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Introduction: Neutrophil-activating peptide 2 (NAP-2, CXCL7), a platelet-derived neutrophil chemoattractant, is involved in inflammation. We investigated associations between NAP-2 levels, neutrophil extracellular traps (NETs) formation, and fibrin clot properties in atrial fibrillation (AF). Materials and Methods: We recruited 237 consecutive patients with AF (mean age, 68±11 years; median CHA2DS2VASc score of 3 [2-4]) and 30 apparently healthy controls. Plasma NAP-2 concentrations were measured, along with plasma fibrin clot permeability (Ks) and clot lysis time (CLT), thrombin generation, citrullinated histone H3 (citH3), as a marker of NETs formation, and 3-nitrotyrosine reflecting oxidative stress. Results: NAP-2 levels were 89% higher in AF patients than in controls (626 [448-796] vs. 331 [226-430] ng/ml; p2DS2-VASc score, or the AF manifestation. Patients with NAP-2 in the top quartile (>796 ng/ml) were characterized by higher neutrophil count (+31.7%), fibrinogen (+20.8%), citH3 (+86%), and 3-nitrotyrosine (+111%) levels, along with 20.2% reduced Ks and 8.4% prolonged CLT as compared to the remaining subjects (all ps. Conclusions: Elevated NAP-2, associated with increased oxidative stress, has been identified as a novel modulator of prothrombotic plasma fibrin clot properties in patients with AF.

Introduction Clinical trial applicability to routine clinical practice is a fundamental consideration. Little is known about eligibility and enrolment in ischaemic heart failure (iHF) trials. Aim To compare clinical characteristics and medical therapy between subjects eligible-and-enrolled vs eligible-but-not-enrolled in iHF interventional randomized controlled trials (RCT). Material and methods Using our detailed database of consecutive hospitalizations, iHF patients clinical characteristics and medical treatment were compared for 4 following periods: P1 (6 months of RCT#1 recruitment), P2 (6 months after the RCT#1), P3 (6 months of RCT#2 recruitment), P4 (6 months after RCT#2). RCT#1 and RCT#2 had similar criteria that involved 18–80 years old, NYHA Class II-IV inclusion and LVEF ≤40% (inclusion), and tumor/neoplasm history, recent (≤3 months) or planned major surgery, heart transplant waiting list (exclusion). Eligibility and enrolment, and reasons for non-eligibility and non-enrolment, were evaluated along baseline clinical characteristics and medical treatment. Results Data of 5,436 patients were reviewed. Eligibility rate was similar between the periods evaluated (P1–56.45%, P2–43.14%, P3–58.49%, P4–50.25%). One in 2 (50.62%) ineligible patients had a single-only reason for ineligibility (recent [≤3 months] or recommended cardiac surgery/cardiovascular intervention outside the trial 16.3%, age>80 years 14.6%, Fig. 1 and Fig. 2). 13.2% of eligible patients were not enrolled due to lack of consent. Eligible-and-enrolled patients did not differ in baseline clinical characteristics such as sex, age, diabetes, and the clinical stage of heart failure against the eligible-but-not-enrolled patients. However, the eligible-and-enrolled had lower left ventricle ejection fraction (echocardiography; 31.2% vs. 33.9%, p=0.0393) and higher end-diastolic volume (197.8ml vs 160.4ml, p Conclusion Enrolment rate was high. Ineligibility resulted mainly from recent or recommended cardiovascular intervention outside RCT. Medical treatment was similar between eligible-and-enrolled and eligible-but-not-enrolled patients. Age (when within the inclusion criteria), gender and time frame were not factors of bias. However, the trial-enrolled patients had more severe left ventricle impairment. This argues, for iHF RCTs, against the routinely assumed lower-risk patient enrolment bias as signalled in other trial types and populations. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): John Paul II Hospital, Krakow, Poland Figure 1Figure 2

Background and aim:Alcohol is a potent risk factor for heart diseases. Alcohol consumption can damage myocytes earlier than overt LV dysfunction occurs. We aimed that two-dimensional speckle tracking echocardiography (2DSTE) can be used for early detection of heart failure caused by alcohol intake.Methods:A 100 chronic alcoholics were enrolled into the study. All patients underwent physical examination, biochemical analysis and echocardiography. Following parameters were assessed: LV diameters, LV systolic and diastolic function. Also RV diameters, LA and RA volumes were measured. LV and RV global longitudinal strain (GLS), LA and RA strain were calculated. The results were compared with control group, composed of 20 healthy subjects.Results:The mean LVEF was 57.55±6.99%, the mean E/A ratio 1.09±0.32 and E/E` 7.36±2.4 in the study group. Mean LA volume was 35.4±10.78 mL, RA volume 34.7±10.25 mL. The 2DSTE of LA was 29.1±10.0, LVGLS was -15.03±2.07. The RA strain was 30.46±10.25 and RVGLS -16.22±6.27. All strain parameters were lower than in the control group. Graded reduction of global longitudinal strain of the both ventricles and both atria in dose-dependent manner was found, lower strain was observed in heavy alcoholics than light/moderate drinkers. Conclusions:The study proved that chronic alcohol consumption leads to myocardial injury in dose-depended manner, the deterioration of global strain of the ventricles and atria can be the sensitive marker of myocardial injury.

The presence of patent foramen ovale (PFO) was found to be associated with a number of medical conditions, including embolic stroke and recurrent transient neurological defects. The closure of PFO remains controversial; however, in recently published guidelines from the European Association of Percutaneous Cardiovascular Interventions in collaboration with 7 other European societies, which extensively refer to the latest randomized clinical trials, it is explicitly recommended to perform percutaneous PFO closure in the prevention of recurrent thromboembolic events. In connection with the above facts and expected increasing number of PFO closure procedures, the joint expert group of the Association of Cardiovascular Interventions and the Grown‑Up Congenital Heart Disease Section of the Polish Cardiac Society developed the following consensus opinion in order to standardize the principles of diagnosis, indications, methods of performing procedures, and postoperative care in relation to Polish conditions and experiences.

It is known that atrial fibrillation (AF) is associated with the procoagulant state. Several studies have reported an increase of circulating microparticles in AF, which may be linked to a hypercoagulable state, atrial thrombosis and thromboembolism. We evaluated in our study alterations in both platelet (PMP, CD42b) and endothelial-derived (EMP, CD144) microparticle levels on anticoagulant therapy with rivaroxaban in nonvalvular AF. After administration of rivaroxaban, PMP levels were increased (median, [IQR] 35.7 [28.8-47.3] vs. 48.4 [30.9-82.8] cells/µL; P = 0.012), along with an increase in EMP levels (14.6 [10.0-18.6] vs. 18.3 [12.9-37.1] cells/µL, P < 0.001). In the multivariable regression analysis, the independent predictor of post-dose change in PMPs was statin therapy (HR −0.43; 95% CI −0.75,−0.10, P = 0.011). The post-dose change in EMPs was also predicted by statin therapy (HR −0.34; 95% CI −0.69, −0.01, P = 0.046). This study showed an increase in both EMPs and PMPs at the peak plasma concentration of rivaroxaban. Statins have promising potential in the prevention of rivaroxaban-related PMP and EMP release. The pro-thrombotic role of PMPs and EMPs during rivaroxaban therapy requires further study.

