Wiesława Tracz - Academia.edu (original) (raw)
Papers by Wiesława Tracz
Przegla̧d lekarski
The case of a young 32 year old male with a primary cardiac angiosarcoma is reported. The neoplas... more The case of a young 32 year old male with a primary cardiac angiosarcoma is reported. The neoplasm manifested itself by a quickly increasing cardiac tamponade but without metastases. The nonradical resection of the tumor was made because of local invasion with tumor tissue. The patient was followed-up for 3 years after the surgery and no recurrence of the malignant process was observed. Cardiac angiosarcoma is a very rare malignant tumor of soft tissues. In spite of significant progress in clinical treatment, for a patient diagnosed antemortem with cardiac angiosarcoma, the long-term expectations are usually very poor. Commonly known risk factors for this group of neoplasms (haemangioma of skin, chroniclymphedema, chronic post-tuberculosis pleurisy, X-ray, thorium dioxide) cannot be easily associated with the primary cardiac angiosarcoma cases. The search for chromosomal anomalies and gene mutations leading to cardiac angiosarcoma is ongoing. There is hope that recently obtained evi...
Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 2008
Haemodialysis patients are at an increased risk of cardiovascular (CV) morbidity and mortality. B... more Haemodialysis patients are at an increased risk of cardiovascular (CV) morbidity and mortality. Both end-stage renal disease (ESRD) and thromboembolic coronary events have been shown to be associated with the formation of dense fibrin clots resistant to fibrinolysis. The aim of the present study was to investigate the effect of long-term haemodialysis on clot structure/function and analyse an influence of markers of inflammation, oxidative stress and lipoprotein(a). We sought also to investigate if clot features might be related to CV events and mortality in haemodialysis patients. Subjects and methods. In 33 patients (19 males, 14 females), aged 27 to 89 years, on long-term haemodialysis and 33 age- and sex-matched apparently healthy controls, we investigated fibrin clot properties and susceptibility to lysis using recombinant tissue plasminogen activator by using permeation and turbidity assays. Haemodialysis patients produced fibrin clots that had less porous structure (P < 0....
Przegla̧d lekarski, 2004
Conventional coronary angiography is the undisputed gold standard for the detection of coronary a... more Conventional coronary angiography is the undisputed gold standard for the detection of coronary artery disease. A small but not negligible risk related to the procedure, cost, and radiation exposure have given rise to the development of noninvasive alternatives such as multi-slice computed tomography, and magnetic resonance coronary angiography. In some patients classic X-ray coronary angiography involves high risk and technical difficulties. Fast, non-complicated and easy to use non-invasive imaging procedures should be developed to avoid unnecessary or technically difficult, uncomfortable situations for patients with documented myocardial ischemia. We present three cases of patients who underwent coronary artery bypass graft surgery or were disqualified from it on the basis of MSCT imaging.
The international journal of cardiovascular imaging, 2003
Tc99m MIBI single-photon emission computed tomography (SPECT) study facilitates the evaluation of... more Tc99m MIBI single-photon emission computed tomography (SPECT) study facilitates the evaluation of the regional myocardial perfusion and tissue Doppler echocardiography imaging facilitates the quantitative assessment of the regional systolic and diastolic function of the myocardium. The aim of the study was an assessment of the correlation between regional rest myocardial perfusion defects and regional rest systolic and diastolic myocardial velocities in patients with ischemic heart disease (IHD). In 40 IHD patients (33 men, 7 women) aged 43-74 years (mean 56 years) rest SPECT imaging with Tc99m MIBI and rest tissue Doppler examinations were performed. The control group consisted of 35 healthy sex and age matched pesons. The left ventricle was divided into 13 segments. The number of non-perfused segments in three myocardial perfusion regions (left anterior descending artery, circumflex artery, right coronary artery) was assessed in IHD patients. During tissue Doppler examination the ...
The international journal of cardiovascular imaging, 2003
Assessing the viability in akinetic myocardium is vital for predicting functional recovery after ... more Assessing the viability in akinetic myocardium is vital for predicting functional recovery after therapeutic management in patients with chronic coronary artery disease (CAD) and depressed left ventricular (LV) function. The present study aimed to evaluate the efficacy of Tc99m MIBI SPECT enhanced with nitroglycerine infusion in detecting myocardial viability, as well as to asses the relationship between the myocardial viability and the subsequent treatment and outcome of patients. Sixty-seven consecutive patients with CAD and LV dysfunction (LV ejection fraction 36.6 +/- 8.4%) underwent Tc99m MIBI imaging--at rest and during intravenous nitroglycerine infusion--for viability assessment. Fourteen patients were treated pharmacologically (Group I), and fifty-three (Group II) were submitted to coronary revascularization (PTCR or CABG). Fifteen major cardiac events were observed during 25 months of the follow-up. A significantly worse event-free survival was registered in the subjects o...
Przegla̧d lekarski, 2002
Myocardial contrast echocardiography is a non-invasive method used to detect coronary artery dise... more Myocardial contrast echocardiography is a non-invasive method used to detect coronary artery disease. It was first described in 1968. New contrast agents which can go through the pulmonary vessels were discovered in the last years. Contrast echocardiography is useful in improving the endocardial border delineation and left ventricular cavity visualisation especially in patients with suboptimal acoustic windows. As the contrast passes further into the coronary artery normal myocardium perfusion is enhanced while ischaemic areas lack enhancement. Analysis of perfusion allows indirect identification of narrowed coronary arteries. Left ventricular function and its myocardium perfusion are made with contrast echocardiography at rest and during pharmacological stress tests. These examinations allow for detection patient with coronary artery disease as well as estimating efficacy of revascularisation procedures.
The international journal of cardiovascular imaging, 2001
The aim of the present study was to determine which clinical, exercise and perfusion variables ca... more The aim of the present study was to determine which clinical, exercise and perfusion variables can be instrumental in the identification of left main coronary artery. A multivariate model for prediction of left main disease was developed, based on a number of clinical, exercise and MIBI perfusion variables in two groups of patients. Group I consisted of 38 patients (30 men and eight women) with angiographically proven left main stenosis, while group II consisted of 41 patients (27 men and 14 women) with multivessel coronary artery diseases. A multivariate logistic regression analysis demonstrated that clinical variables including diabetes, hypertension, together with history of typical angina were the only independent predictors of left main stenosis. It was found that p value was 0.05 for hypertension, 0.01 for diabetes as well as 0.01 for the history of typical angina in clinical examination. No exercise or perfusion variables may be instrumental in prediction of left main stenosi...
