Krystian Wita - Academia.edu (original) (raw)
Papers by Krystian Wita
Kardiologia Polska, May 1, 2006
Kardiologia Polska, 2006
Despite successful reperfusion therapy of acute myocardial infarction and complete restoration of... more Despite successful reperfusion therapy of acute myocardial infarction and complete restoration of infarct-related artery patency, the improvement of systolic function in long-term outcome depends on preserved microvasculature integrity. Myocardial contrast echocardiography (MCE) is a useful technique for identification of viable myocardium. To assess the value of real-time myocardial contrast echocardiography (rt-MCE) in prediction of left ventricular function improvement in patients with anterior wall acute myocardial infarction as well as selection of the optimal cut-off value for the number of dysfunctional segments with preserved complete perfusion, in order to predict the global left ventricular function improvement during one-month observation. Rt-MCE was performed in 74 patients (50 men, aged 58+/-11 years) with anterior wall myocardial infarction, treated with primary percutaneous coronary intervention (PCI) within 12 hours from the onset of symptoms. After estimation of regional contractility disturbances and global systolic function of the left ventricle, rt-MCE was performed with contrast assessment of dysfunctional segments (normal contrast pattern=2, heterogeneous=1, lack of contrast=0). Regional perfusion score index (RPSI) was calculated by adding the perfusion indices and dividing by the number of dysfunctional segments. Of a total of 1184 visualised segments, 344 (29.1%) were dysfunctional (189 hypokinetic, 155 akinetic). Contractility improvement was observed in 192 segments (preserved viability in 105 hypokinetic and 37 akinetic segments). In a group of 44 patients with systolic function improvement, 34 of them had preserved viability, and in a group of 30 patients without LVEF improvement, in 22 of them myocardium viability was not observed. Sensitivity, specificity and accuracy of rt-MCE in prediction of left ventricular global improvement were 72.7%, 73.3% and 73%, respectively, whereas in prediction of regional function improvement these values were 73.9%, 77% and 75.5%, respectively. Rt-MCE performed in the early phase of myocardial infarction enables the prediction of left ventricular regional and global function improvement in patients treated with primary PCI.
Kardiologia Polska, 2006
Despite successful reperfusion therapy of acute myocardial infarction and complete restoration of... more Despite successful reperfusion therapy of acute myocardial infarction and complete restoration of infarct-related artery patency, the improvement of systolic function in long-term outcome depends on preserved microvasculature integrity. Myocardial contrast echocardiography (MCE) is a useful technique for identification of viable myocardium. To assess the value of real-time myocardial contrast echocardiography (rt-MCE) in prediction of left ventricular function improvement in patients with anterior wall acute myocardial infarction as well as selection of the optimal cut-off value for the number of dysfunctional segments with preserved complete perfusion, in order to predict the global left ventricular function improvement during one-month observation. Rt-MCE was performed in 74 patients (50 men, aged 58+/-11 years) with anterior wall myocardial infarction, treated with primary percutaneous coronary intervention (PCI) within 12 hours from the onset of symptoms. After estimation of regional contractility disturbances and global systolic function of the left ventricle, rt-MCE was performed with contrast assessment of dysfunctional segments (normal contrast pattern=2, heterogeneous=1, lack of contrast=0). Regional perfusion score index (RPSI) was calculated by adding the perfusion indices and dividing by the number of dysfunctional segments. Of a total of 1184 visualised segments, 344 (29.1%) were dysfunctional (189 hypokinetic, 155 akinetic). Contractility improvement was observed in 192 segments (preserved viability in 105 hypokinetic and 37 akinetic segments). In a group of 44 patients with systolic function improvement, 34 of them had preserved viability, and in a group of 30 patients without LVEF improvement, in 22 of them myocardium viability was not observed. Sensitivity, specificity and accuracy of rt-MCE in prediction of left ventricular global improvement were 72.7%, 73.3% and 73%, respectively, whereas in prediction of regional function improvement these values were 73.9%, 77% and 75.5%, respectively. Rt-MCE performed in the early phase of myocardial infarction enables the prediction of left ventricular regional and global function improvement in patients treated with primary PCI.
Kardiologia Polska, Aug 1, 2006
Despite successful reperfusion therapy of acute myocardial infarction and complete restoration of... more Despite successful reperfusion therapy of acute myocardial infarction and complete restoration of infarct-related artery patency, the improvement of systolic function in long-term outcome depends on preserved microvasculature integrity. Myocardial contrast echocardiography (MCE) is a useful technique for identification of viable myocardium. To assess the value of real-time myocardial contrast echocardiography (rt-MCE) in prediction of left ventricular function improvement in patients with anterior wall acute myocardial infarction as well as selection of the optimal cut-off value for the number of dysfunctional segments with preserved complete perfusion, in order to predict the global left ventricular function improvement during one-month observation. Rt-MCE was performed in 74 patients (50 men, aged 58+/-11 years) with anterior wall myocardial infarction, treated with primary percutaneous coronary intervention (PCI) within 12 hours from the onset of symptoms. After estimation of regional contractility disturbances and global systolic function of the left ventricle, rt-MCE was performed with contrast assessment of dysfunctional segments (normal contrast pattern=2, heterogeneous=1, lack of contrast=0). Regional perfusion score index (RPSI) was calculated by adding the perfusion indices and dividing by the number of dysfunctional segments. Of a total of 1184 visualised segments, 344 (29.1%) were dysfunctional (189 hypokinetic, 155 akinetic). Contractility improvement was observed in 192 segments (preserved viability in 105 hypokinetic and 37 akinetic segments). In a group of 44 patients with systolic function improvement, 34 of them had preserved viability, and in a group of 30 patients without LVEF improvement, in 22 of them myocardium viability was not observed. Sensitivity, specificity and accuracy of rt-MCE in prediction of left ventricular global improvement were 72.7%, 73.3% and 73%, respectively, whereas in prediction of regional function improvement these values were 73.9%, 77% and 75.5%, respectively. Rt-MCE performed in the early phase of myocardial infarction enables the prediction of left ventricular regional and global function improvement in patients treated with primary PCI.
