Agnieszka Bartczak

Poznan University of Medical Sciences, Posen, Greater Poland Voivodeship, Poland

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Publications (15)17.33 Total impact

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    ABSTRACT: Indications for sudden cardiac death (SCD) primary prevention are unknown in patients with repaired tetralogy of Fallot (ToF). The role of microvolt T-wave alternans (MTWA) in SCD risk stratification was documented. However, the prevalence of spectral MTWA and its association with ventricular arrhythmia (VA) in adults after ToF repair were not elucidated. Microvolt T-wave alternans, electrocardiogram (ECG), ambulatory ECG monitoring, echocardiography, and spiroergometry were evaluated in 102 adults after ToF repair. Microvolt T-wave alternans results were classified as normal: negative(-), abnormal: positive(+), and indeterminate(ind). Owing to similar prognostic significance, MTWA(+) and MTWA(ind) due to patient factors were combined into nonnegative group: MTWA(abnormal). Microvolt T-wave alternans(abnormal) was more frequent in the studied group as compared with controls (P = .0005). The MTWA(abnormal) group had greater right ventricular end-diastolic diameter (P = .005), higher incidence of pulmonary regurgitation (P = .015), lower peak oxygen consumption (P = .01), and higher VE/VCO2 slope (P = .04) in comparison with MTWA(normal). Univariate logistic regression proved pulmonary regurgitation (OR = 3.57, 95% CI 1.27-10.04), VA (OR = 3.26, 95% CI 1.06-10.05), right ventricular end-diastolic enlargement (OR = 1.11, 95% CI 1.03-1.2), increase in VE/VCO2 slope (OR = 1.08, 95% CI 1.01-1.17), and decrease in peak oxygen uptake (OR = .91, 95% CI 0.83-0.99) to increase MTWA(abnormal) prevalence. In adults after ToF repair, abnormal MTWA occurred more often than in controls. Probability of abnormal MTWA did not rise with prevalence of malignant VA; however, presence of abnormal MTWA was associated with VA risk factors: pulmonary regurgitation, right ventricular enlargement, and consequent heart failure. The role of MTWA in selecting patients late after ToF repair at risk of SCD needs further observation. © 2014 Wiley Periodicals, Inc.
    No preview · Article · Nov 2014 · Congenital Heart Disease
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    ABSTRACT: Sudden cardiac death mostly resulting from ventricular arrhythmia remains a cause of mortality in 19-30% of adults with congenital heart defects. Indications for implantable cardioverter-defibrillators in primary prophylaxis are still under research. Microvolt T wave alternans (MTWA) is one of the sudden cardiac death risk stratification methods. We determined the incidence of MTWA in these patients and its coincidence with ventricular arrhythmia as well as risk factors of ventricular arrhythmia/sudden cardiac death. 204 patients with complex congenital heart anomalies and 45 healthy volunteers underwent ambulatory ecg monitoring, a cardiopulmonary test, BNP assessment, echocardiography and an MTWA test. After excluding technically inadequate traces, the remaining 179 patients and 43 controls were classified into MTWA positive(+), negative(-) and indeterminate(ind) subgroups. Additionally, MTWA(+) and MTWA(ind) formed an 'abnormal' group, labeled. MTWA(non-). Results. Abnormal MTWA was observed more frequently in the study group compared to controls (59(33.0%)vs1(2.3%), p=0.000001). The MTWA(non-) group compared to MTWA(-) presented a higher number of males (61.0%vs37.5%, p=0.005), predominance of patients with NYHA>I (44.1%vs25.0%, p=0.007), pulmonary hypertension (16.9%vs0.8%, p=0.00007), lower blood saturation (97%(73-100)vs99%(69-100), p=0.0003), higher incidence of malignant arrhythmia (9(15.2%)vs(3(2.5%), p=0.003), lower peak oxygen consumption VO2(ml/kg/min) (23.1±5.9vs26.3±6.7, p=0.002), higher VE/VCO2slope (36.0(25-74)vs31.0(21-58), p=0.01). Multivariate logistic regression analysis proved that pulmonary hypertension (OR=13.7, p=0.03), male gender (OR=10.4, p=0.00002), VE/VCO2slope (OR=1.07, p=0.045) and VO2 (OR=0.89, p=0.04) increase the probability of MTWA(non-). Abnormal MTWA is more frequent in adults with congenital heart diseases than in the healthy population. Its probability increases in patients demonstrating clinical findings conducive to lethal arrhythmia like heart failure and pulmonary hypertension.
