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Nagy LT, Papp TB, Urbancsek R, Jenei C, Csanadi Z. Right superior pulmonary vein parameter determined by three-dimensional transesophageal echocardiography is an independent predictor of the outcome after cryoballoon isolation of the pulmonary veins. Cardiol J 2023; 30:1010-1017. [PMID: 37853823 PMCID: PMC10713212 DOI: 10.5603/cj.95381] [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: 04/30/2023] [Revised: 08/04/2023] [Accepted: 09/22/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND A direct comparison of three-dimensional transesophageal echocardiography (3DTEE) and cardiac computed tomography imaging has demonstrated good inter-technique agreement for the following pulmonary vein (PV) parameters: the ostium area of the right superior PV (RSPV) and its major (a) and minor axis (b) diameters, the left lateral ridge and the minor axis (b) diameter of the left superior PV. Herein, under investigation, was the predictive value of these parameters for arrhythmia recurrence (AR) after PV isolation with the 28 mm second generation cryoballoon (CBG2). METHODS One hundred eleven patients (67 men, mean age 58.06 ± 10.58 years) undergoing 3DTEE before PV isolation with the CBG2 for paroxysmal atrial fibrillation were followed. "Point by point" redo intervention was offered in case of AR and reconnected PVs were defined. RESULTS During a mean follow-up of 617 ± 258.86 days, 65 (58.9%) patients remained free of AR. Longer RSPV b was found to be the only significant predictor for AR (hazard ratio [HR] 1.059; 95% confidence interval [CI] 1.000-1.121; p = 0.048). RSPV b ≥ 28 mm resulted in a threefold (HR 3.010; 95% CI 1.270-7.134, p = 0.012) increase in the risk of AR. The association of RSPV b with AR was independent of the biophysical parameters of cryoapplications. In 25 "redo" patients, reconnections were found 1.75 times more likely in the RSPV than in the other 3 PVs altogether. CONCLUSIONS Right superior PV b measured with 3DTEE might be a significant predictor of AR after PV isolation with the CBG2. In case of RSPV b exceeding 28 mm, alternative PV isolation techniques or use of a larger balloon might be considered.
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Affiliation(s)
- Laszlo Tibor Nagy
- Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
| | - Timea Bianka Papp
- Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Reka Urbancsek
- Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Csaba Jenei
- Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zoltan Csanadi
- Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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Nagy LT, Jenei C, Papp TB, Urbancsek R, Kolozsvari R, Racz A, Raduly AP, Veisz R, Csanadi Z. Three-dimensional transesophageal echocardiographic evaluation of pulmonary vein anatomy prior to cryoablation: validation with cardiac CT scan. Cardiovasc Ultrasound 2023; 21:6. [PMID: 37076858 PMCID: PMC10114354 DOI: 10.1186/s12947-023-00305-9] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 04/06/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Anatomical characteristics of the left atrium and the pulmonary veins (PVs) may be relevant to the success rate of cryoballoon (CB)-ablation for atrial fibrillation (AF). Cardiac computed tomography (CCT) is considered as the gold standard for preablation imaging. Recently, three-dimensional transesophageal echocardiography (3DTOE) has been proposed for preprocedural assessment of cardiac structures relevant to CB-ablation. The accuracy of 3DTOE has not been validated by other imaging modalities. OBJECTIVE We prospectively evaluated the feasibility and the accuracy of 3DTOE imaging for the assessment of left atrial and PV structures prior to pulmonary vein isolation (PVI). In addition, CCT was used to validate the measurements obtained with 3DTOE. METHODS PV anatomy of 67 patients (59.7% men, mean age 58.5 ± 10.5 years) was assessed using both 3DTOE and CCT scan prior to PVI with the Arctic Front CB. The following parameters were measured bilaterally: PV ostium area (OA), the major and minor axis diameters of the ostium (a > b) and the width of the carina between the superior and the inferior PVs. In addition, the width of the left lateral ridge (LLR) between the left atrial appendage and the left superior PV. Evaluation of inter-technique agreement was based on linear regression with Pearson correlation coefficient (PCC) and Bland-Altman analysis of biases and limits of agreement. RESULTS Moderate positive correlation (PCC 0.5-0.7) was demonstrated between the two imaging methods for the right superior PV's OA and both axis diameters, the width of the LLR and left superior PV (LSPV) minor axis diameter (b) with limits of agreement ˂50% and no significant biases. Low positive or negligible correlation (PCC < 0.5) was found for both inferior PV parameters. CONCLUSIONS Detailed assessment of the right superior PV parameters, LLR and LSPV b is feasible with 3DTOE prior to AF ablation. This 3DTOE measurements demonstrated a clinically acceptable inter-technique agreement with those obtained with CCT.
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Affiliation(s)
- Laszlo Tibor Nagy
- Department of Cardiology, Faculty of Medicine, University of Debrecen, 22 Zsigmond Moricz Boulevard, Debrecen, 4032, Hungary.
| | - Csaba Jenei
- Department of Cardiology, Faculty of Medicine, University of Debrecen, 22 Zsigmond Moricz Boulevard, Debrecen, 4032, Hungary
| | - Timea Bianka Papp
- Department of Cardiology, Faculty of Medicine, University of Debrecen, 22 Zsigmond Moricz Boulevard, Debrecen, 4032, Hungary
| | - Reka Urbancsek
- Department of Cardiology, Faculty of Medicine, University of Debrecen, 22 Zsigmond Moricz Boulevard, Debrecen, 4032, Hungary
| | - Rudolf Kolozsvari
- Department of Cardiology, Faculty of Medicine, University of Debrecen, 22 Zsigmond Moricz Boulevard, Debrecen, 4032, Hungary
| | - Agnes Racz
- Department of Cardiology, Faculty of Medicine, University of Debrecen, 22 Zsigmond Moricz Boulevard, Debrecen, 4032, Hungary
| | - Arnold Peter Raduly
- Department of Cardiology, Faculty of Medicine, University of Debrecen, 22 Zsigmond Moricz Boulevard, Debrecen, 4032, Hungary
| | - Richard Veisz
- Department of Radiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zoltan Csanadi
- Department of Cardiology, Faculty of Medicine, University of Debrecen, 22 Zsigmond Moricz Boulevard, Debrecen, 4032, Hungary
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Bácsi A, Penyige A, Becs G, Benkő S, Kovács EG, Jenei C, Pócsi I, Balla J, Csernoch L, Balatoni I. Whole blood transcriptome characterization of young female triathlon athletes following an endurance exercise: a pilot study. Physiol Genomics 2022; 54:457-469. [PMID: 36250559 PMCID: PMC9762975 DOI: 10.1152/physiolgenomics.00090.2022] [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] [Indexed: 01/11/2023] Open
Abstract
The vast majority of studies focusing on the effects of endurance exercise on hematological parameters and leukocyte gene expression were performed in adult men, so our aim was to investigate these changes in young females. Four young (age 15.3 ± 1.3 yr) elite female athletes completed an exercise session, in which they accomplished the cycling and running disciplines of a junior triathlon race. Blood samples were taken immediately before the exercise, right after the exercise, and then 1, 2, and 7 days later. Analysis of cell counts and routine biochemical parameters were complemented by RNA sequencing (RNA-seq) to whole blood samples. The applied exercise load did not trigger remarkable changes in either cardiovascular or biochemical parameters; however, it caused a significant increase in the percentage of neutrophils and a significant reduction in the ratio of lymphocytes immediately after exercise. Furthermore, endurance exercise induced a characteristic gene expression pattern change in the blood transcriptome. Gene set enrichment analysis (GSEA) using the Reactome database revealed that the expression of genes involved in immune processes and neutrophil granulocyte activation was upregulated, whereas the expression of genes important in translation and rRNA metabolism was downregulated. Comparison of a set of immune cell gene signatures (ImSig) and our transcriptomic data identified 15 overlapping genes related to T-cell functions and involved in podosome formation and adhesion to the vessel wall. Our results suggest that RNA-seq to whole blood together with ImSig analysis are useful tools for the investigation of systemic responses to endurance exercise.
