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Dzierwa K, Kedziora A, Tekieli L, Mazurek A, Musial R, Dobrowolska E, Stefaniak J, Pieniazek P, Paluszek P, Konstanty-Kalandyk J, Sobczynski R, Kapelak B, Kleczynski P, Brzychczy A, Kwiatkowski T, Trystula M, Piatek J, Musialek P. Endovascular carotid revascularization under open-chest extracorporeal circulation combined with cardiac surgery in unstable patients at increased risk of carotid-related stroke: SIMultaneous urgent cardiac surgery and MicroNet-covered stent carotid revascularization in extreme-risk patients-SIMGUARD Study. J Cardiovasc Surg (Torino) 2023; 64:591-607. [PMID: 38078710 DOI: 10.23736/s0021-9509.23.12896-5] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
BACKGROUND In patients at urgent need for cardiac surgery coexisting with increased-stroke-risk carotid stenosis, any staged intervention increases the risk of complications from the primarily unaddressed pathology. In this challenging cohort, we assessed safety and feasibility of endovascular carotid revascularization under open-chest extracorporeal circulation (ECC) combined with cardiac surgery (hybrid-room true simultaneous treatment). METHODS Per-protocol (PP), after general anesthesia induction, chest-opening and ECC stand-by installation, carotid stenting (CAS) was performed (femoral/radial or direct carotid access) with ad-hoc/on-hand switch to ECC cardiac surgery. RESULTS Over 78 months, 60 patients (70.7±6.9years, 85% male, all American Society of Anesthesiology grade IV) were enrolled. All were at increased carotid-related stroke risk (ipsilateral recent stroke/transient ischemick attack, asymptomatic cerebral infarct, increased-risk lesion morphology, bilateral severe stenosis). Majority of study procedures involved CAS+coronary bypass surgery or CAS+valve replacement±coronary bypass. 45 (75%) patients were PP- and 15 (25%) not-PP (NPP-) managed (context therapy). CAS was 100% neuroprotected (transient flow reversal-64.4%, filters-35.6%) and employed micronet-covered plaque-sequestrating stents with routine post-dilatation optimization/embedding. 4 deaths (6.7%) and 7 strokes (11.7%) occurred by 30-days. Despite CAS+surgery performed on aspirin and unfractionated heparin-only (delayed clopidogrel-loading), no thrombosis occurred in the stented arteries, and 30-days stent patency was 100%. NPP-management significantly increased the risk of death/ipsilateral stroke (OR 38.5; P<0.001) and death/any stroke (OR 12.3; P=0.002) by 30-days. CONCLUSIONS In cardiac unstable patients at increased carotid-related stroke risk who require urgent cardiac surgery, simultaneous cardiac surgery and CAS with micronet-covered stent lesion sequestration is feasible and safe and shows efficacy in minimizing stroke risk. Larger-scale, multicentric evaluation is warranted. (SIMGUARD NCT04973579).
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Affiliation(s)
- Karolina Dzierwa
- Cardiovascular Imaging Laboratory, St. John Paul II Hospital, Krakow, Poland -
| | - Anna Kedziora
- Department of Cardiac Surgery and Transplantation, Jagiellonian University Medical College, Krakow, Poland
- St. John Paul II Hospital in Krakow Clinical Medicine Departments, Krakow, Poland
| | - Lukasz Tekieli
- St. John Paul II Hospital in Krakow Clinical Medicine Departments, Krakow, Poland
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, Krakow, Poland
- Stroke Thrombectomy-Capable Center, St. John Paul II Hospital, Krakow, Poland
- Department of Interventional Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Adam Mazurek
- St. John Paul II Hospital in Krakow Clinical Medicine Departments, Krakow, Poland
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, Krakow, Poland
- Department of Interventional Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Robert Musial
- Department of Anesthesia and Intensive Therapy, St. John Paul II Hospital, Krakow, Poland
| | - Elzbieta Dobrowolska
- Department of Anesthesia and Intensive Therapy, St. John Paul II Hospital, Krakow, Poland
| | - Justyna Stefaniak
- Department of Bioinformatics and Telemedicine, Jagiellonian University Medical College, Krakow, Poland
| | - Piotr Pieniazek
- St. John Paul II Hospital in Krakow Clinical Medicine Departments, Krakow, Poland
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, Krakow, Poland
- Department of Vascular Surgery and Endovascular Interventions, St. John Paul II Hospital, Krakow, Poland
| | - Piotr Paluszek
- Department of Vascular Surgery and Endovascular Interventions, St. John Paul II Hospital, Krakow, Poland
| | - Janusz Konstanty-Kalandyk
- Department of Cardiac Surgery and Transplantation, Jagiellonian University Medical College, Krakow, Poland
- St. John Paul II Hospital in Krakow Clinical Medicine Departments, Krakow, Poland
| | - Robert Sobczynski
- Department of Cardiac Surgery and Transplantation, Jagiellonian University Medical College, Krakow, Poland
- St. John Paul II Hospital in Krakow Clinical Medicine Departments, Krakow, Poland
| | - Boguslaw Kapelak
- Department of Cardiac Surgery and Transplantation, Jagiellonian University Medical College, Krakow, Poland
- St. John Paul II Hospital in Krakow Clinical Medicine Departments, Krakow, Poland
| | - Pawel Kleczynski
- St. John Paul II Hospital in Krakow Clinical Medicine Departments, Krakow, Poland
- Department of Interventional Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Andrzej Brzychczy
- Department of Vascular Surgery and Endovascular Interventions, St. John Paul II Hospital, Krakow, Poland
| | - Tomasz Kwiatkowski
- Department of Vascular Surgery and Endovascular Interventions, St. John Paul II Hospital, Krakow, Poland
| | - Mariusz Trystula
- Department of Vascular Surgery and Endovascular Interventions, St. John Paul II Hospital, Krakow, Poland
| | - Jacek Piatek
- Department of Cardiac Surgery and Transplantation, Jagiellonian University Medical College, Krakow, Poland
- St. John Paul II Hospital in Krakow Clinical Medicine Departments, Krakow, Poland
| | - Piotr Musialek
- St. John Paul II Hospital in Krakow Clinical Medicine Departments, Krakow, Poland
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, Krakow, Poland
- Stroke Thrombectomy-Capable Center, St. John Paul II Hospital, Krakow, Poland
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Legutko J, Bryniarski KL, Kaluza GL, Roleder T, Pociask E, Kedhi E, Wojakowski W, Jang IK, Kleczynski P. Intracoronary Imaging of Vulnerable Plaque-From Clinical Research to Everyday Practice. J Clin Med 2022; 11:jcm11226639. [PMID: 36431116 PMCID: PMC9699515 DOI: 10.3390/jcm11226639] [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: 10/18/2022] [Revised: 10/30/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022] Open
Abstract
The introduction into clinical practice of intravascular imaging, including intravascular ultrasound (IVUS), optical coherence tomography (OCT) and their derivatives, allowed for the in vivo assessment of coronary atherosclerosis in humans, including insights into plaque evolution and progression process. Intravascular ultrasound, the most commonly used intravascular modality in many countries, due to its low resolution cannot assess many features of vulnerable plaque such as lipid plaque or thin-cap fibroatheroma. Thus, novel methods were introduced to facilitate this problem including virtual histology intravascular ultrasound and later on near-infrared spectroscopy and OCT. Howbeit, none of the currently used modalities can assess all known characteristics of plaque vulnerability; hence, the idea of combining different intravascular imaging methods has emerged including NIRS-IVUS or OCT-IVUS imaging. All of those described methods may allow us to identify the most vulnerable plaques, which are prone to cause acute coronary syndrome, and thus they may allow us to introduce proper treatment before plaque destabilization.
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Affiliation(s)
- Jacek Legutko
- Department of Interventional Cardiology, Faculty of Medicine, Institute of Cardiology, Jagiellonian University Medical College, 31-202 Kraków, Poland
- Clinical Department of Interventional Cardiology, John Paul II Hospital, 31-202 Kraków, Poland
| | - Krzysztof L. Bryniarski
- Department of Interventional Cardiology, Faculty of Medicine, Institute of Cardiology, Jagiellonian University Medical College, 31-202 Kraków, Poland
- Clinical Department of Interventional Cardiology, John Paul II Hospital, 31-202 Kraków, Poland
| | - Grzegorz L. Kaluza
- Skirball Center for Innovation, Cardiovascular Research Foundation, Orangeburg, NY 10019, USA
| | - Tomasz Roleder
- Department of Cardiology, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Elzbieta Pociask
- Department of Biocybernetics and Biomedical Engineering, AGH University of Science and Technology, 30-059 Kraków, Poland
| | - Elvin Kedhi
- Clinique Hopitaliere Erasme, Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - Wojciech Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-635 Katowice, Poland
| | - Ik-Kyung Jang
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, GRB 800, Boston, MA 02115, USA
- Division of Cardiology, Kyung Hee University Hospital, Seoul 02447, Korea
| | - Pawel Kleczynski
- Department of Interventional Cardiology, Faculty of Medicine, Institute of Cardiology, Jagiellonian University Medical College, 31-202 Kraków, Poland
- Clinical Department of Interventional Cardiology, John Paul II Hospital, 31-202 Kraków, Poland
- Correspondence: ; Tel.: +48-12-614-35-01
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Stapor M, Pilat A, Gorkiewicz-Kot I, Kleczynski P, Zmudka K, Legutko J, Kapelak B, Wierzbicki K, Gackowski A. Changes in right ventricular two-dimensional echocardiographic speckle-tracking indices in adult LVAD population: a prospective clinical study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.019] [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
Objective
Preserved right ventricular (RV) function is crucial in patients supported with left ventricular assist devices (LVAD). The use of strain derived from speckle tracking echocardiography (STE) is recommended by recent guidelines to evaluate intricate RV contractility. The data regarding long-term RV observation in LVAD patients using STE are limited. Thus, the study aimed to determine RV systolic function by STE in the remote period after LVAD implantation.
Methods
Patients with implanted third-generation LVADs with hydrodynamic bearing were prospectively enrolled (NCT05063006). The RV STE indices were analyzed before and after LVAD implantation, both at rest and during the cycle ergometer exercise test.
Results
We included 22 patients, the mean age was 58.4±7 years, 95.5% were men, and 45.5% had dilated cardiomyopathy. Stress tests were conducted 7 months postoperatively. The RV strain analysis was feasible in all subjects both in rest and exercise. The RV free wall strain (RVFWS) worsened from −13% (IQR, −17.3 to −10.9) to −11.3% (IQR, −12.9 to −6; p=0.033) after LVAD implantation with the particular decline in the apical RV segment [−11.3% (IQR, −16.4 to −6.2) vs −7.8% (IQR, −11.7 to −3.9; p=0.012)]. The RV four-chamber longitudinal strain (RV4CSL) remained unchanged [−8.5% (IQR, −10.8 to −6.9) vs −7.3% (IQR, −9.8 to −4.7; p=0.184)]. Neither RVFWS (−11.3% (IQR, −12.9 to −6) vs −9.9% (IQR, −13.5 to −7.5; p=0.077) nor RV4CSL [−7.3% (IQR, −9.8 to −4.7) vs −7.9% (IQR, −9.8 to −6.3; p=0.548)] changed during cycle ergometer stress test.
Conclusion
The RVFWS worsens after LVAD implantation presumably due to impaired apical contractility. In LVAD-supported patients during the cycle ergometer stress test, the detailed RV strain analysis is feasible and its indices remain unchanged.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): 1. Cor Aegrum Foundation of Cardiac Surgery Development in Cracow2. Medtronic Poland sp. z o.o.
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Affiliation(s)
- M Stapor
- John Paul II Hospital, Department of Interventional Cardiology , Krakow , Poland
| | - A Pilat
- AGH University of Science and Technology, Department of Automatic Control and Robotics , Krakow , Poland
| | - I Gorkiewicz-Kot
- John Paul II Hospital, Department of Cardiovascular Surgery and Transplantology , Krakow , Poland
| | - P Kleczynski
- Jagiellonian University Medical College, John Paul II Hospital, Department of Interventional Cardiology , Krakow , Poland
| | - K Zmudka
- Jagiellonian University Medical College, John Paul II Hospital, Department of Interventional Cardiology , Krakow , Poland
| | - J Legutko
- Jagiellonian University Medical College, John Paul II Hospital, Department of Interventional Cardiology , Krakow , Poland
| | - B Kapelak
- Jagiellonian University, John Paul II Hospital, Dept of Cardiovascular Surgery and Transplantology , Krakow , Poland
| | - K Wierzbicki
- Jagiellonian University, John Paul II Hospital, Dept of Cardiovascular Surgery and Transplantology , Krakow , Poland
| | - A Gackowski
- Jagiellonian University Medical College, John Paul II Hospital, Department of Coronary Disease and Heart Failure , Krakow , Poland
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Kleczynski P, Niewiara L, Kulbat A, Kaczynski M, Pawlowski T, Socha` S, Rakowski T, Gil R, Bartus S, Legutko J. Outcomes of COVID-19 patients with STEMI undergoing primary PCI. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1250] [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
Introduction and aim
Coronavirus disease (COVID-19) has substantial impact on acute myocardial infarction (AMI) clinical course and outcome.
In Poland during early phase of COVID-19 pandemic a network of dedicated hospitals was set to treat SARS-Cov2 positive patients. There is scarce data on STEMI patients outcome treated in this setting.
Our aim was to compare outcomes of STEMI patients treated with primary PCI in hospitals dedicated to treat COVID-19 and referral high volume haemodynamic centres.
Methods
Study was a retrospective analysis of 115 consecutive COVID-19 patients with STEMI, treated with primary PCI, admitted to 4 high volume centres (2 referral hospitals and 2 COVID dedicated sites) in southern Poland between May 2020 and November 2021. Data was obtained from patients' electronic medical records.
