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Lasocka-Koriat Z, Lewicka-Potocka Z, Kaleta-Duss A, Siekierzycka A, Kalinowski L, Lewicka E, Dąbrowska-Kugacka A. Differences in cardiac adaptation to exercise in male and female athletes assessed by noninvasive techniques: a state-of-the-art review. Am J Physiol Heart Circ Physiol 2024; 326:H1065-H1079. [PMID: 38391314 DOI: 10.1152/ajpheart.00756.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/20/2024] [Accepted: 02/20/2024] [Indexed: 02/24/2024]
Abstract
Athlete's heart is generally regarded as a physiological adaptation to regular training, with specific morphological and functional alterations in the cardiovascular system. Development of the noninvasive imaging techniques over the past several years enabled better assessment of cardiac remodeling in athletes, which may eventually mimic certain pathological conditions with the potential for sudden cardiac death, or disease progression. The current literature provides a compelling overview of the available methods that target the interrelation of prolonged exercise with cardiac structure and function. However, this data stems from scientific studies that included mostly male athletes. Despite the growing participation of females in competitive sport meetings, little is known about the long-term cardiac effects of repetitive training in this population. There are several factors-biochemical, physiological and psychological, that determine sex-dependent cardiac response. Herein, the aim of this review was to compare cardiac adaptation to endurance exercise in male and female athletes with the use of electrocardiographic, echocardiographic, and biochemical examination, to determine the sex-specific phenotypes, and to improve the healthcare providers' awareness of cardiac remodeling in athletes. Finally, we discuss the possible exercise-induced alternations that should arouse suspicion of pathology and be further evaluated.
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Affiliation(s)
- Zofia Lasocka-Koriat
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
- First Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Zuzanna Lewicka-Potocka
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
- First Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Anna Kaleta-Duss
- Institute for Radiology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Anna Siekierzycka
- Department of Medical Laboratory Diagnostics-Fahrenheit Biobank BBMRI.pl, Medical University of Gdańsk, Gdańsk, Poland
| | - Leszek Kalinowski
- Department of Medical Laboratory Diagnostics-Fahrenheit Biobank BBMRI.pl, Medical University of Gdańsk, Gdańsk, Poland
- BioTechMed Centre/Department of Mechanics of Materials and Structures, Gdańsk University of Technology, Gdańsk, Poland
| | - Ewa Lewicka
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
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2
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Kaufmann D, Królak T, Dąbrowska-Kugacka A, Kapłon-Cieślicka A, Gawałko M, Budnik M, Uziębło-Życzkowska B, Krzesiński P, Starzyk K, Wożakowska-Kapłon B, Wójcik M, Błaszczyk R, Hiczkiewicz J, Budzianowski J, Mizia-Stec K, Wybraniec MT, Kosmalska K, Fijałkowski M, Szymańska A, Dłużniewski M, Haberka M, Kucio M, Michalski B, Kupczyńska K, Tomaszuk-Kazberuk A, Wilk-Śledziewska K, Wachnicka-Truty R, Koziński M, Burchardt P, Daniłowicz-Szymanowicz L. Can transesophageal echocardiography be safely omitted in patients scheduled for elective ablation of atrial arrhythmias? Data based on the LATTEE registry. Kardiol Pol 2024:VM/OJS/J/100081. [PMID: 38606739 DOI: 10.33963/v.phj.100081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 04/02/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND According to the present guidelines, transesophageal echocardiography (TEE) before scheduled catheter ablation (CA) for atrial arrhythmias (atrial fibrillation [AF] or atrial flutter [AFL]) is not deemed obligatory for optimally anticoagulated patients. However, daily clinical practice significantly differs from the recommendations. AIMS That study aimed to identify transthoracic echocardiographic parameters that could be useful in revealing patients without left atrial thrombus (LAT), thereby contributing to avoiding unnecessary TEE before scheduled CA. METHODS This is a sub-analysis of a multicenter, prospective, observational study - LATTEE registry. A total of 1346 patients referred for TEE before scheduled CA of AF/AFL were included. RESULTS LAT was present in 44 patients (3.3%) and absent in the remaining 1302, who were younger, more likely to have paroxysmal AF, and displayed sinus rhythm during TEE. Additionally, they exhibited a lower incidence heart failure, diabetes, systemic connective tissue disease, and chronic obstructive pulmonary disease. Furthermore, they had a lower CHA2DS2-VASc score and a higher prevalence of direct oral anticoagulants. Echocardiographic parameters, including left ventricular ejection fraction (LVEF) > 65%, left atrial diameter (LAD) < 40 mm, left atrial area (LAA) < 20 cm2, left atrial volume (LAV) < 113 ml, and left atrial volume index (LAVI) < 51 ml/m2, demonstrated 100% sensitivity and 100% negative predictive value for the LAT absence, and weremet by 417 patients. Additional echocardiographic indices: LVEF/LAD > 1.4, LVEF/LAVI > 1.6 and LVEF/LAA > 2.7 identified an additional 57 patients, bringing the total predicted LAT-free patients to 474 (35%). CONCLUSIONS Simple echocardiographic parameters could help identify individuals for whom TEE could be safely omitted before scheduled for elective CA due to atrial arrhythmias.
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Affiliation(s)
- Damian Kaufmann
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdańsk, Poland
| | - Tomasz Królak
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdańsk, Poland
| | - Alicja Dąbrowska-Kugacka
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdańsk, Poland
- "Club 30", Polish Cardiac Society, Warszawa, Poland
| | - Agnieszka Kapłon-Cieślicka
- "Club 30", Polish Cardiac Society, Warszawa, Poland
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Monika Gawałko
- "Club 30", Polish Cardiac Society, Warszawa, Poland
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
- Institute of Pharmacology, West German Heart and Vascular Centre, University Duisburg-Essen, Essen, Germany
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Monika Budnik
- "Club 30", Polish Cardiac Society, Warszawa, Poland
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Beata Uziębło-Życzkowska
- Department of Cardiology and Internal Diseases, Military Institute of Medicine - National Research Institute, Warszawa, Poland
| | - Paweł Krzesiński
- "Club 30", Polish Cardiac Society, Warszawa, Poland
- Department of Cardiology and Internal Diseases, Military Institute of Medicine - National Research Institute, Warszawa, Poland
| | - Katarzyna Starzyk
- 1st Clinic of Cardiology and Electrotherapy, Collegium Medicum, Jan Kochanowski University, Świętokrzyskie Cardiology Centre, Kielce, Poland
| | - Beata Wożakowska-Kapłon
- 1st Clinic of Cardiology and Electrotherapy, Collegium Medicum, Jan Kochanowski University, Świętokrzyskie Cardiology Centre, Kielce, Poland
| | - Maciej Wójcik
- Department of Cardiology, Medical University of Lublin, Lublin, Poland
| | - Robert Błaszczyk
- Department of Cardiology, Medical University of Lublin, Lublin, Poland
| | - Jarosław Hiczkiewicz
- Clinical Department of Cardiology, Nowa Sol Multidisciplinary Hospital, Nowa Sól, Poland
- Department of Interventional Cardiology and Cardiac Surgery, Collegium Medicum, University of Zielona Gora, Zielona Góra, Poland
| | - Jan Budzianowski
- Clinical Department of Cardiology, Nowa Sol Multidisciplinary Hospital, Nowa Sól, Poland
- Department of Interventional Cardiology and Cardiac Surgery, Collegium Medicum, University of Zielona Gora, Zielona Góra, Poland
| | - Katarzyna Mizia-Stec
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdańsk, Poland
- 1st Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
- European Reference Network on Heart Diseases - ERN GUARD-HEART
| | - Maciej T Wybraniec
- "Club 30", Polish Cardiac Society, Warszawa, Poland
- 1st Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
- European Reference Network on Heart Diseases - ERN GUARD-HEART
| | | | - Marcin Fijałkowski
- "Club 30", Polish Cardiac Society, Warszawa, Poland
- 1st Department of Cardiology, Medical University of Gdansk, Gdańsk, Poland
| | - Anna Szymańska
- "Club 30", Polish Cardiac Society, Warszawa, Poland
- Department of Heart Diseases, Postgraduate Medical School, Warszawa, Poland
| | | | - Maciej Haberka
- "Club 30", Polish Cardiac Society, Warszawa, Poland
- Department of Cardiology, School of Health Sciences, Medical University of Silesia, Katowice, Poland
| | - Michał Kucio
- Department of Cardiology, School of Health Sciences, Medical University of Silesia, Katowice, Poland
| | - Błażej Michalski
- "Club 30", Polish Cardiac Society, Warszawa, Poland
- Department of Cardiology, Medical University of Lodz, Łódź, Poland
| | - Karolina Kupczyńska
- "Club 30", Polish Cardiac Society, Warszawa, Poland
- Department of Cardiology, Medical University of Lodz, Łódź, Poland
| | - Anna Tomaszuk-Kazberuk
- "Club 30", Polish Cardiac Society, Warszawa, Poland
- Department of Cardiology, Lipidology and Internal Medicine with Intensive Cardiac Care Unit, Medical University of Bialystok, Białystok, Poland
| | - Katarzyna Wilk-Śledziewska
- "Club 30", Polish Cardiac Society, Warszawa, Poland
- Department of Cardiology, Lipidology and Internal Medicine with Intensive Cardiac Care Unit, Medical University of Bialystok, Białystok, Poland
| | - Renata Wachnicka-Truty
- Department of Cardiology and Internal Medicine, Medical University of Gdansk, Gdynia, Poland
| | - Marek Koziński
- "Club 30", Polish Cardiac Society, Warszawa, Poland
- Department of Cardiology and Internal Medicine, Medical University of Gdansk, Gdynia, Poland
| | - Paweł Burchardt
- "Club 30", Polish Cardiac Society, Warszawa, Poland
- Department of Hypertension, Angiology, and Internal Medicine, Poznan University of Medical Sciences, Poznań, Poland
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Koziński Ł, Orzałkiewicz Z, Dąbrowska-Kugacka A. Feasibility and Safety of the Routine Distal Transradial Approach in the Anatomical Snuffbox for Coronary Procedures: The ANTARES Randomized Trial. J Clin Med 2023; 12:7608. [PMID: 38137677 PMCID: PMC10743677 DOI: 10.3390/jcm12247608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 12/01/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
The distal transradial approach (dTRA) through the anatomical snuffbox is hypothesized to offer greater benefits than the conventional transradial access (cTRA) for patients undergoing coronary procedures. Our goal was to assess the safety and efficacy of dTRA. Out of 465 consecutive Caucasian patients, 400 were randomized (1:1) to dTRA or cTRA in a prospective single-center trial. Clinical and ultrasound follow-ups were obtained at 24 h and 60 days post-procedure. The primary combined endpoint consisted of access crossover, access-related complications, and major adverse cardiovascular events (MACE). Secondary endpoints included clinical success endpoints (puncture success, crossover, and access time), access-site complications endpoints, and MACE at 60 days. The primary endpoint was significantly higher in the dTRA [odds ratio (OR): 2.31, 95% confidence interval (CI): 1.38-3.86, p = 0.001]. Clinical success endpoints, namely crossover (10% vs. 3.5%, p < 0.05) and access-time [median: 140s (85-322) vs. 80s (58-127), p < 0.001], did not favor the dTRA, despite a similar success rate in radial artery puncture between the dTRA and cTRA (99.5% vs. 99%). Radial artery spasm (19% vs. 4.5%, p < 0.0001), physical discomfort during access, and transient thumb numbness after the procedure occurred more frequently with the dTRA. However, early (2.5% vs. 4.5%, p = 0.41) and mid-term (2.5% vs. 3%, p = 0.98) forearm radial artery occlusion rates were comparable between the dTRA and cTRA. Randomization to the dTRA, lower forearm radial pulse volume, higher body mass index, and lower body surface area independently predicted the primary endpoint in multivariate analysis. In the interaction effect analysis, only diabetes increased the incidence of the primary endpoint with the dTRA (OR: 18.67, 95% CI: 3.96-88.07). The dTRA was a less favorable strategy than cTRA during routine coronary procedures due to a higher incidence of arterial spasm and the necessity for access crossover. The majority of local complications following the dTRA were clinically minor complications. Individuals with diabetes were particularly susceptible to complications associated with the dTRA.