Introduction CIRCULATE-Acute Myocardial Infarction is a double-blind controlled trial randomizing (RCT) in 105 consecutive patients with their first, large AMI (cMRI-LVEF ≤45% and/or cMRI-infarct size ≥10% of LV) with successful infarct-related artery (IRA) primary percutaneous coronary intervention (pPCI) to transcoronary administration of Wharton's Jelly Mesenchymal Stem Cells (WJMSCs) vs. placebo (2:1). The pilot study cohort (PSC) preceded the RCT. Aim To evaluate WJMSCs long-term safety, and evolution of left-ventricular (LV) function in CIRCULATE-AMI PSC. Material and methods 30 000 000 WJMSCs (50% labelled with 99mTc-exametazime) were administered via IRA in a ten-patient PCS (age 32–65 years, peak hs-Troponin T 17.3±9.1ng/mL and peak CK-MB 533±89U/L, cMRI-LVEF 40.3±2.7% and infarct size 20.1±2.8%) at ≈5–7 days after AMI using a cell delivery-dedicated, coronary-non-occlusive method. Other treatments were per guidelines. WJMSCs showed an unprecedented high myocardial uptake (30.2±5.3%; 95% CI 26.9–33.5%), corresponding to ≈9×10 000 000 cells retention in the infarct zone – in absence of epicardial flow or myocardial perfusion impairment (TIMI-3 in all; cTFC 45±8 vs. 44±9, p=0.51) or any hs-Troponin T elevation. Five-year follow up included cardiac Magnetic Resonance Imaging (cMRI) (at baseline, 1 year and 3 years) and detailed echocardiography (echo) at baseline, 1 year, 3 years and 5 years. Results By 5 years, one patient died from a new, non-index territory AMI. There were no other cardiovascular events and MACCE that might be related to WJMSCs transplantation. On echo (Fig), there was an increase in left ventricular ejection fraction (LVEF) between WJMSCs administration point and 1 year (37.7±2.9% vs. 48.3±2.5%, p=0.002) that was sustained at 3 years (47.2±2.6%, p=0.005 vs. baseline) and at 5 years: (44.7±3.2%, p=0.039 vs. baseline). LVEF reached a peak at 1 year after the AMI and WJMSCs transfer (Fig). cMRI data (obtained up to 3 years; 1 year 41.9±2.6% vs. 51.0±3.3%, p Conclusions 5-year follow up in CIRCULATE-AMI PSC indicates that WJMSC transcoronary application is safe and may be associated with an LVEF improvement. The magnitude of LV increase appears to peak at 1 year, suggesting a potential role for repeated WJMSCs administration(s). Currently running double-blind RCT will provide placebo-controlled insights into the WJMSCs effect(s) on changes in LV function, remodelling, scar reduction and clinical outcomes. Echo-LVEF evolution Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): STRATEGMED 265761 “CIRCULATE” National Centre for Research and Development/Poland/ZDS/00564 Jagiellonian University Medical College

Objective Closure of the atrial septal defect in the elderly patients is controversial. The aim of the study was to evaluate the outcomes of transcatheter closure of secundum atrial septal defect (ASD) in elderly patients. Methods From a total of 650 pts with ASD who underwent transcatheter closure 120 pts over 60 years (70 F, 50 M) with a mean age of 66.7±18.1 (60–78) were analyzed. All patients had an isolated secundum ASD with a mean Qp:Qs: 2.79±1.8 (1.5–3.9). A symptom-limited treadmill exercise tests with respiratory gas exchange analysis and transthoracic color Doppler echocardiographic study as well as Quality of life (QoL) measured using the SF36 questionnaire (SF36q) were repeated in all pts before procedure and after 12 months of follow-up. Results The device was successfully implanted in all pts (procedure time 30.1±9.9 (10–59) minutes, fluoroscopy time 10.1±7.2 (6–40) minutes). There were no major complications. The defect echo diameter was 19.5±15.4 (12 - 34) mm. The mean balloon stretched diameter of ASD was 22.0±7.8 (14 - 36) mm. The diameter of the implanted devices ranged 16 - 38 mm. After 12 months of ASD closure, all the pts showed a significant improvement of exercise capacity parameters. Seven QoL parameters (except mental health) improved at 12 months follow up compared to their baseline data. The mean SF36q scale increased significantly in 96 (80.2%) pts of mean 41.6±26.1 (4–71). The right ventricular dimension decreased in 101 pts (84.2%) (Table 1). Conclusions Closure of ASD in elderly patients caused a significant clinical and hemodynamic improvement after percutaneous treatment, which is maintained to long-term follow-up what justified this procedure in old age. Funding Acknowledgement Type of funding source: None

Valvular heart diseases (VHDs) constitute an increasing problem both as a consequence of population aging and as the sequelae of other heart diseases. Accurate diagnosis is essential for correct clinical decision‑making; however, in many patients, transthoracic and transesophageal echocardiography is insufficient. Stress echocardiography (SE) proved to be a useful tool allowing for simultaneous assessment of left ventricular contractile reserve and HVD hemodynamics under conditions of physiological or pharmacological stress. It is recommended for assessing the severity of VHD, guiding the choice of treatment, as well as for surgical risk stratification. It can be applied both in asymptomatic patients with severe VHD and in symptomatic individuals with moderate disease. In patients with VHD, SE can be performed either as exercise stress echocardiography (ESE) or dobutamine stress echocardiography (DSE). The first modality is recommended to unmask symptoms or abnormal blood pressure response in patients with aortic stenosis (AS) who report to be asymptomatic or in those with mitral stenosis with discordance between clinical symptoms and the severity of valve disease on transthoracic echocardiography. In asymptomatic patients with paradoxical low‑flow, low‑gradient (LFLG) AS, ESE can be used to assess the severity of stenosis. On the other hand, low‑dose DSE can be a useful diagnostic tool in classical LFLG AS, providing information on stenosis severity and contractile reserve. Moreover, SE is indicated in patients with prosthetic valve when there is discordance between symptoms and echocardiographic findings. It is also recommended in high‑risk surgical patients with VHD with poor functional capacity and more than 2 clinical risk factors. The present paper discusses in detail the use of SE in VHD.

