Miklós Csanády - Academia.edu (original) (raw)

Papers by Miklós Csanády

Research paper thumbnail of 464 Impaired coronary flow reserve in patients with diabetes mellitus and coronary artery disease

European Journal of Echocardiography, 1999

Research paper thumbnail of Role of Real Time Three-Dimensional Echocardiography in Heart Failure

Echocardiography, 2008

Aims: A non-optimal resynchronization lead (RL) position is a possible cause of poor CRT response... more Aims: A non-optimal resynchronization lead (RL) position is a possible cause of poor CRT response. The study aims to test the value of real-time-three-dimensional-echocardiography (RT3DE) for individual assessment of LV dyssynchrony and prospective evaluation of CRT response after RL implantation at the pre-determined segment of maximal delay (SMMD) whatever the method of CRT used. Methods: Seventeen HF patients were prospectively included in the study. RT3DE data were obtained before and after 1, 3, 6 months of CRT. Time/volume curves and parametric imaging were applied for pre-implant identification of SMMD and for individual assessment of CRT response. Delta-time delay (delta-t) and selective parameters between tmsv of the latest and earliest activated segments were calculated. Results: All patients received CRT according to accessibility of the SMMD. We used bifocal right ventricular pacing (BFRVP) in 5 patients with septal SMMD; biventricular pacing (BVP) in 12 patients with LV SMMD. The RL was successfully implanted at the SMMD or nearest segment in 14 (82.4%) initial responders (5 BFRVP, 9 BVP). Twelve of them were still responders after 6 months. CRT response was comparable in BFRVP and BIVP. A moderate correlation was found between % change of EF and that of SDI (r = À.406), delta-t (À.497). Baseline delta-t showed a stronger correlation with % change of EF (r = À.718 ** , P = 0.009) than that of SDI (r = À.509, P = 0.091).

Research paper thumbnail of Short-term beat-to-beat variability of the QT interval is increased and correlates with parameters of left ventricular hypertrophy in patients with hypertrophic cardiomyopathy

Canadian Journal of Physiology and Pharmacology, 2015

Stratification models for the prediction of sudden cardiac death (SCD) are inappropriate in patie... more Stratification models for the prediction of sudden cardiac death (SCD) are inappropriate in patients with hypertrophic cardiomyopathy (HCM). We investigated conventional electrocardiogram (ECG) repolarization parameters and the beat-to-beat short-term QT interval variability (QT-STV), a new parameter of proarrhythmic risk, in 37 patients with HCM (21 males, average age 48 ± 15 years). Resting ECGs were recorded for 5 min and the frequency corrected QT interval (QTc), QT dispersion (QTd), beat-to-beat short-term variability of QT interval (QT-STV), and the duration of terminal part of T waves (Tpeak-Tend) were calculated. While all repolarization parameters were significantly increased in patients with HCM compared with the controls (QTc, 488 ± 61 vs. 434 ± 23 ms, p < 0.0001; QT-STV, 4.5 ± 2 vs. 3.2 ± 1 ms, p = 0.0002; Tpeak-Tend duration, 107 ± 27 vs. 91 ± 10 ms, p = 0.0015; QTd, 47 ± 17 vs. 34 ± 9 ms, p = 0.0002), QT-STV had the highest relative increase (+41%). QT-STV also showed the best correlation with indices of left ventricular (LV) hypertrophy, i.e., maximal LV wall thickness normalized for body surface area (BSA; r = 0.461, p = 0.004) or LV mass (determined by cardiac magnetic resonance imaging) normalized for BSA (r = 0.455, p = 0.015). In summary, beat-to-beat QT-STV showed the most marked increase in patients with HCM and may represent a novel marker that merits further testing for increased SCD risk in HCM.

Research paper thumbnail of 714 Diabetes mellitus facilitates aortic stiffening in acromegaly