Results
Detailed characteristics are presented in Table 1 and 2. In general in all hospitals, patients were similar in terms of age (median 69 y.o., IQR: 60–73), with similar profile of comorbidities. All patients used acetylsalicylic acid and unfractioned heparin.
In referral centres, as compared with COVID-19 dedicated sites, there was a higher use of mechanical thrombectomy (p<0.001) and adenosine (p<0.001). Overall mortality rate was higher in COVID-19 centres (50% vs 25%, p=0.008). Detailed results are presented in Table 3.
Conclusions
There is a significantly higher mortality in COVID patients who develop STEMI than in patients with STEMI who were tested positive on admission.
Patients in COVID-19 hospitals had higher levels of CRP and NT-proBNP at baseline.
There are substantial differences in treatment of patients in referral centres and COVID dedicated hospitals.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- P Kleczynski
- Jagiellonian University Medical College, Institute of Cardiology, John Paul II hospital, Faculty of Medicine, Department of Interventional Cardiology , Krakow , Poland
| | - L Niewiara
- Jagiellonian University Medical College, Institute of Cardiology, John Paul II hospital, Faculty of Medicine, Department of Interventional Cardiology , Krakow , Poland
| | - A Kulbat
- Jagiellonian University Medical College, Institute of Cardiology, John Paul II hospital, Faculty of Medicine, Department of Interventional Cardiology , Krakow , Poland
| | - M Kaczynski
- Warsaw Medical University, Central Clinical Hospital of the Ministry of Interior, Department of Invasive Cardiology , Warsaw , Poland
| | - T Pawlowski
- Warsaw Medical University, Central Clinical Hospital of the Ministry of Interior, Department of Invasive Cardiology , Warsaw , Poland
| | - S Socha`
- Jagiellonian University Medical College, Institute of Cardiology, University Hospital, Faculty of Medicine, 2nd Department of Cardiology , Krakow , Poland
| | - T Rakowski
- Jagiellonian University Medical College, Institute of Cardiology, University Hospital, Faculty of Medicine, 2nd Department of Cardiology , Krakow , Poland
| | - R Gil
- Warsaw Medical University, Central Clinical Hospital of the Ministry of Interior, Department of Invasive Cardiology , Warsaw , Poland
| | - S Bartus
- Jagiellonian University Medical College, Institute of Cardiology, University Hospital, Faculty of Medicine, 2nd Department of Cardiology , Krakow , Poland
| | - J Legutko
- Jagiellonian University Medical College, Institute of Cardiology, John Paul II hospital, Faculty of Medicine, Department of Interventional Cardiology , Krakow , Poland
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Szolc PS, Niewiara L, Legutko J, Kleczynski P, Rzeznik D, Tekieli L, Podolec J, Diachyshyn M, Stapor M, Zmudka K, Guzik B. Heterogeneous and overlapping mechanisms of myocardial ischemia in patients with ischemia and non-obstructive coronary arteries. Preliminary results from the MOSAIC-COR Registry. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1111] [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
Patients with ischemia and non-obstructive coronary arteries (INOCA) account for 30–70% of all patients undergoing elective coronary angiography for angina. In these group of patients various mechanisms may be responsible for myocardial ischemia, including increased microvascular resistance, epicardial spasm or microvascular spasm. There are limited data on the prevalence and coexistence of different mechanisms in patients with INOCA.
Purpose
The primary objective was to assess the occurrence of coronary microcirculatory disease (CMD), epicardial vasospastic angina (EVSA), microvascular vasospastic angina (MVSA) and their coexistance in patients with INOCA. The secondary objective was the analysis of subgroups' clinical characteristics.
Methods
This was a single-center, prospective, observational study. In the absence of significant coronary artery stenosis, a complex functional coronary assessment was performed. Values of fractional flow reserve (FFR), RFR, coronary flow reserve (CFR) and index of microcirculatory resistance (IMR) were determined. Coronary artery and microvascular vasoreactivity was tested using the provocative acetylcholine test.
Results
We enrolled 90 consecutive patients with INOCA. Overlapping of CMD and CMD/EVSA phenomenon was observed. Accordingly, we distinguished 6 subgroups of INOCA patients in comparison to the CorMicA trial. Mixed pathophysiology (CMD+EVSA and CMD+MVSA) was diagnosed in 33% of patients. In the CMD+EVSA subgroup, 73% of subjects were male, while in the CMD+MVSA only 7.1% were male (p=0.005). Typical cardiovascular risk factors were common in the whole INOCA group.
Conclusions
The INOCA population is a heterogeneous group with various pathophysiology of myocardial ischemia. Overlapping of different pathomechanisms is a frequent phenomenon, which has to be consider for treatment optimization and future research.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- P S Szolc
- John Paul II Hospital, Jagiellonian University Medical College, Institute of Cardiology, Department of Interventional Cardiology , Krakow , Poland
| | - L Niewiara
- John Paul II Hospital, Jagiellonian University Medical College, Institute of Cardiology, Department of Interventional Cardiology , Krakow , Poland
| | - J Legutko
- John Paul II Hospital, Jagiellonian University Medical College, Institute of Cardiology, Department of Interventional Cardiology , Krakow , Poland
| | - P Kleczynski
- John Paul II Hospital, Jagiellonian University Medical College, Institute of Cardiology, Department of Interventional Cardiology , Krakow , Poland
| | - D Rzeznik
- John Paul II Hospital, Jagiellonian University Medical College, Institute of Cardiology, Department of Interventional Cardiology , Krakow , Poland
| | - L Tekieli
- John Paul II Hospital, Jagiellonian University Medical College, Institute of Cardiology, Department of Interventional Cardiology , Krakow , Poland
| | - J Podolec
- John Paul II Hospital, Jagiellonian University Medical College, Institute of Cardiology, Department of Interventional Cardiology , Krakow , Poland
| | - M Diachyshyn
- John Paul II Hospital, Jagiellonian University Medical College, Institute of Cardiology, Department of Interventional Cardiology , Krakow , Poland
| | - M Stapor
- John Paul II Hospital, Jagiellonian University Medical College, Institute of Cardiology, Department of Interventional Cardiology , Krakow , Poland
| | - K Zmudka
- John Paul II Hospital, Jagiellonian University Medical College, Institute of Cardiology, Department of Interventional Cardiology , Krakow , Poland
| | - B Guzik
- John Paul II Hospital, Jagiellonian University Medical College, Institute of Cardiology, Department of Interventional Cardiology , Krakow , Poland
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Legutko J, Guzik B, Szolc P, Podolec J, Nosal M, Diachyshyn M, Zmudka K, Kleczynski P. TCT-300 The Impact of Coronary Microvascular Dysfunction on Fractional Flow Reserve and Resting Full-Cycle Ratio Discordance in the Assessment of Borderline Coronary Lesions. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.353] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kleczynski P, Dziewierz A, Rzeszutko L, Dudek D, Legutko J. Quantitative flow ratio for evaluation of borderline coronary lesions in patients with severe aortic stenosis. Rev Esp Cardiol (Engl Ed) 2022; 75:472-478. [PMID: 34024746 DOI: 10.1016/j.rec.2021.04.008] [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] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 04/19/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION AND OBJECTIVES Quantitative flow ratio (QFR) is a novel noninvasive method for evaluating coronary physiology. However, data on the QFR in patients with aortic stenosis (AS) and coronary artery disease are scarce. Thus, we compared the diagnostic performance of the QFR with that of the resting distal to aortic coronary pressure (Pd/Pa) ratio, fractional flow reserve (FFR), and instantaneous wave-free ratio (iFR), as well as angiographic indices. METHODS A total of 221 AS patients with 416 vessels undergoing FFR/iFR measurements were enrolled in the study. RESULTS The mean percent diameter stenosis (%DS) was 58.6%±13.4% and the mean Pd/Pa ratio, FFR, iFR, and QFR were 0.95±0.03, 0.85±0.07, 0.90±0.04, and 0.84±0.07, respectively. A FFR ≤ 0.80 was noted in 26.0% of interrogated vessels, as well as an iFR ≤ 0.89 in 33.2% and QFR ≤ 0.80 in 31.7%. The QFR had better agreement with FFR (intraclass correlation coefficient [ICC], 0.96; 95% confidence interval [95%CI], 0.95-0.96) than with the iFR (ICC, 0.79; 95%CI, 0.75-0.82) and Pd/Pa ratio (ICC, 0.52; 95%CI, 0.44-0.58). In addition, the QFR showed better diagnostic accuracy (98.6% vs 94.2%; P <.001) and discriminant function (area under the curve=0.996 vs 0.988; P <.001) when the iFR was used as the reference instead of FFR. CONCLUSIONS In patients with AS, the QFR has good agreement with both FFR and iFR. However, the agreement appears to be even better when the iFR is used as the reference, presumably due to the complex nature of the coronary physiology in the assessment of coronary artery disease in patients with severe AS.
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Affiliation(s)
- Pawel Kleczynski
- Department of Interventional Cardiology, Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland.
| | - Artur Dziewierz
- 2(nd) Department of Cardiology, Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, University Hospital, Krakow, Poland
| | - Lukasz Rzeszutko
- 2(nd) Department of Cardiology, Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, University Hospital, Krakow, Poland
| | - Dariusz Dudek
- 2(nd) Department of Cardiology, Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, University Hospital, Krakow, Poland
| | - Jacek Legutko
- Department of Interventional Cardiology, Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
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Stapor M, Pilat A, Gackowski A, Misiuda A, Gorkiewicz-Kot I, Kaleta M, Kleczynski P, Zmudka K, Legutko J, Kapelak B, Wierzbicki K. Echo-guided left ventricular assist device speed optimisation for exercise maximisation. Heart 2022; 108:1055-1062. [PMID: 35314453 PMCID: PMC9209671 DOI: 10.1136/heartjnl-2021-320495] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 02/24/2022] [Indexed: 11/29/2022] Open
Abstract
Objective Current generation left ventricular assist devices (LVADs) operate with a fixed rotation speed and no automated speed adjustment function. This study evaluates the concept of physiological pump speed optimisation based on aortic valve opening (AVO) imaging during a cardiopulmonary exercise test (CPET). Methods This prospective crossover study (NCT05063006) enrolled patients with implanted third-generation LVADs with hydrodynamic bearing. After resting speed optimisation, patients were randomised to a fixed-modified speed or modified-fixed speed CPET sequence. Fixed speed CPET maintained baseline pump settings. During the modified speed CPET, the LVAD speed was continuously altered to preserve periodic AVO. Results We included 22 patients, the mean age was 58.4±7 years, 4.5% were women and 54.5% had ischaemic cardiomyopathy. Exertional AVO assessment was feasible in all subjects. Maintaining periodic AVO allowed to safely raise the pump speed from 2900 (IQR 2640–3000) to 3440 revolutions per minute (RPM) (IQR 3100–3700; p<0.001). As a result, peak oxygen consumption increased from 11.1±2.4 to 12.8±2.8 mL/kg/min (p<0.001) and maximum workload from 1.1 (IQR 0.9–1.5) to 1.2 W/kg (IQR 0.9–1.7; p=0.028). The Borg scale exertion level decreased from 15.2±1.5 to 13.5±1.2 (p=0.005). Conclusions Transthoracic AVO imaging is possible during CPETs in patients with LVAD. Dynamic echo-guided pump speed adjustment based on the AVO improves exercise tolerance and augments peak oxygen consumption and maximum workload.
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Affiliation(s)
- Maciej Stapor
- Department of Interventional Cardiology, John Paul II Hospital, Krakow, Malopolska, Poland
| | - Adam Pilat
- Department of Automatic Control and Robotics, AGH University of Science and Technology, Krakow, Poland
| | - Andrzej Gackowski
- Department of Coronary Disease and Heart Failure, Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, Krakow, Poland
| | - Agnieszka Misiuda
- Noninvasive Cardiovascular Laboratory, John Paul II Hospital, Krakow, Poland
| | - Izabela Gorkiewicz-Kot
- Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Krakow, Poland
| | - Michal Kaleta
- Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Krakow, Poland
| | - Pawel Kleczynski
- Department of Interventional Cardiology, Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, Krakow, Poland
| | - Krzysztof Zmudka
- Department of Interventional Cardiology, Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, Krakow, Poland
| | - Jacek Legutko
- Department of Interventional Cardiology, Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, Krakow, Poland
| | - Boguslaw Kapelak
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, Krakow, Poland
| | - Karol Wierzbicki
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, Krakow, Poland
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Wańha W, Bil J, Kołodziejczak M, Kowalowka A, Hudziak D, Gocol R, Kowalewski M, Januszek R, Figatowski T, Milewski M, Tomasiewicz B, Kubler P, Desperak P, Kuźma Ł, Milewski K, Gora B, Los A, Kulczycki J, Wlodarczak A, Grygier M, Lesiak M, Kleczynski P, Litwinowicz R, Borin A, Smolka G, Reczuch K, Gruchała M, Gil R, Jaguszewski M, Bartus K, Suwalski P, Dobrzycki S, Dudek D, Bartus S, Gasior M, Legutko J, Ochała A, Lansky A, Deja M, Kedhi E, Wojakowski W. TCT-101 Long-Term Outcomes Following Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting for Treating In-Stent Restenosis in Unprotected Left Main Coronary Artery: Multicenter LM-DRAGON Registry. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.951] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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10
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Stapor M, Pilat A, Gackowski A, Gorkiewicz-Kot I, Kleczynski P, Zmudka K, Legutko J, Kapelak B, Wierzbicki K. Echo-guided LVAD speed optimization for exercise maximization. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0947] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Continuous-flow left ventricular assist devices (LVAD) are becoming a destination therapy in patients with end-stage left ventricular dysfunction and a competitive method for heart transplantation. Current generation pumps operate with a fixed rotation speed and do not have the automatic speed adjustment capability. However, it was shown that acceleration of the pump speed during stress test increases the maximum exercise tolerance.
Purpose
The study aimed to evaluate the concept of dynamic pump speed optimization based on the echocardiographic assessment of aortic valve opening (AVO) during the cardiopulmonary exercise test (CPET).
