Publications by authors named "Agata Krawczyk-Ożóg"

22 Publications

  • Page 1 of 1

Patent Foramen Ovale Channel Morphometric Characteristics Associated with Cryptogenic Stroke: The MorPFO Score.

J Am Soc Echocardiogr 2021 12 11;34(12):1285-1293.e3. Epub 2021 Aug 11.

Department of Interventional Cardiology, University Hospital, Jagiellonian University Medical College, Cracow, Poland.

Background: It is still disputable whether the specific morphologic properties of patent foramen ovale (PFO) may contribute to the occurrence of stroke. The aim of this study was to evaluate the differences in the morphometric and functional features of the PFO channel in patients with cryptogenic stroke and those without stroke.

Methods: PFO channel morphology in 106 consecutive patients with cryptogenic stroke and 93 control patients without stroke with diagnosed PFO (by transesophageal echocardiography) was analyzed using transesophageal echocardiography. A validation cohort was established that consisted of 31 patients with cryptogenic stroke and 30 without stroke.

Results: Multivariable regression logistic analyses indicated PFO channel length change (odds ratio [OR], 2.50; 95% confidence interval [CI], 1.75-3.55; P < .001), PFO length/height ratio during the Valsalva maneuver (OR, 0.75; 95% CI, 0.60-0.95; P = .015), septum primum thickness (OR, 0.34; 95% CI, 0.14-0.80; P = .013), septum secundum height (OR, 0.91; 95% CI, 0.84-0.98; P = .013), the presence of an atrial septal aneurysm (OR, 3.38; 95% CI, 1.27-8.97; P = .014), and large shunt (OR, 2.49; 95% CI, 1.13-5.46; P = .022) as PFO-related stroke factors. The Morphologic Stroke Factors of PFO (MorPFO) score was developed, in which six factors were included: PFO channel length reduction (≥21%; 7 points), short septum secundum (<8.6 mm; 5 points), thin septum primum (<1.6 mm; 3 points), large right-to-left shunt (3 points), low PFO channel length/height ratio during the Valsalva maneuver (≤2.1; 2 points), and atrial septal aneurysm presence (1 point). Patients with scores of 0 to 7 points have low-risk PFO channels, those with scores of 8 to 11 points have intermediate-risk PFO channels, and those with scores of 12 to 21 points have high-risk PFO channels. External validation showed good MorPFO score performance (C index = 0.90).

Conclusions: Transesophageal echocardiography can be used to differentiate pathogenic from incidental PFO channels on the basis of their morphologic characteristics. The MorPFO score may help identify high-stroke-risk PFO channels.
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http://dx.doi.org/10.1016/j.echo.2021.07.016DOI Listing
December 2021

Assessment of the implementation level of the guidelines for secondary prevention of cardiovascular disease in everyday clinical practice.

Kardiol Pol 2021 04 3;79(4):434-441. Epub 2021 Mar 3.

Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland

Background: The goal of secondary prevention is to hinder the recurrence of cardiovascular events in patients already diagnosed with cardiovascular diseases.

Aims: We aimed to assess the level of adherence to guidelines for secondary prevention of cardiovascular disease in everyday clinical practice.

Methods: This was a single‑center retrospective analysis of 460 consecutive rehospitalized patients previously diagnosed with coronary artery disease. The presence of main risk factors for cardiovascular disease was analyzed in this cohort.

Results: Overall, 80.7% of patients did not comply with the body mass index recommendations. Among nondiabetic patients, 43.5% exceeded the recommended blood glucose level and 55.5% of diabetic patients exceeded the recommended level of glycated hemoglobin. Total cholesterol level was higher than recommended in 13.5% of patients, the level of low‑density lipoprotein (LDL) cholesterol was exceeded in 78.7% individuals, and the level of triglycerides was over the limit in 30.2% of patients. Systolic and / or diastolic blood pressure higher than or equal to 140/90 mm Hg was recorded in 41.3% of patients. Low level of physical activity was declared by 56.7% of the studied patients and 14.6% of them admitted to being current tobacco smokers. No patient fulfilled all of the main prevention goals (body weight, no smoking, LDL cholesterol level, glucose level, systolic and / or diastolic blood pressure) and in 10.2% of cases none of the above‑mentioned criteria were achieved. Significant difference in the implementation level of the guidelines was found between the sexes, with men showing lower adherence than women.

Conclusions: The level of adherence to the guidelines for secondary prevention of coronary artery disease was extremely low, with men being worse responders than women.
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http://dx.doi.org/10.33963/KP.15856DOI Listing
April 2021

Is ST-segment elevation myocardial infarction (STEMI) always STEMI? Case report of a rare cause of an electric storm.

Postepy Kardiol Interwencyjnej 2020 Dec 29;16(4):474-476. Epub 2020 Dec 29.

