Search

Patients with severe symptomatic aortic stenosis have a poor prognosis with medical management alone, and surgical aortic valve replacement can improve symptoms and survival. In recent years, transcatheter aortic valve implantation (TAVI) has been demonstrated to improve survival in inoperable patients and to be an alternative treatment in patients in whom the risk of surgical morbidity or mortality is high or intermediate. A representative expert committee, summoned by the Association of Cardiovascular Interventions of the Polish Cardiac Society (ACVI) and the Polish Society of Cardio-Thoracic Surgeons, devel-oped this Consensus Statement in transcatheter aortic valve implantation. It endorses the important role of a multi-disciplinary "TAVI team" in selecting patients for TAVI and defines operator and institutional requirements fundamental to the establish-ment of a successful TAVI programme. The article summarises current evidence and provides specific recommendations on organisation and conduct of transcatheter treatment of patients with aortic valve disease in Poland.

The aim of the study was to evaluate the transcatheter aortic valve replacement (TAVR) in high-risk patients with severe bicuspid aortic valve (BAV) stenosis and to compare the outcomes with a matched group of patients with tricuspid aortic valve. TAVR became an alternative treatment method in high-risk patients with symptomatic aortic stenosis; however, BAV stenosis is regarded as a relative contraindication to TAVR. The study population comprised 28 patients with BAV who underwent TAVR. BAV was diagnosed based on a transesophageal echocardiography. CoreValve and Edwards SAPIEN prostheses were implanted. The control group consisted of 84 patients (3:1 matching) with significant tricuspid aortic valve stenosis treated with TAVR. There were no significant differences between patients with and without BAV in device success (93% vs 93%, p = 1.0), risk of annulus rupture (0% in both groups), or conversion to cardiosurgery (4% vs 0%, respectively, p = 0.25). The postprocedural mean pressure gradient (11.5 ± 6.4 vs 10.4 ± 4.5 mm Hg, p = 0.33), aortic regurgitation grade ≥2 of 4 (32% vs 23%, p = 0.45), 30-day mortality (4% vs 7%, p = 0.68), and 1-year all-cause mortality (19% vs 18%, p = 1.00) did not differ between the groups. Echocardiography showed well-functioning valve prosthesis with a mean prosthetic valve area of 1.6 ± 0.4 cm(2) versus 1.7 ± 0.3 cm(2) (p = 0.73), a mean pressure gradient of 10.3 ± 5.4 versus 9.8 ± 2.8 mm Hg (p = 0.64), and aortic regurgitation grade ≥2 of 4 (22% vs 22%, p = 1.00) for the 2 groups. In conclusion, selected high-risk patients with BAV can be successfully treated with TAVR, and their outcomes are similar to those reported in patients without BAV.

The following case report describes a complication of Swan-Ganz catheterization and its endovascular treatment with a single coil. Application of this particular catheter in the pulmonary artery during cardiac surgery may lead to mechanical perforation and creation of an extravascular sac, which is called a pseudoaneurysm. There are different methods that lead to tamponade or closure of the leakage. Interventional cardiology procedures are nowadays the most appropriate way of treatment of Swan-Ganz catheter induced vascular complications.

A third percutaneous mitral balloon valvuloplasty (PMBV) may provide a means of treating symptomatic patients with re-restenosis after successful initial and second valvuloplasties, though data related to the long-term safety and efficacy of a third PMBV are lacking. The study aim was to determine the immediate and long-term clinical outcome in patients who underwent a third PMBV to treat recurrent mitral stenosis.Among a total of 1,849 patients who underwent PMBV at the authors' institution, seven females (mean age 38.5 ± 12.2 years at the first procedure) required repeat second and third PMBVs. The mean interval between the first and second valvuloplasties was 6.4 ± 2.5 years, and between the first and third valvuloplasties was 12.5 ± 6.5 years. All procedures were performed using the Inoue balloon system.Second and third PMBVs resulted in a significant increase in mitral valve area (MVA), from 1.1 ± 0.1 cm2 to 1.6 ± 0.2 cm2, and from 1.0 ± 0.2 cm2 to 1.6 ± 0.4 cm2, respectively. However, as mitral degeneration progressed, four patients required mitral valve replacement (MVR) at 9.2 ± 5.8 years (range: 6-18 years) after the third PMBV. The preoperative MVA of these patients was 0.97 ± 0.1 cm2. One patient died due to surgical complications, while the fifth and sixth patients remain under clinical observation. If patients have a fourth recurrence of mitral stenosis they are no longer considered to be suitable candidates for re-PMBV. The seventh patient died at the age of 84 years.A repeat, third PMBV is a safe and feasible procedure in selected patients with recurrent stenosis after successful first and second valvuloplasties. Although the third procedure provides good immediate results, the long-term outcome is not satisfactory. Nonetheless, a third PMBV would allow MVR surgery to be postponed for a few years.

The assessment of sound perception in hearing aids, especially in the context of benefits that a prosthesis can bring, is a complex issue. The objective parameters of the hearing aids can easily be determined. These parameters, however, do not always have a direct and decisive influence on the subjective assessment of quality of the patient's hearing while using a hearing aid. The paper presents the development of a method for the assessment of auditory perception and the effectiveness of applying hearing aids for hearing-impaired people during a short-term use. The method involves a questionnaire based on the APHAB (Abbreviated Profile of Hearing Aid Benefit) assessment questionnaire, a measure of self-reported auditory disability. The study includes additional criteria, such as measuring the number of hours and days of use of hearing aids, the degree of hearing loss and the patient's experience. A web-based application is developed to enable to carry out such an examination from any computer with access...