Kardiologia Polska, Aug 1, 2006
Despite successful reperfusion therapy of acute myocardial infarction and complete restoration of... more Despite successful reperfusion therapy of acute myocardial infarction and complete restoration of infarct-related artery patency, the improvement of systolic function in long-term outcome depends on preserved microvasculature integrity. Myocardial contrast echocardiography (MCE) is a useful technique for identification of viable myocardium. To assess the value of real-time myocardial contrast echocardiography (rt-MCE) in prediction of left ventricular function improvement in patients with anterior wall acute myocardial infarction as well as selection of the optimal cut-off value for the number of dysfunctional segments with preserved complete perfusion, in order to predict the global left ventricular function improvement during one-month observation. Rt-MCE was performed in 74 patients (50 men, aged 58+/-11 years) with anterior wall myocardial infarction, treated with primary percutaneous coronary intervention (PCI) within 12 hours from the onset of symptoms. After estimation of regional contractility disturbances and global systolic function of the left ventricle, rt-MCE was performed with contrast assessment of dysfunctional segments (normal contrast pattern=2, heterogeneous=1, lack of contrast=0). Regional perfusion score index (RPSI) was calculated by adding the perfusion indices and dividing by the number of dysfunctional segments. Of a total of 1184 visualised segments, 344 (29.1%) were dysfunctional (189 hypokinetic, 155 akinetic). Contractility improvement was observed in 192 segments (preserved viability in 105 hypokinetic and 37 akinetic segments). In a group of 44 patients with systolic function improvement, 34 of them had preserved viability, and in a group of 30 patients without LVEF improvement, in 22 of them myocardium viability was not observed. Sensitivity, specificity and accuracy of rt-MCE in prediction of left ventricular global improvement were 72.7%, 73.3% and 73%, respectively, whereas in prediction of regional function improvement these values were 73.9%, 77% and 75.5%, respectively. Rt-MCE performed in the early phase of myocardial infarction enables the prediction of left ventricular regional and global function improvement in patients treated with primary PCI.
Kardiologia Polska, Sep 1, 2010
The issue of predicting coronary artery restenosis, especially silent, in patients following prim... more The issue of predicting coronary artery restenosis, especially silent, in patients following primary percutaneous coronary intervention (PCI) has been extensively studied, however, risk factors have not been fully defined. To asses the frequency of silent restenosis and its predictors in patients with anterior ST elevation myocardial infarction (STEMI) treated with primary PCI and implantation of bare metal stents (BMS). We recruited a cohort of 114 patients with first anterior STEMI treated with primary PCI within 12 hours of the onset of symptoms, and with the left anterior descending coronary artery occlusion (TIMI 0) and successful flow restoration (TIMI 3). A 12-lead ECG was performed before and 60 minutes after PCI. Troponin I and CK-MB were measured on admission and after six, 12 and 24 hours. Transthoracic echocardiography (TTE) was performed at discharge. Resting TTE and coronary angiography were performed after a six month follow-up in asymptomatic patients. The frequency of silent restenosis in our study group was 23.9%. The best multivariate models in logistic regression of restenosis prediction were: lower end-systolic volume of the left ventricle assessed two days after infarction longer lesion and smaller reference diameter of the stented vessel. Silent restenosis in patients with first anterior STEMI treated by primary PCI with the use of BMS is still frequent. The best ways to identify patients with silent restenosis at six month follow-up, apart from the lower end systolic volume in the echocardiographic study, are longer narrowing in the infarct-related artery and lower reference diameter of the treated vessel.
Kardiologia Polska, Dec 1, 2010
Complete atrioventricular block can occur, among others, in case of hyperkalemia, that is a life-... more Complete atrioventricular block can occur, among others, in case of hyperkalemia, that is a life-threatening complication of rhabdomyolysis. Statins constitute the medication group that is especially associated with a possibility of muscle complications. Frequency of statin-associated myalgia is 5-10%, and potentially fatal rhabdomyolysis--0.02-0.09%. We describe a male patient who was admitted due to syncope caused by complete atrioventricular block. Iatrogenic rhabdomyolysis with life-threatening hyperkalemia, that was related to statin, was diagnosed. After application of suitable pharmacotherapy, conduction abnormalities resolved. The patient was discharged in a good condition.
Kardiologia Polska, Dec 1, 2010
Complete atrioventricular block can occur, among others, in case of hyperkalemia, that is a life-... more Complete atrioventricular block can occur, among others, in case of hyperkalemia, that is a life-threatening complication of rhabdomyolysis. Statins constitute the medication group that is especially associated with a possibility of muscle complications. Frequency of statin-associated myalgia is 5-10%, and potentially fatal rhabdomyolysis--0.02-0.09%. We describe a male patient who was admitted due to syncope caused by complete atrioventricular block. Iatrogenic rhabdomyolysis with life-threatening hyperkalemia, that was related to statin, was diagnosed. After application of suitable pharmacotherapy, conduction abnormalities resolved. The patient was discharged in a good condition.
European Journal of Heart Failure Supplements, Jun 1, 2006
European Journal of Heart Failure Supplements, Jun 1, 2006
Kardiologia Polska, 2008
Prognostic significance of clinical and non-invasive risk markers in patients after surgical reva... more Prognostic significance of clinical and non-invasive risk markers in patients after surgical revascularisation remains unclear, especially in post-infarction patients with left ventricular (LV) dysfunction. The single-centre, prospective study was designed to assess survival and the predictive power of several clinical and non- -invasive risk markers of all-cause (ACM) and cardiovascular mortality (CVM) in post-CABG patients with LV dysfunction. A cohort of 61 patients (age 59+/-9 years, 49 males, LVEF 33+/-6%) 6-12 months after CABG was prospectively followed for a median of 46 months. Demographics, clinical data, medication, LVEF, QRS>120 ms or late potentials (LP) presence, QT dispersion ł80 ms, premature ventricular contractions (PVC) ł10/h, non-sustained ventricular tachycardia (nsVT), and SDNN Ł70 ms in ambulatory ECG were analysed. The ACM and CVM were evaluated. The prognostic value of analysing parameters was determined. Fourteen patients died, 10 of them due to cardiovascular causes. Univariate Cox analysis showed that incomplete revascularisation, history of angina, heart failure, low LVEF, use of nitrates, digitalis or diuretics, and presence of LP or prolongation of QRS complex were predictors of poor outcome. Combination of angina and low LVEF was the best model in a multivariable Cox analysies for the prediction of both types of death. The present study showed that in post-CABG patients with LV dysfunction, angina class and low LVEF are the main predictors of ACM and CVM. Combination of LVEF <30% with the presence of QRS >120 ms or LP may also be helpful in the identification of high-risk subjects. Other common non-invasive risk markers, particularly arrhythmic and autonomic, seem to lose some of their predictive power in patients after CABG and receiving beta-blocking agents.
