Wojciech Magoń

Competency in ECG Interpretation Among Medical Students

Background Electrocardiogram (ECG) is commonly used in diagnosis of heart diseases, including many life-threatening disorders. We aimed to assess skills in ECG interpretation among Polish medical students and to analyze the determinants of these skills. Material/Methods Undergraduates from all Polish medical schools were asked to complete a web-based survey containing 18 ECG strips. Questions concerned primary ECG parameters (rate, rhythm, and axis), emergencies, and common ECG abnormalities. Analysis was restricted to students in their clinical years (4th–6th), and students in their preclinical years (1st–3rd) were used as controls. Results We enrolled 536 medical students (females: n=299; 55.8%), aged 19 to 31 (23±1.6) years from all Polish medical schools. Most (72%) were in their clinical years. The overall rate of good response was better in students in years 4th–5th than those in years 1st–3rd (66% vs. 56%; p<0.0001). Competency in ECG interpretation was higher in students who reported ECG self-learning (69% vs. 62%; p<0.0001) but no difference was found between students who attended or did not attend regular ECG classes (66% vs. 66%; p=0.99). On multivariable analysis (p<0.0001), being in clinical years (OR: 2.45 [1.35–4.46] and self-learning (OR: 2.44 [1.46–4.08]) determined competency in ECG interpretation. Conclusions Polish medical students in their clinical years have a good level of competency in interpreting the primary ECG parameters, but their ability to recognize ECG signs of emergencies and common heart abnormalities is low. ECG interpretation skills are determined by self-education but not by attendance at regular ECG classes. Our results indicate qualitative and quantitative deficiencies in teaching ECG interpretation at medical schools.

Atrioventricular Conduction Delay Predicts Impaired Exercise Capacity in Patients with Heart Failure with Reduced Ejection Fraction

Background Atrioventricular conduction delay (AVCD) impairs left ventricular (LV) filling and consequently leads to a reduction of cardiac output. We hypothesized that in patients with severely depressed LV function and coexisting intraventricular conduction disturbances (IVCD), AVCD can affect exercise performance. Therefore, we evaluated the association of AVCD and exercise capacity in patients with heart failure (HFREF) and coexisting IVCD. Material/Methods We included patients with stable, chronic HFREF, LVEF <35%, sinus rhythm, and QRS ≥120 ms. PR interval and peak oxygen consumption (VO2 peak) were specifically investigated. Multiple regression analysis was used to adjust the association between PR interval and VO2 peak for possible confounders. Results Most (57.5%) of the 40 included patients [20% female, aged 63±12, 47.5% of ischemic etiology (IHD)] were in NYHA class III. Mean PR interval was 196±38.1 ms. There were 26 (65%) patients with PR interval ≤200 ms and 14 (35%) with >200 ms. Groups were similar in clinical, laboratory, echocardiographic parameters, QRS morphology, and treatment regimens. VO2 peak was lower in patients with longer PR interval group as compared to shorter PR interval group (12.3±4.1 vs. 17.06±4.4, p=0.002). In the regression model, PR interval, female sex, and IHD remained important predictors of VO2 peak (partial=−0.50, p=0.003; rpartial=−0.48, p=0.005; rpartial=−0.44, p=0.01; R2=0.61). Conclusions Delayed AV conduction contributes to decreased exercise capacity in patients with HFREF and coexisting IVCD.

High-density lipoprotein cholesterol level and pulmonary artery vasoreactivity in patients with idiopathic pulmonary arterial hypertension

Introduction Metabolic dysregulation has been recognized as a prognostic marker in idiopathic pulmonary arterial hypertension (IPAH). Objectives We aimed to investigate the association between cardiometabolic risk factors and vascular reactivity of pulmonary arteries in patients with IPAH. Patients and methods Between June 2009 and January 2015, we recruited 66 consecutive patients with IPAH. We assessed main cardiometabolic risk factors, inflammatory markers, and markers of IPAH severity. Hemodynamic evaluation included pulmonary vasoreactivity testing with the use of inhaled nitric oxide. Reduced mean pulmonary artery pressure was considered a marker of acute vasoreactivity. Acute responders were treated with calcium channel blockers and classified as long‑term responders if they had sustained vasoreactivity (near‑normal hemodynamics and World Health Organization functional class I or II) for at least 1 year. Results Thirteen patients (19.7%) showed a positive response to acute pulmonary vasoreactivity testing; however, only 9 (13.6%) remained vasoreactive at follow‑up. Machine‑learning algorithms indicated 4 variables associated with acute vasoreactivity of pulmonary arteries: high‑density lipoprotein cholesterol (HDL‑C), right atrial pressure, cardiac index, and creatinine level, and 4 predictors of long‑term vasoreactivity: HDL‑C, 6‑minute walking distance, creatinine level, and high‑sensitive C‑reactive protein level. Conclusions HDL‑C level is associated with pulmonary vasoreactivity in acute testing and predicts long‑term responsiveness to calcium channel blockers in patients with IPAH.