Mechanically separated meat (MSM) is obtained from bones or fragments with naturally adherent soft tissue by mechanical separation of soft tissue residues from bones remaining after cutting and punching poultry, pork and beef carcasses. Mechanically separated meat is a raw material commonly used in processing in Poland and other countries. The dominant species in the production of mechanically separated meat in Europe is poultry, mainly because of the increase in the consumption of boneless meat and its products. Mechanically separated meat is characterized by poorer technological and physicochemical properties and lower durability compared to poultry meat cut by hand. The high microbiological contamination of raw material limits its further use. The microbiological quality of mechanically separated meat has a significant impact on the microbiological stability and health safety of products manufactured from it. In industrial practice, mechanically separated meat is preserved by freezing or curing. In view of problems with the microbiological quality of mechanically separated meat, it seems advisable to search for new methods of preserving MSM and to improve the existing ones

The aim of this study was to assess the prevalence of variants and anomalies of the coronary arteries in patients with bicuspid aortic valve (BAV) and compare it with patients with tricuspid aortic valve (TAV).A total of 428 patients (193 with BAV, 235 with TAV) who underwent coronary computed tomography angiography were analyzed.The right coronary artery was dominant in 360 (84.1%) cases, including 157 (81.34%) with BAV and 203 (86.38%) with TAV. Left dominance was observed in 51 (11.9%) patients, including 30 (15.54%) with BAV 21 (8.93%) with TAV (P=0.08), and codominance in 17 (4%). The mean length of the left main coronary artery (LMCA) in patients with BAV was 10.45±6.93 versus 12.02±5.12 mm in those with TAV (P=0.008). The absence of the LMCA with separate origins of the left artery descending and the left circumflex artery was observed in 18 cases, 14/193 (7.3%) with BAV and 4/235 (1.7%) with TAV (P=0.004). The ramus intermedius was present in 50 (11.7%) patients, 29 with BAV (15%) and 21 with TAV (8.9%) (P=0.05). Coronary artery anomalies were observed in 2.1% of all patients (5/193 with BAV vs. 4/235 with TAV, P=0.5).The prevalence of anomalies of coronary arteries was similar in both groups. Patients with BAV had a higher incidence of the absence of the LMCA and the presence of the ramus intrermedius. The mean length of the LMCA in patients with BAV was shorter than in patients with TAV. There was a trend for a higher incidence of left dominance in patients with BAV compared to those with TAV, but did not reach statistical significance.

Objective To analyse the impact of postprocedural mitral regurgitation (MR), in an interaction with aortic regurgitation (AR), on mortality following transcatheter aortic valve implantation (TAVI). Methods To assess the interaction between MR and AR, we compared the survival rate of patients (i) without both significant MR and AR versus (ii) those with either significant MR or significant AR versus (iii) with significant MR and AR, all postprocedure. 381 participants of the Polish Transcatheter Aortic Valve Implantation Registry (166 males (43.6%) and 215 females (56.4%), age 78.8±7.4 years) were analysed. Follow-up was 94.1±96.5 days. Results Inhospital and midterm mortality were 6.6% and 10.2%, respectively. Significant MR and AR were present in 16% and 8.1% patients, including 3.1% patients with both significant MR and AR. Patients with significant versus insignificant AR differed with respect to mortality (log rank p=0.009). This difference was not apparent in a subgroup of patients without significant MR (log rank p=0.80). In a subgroup of patients without significant AR, there were no significant differences in mortality between individuals with versus without significant MR (log rank p=0.44). Significant MR and AR had a significant impact on mortality only when associated with each other (log rank p

Background: Degenerative mitral valve (MV) disease is a common cause of severe mitral regurgitation (MR) and accounts for the majority of MV operations. Conventional MV surgery requires cardiopulmonary bypass, aortic cross-clamping, cardioplegia, and a thoracotomy or sternotomy and, therefore, is associated with significant disability, risks, and unpredictable rates of MV repair. Transesophageal echocardiography–guided beating-heart MV repair with expanded polytetrafluoroethylene cordal insertion has the potential to significantly reduce surgical morbidity. We report the first-in-human clinical experience with a novel preformed expanded polytetrafluoroethylene knot implantation device (Harpoon TSD-5) designed to treat degenerative MR. Methods: Through a small left thoracotomy, the device was inserted into the heart and guided by transesophageal echocardiography to the ventricular surface of the prolapsed leaflet. Multiple expanded polytetrafluoroethylene cords were anchored in the leaflet and then adjusted to the correct length to restore MV leaflet coaptation and secured at the epicardium. Results: Eleven patients with posterior leaflet prolapse and severe MR, with mean±SD age of 65±13 years and mean ejection fraction of 69±7%, were treated with 100% procedural success. Immediate postprocedural mean MR grade was trace. At 1 month, the mean MR grade was mild with significant decreases in end-diastolic volume (139 to 107 mL; P =0.03) and left atrial volume (118 to 85 mL; P =0.04). Conclusions: A novel device used for beating-heart image-guided MV repair demonstrates a significant reduction in MR with favorable left ventricular and left atrial reverse remodeling. This approach has the potential to decrease invasiveness and surgical morbidity. Further follow-up is necessary to assess long-term efficacy. Clinical Trial Registration: URL: https://clinicaltrials.gov . Unique identifier: NCT02432196.

A lexicon-based ensemble approach to sentiment analysis that outperforms lexicon-based method is presented in this article. This method consists of two steps. First we employ our own method (called frequentiment) for automatic generation of sentiment lexicons and some of publicly available lexicons. Secondly, an ensemble classification is used to improve the overall accuracy of predictions. Our approach outperforms publicly available sentiment lexicons and automatically generated domain lexicons. We conduct comprehensive analysis based on 10 Amazon review data sets that consist of 4,200,000 reviews.

The paper presents results of author’s own research on business valuation. The research was conducted among experts in business valuation. A total of 182 experts was surveyed. The article attempts to answer the following questions: whether and to what extent are business valuation standards (BVS) conducive to improving the quality of valuations? Do the experts find business valuation standards necessary? Are there differences in the perception of the phenomena connected with valuation between experts working on the U.S. market, where BVS are well-established, and experts from other countries such as Poland and Romania where these standards have a shorter history?