European Journal of Echocardiography, 2006

The stiffening of aorta and other central arteries is a potential risk factor for increased cardi... more The stiffening of aorta and other central arteries is a potential risk factor for increased cardiovascular morbidity and mortality. The association of hypertension with type 2 diabetes may obscure the degree to which diabetes alone contributes to impaired arterial function. The present study was to examining whether the presence of type II diabetes alone is associated with an impaired aortic mechanical function in patients with or without coronary artery disease (CAD). Methods: 154 patients recruited and assigned to (group A, n=46) type II diabetes with no CAD, (group B, n=64) non-diabetic CAD, (group C, n=44) diabetes with CAD and 20 age and sex matched healthy participants (control). Patients were recruited from those send for coronary angiography. CAD was excluded in group A. Pulse pressure (PP), Aortic strain&distensibility were calculated from the aortic diameters measured by echocardiography and BP obtained by sphygmomanometer. Aortic wall systolic velocity (AWSV) was measured using Pulsed-wave Doppler tissue imaging (DTI). Results: PP was significantly higher in patient groups (A, B, C) in comparison to control (40.2±9, 40.1±11, 50.2±13 versus 35.5±9 mm Hg, p<0.01). The pulsatile change in the aortic diameter and distensibility were less in the patient groups than in the control group (11±4%, 8±5%, 8±4% vs 17±9% p<0.001, 6±2, 6±1, 3±2 vs 10 cm 2 /dyn/103) respectively. Also the AWSV was significantly lower in patient groups compared with control (6±2, 6.1±1, 5.1±1 vs 8.5±1.5, cm/sec p<0.01) respectively. Although aortic function parameters were much declined in group C, there was no significant difference between group A&B that reflects equivalent risk. In diabetic groups (A&C) aortic strain, distensibility and AWSV showed strong negative correlation with the duration of diabetes {r=-.53, -.68, -.56 } and glycosylated hemoglobin (HbAIc) {r=-.64, -.77, -.57} p<.01, .001, .01 respectively. Conclusion: The increased aortic stiffness that affects type II diabetic patients seems to be an early event that may explain why diabetics have a particularly high risk of developing cardiovascular complications. Poor glycemic control and duration have detrimental effect on aortic elastic properties.

Research paper thumbnail of 699 Obesity is associated with aortic enlargement and increased stiffness

European Journal of Echocardiography, 2006

Research paper thumbnail of Coronary flow velocity reserve is diminished in hypertensive left ventricular hypertrophy

Kardiologia polska, 2005

Dipyridamole stress transesophageal echocardiography (STEE) is a feasible method for the evaluati... more Dipyridamole stress transesophageal echocardiography (STEE) is a feasible method for the evaluation of coronary flow velocity reserve (CFR). The aim of the present study was to investigate CFR in hypertensive patients with or without left ventricular hypertrophy (LVH). The study comprised 73 patients with a negative coronary angiogram (29 men and 44 women). Three different groups were compared: normotensive patients, hypertensive patients without LVH and hypertensive patients with LVH. CFR was significantly decreased in patients with hypertension with LVH as compared to normotensive cases (2.19+/-0.50 vs 2.71+/-1.10; p<0.05). CFR of hypertensive patients without LVH was only slightly reduced as compared to normotensive cases (2.44+/-0.81 vs 2.71+/-1.10; p=ns). In hypertensive patients with LVH, the LV mass and LV mass index were inversely related to CFR (r = -0.481 and -0.477, p<0.05, respectively). CFR is diminished in patients with hypertension. The degree of CFR reduction i...

Research paper thumbnail of Indices of aortic distensibility and coronary flow velocity reserve in patients with different grades of aortic atherosclerosis

The international journal of cardiovascular imaging, 2004

The purpose of this study was to evaluate the correlation of the elastic properties of the descen... more The purpose of this study was to evaluate the correlation of the elastic properties of the descending aorta, the coronary flow velocity reserve (CFR) and the grade of aortic atherosclerosis (AA) in patients who have undergone coronary angiography. A total of 113 consecutive patients (77 men and 36 women, aged 31-80 years) underwent stress transoesophageal echocardiographic (STEE) assessment of the CFR. The grade of AA and the indices of aortic distensibility were evaluated during the same session of STEE. All patients had chest pain without previous myocardial infarction. Coronary angiography was performed in all cases. The resting systolic and diastolic coronary flow velocities increased, while the coronary flow velocities measured at the peak of stress and the ratio Smax/Srest decreased in parallel with the aortic grade. The CFR and mean CFR were impaired in patients who exhibited aortic intimal thickening, but no further decrease was found in the event of aortic plaque. The elast...

Research paper thumbnail of Atherosclerosis of the descending aorta predicts cardiovascular events: a transesophageal echocardiography study

Cardiovascular ultrasound, 2004

Previous studies have shown that atherosclerosis of the descending aorta detected by transesophag... more Previous studies have shown that atherosclerosis of the descending aorta detected by transesophageal echocardiography (TEE) is a good marker of coexisting coronary artery disease. The aim of our study was to evaluate whether the presence of atherosclerosis on the descending aorta during TEE has any prognostic impact in predicting cardiovascular events. The study group consisted of 238 consecutive in-hospital patients referred for TEE testing (135 males, 103 females, mean age 58 +/- 11 years) with a follow up of 24 months. The atherosclerotic lesions of the descending aorta were scored from 0 (no atherosclerosis) to 3 (plaque >5 mm and/or "complex" plaque with ulcerated or mobile parts). Atherosclerosis was observed in 102 patients, (grade 3 in 16, and grade 2 in 86 patients) whereas 136 patients only had an intimal thickening or normal intimal surface. There were 57 cardiovascular events in the follow-up period. The number of events was higher in the 102 patients with (...

