-
[show abstract]
[hide abstract]
ABSTRACT: Background: Efficacy and safety of radiofrequency (RF) ablation in patients with atrial fibrillation (AF) strongly depend on the possibility of three-dimensional (3D) visualisation of atria as well as the ostia of pulmonary veins. Current angiographic systems allow 3D visualisation of anatomical heart structures using rotational angiography. Aim: To evaluate clinical usefulness of rotational angiography (3D-ATG) after contrast agent administration into the right atrium for the purpose of evaluating left atrial anatomy in patients undergoing RF ablation of AF. Methods: We also compared images obtained using 3D-ATG with magnetic resonance imaging (MRI). In 18 consecutive patients undergoing RF ablation of AF or left-atrial tachycardia, 3D-ATG was performed uneventfully, followed by 3D reconstruction of the left atrium and the aorta. Ablation using the CARTO 3 system was successful in 17 patients. Total ablation time was 127 ± 28 min, fluoroscopy time 31 ± 8 min, and radiation dose was 413 ± 170 mGy. Mean fluoroscopy time for 3D-ATG was 1.75 ± 0.4 min and the mean radiation dose was 159 ± 57 mGy. Appropriate 3D visualisation of the left atrium was possible in 17 patients, including 16 patients in whom all 4 pulmonary venous ostia were imaged. In 1 patient, all right-sided pulmonary veins were located outside the scan area. In 1 case, 3D-ATG did not allow visualisation of the right inferior pulmonary vein, and in another case the left-sided veins had a common ostium as shown in MRI but not visualised in 3D-ATG. Results: Pulmonary vein diameter assessed by 3D-ATG was slightly higher than by MRI (16.6 ± 3.2 vs. 15.2 ± 3.6 mm, p = 0.28), although this was mainly related to a single nonvisualised right inferior pulmonary vein. Good agreement (〈 2 mm) between the two methods for the assessment of pulmonary venous ostia was higher for the right-sided than the left-sided veins (62.5% vs. 44%, p = 0.03). Conclusions: We conclude that 3D-ATG after contrast agent administration into the right atrium seems to be a safe and effective method to visualise pulmonary venous ostia and left atrial anatomy. It remains to be established whether it enables evaluation of anatomical anomalies.
Kardiologia polska 01/2012; 70(9):924-30. · 0.51 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Cardiovascular magnetic resonance (CMR) has a growing application in the diagnostics of myocardial infarction (MI). It is a non-invasive method that can be used regardless of the shape of patient's body. A single study allows assessment of the morphology and function of the cardiac muscle. It visualizes many pathophysiologic changes such as edema, microvascular obstruction (MVO) or necrosis, and complications of MI, like myocardial hemorrhage (MH) or thrombus, which are very difficult to diagnose using other methods. An obvious advantage of CMR is the possibility to differentiate an acute MI from the chronic one and to identify the etiology of fibrosis. All the aforementioned features of CMR have made it a useful tool in planning the treatment and assessing the prognosis of patients after MI.
Polish journal of radiology / Polish Medical Society of Radiology. 07/2011; 76(3):53-7.
-
Journal of Cardiovascular Magnetic Resonance. 01/2011;
-
[show abstract]
[hide abstract]
ABSTRACT: Monocyte chemoattractant protein-1 (MCP-1) plays a key role in the pathogenesis of atherosclerosis and has been proposed as a biomarker for patients with cardiovascular disease.
To assess its clinical usefulness, serum MCP-1 concentrations were measured in patients with ST-elevation myocardial infarction (MI) at admission, immediately after percutaneous coronary intervention (PCI), at 24 h, and after 6 months.
We found no differences in MCP-1 concentrations between patients with acute MI, patients with stable coronary artery disease and healthy individuals. Although median MCP-1 concentrations in patients with MI were similar at admission and after 6 months, there were significant differences between individuals in how MCP-1 levels changed with time. As demonstrated by comparing baseline quartiles of MCP-1, the levels of MCP-1 tended to increase in patients with low MCP-1 concentration at admission, and decrease in patients with initially high MCP-1 levels. We found an inverse correlation between MCP-1 concentration at baseline and the time to reperfusion, and detected a significant decrease in MCP-1 concentration immediately after PCI. We also observed lower MCP-1 concentrations over time in patients who developed restenosis within 6 months. However, we did not confirm the association between MCP-1 concentrations at baseline and a number of previously implicated demographic, clinical and laboratory criteria.