INTRODUCTION: Cardiovascular diseases (CVDs) are the main cause of death worldwide. In the last 40 years we can observe increase in prevalence of CVDs among young population. [1] Control of risk factors is especially important in young group of patients because the long-term prognosis for this group is particularly unfavorable.[2] MATERIALS AND METHODS: 100 medical records of following patients hospitalized between 2014 - 2017 in Department of Cardiac and Vascular Diseases in Cracow Specialist Hospital were analyzed with special attention to myocardial infarction risk factors. The study included 58 women under the age of 55 and 42 men under 45 divided into two groups with or without acute coronary syndrome (ACS). RESULTS: 86% of examined population had LDL level higher than 1,8 mmol/l, 65% smoked cigarettes and 86,4% had thickened intima-media complex. HDL level was below the norm in 47,4% of the group with ACS and only in 20,9% of the group without ACS (p < 0,05). Significant differences between groups in combined risk factors were observed in decreased HDL level accompanied by increased LDL (40,4% with ACS, 20,9% without ACS), tobacco abuse (38,6% with ACS, 18,6% without ACS) or arterial hypertension (40,4% with ACS, 18,6% without ACS). CONCLUSION: The most important risk factor of acute myocardial infarction in the studied group with early onset of CVD was reduced HDL level.

Introduction CIRCULATE-Acute Myocardial Infarction Trial (NCT03404063) is a double-blind controlled trial (RCT) that is randomizing consecutive patients with their first, large AMI (LVEF ≤45% and/or cMRI -infarct size ≥10% of LV) successfully treated by infarct-related artery (IRA) primary percutaneous coronary intervention reperfusion (TIMI ≥2) to transcoronary administration of Wharton Jelly Multipotent Stem Cells (WJMSCs) vs. placebo (2:1), preceded by evaluation of safety, WJMSCs myocardial uptake, and echocardiographic, cMRI and SPECT left ventricular remodelling and hemodynamic changes in pilot study cohort (PSC). Purpose To evaluate LV remodelling and hemodynamic features following WJMSCs transplantation in CIRCULATE-AMI PSC. Methods Ten consecutive patients (age 32–65 years) were administered 30 000 000 WJMSCs via the infarct-related artery at ≈5–7 days after AMI using transradial approach and a coronary-non-occlusive catheter dedicated to cell delivery. Within 3 years of follow up SPECT was performed at baseline and 1 year, echo and cMRI were performed at baseline, 1 year and 3 years. Results 3-year observation (cMRI) shows a significant decrease of median left ventricular mass (LVM) between WJMSCs administration and 1 year 140 g (IQR 128–150) vs. 97 g (95–128), that is sustained at 3 years 93 g (80–119), p0,05 for all. Furthermore, there was a significant increase in stroke volume measured by SPECT baseline vs. 1 year (53.3±7.6 ml vs. 68.2±5.2ml); cMRI baseline vs. 1 year vs. 3 years (72.7±5.2 ml vs. 96.9±8.1 ml vs. 93.2±7.8 ml) and Echo (64.3±2.9 ml vs. 68.8±4.1 ml vs. 81.9±7.1 ml), p cMRI Left Ventricular Mass evolution Conclusions Long-term follow up in CIRCULATE-AMI PSC suggests that transcoronary administration of WJMSCs in a recent large AMI in humans might be associated with an inhibition of LV adverse remodelling and a significant hemodynamic improvement. Our currently running randomized double-blind controlled trial will verify LV remodelling evolution in WJMSCs-treated patients. Acknowledgement/Funding K/ZDS/00564 Jagiellonian University Medical College; STRATEGMED 265761 “CIRCULATE” National Centre for Research and Development/Poland

The size of the right atrium (RA) reduces after transcatheter closure of the atrial septal defect (ASD). Inverse structural and electrical remodeling is observed.The aim of study was to analyze the parameters predisposing to the lack of normalization of enlarged RA after transcatheter closure of ASD during 6-month follow-up.A prospective study included 56 consecutive adult patients (12 men) aged from 23 to 76 years (49.8±13.3 years) with ASD, in whom transcatheter ASD closure was performed. Each patient was assessed before and 6 months after the treatment using standard 12-lead resting electrocardiogram (ECG), 24-hour Holter monitoring and echocardiography.Before the procedure in 37 patients with ASD enlarged RA was observed, while after transcatheter ASD closure in 24 patients normalization of enlarged RA was noted. Patients in whom 6 months after the procedure there was no normalization of the enlarged RA were older, characterized by higher right ventricular systolic pressure (RVSP), pulmonary to systemic blood flow ratio (Qp/Qs), larger size of the occluder, interatrial septal defect, longer fluoroscopy time and lower left ventricular ejection fraction. P-wave dispersion (Pdysp) was found to be a destimulant i.e. increased Pdysp (67 ms, P0.000) decreased the chance of RA normalization after procedure. On the other hand, minimum P-wave duration (Pmin) was a stimulant, therefore, increased Pmin (72ms, P0.000) increased the chance of RA normalization. A significant association was found between the reduction of supraventricular extrasystolic beats and RA area normalization (P0.001), and there was no association between the incidence of atrial fibrillation episodes and RA area normalization.Evaluation of the duration of the P-wave and its dispersion may help to assess the prognosis of the right atrium size normalization in the mid-term follow-up after transcatheter closure of ASD. There is a significant relationship between normalization of the right atrium size and reduction of supraventricular extrasystolic beats.

INTRODUCTION A hemodynamic derangement in Fontan circulation causes liver pathology known as Fontan‑‑associated liver disease. Although liver biopsy is a standard for diagnosis of liver fibrosis, noninvasive methods are being developed, including shear wave elastography (SWE). OBJECTIVES We aimed to evaluate the degree of liver stiffness (LS) using SWE in patients with Fontan circulation in a long‑‑term follow‑‑up and to investigate a relationship between patient characteristics and LS. PATIENTS AND METHODS The study included 59 patients after the Fontan procedure. Clinical examinations and laboratory tests were performed. According to the stage of LS, patients were divided into 2 subgroups: group 1 (METAVIR stages F1 and F2) and group 2 (METAVIR stages F3 and F4). The ratio of aspartate transaminase to alanine transaminase, aspartate transaminase‑‑to‑‑platelet ratio index (APRI), fibrosis‑‑4 (FIB‑‑4) score, and Forns index were assessed. RESULTS The median LS was 9.1 kPa (interquartile range, 3.9-18.5 kPa). Five patients (9%) demonstrated LS in stage F1; 14 (26%), F2; 28 (52%), F3; and 7 (13%), F4. Group 2 had significantly higher aspartate transaminase and γ‑‑glutamyltranspeptidase levels, APRI, FIB‑‑4, and Forns index, and lower platelet count than group 1. A canonical correlation analysis indicated that LS and thrombocytopenia were related to time from the Fontan procedure, age at procedure, and single ventricular ejection fraction. CONCLUSIONS We showed that adult patients after the Fontan procedure develop liver dysfunction. Time from surgery, age at procedure, and single ventricular ejection fraction are related to the degree of LS assessed by SWE. Finally, SWE, APRI, Forns index, and FIB‑4 score may help assess the degree of liver fibrosis.

