Predictors of Tricuspid Valve Anulus Dilation in a Heart Recipient Population.

BACKGROUND: Tricuspid valve regurgitation in reported in >20% of heart recipients. It severity has not only clinical impact, but it is also associated with increased mortality. Risk factors for developing tricuspid valve dysfunction include allograft rejection, donor/recipient pericardial cavity mismatch, preoperative transpulmonary gradient and vascular resistance, biatrial anastomosis technique, and biopsy-induced injury. Tricuspid valve annulus distention is reported to causative factor for most common type of tricuspid valve dysfunction after heart transplantation. The aim of the study was to estimate possible early predictors for tricuspid valve regurgitation after orthotopic heart transplantation performed with standard Lower-Shumway technique on magnetic resonance imaging studies. METHODS: A total of 20 patients (18 men and 2 women) with a mean age of 45 ± 12 years were enrolled into the study. Echocardiographic evaluation followed by magnetic resonance studies were performed. The mean duration from time of transplantation was 34 ± 12 months. Magnetic resonance and echocardiographic imaging focused on tricuspid valve annulus diameter and atrium dimensions. RESULTS: The was a progressive distension of tricuspid valve annulus observed during the follow-up period. Mean tricuspid valve diameter increased from 3.0 ± 0.3 to 3.34 ± 0.3 mm (P < .05). There was a positive correlation observed between recipient native right atrium and overall right atrium diameter and tricuspid valve diameter distension. CONCLUSIONS: Overall right atrium diameter and native recipient right atrium diameter were found to be a risk factor for tricuspid valve annulus distension.

Novel Method of Infection Prophylaxis in Heart Transplantation by Retrosternal Gentamycin Sponge Application.

BACKGROUND: Surgical wound infections are more frequent in patients undergoing heart transplantation than in other heart surgery patients. There is a wide spread of sternal wound infection incidence in transplant patients ranging from 4% to 40%. It is first study describing local gentamicin sponge application during heart transplantation procedure. MATERIALS AND METHODS: We enrolled 75 patients in a retrospective, single-center study, including 25 patients who underwent orthotopic heart transplantation (heart transplant group) and 50 in the cardiac surgery group. They were in mean age of 49 ± 12 years and 51 ± 13 years in heart transplantation and cardiac surgery group, respectively. A gentamicin sponge was inserted intraoperatively between sternal borders before chest closure in all heart transplantation patients. RESULTS: There was 1 early death (4%) on postoperative day 7 owing to Clostridium difficile infection in the heart transplant group. There was 1 death (2%) in the cardiac surgery group owing to multiorgan failure secondary to perioperative heart ischemia. There was neither bacterial sternal wound infection nor sternal instability in the heart transplant group. None of the patients who had gentamicin sponge applied had wound healing problems. Two patients (4%) had a deep sternal wound infection in the cardiac surgery group, who had no sponge application; 1 (2%) was treated by surgical debridement and active drainage and 1 (2%) by vacuum therapy. There were 11 patients (44%) discharged on insulin therapy in the heart transplant group and 21 (21%) in the cardiac surgery group. Mean overall postoperative hospital stay was 35 ± 19 days in the heart transplant group and 10 ± 4 days in the cardiac surgery group. CONCLUSIONS: Gentamicin sponge is an effective local infection prophylaxis in heart transplant patients.

Visfatin, resistin, hsCRP and insulin resistance in relation to abdominal obesity in women with rheumatoid arthritis.

OBJECTIVES: The increasing incidence of overweight and obesity in modern societies, and the demonstration that adipose tissue produces numerous cytokines, increases interest of investigators in the associations between adipose tissue, adipokines, CRP and insulin resistance in rheumatoid arthritis (RA) and their possible role in the pathogenesis of this disease.The purpose of the study was to investigate serum levels of visfatin, resistin, hsCRP and insulin resistance in relation to abdominal obesity in patients with RA. METHODS: Serum levels of visfatin, resistin, hsCRP and glucose metabolism parameters were measured in 46 women with RA - 22 without abdominal obesity and 24 with abdominal obesity. RESULTS: Patients with RA and abdominal obesity showed significant lower visfatin levels (1.00+/-0.93 vs. 1.44+/-0.85 ng/ml; p<0.05) in comparison to those without abdominal obesity. We found significant correlations between levels of visfatin and resistin (r=0.41; p<0.01); and between resistin levels and hsCRP levels (r=0.41; p<0.01); resistin levels and leucocytes count (r=0.36; p<0.05); and resistin levels and ESR (r=0.30; p<0.05), in the whole investigated group. Visfatin as well as resistin did not correlate with anthropometric parameters or insulin resistance in whole patients with RA. CONCLUSIONS: In patients with RA and abdominal obesity, in comparison to patients without abdominal obesity, significantly lower visfatin levels have been demonstrated. Resistin was associated with laboratory markers of inflammation. Positive correlation between levels of visfatin and resistin may suggest that visfatin plays a role in inflammation in RA.

Correlation of ST-segment depression during ambulatory electrocardiographic monitoring with myocardial perfusion and left ventricular function.

