Kálmán Havasi

Left Atrial Deformation Analysis in Patients with Corrected Tetralogy of Fallot by 3D Speckle-Tracking Echocardiography (from the MAGYAR-Path Study)

Background: Three-dimensional (3D) echocardiography coupled with speckle-tracking echocardiographic (STE) capability is a novel methodology which has been demontrated to be useful for the assessment of left atrial (LA) volumes and functional properties. There is increased scientific interest on myocardial deformation analysis in adult patients with corrected tetralogy of Fallot (cTOF). Objectives: To compare LA volumes, volume-based functional properties and strain parameters between cTOF patients and age- and gender-matched healthy controls. Methods: The study population consisted of 19 consecutive adult patients with cTOF in sinus rhythm nursing at the University of Szeged, Hungary (mean age: 37.9 ± 11.3 years, 8 men, who had repair at the age of 4.1 ± 2.5 years). They all had undergone standard transthoracic two-dimensional Doppler echocardiographic study extended with 3DSTE. Their results were compared to 23 age- and gender-matched healthy controls (mean age: 39.2 ± 10.6 years, 14 men). Results: Increased LA volumes and reduced LA emptying fractions respecting cardiac cycle could be demonstrated in cTOF patients compared to controls. LA stroke volumes featuring all LA functions showed no differences between the 2 groups examined. LA global and mean segmental uni- and multidirectional peak strains featuring LA reservoir function were found to be diminished in adult patients with cTOF as compared to controls. Similarly to peak strains reduced global and mean segmental LA strains at atrial contraction characterizing atrial booster pump function could be demonstrated in cTOF patients as compared to controls. Conclusions: Significant deterioration of all LA functions could be demonstrated in adult patients with cTOF late after repair. Fundamento: Ecocardiografia tridimensional (3D) acoplada à técnica de speckle-tracking (3DSTE) é uma nova metodologia útil para a avaliação de volumes e propriedades funcionais do átrio esquerdo (AE). Há crescente interesse científico na análise da deformação miocárdica em adultos com tetralogia de Fallot corrigida (cTOF). Objetivos: Comparar os volumes de AE, propriedades funcionais baseadas no volume e parâmetros de strain entre pacientes com cTOF e controles saudáveis pareados por idade e sexo. Métodos: A população do estudo consistiu em 19 adultos com cTOF consecutivos, em ritmo sinusal, acompanhados na Universidade Szeged, Hungria (idade média: 37,9 ± 11,3 anos; 8 homens; com correção cirúrgica aos 4,1 ± 2,5 anos de idade). Todos foram submetidos a ecocardiografia transtorácica bidimensional com Doppler padrão e 3DSTE. Os resultados foram comparados aos de 23 controles saudáveis pareados por idade e sexo (idade média: 39,2 ± 10,6 anos; 14 homens). Resultados: Aumento dos volumes de AE e redução das frações de esvaziamento de AE em relação ao ciclo cardíaco foram demonstrados em pacientes com cTOF em comparação aos dos controles. Os volumes de ejeção de AE caracterizando todas as funções do AE não diferiram entre os dois grupos. Strains de AE global e segmentar médio uni- e multidimensional, caracterizando função de reservatório de AE, estavam diminuídos em adultos com cTOF em comparação aos de controles. À semelhança dos strains de pico, reduzidos strains de AE global e segmentar médio na contração atrial, caracterizando função de bomba atrial, foram demonstrados em pacientes com cTOF em comparação aos de controles. Conclusões: Demonstrou-se significativa deterioração das funções de AE em adultos com cTOF em fase tardia após correção.

Dipyridamole in Heart Failure due to Dilated Cardiomyopathy: A Pilot Study

Introduction: Dipyridamole (DIP) might be beneficial in heart failure (HF). It has been reported to improve symptoms in observational, small-scale studies. The PRoFESS study for secondary prevention of stroke observed a reduction in the risk of HF with acetylsalicylic acid (ASA) plus DIP in comparison with clopidogrel. The present pilot study was aimed at assessing the clinical effects of DIP and ASA in dilated cardiomyopathy. Materials and Methods: Nineteen outpatients with nonischemic HF, New York Heart Association (NYHA) Class II, ejection fraction (EF) <40%, were randomized to ASA 25 mg, or ASA 25 mg plus DIP 200 mg (ASA + DIP), twice daily. They were evaluated at baseline and after 6 months for symptoms, EF, and exercise capacity through 6-min walk test. Results: Eleven subjects were in the ASA group and 8 in the ASA + DIP. Dyspnea improved, without differences between the two arms: n = 6/5/0/0 for NYHA I/II/III/IV in ASA, n = 4/3/1/0 in ASA + DIP. EF increased in both groups (ASA: from 34 [28-35%] to 40 [32-46%]; ASA + DIP from 32.5 [25.75-34%] to 36 [31.5-46%]). No change in meters walked or points in the Borg scale was observed. In a similar population, an adequately powered study would need to recruit 38 subjects. Conclusion: The study, although underpowered, did not show any difference between the two treatment strategies. While this appears in contrast with previous studies, the strict inclusion criteria, the randomized, double-blind design, and the clinical end-points give strength to our findings. A properly sized trial would be within the capabilities of a single center.

