Publications by authors named "Rafał Młynarski"

51 Publications

Temporal changes of the diameter of the coronary sinus during the cardiac cycle.

Clin Physiol Funct Imaging 2021 Mar 19;41(2):192-198. Epub 2020 Dec 19.

Department of Radiology, School of Health Sciences, Medical University of Silesia, Katowice, Poland.

Introduction: Currently, there are no studies that analyse the changes in the cardiac venous system that are dependent on the phase (RR interval) of reconstruction. The aim of the study was to assess the size of the coronary sinus at two measurement sites depending on the phase of the heart cycle.

Methods: Fifty patients were included. Cardiac computed tomography was performed in all of the patients due to a suspicion of coronary artery disease (typical indications) using a dual-source Siemens Somatom Force scanner. The "MM reading" presets were used to measure the coronary sinus ostium (measurement 1) and the coronary sinus trunk, which is close to the great cardiac vein (measurement 2) in millimetres. All of the calculations were performed on axial scans using 0%-100% and a 256 × 256 matrix.

Results: The largest CS was found at the 30%, 40% and 50% RR interval-this phenomenon occurred in 37 of the 50 cases (74%). The CS was largest in the 30% phase (9/50 cases; 18%), in the 40% phase (17/50 cases; 34%) and in the 50% phase, and it was the largest in 11 of the 50 cases (22%). There were also no gender-related differences.

Conclusions: The size of the coronary sinus varies with the phase of the heart cycle. At the 40% phase, it is largest in most cases.
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http://dx.doi.org/10.1111/cpf.12685DOI Listing
March 2021

Anomalous coronary sinus ostium on cardiac computed tomography. Authors' reply.

Kardiol Pol 2020 09 25;78(9):948-949. Epub 2020 Sep 25.

Unit of Noninvasive Cardiovascular Diagnostics, Upper Silesian Medical Centre, Katowice, Poland; 3rd Division of Cardiology, Medical University of Silesia, Katowice, Poland

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http://dx.doi.org/10.33963/KP.15612DOI Listing
September 2020

The impact of cardiac pacemaker implantation on male sexual function.

Pacing Clin Electrophysiol 2020 12 1;43(12):1508-1514. Epub 2020 Sep 1.

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

Background: The possibility of sexual functioning is an important aspect of human life, and sexual disorders have a negative impact on the quality of life and well-being. The aim of the study was to assess the sexuality and occurrence of sexual dysfunction within 6 months after pacemaker implantation.

Methods And Results: The study sample was a group of 80 patients with heart rhythm disorders who had been qualified for cardiac pacemaker implantation. The International Index of Erectile Function (IIEF)-15 was completed by all the patients at least 1 day before and 6 months after cardiac pacemaker implantation. The average results of the IIEF for all those who were included before implantation were 41.87 ± 7.57 and were statistically the worst after pacemaker implantation 46.76 ± 6.64; P < .0001. After the implantation of a pacemaker, there was an improvement in all of the subcategories of sexual life for all the men: erectile function P < .0001, orgasmic function P < .0001, sexual desire P < .0001, intercourse satisfaction P < .0001, and overall satisfaction P < .0001.

Conclusions: Pacemaker implantation had a positive effect on sexual functioning for all the patients. Pacemaker implantation did not affect sexual desire in the patients who were observed. Erectile dysfunction occurred in most of patients both before and after pacemaker implantation.
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http://dx.doi.org/10.1111/pace.14035DOI Listing
December 2020

Modified Frailty as a Novel Factor in Predicting the Maintenance of the Sinus Rhythm After Electrical Cardioversion of Atrial Fibrillation in the Elderly Population.

Clin Interv Aging 2020 17;15:1193-1199. Epub 2020 Jul 17.

Department of Electrocardiology, Upper Silesian Heart Centre, Katowice, Poland.

Introduction: Frailty is a common geriatric syndrome that causes an elevated risk of catastrophic declines in the health and function among older adults - we hypothesized that frailty may be related to the maintenance of sinus rhythm after cardioversion.

Methods: The study sample was a group of 199 consecutive patients over 60 (average age 71.41 ± 6.99; 40.2% women) with AF who were hospitalized in order to perform electrical cardioversion. The Tilburg Frailty Indicator (TFI) was used to assess frailty before cardioversion. The six-month visit after the electrical cardioversion was a follow-up. The follow-up period for the maintenance of sinus rhythm after electrical cardioversion was 180 ± 14 days.

Results: Patients in whom cardioversion was effective had a statistically significantly lower severity of frailty syndrome (3.44 ± 1.83 vs 5.87 ± 1.12; p=0.000) and its components: physical components (2.14 ± 1.33 vs 3.62 ± 1.05 p=0.000); emotional components (0.92 ± 0.79 vs 1.29 ± 0.86 p=0.037) and social components (0.37 ± 0.56 vs 0.96 ± 0.46; p=0.000) compared to those patients in which cardioversion was ineffective. In the logistic regression, frailty (OR: 0.65, 95% CI:0.5010-0.8330; p=0.000) was observed to be an independent predictor for maintaining sinus rhythm.

Conclusion: Frailty is a novel, independent factor that can be used to predict the effectiveness of electrical cardioversion and the maintenance of sinus rhythm in the elderly population. Modifying the level of recognition in the Tilburg Frailty Indicator to a 4 improved the prediction of the effectiveness of electrical cardioversion as well as the maintenance of sinus rhythm.
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http://dx.doi.org/10.2147/CIA.S255853DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7381784PMC
December 2020

Crosscultural adaptation and reliability testing of the Implantable Cardioverter-Defibrillator Concerns questionnaire to optimize the care of Polish patients with implantable cardioverter-defibrillators.

Kardiol Pol 2020 09 17;78(9):906-912. Epub 2020 Jul 17.

Department of Electrocardiology, Upper Silesian Medical Centre, Katowice, Poland; Department of Electrocardiology and HeartFailure, School of Health Sciences, Medical University of Silesia, Katowice, Poland

Background: Implantable cardioverter‑defibrillator (ICD) placement has now become a standard procedure in patients with ventricular arrhythmias. The primary task of an ICD is to recognize and immediately interrupt life‑threatening ventricular arrhythmia via an intracardiac electrical discharge, known as a shock.

Aims: The aim of this study was to adapt and test the reliability of the Polish version of the Implantable Cardioverter‑Defibrillator Concerns (ICDC) questionnaire, an instrument used to determine the concerns of patients with ICDs.