The paper presents a part of results of a survey on business valuation carried out in October 2011. The survey involved 182 experts in business valuation from twelve countries worldwide. The article attempts to answer the following questions: Has progress been made in business valuation practice in recent years? Can business valuation experts estimate value better than ever before? Is the process of business valuation becoming more and more complicated and to what extent? What problems do experts face in business valuation? Are there differences in the perception of the phenomena connected with valuation between experts working on the U.S. market, where the business valuation standards are well established, and experts from other countries such as Poland and Romania, where these standards have a shorter history?

The paper presents a part of the survey results on business valuation carried out in October 2011. The survey involved 182 experts in business valuation from 12 countries worldwide. The article attempts to answer the question: what problems do experts face in business valuation? Are there differences in the perception of the phenomena connected with valuation between experts working on the U.S. market, where the busieness valuation standards are well-established, and experts from other countries such as Poland and Romania where these standards have a shorter history? Survey results idicated that experts face many the same problems in business valuation. The key issue faced by the experts in the valuation is the problem of forecasting future events.

We propose a novel method for counting sentiment orientation that outperforms supervised learning approaches in time and memory complexity and is not statistically significantly different from them in accuracy. Our method consists of a novel approach to generating unigram, bigram and trigram lexicons. The proposed method, called frequentiment, is based on calculating the frequency of features (words) in the document and averaging their impact on the sentiment score as opposed to documents that do not contain these features. Afterwards, we use ensemble classification to improve the overall accuracy of the method. What is important is that the frequentiment-based lexicons with sentiment threshold selection outperform other popular lexicons and some supervised learners, while being 3–5 times faster than the supervised approach. We compare 37 methods (lexicons, ensembles with lexicon’s predictions as input and supervised learners) applied to 10 Amazon review data sets and provide the first statistical comparison of the sentiment annotation methods that include ensemble approaches. It is one of the most comprehensive comparisons of domain sentiment analysis in the literature.

Background There are very few and inconclusive data concerning the renin–angiotensin–aldosterone system activity in adults with systemic right ventricles, compared to classic heart failure patients. Therefore, we prospectively evaluated angiotensin II and aldosterone levels in a series of patients following Mustard or Senning procedures for complete transposition of the great arteries. Methods Forty-two patients (31 male and 11 female, mean age 20.8±3.7years), 18.2±2.8years following atrial switch procedures, were included in the analysis. All the patients underwent comprehensive echocardiographic examinations. Angiotensin II and aldosterone levels were measured with immunoradiometric assays. Results The mean angiotensin II level was 11.9±9.4pg/mL; 15 patients (35.7%) had angiotensin II levels exceeding the upper limit of normal values. There was a negative correlation between angiotensin II levels and treatment with angiotensin enzyme inhibitors ( r =−0.33, P =0.03). The mean aldosterone level was 217.7±160.2pg/mL; 26 patients (61.9%) had aldosterone levels exceeding the upper limit of normal values. Female patients had significantly higher aldosterone levels than male patients (321±248 vs 180±95pg/mL, P =0.01). A negative correlation between angiotensin II levels and fractional area change ( r =−0.65, P =0.03), and a positive correlation between aldosterone levels and right ventricular end-diastolic area ( r =0.66, P =0.03) were observed in female but not in male patients. Conclusions Renin–angiotensin–aldosterone axis activation in patients with systemic right ventricles was similar to reported values in other studies of stable heart failure. The gender differences in aldosterone levels in patients with systemic right ventricles were similar to that associated with left ventricular remodeling in systemic arterial hypertension.

Background The basic reservation concerning the use of hand-carried echocardiographic devices by general practitioners has been a lack of data demonstrating that they would provide clinically important information on patients' outcomes. Methods One hundred seventy-five patients with heart failure and/or heart failure risk factors were selected from a general community outpatient clinic. They underwent simplified hand-carried echocardiography performed by an internist with basic echocardiographic experience and N-terminal pro–B-type natriuretic peptide measurements. Patients were followed for the occurrence of the combined end point, consisting of death or hospitalization for cardiovascular causes. Results Hand-carried echocardiographic results were abnormal in 90 patients (55%). During 48 ± 7 months of follow-up, the combined end point occurred in 41 patients (25%). On multivariate analysis, only abnormal echocardiography (hazard ratio, 5.55; 95% confidence interval, 2.04–14.28; P = .0004) was an independent predictor of outcomes. Conclusions Hand-carried echocardiographic examinations performed by an internist with basic echocardiographic training can provide important prognostic information, independent of N-terminal pro–B-type natriuretic peptide levels.

To the Editor We read, with great interest, the recent review of contemporary management and outcomes in congenitally corrected transposition of the great arteries (ccTGA) by Kutty et al .1 The authors mainly focused on surgical management of ccTGA, nearly omitting pharmacotherapy and general prevention strategies. However, in our experience, pharmacotherapy is effective in properly selected patients …

We report our observations in a 54-year-old woman with right midseptal AV accessory pathway (AP) and manifest ventricular preexcitation. Although the patient has a several-year history of paroxysmal palpitations, her major daily symptom was impaired exercise tolerance due to resting and exertional dyspnea. Organic diseases of the pulmonary vessels, lung, and heart were excluded by x-ray film and computed tomographic angiography. Cardiopulmonary exercise test prior to ablation showed objective evidence of exertional dyspnea. Stress echocardiography using tissue Doppler imaging revealed significant interventricular asynchrony. The patient underwent successful AP radiofrequency (RF) ablation, which resulted in immediate disappearance of her exertional dyspnea. Cardiopulmonary exercise test performed 1 week after ablation showed significant improvement in pulmonary and cardiac performance. However, within 2 weeks of the procedure, her symptoms of resting and exertional dyspnea recurred simultaneously with recurrence of ventricular preexcitation. Cardiopulmonary exercise capacity in cardiopulmonary exercise test deteriorated as well. After a second RF ablation, the patient's symptoms and preexcitation resolved, and tissue Doppler imaging was free of interventricular asynchrony. These findings suggest that in patients without organic heart and pulmonary diseases, ventricular preexcitation may lead to symptomatic exertional dyspnea in sinus rhythm and interventricular asynchrony that persists during exercise. RF ablation can reverse dyspnea associated with preexcitation. Therefore, in symptomatic patients, preexcitation-related exertional dyspnea during sinus rhythm can be diagnosed by cardiopulmonary exercise test and could be an additional indication for RF ablation in patients with Wolff-Parkinson-White pattern.