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Affiliation(s)
- Łukasz Koziński
- Department of Cardiology, Chojnice Specialist Hospital, Lesna 10, 89-600 Chojnice, Poland
| | - Zbigniew Orzałkiewicz
- Department of Cardiology, Chojnice Specialist Hospital, Lesna 10, 89-600 Chojnice, Poland
| | - Alicja Dąbrowska-Kugacka
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Smoluchowskiego 17, 80-214 Gdansk, Poland
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Grzybowski J, Podolec P, Holcman K, Gawor-Prokopczyk M, Jankowska E, Kostkiewicz M, Dąbrowska-Kugacka A, Lipowska M, Mazurkiewicz Ł, Rajtar-Salwa R, Rubiś P, Straburzyńska-Migaj E, Szczygieł J, Mitkowski P. Diagnosis and treatment of transthyretin amyloidosis cardiomyopathy: A position statement of the Polish Cardiac Society. Kardiol Pol 2023; 81:1167-1185. [PMID: 37768101 DOI: 10.33963/v.kp.97648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 09/28/2023] [Indexed: 09/29/2023]
Abstract
Considering the rare incidence of transthyretin amyloidosis cardiomyopathy (ATTR-CM) in Poland, patients encounter difficulties at the stages of diagnosis and treatment. For successful diagnosis, it is vital to raise the suspicion of ATTR-CM, that is, to identify typical clinical scenarios such as heart failure with preserved ejection fraction or the red flags of amyloidosis. In most cases, it is possible to establish the diagnosis on the basis of noninvasive tests. This article presents the recommended diagnostic algorithms including laboratory workup, imaging tests (in particular, isotope scanning), and genetic tests. Since ATTR-CM should be differentiated from light chain amyloidosis, we also discuss aspects related to hematological manifestations and invasive diagnosis. We describe neurological signs and symptoms in patients with amyloidosis and present therapeutic options, including the causative treatment of ATTR-CM with the only currently approved drug, tafamidis. We also discuss drugs that are being assessed in ongoing clinical trials. We outline differences in the symptomatic treatment of heart failure in ATTR-CM and recommendations for nonpharmacological treatment and monitoring of the disease. Finally, we underline the need for providing access to the causative treatment with tafamidis as part of a drug program, as in other rare diseases, so that patients with ATTR-CM can be treated according to the European Society of Cardiology guidelines on heart failure and cardiomyopathy.
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Affiliation(s)
- Jacek Grzybowski
- Department of Cardiomyopathy, Cardinal Wyszynski National Institute of Cardiology, Warszawa, Poland.
| | - Piotr Podolec
- Department of Cardiovascular Disease, Jagiellonian University Medical College, Centre for Rare Cardiovascular Diseases, John Paul II Hospital, Kraków, Poland
| | - Katarzyna Holcman
- Department of Cardiovascular Disease, Jagiellonian University Medical College, Centre for Rare Cardiovascular Diseases, John Paul II Hospital, Kraków, Poland
- Nuclear Medicine Laboratory, John Paul II Hospital, Kraków, Poland
| | - Monika Gawor-Prokopczyk
- Department of Cardiomyopathy, Cardinal Wyszynski National Institute of Cardiology, Warszawa, Poland
| | - Ewa Jankowska
- Institute of Heart Diseases, Wroclaw Medical University, Wrocław, Poland
| | - Magdalena Kostkiewicz
- Department of Cardiovascular Disease, Jagiellonian University Medical College, Centre for Rare Cardiovascular Diseases, John Paul II Hospital, Kraków, Poland
- Nuclear Medicine Laboratory, John Paul II Hospital, Kraków, Poland
| | | | - Marta Lipowska
- Department of Neurology, Medical University of Warsaw, Warszawa, Poland
| | - Łukasz Mazurkiewicz
- Department of Cardiomyopathy, Cardinal Wyszynski National Institute of Cardiology, Warszawa, Poland
| | - Renata Rajtar-Salwa
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | - Paweł Rubiś
- Department of Cardiovascular Disease, Jagiellonian University Medical College, Centre for Rare Cardiovascular Diseases, John Paul II Hospital, Kraków, Poland
| | - Ewa Straburzyńska-Migaj
- 1st Department of Cardiology, Poznan University of Medical Sciences, University Clinical Hospital, Poznań, Poland
| | - Justyna Szczygieł
- Department of Cardiomyopathy, Cardinal Wyszynski National Institute of Cardiology, Warszawa, Poland
| | - Przemysław Mitkowski
- 1st Department of Cardiology, Poznan University of Medical Sciences, University Clinical Hospital, Poznań, Poland
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5
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Sławiński G, Zieleniewicz P, Faran A, Dąbrowska-Kugacka A, Kurzyna M, Kempa M, Daniłowicz-Szymanowicz L, Lewicka E. Case report: Transected Hickman catheter and its thrombotic occlusion in a patient with idiopathic pulmonary arterial hypertension-can a catheter replacement be avoided? Front Cardiovasc Med 2023; 10:1230417. [PMID: 37547245 PMCID: PMC10397384 DOI: 10.3389/fcvm.2023.1230417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 07/05/2023] [Indexed: 08/08/2023] Open
Abstract
A 25-year-old female with idiopathic pulmonary arterial hypertension (PAH), who had a Hickman catheter implanted for continuous intravenous epoprostenol infusion, was admitted to the clinic after inadvertently cutting the catheter with nail scissors during a routine dressing change. Approximately 7 cm of the external segment of the Hickman catheter remained intact, with the distal end knotted by paramedics. A decision was made to repair the damaged Hickman catheter. However, it was discovered that its lumen was completely occluded by thrombosis. Therefore, catheter patency was mechanically restored using a 0.035-inch stiff guidewire in a sterile operating theatre setting, under fluoroscopy guidance. Successful aspiration and catheter flushing were achieved. Continuity of the Hickman catheter was then restored using a repair kit (Bard Access Systems) as per the manufacturer's instructions, with no visible leakage thereafter. Epoprostenol infusion through the Hickman catheter was resumed 24 h later, and the patient was discharged in good general condition two days afterward.
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Affiliation(s)
- Grzegorz Sławiński
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
- Club 30, Polish Cardiac Society, Warsaw, Poland
| | - Piotr Zieleniewicz
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Anna Faran
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Alicja Dąbrowska-Kugacka
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Marcin Kurzyna
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education in EHC Otwock, ERN-Lung Member, Otwock, Poland
| | - Maciej Kempa
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | | | - Ewa Lewicka
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
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Nabiałek-Trojanowska I, Jankowska H, Sławiński G, Dąbrowska-Kugacka A, Lewicka E. Echocardiographic Findings in Asymptomatic Mediastinal Lymphoma Survivors Years after Treatment Termination. J Clin Med 2023; 12:jcm12103427. [PMID: 37240533 DOI: 10.3390/jcm12103427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/04/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
Patients treated due to mediastinal lymphomas are at risk of cardiovascular complications, as they receive chemotherapy, usually containing anthracyclines, often combined with thoracic radiotherapy. The aim of this prospective study was to assess early asymptomatic cardiac dysfunction using resting and dobutamine stress echocardiography (DSE) at least 3 years after the end of mediastinal lymphoma treatment. Two groups of patients were compared: those treated with chemoradiotherapy and those exclusively treated with chemotherapy. Left ventricular contractile reserve (LVCR) during DSE was assessed using changes in LV ejection fraction (LVEF), LV global longitudinal strain (LV GLS), and a novel parameter-Force, which is the ratio of the systolic blood pressure to the LV end-systolic volume. The study included 60 patients examined at a median of 89 months after the end of treatment. Resting echocardiography showed normal LVEF of 58.9 ± 9.6%, borderline LV GLS of -17.7 ± 3%, decreased mean stroke volume (SV) of 51.4 ± 17 mL, and indexed SV of 27.3 ± 8 mL/m2, and the right ventricular free wall longitudinal strain (LS) was impaired in some patients but not in all. There were no significant differences between the groups, with the exception of arterial hypertension, which was more common in the chemotherapy group (32% vs. 62.5%, p = 0.04). In resting echocardiography, only LV posterior wall LS differed significantly and was impaired in patients treated with chemotherapy (-19.1 ± 3.1% vs. -16.5 ± 5.1%, p = 0.04). DSE, performed in 21 patients after a median of 166 months from the end of cancer treatment, detected new contractility disorders in 1 patient (4.8%) and decreased LVCR in the majority of patients when determined using changes in LVEF or LV GLS, and in all patients when assessed with changes in Force. Conclusions: Most asymptomatic mediastinal lymphoma survivors showed preserved ventricular function on resting echocardiography. However, all of them showed impaired LV contractile reserve on DSE, as assessed with a simple parameter-Force. This may indicate subtle LV dysfunction and confirms the need for long-term monitoring of patients with potentially cardiotoxic cancer treatment.
