Nóra Ambrus

Prolonged Antispasmodic Effect in Isolated Radial Artery Graft and Pronounced Platelet Inhibition Induced by the Inodilator Drug, Levosimendan

Radial artery frequently develops spasm and requires vasodilator therapy during coronary artery bypass graft surgery (CABG). Levosimendan was recently shown to oppose 5-hydroxytryptamine-induced contraction of radial artery (RA) grafts. The aim of the present study was to explore whether levosimendan retains its vasodilatory capacity following in vitro pre-incubation of RA segments with the inodilator. A possible cumulative effect of the drug in human platelets was also studied. Human isolated RA segments were pre-incubated in 0.16 μmol/L levosimendan containing solution or in 0.9% NaCl, Bretschneider, 5% albumin and a 5% human serum protein solution (Biseko) as controls for 45 min. Contractions were induced by three consecutive administrations of 5-hydroxytryptamine (0.31 μM) 45, 90 and 120 min. after exchanging the pre-incubation solutions with Krebs-Henseleit solution, uniformly. Receptor-independent contractions (KCl, 80 mmol/L), endothelium-dependent (acetylcholine, 1 μmol/L) and independent relaxations (papaverine, 100 μmol/L) were also investigated. Washed human platelets were pre-incubated with levosimendan (0.06 μmol/L) for 2 or 15 min. and aggregated with thrombin (0.1 IU/mL). Contractions of RA grafts induced by 5-hydroxytryptamine were significantly smaller 45 min. and 90 min. after the replacement of levosimendan with Krebs-Henseleit solution. Biseko solution also decreased the contraction of the graft at 45 min. Contractions did not change in time following the pre-incubations of radial arteries with 0.9% NaCl, Bretschneider and 5% albumin solutions. The grafts remained intact as assessed by their maximum contractions and endothelium-dependent and endothelium-independent relaxations at the end of the investigations. Platelets revealed larger anti-aggregatory effect to levosimendan following the enhancement of the incubation time. Results indicate that the antispasmodic and anti-aggregatory effects of levosimendan cumulate in the vascular tissue and in platelets. The storage of RA with the inodilator before implantation may help to prevent the intraoperative spasm of the graft and also thrombotic occlusion during CABG surgery.

Left atrial dysfunction in light-chain cardiac amyloidosis and hypertrophic cardiomyopathy – A comparative three-dimensional speckle-tracking echocardiographic analysis from the MAGYAR-Path Study

INTRODUCTION While cardiac amyloidosis (CA) is a rare systemic disease characterized by extracellular deposition of protein-derived fibrils, hypertrophic cardiomyopathy (HCM) is histopathologically characterized by myocyte hypertrophy and disarray, interstitial fibrosis, and small intramural coronary arteriole dysplasia. The aim of the present study was to compare left atrial (LA) volumetric and functional characteristics between light-chain (AL) CA and HCM by three-dimensional (3D) speckle-tracking echocardiography (STE). METHODS The AL-CA group initially consisted of 17 patients with AL-CA, but one patient was excluded due to inadequate image quality, and so the study population consisted of 16 patients (mean age: 64.0±9.6 years, five men). Their results were compared with data on 20 age-matched HCM patients (mean age: 59.8±5.2 years, 10 men) and on 16 age-matched healthy controls (mean age: 58.2±7.2 years, six men). Complete two-dimensional Doppler echocardiography and 3D-STE were performed in all cases. RESULTS Significantly increased LA volumes were observed in both AL-CA and HCM compared with the control group. Only active atrial emptying fraction was found to be significantly reduced in AL-CA patients compared to controls. Peak global and mean segmental circumferential, longitudinal and area strains showed significant reductions in AL-CA patients compared with controls, but only peak mean segmental longitudinal strain differed significantly between HCM patients and controls. While no differences were demonstrated in global and mean segmental strain at atrial contraction between HCM patients and controls, AL-CA patients showed reductions in certain strain parameters compared to controls and HCM patients. CONCLUSIONS Different patterns of LA functional characteristics were demonstrated in AL-CA and HCM patients by 3D-STE.