An 82-year-old woman suspected of a cardiac tumour was referred for evaluation. Patient's medical history included atrial fibrillation, implantation of a VVI (ventricular stimulation) pacemaker 3 years earlier due to advanced atrioventicular (AV) block, arterial hypertension and hypothyroidism. Patient was adequately anticoagulated with warfarin (international normalized ratio (INR) 3.0 at admission). She reported occasional palpitations and a 2 kg weight loss in the last 2 years, but denied shortness of breath, chest pain, malaise, fever, chills or cough. Blood samples were taken for tests and cultures. Red blood cells, haemoglobin, white blood cells, platelets, C- reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were within normal ranges. Blood cultures were negative. Echocardiogram (figure 1A) (see online supplementary videos 1 and 2) and cardiac CT were performed (figure 1B).Which of the following is the most likely diagnosis?Caseous calcification of the mitral annulusCoconut left atriumMitral valve myxomaPeriannular abscess.

Background and aim: Several studies have reported that elevated red cell distribution width (RDW) is associated with poor outcomes in patients with coronary artery disease, chronic heart failure and aortic stenosis following transcatheter aortic valve replacement. Their prognostic utility in patients undergoing aortic valve replacement (AVR) surgery is unknown. Methods: We prospectively evaluated the prognostic value of RDW in a group of 191 consecutive patients with severe symptomatic aortic stenosis undergoing AVR. The pre-defined primary endpoint at the 30-day follow-up was composed of: all cause mortality, perioperative myocardial infarction, perioperative renal failure, prolonged mechanical ventilation, stroke, heart failure, successfully resuscitated cardiac arrest, the occurrence of multiple-organ failure, and the need for additional surgery for any reason. The secondary endpoint was total mortality. Results: The composite endpoint occurred in 54 patients. In univariate analysis RDW (p < 0.0001), haemoglobin level (p = 0.005), haematocrit (p = 0.01), red blood cell count (RBC; p = 0.002), glomerular filtration rate (p = 0.003), New York Heart Association classification (p = 0.02), atrial fibrillation (p = 0.0044), and pulmonary blood pressure (p = 0.004) were associated with the occurrence of the composite endpoint. RDW (p = 0.0005), haemoglobin level (p = 0.004), haematocrit (p = 0.004), RBC (p = 0.0009) and mean corpuscular volume (p = 0.01) were associated with an increased risk of death. In multivariate analysis, RDW (OR 3.274; 95% CI 1.285–8.344; p = 0.0003) and RBC (OR 0.373; 95% CI 0.176–0.787; p = 0.0097) remained independent predictors of the composite endpoint. Receiver operating characteristic analysis determined a cut-off value of RDW for the prediction of the occurrence of the combined endpoint at 14.1%. Conclusions: Elevated RDW is associated with a worse outcome following AVR, independent of RBC.

Wstep: Przezcewnikowa implantacja zastawki aortalnej (TAVI) jest ustaloną metodą leczenia wybranych chorych ze zwezeniem zastawki aortalnej. Wedlug wspolnego stanowiska ekspertow, Europejskiego Towarzystwa Torakochirurgow i Kardiochirurgow, Europejskiego Towarzystwa Kardiologicznego i Asocjacji Interwencji Sercowo-Naczyniowych, opublikowanego w 2008 r. TAVI powinno sie wykonywac u chorych z grupy wysokiego ryzyka chirurgicznego z logistic EuroSCORE (log ES) ≥ 20%. Istnieje natomiast niewiele doniesien na temat TAVI u pacjentow z grupy wysokiego ryzyka chirurgicznego, ale z log ES < 20%. Cel: Celem pracy bylo porownanie wynikow TAVI u chorych z log ES ≥ 20% z rezultatami uzyskanymi u pacjentow z log ES < 20%, ktorzy ze wzgledu na inne choroby wspoltowarzyszące zostali ostatecznie zdyskwalifikowani z leczenia operacyjnego. Metody i wyniki: W okresie od stycznia 2009 do grudnia 2011 r. TAVI wykonano u 93 chorych, ktorzy zastali podzieleni na dwie grupy. Grupe 1 stanowilo 59 (63.4%) pacjentow z log ES ≥ 20%, a grupe 2 — 34 (36,6%) osob z log ES < 20%. Średnia wartośc Log ES wynosila 30,9 ± 9,7% w grupie 1 oraz 12,7 ± 4,9% w grupie 2 (p < 0,001). Chorzy z grupy 1 byli starsi (82,9 ± 5,9 vs . 78,7 ± 7,8 roku; p = 0,01), charakteryzowali sie nizszą frakcją wyrzutową lewej komory (51,5 ± 14% vs . 60,4 ± 9,6%; p = 0,002), wyzszym ciśnieniem skurczowym w tetnicy plucnej (56 ± 11 vs . 49 ± 10,6 mm Hg; p = 0,02) oraz gorszą funkcją nerek (GFR 51,3 ± 18,4 vs . 60,6 ± 16,6 ml/min/m2; p = 0,02). Przezycie po roku i po 2 latach bylo porownywalne i wynosilo 76,6% i 69,0% oraz 89,0% i 83,6% odpowiednio w grupie 1 i 2 (p = NS), natomiast czestośc wy­stepowania zgonow sercowych po roku i po 2 latach byla istotnie wyzsza w grupie 1 (21,4% i 28,6%) niz w grupie 2 (8,1% i 10,8%) (p = 0,02). Wnioski: Wyniki niniejszej pracy pokazują, ze czestośc wystepowania zgonow sercowych w okresie 2-letniej obserwacji po TAVI jest wyzsza u chorych z grupy wysokiego ryzyka chirurgicznego z log ES ≥ 20% niz u pacjentow zdyskwalifikowanych z leczenia chirurgicznego przez Zespol Sercowy, ale z log ES < 20%.