INTRODUCTION A hemodynamic derangement in Fontan circulation causes liver pathology known as Fontan‑‑associated liver disease. Although liver biopsy is a standard for diagnosis of liver fibrosis, noninvasive methods are being developed, including shear wave elastography (SWE). OBJECTIVES We aimed to evaluate the degree of liver stiffness (LS) using SWE in patients with Fontan circulation in a long‑‑term follow‑‑up and to investigate a relationship between patient characteristics and LS. PATIENTS AND METHODS The study included 59 patients after the Fontan procedure. Clinical examinations and laboratory tests were performed. According to the stage of LS, patients were divided into 2 subgroups: group 1 (METAVIR stages F1 and F2) and group 2 (METAVIR stages F3 and F4). The ratio of aspartate transaminase to alanine transaminase, aspartate transaminase‑‑to‑‑platelet ratio index (APRI), fibrosis‑‑4 (FIB‑‑4) score, and Forns index were assessed. RESULTS The median LS was 9.1 kPa (interquartile range, 3.9-18.5 kPa). Five patients (9%) demonstrated LS in stage F1; 14 (26%), F2; 28 (52%), F3; and 7 (13%), F4. Group 2 had significantly higher aspartate transaminase and γ‑‑glutamyltranspeptidase levels, APRI, FIB‑‑4, and Forns index, and lower platelet count than group 1. A canonical correlation analysis indicated that LS and thrombocytopenia were related to time from the Fontan procedure, age at procedure, and single ventricular ejection fraction. CONCLUSIONS We showed that adult patients after the Fontan procedure develop liver dysfunction. Time from surgery, age at procedure, and single ventricular ejection fraction are related to the degree of LS assessed by SWE. Finally, SWE, APRI, Forns index, and FIB‑4 score may help assess the degree of liver fibrosis.

BACKGROUND Atrial septal defect (ASD) and patent foramen ovale (PFO) are specific types of atrial septal communications (ASC). OBJECTIVES We aimed to assess quality of life (QoL) in patients before and after percutaneous closure of ASC and determine the factors influencing QoL in this group of patients. MATERIAL AND METHODS We performed a clinical assessment and conducted an SF-36 questionnaire, electrocardiography and echocardiography studies in patients before and 6 months after percutaneous ASC closure. RESULTS Patients with ASD (n = 56) had a lower SF-36 total score than those with PFO (n = 73), before and after percutaneous ASC occlusion (both p < 0.001). After the procedure, the improvement of SF-36 total score in patients with ASD or atrial fibrillation was greater (p < 0.001 and p = 0.005, respectively). We observed correlations between improvement of QoL and baseline supraventricular extrasystolic beats (rs = 0.28; p = 0.002), but not ventricular extrasystolic beats (rs = 0.03; p = 0.76). Quality of life improvement was predicted in patients with ASD by higher baseline tricuspid annular plane systolic excursion (TAPSE) and right ventricular longitudinal dimension R2 = 0.38; p < 0.001. However, in patients with PFO, this was predicted by TAPSE, lack of arterial hypertension and usage of angiotensin-converting enzyme inhibitors, R2 = 0.30; p < 0.001. CONCLUSIONS Patients with ASD have lower QoL than those with PFO before and after percutaneous ASC occlusion. Six months after the procedure, the improvement of QoL in patients with ASD was higher than in those with PFO. The change in QoL self-assessed by patients after the procedure was associated with episodes of arrhythmia and was predicted with echocardiographic and clinical parameters.

Background and purpose Atrial fibrillation (AF) has a progressive nature, leading to structural, functional, and electrical changes in the left atrium (LA). Enhanced response to treatment in patients with AF can be achieved through improved knowledge of atrial structure and a better understanding of its function. The aim of this study was to assess LA strain and its determinants in patients with paroxysmal (PAF), persistent (PsAF), and permanent AF (PmAF). Methods Fifty-eight patients with registered non-valvular AF were divided into 3 groups depending on the type of AF. The participants underwent transthoracic echocardiography to assess the anatomy and function of heart chambers. Left atrial longitudinal strain (LALS) was measured in four-chamber projections using two-dimensional speckle tracking echocardiography. Results Patients with PAF had higher LALS (15.7±12.0) when compared to those with PsAF (4.3±7.9) and PmAF (5.8±7.8, all P=0.003). Multiple linear regression showed that the independent predictors of LALS were diastolic blood pressure (β=0.95, R2=0.88) in the PAF group; left atrial area (β=-0.56) and creatinine (β=-0.63, R2=0.58) in the PsAF group; AF duration (β=0.89) in the PmAF group (R2=0.72). Conclusion LA strain has different determinants depending on AF type. LA size, renal function, and AF duration determine LALS in long-lasting AF. LA strain is a simple and accurate technique to estimate LA dysfunction in patients with long-lasting AF.

Background Tetralogy of Fallot (ToF) is the most common cyanotic congenital heart disease and the population of ToF repair survivors is growing rapidly. Adults with repaired ToF develop late complications. The aim of this study was to describe and analyze long-term follow-up of patients with repaired ToF. Methods This is a retrospective cohort study. Consecutive 83 patients with repaired ToF who did not undergo pulmonary valve replacement were included. Mean age of all patients was 30.5 ± 10.7. There were 49 (59%) male. Patients were divided into two groups according to the time since the repair (

Background: Atrial septal communications (ASCs) include atrial septal defects (ASDs) and patent foramen ovale (PFO). Aim: The purpose of this study was to assess P-wave dispersion (PWD) and the prevalence of arrhythmia in patients before and after ASC closure. Methods: We analysed the clinical history and performed 12-lead electrocardiograms, echocardiograms, and 24-h Holter electrocardiograms in patients with ASC, before and six months after ASC closure. Results: We included patients with ASD (n = 56) and PFO (n = 73). PWD before percutaneous ASC closure was predicted by right ventricular outflow tract (RVOT) proximal diameter, left atrial area, ASD, smoking, and paroxysmal dyspnoea, R2 = 0.67; p < 0.001. RVOT proximal diameter was an independent predictor of PWD, both in patients with ASD and PFO. Six months after successful closure of ASC, a reduction in PWD was observed in the whole group of patients as well as in patients with ASD and PFO considered separately. A decrease in PWD was associated with reduction of maximum P-wave duration. At the same time, in the whole group, we noticed a reduction in the number of supraventricular and ventricular extrasystolic beats and fewer atrial fibrillation (AF) episodes, p < 0.04 for all variables. Postprocedural AF episodes in patients with ASD were predicted by PWD of 80 ms. Conclusions: Percutaneous closure of ASC is associated with a reduction of PWD and fewer arrhythmia episodes six months after the procedure. PWD predicts AF episodes after ASD closure.