Scandinavian Cardiovascular Journal, 2002
Examination of exercise function of Fontan patients and comparison with healthy control subjects.... more Examination of exercise function of Fontan patients and comparison with healthy control subjects. Fourteen patients (6 males, 8 females; age: 5.7-17 years, mean 8.1 years) after Fontan repair in New York Heart Association (NYHA) class I with rest O(2)sat &amp;amp;amp;amp;amp;amp;amp;gt; 85% requiring no cardiovascular medications performed graded exercises on a treadmill 0.5-3.2 years postoperatively (mean 1.8 years). During the tests the heart and respiratory rate, blood pressure, oxygen uptake, carbon dioxide production, minute ventilation, tidal volume and O(2)sat were recorded. Spirometry was performed before and during exercise. The peak VO(2)max in Fontan patients was significantly reduced compared with controls (p = 0.0002). Other parameters: anaerobic threshold (p = 0.0001); pulsO(2) (p = 0.00005); peak minute ventilation (p = 0.0014); physiological dead space to tidal volume ratio at peak exercise (p = 0.0004); maximal work rate (p = 0.00008); exercise time (p = 0.00003) were significantly reduced in univentricular patients. The heart rate at peak exercise was lower in the patients (p = 0.0003) and O(2)sat dropped significantly (p = 0.003). The aerobic capacity, work and ventilatory parameters in Fontan patients are markedly reduced compared with controls. The anaerobic threshold was significantly lower. The decreased O(2)sat at peak exercise may suggest intrapulmonary shunting.
Catheterization and Cardiovascular Interventions, 2000
Dual chamber (DDD) pacing and catheter-based nonsurgical septal reduction therapy (NSRT) with eth... more Dual chamber (DDD) pacing and catheter-based nonsurgical septal reduction therapy (NSRT) with ethanol are evaluated for treatment of patients with hypertrophic cardiomyopathy. This report describes a patient with hypertrophic cardiomyopathy and left ventricular outflow tract obstruction who had failed to respond to DDD pacing but showed benefit from subsequent NSRT. Procedural difficulties during NSRT due to massive septal hypertrophy are presented.
Journal of the American Society of Echocardiography, 2008
Background: Diastolic dysfunction and elevated left ventricular (LV) filling pressure at rest are... more Background: Diastolic dysfunction and elevated left ventricular (LV) filling pressure at rest are key factors of exercise intolerance in patients with heart failure (HF). There are few studies, however, that have addressed the issue of changes of LV diastolic function and filling pressure during exercise in patients with HF with severe systolic dysfunction. The ratio of early diastolic velocity of mitral inflow (E) and early myocardial diastolic velocity (E=) strongly correlates with invasively obtained LV filling pressure.
Journal of Endovascular Therapy, 2004
To report the use of the Parodi Anti-Emboli System (PAES) for cerebral protection during emergent... more To report the use of the Parodi Anti-Emboli System (PAES) for cerebral protection during emergent vertebral artery recanalization. A 56-year-old chimney sweep was referred with recurrent episodes of vertigo and gait ataxia. Left vertebral artery (LVA) flow was barely detectable on duplex Doppler, and brain computed tomography revealed a small infarct in the posterior inferior cerebellar artery territory. Angiography showed subtotal ostial stenosis of the LVA with poor distal flow and possible thrombus. Due to a high risk of distal embolization with percutaneous treatment, anticoagulation was initiated, and the lesion was to be re-evaluated in 2 to 3 weeks. However, 2 days later, the patient developed severe, aggravating headache, gait and left-limb ataxia, horizontal nystagmus, and vomiting. Emergent angiography showed a total ostial LVA occlusion. The PAES was employed to elicit a temporary subclavian steal during percutaneous LVA recanalization, thus protecting the brain from embolization. The ostial LVA was successfully recanalized and stented, with immediate symptom cessation. The PAES can be successfully applied in the subclavian artery to prevent distal embolization during emergent vertebral artery recanalization. Since a significant proportion of vertebral strokes are embolic, PAES may play a novel role in the treatment of acute cerebellar stroke.
Journal of Endovascular Therapy, 2009
To report the utility of proximal brain protection by flow reversal in endovascular management of... more To report the utility of proximal brain protection by flow reversal in endovascular management of critical internal carotid artery (ICA) stenosis coexisting with ipsilateral external carotid artery (iECA) occlusion. Four patients with a symptomatic, critical ICA stenosis (in-stent restenosis in one) and iECA occlusion were admitted for carotid artery stenting (CAS). In all cases, the stenosis severity and high-risk lesion morphology precluded the use of filter protection. The &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;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;tailored&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;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; CAS algorithm indicated that a proximal anti-embolism system should be used to maximize the potential for effective neuroprotection. The flow reversal system, which consists of an independent guiding sheath balloon positioned in the common carotid artery (CCA) and an iECA balloon-wire, was employed, using the CCA balloon only. The system was well-tolerated, and the CAS procedures were uneventful. Due to a unique design with separate CCA and iECA balloons, the flow reversal system can be used for proximal neuroprotection during CAS in severe, symptomatic ICA lesions coexisting with iECA occlusion.
The International Journal of Cardiovascular Imaging, 2012
Chronic ischemic mitral regurgitation (IMR) is associated with a markedly worse prognosis after m... more Chronic ischemic mitral regurgitation (IMR) is associated with a markedly worse prognosis after myocardial infarction (MI).The study aimed to evaluate the relationship between anterior and posterior mitral leaflet angle (MLA) values, left ventricle remodeling and severity of ischaemic mitral regurgitation (IMR). Methods: Forty-two patients (age 63.5 ± 9.7 years, 36 men) with chronic IMR (regurgitant volume, RV [ 20 ml; [6 months after MI) underwent transthoracic echocardiography (TTE) and cardiovascular magnetic resonance (CMR) imaging. Anterior and posterior MLA, determined by echocardiography, were correlated with indices of LV remodeling, mitral apparatus deformation and IMR severity by CMR. The anterior and posterior MLA was 25.41 ± 4.28 and 38.37 ± 8.89°(mean ± SD). In 5 patients (11.9%) the posterior MLA was C45°. There was a significant correlation between anterior MLA and RV (r = 0.74, P = 0.01). For patients with RV [ 30 ml this correlation was stronger (r = 0.97, P = 0.005) and, in addition, there was a correlation between the RV and posterior MLA (r = 0.90, P = 0.037), between tenting area and posterior MLA (r = 0.90, P = 0.04), and between tenting area and anterior MLA (r = 0.82, P = 0.08). With regard to LV remodeling parameters, there was weaker but significant correlation between posterior MLA and LV end-diastolic volume index (r = 0.35, P = 0.031), LV end-systolic volume index (r = 0.37, P = 0.021), stroke volume (r = 0.35, P = 0.03), sphericity index (r = 0.33, P = 0.041). Anterior MLA correlated with wall motion score index (r = 0.41, P = 0.019). Besides, there was a correlation between posterior MLA and left atrial volume (r = 0.41, P = 0.012). Measurement of anterior and posterior MLA may play an important role in evaluating patients with IMR.
