Patrycja Pruszkowska-Skrzep

Mid-term outcomes of triple-site vs. conventional cardiac resynchronization therapy: a preliminary study.

BACKGROUND The primary objectives of this study were to compare the implantation course of triple-site (double left-single right) and conventional cardiac resynchronization devices. The secondary target was to assess mid-term outcomes of both types of cardiac resynchronization therapy (CRT). METHODS Fifty-four patients with NYHA classes III-IV, left ventricular EF<or=35% and QRS>or=120 ms were included; 27 received triple-site pacemakers (TRIV group), 27 conventional CRT devices (BIV group). Procedural course, clinical data, QRS duration, echocardiographic parameters, peak oxygen consumption (VO2max) and 6-minute walking distance (6MWD) were screened for inter-group differences. RESULTS Procedure duration was higher in TRIV than in BIV group (197.6 vs. 137.6 min, P<0.001), fluoroscopy exposure and complication-rates were similar. After 3 months of CRT, triple-site pacing was associated with a more significant (P<0.05) NYHA class reduction (by 1.4 vs. 1.0 class, respectively), increase in VO(2) max (2.9 vs. 1.1 mL/kg/min) and 6MWD (98.7 vs. 51.6 m) than conventional CRT. A higher EF and more improved intraventricular synchrony were observed in the TRIV than in the BIV group. The response rate in the TRIV group was 96.3% vs. 62.9% in the conventional group (P=0.002). Triple-site stimulation was an independent predictor of response to CRT (adjusted odds ratio 26.4, P=0.01). CONCLUSIONS Triple-site resynchronization appears to be more beneficial than conventional CRT. Upgrade to triple-site CRT may be considered in non-responders to standard resynchronization.

The prognostic value of different glucose abnormalities in patients with acute myocardial infarction treated invasively

BackgroundDiabetes (DM) deteriorates the prognosis in patients with coronary heart disease. However, the prognostic value of different glucose abnormalities (GA) other than DM in subjects with acute myocardial infarction (AMI) treated invasively remains unclear.AimsTo assess the incidence and impact of GA on clinical outcomes in AMI patients treated with percutaneous coronary intervention (PCI).MethodsA single-center, prospective registry encompassed 2733 consecutive AMI subjects treated with PCI. In all in-hospital survivors (n = 2527, 92.5%) without the history of DM diagnosed before or during index hospitalization standard oral glucose tolerance test (OGTT) was performed during stable condition before hospital discharge and interpreted according to WHO criteria. The mean follow-up period was 37.5 months.ResultsThe incidence of GA was as follows: impaired fasting glycaemia - IFG (n = 376, 15%); impaired glucose tolerance - IGT (n = 560, 22%); DM (n = 425, 17%); new onset DM (n = 384, 15%); and normal glucose tolerance – NGT (n = 782, 31%). During the long-term follow-up, death rate events for previously known DM, new onset DM and IGT were significantly more frequent than those for IFG and NGT (12.3; 9.6 and 9.4 vs. 5.6 and 6.4%, respectively, P < 0.05). The strongest and common independent predictors of death in GA patients were glomerular filtration rate < 60 ml/min/1,73 m^2 (HR 2.0 and 2.8) and left ventricle ejection fraction < 35% (HR 2.5 and 1.8, all P < 0.05) respectively.ConclusionsGlucose abnormalities are very common in AMI patients. DM, new onset DM and IGT increase remote mortality. Impaired glucose tolerance bears similar long-term prognosis as diabetes.

Effect of Cardiac Resynchronization on Gradient Reduction in Patients with Obstructive Hypertrophic Cardiomyopathy: Preliminary Study

Background: The purpose of this study was to assess the effectiveness of cardiac resynchronization therapy (CRT) in terms of outflow tract gradient reduction and functional improvement in symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM) requiring implantable cardioverter‐defibrillator (ICD) implantation.