Intensive Cardiac Care Unit, University Hospital, Jagiellonian University, Krakow, Poland.

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http://dx.doi.org/10.5114/aic.2020.101774DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7863835PMC
December 2020

Assessment of mitral regurgitation and mitral complex geometry in patients after transcatheter aortic valve implantation.

Postepy Kardiol Interwencyjnej 2020 Sep 2;16(3):300-305. Epub 2020 Oct 2.

Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland.

Introduction: Mitral regurgitation (MR) of varying degrees and mechanisms is a common finding in patients with aortic stenosis with different improvement after transcatheter aortic valve implantation (TAVI).

Aim: To evaluate the impact of TAVI on mitral complex geometry and the degree of MR.

Material And Methods: A total of 31 patients (29.0% males) with severe aortic stenosis and moderate or severe MR at the baseline who underwent TAVI were included in this study. Clinical and echocardiographic characteristics were determined at baseline and at 6 and 12 months.

Results: After TAVI, decrease of MR vena contracta width ( = 0.00002, = 0.00004), aorto-mural mitral annulus diameter ( = 0.00008, = 0.02), increase of mitral annular plane systolic excursion ( = 0.0004, = 0.0003), left ventricular stroke volume ( = 0.0003, = 0.0004), ejection fraction ( = 0.0004, = 0.01) and decrease of major dimension of left ventricle in three chamber view ( = 0.05, = 0.002) were observed in patients at both time points. Additionally, we observed a decrease of distance between the head of the papillary muscles ( = 0.003) at 6 months and a decrease of left atrium volume index ( = 0.01) and systolic pulmonary artery pressure ( = 0.01) at 12 months.

Conclusions: Patients with moderate or severe MR undergoing TAVI achieved significant improvement of mitral valve complex function resulting in the reduction of MR degree.
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http://dx.doi.org/10.5114/aic.2020.99265DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7863815PMC
September 2020

The Usefulness of [F]F-Fluorodeoxyglucose and [F]F-Sodium Fluoride Positron Emission Tomography Imaging in the Assessment of Early-Stage Aortic Valve Degeneration after Transcatheter Aortic Valve Implantation (TAVI)-Protocol Description and Preliminary Results.

J Clin Med 2021 Jan 22;10(3). Epub 2021 Jan 22.

Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Kraków, Poland.

Transcatheter aortic valve implantation (TAVI) is now a well-established treatment for severe aortic stenosis. As the number of procedures and indications increase, the age of patients decreases. However, their durability and factors accelerating the process of degeneration are not well-known. The aim of the study was to verify the possibility of using [F]F-sodium fluoride ([F]F-NaF) and [F]F-fluorodeoxyglucose ([F]F-FDG) positron emission tomography/computed tomography (PET/CT) in assessing the intensity of TAVI valve degenerative processes. In 73 TAVI patients, transthoracic echocardiography (TTE) at initial (before TAVI), baseline (after TAVI), and during follow-up, as well as transesophageal echocardiography (TEE) and PET/CT, were performed using [F]F-NaF and [F]F-FDG at the six-month follow-up (FU) visit as a part of a two-year FU period. The morphology of TAVI valve leaflets were assessed in TEE, transvalvular gradients and effective orifice area (EOA) in TTE. Calcium scores and PET tracer activity were counted. We assessed the relationship between [F]F-NaF and [F]F-FDG PET/CT uptake at the 6 = month FU with selected indices e.g.,: transvalvular gradient, valve type, EOA and insufficiency grade at following time points after the TAVI procedure. We present the preliminary PET/CT ([F]F-NaF, [F]F-FDG) results at the six-month follow-up period as are part of an ongoing study, which will last two years FU. We enrolled 73 TAVI patients with the mean age of 82.49 ± 7.11 years. A significant decrease in transvalvular gradient and increase of effective orifice area and left ventricle ejection fraction were observed. At six months, FU valve thrombosis was diagnosed in four patients, while 7.6% of patients refused planned controls due to the COVID-19 pandemic. We noticed significant correlations between valve types, EOA and transaortic valve gradients, as well as [F]F-NaF and [F]F-FDG uptake in PET/CT. PET/CT imaging with the use of [F]F-FDG and [F]F-NaF is intended to be feasible, and it practically allows the standardized uptake value (SUV) to differentiate the area containing the TAVI leaflets from the SUV directly adjacent to the ring calcifications and the calcified native leaflets. This could become the seed for future detection and evaluation capabilities regarding the progression of even early degenerative lesions to the TAVI valve, expressed as local leaflet inflammation and microcalcifications.
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http://dx.doi.org/10.3390/jcm10030431DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7866182PMC
January 2021

Morphology of the Vieussens valve and its imaging in cardiac multislice computed tomography.

J Cardiovasc Electrophysiol 2019 08 18;30(8):1325-1329. Epub 2019 Jun 18.

HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland.

Introduction: To deliver accurate morphological descriptions of the Vieussens valve (VV) and to investigate whether this structure could be visualized using standard contrast-enhanced electrocardiogram-gated multislice computed tomography (MSCT).

Methods: A total of 145 human autopsied hearts and 114 cardiac MSCT scans were examined.

Results: The VV was observed in both study groups, however, the detection rate was significantly worse in the MSCT examination (18.4% in MSCT vs 62.1% in cadavers, P < .0001). The VV height was larger in MSCT patients (2.8 ± 1.2 vs 5.4 ± 1.7 mm; P < .0001). No significant difference was found in the measured distance between the VV and the coronary sinus ostium between the two separate subgroups (27.3 ± 9.5 vs 24.4 ± 5.8 mm; P = .18). In autopsied material the most frequent valve location was the anterior wall of the coronary sinus (43.3%); the same was observed in MSCT scans (71.4%).

Conclusion: The VV is a common heart structure, present in over 60% of humans, located mainly on the anterior and superior circuit of the coronary sinus, with relatively high morphological variability. Large VVs, which pose a significant obstacle in catheterization procedures, may be visualized using standard-protocol contrast-enhanced cardiac MSCT.
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http://dx.doi.org/10.1111/jce.14018DOI Listing
August 2019

The obesity paradox in patients undergoing transcatheter aortic valve implantation: is there any effect of body mass index on survival?

Kardiol Pol 2019;77(2):190-197. Epub 2018 Dec 21.

2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland.

Background: Conflicting results have been presented regarding the influence of body mass index (BMI) on outcomes among patients undergoing transcatheter aortic valve implantation (TAVI).

Aims: To investigate the impact of BMI on clinical outcomes after TAVI.

Methods: A total of 148 consecutive patients were categorised using baseline BMI according to the World Health Organization criteria. Baseline patient characteristics, frailty, and procedural and clinical outcomes including 30-day and 12-month all-cause mortality were compared between the BMI categories. Patients were followed up for a median of 460.0 (182.0-1042.0) days.

Results: Obesity was diagnosed in 37 (25.2%) patients, 73 (49.7%) patients were overweight, and 37 (25.2%) had normal weight. Prevalence of lower frailty as assessed by five-metre walk test was confirmed in obese patients as compared to other groups. A trend towards a lower rate of in-hospital bleeding complications (18 [48.6%] vs. 21 [28.8%] vs. 9 [24.3%] in normal-weight, overweight, and obese patients, respectively; p = 0.06) and less frequent blood transfusions (18 [48.6%] vs. 17 [23.3%) vs. 8 [21.6%]; p = 0.016) was observed in overweight and obese groups. The rate of grade 3 acute kidney injury was lowest in the overweight group (4 [10.8%] vs. 1 [1.4%] vs. 3 [8.1%]; p = 0.05). There was no difference between the groups in terms of 30-day all-cause mortality (p = 0.15). However, 12-month all-cause mortality was lowest in obese pa-tients (12 [32.4%] vs. 10 [13.7%] vs. 2 [5.4%]; p = 0.004). Increase in BMI was independently associated with lower all-cause mortality (hazard ratio [95% confidence interval] per 1 kg/m2 increase: 0.91 [0.845-0.98]; p = 0.018).

Conclusions: Increased BMI was independently associated with survival benefit after TAVI.
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http://dx.doi.org/10.5603/KP.a2018.0243DOI Listing
August 2019

Comparison of clinical and echocardiographic outcomes and quality of life in patients with severe mitral regurgitation treated by MitraClip implantation or treated conservatively.

Postepy Kardiol Interwencyjnej 2018 21;14(3):291-298. Epub 2018 Sep 21.

2 Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland.

Introduction: The most common alternative method of treatment for patients with severe mitral regurgitation (MR) is the implantation of a MitraClip device.

Aim: To evaluate clinical and echocardiographic outcomes and quality of life (QoL) in patients with severe secondary MR, disqualified from surgical intervention, treated by implantation of a MitraClip in comparison to conservative therapy.

Material And Methods: A total of 33 patients were included. Patients were stratified by treatment method: group A, MitraClip implantation ( = 10); group B, conservative treatment ( = 23). Clinical, echocardiographic, and QoL (EQ-5D-3L, SF-12v2 Health Survey) characteristics were compared at baseline and at follow-up of 8.0 ±2.3 months.

