Edyta Płońska-Gościniak

Echocardiography in aortic diseases: EAE recommendations for clinical practice

Echocardiography plays an important role in the diagnosis and follow-up of aortic diseases. Evaluation of the aorta is a routine part of the standard echocardiographic examination. Transthoracic echocardiography (TTE) permits adequate assessment of several aortic segments, particularly the aortic root and proximal ascending aorta. Transoesophageal echocardiography (TOE) overcomes the limitations of TTE in thoracic aorta assessment. TTE and TOE should be used in a complementary manner. Echocardiography is useful for assessing aortic size, biophysical properties, and atherosclerotic involvement of the thoracic aorta. Although TOE is the technique of choice in the diagnosis of aortic dissection, TTE may be used as the initial modality in the emergency setting. Intimal flap in proximal ascending aorta, pericardial effusion/tamponade, and left ventricular function can be easily visualized by TTE. However, a negative TTE does not rule out aortic dissection and other imaging techniques must be considered. TOE should define entry tear location, mechanisms and severity of aortic regurgitation, and true lumen compression. In addition, echocardiography is essential in selecting and monitoring surgical and endovascular treatment and in detecting possible complications. Although other imaging techniques such as computed tomography and magnetic resonance have a greater field of view and may yield complementary information, echocardiography is portable, rapid, accurate, and cost-effective in the diagnosis and follow-up of most aortic diseases.

Enlarged Left Atrium Is a Simple and Strong Predictor of Poor Prognosis in Patients after Myocardial Infarction

Background and Aim: Patients after myocardial infarction (MI) differ according to the extend of myocardial damage and prognosis. Diastolic function impairment may have great impact on development of heart failure and outcomes. We evaluated the prognostic value of various echocardiographic measurements in 18‐month and 3‐year observation after MI. Methods: 60 patients after MI (44 male, mean age 60 ± 11) were examined by transthoracic echocardiography with the assessment of wide spectrum of parameters. Mortality and combined end points (cardiac deaths and heart failure exacerbation) were assessed after 18‐month and 3‐year observation and groups with and without end points were compared. Optimal cutoff values were estimated by receiver operating characteristic (ROC) analysis and resulting Kaplan–Meier curves were compared. Results and Conclusions: After 18 months, 11 deaths occurred and 20 subjects experienced hospitalization caused by heart failure exacerbation. Although the group with cardiac events showed a greater enlargement of the left ventricle and lower ejection fraction, the highest relative risk of poor outcome (RR = 5.0) was related to the left atrial enlargement above 44 mm. Although restrictive or pseudonormal inflows were connected with 2.1 relative risk of combined end point, all patients with E deceleration time ≤130 ms experienced heart failure exacerbation or death. Despite tissue Doppler and propagation parameters describing elevated end‐diastolic pressure differed between groups with various outcomes in multivariate analysis, only enlarged left atrium was an independent predictor for both combined end point and cardiac death. Further 3‐year follow‐up solely confirmed the role of above described predictors.

Cardiovascular imaging practice in Europe: a report from the European Association of Cardiovascular Imaging.

The need for cardiovascular imaging (CVI) is expected to increase over the coming years due to the changes in CV disease epidemiology and ageing of the population. However, reliable statistics on CVI practice in Europe are lacking. Establishing the current status of the use of CVI across Europe has become the first comprehensive project of the European Association of Cardiovascular Imaging and the European Society of Cardiology Taskforce on CVI. In 2013, a survey with relevant information regarding CVI was sent to all National Imaging/Echocardiography Societies and Working Groups. Representatives from 41 countries returned the questionnaire. The present report provides key results of the survey, relating to existing education, training, certification and national accreditation programmes, healthcare organizations, and reimbursement systems.

Five-chambered heart: a 20-year story of left atrial appendage aneurysm

Left atrial aneurysm (LAAn) is a rare congenital pathology described by Semans and Taussig in 1938. Most commonly, clinical presentation includes exercise dyspnoea, palpitations, or angina. The condition may be complicated by atrial ectopy or fibrillation, embolism, mitral regurgitation, and, rarely, cardiac tamponade or infarction. To date, approximately 80 case reports on LAAn have been published. This case represents the sole occurrence of the entity in >300 000 echocardiographic examinations performed over 20 years in the laboratories of the authors. A 25-year-old male was admitted to hospital for the first time in 1988 due to exercise intolerance [New York Heart Association (NYHA) functional class II/III]. Chest X-ray suggested cardiac enlargement. Echocardiogram revealed an additional echo-free cavity adjacent to the left ventricle. Preliminary echocardiographic diagnosis was pericardial cyst. Surgery was advised but rejected by the patient. Ten years later, he was reassessed and echocardiography demonstrated a 2 cm wide communication between the left atrium …