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Affiliation(s)
- Attila Bácsi
- 1Department of Immunology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - András Penyige
- 2Department of Human Genetics, Faculty of Medicine, Faculty of Pharmacy, University of Debrecen, Debrecen, Hungary
| | - Gergely Becs
- 3Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Szilvia Benkő
- 4Department of Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Elek Gergő Kovács
- 4Department of Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary,5Doctoral School of Molecular Cellular and Immune Biology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Csaba Jenei
- 6Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - István Pócsi
- 7Department of Molecular Biotechnology and Microbiology, Institute of Biotechnology, Faculty of Science and Technology, University of Debrecen, Debrecen, Hungary
| | - József Balla
- 8Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - László Csernoch
- 4Department of Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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Urbancsek R, Csanádi Z, Forgács IN, Papp TB, Boczán J, Barta J, Jenei C, Nagy L, Rudas L. The Feasibility of Baroreflex Sensitivity Measurements in Heart Failure Subjects: The Role of Slow-patterned Breathing. Clin Physiol Funct Imaging 2022; 42:260-268. [PMID: 35396907 DOI: 10.1111/cpf.12755] [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: 12/09/2021] [Revised: 03/14/2022] [Accepted: 03/28/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Increased muscle sympathetic nerve activity (MSNA) indicates an adverse outcome in heart failure. Decreased baroreflex modulation of MSNA is well known feature of the disease. The determinability of cardiovagal baroreflex sensitivity (BRS) in heart failure is low, however, the determinability of sympathetic BRS is not known. METHODS We have assessed the spontaneous, MSNA burst incidence-based baroreflex index (BRSsymp) in 33 stable heart failure patients and in 10 healthy controls using the traditional r≥0.5 cut-off for acceptable individual diastolic pressure-burst incidence slopes, and also a more stringent r≥0.7 cut-off. We have also assessed the influence of 6/min breathing. RESULTS The determinability of BRSsymp in heart failure patients was 64% during spontaneous breathing with r≥0.5 cut-off, and 39% using the r≥0.7 cut-off. The determinability of these indices further decreased during 6/min breathing, dropping to 29% with the r≥0.7 cut-off. In contrast, the determinability of the cardiovagal BRS indices increased significantly with 6/min breathing (from 24% to 66%; p<0.001). Patients who still had determinable BRSsymp at the r≥0.7 cut-off had a significantly lower baseline burst incidence than those with an undeterminable index (70±14 vs.89±10 burst/100 cycles; p<0.002). Neither the 6/min breathing, nor the r≥0.7 cut-off limit influenced the high availability of BRSsymp in healthy subjects. CONCLUSION The determinability of BRSsymp in heart failure patients is limited, especially with the 0.7 limit for correlation. Undeterminable BRSsymp in patients is associated with higher sympathetic activity. 6/min breathing improves the determinability of cardiovagal BRS indices, but not that of BRSsymp. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Réka Urbancsek
- Faculty of Medicine, Department of Cardiology, University of Debrecen, Debrecen, Hungary
| | - Zoltán Csanádi
- Faculty of Medicine, Department of Cardiology, University of Debrecen, Debrecen, Hungary
| | - Ildikó Noémi Forgács
- Faculty of Medicine, Department of Cardiology, University of Debrecen, Debrecen, Hungary
| | - Tímea Bianka Papp
- Faculty of Medicine, Department of Cardiology, University of Debrecen, Debrecen, Hungary
| | - Judit Boczán
- Faculty of Medicine, Department of Neurology, University of Debrecen, Debrecen, Hungary
| | - Judit Barta
- Faculty of Medicine, Department of Cardiology, University of Debrecen, Debrecen, Hungary
| | - Csaba Jenei
- Faculty of Medicine, Department of Cardiology, University of Debrecen, Debrecen, Hungary
| | - László Nagy
- Faculty of Medicine, Department of Cardiology, University of Debrecen, Debrecen, Hungary
| | - László Rudas
- Department of Anesthesiology and Intensive Care, University of Szeged, Szeged, Hungary
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Jenei C, Toth A, Nagy L, Clemens M, Papp E, Csanadi Z. The role of right ventricular longitudinal function in non-responder patient following cardiac resynchronization therapy. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.132] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Hungarian Government Research Fund, Szív- és érkutatási kiválóságközpont (IRONHEART)
Background
In approximately 30-40% of cases, the left ventricular systolic function does not improve following cardiac resynchronization therapy (CRT; non-responders). Currently, the role of right ventricular (RV) systolic function is yet not well established. Our aim was to assess the RV systolic function with 3D echocardiography in CRT patients.
Methods
We involved 24 patients (12–12 CRT responder and non-responder) who received CRT in our department, and whose 1-year follow-up data were available. We considered the patients "responder" when the left ventricular ejection fraction (LV EF) improved with at least 10% after CRT implantation. We characterized several 3D and 2D parameters of RV using a dedicated RV analysis software, such as RV ejection fraction (EF), body surface area-indexed end-diastolic (EDVi) and end-systolic (ESVi) volumes, free-wall longitudinal (RV GLS) and radial strains.
Results
After the follow-up, LV EF was 43 ± 8% in responders and 26 ± 7% in non-respoders (p < 0.0001). RV EF was significantly higher (EF: 44 ± 9%; p = 0.003) in responders compared to non-reponders (EF: 32 ± 9%). There was no significant difference in RV EDVi: 65 ml/m² (IQR: 54-74) in responders and 53 ml/m2 (IQR: 42-67) in non-responders (p = 0.22). RV ESVi was also comparable between CRT responders (37 ml/m² - IQR: 28-39) and non-responders (36 ml/m² - IQR: 28-46), (p = 0.85). RV GLS was significantly higher in CRT responders (-13 ± 3% vs. -10 ± 4% in non-responders; p = 0.02) in parallel with the change of the RV EF, while the RV radial strains did not differ between the two groups (2.5 ± 1.7% in responders vs. 2 ± 1% in non-responders; p = 0.47).
Conclusions
The lower RV EF based on mainly the longitudinal function of RV indicates non-respondence to CRT, however, it is not associated with RV dilation, i.e. adverse remodelling. These results suggest mechanical abnormality of RV function in the background of impaired EF.
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Affiliation(s)
- C Jenei
- University of Debrecen, MHSC-Faculty of Medicine, Institute of Cardiology, Department of Cardiology, Debrecen, Hungary
| | - A Toth
- University of Debrecen, MHSC-Faculty of Medicine, Institute of Cardiology, Department of Cardiology, Debrecen, Hungary
| | - L Nagy
- University of Debrecen, MHSC-Faculty of Medicine, Institute of Cardiology, Department of Cardiology, Debrecen, Hungary
| | - M Clemens
- University of Debrecen, MHSC-Faculty of Medicine, Institute of Cardiology, Department of Cardiology, Debrecen, Hungary
| | - E Papp
- University of Debrecen, MHSC-Faculty of Medicine, Institute of Cardiology, Department of Cardiology, Debrecen, Hungary
| | - Z Csanadi
- University of Debrecen, MHSC-Faculty of Medicine, Institute of Cardiology, Department of Cardiology, Debrecen, Hungary
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Csippa B, Üveges Á, Gyürki D, Jenei C, Tar B, Bugarin-Horváth B, Szabó GT, Komócsi A, Paál G, Kőszegi Z. Simplified coronary flow reserve calculations based on three-dimensional coronary reconstruction and intracoronary pressure data. Cardiol J 2021; 30:516-525. [PMID: 34622434 PMCID: PMC10508073 DOI: 10.5603/cj.a2021.0117] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Measurements of fractional flow reserve (FFR) and/or coronary flow reserve (CFR) are widely used for hemodynamic characterization of coronary lesions. The frequent combination of the epicardial and microvascular disease may indicate a need for complex hemodynamic evaluation of coronary lesions. This study aims at validating the calculation of CFR based on a simple hemodynamic model to detailed computational fluid dynamics (CFD) analysis. METHODS Three-dimensional (3D) morphological data and pressure values from FFR measurements were used to calculate the target vessel. Nine patients with one intermediate stenosis each, measured by pressure wire, were included in this study. RESULTS A correlation was found between the determined CFR from simple equations and from a steady flow simulation (r = 0.984, p < 10-5). There was a significant correlation between the CFR values calculated by transient and steady flow simulations (r = 0.94, p < 10-3). CONCLUSIONS Feasibility was demonstrated of a simple hemodynamic calculation of CFR based on 3D-angiography and intracoronary pressure measurements. A simultaneous determination of both the FFR and CFR values provides the capability to diagnose microvascular dysfunction: the CFR/FFR ratio characterizes the microvascular reserve.