Introduction: Transcatheter aortic valve implantation (TAVI) is a treatment alternative for the elderly population with severe symptomatic aortic stenosis (AS) at high risk for surgical aortic valve replacement (SAVR). Aim: To assess the impact of TAVI on echocardiographic parameters of left ventricular (LV) performance and wall thickness in patients subjected to the procedure in a single-centre between 2009 and 2013. Material and methods: The initial group consisted of 170 consecutive patients with severe AS unsuitable for SAVR. Logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) was 21.73 ±12.42% and mean age was 79.9 ±7.5 years. Results: The TAVI was performed in 167 (98.2%) patients. Mean aortic gradient decreased significantly more rapidly after the procedure (from 58.6 ±16.7 mm Hg to 11.9 ±4.9 mm Hg, p < 0.001). The LV ejection fraction (LVEF) significantly increased in both short-term and long-term follow-up (57 ±14% vs. 59 ±13%, p < 0.001 and 56 ±14% vs. 60 ±12%, p < 0.001, respectively). Significant regression of interventricular septum diameter at end-diastole (IVSDD) and end-diastolic posterior wall thickness (EDPWth) was noted in early (15.0 ±2.4 mm vs. 14.5 ±2.3 mm, p < 0.001 and 12.7 ±2.1 mm vs. 12.4 ±1.9 mm, p < 0.028, respectively) and late post-TAVI period (15.1 ±2.5 mm to 14.3 ±2.5 mm, p < 0.001 and 12.8 ±2.0 mm to 12.4 ±1.9 mm, p < 0.007, respectively). Significant paravalvular leak (PL) was noted in 21 (13.1%) patients immediately after TAVI and in 13 (9.6%) patients in follow-up (p < 0.001). Moderate or severe mitral regurgitation (msMR) was seen in 24 (14.9%) patients from the initial group and in 19 (11.8%) patients after TAVI (p < 0.001). Conclusions: The TAVI had an immediate beneficial effect on LVEF, LV walls thickness, and the incidence of msMR. The results of the procedure are comparable with those described in other centres.

Assessment of systemic right ventricle (RV) function is a key point in the follow-up of patients with dextroposition of the great arteries (D-TGA) after the atrial switch procedure. Cardiac magnetic resonance (CMR) is considered the reference standard but is not feasible for a considerable number of patients. Experience with the application of 2-dimensional speckle tracking echocardiography for the assessment of systemic RV function in such patients is very limited, and the cutoff strain value differentiating normal and subnormal RV function is missing.We prospectively examined, with echocardiography and CMR, 40 patients with D-TGA (mean age, 25.6 ± 5 years; 25 men; 33 after the Senning, 7 after the Mustard procedure) who attended a tertiary adult congenital heart disease centre.There was a linear correlation between global longitudinal strain (GLS) and CMR systemic RV ejection fraction (EF) values (r = 0.4; P = 0.01), systemic RV fractional area change and CMR systemic RV EF (r = 0.41; P = 0.008). There was no correlation between systemic RV s', tricuspid annular plane systolic excursion or the rate of change of the systemic RV pressure with time and CMR systemic RV EF. Only 1 of 19 patients with GLS -14.2% had CMR systemic RV EF45%. The GLS cutoff value of -14.2% predicted the CMR systemic RV EF of ≥ 45% with 90% specificity and 83% sensitivity. Its positive predictive value was 96%.The systemic RV GLS is able to discriminate between D-TGA patients after the atrial switch with, and those without, a CMR systemic RV EF of at least 45%.

Vasa previa is a rare condition in which unsupported by the placenta, umbilical cord blood vessels runs within the placental membranes between internal os of the cervix and presenting part of the fetus. We report an antenatal diagnostic procedure and management of a patient with low-lying placenta and velamentous cord insertion near to the internal os with two large fetal blood vessels coursing between the internal cervical os and fetal presenting part. An elective cesarean section was performed at 36 weeks gestation.

The pressure overload may be responsible for the failure of the systemic ventricle. No study so far has evaluated the association between arterial blood pressure values and right ventricular function in adults with atrially corrected complete transposition.This was a retrospective analysis. The studied population consisted of 60 patients with complete transposition, 11.5+/-2.7 years after atrial switch procedure, divided into subgroups according to the severity of systemic ventricular dysfunction (right ventricular ejection fractionor = 0.40 vs.0.40), and the severity of perfusion abnormalities in the radionuclide study (absent or mild vs. moderate-to-severe).All patients had blood pressure values (systolic 109.1+/-11.7 mm Hg and diastolic 72.3+/-9.7 mm Hg) within the normal range. Systolic blood pressure values correlated inversely with right ventricular ejection fraction (r = -0.450; p0.001). Compared to patients with systolic blood pressure below median values, patients with "elevated" blood pressure had lower right ventricular ejection fraction (32.6+/-6.3 vs. 38.9.+/-7.2; por = 0.002) and more significant perfusion abnormalities (1.5+/-1.0 vs. 2.9+/-1.5; por = 0.001). In a multivariate backward logistic regression model age at surgery and at the time of the study, systolic blood pressure at rest predicted impaired right ventricular ejection fraction (p0.02). Greater pulse pressure at peak exercise female sex were associated with greater more severe perfusion abnormalities (p0.01).There is a significant correlation between blood pressure values and indices of right ventricular dysfunction in patients who underwent an atrial switch procedure for complete transposition. Blood pressure values might be considered as a surrogate end point in these patients.