Kardiologia Polska, 2008
Prognostic significance of clinical and non-invasive risk markers in patients after surgical reva... more Prognostic significance of clinical and non-invasive risk markers in patients after surgical revascularisation remains unclear, especially in post-infarction patients with left ventricular (LV) dysfunction. The single-centre, prospective study was designed to assess survival and the predictive power of several clinical and non- -invasive risk markers of all-cause (ACM) and cardiovascular mortality (CVM) in post-CABG patients with LV dysfunction. A cohort of 61 patients (age 59+/-9 years, 49 males, LVEF 33+/-6%) 6-12 months after CABG was prospectively followed for a median of 46 months. Demographics, clinical data, medication, LVEF, QRS>120 ms or late potentials (LP) presence, QT dispersion ł80 ms, premature ventricular contractions (PVC) ł10/h, non-sustained ventricular tachycardia (nsVT), and SDNN Ł70 ms in ambulatory ECG were analysed. The ACM and CVM were evaluated. The prognostic value of analysing parameters was determined. Fourteen patients died, 10 of them due to cardiovascular causes. Univariate Cox analysis showed that incomplete revascularisation, history of angina, heart failure, low LVEF, use of nitrates, digitalis or diuretics, and presence of LP or prolongation of QRS complex were predictors of poor outcome. Combination of angina and low LVEF was the best model in a multivariable Cox analysies for the prediction of both types of death. The present study showed that in post-CABG patients with LV dysfunction, angina class and low LVEF are the main predictors of ACM and CVM. Combination of LVEF <30% with the presence of QRS >120 ms or LP may also be helpful in the identification of high-risk subjects. Other common non-invasive risk markers, particularly arrhythmic and autonomic, seem to lose some of their predictive power in patients after CABG and receiving beta-blocking agents.
Cardiology Journal, 2006
Material and methods: We studied 114 consecutive patients, of whom 85 were male, aged 57.9 ± 11 y... more Material and methods: We studied 114 consecutive patients, of whom 85 were male, aged 57.9 ± 11 years, within 12 hours of the onset of symptoms of their first anterior myocardial infarction. These were treated with primary PCI, after which PCI myocardial blush grading was assessed (MBG 0-1 no perfusion, 2-3 normal perfusion). One hour after PCI a reduction of > 50% in the sum of ST-segment elevation (SST 50%) was assessed as an indicator of perfusion restoration. During the first 24 hours continuous ECG monitoring recorded reperfusion arrhythmias (RA) and the time required for ST-segment reduction to exceed 50% in the single lead with the highest ST elevation (Dt ST 50%). On the next day of MI, after LVEF evaluation, real-time myocardial contrast echocardiography (RT-MCE) was performed to assess perfusion in dysfunctional segments. The reperfusion index as an average of the dysfunctional segment perfusion score was determined. Regional LVEF was 41.9 ± 7.1% and in group B it was 38.9 ± 7.4% (p = NS). The reperfusion indices were 1.59 and 0.78 (p < 0.001) respectively. MBG 2-3 occurred more often in group A (64%) than in group B (34%) p<0.001. S ST50% and Dt ST 50%, after determination of the cut point on the ROC curve (61 min), occurred in 47 and 48 patients in Editorial p. 269 294 Folia Cardiol. 2006, Vol. 13, No. 4 www.fc.viamedica.pl group A and 17 and 16 patients in group B respectively. The accuracy of the tests under discussion for LVEF prognosis was 76.3%, 64%, 63.2% and 64.9% for RT-MCE, MBG, SST50% and Dt ST 50% respectively. Conclusions: Myocardial perfusion echocardiography had a high prognostic value for the prediction of LV global function improvement. It turned out to be the best predictor among the other angiographic, echocardiographic and electrocardiographic markers. (Folia Cardiol. 2006; 13: 293-301) myocardial contrast echocardiography, myocardial perfusion, acute myocardial infarction
Cardiology Journal, 2006
Material and methods: We studied 114 consecutive patients, of whom 85 were male, aged 57.9 ± 11 y... more Material and methods: We studied 114 consecutive patients, of whom 85 were male, aged 57.9 ± 11 years, within 12 hours of the onset of symptoms of their first anterior myocardial infarction. These were treated with primary PCI, after which PCI myocardial blush grading was assessed (MBG 0-1 no perfusion, 2-3 normal perfusion). One hour after PCI a reduction of > 50% in the sum of ST-segment elevation (SST 50%) was assessed as an indicator of perfusion restoration. During the first 24 hours continuous ECG monitoring recorded reperfusion arrhythmias (RA) and the time required for ST-segment reduction to exceed 50% in the single lead with the highest ST elevation (Dt ST 50%). On the next day of MI, after LVEF evaluation, real-time myocardial contrast echocardiography (RT-MCE) was performed to assess perfusion in dysfunctional segments. The reperfusion index as an average of the dysfunctional segment perfusion score was determined. Regional LVEF was 41.9 ± 7.1% and in group B it was 38.9 ± 7.4% (p = NS). The reperfusion indices were 1.59 and 0.78 (p < 0.001) respectively. MBG 2-3 occurred more often in group A (64%) than in group B (34%) p<0.001. S ST50% and Dt ST 50%, after determination of the cut point on the ROC curve (61 min), occurred in 47 and 48 patients in Editorial p. 269 294 Folia Cardiol. 2006, Vol. 13, No. 4 www.fc.viamedica.pl group A and 17 and 16 patients in group B respectively. The accuracy of the tests under discussion for LVEF prognosis was 76.3%, 64%, 63.2% and 64.9% for RT-MCE, MBG, SST50% and Dt ST 50% respectively. Conclusions: Myocardial perfusion echocardiography had a high prognostic value for the prediction of LV global function improvement. It turned out to be the best predictor among the other angiographic, echocardiographic and electrocardiographic markers. (Folia Cardiol. 2006; 13: 293-301) myocardial contrast echocardiography, myocardial perfusion, acute myocardial infarction