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Affiliation(s)
- Izabela Nabiałek-Trojanowska
- First Department of Cardiology, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Hanna Jankowska
- Division of Cardiac Diagnostics, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Grzegorz Sławiński
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Alicja Dąbrowska-Kugacka
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Ewa Lewicka
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
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Dąbrowska-Kugacka A, Lewicka E. The sixtieth anniversary of the first pacemaker implantation in Poland. Kardiol Pol 2023; 81:1308-1311. [PMID: 38189514 DOI: 10.33963/v.kp.98513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 12/12/2023] [Indexed: 01/09/2024]
Affiliation(s)
| | - Ewa Lewicka
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdańsk, Poland
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8
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Lasocka Z, Lewicka-Potocka Z, Faran A, Daniłowicz-Szymanowicz L, Nowak R, Kaufmann D, Kaleta-Duss A, Kalinowski L, Raczak G, Lewicka E, Dąbrowska-Kugacka A. Exercise-Induced Atrial Remodeling in Female Amateur Marathon Runners Assessed by Three-Dimensional and Speckle Tracking Echocardiography. Front Physiol 2022; 13:863217. [PMID: 35860663 PMCID: PMC9289460 DOI: 10.3389/fphys.2022.863217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 05/24/2022] [Indexed: 11/18/2022] Open
Abstract
Endurance athletes have an increased risk of atrial remodeling and atrial arrhythmias. However, data regarding atrial adaptation to physical exercise in non-elite athletes are limited. Even less is known about atrial performance in women. We aimed to elucidate exercise-induced changes in atrial morphology and function in female amateur marathon runners using three-dimensional (3D) echocardiography and two-dimensional (2D) speckle tracking echocardiography (STE). The study group consisted of 27 female (40 ± 7 years) amateur athletes. Right (RA) and left atrial (LA) measures were assessed three times: 2–3 weeks before the marathon (stage 1), immediately after the run (stage 2), and 2 weeks after the competition (stage 3). Directly after the marathon, a remarkable RA dilatation, as assessed by RA maximal volume (RAVmax, 31.3 ± 6.8 vs. 35.0 ± 7.0 ml/m2; p = 0.008), with concomitant increase in RA contractile function [RA active emptying fraction (RA active EF), 27.7 ± 8.6 vs. 35.0 ± 12.1%; p = 0.014; RA peak atrial contraction strain (RA PACS) 13.8 ± 1.8 vs. 15.6 ± 2.5%; p = 0.016] was noticed. There were no significant changes in LA volumes between stages, while LA active EF (34.3 ± 6.4 vs. 39.4 ± 8.6%; p = 0.020), along with LA PACS (12.8 ± 2.1 vs. 14.9 ± 2.7%; p = 0.002), increased post race. After the race, an increase in right ventricular (RV) dimensions (RV end-diastolic volume index, 48.8 ± 11.0 vs. 60.0 ± 11.1 ml/m2; p = 0.001) and a decrease in RV function (RV ejection fraction, 54.9 ± 6.3 vs. 49.1 ± 6.3%; p = 0.006) were observed. The magnitude of post-race RV dilatation was correlated with peak RA longitudinal strain deterioration (r = −0.56, p = 0.032). The measured parameters did not differ between stages 1 and 3. In female amateur athletes, apart from RV enlargement and dysfunction, marathon running promotes transient biatrial remodeling, with more pronounced changes in the RA. Post-race RA dilatation and increment of the active contraction force of both atria are observed. However, RA reservoir function diminishes in those with post-race RV dilation.
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Affiliation(s)
- Zofia Lasocka
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
- First Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Zuzanna Lewicka-Potocka
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
- First Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Anna Faran
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | | | - Radosław Nowak
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Damian Kaufmann
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Anna Kaleta-Duss
- Institute for Radiology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Leszek Kalinowski
- Department of Medical Laboratory Diagnostics—Fahrenheit Biobank BBMRI.pl, Medical University of Gdańsk, Gdańsk, Poland
- BioTechMed Centre/Department of Mechanics of Materials and Structures, Gdańsk University of Technology, Gdańsk, Poland
| | - Grzegorz Raczak
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Ewa Lewicka
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Alicja Dąbrowska-Kugacka
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
- *Correspondence: Alicja Dąbrowska-Kugacka,
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9
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Liżewska-Springer A, Królak T, Dorniak K, Kempa M, Dąbrowska-Kugacka A, Sławiński G, Lewicka E. Right Ventricular Endocardial Mapping and a Potential Arrhythmogenic Substrate in Cardiac Amyloidosis-Role of ICD. Int J Environ Res Public Health 2021; 18:ijerph182111631. [PMID: 34770146 PMCID: PMC8583432 DOI: 10.3390/ijerph182111631] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 10/28/2021] [Accepted: 11/03/2021] [Indexed: 11/16/2022]
Abstract
Patients with cardiac amyloidosis (CA) have an increased risk of sudden cardiac death. (SCD). However, the role of an implantable cardioverter-defibrillator in the primary prevention of SCD in this group of patients is still controversial. We present a case with CA with recurrent syncope and non-sustained ventricular tachycardia. In order to further stratify the risk of SCD, an electrophysiological study with endocardial electroanatomic voltage mapping was performed prior to the ICD placement.
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Affiliation(s)
- Aleksandra Liżewska-Springer
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, 80-952 Gdansk, Poland; (T.K.); (M.K.); (A.D.-K.); (G.S.); (E.L.)
- Correspondence:
| | - Tomasz Królak
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, 80-952 Gdansk, Poland; (T.K.); (M.K.); (A.D.-K.); (G.S.); (E.L.)
| | - Karolina Dorniak
- Department of Nonivasive Cardiac Diagnostics, Medical University of Gdansk, 80-952 Gdansk, Poland;
| | - Maciej Kempa
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, 80-952 Gdansk, Poland; (T.K.); (M.K.); (A.D.-K.); (G.S.); (E.L.)
| | - Alicja Dąbrowska-Kugacka
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, 80-952 Gdansk, Poland; (T.K.); (M.K.); (A.D.-K.); (G.S.); (E.L.)
| | - Grzegorz Sławiński
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, 80-952 Gdansk, Poland; (T.K.); (M.K.); (A.D.-K.); (G.S.); (E.L.)
| | - Ewa Lewicka
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, 80-952 Gdansk, Poland; (T.K.); (M.K.); (A.D.-K.); (G.S.); (E.L.)
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10
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Lasocka Z, Dąbrowska-Kugacka A, Lewicka E, Liżewska-Springer A, Królak T. Successful Catheter Ablation of the "R on T" Ventricular Fibrillation. Int J Environ Res Public Health 2021; 18:ijerph18189587. [PMID: 34574512 PMCID: PMC8468308 DOI: 10.3390/ijerph18189587] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/04/2021] [Accepted: 09/06/2021] [Indexed: 11/16/2022]
Abstract
In patients with idiopathic ventricular fibrillation (VF), recurrent implantable cardioverter-defibrillator (ICD) shocks might increase mortality risk and reduce patients’ quality of life. Catheter ablation of triggering ectopic beats is considered to be an effective method. We present a patient with recurrent VF, caused by the “R on T” premature ventricular complexes. In the presented case radiofrequency catheter ablation efficiently eliminated arrhythmia trigger, which was possible to detect thanks to the intracardiac electrocardiograms (ECG’s) stored in the ICD.
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Affiliation(s)
- Zofia Lasocka
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, 80-211 Gdansk, Poland
| | - Alicja Dąbrowska-Kugacka
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, 80-211 Gdansk, Poland
| | - Ewa Lewicka
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, 80-211 Gdansk, Poland
| | | | - Tomasz Królak
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, 80-211 Gdansk, Poland
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11
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Zienciuk-Krajka A, Daniłowicz-Szymanowicz L, Dorniak K, Owczuk R, Kaufmann D, Zacharek D, Dąbrowska-Kugacka A, Figura-Chmielewska M, Nowak R, Kempa M, Kuźmiński P, Raczak G. Clinical characteristics of patients with arrhythmic mitral valve prolapse in a single tertiary center: prevalence of electrocardiographic and myocardial abnormalities. Kardiol Pol 2021; 79:693-696. [PMID: 34013515 DOI: 10.33963/kp.a2021.0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 05/13/2021] [Indexed: 11/23/2022]
Affiliation(s)
| | | | - Karolina Dorniak
- Department of Noninvasive Cardiac Diagnostics, Medical University of Gdansk, Gdańsk, Poland
| | - Radosław Owczuk
- Department of Anaesthesiology and Intensive Therapy, Medical University of Gdansk, Gdańsk, Poland
| | - Damian Kaufmann
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdańsk, Poland
| | - Dariusz Zacharek
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdańsk, Poland
| | | | | | - Radosław Nowak
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdańsk, Poland
| | - Maciej Kempa
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdańsk, Poland
| | - Piotr Kuźmiński
- Cardiology Unit, Hospital of the Ministry of Internal Affairs, Gdańsk, Poland
| | - Grzegorz Raczak
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdańsk, Poland
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12
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Klimkiewicz M, Sławiński G, Faran A, Dąbrowska-Kugacka A, Romanowicz G, Kurzyna M, Lewicka E. Ciężkie przewlekłe zakrzepowo-zatorowe nadciśnienie płucne po splenektomii z powodu sferocytozy wrodzonej — potrzeba długoterminowego nadzoru i ścisłej współpracy hematologów i kardiologów. Folia Cardiologica 2021. [DOI: 10.5603/fc.2021.0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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13
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Kopeć G, Dzikowska-Diduch O, Mroczek E, Mularek-Kubzdela T, Chrzanowski Ł, Skoczylas I, Tomaszewski M, Peregud-Pogorzelska M, Karasek D, Lewicka E, Jacheć W, Gąsior Z, Błaszczak P, Ptaszyńska-Kopczyńska K, Mizia-Stec K, Biederman A, Zieliński D, Przybylski R, Kędzierski P, Waligóra M, Roik M, Grabka M, Orłowska J, Araszkiewicz A, Banaszkiewicz M, Sławek-Szmyt S, Darocha S, Magoń W, Dąbrowska-Kugacka A, Stępniewski J, Jonas K, Kamiński K, Kasprzak JD, Podolec P, Pruszczyk P, Torbicki A, Kurzyna M. Characteristics and outcomes of patients with chronic thromboembolic pulmonary hypertension in the era of modern therapeutic approaches: data from the Polish multicenter registry (BNP-PL). Ther Adv Chronic Dis 2021; 12:20406223211002961. [PMID: 33854746 PMCID: PMC8010818 DOI: 10.1177/20406223211002961] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 02/24/2021] [Indexed: 12/13/2022] Open
Abstract
Background: Significant achievements in the treatment of chronic thromboembolic pulmonary hypertension (CTEPH) have provided effective therapeutic options for most patients. However, the true impact of the changed landscape of CTEPH therapies on patients’ management and outcomes is poorly known. We aimed to characterize the incidence, clinical characteristics, and outcomes of CTEPH patients in the modern era of CTEPH therapies. Methods: We analyzed the data of CTEPH adults enrolled in the prospective multicenter registry. Results: We enrolled 516 patients aged 63.8 ± 15.4 years. The incidence rate of CTEPH was 3.96 per million adults per year. The group was burdened with several comorbidities. New oral anticoagulants (n = 301; 58.3%) were preferred over vitamin K antagonists (n = 159; 30.8%). Pulmonary endarterectomy (PEA) was performed in 120 (23.3%) patients and balloon pulmonary angioplasty (BPA) in 258 (50%) patients. PEA was pretreated with targeted pharmacotherapy in 19 (15.8%) patients, and BPA in 124 (48.1%) patients. Persistent CTEPH was present in 46% of PEA patients and in 65% of patients after completion of BPA. Persistent CTEPH after PEA was treated with targeted pharmacotherapy in 72% and with BPA in 27.7% of patients. At a mean time period of 14.3 ± 5.8 months, 26 patients had died. The use of PEA or BPA was associated with better survival than the use of solely medical treatment. Conclusions: The modern population of CTEPH patients comprises mostly elderly people significantly burdened with comorbid conditions. This calls for treatment decisions that are tailored individually for every patient. The combination of two or three methods is currently a frequent approach in the treatment of CTEPH. Clinical Trial Registration: clinicaltrials.gov/ct2/show/NCT03959748