Results: In group A, 2 deaths were observed: one patient died 7 days after MitraClip implantation, and the second patient died 4 months after the procedure. No cases of rehospitalization were reported. In group B, 4 (17.4%) deaths and 6 (26.1%) hospitalizations were reported. After MitraClip implantation a significant reduction of the NYHA class ( = 0.02), decrease in grade of MR ( = 0.01), vena contracta width ( = 0.006), effective regurgitant orifice area (EROA) ( = 0.003), regurgitant volume ( = 0.03) and end-diastolic left ventricle diameter ( = 0.02) as well as an improvement in QoL were reported. There were no significant changes in the NYHA class and QoL in the group treated conservatively. In those patients, we observed increased intercommissural mitral annulus diameter ( = 0.03), left atrium diameter ( = 0.002), and right ventricle dimension ( = 0.008), more severe tricuspid regurgitation ( = 0.02) and lower mitral annular plane systolic excursion ( = 0.01).

Conclusions: Patients with severe secondary MR treated with the MitraClip achieved a significant reduction in symptoms and MR grade, as well as an improvement in QoL, as compared to patients treated conservatively.
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http://dx.doi.org/10.5114/aic.2018.78334DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6173086PMC
September 2018

Cardiac computed tomography compared with two-dimensional transesophageal echocardiography for the detection and assessment of atrial septal pouches.

Int J Cardiovasc Imaging 2018 Aug 24;34(8):1305-1313. Epub 2018 Mar 24.

HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Kopernika 12, 31-034, Cracow, Poland.

The aim of this study is to compare the two-dimensional transesophageal echocardiography (2D-TEE) with multi-slice computed tomography (MSCT) and with autopsied material to evaluate the ability and precision of the imaging methods for the detection and assessment of septal pouch (SP). One hundred and fifty patients that underwent both 2D-TEE and MSCT and 50 autopsied human hearts were investigated. In MSCT, the interatrial septum was classified as a left SP in 37.3%, right SP in 3.3%, and patent foramen ovale (PFO) channel in 3.3%. In 2D-TEE, the interatrial septum was classified as a left SP in 39.3%, right SP in 11.3%, double SP in 4.7%, and PFO channel in 2.0%. The weighted kappa coefficient between MSCT and 2D-TEE in assessing the septum morphology was 0.59. The prevalence of the left SP is lower when it is evaluated by MSCT or 2D-TEE than by anatomical study, but this difference is insignificant (37.3% vs. 44.0%, p = 0.40, and 39.3% vs. 44.0%, p = 0.56, respectively). The prevalence of left SPs is lower when detected by MSCT or 2D-TEE than during autopsy, but the difference is statistically insignificant (37.3% vs. 44.0%, p = 0.40, and 39.3% vs. 44.0%, p = 0.56, respectively). Both 2D-TEE and MSCT are comparable techniques for detecting left-sided SPs with the insignificant lower prevalence of detecting left-sided SPs compared to autopsied material. However, TEE with the contrast seems to be superior over MSCT due to the possibility of unambiguous PFO channel detection. Therefore, TEE with contrast should be preferred over MSCT in the identification of left-sided SPs.
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http://dx.doi.org/10.1007/s10554-018-1342-0DOI Listing
August 2018

Left-Sided Atrial Septal Pouch is a Risk Factor for Cryptogenic Stroke.

J Am Soc Echocardiogr 2018 07 21;31(7):771-776. Epub 2018 Mar 21.

Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland.

Background: The atrial septal pouch is an anatomic variant of the interatrial septum. The morphology of the left-sided septal pouch (LSSP) may favor blood stasis and predispose to thromboembolic events. The aim of this study was to determine the association between LSSP presence and cryptogenic stroke.

Methods: A total of 126 consecutive patients with cryptogenic stroke and 137 age-matched control patients without stroke were analyzed retrospectively. The presence and dimensions of LSSPs were assessed using transesophageal echocardiography.

Results: LSSP was present in 55.6% of patients with cryptogenic stroke and in 40.9% of those without stroke (P = .02). In univariate analysis, patients with LSSP were more likely to have cryptogenic stroke (odds ratio, 1.81; 95% CI, 1.11-2.95; P = .02). After adjusting for other risk factors using multiple logistic regression, the presence of an LSSP was found to be associated with an increased risk for cryptogenic stroke (odds ratio, 2.02; 95% CI, 1.19-3.41; P = .01). There were no statistically significant differences in size of the LSSP between patients with and those without stroke (P > .05).

Conclusions: There is an association between the presence of an LSSP and an increased risk for cryptogenic stroke. More attention should be paid to clinical evaluations of LSSPs.
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http://dx.doi.org/10.1016/j.echo.2018.01.023DOI Listing
July 2018

Mid-esophageal bicaval versus short-axis view of interatrial septum in two-dimensional transesophageal echocardiography for diagnosis and measurement of atrial septal pouches.

Echocardiography 2018 06 28;35(6):827-833. Epub 2018 Feb 28.

Department of Anatomy, HEART-Heart Embryology and Anatomy Research Team, Jagiellonian University Medical College, Cracow, Poland.