Summary Background:Angioplasty of an infarct related artery (IRA) performed several weeks or months after myocardial infarction (MI) may improve myocardial function. Hypothesis: We hypothesized that, as Doppler myocardial imaging (DMI) allows for the quantitative assessment of the systolic movement of myocardial segments, it may be a sensitive method for assessing changes in regional myocardial contraction and contractile reserve pre and post angioplasty of the IRA. Methods:In all, 39 patients (30 men, mean age 53.4 ± 8.3 years), 1 to 6 months after MI, who qualified for IRA angioplasty on the basis of myocardial viability in the infarcted zone as demonstrated by dobutamine stress echocardiography, were included in the study. Peak regional myocardial systolic velocities (S wave) of the infarcted segments were measured at rest and during low-dose dobutamine infusion (15 µg/kg/min) 1 day before angioplasty (Exam 1), 2 to 5 days (Exam 2), and 30 days (Exam 3) after successful angioplasty. The long-axis movement of the mitral annulus and of the basal and medial segments of the posterior (20 patients), anterior (17 patients), and lateral walls (2 patients) was evaluated. Results: At rest, S-wave velocity of the infarcted segments increased between Exams 1 and 2, without further improvement between Exams 2 and 3 (4.9 ± 1.2 vs. 5.6 ± 1.3 cm/s, p < 0.05 and 5.6 ± 1.3 vs. 5.5 ± 1.3 cm/s, NS, respectively). However, S-wave velocities measured during low-dose dobutamine infusion differed significantly both between Exams 1 and 2, and 2 and 3 (7.0 ± 1.5 vs. 7.8 ± 1.8 cm/s; p < 0.01; 7.8 ± 1.8 vs. 8.5 ± 1.6 cm/s; p < 0.05). Conclusions:Resting contractility at an infarct zone demonstrated rapid initial improvement after angioplasty of the IRA with no further change, whereas contractile reserve improved not only immediately after angioplasty but also during the next month.

Background: The Tei index of myocardial performance (IMP), which combines parameters of both systolic and diastolic ventricular function, is a useful prognostic factor in many clinical settings. Hypothesis: This study assessed the long-term prognostic value of IMP in patients discharged from hospital after acute myocardial infarction (AMI). Methods: Doppler/echocardiographic studies were recorded in 90 consecutive patients on Day 14 ± 2 following an AMI. The IMP was calculated from the Doppler recordings, as a sum of isovolumetric contraction time and isovolumetric relaxation time, divided by the ejection time. Results: The patients were followed for an average (SD) of 57.8 (16.1) months. During this period there were 22 (24%) cardiac events, defined as cardiac deaths (10) or Nonfatal recurrent myocardial infarctions (12). After multivariate Cox analysis, Tei index > 0.55 (relative risk [RR] 4.45; 95% confidence interval [CI] 1.28-15.45; p = 0.019), LV end-systolic volume > 65 ml (RR 3.23; 95% CI 1.34-7.79; p = 0.009), and mitral E wave deceleration time ⩽ 0.145 s (RR 2.94; 95% CI 1.24-6.92; p = 0.014) were the only independent predictors of cardiac events during the follow-up period. In a subgroup of patients with preserved LV systolic function (ejection fraction > 0.40), IMP was the only predictor of cardiac events (RR 6.37; 95% CI 1.32-30.77, p = 0.02). Conclusions: The Tei index of myocardial performance, which is simple and easy to calculate, is a useful tool for risk assessment in patients following myocardial infarction, and in a subgroup of patients with Normal or only mildly impaired systolic function.

Aim to investigate the drug-class-specific changes in the volume and cost of antidiabetic medications in Poland in 2012–2015. Methods This retrospective analysis was conducted based on the National Health Fund database covering an entire Polish population. The volume of antidiabetic medications is reported according to ATC/DDD methodology, costs—in current international dollars, based on purchasing power parity. Results During a 4-year observational period the number of patients, consumption of antidiabetic drugs and costs increased by 17%, 21% and 20%, respectively. Biguanides are the basic diabetes medication with a 39% market share. The insulin market is still dominated by human insulins, new antidiabetics (incretins, thiazolidinediones) are practically absent. Insulins had the largest share in diabetes medications expenditures (67% in 2015). The increase in antidiabetic medications costs over the analysed period of time was mainly caused by the increased use of insulin analogues. Conclusions The observed tendencies correspond to the evidence-based HTA recommendations. The reimbursement status, the ratio of cost to clinical outcomes and data on the long-term safety have a deciding impact on how a drug is used.

Purpose Few studies describe diastolic (presystolic) tricuspid regurgitation (DTR) mainly in the context of atrioventricular conduction abnormalities. Little is known about its occurrence in the other clinical settings. Methods We identified patients with DTR recorded during routine echocardiographic examinations. DTR was defined as low velocity backward flow through the tricuspid valve orifice during end-diastole recorded with a continuous and/or pulsed-wave Doppler and/or color-coded M-mode Doppler echocardiography. Results Diastolic tricuspid regurgitation was present in a wide variety of clinical entities. Of the 23 patients with DTR 6 patients had ischemic and 10 dilated cardiomyopathy. Others had clinical conditions including: inappropriate pacemaker settings, decompensated hypertrophic cardiomyopathy, biventricular dysfunction following orthotropic heart transplantation, torrential aortic regurgitation, low ejection fraction aortic stenosis, advanced endocardial fibroelastosis, and complex congenital heart disease. Twenty of 23 patients had significantly impaired right ventricle (RV) systolic function. Systolic tricuspid regurgitation was estimated as moderate or severe in 13 cases and mild in the remaining 10 cases. RV systolic pressure was significantly elevated in all but 2 cases. In all but 4 cases DTR was transient. The persistence of DTR was associated with severe pulmonary hypertension, severe biventricular failure, and persistent severe pulmonary regurgitation. Conclusions Diastolic tricuspid regurgitation may be encountered in a variety of clinical settings and should be sought for especially in patients with advanced RV systolic dysfunction, pulmonary hypertension, pulmonary regurgitation, or conduction abnormalities. Significant systolic regurgitation is not prerequisite for the development of DTR.