The International Journal of Cardiovascular Imaging, 2007
Aim To assess the extent of hyperenhancement in hypertrophic cardiomyopathy (HCM) patients with n... more Aim To assess the extent of hyperenhancement in hypertrophic cardiomyopathy (HCM) patients with nonsustained ventricular tachycardia (NSVT) in comparison to patients without NSVT. Design In HCM patients, NSVT in Holter monitoring is a risk factor for sudden cardiac death; however, its positive predictive value is low. Varying risk of sudden death related to NSVT may be dependent on the heterogeneous extent of the arrhythmogenic substrate, which seems to be visible as hyperenhancement in gadolinium-enhanced magnetic resonance imaging (MRI). Methods Hyperenhancement was assessed in 47 HCM patients (30 males and 17 females, mean age 42 ± 12 years): 32 patients had NSVT, 15 patients had no NSVT. The extent of hyperenhancement was calculated by software and expressed as a mass. Results In HCM patients with NSVT 97% had some extent of hyperenhancement on MRI, ranging from 1 to 76 g. The mean mass of hyperenhanced myocardium was 19 ± 18 g (8.1 ± 7.6% of total left ventricular mass). In HCM patients without NSVT, a significantly lower percentage of patients (60%) had hyperenhancement (P < 0.05). However, the amount of hyperenhanced myocardium was not significantly different (13 ± 19 g, 6.3 ± 9.1% of total left ventricular mass; P < 0.05). Conclusions Hyperenhancement was visible in almost all HCM patients with NSVT (97%) and in a significantly lower percentage of patients without NSVT (60%). Whether this finding explains the increased risk of sudden death in case of NSVT is not clear, since the extent of hyperenhancement was not significantly different between the two groups.
International Journal of Cardiology, 2003
Background: Myocardial perfusion (MP) can be assessed in real time when using a low mechanical in... more Background: Myocardial perfusion (MP) can be assessed in real time when using a low mechanical index (MI) and harmonic imaging following an intravenous injection of contrast agent. The aim of the study was to determine the feasibility and accuracy of the real-time imaging of contrast echocardiography (MCE) for detecting myocardial perfusion defects at rest and during dobutamine stress 99m echocardiography (DE) compared with Tc MIBI SPECT. The study group consisted of 44 patients (24 men, 20 women, mean age 58.967.8) with suspected coronary artery disease (CAD). All patients underwent DE. Wall motion (WM) and segmental perfusion were estimated in real time before and at peak stress using a low MI (0.4) after 0.3 ml bolus injections of intravenous Optison. All patients 99m underwent a rest and exercise Tc MIBI SPECT study (SPECT). A 16-segment model of the left ventricle was used for the analysis of MP, WM and SPECT by a blinded reviewer. All patients underwent coronary angiography. Significant coronary artery disease was defined as .60% luminal diameter stenosis. Results: All patients had significant CAD. Twenty-nine patients had single-vessel and 15 patients had double-vessel disease. For all patients, agreement between MCE and SPECT was 89%, between MCE and WM 286%, and between SPECT and WM 282%. The agreement between MCE and SPECT for LAD, RCA and Cx territories was 81, 91 and 73%, respectively. The sensitivity of MCE and SPECT for detecting perfusion defects due to significant CAD (confirmed angiographically) was 97% and 93%, respectively, and the specificity was 93 and 84%, respectively. Conclusion: MCE in real-time imaging with Optison has significant potential for the identification of MP abnormalities. MCE correlates very well with SPECT images.
International Journal of Cardiology, 1996
We studied the value of exercise thallium-201 (Tl-201) scintigraphy for evaluation of myocardial ... more We studied the value of exercise thallium-201 (Tl-201) scintigraphy for evaluation of myocardial perfusion improvement and the detection of restenosis in patients after successful percutaneous transluminal coronary angioplasty (PTCA). Fifty-three patients (43 male and 10 female) ages 38-71 years (mean 55.3) were analysed. Exercise Tl-201 scintigraphy was performed before PTCA, and 6-10 days and then 3-6 months after the procedure. In all patients repeated coronary angiography was done 3-6 months after PTCA. Before PTCA myocardial perfusion defects were observed in all patients. Immediately after PTCA, an improvement in myocardial perfusion was noted in 36 patients (61%). Total normalisation of the scintigraphic picture was observed in only 12 patients. Coronary angiography after 3-6 months showed patency of dilated vessels in 11 out of those 12 patients (91.3%). In scintigraphy, performed 3-6 months after PTCA, a normal scan was present in 20 patients and recurrence of stenosis was found in only 2 of those 20. Stenosis was found in 22 (60%) of 33 patients with perfusion defects. For the purpose of describing the character of the myocardial perfusion changes, statistical analysis of a number of segments was performed. The predictive value of Tl-201 scintigraphy for detection of restenosis was established. The positive value for the procedure performed 6-10 days after PTCA was 56%, and the negative value of prediction of restenosis was 91%. Three to 6 months after PTCA, a high negative value of scintigraphy was observed (-90%) and a low positive predictive value was still present (63%).