Methods: Standard guidelines were applied with regard to the translation and cultural adaptation of the English version of the ICDC questionnaire in Poland. The study included 129 Polish patients with ICDs, including 28 women, at a mean (SD) age of 66.24 (12.94) years. The Cronbach α was calculated to analyze the internal consistency of the ICDC questionnaire.

Results: The mean ICDC score for overall concerns was 36.63 (18.56); 9.19 (5.93) for factor 1 assessing the perceived limitations, and 9.72 (5.61) for factor 2 assessing device‑specific concerns. The Cronbach α reliability coefficients ranged from 0.9619 to 0.9647, after each questionnaire item was deleted. The Cronbach α that characterized the internal consistency of the entire questionnaire was 0.96.

Conclusion: The Polish adaptation of the ICDC questionnaire proved to be a useful and quick tool to assess patients' concerns after ICD placement. Its use is recommended in the evaluation of all patients after device implantation in order to optimize therapy.
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http://dx.doi.org/10.33963/KP.15520DOI Listing
September 2020

Factors that influence marital satisfaction in men with a heart rhythm disorders.

Aging Male 2020 Dec 28;23(5):1374-1380. Epub 2020 May 28.

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

Background: A diagnosis of a cardiac arrhythmia can affect marital relations and diminish libido and satisfaction with a patient's sex life. The aim of the study was to assess the factors that affect marital satisfaction in men with an arrhythmias who had qualified for cardiac pacemaker implantation.

Methods: The study included 103 men (aged 58.28 ± 8.72) with recognized heart rhythm disorders who were hospitalized in Department of Electrocardiology. The Hospital Anxiety and Depression Scale (HADS), the International Erectile Function Index (IIEF) and the Index of Marital Satisfaction (IMS) were used in this research.

Results: The greater the severity of the anxiety ( = 0.2492,  = 0.011) and depression symptoms ( = 0.3735,  = 0.000), the less satisfied a patient was with the relationship. An analysis showed that depression ( = 0.000), sexual desire ( = 0.001), overall satisfaction ( = 0.009), erectile function ( = 0.0162) and intercourse satisfaction ( = 0.026) are important predictors of marital satisfaction. Only sexual desire was an important predictor of marital satisfaction in patients with sinus node dysfunction, while the depression, sexual desire and overall satisfaction results were predictors in patients with atrioventricular blocks.

Conclusion: Anxiety and depression symptoms affect the assessment of marital satisfaction in men with a heart rhythm disorder. Different factors influence marital satisfaction for different heart rhythm disorders.
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http://dx.doi.org/10.1080/13685538.2020.1770211DOI Listing
December 2020

Presence of the Vieussens valve on cardiac computed tomography.

Kardiol Pol 2020 08 7;78(7-8):703-708. Epub 2020 May 7.

Unit of Noninvasive Cardiovascular Diagnostics, Upper Silesian Medical Centre, Katowice, Poland; 3rd Division of Cardiology, Medical University of Silesia, Katowice, Poland

Background: The Vieussens valve is a venous valve often found between the coronary sinus ostium and the great cardiac vein.

Aims: This study aimed to analyze the Vieussens valve in vivo using cardiac computed tomography (CT).

Methods: A total of 325 patients (120 women; mean [SD] age, 58 [11] years) were included into the study. Retrospective scanning using 64 slices of 0.5 mm in thickness was performed and multiplanar reformatted reconstructions and 3‑dimensional volume renderings were used. As the Vieussens valve is difficult to find in standard reconstructions owing to its very small thickness, we decided to prepare and use indirect analyses in order to determine the presence of the valve. The basis for the analysis was the fact that even a very thin valve is an obstacle to the flow of the contrast agent in the same way as the much larger valves are.

Results: The Vieussens valve was present on CT in 141 of the 325 study patients (43.38%). No sex differences were found (P = 0.83): the valve was present in 88 of 205 men (42.92%) and in 53 of 120 women (44.17%). The mean (SD) distance between the Vieussens valve and the coronary sinus ostium was 38.89 (7.47) mm. We determined 3 types of the Vieussens valve: varicose, diminutive, and Marshall vein type.

Conclusions: It is possible to visualize the Vieussens valve on CT. Due to the usually small size of the valve, the best way to find it is to analyze the distribution (density) of a contrast agent in the coronary sinus. Differentiating the proposed valve types can facilitate further analysis.
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http://dx.doi.org/10.33963/KP.15341DOI Listing
August 2020

The Relationship between Frailty Syndrome and Concerns about an Implantable Cardioverter Defibrillator.

Int J Environ Res Public Health 2020 03 17;17(6). Epub 2020 Mar 17.

Department of Electrocardiology, Upper Silesian Heart Centre, Katowice 40-635, Poland.

Frailty syndrome may cause cognitive decline and increased sensitivity to stressors. This can result in an increased incidence of anxiety and depression, and thus, concerns about life with an implantable cardioverter defibrillator (ICD). The aim of the study was to assess the impact of frailty syndrome on the increase in the number of device-related concerns after the implantation of an ICD.

Material And Methods: The study sample was a group of 103 consecutive patients (85 M; aged 71.6 ± 8.2) with an implanted ICD. The ICD Concerns Questionnaire (ICDC) was used to analyze their concerns about life with an ICD, and the Tilburg Frailty Indicator scale (TFI) was used to diagnose frailty.

Results: In the group of patients with an ICD implanted, 73% had recognized frailty (83.3% women, 74.1% men); the average point value was 6.55 ± 2.67. The total ICDC questionnaire score for the patients with an implanted cardioverter defibrillator was 34.06 ± 18.15. Patients with frailty syndrome had statistically ( = 0.039) higher scores (36.14 ± 17.08) compared to robust patients (27.56 ± 20.13). In the logistic regression analysis, the presence of frailty was strongly associated with the total questionnaire score (OR = 1.0265, = 0.00426), the severity of the concerns (OR = 1.0417, = 0.00451), and device-specific concerns (OR = 1.0982, = 0.00424).

Conclusion: Frailty syndrome occurs in about 80% of patients after ICD implantation. The presence of frailty syndrome was strongly associated with concerns about an implantable cardioverter defibrillator.
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http://dx.doi.org/10.3390/ijerph17061954DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7142564PMC
March 2020

Usefulness of the Coronary Artery Calcium Score in Predicting Subsequent Coronary Interventions-A Ten-Year Single-Center Perspective.

Int J Environ Res Public Health 2019 06 16;16(12). Epub 2019 Jun 16.