Methods
Patients with implanted third-generation centrifugal continuous-flow LVAD's with hydrodynamic bearing were prospectively included. Two CPET's were performed after resting speed optimization. The first one with maintained baseline pump speed settings, and the second one with gradually increased speed depending on live echocardiographic imaging. The sequence of tests was random.
Results
Exercise AVO was apparent in all 22 included patients. The resting pump speed was 2691 RPM and incremented on average by 566 RPM (20%). Pump power and flow raised from 5.6 to 9.8 Watts (p<0.0001) and from 5.8 to 7.3 l/min (p<0.0001), respectively. Peak VO2 increased from 11.1 to 12.8 ml/kg/min (p=0.0003) and maximum workload from 1.1 to 1.2 W/kg (p=0.03). The Borg scale exertion level decreased from 15.2 to 13.5 (p=0.0049). There was a visible trend towards longer exercise time (36s) but no statistical significance was achieved (p=0.1).
Conclusion
Ultrasonographic AVO analysis is possible during CPET's in patients supported with LVAD. Dynamic echo-guided pump speed adjustment based on the AVO improves exercise tolerance, augments peak VO2 consumption and maximal workload. An automatic speed adjustment in the next generations of LVAD controllers might improve functional capacity and requires further basic, technological and clinical research.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): 1. Cor Aegrum Foundation of Cardiac Surgery Development in Cracow2. Medtronic Poland Sp. z o.o.
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Affiliation(s)
- M Stapor
- John Paul II Hospital, Department of Interventional Cardiology, Krakow, Poland
| | - A Pilat
- AGH University of Science and Technology, Department of Automatics and Biomedical Engineering, Krakow, Poland
| | - A Gackowski
- Jagiellonian University Medical College, John Paul II Hospital, Department of Coronary Disease and Heart Failure, Krakow, Poland
| | - I Gorkiewicz-Kot
- John Paul II Hospital, Department of Cardiovascular Surgery and Transplantology, Krakow, Poland
| | - P Kleczynski
- Jagiellonian University Medical College, John Paul II Hospital, Department of Interventional Cardiology, Krakow, Poland
| | - K Zmudka
- Jagiellonian University Medical College, John Paul II Hospital, Department of Interventional Cardiology, Krakow, Poland
| | - J Legutko
- Jagiellonian University Medical College, John Paul II Hospital, Department of Interventional Cardiology, Krakow, Poland
| | - B Kapelak
- Jagiellonian University Medical College, John Paul II Hospital, Department of Cardiovascular Surgery and Transplantology, Krakow, Poland
| | - K Wierzbicki
- Jagiellonian University Medical College, John Paul II Hospital, Department of Cardiovascular Surgery and Transplantology, Krakow, Poland
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Kleczynski P, Kulbat A, Brzychczy P, Dziewierz A, Trebacz J, Stapor M, Sorysz D, Rzeszutko L, Bartus S, Dudek D, Legutko J. Balloon Aortic Valvuloplasty for Severe Aortic Stenosis as Rescue or Bridge Therapy. J Clin Med 2021; 10:jcm10204657. [PMID: 34682783 PMCID: PMC8538854 DOI: 10.3390/jcm10204657] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 09/26/2021] [Revised: 10/07/2021] [Accepted: 10/09/2021] [Indexed: 12/13/2022] Open
Abstract
The study aimed to assess procedural complications, patient flow and clinical outcomes after balloon aortic valvuloplasty (BAV) as rescue or bridge therapy, based on data from our registry. A total of 382 BAVs in 374 patients was performed. The main primary indication for BAV was a bridge for TAVI (n = 185, 49.4%). Other indications included a bridge for AVR (n = 26, 6.9%) and rescue procedure in hemodynamically unstable patients (n = 139, 37.2%). The mortality rate at 30 days, 6 and 12 months was 10.4%, 21.6%, 28.3%, respectively. In rescue patients, the death rate raised to 66.9% at 12 months. A significant improvement in symptoms was confirmed after BAV, after 30 days, 6 months, and in survivors after 1 year (p < 0.05 for all). Independent predictors of 12-month mortality were baseline STS score [HR (95% CI) 1.42 (1.34 to 2.88), p < 0.0001], baseline LVEF <20% [HR (95% CI) 1.89 (1.55-2.83), p < 0.0001] and LVEF <30% at 1 month [HR (95% CI) 1.97 (1.62-3.67), p < 0.0001] adjusted for age/gender. In everyday clinical practice in the TAVI era, there are still clinical indications to BAV a standalone procedure as a bridge to surgery, TAVI or for urgent high risk non-cardiac surgical procedures. Patients may improve clinically after BAV with LV function recovery, allowing to perform final therapy, within limited time window, for severe AS which ameliorates long-term outcomes. On the other hand, in patients for whom an isolated BAV becomes a destination therapy, prognosis is extremely poor.
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Affiliation(s)
- Pawel Kleczynski
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Pradnicka 80 Street, 31-202 Krakow, Poland; (J.T.); (M.S.); (J.L.)
- Correspondence:
| | - Aleksandra Kulbat
- Students’ Scientific Group at the Department of Interventional Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Pradnicka 80 Street, 31-202 Krakow, Poland; (A.K.); (P.B.)
| | - Piotr Brzychczy
- Students’ Scientific Group at the Department of Interventional Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Pradnicka 80 Street, 31-202 Krakow, Poland; (A.K.); (P.B.)
| | - Artur Dziewierz
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, University Hospital, Jakubowskiego 2 Street, 30-688 Krakow, Poland; (A.D.); (D.S.); (L.R.); (S.B.); (D.D.)
| | - Jaroslaw Trebacz
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Pradnicka 80 Street, 31-202 Krakow, Poland; (J.T.); (M.S.); (J.L.)
| | - Maciej Stapor
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Pradnicka 80 Street, 31-202 Krakow, Poland; (J.T.); (M.S.); (J.L.)
| | - Danuta Sorysz
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, University Hospital, Jakubowskiego 2 Street, 30-688 Krakow, Poland; (A.D.); (D.S.); (L.R.); (S.B.); (D.D.)
| | - Lukasz Rzeszutko
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, University Hospital, Jakubowskiego 2 Street, 30-688 Krakow, Poland; (A.D.); (D.S.); (L.R.); (S.B.); (D.D.)
| | - Stanislaw Bartus
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, University Hospital, Jakubowskiego 2 Street, 30-688 Krakow, Poland; (A.D.); (D.S.); (L.R.); (S.B.); (D.D.)
| | - Dariusz Dudek
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, University Hospital, Jakubowskiego 2 Street, 30-688 Krakow, Poland; (A.D.); (D.S.); (L.R.); (S.B.); (D.D.)
| | - Jacek Legutko
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Pradnicka 80 Street, 31-202 Krakow, Poland; (J.T.); (M.S.); (J.L.)
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Kleczynski P, Dziewierz A, Rzeszutko L, Dudek D, Legutko J. Hyperemic versus non-hyperemic indexes for coronary physiology assessment in patients with severe aortic stenosis. Adv Med Sci 2021; 66:366-371. [PMID: 34315011 DOI: 10.1016/j.advms.2021.07.008] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 06/22/2021] [Accepted: 07/18/2021] [Indexed: 01/09/2023]
Abstract
PURPOSE Recent data suggests that fractional flow reserve (FFR) may underestimate intermediate coronary stenosis in the presence of severe aortic stenosis (AS), whereas instantaneous wave-free ratio (iFR) values may remain similar after treatment of AS, yet the evidence still lacks to use iFR as the reference. We aimed to compare FFR/iFR values in the AS setting. MATERIALS AND METHODS The functional significance of 416 coronary lesions in 221 patients with severe AS was investigated with iFR and FFR. RESULTS The diagnostic agreement between iFR and FFR has been tested, using the cut-off value of 0.89 for iFR and 0.80 for FFR. The mean diameter stenosis was 58.6 ± 13.4% with FFR of 0.85 ± 0.07 and iFR of 0.90 ± 0.04. FFR ≤0.80 was identified in 26.0% and iFR≤0.89 in 33.2% of interrogated vessels. Good agreement between iFR and FFR was confirmed (Intraclass Correlation Coefficient 0.83 [95%CI 0.79-0.85]). The overall diagnostic accuracy (AUC in ROC analysis) of FFR in detecting iFR≤0.89 was 0.997 (95%CI 0.986 to 1.000; p<0.001) and of iFR in detecting FFR≤0.80 was 0.995 (95%CI 0.983 to 0.999; p<0.001). The optimal cut-off value for FFR to detect iFR≤0.89 was 0.82 with sensitivity, specificity, and accuracy of 97.1%, 98.9%, and 97.7%, respectively, and for IFR to detect FFR≤0.80 was 0.88 with sensitivity, specificity, and accuracy of 99.1%, 95.8%, and 97.4%, respectively. CONCLUSION In the presence of AS, FFR has good agreement with iFR. However, the optimal FFR/iFR threshold to identify iFR≤0.89/FFR≤0.80 may be different from the standard thresholds of ischemia.
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Affiliation(s)
- Pawel Kleczynski
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland.
| | - Artur Dziewierz
- 2(nd) Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, University Hospital, Krakow, Poland
| | - Lukasz Rzeszutko
- 2(nd) Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, University Hospital, Krakow, Poland
| | - Dariusz Dudek
- 2(nd) Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, University Hospital, Krakow, Poland
| | - Jacek Legutko
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
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Bryniarski K, Gasior P, Legutko J, Makowicz D, Kedziora A, Szolc P, Bryniarski L, Kleczynski P, Jang IK. OCT Findings in MINOCA. J Clin Med 2021; 10:2759. [PMID: 34201727 PMCID: PMC8269308 DOI: 10.3390/jcm10132759] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 04/09/2021] [Revised: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 11/24/2022] Open
Abstract
Myocardial infarction with non-obstructive coronary artery disease (MINOCA) is a working diagnosis for patients presenting with acute myocardial infarction without obstructive coronary artery disease on coronary angiography. It is a heterogenous entity with a number of possible etiologies that can be determined through the use of appropriate diagnostic algorithms. Common causes of a MINOCA may include plaque disruption, spontaneous coronary artery dissection, coronary artery spasm, and coronary thromboembolism. Optical coherence tomography (OCT) is an intravascular imaging modality which allows the differentiation of coronary tissue morphological characteristics including the identification of thin cap fibroatheroma and the differentiation between plaque rupture or erosion, due to its high resolution. In this narrative review we will discuss the role of OCT in patients presenting with MINOCA. In this group of patients OCT has been shown to reveal abnormal findings in almost half of the cases. Moreover, combining OCT with cardiac magnetic resonance (CMR) was shown to allow the identification of most of the underlying mechanisms of MINOCA. Hence, it is recommended that both OCT and CMR can be used in patients with a working diagnosis of MINOCA. Well-designed prospective studies are needed in order to gain a better understanding of this condition and to provide optimal management while reducing morbidity and mortality in that subset patients.
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Affiliation(s)
- Krzysztof Bryniarski
- Jagiellonian University Medical College, Institute of Cardiology, Department of Interventional Cardiology, John Paul II Hospital, 31-202 Krakow, Poland; (K.B.); (J.L.); (P.S.); (P.K.)
| | - Pawel Gasior
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-635 Katowice, Poland;
| | - Jacek Legutko
- Jagiellonian University Medical College, Institute of Cardiology, Department of Interventional Cardiology, John Paul II Hospital, 31-202 Krakow, Poland; (K.B.); (J.L.); (P.S.); (P.K.)
| | - Dawid Makowicz
- Interventional Cardiology, Electrotherapy and Angiology Department, John Paul II Hospital, 38-400 Krosno, Poland;
| | - Anna Kedziora
- Department of Cardiovascular Surgery and Transplantation, John Paul II Hospital, 31-202 Krakow, Poland;
| | - Piotr Szolc
- Jagiellonian University Medical College, Institute of Cardiology, Department of Interventional Cardiology, John Paul II Hospital, 31-202 Krakow, Poland; (K.B.); (J.L.); (P.S.); (P.K.)
| | - Leszek Bryniarski
- 2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Institute of Cardiology, Jagiellonian University Medical College, 31-501 Krakow, Poland;
| | - Pawel Kleczynski
- Jagiellonian University Medical College, Institute of Cardiology, Department of Interventional Cardiology, John Paul II Hospital, 31-202 Krakow, Poland; (K.B.); (J.L.); (P.S.); (P.K.)
| | - Ik-Kyung Jang
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street|GRB 800, Boston, MA 02114, USA
- Department of Cardiology, School of Medicine, Kyung Hee University, Dongdaemoon-gu, Seoul 130-701, Korea
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Kleczynski P, Dziewierz A, Rzeszutko L, Dudek D, Legutko J. El cociente de flujo cuantitativo en pacientes con estenosis aórtica grave y lesiones coronarias intermedias. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2021.04.008] [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: 01/09/2023]
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Kleczynski P, Trebacz J, Stapor M, Sobczynski R, Konstanty-Kalandyk J, Kapelak B, Zmudka K, Legutko J. Inpatient Cardiac Rehabilitation after Transcatheter Aortic Valve Replacement Is Associated with Improved Clinical Performance and Quality of Life. J Clin Med 2021; 10:jcm10102125. [PMID: 34068973 PMCID: PMC8156110 DOI: 10.3390/jcm10102125] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 05/01/2021] [Accepted: 05/11/2021] [Indexed: 12/17/2022] Open
Abstract
Cardiac rehabilitation (CR) provides multifactorial support and intervention for cardiac patients and improves quality of life (QoL). We aimed to assess clinical performance and QoL changes in patients undergoing transcatheter aortic valve replacement (TAVR) scheduled directly to inpatient CR (CR group) and those who were discharged home (DH group). The following patient-related outcomes were recorded: 5 m walk time (5MWT), 6 min walk test (6MWT), handgrip strength (HGS) with dynamometer, Katz index of Independence of Activities in Daily Living (KI of ADL), Hospital Anxiety and Depression Scores (HADS) Score. Quality of life was evaluated with Kansas City Cardiomyopathy Questionnaire (KCCQ). Baseline data, 30-day and 6- and 12-month data were assessed. The CR group consisted of 52 patients and 53 were in the discharged home (DH group). When we compared outcomes between the groups, the 5MWT, 6MWT, HGS KI of ADL, and KCCQ were significantly better in the CR group at 30 days (p = 0.03, p = 0.01, p = 0.02, p = 0.048, respectively), and no difference was found in HADS scores. At 6 months, the effect of CR was sustained for 6MWT, HGS, KI of ADL, and KCCQ (p = 0.001, p = 0.001, p = 0.03, p = 0.003, respectively) but not for 5MWT. Interestingly, at 12 months, the CR group had better performance only in 6MWT and HGS compared with the DH group (p = 0.04, p = 0.03, respectively). We showed that inpatient CR is strongly associated with better clinical performance and QoL in patients undergoing TAVR. All patients may benefit from CR after TAVR. The most important aspect of inpatient CR after TAVR from the patient’s perspective may be better performance in daily activities; however, performance was attenuated after 1 year.