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Affiliation(s)
- Benjamin Csippa
- Department of Hydrodynamic Systems, Budapest University of Technology and Economics, Budapest, Hungary
| | - Áron Üveges
- Division of Cardiology, Faculty of Medicine, University of Debrecen, Hungary
- Szabolcs-Szatmár-Bereg County Hospitals and University Teaching Hospital, Nyíregyháza, Hungary
- Kálmán Laki Doctoral School of Biomedical and Clinical Sciences, University of Debrecen, Hungary
| | - Dániel Gyürki
- Department of Hydrodynamic Systems, Budapest University of Technology and Economics, Budapest, Hungary
| | - Csaba Jenei
- Division of Cardiology, Faculty of Medicine, University of Debrecen, Hungary
- Kálmán Laki Doctoral School of Biomedical and Clinical Sciences, University of Debrecen, Hungary
| | - Balázs Tar
- Szabolcs-Szatmár-Bereg County Hospitals and University Teaching Hospital, Nyíregyháza, Hungary
- Kálmán Laki Doctoral School of Biomedical and Clinical Sciences, University of Debrecen, Hungary
| | - Balázs Bugarin-Horváth
- Szabolcs-Szatmár-Bereg County Hospitals and University Teaching Hospital, Nyíregyháza, Hungary
| | - Gábor Tamás Szabó
- Division of Cardiology, Faculty of Medicine, University of Debrecen, Hungary
- Kálmán Laki Doctoral School of Biomedical and Clinical Sciences, University of Debrecen, Hungary
| | - András Komócsi
- Heart Institute, Medical School, University of Pécs, Hungary
| | - György Paál
- Department of Hydrodynamic Systems, Budapest University of Technology and Economics, Budapest, Hungary
| | - Zsolt Kőszegi
- Division of Cardiology, Faculty of Medicine, University of Debrecen, Hungary.
- Szabolcs-Szatmár-Bereg County Hospitals and University Teaching Hospital, Nyíregyháza, Hungary.
- Kálmán Laki Doctoral School of Biomedical and Clinical Sciences, University of Debrecen, Hungary.
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Urbancsek R, Csanádi Z, Forgács IN, Papp TB, Boczán J, Barta J, Jenei C, Nagy L, Rudas L. Sympathetic activation in heart failure with reduced and mildly reduced ejection fraction: the role of aetiology. ESC Heart Fail 2021; 8:5112-5120. [PMID: 34492735 PMCID: PMC8712902 DOI: 10.1002/ehf2.13580] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 07/12/2021] [Accepted: 08/11/2021] [Indexed: 01/08/2023] Open
Abstract
Aim While sympathetic overactivity in heart failure (HF) with reduced ejection fraction (HFrEF; EF < 40%) is well‐documented, it is ill‐defined in patients with mildly reduced EF (HFmrEF; EF 40–49%). Furthermore, the significance of ischaemic versus non‐ischaemic aetiology in sympathetic activation is also unclear and has yet to be studied in HF. Our goal was to compare muscle sympathetic nerve activity (MSNA) in HFmrEF and HFrEF patients and in healthy subjects, as well as to elucidate the influence of the underlying disease. Methods and results Twenty‐three HFrEF (age 58 ± 10 years), 33 HFmrEF patients (age 61 ± 10 years), including 11 subjects with non‐ischaemic cardiomyopathy in each HF groups and 10 healthy controls (age 55 ± 10 years), were studied. MSNA—detected by peroneal microneurography, continuous arterial pressure, and ECG—was recorded. MSNA frequency (burst/min) and incidence (burst/100 cycles) were calculated. Association with the patients' characteristics were assessed, and aetiology‐based comparisons were performed. Burst frequency demonstrated a significant stepwise increase in both HFmrEF (41 ± 11 burst/min) and HFrEF (58 ± 17 burst/min, P < 0.001) patients as compared with controls (27 ± 9; P < 0.001 for both HF groups). Similarly, burst incidences were 66 ± 17, 82 ± 15, and 36 ± 10 burst/100 cycles in HFmrEF, HFrEF patients, and in healthy controls, respectively (P < 0.001 for all). Burst frequencies in HF patients showed significant correlation with NT‐proBNP levels, and significant inverse correlations with the subjects' mean RR intervals, stroke volumes, pulse pressures, and EF. Conclusions Muscle sympathetic nerve activity parameters indicated significant sympathetic activation in both HFmrEF and HFrEF patients as compared with healthy controls with no difference in relation to ischaemic versus non‐ischaemic aetiology.
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Affiliation(s)
- Réka Urbancsek
- Faculty of Medicine, Department of Cardiology, University of Debrecen, Móricz Zsigmond körút 22, Debrecen, 4032, Hungary
| | - Zoltán Csanádi
- Faculty of Medicine, Department of Cardiology, University of Debrecen, Móricz Zsigmond körút 22, Debrecen, 4032, Hungary
| | - Ildikó Noémi Forgács
- Faculty of Medicine, Department of Cardiology, University of Debrecen, Móricz Zsigmond körút 22, Debrecen, 4032, Hungary
| | - Tímea Bianka Papp
- Faculty of Medicine, Department of Cardiology, University of Debrecen, Móricz Zsigmond körút 22, Debrecen, 4032, Hungary
| | - Judit Boczán
- Faculty of Medicine, Department of Neurology, University of Debrecen, Debrecen, Hungary
| | - Judit Barta
- Faculty of Medicine, Department of Cardiology, University of Debrecen, Móricz Zsigmond körút 22, Debrecen, 4032, Hungary
| | - Csaba Jenei
- Faculty of Medicine, Department of Cardiology, University of Debrecen, Móricz Zsigmond körút 22, Debrecen, 4032, Hungary
| | - László Nagy
- Faculty of Medicine, Department of Cardiology, University of Debrecen, Móricz Zsigmond körút 22, Debrecen, 4032, Hungary
| | - László Rudas
- Department of Anaesthesiology and Intensive Care, University of Szeged, Szeged, Hungary
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Jenei C, Kádár R, Balogh L, Borbély A, Győry F, Péter A, Daragó A, Csanádi Z. Role of 3D echocardiography-determined atrial volumes in distinguishing between pre-capillary and post-capillary pulmonary hypertension. ESC Heart Fail 2021; 8:3975-3983. [PMID: 34184427 PMCID: PMC8497217 DOI: 10.1002/ehf2.13496] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 05/03/2021] [Accepted: 06/16/2021] [Indexed: 11/10/2022] Open
Abstract
Aims The current guidelines on pulmonary hypertension (PH) recommend the use of invasive examination for differentiating between left‐sided heart disease‐related (post‐capillary) and pre‐capillary PH. However, atrial sizes are considered markers of ventricular filling pressures. Therefore, we aimed to test the clinical applicability of atrial volumes measured by transthoracic three‐dimensional echocardiography (3DE) in differentiating between pre‐capillary and post‐capillary PH. Methods and results Seventy‐five consecutive patients with PH were prospectively examined with transthoracic 3DE. After less than 24 h, the patients underwent right heart catheterization and 3DE and were classified as pre‐capillary or post‐capillary PH according to the recommendations of the ESC guidelines. The atrial volumes were measured offline with dedicated commercial software. Thirty‐eight patients (13 men, age 65 ± 18 year) had pre‐capillary PH, and 37 (23 men, age 62 ± year) had post‐capillary PH. The mean pulmonary artery pressures were similar in patients with pre‐capillary and post‐capillary PH (38 [IQR 26, 54] mmHg vs. 41 [IQR 33, 48] mmHg, respectively, P = 0.49). The left atrial indexed maximum (LAVi max) and minimum (LAVi min) volumes were significantly larger in the post‐capillary PH patient group than in the pre‐capillary PH patient group (LAVi max: 64 ± 32 mL/m2 vs. 41 ± 25 mL/m2, P = 0.001; LAVi min: 50 ± 22 mL/m2 vs. 26 ± 24 mL/m2, P < 0.0001). The indexed right atrial minimum volume (RAVi min) was also higher in patients with post‐capillary PH (51 ± 27 mL/m2 vs. 38 ± 26 mL/m2; P = 0.02). Both the left atrial (LA) and right atrial (RA) volumes, especially the LA minimum volume, correlated with the pulmonary artery wedge pressure (PAWP) (r = 0.62 (P < 0.0001) for LAV min vs. r = 0.49 (P < 0.0001) for LAV max; r = 0.32 (P = 0.005) for RAV min vs. r = 0.24 (P = 0.04) for RAV max). Multivariate logistic regression analysis showed that LAVi min was an independent predictor of post‐capillary PH. In the receiver operating characteristic (ROC) curves of parameters predicting the post‐capillary PH, the areas under the curve (AUC) for LAVi min, LAVi max, and RAVi min were 0.86 (95% CI, 0.76–0.95), 0.78 (95% CI, 0.67–0.89), and 0.66 (0.53–0.78), respectively. Concerning the performance of the atrial volume ratio for differentiating post‐capillary PH, the AUC of the atrial volume ratio was significantly lower [AUC: 0.66 (95% CI, 0.53–0.78)]. The ROC analysis indicated a possible cutoff value of 27.7 mL/m2 for LAVi min to predict post‐capillary PH (AUC = 0.86; sensitivity = 86%, specificity = 76%). Conclusions The BSA‐indexed left atrial minimum volume measured by transthoracic 3DE is a useful parameter for differentiating pre‐capillary from post‐capillary pulmonary hypertension.