Background: Recent studies suggest that the left-sided septal pouch (SP) may increase the risk of cryptogenic stroke and act as an arrhythmogenic substrate. The aim of this study was to compare two transesophageal echocardiography (TEE) projections of the interventricular septum: mid-esophageal bicaval and short-axis views toward evaluating their ability to detect SPs.

Materials And Methods: A total of 146 patients with both bicaval and short-axis TEE views were included in this study. The presence of SPs was determined, and they were evaluated for morphology.

Results: Irrespective of TEE projection view, the left SP was detected in 74 cases (50.7%), right SP in 16 cases (11.0%), and double in one case (0.7%). Agreement between both projections occurred in 119 cases (81.5%) with a weighted kappa coefficient of 0.68 (good agreement). We detected more left SPs from the bicaval view compared to the short-axis view; however, the observed difference was statistically insignificant (72 vs 59, P = .13). The detection of right SPs was higher in the short-axis view, but also statistically insignificant (9 vs 13, P = .38). Bland-Altman analysis revealed a significant difference in the left SP depth with higher values in the bicaval than short-axis view (systematic difference = 1.17 mm, LoA: -4.88-7.22 mm, P = .02, ICC = 0.58).

Conclusions: The mid-esophageal bicaval view should be preferable over mid-esophageal short-axis view of interatrial septum for the diagnosis and measurement of the left SP.
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http://dx.doi.org/10.1111/echo.13847DOI Listing
June 2018

Comparative iTRAQ analysis of protein abundance in the human sinoatrial node and working cardiomyocytes.

J Anat 2018 06 27;232(6):956-964. Epub 2018 Feb 27.

HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Faculty of Medicine, Jagiellonian University Medical College, Cracow, Poland.

Our objective was to assess the changes in protein abundance in the human sinoatrial node (SAN) compared with working cardiomyocytes to identify SAN-specific protein signatures. Four pairs of samples (the SAN and working cardiomyocytes) were obtained postmortem from four human donors with no evidence of cardiovascular disease. We performed protein identification and quantitation using two-dimensional chromatography-tandem mass spectrometry with isobaric peptide labeling (iTRAQ). We identified 451 different proteins expressed in both the SAN and working cardiomyocytes, 166 of which were differentially regulated (110 were upregulated in the SAN and 56 in the working cardiomyocytes). We identified sarcomere structural proteins in both tissues, although they were differently distributed among the tested samples. For example, myosin light chain 4, myosin regulatory light chain 2-atrial isoform, and tropomyosin alpha-3 chain levels were twofold higher in the SAN than in working cardiomyocytes, and myosin light chain 3 and myosin regulatory light chain 2-ventricular/cardiac muscle isoform levels were twofold higher in the ventricle tissue than in SAN. We identified many mitochondrial oxidative phosphorylation, β-oxidation, and tricarboxylic acid cycle proteins that were predominantly associated with working cardiomyocytes tissue. We detected upregulation of the fatty acid omega activation pathway proteins in the SAN samples. Some proteins specific for smooth muscle tissue were highly upregulated in the SAN (e.g. transgelin), which indicates that the SAN tissue might act as the bridge between the working myocardium and the smooth muscle. Our results show possible implementation of proteomic strategies to identify in-depth functional differences between various heart sub-structures.
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http://dx.doi.org/10.1111/joa.12798DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5978942PMC
June 2018

Anatomy of the mitral subvalvular apparatus.

J Thorac Cardiovasc Surg 2018 05 23;155(5):2002-2010. Epub 2017 Dec 23.

HEART-Heart Embryology and Anatomy Research Team, Jagiellonian University Medical College, Krakow, Poland; Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland.

Objectives: To characterize morphologic variations in the papillary muscles and tendinous cords of the left ventricle and ventricular zones of the mitral valve leaflets.

Methods: A total of 100 autopsied human hearts from healthy donors with classical mitral valve type were investigated.

Results: In 1 heart, only 1 group of papillary muscles was found, and in the remaining 99%, we could distinguish 2 groups of muscles: Superolateral (SLPM) and inferoseptal papillary muscle (ISPM) groups. The SLPM group had 1 papillary muscle (75.8%), 2 in 20.2%, and >3 in 4.0%. In the ISPM group, the muscle percentages were 38.4%, 36.4%, and 25.2%, respectively. The apex of at least 1 papillary muscle was situated higher than the plane of the opened anterior leaflet (AML) in 47.5% and 50.5% for the SLPM and ISPM groups, respectively. The number of strut cords arising from the SLPM group was 0 (2.0%), 1 (50.5%), 2 (33.3%), 3 (12.1%), and 4 (2.0%), and from the ISPM group was 0 (6.1%), 1 (52.5%), 2 (35.4%), or 3 (6.1%). Cords to left ventricular outflow tract were present in 14 specimens. Muscular cords were found in eight hearts. In all hearts specimens AML had rough and clear zones. The classical zones (rough, clear, and basal) in the posterior mitral leaflet were observed in 38.4%.