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Affiliation(s)
- Pawel Kleczynski
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, 31-202 Krakow, Poland; (J.T.); (M.S.); (K.Z.); (J.L.)
- Correspondence:
| | - Jaroslaw Trebacz
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, 31-202 Krakow, Poland; (J.T.); (M.S.); (K.Z.); (J.L.)
| | - Maciej Stapor
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, 31-202 Krakow, Poland; (J.T.); (M.S.); (K.Z.); (J.L.)
| | - Robert Sobczynski
- Department of Cardiac and Vascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, 31-202 Krakow, Poland; (R.S.); (J.K.-K.); (B.K.)
| | - Janusz Konstanty-Kalandyk
- Department of Cardiac and Vascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, 31-202 Krakow, Poland; (R.S.); (J.K.-K.); (B.K.)
| | - Boguslaw Kapelak
- Department of Cardiac and Vascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, 31-202 Krakow, Poland; (R.S.); (J.K.-K.); (B.K.)
| | - Krzysztof Zmudka
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, 31-202 Krakow, Poland; (J.T.); (M.S.); (K.Z.); (J.L.)
| | - Jacek Legutko
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, 31-202 Krakow, Poland; (J.T.); (M.S.); (K.Z.); (J.L.)
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16
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Wiktorowicz A, Wit A, Malinowski KP, Dziewierz A, Rzeszutko L, Dudek D, Kleczynski P. Paravalvular leak prediction after transcatheter aortic valve replacement with self-expandable prosthesis based on quantitative aortic calcification analysis. Quant Imaging Med Surg 2021; 11:652-664. [PMID: 33532265 DOI: 10.21037/qims-20-669] [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] [Indexed: 11/06/2022]
Abstract
Background Paravalvular leak (PVL) is one of the most common complications of transcatheter aortic valve replacement (TAVR) and affects short- and long-term outcomes. The aim of this study was to identify the computed tomography (CT) imaging biomarkers that allow PVL after TAVR to be predicted. Methods Patients were included who had severe aortic valve stenosis, had undergone TAVR with a self-expanding valve, and had undergone a pre-procedural CT scan. Data on baseline characteristics, procedural and long-term outcomes were collected retrospectively. We used MATLAB software with a self-developed algorithm for CT scan analysis and found parameters that quantified aortic valve calcifications (AVC) in detail. Results Fifty patients were included. The identified CT-derived parameters included AVC size, volume, thickness and density, as well as calcium radial distribution. The volume of the largest calcium block, calcium perimeter and calcium size (assessed by Feret's diameter) showed a strong association with PVL occurrence after TAVR (P=0.012, P=0.001 and P=0.045, respectively). The prognostic model showed that a 10 mm2 increase in the local AVC amount in each valve section was associated with a 9.8% (95% CI: 2-18%; P=0.019) increase in the risk of PVL occurrence in the corresponding area after TAVR. ROC analysis revealed that the cut-off point of the AVC area was 96.5 mm2 in the polar coordinate system presentation. Kaplan-Meier curves showed worse PVL-free survival in patients with more than 96.5 mm2 of calcium area (P=0.013; log-rank). Conclusions Quantitative AVC assessment for PVL prediction may play an important role in screening before TAVR. In future, the use of quantitative AVC assessment as an imaging biomarker in TAVR candidates and the creation and extension of an online database containing quantitative AVC parameters may help to identify high PVL risk patients.
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Affiliation(s)
- Agata Wiktorowicz
- Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, 2 Department of Cardiology, 30-688, Krakow, Poland
| | - Adrian Wit
- Faculty of Physics and Applied Computer Science, AGH University of Science and Technology, 30-059 Krakow, Poland
| | - Krzysztof Piotr Malinowski
- Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, 2 Department of Cardiology, 30-688, Krakow, Poland
| | - Artur Dziewierz
- Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, 2 Department of Cardiology, 30-688, Krakow, Poland
| | - Lukasz Rzeszutko
- Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, 2 Department of Cardiology, 30-688, Krakow, Poland
| | - Dariusz Dudek
- Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, 2 Department of Cardiology, 30-688, Krakow, Poland
| | - Pawel Kleczynski
- Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, Department of Interventional Cardiology, John Paul II Hospital, 31-202 Krakow, Poland
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Bryndza M, Legutko J, Kleczynski P, Kapelak B, Bartus K, Litwinowicz R. Impact of COVID-19 on the incidence of post-acute myocardial infarction mechanical complications. Ann Cardiothorac Surg 2021; 11:319-321. [DOI: 10.21037/acs-2021-ami-150] [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] [Received: 08/11/2021] [Accepted: 11/08/2021] [Indexed: 11/06/2022]
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18
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Kleczynski P, Dziewierz A, Rzeszutko L, Dudek D, Legutko J. Comparison of iFR and FFR for coronary physiology evaluation in patients with severe aortic stenosis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2479] [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
Reliable coronary physiology assessment with pressure derived indexes in patients with aortic stenosis (AS) rises problems due to its complex nature. Recent data suggest that fractional flow reserve (FFR) may underestimate intermediate coronary stenosis in a presence of AS whereas instantaneous wave-free ratio (iFR) values may remain similar after treatment of AS. Furthermore, both indices has not been validated yet in AS.
Aim
We aimed to find a thresholds for coronary ischemia in the setting of aortic
Material and methods
The functional significance of 416 coronary lesions was investigated with iFR and FFR measurements in 221 AS patients. The iFR-FFR diagnostic agreement has been tested using the cut-off value for iFR of 0.89.
Results
Mean value of %DS was 58.6±13.4%, FFR was 0.85±0.07 and iFR – 0.90±0.04. FFR ≤0.80 was measured in 26.0% of interrogated vessels, iFR ≤0.89 – in 33.2%. The correlation between iFR and FFR was good (r=0.83, p<0.001) and with good agreement between iFR and FFR (mean difference −0.0059, 95% CI −0.056–0.062). The AUC at ROC curve analysis for iFR ≤0.89 was 0,997 (0,986 to 1,000, p<0.001) for FFR. According to ROC analysis, the best FFR cut-off in predicting iFR ≤0.89 was ≤0.82 (J=0.96). The diagnostic accuracy for identifying iFR ≤0.89 was 97.7% for FFR.
Conclusion
In the presence of AS, FFR had good agreement with iFR values. However, FFR threshold for predicting iFR below 0.89 may be different from a standard threshold and that should be taken into account while assessing coronary physiology in the setting of AS.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Science Center
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Affiliation(s)
- P Kleczynski
- Jagiellonian University Medical College, Cracow, Poland
| | - A Dziewierz
- Institute of Cardiology, Jagiellonian University, Krakow, Poland
| | - L Rzeszutko
- Institute of Cardiology, Jagiellonian University, Krakow, Poland
| | - D Dudek
- Institute of Cardiology, Jagiellonian University, Krakow, Poland
| | - J Legutko
- Institute of Cardiology, Jagiellonian University, Krakow, Poland
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Kleczynski P, Dziewierz A, Rzeszutko L, Dudek D, Legutko J. Comparison of FFR with iFR and QFR in assessment of intermediate coronary artery disease in patients with severe aortic stenosis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2475] [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
Background
The functional assessment of coronary artery disease (CAD) in patients with severe aortic stenosis (AS) has been barely examined so far, and the best strategy to physiologically investigate the relevance of coronary stenosis in this specific setting of patients remains undetermined. The aim of the study is to compare the diagnostic performance of instantaneous wave-free ratio (iFR), quantitative flow ratio (QFR) and fractional flow reserve (FFR) in patients with severe AS.
Methods
The functional significance of 416 coronary lesions was investigated with iFR, FFR and QFR measurements in 221 AS patients. The iFR-FFR and QFR-FFR diagnostic agreement has been tested using the conventional 0.80 FFR cut-off.
Results
Mean value of FFR was 0.85±0.07; iFR – 0.90±0.04; QFR – 0.84±0.07. The correlation between iFR and FFR was good (r=0.83, p<0.001) and QFR and FFR was goot too (r=0.77, p<0.001), as well as the area under the curve at ROC curve analysis 0,995 (0,983 to 0,999, p<0.001) for iFR and 0,988 (0,972 to 0,996, p<0.001) for QFR. However, using the standard iFR 0.89 and QFR 0.8 threshold, the diagnostic accuracy of iFR was 100% sensitivity and 90.26% specificity and for QFR – 100% and 92.21%, respectively. According to ROC analysis, the best iFR cut-off in predicting FFR ≤0.8 was 0.88 (J=0.94), the best QFR cut-off value was 0.80 (J=0.92).
Conclusions
In the presence of severe AS, iFR and QFR had good agreement with FFR values for assessment of borderline coronary lesions. However, iFR threshold for predicting FFR below 0.8 may be different from a standard value of 0.89.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Science Centre
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Affiliation(s)
- P Kleczynski
- Jagiellonian University Medical College, Cracow, Poland
| | - A Dziewierz
- Institute of Cardiology, Jagiellonian University, Krakow, Poland
| | - L Rzeszutko
- Institute of Cardiology, Jagiellonian University, Krakow, Poland
| | - D Dudek
- Institute of Cardiology, Jagiellonian University, Krakow, Poland
| | - J Legutko
- Institute of Cardiology, Jagiellonian University, Krakow, Poland
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Szolc P, Niewiara L, Guzik B, Horszczaruk G, Podolec J, Kleczynski P, Zmudka K, Buksinska-Lisik M, Mamcarz A, Legutko J. Correlations between fractional flow reserve and a novel non-hyperemic index: resting full-cycle ratio in patients with an ambiguous coronary artery stenosis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2488] [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: 11/13/2022] Open
Abstract
Abstract
Background
Fractional flow reserve (FFR) measurement has been the gold standard for invasive assessment of coronary ischemia. Resting full cycle ratio (RFR) is a new non-hyperemic index used to define physiologic significance of coronary artery stenosis. However, there are limited data available to establish optimal cut-off value of RFR for decision making on revascularization.
Aim
The aim of our study was to assess optimal cut-off value of RFR at which to predict FFR of 0.8.
Methods
The RFR and FFR values were recorded during invasive coronary angiography in vessels with angiographic stenosis 40–70% according to visual assessment. Maximum hyperemia for FFR measurement was achieved with adenosine iv. infusion at 140 μg/kg/min. Left main disease, acute myocardial infarction and systolic left ventricular dysfunction (EF <40%) were the main exclusion criteria.
Results
We evaluated 332 vessels, including 189 (56.9%) left anterior descending arteries, 77 (23.2%) left circumflex arteries and 66 (19.9%) right coronary arteries. Median diameter stenosis as assed by QCA was 45% (IQR 40; 50). Median RFR and FFR values were 0.90 [IQR 0.85; 0.94] and 0.86 [IQR 0.81; 0.92] respectively, with significant correlation (p<0.001, Figure 1, panel A). Optimal cut-off value for RFR to detect FFR 0.80 was 0.90 with area under the curve of 90.3%, sensitivity of 81.4% and specificity 88.0% (Figure 1, panel B).
Conclusions
Our data confirm RFR cut-off value ≤0.90 as an optimal threshold to detect ischemic lesions with good sensitivity and specificity in comparison to FFR assessment. Further research is necessary to assess outcomes of RFR-guided revascularization strategy.