Research paper thumbnail of Prognostic value of dipyridamole echocardiography testing

International Journal of Angiology, 1995

The aim of this study was to follow the results of dipyridamole echocardiography testing (DET) in... more The aim of this study was to follow the results of dipyridamole echocardiography testing (DET) in 105 patients (mean age 53.2 -+ 8.5 years) with suspected ischemic heart disease. The follow-up period was 31.4 +--4.2 months. Twenty-nine patients had a positive DET result, and 76 a negative one. Fifty-two of the 105 underwent coronarography, and the remainder had no heart catheterization. In the follow-up study, the patients' subjective condition and the new heart events (angina, infarction, coronary bypass surgery, and death) were registered. The new heart events were more frequent in the DET-positive group than the negative one (45% vs 22%; p < 0.05). In the coronarography-positive and -negative group these values were 77% and 10%, respectively (p < 0.001). In the coronarography-and DET-positive group the frequency of new cardiac events was 69%. This value was only 10% in the coronarography-and DETnegative group. The difference between the truepositive and true-negative groups was highly significant (p < 0.001). Coronarography was found to be a good predictor of future cardiac events, however, the noninvasive dipyridamole echocardiography testing was also an appropriate method for follow-up.

Research paper thumbnail of The comparative value of the aortic atherosclerosis and the coronary flow velocity reserve evaluated by stress transesophageal echocardiography in the prediction of patients with aortic stenosis with coronary artery disease

The present study was conducted to examine whether it is possible to differentiate patients with ... more The present study was conducted to examine whether it is possible to differentiate patients with aortic stenosis (AOS) with or without significant stenosis of the left anterior descending coronary artery (LAD) on the basis of the age, gender, hypertension, diabetes mellitus, hypercholesterolemia, the coronary flow velocity reserve (CFVR) and the grade of aortic atherosclerosis (AA) evaluated by TEE in the course of the same semi-invasive examination. Thirty-nine consecutive AOS patients who had undergone coronary angiography were examined by dipyridamole stress TEE to assess the CFVR. From this patient population, 21 AOS patients with anatomically normal coronary arteries (group 1), and 18 AOS patients with &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 75% stenosis of the LAD (group 2) were selected for the present study. The CFVR was calculated as the ratio of the average peak diastolic flow velocity (APV) during hyperemia to the resting APV. The grade of AA in the descending aorta was determined by means of the same TEE examination. The demographic, clinical and transthoracic echocardiographic data, the coronary flow velocities and the CFVRs were similar in the two patient groups. Only the grade of AA (ROC area, 73%, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.02) appears useful for the distinction of AOS patients with or without significant LAD stenosis. These results demonstrate that only the grade of AA furnishes additional help in the prediction of AOS patients with severe LAD disease. CFVR has no any diagnostic power in the differentiation of AOS patients with or without significant LAD stenosis.

Research paper thumbnail of 439 Relationship between coronary flow reserve, aortic distensibility and coronary angiography

European Journal of Echocardiography, 1999

Research paper thumbnail of Grade of Aortic Atherosclerosis: A Valuable Adjunct to Coronary Flow Velocity Reserve in the Evaluation of Coronary Artery Disease

Upsala Journal of Medical Sciences, 2007

Background: Atherosclerosis is a generalized disease of the arterial vasculature; among thus it m... more Background: Atherosclerosis is a generalized disease of the arterial vasculature; among thus it manifests in the descending aorta and the coronary arteries. We tested whether known risk factors, the coronary flow velocity reserve and the grade of aortic atherosclerosis detected by transoesophageal echocardiography in the course of the same semi-invasive examination is able to distinguish between patients with significant left anterior descending coronary artery (LAD) stenosis or with multivessel disease.

Research paper thumbnail of The coronary flow velocity reserve measured by stress transoesophageal echocardiography evaluates the success of coronary interventions – Results of a 5-year follow-up

Scandinavian Cardiovascular Journal, 2005

The aim of the present study was to examine the long-term prognostic value of coronary flow veloc... more The aim of the present study was to examine the long-term prognostic value of coronary flow velocity reserve (CFR) evaluated by means of stress transoesophageal echocardiography (STEE) in patients who have undergone percutaneous coronary intervention (PCI). The study comprised 31 patients with significant LAD stenosis who underwent LAD-PCI. In consequence of their clinical signs, 11 subjects required rePCI or coronary artery bypass graft (CABG) operation within six months. The clinical status of the remaining 20 cases improved during the follow-up. STEE examinations were performed before LAD-PCI and after it. The CFR of patients in a stable clinical condition improved during the follow-up, while the CFR of those who required rePCI or CABG remained unchanged. From this patient population, two subjects died during the 5-year follow-up. Most of the patients who displayed an improved CFR after PCI suffered no major clinical events during the 5-year follow-up; in contrast, in those who a priori had a low CFR and did not show any improvement after PCI, major events did occur during this period.