To assess the relation between silent ischemia and objective markers of ischemia we compared ambulatory electrocardiographic (AECG) monitoring, exercise stress testing, and technetium-99m methoxyisobutyl isonitrile single-photon emission computed tomography (SPECT) in 68 patients with coronary artery disease. ST-segment depression at AECG monitoring occurred in 40%, exercise testing was positive in 88%, and SPECT was abnormal in 98% of patients. Patients with ST-segment depression had a higher incidence of 3-vessel disease (70% vs 45%, p = 0.04), shorter duration of exercise (267 +/- 109 vs 416 +/- 167 seconds, p < 0.01), lower workload achieved (5.1 +/- 1.9 vs 7.6 +/- 2.8 METs, p < 0.0002), and a greater extent of ischemia at scintigraphy (p = 0.01). Patients with a total ischemic time of >30 minutes in a 24-hour period had a lower ejection fraction (48 +/- 21% vs 70 +/- 9%, p = 0.001), a higher perfusion index at rest (2.4 +/- 0.6 vs 1.6 +/- 0.6, p = 0.001), and a greater number of segments with fixed perfusion defects (4.1 +/- 3.7 vs 1.3 +/- 1.8, p = 0.02) in comparison with those who had a shorter ischemic time. We conclude that AECG monitoring fails to identify a substantial proportion of patients with objective markers of ischemia; however, ST-segment depression reflects more significant disease. Longer total ischemic time correlates with the area of myocardial damage but not with other markers of ischemia.

[Echocardiographic heart assessment in systemic lupus erythematosus]. / Echokardiograficzny obraz serca w toczniu ukladowym.

A prospective two dimensional and Doppler echocardiographic studies were performed in 41 patients to assess the incidence and spectrum of cardiac abnormalities. All patients included in the study fulfilled the 1982 revised criteria of the American Rheumatism Association for classification of SLE. There were 37 women and 4 men with average age of 38 years. Average duration of SLE was 6.5 years (range 6 months to 20 years). Nineteen patients (46.3%) with SLE had cardiac abnormalities. Valvular abnormalities were found in 14 patients (34.1%). Mitral valve abnormalities were the most common findings-in 7 patients (17.1%). There were 6 patients with aortic (14.6%), and 3 patients with tricuspid valve abnormalities (7.3%). One patient had morphological echocardiographic pattern suggesting noninfective verrucous vegetations affecting the tricuspid valve. Pericardial effusion was identified in 5 patients (12.2%). We found no correlation between the prevalence of cardiac abnormalities and duration, age and disease activity in SLE patients.

[Exertion tolerance in the early period after myocardial infarction, the results of echocardiographic examination and the clinical course of infarction]. / Tolerancja wysilku we wczesnym okresie po zawale serca a wynik badania echokardiograficznego i przebieg kliniczny zawalu.

The relation between exercise test, echocardiography and clinical course of acute myocardial infarction was investigated. 17-34 days after an acute myocardial infarction, before hospital discharge, 58 patients underwent exercise test and 17-28 days- echocardiography. Low exercise capacity was significant related to angina before infarction, maximal CKNAC and complications during clinical course. There was inverted correlation of asynergy index calculated from echocardiography with maximal workload achieved during exercise test.

[Value of exertional echocardiography and performance of transesophageal left atrial pacing done 3-4 weeks after acute myocardial infarction]. / Wartosc echokardiografii wysilkowej oraz wykonanej w czasie szybkiej przezprzelykowej stymulacji lewego przedsionka w 3-4 tygodniu zawalu serca.

Two-dimensional echocardiography during exercise (ECHO W) and left atrial pacing (ECHO S) was done in 30 patients 3-4 weeks after acute myocardial infarction. Sensitivity of these methods to detect fresh myocardial ischemia was compared. Their prognostic value during 2 years after myocardial infarction was determined too. Both methods increase sensitivity of simultaneously performed ecg. Sensitivity of ECHO S (80%) was higher than ECHO W (67%). Sensitivity of the two methods altogether was higher (93%) then each method independently. Coexistence of worsening systolic wall motion abnormalities and a decrease in ejection fraction during both examinations may suggest worse clinical course and prognosis 2 years after myocardial infarction.

[The value of echocardiography in interpreting exercise ST elevation 3-4 weeks after myocardial infarction]. / Wartosc badania echokardiograficznego w interpretacji wysilkowego uniesienia odcinka ST w 3-4 tygodniu zawalu serca.

To assess the value of echocardiography in interpretation of exercise ST-elevation 61 patients (age 29-70, mean 53 years old) underwent exercise stress test and echocardiography 3-4 weeks after an acute myocardial infarction. Isolated ST-elevation in exercise ecg was found in 12 patients (19.7%), significant more frequently in anterior than inferior infarction. All patients with ST-elevation had left ventricular asynergy recognized by echocardiography. When compared to the patients without exercise ST-elevation, we found that dyskinesis was significant more frequently in patients without exercise ST-elevation (respectively: 50% i 2.6%; p less than 0.001). Index of asynergy was significant higher in patients with exercise ST-elevation (respectively: 0.59 and 0.25; p less than 0.01). Thus, exercise ST-elevation after acute myocardial infarction is a good marker of severe left ventricular asynergy recognized by echocardiography.