    Full-text · Article · Oct 2013 · Cardiology journal
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    ABSTRACT: Background Among adults with congenital heart diseases (CHD) evaluation of sudden cardiac death (SCD) risk remains a great challenge. Although microvolt T-wave alternans has been incorporated into SCD risk stratification algorithm, its role in adults with CHD still requires investigation. We sought to determine the incidence of MTWA in this specific group and its coincidence with ventricular arrhythmia (VA) and other clinical findings presumably associated with SCD. Methods A case–control study was performed in which 102 patients with CHD characterized by right ventricle pathology or single ventricle physiology (TGA, UVH, Ebstein’s anomaly, ccTGA, Eisenmenger syndrome, DORV, CAT, unoperated ToF) were compared to 45 age- and sex-matched controls. All subjects underwent spectral MTWA test, ambulatory ecg monitoring, cardiopulmonary test, BNP assessment. After excluding technically inadequate traces, the remaining MTWA results were classified as positive(+), negative(−) and indeterminate(ind). Due to similar prognostic significance MTWA(+) and (ind) were combined into a common group labeled ‘abnormal’. Results Abnormal MTWA was present more often in the study group, compared to controls (39.2% vs 2.3%, p = 0.00001). Sustained ventricular tachycardia (sVT) was observed more often among subjects with abnormal MTWA compared to MTWA(−): 19.4% vs 3.6%, p = 0.026. The patients with abnormal MTWA had a lower blood saturation (p = 0.047), more often were males (p = 0.031), had higher NYHA class (p = 0.04), worse cardiopulmonary parameters: %PeakVO2 (p = 0.034), %HRmax (p = 0.003). Factors proven to increase probability of abnormal MTWA on multivariate linear regression analysis were: sVT (OR = 20.7, p = 0.037) and male gender (OR = 15.9, p = 0.001); on univariate analysis: male gender (OR = 2.7, p = 0.021), presence of VA (OR = 2.6, p = 0.049), NYHA > I (OR = 2.06, p = 0.033), %HRmax (OR = 0.94, p = 0.005), %PeakVO2 (OR = 0.97, p = 0.042), VE/VCO2slope (OR = 1.05, p = 0.037). Conclusions Abnormal MTWA occurs significantly more often in adults with the chosen forms of CHD than among healthy subjects. The probability of abnormal MTWA increases in patients with malignant VA, in males and among subjects with heart failure and cyanosis. MTWA might be of potential role in risk stratification for SCD in adults with CHD.
    Full-text · Article · Apr 2013 · BMC Cardiovascular Disorders
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    ABSTRACT: Cardiovascular events are the main cause of premature death after successful repair of aortic coarctation (CoA). The aim of this study was to assess the selected biochemical markers of atherosclerosis in normotensive CoA repaired patients and to establish its relation to ultrasound indexes of vascular pathology. 62 patients after CoA repair (37 males, age: 34.1 ± 1.4 yrs) and 20 control individuals (10 males, age: 34.8 ± 2.2 yrs) were enrolled in the study. The serum markers: asymmetric dimethylarginine (ADMA), nitrites/nitrates (NOx), high-sensitivity C-reactive protein (hsCRP), and following vascular parameters: flow-mediated dilatation (FMD), intima-media thickness (IMT) and pulse wave velocity (PWV) were analyzed. 33 CoA repaired patients were normotensive, and compared to controls, they presented higher serum ADMA concentrations (0.59 ± 0.04 umol/l vs. 0.46 ± 0.03 umol/l, p=0.035). An analysis of the vascular parameters revealed decreased FMD (4.75 ± 0.5%), NMD (11.86 ± 0.8%) and increased PWV (6.90 ± 0.2 m/s) values in the normotensive patients as compared with the control group (FMD: 8.6 ± 0.9%, p<0.001, NMD: 20.94 ± 1.7%, p<0.001; PWV: 5.49 ± 0.2, p=0.023). There were no differences in the serum levels of NOx, hsCRP as well as IMT values between normotensive patients and the control group. A multivariate regression analysis revealed that serum ADMA level was a factor independently associated with the FMD value (r=-0.334; p=0.031) in normotensive CoA repaired group. Early biochemical and vascular indices of atherosclerosis such as increased serum ADMA concentration as well as impaired vasodilatation and increased arterial stiffness are observed in patients after CoA repair. Serum ADMA is a strong predictor of endothelial dysfunction in patients with CoA repair.