Unit of Noninvasive Cardiovascular Diagnostics, Upper Silesian Medical Centre, 40-635 Katowice, Poland.

There is no consensus as to whether the Coronary Artery Calcium Score (CACS) results can affect the therapeutic approach that is selected for coronary artery disease. The aim of this study was to follow patients' management over a period of ten years after application of the CACS. : The research was conducted as a prospective, single-center, long-distance study. In 174 asymptomatic patients (78M; aged 58.9 ± 7.86), a CACS examination using 64-slice computed tomography was performed between 2008 and 2009. The patients were divided into three subgroups according to the CACS results using Agatston Units (AU)-G1: CACS = 0 AU (52 pts); G2: CACS = 1-399 AU (64 pts) and G3: CACS ≥ 400 AU (58 pts). During the ten years of follow-up, the classical cardiovascular risk factors, drugs, diseases, and information about the therapeutic approach that was used (PCI-Percutaneous Coronary Intervention; CABG-Coronary Artery Bypass Graft) were also analyzed. : The average time until a percutaneous intervention (PCI) was 825.2 ± 1111.7 and for CABG, it was 529.0 ± 833.6. PCI was performed in 5.8% (G1), 4.7% (G2) and 32.6% (G3) of the cases, respectively; = 0.0000. CABG was performed in 0% (G1), 1.6% (G2) and 18.9% (G3) of the cases, respectively; 0.0035 Yates. The area under the curve in PCI was 0.783 (95% CI: 0.714-0.841); in CABG, it was 0.825 (95% CI: 0.760-0.878) and the average for both groups was 0.838 (95% CI: 0.774-0.889). : The coronary artery calcium score can potentially help to predict the best therapeutic approach for coronary artery disease in a ten-year perspective.
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http://dx.doi.org/10.3390/ijerph16122132DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6617306PMC
June 2019

Pol-CDRIE registry - 1-year observational data on patients hospitalized due to cardiac device-related infective endocarditis in Polish referential cardiology centres.

Kardiol Pol 2019 May 26;77(5):561-567. Epub 2019 Apr 26.

Department of Cardiology, Medical University of Łódź, Łódź, Poland

Background: The rate of cardiac device-related infective endocarditis (CDRIE) is increasing worldwide, but no detailed data are available for Poland.

Aims: We aimed to evaluate clinical, diagnostic, and therapeutic data of patients hospitalized due to CDRIE in 22 Polish referential cardiology centers from May 1, 2016 to May 1, 2017.

Methods: Participating cardiology departments were asked to fill in a questionnaire that included data on the number of hospitalized patients, number and types of implanted cardiac electrotherapy devices, and number of infective endocarditis cases. We also collected clinical data and data regarding the management of patients with CDRIE.

Results: Overall, 99 621 hospitalizations were reported. Infective endocarditis unrelated to cardiac device was the cause of 596 admissions (0.6%), and CDRIE, of 195 (0.2%). Pacemaker was implanted in 91 patients with CDRIE (47%); cardioverter‑defibrillator, in 51 (26%); cardiac resynchronization therapy‑defibrillator, in 48 (25%); and cardiac resynchronization therapy‑pacemaker, in 5 (2.5%). The most common symptoms were malaise (62%), fever/chills (61%), cough (21%), chest pain (19.5%), and inflammation of the device pocket (5.6%). Cultures were positive in 77.5% of patients. The cardiac device was removed in 91% of patients. The percutaneous approach was most common for cardiac device removal. All patients received antibiotic therapy, and 3 patients underwent a heart valve procedure. Transesophageal echocardiography was performed in 80% of patients. The most common complication was heart failure (25% of patients).

Conclusions: The clinical profile, pathogen types, and management strategies in Polish patients with CDRIE are consistent with similar data from other European countries. Transesophageal echocardiography was performed less frequently than recommended. The removal rate in the Polish population is consistent with the general rates observed for interventional treatment in patients with CDRIE.
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http://dx.doi.org/10.33963/KP.14811DOI Listing
May 2019

Attitude towards sexuality and sexual behaviors among men with heart rhythm disorders.

Aging Male 2020 Dec 29;23(5):764-769. Epub 2019 Mar 29.

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

Aim: Symptoms of cardiac arrhythmias and the perception of the implantation of a cardiac pacemaker can negatively affect mental health including sexuality and sexual behaviors. The aim of this study was to assess the attitude towards sexuality and sexual behaviors among men with cardiac arrhythmias.

Methods: The study included 80 men (aged 58.6 ± 9.23 years) with heart rhythm disorders who had qualified for cardiac pacemaker implantation. The International Index of Erectile Function IIEF-15 was completed at least one day before cardiac pacemaker implantation by all of the patients.

Results: The average results of the IIEF for all of the included patients was 41.87 ± 7.57 and were statistically worse in the population with atrioventricular blocks (39.60 ± 7.79) compared to those with sinus node dysfunction (44.15 ± 6.71) ( = .0110). The same relationships were found in the subcategory of orgasmic function ( = .0108) as well as intercourse satisfaction ( = .0111). Erectile dysfunction occurred in 88.75% of the patients with diagnosed arrhythmias. There was no statistically significant difference between the occurrence of erectile dysfunction in patients with sinus node dysfunction (87.5%) compared to patients with atrioventricular blocks (90%);  = .7236.

Conclusion: We demonstrated that sexuality and sexual behaviors among men with cardiac arrhythmias was found to be statistically worse in the population with atrioventricular blocks compared to those with sinus node dysfunction. It was especially marked in the area of orgasmic function as well as for intercourse satisfaction.
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http://dx.doi.org/10.1080/13685538.2019.1592152DOI Listing
December 2020

Modified frailty as a novel factor in predicting the response to cardiac resynchronization in the elderly population.

Clin Interv Aging 2019 25;14:437-443. Epub 2019 Feb 25.

Department of Electrocardiology, Upper Silesian Heart Centre, Katowice, Poland,

Background: The response to cardiac resynchronization therapy (CRT) is an important element of the treatment of advanced heart failure, especially in the geriatric population. The aim of the study was to examine the impact of frailty syndrome on the response to treatment with CRT.

Methods: Two hundred and forty-six patients of 60 years or older (aged 73.35±6.95; 22.4% women) with an implanted CRT were included in this single-center prospective study. There was a 12-month follow-up. The Tilburg Frailty Indicator was used to determine frailty (5 or more points). The response to CRT was evaluated based on an analysis of clinical criteria.