We discuss a 56‑year‑old man with Fabry disease (FD), a genetic X‑linked glycolipid storage disorder. The patient presented at the Emergency Room in a local hospital due to tachycardia‑associated chest pain, which had occurred occasionally in the past, but on that occasion was long‑lasting (>12h) and distressing. The patient had been diagnosed with FD at the age of 42. He presented a range of symptoms characteristic for the condition, including hypertrophic cardiac myopathy with impaired left ventricular relaxation, angiokeratomas, cornea verticillata, hypohydrosis and acroparesthesia. Residual alpha‑galactosidase A activity at diagnosis was ≈3%. The Enzyme Replacement Therapy (ERT) with the agalsidase alpha was induced. A year later pacemaker implantation was performed due to sick sinus syndrome with symptomatic, severe episodes of bradycardia. The initial diagnosis was tachycardia‑associated chest pain with troponin release in the context of FD left ventricular hypertrophy. However, a decision was made to perform an urgent angiographic evaluation to exclude coronary pathology as a potential factor in the clinical picture. Coronary angiography showed a critical, flow-limiting, stenosis of the left anterior descending artery (LAD) which changed the initial type 2 myocardial infarction (MI) diagnosis to the type 1 MI. Percutaneous stent‑assisted treatment was performed with an optimal angiographic and clinical outcome. However, 5 days later the patient developed a minor left hemispheric ischaemic stroke. In conclusion, the clinical course of a rare pathology such as FD may be importantly complicated by other (more common) pathologies. Physicians, in their diagnostic and therapeutic decision‑making, need to be open to thinking beyond the patient label. JRCD 2018; 3 (7): 246–252

Observations of patients after repair of tetralogy of Fallot (ToF) indicate good correction results and long-term survival. Few papers have been published in which the quality of life (QoL) of this population has been assessed.To evaluate QoL in adults with repaired ToF. .We included 39 patients with repaired ToF and 40 age- and sex-matched healthy volunteers. Information recorded included echocardiography, cardiac magnetic resonance, cardiopulmonary exercise test, and self-reported health-related QoL questionnaire (SF-36). .The perceived physical and mental domains of health were signi cantly poorer in ToF patients than in controls. A positive correlation between VOThe QoL in adults after repair of ToF and healthy control subjects was compared directly. The self-perceived physical and mental domains of health were significantly poorer in ToF patients than in controls. Strong associations were found between objective exercise capacity and physical aspects of quality of life. Complex assessment and quality of life instruments should be used together to obtain an accurate view of health status of patients with repaired ToF.Obserwacje chorych poddanych operacji korekcji tetralogii Fallota (ToF) wskazują na dobre wyniki korekcji oraz długoletnią przeżywalność pacjentów. Dotychczas opublikowano niewiele prac, w których oceniano jakość życia (QoL) tej populacji chorych.Ocena QoL dorosłych pacjentów po korekcji ToF.Do badania włączono 39 pacjentów po korekcji ToF oraz 40-osobową grupę kontrolną, równoważną pod względem wieku i płci. Ocenę kliniczną przeprowadzono na podstawie badania echokardiograficznego, rezonansu magnetycznego, testu spiroergometrycznego oraz kwestionariusza oceny jakości życia SF-36.Samoocena poszczególnych domen zdrowia fizycznego oraz psychicznego znacząco różniła się w grupie badanej i kontrolnej. Obserwowano pozytywną korelację między szczytowym VOPorównywano bezpośrednio jakość życia u dorosłych po korekcji ToF i zdrowych osób z grupy kontrolnej. Fizyczne i psychiczne obszary zdrowia były znacznie gorsze u pacjentów z ToF niż w grupie kontrolnej. Stwierdzono silny związek między obiektywną oceną wydolności fizycznej a fizycznymi aspektami QoL. Kompleksowa ocena QoL i obiektywnych narzędzi wydolności fizycznej powinna być używana jednocześnie w celu oceny statusu chorych po korekcji ToF.

Although 85% of patients with univentricular heart after Fontan procedure survive twenty years after operation, the procedure alone seems to be an inadequate treatment as a permanent clinical solution. Patients with a "Fontan physiology" additionally have to face a various extra-cardiac complications, including thyroid, liver and kidney dysfunction, which are not only potentially life-threatening, but also can potentiate the circulatory insufficiency.The aim of the study was to assess a multiorgan dysfunction in adult patients after Fontan operation in long term follow-up and compare to healthy controls.54 patients after Fontan procedure (age=25.1±7 years, time after operation =19.8±6.3 years, age at the time of the procedure =5.3±4.3 years) and 30 controls (26.2±5.8 years) were included to the study. Clinical and laboratory examinations were performed including: hematologic, hepatic, renal and thyroid function tests. The following laboratory tests were performed: red blood cell counts (RBC), hematocrit (Ht), hemoglobin (Hb), platelets count, red blood cell distribution width (RDW), iron level; Btype natriuretic peptide (NT-proBNP), proteinogram blood test, alanine aminotransferase (ALT), aspartate aminotransferase (AST), gammaglutamyl transpeptidase (GGTP), alkaline phosphatase (ALP), total bilirubin, alpha fetoprotein (AFP) level. Furthermore creatinine level; cystatin C, urine albumin to creatynine ratio (ACR) and urinalysis were assessed. To assess a thyroid function free triiodothyronine (fT3), free thyroxine (fT4) and thyroid stimulating hormone (TSH) were measured. Furthermore an abdomen ultrasonography was performed.In terms of the hematological disorders Fontan patients had a statistically significant higher level of RBC (5.6±0,8 vs 4.8±0.4 109/μl; p0,001), Hb (16.5±2.8 vs 14.2±1.2 g/dl; p0,001), HCT (48.7±8.1 vs 42.1±3 %; p0,001), RDW (14±2.6 vs 12.8±0.5 %; p=0.001), as compared to control group, while PLT level was statistically lower in Fontan group (156.2±61.4 vs 224.2±48 103/μl; p0,0001). Hepatic parameters in Fontan patients were statistically significant higher, as depicted by the level of: ALT (28.5±10.5 vs 21.5±6 U/l, p0,001), GGTP (85.6±48.8 vs 19.3±9 U/ l, p0,001), total bilirubin (26.6±24.8 vs 8.9±4.7 μmol/l; p0,001), ALP (82.4±31.5 vs 51.2±16 U/l; p0,001) and INR (1.21±0.3 vs 0.98±0.2; p0,001). Other parameters such as: AFP, total protein and albumin level did not statistically significantly differ. Additionally five patients (9%) according to clinical symptoms and serum albumin level were diagnosed protein-losing enteropathy (PLE). There was no difference in serum creatinine level between Fontan patients and control group (79.6±23.6 vs 75.9±18.9 μmol/l; p=0.8) as well as in uric acid level (342.7±102 vs 303±105 μmol/l; p=0.2). Cystatin C level was significantly higher in Fontan group in comparison to controls (1.1±0.6 vs 0.8±0.1 ng/ml; p=0,05). Furthermore four Fontan patients (7%) had abnormal microalbumin/creatynine ratio. Urine testing preformed in 30 Fontan patients pointed to 7 cases (23%) where hematuria was observed, while proteinuria was detected in 4 cases (13%) and urobilinogen in 2 (7%). Dysfunction of the thyroid gland was found in 30% of patients after Fontan operation (7% in the control group, p=0,034). Among disorders of the thyroid gland: 13% of patients were diagnosed with hyperthyroidism, 54% diagnosed with subclinical hypothyroidism, and the remaining 33% with hypothyroidism.Our study show that adult patients after Fontan procedure in long-term follow are exposed to multiorgan complications including hematological, liver, kidney and thyroid dysfunction.