Kardiologia Polska, Apr 1, 2010
Despite the widespread use of reperfusion methods, the long-term outcome after primary percutaneo... more Despite the widespread use of reperfusion methods, the long-term outcome after primary percutaneous coronary intervention (PCI) is variable, and accurate risk stratification is of clinical importance. To assess the predictors of long term outcome after PCI for acute anterior myocardial infarction (AMI). One hundred and twenty-seven consecutive patients undergoing PCI within 12 hours from the onset of the first AMI were enrolled. Troponin I, CK-MB, creatinine, NT-proBNP, echocardiographic left ventricular (LV) function, myocardial contrast perfusion, results of coronary angiography, ECG, 24-hour Holter ECG, and T-wave alternans (TWA) were analysed as predictors of major adverse cardiac events (MACE), defined as death, non-fatal reinfarction, sustained ventricular tachycardia, and rehospitalisation for decompensated heart failure. Patients were followed up for two years. Twenty-seven patients developed MACE. The best predictive model for MACE consisted of impaired perfusion (MCE, myocardial contrast echocardiography), higher CK-MB at 24 hours, discharge NT-proBNP, and non-negative TWA. The combination of elevated creatinine level, decreased LV ejection fraction, and a non-negative TWA proved the best for identification of patients at risk of cardiac death. The best multivariate model for predicting heart failure hospitalisation consisted of higher 24-hour CK-MB, discharge NT-proBNP, impaired perfusion and prolonged duration of ST elevation. Our study showed that the rate of MACE in patients with anterior ST-segment elevation myocardial infarction undergoing primary PCI at two years follow-up is low. A combined assessment of myocardial contrast perfusion, TWA, CK-MB and discharge NT-proBNP seems to optimally predict patients at risk of MACE.
Kardiologia Polska, Apr 1, 2010
Despite the widespread use of reperfusion methods, the long-term outcome after primary percutaneo... more Despite the widespread use of reperfusion methods, the long-term outcome after primary percutaneous coronary intervention (PCI) is variable, and accurate risk stratification is of clinical importance. To assess the predictors of long term outcome after PCI for acute anterior myocardial infarction (AMI). One hundred and twenty-seven consecutive patients undergoing PCI within 12 hours from the onset of the first AMI were enrolled. Troponin I, CK-MB, creatinine, NT-proBNP, echocardiographic left ventricular (LV) function, myocardial contrast perfusion, results of coronary angiography, ECG, 24-hour Holter ECG, and T-wave alternans (TWA) were analysed as predictors of major adverse cardiac events (MACE), defined as death, non-fatal reinfarction, sustained ventricular tachycardia, and rehospitalisation for decompensated heart failure. Patients were followed up for two years. Twenty-seven patients developed MACE. The best predictive model for MACE consisted of impaired perfusion (MCE, myocardial contrast echocardiography), higher CK-MB at 24 hours, discharge NT-proBNP, and non-negative TWA. The combination of elevated creatinine level, decreased LV ejection fraction, and a non-negative TWA proved the best for identification of patients at risk of cardiac death. The best multivariate model for predicting heart failure hospitalisation consisted of higher 24-hour CK-MB, discharge NT-proBNP, impaired perfusion and prolonged duration of ST elevation. Our study showed that the rate of MACE in patients with anterior ST-segment elevation myocardial infarction undergoing primary PCI at two years follow-up is low. A combined assessment of myocardial contrast perfusion, TWA, CK-MB and discharge NT-proBNP seems to optimally predict patients at risk of MACE.
The Annals of thoracic surgery, 2015
Restrictive mitral annuloplasty is the preferred method of treating secondary mitral regurgitatio... more Restrictive mitral annuloplasty is the preferred method of treating secondary mitral regurgitation. The use of small annuloplasty rings to reduce the high recurrence rates may result in mitral stenosis. Thirty-six patients who underwent restrictive mitral annuloplasty with Carpentier-Edwards classic 26 size ring underwent exercise echocardiography and ergospirometry. Resting catecholamines and N-terminal pro brain natriuretic peptide (NT-proBNP) levels were measured. At the time of study, the median time from operation was 16.6 months (interquartile range, 8.5 to 43.3 months). Left ventricular end-systolic volume index (LVESVI) was 67 mL/m(2) (interquartile range, 25 to 92 mL/m(2)), and ejection fraction (EF) was 38.8% (interquartile range, 28.3% to 59.0%). Mitral gradients were higher at the leaflet tips than at the annular level. Continuous wave (CW) Doppler gradients at rest were 3.4 mmHg (interquartile range, 2.4 to 4.9 mmHg) mean and 9.5 mmHg (interquartile range, 7.0 to 14.7 m...
The Annals of thoracic surgery, 2015
Restrictive mitral annuloplasty is the preferred method of treating secondary mitral regurgitatio... more Restrictive mitral annuloplasty is the preferred method of treating secondary mitral regurgitation. The use of small annuloplasty rings to reduce the high recurrence rates may result in mitral stenosis. Thirty-six patients who underwent restrictive mitral annuloplasty with Carpentier-Edwards classic 26 size ring underwent exercise echocardiography and ergospirometry. Resting catecholamines and N-terminal pro brain natriuretic peptide (NT-proBNP) levels were measured. At the time of study, the median time from operation was 16.6 months (interquartile range, 8.5 to 43.3 months). Left ventricular end-systolic volume index (LVESVI) was 67 mL/m(2) (interquartile range, 25 to 92 mL/m(2)), and ejection fraction (EF) was 38.8% (interquartile range, 28.3% to 59.0%). Mitral gradients were higher at the leaflet tips than at the annular level. Continuous wave (CW) Doppler gradients at rest were 3.4 mmHg (interquartile range, 2.4 to 4.9 mmHg) mean and 9.5 mmHg (interquartile range, 7.0 to 14.7 m...