Background Other than aspirin, there are few oral antithrombotic treatments with proven efficacy in patients with acute coronary syndrome. In this report, we present the rationale, design and baseline characteristics of the Clopidogrel in Unstable angina to prevent Recurrent ischaemic Events (CURE) trial, which includes a meta-analysis of the effects of thienopyridines in patients with vascular disease. Methods and Results Combined data from randomized trials of thienopyrindines in patients with atherosclerotic disease demonstrated a 29% reduction in vascular events when compared with placebo/control (n=2392) (OR 0.71, 95% CI 0.58-0.86, P=0.0006) and a 10% reduction in vascular events when compared with aspirin (n=22 254) (OR 0.91, 95% Cl 0.84-0.99, P=0.039). Similarly, randomized trials of aspirin plus thienopyridines in patients undergoing intracoronary stenting, demonstrated marked benefit of aspirin plus ticlopidine in reducing death or myocardial infarction compared with aspirin alone (OR 0.23, 95% CI 0.11-0.49, P=0.0001) or aspirin plus warfarin (OR 0.51, 95% CI 0.33-0.78, P=0.002). Whether these benefits extend to the much larger population of patients with acute coronary syndrome is unknown. CURE is an international, randomized, double-blind trial, in which patients with acute coronary syndrome will be randomized to receive either a bolus dose of clopidogrel (300 mg) followed by 75 mg per day for 3-12 months, or matching placebo. Both groups will receive aspirin. The co-primary efficacy end-points of CURE are: (1) the composite of cardiovascular death, myocardial infarction or stroke; and (2) the composite of cardiovascular death, myocardial infarction, stroke or refractory ischaemia. CURE will recruit approximately 12 500 patients with acute coronary syndrome (from 28 countries) and its power to detect moderate treatment benefits will be in the region of 80-90%, while maintaining an overall type I error (a) of 0.05. The baseline characteristics of the study population are consistent with at least a moderate risk group of patients with acute coronary syndrome. Conclusions Randomized trials of thienopyridines in patients with vascular disease demonstrate that thienopyridines are effective in reducing vascular events when compared with placebo/control or aspirin, as well as when used in combination with aspirin in patients undergoing intracoronary stent implantation. The CURE trial is a large international study to determine if acute and longterm treatment with the combination of clopidogrel and aspirin is superior to aspirin alone in patients with acute coronary syndrome. (C) 2000 The European Society of Cardiology.

This paper tries to analyze whether and to what extent business valuation standards regulate valuation approaches and methods. The paper includes research carried out on 12 business valuation standards (four American standards, Canadian, Australian, New Zealand, Chinese – Hong Kong, German, Polish and two international standards) in order to show differences and similarities in regulations. The research shows that some business valuation standards interfere very deeply in the scope of valuation approaches and methods. Udostępnienie publikacji Wydawnictwa Uniwersytetu Łódzkiego finansowane w ramach projektu „Doskonałość naukowa kluczem do doskonałości kształcenia”. Projekt realizowany jest ze środków Europejskiego Funduszu Społecznego w ramach Programu Operacyjnego Wiedza Edukacja Rozwój; nr umowy: POWER.03.05.00-00-Z092/17-00.

Multi-label classification on data sets with large number of labels is a practically viable and intractable problem. This paper presents an optimization method for the multi-label classification process for data with a high number of labels. The newly proposed method starts with label grouping using community detection methods on interconnectedness graph of labels based on support sizes for every pair of labels. The grouping process is based on modularity-oriented community detection methods. Next the data instances are classified separately for each label community and the resulting labellings are merged afterwards. Both theoretical analysis and experimental results are provided. Experimental results comparing common classification methods to proposed Modularity-based Label Grouping (MLG) with embedded Binary Relevance, executed on on differentiated data sets show a performance increase by 27-41% compared to standard binary relevance, by 72-81% compared to RAkel and by several dozens compared to ECOC-BR-BCH with none or negligible difference in classification quality.

Polskie Kliniczne Forum Obrazowania Serca i Naczyn: Edyta Plonska-Gościniak, Magdalena Kostkiewicz, Piotr Lipiec, Tomasz Miszalski-Jamka, Andrzej Szyszka, Mieczyslaw Pasowicz, Andrzej Gackowski, Tomasz Kukulski, Miroslaw Dziuk, Cezary Kepka, Mariusz Skowerski, Zbigniew Gąsior, Jerzy Walecki, Piotr Szymanski, Katarzyna Mizia-Stec, Anna Klisiewicz, Piotr Hoffman, Piotr Podolec, Piotr Pruszczyk, Jaroslaw D. Kasprzak, Adam Torbicki

Heart failure (HF) is commonly misdiagnosed, and the validity of diagnosis in primary care is poor. According to the guidelines, an electrocardiogram, a chest X-ray and a standard echocardiogram should be obtained and the level of B-type natriuretic peptide (BNP) should be determined in every patient with signs and symptoms suggestive of HF.We performed a community-based study to evaluate the diagnostic evaluation of patients with HF and/or HF risk factors carried out by primary care physicians.We screened the adult population of a small Polish town (5521 inhabitants). Inclusion criteria were as follows: age ≥ 55 years and either the diagnosis of HF or presence of at least one of the following HF risk factors: ischaemic heart disease and/or hypertension with complications and/or diabetes mellitus.A total of 218 patients who met the inclusion criteria were invited to participate in the study and 175 of them (80.3%) were evaluated and followed up for 58 ± 1 months. The diagnosis of HF was established in 38/175 patients (22%) (Group 1). The signs and symptoms of HF without the formal diagnosis of HF were present in 44/175 patients (25%) (Group 2) and 93/175 patients (53%) had neither HF nor its signs or symptoms (Group 3). During the follow-up, in some of patients from Groups 2 and 3, the diagnosis of HF was established and these patients crossed over to Group 1a. In 2009, there were 56 patients in Group 1a, 37 in Group 2a and 82 in Group 3a. At baseline, in years 2004/2005, echocardiograms were available in 37%, 25% and 17% of the patients in Groups 1, 2 and 3, respectively, chest radiograms in 86%, 54%, 58% of the patients, respectively, and BNP measurements in 5%, 5% and 0% of the patients, respectively. At the end of the follow-up we observed an increased number of diagnostic tests performed but the difference was not statistically significant.Our study showed a considerable discrepancy between the guidelines and primary practice and underscores the need to change the practical approach to diagnostic investigations, especially echocardiography and BNP measurements in HF patients.