Exertional dyspnea is a common manifestation of sarcoidosis. Cardiopulmonary exercise testing (CPET) is a useful tool to evaluate exercise tolerance of sarcoid patients.The aim of the study was to evaluate of exercise capacity in patients with pulmonary sarcoidosis with regard to duration of the disease. Analysis of differences in physical tolerance between patients with cardiac sarcoidosis and without cardiac sarcoidosis.39 patients diagnosed with pulmonary sarcoidosis were enrolled to our study. Cardiopulmonary exercise test was used to assess exercise capacity. According to time passed from diagnosis of sarcoidosis patients were grouped into 2 groups. Cardiac sarcoidosis was diagnosed in 9 subjects (23.07%). The control group consisted of 33 healthy volunteers.The results of the ergospirometry test in patients with lung sarcoidosis showed statistically significant differences in comparison to the control group. The age of patients with pulmonary sarcoidosis correlated negatively with maximal heart rate, oxygen consumption at peak exercise and at anaerobic threshold, breathing frequency at peak exercise, minute ventilation at peak exercise and metabolic equivalent. There was a negative, statistically significant correlation between the oxygen pulse at the peak of exercise and the treatment of steroids in the past.Exercise limitation in patients with pulmonary sarcoidosis is a consequence of both ventilatory and cardiocirculatory impairment. Patients with longer disease history of sarcoidosis achieved worse results at cardiopulmonary exercise test than patients with shorter disease history. Trend towards worse exercise tolerance in patients with cardiac sarcoidosis compared to patients without cardiac sarcoidosis was observed.

Sarcoidosis is a systemic, granulomatous disease of unknown etiology. Cardiac involvement in the course of sarcoidosis occurs in 5% of patients. However, about 25% of patient with systemic/pulmonary sarcoidosis might present with asymptomatic myocardial injury. The main manifestations of cardiac sarcoidosis are conduction abnormalities, ventricular arrhythmias and heart failure. Diagnosis of cardiac sarcoidosis remains a challenge for physicians. Treatment should be introduced at the time of diagnosis to prevent potentially lethal progression of cardiac disease. Steroids are the first drugs of choice. Additional anti‑sarcoidosis agents are used as alternatives or to reduce the steroids dose. Some patients require implantation of a cardioverter‑defibrillator for the prevention of sudden cardiac death. Patients with refractory ventricular tachyarrhythmia or severe, intractable heart failure unresponsive to optimal pharmacotherapy, require heart transplantation. Prognosis in cardiac sarcoidosis is highly variable, dependent on location and severity of heart involvement. This article reviews current diagnostic and therapeutic recommendations for cardiac sarcoidosis. JRCD 2017; 3 (2): 37–43

Sarcoidosis is a systemic inflammatory disease characterized by the presence of noncaseating granulomas. Etiology of the disease remains unknown. From 3.7% to 54.9% patients with extra‑cardiac sarcoidosis have asymptomatic heart involvement. Conduction abnormalities, arrhythmias and congestive heart failure are the most common clinical manifestations of cardiac sarcoidosis (CS). The aim of the study was to evaluate the type and frequency of electrocardiographic abnormalities in patients with pulmonary sarcoidosis and to compare differences in the occurrence of electrocardiographic changes between patients diagnosed with CS and patients without confirmation of CS. Materials and methods : 49 patients (18 women, 31 men), mean age 45.6 ±12.2 years with biopsy‑proven pulmonary sarcoidosis were enrolled in the study. The patients were divided into two groups. Group 1 consisted of 12 patients diagnosed with CS, and Group 2 of 37 patients without diagnosis of CS. 12‑lead baseline electrocardiogram (ECG) was recorded for all participants. Results : 89.8% patients with pulmonary sarcoidosis had abnormal ECG. The most common ECG abnormalities were ST‑T changes observed in 79.6%. Conduction abnormalities were present in 26.5% of patients. 22.45% patients had left axis deviation. Rhythm abnormalities were recorded in 20.4% of all analyzed ECGs. ECGs of 8.16% of patients met criteria of hypertrophy. There was a trend towards more frequent prevalence of some ECG changes in patients with CS than patients without CS. However, these differences were not statistically significant. Conclusions : We observed a trend towards more frequent prevalence of some ECG abnormalities in a group of patients with CS than in patients without CS. However, these differences were not statistically significant. ECG abnormalities in patients with pulmonary sarcoidosis require further diagnostics. JRCD 2017; 3 (3): 81–85

Background Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital cardiac anomaly which requires surgical treatment, which improves left ventricular function and clinical outcomes. The definitive diagnosis of ALCAPA is based on coronary angiography, however, noninvasive visualization of the origin of the coronary artery is often helpful in the diagnosis of ALCAPA. Objectives The purpose of this study was to evaluate noninvasive techniques for the diagnosis of ALCAPA, and present the clinical outcomes in adults after surgical correction of ALCAPA. Methods Medical charts of five patients with ALCAPA treated at the John Paul II Hospital in Cracow between 2004 and 2012 were analyzed retrospectively. Noninvasive imaging techniques were used to visualize coronary vessels preoperatively. Patients were followed one year after the operation with echocardiograms and assessment of the New York Heart Association functional class. Results Computed tomography showed ALCAPA in four patients. Magnetic resonance imaging showed abnormal left ventricle remodeling suggestive of ischemia of the anterior cardiac wall. Myocardial perfusion imaging revealed ischemia of the middle and periapical segments of the anterior and anterolateral wall of the left ventricle in two patients. Postoperatively, patients had symptomatic improvement, but there was no statistically significant difference in mean ejection fraction. Conclusions Noninvasive techniques can be used to visualize the origin of the coronary arteries and characterize their morphology. Long-term follow-up of adult patients after surgical correction of ALCAPA is not well documented in the literature, but surgical treatment revealed beneficial short-term effects and symptoms relief.