Biseko® colloidal solution diminishes the vasoreactivity of human isolated radial arteries

OBJECTIVE Radial arteries are increasingly used as grafts in coronary artery bypass surgery. The surgical preparation and intraoperative management of this conduit artery may affect its early and long-term patencies. We investigated the effects of the colloidal Biseko and 5% albumin solutions as well as the crystalloid physiological saline (0.9% NaCl) and Bretschneider solutions on the contractile and relaxing capacities of isolated human radial artery grafts. METHOD Radial artery segments were harvested using the technique with an ultrasonic scalpel, and 2.5-3mm rings were obtained from the proximal part of the artery. Arterial rings were stored in Biseko or 5% albumin solutions and in 0.9% NaCl or Bretschneider solutions for 45 min. Isometric tensions of radial arteries obtained from 26 patients were measured in isolated organ baths. Contractions were induced by 0.31 micromolL(-1) 5-hydroxytryptamine and 10 micromol L(-1) noradrenaline. Endothelium-dependent relaxations were induced by 10 micromol L(-1) acetylcholine and 1 micromol L(-1) bradykinin as well as the endothelium-independent relaxations by 10 micromol L(-1) glyceryl trinitrate and 100 micromol/l papaverine. RESULTS Contractions of radial arteries induced by 5-hydroxytryptamine were significantly lower following storage in Biseko solution (12.6+/-4.4 mN) than in 5% albumin (37.9+/-13.0 mN, p=0.03) or in 0.9% NaCl solution (35.9+/-11.9 mN, p=0.04). Noradrenaline-induced contractions of the arteries were also diminished in Biseko solution compared to those stored in 5% albumin (32.9+/-6.2 mN vs 49.2+/-6.4 mN, p=0.01). No significant differences in relaxations were obtained between the two crystalloid and the two colloidal solutions using endothelium-dependent and independent vasorelaxants. CONCLUSION Our results suggest that storage of radial artery in Biseko colloidal solution before coronary artery bypass grafting decreases the sensitivity of the graft to vasoconstriction, thereby decreasing the risk of intra/perioperative graft failure.

Three-dimensional speckle-tracking echocardiography detects different patterns of right atrial dysfunction in selected disorders: a short summary from the MAGYAR-Path Study

The right atrium (RA) is the most under-evaluated heart chamber in the clinical practice. Three-dimensional (3D) speckle-tracking echocardiography (STE) merges the benefits of 3D echocardiography and STE: volumetric and strain assessment of the RA can be performed at the same time from the same digitally acquired 3D echocardiographic dataset with a special equipment using a virtual 3D model of the RA. A diagnostic focused study is under way at the Second Department of Medicine and Cardiology Center, University of Szeged, Hungary to assess 3D-STE-derived RA variables in different patient populations, which serves as a substudy of Motion Analysis of the heart and Great vessels bY three-dimensionAl speckle-tRacking echocardiography in Pathological cases (MAGYAR-Path) Study. The aim of the present review is to summarize these early results.

Rigid body rotation of the left ventricle in hidradenitis suppurativa (a case from the three-dimensional speckle-tracking echocardiographic MAGYAR-Path Study)

In healthy subject, the left ventricular (LV) apex rotates in counterclockwise direction, while the LV base shows a clockwise rotation resulting in a towel-wringing-like motion called LV twist (1). However, this is a very sensitive motion, which could be altered early by several pathological states.

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.

Change of left ventricular “rigid body rotation” during dipyridamole-induced vasodilation: A case from the three-dimensional speckle tracking echocardiographic MAGYAR-Stress Study

A patient with previous coronary stenting presented with stable angina and positive exercise treadmill test. Echocardiography with three‐dimensional speckle‐tracking demonstrated left ventricular rigid body rotation (near absence of left ventricular twist), whose characteristics changed dramatically during dipyridamole‐induced vasodilatation.

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.

Interspecies differences and extracellular calcium dependence in the vasorelaxing effect of cromakalim in isolated human, porcine, and canine coronary arteries.

Coronary arteries isolated from human, porcine, and canine hearts were depolarized with potassium chloride and relaxed by cromakalim (0.0125-10.0 μmol/L) at low (1.5 mmol/L) and high (7.5 mmol/L) extracellular calcium concentration ([Ca2+] o). At low [Ca2+]o, cromakalim (1 μmol/L) relaxed the coronary arteries with the order of porcine > canine > human. Fifty percent effective concentrations of cromakalim revealed the same order: 0.15 μmol/L in porcine, 0.36 μmol/L in canine, and 3.91 μmol/L in human coronary arteries. High [Ca2+]o significantly enhanced the relaxing effect and decreased the potency of cromakalim in porcine and human but not in canine coronary arteries. In human coronary arteries, precontracted with the prostaglandin analogue (U46619), high [Ca2+] o enhanced the effect of 0.1 μmol/L cromakalim more efficiently in the presence than in the absence of endothelium. It appears that the coronary dilating effect of cromakalim largely depends on the species and is modulated by [Ca2+]o, with a partly endothelium dependent manner.