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Affiliation(s)
- Grzegorz Kopeć
- Pulmonary Circulation Centre, Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, ul. Pradnicka 80, Krakow 31-202, Poland
| | - Olga Dzikowska-Diduch
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Ewa Mroczek
- Department of Cardiology, Provincial Specialist Hospital Research and Development Center, Wrocław, Poland
| | | | - Łukasz Chrzanowski
- I Department and Chair of Cardiology, Medical University of Lodz, Łódź, Poland
| | - Ilona Skoczylas
- 3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | | | | | - Danuta Karasek
- 2nd Department of Cardiology, Faculty of Health Sciences, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Ewa Lewicka
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Wojciech Jacheć
- 2nd Department of Cardiology, School of Medicine with Dentistry Division in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Zbigniew Gąsior
- Department of Cardiology, School of Health Sciences, Medical University of Silesia, Katowice, Poland
| | - Piotr Błaszczak
- Department of Cardiology, Cardinal Wyszynski Hospital, Lublin, Poland
| | | | - Katarzyna Mizia-Stec
- 1st Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | | | | | - Roman Przybylski
- Department of Heart Diseases, Wroclaw Medical University, Clinic of Cardiac Transplantation and Mechanical Circulatory Support, Wrocław, Poland
| | - Piotr Kędzierski
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, Otwock, Poland
| | - Marcin Waligóra
- Pulmonary Circulation Centre Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland, Department of Medical Education, Center for Innovative Medical Education, Jagiellonian University Medical College, Krakow, Poland
| | - Marek Roik
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Marek Grabka
- 1st Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Joanna Orłowska
- Department of Cardiology, Provincial Specialist Hospital Research and Development Center, Wrocław, Poland
| | | | - Marta Banaszkiewicz
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, Otwock, Poland
| | - Sylwia Sławek-Szmyt
- Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland
| | - Szymon Darocha
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, Otwock, Poland
| | - Wojciech Magoń
- Pulmonary Circulation Centre, Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | | | - Jakub Stępniewski
- Pulmonary Circulation Centre Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland, Department of Medical Education, Center for Innovative Medical Education, Jagiellonian University Medical College, Krakow, Poland
| | - Kamil Jonas
- Pulmonary Circulation Centre Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland, Department of Medical Education, Center for Innovative Medical Education, Jagiellonian University Medical College, Krakow, Poland
| | - Karol Kamiński
- Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Białystok, Białystok, Poland
| | - Jarosław D Kasprzak
- I Department and Chair of Cardiology, Medical University of Lodz, Łódź, Poland
| | - Piotr Podolec
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland
| | - Piotr Pruszczyk
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Adam Torbicki
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, Otwock, Poland
| | - Marcin Kurzyna
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, Otwock, Poland
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14
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Lasocka Z, Dąbrowska-Kugacka A, Kaleta AM, Lewicka-Potocka Z, Faran A, Szołkiewicz E, Przybyłowski K, Szołkiewicz A, Daniluk P, Raczak G, Lewicka E. Electrocardiographic Changes in Male and Female Amateur Marathon Runners: A Comparison Study. Int J Sports Med 2021; 42:936-944. [PMID: 33621993 DOI: 10.1055/a-1323-3215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Physical training is gaining popularity among amateurs. Males and females exhibit different cardiac adaptation to exercise. The aim of the study was to compare the incidence of electrocardiographic abnormalities before and after the marathon between sexes. 12-lead electrocardiogram was performed in 40 male (39±8 years) and 27 female (40±7 years) amateur runners: 2-3 weeks before (Stage 1) and immediately after (Stage 2) the marathon. Abnormalities in the resting (Stage 1) and exercise (Stage 2) electrocardiograms were compared between sexes. At rest left atrial enlargement was more frequent in females than males (48 vs. 20%; p<0.05). The incidence of right atrial enlargement was significantly more common at Stage 2 than 1, both in men (43 vs. 0%; p<0.001) and in women (48 vs. 4%; p=0.001). Significant increase of P-wave amplitude was found in male runners after the marathon (0.12±0.05 vs. 0.21±0.09 mV; p<0.001 Stage 1 vs. 2), but was absent in females. QTc prolongation was observed in both sexes, however to a higher degree in males (p<0.05 for the interaction stage and sex). Although both male and female amateur marathon runners exhibit abnormalities in resting and exercise electrocardiograms, men present more exercise-induced electrocardiographic changes, which might indicate a higher propensity for post-marathon arrhythmias. Electrocardiographic screening in amateurs should be considered.
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Affiliation(s)
- Zofia Lasocka
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | | | - Anna Maria Kaleta
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Zuzanna Lewicka-Potocka
- Department of Cardiology and Electrotherapy, First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Anna Faran
- University Clinical Centre in Gdańsk, Medical University of Gdansk, Gdansk, Poland
| | - Ewa Szołkiewicz
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Krystian Przybyłowski
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Alicja Szołkiewicz
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Paulina Daniluk
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Grzegorz Raczak
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Ewa Lewicka
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
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15
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Sławiński G, Wrona A, Dąbrowska-Kugacka A, Raczak G, Lewicka E. Immune Checkpoint Inhibitors and Cardiac Toxicity in Patients Treated for Non-Small Lung Cancer: A Review. Int J Mol Sci 2020; 21:E7195. [PMID: 33003425 PMCID: PMC7582741 DOI: 10.3390/ijms21197195] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/25/2020] [Accepted: 09/27/2020] [Indexed: 12/24/2022] Open
Abstract
Lung cancer is a major cause of cancer-related mortality worldwide, both in men and women. The vast majority of patients are diagnosed with non-small-cell lung cancer (NSCLC, 80-85% of lung cancer cases). Therapeutics named immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment in the last decade. They are monoclonal antibodies, and those directed against PD-1 (programmed cell death protein 1) or PD-L1 (programmed cell death-ligand 1) have been used in the treatment of lung cancer and significantly improved the prognosis of NSCLC patients. However, during treatment with ICIs, immune-related adverse events (irAEs) can occur in any organ and any tissue. At the same time, although cardiac irAEs are relatively rare compared to irAEs in other organs, they have a high mortality rate. The two most common clinical manifestations of immunotherapy-related cardiotoxicity are myocarditis and pericarditis. Various types of arrhythmias have been reported in patients treated with ICIs, including the occurrence of life-threatening complete atrioventricular block or ventricular tachyarrhythmias. Here, we aim to summarize the incidence, clinical manifestations, underlying mechanisms, diagnosis, and treatment strategies for ICI-associated cardiotoxicity as these issues become very important in view of the increasing use of ICI in the treatment of lung cancer.
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Affiliation(s)
- Grzegorz Sławiński
- Department of Cardiology & Electrotherapy, Medical University of Gdańsk, Debinki 7 Street, 80-952 Gdańsk, Poland; (G.S.); (A.D.-K.); (G.R.)
| | - Anna Wrona
- Department of Oncology & Radiotherapy, Medical University of Gdańsk, 80-952 Gdańsk, Poland;
| | - Alicja Dąbrowska-Kugacka
- Department of Cardiology & Electrotherapy, Medical University of Gdańsk, Debinki 7 Street, 80-952 Gdańsk, Poland; (G.S.); (A.D.-K.); (G.R.)
| | - Grzegorz Raczak
- Department of Cardiology & Electrotherapy, Medical University of Gdańsk, Debinki 7 Street, 80-952 Gdańsk, Poland; (G.S.); (A.D.-K.); (G.R.)
| | - Ewa Lewicka
- Department of Cardiology & Electrotherapy, Medical University of Gdańsk, Debinki 7 Street, 80-952 Gdańsk, Poland; (G.S.); (A.D.-K.); (G.R.)
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16
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Kaleta-Duss AM, Lewicka-Potocka Z, Dąbrowska-Kugacka A, Raczak G, Lewicka E. Myocardial Injury and Overload among Amateur Marathoners as Indicated by Changes in Concentrations of Cardiovascular Biomarkers. Int J Environ Res Public Health 2020; 17:ijerph17176191. [PMID: 32859020 PMCID: PMC7503477 DOI: 10.3390/ijerph17176191] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/21/2020] [Accepted: 08/24/2020] [Indexed: 11/16/2022]
Abstract
Marathons continue to grow in popularity among amateurs. However, the impact of intensive exercise on the amateur's cardiovascular system has not yet been studied. Analysis of the influence of the marathon on kinetics of biomarkers reflecting cardiac injury and overload may bring new insights into this issue. We investigated the effect of running a marathon on the concentrations of high sensitivity cardiac troponin I (hs-cTnI), heart-type fatty acid binding protein (H-FABP), N-terminal proatrial natriuretic peptide (NT-proANP), B-type natriuretic peptide (BNP), growth differentiation factor 15 (GDF-15) and galectin 3 (Gal-3) in the population of male amateur runners. The study included 35 amateur marathoners and followed 3 stages: S1-two weeks prior to the marathon, S2-at the finish line and S3-two weeks after. Blood samples were collected at each stage and analyzed for biomarkers and laboratory parameters. Concentrations of all studied biomarkers were significantly higher at S2, whereas at S3 did not differ significantly compared to S1. Running a marathon by an amateur causes an acute rise in biomarkers of cardiac injury and stress. Whether repetitive bouts of intensive exercise elicit long-term adverse cardiovascular effects in amateur marathoners needs further research.
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Affiliation(s)
- Anna Maria Kaleta-Duss
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, 80-210 Gdańsk, Poland; (A.M.K.-D.); (Z.L.-P.); (A.D.-K.); (G.R.)
| | - Zuzanna Lewicka-Potocka
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, 80-210 Gdańsk, Poland; (A.M.K.-D.); (Z.L.-P.); (A.D.-K.); (G.R.)
- First Department of Cardiology, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Alicja Dąbrowska-Kugacka
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, 80-210 Gdańsk, Poland; (A.M.K.-D.); (Z.L.-P.); (A.D.-K.); (G.R.)
| | - Grzegorz Raczak
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, 80-210 Gdańsk, Poland; (A.M.K.-D.); (Z.L.-P.); (A.D.-K.); (G.R.)
| | - Ewa Lewicka
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, 80-210 Gdańsk, Poland; (A.M.K.-D.); (Z.L.-P.); (A.D.-K.); (G.R.)