Research paper thumbnail of Cytokine Production and Antibodies against Heat Shock Protein 60 in Cardiomyopathies of Different Origins

Pathobiology, 2000

There is growing evidence that proinflammatory cytokines play an important role in a variety of c... more There is growing evidence that proinflammatory cytokines play an important role in a variety of cardiac pathophysiological conditions. The purpose of this study was to determine the circulating tumour necrosis factor (TNF) and interleukin-6 (IL-6) levels in patients with dilated cardiomyopathy (DCM) (n = 40) or ischaemic heart disease (IHD) (n = 38) in comparison with the corresponding data from patients with hypertrophic cardiomyopathy (HCM) (n = 10) or valvular aorta stenosis (AS) (n = 10) and from healthy blood donors (n = 20). To investigate the possible sources of cytokines, the in vitro cytokine-inducing capacity of the patients&amp;amp;#39; peripheral blood leucocytes was also measured. The TNF and IL-6 expression levels in the myocardium were investigated from biopsy specimens. The study of the immunological background of the cardiomyopathies was supplemented with screening of anti-heat shock protein 60 (Hsp60) antibodies in the sera of the patients. Elevated levels of circulating TNF (25-150 U/ml) and IL-6 (50-500 pg/ml) were found in 85% of the patients in the DCM and IHD groups, whereas only the IL-6 level was elevated (125-500 pg/ml) in the HCM patients. The in vitro TNF-alpha production was higher than in the normal controls only in the DCM group. The ventricular tissue of the DCM patients expressed TNF-alpha and IL-6. In vitro experiments were performed to examine the production of TNF and IL-6 by cultured rat cardiac myocytes (H9C2) under hypoxic conditions. Even a short hypoxic treatment resulted in cytokine production between 4 and 72 h following reoxygenization. Considerable amounts of anti-Hsp60 antibodies were found in 80% of the IHD patients and in 65% of the DCM patients. The in vitro cytokine production of leucocytes and the frequency of anti-Hsp60 positivity in patients with HCM or AS was not significantly different from those in the normal blood donors. These results demonstrate that TNF-alpha and IL-6 are of pathophysiological importance in some but not all types of cardiomyopathies, and the sources of cytokine production may differ. The mechanism of the development of primary DCM is still unknown; the high in vitro production of proinflammatory cytokines in the leucocytes of patients with DCM, the presence of TNF and IL-6 in their cardiac tissue and the high prevalence of anti-Hsp60 antibodies in their sera suggest a strong immunological background in the pathophysiology of the disease.

Research paper thumbnail of The evaluation of aortic atherosclerosis and distensibility in aortic valve stenosis—The role of transesophageal echocardiography

The Journal of Thoracic and Cardiovascular Surgery, 2005

Research paper thumbnail of Coronary flow reserve and indices of aortic distensibility in patients with different grade of aortic atherosclerosis

Journal of the American College of Cardiology, 2003

The aim of our study was the differentiation of proximal and non-proximal left descending artery ... more The aim of our study was the differentiation of proximal and non-proximal left descending artery (LDA) stenoses with simultaneous assessment of coronary flow reserve (CFR) in the LDA and coronary sinus (CS) in CAD patients with single-vessel LDA stenosis using multiplane transesophageal echocardlography. Methods: We studied 17 men (mean age 46~7 years) with over 50% single-vessel LDA stenosis, confirmed with quantitative coronary angiography. Nine patients with over 50% smgle-vessel proximal LDA stenosis were included in group la. Eight patients with over 50% stenosis of the LDA mid and/or distal third composed group lb. The control group (II) consisted of 25 healthy volunteers (men, mean age 35*5 years). Transesophageal Doppler assessment of coronary blood flow in proximal LDA and CS was performed at baseline and after intravenous dipyridamole (0,56 mg/kg for 4 minutes) using ultrasound diagnostic systems HDI 5000 SonoCT and Ultramark 9 HDI CV (Philips-ATL).

Research paper thumbnail of Increased Aortic Stiffness in Hypertrophic Cardiomyopathy

Journal of the American College of Cardiology, 2010

Research paper thumbnail of Aortic Elastic Properties in Patients With Bicuspid Aortic Valve

Journal of the American College of Cardiology, 2011

Research paper thumbnail of Clinical value of left atrial appendage flow for prediction of long-term sinus rhythm maintenance in patients with nonvalvular atrial fibrillation

Journal of Molecular and Cellular Cardiology, 2002

This study evaluated the role of various clinical and echocardiographic parameters, including the... more This study evaluated the role of various clinical and echocardiographic parameters, including the left atrial appendage (LAA) anterograde flow velocity, for prediction of the long-term preservation of sinus rhythm (SR) in patients with successful cardioversion (CV) of nonvalvular atrial fibrillation (AF). BACKGROUND Echocardiographic parameters for assessing long-term SR maintenance after successful CV of nonvalvular AF are not accurately defined.