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Affiliation(s)
- Csaba Jenei
- Department of Cardiology and Cardiac Surgery, University of Debrecen, Debrecen, Hungary
| | - Rebeka Kádár
- Department of Radiology (Medical Imaging Clinic), University of Debrecen, Debrecen, Hungary
| | - László Balogh
- Department of Cardiology and Cardiac Surgery, University of Debrecen, Debrecen, Hungary
| | - Attila Borbély
- Department of Cardiology and Cardiac Surgery, University of Debrecen, Debrecen, Hungary
| | - Ferenc Győry
- Department of Cardiology and Cardiac Surgery, University of Debrecen, Debrecen, Hungary
| | - Andrea Péter
- Department of Cardiology and Cardiac Surgery, University of Debrecen, Debrecen, Hungary
| | - Andrea Daragó
- Department of Cardiology and Cardiac Surgery, University of Debrecen, Debrecen, Hungary
| | - Zoltán Csanádi
- Department of Cardiology and Cardiac Surgery, University of Debrecen, Debrecen, Hungary
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9
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Szabó GT, Üveges Á, Tar B, Ágoston A, Dorj A, Jenei C, Kolozsvári R, Csippa B, Czuriga D, Kőszegi Z. The Holistic Coronary Physiology Display: Calculation of the Flow Separation Index in Vessel-Specific Individual Flow Range during Fractional Flow Reserve Measurement Using 3D Coronary Reconstruction. J Clin Med 2021; 10:jcm10091910. [PMID: 33924961 PMCID: PMC8124623 DOI: 10.3390/jcm10091910] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 03/15/2021] [Revised: 04/19/2021] [Accepted: 04/25/2021] [Indexed: 12/25/2022] Open
Abstract
In order to make optimal decisions on the treatment of atherosclerotic coronary heart disease (CHD), appropriate evaluation is necessary, including both the anatomical and physiological assessment of the coronary arteries. According to current guidelines, a fractional flow reserve (FFR)-based clinical decision is recommended, but coronary flow reserve (CFR) measurements and microvascular evaluation should also be considered in special cases for a detailed exploration of the coronary disease state. We aimed to generate an extended physiological evaluation during routine FFR measurement and define a new pathological flow-related prognostic factor. Fluid dynamic equations were applied to calculate CFR on the basis of the three-dimensional (3D) reconstruction of the invasively acquired coronary angiogram and the measured intracoronary pressure data. A new, potentially robust prognostic parameter of a coronary lesion called the "flow separation index" (FSi), which is thought to detect the pathological flow amount through a stenosis was introduced in a vessel-specific flow range. Correlations between FSi and the clinically established physiological indices (CFR and FFR) were determined. The FSi was calculated in 19 vessels of 16 patients, including data from the pre- and post-stent revascularization treatment of 3 patients. There was no significant correlation between the FSi and the CFR (r = -0.23, p = 0.34); however, there was significant negative correlation between the FSi and the FFR (r = -0.66, p = 0.002). An even stronger correlation was found between the FSi and the ratio of the resting pressure ratio and the FFR (r = 0.92, p < 0.0001). The diagnostic power of the FSi for predicting the FFR value of <0.80, as a gold standard prognostic factor, was tested by receiver operating characteristic analysis. FSi > 0.022 proved to be the cutoff value of the prediction of a pathologically low FFR with a 0.856 area under the curve (95% confidence interval: 0.620 to 0.972). The present flow-pressure-velocity display provides a comprehensive summary of patient-specific pathophysiology in CHD. The consequences of epicardial stenoses can be evaluated together with their complex relations to microvascular conditions. Based on these values, clinical decision-making concerning both pharmacological therapy and percutaneous or surgical revascularization may be more precisely guided.
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Affiliation(s)
- Gábor Tamás Szabó
- Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Móricz Zs. krt. 22, 4032 Debrecen, Hungary; (G.T.S.); (A.D.); (C.J.); (R.K.); (D.C.)
- Kálmán Laki Doctoral School of Biomedical and Clinical Sciences, University of Debrecen, 4032 Debrecen, Hungary; (Á.Ü.); (B.T.); (A.Á.)
| | - Áron Üveges
- Kálmán Laki Doctoral School of Biomedical and Clinical Sciences, University of Debrecen, 4032 Debrecen, Hungary; (Á.Ü.); (B.T.); (A.Á.)
- Szabolcs–Szatmár–Bereg County Hospitals and University Teaching Hospital, 4400 Nyíregyháza, Hungary
| | - Balázs Tar
- Kálmán Laki Doctoral School of Biomedical and Clinical Sciences, University of Debrecen, 4032 Debrecen, Hungary; (Á.Ü.); (B.T.); (A.Á.)
- Szabolcs–Szatmár–Bereg County Hospitals and University Teaching Hospital, 4400 Nyíregyháza, Hungary
| | - András Ágoston
- Kálmán Laki Doctoral School of Biomedical and Clinical Sciences, University of Debrecen, 4032 Debrecen, Hungary; (Á.Ü.); (B.T.); (A.Á.)
- Szabolcs–Szatmár–Bereg County Hospitals and University Teaching Hospital, 4400 Nyíregyháza, Hungary
| | - Azzaya Dorj
- Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Móricz Zs. krt. 22, 4032 Debrecen, Hungary; (G.T.S.); (A.D.); (C.J.); (R.K.); (D.C.)
| | - Csaba Jenei
- Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Móricz Zs. krt. 22, 4032 Debrecen, Hungary; (G.T.S.); (A.D.); (C.J.); (R.K.); (D.C.)
- Kálmán Laki Doctoral School of Biomedical and Clinical Sciences, University of Debrecen, 4032 Debrecen, Hungary; (Á.Ü.); (B.T.); (A.Á.)
| | - Rudolf Kolozsvári
- Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Móricz Zs. krt. 22, 4032 Debrecen, Hungary; (G.T.S.); (A.D.); (C.J.); (R.K.); (D.C.)
- Kálmán Laki Doctoral School of Biomedical and Clinical Sciences, University of Debrecen, 4032 Debrecen, Hungary; (Á.Ü.); (B.T.); (A.Á.)
| | - Benjamin Csippa
- Department of Hydrodynamic Systems, Budapest University of Technology and Economics, 1111 Budapest, Hungary;
| | - Dániel Czuriga
- Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Móricz Zs. krt. 22, 4032 Debrecen, Hungary; (G.T.S.); (A.D.); (C.J.); (R.K.); (D.C.)
- Kálmán Laki Doctoral School of Biomedical and Clinical Sciences, University of Debrecen, 4032 Debrecen, Hungary; (Á.Ü.); (B.T.); (A.Á.)
| | - Zsolt Kőszegi
- Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Móricz Zs. krt. 22, 4032 Debrecen, Hungary; (G.T.S.); (A.D.); (C.J.); (R.K.); (D.C.)
- Kálmán Laki Doctoral School of Biomedical and Clinical Sciences, University of Debrecen, 4032 Debrecen, Hungary; (Á.Ü.); (B.T.); (A.Á.)