    No preview · Article · Feb 2011 · International journal of cardiology
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    ABSTRACT: Patients after successful repair of coarctation of aorta (CoAo) are at risk of hypertension at rest and associated end-organ damage. The aim of the study was to assess arterial stiffness and function in adults after coarctation repair in relation to descending aorta (AoD) residual coarctation and patient's age at operation. 85 patients after CoAo repair (53 males) aged 34.6 ± 10.3 years; median age at operation 0.9 ± 8.2 years. The control group-30 individuals (18 males) at mean age 33.6 ± 8.2 years. The following central parameters: augmentation pressure (AP) and augmentation index (AI) as well as peripheral vascular parameters: flow-mediated dilatation (FMD), nitroglycerin-mediated vasodilatation (NMD), intima-media thickness (IMT) and pulse wave velocity (PWV) were measured. 47 CoAo-repaired patients were normotensive, and compared to control, they presented higher values of central parameters AP (7.3 ± 4.6 vs. 4.4 ± 3.6 mmHg; p = 0.002) and AI (18.6 ± 10.4 vs. 13.5 ± 4.3%; p = 0.03); as well as the increased PWV (6.8 ± 1.2 vs. 5.4 ± 0.9 m/s; p = 0.003), while IMT was comparable (0.53 ± 0.01 vs. 0.51 ± 0.01 mm; p = 0.06). The vasodilatation was impaired in the normotensive patients: FMD (4.8 ± 2.8 vs. 8.5 ± 2.3%; p = 0.00003) and NMD (11.3 ± 4.6 vs. 19.8 ± 7.2%; p = 0.00001). The comparison of recoarctation (46, 54%) to non-recoarctation (39, 46%) patients did not reveal any significant differences in resting systolic and diastolic pressures, as well as the values of AI and the peripheral vascular parameters; the value of AP was higher in the recoarctation patients (10.5 ± 6.9 vs. 7.5 ± 4.1; p = 0.02) and correlated positively with the gradient across AoD (r = 0.295, p = 0.01). There was no significant linear correlation between age at the time of surgery and any of peripheral arterial parameters. Residual stenosis in AoD does not affect the arterial vasodilatation nor stiffness in patients after CoAo repair. Early operation has no impact on peripheral vascular remodeling or central pressure which supports the claim that coarctation of the aorta is a systemic vascular disorder which leads to progressive vascular and end-organ damage despite early correction.
    Full-text · Article · Dec 2010 · Clinical Research in Cardiology

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  • No preview · Article · Jun 2010 · Journal of Hypertension

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  • No preview · Conference Paper · Jan 2010
  • O. Trojnarska · A. Bartczak · M. Janus
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    ABSTRACT: In patients with congenital heart defects right ventricle anomaly is usually observed. Because of specific character of right ventricle's anatomy and position, there is no precise method for its evaluation; therefore clinical application of tissue Doppler echocardiography (TDE) shows promising results. Analysis of patients with atrial septal defect, characterized by volumetric overload, proved increased values of right ventricle myocardial deformation and velocities. The influence of atrial septal defect closure on tissue Doppler parameters was ambiguous. In patients after repair of tetralogy of Fallot following findings were revealed: reduction in myocardial deformation parameters and velocities, increase in Tei index, reduction in myocardial acceleration index during the isovolumic contraction of right ventricle, especially in patients with significant pulmonary insufficiency. Right ventricle systolic overload, in pulmonary stenosis, impairs mainly the diastolic function and reduces ventricular ejection fraction. The right ventricular function in systemic position [eg. in transposition of great arteries and congenitally corrected transposition of great arteries) deteriorates. This phenomenon progresses faster in the former entity, what was proved using TDE. In patients with single-ventricle physiology following results were obtained: decrease of systolic myocardial velocities, deterioration of myocardial deformation parameters, increase in Tei index and elongation of isovolumic relaxation time, what proves systolic and diastolic dysfunction. Analysis of the right ventricle by means of modern echocardiographic techniques, has still many limitations, including influence of concomitant tricuspid valve anomalies and loss of sinus rhythm. There is also a limited number of publications and few of them include comparisonwith magnetic resonance imaging results. Therefore, it is currently recommended to use and interpret together some complementary echocardiographic techniques. On the basis of recently obtained data it is recommended to use tissue Doppler imaging in this population, especially in patients with suspicion of subclinical ventricular damage and patients potentially requiring cardiac surgery.