Kardiologia Polska, May 1, 2006
Kardiologia Polska, 2006
Despite successful reperfusion therapy of acute myocardial infarction and complete restoration of... more Despite successful reperfusion therapy of acute myocardial infarction and complete restoration of infarct-related artery patency, the improvement of systolic function in long-term outcome depends on preserved microvasculature integrity. Myocardial contrast echocardiography (MCE) is a useful technique for identification of viable myocardium. To assess the value of real-time myocardial contrast echocardiography (rt-MCE) in prediction of left ventricular function improvement in patients with anterior wall acute myocardial infarction as well as selection of the optimal cut-off value for the number of dysfunctional segments with preserved complete perfusion, in order to predict the global left ventricular function improvement during one-month observation. Rt-MCE was performed in 74 patients (50 men, aged 58+/-11 years) with anterior wall myocardial infarction, treated with primary percutaneous coronary intervention (PCI) within 12 hours from the onset of symptoms. After estimation of regional contractility disturbances and global systolic function of the left ventricle, rt-MCE was performed with contrast assessment of dysfunctional segments (normal contrast pattern=2, heterogeneous=1, lack of contrast=0). Regional perfusion score index (RPSI) was calculated by adding the perfusion indices and dividing by the number of dysfunctional segments. Of a total of 1184 visualised segments, 344 (29.1%) were dysfunctional (189 hypokinetic, 155 akinetic). Contractility improvement was observed in 192 segments (preserved viability in 105 hypokinetic and 37 akinetic segments). In a group of 44 patients with systolic function improvement, 34 of them had preserved viability, and in a group of 30 patients without LVEF improvement, in 22 of them myocardium viability was not observed. Sensitivity, specificity and accuracy of rt-MCE in prediction of left ventricular global improvement were 72.7%, 73.3% and 73%, respectively, whereas in prediction of regional function improvement these values were 73.9%, 77% and 75.5%, respectively. Rt-MCE performed in the early phase of myocardial infarction enables the prediction of left ventricular regional and global function improvement in patients treated with primary PCI.
Kardiologia Polska, 2006
Despite successful reperfusion therapy of acute myocardial infarction and complete restoration of... more Despite successful reperfusion therapy of acute myocardial infarction and complete restoration of infarct-related artery patency, the improvement of systolic function in long-term outcome depends on preserved microvasculature integrity. Myocardial contrast echocardiography (MCE) is a useful technique for identification of viable myocardium. To assess the value of real-time myocardial contrast echocardiography (rt-MCE) in prediction of left ventricular function improvement in patients with anterior wall acute myocardial infarction as well as selection of the optimal cut-off value for the number of dysfunctional segments with preserved complete perfusion, in order to predict the global left ventricular function improvement during one-month observation. Rt-MCE was performed in 74 patients (50 men, aged 58+/-11 years) with anterior wall myocardial infarction, treated with primary percutaneous coronary intervention (PCI) within 12 hours from the onset of symptoms. After estimation of regional contractility disturbances and global systolic function of the left ventricle, rt-MCE was performed with contrast assessment of dysfunctional segments (normal contrast pattern=2, heterogeneous=1, lack of contrast=0). Regional perfusion score index (RPSI) was calculated by adding the perfusion indices and dividing by the number of dysfunctional segments. Of a total of 1184 visualised segments, 344 (29.1%) were dysfunctional (189 hypokinetic, 155 akinetic). Contractility improvement was observed in 192 segments (preserved viability in 105 hypokinetic and 37 akinetic segments). In a group of 44 patients with systolic function improvement, 34 of them had preserved viability, and in a group of 30 patients without LVEF improvement, in 22 of them myocardium viability was not observed. Sensitivity, specificity and accuracy of rt-MCE in prediction of left ventricular global improvement were 72.7%, 73.3% and 73%, respectively, whereas in prediction of regional function improvement these values were 73.9%, 77% and 75.5%, respectively. Rt-MCE performed in the early phase of myocardial infarction enables the prediction of left ventricular regional and global function improvement in patients treated with primary PCI.
Kardiologia Polska, Aug 1, 2006
Despite successful reperfusion therapy of acute myocardial infarction and complete restoration of... more Despite successful reperfusion therapy of acute myocardial infarction and complete restoration of infarct-related artery patency, the improvement of systolic function in long-term outcome depends on preserved microvasculature integrity. Myocardial contrast echocardiography (MCE) is a useful technique for identification of viable myocardium. To assess the value of real-time myocardial contrast echocardiography (rt-MCE) in prediction of left ventricular function improvement in patients with anterior wall acute myocardial infarction as well as selection of the optimal cut-off value for the number of dysfunctional segments with preserved complete perfusion, in order to predict the global left ventricular function improvement during one-month observation. Rt-MCE was performed in 74 patients (50 men, aged 58+/-11 years) with anterior wall myocardial infarction, treated with primary percutaneous coronary intervention (PCI) within 12 hours from the onset of symptoms. After estimation of regional contractility disturbances and global systolic function of the left ventricle, rt-MCE was performed with contrast assessment of dysfunctional segments (normal contrast pattern=2, heterogeneous=1, lack of contrast=0). Regional perfusion score index (RPSI) was calculated by adding the perfusion indices and dividing by the number of dysfunctional segments. Of a total of 1184 visualised segments, 344 (29.1%) were dysfunctional (189 hypokinetic, 155 akinetic). Contractility improvement was observed in 192 segments (preserved viability in 105 hypokinetic and 37 akinetic segments). In a group of 44 patients with systolic function improvement, 34 of them had preserved viability, and in a group of 30 patients without LVEF improvement, in 22 of them myocardium viability was not observed. Sensitivity, specificity and accuracy of rt-MCE in prediction of left ventricular global improvement were 72.7%, 73.3% and 73%, respectively, whereas in prediction of regional function improvement these values were 73.9%, 77% and 75.5%, respectively. Rt-MCE performed in the early phase of myocardial infarction enables the prediction of left ventricular regional and global function improvement in patients treated with primary PCI.