2015 ESC Guidelines for the management of infective endocarditis

Authors/Task Force Members: Gilbert Habib* (Chairperson) (France), Patrizio Lancellotti* (co-Chairperson) (Belgium), Manuel J. Antunes (Portugal), Maria Grazia Bongiorni (Italy), Jean-Paul Casalta (France), Francesco Del Zotti (Italy), Raluca Dulgheru (Belgium), Gebrine El Khoury (Belgium), Paola Anna Erba (Italy), Bernard Iung (France), Jose M. Miro (Spain), Barbara J. Mulder (The Netherlands), Edyta Plonska-Gosciniak (Poland), Susanna Price (UK), Jolien Roos-Hesselink (The Netherlands), Ulrika Snygg-Martin (Sweden), Franck Thuny (France), Pilar Tornos Mas (Spain), Isidre Vilacosta (Spain), and Jose Luis Zamorano (Spain)

Low-dose dobutamine stress echo for reverse remodeling prediction after cardiac resynchronization

PURPOSE Cardiac resynchronization therapy (CRT) is a valuable option for patients with heart failure and wide QRS to reduce electromechanical dyssynchrony (DYS). High non-responders rate (30%) urges the need to improve selection of candidates for CRT. We hypothesized that low-dose dobutamine stress echocardiography (DSE) can help unmask dyssynchronous motion. The aim of this study is comparison between dyssynchrony index at rest and during low-dose dobutamine stress to predict left ventricular reverse remodeling after CRT. PATIENTS AND METHODS Prospectively, 57 consecutive patients (37 male) aged 61.8±9 who qualified for CRT according to current guidelines were enrolled. Two dimensional echocardiography and tissue Doppler imaging (TDI) were performed before and 6 month after CRT to assess reverse remodeling (rLV). Additionally DSE was performed before CRT. DYS was assessed at rest (DYSr) and peak DSE (DYSd) separately, as a difference between time to peak systolic velocity (Ts) of septum and lateral wall. Ts was corrected for heart rate. RESULTS rLV defined as decrease ≥15% of LVESV at follow-up was found in 38 (67%) patients. DYSr and DYSd were independent predictors of rLV (OR=1.04, Cl ±1.02-1.06, p<0.02 and OR=1.05, Cl±1.03-1.08, p<0.0002 respectively). ROC analysis found that DYSr>42ms and DYSd>59ms had sensitivity of 70% and 87%, specificity of 61% and 78%, and accuracy of 70% and 84% respectively for prediction of reverse remodeling LV. Area under Receiver Operating Characteristic Curve for DYSd was higher than for DYSr (0.89 vs 0.71, p<0.007). CONCLUSION Exercise intraventricular dyssynchrony assessed by dobutamine stress echo is a strong independent predictor of cardiac resynchronization therapy response.

Role of echocardiography in monitoring of cardiac toxicity of cancer pharmacotherapy. Expert consensus statement of the Polish Clinical Forum for Cardiovascular Imaging

Recent oncology development results in significant reduction of morbidity and mortality of several kinds of cancer. Such great achievements are at the cost of frequent cardiotoxicity, which predominantly is manifested as cardiomyopathy, cardiac dysfunction and heart failure (HF). Cardiotoxicity may manifest early - during treatment or late - after treatment completion. There are type 1 - anthracycline-related and type 2 - trastuzumab-related cardiotoxicity. Early detection of cardiotoxicity is crucial for preventing late heart dysfunction and HF. Baseline echocardiographic assessment should be performed in every patient before initiation of cancer treatment and serial monitoring of cardiac safety by means of echocardiography is recommended. The most widely used for this purpose is left ventricular ejection fraction (LVEF) calculated by Simpsons method with 2 dimensional transthoracic echocardiography. LVEF has numerous limitations, among which significant inter- and intraobserver variability, late decrease of LVEF with its often irreversibility are the most important. Noncontrast 3 dimesional echocardiography is the most reproducible technique for LVEF measurement. Newer echocardiographic technique - myocardial strain imaging has the potential to detect early subclinical cardiac dysfunction due to cardiotoxicity and may be used for the prediction of LV dysfunction. The role of other echocardiographic parameters, particularly of LV diastolic function has not been exactly defined in literature. The decision on discontinuation or modification of cancer therapy should be based on 2 improper, separate measurements of particular echocardiographic parameter or better more than 1 improper parameter should be taken into account. After completion of cancer treatment, echocardiography follow-up is recommended to detect late cardiotoxicity.