BackgroundGrowing evidence indicates that iron-deficiency anemia is common in patients with congenital heart diseases.The aim of this study was to characterize hematologic changes and iron metabolism in adult Fontan patients. We also searched for the associations between these parameters and physical performance in the study group.Methods and resultsThirty-two white Fontan patients with a mean age of 25±4.5 years and 30 healthy control subjects matched for age and sex were studied. Complete blood count together with iron-related parameters was determined in plasma of peripheral venous blood. The cardiopulmonary exercise test was performed.The Fontan patients had higher red blood cell counts (6.0±2.1×109/μl vs. 4.8±0.4×109/μl, p

Background— Effective progenitor cell recruitment to the ischemic injury zone is a prerequisite for any potential therapeutic effect. Cell uptake determinants in humans with recent myocardial infarction are not defined. We tested the hypothesis that myocardial uptake of autologous CD34 + cells delivered via an intracoronary route after recent myocardial infarction is related to left ventricular (LV) ejection fraction (LVEF) and infarct size. Methods and Results— Thirty-one subjects (age, 36–69 years; 28 men) with primary percutaneous coronary intervention–treated anterior ST-segment–elevation myocardial infarction and significant myocardial injury (median peak troponin I, 138 ng/dL [limits, 58–356 ng/dL]) and sustained LVEF depression at ≤45% were recruited. On day 10 (days 7–12), 4.3×10 6 (0.7–9.9×10 6 ) 99m Tc-extametazime–labeled autologous bone marrow CD34 + cells (activity, 77 MBq [45.9–86.7 MBq]) were administered transcoronarily (left anterior descending coronary artery). 99m Tc-methoxyisobutyl isonitrile (99 m Tc-MIBI) single-photon emission computed tomography before cell delivery showed 7 (2–11) (of 17) segments with definitely abnormal/absent perfusion. Late gadolinium-enhanced infarct core mass was 21.7 g (4.4–45.9 g), and infarct border zone mass was 29.8 g (3.9–60.2 g) (full-width at half-maximum, signal intensity thresholding algorithm). One hour after administration, 5.2% (1.7%–9.9%) of labeled cell activity localized in the myocardium (whole-body planar γ scan). Image fusion of labeled cell single-photon emission computed tomography with LV perfusion single-photon emission computed tomography or with cardiac magnetic resonance infarct imaging indicated cell uptake in the peri-infarct zone. Myocardial uptake of labeled cells activity correlated in particular with late gadolinium-enhanced infarct border zone mass ( r =0.84, P r =0.76, P r =0.45, P =0.008) and late gadolinium-enhanced infarct core ( r =0.58 and r =0.84, P r =−0.07, P =0.68) or gated single-photon emission computed tomography LVEF ( r =−0.28, P =0.16). The correlation with cardiac magnetic resonance imaging-LVEF was weak ( r =−0.38; P =0.04). Conclusions— This largest human study with labeled bone marrow CD34 + cell transcoronary transplantation after recent ST-segment–elevation myocardial infarction found that myocardial cell uptake is determined by infarct size rather than LVEF and occurs preferentially in the peri-infarct zone.

Background: Despite the low early mortality of Fontan procedures, Fontan patients are prone to vari­ous cardiac and extra-cardiac complications in the long term. This may influence patient perception of their health and outcome. The aim of the study was to assess the relationship of multi-organ compli­cations and physical efficiency with self-reported health-related quality of life (QOL) in adult Fontan patients. Methods: Quality of life was assessed with the Short Form-36 questionnaire. Laboratory tests were done together with echocardiography, plethysmography, and cardiopulmonary exercise test. Results: The QOL was poorer in patients than in control subjects. The physical characteristics of patients correlated with dynamic ventilatory parameters, heart rate at the peak of exercise, alanine aminotransferase and albumin level. Conclusions: Liver impairment and chronotropic incompetence during exercise are associated with poor QOL in patients after Fontan procedure. In these patient, hepatic, pulmonary and cardiac functions should be carefully monitored. (Cardiol J 2018; 25, 1: 72–80)

Sarcoidosis is a multisystem inflammatory disease defined histologically by the formation of noncaseating granulomas. The etiology of sarcoidosis remains unknown. Heart involvement in the course of sarcoidosis concerns about 5% of patients. The most common manifestation of cardiac sarcoidosis are conduction abnormalities, arrhythmias and heart failure. The diagnostic algorithm includes performing a clinical history, a 12-lead electrocardiogram (ECG) and an echocardiogram. If any of the initial screening investigations yields an abnormality, diagnostics should be continue using advanced imaging techniques: cardiovascular magnetic resonance (CMR) or fluorodeoxyglucose positron emission tomography (FDG-PET). Nowadays endomyocardial biopsy is not performed routinely.The clinical picture of cardiac sarcoidosis is highly variable. Screening for cardiac sarcoidosis should be performed in all patients diagnosed with extracardiac sarcoidosis. Cardiac sarcoidosis should also be suspected in young patients without a diagnosis of sarcoidosis who present with conduction abnormalities of unknown etiology, because cardiac sarcoidosis may be the first or the only manifestation of the disease.

The role of autoimmune factors in the etiology of coronary artery disease (CAD) was suggested in numerous studies but has not been definitively determined.To assess the possible influence of antiphospholipid and antinuclear antibodies on atherosclerosis development in young patients after myocardial revascularization procedures.The study group included 39 patients younger than 45 years with CAD who underwent myocardial revascularization. Serum levels of antiphospholipid (aPL), antinuclear (ANA) and antineutrophil cytoplasmatic (ANCA) antibodies were tested within 1 month after the procedure.All three types of aPL were significantly higher in CAD patients when compared to healthy controls: anti-β2-glycoprotein I (aβ2GPI), both immunoglobulin (Ig)G and IgM classes (median 4.10 SGU, range 3.45-21.63 vs. 0.76, 0.12-6.01, P0.001, and 2.82 SGU, 1.44-11.70 vs. 1.08, 0.44-3.64, P0.001, respectively); anticardiolipin antibodies (aCL) both IgG and IgM classes (3.13 GPL, 1.32-14.03 vs. 2.42, 0.96-18.45, P = 0.0037, and 6.94 MPL, 1.90-26.40 vs. 4.32, 1.9-28.73, P0.008, respectively); and lupus anticoagulant (LA) (27.7% vs. 0%, P = 0.005). ANA were elevated in one patient and ANCA in 23 (60%). The levels of aPL did not correlate with the presence of a clot in a coronary vessel detected during angiography or with exacerbation of coronary artery atherosclerosis.In young patients with CAD who underwent myocardial revascularization the levels of aPL were significantly higher than in young healthy subjects. Thus, besides the classic risk factors for CAD, autoimmunity may play an important role in atherosclerotic plaque formation and progression.