Figure 1. RFR–FFR correlation and ROC analysis
Funding Acknowledgement
Type of funding source: Other. Main funding source(s): Jagiellonian University statutory grant
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Affiliation(s)
- P Szolc
- Jagiellonian University Medical College, Institute of Cardiology, John Paul II hospital, Faculty of Medicine, Department of Interventional Cardiology, Krakow, Poland
| | - L Niewiara
- Jagiellonian University Medical College, Institute of Cardiology, John Paul II hospital, Faculty of Medicine, Department of Interventional Cardiology, Krakow, Poland
| | - B Guzik
- Jagiellonian University Medical College, Institute of Cardiology, John Paul II hospital, Faculty of Medicine, Department of Interventional Cardiology, Krakow, Poland
| | | | - J Podolec
- Jagiellonian University Medical College, Institute of Cardiology, John Paul II hospital, Faculty of Medicine, Department of Interventional Cardiology, Krakow, Poland
| | - P Kleczynski
- Jagiellonian University Medical College, Institute of Cardiology, University Hospital, Faculty of Medicine, 2nd Department of Cardiology, Krakow, Poland
| | - K Zmudka
- Jagiellonian University Medical College, Institute of Cardiology, John Paul II hospital, Faculty of Medicine, Department of Interventional Cardiology, Krakow, Poland
| | - M Buksinska-Lisik
- Medical University of Warsaw, 3rd Department of Internal Diseases and Cardiology, Warsaw, Poland
| | - A Mamcarz
- Medical University of Warsaw, 3rd Department of Internal Diseases and Cardiology, Warsaw, Poland
| | - J Legutko
- Jagiellonian University Medical College, Institute of Cardiology, John Paul II hospital, Faculty of Medicine, Department of Interventional Cardiology, Krakow, Poland
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Wiktorowicz A, Wit A, Dziewierz A, Rzeszutko L, Dudek D, Kleczynski P. Calcium Pattern Assessment in Patients with Severe Aortic Stenosis Via the Chou's 5-Steps Rule. Curr Pharm Des 2020; 25:3769-3775. [PMID: 31566130 DOI: 10.2174/1381612825666190930101258] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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: 05/13/2019] [Accepted: 09/26/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Progression of aortic valve calcifications (AVC) leads to aortic valve stenosis (AS). Importantly, the AVC degree has a great impact on AS progression, treatment selection and outcomes. Methods of AVC assessment do not provide accurate quantitative evaluation and analysis of calcium distribution and deposition in a repetitive manner. OBJECTIVE We aim to prepare a reliable tool for detailed AVC pattern analysis with quantitative parameters. METHODS We analyzed computed tomography (CT) scans of fifty patients with severe AS using a dedicated software based on MATLAB version R2017a (MathWorks, Natick, MA, USA) and ImageJ version 1.51 (NIH, USA) with the BoneJ plugin version 1.4.2 with a self-developed algorithm. RESULTS We listed unique parameters describing AVC and prepared 3D AVC models with color pointed calcium layer thickness in the stenotic aortic valve. These parameters were derived from CT-images in a semi-automated and repeatable manner. They were divided into morphometric, topological and textural parameters and may yield crucial information about the anatomy of the stenotic aortic valve. CONCLUSION In our study, we were able to obtain and define quantitative parameters for calcium assessment of the degenerated aortic valves. Whether the defined parameters are able to predict potential long-term outcomes after treatment, requires further investigation.
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Affiliation(s)
- Agata Wiktorowicz
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 31-501 Kopernika St. 17, Krakow, Poland
| | - Adrian Wit
- Faculty of Physics and Applied Computer Science, University of Science and Technology, Mickiewicza Ave. 30, 30-059 Krakow, Poland
| | - Artur Dziewierz
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 31-501 Kopernika St. 17, Krakow, Poland
| | - Lukasz Rzeszutko
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 31-501 Kopernika St. 17, Krakow, Poland
| | - Dariusz Dudek
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 31-501 Kopernika St. 17, Krakow, Poland
| | - Pawel Kleczynski
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 31-501 Kopernika St. 17, Krakow, Poland
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Kleczynski P, Dziewierz A, Socha S, Rakowski T, Daniec M, Zawislak B, Arif S, Wojtasik-Bakalarz J, Dudek D, Rzeszutko L. Direct Rapid Left Ventricular Wire Pacing during Balloon Aortic Valvuloplasty. J Clin Med 2020; 9:jcm9041017. [PMID: 32260289 PMCID: PMC7230545 DOI: 10.3390/jcm9041017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/27/2020] [Accepted: 03/31/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Rapid ventricular pacing is mandatory for optimal balloon positioning during aortic valvuloplasty (BAV) in patients with severe aortic stenosis. We aimed to assess the safety and efficacy of direct left ventricular (LV) guidewire pacing in comparison with regular pacing induced by temporary pacemaker (PM) placement in the right ventricle. Methods: Direct rapid LV pacing was provided with a 0.035″ guidewire. Baseline clinical characteristics, echocardiographic and procedural data, as well as complication rates, were compared between the two groups. Results: A total of 202 patients undergoing BAV were enrolled (49.5% with direct LV guidewire pacing). The pacing success rate was 100%. In the direct LV guidewire pacing group, we found a lower radiation dose, shorter fluoroscopy and overall procedural time (0.16 vs. 0.28 Gy, p = 0.02; 5.4 vs. 10.3 min, p = 0.01; 17 vs. 25 min, p = 0.01; respectively). In addition, the complication rate was lower in that group (cardiac tamponades, vascular access site complications, blood transfusions rate, and in-hospital mortality: 0% vs. 3.9%; 4.0% vs. 15.7%; 2.0% vs. 12.7%; 2.0% vs. 9.8%, p = 0.01 for all, respectively). Conclusions: Direct rapid LV guidewire pacing is a simple, safe and effective option for BAV with a reduced complication rate compared to a temporary PM placed in the right ventricle.
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Affiliation(s)
- Pawel Kleczynski
- Department of Interventional Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Pradnicka 80 Street, 31-202 Krakow, Poland
- 2nd Department of Cardiology, Jagiellonian University Medical College, University Hospital, Jakubowskiego 2 Street, 30-688 Krakow, Poland; (A.D.); (T.R.); (B.Z.); (D.D.)
- Correspondence:
| | - Artur Dziewierz
- 2nd Department of Cardiology, Jagiellonian University Medical College, University Hospital, Jakubowskiego 2 Street, 30-688 Krakow, Poland; (A.D.); (T.R.); (B.Z.); (D.D.)
| | - Sylwia Socha
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Jakubowskiego 2 Street, 30-688 Krakow, Poland; (S.S.); (M.D.); (S.A.); (J.W.-B.); (L.R.)
| | - Tomasz Rakowski
- 2nd Department of Cardiology, Jagiellonian University Medical College, University Hospital, Jakubowskiego 2 Street, 30-688 Krakow, Poland; (A.D.); (T.R.); (B.Z.); (D.D.)
| | - Marzena Daniec
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Jakubowskiego 2 Street, 30-688 Krakow, Poland; (S.S.); (M.D.); (S.A.); (J.W.-B.); (L.R.)
| | - Barbara Zawislak
- 2nd Department of Cardiology, Jagiellonian University Medical College, University Hospital, Jakubowskiego 2 Street, 30-688 Krakow, Poland; (A.D.); (T.R.); (B.Z.); (D.D.)
- Intensive Cardiac Care Unit, University Hospital, Jakubowskiego 2 Street, 30-688 Krakow, Poland
| | - Saleh Arif
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Jakubowskiego 2 Street, 30-688 Krakow, Poland; (S.S.); (M.D.); (S.A.); (J.W.-B.); (L.R.)
| | - Joanna Wojtasik-Bakalarz
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Jakubowskiego 2 Street, 30-688 Krakow, Poland; (S.S.); (M.D.); (S.A.); (J.W.-B.); (L.R.)
| | - Dariusz Dudek
- 2nd Department of Cardiology, Jagiellonian University Medical College, University Hospital, Jakubowskiego 2 Street, 30-688 Krakow, Poland; (A.D.); (T.R.); (B.Z.); (D.D.)
| | - Lukasz Rzeszutko
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Jakubowskiego 2 Street, 30-688 Krakow, Poland; (S.S.); (M.D.); (S.A.); (J.W.-B.); (L.R.)
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Wegiel M, Rakowski T, Siudak Z, Plens K, Dziewierz A, Birkemeyer R, Kleczynski P, Tokarek T, Rzeszutko L, Dudek D. TCT-250 Prevalence and Predictors of Coronary Artery Perforation During Percutaneous Coronary Interventions: Data From the ORPKI National Registry in Poland. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Januszek R, Pawlik A, Ruzsa Z, Nyerges A, Wojtasik-Bakalarz J, Rakowski T, Kleczynski P, Dudek D, Bartus S. P4706Sex-related differences in clinical outcomes after percutaneous transluminal angioplasty in patients with peripheral artery disease. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.1087] [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: 11/13/2022] Open
Abstract
Abstract
Aim
There are inconsistent data on the sex-related differences in clinical outcomes after percutaneous transluminal angioplasty (PTA) in patients with peripheral artery disease (PAD). We aimed to investigate sex-related differences in clinical outcomes after PTA.
Methods
A total of 939 consecutive patients undergoing PTA were enrolled in two large volume centers. Patients were stratified by gender. Baseline characteristics, procedural and long-term clinical outcomes were compared between women and men.
Results
Women represented 37.4% of the study population. Women, compared to men, had more often hypertension (92% vs 86%, p=0.001) and diabetes (54% vs 46%, p=0.02). However, men presented more often with chronic obstructive pulmonary disease (14.8% vs 6.8%, p=0.0003), coronary artery disease (45.4% vs 32.7%, p=0.0001), smoking (60.4% vs 45%, p=0.007) and previous PTA (25% vs 17%, p=0.005). There were no differences in 120-month all-cause mortality between groups (women vs. men: 29% vs. 21%, p=0.6). Men were at higher risk of re-PTA at 5-year follow-up (40% vs. 49%; p=0.03). Moreover, male sex was an independent predictor of re-PTA (age-adjusted odds ratio (OR) (95% CI): 1.276 (1.015–1.614), p=0.03). In multivariable Cox regression analysis, a superficial femoral artery chronic total occlusion (SFA-CTO) (hazard ratio [HR]) (95% confidence interval [CI]): 1.68 (1.12–2.5), body mass index (BMI) (hazard ratio (HR)) (95% CI): 0.93 (0.87–0.99), baseline creatinine level hazard ratio (HR)) (95% CI): 0.95 (0.88–0.99) were identified as independent factors of re-PTA in women.
Figure 1. Months to re-PTA for grouping variable male.
Conclusion
Male sex was identified as an independent predictor of re-PTA. SFA-CTO, BMI and baseline creatinine level were associated with re-PTA in women.
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Affiliation(s)
- R Januszek
- The University Hospital, 2nd Department of Cardiology and Cardiovascular Interventions, Cracow, Poland
| | - A Pawlik
- The University Hospital, 2nd Department of Cardiology and Cardiovascular Interventions, Cracow, Poland
| | - Z Ruzsa
- Semmelweis University Heart Center, Heart and Vascular Center, Budapest, Hungary
| | - A Nyerges
- Fejér County Szent György Hospital, Invasive Cardiology Department, Kecskemet, Hungary
| | - J Wojtasik-Bakalarz
- The University Hospital, 2nd Department of Cardiology and Cardiovascular Interventions, Cracow, Poland
| | - T Rakowski
- The University Hospital, 2nd Department of Cardiology and Cardiovascular Interventions, Cracow, Poland
| | - P Kleczynski
- The University Hospital, 2nd Department of Cardiology and Cardiovascular Interventions, Cracow, Poland
| | - D Dudek
- The University Hospital, 2nd Department of Cardiology and Cardiovascular Interventions, Cracow, Poland
| | - S Bartus
- The University Hospital, 2nd Department of Cardiology and Cardiovascular Interventions, Cracow, Poland
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Wiktorowicz A, Kleczynski P, Dziewierz A, Tokarek T, Sorysz D, Bagienski M, Rzeszutko L, Dudek D. Impact of Pre-procedural Cerebrovascular Events on Clinical Outcomes After Transcatheter Aortic Valve Implantation in Patients with Severe Aortic Stenosis. Curr Pharm Des 2019; 24:641-646. [PMID: 29468958 DOI: 10.2174/1381612824666180219145229] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 02/09/2018] [Accepted: 02/13/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) is an increasingly common treatment of symptomatic severe aortic valve stenosis (AS). Thus, it is reasonable to carefully investigate the impact of individual clinical factors on outcomes after TAVI. OBJECTIVES We aimed to investigate the impact of the previous cerebro-vascular events (CVEs) on outcomes of patients with severe AS undergoing TAVI. METHODS A total of 148 consecutive patients scheduled for TAVI were included and stratified as with and without a history of CVEs (stroke or transient ischemic attack). Frailty features were also assessed. The primary endpoint was a 12-month all-cause mortality. RESULTS Seventeen (11.5%) patients had a history of CVEs (the CVE group). At 30 days and 12 months, all-cause mortality was higher in the CVE group [30-day: 5 (29.4%) vs. 7 (5.3%); p=0.005; 12-month: 9 (52.9%) vs. 13 (9.9%); p=0.001]. Similarly, at the longest available follow-up, mortality was higher in the CVE group [10 (58.8%) vs. 23 (17.6%); p=0.001]. Similar rates of other complications after TAVI were noted, apart from inhospital acute kidney injury (AKI) grade 3 [3 (17.6%) vs. 5 (3.8%); p=0.049] and blood transfusions [9 (52.9%) vs. 35 (26.7%); p=0.026]. Results of 5MWT and Katz index assessment indicated a greater level of frailty in the CVE group. There were no differences in subsequent events including CVEs, bleeding, myocardial infarction, and new-onset of atrial fibrillation (AF) at 12 months between the groups. CONCLUSION We showed that a history of CVEs in patients with severe AS undergoing TAVI is associated with a higher long-term mortality.
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Affiliation(s)
- Agata Wiktorowicz
- 2nd Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Pawel Kleczynski
- 2nd Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Artur Dziewierz
- 2nd Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Tokarek
- 2nd Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Danuta Sorysz
- 2nd Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Maciej Bagienski
- 2nd Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Lukasz Rzeszutko
- 2nd Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Dariusz Dudek
- 2nd Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
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Wegiel M, Rzeszutko L, Kleczynski P, Zasada W, Depukat R, Rakowski T, Legutko J, Surdacki A, Dudek D, Bartus S. Long-term clinical outcomes of direct absorb bioresorbable vascular scaffold implantation in acute coronary syndrome. Minerva Cardioangiol 2019; 67:374-379. [PMID: 31527582 DOI: 10.23736/s0026-4725.19.04854-0] [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] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Preferred technique for bioresorbable vascular scaffold (BVS) implantation included high pressure predilation. Data about direct BVS implantation in acute coronary syndrome (ACS) patients are scarce. METHODS Analysis of 90 consecutive patients with acute myocardial infarction (MI) treated with primary PCI with Absorb deployment between 2013-2016 in a single center. In 45 patients, scaffolds were implanted in the direct technique, other 45 patients underwent Absorb deployment after balloon predilation. RESULTS Follow-up was available in 100% of patients with mean duration of 32±11 months. No cardiac death or scaffold thrombosis were observed in both groups. In the direct group, no target lesion revascularization (TLR) was reported. In the predilation arm, TLR occurred in 4 (9%) patients (P=0.12). Target vessel revascularization (TVR) was observed in 1 (2%) case in the direct group and in 6 (13%) patients from the predilation group (P=0.11). Target vessel MI was reported in one patient from each group. In an intention to treat analysis, we observed significantly higher rates of TVR (15% vs. 2%; P<0.043) and TLR (10% vs. 0%; P=0.038) in the predilation arm. Kaplan-Meier survival analysis did not show significant differences in TLR, TVR and device oriented composite endpoint (a combination of cardiac death, target vessel MI and ischemia driven TLR) between patients treated with both methods. CONCLUSIONS Direct Absorb implantation in patients with ACS may be feasible and safe.