Prognostic role of traditional cardiovascular risk factors in patients with idiopathic pulmonary arterial hypertension

Introduction Metabolic alterations have been recently associated with onset and progression of idiopathic pulmonary arterial hypertension (IPAH). We aimed to determine the prevalence and prognostic role of cardiovascular risk factors in patients with IPAH. Material and methods Between February 2009 and January 2015 we recruited consecutive IPAH patients. Clinical assessment included medical history, fasting glucose, lipid profile, N-terminal pro-brain natriuretic peptide concentration, 6-minute walk test distance, WHO functional class and hemodynamic evaluation. Patients’ risk was estimated based on the Swedish PAH Register grading system. Results The study group included 61 IPAH patients, and the control group included 2413 Polish residents. When compared to the general population, IPAH patients had lower low-density lipoprotein cholesterol (LDL-C) and a higher triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio. Female patients were characterized by elevated glucose level, higher prevalence of diabetes and lower HDL-C than controls. PAH severity grade correlated positively with age and TG/HDL-C ratio (R = 0.29, p = 0.02) and inversely with LDL-C (R = –0.28, p = 0.03) and HDL-C (R = –0.39, p = 0.02) concentrations. After a follow-up of 48 (23–79) months we recorded 28 deaths in the IPAH group. In the regression analysis lower LDL-C (p = 0.002) and HDL-C (p = 0.0002) levels, and higher TG/HDL-C ratio (p = 0.003) and glucose level (p = 0.003) were associated with all-cause mortality after adjustment for age, sex or PAH severity grade. Conclusions Patients with IPAH are characterized by an altered profile of lipid and glucose metabolism. Lowered levels of LDL-C and HDL-C and increased TG/HDL-C ratio correlate with disease severity and together with elevated plasma glucose level predict poor survival in IPAH.

Right Ventricular Epicardial Vascularisation in Patients With Pulmonary Arterial Hypertension

BACKGROUND Pulmonary arterial hypertension (PAH) leads to a haemodynamic overload and ischaemia of the right ventricle (RV), which are important triggers of an arterial growth. Thus, we aimed to assess whether patients with PAH have altered epicardial vasculature of the RV, and how it corresponds to RV haemodynamic stress. METHODS We enrolled consecutive patients with PAH diagnosed in a single pulmonary hypertension centre, who underwent coronary angiography. The control group consisted of patients with normal coronary arteries. Artery branches from segments I-III of the right coronary artery (RCAB) and branches of the left coronary artery (LCAB) were assessed. The sum of the diameters of RCABs (RCAB_sum) was used as a marker of RV epicardial vascularisation. Linear regression models were used to investigate associations between the RCAB_sum and markers of RV dysfunction. RESULTS We recruited 37 PAH patients (idiopathic, n=25; associated with connective tissue disease, n=12) and 37 control subjects of similar age (56±18 vs. 56±13 years, p=0.99) and sex (73% vs. 73% of women, p=0.99). Pulmonary arterial hypertension patients as compared with control subjects had more RCABs (7 [6-8] vs. 6 [5-7], p<0.001) and increased RCAB_sum (9.4 [8.2-10.5] vs. 7.3 [6.6-7.40] mm; p<0.001) although comparable LCAB count (4 [4-5] vs. 4 [4-5]; p=0.50). In a stepwise multivariable linear regression model, RA area (β=0.152 [0.062-0.242]; p=0.002) and diastolic wall stress (β=0.025 [0.005-0.045]; p=0.02) were significant predictors of RCAB_sum (model R2=0.65; p<0.0001). CONCLUSIONS Right ventricular epicardial vasculature is more extensive in PAH patients as compared with control subjects, and it is in linear relation to potential markers of RV diastolic dysfunction.