Research paper thumbnail of Basal vagal nerve activity does not predict susceptibility to dofetilide-induced torsade de pointes in anaesthetized rabbits

Journal of Molecular and Cellular Cardiology, 2006

Research paper thumbnail of 464 Impaired coronary flow reserve in patients with diabetes mellitus and coronary artery disease

European Journal of Echocardiography, 1999

Research paper thumbnail of Role of Real Time Three-Dimensional Echocardiography in Heart Failure

Echocardiography, 2008

Aims: A non-optimal resynchronization lead (RL) position is a possible cause of poor CRT response... more Aims: A non-optimal resynchronization lead (RL) position is a possible cause of poor CRT response. The study aims to test the value of real-time-three-dimensional-echocardiography (RT3DE) for individual assessment of LV dyssynchrony and prospective evaluation of CRT response after RL implantation at the pre-determined segment of maximal delay (SMMD) whatever the method of CRT used. Methods: Seventeen HF patients were prospectively included in the study. RT3DE data were obtained before and after 1, 3, 6 months of CRT. Time/volume curves and parametric imaging were applied for pre-implant identification of SMMD and for individual assessment of CRT response. Delta-time delay (delta-t) and selective parameters between tmsv of the latest and earliest activated segments were calculated. Results: All patients received CRT according to accessibility of the SMMD. We used bifocal right ventricular pacing (BFRVP) in 5 patients with septal SMMD; biventricular pacing (BVP) in 12 patients with LV SMMD. The RL was successfully implanted at the SMMD or nearest segment in 14 (82.4%) initial responders (5 BFRVP, 9 BVP). Twelve of them were still responders after 6 months. CRT response was comparable in BFRVP and BIVP. A moderate correlation was found between % change of EF and that of SDI (r = À.406), delta-t (À.497). Baseline delta-t showed a stronger correlation with % change of EF (r = À.718 ** , P = 0.009) than that of SDI (r = À.509, P = 0.091).

Research paper thumbnail of Short-term beat-to-beat variability of the QT interval is increased and correlates with parameters of left ventricular hypertrophy in patients with hypertrophic cardiomyopathy

Canadian Journal of Physiology and Pharmacology, 2015

Stratification models for the prediction of sudden cardiac death (SCD) are inappropriate in patie... more Stratification models for the prediction of sudden cardiac death (SCD) are inappropriate in patients with hypertrophic cardiomyopathy (HCM). We investigated conventional electrocardiogram (ECG) repolarization parameters and the beat-to-beat short-term QT interval variability (QT-STV), a new parameter of proarrhythmic risk, in 37 patients with HCM (21 males, average age 48 ± 15 years). Resting ECGs were recorded for 5 min and the frequency corrected QT interval (QTc), QT dispersion (QTd), beat-to-beat short-term variability of QT interval (QT-STV), and the duration of terminal part of T waves (Tpeak-Tend) were calculated. While all repolarization parameters were significantly increased in patients with HCM compared with the controls (QTc, 488 ± 61 vs. 434 ± 23 ms, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001; QT-STV, 4.5 ± 2 vs. 3.2 ± 1 ms, p = 0.0002; Tpeak-Tend duration, 107 ± 27 vs. 91 ± 10 ms, p = 0.0015; QTd, 47 ± 17 vs. 34 ± 9 ms, p = 0.0002), QT-STV had the highest relative increase (+41%). QT-STV also showed the best correlation with indices of left ventricular (LV) hypertrophy, i.e., maximal LV wall thickness normalized for body surface area (BSA; r = 0.461, p = 0.004) or LV mass (determined by cardiac magnetic resonance imaging) normalized for BSA (r = 0.455, p = 0.015). In summary, beat-to-beat QT-STV showed the most marked increase in patients with HCM and may represent a novel marker that merits further testing for increased SCD risk in HCM.

Research paper thumbnail of 714 Diabetes mellitus facilitates aortic stiffening in acromegaly