The presented case report illustrates a rare and unexpected cause of tachycardia and exercise tolerance reduction in a young patient with noncoronary sinus of Valsalva aneurysm rupture. The patient was referred to our hospital due to complaints of palpitation, dyspnoea and severe reduction of exercise tolerance of acute onset. Transthoracic echocardiography revealed a shunt between aorta and right atrium, moderate aortic and tricuspid regurgitation and signs of hyperkinetic circulation. Transesophageal echocardiogram confirmed the presence of ruptured aneurysm. The patient was consulted by a local multidisciplinary Heart Team and referred for cardiac surgery, after which he recovered without any complications. JRCD 2016; 3 (1): 17–19

Background: The aim of Fontan procedure is to restore a balance between pulmonary and systemic circulation and improve or nearly normalize arterial saturation in patients with functionally univentricular heart. Nevertheless, due to the lack of subpulmonary pump, the circulatory system becomes haemodynamically less efficient, what can lead to the impairment of exercise capacity. Aim: The aim of the study was to investigate exercise capacity by means of cardiopulmonary exercise test and pulmonary function tests, of 37 adult Fontan patients with regard to the time passed from the index procedure. The patients were divided into 3 groups: group I – up to 15 years post procedure; group II – 16–20 years, group III – more than 20 years after Fontan procedure). Results: 37 Fontan patients (mean age was 24.4 ±5.7 years, 40% of women) were enrolled in the study. The mean postoperative time was 19.4 ±5.1 (13–30) years. Mean, peak oxygen consumption (VO2peak) was 22.7 ±7.1 ml/kg/min (64.2 ±18.5% of predicted value). According to postoperative time a significant increase of ventilatory equivalent of carbon dioxide (VE/VCO2) (p = 0.033) and significant decrease of forced expiratory volume in 1 s/ vital capacity (FEV1%VC) between group 2 and 3 (p = 0.026) were observed. Additionally, the age of the patients correlated negatively with and heart rate (HR) (r = -0.360, p

Aims: The aim of this study was to analyze the incidence of long-term complications observed during follow-up of patients who had undergone the Ross procedure in childhood. Methods: The study engaged a cohort of 9 patients, all of whom were between 19 to 32 years old. Patients had been in the care of the Centre for Rare Cardiovascular Diseases since the age of 18. Clinical and echocardiographic data were collected from the follow-up period. Results: 78% of patients had preserved global systolic function of the left ventricle, and 56% had dilatation of the ascending aorta. Due to the aneurysm of the ascending aorta one patient required the Bentall de Bono procedure. Another patient underwent a reoperation because of endocarditis of the pulmonary homograft with severe aortic and pulmonary regurgitation. 1/3 of the studied patients were being considered for a reoperation. 23% of patients developed severe pulmonary valve regurgitation, 33% moderate. 67% of patients developed mild to moderate pulmonary valve stenosis. Most patients were in NYHA class I-II. Conclusion: Late complications are frequent in this group of patients, and hence they require surveillance in specialized Centers for Grown-up Congenital Heart Diseases. JRCD 2016; 3 (1): 9–13

Background For transcoronary progenitor cells’ administration, injections under flow arrest (over-the-wire balloon technique, OTW) are used universally despite lack of evidence for being required for cell delivery or being effective in stimulating myocardial engraftment. Flow-mediated endothelial rolling is mandatory for subsequent cell adhesion and extravasation. Methods To optimize cell directing toward the coronary endothelium under maintained flow, the authors developed a cell-delivery side-holed perfusion catheter (PC). Thirty-four patients (36-69 years, 30 men) with primary stent-assisted angioplasty-treated anterior MI (peak TnI 151 [53-356]ng/dL, mean[range]) were randomly assigned to OTW or PC autologous 99Tc-extametazime-labeled bone marrow CD34+ cells (4.34 [0.92-7.54] × 106) administration at 6-14 days after pPCI (LVEF 37.1 [24-44]%). Myocardial perfusion (99mTc-MIBI) and labeled cells’ activity were evaluated (SPECT) at, respectively, 36-48 h prior to and 60 min after delivery. Results In contrast to OTW coronary occlusions, no intolerance or ventricular arrhythmia occurred with PC cells’ administration (P

Objective: This study aimed to assess the role of myocardial contrast echocardiography (MCE) as a predictor of cardiac events and death in patients with acute myocardial infarction (AMI). Methods: Eighty-six patients underwent primary percutaneous coronary angioplasty for AMI. Segmental perfusion was estimated by MCE in real time at mean 5 days after PCI using low MI (0.3) after 0.3–0.5 ml bolus injection of intravenous Optison. MCE was scored semiquantitatively as: (1) normal perfusion (homogenous contrast effect), (2) partial perfusion (patchy myocardial contrast enhancement), (3) lack of perfusion (no visible contrast effect). A contrast score index (CSI) was calculated as the sum of MCE scores in each segment divided by the total number of segments. The patients were followed up for cardiac events and death. Results: A CSI of >1.68 was taken to be a predictor of cardiac events and death. Death occurred only in patients with CSI >1.68. Patients with CSI >1.68 had a significantly (P = 0.03) higher incidence of cardiac death or cardiac events (75%) compared to those with CSI

Aims To evaluate right-ventricular (RV) function during stress echocardiography (SE) and to assess its relationship with exercise capacity in heart failure (HF) patients. Methods and results We included 88 patients aged 60.9 ± 11.2 years with a mean LVEF of 27.2 ± 9.5%. The following RV parameters were measured at baseline and peak exercise during semi-supine SE: velocity (IVV) and acceleration during isovolumic contraction (IVA), S′, E′, A′, and ratio of early diastolic tricuspid velocity to E′ (E/E′) and longitudinal strain and strain rate. Patients were stratified into two groups according to their VO2peak values: group 1 (n = 35) with VO2peak

Objective: Closure of the atrial septal defect in the elderly patients is controversial. The aim of the study was to evaluate the outcomes of transcatheter closure of secundum atrial septal defect (ASD) in elderly patients. Methods: From a total of 488 patients with ASD who underwent transcatheter closure 15 pts over 70 years (10 females, 5 males) with a mean age of 75.3 ±12.7 (70–79) were analyzed. All patients had an isolated secundum ASD with a mean Qp:Qs: 3.01 ±1.9 (2.6–3.9). A symptom-limited treadmill exercise tests with respiratory gas exchange analysis and transthoracic color Doppler echocardiographic study as well as Quality of life (QoL) measured using the SF36 questionnaire (SF36q) were repeated in all patients before procedure and after 12 months of follow-up. Results: The atrial septal occluder (ASO) device was successfully implanted in all patients (procedure time 29.7±6.5 (14–59) minutes, fluoroscopy time 13.2 ±9.3(6–40) minutes). There were no major complications. The defect echo diameter was 21.7± 15.8 (18–33) mm. The diameter of the implanted devices ranged 20 – 36 mm. After 12 months of ASD closure, all the patients showed a significant improvement of exercise capacity parameters. Seven QoL parameters (except mental health) improved at 12 months follow up compared to their baseline data. The right ventricular dimension decreased (p