- Correspondence: ; Tel.: +48-608670152
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17
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Koziński Ł, Dąbrowska-Kugacka A, Orzalkiewicz Z. Successful management of arteriovenous fistula after coronary catheterization via the snuffbox approach. Cardiol J 2020; 27:200-201. [PMID: 32463111 DOI: 10.5603/cj.2020.0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 01/01/2020] [Accepted: 01/20/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- Łukasz Koziński
- Department of Cardiology, District Hospital, 10 Lesna Street, 89-600 Chojnice, Poland.
| | - Alicja Dąbrowska-Kugacka
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Dębinki 7, 80-211 Gdańsk, Poland
| | - Zbigniew Orzalkiewicz
- Department of Cardiology, District Hospital, 10 Lesna Street, 89-600 Chojnice, Poland
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18
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Lewicka E, Daniluk P, Lasocka Z, Zarzycka E, Dąbrowska-Kugacka A, Nabiałek-Trojanowska I, Zaucha JM. Assessment of dabigatran plasma concentration may improve the safety of anticoagulation in patients treated with ibrutinib with concomitant atrial fibrillation. Kardiol Pol 2020; 78:454-457. [PMID: 32210217 DOI: 10.33963/kp.15255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Ewa Lewicka
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland.
| | - Paulina Daniluk
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Zofia Lasocka
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Ewa Zarzycka
- Department of Hematology and Transplantology, Medical University of Gdańsk, Gdańsk, Poland
| | | | | | - Jan M Zaucha
- Department of Hematology and Transplantology, Medical University of Gdańsk, Gdańsk, Poland
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Kubik M, Dąbrowska-Kugacka A, Dorniak K, Kutniewska-Kubik M, Daniłowicz-Szymanowicz L, Lewicka E, Szurowska E, Raczak G. Influence of observer-dependency on left ventricular hypertrabeculation mass measurement and its relationship with left ventricular volume and ejection fraction - comparison between manual and semiautomatic CMR image analysis methods. PLoS One 2020; 15:e0230134. [PMID: 32160262 PMCID: PMC7065796 DOI: 10.1371/journal.pone.0230134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 02/22/2020] [Indexed: 12/20/2022] Open
Abstract
Background Recent studies concerning left ventricular noncompaction (LVNC) suggest that the extent of left ventricular (LV) hypertrabeculation has no impact on prognosis. The variety of methods of LV noncompacted myocardial mass (NCM) assessment may influence the results. Hence, we compared two methods of NCM estimation: largely observer-independent Hautvast’s(H) computed algorithm-based approach and commonly used Jacquier’s(J) method, and their associations with LV end-diastolic volume (EDV) and ejection fraction (EF). Methods Cardiac magnetic resonance images of 77 persons (45±17yo) - 42 LVNC, 15 non-ischemic dilative cardiomyopathy, 20 control group were analyzed. LVNC patients were divided into the subgroup with normal (LVNCN) and high EDV (LVNCDCM). NCM and total left ventricular mass (LVM) were estimated by Hautvast’s [excluding intertrabecular blood (ITB) and including papillary muscles (PMs) into NCM] and Jacquier’s approach (including ITB and PMs, if unclearly distinguished, into NCM). Results The cut-off value of NCM for LVNC diagnosis was 22% (AUC 0.933) for NCMH/LVMH and 26% (AUC 0.883) for NCMJ/LVMJ. Inter- and intra-observer variability (estimated by coefficient of variation [CoV] and intraclass correlation coefficient [ICC]) of NCMH/LVMH appeared better than of NCMJ/LVMJ (CoV 4.3%, ICC 0.981 and CoV 4.9%, ICC 0.978; respectively for NCMH/LVMH, while for NCMJ/LVMJ: CoV 19.7%, ICC 0.15 and CoV 12.9%, ICC 0.504). In LVNCN subgroup, the correlation between EDV and NCMH was stronger than NCMJ (r = 0.677, p<0.001 vs. r = 0.480, p = 0.038; respectively). In LVNC the EDV correlated with NCMH/LVMH (r = 0.391, p<0.01), but not with NCMJ/LVMJ. In the overall group a relationship was present between EF and NCMH/LVMH (r = -0.449, p<0.001), but not NCMJ/LVMJ. Only NCMH/LVMH explained the variability of EDV (b 0.434, p<0.001). Conclusions Choosing a method of NCM assessment that is less observer-dependent might increase the reliability of results. The impact of method selection on the LV parameters and cut-off values for hypertrabeculation should be further investigated.
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Affiliation(s)
- Marcin Kubik
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Alicja Dąbrowska-Kugacka
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
- * E-mail:
| | - Karolina Dorniak
- Department of Cardiac Diagnostics, Medical University of Gdansk, Gdansk, Poland
| | - Marta Kutniewska-Kubik
- Centre of Psychological Diagnosis, Therapy, and Personal Development, Mala Piasnica, Poland
| | | | - Ewa Lewicka
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Edyta Szurowska
- Department of Radiology, Medical University of Gdansk, Gdansk, Poland
| | - Grzegorz Raczak
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
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20
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Lewicka-Potocka Z, Dąbrowska-Kugacka A, Lewicka E, Kaleta AM, Dorniak K, Daniłowicz-Szymanowicz L, Fijałkowski M, Nabiałek-Trojanowska I, Ratkowski W, Potocki W, Raczak G. The "athlete's heart" features in amateur male marathon runners. Cardiol J 2020; 28:707-715. [PMID: 31909474 DOI: 10.5603/cj.a2019.0110] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/30/2019] [Accepted: 11/05/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Training on a professional level can lead to cardiac structural adaptations called the "athlete's heart". As marathon participation requires intense physical preparation, the question arises whether the features of "athlete's heart" can also develop in recreational runners. METHODS The study included 34 males (mean age 40 ± 8 years) who underwent physical examination, a cardiopulmonary exercise test and echocardiographic examination (ECHO) before a marathon. ECHO results were compared with the sedentary control group, reference values for an adult male population and those for highly-trained athletes. Runners with abnormalities revealed by ECHO were referred for cardiac magnetic resonance imaging (CMR). RESULTS The mean training distance was 56.5 ± 19.7 km/week, peak oxygen uptake was 53.7 ± 6.9 mL/kg/min and the marathon finishing time was 3.7 ± 0.4 h. Compared to sedentary controls, amateur athletes presented larger atria, increased left ventricular (LV) wall thickness, larger LV mass and basal right ventricular (RV) inflow diameter (p < 0.05). When compared with ranges for the general adult population, 56% of participants showed increased left atrial volume, indexed to body surface area (LAVI), 56% right atrial area and interventricular septum thickness, while 47% had enlarged RV proximal outflow tract diameter. In 50% of cases, LAVI exceeded values reported for highly-trained athletes. Due to ECHO abnormalities, CMR was performed in 6 participants, which revealed hypertrophic cardiomyopathy in 1 runner. CONCLUSIONS "Athlete's heart" features occur in amateur marathon runners. In this group, ECHO reference values for highly-trained elite athletes should be considered, rather than those for the general population and even then LAVI can exceed the upper normal value.
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Affiliation(s)
- Zuzanna Lewicka-Potocka
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Poland. .,First Department of Cardiology, Medical University of Gdansk, Poland.
| | | | - Ewa Lewicka
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Poland
| | - Anna Maria Kaleta
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Poland
| | - Karolina Dorniak
- Noninvasive Cardiac Diagnostics Department, Medical University of Gdansk, Poland
| | | | | | - Izabela Nabiałek-Trojanowska
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Poland.,First Department of Cardiology, Medical University of Gdansk, Poland
| | - Wojciech Ratkowski
- Department of Management Tourism and Recreation, Gdansk University of Physical Education and Sport, Gdansk, Poland
| | - Wojciech Potocki
- Department of Molecular Bacteriology, Intercollegiate Faculty of Biotechnology University of Gdansk and Medical University of Gdansk, Poland
| | - Grzegorz Raczak
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Poland
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21
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Dąbrowska-Kugacka A, Ciećwierz D, Żuk G, Fijałkowski M, Ottowicz A, Kwiatkowska J, Lewicka E, Sabiniewicz R. Atrial flow regulator for severe drug resistant pulmonary arterial hypertension after congenital heart defect correction. Cardiol J 2019; 26:102-104. [PMID: 30882193 DOI: 10.5603/cj.2019.0016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 10/28/2018] [Indexed: 11/25/2022] Open
Affiliation(s)
| | | | - Grzegorz Żuk
- Department of Cardiology, Medical University of Gdansk, Poland
| | | | - Antoni Ottowicz
- Department of Anesthesiology and Intensive Care, Medical University of Gdansk, Poland
| | - Joanna Kwiatkowska
- Department of Pediatric Cardiology and Congenital Heart Disease, Medical University of Gdansk, Poland
| | - Ewa Lewicka
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Poland
| | - Robert Sabiniewicz
- Department of Pediatric Cardiology and Congenital Heart Disease, Medical University of Gdansk, Poland
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22
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Nabiałek-Trojanowska I, Dąbrowska-Kugacka A, Lewicka-Potocka Z, Abdulaziz Y, Szerszyńska A, Raczak G, Lewicka E. Acute coronary syndrome in patients undergoing anticancer therapies: A single-center, controlled case study. ADV CLIN EXP MED 2019; 28:1667-1673. [PMID: 31851792 DOI: 10.17219/acem/110316] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Anticancer therapies can be accompanied by cardiovascular complications, including acute coronary syndrome (ACS). In turn, the presence of cancer can influence therapeutic decisions if ACS occurs. OBJECTIVES The aim of the study was to analyze ACS treatment in patients with cancer. MATERIAL AND METHODS The study consisted of a retrospective analysis based on the medical records of patients who were admitted due to ACS, with cancer diagnoses. Patients currently undergoing cancer treatment or having treatment which ended up to 6 months before the ACS were included. They were compared to a control group consisting of consecutive patients admitted for ACS during the same period, but who did not have a diagnosis of cancer; they were matched with the experimental group in terms of age, gender and clinical type of ACS. RESULTS Thirty-two consecutive cancer patients (70 ±9 years; 53% men) met the inclusion criteria. In 22 of them (69%), ACS occurred during their cancer treatment, and in 10 (31%), it presented within 6 months of completing cancer treatment. Upon hospital admission, 19 (59%) cancer patients complained of dyspnea and 7 of typical angina, while in the control group 28, (87%) and 4 (13%) reported such symptoms, respectively.The clinical manifestation of ACS was NSTEMI in 16 patients (50%), UA in 10 (31%) and STEMI in 5 (15.6%). Coronary angiography was done in 25 (78%) of the cancer patients and in all members of the control group. Percutaneous coronary angioplasty (PCA) was performed in 17 (53%) and 23 (72%) of the patients from the respective groups. The median time to percutaneous coronary intervention (PCI) was 10 h (30 min-10 days) among the cancer patients and 7.5 h among the control group (30 min-6 days). There were no PCI-related complications or severe bleeding in both groups. In-hospital mortality was 6.25% in the cancer group and there were no reported hospital deaths in the control group. CONCLUSIONS Dyspnea is the most common symptom of ACS in cancer patients who are treated invasively too rarely: the presence of cancer and active anticancer treatment should not limit the management of ACS in accordance with current guidelines.