- Szabolcs–Szatmár–Bereg County Hospitals and University Teaching Hospital, 4400 Nyíregyháza, Hungary
- Correspondence: ; Tel./Fax: +36-52-255928
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10
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Tar B, Jenei C, Üveges Á, Szabó GT, Ágoston A, Dézsi CA, Komócsi A, Czuriga D, Juhász A, Kőszegi Z. Hyperemic contrast velocity assessment improves accuracy of the image-based fractional flow reserve calculation. Cardiol J 2020; 28:163-165. [PMID: 33140387 DOI: 10.5603/cj.a2020.0144] [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: 07/29/2020] [Accepted: 10/13/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- Balázs Tar
- III. Department of Internal Medicine, Szabolcs - Szatmár - Bereg County Hospitals and University Teaching Hospital, Szent István út 68., 4400 Nyíregyháza, Hungary
| | - Csaba Jenei
- Institute of Cardiology, University of Debrecen Medical Center, Móricz Zs. krt. 22., 4032 Debrecen, Hungary
| | - Áron Üveges
- Institute of Cardiology, University of Debrecen Medical Center, Móricz Zs. krt. 22., 4032 Debrecen, Hungary
| | - Gábor Tamás Szabó
- Institute of Cardiology, University of Debrecen Medical Center, Móricz Zs. krt. 22., 4032 Debrecen, Hungary
| | - András Ágoston
- III. Department of Internal Medicine, Szabolcs - Szatmár - Bereg County Hospitals and University Teaching Hospital, Szent István út 68., 4400 Nyíregyháza, Hungary
| | | | - András Komócsi
- Heart Institute, Medical School, University of Pécs, Pécs, Hungary
| | - Dániel Czuriga
- Institute of Cardiology, University of Debrecen Medical Center, Móricz Zs. krt. 22., 4032 Debrecen, Hungary
| | - Attila Juhász
- GE Healthcare Limited, Pharmaceutical Diagnostics, Pollards Wood, United Kingdom
| | - Zsolt Kőszegi
- Institute of Cardiology, University of Debrecen Medical Center, Móricz Zs. krt. 22., 4032 Debrecen, Hungary.
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11
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Jenei C, Nagy L, Urbancsek R, Czuriga D, Csanadi Z. Three-Dimensional Echocardiographic Method for the Visualization and Assessment of Specific Parameters of the Pulmonary Veins. J Vis Exp 2020. [PMID: 33191923 DOI: 10.3791/61215] [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: 10/31/2022] Open
Abstract
The dimensions of the pulmonary veins are important parameters when planning pulmonary vein isolation (PVI), especially with the cryoballoon ablation technique. Acknowledging the dimensions and anatomical variations of the pulmonary veins (PVs) may improve the outcome of the intervention. Conventional 2D transoesophageal echocardiography can only provide limited data about the dimensions of the PVs; however, 3D echocardiography can further evaluate relevant diameters and areas of the PVs, as well as their spatial relationship to surrounding structures. In previous literature data, parameters influencing the success rate of PVI have already been identified. These are the left lateral ridge, the intervenous ridge, the ostial area of the PVs and the ovality index of the ostium. Proper imaging of the PVs by 3D echocardiography is a technically challenging method. One crucial step is the collection of images. Three individual transducer positions are necessary to visualize the important structures; these are the left lateral ridge, the ostium of the PVs and the intervenous ridge of the left and right PVs. Next, 3D images are acquired and saved as digital loops. These datasets are cropped, which result in the en face views displaying spatial relationships. This step can also be employed to determine the anatomical variations of the PVs. Finally, multiplanar reconstructions are created to measure each individual parameter of the PVs. Optimal quality and orientation of the acquired images are paramount for the appropriate assessment of PV anatomy. In the present work, we examined the 3D visibility of the PVs and the suitability of the above method in 80 patients. The aim was to provide a detailed outline of the essential steps and potential pitfalls of PV visualization and assessment with 3D echocardiography.
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Affiliation(s)
- Csaba Jenei
- Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen;
| | - Laszlo Nagy
- Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen
| | - Reka Urbancsek
- Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen
| | - Daniel Czuriga
- Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen
| | - Zoltan Csanadi
- Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen
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12
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Üveges Á, Tar B, Jenei C, Czuriga D, Papp Z, Csanádi Z, Kőszegi Z. The impact of hydrostatic pressure on the result of physiological measurements in various coronary segments. Int J Cardiovasc Imaging 2020; 37:5-14. [PMID: 32804319 PMCID: PMC7878210 DOI: 10.1007/s10554-020-01971-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 03/25/2020] [Accepted: 08/12/2020] [Indexed: 12/03/2022]
Abstract
The effect of hydrostatic pressure on physiological intracoronary measurements is usually ignored in the daily clinical practice. Our aim was to investigate this effect on Pd/Pa (distal/aortic pressure) and FFR (fractional flow reserve). 41 FFR measurements between 0.7 and 0.9 were selected. The difference in the height of the orifice and that of the sensor was defined in mm on the basis of 3D coronary reconstruction. Resting Pd/Pa and FFR were adjusted by subtracting the hydrostatic pressure gradient from the distal pressure. Height measurements were also performed from 2D lateral projections for each coronary segment (n = 305). In case of the LAD, each segment was located higher (proximal: − 13.69 ± 5.4; mid: − 46.13 ± 6.1; distal: − 56.80 ± 7.7 mm), whereas for the CX, each segment was lower (proximal: 14.98 ± 8.3; distal: 28.04 ± 6.3 mm) compared to the orifice. In case of the RCA, the distances from the orifice were much less (proximal: − 6.39 ± 2.9; mid: − 6.86 ± 7.0; distal: 17.95 ± 6.6 mm). The effect of these distances on pressure ratios at 100 Hgmm aortic pressure was between − 0.044 and 0.023. The correction for height differences changed the interpretation of the measurement (negative/positive result) in 5 (12%) and 11 (27%) cases for the FFR (cut-off value at 0.80) and the resting Pd/Pa (cut-off value at 0.92), respectively. The clinical implementation of hydrostatic pressure calculation should be considered during intracoronary pressure measurements. A correction for this parameter may become crucial in case of a borderline significant coronary artery stenosis, especially in distal coronary artery segments.
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Affiliation(s)
- Áron Üveges
- Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary. .,III. Department of Internal Medicine, Szabolcs-Szatmár-Bereg County Hospitals and University Teaching Hospital, 68. Szent István Street, Nyíregyháza, 4400, Hungary. .,Kálmán Laki Doctoral School of Biomedical and Clinical Sciences, University of Debrecen, Debrecen, Hungary.
| | - Balázs Tar
- III. Department of Internal Medicine, Szabolcs-Szatmár-Bereg County Hospitals and University Teaching Hospital, 68. Szent István Street, Nyíregyháza, 4400, Hungary.,Kálmán Laki Doctoral School of Biomedical and Clinical Sciences, University of Debrecen, Debrecen, Hungary
| | - Csaba Jenei
- Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,Kálmán Laki Doctoral School of Biomedical and Clinical Sciences, University of Debrecen, Debrecen, Hungary
| | - Dániel Czuriga
- Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,Kálmán Laki Doctoral School of Biomedical and Clinical Sciences, University of Debrecen, Debrecen, Hungary
| | - Zoltán Papp
- Kálmán Laki Doctoral School of Biomedical and Clinical Sciences, University of Debrecen, Debrecen, Hungary.,Division of Clinical Physiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zoltán Csanádi
- Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,Kálmán Laki Doctoral School of Biomedical and Clinical Sciences, University of Debrecen, Debrecen, Hungary
| | - Zsolt Kőszegi
- Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,III. Department of Internal Medicine, Szabolcs-Szatmár-Bereg County Hospitals and University Teaching Hospital, 68. Szent István Street, Nyíregyháza, 4400, Hungary.,Kálmán Laki Doctoral School of Biomedical and Clinical Sciences, University of Debrecen, Debrecen, Hungary
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13
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Jenei C, Papp E, Clemens M, Csanadi Z. P797 Assessment of right ventricular systolic function with 3D echocardiography following cardiac resynchronization therapy. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.453] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
In approximately 30-40% of cases, the left ventricular systolic function does not improve following cardiac resynchronization therapy (CRT; non-responders). Currently, the role of right ventricular (RV) systolic function is not yet completely clear in the background. Our aim was to assess the RV systolic function with 3D echocardiography in CRT patients.
Methods
We selected 19 patients who received CRT in our department between May and June 2017, and whose 1-year follow-up data were available. We characterized several 2D parameters of RV systolic function, such as RV free wall strain (RV GLSFW), annular s’ wave velocity (TDI s), tricuspid annulus plane systolic excursion (TAPSE), RV fractional area change (RV FAC). A number of 3D parameters were also assessed, such as RV ejection fraction (EF), end-diastolic (EDV) and end-systolic (ESV) volumes, using a dedicated RV analysis software. Moreover, we measured the LV EF and considered the patients "responder", when the LV EF improved with at least 10% after CRT implantation.