Results: One hundred and sixty-nine of 246 (68.9%) patients were found to be clinical CRT responders. Frailty syndrome was recognized in 173 (70.32%). There were 63.0% responders in the frailty-affected group, whereas there were statistically more responders (79.5%) in the robust group (=0.0116). In the logistic regression, frailty emerged as an independent predictor of the response to CRT (OR=0.81, 95% CI=0.71-0.92; =0.0008). The area under the curve of the ROC curve for frailty in the responders to CRT was 0.62. The cut-off value for a designation of frailty was 6 (=0.0014).

Conclusion: Frailty is a novel independent factor that can be used to predict the clinical response to CRT in the elderly population. Modifying the level of recognition in the Tilburg Frailty Indicator can improve the prediction of a response to CRT.
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http://dx.doi.org/10.2147/CIA.S193577DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6394238PMC
April 2019

Capability for self-care of patients with heart failure.

Clin Interv Aging 2018 8;13:1919-1927. Epub 2018 Oct 8.

Department of Electrocardiology, Upper Silesian Heart Centre, Katowice, Poland,

Background: A thorough analysis of the capability for self-care in patients with heart failure (HF) reduces the frequency of hospitalizations that are caused by decompensation. The aim of the study was to assess the effect of the method of therapy for HF, the degree of the acceptance of illness, and the occurrence of frailty syndrome on adherence to the therapeutic recommendations and self-care in patients with HF.

Methods: The study included 180 patients who were hospitalized after being diagnosed with HF. In all, we used the Polish versions of three validated instruments: the nine-item European Heart Failure Self-care Behavior Scale, Illness Acceptance Scale, and The Tilburg Frailty Indicator.

Results: The capability for self-care of patients with HF was 27.8%. More than 65% of the patients followed the recommendations for taking medication and also followed a low-sodium diet, while only 5.5% of the patients followed the recommendations for physical exercise. Positive correlations were found between the capability for self-care and frailty syndrome and its components: general frailty components vs the capability for self-care: =0.4449, =0.0000; physical frailty components vs the capability for self-care: =0.3974, =0.0000; emotional frailty components vs the capability for self-care: =0.2831, =0.0001; social frailty components vs the capability for self-care: =0.2180, =0.0032, and a negative correlation between the capability for self-care and the degree of the acceptance of the illnesses (=-0.4662, =0.0000).

Conclusion: A relatively low capability for self-care was found in patients with HF. The presence of frailty syndrome and a low level of the acceptance of illness are connected with a low capability for self-care.
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http://dx.doi.org/10.2147/CIA.S178393DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6183697PMC
December 2018

Visualisation of the oblique vein of the left atrium (vein of Marshall) using cardiac computed tomography: is the game worth the candle?

Kardiol Pol 2018;76(9):1344-1349

Department of Electrocardiology, Upper Silesian Medical Centre, Poland.

Background: The vein of Marshall (VoM) is a small vessel that descends obliquely on the back of the left atrium and ends in the coronary sinus near the area where the great cardiac vein continues into the coronary sinus.

Aim: The aim of the study was to examine the frequency of occurrence and anatomical aspects as well as the possibility of visualising the VoM, including an evaluation of the quality of the visualisation, on computed tomography (CT).

Methods: Three hundred patients aged 58.8 ± 11.5 years (111 women) were included into this single-centre study. Cardiac CT was performed in all patients. The search for the VoM was performed by two experienced researchers using two- and three-dimensional techniques. A dedicated Likert-based scale was used to evaluate the quality of the visualisations.

Results: The VoM was found in 61 (20.33%) of 300 patients. Its average diameter was 1.72 ± 0.69 mm with no sex-related differences (men: 1.71 ± 0.69 mm; women: 1.73 ± 0.57 mm; p = 0.91). The average length of the vessel was 9.24 ± 7.58 mm. The VoM was more frequently (p = 0.01) visualised in the systolic phases (68.85% of cases) compared to the diastolic phases (27.86% of cases). Occasionally it was visualised in other phases (3.29%).

Conclusions: Although it was possible to visualise the VoM using cardiac CT in about 20% of the population, this method of visualisation requires that special attention be paid to the quality of the images, especially in the systolic phases. Visualisation may be useful before certain electrophysiology procedures.
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http://dx.doi.org/10.5603/KP.a2018.0131DOI Listing
December 2018

Frailty as a predictor of negative outcomes after cardiac resynchronization therapy.

Pacing Clin Electrophysiol 2018 06 23;41(6):572-577. Epub 2018 Apr 23.

Department of Electrocardiology, Upper Silesian Heart Centre, Katowice, Poland.

Aim: To assess the prevalence of frailty among patients who had cardiac resynchronization as well as the influence of frailty on the main endpoints during follow-up.

Methods: The study included 156 patients (aged 74.33 ± 6.75; 27 W) with diagnosed heart failure who were hospitalized for the implantation of a cardiac resynchronization device. The Tilburg Frailty Indicator questionnaire was used to evaluate frailty syndrome.

Results: Frailty syndrome was diagnosed in 75.64% of patients who were included. The average value of frailty for the whole group was 6.21 ± 1.94, for the physical domain 4.29 ± 1.32, for the psychological domain 1.40 ± 1.04, and for the social domain 0.51 ± 0.57. During the follow-up period, 5.7% of the patients died, and the mortality rate was not statistically higher (P  =  0.5795) among patients who were diagnosed with frailty syndrome (6.78%) compared to robust patients (2.63%). Analysis of the complications and first electrical storm episodes demonstrated that these events did not occur in patients with no identifiable frailty syndrome. These occurred at a rate of 4.24% (complications) and 2.54% (electric storm) in patients with frailty syndrome.

Conclusions: Frailty syndrome can be an important predictor of negative outcomes in patients with heart failure who undergo cardiac resynchronizations.
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http://dx.doi.org/10.1111/pace.13329DOI Listing
June 2018

Three-dimensional visualisation of coronary sinus ostium from the inside right atrium perspective.

Kardiol Pol 2018 19;76(3):536-541. Epub 2018 Jan 19.

Department of Electrocardiology, Upper Silesian Medical Centre.

Background: There is no in vivo method of coronary sinus visualisation from the right atrium perspective.

Aim: The objective of the study was to create a cardiac computed tomography (CT) angiography-based method of visualising the coronary sinus ostium and the Thebesian valve from the inside right atrium perspective.

