percutaneous revascularisation. Regional and global left ventricular (LV) functions and LGE were repeatedly assessed 6 ± 1 and 35 ± 6 months after revascularisation. In total, 319 at baseline dysfunctional and successfully revascularised segments were available for statistical analysis. The likelihood of long-term functional improvement was directly related to the presence of CR and inversely related to both the LGE and the degree of contractile dysfunction at baseline. The time course of functional improvement was protracted, with significantly more delay in segments with more extensive LGE (p = 0.005) and more severe contractile dysfunction at baseline (p = 0.002). The presence of CR was the predictor of earlier functional improvement (p &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). Using a definition of viable segment as a segment without any LGE or with any LGE and producing CR during LDD stimulation, ≥55% of viable segments from all dysfunctional and revascularised segments in a patient was the only independent predictor of significant improvement (≥5%) in the left ventricular ejection fraction (LVEF) after revascularisation, with a 72% sensitivity and an 80% specificity (AUC 0.76, p = 0.014). Reverse LV remodelling was observed in patients who had a significant amount of viable myocardium successfully revascularised. In patients with chronic ischaemic LVD, improvement of dysfunctional but viable myocardium can be considerably delayed. Both the likelihood and the time course of functional improvement are related to the LGE, CR and the degree of contractile dysfunction at baseline. At 35 ± 6 months after revascularisation, patients with ≥55% of viable segments from all dysfunctional and revascularised segments significantly improve LVEF and experience reverse LV remodelling. A combination of LDD-CMR and LGE-CMR is a simple and powerful tool for identifying which patients with impaired LV function will benefit from revascularisation.

Research paper thumbnail of Complicated Congenital Gluteal Arteriovenous Malformation With Hemorrhage in Pregnancy

Annals of Vascular Surgery, 2013

Extracranial congenital arteriovenous malformations (AVMs) are rare clinical entities that can be... more Extracranial congenital arteriovenous malformations (AVMs) are rare clinical entities that can be progressive in nature. The influence of pregnancy on lesion progression has been discussed in the past. This report presents an unusual case of 23-year-old primigravida woman who presented at 36 weeks&amp;amp;amp;amp;amp;amp;amp;amp;#39; gestation with complicated necrotic ulceration and hemorrhage of the right gluteal region. A hyperpigmented mark with varicosities was initially noted at birth, but during pregnancy it showed remarkable progression and was first identified as an AVM. After hemorrhage control and induced delivery, the lesion was successfully treated with several embolizations. Complete wound healing was achieved, but because of partial recurrence at 3 years, repeat embolization was performed, with satisfactory clinical improvement and residual 25% arteriovenous shunting on transarterial lung perfusion scintigraphy study. AVM complications during pregnancy are uncommon, and this case supports the prior opinion that pregnancy can stimulate lesion progression. Especially in undiagnosed and previously untreated cases, this can lead to life-threatening complications for the mother and fetus. Long-term lesion management usually requires combined endovascular and surgical treatment.

Research paper thumbnail of ClInICal InVestIgatIons Correspondence to Differentiation of acute Myocarditis and acute Myocardial Infarction by the Regional Distribution of Myocardial Irreversible Injury Using Cardiovascular Magnetic Resonance Imaging

Medicina (Kaunas, Lithuania)

Background and Objective. In this study, we have sought for differences between cardiovascular ma... more Background and Objective. In this study, we have sought for differences between cardiovascular magnetic resonance patterns of acute myocarditis and acute myocardial infarction. Material and Methods. A prospective analysis of 110 consecutive patients was performed. The presence, precise location, and pattern of late gadolinium enhancement (LGE) by cardiovascular magnetic resonance were investigated. Results. The subendocardial LGE pattern was much more frequent in the myocardial infarction group (76.7%) than myocarditis group (10.0%) (P<0.001). Meanwhile, midmyocardial LGE was much more typical of myocarditis (65.0%) than acute myocardial infarction (1.1%) (P<0.001), and epicardial LGE was also much more typical of myocarditis (55.0%) than acute myocardial infarc-tion (0.0%) (P<0.001). Midmyocardial and epicardial LGE patterns were defined as a nonischemic LGE pattern more typical of myocarditis. Logistic regression analysis revealed that the subendo-cardial and midmyocardia...

Research paper thumbnail of CLINICAL CASE REPORT Cardiovascular Magnetic Resonance for Visualization of Myocardial Ischemia at Rest

Medicina (Kaunas, Lithuania)

Key words: cardiovascular magnetic resonance; myocardial ischemia; coronary artery disease. Summa... more Key words: cardiovascular magnetic resonance; myocardial ischemia; coronary artery disease. Summary. This article presents the case of a 54-year-old male with evidence of myocardial is-chemia at rest. In our case, by means of cardiovascular magnetic resonance, myocardial ischemia at rest in theoretical left anterior descending artery territory was proved, myocardial scar was excluded, and need for revascularization was validated. Adresas susirašinėti: S. Glaveckaitė, VU MF Širdies ir kraujagys-lių ligų klinika, Introduction We present a case of resting myocardial ischemia and shortly discuss the value of cardiovascular mag-netic resonance (CMR) for the assessment of rest and stress ischemia especially in case when coronary artery stenosis is of unclear signifi cance.