Results
From 19 patients, 12 was identified as responders (R) and 7 as non-responders (NR). No significant difference was seen in the mean age of patients in the two groups (NR: 68 ± 6 year; R: 67 ± 9 year, p = 0.76), however, the proportion of male individuals was higher in the NR group (8/12 vs. 1/7). The RV EF was higher in the R group (41 ± 8% vs.29 ± 10%; p = 0.012), while the EDV or ESV did not differ between the two groups. The RV GLSFW (–21.2 ± 7% vs.–13.9 ± 7%, p = 0.045) and the TAPSE (16.8 ± 5 mm vs.11.4 ± 3 mm, P = 0.03) values were significantly different between the two groups. Based on logistic regression analysis, the RV EF was an independent predictor of non-respondence.
Conclusions
The lower RV EF indicates non-respondence to CRT, however, it is not associated with RV dilation, i.e.adverse remodelling. These results suggest mechanical abnormality of RV function in the background of impaired EF.
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Affiliation(s)
- C Jenei
- University of Debrecen, MHSC-Faculty of Medicine, Institute of Cardiology, Department of Cardiology, Debrecen, Hungary
| | - E Papp
- University of Debrecen, MHSC-Faculty of Medicine, Institute of Cardiology, Department of Cardiology, Debrecen, Hungary
| | - M Clemens
- University of Debrecen, MHSC-Faculty of Medicine, Institute of Cardiology, Department of Cardiology, Debrecen, Hungary
| | - Z Csanadi
- University of Debrecen, MHSC-Faculty of Medicine, Institute of Cardiology, Department of Cardiology, Debrecen, Hungary
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14
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Jenei C, Kadar R, Clemens M, Csanadi Z. P335 Evaluation of systolic right ventricular function with 3D echocardiography in patients with isolated right ventricular pacing induced left ventricle dysfunction. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.188] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Right ventricular (RV) pacing may worsen left ventricular (LV) systolic function causing heart failure, but the exact mechanism of the LV dysfunction is unknown. The purpose of this study was to examine the right ventricle by three-dimensional echocardiography in patients with LV dysfunction accompanied by long-term RV pacing.
Methods
We analysed consecutive patients receiving permanent pacemaker (PPM) due to atrioventricular block from 2015 January to 2017 March (n = 335). During the mean follow-up period (27 months) 4 patients were selected with at least 5% decrease in the LV ejection fraction measured by two-dimensional echocardiography (B group). Control (K) group contains 4 age-, sex-, concomitant disease matched patients without the sign of LV dysfunction from the same time interval. Right ventricle function was assessed by 3D echocardiography.
Results
In both groups, there were 3 men, and the mean age was similar (B: 68 ± 6 y vs. K: 66 ± 10 y; p = 0.65). Right ventricular ejection fraction (EF) was significantly higher in controls compared to patients (K: 49 ± 7.8% vs. B: 36 ± 3.1%; p = 0.02), while the right ventricular volumes [end-systolic (K: 79 ± 47 ml vs. B: 71 ± 7 ml; p = 0.77), end-diastolic (K: 151 ± 73 ml vs. B: 111 ± 11 ml; p = 0.36) and stroke volumes (K: 58 ± 44 ml vs. B: 40 ± 6 ml; p = 0.5)] did not differ significantly. We did not find any important differences between the groups regarding the permanent right ventricle pace rate (K: 93 ± 5.6% vs. B: 84 ± 19.5%; p = 0.5), systolic pulmonary pressure (K: 34 ± 6 mmHg vs. B: 35 ± 18 mmHg; p = 0.92), or the severity of tricuspid regurgitation.
Conclusion
The left ventricular dysfunction after permanent right ventricular pacing results in right ventricular systolic dysfunction. The decrease of RV ejection fraction is not associated with RV enlargement or increase of pulmonary pressure.
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Affiliation(s)
- C Jenei
- University of Debrecen, MHSC-Faculty of Medicine, Institute of Cardiology, Department of Cardiology, Debrecen, Hungary
| | - R Kadar
- University of Debrecen, MHSC-Faculty of Medicine, Institute of Cardiology, Department of Cardiology, Debrecen, Hungary
| | - M Clemens
- University of Debrecen, MHSC-Faculty of Medicine, Institute of Cardiology, Department of Cardiology, Debrecen, Hungary
| | - Z Csanadi
- University of Debrecen, MHSC-Faculty of Medicine, Institute of Cardiology, Department of Cardiology, Debrecen, Hungary
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15
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Üveges Á, Jenei C, Kiss T, Szegedi Z, Tar B, Szabó GT, Czuriga D, Kőszegi Z. Three-dimensional evaluation of the spatial morphology of stented coronary artery segments in relation to restenosis. Int J Cardiovasc Imaging 2019; 35:1755-1763. [PMID: 31127455 PMCID: PMC6773821 DOI: 10.1007/s10554-019-01628-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 01/11/2019] [Accepted: 05/13/2019] [Indexed: 11/30/2022]
Abstract
To investigate the correlations between the three-dimensional (3D) parameters of target coronary artery segments and restenosis after stent implantation. Sixty-four patients after single, cobalt chromium platform stent (27 BM stents and 37 DES) implantation were investigated retrospectively 12 ± 6 months after the index procedure. 3D coronary artery reconstruction was performed before and after the stent implantation using appropriate projections by a dedicated reconstruction software. The curve of the target segment was characterized by the ratio of the vessel length measured at midline (arc: A) and the distance between the edge points of the stent (chord: C): A/C ratio (ACr). Age, diabetes and hyperlipidaemia were taken into account for the statistical evaluation. 22 patients were diagnosed with ISR, while 42 patients without any restenosis served as controls. The two groups did not differ regarding major cardiovascular risk factors, proportion of the treated vessels or the type of stents. Higher initial ACr values were associated with greater straightening of the vessel curvature in all groups (p < 0.001). Significant negative correlations were found in cases of proximal or distal edge bending angles (p < 0.001). Pre-stent edge bending angles < 7° often showed an increase after the stent implantation, while in case of higher initial values, the bending angles generally decreased. Using multivariate logistic regression modelling we found that the pre-stent ACr was an independent predictor of in-stent restenosis (odds ratio for 1% increase of the ACr: 1.08; p = 0.012). Changes of angles at the stent edges following stent implantation correlate with the initial local bending angles. The ACr predispose to chronic shear stress in the vessel wall, which may contribute to the pathological intimal proliferation.
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Affiliation(s)
- Áron Üveges
- Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary. .,Szabolcs - Szatmár - Bereg County Hospitals and University Teaching Hospital, Nyíregyháza, Hungary.