Kardiologia Polska, Aug 1, 2006
Despite successful reperfusion therapy of acute myocardial infarction and complete restoration of... more Despite successful reperfusion therapy of acute myocardial infarction and complete restoration of infarct-related artery patency, the improvement of systolic function in long-term outcome depends on preserved microvasculature integrity. Myocardial contrast echocardiography (MCE) is a useful technique for identification of viable myocardium. To assess the value of real-time myocardial contrast echocardiography (rt-MCE) in prediction of left ventricular function improvement in patients with anterior wall acute myocardial infarction as well as selection of the optimal cut-off value for the number of dysfunctional segments with preserved complete perfusion, in order to predict the global left ventricular function improvement during one-month observation. Rt-MCE was performed in 74 patients (50 men, aged 58+/-11 years) with anterior wall myocardial infarction, treated with primary percutaneous coronary intervention (PCI) within 12 hours from the onset of symptoms. After estimation of regional contractility disturbances and global systolic function of the left ventricle, rt-MCE was performed with contrast assessment of dysfunctional segments (normal contrast pattern=2, heterogeneous=1, lack of contrast=0). Regional perfusion score index (RPSI) was calculated by adding the perfusion indices and dividing by the number of dysfunctional segments. Of a total of 1184 visualised segments, 344 (29.1%) were dysfunctional (189 hypokinetic, 155 akinetic). Contractility improvement was observed in 192 segments (preserved viability in 105 hypokinetic and 37 akinetic segments). In a group of 44 patients with systolic function improvement, 34 of them had preserved viability, and in a group of 30 patients without LVEF improvement, in 22 of them myocardium viability was not observed. Sensitivity, specificity and accuracy of rt-MCE in prediction of left ventricular global improvement were 72.7%, 73.3% and 73%, respectively, whereas in prediction of regional function improvement these values were 73.9%, 77% and 75.5%, respectively. Rt-MCE performed in the early phase of myocardial infarction enables the prediction of left ventricular regional and global function improvement in patients treated with primary PCI.
Kardiologia Polska, Sep 1, 2010
The issue of predicting coronary artery restenosis, especially silent, in patients following prim... more The issue of predicting coronary artery restenosis, especially silent, in patients following primary percutaneous coronary intervention (PCI) has been extensively studied, however, risk factors have not been fully defined. To asses the frequency of silent restenosis and its predictors in patients with anterior ST elevation myocardial infarction (STEMI) treated with primary PCI and implantation of bare metal stents (BMS). We recruited a cohort of 114 patients with first anterior STEMI treated with primary PCI within 12 hours of the onset of symptoms, and with the left anterior descending coronary artery occlusion (TIMI 0) and successful flow restoration (TIMI 3). A 12-lead ECG was performed before and 60 minutes after PCI. Troponin I and CK-MB were measured on admission and after six, 12 and 24 hours. Transthoracic echocardiography (TTE) was performed at discharge. Resting TTE and coronary angiography were performed after a six month follow-up in asymptomatic patients. The frequency of silent restenosis in our study group was 23.9%. The best multivariate models in logistic regression of restenosis prediction were: lower end-systolic volume of the left ventricle assessed two days after infarction longer lesion and smaller reference diameter of the stented vessel. Silent restenosis in patients with first anterior STEMI treated by primary PCI with the use of BMS is still frequent. The best ways to identify patients with silent restenosis at six month follow-up, apart from the lower end systolic volume in the echocardiographic study, are longer narrowing in the infarct-related artery and lower reference diameter of the treated vessel.
Kardiologia Polska, Dec 1, 2010
Complete atrioventricular block can occur, among others, in case of hyperkalemia, that is a life-... more Complete atrioventricular block can occur, among others, in case of hyperkalemia, that is a life-threatening complication of rhabdomyolysis. Statins constitute the medication group that is especially associated with a possibility of muscle complications. Frequency of statin-associated myalgia is 5-10%, and potentially fatal rhabdomyolysis--0.02-0.09%. We describe a male patient who was admitted due to syncope caused by complete atrioventricular block. Iatrogenic rhabdomyolysis with life-threatening hyperkalemia, that was related to statin, was diagnosed. After application of suitable pharmacotherapy, conduction abnormalities resolved. The patient was discharged in a good condition.
Kardiologia Polska, Dec 1, 2010
Complete atrioventricular block can occur, among others, in case of hyperkalemia, that is a life-... more Complete atrioventricular block can occur, among others, in case of hyperkalemia, that is a life-threatening complication of rhabdomyolysis. Statins constitute the medication group that is especially associated with a possibility of muscle complications. Frequency of statin-associated myalgia is 5-10%, and potentially fatal rhabdomyolysis--0.02-0.09%. We describe a male patient who was admitted due to syncope caused by complete atrioventricular block. Iatrogenic rhabdomyolysis with life-threatening hyperkalemia, that was related to statin, was diagnosed. After application of suitable pharmacotherapy, conduction abnormalities resolved. The patient was discharged in a good condition.
European Journal of Heart Failure Supplements, Jun 1, 2006
European Journal of Heart Failure Supplements, Jun 1, 2006
Kardiologia Polska, 2008
Prognostic significance of clinical and non-invasive risk markers in patients after surgical reva... more Prognostic significance of clinical and non-invasive risk markers in patients after surgical revascularisation remains unclear, especially in post-infarction patients with left ventricular (LV) dysfunction. The single-centre, prospective study was designed to assess survival and the predictive power of several clinical and non- -invasive risk markers of all-cause (ACM) and cardiovascular mortality (CVM) in post-CABG patients with LV dysfunction. A cohort of 61 patients (age 59+/-9 years, 49 males, LVEF 33+/-6%) 6-12 months after CABG was prospectively followed for a median of 46 months. Demographics, clinical data, medication, LVEF, QRS&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;120 ms or late potentials (LP) presence, QT dispersion ł80 ms, premature ventricular contractions (PVC) ł10/h, non-sustained ventricular tachycardia (nsVT), and SDNN Ł70 ms in ambulatory ECG were analysed. The ACM and CVM were evaluated. The prognostic value of analysing parameters was determined. Fourteen patients died, 10 of them due to cardiovascular causes. Univariate Cox analysis showed that incomplete revascularisation, history of angina, heart failure, low LVEF, use of nitrates, digitalis or diuretics, and presence of LP or prolongation of QRS complex were predictors of poor outcome. Combination of angina and low LVEF was the best model in a multivariable Cox analysies for the prediction of both types of death. The present study showed that in post-CABG patients with LV dysfunction, angina class and low LVEF are the main predictors of ACM and CVM. Combination of LVEF &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;30% with the presence of QRS &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;120 ms or LP may also be helpful in the identification of high-risk subjects. Other common non-invasive risk markers, particularly arrhythmic and autonomic, seem to lose some of their predictive power in patients after CABG and receiving beta-blocking agents.