Conclusions: There is a high variability in the papillary muscles and tendinous cords in the mitral valve complex. Proper nomenclature, simple classification, and the most common variants for papillary muscle groups and tendinous cords were presented.
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http://dx.doi.org/10.1016/j.jtcvs.2017.12.061DOI Listing
May 2018

Morphologic variability of the mitral valve leaflets.

J Thorac Cardiovasc Surg 2017 12 16;154(6):1927-1935. Epub 2017 Aug 16.

HEART-Heart Embryology and Anatomy Research Team, Jagiellonian University Medical College, Krakow, Poland; Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland.

Objectives: The rapid development of surgical and less-invasive percutaneous mitral valve repair procedures has increased interest in mitral valve anatomy. We characterize the morphologic variability of the mitral valve leaflets and provide the size of their particular parts.

Methods: We studied 200 autopsied human hearts from white individuals without any valvar diseases. We measured the intercommissural and aorto-mural diameters of the mitral annulus and identified the leaflets and their scallops. We also noted the base and the height of the inferoseptal commissure, superolateral commissure, anterior mitral leaflet, and posterior mitral leaflet with their scallops.

Results: Variations in posterior mitral leaflet were found in 55 specimens (27.5%), and variations in anterior mitral leaflet were found in 5 hearts (2.5%). The most common variations included valves with 1 accessory scallop between P3 and inferoseptal commissure (7%), accessory scallop between P1 and superolateral commissure (4%), connections of P2 and P3 scallops (4%), connections of P1 and P2 scallops (3%), and accessory scallop in anterior mitral leaflet (2.5%).

Conclusions: In all cases, the mitral valve is built by 2 main leaflets with possible variants in scallops (29.5%). The variations are largely associated with posterior mitral leaflet and are mostly related to the presence of accessory scallop. Anatomically, the anterior mitral leaflet is not divided into scallops, but could have an accessory scallop (2.5%). Understanding the anatomy of the mitral valve leaflets helps with the planning and performing of mitral valve repair procedures. Variations in scallops may affect repair procedures, but unfortunately cannot be predicted by any of the annular sizes.
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http://dx.doi.org/10.1016/j.jtcvs.2017.07.067DOI Listing
December 2017

In-hospital and long-term outcomes of percutaneous balloon aortic valvuloplasty with concomitant percutaneous coronary intervention in patients with severe aortic stenosis.

J Interv Cardiol 2018 Feb 22;31(1):60-67. Epub 2017 Aug 22.

Department of Interventional Cardiology, Jagiellonian University Medical College, Krakow, Poland.

Background: Severe aortic stenosis (AS) often coexists with significant coronary artery disease.

Objective: To evaluate procedural complications and long-term outcomes of patients with severe AS undergoing balloon aortic valvuloplasty (BAV) and percutaneous coronary intervention (PCI).

Methods: A total of 97 patients with severe AS underwent 104 BAVs as palliative procedure, bridge to definitive treatment, or before urgent non-cardiac surgery. Patients were followed-up for at least 12 months.

Results: Of the 97 patients, 34 (35.0%) underwent standalone BAV, 45 (46.4%) underwent BAV with coronary angiography, and 18 (18.6%) BAV with PCI. There were no differences in baseline characteristics and indications for BAV among the groups (P > 0.05). No higher risk of complications after BAV performed with concomitant coronary angiography/PCI was observed. Transcatheter aortic valve implantation was performed after BAV in 13 (13.4%) patients and surgical aortic valve replacement in three (3.1%) patients. In spite of no difference in in-hospital mortality (5.6% vs. 8.9%; P = 0.76), patients with BAV and concomitant PCI had lower long-term mortality than patients with BAV and concomitant coronary angiography (28.5% vs. 51.0%; P = 0.03). In multivariable Cox analysis adjusted for age, sex, and body mass index, the Society of Thoracic Surgeons Predicted Risk of Mortality score was identified as the only independent predictor of long-term mortality for all patients (HR: 1.09, 95%CI: 1.04-1.15, P = 0.0006).

Conclusions: Concomitant PCI or coronary angiography performed with BAV may not increase the risk of major and vascular complications. Patients with BAV and concomitant PCI may have better survival than patients with BAV and concomitant coronary angiography.
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http://dx.doi.org/10.1111/joic.12418DOI Listing
February 2018

"Heart without smoke" educational campaign - the role of patient education in secondary prevention of cardiovascular disease.

Kardiol Pol 2018 23;76(1):125-129. Epub 2017 Aug 23.

2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland; Department of Interventional Cardiology, Jagiellonian University Medical College, Krakow, Poland

Background: Nicotine addiction is the strongest factor in the increase of the risk of recurrent ischaemic events.