Left atrioventricular valve (LAVV) regurgitation usually follows surgical repair of partial atrioventricular canal (PAVC). Although measurements of B-type natriuretic peptide (BNP) levels are useful for the monitoring and prediction of outcomes in chronic mitral regurgitation, no data are available on the role of BNP measurements in the assessment of LAVV regurgitation in patients after surgical correction of PAVC.To determine the role of plasma BNP determination in the assessment of LAVV regurgitation in patients after surgical repair of PAVC.We evaluated 41 patients who had undergone surgery for PAVC between 1968 and 2005 with preserved left ventricular ejection fraction (LVEF, mean age at follow-up: 39.2 ± 14.0 years, mean age at the time of surgery: 31.3 ± 15.6 years, 32 females) and 13 healthy controls (mean age: 38.9 ± 13.2 years, 9 females). All the subjects had undergone transthoracic echocardiography and had their plasma BNP levels determined. LAVV regurgitation was assessed qualitatively on 1+ to 4+ grading scale and quantitatively by calculating the effective regurgitant orifice area (EROA).LAVV regurgitation was present in 40 (97.6%) patients. Compared to patients with mild-to-moderate LAVV regurgitation (grade 1+ to 2+/EROA 〈 0.4 cm²) evaluated qualitatively and quantitatively, the group with severe regurgitation (grade 3+ to 4+/EROA ≥ 0.4 cm²) had higher values of left atrial volume (LAvol) and right ventricular (RV) systolic pressure, although there was no significant difference in plasma BNP levels. There were significant correlations between BNP levels and LAvol (r = 0.54, p = 0.0001), age at follow-up (r = 0.61, p=0.0001), age at the time of surgery (r = 0.58, p = 0.0001), RV diastolic diameter (r = 0.38, p = 0.02) and RV systolic pressure (r = 0.48, p = 0.002). Multivariate logistic regression analysis showed that only LAvol and age at the time of surgery but not the degree of LAVV regurgitation were independently associated with elevated plasma BNP levels.In patients late after surgical repair of the PAVC with preserved LVEF, plasma BNP levels reflect the consequences of the shunt at atrial level and LAVV regurgitation expressed by LAvol but it does not allow to estimate the severity of regurgitation.

Double-orifice mitral valve (DOMV) is a rare congenital malformation characterised by the presence of two orifices in the left atrio-ventricular valve area, each having an independent chordal attachment to the papillary muscle.To establish the echocardiographic features and incidence of DOMV in patients undergoing an echo study in a tertiary referral centre.We carried out a retrospective review of 215,193 echocardiographic studies in 79,919 patients performed between 1993 and 2006. Transthoracic echocardiographic examinations (TTE) of nine patients with DOMV (six female, mean age 37.9 years, range 8-59) were analysed.In six patients, the complete bridge type of DOMV was recognised, two patients had a duplicate mitral valve, and one had the hole type. In all cases, mild to moderate mitral regurgitation was present. Moderate to severe mitral stenosis was diagnosed in five cases and was associated with the complete bridge type. In four patients, ostium primum atrial septal defect was present. The TTE was sufficient to define the type, anatomy and associated lesions in seven cases. In two patients, TEE was essential to establish the diagnosis.Transthoracic echocardiographic examination is a reliable, and in most cases sufficient, means of diagnosing DOMV and determining its type. The DOMV as a cause of symptomatic mitral valve disease is seen in middle-aged/elderly patients. The incidence of double-orifice mitral valve in the adult tertiary referral echocardiographic laboratory is estimated at 0.01%.

The absence of costs of externalities generated in the environment by business operations results in suboptimal resource allocation in Pareto terms as well as in Kaldor-Hicks terms, the destruction of valuable natural areas and the reduction in biodiversity. The article examines the existing solutions to the problem of the conversion of externality costs occurring in the environment into private costs. It also presents the idea of a mechanism, which could raise the value of natural areas to such a level that the risk of their development would be significantly reduced.

Churg-Strauss syndrome is a rare systemic disease characterized by necrotising vasculitis and peripheral eosinophilia. Cardiac involvement is found in up to 64% of patients and is given a high rank among the causes of morbidity and mortality. We presented a case of 26 year-old male with Churg-Strauss syndrome and left intraventricular thrombus.

Introduction: The study aimed to evaluate function of the left atrium (LA) and of the left atrial appendage (LAA) after myocardial infarction (MI) complicated by intracardiac conduction disturbances. Material and methods: The study comprised 59 patients with persistent post- myocardial distal blocks, who were allocated to one of the three following subgroups: study group I - 20 patients with left bundle branch block (LBBB); study group II - 20 patients with right bundle branch block (RBBB), and study group III -19 pts with left anterior hemiblock (LAHB). The control groups included patients with MI in their history and no BBBs (19 pts - group IV) and clinically healthy people (16 patients - group V). The parameters of LA and LAA systolic function were determined by means of transthoracic (TTE) and transoesophageal echocardiography (TOE). Results: We showed that patients who experienced myocardial infarction not complicated with conduction disturbances expressed compensatory LA systolic function enhancement. In patients with post-myocardial RBBB and LAHB significant enhancement of LA systolic function was observed as well but it was expressed to a lesser degree. There was also a tendency towards deterioration of LA systolic function in patients with post-myocardial LBBB. LBBB did not affect LAA systolic function negatively. Conclusions: Parameters of LAA systolic function showed its enhancement in all patients after myocardial infarction irrespective of whether it was complicated by conduction disturbances.