Kardiologia Polska, 2008
Prognostic significance of clinical and non-invasive risk markers in patients after surgical reva... more Prognostic significance of clinical and non-invasive risk markers in patients after surgical revascularisation remains unclear, especially in post-infarction patients with left ventricular (LV) dysfunction. The single-centre, prospective study was designed to assess survival and the predictive power of several clinical and non- -invasive risk markers of all-cause (ACM) and cardiovascular mortality (CVM) in post-CABG patients with LV dysfunction. A cohort of 61 patients (age 59+/-9 years, 49 males, LVEF 33+/-6%) 6-12 months after CABG was prospectively followed for a median of 46 months. Demographics, clinical data, medication, LVEF, QRS&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;120 ms or late potentials (LP) presence, QT dispersion ł80 ms, premature ventricular contractions (PVC) ł10/h, non-sustained ventricular tachycardia (nsVT), and SDNN Ł70 ms in ambulatory ECG were analysed. The ACM and CVM were evaluated. The prognostic value of analysing parameters was determined. Fourteen patients died, 10 of them due to cardiovascular causes. Univariate Cox analysis showed that incomplete revascularisation, history of angina, heart failure, low LVEF, use of nitrates, digitalis or diuretics, and presence of LP or prolongation of QRS complex were predictors of poor outcome. Combination of angina and low LVEF was the best model in a multivariable Cox analysies for the prediction of both types of death. The present study showed that in post-CABG patients with LV dysfunction, angina class and low LVEF are the main predictors of ACM and CVM. Combination of LVEF &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;30% with the presence of QRS &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;120 ms or LP may also be helpful in the identification of high-risk subjects. Other common non-invasive risk markers, particularly arrhythmic and autonomic, seem to lose some of their predictive power in patients after CABG and receiving beta-blocking agents.
Cardiology Journal, 2006
Material and methods: We studied 114 consecutive patients, of whom 85 were male, aged 57.9 ± 11 y... more Material and methods: We studied 114 consecutive patients, of whom 85 were male, aged 57.9 ± 11 years, within 12 hours of the onset of symptoms of their first anterior myocardial infarction. These were treated with primary PCI, after which PCI myocardial blush grading was assessed (MBG 0-1 no perfusion, 2-3 normal perfusion). One hour after PCI a reduction of > 50% in the sum of ST-segment elevation (SST 50%) was assessed as an indicator of perfusion restoration. During the first 24 hours continuous ECG monitoring recorded reperfusion arrhythmias (RA) and the time required for ST-segment reduction to exceed 50% in the single lead with the highest ST elevation (Dt ST 50%). On the next day of MI, after LVEF evaluation, real-time myocardial contrast echocardiography (RT-MCE) was performed to assess perfusion in dysfunctional segments. The reperfusion index as an average of the dysfunctional segment perfusion score was determined. Regional LVEF was 41.9 ± 7.1% and in group B it was 38.9 ± 7.4% (p = NS). The reperfusion indices were 1.59 and 0.78 (p < 0.001) respectively. MBG 2-3 occurred more often in group A (64%) than in group B (34%) p<0.001. S ST50% and Dt ST 50%, after determination of the cut point on the ROC curve (61 min), occurred in 47 and 48 patients in Editorial p. 269 294 Folia Cardiol. 2006, Vol. 13, No. 4 www.fc.viamedica.pl group A and 17 and 16 patients in group B respectively. The accuracy of the tests under discussion for LVEF prognosis was 76.3%, 64%, 63.2% and 64.9% for RT-MCE, MBG, SST50% and Dt ST 50% respectively. Conclusions: Myocardial perfusion echocardiography had a high prognostic value for the prediction of LV global function improvement. It turned out to be the best predictor among the other angiographic, echocardiographic and electrocardiographic markers. (Folia Cardiol. 2006; 13: 293-301) myocardial contrast echocardiography, myocardial perfusion, acute myocardial infarction
Cardiology Journal, 2006
Material and methods: We studied 114 consecutive patients, of whom 85 were male, aged 57.9 ± 11 y... more Material and methods: We studied 114 consecutive patients, of whom 85 were male, aged 57.9 ± 11 years, within 12 hours of the onset of symptoms of their first anterior myocardial infarction. These were treated with primary PCI, after which PCI myocardial blush grading was assessed (MBG 0-1 no perfusion, 2-3 normal perfusion). One hour after PCI a reduction of > 50% in the sum of ST-segment elevation (SST 50%) was assessed as an indicator of perfusion restoration. During the first 24 hours continuous ECG monitoring recorded reperfusion arrhythmias (RA) and the time required for ST-segment reduction to exceed 50% in the single lead with the highest ST elevation (Dt ST 50%). On the next day of MI, after LVEF evaluation, real-time myocardial contrast echocardiography (RT-MCE) was performed to assess perfusion in dysfunctional segments. The reperfusion index as an average of the dysfunctional segment perfusion score was determined. Regional LVEF was 41.9 ± 7.1% and in group B it was 38.9 ± 7.4% (p = NS). The reperfusion indices were 1.59 and 0.78 (p < 0.001) respectively. MBG 2-3 occurred more often in group A (64%) than in group B (34%) p<0.001. S ST50% and Dt ST 50%, after determination of the cut point on the ROC curve (61 min), occurred in 47 and 48 patients in Editorial p. 269 294 Folia Cardiol. 2006, Vol. 13, No. 4 www.fc.viamedica.pl group A and 17 and 16 patients in group B respectively. The accuracy of the tests under discussion for LVEF prognosis was 76.3%, 64%, 63.2% and 64.9% for RT-MCE, MBG, SST50% and Dt ST 50% respectively. Conclusions: Myocardial perfusion echocardiography had a high prognostic value for the prediction of LV global function improvement. It turned out to be the best predictor among the other angiographic, echocardiographic and electrocardiographic markers. (Folia Cardiol. 2006; 13: 293-301) myocardial contrast echocardiography, myocardial perfusion, acute myocardial infarction
