Retrospective Analysis of Intra-Aortic Balloon Pump Use in Cardiology Ward Patients Undergoing Coronary Angiography between 2012 and 2020.

We aimed to evaluate the rate and risk factors of in-hospital mortality in patients undergoing coronary angiography/angioplasty with IABP use as support. We included 214 patients (mean age: 67.5 ± 7.5 years, M/F: 143/71) with an IABP used as the periprocedural support between 2012 and 2020. The main indications for an IABP were cardiogenic shock (143 pts; 66.8%: 55 survivors (51.9%)/88 non-survivors (81.5%); p < 0.001) and infarction with an initial significant impairment of ventricular function (34 pts; 15.9%: 21 (19.8%)/13 (12%); p = 0.12). In-hospital death was the endpoint of this study. In-hospital death occurred in 108 (50.5%, M/F: 69.4%/30.6%) patients. The mean hospitalization time was 7 days (2-13); deaths occurred more frequently on the first day after the procedure (1 (1-3 days) vs. 3 (1-8), p < 0.001); and the mean hospitalization time was 2 days (1-6) for non-survivors vs. 11 days (7-17) for survivors (p < 0.001). Regarding the patients who did not survive, they were older (69 vs. 66.5, p = 0.043), their LVEF was lower (0-15%: 15 (13.9%) vs. 12 (11.3%); 16-40%: 73 (67.6%) vs. 65 (61.3%); >40%: 14 (13%) vs. 29 (27.4%); p = 0.007), and hyperlipidemia was less common (30 (27.8%) vs. 55 (51.9%) pts, p = 0.001) than in those who survived. The IABP is still a method for cardiac support; however, mortality limits its use.

A large pseudoaneurysm of the left cardiac ventricle in a 57-year-old patient after urgent coronary artery bypass grafting and surgical mitral valve replacement due to acute myocardial infarction.

We present a rare case of a left ventricular pseudoaneurysm in a patient after inferior wall myocardial infarction. The infarction was complicated with acute mitral insufficiency, pulmonary edema, and cardiogenic shock. Urgent surgical mitral valve replacement and coronary artery bypass grafting were performed. After several months, the patient was hospitalized again because of deterioration of exercise tolerance and symptoms of acute congestive heart failure. A large pseudoaneurysm of the left ventricle was recognized and successfully treated surgically.

Impact of atherosclerotic changes of carotid vessels on long-term outcome in relatively young patients with acute coronary syndrome.

BACKGROUND: Complex stenoses of coronary vessels as well as unstable plaques are part of the widespread atherosclerotic process. AIM: The possible association between the incidence of unstable coronary artery disease (CAD) and the morphology of carotid artery wall and cardiovascular events (MACE) was assessed prospectively in a two-year follow-up study. METHODS AND RESULTS: Ninety-seven consecutive patients, aged under 60, admitted to hospital with suspected acute coronary syndrome (ACS) were included. Angiography was performed in all patients. Coronary artery disease was confirmed in 78 patients. This was the CAD(+) group. In 19 patients, coronary arteries were normal. This was the CAD(-) group. In all cases, carotid ultrasound was performed before discharge and at two-year follow-up, with evaluation of carotid arteries wall morphology: carotid intima-media thickness (CIMT) in far distal wall of common carotid artery and the presence of plaques. Carotid atherosclerosis was defined as CIMT > 0.9 mm or incidence of plaques; MACE was defined as death, ACS, stroke or need for urgent coronary revascularisation. Sixty patients from the CAD(+) group met the carotid atherosclerosis criteria. This was named the CAR(+) subgroup; 18 patients with normal carotid morphology comprised the CAR(-) subgroup. During the two years, MACE occurred only in the CAD(+) group (22 events). There was no statistical difference in the MACE-free survival curve of the CAR(+) and CAR(-) subgroups (p = 0.91). CONCLUSIONS: The presence of atherosclerotic process in carotid region coexists well with the incidence of CAD; however, it does not determine prognosis after ACS.

Predictors of long-term outcome in patients with left ventricular dysfunction following coronary artery bypass grafting.