Aim: The aim of the study was to analyse the effectiveness of a smoking cessation educational programme in a population of patients hospitalised with acute myocardial infarction within the "Heart without smoke" campaign.

Methods: In this study, we included 100 consecutive patients, active smokers, hospitalised with acute myocardial infarction (STEMI or NSTEMI) at the Centre for Invasive Cardiology, Angiology, and Electrotherapy in Pinczow, Poland in the period from January to December 2015 (12 months). Patients were participants in the educational campaign about tobacco addiction "Heart without smoke".

Results: At one-month follow-up observation: 61 patients had quit smoking and an additional 35 had decreased the number of cigarettes smoked per day. During six-month follow-up interview: 51 patients did not smoke cigarettes (13 had returned to smoking, three had additionally stopped smoking, one person had died). There were no statistically significant correlations between smoking cessation and gender (p = 0.4; p = 0.2), age (p = 0.8; p = 0.8) and length of prior smoking habit (p = 0.8; p = 0.5) and daily cigarette consumption before myocardial infarctions (p = 0.3; p = 0.3), one month, and six months after hospital discharge, respectively.

Conclusions: Constant education of patients after myocardial infarction was an effective method for smoking cessation in over 50% of smokers six months after myocardial infarction.
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http://dx.doi.org/10.5603/KP.a2017.0167DOI Listing
November 2018

Left atrial accessory appendages, diverticula, and left-sided septal pouch in multi-slice computed tomography. Association with atrial fibrillation and cerebrovascular accidents.

Int J Cardiol 2017 Oct 13;244:163-168. Epub 2017 Jun 13.

Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland; HEART - Heart Embryology and Anatomy Research Team, Jagiellonian University Medical College, Cracow, Poland.

Background: The aim of this study is to provide a morphometric description of the left-sided septal pouch (LSSP), left atrial accessory appendages, and diverticula using cardiac multi-slice computed tomography (MSCT) and to compare results between patient subgroups.

Methods: Two hundred and ninety four patients (42.9% females) with a mean of 69.4±13.1years of age were investigated using MSCT. The presence of the LSSP, left atrial accessory appendages, and diverticula was evaluated. Multiple logistic regression analysis was performed to check whether the presence of additional left atrial structures is associated with increased risk of atrial fibrillation and cerebrovascular accidents.

Results: At least one additional left atrial structure was present in 51.7% of patients. A single LSSP, left atrial diverticulum, and accessory appendage were present in 35.7%, 16.0%, and 4.1% of patients, respectively. After adjusting for other risk factors via multiple logistic regression, patients with LSSP are more likely to have atrial fibrillation (OR=2.00, 95% CI=1.14-3.48, p=0.01). The presence of a LSSP was found to be associated with an increased risk of transient ischemic attack using multiple logistic regression analysis after adjustment for other risk factors (OR=3.88, 95% CI=1.10-13.69, p=0.03).

Conclusions: In conclusion LSSPs, accessory appendages, and diverticula are highly prevalent anatomic structures within the left atrium, which could be easily identified by MSCT. The presence of LSSP is associated with increased risk for atrial fibrillation and transient ischemic attack.
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http://dx.doi.org/10.1016/j.ijcard.2017.06.042DOI Listing
October 2017

Spatial relationship of blood vessels within the mitral isthmus line.

Europace 2018 04;20(4):706-711

Department of Anatomy, Jagiellonian University Medical College, Cracow, Kopernika 12, 31-034 Krakow, Poland.

Aims: The aim of this study was to assess the spatial relationship of blood vessels and the thickness of the atrial wall within the mitral isthmus line.

Methods And Results: A total of 200 randomly selected autopsied adult human hearts (Caucasian) were examined. The mitral isthmus line was cut longitudinally and the thickness of the left atrial wall was measured. The blood vessels within the isthmus were identified and their relationship with the endocardial surface (ES), mitral annulus (MA), and the left inferior pulmonary vein (LIPV) ostium was assessed. The mean myocardial thickness in the upper, middle, and lower 1/3 of the mitral isthmus section were 1.9 ± 1.0, 3.0 ± 1.5, and 2.7 ± 1.3 mm, respectively. The great cardiac vein (GCV) was present within the isthmus in 98.0%, the left circumflex artery (LCx) in 57.0%, and the Marshall vein in 35.0% of all hearts. The GCV was located 4.5 ± 2.2 mm from the ES, 7.3 ± 5.3 mm from the MA, and 24.3 ± 7.3 mm from the LIPV. The LCx was situated 3.8 ± 2.3 mm from the ES, 7.9 ± 5.1 mm from the MA, and 25.3 ± 8.0 mm from the LIPV. We were able to detect eight different patterns of GCV and LCx mutual arrangement within the mitral isthmus line.