International Journal of Cardiology, 2000
Diabetes is recognised to increase morbidity and mortality after coronary revascularization. We c... more Diabetes is recognised to increase morbidity and mortality after coronary revascularization. We compared clinical outcomes in mean 5-year-long follow-up of coronary balloon angioplasty in diabetic and non-diabetic patients. We studied 621 patients undergoing elective angioplasty from 1987 to 1996. There were 60 (9.7%) patients with diabetes who were compared with 561 non-diabetic patients. Diabetics were older, more often obese, less frequently were current smokers, and less frequently had hypercholesterolaemia. Diabetic patients in comparison with non-diabetics had lower ejection fraction and more frequently had angioplasty of complex (B2 or C) lesions, but there were no differences between both groups in the other clinical and angiographic risk factors. Clinical success of angioplasty, as well as complications rate were similar in both groups. In follow-up restenosis occurred more frequently in diabetics (46.3 vs. 32.2%, P=0.03), resulting in significantly higher re-intervention rate (50.0 vs. 35.4%, P=0.03). Especially diabetic patients were more frequently referred to CABG (20.4 vs. 9. 9%, P=0.02). There were no significant differences in deaths (1.9 vs. 2.8%) and myocardial infarction (3.7 vs. 4.4%). Diabetics presented worse CCS status at the end of observation (Class 0 and I - 61.1 vs. 74.4%, P=0.037). Angioplasty proved to be a safe procedure in diabetic patients. Despite higher restenosis and re-intervention rate in diabetics, mortality as well as myocardial infarction rate was the same in both groups during mean 5-year follow-up.
International Journal of Cardiology, 1997
The aim of the study was to assess the long-term results of surgical treatment with homogenic aor... more The aim of the study was to assess the long-term results of surgical treatment with homogenic aortic grafts (HAGs) implantation in patients with Marfan syndrome. There were 31 patients with Marfan syndrome and aortic aneurysm who were operated on between 1980 and 1996. Aortic dissection was diagnosed in 14 patients, DeBakey Type I in six patients and Type II in eight patients. Four patients had to be operated urgently in cardiogenic shock with cardiac tamponade. Sealing up and reinforcement with strip of felt or Gore-Tex has been applied in 22 patients. The surgical modifications mentioned above have been applied since 1987 in all patients with the diameter of the aortic ring exceeding 30 mm or with active infective endocarditis or during reoperation. In 16 patients the space between the aortic homograft and patients own aortic wall was joined to the right atrial auricle. Patients were followed up for 12-179 months (average: 94.6 +/- 499). Three patients died in the early postoperative period and four patients died in the late postoperative period. Rethoracotomy because of bleeding complications was necessary in five patients. HAG damage was responsible for six other reoperations-new HAGs have been implanted in three patients and artificial prostheses were implanted in the other three patients. In the late follow-up period significant improvement in cardiac performance was observed in 24 patients (NYHA I or II). Survival probability of 15 years for the whole group was 80%. The lowest survival probability has been shown in the group of patients with DeBakey Type I aortic dissection (35% survived 15 years after operation). Echocardiographic follow-up has shown that the pressure gradient in HAG was low (7.4 +/- 6.2 mmHg). Only in two patients did the HAG gradient exceeded 20 mmHg. There were no significant differences concerning aortic ring diameters, dimensions of HAG and echocardiographic parameters between the group with surgical modifications, i.e. sealing up and reinforcement with strip of felt or Gore-Tex applied and the group in which these modifications were not applied. Homogenic aortic graft implantation as a method of surgical treatment of aortic aneurysm in patients with Marfan syndrome avoids postoperative anticoagulation, results in substantial improvement of cardiac performance and prolongs life. Surgical treatment should be considered in asymptomatic patients with large aneurysms (exceeding 55-65 mm) in patients with Marfan syndrome because there is a high risk of death in this group of patients in the case of dissection.
Hypertension Research, 2007
The objectives of this study were to determine the relationship between carotid-femoral (cfPWV) a... more The objectives of this study were to determine the relationship between carotid-femoral (cfPWV) and aortic pulse wave velocity (aPWV) and to compare their modulators and association with coronary artery disease (CAD). We studied 107 consecutive patients (68 men) with a mean age of 60.49+/-8.31 years who had stable angina and had been referred for coronary angiography. cfPWV and aPWV were measured simultaneously during cardiac catheterization using the Complior device and aortic pressure waveform recordings, respectively. Based on the presence or absence of significant coronary artery stenosis (CAS) patients were subdivided into a CAS+ or CAS- group. The mean values of cfPWV and aPWV were 10.65+/-2.29 m/s and 8.78+/-2.24 m/s, respectively. They were significantly higher in the CAS+ (n=71) compared with the CAS- (n=36) group and predicted significant CAS independently of cardiovascular risk factors and mean or systolic aortic blood pressure. aPWV and cfPWV were significantly correlated (r=0.70; p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001) but the degree of correlation differed significantly (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.03) between the CAS+ (r=0.74, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001) and CAS- group (r=0.46, p=0.003). Age and mean aortic blood pressure were independent predictors for aPWV as well as cfPWV. In the receiver operating characteristic (ROC) analysis, aPWV and cfPWV had similar accuracy in identification of significant CAS (AUC [area under the ROC curve]=0.76 and 0.69, respectively; p=0.13). However, neither cfPWV nor aPWV was effective at differentiating the extent of CAD. In conclusion, aPWV and cfPWV are highly correlated parameters with similar determinants and comparable accuracy in predicting significant CAS. The strength of correlation between these two indices differed significantly between subjects with and those without CAS.
Echocardiography, 2010
Objective: This study aimed to assess the role of myocardial contrast echocardiography (MCE) as a... more Objective: This study aimed to assess the role of myocardial contrast echocardiography (MCE) as a predictor of cardiac events and death in patients with acute myocardial infarction (AMI). Methods: Eighty-six patients underwent primary percutaneous coronary angioplasty for AMI. Segmental perfusion was estimated by MCE in real time at mean 5 days after PCI using low MI (0.3) after 0.3-0.5 ml bolus injection of intravenous Optison. MCE was scored semiquantitatively as: (1) normal perfusion (homogenous contrast effect), (2) partial perfusion (patchy myocardial contrast enhancement), (3) lack of perfusion (no visible contrast effect). A contrast score index (CSI) was calculated as the sum of MCE scores in each segment divided by the total number of segments. The patients were followed up for cardiac events and death. Results: A CSI of >1.68 was taken to be a predictor of cardiac events and death. Death occurred only in patients with CSI >1.68. Patients with CSI >1.68 had a significantly (P = 0.03) higher incidence of cardiac death or cardiac events (75%) compared to those with CSI <1.68 (27%). The absence of residual perfusion within the infarct zone was an independent predictor of death and cardiac events (P = 0.02). Conclusions: The absence of residual myocardial viability in the infarct zone supplied by an infarct-related artery is a powerful predictor of cardiac events in patients after AMI. (Echocardiography 2010;27:430-434)
Przegla̧d lekarski
The case of a young 32 year old male with a primary cardiac angiosarcoma is reported. The neoplas... more The case of a young 32 year old male with a primary cardiac angiosarcoma is reported. The neoplasm manifested itself by a quickly increasing cardiac tamponade but without metastases. The nonradical resection of the tumor was made because of local invasion with tumor tissue. The patient was followed-up for 3 years after the surgery and no recurrence of the malignant process was observed. Cardiac angiosarcoma is a very rare malignant tumor of soft tissues. In spite of significant progress in clinical treatment, for a patient diagnosed antemortem with cardiac angiosarcoma, the long-term expectations are usually very poor. Commonly known risk factors for this group of neoplasms (haemangioma of skin, chroniclymphedema, chronic post-tuberculosis pleurisy, X-ray, thorium dioxide) cannot be easily associated with the primary cardiac angiosarcoma cases. The search for chromosomal anomalies and gene mutations leading to cardiac angiosarcoma is ongoing. There is hope that recently obtained evi...
Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 2008
Haemodialysis patients are at an increased risk of cardiovascular (CV) morbidity and mortality. B... more Haemodialysis patients are at an increased risk of cardiovascular (CV) morbidity and mortality. Both end-stage renal disease (ESRD) and thromboembolic coronary events have been shown to be associated with the formation of dense fibrin clots resistant to fibrinolysis. The aim of the present study was to investigate the effect of long-term haemodialysis on clot structure/function and analyse an influence of markers of inflammation, oxidative stress and lipoprotein(a). We sought also to investigate if clot features might be related to CV events and mortality in haemodialysis patients. Subjects and methods. In 33 patients (19 males, 14 females), aged 27 to 89 years, on long-term haemodialysis and 33 age- and sex-matched apparently healthy controls, we investigated fibrin clot properties and susceptibility to lysis using recombinant tissue plasminogen activator by using permeation and turbidity assays. Haemodialysis patients produced fibrin clots that had less porous structure (P < 0....
Przegla̧d lekarski, 2004
Conventional coronary angiography is the undisputed gold standard for the detection of coronary a... more Conventional coronary angiography is the undisputed gold standard for the detection of coronary artery disease. A small but not negligible risk related to the procedure, cost, and radiation exposure have given rise to the development of noninvasive alternatives such as multi-slice computed tomography, and magnetic resonance coronary angiography. In some patients classic X-ray coronary angiography involves high risk and technical difficulties. Fast, non-complicated and easy to use non-invasive imaging procedures should be developed to avoid unnecessary or technically difficult, uncomfortable situations for patients with documented myocardial ischemia. We present three cases of patients who underwent coronary artery bypass graft surgery or were disqualified from it on the basis of MSCT imaging.
The international journal of cardiovascular imaging, 2003
Tc99m MIBI single-photon emission computed tomography (SPECT) study facilitates the evaluation of... more Tc99m MIBI single-photon emission computed tomography (SPECT) study facilitates the evaluation of the regional myocardial perfusion and tissue Doppler echocardiography imaging facilitates the quantitative assessment of the regional systolic and diastolic function of the myocardium. The aim of the study was an assessment of the correlation between regional rest myocardial perfusion defects and regional rest systolic and diastolic myocardial velocities in patients with ischemic heart disease (IHD). In 40 IHD patients (33 men, 7 women) aged 43-74 years (mean 56 years) rest SPECT imaging with Tc99m MIBI and rest tissue Doppler examinations were performed. The control group consisted of 35 healthy sex and age matched pesons. The left ventricle was divided into 13 segments. The number of non-perfused segments in three myocardial perfusion regions (left anterior descending artery, circumflex artery, right coronary artery) was assessed in IHD patients. During tissue Doppler examination the ...
The international journal of cardiovascular imaging, 2003
Assessing the viability in akinetic myocardium is vital for predicting functional recovery after ... more Assessing the viability in akinetic myocardium is vital for predicting functional recovery after therapeutic management in patients with chronic coronary artery disease (CAD) and depressed left ventricular (LV) function. The present study aimed to evaluate the efficacy of Tc99m MIBI SPECT enhanced with nitroglycerine infusion in detecting myocardial viability, as well as to asses the relationship between the myocardial viability and the subsequent treatment and outcome of patients. Sixty-seven consecutive patients with CAD and LV dysfunction (LV ejection fraction 36.6 +/- 8.4%) underwent Tc99m MIBI imaging--at rest and during intravenous nitroglycerine infusion--for viability assessment. Fourteen patients were treated pharmacologically (Group I), and fifty-three (Group II) were submitted to coronary revascularization (PTCR or CABG). Fifteen major cardiac events were observed during 25 months of the follow-up. A significantly worse event-free survival was registered in the subjects o...
Przegla̧d lekarski, 2002
Myocardial contrast echocardiography is a non-invasive method used to detect coronary artery dise... more Myocardial contrast echocardiography is a non-invasive method used to detect coronary artery disease. It was first described in 1968. New contrast agents which can go through the pulmonary vessels were discovered in the last years. Contrast echocardiography is useful in improving the endocardial border delineation and left ventricular cavity visualisation especially in patients with suboptimal acoustic windows. As the contrast passes further into the coronary artery normal myocardium perfusion is enhanced while ischaemic areas lack enhancement. Analysis of perfusion allows indirect identification of narrowed coronary arteries. Left ventricular function and its myocardium perfusion are made with contrast echocardiography at rest and during pharmacological stress tests. These examinations allow for detection patient with coronary artery disease as well as estimating efficacy of revascularisation procedures.
The international journal of cardiovascular imaging, 2001
The aim of the present study was to determine which clinical, exercise and perfusion variables ca... more The aim of the present study was to determine which clinical, exercise and perfusion variables can be instrumental in the identification of left main coronary artery. A multivariate model for prediction of left main disease was developed, based on a number of clinical, exercise and MIBI perfusion variables in two groups of patients. Group I consisted of 38 patients (30 men and eight women) with angiographically proven left main stenosis, while group II consisted of 41 patients (27 men and 14 women) with multivessel coronary artery diseases. A multivariate logistic regression analysis demonstrated that clinical variables including diabetes, hypertension, together with history of typical angina were the only independent predictors of left main stenosis. It was found that p value was 0.05 for hypertension, 0.01 for diabetes as well as 0.01 for the history of typical angina in clinical examination. No exercise or perfusion variables may be instrumental in prediction of left main stenosi...