Methods: In 78 consecutive patients, a cardiac CT angiography (Aquilion 64, Toshiba) with retrospective gating (slice 0.5 mm) was performed. Raw data were reconstructed on Vitrea 2 workstations (Vital Images). In order to create the three-dimensional (3D) coronary sinus visualisation from the "inside view" perspective, patented "Fly Through" algorithms were used, and the anatomical positions on the multiplanar reconstruction images were marked. A dedicated, Likert-based five-point scale was developed and used to evaluate the quality of the visualisations.

Results: The average quality of the visualisations of the coronary sinus ostium in two-dimensional multiplanar reconstruction images was good (4.17 ± 0.85 points) and was clinically interpretable in all cases. The image quality of the "inside view" 3D images was 3.61 ± 1.12 points. In 57.7% of cases we obtained high scores (4 and 5 points). The main diameter was 10.72 ± 2.48 mm, and the entrance angle of the coronary sinus into the right atrium was 103.76 ± 10.71°.

Conclusions: Cardiac CT angiography is a useful method that permits the coronary sinus ostium and Thebesian valve to be visualised in vivo from the inside of the right atrium in a comparable manner.
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http://dx.doi.org/10.5603/KP.a2017.0246DOI Listing
November 2018

Novel combined index of cardiometabolic risk related to periarterial fat improves the clinical prediction for coronary artery disease complexity.

Atherosclerosis 2018 01 15;268:76-83. Epub 2017 Sep 15.

Department of Cardiology, School of Health Sciences, Medical University of Silesia, Katowice, Poland.

Background And Aims: Cardiovascular (CV) risk assessment based on conventional risk factors has a limited performance in the prediction of obstructive coronary artery disease (CAD). Therefore, our aim was to provide a complete assessment on the associations between single or combined cardiovascular ultrasound indexes and the complexity of CAD in high and very-high risk patients.

Methods: Two hundred fifteen patients scheduled for elective coronary angiography were enrolled in the study (F/M: 80/135 pts; age: 61.8 ± 7.9 years). Detailed clinical characteristics, including several obesity parameters, and the following ultrasound indexes were obtained: carotid intima-media thickness (IMT) and extra-media thickness (EMT), epicardial fat thickness (EFT) and intra-abdominal fat thickness (IAT). CAD severity and complexity were assessed based on the well-evidenced SYNTAX score (SS) algorithm.

Results: The study patients (79% with a very high CV risk) had central obesity (77%), and arterial hypertension (81%), one-third (37%) had diabetes and most of the individuals (74%) were current or previous smokers. In the study group, male sex, higher number of CV risk factors, diabetes and increased carotid vascular indexes (IMT or EMT ≥ 900 μm) were associated with significantly higher SS (p < 0.05). Paradoxically, obese patients revealed a significantly lower SS compared to non-obese individuals (3.65 ± 6.66 vs. 5.93 ± 8.8; p < 0.01), which was not explained by the number of CV risk factors or age. All the ultrasound indexes (except for visceral fat - IAT) revealed significant associations with the SS and the highest correlation coefficient was found for PATIMA combined index (r = 0.45; p < 0.01). Hence, none of the obesity-related clinical indexes showed any associations with CAD complexity. Multivariate regression analysis showed that male sex, chronic kidney disease and the PATIMA index were independently associated with the Syntax Score. The ROC analysis showed that the highest sensitivity (71% and 82%) and specificity (77% and 72%) in prediction of either SS > 1 or SS > 7 were found for the combined PATIMA index (negative predictive value = 92% for SS > 7).

Conclusions: We present the first study showing that a combination of ultrasound indexes related to periarterial fat and vascular wall (PATIMA index) is associated with more complex CAD in high and very-high risk patients. PATIMA index revealed improved predictive value compared to other single ultrasound indexes and clinical risk assessment.
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http://dx.doi.org/10.1016/j.atherosclerosis.2017.09.015DOI Listing
January 2018

Anxiety, age, education and activities of daily living as predictive factors of the occurrence of frailty syndrome in patients with heart rhythm disorders.

Aging Ment Health 2018 09 10;22(9):1179-1183. Epub 2017 Jul 10.

b Department of Electrocardiology , Upper Silenian Heart Center , Katowice , Poland.

Objectives: Frailty is one of the geriatric syndromes that are caused by subclinical impairment of many organs, leading to the loss of reserves and the ability to maintain homeostasis. Aim of the study was to assess which factors including anxiety and depression can be predictive factors for the occurrence of frailty syndrome in patients with heart rhythm disorders.

Methods: The study included 171 consecutive patients >64 years (73.91 ± 6.72; 48.5% W) with diagnosed cardiac arrhythmias who had been qualified for pacemaker implantation. The Tilburg Frailty Indicator scale as well as the Hospital Anxiety and Depresion Scale (HADS) were used.

Results: The average HADS results in the frailty group was significantly higher 7.42 ± 2.63 compared to the robust patients 6.33 ± 2.83; p =0.0019. Similar results were observed in patients with atrio-ventricular blocks (AVB): HADS-A: frail 8.23 ± 2.13 vs. robust 6.62 ± 2.27; p = 0.0036 and HADS-D: frail 8.84 ± 2.85 vs. robust 7.17 ± 2.48; p =0.0086. The multiple regression model showed that age (p =0.0023), education (p =0.0001), ADL (p =0.0001) and the severity of the anxiety (p = 0.0414) were important predictors of the dependent variable and predicted higher levels of frailty syndrome.

Conclusion: Anxiety, age, education and the activities of daily living can be predictive factors of the occurrence of frailty syndrome in patients with heart rhythm disorders who have been qualified for pacemaker implantation.
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http://dx.doi.org/10.1080/13607863.2017.1348468DOI Listing
September 2018

Influence of frailty on the quality of life patients qualified for pacemaker implantation.

J Clin Nurs 2018 Feb 17;27(3-4):555-560. Epub 2017 Jul 17.

Department of Electrocardiology, Upper Silesian Heart Centre, Katowice, Poland.

Aims And Objectives: An important question is whether frailty syndrome affects the assessment of quality of life or whether frailty syndrome may reduce the benefits of a cardiac pacemaker implantation.

Background: Frailty syndrome is known risk factor for quality of life evaluation after selected cardiology invasive procedures.

Design: The study was designed as single-centre prospective study.

Methods: The study included 171 patients aged ≥60 years who were qualified for pacemaker implantation. Quality of life was evaluated twice-before and 6 months after implantation using MLHF questionnaire. A frailty syndrome evaluation using the Tilburg Frailty Indicator (TFI) was performed prior to pacemaker implantation. A DDDR pacemaker was implanted in each patient.