Kardiologia Polska, Apr 1, 2010
Despite the widespread use of reperfusion methods, the long-term outcome after primary percutaneo... more Despite the widespread use of reperfusion methods, the long-term outcome after primary percutaneous coronary intervention (PCI) is variable, and accurate risk stratification is of clinical importance. To assess the predictors of long term outcome after PCI for acute anterior myocardial infarction (AMI). One hundred and twenty-seven consecutive patients undergoing PCI within 12 hours from the onset of the first AMI were enrolled. Troponin I, CK-MB, creatinine, NT-proBNP, echocardiographic left ventricular (LV) function, myocardial contrast perfusion, results of coronary angiography, ECG, 24-hour Holter ECG, and T-wave alternans (TWA) were analysed as predictors of major adverse cardiac events (MACE), defined as death, non-fatal reinfarction, sustained ventricular tachycardia, and rehospitalisation for decompensated heart failure. Patients were followed up for two years. Twenty-seven patients developed MACE. The best predictive model for MACE consisted of impaired perfusion (MCE, myocardial contrast echocardiography), higher CK-MB at 24 hours, discharge NT-proBNP, and non-negative TWA. The combination of elevated creatinine level, decreased LV ejection fraction, and a non-negative TWA proved the best for identification of patients at risk of cardiac death. The best multivariate model for predicting heart failure hospitalisation consisted of higher 24-hour CK-MB, discharge NT-proBNP, impaired perfusion and prolonged duration of ST elevation. Our study showed that the rate of MACE in patients with anterior ST-segment elevation myocardial infarction undergoing primary PCI at two years follow-up is low. A combined assessment of myocardial contrast perfusion, TWA, CK-MB and discharge NT-proBNP seems to optimally predict patients at risk of MACE.
Kardiologia Polska, Apr 1, 2010
Despite the widespread use of reperfusion methods, the long-term outcome after primary percutaneo... more Despite the widespread use of reperfusion methods, the long-term outcome after primary percutaneous coronary intervention (PCI) is variable, and accurate risk stratification is of clinical importance. To assess the predictors of long term outcome after PCI for acute anterior myocardial infarction (AMI). One hundred and twenty-seven consecutive patients undergoing PCI within 12 hours from the onset of the first AMI were enrolled. Troponin I, CK-MB, creatinine, NT-proBNP, echocardiographic left ventricular (LV) function, myocardial contrast perfusion, results of coronary angiography, ECG, 24-hour Holter ECG, and T-wave alternans (TWA) were analysed as predictors of major adverse cardiac events (MACE), defined as death, non-fatal reinfarction, sustained ventricular tachycardia, and rehospitalisation for decompensated heart failure. Patients were followed up for two years. Twenty-seven patients developed MACE. The best predictive model for MACE consisted of impaired perfusion (MCE, myocardial contrast echocardiography), higher CK-MB at 24 hours, discharge NT-proBNP, and non-negative TWA. The combination of elevated creatinine level, decreased LV ejection fraction, and a non-negative TWA proved the best for identification of patients at risk of cardiac death. The best multivariate model for predicting heart failure hospitalisation consisted of higher 24-hour CK-MB, discharge NT-proBNP, impaired perfusion and prolonged duration of ST elevation. Our study showed that the rate of MACE in patients with anterior ST-segment elevation myocardial infarction undergoing primary PCI at two years follow-up is low. A combined assessment of myocardial contrast perfusion, TWA, CK-MB and discharge NT-proBNP seems to optimally predict patients at risk of MACE.
The Annals of thoracic surgery, 2015
Restrictive mitral annuloplasty is the preferred method of treating secondary mitral regurgitatio... more Restrictive mitral annuloplasty is the preferred method of treating secondary mitral regurgitation. The use of small annuloplasty rings to reduce the high recurrence rates may result in mitral stenosis. Thirty-six patients who underwent restrictive mitral annuloplasty with Carpentier-Edwards classic 26 size ring underwent exercise echocardiography and ergospirometry. Resting catecholamines and N-terminal pro brain natriuretic peptide (NT-proBNP) levels were measured. At the time of study, the median time from operation was 16.6 months (interquartile range, 8.5 to 43.3 months). Left ventricular end-systolic volume index (LVESVI) was 67 mL/m(2) (interquartile range, 25 to 92 mL/m(2)), and ejection fraction (EF) was 38.8% (interquartile range, 28.3% to 59.0%). Mitral gradients were higher at the leaflet tips than at the annular level. Continuous wave (CW) Doppler gradients at rest were 3.4 mmHg (interquartile range, 2.4 to 4.9 mmHg) mean and 9.5 mmHg (interquartile range, 7.0 to 14.7 m...
The Annals of thoracic surgery, 2015
Restrictive mitral annuloplasty is the preferred method of treating secondary mitral regurgitatio... more Restrictive mitral annuloplasty is the preferred method of treating secondary mitral regurgitation. The use of small annuloplasty rings to reduce the high recurrence rates may result in mitral stenosis. Thirty-six patients who underwent restrictive mitral annuloplasty with Carpentier-Edwards classic 26 size ring underwent exercise echocardiography and ergospirometry. Resting catecholamines and N-terminal pro brain natriuretic peptide (NT-proBNP) levels were measured. At the time of study, the median time from operation was 16.6 months (interquartile range, 8.5 to 43.3 months). Left ventricular end-systolic volume index (LVESVI) was 67 mL/m(2) (interquartile range, 25 to 92 mL/m(2)), and ejection fraction (EF) was 38.8% (interquartile range, 28.3% to 59.0%). Mitral gradients were higher at the leaflet tips than at the annular level. Continuous wave (CW) Doppler gradients at rest were 3.4 mmHg (interquartile range, 2.4 to 4.9 mmHg) mean and 9.5 mmHg (interquartile range, 7.0 to 14.7 m...