Vlatka Rešković Lukšić

Impact of mild patient prosthesis mismatch on quality of life in patients with preserved ejection fraction after isolated aortic valve replacement for aortic stenosis

AIM To analyze whether PPM affects QOL and functional status in patients after isolated AVR for aortic stenosis (AS) with preserved left ventricular ejection fraction (LVEF). METHODS Consecutive patients who underwent AVR in University Hospital Center Zagreb for isolated severe symptomatic AS and preserved EF were enrolled. Echo data was obtained from complete transthoracic examinations prior and after surgery by offline analysis. Patients were divided into two groups according to the presence of PPM (effective orifice area (EOA)/body surface area (BSA)<0,85cm2/m2). QOL was assessed by telephone interview using Short Form 36-Item Health Survey (SF-36) along with functional NYHA status estimation. RESULTS A total of 45 pts were included (23 female), and divided in PPM (n=26), and non-PPM group (n=19). Both groups were similar in pts age, LVEF, AVA/BSA prior surgery. After surgery, 57% of pts had PPM categorized as mild PPM. During follow-up of 2,5years, 3 pts had died and 10 were lost from following. There was no difference in NYHA status after surgery between groups (p=0,758). SF36 results showed no difference between groups. However, there was a significant improvement in Physical functioning (47,50% vs 75,47%,p=0,000) and Role limitation due to physical health (41,41% vs 81,25%, p=0,007) scores in the whole study population after AVR. Males had significantly better Energy/fatigue (p=0,034), Social functioning (p=0,004) and Pain (p=0,017) scores. CONCLUSIONS Mild to moderate PPM showed no clinical relevance. All patients revealed improvement in QOL after AVR, while male sex was related to better functioning scores irrespectively of PPM.

Manual Intracardiac Electrogram Method Is Accurate Alternative to Echocardiography for Atrioventricular and Interventricular Optimization in Cardiac Resynchronization Therapy

Some manufacturers do not provide automated intracardiac electrogram method (IEGM) systems for atrioventricular (AV) and interventricular (VV) delay optimization in cardiac resynchronization therapy (CRT). We aimed to evaluate the accuracy of manual IEGM method in 48 patients previously implanted with Medtronic Syncra CRT. All patients underwent standard device interrogation followed by CRT optimization by IEGM method and by echocardiography one month after implantation. The patient mean age was 60.7±11.8 years and there were 33 (68.8%) males. After CRT implantation, the left ventricular ejection fraction increased from 28.0±7.9% to 39.1±11.0% (p<0.001). Optimal aortic flow Velocity Time Integral (aVTI) was obtained when VV was set to 20-50 ms left ventricular pre-activation. There was a strong correlation between VV values determined by echocardiography and IEGM (R=0.823, p<0.001). We found no significant difference in AV, VV and aVTI values between echocardiography and IEGM method. However, IEGM was significantly less time-consuming than echocardiography [20 (10-28) vs. 40 (35-60) minutes, p<0.001]. Manual IEGM method may be good alternative to echocardiography and automated IEGM method. It also emphasizes the need for implementation of automated IEGM systems in as many CRT devices as possible.

Global radial strain is reduced in healthy heart transplant patients

Cardiologia CROATICA Background: Allograft rejection and vasculopathy in heart transplant (HTx) patients require timely recognition, with coronary angiography and endomyocardial biopsy being the diagnostic gold standards. Finding a non-invasive alternative remains the major objective. Speckle tracking echocardiography (STE) permits early recognition of myocardial dysfunction. The reduction in strain has been shown to denote both rejection and vasculopathy. However, deformation indices are also reduced in “healthy” HTx recipients ≥1 year after transplantation when compared with control subjects. Whether the reduction in strain is a chronic progressive process or the immediate result of transplantation (due to allograft ischaemia, denervation, cardioplegia etc.) has not yet been established. Hence, the lack of STE reference values in HTx population, especially during early post-transplant period, is one of the reasons that strain has not been used to follow-up these patients. The aim of the study was to evaluate whether radial deformation parameters are reduced in “healthy” HTx recipients during the first post-transplant year. Methods: Two-dimensional STE was used to evaluate radial strain in 15 “healthy” patients up to 6 months following heart transplantation. Patients were excluded if they had histologic evidence of acute rejection (>1A ISHLT), reduced LVEF (<55%), significant coronary vasculopathy (epicardial coronary narrowing >50% assessed by coronary angiography), wide QRS-complex (>120 ms), significant valvular disease or major cardiac events. Frame rates of ≈50 to 70s to avoid speckle decorrelation and good image quality for accurate tracking were mandatory. Segmental radial strain analysis was performed at the LV basal, middle and apical levels, and values were averaged to determine global radial strain. The results were then compared with the healthy normal subjects’ values, using recent meta-analysis data. Results: Global radial strain was significantly lower in transplant patients when compared with control subjects — mean 39.2% (95% CI 33.5 to 44.9%) vs. 47.3% (95% CI 43.6 to 51.0%), p 0.008. Conclusions: The reduction of global radial strain in “healthy” HTx subjects during early post-transplant period may be an immediate consequence of the transplant procedure. The baseline strain values should be obtained in all transplant patients soon after the transplantation, so that these values can later be used as a reference for early detection of myocardial abnormalities.