Publications by authors named "Jacek Wilczek"

8 Publications

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Local electromechanical alterations determine the left ventricle rotational dynamics in CRT-eligible heart failure patients.

Sci Rep 2021 Feb 5;11(1):3267. Epub 2021 Feb 5.

Department of Cardiology and Structural Heart Disease, Medical University of Silesia, Ziołowa 45-47, Katowice, Poland.

Left ventricle, LV wringing wall motion relies on physiological muscle fiber orientation, fibrotic status, and electromechanics (EM). The loss of proper EM activation can lead to rigid-body-type (RBT) LV rotation, which is associated with advanced heart failure (HF) and challenges in resynchronization. To describe the EM coupling and scar tissue burden with respect to rotational patterns observed on the LV in patients with ischemic heart failure with reduced ejection fraction (HFrEF) left bundle branch block (LBBB). Thirty patients with HFrEF/LBBB underwent EM analysis of the left ventricle using an invasive electro-mechanical catheter mapping system (NOGA XP, Biosense Webster). The following parameters were evaluated: rotation angle; rotation velocity; unipolar/bipolar voltage; local activation time, LAT; local electro-mechanical delay, LEMD; total electro-mechanical delay, TEMD. Patients underwent late-gadolinium enhancement cMRI when possible. The different LV rotation pattern served as sole parameter for patients' grouping into two categories: wringing rotation (Group A, n = 6) and RBT rotation (Group B, n = 24). All parameters were aggregated into a nine segment, three sector and whole LV models, and compared at multiple scales. Segmental statistical analysis in Group B revealed significant inhomogeneities, across the LV, regarding voltage level, scar burdening, and LEMD changes: correlation analysis showed correspondently a loss of synchronization between electrical (LAT) and mechanical activation (TEMD). On contrary, Group A (relatively low number of patients) did not present significant differences in LEMD across LV segments, therefore electrical (LAT) and mechanical (TEMD) activation were well synchronized. Fibrosis burden was in general associated with areas of low voltage. The rotational behavior of LV in HF/LBBB patients is determined by the local alteration of EM coupling. These findings serve as a strong basic groundwork for a hypothesis that EM analysis may predict CRT response.Clinical trial registration: SUM No. KNW/0022/KB1/17/15.
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http://dx.doi.org/10.1038/s41598-021-82793-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7865069PMC
February 2021

Survival of patients with pacing-induced cardiomyopathy upgraded to CRT does not depend on defibrillation therapy.

Pacing Clin Electrophysiol 2020 05 15;43(5):471-478. Epub 2020 Apr 15.

Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland.

Background: Permanent right ventricular pacing (RVP) results in cardiac dyssynchrony that may lead to heart failure and may be an indication for the use of cardiac resynchronization therapy (CRT). The study aimed to evaluate predictors of outcomes in patients with pacing-induced cardiomyopathy (PICM) if upgraded to CRT.

Methods: One hundred fifteen patients, 75.0 years old (IQR 67.0-80.0), were upgraded to CRT due to the decline in left ventricle ejection fraction (LVEF) caused by the long-term RVP. A retrospective analysis was performed using data from hospital and outpatient clinic records and survival data from the National Health System.

Results: The prior percentage of RVP was 100.0% (IQR 97.0-100.0), with a QRS duration of 180.0 ms (IQR 160.0-200.0). LVEF at the time of the upgrade procedure was 27.0% (IQR 21.0-32.75). The mean follow-up was 980 ± 522 days. The primary endpoint, death from any cause, was met by 26 (22%) patients. Age > 82 years (HR 5.96; 95% CI 2.24-15.89; P = .0004) and pre-CRT implantation LVEF < 20% (HR 5.63; 95%CI 2.19-14.47; P = .0003), but neither the cardioverter-defibrillator (ICD) implantation (HR 1.00; 95%CI 0.45-2.22; P = 1.00), nor the presence of atrial fibrillation (HR 1.22; 95%CI 0.56-2.64; P = .62), were independently associated with all-cause mortality.

Conclusion: Advanced age and an extremely low LVEF, but neither the presence of atrial fibrillation nor implanting an additional high voltage lead, influence the all-cause mortality in patients after long-term RVP, when upgraded to CRT.
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http://dx.doi.org/10.1111/pace.13906DOI Listing
May 2020

The influence of scar on the spatio-temporal relationship between electrical and mechanical activation in heart failure patients.

Europace 2020 05;22(5):777-786

Center for Computational Medicine in Cardiology, Università della Svizzera italiana, Via G. Buffi 13, CH-6900 Lugano, Switzerland.

Aims: The aim of this study was to determine the relationship between electrical and mechanical activation in heart failure (HF) patients and whether electromechanical coupling is affected by scar.

Methods And Results: Seventy HF patients referred for cardiac resynchronization therapy or biological therapy underwent endocardial anatomo-electromechanical mapping (AEMM) and delayed-enhancement magnetic resonance (CMR) scans. Area strain and activation times were derived from AEMM data, allowing to correlate mechanical and electrical activation in time and space with unprecedented accuracy. Special attention was paid to the effect of presence of CMR-evidenced scar. Patients were divided into a scar (n = 43) and a non-scar group (n-27). Correlation between time of electrical and mechanical activation was stronger in the non-scar compared to the scar group [R = 0.84 (0.72-0.89) vs. 0.74 (0.52-0.88), respectively; P = 0.01]. The overlap between latest electrical and mechanical activation areas was larger in the absence than in presence of scar [72% (54-81) vs. 56% (36-73), respectively; P = 0.02], with smaller distance between the centroids of the two regions [10.7 (4.9-17.4) vs. 20.3 (6.9-29.4) % of left ventricular radius, P = 0.02].