Research paper thumbnail of ŠIRDIES AL AMILOIDOZĖ: KLINIKINIO ATVEJO APRAŠYMAS

Sveikatos mokslai, 2014

ABSTRACT Amiloidozė – tai grupė retų sisteminių ligų, kurioms būdingas sutrikęs baltyminių strukt... more ABSTRACT Amiloidozė – tai grupė retų sisteminių ligų, kurioms būdingas sutrikęs baltyminių struktūrų susidarymas ir fibrilių formavimasis. Amiloidozės atsiradimą lemia didelis amiloido pirmtako kiekis organizme, nevisiškas amiloido pirmtako suirimas makrofagų sistemoje bei tam tikri audinių ypatumai. Nors liga sukelia sisteminius pakitimus, tačiau amiloido depozicijos laipsnis įvairiuose organuose skiriasi ir lemia skirtingas klinikines amiloidozės išraiškas. Širdies amiloidozė – tai klinikinis susikaupusio amiloido širdyje pasireiškimas. Širdies amiloidozės metu pagrindinis patogenezinis elementas – intersticinė amiloido infiltracija, sukelianti infiltracinę kardiomiopatiją, kuri progresuoja iki restrikcinės kardiomiopatijos ir širdies nepakankamumo. Širdies pažeidimas amiloidozės metu lemia itin blogą prognozę ir didelį mirštamumą. Todėl labai svarbu kuo ankstyvesnė diagnostika, kuri užkirstų kelią amiloido depozicijai įvairiuose organuose. Vis dėlto širdies amiloidozės diagnostika dažnai būna atlikta procesui esant toli pažengus, nes nėra specifinio klinikinio ligos pasireiškimo, todėl instrumentiniai tyrimai, patvirtinantys ligos diagnozę, atliekami per vėlai. Pagrindinis amiloidozės gydymas nukreiptas į infiltracinio proceso sustabdymą, kurio metu siekiama blokuoti amiloido depoziciją įvairiuose organuose ir į amiloidozės sukeltų komplikacijų gydymą, kuris mažina simptomus ir pagerina bendrą paciento būklę.

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

Journal of Cardiovascular Magnetic Resonance, 2011

This study sought to prospectively and directly compare three cardiovascular magnetic resonance (... more 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. 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. 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. 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.

Research paper thumbnail of An assessment of iron overload in children treated for cancer and nonmalignant hematologic disorders

European Journal of Pediatrics, 2014

Our goal was to assess the natural fate of iron overload (IO) following transfusions of packed re... more Our goal was to assess the natural fate of iron overload (IO) following transfusions of packed red blood cells (PRBCs) in children treated for cancer and nonmalignant disorders according to the intensity level of their treatment. Sixty-six children were followed up from February 2010 to March 2013. The transfusion burden was compared between three treatment intensity groups assigned according to the Intensity of Treatment Rating Scale 3.0 (ITR-3). IO was assessed by serial measurements of serum ferritin (SF) (n= 66) and quantification of tissue iron by magnetic resonance imaging (MRI) (n=12). Of the children studied, 36 % (24/66) received moderately intensive treatment (level 2), 21 % (14/ 66) received very intensive treatment (level 3), and 42 % (28/ 66) received the most intensive treatment (level 4). The number of PRBC (p=0.016), the total transfused volume (p= 0.026), and transfused volume adjusted to body weight (p= 0.004) were significantly higher in the level 4 group. By the median follow-up time of 35.5 months (range 8–133), 21– 29 % of patients (including level 2 and level 3 children) had SF &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;1,000 μg/l 1 year after cessation of transfusions. The slowest decrease of SF was observed in the level 4 group. Initial MRI examination demonstrated either mild or moderate IO in the liver and spleen. Repetitive MRI showed significant improvement in relaxation time between the initial and follow-up MRI performances in the liver (5.9 vs. 8.6 ms, p= 0.03) and the spleen (4.3 vs. 8.8 ms, p=0.03). IO diminished over time, but in the level 4 patients, it was detectable for years after cessation of transfusions.

Research paper thumbnail of Neurovascular intervention

Cardiovascular Revascularization Medicine, 2010

Research paper thumbnail of Early ischemic brain lesions after carotid angioplasty and stenting on diffusion-weighted magnetic resonance imaging study

Seminars in Cardiovascular Medicine, 2000

The aim of the paper is to evaluate the appearance of the new early ischemic lesions in the brain... more The aim of the paper is to evaluate the appearance of the new early ischemic lesions in the brain after carotid angioplasty and stenting on diffusion-weighted magnetic resonance imaging, and their relationship with clinical and procedural factors.