Elzbieta Suchon

Heart structure and function in patients with generalized autoimmune diseases: echocardiography with tissue Doppler study.

Objective Heart pathology strongly infl uences the course and prognosis of patients with generalized autoimmune diseases. In spite of autoimmunity being a common denominator of these diseases, systemic sclerosis (SSc), systemic lupus erythematosus (SLE) and dermato/polymyositis (DPM) diff er signifi cantly in the pathogenesis of organ damage. The aim of the study was to compare pathologic changes in heart structure and function in these diseases by means of standard echocardiography and tissue Doppler (TDE). Material and methods Four groups were examined: 60 SSc, 60 SLE and 15 DPM patients in stable clinical conditions and 30 healthy control subjects. Echocardiography with TDE was performed with the assessment of systolic (S) and diastolic (E) velocities of mitral and tricuspid annuli. Results Heart in SSc was characterized by signifi cant diastolic left ventricular dysfunction (mitral E 8.61 ± 2.3 cm/s vs. 12.4 ± 3.5 cm/s in the control group; P < 0.01) with preserved systolic function (mitral S 7.85 ± 1.5 cm/s vs. 7.95 ± 0.9 cm/s in control group; ns). SLE and DPM resulted mainly in pathologic thickening of valvular leafl ets and/or pericardium [mitral or aortic leafl ets thickened in 38 (63.3%) of SLE patients, 7 (46.7%) of DPM patients; pericardium thickened in 36 (60%) of SLE patients]. Pulmonary capillary wedge pressure was elevated in SSc (13.8 ± 3.5 mmHg) and DPM (13.2 ± 2.5 mmHg) patients, as compared to the control group (9.2 ± 3.7 mmHg, P < 0.01). Right ventricular systolic and diastolic dysfunction was frequent irrespective of the presence or absence of pulmonary hypertension. Conclusions Echocardiography with TDE reveals characteristic pathology in diff erent forms of generalized autoimmune diseases refl ecting their diff erent pathogenetic mechanisms. Overproduction of collagen in SSc results in diastolic left ventricular dysfunction, while generalized infl ammation in SLE and DPM leads mainly to pathologic changes on valvular leafl ets and/or pericardium. Interestingly, right ventricular dysfunction is common in all diseases analyzed, regardless of the presence of pulmonary hypertension. Echocardiography, preferably with TDE, could add valuable information about usually asymptomatic heart pathology in an individual patient with generalized autoimmune disease.

Evaluation of left ventricular function in patients with chronic obstructive pulmonary disease

INTRODUCTION Patients with right ventricle (RV) pressure overload often have impaired left ventricular (LV) diastolic function. Objectives. The aim of study was to evaluate LV function in patients with chronic obstructive pulmonary disease (COPD). Patients and methods. Thirty-five patients (mean age: 62.1 +/- 7.7 y) with COPD without additional cardiac diseases and 25 age--and sex-matched healthy subjects were enrolled into the study. All patients underwent resting ECG tracing, blood pressure, spirometry, standard and tissue Doppler echocardiography. RESULTS The mean value of forced expiratory volume in one second (FEV1) in the COPD group was 40 +/- 8.9% of the predicted value. We found no significant differences in LV end-diastolic and systolic diameter and interventricular septum as well between COPD patients and controls. RV end-diastolic diameter and RV wall thickness were significantly larger and right ventricle systolic pressure--RVSP (38 +/- 11.2 vs. 20 +/- 2.5 mm Hg) significantly higher in the COPD group. Both peak early to peak atrial filling velocities ratio--E/A and peak annular velocity during early diastole to peak annular velocity during atrial contraction--Em/Am were significantly lower in COPD compared to controls. Moreover, there was a strong inverse correlation between Em/Am and RVSP (r = -0.75; p < 0.001) and between E/A (r = -0.6; p < 0.001) as well. We found no significant differences in parameters assessing the LV systolic function between both groups. CONCLUSIONS In COPD patients LV diastolic function is significantly impaired and its magnitude is related with increase in pulmonary artery pressure, while systolic LV function is well preserved.

Radial artery pseudoaneurysm as an extremely rare complication associated with transradial catheterisation

The transradial approach has recently been recommended as the first choice of arterial access to reduce vascular complications during percutaneous coronary diagnostic and interventional procedures. Radial artery pseudoaneurysm is an extremely rare complication associated with transradial access. We report such a case in an 85 year-old woman with a diagnosis of coronary artery syndrome who underwent cardiac catheterisation via the transradial approach. An 85 year-old woman with a history of hypertension and recurring chest pain, slightly elevated level of troponin I (0.9 [n: < 0.1] ng/mL), left bundle branch block and atrial fibrillation on ECG tracing (duration unknown) was referred to our department with a diagnosis of acute cardiac syndrome. Before admission, she was treated with acetylosalicic acid, perindopril, bisoprolol and indapamide. Echocardiography showed a slightly enlarged left ventricle with decreased ejection fraction (45%), moderate mitral regurgitation and slightly enlarged left atrium. Coronary angiography performed via the left radial artery using a 6 F catheter sheath and 5 F diagnostic catheters revealed non-significant atherosclerosis in coronary arteries. As per convention, a 5,000 IU heparin bolus was administered though the sheath. The arterial sheath was withdrawn just after the procedure and a compressive dressing was applied for 2 h. The next morning, enoxaparin was administered because of sustained atrial fibrillation (AF) with a CHA2DS2-VASc score of 4. Two days after the radial artery puncture, a painful swelling with a small haematoma was noted at the site of radial access. Colour Doppler ultrasonography (USG) revealed a pseudoaneurysm (Fig. 1A) with a typical to-and-fro flow in its neck (Fig. 1B). Enoxaparin was stopped and prolonged compression was applied for the next 24 h, but only partial thrombosis with continued flow through the neck was seen on follow-up USG (Fig. 2). After obtaining verbal informed consent, the patient underwent ultrasound-guided compression therapy for 25 min at the neck of the pseudoaneurysm, successfully obtaining complete thrombosis (Fig. 3). The sinus rhythm was restored spontaneously, but short episodes of AF were recorded on 24-h ECG monitoring. After confirmation 2 weeks later of complete resolution of the radial artery pseudo aneurysm and normal blood flow in the radial artery, oral anticoagulation was recommended. Although uncommon, radial-related vascular complications are possible and may not be trivial. Early confirmation and treatment of a radial artery pseudoaneurysm using USG is essential to avoid further complications such as hand ischaemia, compartment syndrome, neurologic complications and spontaneous rupture.

Left coronary arteriovenous malformation with fistulous connections to the left and right ventricles

A 20-year-old man with right bundle branch block in recorded ECG was referred to our department. His physical examination was unremarkable. Transthoracic echocardiography showed a severe hypertrophy of the interventricular septum (22 mm)which contained multiple echo-free spaces of the vascular nature. A flow pattern suggestive to a coronary artery fistula into the left ventricle was recorded. The patient was referred for a coronary angiography, which revealed an arteriovenous malformation starting from the septal branch of the enlarged left anterior descending artery. The malformation communicated with the lumen of the left (arterial phase) and right ventricle(venous phase) as well. The posterior descending artery was fed exclusively from the described arteriovenous malformation.99mTc MIBI SPECT images showed a moderately reversible perfusion defect in the inferior wall, suggesting non-critical ischemia of this region.