| | - Csaba Jenei
- Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Tibor Kiss
- Szabolcs - Szatmár - Bereg County Hospitals and University Teaching Hospital, Nyíregyháza, Hungary
| | - Zoltán Szegedi
- Szabolcs - Szatmár - Bereg County Hospitals and University Teaching Hospital, Nyíregyháza, Hungary
| | - Balázs Tar
- Szabolcs - Szatmár - Bereg County Hospitals and University Teaching Hospital, Nyíregyháza, Hungary
| | - Gábor Tamás Szabó
- Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Dániel Czuriga
- Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zsolt Kőszegi
- Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,Szabolcs - Szatmár - Bereg County Hospitals and University Teaching Hospital, Nyíregyháza, Hungary
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16
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Tar B, Jenei C, Dezsi CA, Bakk S, Beres Z, Santa J, Svab M, Szentes V, Polgar P, Bujaky C, Czuriga D, Kőszegi Z. Less invasive fractional flow reserve measurement from 3-dimensional quantitative coronary angiography and classic fluid dynamic equations. EUROINTERVENTION 2018; 14:942-950. [DOI: 10.4244/eij-d-17-00859] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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17
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Koszegi Z, Bugarin-Horvath B, Uveges A, Tar B, Jenei C, Szabo GT, Csanadi Z. P1713Calculation of coronary flow reserve by intracoronary pressure measurement and three-dimensional coronary angiography data. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1713] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Z Koszegi
- University of Debrecen, MHSC-Faculty of Medicine, Institute of Cardiology, Department of Cardiology, Debrecen, Hungary
| | | | - A Uveges
- University of Debrecen, MHSC-Faculty of Medicine, Institute of Cardiology, Department of Cardiology, Debrecen, Hungary
| | - B Tar
- Jόsa András Teaching Hospital, Nyíregyháza, Hungary
| | - C Jenei
- University of Debrecen, MHSC-Faculty of Medicine, Institute of Cardiology, Department of Cardiology, Debrecen, Hungary
| | - G T Szabo
- University of Debrecen, MHSC-Faculty of Medicine, Institute of Cardiology, Department of Cardiology, Debrecen, Hungary
| | - Z Csanadi
- University of Debrecen, MHSC-Faculty of Medicine, Institute of Cardiology, Department of Cardiology, Debrecen, Hungary
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18
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Koszegi Z, Kiss B, Sipos D, Jenei C, Szabo GT, Dezsi CA, Maros T, Szerafin T. P2695Comparing the shear stress in degenerated and intact venous grafts from the same patients. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2695] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Z Koszegi
- University of Debrecen, MHSC-Faculty of Medicine, Institute of Cardiology, Department of Cardiology, Debrecen, Hungary
| | - B Kiss
- University of Debrecen, MHSC-Faculty of Medicine, Institute of Cardiology, Department of Cardiology, Debrecen, Hungary
| | - D Sipos
- University of Debrecen, MHSC-Faculty of Medicine, Institute of Cardiology, Department of Cardiology, Debrecen, Hungary
| | - C Jenei
- University of Debrecen, MHSC-Faculty of Medicine, Institute of Cardiology, Department of Cardiology, Debrecen, Hungary
| | - G T Szabo
- University of Debrecen, MHSC-Faculty of Medicine, Institute of Cardiology, Department of Cardiology, Debrecen, Hungary
| | - C A Dezsi
- Petz Aladar County Teaching Hospital, Gyor, Hungary
| | - T Maros
- University of Debrecen, MHSC-Faculty of Medicine, Institute of Cardiology, Department of Cardiology, Debrecen, Hungary
| | - T Szerafin
- University of Debrecen, MHSC-Faculty of Medicine, Institute of Cardiology, Department of Cardiology, Debrecen, Hungary
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Úri K, Fagyas M, Kertész A, Borbély A, Jenei C, Bene O, Csanádi Z, Paulus WJ, Édes I, Papp Z, Tóth A, Lizanecz E. Circulating ACE2 activity correlates with cardiovascular disease development. J Renin Angiotensin Aldosterone Syst 2016; 17:17/4/1470320316668435. [PMID: 27965422 PMCID: PMC5843890 DOI: 10.1177/1470320316668435] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [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: 05/05/2016] [Accepted: 08/05/2016] [Indexed: 12/17/2022] Open
Abstract
It was shown recently that angiotensin-converting enzyme activity is limited by endogenous inhibition in vivo, highlighting the importance of angiotensin II (ACE2) elimination. The potential contribution of the ACE2 to cardiovascular disease progression was addressed. Serum ACE2 activities were measured in different clinical states (healthy, n=45; hypertensive, n=239; heart failure (HF) with reduced ejection fraction (HFrEF) n=141 and HF with preserved ejection fraction (HFpEF) n=47). ACE2 activity was significantly higher in hypertensive patients (24.8±0.8 U/ml) than that in healthy volunteers (16.2±0.8 U/ml, p=0.01). ACE2 activity further increased in HFrEF patients (43.9±2.1 U/ml, p=0.001) but not in HFpEF patients (24.6±1.9 U/ml) when compared with hypertensive patients. Serum ACE2 activity negatively correlated with left ventricular systolic function in HFrEF, but not in hypertensive, HFpEF or healthy populations. Serum ACE2 activity had a fair diagnostic value to differentiate HFpEF from HFrEF patients in this study. Serum ACE2 activity correlates with cardiovascular disease development: it increases when hypertension develops and further increases when the cardiovascular disease further progresses to systolic dysfunction, suggesting that ACE2 metabolism plays a role in these processes. In contrast, serum ACE2 activity does not change when hypertension progresses to HFpEF, suggesting a different pathomechanism for HFpEF, and proposing a biomarker-based identification of these HF forms.
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Affiliation(s)
- Katalin Úri
- Department of Clinical Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Miklós Fagyas
- Department of Clinical Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,Department of Cardiology, Institute of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Attila Kertész
- Department of Cardiology, Institute of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Attila Borbély
- Department of Cardiology, Institute of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Csaba Jenei
- Department of Cardiology, Institute of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Orsolya Bene
- Department of Cardiology, Institute of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zoltán Csanádi
- Department of Cardiology, Institute of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Walter J Paulus
- Department of Physiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, the Netherlands
| | - István Édes
- Department of Cardiology, Institute of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zoltán Papp
- Department of Clinical Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Attila Tóth
- Department of Clinical Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Erzsébet Lizanecz
- Department of Clinical Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary .,Department of Cardiology, Institute of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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20
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Jenei C, Balogh E, Szabó GT, Dézsi CA, Kőszegi Z. Wall shear stress in the development of in-stent restenosis revisited. A critical review of clinical data on shear stress after intracoronary stent implantation. Cardiol J 2016; 23:365-73. [PMID: 27439365 DOI: 10.5603/cj.a2016.0047] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 01/27/2016] [Revised: 07/20/2016] [Accepted: 06/13/2016] [Indexed: 11/25/2022] Open
Abstract
The average wall shear stress (WSS) is in 1 Pa range in coronary arteries, while the stretching effect of an implanted coronary stent can generate up to 3 × 105 times higher circumferential stress in the vessel wall. It is widely accepted that WSS plays a critical role in the development of restenosis after coronary stent implantation, but relevant clinical endpoint studies are lack-ing. Fluid dynamics modeling suggests an association between WSS and intimal hyperplasia, however, such an association is not established when the compensating healing process becomes an overshoot phenomenon. This review summarizes available clinical results and concepts of potential clinical importance.
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Muraru D, Spadotto V, Cecchetto A, Romeo G, Aruta P, Ermacora D, Jenei C, Cucchini U, Iliceto S, Badano LP. New speckle-tracking algorithm for right ventricular volume analysis from three-dimensional echocardiographic data sets: validation with cardiac magnetic resonance and comparison with the previous analysis tool. Eur Heart J Cardiovasc Imaging 2015; 17:1279-1289. [DOI: 10.1093/ehjci/jev309] [Citation(s) in RCA: 131] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 10/26/2015] [Indexed: 01/05/2023] Open
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Kracskó B, Garai I, Barna S, Szabó GT, Rácz I, Kolozsvári R, Tar B, Jenei C, Varga J, Kõszegi Z. Relationship between reversibility score on corresponding left ventricular segments and fractional flow reserve in coronary artery disease. Anatol J Cardiol 2015; 15:469-74. [PMID: 25430413 PMCID: PMC5779139 DOI: 10.5152/akd.2014.5500] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: The objective of this study was to find the correlation between the severity of perfusion abnormality detected by scintigraphy and the FFR value, as well as the localization of a particular coronary lesion. On the basis of FFR values and the corresponding left ventricular segments, we proposed a combined index to aim for better correlation with myocardial ischemia than the FFR parameter alone. Methods: Twenty-eight patients (male: 22, female: 6, age 62±7.62) having FFR measurements and myocardial perfusion SPECT studies were enrolled in our retrospective analysis. FFR measurements on 36 vessels (20 LAD, 6 LCx, 10 RCA) with intermediate stenosis (40%-60%) were compared to the Tc-99m SestaMIBI myocardial perfusion SPECT studies. SPECT studies were performed before the invasive procedure in all cases. We introduced a new ischemic index, the left ventricular ischemic index (LVIi), by combining FFR values with the number of corresponding myocardial segments (N) [LVIi=N x (1-FFR)]. This index correlated with the regional myocardial perfusion defects identified on the scintigrams. A perfusion reversibility score of 2 or above was considered indicative of active ischemia (regional difference score: rDSc). For the statistical analysis, we used linear regression analysis and receiver operating characteristic (ROC) curve analysis to compare the different parameters. Results: A close linear relationship was found between the LVIi and rDSc values (p<0.001) with linear regression analysis. When analyzing all FFR values independently of the localization of the lesions, they also correlated significantly to the rDSc, but this relation was not as close. LVIi predicted active ischemia (≥2 rDSc) on myocardial scintigraphy with 78% sensitivity and 94% specificity when the cutoff value was set to 0.96. FFR alone predicted ischemia on scintigraphy with 72% sensitivity and 94% specificity at the best 0.8 cut-off value. The area under the ROC curve was significantly higher for LVIi than FFR (0.94 vs. 0.87; p<0.05). Conclusion: The scintigraphic data indicate that an LVIi >0.96 implies a clinically relevant stenotic lesion. In our opinion, FFR values, weighted with the corresponding left ventricular segments, should be taken into consideration for the best clinical decision-making.