Scandinavian Cardiovascular Journal, 2002
Examination of exercise function of Fontan patients and comparison with healthy control subjects.... more Examination of exercise function of Fontan patients and comparison with healthy control subjects. Fourteen patients (6 males, 8 females; age: 5.7-17 years, mean 8.1 years) after Fontan repair in New York Heart Association (NYHA) class I with rest O(2)sat &amp;amp;amp;amp;amp;amp;amp;gt; 85% requiring no cardiovascular medications performed graded exercises on a treadmill 0.5-3.2 years postoperatively (mean 1.8 years). During the tests the heart and respiratory rate, blood pressure, oxygen uptake, carbon dioxide production, minute ventilation, tidal volume and O(2)sat were recorded. Spirometry was performed before and during exercise. The peak VO(2)max in Fontan patients was significantly reduced compared with controls (p = 0.0002). Other parameters: anaerobic threshold (p = 0.0001); pulsO(2) (p = 0.00005); peak minute ventilation (p = 0.0014); physiological dead space to tidal volume ratio at peak exercise (p = 0.0004); maximal work rate (p = 0.00008); exercise time (p = 0.00003) were significantly reduced in univentricular patients. The heart rate at peak exercise was lower in the patients (p = 0.0003) and O(2)sat dropped significantly (p = 0.003). The aerobic capacity, work and ventilatory parameters in Fontan patients are markedly reduced compared with controls. The anaerobic threshold was significantly lower. The decreased O(2)sat at peak exercise may suggest intrapulmonary shunting.
Catheterization and Cardiovascular Interventions, 2000
Dual chamber (DDD) pacing and catheter-based nonsurgical septal reduction therapy (NSRT) with eth... more Dual chamber (DDD) pacing and catheter-based nonsurgical septal reduction therapy (NSRT) with ethanol are evaluated for treatment of patients with hypertrophic cardiomyopathy. This report describes a patient with hypertrophic cardiomyopathy and left ventricular outflow tract obstruction who had failed to respond to DDD pacing but showed benefit from subsequent NSRT. Procedural difficulties during NSRT due to massive septal hypertrophy are presented.
Journal of the American Society of Echocardiography, 2008
Background: Diastolic dysfunction and elevated left ventricular (LV) filling pressure at rest are... more Background: Diastolic dysfunction and elevated left ventricular (LV) filling pressure at rest are key factors of exercise intolerance in patients with heart failure (HF). There are few studies, however, that have addressed the issue of changes of LV diastolic function and filling pressure during exercise in patients with HF with severe systolic dysfunction. The ratio of early diastolic velocity of mitral inflow (E) and early myocardial diastolic velocity (E=) strongly correlates with invasively obtained LV filling pressure.
Journal of Endovascular Therapy, 2004
To report the use of the Parodi Anti-Emboli System (PAES) for cerebral protection during emergent... more To report the use of the Parodi Anti-Emboli System (PAES) for cerebral protection during emergent vertebral artery recanalization. A 56-year-old chimney sweep was referred with recurrent episodes of vertigo and gait ataxia. Left vertebral artery (LVA) flow was barely detectable on duplex Doppler, and brain computed tomography revealed a small infarct in the posterior inferior cerebellar artery territory. Angiography showed subtotal ostial stenosis of the LVA with poor distal flow and possible thrombus. Due to a high risk of distal embolization with percutaneous treatment, anticoagulation was initiated, and the lesion was to be re-evaluated in 2 to 3 weeks. However, 2 days later, the patient developed severe, aggravating headache, gait and left-limb ataxia, horizontal nystagmus, and vomiting. Emergent angiography showed a total ostial LVA occlusion. The PAES was employed to elicit a temporary subclavian steal during percutaneous LVA recanalization, thus protecting the brain from embolization. The ostial LVA was successfully recanalized and stented, with immediate symptom cessation. The PAES can be successfully applied in the subclavian artery to prevent distal embolization during emergent vertebral artery recanalization. Since a significant proportion of vertebral strokes are embolic, PAES may play a novel role in the treatment of acute cerebellar stroke.
Journal of Endovascular Therapy, 2009
To report the utility of proximal brain protection by flow reversal in endovascular management of... more To report the utility of proximal brain protection by flow reversal in endovascular management of critical internal carotid artery (ICA) stenosis coexisting with ipsilateral external carotid artery (iECA) occlusion. Four patients with a symptomatic, critical ICA stenosis (in-stent restenosis in one) and iECA occlusion were admitted for carotid artery stenting (CAS). In all cases, the stenosis severity and high-risk lesion morphology precluded the use of filter protection. The &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;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;tailored&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;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; CAS algorithm indicated that a proximal anti-embolism system should be used to maximize the potential for effective neuroprotection. The flow reversal system, which consists of an independent guiding sheath balloon positioned in the common carotid artery (CCA) and an iECA balloon-wire, was employed, using the CCA balloon only. The system was well-tolerated, and the CAS procedures were uneventful. Due to a unique design with separate CCA and iECA balloons, the flow reversal system can be used for proximal neuroprotection during CAS in severe, symptomatic ICA lesions coexisting with iECA occlusion.
The International Journal of Cardiovascular Imaging, 2012
Chronic ischemic mitral regurgitation (IMR) is associated with a markedly worse prognosis after m... more Chronic ischemic mitral regurgitation (IMR) is associated with a markedly worse prognosis after myocardial infarction (MI).The study aimed to evaluate the relationship between anterior and posterior mitral leaflet angle (MLA) values, left ventricle remodeling and severity of ischaemic mitral regurgitation (IMR). Methods: Forty-two patients (age 63.5 ± 9.7 years, 36 men) with chronic IMR (regurgitant volume, RV [ 20 ml; [6 months after MI) underwent transthoracic echocardiography (TTE) and cardiovascular magnetic resonance (CMR) imaging. Anterior and posterior MLA, determined by echocardiography, were correlated with indices of LV remodeling, mitral apparatus deformation and IMR severity by CMR. The anterior and posterior MLA was 25.41 ± 4.28 and 38.37 ± 8.89°(mean ± SD). In 5 patients (11.9%) the posterior MLA was C45°. There was a significant correlation between anterior MLA and RV (r = 0.74, P = 0.01). For patients with RV [ 30 ml this correlation was stronger (r = 0.97, P = 0.005) and, in addition, there was a correlation between the RV and posterior MLA (r = 0.90, P = 0.037), between tenting area and posterior MLA (r = 0.90, P = 0.04), and between tenting area and anterior MLA (r = 0.82, P = 0.08). With regard to LV remodeling parameters, there was weaker but significant correlation between posterior MLA and LV end-diastolic volume index (r = 0.35, P = 0.031), LV end-systolic volume index (r = 0.37, P = 0.021), stroke volume (r = 0.35, P = 0.03), sphericity index (r = 0.33, P = 0.041). Anterior MLA correlated with wall motion score index (r = 0.41, P = 0.019). Besides, there was a correlation between posterior MLA and left atrial volume (r = 0.41, P = 0.012). Measurement of anterior and posterior MLA may play an important role in evaluating patients with IMR.