Conclusion: The myocardium is the thinnest in the upper 1/3 sector, and the blood vessels are mainly located in the middle and lower 1/3. In 49.1%, the LCx is situated at a distance of less than 3 mm from the ES. In 55.3%, the LCx is located between the GCV and ES of the left atrium.
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http://dx.doi.org/10.1093/europace/euw423DOI Listing
April 2018

Long-term quality of life and clinical outcomes in patients with resistant hypertension treated with renal denervation.

Postepy Kardiol Interwencyjnej 2016 17;12(4):329-333. Epub 2016 Nov 17.

Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland; 2 Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland.

Introduction: Pharmacological treatment combined with lifestyle modifications is an effective treatment for arterial hypertension. However, there are still patients who do not respond to standard treatments. Patients with pharmacologically resistant hypertension may benefit from renal denervation (RDN).

Aim: To assess long-term quality of life (QoL) after RDN and effectiveness in reduction of blood pressure (BP) in patients with resistant hypertension.

Material And Methods: From 2011 to 2014, 12 patients with previously diagnosed resistant hypertension, treated by RDN, were included in this study. The QoL was assessed using a standardized Polish version of the Nottingham Health Profile questionnaire (NHP).

Results: The median age was 54 (IQR: 51-57.5) years. Mean baseline ambulatory pre-procedural systolic/diastolic BP was 188/115 ±29.7/18 mm Hg. The mean values of systolic/diastolic BP measured perioperatively and 3, 6, 12 and 24 months postoperatively were 138/86, 138/85, 146/82, 152/86, and 157/91. All -values for mean systolic and diastolic BP before versus successive time points after RDN were statistically significant; -value for all comparisons < 0.05. Improvement of QoL was only observed in two sections of the NHP questionnaire: emotional reaction and sleep disturbance. The analysis of the NHP index of Distress (NHP-D) showed a lower distress level perioperatively and 3, 6, 12 and 24 months after RDN as compared to baseline. The RDN was not associated with any significant adverse events.

Conclusions: Patients with pharmacologically resistant hypertension treated with RDN achieved significant reduction in BP during 24-month follow-up. Furthermore, a significant improvement in the QoL was observed in those patients.
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http://dx.doi.org/10.5114/aic.2016.63633DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5133321PMC
November 2016

Assessment of quality of life in patients after surgical and transcatheter aortic valve replacement.

Catheter Cardiovasc Interv 2016 Sep 23;88(3):E80-8. Epub 2016 Jan 23.

Department of Interventional Cardiology at University Hospital, Jagiellonian University Medical College in Krakow, Poland.

Objectives: Transcatheter aortic valve implantation (TAVI) and minimally invasive aortic valve replacement (mini-thoracotomy, mini-sternotomy, MIAVR) have become an appealing alternative to conventional surgical (SAVR) treatment of severe aortic stenosis (AS) in high-risk patients.

Background: Aim of the study was to evaluate the quality of life (QoL) in patients with AS and treated with transfemoral TAVI, SAVR, mini-thoracotomy and mini-sternotomy.

Methods: One hundred and seventy-three patients with symptomatic AS were enrolled in 2011-2013. TAVI group consisted of 39 patients (22.5%), mini-sternotomy was performed in 44 patients (25.5%), mini-thoracotomy in 50 (29%), and AVR in 40 patients (23%). QoL was assessed perioperatively, 12 and 24 months after aortic valve replacement (AVR) by Minnesota Living with Heart Failure Questionnaire (MLHFQ) and EQ-5D-3L.

Results: Median follow-up was 583.5 (IQR: 298-736) days. Improvement of health status after procedure in comparison with pre-operative period was significantly more often reported after TAVI in perioperative period (90.3%; P = 0.004) and 12 months after procedure (100%, P = 0.02). Global MLHFQ, physical and emotional dimension score at 30-day from AVR presented significant improvement after TAVI in comparison with surgical methods (respectively: 8.3(±8.6), P = 0.003; 4.1(±5.9), P = 0.01; 1.5(±2.6), P = 0.005). Total MLHFQ score was significantly lower (better outcome) in TAVI patients 1 year after procedure (4.8(±6.8), P = 0.004), no differences in somatic and emotional component were found. No differences were found in MLHFQ score 24 months after AVR. Data from EQ-D5-3L questionnaire demonstrated significant improvement of QoL at 30-day follow-up after TAVI in comparison with surgical methods (1.2(±1.7), P = 0.0008).

Conclusions: TAVI improves QoL in perioperative and 12 months observation in comparison with mini-thoracotomy, mini-sternotomy and SAVR. Improvement in QoL was obtained in both generic and disease specific questionnaires. © 2016 Wiley Periodicals, Inc.
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http://dx.doi.org/10.1002/ccd.26400DOI Listing
September 2016
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