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Affiliation(s)
- Bertalan Kracskó
- Institute of Cardiology, University of Debrecen Clinical Center; Debrecen-Hungary.
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23
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Köszegi Z, Szük T, Vajda G, Marty F, Jenei C. Optical coherence tomography imaging of intrastent neointimal bridge caused by semicircumferencial dissection after drug eluting balloon dilatation of instent restenosis of sapheneous venous graft. ACTA ACUST UNITED AC 2014; 14:E5. [PMID: 24566488 DOI: 10.5152/akd.2014.5200] [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] [Indexed: 11/22/2022]
Affiliation(s)
- Zsolt Köszegi
- Institute of Cardiology, University of Debrecen, Debrecen-Hungary.
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Koiss R, Babarczi E, Jenei C, Göcze P, Horányi D, Siklós P. Repeat conisation or HPV test? What should be done if histology of the primary conisation requires a second conisation? EUR J GYNAECOL ONCOL 2012; 33:134-137. [PMID: 22611949] [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
OBJECTIVE In our retrospective study we focused on the sensitivity of HPV DNA testing towards reducing the number of repeat (re)conisations. Is the second HPV test (pre repeat conisation) an appropriate method to reduce the number of interventions in histologically positive cases? STUDY 438 cervical conisations--loop electrosurgical excision procedure (LEEP)--were performed between March 2008 and August 2010 at our Gynaecology Department. Samples for high-risk HPV testing (Genoid, Hungary) were taken from the surface of the cervix and from the cervical canal before the LEEP procedure, and histopathological examinations were performed. Margin positivity was the indication for re-conisation (re-LEEP). RESULTS 119 (27.2%) out of 438 cases were re-conisations. In cases of histologically proven residual dysplasia (29 of 119) high-risk HPV infection was also detected by HPV testing. In 90 cases of 119 residual dysplasia was not seen by histological examination. In this high-risk group HPV infection had not been detected in 77 cases (85.5%) by the time the second HPV test was performed. HPV tests for high-risk types were positive only in 13 of 90 (14.5%) without residual dysplasia. Furthermore the same HPV type was detected only in three cases taken before the first and second conisation procedure. CONCLUSION Pre re-conisation HPV testing might be useful in reducing the number of re-conisations where the high-risk HPV test is either negative or does not confirm the previously proven HPV type.
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Affiliation(s)
- R Koiss
- Department of Obstetrics and Gynaecology, St. Stephan's Hospital, Budapest, Hungary.
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Koszegi Z, Balkay L, Galuska L, Varga J, Hegedus I, Fulop T, Balogh E, Jenei C, Szabo G, Kolozsvari R, Racz I, Edes I. Holistic polar map for integrated evaluation of cardiac imaging results. Comput Med Imaging Graph 2007; 31:577-86. [PMID: 17714916 DOI: 10.1016/j.compmedimag.2007.06.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2006] [Revised: 04/25/2007] [Accepted: 06/26/2007] [Indexed: 11/17/2022]
Abstract
Polar map display (PM) is a comprehensive interpretation of the left ventricle. This is a non-rigid registration of the left ventricle originally for the visual and quantitative analysis of tomographic myocardial perfusion scintigrams. In this scheme the maximal-count circumferential profiles of well-defined short- and long-axis planes are plotted to a map showing the distribution of the perfusion tracer onto a two-dimensional polar representation. The usual coronary artery distribution is often indicated on the PMs of SPECT studies by referring to the regions of the three main coronary branches, nevertheless, the individual variations may differ extensively. We set out to develop an Access (Microsoft)-based computer program that permits an integrated evaluation of the imaging results (coronary angiography, echocardiography and SPECT) on patients with coronary artery disease. This semi-quantitative registration of the coronary tree to a PM focused on the relation between the supplying coronary branches and the myocardial regions of the 16-segment left ventricular evaluating model. All the recorded anatomical and functional data were related to these 16 left ventricular segments, which allowed the direct comparison and holistic synthesis of the results. Two projections were taken into consideration for generation of the coronary PM: from the right anterior oblique projections, the left anterior descendent (LAD)/right coronary artery (RCA) border was assessed through the comparison of the left and right coronary angiograms. The terminations of the visually detected end-arteries showed the separation of the myocardial beds supplied by the two branches. The border of the myocardial beds on the polar map was determined on the "vertical axis" of the local coordinate system. The RCA/ left circumflex (LCx) separation can be determined from the left anterior oblique view. In this projection, the left ventricular septal edge was delineated by the LAD, while the LCx indicated the lateral epicardial surface. The individual coronary artery circulation was typified from among 12 variations in the Holistic Coronary Care program. With this determination of the individual coronary circulation, the lesion-associated segments are generated automatically by the software. The lesion-associated regions are defined as the myocardial bed of a diseased artery distal to the lesion. The PMs generated from the coronary angiographic results were compared with those of 99Tc-labelled MIBI single photon emission computed tomography (SPECT) in order to test the accuracy of the localizing method. The overlap between the segments associated with the coronary lesion and the stress perfusion defects (<80% relative MIBI activity during stress tests) was analyzed in 10 patients with (sub)total coronary occlusion after myocardial infarction. The distributions of the segments with stress perfusion defects on MIBI SPECT gave positive and negative predictive values of coronary occlusion of 0.94 and 0.8, respectively. According to the 16-segment wall motion analysis by echocardiography, the positive and negative predictive values of coronary occlusion for wall motion abnormality were 0.82 and 0.76, respectively. While the distal part of the subtended region usually demonstrated a higher degree perfusion abnormality than the proximal part, the high positive predictive value proved that, during the stress condition, the perfusion defect could be detected in practically all the subtended regions. The low negative predictive value of the coronary lesion for the wall motion abnormality was associated with the remodeling of the entire left ventricle.
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Affiliation(s)
- Zsolt Koszegi
- University of Debrecen, Medical and Health Science Center, Hungary. hu
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Bárdi E, Jenei C, Kiss C. Polymorphism of angiotensin converting enzyme is associated with severe circulatory compromise in febrile neutropenic children with cancer. Pediatr Blood Cancer 2005; 45:217-21. [PMID: 15806540 DOI: 10.1002/pbc.20400] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Angiotensin converting enzyme (ACE) gene insertion(I)/deletion(D) polymorphism influences the outcome of a number of cardiovascular diseases. ACE I/D polymorphism was investigated by PCR in 207 pediatric cancer patients and 144 controls. ACE I/D distribution of patients and controls was similar. The frequency of the D allele and the prevalence of the deletion (DD) genotype were significantly (P < 0.05) higher among patients with severe circulatory compromise requiring treatment in the intensive care unit (ICU) than among the other patients and controls. Patients with the DD and ID genotypes spent significantly (P < 0.05) longer time in the ICU than patients with the II genotype.
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Affiliation(s)
- Edit Bárdi
- Department of Pediatrics, Medical and Health Science Center, University of Debrecen, Debrecen, Hungary.
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Bárdi E, Oláh AV, Bartyik K, Endreffy E, Jenei C, Kappelmayer J, Kiss C. Late effects on renal glomerular and tubular function in childhood cancer survivors. Pediatr Blood Cancer 2004; 43:668-73. [PMID: 15390293 DOI: 10.1002/pbc.20143] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Late nephrotoxicity among childhood cancer survivors is poorly documented. METHODS We investigated 115 patients and 86 controls assessing serum cystatin C concentration (CysC), urinary N-acetyl-beta-D-glucosaminidase activity (NAG), and microalbuminuria. Proteinuria was quantified and electrophoresis performed. Polymorphism of the angiotensin convertase enzyme (ACE) gene was determined by genomic PCR. RESULTS CysC was elevated in Wilms tumor (WT) patients. Gross proteinuria was observed in 30 patients including three patients with progressive proteinuria who improved on ACE-inhibitor treatment. Neither patients with proteinuria nor the entire study population differed from controls with respect to ACE polymorphism. Pathologically elevated urinary NAG was noted in 38% of leukemia/lymphoma, 54% of solid tumor, 20% of WT survivors. A similar distribution of pathological microalbuminuria was found. CONCLUSIONS Mild-to-moderate subclinical glomerular and tubular damage can be identified in many childhood cancer survivors. However, most patients experience some spontaneous recovery from acute nephrotoxicity.
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Affiliation(s)
- Edit Bárdi
- Department of Pediatrics, Medical and Health Science Center, University of Debrecen, Debrecen, Hungary.
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