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Affiliation(s)
- Michal Wegiel
- Second Department of Cardiology and Cardiovascular Interventions, Jagiellonian University Medical College, Cracow, Poland.,Institute of Cardiology, Jagiellonian University Medical College, Cracow, Poland
| | - Lukasz Rzeszutko
- Second Department of Cardiology and Cardiovascular Interventions, Jagiellonian University Medical College, Cracow, Poland
| | - Pawel Kleczynski
- Second Department of Cardiology and Cardiovascular Interventions, Jagiellonian University Medical College, Cracow, Poland.,Institute of Cardiology, Jagiellonian University Medical College, Cracow, Poland
| | - Wojciech Zasada
- Second Department of Cardiology and Cardiovascular Interventions, Jagiellonian University Medical College, Cracow, Poland
| | - Rafal Depukat
- Second Department of Cardiology and Cardiovascular Interventions, Jagiellonian University Medical College, Cracow, Poland
| | - Tomasz Rakowski
- Second Department of Cardiology and Cardiovascular Interventions, Jagiellonian University Medical College, Cracow, Poland.,Institute of Cardiology, Jagiellonian University Medical College, Cracow, Poland
| | - Jacek Legutko
- Institute of Cardiology, Jagiellonian University Medical College, Cracow, Poland
| | - Andrzej Surdacki
- Institute of Cardiology, Jagiellonian University Medical College, Cracow, Poland
| | - Dariusz Dudek
- Second Department of Cardiology and Cardiovascular Interventions, Jagiellonian University Medical College, Cracow, Poland.,Institute of Cardiology, Jagiellonian University Medical College, Cracow, Poland
| | - Stanislaw Bartus
- Second Department of Cardiology and Cardiovascular Interventions, Jagiellonian University Medical College, Cracow, Poland - .,Institute of Cardiology, Jagiellonian University Medical College, Cracow, Poland
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28
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Wiktorowicz A, Wit A, Dziewierz A, Rzeszutko L, Dudek D, Kleczynski P. A novel approach to quantification of aortic valve calcifications in patients undergoing transcatheter aortic valve implantation. Minerva Cardioangiol 2018; 67:3-10. [PMID: 30226030 DOI: 10.23736/s0026-4725.18.04793-x] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Precise calcium evaluation in the aortic complex may be complicated. We aimed to assess the usefulness of a novel semi-automatic algorithm for multi slice computed tomography-derived (MSCT) quantitative estimation of aortic valve calcifications (AVC) in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). METHODS Ten patients with severe AS who underwent TAVI with Edwards Sapien S3 26 mm prosthesis and had a pre-procedural MSCT scan were included. Data on baseline characteristics, procedural and long-term outcomes were collected prospectively. Pre-procedural MSCT data were used for AVC evaluation with 3D modeling (calcium volume, thickness, area, density, and distribution) in a dedicated program. RESULTS Mean calcium thickness was 4.6 (3.6-5.8) mm. Median calcium are 333.6 (274.7-386.7) mm2. We found a significant correlation between larger maximal calcium layer thickness and PVL occurrence after TAVI (P=0.039). The radial representation of the calcium distribution allowed to divide aortic valve into 3 zones and to compare each zone to parallel zone on TTE images. In zones with PVL ≥2 mean AVC was higher than in zones with PVL <2 (7354.6±4020.4 pixels vs. 4325.1±1790.6 pixels; P=0.018). Based on ROC analysis, the optimal cut-off value of AVC to predict PVL ≥2 was >6506 pixels with 57.1% sensitivity and 90.5% specificity (AUC 0.762 [95% CI: 0.564 to 0.901], P=0.029). CONCLUSIONS Multiplane AVC quantitative evaluation provided details on total calcium amount, pattern and distribution in aortic valve. Established AVC parameters allowed better visualization of an operating area and prediction of PVL after TAVI.
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Affiliation(s)
- Agata Wiktorowicz
- Second Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Adrian Wit
- Faculty of Physics and Applied Computer Science, University of Science and Technology, Krakow, Poland
| | - Artur Dziewierz
- Second Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Lukasz Rzeszutko
- Second Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Dariusz Dudek
- Second Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Pawel Kleczynski
- Second Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland -
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Dziewierz A, Tokarek T, Kleczynski P, Sorysz D, Bagienski M, Rzeszutko L, Dudek D. Impact of chronic obstructive pulmonary disease and frailty on long-term outcomes and quality of life after transcatheter aortic valve implantation. Aging Clin Exp Res 2018; 30:1033-1040. [PMID: 29185204 PMCID: PMC6096867 DOI: 10.1007/s40520-017-0864-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 11/17/2017] [Indexed: 10/30/2022]
Abstract
BACKGROUND Association between chronic obstructive pulmonary disease (COPD) and long-term mortality as well as the quality of life (QoL) in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI) is still unclear. AIM We sought to evaluate the impact of COPD on mortality and QoL of patients with AS undergoing TAVI. METHODS A total of 148 consecutive patients who underwent TAVI were enrolled and stratified by history of COPD. RESULTS Of 148 patients enrolled, 19 (12.8%) patients had a history of COPD. Patients with COPD were high-risk patients with higher prevalence of incomplete revascularization and frailty features. At follow-up of 15.8 months, all-cause mortality in patients with COPD was over four times higher than in patients without COPD [17.8% vs. 52.6%; p = 0.002-age/gender-adjusted OR (95% CI) 4.73 (1.69-13.24)]. On the other hand, in Cox regression model, the only independent predictors of all-cause death at long-term follow-up were: incomplete coronary revascularization [HR (95% CI) 5.45 (2.38-12.52); p = 0.001], estimated glomerular filtration rate [per 1 ml/min/1.73 m2 increase: 0.96 (0.94-0.98); p = 0.001], and previous stroke/transient ischemic attack [2.86 (1.17-7.00); p = 0.021]. Also, the difference in mortality between patients with and without COPD was not significant after adjustment for the most of frailty indices. Importantly, groups were comparable in terms of QoL at baseline and 12 months. CONCLUSION COPD may pose an important factor affecting long-term outcomes of patients with severe AS undergoing TAVI. However, its effects might be partially related to coexisting comorbidities and frailty.
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Rakowski T, Siudak Z, Plens K, Dziewierz A, Kleczynski P, Tokarek T, Dudek D. P3425Characteristics of patients presenting with myocardial infarction with non-obstructive coronary arteries (MINOCA) in Poland. Data from ORPKI national registry. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3425] [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)
- T Rakowski
- Jagiellonian University Medical College, Krakow, Poland
| | - Z Siudak
- Jan Kochanowski University, Kielce, Poland
| | | | - A Dziewierz
- Jagiellonian University Medical College, Krakow, Poland
| | - P Kleczynski
- Jagiellonian University Medical College, Krakow, Poland
| | - T Tokarek
- Jagiellonian University Medical College, Krakow, Poland
| | - D Dudek
- Jagiellonian University Medical College, Krakow, Poland
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Kleczynski P, Tokarek T, Dziewierz A, Bagienski M, Rzeszutko L, Sorysz D, Dudek D. P4495Psoas muscle area and volume and frailty scoring as predictors of outcomes after transcatheter aortic valve implantation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4495] [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)
- P Kleczynski
- Institute of Cardiology, Jagiellonian University, Krakow, Poland
| | - T Tokarek
- Institute of Cardiology, Jagiellonian University, Krakow, Poland
| | - A Dziewierz
- Institute of Cardiology, Jagiellonian University, Krakow, Poland
| | - M Bagienski
- Institute of Cardiology, Jagiellonian University, Krakow, Poland
| | - L Rzeszutko
- Institute of Cardiology, Jagiellonian University, Krakow, Poland
| | - D Sorysz
- Institute of Cardiology, Jagiellonian University, Krakow, Poland
| | - D Dudek
- Institute of Cardiology, Jagiellonian University, Krakow, Poland
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Tokarek T, Dziewierz A, Bagienski M, Rzeszutko L, Sorysz D, Kleczynski P, Dudek D. Impact of previous cardiac surgery with sternotomy on clinical outcomes and quality of life after transcatheter aortic valve implantation for severe aortic stenosis. Kardiol Pol 2018; 76:838-844. [PMID: 29350385 DOI: 10.5603/kp.a2018.0028] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 10/23/2017] [Accepted: 12/04/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) has evolved as an effective treatment in patients with symptomatic severe aortic stenosis (AS) and increased operative risk. Data on the influence of previous sternotomy on the risk of TAVI are limited. AIM We sought to investigate the effect of previous cardiac surgery with sternotomy on clinical outcomes and quality of life (QoL) after TAVI. METHODS The study included 148 consecutive patients with symptomatic severe AS, who underwent TAVI. Baseline charac-teristics, procedural and long-term clinical outcomes, and QoL assessment with the EQ-5D-3L questionnaire were compared between patients with and without previous sternotomy. RESULTS Patients with previous sternotomy (23.0% of the population) were younger and more often male, had higher rate of previous myocardial infarction (MI; 26 [22.8%] vs. 22 [64.7%], p = 0.001), and lower median left ventricular ejection frac-tion (60.0% [50.0-65.0] vs. 50.0% [42.0-60.0], p = 0.004). Periprocedural risk measured with the Logistic Euroscore and the Society of Thoracic Surgeons scale was comparable in both groups. There were no differences in 30-day and 12-month all-cause mortality between the groups with and without sternotomy (10 [8.8%] vs. 2 [5.9%], p = 0.7; odds ratio [OR] adjusted for age/sex/previous MI, 0.56, 95% confidence interval [CI] 0.10-3.29; for 12-month mortality adjusted OR 0.19, 95% CI 0.04-0.99). At the longest available follow-up, mortality was higher in patients without sternotomy (30 [26.3%] vs. 3 [8.8%], p = 0.03; adjusted OR 0.10, 95% CI 0.02-0.42). Similar rates of other complications after TAVI were noted. No differences in the EQ-5D-3L questionnaire at baseline and 12-month follow-up were confirmed. CONCLUSIONS TAVI seems to be a safe and effective technique for the treatment of severe AS in patients with previous cardiac surgery.
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Affiliation(s)
| | | | | | | | | | - Pawel Kleczynski
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University, Medical College, Krakow, Poland.
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Bagienski M, Kleczynski P, Dziewierz A, Rzeszutko L, Sorysz D, Trebacz J, Sobczynski R, Tomala M, Stapor M, Dudek D. Incidence of Postoperative Delirium and Its Impact on Outcomes After Transcatheter Aortic Valve Implantation. Am J Cardiol 2017; 120:1187-1192. [PMID: 28826892 DOI: 10.1016/j.amjcard.2017.06.068] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [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] [Received: 04/09/2017] [Revised: 05/30/2017] [Accepted: 06/15/2017] [Indexed: 01/05/2023]
Abstract
There are limited data on the occurrence of postoperative delirium after transcatheter aortic valve implantation (TAVI). We sought to investigate the incidence of delirium after TAVI and its impact on clinical outcomes. A total of 148 consecutive patients who underwent TAVI were enrolled. Of these patients, 141 patients survived hospital stay. The incidence of delirium was assessed in these patients for the first 4 days after the index procedure. The patients were divided into 2 groups based on the presence of delirium. Baseline characteristics, procedural and long-term outcomes, and frailty and quality-of-life indexes were compared among the groups. Of the 141 patients analyzed, 29 patients developed delirium. The transapical access was more common in patients with delirium (51.7% vs 8.9%, p <0.001). A greater median contrast volume load in the delirium group was noted (75 vs 100 ml, p = 0.001). Significantly more patients with delirium were considered as frail before TAVI. Thirty-day and 12-month all-cause mortality rates were higher in the delirium group (0.0% vs 17.2%, p <0.001; and 3.6% vs 37.9%, p <0.001, respectively). Differences in mortality were significant even after adjustment for baseline characteristics. The quality of life at 12 months, assessed by the 3-level version of the EuroQol 5-dimensional questionnaire, was similar in both groups. Despite a relatively minimally invasive character of TAVI as compared with surgery, some patients experience delirium after TAVI. Importantly, the occurrence of delirium after TAVI may help to identify patients with worse short- and long-term outcomes.