Results: Frailty syndrome was identified in half of the patients with indications for cardiac pacemaker implantation. There was an improvement in quality of life in the six months after pacemaker implantation in all of the robust and frailty syndrome-affected patients that were included into the study-in general, physical and emotional domains.

Conclusion: Implantation of cardiac pacemaker influences the compensation quality of life evaluation in patients with sinus node dysfunction. Presence of frailty influences worse quality of life of patients when evaluated before cardiac pacemaker implantation.

Relevance To Clinical Practice: Frailty should be evaluated in all older patients qualified for pacemaker implantation to evaluate high-risk group, optimise therapeutic approach and to intense education activities for patients and family.
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http://dx.doi.org/10.1111/jocn.13897DOI Listing
February 2018

Older age and a higher EHRA score allow higher levels of frailty syndrome to be predicted in patients with atrial fibrillation.

Aging Male 2017 Mar 12;20(1):23-27. Epub 2016 Nov 12.

c Department of Electrocardiology and Heart Failure , School of Health Sciences, Medical University of Silesia , Katowice , Poland.

Background: There is no research that evaluates the relationship between the severity of the symptoms of atrial fibrillation (AF), the presence of frailty syndrome and acceptance of the illness.

Methods: The study included 132 patients aged 72.7 ± 6.73 with diagnosed AF. The severity of the symptoms of AF was determined according to European Heart Rhythm Association (EHRA) guidelines, frailty syndrome was assessed using the Tilburg frailty indicator (TFI) and the acceptance of the illness was assessed using the acceptance of illness scale (AIS). A standard statistical comparison and multiple regression analysis using the stepwise method were performed.

Results: In patients with AF, frailty was 5.31 ± 2.69 (TFI). Frailty syndrome was diagnosed in 59.8% of the AF patients who had a score of 7.17 ± 1.72. A higher level of EHRA score was connected with a smaller degree of the acceptance of the illness p = 0.0000. The multiple regression model indicated that age (p = 0.0009) and the severity of the symptoms (p = 0.0001) are important predictors of frailty syndrome.

Conclusions: There is a relationship between the presence of frailty syndrome and the intensity of the symptoms and the acceptance of AF. Age and the EHRA score permitted higher levels of frailty syndrome to be predicted.
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http://dx.doi.org/10.1080/13685538.2016.1241761DOI Listing
March 2017

Gender-related differences in coronary venous anatomy: a potential basis for various response to cardiac resynchronisation therapy.

Kardiol Pol 2017 17;75(3):247-254. Epub 2016 Oct 17.

Department of Internal Nursing, School of Health Sciences, Medical University of Silesia, Katowice, Poland Department of Electrocardiology, Upper Silesian Cardiology Centre, Katowice, Poland.

Background And Aim: We hypothesised that small differences in the anatomy of the coronary venous tree might be one of the factors responsible for the differences in the response for cardiac resynchronisation depending on a patient's gender.

Methods: Cardiac computed tomography scans with retrospective gating were performed on 315 subjects (aged 58.3 ± 11.6 years; 117 women) according to the clinical criteria. The standard protocol for coronary arteries was used during scanning. Additional reconstructions that were focused on the coronary veins during post processing were used to analyse the data. Gender-related anatomical variants were identified.

Results: The average of 3.6 ± 1.4 veins per case were visualised. The posterolateral vein was visualised more frequently in men than in women (p < 0.05). Eight variants were identified as being more frequent - they were found in 237 out of 315 cases (75.24%). Those variants occurred in 95 (81.19%) of the women and in 142 (71.72%) of the men, p = 0.080. Six variants occurred more frequently in women; however, the differences were not significant.

Conclusions: In women a more frequent presence of favourable coronary vein variants in the target area for cardiac resynchronisation can be seen. Anatomical findings may help to explain why women more frequently respond to cardiac resyn-chronisation therapy compared to men.
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http://dx.doi.org/10.5603/KP.a2016.0153DOI Listing
May 2017

Frailty syndrome in patients with heart rhythm disorders.

Geriatr Gerontol Int 2017 Sep 25;17(9):1313-1318. Epub 2016 Aug 25.

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

Aim: To assess the prevalence of frailty syndrome in patients with heart rhythm disorders that qualified for pacemaker implantation.

Methods: The study included 171 patients (83 women, aged 73.9 ± 6.7 years) who qualified for pacemaker implantation as a result of sinus node dysfunction (81 patients) or atrio-ventricular blocks (AVB; 90 patients). A total of 60 patients (25 women, aged 72.40 ± 7.09 years) without heart rhythm disorders were included in the control group. Frailty syndrome was diagnosed using the Canadian Study of Health and Aging Clinical Frailty Scale test.

Results: Frailty syndrome was diagnosed in 25.15% of the patients, and pre-frailty in 36.84% of the patients. Frailty syndrome was diagnosed in 10% of the control group, and the average value of frailty was 3.35 ± 0.92. Frailty occurred significantly more often among patients with AVB (33.34%) compared with patients who were diagnosed with sinus node dysfunction (16.05%); P = 0.0081. The average score of frailty for sinus node dysfunction was 3.71 ± 0.89, and for AVB it was 4.14 ± 0.93; P = 0.0152. In the case of AVB, the women had a statistically more intense level of frailty of 4.54 ± 0.90 as compared with the men 3.87 ± 0.85; P = 0.0294. In the multiple logistic analysis, the presence of any arrhythmia was strongly associated with frailty syndrome (OR 2.1286, 95% CI 1.4594 - 3.1049; P = 0.0001).

Conclusions: Frailty syndrome was diagnosed in one-quarter of patients with cardiac arrhythmias, whereas a further 40% were at a higher risk of frailty syndrome, and its occurrence was significantly higher if compared with the control group. Frailty occurred significantly more often among patients with atrio-ventricular blocks, especially in women. The results of the present research showed that there is a statistical association between frailty and arrhythmias. Geriatr Gerontol Int 2017; 17: 1313-1318.
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http://dx.doi.org/10.1111/ggi.12868DOI Listing
September 2017

Variation in Cardiac Vein System is Associated with Coronary Artery Calcium - A Venous-Atherosclerosis Paradox?

Acta Cardiol Sin 2015 Nov;31(6):536-42

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

Background: The factors that determine the different patterns of venous anatomy are not well understood. This study was designed to evaluate the relationship between variation in the cardiac vein system and the extent of coronary artery calcium score (CACS).