BACKGROUND: Prognostic significance of clinical and non-invasive risk markers in patients after surgical revascularisation remains unclear, especially in post-infarction patients with left ventricular (LV) dysfunction. AIM: The single-centre, prospective study was designed to assess survival and the predictive power of several clinical and non- -invasive risk markers of all-cause (ACM) and cardiovascular mortality (CVM) in post-CABG patients with LV dysfunction. METHODS: A cohort of 61 patients (age 59+/-9 years, 49 males, LVEF 33+/-6%) 6-12 months after CABG was prospectively followed for a median of 46 months. Demographics, clinical data, medication, LVEF, QRS>120 ms or late potentials (LP) presence, QT dispersion l80 ms, premature ventricular contractions (PVC) l10/h, non-sustained ventricular tachycardia (nsVT), and SDNN L70 ms in ambulatory ECG were analysed. The ACM and CVM were evaluated. The prognostic value of analysing parameters was determined. RESULTS: Fourteen patients died, 10 of them due to cardiovascular causes. Univariate Cox analysis showed that incomplete revascularisation, history of angina, heart failure, low LVEF, use of nitrates, digitalis or diuretics, and presence of LP or prolongation of QRS complex were predictors of poor outcome. Combination of angina and low LVEF was the best model in a multivariable Cox analysies for the prediction of both types of death. CONCLUSIONS: The present study showed that in post-CABG patients with LV dysfunction, angina class and low LVEF are the main predictors of ACM and CVM. Combination of LVEF <30% with the presence of QRS >120 ms or LP may also be helpful in the identification of high-risk subjects. Other common non-invasive risk markers, particularly arrhythmic and autonomic, seem to lose some of their predictive power in patients after CABG and receiving beta-blocking agents.

Correlation between electrical and mechanical properties of the left ventricle in patients with postinfarction ventricular tachycardia.

BACKGROUND: Electroanatomical mapping allows differentiation between viable and scarred myocardium. Echocardiography is widely used to assess myocardial contractility. The relationship between electrophysiological and echocardiographic assessment of left ventricular function has not yet been well established. AIM: To correlate mechanical and electrical function of the left ventricle in patients with postinfarction ventricular tachycardia and to assess clinical, echocardiographic and angiographic parameters affecting regional electrical function. METHODS: In 32 patients (25 males, 64+/-9 years old) mean unipolar (UP) and bipolar (BP) voltages were obtained with electroanatomical mapping (CARTO system) for a 12-segment model and compared with segmental wall motion function scored as normal, hypokinetic and a- or dyskinetic. UP voltage in individual groups of segments was: 7.8+/-4.2 mV, 6.5+/-4.2 mV, 4.7+/-2.5 mV, p <0.01 and for BP voltage 2.1+/-1.5 mV, 1.9+/-1.9 mV, 1.1+/-1.0 mV, p < 0.01, respectively. Left ventricular ejection fraction < or =30%, end-diastolic diameter >56 mm, previous inferior or anterior myocardial infarction (MI), MI < or =5 years and open infarct-related artery were associated with lower voltage in normokinetic segments. CONCLUSIONS: Segments with advanced systolic dysfunction had significantly lower uni- and bipolar voltage than normo- and hypokinetic segments. However, preserved local electrical function could be found in a/dyskinetic regions. Left ventricular remodelling, time and location of MI and patency of infarct-related artery influenced voltage in normokinetic segments.

The use of myocardial contrast echocardiography in the assessment of left ventricular function recovery after primary percutaneous coronary intervention in the setting of acute myocardial infarction.

BACKGROUND: Despite successful reperfusion therapy of acute myocardial infarction and complete restoration of infarct-related artery patency, the improvement of systolic function in long-term outcome depends on preserved microvasculature integrity. Myocardial contrast echocardiography (MCE) is a useful technique for identification of viable myocardium. AIM: To assess the value of real-time myocardial contrast echocardiography (rt-MCE) in prediction of left ventricular function improvement in patients with anterior wall acute myocardial infarction as well as selection of the optimal cut-off value for the number of dysfunctional segments with preserved complete perfusion, in order to predict the global left ventricular function improvement during one-month observation. METHODS: Rt-MCE was performed in 74 patients (50 men, aged 58+/-11 years) with anterior wall myocardial infarction, treated with primary percutaneous coronary intervention (PCI) within 12 hours from the onset of symptoms. After estimation of regional contractility disturbances and global systolic function of the left ventricle, rt-MCE was performed with contrast assessment of dysfunctional segments (normal contrast pattern=2, heterogeneous=1, lack of contrast=0). Regional perfusion score index (RPSI) was calculated by adding the perfusion indices and dividing by the number of dysfunctional segments. RESULTS: Of a total of 1184 visualised segments, 344 (29.1%) were dysfunctional (189 hypokinetic, 155 akinetic). Contractility improvement was observed in 192 segments (preserved viability in 105 hypokinetic and 37 akinetic segments). In a group of 44 patients with systolic function improvement, 34 of them had preserved viability, and in a group of 30 patients without LVEF improvement, in 22 of them myocardium viability was not observed. Sensitivity, specificity and accuracy of rt-MCE in prediction of left ventricular global improvement were 72.7%, 73.3% and 73%, respectively, whereas in prediction of regional function improvement these values were 73.9%, 77% and 75.5%, respectively. CONCLUSION: Rt-MCE performed in the early phase of myocardial infarction enables the prediction of left ventricular regional and global function improvement in patients treated with primary PCI.

Diagnostic utility of tissue tracking echocardiography for the diagnosis of ischaemic heart disease.