Conclusion: Scar decreases the association between electrical and mechanical activation, even when scar is remote from late activated regions.
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http://dx.doi.org/10.1093/europace/euz346DOI Listing
May 2020

Perception of health control and self-efficacy in heart failure.

Kardiol Pol 2016 ;74(2):168-178

Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland Department of Physiology, Wroclaw Medical University, Wroclaw, Poland Department of Cardiology, Centre for Heart Disease, Military Hospital, Wroclaw, Poland.

Background: The issue of self-perceived health control and related sense of self-efficacy has not received any attention in patients with heart failure (HF), although these psychological features have been established to determine the patients' approach towards healthcare professionals and their recommendations, which strongly affects compliance.

Methods: A total of 758 patients with systolic HF (age: 64 ± 11 years, men: 79%, NYHA class III–IV: 40%, ischaemic aetiology: 61%) were included in a prospective Polish multicentre Caps-Lock-HF study. A Multidimensional Health Locus of Control (MHLC) scale was used to assess subjective perception of health control in three dimensions (internal control, external control by the others, and by chance); the Generalised Self Efficacy scale (GSES) was used to estimate subjective sense of self-efficacy; and the Beck Depression Inventory (BDI) was used to determine depressive symptoms.

Results: The majority of patients perceived the external control (by the others) and internal control of their health as high (77% and 63%, respectively) or moderate (22% and 36%, respectively), whereas self-efficacy was perceived as high or moderate (63% and 27%), which was homogenous across the whole spectrum of the HF cohort, being unrelated to HF severity, HF duration, the presence of co-morbidities, and the applied treatment. The stronger the perception of internal health control, the higher the self-efficacy (p < 0.05); both features were related to less pronounced depressive symptoms (p < 0.05).

Conclusions: The established pattern of self-perceived control of own health and self-efficacy indicates that patients with HF acknowledge the role of others (i.e. healthcare providers) and themselves in the process of the management of HF, and are convinced about the high efficacy of their undertaken efforts. Such evidence supports implementation of a partnership model of specialists’ care of patients with HF.
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http://dx.doi.org/10.5603/KP.a2015.0137DOI Listing
February 2017

[Diagnostics enigma: left ventricular noncompaction or systemic right ventricle?]

Wiad Lek 2015 ;68(3 pt 2):410-412

Klinika Elektrokardiologii i Niewydolności Serca Wydziału Nauk o Zdrowiu Śląskiego Uniwersytetu Medycznego, Katowice.

A case of congenitally corrected transposition of great arteries, a rare congenital heart defect diagnosed in an adult is presented and difficulties in differential diagnosis of congenital heart defects in the adults are described. The crucial point is proper interpretation of the echocardiography examination.
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January 2015

Can multi-slice computed tomography of the heart be useful in patients with epicardial leads?

Cardiol J 2013 ;20(1):87-9

New visualization methods are helpful in the noninvasive diagnosis of heart diseases. However, sometimes epicardial and endocardial leads can cause problems due to a large number of artifacts. Based on the presented case, we conclude that it is possible to perform multi-slice computed tomography of coronary arteries despite the coexistence of transvenous and epicardial leads.
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http://dx.doi.org/10.5603/CJ.2013.0014DOI Listing
August 2014

Optimal visualization of heart vessels before percutaneous mitral annuloplasty.

Cardiol J 2012 ;19(5):459-65

Department of Electrocardiology, Upper Silesian Medical Center, Katowice, Poland.

Background: Multi-slice computed tomography (MSCT) can be useful before percutaneous mitral annuloplasty (PMA) procedures to visualize the relations between the mitral valve (MV), left circumflex artery (LCx) and coronary sinus (CS).

Methods And Results: We performed a 64-slice MSCT in 196 patients (109 male; age 56.6 ± 11.4) with suspected coronary artery disease. A retrospective scan with ECG-gating was performed in each. In each case 3D VR and 2D MPR reconstructions were created. We used a subjective assessment of the quality of visualization to find the optimal phases of visualization for LCx, CS and both vessels together (relations). The quality of visualization were graded by 2 experts on 6-points scale. LCx was usually optimally visualized in the diastolic phases (70-80-90%) - 126/196 (64.3%). CS was usually optimally visualized in the systolic phases (30-40-50%) - 177/196 (90.3%). The optimal phase for parallel visualization of LCx/CS (to observe anatomical relations) was 70-80% - 140/196 (71.4%). Good quality visualization was obtained for both vessels: LCx: 3.6 ± 1.4/CS: 4.1 ± 1.1.

Conclusions: Reconstructions of parallel visualization of LCx/CS for PMA procedures to observe the relations between those vessels should be considered during diastole. In addition, independent reconstructions should also be performed optimized for the LCx and the CS.
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http://dx.doi.org/10.5603/cj.2012.0085DOI Listing
March 2013

Two-point left ventricle pacing and cardiac computed tomography.

Case Rep Cardiol 2012 9;2012:347189. Epub 2012 Sep 9.

Unit of Noninvasive Cardiovascular Diagnostics, Upper-Silesian Medical Centre, 40-635 Katowice, Poland ; 3rd Division of Cardiology, Medical University of Silesia, 40-752 Katowice, Poland.

Endocardial leads can potentially cause problems during coronary vessels visualization in multislice computed tomography (MSCT) due to a large number of artifacts. Based on presented case, we conclude that it is possible to perform MSCT of coronary arteries and leads visualization despite coexistence of four endocardial leads.
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http://dx.doi.org/10.1155/2012/347189DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4007785PMC
May 2014