Ewa Kowalik

Pregnancy and long-term cardiovascular outcomes in women with congenitally corrected transposition of the great arteries

To define maternal/neonatal outcomes and long‐term cardiovascular effects of pregnancy in women with congenitally corrected transposition of the great arteries (ccTGA).

The Impact of Pulmonary Regurgitation on Right Ventricular Regional Myocardial Function: An Echocardiographic Study in Adults after Total Repair of Tetralogy of Fallot

BACKGROUND Early results of tetralogy of Fallot (TOF) surgical repair are excellent, but patients are at risk for long-term complications. The purpose of the study was to determine to what extent ultrasonic tissue indices can be helpful in assessing the degree of pulmonary regurgitation (PR). METHODS Fifty adults (26 men, 24 women; mean age, 34.4 years) who had undergone TOF correction were studied. RESULTS Compared with normal controls, patients had decreased tricuspid annular plane systolic excursion (20.66 vs 26.79 mm, P < .05). In patients with TOF, maximal strain was reduced in all right ventricular free wall and interventricular septal segments. In patients with previous palliative shunts, lower maximal strain for RV basal segment was observed compared with subjects with no palliative surgery (-18.22% vs -22.27%, P < .05). Maximal systolic and early diastolic strain and strain rate values were significantly higher in patients with PR widths ≥ 3 mm compared with patients with PR widths < 3 mm. CONCLUSIONS Adults after TOF repair have decreased regional deformation of the right ventricle and intraventricular septum. Prior palliative treatment reduces the indices of right ventricular regional deformation. PR severity can be described by the extent of right ventricular regional deformation.

Regional Left Ventricular Myocardial Shortening in Normotensive Patients Late after Aortic Coarctation Repair - Normal or Impaired?

Despite successful repair of aortic coarctation (AoC), changes in the left ventricular (LV) regional myocardial function are reported. The aims of this study were (i) to determine LV regional longitudinal deformation in patients who underwent a repair of AoC, who were normotensive and who had normal LV global function; and (ii) to establish a potential correlation between the degree of residual narrowing in the descending aorta and the extent of LV regional deformation. We studied 22 normotensive patients aged 19-58 y (mean 32.6; SD+/-11.3). Maximal strain, epsilon (%), as well as peak systolic and early and late diastolic strain rates (SRs; s(-1)), were obtained on the basis of speckle tracking. The data were compared with those obtained from sex and age-matched controls. Regional SRs were significantly reduced for the LV anterior wall during systole and early diastole -1.1 vs. -1.39; 1.41 vs. 1.86 s(-1), respectively; p<0.05. Transaortic maximal and mean gradients across the coarctation site correlated with epsilon and systolic SR obtained from the midsegment of the LV anterior wall. Despite a successful repair, absence of systemic hypertension and normal global LV function, regional deformation properties of the anterior LV wall were impaired. The degree of longitudinal impairment in this anatomical region correlated with the extent of residual narrowing.

Is right ventricular myocardial deformation affected by degree of interatrial shunt in adults

AIMS Data on right ventricle (RV) regional function in adults with interatrial shunt are scarce. The aim of the study was to assess the regional RV deformation in the population of adults with uncorrected atrial left-to-right shunt and to establish a potential relationship between its magnitude and RV regional deformation. METHODS AND RESULTS We studied 40 adults (30F/10M; mean age 39.2 years) with atrial septal defect (ASD) [average pulmonary-to-systemic blood flow ratio (Qp/Qs) 2.1 ± 0.7]. Standard echocardiographic evaluation was completed with right ventricular dimensions, parameters of its global [tricuspid annular plane systolic excursion (TAPSE), fractional area change, myocardial performance index], and regional [strain/strain rate (ε/SR)] function. Among echocardiographic indices describing RV global function, only TAPSE was increased when compared with healthy subjects. No differences in RV deformation data (ε/SR) between ASD patients and control group were found. Non-linear relationship between the differing Qp/Qs and maximal ε in the mid-segments of the RV free wall was observed. In patients with moderate shunt, maximal ε values were higher when compared with the values obtained in mild and large shunts. CONCLUSION Regional RV deformation (ε/SR) does not differ significantly in the group of patients with various degrees of the left-to-right shunts when compared with healthy subjects. However, a non-linear correlation between Qp/Qs and ε could be observed. The affected region of the RV wall is the mid-segment and the highest values of ε were recorded in patients with moderate left-to-right shunts.