European Journal of Echocardiography, 2006

The stiffening of aorta and other central arteries is a potential risk factor for increased cardi... more The stiffening of aorta and other central arteries is a potential risk factor for increased cardiovascular morbidity and mortality. The association of hypertension with type 2 diabetes may obscure the degree to which diabetes alone contributes to impaired arterial function. The present study was to examining whether the presence of type II diabetes alone is associated with an impaired aortic mechanical function in patients with or without coronary artery disease (CAD). Methods: 154 patients recruited and assigned to (group A, n=46) type II diabetes with no CAD, (group B, n=64) non-diabetic CAD, (group C, n=44) diabetes with CAD and 20 age and sex matched healthy participants (control). Patients were recruited from those send for coronary angiography. CAD was excluded in group A. Pulse pressure (PP), Aortic strain&distensibility were calculated from the aortic diameters measured by echocardiography and BP obtained by sphygmomanometer. Aortic wall systolic velocity (AWSV) was measured using Pulsed-wave Doppler tissue imaging (DTI). Results: PP was significantly higher in patient groups (A, B, C) in comparison to control (40.2±9, 40.1±11, 50.2±13 versus 35.5±9 mm Hg, p<0.01). The pulsatile change in the aortic diameter and distensibility were less in the patient groups than in the control group (11±4%, 8±5%, 8±4% vs 17±9% p<0.001, 6±2, 6±1, 3±2 vs 10 cm 2 /dyn/103) respectively. Also the AWSV was significantly lower in patient groups compared with control (6±2, 6.1±1, 5.1±1 vs 8.5±1.5, cm/sec p<0.01) respectively. Although aortic function parameters were much declined in group C, there was no significant difference between group A&B that reflects equivalent risk. In diabetic groups (A&C) aortic strain, distensibility and AWSV showed strong negative correlation with the duration of diabetes {r=-.53, -.68, -.56 } and glycosylated hemoglobin (HbAIc) {r=-.64, -.77, -.57} p<.01, .001, .01 respectively. Conclusion: The increased aortic stiffness that affects type II diabetic patients seems to be an early event that may explain why diabetics have a particularly high risk of developing cardiovascular complications. Poor glycemic control and duration have detrimental effect on aortic elastic properties.

Research paper thumbnail of 699 Obesity is associated with aortic enlargement and increased stiffness

European Journal of Echocardiography, 2006

Research paper thumbnail of Coronary flow velocity reserve is diminished in hypertensive left ventricular hypertrophy

Kardiologia polska, 2005

Dipyridamole stress transesophageal echocardiography (STEE) is a feasible method for the evaluati... more Dipyridamole stress transesophageal echocardiography (STEE) is a feasible method for the evaluation of coronary flow velocity reserve (CFR). The aim of the present study was to investigate CFR in hypertensive patients with or without left ventricular hypertrophy (LVH). The study comprised 73 patients with a negative coronary angiogram (29 men and 44 women). Three different groups were compared: normotensive patients, hypertensive patients without LVH and hypertensive patients with LVH. CFR was significantly decreased in patients with hypertension with LVH as compared to normotensive cases (2.19+/-0.50 vs 2.71+/-1.10; p<0.05). CFR of hypertensive patients without LVH was only slightly reduced as compared to normotensive cases (2.44+/-0.81 vs 2.71+/-1.10; p=ns). In hypertensive patients with LVH, the LV mass and LV mass index were inversely related to CFR (r = -0.481 and -0.477, p<0.05, respectively). CFR is diminished in patients with hypertension. The degree of CFR reduction i...

Research paper thumbnail of Indices of aortic distensibility and coronary flow velocity reserve in patients with different grades of aortic atherosclerosis

The international journal of cardiovascular imaging, 2004

The purpose of this study was to evaluate the correlation of the elastic properties of the descen... more The purpose of this study was to evaluate the correlation of the elastic properties of the descending aorta, the coronary flow velocity reserve (CFR) and the grade of aortic atherosclerosis (AA) in patients who have undergone coronary angiography. A total of 113 consecutive patients (77 men and 36 women, aged 31-80 years) underwent stress transoesophageal echocardiographic (STEE) assessment of the CFR. The grade of AA and the indices of aortic distensibility were evaluated during the same session of STEE. All patients had chest pain without previous myocardial infarction. Coronary angiography was performed in all cases. The resting systolic and diastolic coronary flow velocities increased, while the coronary flow velocities measured at the peak of stress and the ratio Smax/Srest decreased in parallel with the aortic grade. The CFR and mean CFR were impaired in patients who exhibited aortic intimal thickening, but no further decrease was found in the event of aortic plaque. The elast...

Research paper thumbnail of Atherosclerosis of the descending aorta predicts cardiovascular events: a transesophageal echocardiography study

Cardiovascular ultrasound, 2004

Previous studies have shown that atherosclerosis of the descending aorta detected by transesophag... more Previous studies have shown that atherosclerosis of the descending aorta detected by transesophageal echocardiography (TEE) is a good marker of coexisting coronary artery disease. The aim of our study was to evaluate whether the presence of atherosclerosis on the descending aorta during TEE has any prognostic impact in predicting cardiovascular events. The study group consisted of 238 consecutive in-hospital patients referred for TEE testing (135 males, 103 females, mean age 58 +/- 11 years) with a follow up of 24 months. The atherosclerotic lesions of the descending aorta were scored from 0 (no atherosclerosis) to 3 (plaque >5 mm and/or "complex" plaque with ulcerated or mobile parts). Atherosclerosis was observed in 102 patients, (grade 3 in 16, and grade 2 in 86 patients) whereas 136 patients only had an intimal thickening or normal intimal surface. There were 57 cardiovascular events in the follow-up period. The number of events was higher in the 102 patients with (...