INTRODUCTION: Both the resting electrocardiogram and standard echocardiography have limited value in detecting ischaemic heart disease (IHD) in patients with atypical symptoms or asymptomatic subjects. Tissue tracking (TT) is a novel method based on tissue Doppler echocardiography for the assessment of longitudinal apical myocardial motion. AIM: To assess diagnostic utility of TT mode in the diagnosis of IHD. METHODS: The study was performed in a group of 36 patients (aged 58+/-8 years, 15 males) with good acoustic window, sinus rhythm and normal left ventricular ejection fraction on standard echocardiography who were previously selected for coronary angiography. Systolic displacement of myocardium (TT) was assessed in all patients using apical views (4, 2, and 3-chamber) and 7-colour-coded visualisation expressing various apical displacements of the myocardium during systole. Group IHD(-) consisted of 16 patients with normal coronary angiography or insignificant lesions and group IHD(+) consisted of 20 patients with significant (>70%) coronary lesions. RESULTS: Despite similar prevalence of arterial hypertension and diabetes as well as similar pharmacological treatment patients from the IHD(+) group had a lower TT index (ratio of the sum of regional TT values to the number of analysed segments than the IHD(-) (patients 4.5+/-0.8 mm vs 5.9+/-0.9 mm respectively, p <0.001). CONCLUSIONS: Resting echocardiography with tissue tracking enables fast, non-invasive and semiquantitative evaluation of left ventricular function. This method of assessment of longitudinal layers of the left ventricle may be useful in the diagnosis of ischaemic heart disease.

Circumferential pulmonary vein RF ablation in the treatment of atrial fibrillation: 3-year experience of one centre.

INTRODUCTION: In patients with atrial fibrillation (AF), significantly symptomatic in particular, restoring and maintaining sinus rhythm is one of treatment strategies. Considering the limited efficacy and side effects of anti-arrhythmic agents, growing hopes are attributed to the developing techniques of percutaneous ablation. AIM: To determine the efficacy and safety of circumferential pulmonary vein ablation performed using the CARTO system in patients with paroxysmal or permanent AF. METHODS: The study involved 94 patients (mean age 54 years, males 65%, structural heart disease 29.4%) with symptomatic, recurrent and AF resistant to antiarrhythmic agents (paroxysmal AF 63.8%), selected for circumferential pulmonary vein ablation with the Pappone method. Follow-up examinations were performed after 1, 3, 6, 9, and 12 months. The symptoms, ECG, 24-hour ECG monitoring and complications were recorded. RESULTS: Mean procedure and fluoroscopy durations were 4.5 hours and 22.4 minutes respectively. The long-term follow-up ranged from 3 to 24 months, with median time of 12 months. At six months, 47.8% of patients remained free from AF, and improvement in terms of infrequent arrhythmia occurrence and low incidence of symptoms in an additional 36.7% was observed. Efficacy was lower in patients with permanent AF (12 months 90% vs 70%). Complications were seen in six (6.4%) patients: cardiac tamponade in two patients; and pericardial effusion, retroperitoneal bleeding, stroke, and pulmonary vein thrombosis each in one patient. CONCLUSIONS: Circumferential pulmonary vein ablation leads to resolution of arrhythmia or marked clinical improvement in about 75% of patients with symptomatic, resistant AF. The success rate is lower in patients with permanent rather than paroxysmal AF. As severe complications are not unlikely, the indications for such therapy must be carefully balanced.

Influence of coronary artery bypass grafting on QT dispersion.

BACKGROUND: Abnormal dispersion of the QT interval (QTd), measured as the interlead variability of QT, reflects an inhomogeneity of ventricular action potentials. In this study we observed both short- and long-term influences of coronary artery bypass grafting (CABG) on rest and exercise QTd in 64 male patients, having a mean age of 54+/-10 years, with coronary heart disease. MATERIAL/METHODS: QTd was measured as the difference between QT maximum and minimum from 12 leads on an averaged ECG (25 mm/s). QTd and QTdc were measured at rest and at peak exercise during symptom-limited treadmill exercise (ET), which was performed before, 6 months after, and 2 years after CABG. RESULTS: There was a significant reduction in rest QTd from before CABG to 6 months and 2 years after (60+/-20 ms vs. 43+/-14 ms and 45+/-13 ms, respectively; p<0.001). Similarly, there was a significant reduction in peak QTd from before CABG to 6 months and 2 years after (66+/-22 ms vs. 38+/-11 ms and 36+/-11 ms, respectively; p<0.001). Two years after CABG, 17 patients had a recurrence of angina and ET provoked chest pain and/or >2 mm ST depression. The resting values did not distinguish patients with ischemia from nonischemic ones. In patients with ischemia, ET provoked an increase in QTdc. CONCLUSIONS: Rest and exercise QTd is significantly reduced after CABG. It seems that the measurement of QT dispersion during ET can be helpful in distinguishing patients with a recurrence of ischemia.