Sleep apnoea as a predictor of mid- and long-term outcome in patients undergoing cardiac resynchronization therapy

AIMS To assess the impact of baseline apnoea-hypopnoea index (AHI) on mid-term outcome and its change after 6 months of cardiac resynchronization therapy (CRT) on remote outcome. METHODS AND RESULTS In 71 patients with CRT devices, Holter-derived AHI was assessed before and 6 months after the procedure. Baseline AHI >20 was considered abnormal. After 6 months of CRT, a 50% decrease of baseline AHI was considered significant and stratified patients into AHI dippers and non-dippers, except those who preserved normal AHI. Prognostic value of baseline AHI and its change were assessed in relation to mortality and major cardiac events (MACE). More patients with an abnormal AHI died during 6 months follow-up (P = 0.02), especially due to sudden cardiac death. MACE-rate was insignificantly higher in abnormal AHI patients. Significantly higher mortality (P = 0.001), especially due to heart failure progression and higher MACE-rate (P < 0.001) during further observation were observed in AHI non-dippers. In multivariate analysis, the absence of AHI reduction was an independent predictor of mortality [hazard ratio (HR) 6.56, P = 0.015)] and MACE (HR 6.05, P = 0.002). CONCLUSIONS Abnormal baseline AHI identifies patients prone to death during mid-term observation. Lack of AHI reduction after 6 months of CRT is an independent risk factor of death and MACE during further follow-up.

Triple site biventricular pacing in a patient with congestive heart failure and severe mechanical dyssynchrony.

We report on a case of a 62-year-old patient with symptomatic heart failure and severe ventricular electrical and mechanical dyssynchrony, who was implanted percutaneously with a triple site (dual-left single-right) resynchronization device. At 3-months follow-up, the patient’s functional status improved significantly as shown by subjective and objective tests. Furthermore, this mode of pacing has allowed nearly complete inter- and intraventricular mechanical resynchronization.

The impact of unsuccessful percutaneous coronary intervention on short- and long-term prognosis in STEMI and NSTEMI.

Objectives: To compare the impact of the efficacy of percutaneous coronary intervention (PCI) on prognosis in ST and non‐ST elevation myocardial infarction (STEMI and NSTEMI) patients with respect to infarct‐related artery (IRA). Background: The significance of the efficacy of PCI in STEMI and NSTEMI depending on the type of IRA has yet to be clarified. Methods: Study population consisted of 2,179 STEMI and 554 NSTEMI consecutive patients treated with urgent PCI. The efficacy of PCI (TIMI [thrombolysis in myocardial infarction] 3 vs. TIMI < 3) was assessed with regard to the type of IRA (left anterior descending artery, circumflex artery [Cx] or right coronary artery). The mean follow‐up was 37.5 months. Results: The rate of unsuccessful PCI was similar in STEMI and NSTEMI irrespectively of IRA (14.1 vs. 17.7%; P = 0.062). In STEMI, unsuccessful PCI was associated with significantly higher early (23.1 vs. 5.6%; P < 0.001) and late (29.9 vs. 12.8%; P < 0.001) mortality regardless of IRA. In NSTEMI, the inefficacious PCI significantly increased early (19.0% vs. 0.9%; P < 0.001) and late (27.3% vs. 6.3%; P < 0.001) mortality only in patients with Cx‐related infarction. Unsuccessful PCI of IRA was an independent risk factor for death in STEMI (HR 1.64; P < 0.05), but not in NSTEMI (P = 0.64). Further analysis showed that whilst unsuccessful PCI of any vessel in STEMI is an independent risk factor for death, in NSTEMI this applies to unsuccessful PCI of Cx only. Conclusions: The significance of unsuccessful PCI of IRA seems to be different in STEMI and NSTEMI. Unsuccessful PCI is an independent risk factor for death in STEMI regardless of IRA and in NSTEMI with the involvement of Cx.

The risk of stroke in patients with acute myocardial infarction treated invasively.

BackgroundTo assess the incidence, clinical significance, and independent risk factors of stroke in patients with acute myocardial infarction (AMI) treated invasively. Materials and methodsWe analyzed 2520 consecutive patients with AMI admitted between 2003 and 2007. Data on long-term follow-up were screened to identify patients who had stroke. ResultsDuring a median of 25.5 months, 52 patients (2.07%) had stroke. The cumulative risk of stroke was the highest during the first year (1.23%) and particularly within the first month after AMI (0.28%). Patients with stroke were at a significantly higher risk of developing major adverse cardiovascular events, including repeated AMI (26.9 vs. 14.6%, P<0.05) and death (40.4 vs. 13.6%, P<0.001). Previous stroke [hazard ratio (HR) 5.89], female sex (HR 2.60), glomerular filtration rate <60 ml/min/1.73 m2 (HR 1.92), and contrast nephropathy (HR 1.87, all P<0.05) were independent predictors of stroke. The receiver-operating curve calculated for the Contrast nephropathy, renal Insufficiency, Female, prior Stroke (CIFS) risk scale demonstrated a significant predictive value of this scale (area under curve 0.73, P<0.001). Patients with the lowest, median, and highest risk scores (<4, 4–5, ≥6 points, respectively) differed significantly with regard to stroke incidence (2.1 vs. 7.9 vs. 14.0%, respectively, P<0.05). ConclusionThe risk of stroke is the highest within the first month after AMI. Stroke is a marker of unfavorable outcome in this population. Independent risk factors for stroke after invasive treatment of AMI are different from those commonly perceived as stroke predictors. A risk scale based on sex, stroke history, and renal impairment is useful in risk stratification.