The International Journal of Cardiovascular Imaging, 2007
Aim To assess the extent of hyperenhancement in hypertrophic cardiomyopathy (HCM) patients with n... more Aim To assess the extent of hyperenhancement in hypertrophic cardiomyopathy (HCM) patients with nonsustained ventricular tachycardia (NSVT) in comparison to patients without NSVT. Design In HCM patients, NSVT in Holter monitoring is a risk factor for sudden cardiac death; however, its positive predictive value is low. Varying risk of sudden death related to NSVT may be dependent on the heterogeneous extent of the arrhythmogenic substrate, which seems to be visible as hyperenhancement in gadolinium-enhanced magnetic resonance imaging (MRI). Methods Hyperenhancement was assessed in 47 HCM patients (30 males and 17 females, mean age 42 ± 12 years): 32 patients had NSVT, 15 patients had no NSVT. The extent of hyperenhancement was calculated by software and expressed as a mass. Results In HCM patients with NSVT 97% had some extent of hyperenhancement on MRI, ranging from 1 to 76 g. The mean mass of hyperenhanced myocardium was 19 ± 18 g (8.1 ± 7.6% of total left ventricular mass). In HCM patients without NSVT, a significantly lower percentage of patients (60%) had hyperenhancement (P < 0.05). However, the amount of hyperenhanced myocardium was not significantly different (13 ± 19 g, 6.3 ± 9.1% of total left ventricular mass; P < 0.05). Conclusions Hyperenhancement was visible in almost all HCM patients with NSVT (97%) and in a significantly lower percentage of patients without NSVT (60%). Whether this finding explains the increased risk of sudden death in case of NSVT is not clear, since the extent of hyperenhancement was not significantly different between the two groups.
International Journal of Cardiology, 2003
Background: Myocardial perfusion (MP) can be assessed in real time when using a low mechanical in... more Background: Myocardial perfusion (MP) can be assessed in real time when using a low mechanical index (MI) and harmonic imaging following an intravenous injection of contrast agent. The aim of the study was to determine the feasibility and accuracy of the real-time imaging of contrast echocardiography (MCE) for detecting myocardial perfusion defects at rest and during dobutamine stress 99m echocardiography (DE) compared with Tc MIBI SPECT. The study group consisted of 44 patients (24 men, 20 women, mean age 58.967.8) with suspected coronary artery disease (CAD). All patients underwent DE. Wall motion (WM) and segmental perfusion were estimated in real time before and at peak stress using a low MI (0.4) after 0.3 ml bolus injections of intravenous Optison. All patients 99m underwent a rest and exercise Tc MIBI SPECT study (SPECT). A 16-segment model of the left ventricle was used for the analysis of MP, WM and SPECT by a blinded reviewer. All patients underwent coronary angiography. Significant coronary artery disease was defined as .60% luminal diameter stenosis. Results: All patients had significant CAD. Twenty-nine patients had single-vessel and 15 patients had double-vessel disease. For all patients, agreement between MCE and SPECT was 89%, between MCE and WM 286%, and between SPECT and WM 282%. The agreement between MCE and SPECT for LAD, RCA and Cx territories was 81, 91 and 73%, respectively. The sensitivity of MCE and SPECT for detecting perfusion defects due to significant CAD (confirmed angiographically) was 97% and 93%, respectively, and the specificity was 93 and 84%, respectively. Conclusion: MCE in real-time imaging with Optison has significant potential for the identification of MP abnormalities. MCE correlates very well with SPECT images.
International Journal of Cardiology, 1996
We studied the value of exercise thallium-201 (Tl-201) scintigraphy for evaluation of myocardial ... more We studied the value of exercise thallium-201 (Tl-201) scintigraphy for evaluation of myocardial perfusion improvement and the detection of restenosis in patients after successful percutaneous transluminal coronary angioplasty (PTCA). Fifty-three patients (43 male and 10 female) ages 38-71 years (mean 55.3) were analysed. Exercise Tl-201 scintigraphy was performed before PTCA, and 6-10 days and then 3-6 months after the procedure. In all patients repeated coronary angiography was done 3-6 months after PTCA. Before PTCA myocardial perfusion defects were observed in all patients. Immediately after PTCA, an improvement in myocardial perfusion was noted in 36 patients (61%). Total normalisation of the scintigraphic picture was observed in only 12 patients. Coronary angiography after 3-6 months showed patency of dilated vessels in 11 out of those 12 patients (91.3%). In scintigraphy, performed 3-6 months after PTCA, a normal scan was present in 20 patients and recurrence of stenosis was found in only 2 of those 20. Stenosis was found in 22 (60%) of 33 patients with perfusion defects. For the purpose of describing the character of the myocardial perfusion changes, statistical analysis of a number of segments was performed. The predictive value of Tl-201 scintigraphy for detection of restenosis was established. The positive value for the procedure performed 6-10 days after PTCA was 56%, and the negative value of prediction of restenosis was 91%. Three to 6 months after PTCA, a high negative value of scintigraphy was observed (-90%) and a low positive predictive value was still present (63%).