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Affiliation(s)
- Maciej Bagienski
- Institute of Cardiology, Jagiellonian University, Krakow, Poland
| | - Pawel Kleczynski
- Institute of Cardiology, Jagiellonian University, Krakow, Poland.
| | - Artur Dziewierz
- Institute of Cardiology, Jagiellonian University, Krakow, Poland
| | - Lukasz Rzeszutko
- Institute of Cardiology, Jagiellonian University, Krakow, Poland
| | - Danuta Sorysz
- Institute of Cardiology, Jagiellonian University, Krakow, Poland
| | - Jaroslaw Trebacz
- Institute of Cardiology, Jagiellonian University, Krakow, Poland
| | | | - Marek Tomala
- Institute of Cardiology, Jagiellonian University, Krakow, Poland
| | - Maciej Stapor
- Institute of Cardiology, Jagiellonian University, Krakow, Poland
| | - Dariusz Dudek
- Institute of Cardiology, Jagiellonian University, Krakow, Poland
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Rakowski T, Dziewierz A, Kleczynski P. TCT-675 Contrast Induced Nephropathy in Patients with Acute Coronary Syndromes Referred to Coronary Angiography. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.09.923] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Ruzsa Z, Wojtasik-Bakalarz J, Nyerges A, Rakowski T, Kleczynski P, Bartus S. Long-Term Follow-up After Retrograde Recanalization of Superficial Femoral Artery Chronic Total Occlusion. J Invasive Cardiol 2017; 29:336-339. [PMID: 28974660] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES The aim of this study was to assess the safety of the retrograde procedure with long-term follow-up of 86 patients after retrograde recanalization of the superficial femoral artery (SFA). BACKGROUND Chronic total occlusion (CTO) of SFAs occurs in >50% of the patient population with peripheral artery disease. The retrograde technique is an option for patients with unsuccessful antegrade percutaneous interventions, but data from long-term follow-up after retrograde recanalization are still limited. METHODS The study included 86 patients (67% males), who underwent percutaneous retrograde recanalization. Major adverse cardiovascular or cerebrovascular events and major adverse peripheral events were assessed from long-term (47.5 ± 40 months) follow-up data. RESULTS Mean patient age was 64 ± 9 years. Retrograde puncture was successful in all cases. Procedural success rate was 93%. In-hospital observation showed vascular perforation/bleeding in 4.7%, proximal hematoma in 9.3%, distal hematoma in 4.7%, pseudoaneurysm in 1.2%, thrombosis in 1.2%, puncture-site bleeding in 3.5%, and local inflammation in 1.2%. Mortality rate was 6.98%. Target-vessel reintervention was needed in 20.9% of cases, and percutaneous transluminal angioplasty of another artery was done in 27% of cases. Amputation rate was 4.7%. CONCLUSIONS Long-term follow-up shows that retrograde recanalization is connected with a high rate of technical success and low percentage of reinterventions. Retrograde technique is safe and related to low complication rates; most complications were localized in nature.
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Affiliation(s)
| | | | | | | | | | - Stanislaw Bartus
- II Dept. of Cardiology, Jagiellonian University, Krakow, Poland.
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Legutko J, Kleczynski P, Dziewierz A, Rzeszutko L, Bartus S, Bagienski M, Dudek D. P2378Correlation between quantitative flow ratio (QFR) and fractional flow reserve (FFR). Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Tokarek T, Dziewierz A, Wiktorowicz A, Bagienski M, Rzeszutko L, Sorysz D, Kleczynski P, Dudek D. Effect of diabetes mellitus on clinical outcomes and quality of life after transcatheter aortic valve implantation for severe aortic valve stenosis. Hellenic J Cardiol 2017; 59:100-107. [PMID: 28807801 DOI: 10.1016/j.hjc.2017.08.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 05/09/2017] [Revised: 08/03/2017] [Accepted: 08/07/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Diabetes mellitus (DM) is considered a marker of poor prognosis after cardiac surgery. We sought to investigate the effect of DM on clinical outcomes and quality of life (QoL) after transcatheter aortic valve implantation (TAVI). METHODS A total of 148 consecutive patients with symptomatic, severe aortic stenosis who underwent TAVI were included. Baseline characteristics, procedural and long-term clinical outcomes, and the results of frailty and QoL assessment with EQ-5D-3L questionnaire were compared between patients with and without DM. RESULTS DM was present in 48 of 148 (32.4%) patients. No differences in periprocedural risk (Logistic Euroscore and Society of Thoracic Surgeons (STS) scale) between groups were observed. There were no differences in 30-day and 12-month all-cause mortality between groups [DM(-) vs. DM(+): 7 (7.0%) vs. 5 (10.4%), p = 0.53 and 12 (12.0%) vs. 10 (20.8%), p = 0.16, respectively]. No influence of DM presence on the risk of death was confirmed after adjustment for age and gender (for 30-day mortality, age/gender-adjusted OR 1.55, 95%CI 0.47-5.17; for 12-month mortality, age/gender-adjusted OR 2.05, 95%CI 0.79-5.32). Similarly, at the longest available follow-up, mortality did not differ between groups [14 (29.2%) vs. 19 (19.0%), p = 0.16; age/gender-adjusted OR 1.81, 95%CI 0.80-4.08]. Similar rates of other complications after TAVI were noted. Frailty measured with the 5-meter walking test was more frequently reported in patients with DM [11 (22.9%) vs. 10 (10.0%), p = 0.035]. No differences in QoL parameters at baseline and 12 months were noted. CONCLUSIONS Patients with DM undergoing TAVI demonstrated similar mortality, complication rates, and QoL outcomes compared to patients without DM.
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Affiliation(s)
- Tomasz Tokarek
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 17 Kopernika St., 31-501 Krakow, Poland
| | - Artur Dziewierz
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University, Medical College, 17 Kopernika St., 31-501 Krakow, Poland
| | - Agata Wiktorowicz
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University, Medical College, 17 Kopernika St., 31-501 Krakow, Poland
| | - Maciej Bagienski
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University, Medical College, 17 Kopernika St., 31-501 Krakow, Poland
| | - Lukasz Rzeszutko
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University, Medical College, 17 Kopernika St., 31-501 Krakow, Poland
| | - Danuta Sorysz
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University, Medical College, 17 Kopernika St., 31-501 Krakow, Poland
| | - Pawel Kleczynski
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University, Medical College, 17 Kopernika St., 31-501 Krakow, Poland.
| | - Dariusz Dudek
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 17 Kopernika St., 31-501 Krakow, Poland
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Legutko J, Kleczynski P, Dziewierz A, Rzeszutko L, Bartus S, Bagienski M, Dudek D. P2385What should be the optimal way of achieving maximal hyperemia for assessment of coronary fractional flow reserve? Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2385] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kleczynski P, Dziewierz A, Wiktorowicz A, Bagienski M, Rzeszutko L, Sorysz D, Trebacz J, Sobczynski R, Tomala M, Dudek D. Prognostic value of tricuspid regurgitation velocity and probability of pulmonary hypertension in patients undergoing transcatheter aortic valve implantation. Int J Cardiovasc Imaging 2017; 33:1931-1938. [PMID: 28668978 PMCID: PMC5698373 DOI: 10.1007/s10554-017-1210-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 06/28/2017] [Indexed: 11/26/2022]
Abstract
Pulmonary hypertension (PH) is associated with adverse clinical outcomes after transcatheter aortic valve implantation (TAVI). We sought to investigate the effects of tricuspid regurgitant velocity (TRV) and echocardiographic probability of PH on clinical outcomes of patients undergoing TAVI. A total of 148 consecutive patients undergoing TAVI were included and stratified as having "low" (TRV ≤2.8 m/s), "intermediate" (TRV 2.9-3.4 m/s), and "high" (TRV >3.4 m/s) probability of PH. Only the patients from the "high" probability group were considered as patients with PH. All-cause mortality, complications rate and quality of life (QoL) were assessed according to VARC-2 recommendations. Of 148 patients, 65 (43.9%) were considered as patients with PH. These presented with higher NYHA class at baseline (p = 0.027) and had more frequently a history of previous stroke/transient ischemic attack (p = 0.019). A difference in all-cause mortality was noted at 12 months [PH (-) vs. PH (+): 9.6 vs. 21.5%; p = 0.043]; however, it was no longer significant after adjustment for age and gender (OR 2.39, 95% CI 0.91-6.24; p = 0.08). Unadjusted and adjusted rates of all-cause death at maximal follow-up of 13.3 (6.0-31.1) months were higher in patients with PH. However, the presence of PH was not identified as an independent predictor of all-cause mortality at follow-up. No difference in other complications rates and QoL were noted. The presence of TRV >3.4 m/s indicating "high" probability of PH may predict impaired clinical outcomes after TAVI. No impact of PH on QoL outcomes was confirmed.
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Affiliation(s)
- Pawel Kleczynski
- Institute of Cardiology, Jagiellonian University, Kopernika 17 Street, 31-501, Krakow, Poland.
| | - Artur Dziewierz
- Institute of Cardiology, Jagiellonian University, Kopernika 17 Street, 31-501, Krakow, Poland
| | - Agata Wiktorowicz
- Institute of Cardiology, Jagiellonian University, Kopernika 17 Street, 31-501, Krakow, Poland
| | - Maciej Bagienski
- Institute of Cardiology, Jagiellonian University, Kopernika 17 Street, 31-501, Krakow, Poland
| | - Lukasz Rzeszutko
- Institute of Cardiology, Jagiellonian University, Kopernika 17 Street, 31-501, Krakow, Poland
| | - Danuta Sorysz
- Institute of Cardiology, Jagiellonian University, Kopernika 17 Street, 31-501, Krakow, Poland
| | - Jaroslaw Trebacz
- Institute of Cardiology, Jagiellonian University, Kopernika 17 Street, 31-501, Krakow, Poland
| | - Robert Sobczynski
- Institute of Cardiology, Jagiellonian University, Kopernika 17 Street, 31-501, Krakow, Poland
| | - Marek Tomala
- Institute of Cardiology, Jagiellonian University, Kopernika 17 Street, 31-501, Krakow, Poland
| | - Dariusz Dudek
- Institute of Cardiology, Jagiellonian University, Kopernika 17 Street, 31-501, Krakow, Poland
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Kleczynski P, Dziewierz A, Bagienski M, Rzeszutko L, Sorysz D, Trebacz J, Sobczynski R, Tomala M, Stapor M, Dudek D. Impact of frailty on mortality after transcatheter aortic valve implantation. Am Heart J 2017; 185:52-58. [PMID: 28267475 DOI: 10.1016/j.ahj.2016.12.005] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 12/09/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND We sought to investigate the relation between frailty indices and 12-month mortality after transcatheter aortic valve implantation (TAVI). METHODS We included 101 consecutive patients with severe aortic stenosis who have undergone TAVI. Frailty indices according to Valve Academic Research Consortium-2 recommendations (5-m walk test [5MWT] and hand grip strength) as well as other available scales of frailty (Katz index, Elderly Mobility Scale [EMS], Canadian Study of Health and Aging [CSHA] scale, Identification of Seniors at Risk [ISAR] scale) were assessed at baseline. The primary endpoint was 12-month all-cause mortality. RESULTS Twelve-month all-cause mortality was 17.8%. According to 5MWT, 17.8% were frail; hand grip test: 6.9%; Katz index: 17.8%; EMS: 7.9%; CSHA scale: 16.9%; and ISAR scale: 52.5%. Associations between frailty indices and 12-month all-cause mortality after TAVI were significant in Cox regression analysis (frail vs not frail, presented as hazard ratio[95%CI] adjusted for logistic EuroSCORE): for 5MWT, 72.38 (15.95-328.44); for EMS, 23.39 (6.89-79.34); for CSHA scale, 53.97 (14.67-198.53); for Katz index, 21.69 (6.89-68.25); for hand grip strength, 51.54 (12.98-204.74); and for ISAR scale, 15.94 (2.10-120.74). Similarly, such relationship was confirmed when 5MWT, EMS, and CSHA were used as continuous variables (hazard ratio [95%CI] adjusted for logistic EuroSCORE: for 5MWT per 1-second increase, 2.55 [1.94-3.37]; for EMS per 1-point decrease, 2.90 (1.99-4.21); and for CSHA per 1-point increase, 3.13 [2.17-4.53]). CONCLUSIONS Our study confirmed a strong predictive ability of most of the proposed frailty indices for 12-month mortality after TAVI. For patients scheduled for TAVI, the use of frailty indices, which are easy and quick to assess on clinical basis but with strong performance, for example, 5MWT, EMS, or hand grip test, may be advocated.
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Kleczynski P, Dziewierz A, Bagienski M, Rzeszutko L, Sorysz D, Trebacz J, Sobczynski R, Tomala M, Stapor M, Dudek D. Association Between Blood Transfusions and 12-Month Mortality After Transcatheter Aortic Valve Implantation. Int Heart J 2017; 58:50-55. [DOI: 10.1536/ihj.16-131] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 11/18/2022]
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Kleczynski P, Dziewierz A, Bagienski M, Rzeszutko L, Sorysz D, Trebacz J, Sobczynski R, Tomala M, Gackowski A, Dudek D. Long-Term Mortality and Quality of Life After Transcatheter Aortic Valve Insertion in Very Elderly Patients. J Invasive Cardiol 2016; 28:492-496. [PMID: 27743507] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND We sought to compare long-term mortality and quality of life (QoL) in very elderly (≥80 years) patients undergoing transcatheter aortic valve implantation (TAVI) in comparison with younger patients (<80 years). METHODS A total of 101 patients treated with TAVI were divided into two groups according to age: <80 years (n = 42; 41.6%) and ≥80 years (n = 59; 58.4%). The baseline characteristics, including procedural outcomes as well as frailty and QoL assessment were compared between age groups. RESULTS Very elderly patients (≥80 years) were more frequently female, with a higher estimated risk of death based on STS score. Other baseline characteristics, including frailty indices, were comparable between groups. No difference in complication rate between age groups was observed. At 12 months, mortality rates were comparable for patients <80 years vs ≥80 years (16.7% vs 18.6%, respectively; P=.99). An improvement in QoL after 12 months as assessed by EQ-5D-3L was confirmed for both age groups, but with more pronounced beneficial effect of TAVI in younger patients. CONCLUSION The results of our single-center study showed that older age does not seem to be associated with impaired clinical outcomes after TAVI. However, benefit of TAVI in terms of long-term QoL improvement may be less apparent in very elderly patients.
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Affiliation(s)
- Pawel Kleczynski
- Institute of Cardiology, University Hospital, Kopernika 17 Street, 31-501 Krakow, Poland.