Echocardiography vs magnetic resonance imaging in assessing ventricular function and systemic atrioventricular valve status in adults with congenitally corrected transposition of the great arteries

The survival in adults with congenitally corrected transposition of the great arteries (ccTGA) might be reduced due to dysfunction of the systemic right ventricle (sRV). The quantitative echocardiographic assessment of sRV function and tricuspid (systemic atrioventricular valve) regurgitation (TR) is still a diagnostic challenge. Thus, the aim of this study was to compare echocardiographic indices of sRV function and the degree of TR with corresponding MRI (magnetic resonance imaging)‐derived parameters in adults with ccTGA.

Assessment of systemic right ventricular function in adult overweight and obese patients with congenitally corrected transposition of the great arteries

BACKGROUND In congenitally corrected transposition of the great arteries the right ventricle (RV) supports systemic circulation, and patients are prone to develop heart failure over time. Chronic volume overload secondary to obesity may contribute to premature dysfunction of the systemic RV. AIM The aim of our study was to assess the systemic RV function in overweight/obese adult patients with congenitally corrected transposition of the great arteries. METHODS Transthoracic echocardiographic studies and laboratory testing (N-terminal pro-B-type natriuretic peptide [NT-proBNP] assessment) were performed in patients with congenitally corrected transposition, who were scheduled for a routine examination, and the body mass index was calculated for each patient. RESULTS We studied 56 adults (31 men; mean age 33.9 years); 22 of whom were overweight (body mass index [BMI] of 25-29.9 kg/m²) or obese (BMI of 30 kg/m² or more), and 34 of whom were normal weight (BMI below 25 kg/m²). Age, gender, heart rate, and blood pressure were similar in both groups. The mean NT-proBNP levels were not significantly different. On echocardiography, the overweight/obese patients had a decreased systemic RV fractional area change (0.38) compared to normal weight patients (0.43); p = 0.02. Moreover, a significant reduction in the global longitudinal strain in the overweight/obese group was observed (-15.3% vs. -18.3%; p = 0.01). CONCLUSIONS Overweight/obesity in adult patients with congenitally corrected transposition of the great arteries is associated with impaired systemic RV function.

Papillary muscle dyssynchrony in patients with systolic left ventricular dysfunction

Objectives. Papillary muscles (PM) dyssynchrony is among the crucial mechanisms leading to mitral valve regurgitation (MR). The purpose of this study was to find a potential relationship between the level of PM asynchrony and the degree of MR in patients with ischemic and nonischemic cardiomyopathies (ICM and nICM, respectively). Design. Twenty-one ICM and ten nICM patients with EF ≤ 35% and sinus rhythm were enrolled in the study. The parameters describing the degree of MR and the deformation of mitral apparatus and PM function were obtained using standard echocardiography and tissue Doppler imaging, respectively. The difference of 65 ms and more in time to peak strain (ε) between anterolateral and postero-medial PM was considered indicative of PM dyssynchrony. Results. PM dyssynchrony correlated with mitral tenting area and left atrial area. The correlation between nICM PM dyssynchrony and nICM LAA was stronger and far exceeded the one observed for ICM patients. The relationship between the PM asynchrony and the remainder of the indices characterizing the degree of MR was weak. Conclusions. PM dyssynchrony did not reflect the degree of MR but seems to be associated with the deformation of mitral apparatus measured by tenting area. The level of haemodynamic consequences of MR can be better characterized by PM dyssynchrony in nICM than in ICM patients.