Our data demonstrate some new aspects of MCP-1 measurement in patients with MI, but do not corroborate many earlier observations.
Clinical Research in Cardiology 02/2010; 99(5):315-22. · 2.95 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Adult patients with congenital heart disease (CHD) usually find their exercise capacity satisfactory. However, objective evaluation is important for diagnostic and prognostic purposes. The aim of this study was to evaluate exercise capacity using cardiopulmonary exercise tests and measurement of serum B-type natriuretic peptide (BNP) levels in adult patients with CHDs, both in the entire study cohort and in subjects with individual types of cardiac lesions, as well as to verify the relation between BNP level and cardiac performance.
The study group included 265 patients (136 males; mean age 34.4 +/- 11.6 years) 173 of whom were operated on at the mean age of 9.2 +/- 7.3 years. They represented the following types of CHD: 72 patients--surgically corrected coarctation of the aorta, 62--surgically corrected tetralogy of Fallot, 28--Ebstein anomaly, 26--patent atrial septal defect, 24--Eisenmenger syndrome, 20--uncorrected or palliated complex cyanotic lesions, 11--corrected transposition of the great arteries (TGA), 14--TGA after Senning operation, and 8--common ventricle after Fontana operation. The control group consisted of 39 healthy individuals (17 males) with a mean age of 35.8 +/- 9.3 years.
According to NYHA classification, 207 patients were recognized as representing class I symptoms, 47 subjects class II, and 11 class III. Cardiopulmonary exercise revealed significantly reduced exercise capacity in adults with CHD in general, compared to control subjects: maximal oxygen uptake (VO2max) was 23.3 +/- 6.9 vs. 33.6 +/- 7.2 mL/kg/min, respectively (p = 0.00001); maximum heart rate at peak exercise (HRmax) -161.1 +/- 33.2 vs. 179.6 +/- 12.3 bpm (p = 0.00001); respiratory workload (VE/VCO2slope) - 35.7 +/- 9.7 vs. 26.3 +/- 3.1 (p = 0.00001); and forced vital capacity (FVC) - 3.8 +/- 1.1 vs. 4.6 +/- 0.7 L (p = 0.00003). Various degrees of peak VO2max reduction were observed across the spectrum of CHD. Patients after repair of aortic coarctation demonstrated the highest VO2max (26.8 +/- 6.6 mL/kg/min), and the lowest was demonstrated by patients with Eisenmenger syndrome (12.8 +/- 4.8; ANOVA p = 0.00001). Serum BNP levels in the study group were higher than in the controls: 55.4 +/- 67.5 vs. 13.9 +/- 13.7 pg/mL, respectively (p = 0.00001). Various degrees of BNP level increase were found across the spectrum of CHD. Patients after repair of aortic coarctation demonstrated the lowest BNP level (24.8 pg/mL), and the highest level was found in patients with cyanotic defects (120.7 pg/mL; ANOVA p = 0.00001). BNP levels across the NYHA classes were as follows: I--35.7 pg/mL, II--94.1 pg/mL, and III--225.6 pg/mL. BNP levels showed negative correlation with VO2max (r = -0.525, p = 0.0001), FVC (r = -0.349, p = 0.00001), FEV1 (r = -0.335, p = 0.00001), and positive correlation with VE/VCO2slope (r = 0.447, p = 0.00001).
The exercise capacity of patients with CHD is, in general, compromised, most strikingly in patients suffering from pulmonary hypertension and cyanosis. Serum BNP levels in these subjects are increased and correlate well with exercise capacity. BNP level is higher in patients with cyanotic CHDs.