Az N-terminális pro-B natriureticus peptid jelentősége a felnőtt korú congenitalis szívbetegek gondozásában – Eredmények a CSONGRAD Regiszterből

Absztrakt: Bevezetes: Kronikus szivelegtelensegben es congenitalis szivbetegsegekben etiologiatol fuggetlenul igazoltak a B-tipusu natriureticus peptid (BNP)-szint prognosztikai szerepet is. Celkitűzes: A jelen vizsgalat celja a klinikai rutinban merhető N-terminalis pro-B natriureticus peptid (NT-proBNP) es a fontosabb klinikai es echokardiografias parameterek osszehasonlitasa volt az altalunk gondozott felnőtt koru congenitalis szivbetegekben. Modszer: Osszesen 70 beteg adatait dolgoztuk fel. A diagnozis 34 betegnel korrigalt Fallot‑tetralogia es 19 esetben korrigalt teljes nagyer-transzpozicio volt. Tizenhet esetben egyeb congenitalis vitiumos beteg tartozott a vizsgalati csoportba. Valamennyi esetben ambulans vizsgalat tortent elektrokardiografiaval, echokardiografiaval es NT‑proBNP-meressel kiegeszitve. Meghataroztuk a szivelegtelenseg New York Heart Association (NYHA) szerinti stadiumat, es a betegek az eletminősegukkel kapcsolatos kerdőivet is kitoltottek. Eredmenyek: A magasabb NT‑proBNP-szint ros...

A bal pitvari fülcse echokardiográfiás vizsgálata – transoesophagealis, transthoracalis és intracardialis lehetőségek

Absztrakt: A bal pitvari fulcse egy alakban es meretben valtozo előfordulasu ureg a szivben, melynek allapota osszefuggest mutat a pitvari aritmiakkal es a thrombus jelenletevel. Tekintettel a bal pitvari fulcse nehezkes abrazolhatosagara, a jelen osszefoglalo celja a kulonboző echokardiografias modszerek szerepenek bemutatasa. Orv Hetil. 2018; 159(9): 335–345.

Primary cardiac angiosarcoma: A case report

Cardiac angiosarcomas are the most common primary malignant cardiac tumors in adults. The diagnosis is often delayed due to nonspecific clinical symptoms at presentation. The cornerstones of diagnosis are echocardiography and the histological evaluation of the cardiac biopsy. The knowledge on the treatment is limited; the outcomes of chemotherapy, radiotherapy, complete surgical removal, and heart transplantation are controversial. We report a 38‐year‐old woman with a primary heart tumor which infiltrated the right atrial wall and the pericardium and caused pericardial effusion. Angiosarcoma was verified histologically. The surgical excision could not be radical, and the patient died 3 months from diagnosis.

[More than 50 years' experience in the treatment of patients with congenital heart disease at a Hungarian university hospital].

Improvements in surgical techniques and technical advancements have made possible for several patients with congenital heart disease to grow up to adulthood. It has been decided to create a registry for their more precise treatment. This registry now includes 2770 patients with data on 3043 operations, with almost 30 different diagnoses. The purpose of this paper is to review the facts and the basics leading to the establishment of this registry.Absztrakt Koszonhetően az egyre tokeletesedő műteti technikaknak es a technikai fejlődesnek, ma mar sok, congenitalis szivbetegsegben szenvedő egyen eri meg a felnőttkort. Ezeknek a betegeknek a jobb ellatasa celjabol egy regiszter osszeallitasa mellett dontottek, amely jelenleg 2770 beteg 3043 műteti beavatkozasanak adatait tartalmazza, amelyeket kozel 30-fele diagnozis miatt vegeztek. Jelen tanulmany celja a regiszter-osszeallitas okainak es alapjainak bemutatasa. Orv. Hetil., 2015, 156(20), 794–800.

Efficacy and safety of apixaban compared with warfarin regarding time within the therapeutic range

Prevention of thromboembolism by lifelong anticoagulation is an important therapeutic goal in patients with atrial fibrillation according to recent guidelines. Major drawback of vitamin K antagonists are their narrow therapeutic range and interactions with other drugs and food. These have significant impact on the pharmacokinetics and pharmacodynamics requiring regular measurements of the international normalized ratio. Efficiency of the anticoagulant therapy depends considerably on time within the therapeutic range of prothrombin international normalized ratio. Time within the therapeutic range represents the percentage of time within the required range of prothrombin international normalized ratio. Prothrombin international normalized ratio outside the therapeutic range increases the risk of thromboembolism or bleeding according to whether it falls below or above the range. New oral anticoagulants do not require routine monitoring of anticoagulation. Their efficacy and safety are shown to be at least as good as or better than those of warfarin. In patients with nonvalvular atrial fibrillation ARISTOTLE study revealed that antithrombotic effect of apixaban compared with warfarin is better and with lower bleeding risk irrespective of the quality of prothrombin international normalized ratio control. Orv. Hetil., 2014, 155(5), 177-181.