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Affiliation(s)
- Izabela Nabiałek-Trojanowska
- First Department of Cardiology, Medical University of Gdańsk, Poland
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Poland
| | | | - Zuzanna Lewicka-Potocka
- First Department of Cardiology, Medical University of Gdańsk, Poland
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Poland
| | - Yasmina Abdulaziz
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Poland
| | - Anna Szerszyńska
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Poland
| | - Grzegorz Raczak
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Poland
| | - Ewa Lewicka
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Poland
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23
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Dąbrowska-Kugacka A, Dorniak K, Meyer-Szary J, Rey AH, Lewicka E, Ostrowska K, Kwiatkowska J. Myocardial function in patients with anomalous left coronary artery from the pulmonary artery syndrome: A long-term speckle tracking echocardiographic study. PLoS One 2019; 14:e0223227. [PMID: 31613933 PMCID: PMC6793868 DOI: 10.1371/journal.pone.0223227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 09/16/2019] [Indexed: 11/23/2022] Open
Abstract
Background Anomalous origin of the left coronary artery (LCA) from the pulmonary artery (ALCAPA) is a rare congenital heart disease. Retrograde flow from the right coronary artery (RCA) through natural collaterals to the low-pressure main pulmonary artery causes extensive ischemia. Limited data concerning the extent of permanent myocardial damage and functional recovery after surgical repair in the long-term follow-up is available. Aim Determination of the incidence of incipient myocardial dysfunction in ALCAPA patients in the long-term observation using tissue Doppler and speckle tracking echocardiography. Methods and results Eighteen ALCAPA patients after surgical repair (at median age of 7 months, range 3–167) underwent echocardiographic examination after (median) 17 years. All but 4 patients in NYHA class II presented well at follow-up. No narrowing in proximal LCA was detected in color Doppler. The initial (pre-surgical) left ventricular (LV) ejection fraction of 33±17% almost normalized to 55±6%, but was lower than in the age, sex and body surface area matched control group: 62±5% (p<0.001). At follow-up, LV global longitudinal strain (LS): -15.8±3.3% vs -21.9±1.7%; right ventricular LS: -20.6±3.9% vs -24.9±4.6%; left atrial LS: 27.7±4.3% vs 41.0±11.5%; right atrial LS: 26.8±7.4% vs 44.0±7.9% and early pulsed wave to tissue Doppler mitral filling ratio (E/E’): 8.1±2.6 vs 5.8±1.3 were impaired in the ALCAPA population in comparison to the control group (p<0.01 for all comparisons). LV radial and circumferential strain did not differ between groups. Mean LS in the ALCAPA patients in the RCA region was -19.0±4.4%, while in the LCA region -13.8±7.3% (p<0.00001). Conclusions Despite good clinical condition and normalized LV ejection fraction in ALCAPA patients after surgical repair in the long-term follow-up, the diastolic and longitudinal systolic function of all cardiac chambers remained impaired, especially in the LCA region. Lifelong surveillance of repaired ALCAPA patients is needed.
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Affiliation(s)
| | - Karolina Dorniak
- Department of Noninvasive Cardiac Diagnostics, Medical University of Gdansk, Gdansk, Poland
| | - Jarosław Meyer-Szary
- Department of Pediatric Cardiology and Congenital Heart Disease, Medical University of Gdansk, Gdansk, Poland
| | - Agnieszka Herrador Rey
- Department of Pediatric Cardiology and Congenital Heart Disease, Medical University of Gdansk, Gdansk, Poland
| | - Ewa Lewicka
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Katarzyna Ostrowska
- Department of Cardiology, Polish Mother's Memorial Hospital-Research Institute, Lodz, Poland
| | - Joanna Kwiatkowska
- Department of Pediatric Cardiology and Congenital Heart Disease, Medical University of Gdansk, Gdansk, Poland
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24
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Kwiatkowska J, Herrador Rey A, Meyer-Szary J, Dorniak K, Ostrowska K, Wałdoch A, Kozłowski D, Dąbrowska-Kugacka A. Long‑term outcome after surgical repair of anomalous origin of the left coronary artery from the pulmonary artery: 24 years of experience. Kardiol Pol 2019; 77:716-718. [PMID: 31066728 DOI: 10.33963/kp.14816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Joanna Kwiatkowska
- Department of Pediatric Cardiology and Congenital Heart Defects, Medical University of Gdańsk, Gdańsk, Poland
| | - Agnieszka Herrador Rey
- Department of Pediatric Cardiology and Congenital Heart Defects, Medical University of Gdańsk, Gdańsk, Poland
| | - Jarosław Meyer-Szary
- Department of Pediatric Cardiology and Congenital Heart Defects, Medical University of Gdańsk, Gdańsk, Poland
| | - Karolina Dorniak
- Department of Noninvasive Cardiac Diagnostics, Medical University of Gdańsk, Gdańsk, Poland
| | - Katarzyna Ostrowska
- Department of Cardiology, Polish Mother’s Memorial Hospital, Research Institute,Łódź, Poland
| | - Anna Wałdoch
- Department of Pediatric Cardiology and Congenital Heart Defects, Medical University of Gdańsk, Gdańsk, Poland
| | - Dariusz Kozłowski
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
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25
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Sławiński G, Lewicka E, Kempa M, Budrejko S, Dąbrowska-Kugacka A, Romanowicz G, Raczak G. The 18-fluorine-fluorodeoxyglucose positron-emission-tomography/computed tomography-guided treatment of prosthetic valve endocarditis. Cardiol J 2019; 26:105-108. [PMID: 30882194 DOI: 10.5603/cj.2019.0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 02/02/2019] [Accepted: 02/04/2019] [Indexed: 11/25/2022] Open
Affiliation(s)
- Grzegorz Sławiński
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Poland
| | - Ewa Lewicka
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Poland.
| | - Maciej Kempa
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Poland
| | - Szymon Budrejko
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Poland
| | | | | | - Grzegorz Raczak
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Poland
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26
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Liżewska-Springer A, Dąbrowska-Kugacka A, Lewicka E, Królak T, Drelich Ł, Zagożdżon P, Kozłowski D, Raczak G. Biatrial strain as a new predictive marker of successful pulmonary vein ablation in patients with atrial fibrillation and preserved left ventricular function. Kardiol Pol 2019; 77:471-474. [PMID: 31025652 DOI: 10.5603/kp.a2019.0016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
| | | | - Ewa Lewicka
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Tomasz Królak
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Łukasz Drelich
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Paweł Zagożdżon
- Department of Hygiene and Epidemiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Dariusz Kozłowski
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Grzegorz Raczak
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
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27
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Kaleta AM, Lewicka E, Dąbrowska-Kugacka A, Lewicka-Potocka Z, Wabich E, Szerszyńska A, Dyda J, Sobolewski J, Koenner J, Raczak G. Electrocardiographic abnormalities in amateur male marathon runners. ADV CLIN EXP MED 2018; 27:1091-1098. [PMID: 29911749 DOI: 10.17219/acem/73700] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Sports activity has become extremely popular among amateurs. Electrocardiography is a useful tool in screening for cardiac pathologies in athletes; however, there is little data on electrocardiographic abnormalities in the group of amateur athletes. OBJECTIVES The aim of this study was to analyze the abnormalities in resting and exercise electrocardiograms (ECGs) in a group of amateur athletes, and try to determine whether the criteria applied for the general population or for athletes' ECGs should be implemented in this group. MATERIAL AND METHODS In 40 amateur male marathon runners, 3 consecutive 12-lead ECGs were performed: 2-3 weeks before (stage 1), just after the run (stage 2) and 2-3 weeks after the marathon (stage 3). Resting (stage 1) and exercise (stage 2) ECGs were analyzed following the refined criteria for the assessment of athlete's ECG (changes classified as training-related, borderline or training-unrelated). RESULTS In resting ECGs, at least 1 abnormality was found in 92.5% of the subjects and the most common was sinus bradycardia (62.5%). In post-exercise ECGs, at least 1 abnormality was present in 77.5% of the subjects and the most common was right atrium enlargement (RAE) (42.5%). Training-related ECG variants were more frequent at rest (82.5% vs 42.5%; p = 0.0008), while borderline variants - after the run (22.5% vs 57.5%; p = 0.0004). Training-unrelated abnormalities were found in 15% and 10% of the subjects, respectively (p-value - nonsignificant), and the most common was T-wave inversion. CONCLUSIONS Even if the refined criteria rather than the criteria used for normal sedentary population were applied, the vast majority of amateur runners showed at least 1 abnormality in resting ECGs, which were mainly training-related variants. However, at rest, in 15% of the subjects, pathologic training-unrelated abnormalities were found. The most frequent post-exercise abnormality was right atrial enlargement. General electrocardiographic screening in amateur athletes should be taken into consideration.
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Affiliation(s)
- Anna M Kaleta
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Poland
| | - Ewa Lewicka
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Poland
| | | | | | - Elżbieta Wabich
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Poland
| | - Anna Szerszyńska
- Students' Cardiology Scientific Association, Department of Cardiology, Medical University of Gdańsk, Poland
| | - Julia Dyda
- Students' Cardiology Scientific Association, Department of Cardiology, Medical University of Gdańsk, Poland
| | - Jakub Sobolewski
- Students' Cardiology Scientific Association, Department of Cardiology, Medical University of Gdańsk, Poland
| | - Jakub Koenner
- Students' Cardiology Scientific Association, Department of Cardiology, Medical University of Gdańsk, Poland
| | - Grzegorz Raczak
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Poland
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28
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Liżewska-Springer A, Dąbrowska-Kugacka A, Lewicka E, Drelich Ł, Królak T, Raczak G. Echocardiographic predictors of atrial fibrillation recurrence after catheter ablation: A literature review. Cardiol J 2018; 27:848-856. [PMID: 29924375 DOI: 10.5603/cj.a2018.0067] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 06/10/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Catheter ablation (CA) is a well-known treatment option for patients with symptomatic drug-resistant atrial fibrillation (AF). Multiple factors have been identified to determine AF recurrence after CA, however their predictive value is rather small. Identification of novel predictors of CA outcome is therefore of primary importance to reduce health costs and improve long-term results of intervention. The recurrence of AF following CA is related to severity of left ventricular (LV) dysfunction, extent of atrial dilatation and fibrosis. The aim of this paper was to present and discuss the latest studies on the utility of echocardiographic parameters in terms of CA effectiveness in patients with paroxysmal and persistent AF. METHODS PubMed, Google Scholar, EBSCO databases were searched for studies reporting echocardiographic preprocedural predictors of AF recurrence after CA. LV systolic and diastolic function, as well as atrial size, strain and dyssynchrony were taken into consideration. RESULTS Twenty one full-text articles were analyzed, including three meta-analyses. Several echocardiographic parameters have been reported to determine a risk of AF recurrence after CA. There are conventional methods that measure left atrial size and volume, LV ejection fraction, parameters assessing LV diastolic dysfunction, and methods using more innovative technologies based on speckle tracking echocardiography to determine left atrial synchrony and strain. Each of these parameters has its own predictive value. CONCLUSIONS Regarding CA effectiveness, every patient has to be evaluated individually to estimate the risk of AF recurrence, optimally using a combination of several echocardiographic parameters.