Transesophageal echocardiography in adults — guidelines of the Working Group on Echocardiography of the Polish Cardiac Society

This document presents current Polish guidelines on the clinical use of transthoracic echocardiography, including stress examinations, in adult patients. The examinations with pocket-size imaging devices are also discussed. The authors present recommendations regarding indications and contraindications, staff and equipment requirements, patient preparation and information, examination protocol, reporting and reimbursement.

Predictors of functional mitral regurgitation improvement during a short-term follow-up after cardiac resynchronisation therapy

BACKGROUND AND AIM The study was undertaken to assess the predictive role of myocardial contractile reserve for functional mitral regurgitation (FMR) improvement after cardiac resynchronisation therapy (CRT), and to define other predictors of FMR improvement (FMRI) and the impact of FMRI on left ventricular (LV) reverse remodelling. METHODS AND RESULTS Among 90 patients in whom echocardiography was performed one day before and six weeks after CRT implantation, 66 with at least FMR(2+) in a four-point scale (mean age 64 ± 10 years, mean LV ejection fraction [LVEF] 25.7 ± 6%, ischaemic aetiology 48%) were included. FMRI was defined as the reduction of the FMR severity by at least one grade. The patients were divided into groups: A with FMRI (n = 30) and B without FMRI (n = 36). Contractile reserve was evaluated using low-dose dobutamine stress-echo before CRT implantation and was defined as a relative improvement in LVEF of more than 20% and segmental contractility improvement. Reverse remodelling was defined as the reduction of the LV end-systolic volume (LVESV) by at least 15%. Cox regression multivariate analysis revealed the following predictors for FMRI: contractile reserve preserved in more than three segments with an OR = 5.7 (95% CI 1.81-17.97, p = 0.005, sensitivity 65.5%, specificity 72.2%, AUC = 0.727) and LV end-diastolic diameter ≤ 74 mm with an OR = 2.09 (95% CI 0.75-5.78, p < 0.05, sensitivity 80.0%, specificity 47.2%, AUC = 0.632). FMRI was associated with greater reduction of LVESV (p = 0.002), greater increase in LVEF (p < 0.001) and higher incidence of the LV reverse remodelling (p < 0.001). CONCLUSIONS Preserved contractile reserve and lesser degree of LV dilation were predictive factors of short-term FMR improvement after CRT implantation. FMR improvement was associated with higher incidence of the LV reverse remodelling early, already in the six weeks after CRT implantation.

Infective endocarditis due to Streptococcus agalactiae giant mitral valve vegetation

We present a case of giant mitral valve vegetation in a 68-year-old woman who was admitted to our ward in septic shock. On transoesophageal echocardiography, a large (45 × 28 mm), mobile, hyperechoic mass was seen on the mitral valve (Figs. 1, 2). Mild mitral regurgitation was present. The patient underwent urgent surgery. Intraoperatively, a large vegetation was found on the anterior mitral valve leaflet. After removal of the infected tissue, a bioprosthetic valve was implanted (Fig. 3). Blood cultures revealed the presence of Streptococcus agalactiae. The postoperative course was uneventful. Group B Streptococcus, also known as Streptococcus agalactiae, is a gram-positive organism frequently colonising the female genito-urinary tract. It is a rare cause of infective endocarditis (1.7%) and concerns the mitral valve in about 50% of cases. The disease is found frequently in immune-compromised patients and is associated with a significant rate of complications and mortality rates of 20–50%. The presence of large vegetations and frequent embolic complications are attributed to a lack of fibrinolysin in S. agalactiae. We did not note embolic complications, but the vegetation found in our patient was to the best of our knowledge the largest ever reported. As S. agalactiae can be less susceptible to penicillin than other Streptococci, the addition of gentamycin or ceftriaxone with gentamycin is recommended. Echocardiographic examination plays an important role in early diagnosis and is crucial for choosing an appropriate method of treatment. Antibiotic therapy combined with early surgery, especially in cases with a large vegetation, is in our opinion the treatment of choice.