Methods: We reviewed the results of 64-slice CTs of 226 subjects (age 57.2 ± 11.2; 133M) enrolled in our study. The subjects were divided into 3 groups based on coronary artery calcium: 92 patients. with CACS = 0 AU (Agatston Unit, AU); 56 with CACS = 1-100 AU; and 78 patients with CACS > than 100 AU. The cardiac venous system was reconstructed during the optimal phase of the cardiac cycle in each subject.

Results: Subjects with a higher CACS had a better quality of vein images (p < 0.01). The number of visible veins differed between the groups. Eight subjects (8.7%) in the group with CACS = 0 AU, 7 (12.5%) in the group with CACS = 1-100 AU, and 23 (29.5%) in the group with CACS > 100 AU had five or more visible veins (p < 0.001), whereas the proportion of subjects with less than three visible veins was 56 (60.8%), 31 (55.4%) and 30 (38.4%), respectively (p < 0.05). The number of visible veins correlated with CACS (r = 0.28; p < 0.05). In a multivariate regression analysis, which included age, gender, CACS, LV ejection fraction, myocardial volume and heart rate, the CACS was found to be an independent determinant of the number of visible veins (p < 0.05).

Conclusions: The results of our study suggested that there is a link between a variation in the cardiac venous system and the extent of atherosclerosis.

Key Words: Coronary artery calcium score (CACS); Computed tomography; Coronary veins.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4804979PMC
http://dx.doi.org/10.6515/acs20150204bDOI Listing
November 2015

Frailty Syndrome in Heart Failure Patients who are Receiving Cardiac Resynchronization.

Pacing Clin Electrophysiol 2016 Apr 21;39(4):370-4. Epub 2016 Jan 21.

Department of Electrocardiology, Upper Silesian Heart Centre, Katowice, Poland.

Background: We hypothesized that patients with de novo cardiac resynchronization therapy (CRT) implantation had a more intense frailty syndrome when compared to the patients who qualified for a system upgrade.

Methods: One hundred and six patients aged ≥65 years were included. They were divided into two groups: de novo CRT implantation--74 patients and upgrade from standard right heart pacing--32 patients. A CRT was finally implanted in all of the patients. Frailty was evaluated using the Canadian Study of Health and Aging Clinical Frailty Scale (CSHA-CFS).

Results: The average results in CSHA-CFS were statistically higher (5.3 ± 0.8) in the de novo patients when compared to the patients who qualified for a system upgrade (4.9 ± 0.8); P = 0.027. Frailty syndrome was recognized in 81.1% of the patients in the de novo group and in 68.7% of the patients in the upgrade group; P = 0.164. Only one patient of the 106 had no attributes of frailty (or exposed ones) syndrome.

Conclusions: Frailty syndrome is a common phenomenon in patients with heart failure and over 65 years of age. The syndrome is most often recognized in patients who are de novo qualified for cardiac resynchronization.
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http://dx.doi.org/10.1111/pace.12800DOI Listing
April 2016

[Terminology concerning intravenous ports].

Wiad Lek 2015 ;68(1):111-4

Ports are more and more often applied with patients requiring the permanent intravenous access, not only in the cancer treatment. Very devices, as well as procedures associated with applying them are determined in the heterogeneous way. Therefore during the last conference "Intravenous Port--implantation, care, complications" an attempt to systematize the applied terminology was made.
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July 2015

The Thebesian valve and coronary sinus in cardiac magnetic resonance.

J Interv Card Electrophysiol 2015 Aug 12;43(2):197-203. Epub 2015 Apr 12.

Department of Electrocardiology, Upper Silesian Heart Centre, Ziolowa 45/47, 40-635, Katowice, Poland,

Purpose: There is no complex research exploring usefulness of cardiac magnetic resonance in the evaluation of the coronary sinus including Thebesian valve, which can be useful before selected electrophysiology procedures.

Methods: One hundred twenty-two patients aged 49.2 ± 17.2 (42 women) were included in the study; 4 of them were excluded. A steady-state free-precession (SSFP) sequence was the basis of the visualization and analysis of the coronary sinus as well as Thebesian valve. In selected cases, dedicated coronary sinus sequences were created. All data were evaluated by experienced cardiac magnetic resonance investigators.

Results: We were able to visualize the coronary sinus by using basic SSFP sequence in all patients, however in four cases in suboptimal quality. Average length of the coronary sinus was 39.73 ± 16.9 mm, average diameter was 9.81 ± 9.3 mm, and average angle of the entrance of the coronary sinus into the right atrium was 111.37 ± 13.8°. The Thebesian valve as the gate of the coronary sinus was found in 56 cases (45.9%). In 21 patients (17.2% of all), the valve was porous or almost totally covered the coronary sinus ostium, which can potentially create problems during CS cannulation.

Conclusions: In most of the cases, it is possible to visualize and measure the coronary sinus using cardiac magnetic resonance with SSFP sequence. In selected cases, it is necessary to perform additional dedicated short sequences. Thebesian valve was visualized in almost 50% of patients.
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http://dx.doi.org/10.1007/s10840-015-9994-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4486412PMC
August 2015

Coronary venous system in cardiac computer tomography: Visualization, classification and role.

World J Radiol 2014 Jul;6(7):399-408

Rafal Mlynarski, Agnieszka Mlynarska, Maciej Sosnowski, Unit of Noninvasive Cardiovascular Diagnostics, Medical University of Silesia, Upper-Silesian Cardiology Center, Katowice 40-635, Poland.

The role of the coronary venous system was underestimated for many years. In the last 20 years, a few percutaneous cardiology techniques in which the anatomy of the coronary venous system was significant were developed and are in use. The most important seems to be cardiac resynchronization therapy, which is an invasive method for the treatment of heart failure. Unfortunately, one of the major problems is the significant anatomical variability of the coronary venous system. The description of the selected anatomical structures is only useful in selected cases such as, for example, the obstruction of selected vessels, a huge Thebesian valve, etc. The 3D images can add significant value; however, their usefulness is limited due to the different points of view that are obtained during intra-operational fluoroscopy. After summarizing all of the articles and guidelines, it can be recommended that the visualization of the coronary venous system be performed in certain patients before cardiac resynchronization. The best option is to use tomography with retrospective gating with the optimal reconstruction of cardiac veins that occurs during the diastolic phases.
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http://dx.doi.org/10.4329/wjr.v6.i7.399DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4109091PMC
July 2014

Effect of coronary artery calcium score on the reduction of global cardiovascular risk.