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Affiliation(s)
| | - Alicja Dąbrowska-Kugacka
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Dębinki 7, 80-952 Gdańsk, Poland.
| | - Ewa Lewicka
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Dębinki 7, 80-952 Gdańsk, Poland
| | - Łukasz Drelich
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Dębinki 7, 80-952 Gdańsk, Poland
| | - Tomasz Królak
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Dębinki 7, 80-952 Gdańsk, Poland
| | - Grzegorz Raczak
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Dębinki 7, 80-952 Gdańsk, Poland
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29
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Kubik M, Dąbrowska-Kugacka A, Lewicka E, Daniłowicz-Szymanowicz L, Raczak G. Predictors of poor outcome in patients with left ventricular noncompaction: Review of the literature. ADV CLIN EXP MED 2018; 27:415-422. [PMID: 29558024 DOI: 10.17219/acem/67457] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Left ventricular noncompaction (LVNC) is a unique inherited cardiomyopathy, characterized by an increased risk of adverse cardiovascular events such as heart failure, arrhythmia or sudden cardiac death. Although in comparison to dilated cardiomyopathy, the number of clinical studies concerning LVNC is still small, it is quickly increasing, which reflects a huge effort of the cardiovascular society to develop data to improve understanding of this cardiomyopathy. However, the predictors of adverse outcomes in LVNC are not well established. The aim of this review is to systematize the available data obtained from the medical literature in order to establish a proper prognosis, so that affected patients can receive the most appropriate treatment. The review considers issues connected with various areas of risk in LVNC, referring to its incidence and prevalence, comorbidity, genetics, morphology, symptoms, thromboembolic events, incidence of arrhythmia, sudden cardiac death, and mortality. Beginning with a genetic approach to the disease, passing through diagnostic tools, and finishing with issues relating to invasive methods of treatment, the article points out the most important and valuable clues for predicting a poor prognosis in LVNC. The review confirms that LVNC is not a disease, but a type of cardiac abnormality laden with a variety of prognostic factors of poor outcomes in terms of life-threatening ventricular arrhythmia and progression of heart failure. Thus, establishing a proper prognosis for individual patients is crucial for implementing the most appropriate treatment, and it should be based on the outcomes of a variety of clinical tests.
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Affiliation(s)
- Marcin Kubik
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Poland
| | | | - Ewa Lewicka
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Poland
| | | | - Grzegorz Raczak
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Poland
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Abstract
Pulmonary arterial hypertension is a disease that has a bad influence on the patient's prognosis. Recently, the possibility of therapy has dramatically changed. Nowadays, the treatment of this disease is concerned mainly with the pathophysiological target. In clinical practice, it is important to start therapy at the appropriate time, when the patient is qualified because of an unsatisfactory examination result or improve therapy when the patient is getting worse. The understanding of prognosis factors in pulmonary arterial hypertension is necessary, because it is used to determine the length of patients' life expectancy. In September of 2015, new guidelines of ESC concerning the diagnosis and treatment of pulmonary hypertension have been presented. In our article we centered on the prognosis factor in pulmonary arterial hypertension. This document is a continuation of ESC guidelines. Many of the most contemporary articles are here summarized.
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Affiliation(s)
- Emilia Stępnowska
- Department of Cardiology, Saint Vincent de Paul Hospital, Gdynia, Poland
| | - Ewa Lewicka
- Department of Cardiology and Cardiac Electrotherapy, Medical University of Gdańsk, Poland
| | | | - Paweł Miękus
- Department of Cardiology, Saint Vincent de Paul Hospital, Gdynia, Poland
| | - Grzegorz Raczak
- Department of Cardiology and Cardiac Electrotherapy, Medical University of Gdańsk, Poland
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Kaleta AM, Lewicka E, Dąbrowska-Kugacka A, Lewicka-Potocka Z, Wabich E, Potocki W, Raczak G. Intensive exercise and its effect on the heart: Is more always better? Cardiol J 2017; 24:111-116. [DOI: 10.5603/cj.2017.0039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 02/06/2017] [Indexed: 11/25/2022] Open
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Daniłowicz-Szymanowicz L, Szwoch M, Dąbrowska-Kugacka A, Dudziak M, Kozłowski D, Raczak G. Usefulness of microvolt T-wave alternans testing in the assessment of all-cause mortality and life-threatening ventricular arrhythmia risk in patients with left ventricular dysfunction. Arch Med Sci 2015; 11:945-51. [PMID: 26528334 PMCID: PMC4624729 DOI: 10.5114/aoms.2013.37936] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 07/15/2013] [Accepted: 09/23/2013] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Patients with left ventricular ejection fraction (LVEF) ≤ 35% are eligible for implantable cardioverter-defibrillator (ICD) placement in the primary prevention of sudden cardiac death. Nevertheless, other risk factors facilitating the selection of individuals with highest mortality are still sought. The aim of the study was to verify the usefulness of microvolt T-wave alternans (MTWA) testing in the assessment of all-cause mortality and life-threatening ventricular arrhythmias (EVENTs) in these patients. Previous data from the literature are inconclusive. MATERIAL AND METHODS Patients with LVEF ≤ 35% were eligible if they did not have a history of sustained ventricular arrhythmias, and were treated with β-blockers. Participants underwent MTWA testing and were subsequently followed. RESULTS The group consisted of 139 patients. MTWA results were classified as non-negative (MTWA_non-neg) in 93 and negative (MTWA_neg) in 46 patients. During the 14.3 ±8.6 months of follow-up, EVENTs were observed in 21 patients. The 1-year EVENT rate was 16.4% among MTWA_non-neg patients, and 2.6% among MTWA_neg patients (p = 0.006). The sensitivity of the MTWA test was 95.24%, the specificity - 38.14%, the positive predictive value - 21.51% and the negative predictive value - 97.83%. CONCLUSIONS In the group of patients with left ventricular systolic dysfunction, with the exclusion of patients with the history of life-threatening ventricular arrhythmia and individuals not being on chronic β-adrenolytic therapy, the abnormal result of MTWA testing is associated with significantly increased risk of all-cause mortality and life-threatening ventricular arrhythmia during 1 year of follow-up, thus identifying the individuals at the highest risk.
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Affiliation(s)
| | - Małgorzata Szwoch
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | | | - Maria Dudziak
- Department of Noninvasive Cardiac Diagnostics, Medical University of Gdansk, Gdansk, Poland
| | - Dariusz Kozłowski
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Grzegorz Raczak
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
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Lewicka E, Dudzińska-Gehrmann J, Dąbrowska-Kugacka A, Zagożdżon P, Stepnowska E, Liżewska A, Kozłowski D, Raczak G. Plasma biomarkers as predictors of recurrence of atrial fibrillation. ACTA ACUST UNITED AC 2015; 125:424-33. [PMID: 26038944 DOI: 10.20452/pamw.2882] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Atrial fibrillation (AF) is the most common arrhythmia in the general population. There are numerous factors associated with the incidence and relapse of AF. It seems that some of them, such as neurohumoral changes, may affect AF-related atrial structural remodeling and lead to recurrence of AF. OBJECTIVES The study aimed to assess the predictive value of plasma brain natriuretic peptide (BNP), atrial natriuretic peptide (ANP), aldosterone (ALD), and endothelin 1 (ET-1) concentrations before and after electrical cardioversion (CV). PATIENTS AND METHODS The study included 60 patients with a dual-chamber pacemaker, persistent AF, and preserved left ventricular function who underwent successful CV. Blood samples were collected before and 24 hours and 7 days after CV. Recurrence of AF was identified by pacemaker logs lasting 30 minutes or longer. RESULTS During a 12-month follow-up, only 5 patients (8%) had no recurrence of AF. Before cardioversion, ANP, ALD, and ET-1 levels were the same as those observed in the control group. BNP levels were significantly elevated and the level of 1237 fmol/ml or higher differentiated between patients with and without the recurrence of AF (sensitivity, 68%; specificity, 67%). Sinus rhythm restoration resulted in a significant decrease only in the BNP level. The BNP level of 700 fmol/ml or higher on day 7 after cardioversion was the most predictive for AF recurrence (sensitivity, 78%; specificity, 71%). In a multivariate analysis, only BNP levels of 700 fmol/ml or higher on day 7 after cardioversion (P = 0.04) and lack of amiodarone (P = 0.03) were independent predictors of AF recurrence. CONCLUSIONS A BNP level of 700 fmol/ml or higher 7 days after cardioversion is an independent predictor of AF recurrence during 12 months after cardioversion. ANP, ALD, and ET-1 levels at baseline or 7 days after cardioversion are not predictive of AF recurrence.
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Lewicka E, Daniłowicz-Szymanowicz L, Dąbrowska-Kugacka A, Zięba B, Zagożdżon P, Raczak G. Microvolt T-wave alternans profile in patients with pulmonary arterial hypertension. Int J Cardiol 2014; 176:1294-6. [PMID: 25115244 DOI: 10.1016/j.ijcard.2014.07.173] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 07/27/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Ewa Lewicka
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Poland.
| | | | | | - Bożena Zięba
- Department of Cardiology, Medical University of Gdańsk, Poland
| | - Paweł Zagożdżon
- Department of Hygiene and Epidemiology, Medical University of Gdańsk, Poland
| | - Grzegorz Raczak
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Poland
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Kamiński R, Grzybiak M, Nowicka E, Kosiński A, Lewicka E, Dąbrowska-Kugacka A, Kozłowski D. Macroscopic morphology of right atrial appendage in humans. Kardiol Pol 2014; 73:183-7. [PMID: 25179484 DOI: 10.5603/kp.a2014.0170] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 07/06/2014] [Accepted: 07/21/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIM Atrial fibrillation (AF) is a common arrhythmia in elderly people, and in many cases it is responsible for stroke or pulmonary embolism. One of the factors facilitating atrial thrombus formation is anatomical morphology of the atria, and especially the appendages. The pharmacological treatment of arrhythmia is generally focused on ventricular rate control. Electrical cardioversion is the preferred treatment method in the majority of clinics but it can occasionally produce the potentially dangerous complication of AF. METHODS A macroscopic study was carried out on 40 (25 male [M], 15 female [F]) human hearts, 18-72 years of age, and a microscopic study in a group of 20 human right atrial appendages (RAA) (M 10, F 10), 18-72 years of age. Only hearts without anomalies were included in the study. Classical anatomical studies and statistic analyses were applied. RESULTS AND CONCLUSIONS RAA is triangle shaped with a mean area of 2.73 cm2. Muscle fascicules build the wall of RAA and compose a dense net inside a chamber. Sagittal bundle connecting terminal crest with an apex of RAA was observed in all examined hearts. In microscopic specimens longitudinal and perpendicular fascicles were described.