International Journal of Cardiology, 2000
Diabetes is recognised to increase morbidity and mortality after coronary revascularization. We c... more Diabetes is recognised to increase morbidity and mortality after coronary revascularization. We compared clinical outcomes in mean 5-year-long follow-up of coronary balloon angioplasty in diabetic and non-diabetic patients. We studied 621 patients undergoing elective angioplasty from 1987 to 1996. There were 60 (9.7%) patients with diabetes who were compared with 561 non-diabetic patients. Diabetics were older, more often obese, less frequently were current smokers, and less frequently had hypercholesterolaemia. Diabetic patients in comparison with non-diabetics had lower ejection fraction and more frequently had angioplasty of complex (B2 or C) lesions, but there were no differences between both groups in the other clinical and angiographic risk factors. Clinical success of angioplasty, as well as complications rate were similar in both groups. In follow-up restenosis occurred more frequently in diabetics (46.3 vs. 32.2%, P=0.03), resulting in significantly higher re-intervention rate (50.0 vs. 35.4%, P=0.03). Especially diabetic patients were more frequently referred to CABG (20.4 vs. 9. 9%, P=0.02). There were no significant differences in deaths (1.9 vs. 2.8%) and myocardial infarction (3.7 vs. 4.4%). Diabetics presented worse CCS status at the end of observation (Class 0 and I - 61.1 vs. 74.4%, P=0.037). Angioplasty proved to be a safe procedure in diabetic patients. Despite higher restenosis and re-intervention rate in diabetics, mortality as well as myocardial infarction rate was the same in both groups during mean 5-year follow-up.
International Journal of Cardiology, 1997
The aim of the study was to assess the long-term results of surgical treatment with homogenic aor... more The aim of the study was to assess the long-term results of surgical treatment with homogenic aortic grafts (HAGs) implantation in patients with Marfan syndrome. There were 31 patients with Marfan syndrome and aortic aneurysm who were operated on between 1980 and 1996. Aortic dissection was diagnosed in 14 patients, DeBakey Type I in six patients and Type II in eight patients. Four patients had to be operated urgently in cardiogenic shock with cardiac tamponade. Sealing up and reinforcement with strip of felt or Gore-Tex has been applied in 22 patients. The surgical modifications mentioned above have been applied since 1987 in all patients with the diameter of the aortic ring exceeding 30 mm or with active infective endocarditis or during reoperation. In 16 patients the space between the aortic homograft and patients own aortic wall was joined to the right atrial auricle. Patients were followed up for 12-179 months (average: 94.6 +/- 499). Three patients died in the early postoperative period and four patients died in the late postoperative period. Rethoracotomy because of bleeding complications was necessary in five patients. HAG damage was responsible for six other reoperations-new HAGs have been implanted in three patients and artificial prostheses were implanted in the other three patients. In the late follow-up period significant improvement in cardiac performance was observed in 24 patients (NYHA I or II). Survival probability of 15 years for the whole group was 80%. The lowest survival probability has been shown in the group of patients with DeBakey Type I aortic dissection (35% survived 15 years after operation). Echocardiographic follow-up has shown that the pressure gradient in HAG was low (7.4 +/- 6.2 mmHg). Only in two patients did the HAG gradient exceeded 20 mmHg. There were no significant differences concerning aortic ring diameters, dimensions of HAG and echocardiographic parameters between the group with surgical modifications, i.e. sealing up and reinforcement with strip of felt or Gore-Tex applied and the group in which these modifications were not applied. Homogenic aortic graft implantation as a method of surgical treatment of aortic aneurysm in patients with Marfan syndrome avoids postoperative anticoagulation, results in substantial improvement of cardiac performance and prolongs life. Surgical treatment should be considered in asymptomatic patients with large aneurysms (exceeding 55-65 mm) in patients with Marfan syndrome because there is a high risk of death in this group of patients in the case of dissection.
Hypertension Research, 2007
The objectives of this study were to determine the relationship between carotid-femoral (cfPWV) a... more The objectives of this study were to determine the relationship between carotid-femoral (cfPWV) and aortic pulse wave velocity (aPWV) and to compare their modulators and association with coronary artery disease (CAD). We studied 107 consecutive patients (68 men) with a mean age of 60.49+/-8.31 years who had stable angina and had been referred for coronary angiography. cfPWV and aPWV were measured simultaneously during cardiac catheterization using the Complior device and aortic pressure waveform recordings, respectively. Based on the presence or absence of significant coronary artery stenosis (CAS) patients were subdivided into a CAS+ or CAS- group. The mean values of cfPWV and aPWV were 10.65+/-2.29 m/s and 8.78+/-2.24 m/s, respectively. They were significantly higher in the CAS+ (n=71) compared with the CAS- (n=36) group and predicted significant CAS independently of cardiovascular risk factors and mean or systolic aortic blood pressure. aPWV and cfPWV were significantly correlated (r=0.70; p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001) but the degree of correlation differed significantly (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.03) between the CAS+ (r=0.74, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001) and CAS- group (r=0.46, p=0.003). Age and mean aortic blood pressure were independent predictors for aPWV as well as cfPWV. In the receiver operating characteristic (ROC) analysis, aPWV and cfPWV had similar accuracy in identification of significant CAS (AUC [area under the ROC curve]=0.76 and 0.69, respectively; p=0.13). However, neither cfPWV nor aPWV was effective at differentiating the extent of CAD. In conclusion, aPWV and cfPWV are highly correlated parameters with similar determinants and comparable accuracy in predicting significant CAS. The strength of correlation between these two indices differed significantly between subjects with and those without CAS.
Echocardiography, 2010
Objective: This study aimed to assess the role of myocardial contrast echocardiography (MCE) as a... more Objective: This study aimed to assess the role of myocardial contrast echocardiography (MCE) as a predictor of cardiac events and death in patients with acute myocardial infarction (AMI). Methods: Eighty-six patients underwent primary percutaneous coronary angioplasty for AMI. Segmental perfusion was estimated by MCE in real time at mean 5 days after PCI using low MI (0.3) after 0.3-0.5 ml bolus injection of intravenous Optison. MCE was scored semiquantitatively as: (1) normal perfusion (homogenous contrast effect), (2) partial perfusion (patchy myocardial contrast enhancement), (3) lack of perfusion (no visible contrast effect). A contrast score index (CSI) was calculated as the sum of MCE scores in each segment divided by the total number of segments. The patients were followed up for cardiac events and death. Results: A CSI of >1.68 was taken to be a predictor of cardiac events and death. Death occurred only in patients with CSI >1.68. Patients with CSI >1.68 had a significantly (P = 0.03) higher incidence of cardiac death or cardiac events (75%) compared to those with CSI <1.68 (27%). The absence of residual perfusion within the infarct zone was an independent predictor of death and cardiac events (P = 0.02). Conclusions: The absence of residual myocardial viability in the infarct zone supplied by an infarct-related artery is a powerful predictor of cardiac events in patients after AMI. (Echocardiography 2010;27:430-434)