    No preview · Article · Jan 2009 · Polski Przeglad Kardiologiczny
  • O. Trojnarska · S. Grajek · L. Kramer · A. Bartczak
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    ABSTRACT: Introduction: Advanced disorders of conduction and impulse formation (DCIF) are frequent complication among patients with congenital heart defect (CHD). Their pathogenesis is compound because they may be the effect of primary changes in the structure of conduction system of the heart, its vascular supply anomalies, as well as its damage during cardiosurgery. In some patients dysfunction of sinus node was observed. Because of anomalies of heart and vessels construction DCIF cause essential difficulty during implantation of pacemaker. The aim of the study is to evaluate prognostic significance of selected features characterizing adult patient with CHD, presenting for the first time to an outpatient clinic, on occurrence of impulse formation and conduction disorders during long-term observation. We assumed following features as characteristic for analyzed patients: complexity of defect, undergoing cardiac surgery in the past, initial heart failure - NYHA >1, presence of cyanosis, age and gender. Material and methods: We analyzed the data of 1304 patients (586 males) 18-72 years of age (mean 29.4±10.6 years) followed-up from 1995 to 2004 in the Out-patient Clinic of Congenital Heart Defects in Adults by I Department of Cardiology Poznań University of Medical Sciences. Mean observation time approximated 3.52±1.83 years. Following clinical states were assumed as disorders of impulse conduction: atrioventricular block I-III°, disorders of impulse formation: nodal rhythm, sinus pause (pause ≥2 sec.), bradycardia (<30 beats per minute at night and <40 beats per minute at day). Results: DCIF occurred among 139 patients - that made up 10.6% of study population. Probability of DCIF appearance is higher among patients with: complex heart defect (p=0.00001), initial heart failure (p=0.00001), cyanosis (p=0.002) and in men (p=0.005). Undergoing cardiac surgery does not have such prognostic value. We proved that risk factors of DCIF occurrence are: complexity of defect (HR=2.64), initial heart failure (HR=2.13) and male gender (HR=1.63). Remaining features do not have prognostic significance. Conclusions: Anatomical complexity of defect, male gender and initial heart failure increase risk of disorders of conduction and impulse formation among adult patients with CHD. Cyanosis raises probability of DCIF appearance. Performing cardiac surgery and age of patient do not have prognostic significance.
    No preview · Article · Jan 2009 · Polski Przeglad Kardiologiczny
  • O. Trojnarska · S. Grajek · L. Kramer · A. Bartczak
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    ABSTRACT: Introduction: Ventricular arrhythmia (EV) is the most frequent cause of sudden death, which incidence is higher among population of adults with congenital heart defects (CHD) than in the age-comparable population. Aim of study: was to estimate prognostic significance of congenital heart defect complexity, performed cardiac surgery, initial heart failure - NYHA>I, cyanosis, age and gender among adults with CHD presenting for the first time to an outpatient clinic, on EV appearance during 10 years long observation. Material and methods: We analyzed the data of 1304 patients (568 male) 18-72 years of age (mean 29.4±10.6 years) followed-up from 1995 to 2004. Mean time of observation -3.52±1.83 years. EV was defined as ≥30 per hour monomorphic ventricular ectopic extrasytoles. Results: The observation proved that EV appearance probability approximated 2.3% after 2 years and 12.4% after 10 years. Univariate analysis revealed that EV incidence during the observation time was higher among adults with complex heart defect (p=0.00001), initial heart failure (NYHA>I) (p=0.00001) and cyanosis (p=0.00001). Undergoing cardiac surgery in the past and gender are not important. Cox regression analysis proved complexity of the defect as the only statistically significant EV risk factor (HR=3.45). The other factors are not substantial, nevertheless initial heart failure is of some clinical value as it increases relative risk of EV (HR=2.23). Cyanosis, age, performing cardiac surgery are of no prognostic value. Conclusions: 1. Complexity of the defect is a significant EV risk factor. 2. Initial heart failure raises relative risk of EV appearance. 3. Cyanosis increases probability of EV occurrence, but does not have prognostic significance. 4. Performing cardiac surgery, gender and age of patient does not influence the appearance of EV.
    No preview · Article · Jan 2009 · Polski Przeglad Kardiologiczny