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Lewicka E, Dudzińska-Gehrmann J, Dąbrowska-Kugacka A, Zagożdżon P, Kozłowski D, Raczak G. Neurohumoral factors as markers of recurrence of atrial fibrillation examined in patients with dual-chamber pacemaker. Int J Cardiol 2014; 175:213-4. [PMID: 24836686 DOI: 10.1016/j.ijcard.2014.04.249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 04/23/2014] [Indexed: 11/24/2022]
Affiliation(s)
- Ewa Lewicka
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Poland.
| | | | | | - Paweł Zagożdżon
- Department of Hygiene and Epidemiology, Medical University of Gdańsk, Poland
| | - Dariusz Kozłowski
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Poland
| | - Grzegorz Raczak
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Poland
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Kosiński A, Grzybiak M, Nowiński J, Kędziora K, Kuta W, Dąbrowska-Kugacka A, Lewicka E, Raczak G, Kozłowski D. Morphological remarks regarding the structure of conduction system in the right ventricle. Kardiol Pol 2012; 70:472-476. [PMID: 22623238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND The knowledge of conduction system morphology has a vital significance in cardiology and cardiac surgery - it enables to interpret pathologies and choose treatment. This has been confirmed by numerous accounts, both in the context of e.g. atrial fibrillation ablations as well as treating septum defects. Due to diversity and changeability of conduction system structure and their clinical implications, its thorough analyses seem to bear special importance. AIM To examine the structure of selected elements of conduction system present in the right ventricle (RV). METHODS Elements of conduction system present in RV of 6 foetuses (from 12 to 32 weeks of foetus age), 6 children (from 1 day to 7-year-old) and 10 adults (from 37 to 79-year-old) were histologically examined. Cross sections of 10 moderator bands and 10 anterior papillary muscles of adult human hearts were made. Specimens including membranous and muscular parts of the septum along with diverging moderator band were taken from a group of foetus, child and adult hearts. Cuttings of 10 micron width were stained with Masson's method in Goldner's modification. On the basis of the sections of membranous and muscular parts of the septum, the continuities of the elements of the conduction system were analysed. RESULTS It was observed that in most cases the right branch of His' bundle locates itself deep in the muscular tissue of the septum irrespective of age; it is clearly separate along its whole run and gradually penetrates the muscular tissue with its fibers. Hardly ever does the right branch of His' bundle locate itself on the surface, subendocardially, with a minimum penetration into the muscular tissue. Moreover, in most cases, elements of conduction system are present in moderator band. The main tissue constituting its stroma is above all muscular tissue and to a lesser extent, connective tissue. In addition to this, fat tissue in variable proportion was also observed. In cross sections of the moderator band a distinctively circumscribed stripe of fibers of the conduction system was found. However, one could also observe samples in which its identification was not possible. CONCLUSIONS The right branch of His bundle within the muscular part of the septum in most cases is located intramuscularly irrespective of age. The results of analyses prove a relatively constant character of the presence of the conduction system within the moderator band.
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Affiliation(s)
- Adam Kosiński
- Department of Clinical Anatomy, Medical University of Gdansk, Poland
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Graff B, Graff G, Koźluk E, Tokarczyk M, Piątkowska A, Budrejko S, Kozłowski D, Dąbrowska-Kugacka A, Lewicka E, Świątecka G, Raczak G. Electrophysiological features in patients with sinus node dysfunction and vasovagal syncope. Arch Med Sci 2011; 7:963-70. [PMID: 22328878 PMCID: PMC3264987 DOI: 10.5114/aoms.2011.26607] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Revised: 03/20/2011] [Accepted: 04/11/2011] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Syncope is a common presentation of sinus node dysfunction (SND). Some patients who receive a permanent pacemaker due to SND do not benefit from it and further diagnostic workup leads to the diagnosis of vasovagal syncope (VVS). The aim of the study was to identify electrophysiological criteria that can be used for identification of patients with SND and concurrent VVS. MATERIAL AND METHODS Transoesophageal atrial pacing (TAP) was performed in 100 patients divided into four groups depending on symptoms and TAP results. Standard electrophysiological parameters of sinus node function and their variability were obtained in the basal state and after pharmacological autonomic blockade (AB). RESULTS Patients with concurrent SND and VVS had a greater variability of sinoatrial conduction time assessed by Strauss' method than patients without incidents of syncope (83.2 ±53.9 vs. 34.1 ±19.6, 47.8 ±33.6 and 32.1 ±22.99). Apart from abnormal sinus node recovery time and second pause, patients with SND had bigger basal state variability of these parameters. In patients with SND and concurrent vasovagal syncope the variability of sinus node recovery time (SNRT), corrected SNRT (cSNRT) and second pause (IIP) decreased after autonomic blockade. CONCLUSIONS Patients with concurrent SND and VVS have distinct electrophysiological features - greater sinoatrial conduction time (SACT) variability and the decrease of SNRT, cSNRT and IIP variability after AB. However, further studies in larger study groups are needed to validate our findings. Transoesophageal atrial pacing is a useful procedure in patients with syncope, especially when the coexistence of more than one cardiac cause is suspected.
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Affiliation(s)
- Beata Graff
- Hypertension Unit, Department of Hypertension and Diabetology, Medical University of Gdansk, Poland
| | - Grzegorz Graff
- Faculty of Applied Physics and Mathematics, Gdansk University of Technology, Poland
| | - Edward Koźluk
- 1 Chair and Department of Cardiology, Medical University of Warsaw, Poland
| | - Monika Tokarczyk
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Poland
| | | | - Szymon Budrejko
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Poland
| | - Dariusz Kozłowski
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Poland
| | | | - Ewa Lewicka
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Poland
| | - Grażyna Świątecka
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Poland
| | - Grzegorz Raczak
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Poland
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Dąbrowska-Kugacka A, Lewicka E, Faran A, Kozłowski D, Kempa M, Raczak G. Right atrial appendage pacing in cardiac resynchronization therapy - haemodynamic consequences of interatrial conduction delay. Arch Med Sci 2011; 7:728-31. [PMID: 22291812 PMCID: PMC3258784 DOI: 10.5114/aoms.2011.24146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Revised: 04/17/2011] [Accepted: 06/23/2011] [Indexed: 11/17/2022] Open
Abstract
The present case report describes a patient with an artificial mitral valve and dual chamber pacemaker implanted due to perioperative complete atrio-ventricular block. One year later an upgrade to cardiac resynchronization therapy (CRT) combined with ICD function was performed due to significant progression of heart failure symptoms. Beneficial effects of CRT are demonstrated, but unfavourable haemodynamic consequences of right atrial appendage pacing are also underlined. Important interatrial conduction delay during atrial paced rhythm resulted in a significant time difference between optimal sensed and paced atrio-ventricular delay (AVD). This report provides a practical outline how to determine the interatrial delay and the sensed-paced AVD offset under echocardiography in patients treated with CRT.
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Kosiński A, Kozłowski D, Nowiński J, Lewicka E, Dąbrowska-Kugacka A, Raczak G, Grzybiak M. Morphogenetic aspects of the septomarginal trabecula in the human heart. Arch Med Sci 2010; 6:733-43. [PMID: 22419933 PMCID: PMC3298343 DOI: 10.5114/aoms.2010.17089] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2010] [Revised: 08/05/2010] [Accepted: 08/27/2010] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The septomarginal trabecula is a constant element of the anatomy of the human heart, which connects the interventricular septum and the anterior wall of the right ventricle. Considering the diversity of opinions about the structure and numerous studies suggesting its important role in haemodynamics and conduction of electrical impulses in the heart, we decided to study this element in detail. MATERIAL AND METHODS The research was conducted on 220 human hearts. Attention was mainly paid to the structure and topography of the trabecula. Its relation to the anterior papillary muscle was also a part of the study. RESULTS The presence of this morphologically diverse element was confirmed in each of the studied hearts. In most cases the trabecula originated from the upper part of the interventricular septum, separating at an angle increasing proportionally to the number of branches of the crista supraventricularis as well as the number of secondary trabeculae. The criteria established for the study, which included the course of the trabecula in the lumen of the right ventricle and its relation to the anterior papillary muscle, let us distinguish 4 types of septomarginal trabecula (I, II, III, IV). The most common was type III, the undivided trabecula, tightly connecting with the anterior papillary muscle. CONCLUSIONS Based on the results of the following study we propose a hypothesis on the genesis of respective parts of the septomarginal trabecula and a plausible sequence of changes they undergo during human ontogenesis and phylogenesis of the primates.
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Affiliation(s)
- Adam Kosiński
- Department of Clinical Anatomy, Medical University of Gdansk, Poland
| | - Dariusz Kozłowski
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Poland
| | - Janusz Nowiński
- Department of Clinical Anatomy, Medical University of Gdansk, Poland
| | - Ewa Lewicka
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Poland
| | | | - Grzegorz Raczak
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Poland
| | - Marek Grzybiak
- Department of Clinical Anatomy, Medical University of Gdansk, Poland
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Kozłowski D, Kosiński A, Dąbrowska-Kugacka A, Lewicka-Nowak E, Dudziak M, Grzybiak M, Raczak G. Assessment of a single monomorphic ventricular ectopy from the right ventricular outflow tract in standard and high resolution electrocardiogram. Arch Med Sci 2010; 6:713-8. [PMID: 22419930 PMCID: PMC3298340 DOI: 10.5114/aoms.2010.17086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Revised: 02/12/2009] [Accepted: 08/04/2010] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION High-resolution electrocardiography (ECG-CREM) is a method based on digital electrocardiography. In order to facilitate the interpretation of the Crem records the technique of vectorcardiography was used. In comparison the origin of the ventricular premature complexes (VPCs) could be estimated based on a standard 12-lead electrocardiogram. The aim of the study was to assess the point of origin of the VPCs in ECG-CREM and correlate it with standard electrocardiography (ECG-Stand). MATERIAL AND METHODS Our study included 26 patients (16 females, 10 males), aged 51-83 years (avg. 58.1 ±12.3), who presented with recurrent, during at least 6 months' observation, VPCs. The point of origin of VPCs was compared in both methods. RESULTS The performed analysis of collected ECG-Stand records revealed the presence of arrhythmogenic focal points in six different locations (1, 3, 5, 7, 8, 9). However, we did not affirm their presence in points 2,4,6. They were most commonly located in RVOT zones 8 (30.7%), 9 (23.0%), 5 (23.0%), and most seldom in zones 1, 3, 7 (7.6% each). In the simultaneous record of ECG-CREM with a single VPC it was confirmed that the FPb zone was activated the most frequently (40.0%); the next in relation to frequency were SD and ST (20.0%). Less frequent VPCs have their origin in Crem zones SP, FPa and SB (6.6%). CONCLUSIONS Electrocardiogram of high signal resolution (ECG-CREM) might be useful in recognition of the origin of ventricular premature complexes from RVOT.
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Affiliation(s)
- Dariusz Kozłowski
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Poland
| | - Adam Kosiński
- Department of Clinical Anatomy, Medical University of Gdansk, Poland
| | | | - Ewa Lewicka-Nowak
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Poland
| | - Maria Dudziak
- Noninvasive Cardiac Diagnostic Department, Medical University of Gdansk, Poland
| | - Marek Grzybiak
- Department of Clinical Anatomy, Medical University of Gdansk, Poland
| | - Grzegorz Raczak
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Poland
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Hrynkiewicz-Szymanska A, Szymanski FM, Filipiak KJ, Grabowski M, Dąbrowska-Kugacka A, Karpinski G, Opolski G. Can obstructive sleep apnea be a cause of in-stent thrombosis? Sleep Breath 2010; 15:607-9. [PMID: 20496114 DOI: 10.1007/s11325-010-0361-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Revised: 04/15/2010] [Accepted: 05/03/2010] [Indexed: 10/19/2022]
Abstract
We present the case of a 45-year-old patient readmitted to Central University Hospital at 3 a.m. for acute retrosternal chest pain associated with ST-segment elevation in lead I, aVL, V1-V6 in standard 12-lead ECG performed on admission in emergency department. Coronary angiography revealed late in-stent thrombosis in left anterior descending artery. According to the new universal definition of myocardial infarction patient was finally recognized acute ST-segment elevation myocardial infarction type 4b with additional diagnosis of severe obstructive sleep apnea and overweight.
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