The incidence and risk factors of stroke in patients with acute myocardial infarction treated invasively and concomitant impaired renal function

BACKGROUND Impaired renal function is a marker of poor prognosis in patients with acute myocardial infarction (AMI). The aim of the study was to assess the incidence and independent predictors of stroke in population of patients with AMI treated invasively and concomitant impaired renal function (IRF). METHODS We analyzed 2,520 consecutive AMI patients admitted to our Center between 2003 and 2007 and treated with percutaneous coronary intervention. The whole population was divided into patients with IRF, defined as glomerular filtration rate < 60 mL/min/1.73 m(2) or contrast induced nephropathy (IRF group, n = 933; 37.02%) and patients without IRF (control group, n = 1587; 62.98%). The IRF group was subjected to further analysis. Data on long-term follow-up were screened to identify the patients who experienced stroke. RESULTS During median of 25.5 months of follow-up 52 (2.07%) the patients experienced stroke - 33 (3.54%) in the IRF group and 19 (1.2%) patients in the control group. The risk of major adverse cardiovascular events in the IRF group, including repeated AMI (68.8 vs.14.9%, p < 0.001) and death (45.5 vs. 25.1%, p < 0.05) was significantly higher in patients with stroke. Previous stroke (HR 6.85), female gender (HR 3.13), as well as STEMI anterior (HR 2.55) were independent risk factors of stroke in this population. CONCLUSIONS Patients with AMI treated invasively and concomitant IRF were at higher risk of stroke occurrence in the future. Stroke was associated with poor outcome in the studied population. Independent predictors of stroke in patients with IRF and AMI treated invasively were different from commonly recognized stroke predictors.

Influence of Reciprocating Tachycardia on the Development of Atrial Fibrillation in Patients with Preexcitation Syndrome

Background: We sought to evaluate the influence of atrio‐ventricular reentrant tachycardia (AVRT) on atrial pressures during tachycardia and the presence of atrial fibrillation (AF) in patients with preexcitation syndrome.

Sequence of electrical activation, atrial remodelling and atrial fibrillation in patients with nodal re-entrant tachycardia.

Objective — The objective of the study was to verify, if the particular sequence of electrical atrioventricular activation during tachycardia is associated with the development of atrial remodelling and predisposition to atrial fibrillation (AF) in patients with nodal reentry tachycardia (AVNRT). Methods and results — We assessed 117 consecutive patients with AVNRT identified during electrophysiological study.Two groups were identified: the AF group, n = 21 (17.9%, median age 46.0, 15 women), with clinically documented AF, and the control group, n = 96, without AF (median age 48.5, 69 women). Tachycardia cycle length (VV), anterograde AV, retrograde VA activation intervals and indexes (AV/VV, VA/VV) during AVNRT, atrial refractory period (AERP), intraatrial (IntraCT) and interatrial conduction time (InterCT) of the sinus beat and premature stimuli were analysed. The longer retrograde and shorter anterograde activation was found in AF patients with typical AVNRT, the opposite relations showed the subjects with atypical tachycardia. Intra and InterCT of sinus beat, and of paced extrastimuli were longer, AERP was borderline shorter in the AF-group than in the con-trols.The longest conduction times and shortest AERP were seen in the patients with VA/VV within 20-40% of the tachycardia cycle, this group comprised 71% of all AF-patients (P< 0.001).VA was predictive for AF in typical (OR/unit 1.04) and atypical AVNRT (OR/unit 0.93, P< 0.05). Conclusions — The particular sequence of electrical atrioventricular activation, seen in some patients during AVNRT, is associated with disturbances of atrial conduction, refractoriness and predisposes to atrial fibrillation.