Pol Arch Med Wewn 2014 24;124(3):88-96. Epub 2014 Jan 24.

Introduction: There are no studies evaluating an association between different coronary artery calcium scores (CACS) and reduction of traditional cardiovascular risk.

Objectives: The aim of the study was to evaluate the effect of coronary calcium scoring on the reduction of global cardiovascular risk.

Patients And Methods: This was a prospective single-center study including 180 subjects (mean age, 58.8 years). Calcifications on computed tomography were calculated by 2 experts using the Agatston scale. Selected cardiovascular risk factors and medical procedures used in subjects were analyzed.

Results: Invasive coronary angiography was performed in 60 patients (33.2%). It did not show significant coronary lesions in 26 patients (43.3%), while in the other 26 patients (43.3%), coronary angioplasty (stent implantation, balloon angioplasty) was performed. Eight subjects (13.3%) were referred for coronary artery bypass grafting (CABG), and the procedure was performed only in patients with a CACS of 400 AU and higher. Angioplasty was performed 10 times more often in these patients compared with patients with a CACS of 1 to 399 AU. A significant correlation between the CACS and cardiovascular risk was observed in relation to age, weight, and systolic and diastolic blood pressure.

Conclusions: Coronary calcium scoring allows to identify patients requiring invasive coronary angioplasty, or, in some cases, CABG, with greater precision. This can strengthen the role of the CACS as a complement to a classic evaluation of cardiovascular risk factors.
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http://dx.doi.org/10.20452/pamw.2130DOI Listing
November 2014

Traditional, forgotten and new left ventricular systolic function parameters on a 64-row multidetector cardiac computed tomography: a reproducibility study.

Cardiol J 2013 ;20(4):385-93

Unit for Noninvasive Cardiovascular Diagnostics, 3rd Chair of Cardiology, Medical University of Silesia, Katowice, Poland.

Background: Multidetector computed tomography angiography (MDCT) can provide data regarding cardiac function if a retrospective scanning is applied. We aimed at examination of the reproducibility of traditional and more sensitive parameters of the left ventricular (LV) contractility by means of a 64-row CT in order to establish errors of measurement and to determine limits that allow for a reliable detection of their changes.

Methods And Results: A random sample of 25 individuals, including 15 females (aged 64 ± 13 years) and 10 males (54 ± 13 years), who had MDCT examination were retrospectively included in this study. Data reconstructions were performed on a dedicated workstation. In each case, axial image series were created with a 10% step from 0% to 90% of the RR interval using a 2 mm slice thickness. LV volume was determined in each phase. Detailed LV volume changes within phases were analyzed to determine the largest difference between the neighbor phases (peak ejection volume, PEV, mL) during systole and to calculate the peak ejection rate (PER i.e. PEV/phase duration [1/10th of RR interval], mL/s). The derived parameters were calculated as the PER normalized for LVEDV (PER-V, 1/s), the PER normalized for LVM (PER-M, mL/g × s) and the PER normalized for LVEDV times the PER normalized for LVM product (PER-VM, ml/g × s2). Considering the errors percentages, the respective values for intra- and inter-observer errors were around 5% and 8% for standard LV systolic measures. The percentage intra-observer errors' ranged between -7.8% and -10.8%, and the inter-observer errors' ranged between -11.8% and -15.7% for both PEV and PER. For the same reader, the percentage errors ranged between -8.7% and +11.9% for PER-V, -10% and +12.7% for PER-M and -18.2% and +24% for PER-VM. For the independent reader the corresponding values were -15.2% and +15.5%, -12.3% and +16.3%, and -26.6% and +30.9%. The intra- -class coeffi cients for repeated measurements for both the same reader (intra-observer) or independent reader (inter-observer) did reach values above 0.9 and around 0.8, respectively.

Conclusions: We concluded that traditional LV systolic parameters, as well as more sensitive measures of cardiac contractility could be determined reliably by means of a 64-row MDCT. The errors for global LV systolic function measures amount to about 5%, for PEV and PER about 15% and for the PER-derived parameters about 25%. The measurement errors established might help to assess the signifi cance of changes in repeated MDCT examinations.
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http://dx.doi.org/10.5603/CJ.2013.0097DOI Listing
August 2014

Anatomical variants of left circumflex artery, coronary sinus and mitral valve can determine safety of percutaneous mitral annuloplasty.

Cardiol J 2013 ;20(3):235-40

Background: The anatomical variants of the relations of the left circumflex artery (LCx) andthe coronary sinus (CS) determine the safety of percutaneous mitral annuloplasty (PMA) as an occlusion of the LCx and its consequences might occur in some cases. Thus, knowledge ofthe anatomy of cardiac anatomy and any variations are important for surgeons.

Methods: In 320 (126 women, age 59 ± 11) patients, a 64-slice computed tomography (MSCT) (Aquilion 64) was performed due to a suspicion of coronary artery disease. A scanwith ECG-gating was performed using a slice thickness of 0.5 mm during a breath-hold. The helical pitch was 12.8, rotation time: 0.4 s and average tube voltage: 135 kV at 380 mA.100 mL of non-ionic contrast agent was given in three phases at an average rate of 4.5 mL/s.In each case, ten 3D volume rendering and 2D multiplanar reconstructions of the vessels were created (Vitrea 2).

Results: The CS was visualized in all cases and the LCx in 315 (98.4%). In 302 (95.8%)cases, the CS was the dominant vessel; in 10 (3.17%) cases both vessels were equal and the LCxwas dominant in only 3 (0.9%) cases. 52 anatomical variants were identified; 3 of them werethe most common (in 164/315 cases; 50.8%). The CS usually lies above the atrioventricular(AV) sulcus (239-75.9%) and the LCx within the AV sulcus (173-54.9%). In 235 (74.6%)cases, the LCx was closer (than the CS) to the mitral valve. It was found that in 78 (24.7%) cases, the LCx was beneath the CS in selected phases (a risk of LCx occlusion by a PMA device).The LCx closer to the mitral valve, which is considered as a safe feature for PMA, was observed in only 75 (23.8%) of the cases. The most dangerous pattern was found in 19 cases(6.1%) - 2 or 3 CS/LCx crosses.

Conclusions: The huge anatomical variability of the anatomy of the CS/LCx strengthens the role of MSCT before PMA implantation.
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http://dx.doi.org/10.5603/CJ.2013.0067DOI Listing
August 2014