Cardiology journal 02/2009; 16(2):133-41. · 1.31 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The aim of the study was to investigate, in adult patients after successful repair of aortic coarctation, potential relationships between B-type natriuretic peptide levels and exercise capacity and the following factors: arterial hypertension, residual stenosis of the ascending aorta, and age at the time of surgery. The study group comprised 74 patients (45 men) aged 19 to 61 years (mean, 31.2 +/- 9.8 yr), who had undergone surgery at the age of 0.5 to 34 years (mean, 10.4 +/- 6.8 yr). The surgery was performed between 5 and 34 years earlier (mean, 21.4 +/- 6.2 yr). A subgroup with residual aortic stenosis (significant when > or =25 mmHg) comprised 32 patients; a subgroup without residual stenosis comprised 42 patients. Patients were also divided into subgroups without arterial hypertension (n=32), with exercise-induced arterial hypertension (n=10), and with persistent arterial hypertension (n=32). All patients were in New York Heart Association functional class I. The control group comprised 30 healthy subjects (18 men) aged 26 to 46 years (mean, 32.2 +/- 6.6 yr). After testing exercise capacity in accordance with a modified Bruce protocol, we concluded that the exercise capacity of adults is reduced after surgical repair of aortic coarctation. This reduction is more pronounced in patients who have arterial hypertension, but it is unaffected by residual stenosis of the descending aorta. Serum B-natriuretic peptide concentrations, as determined by immunoradiometric assay, are significantly elevated, which may result from pressure overload of the left ventricle or from residual myocardial lesions due to coarctation repair at an older age.
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital 01/2007; 34(4):412-9. · 0.65 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Background: Despite effective repair of coarctation of the aorta (CoAo), arterial hypertension (AH) and early coronary artery disease that may result in heart failure. The aim of the study was to evaluate exercise capacity by a cardiopulmonary exercise test in patients after of CoAo repair, and to determine relations between these parameters and the presence of AH, residual stenosis of the descending aorta (AoD) and the patient's age at the time of the surgery. Methods: 74 patients at mean age 31.2 +/- 9.8 years. The controls: 30 at mean age 32.2 +/- 6.6. Descending aorta (AoD) gradient was evaluated by echocardiography. The group with residual AoD stenosis: >/= 25 mm Hg (AoD+) 32 patients and AoD-: 41 patients. Subgroups without AH (AH-, n = 32), exercise-induced AH (AHex, n = 10), persistent AH (AH+, n = 32). The maximum exercise test was performed. Results: A comparison of the study and control groups: VO(2)max: p = 0.0001), VO(2)max%: p=0.0001 and VE/VCO(2): p = 0.001. Negative correlation: between VO(2)max and the age at the time of surgery: p = 0.004) and a positive: between VE/VCO(2) and age at surgery: p = 0.005. No differences were observed between the AoD+ and AoD- groups with respect to cardiopulmonary parameters. A comparison of the AH+ and AH- groups revealed: VO(2)max: p = 0.01, VO(2)max%: p = 0.02 and VE/VCO(2): p = 0.003. A comparison of the AHex and AH- groups showed VE/VCO(2): p = 0.01. Conclusions: The exercise capacity of adults after surgical CoAo repair is reduced. This is more pronounced in patients with AH and those operated on at a more advanced age, but not in AoD+. (Cardiol J 2007; 14: 76-82).
Cardiology journal 01/2007; 14(1):76-82. · 1.31 Impact Factor
-
Małgorzata Pyda,
Katarzyna Korybalska,
Krzysztof Ksiazek,
Stefan Grajek, Magdalena Lanocha,
Maciej Lesiak,
Justyna Wiśniewska-Elnur,
Anna Olasińska,
Andrzej Breborowicz,
Andrzej Cieśliński,
Janusz Witowski
[show abstract]
[hide abstract]
ABSTRACT: It has been demonstrated that high blood vascular endothelial growth factor (VEGF) levels in patients with myocardial infarction decrease rapidly after reperfusion, possibly in response to heparin administration. We measured serum VEGF concentration before and after heparin infusion in 105 patients with ST-elevation acute myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI). Serum VEGF concentration in patients with STEMI was significantly higher than in healthy controls. After PCI, the concentration of VEGF decreased by approximately 70%, with the greatest decrease seen in patients with the highest initial VEGF levels. To determine whether heparin could decrease VEGF concentration by sequestering VEGF in the endothelium, a fixed dose of recombinant VEGF was incubated for 40 minutes with EA.hy926 endothelial cells in vitro. Recovery of VEGF from medium after culture was decreased by up to 15% with increasing doses of heparin. Concentration of VEGF did not change in the absence of heparin and/or endothelial cells. In conclusion, these results suggest that a rapid decrease in blood VEGF after PCI may be related to the administration of heparin, which binds simultaneously to VEGF and endothelial cells.
The American Journal of Cardiology 11/2006; 98(7):902-5. · 3.37 Impact Factor