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Kleczynski P, Dziewierz A, Bagienski M, Rzeszutko L, Sorysz D, Trebacz J, Sobczynski R, Tomala M, Gackowski A, Dudek D. Impact of Coronary Artery Disease Burden on 12-Month Mortality of Patients After Transcatheter Aortic Valve Implantation. J Interv Cardiol 2016; 29:375-81. [PMID: 27358194 DOI: 10.1111/joic.12308] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES The aim of the study was to compare 12-month mortality rate of patients with and without complete coronary revascularization before transcatheter aortic valve implantation (TAVI). BACKGROUND There are limited data on the impact of coronary artery disease burden in patients with severe aortic stenosis undergoing TAVI. METHODS One hundred and one consecutive patients undergoing TAVI were enrolled. Of them 16 (15.8%) had an incomplete coronary revascularization. The primary endpoint was 12-month all-cause mortality. RESULTS Twelve-month all-cause mortality was higher in patients with incomplete coronary revascularization than in patients with complete coronary revascularization or without significant lesions (75.0% vs 7.1%; P < 0.001). Importantly, incomplete coronary revascularization was an independent predictor of higher mortality rate after 12 months (hazard ratio (HR) for incomplete coronary revascularization 10.86, 95% CI 3.72-31.73; P < 0.001; HR for a history of stroke/TIA 3.93, 95% confidence interval (CI) 1.39-11.07; P < 0.001; HR for blood transfusion 2.84 95% CI (1.06-7.63); P = 0.039). In 9 of 16 (56.3%) patients, incomplete revascularization was related to the presence of chronic total occlusions (CTO). Patients with CTO had an increased mortality rate after 12 months (55.6% vs 14.1%; P = 0.008) as compared to patients without the CTO. CONCLUSIONS Incomplete coronary revascularization and a history of stroke or TIA may be independent predictors of all-cause mortality in patients undergoing TAVI. However, further studies are recommended to confirm the results, especially in terms of the impact of CTO presence on long-term mortality after TAVI.
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Rakowski T, Dziewierz A, Legutko J, Kleczynski P, Brzozowska-Czarnek A, Siudak Z, Urbanik A, Dubiel JS, Dudek D. Creatine kinase-MB assessed in patients with acute myocardial infarction correlates with cardiac magnetic resonance infarct size at 6-month follow up. Hellenic J Cardiol 2014; 55:4-8. [PMID: 24491929] [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: 06/03/2023] Open
Abstract
INTRODUCTION There are still only limited data concerning the use of creatine kinase-MB (CKMB) values for predicting infarct size in long-term follow up in patients with ST-segment elevation myocardial infarction (STEMI) who have undergone primary percutaneous coronary intervention (PCI). The aim of this study was to analyze the correlation between CKMB and both infarct size and left ventricular function during a 6-month follow up. METHODS In a cohort of 68 patients with STEMI treated with PCI, serial CKMB assessment was performed at baseline and at 6, 12, 18, 24 and 48 hours after PCI. The area under the curve (AUC) of CKMB was calculated. Cardiac magnetic resonance (CMR) parameters were assessed at 6 months. RESULTS All CKMB single time-point values, AUC CKMB, and CKMB maximal value after primary PCI were correlated with CMR infarct size and left ventricular function, but a high correlation (r>0.7) was found only for CKMB at 6 hours, CKMB at 12 hours, CKMB AUC, CKMB maximal value, and CMR infarct size (r=0.71, r=0.73, r=0.72, r=0.75, respectively, p<0.001 for all). CONCLUSIONS CKMB assessment is a good predictor of infarct size at 6 months in patients with STEMI treated with PCI. The CKMB value at a single time point 12 hours after PCI is a good predictor of infarct size at 6 months, comparable to serial assessment parameters such as AUC CKMB and CKMB maximal value.
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Affiliation(s)
- Tomasz Rakowski
- Second Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
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Iliuta L, Uno K, Ebihara A, Hayashi N, Chigira M, Yoshikawa T, Kimura K, Yamagata H, Yatomi Y, Takenaka K, Neves A, Mathias L, Leshko J, Linask K, Henriques-Coelho T, Areias J, Huhta J, Barbier P, Castiglioni L, Colazzo F, Fontana L, Nobili E, Franzosi M, Li Causi T, Sironi L, Tremoli E, Guerrini U, Stankovic I, Claus P, Jasaityte R, Putnikovic B, Neskovic A, Voigt J, Kutty S, Attebery J, Yeager E, Truemper E, Li L, Hammel J, Danford D, Tumasyan L, Adamyan K, Chilingaryan A, Mjolstad O, Andersen G, Dalen H, Graven T, Kleinau J, Skjetne K, Haugen B, Sucu M, Uku O, Sari I, Ercan S, Davutoglu V, Ozer O, Kim S, Na JO, Im S, Choi C, Lim H, Kim J, Han S, Seo H, Park C, Oh D, Hammoudi N, Duprey M, Regnier P, Vignalou J, Boubrit L, Pousset F, Jobard O, Isnard R, Shin SH, Woo S, Kim D, Park K, Kwan J, Andersen G, Mjolstad O, Graven T, Kleinau J, Skjetne K, Haugen B, Dalen H, Grigoryan S, Tunyan L, Hazarapetyan L, Shkolnik E, Vasyuk Y, Nesvetov V, Ruddox V, Edvardsen T, Otterstad J, Patrianakos A, Zacharaki A, Kalogerakis A, Nyktari E, Psathakis E, Parthenakis F, Vardas P, Yodwut C, Weinert L, Lang R, Mor-Avi V, Bandera F, Arena R, Labate V, Castelvecchio S, Menicanti L, Guazzi M, Nedeljkovic I, Ostojic M, Stepanovic J, Giga V, Beleslin B, Popovic D, Djordjevic-Dikic A, Petrovic M, Nedeljkovic M, Seferovic P, Popovic D, Ostojic M, Popovic B, Petrovic M, Vujisic-Tesic B, Nedeljkovic I, Arandjelovic A, Banovic M, Seferovic P, Damjanovic S, Horovitz A, Iriart X, De Guillebon D, Reant P, Lafitte S, Thambo J, Venkatesh A, Shahgaldi K, Johnson J, Brodin L, Winter R, Sahlen A, Manouras A, Szulik M, Streb W, Kalarus Z, Kukulski T, Lesniak-Sobelga AM, Kostkiewicz M, Tomkiewicz-Pajak L, Olszowska M, Hlawaty M, Rubis P, Podolec P, Spinelli L, Di Panzillo EA, Morisco C, Crispo S, Trimarco B, Lutay Y, Parkhomenko A, Stepura A, Zamfir D, Tautu O, Nestoruc A, Onut R, Comanescu I, Scafa Udriste A, Dorobantu M, Guseva O, Zhuravskaya N, Bartosh-Zelenaya S, Zagatina A, Kekovic P, Isailovic-Kekovic M, Squeri A, Macri' G, Anglano F, Censi S, Conti R, Pizzarelli M, Trecroci U, Bosi S, Le Tourneau T, Probst V, Kyndt F, Duval D, Trochu J, Bernstein J, Hagege A, Levine R, Le Marec H, Schott J, Enache R, Muraru D, Popescu B, Mateescu A, Purcarea F, Calin A, Beladan C, Rosca M, Ginghina C, Urdaniz MM, Rodriguez Palomares JF, Rius JB, Acosta Velez JG, Garcia-Moreno LG, Tura GT, Alujas MTG, Mas PT, Masip AE, Dorado DG, Zito C, Cusma-Piccione M, Miceli M, Di Bella G, Mohammed M, Oreto L, Di Matteo I, Crea P, Alongi G, Carerj S, Mizariene V, Zaliaduonyte-Peksiene D, Vaskelyte J, Jonkaitiene R, Jurkevicius R, D'auria F, Stinziani V, Grego S, Polisca P, Chiariello L, Cardoso M, Almeida A, David C, Marques J, Jorge C, Silva D, Magalhaes A, Goncalves S, Diogo A, Shiran A, Adawi S, Sachner R, Asmer I, Ganaeem M, Rubinshtein R, Gaspar T, Necas J, Kovalova S, Bombardini T, Sicari R, Ciampi Q, Gherardi S, Costantino M, Picano E, Casartelli M, Bombardini T, Simion D, Gaspari M, Procaccio F, Tsatsopoulou A, Prappa E, Kalantzi M, Patrianakos A, Anastasakis A, Protonotarios N, Monteforte N, Bloise R, Napolitano C, Priori S, Davos C, Varela A, Tsilafakis C, Kostavassili I, Mavroidis M, Di Molfetta A, Musca F, Fresiello L, Santini L, Forleo G, Lunati M, Ferrari G, Romeo F, Moreo A, Lourenco M, Azevedo O, Machado I, Nogueira I, Fernandes M, Pereira V, Quelhas I, Lourenco A, Estensen M, Langesaeter E, Gullestad L, Aakhus S, Skulstad H, Gronlund C, Gustavsson S, Morner S, Suhr O, Lindqvist P, Sunbul M, Kepez A, Durmus E, Ozben B, Mutlu B, Esposito R, Santoro A, Ippolito R, Schiano Lomoriello V, De Palma D, Santoro C, Muscariello R, Ierano P, Galderisi M, Mohammed M, Zito C, Cusma-Piccione M, Di Bella G, Antonini-Canterin F, Taha N, Di Bello V, Vriz O, Pugliatti P, Carerj S, Beladan C, Popescu B, Calin A, Rosca M, Matei F, Enache E, Gurzun M, Ginghina C, Stanescu C, Manoliu V, Branidou K, Daha I, Baicus C, Adam C, Ene I, Dan G, Von Bibra H, Wulf G, Schuster T, Pfuetzner A, Heilmeyer P, Dobson G, Smith B, Grapsa J, Nihoyannopoulos P, Montoro Lopez M, Alonso Ladreda A, Florez Gomez R, Itziar Soto C, Rios Blanco J, Gemma D, Iniesta Manjavacas A, Moreno Yanguela M, Lopez Sendon J, Guzman Martinez G, O'driscoll J, Marciniak A, Perez-Lopez M, Sharma R, Bombardini T, Cini D, Gherardi S, Del Bene R, Serra W, Moreo A, Sicari R, Picano E, Fernandez Cimadevilla O, De La Hera Galarza J, Pasanisi E, Alvarez Pichel I, Diaz Molina B, Martin Fernandez M, Corros C, Lambert Rodriguez J, Sicari R, Jedrzychowska-Baraniak J, Jarosz K, Jozwa R, Kasprzak J, Mohty D, Petitalot V, El Hamel C, Damy T, Lavergne D, Echahidi N, Virot P, Cogne M, Jaccard A, Weng KP, Hsieh KS, Yang YY, Wutthachusin T, Kaier T, Grapsa J, Morgan D, Hakky S, Purkayastha S, Connolly S, Fox K, Ahmed A, Cousins J, Nihoyannopoulos P, Sveric K, Richter U, Wunderlich C, Strasser R, Spethmann S, Dreger H, Baldenhofer G, Mueller E, Stuuer K, Stangl V, Laule M, Baumann G, Stangl K, Knebel F, Ruiz Ortiz M, Mesa D, Delgado M, Romo E, Castillo F, Morenate M, Baeza F, Toledano F, Leon C, De Lezo JS, Ishizu T, Seo Y, Kameda Y, Enomoto M, Atsumi A, Yamamoto M, Nogami Y, Aonuma K, Theodosis-Georgilas A, Tountas H, Fousteris E, Tsaoussis G, Margetis P, Deligiorgis A, Katidis Z, Melidonis A, Beldekos D, Foussas S, Butz T, Faber L, Piper C, Reckefuss N, Wirdeier S, Van Bracht M, Prull M, Plehn G, Horstkotte D, Trappe HJ, Winter S, Martinek M, Ebner C, Nesser H, Kilickiran Avci B, Yurdakul S, Sahin S, Tanrikulu A, Ermis E, Aytekin S, Cefalu C, Barbier P, Santoro A, Ippolito R, Esposito R, Schiano Lomoriello V, De Palma D, Muscariello R, Galderisi M, Karamanou A, Hamodraka E, Vrakas S, Paraskevaides I, Lekakis I, Kremastinos D, Enache R, Piazza R, Muraru D, Mateescu A, Popescu B, Calin A, Beladan C, Rosca M, Nicolosi G, Ginghina C, Erdogan E, Bacaksiz A, Akkaya M, Tasal A, Vatankulu M, Turfan M, Sonmez O, Ertas G, Uyarel H, Goktekin O, Singelton J, Petraco R, Shaikh R, Cole G, Francis D, Manisty C, Almeida A, Cortez-Dias N, Sousa J, Carpinteiro L, Marques J, Silva D, Jorge C, Carrilho-Ferreira P, Pinto F, Diogo A, Kleczynski P, Legutko J, Rakowski T, Dziewierz A, Siudak Z, Zdzienicka J, Brzozowska-Czarnek A, Dubiel J, Dudek D, Carvalho MS, De Araujo Goncalves P, Dores H, Sousa P, Marques H, Pereira Machado F, Gaspar A, Aleixo A, Mota Carmo M, Roquette J, Obase K, Sakakura T, Matsushita S, Takeuchi M, Tamai S, Komeda M, Yoshida K, Jimenez Rubio C, Isasti Aizpurua G, Miralles Ibarra J, Gianstefani S, Catibog N, Whittaker A, Wathen P, Kogoj P, Reiken J, Monaghan M, Salvetti M, Muiesan M, Paini A, Agabiti Rosei C, Aggiusti C, Bertacchini F, Stassaldi D, Rubagotti G, Comaglio A, Agabiti Rosei E, Soldati E, Corciu A, Zucchelli G, Di Cori A, Segreti L, De Lucia R, Paperini L, Viani S, Vannozzi A, Bongiorni M, Kablak-Ziembicka A, Przewlocki T, Stepien E, Wrotniak L, Karch I, Podolec P, Kleczynski P, Rakowski T, Dziewierz A, Jakala J, Legutko J, Dubiel J, Dudek D. Poster session Friday 7 December - PM: Effect of systemic illnesses on the heart. Eur Heart J Cardiovasc Imaging 2012. [DOI: 10.1093/ehjci/jes266] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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