Research paper thumbnail of Prognostic value of dipyridamole echocardiography testing

International Journal of Angiology, 1995

The aim of this study was to follow the results of dipyridamole echocardiography testing (DET) in... more The aim of this study was to follow the results of dipyridamole echocardiography testing (DET) in 105 patients (mean age 53.2 -+ 8.5 years) with suspected ischemic heart disease. The follow-up period was 31.4 +--4.2 months. Twenty-nine patients had a positive DET result, and 76 a negative one. Fifty-two of the 105 underwent coronarography, and the remainder had no heart catheterization. In the follow-up study, the patients' subjective condition and the new heart events (angina, infarction, coronary bypass surgery, and death) were registered. The new heart events were more frequent in the DET-positive group than the negative one (45% vs 22%; p < 0.05). In the coronarography-positive and -negative group these values were 77% and 10%, respectively (p < 0.001). In the coronarography-and DET-positive group the frequency of new cardiac events was 69%. This value was only 10% in the coronarography-and DETnegative group. The difference between the truepositive and true-negative groups was highly significant (p < 0.001). Coronarography was found to be a good predictor of future cardiac events, however, the noninvasive dipyridamole echocardiography testing was also an appropriate method for follow-up.

Research paper thumbnail of The comparative value of the aortic atherosclerosis and the coronary flow velocity reserve evaluated by stress transesophageal echocardiography in the prediction of patients with aortic stenosis with coronary artery disease

The present study was conducted to examine whether it is possible to differentiate patients with ... more The present study was conducted to examine whether it is possible to differentiate patients with aortic stenosis (AOS) with or without significant stenosis of the left anterior descending coronary artery (LAD) on the basis of the age, gender, hypertension, diabetes mellitus, hypercholesterolemia, the coronary flow velocity reserve (CFVR) and the grade of aortic atherosclerosis (AA) evaluated by TEE in the course of the same semi-invasive examination. Thirty-nine consecutive AOS patients who had undergone coronary angiography were examined by dipyridamole stress TEE to assess the CFVR. From this patient population, 21 AOS patients with anatomically normal coronary arteries (group 1), and 18 AOS patients with &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 75% stenosis of the LAD (group 2) were selected for the present study. The CFVR was calculated as the ratio of the average peak diastolic flow velocity (APV) during hyperemia to the resting APV. The grade of AA in the descending aorta was determined by means of the same TEE examination. The demographic, clinical and transthoracic echocardiographic data, the coronary flow velocities and the CFVRs were similar in the two patient groups. Only the grade of AA (ROC area, 73%, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.02) appears useful for the distinction of AOS patients with or without significant LAD stenosis. These results demonstrate that only the grade of AA furnishes additional help in the prediction of AOS patients with severe LAD disease. CFVR has no any diagnostic power in the differentiation of AOS patients with or without significant LAD stenosis.

Research paper thumbnail of 439 Relationship between coronary flow reserve, aortic distensibility and coronary angiography

European Journal of Echocardiography, 1999

Research paper thumbnail of Grade of Aortic Atherosclerosis: A Valuable Adjunct to Coronary Flow Velocity Reserve in the Evaluation of Coronary Artery Disease

Upsala Journal of Medical Sciences, 2007

Background: Atherosclerosis is a generalized disease of the arterial vasculature; among thus it m... more Background: Atherosclerosis is a generalized disease of the arterial vasculature; among thus it manifests in the descending aorta and the coronary arteries. We tested whether known risk factors, the coronary flow velocity reserve and the grade of aortic atherosclerosis detected by transoesophageal echocardiography in the course of the same semi-invasive examination is able to distinguish between patients with significant left anterior descending coronary artery (LAD) stenosis or with multivessel disease.

Research paper thumbnail of The coronary flow velocity reserve measured by stress transoesophageal echocardiography evaluates the success of coronary interventions – Results of a 5-year follow-up

Scandinavian Cardiovascular Journal, 2005

The aim of the present study was to examine the long-term prognostic value of coronary flow veloc... more The aim of the present study was to examine the long-term prognostic value of coronary flow velocity reserve (CFR) evaluated by means of stress transoesophageal echocardiography (STEE) in patients who have undergone percutaneous coronary intervention (PCI). The study comprised 31 patients with significant LAD stenosis who underwent LAD-PCI. In consequence of their clinical signs, 11 subjects required rePCI or coronary artery bypass graft (CABG) operation within six months. The clinical status of the remaining 20 cases improved during the follow-up. STEE examinations were performed before LAD-PCI and after it. The CFR of patients in a stable clinical condition improved during the follow-up, while the CFR of those who required rePCI or CABG remained unchanged. From this patient population, two subjects died during the 5-year follow-up. Most of the patients who displayed an improved CFR after PCI suffered no major clinical events during the 5-year follow-up; in contrast, in those who a priori had a low CFR and did not show any improvement after PCI, major events did occur during this period.

Research paper thumbnail of Cytokine Production and Antibodies against Heat Shock Protein 60 in Cardiomyopathies of Different Origins

Pathobiology, 2000

There is growing evidence that proinflammatory cytokines play an important role in a variety of c... more There is growing evidence that proinflammatory cytokines play an important role in a variety of cardiac pathophysiological conditions. The purpose of this study was to determine the circulating tumour necrosis factor (TNF) and interleukin-6 (IL-6) levels in patients with dilated cardiomyopathy (DCM) (n = 40) or ischaemic heart disease (IHD) (n = 38) in comparison with the corresponding data from patients with hypertrophic cardiomyopathy (HCM) (n = 10) or valvular aorta stenosis (AS) (n = 10) and from healthy blood donors (n = 20). To investigate the possible sources of cytokines, the in vitro cytokine-inducing capacity of the patients&amp;amp;#39; peripheral blood leucocytes was also measured. The TNF and IL-6 expression levels in the myocardium were investigated from biopsy specimens. The study of the immunological background of the cardiomyopathies was supplemented with screening of anti-heat shock protein 60 (Hsp60) antibodies in the sera of the patients. Elevated levels of circulating TNF (25-150 U/ml) and IL-6 (50-500 pg/ml) were found in 85% of the patients in the DCM and IHD groups, whereas only the IL-6 level was elevated (125-500 pg/ml) in the HCM patients. The in vitro TNF-alpha production was higher than in the normal controls only in the DCM group. The ventricular tissue of the DCM patients expressed TNF-alpha and IL-6. In vitro experiments were performed to examine the production of TNF and IL-6 by cultured rat cardiac myocytes (H9C2) under hypoxic conditions. Even a short hypoxic treatment resulted in cytokine production between 4 and 72 h following reoxygenization. Considerable amounts of anti-Hsp60 antibodies were found in 80% of the IHD patients and in 65% of the DCM patients. The in vitro cytokine production of leucocytes and the frequency of anti-Hsp60 positivity in patients with HCM or AS was not significantly different from those in the normal blood donors. These results demonstrate that TNF-alpha and IL-6 are of pathophysiological importance in some but not all types of cardiomyopathies, and the sources of cytokine production may differ. The mechanism of the development of primary DCM is still unknown; the high in vitro production of proinflammatory cytokines in the leucocytes of patients with DCM, the presence of TNF and IL-6 in their cardiac tissue and the high prevalence of anti-Hsp60 antibodies in their sera suggest a strong immunological background in the pathophysiology of the disease.

Research paper thumbnail of The evaluation of aortic atherosclerosis and distensibility in aortic valve stenosis—The role of transesophageal echocardiography

The Journal of Thoracic and Cardiovascular Surgery, 2005

Research paper thumbnail of Coronary flow reserve and indices of aortic distensibility in patients with different grade of aortic atherosclerosis

Journal of the American College of Cardiology, 2003

The aim of our study was the differentiation of proximal and non-proximal left descending artery ... more The aim of our study was the differentiation of proximal and non-proximal left descending artery (LDA) stenoses with simultaneous assessment of coronary flow reserve (CFR) in the LDA and coronary sinus (CS) in CAD patients with single-vessel LDA stenosis using multiplane transesophageal echocardlography. Methods: We studied 17 men (mean age 46~7 years) with over 50% single-vessel LDA stenosis, confirmed with quantitative coronary angiography. Nine patients with over 50% smgle-vessel proximal LDA stenosis were included in group la. Eight patients with over 50% stenosis of the LDA mid and/or distal third composed group lb. The control group (II) consisted of 25 healthy volunteers (men, mean age 35*5 years). Transesophageal Doppler assessment of coronary blood flow in proximal LDA and CS was performed at baseline and after intravenous dipyridamole (0,56 mg/kg for 4 minutes) using ultrasound diagnostic systems HDI 5000 SonoCT and Ultramark 9 HDI CV (Philips-ATL).

Research paper thumbnail of Increased Aortic Stiffness in Hypertrophic Cardiomyopathy

Journal of the American College of Cardiology, 2010

Research paper thumbnail of Aortic Elastic Properties in Patients With Bicuspid Aortic Valve

Journal of the American College of Cardiology, 2011

Research paper thumbnail of Clinical value of left atrial appendage flow for prediction of long-term sinus rhythm maintenance in patients with nonvalvular atrial fibrillation

Journal of Molecular and Cellular Cardiology, 2002

This study evaluated the role of various clinical and echocardiographic parameters, including the... more This study evaluated the role of various clinical and echocardiographic parameters, including the left atrial appendage (LAA) anterograde flow velocity, for prediction of the long-term preservation of sinus rhythm (SR) in patients with successful cardioversion (CV) of nonvalvular atrial fibrillation (AF). BACKGROUND Echocardiographic parameters for assessing long-term SR maintenance after successful CV of nonvalvular AF are not accurately defined.

Research paper thumbnail of Basal vagal nerve activity does not predict susceptibility to dofetilide-induced torsade de pointes in anaesthetized rabbits

Journal of Molecular and Cellular Cardiology, 2006