•Data on atrial appendages' mechanics as predictors of AF recurrence after PVI is scarce.•3D and 2D-TEE have potential to provide additional data on LAA function.•Patients with AFR had significantly ...lower LAA tissue velocity and ostium surface area.•RAA tissue velocity and SVC ostium surface area were not correlated to AF recurrence.
Although there are numerous studies reflecting predictors of atrial fibrillation (AF) recurrence (AFR) after pulmonary vein isolation (PVI), data on atrial appendages' mechanics is scarce. This study aimed to assess atrial appendages' mechanics by 2-dimensional (2D) and 3-dimenssional (3D) transoesphageal echocardiography (TEE) and to explore its value to predict AFR after PVI.
Consecutive patients with paroxysmal AF undergoing first PVIwere analysed. 3D and 2D-TEE with tissue Doppler imaging (TDI) and strain analysis was obtained prior to the PVI, including: left atrial appendage (LAA) TDI and strain analysis, LAA ostium surface area, right atrial appendage’s TDI velocity and superior vena cava (SVC) ostium surface area. The primary end-point was freedom from any documented recurrence of atrial arrhythmia lasting > 30 s.
This single-centre, prospective study included 74 patients with paroxysmal AF (median age 59 years; 36% female; BMI 27.4 ± 4.1 kg/m2, LA volume index 32 ± 11 mL/m2). After a median follow-up of 14 (IQR 10–22) months, 21 (28%) patients had AFR. In a univariate and multivariate Cox-regression analysis LAA TDI velocity (HR 1.48, 95%CI 1.28–1.62, p < 0.001) and LAA ostium surface area(HR 1.58, 95%CI 1.06–1.81, p = 0.033) both independently predicted AFR after single PVI. RAA TDI velocity and SVC ostium surface area were not correlated to AFR.
Paroxysmal AF patients with lower LAA TDI tissue velocity and LAA ostium surface area have higher risk of developing AFR after PVI. To our knowledge, this is the first study assessing atrial appendages’ mechanics in predicting AFR after PVI.
Clinical trial registration: www.drks.de(Identifier: DRKS00010495)
Background. Spontaneous recanalization of a chronically occluded artery is rare and reported anecdotally. Case Summary. We report a case of a patient with a chronically occluded right coronary ...artery, found on a coronary angiography performed due to acute ST elevation myocardial infarction with an occluded circumflex artery as a culprit lesion. Three months later, a follow-up angiography was performed and a recanalization of the occluded right coronary artery was detected. Discussion. There is a possibility that intrinsic fibrinolytic mechanisms with the additional effect of standard antithrombotic drugs administrated after the acute coronary event led to the recanalization.
•Macrotroponin complex is a probable cause of false-positive hsTnI on Alinity i.•In case of suspected falsely elevated hsTnI concentrations, it is recommended to follow the guidelines of the ...International Federation of Clinical Chemistry Committee on Clinical Applications of Cardiac Biomarkers.•Elevated hsTnI requires interpretation in the specific clinical context.
Elevated troponin levels are often indicative of various cardiac diseases; however, analytical interference can lead to false positive troponin concentrations. We present the case of a 48-year-old female patient with persistently falsely elevated high sensitivity troponin I (hsTnI) probably caused by the presence of macrotroponin. Laboratory testing included determination of hsTnI using various analytical methods, serial dilutions and determination of heterophilic antibodies and other autoimmune antibodies. Only precipitation with polyethylene glycol (PEG) indicated the presence of an interference by causing a significant decrease in hsTnI concentration.
Our results suggest that the falsely elevated hsTnI concentration could be due to interference with the macrotroponin complex.
Background—Current guidelines do not recommend routine use of transesophageal echocardiography (TOE) in anticoagulated patients with atrial fibrillation (AF). The aim of our study was to identify ...predictors for left atrial thrombosis (LAT) in patients with AF that would require TOE despite anticoagulation therapy, using clinical, laboratory and echocardiographic data which are usually obtained in those patients in a real-world setting. Methods—We analyzed data from electronic medical records (EMR) of consecutive AF patients referred to two university hospitals between January 2014 and December 2017 for pulmonary vein isolation (PVI) or direct current cardioversion. The primary endpoint was the presence of left atrial thrombus on TOE. Multivariable and univariable logistic regression models were computed using variables that were significantly different between the LAT and the control groups. Results—A total of 838 patients were included, of whom 132 (15.8%) had LAT. After controlling for other variables, only the left ventricle ejection fraction (LVEF) remained statistically significant with an OR of 0.956 (95% CI 0.934−0.979), p < 0.01. Regression models including LVEF had significantly higher areas under the receiver operating characteristic (ROC) curves, including in subgroups with non-high thromboembolic risk (CHA2DS2-Vasc = 0 or 1), with an area under the curve (AUC) of 0.76 (95% CI 0.71−0.81), p < 0.0001. Conclusions—The LVEF is an independent predictor of LAT, and it might improve thromboembolic risk stratification in future models. LVEF significantly increased the predictive value of the CHA2DS2-Vasc model and was able to identify LAT in non-high-risk patients.
The aim of this study was to analyze hemodynamic changes in hypertensive and normotensive patients undergoing total hip or knee replacement in spinal and general anesthesia. Eighty patients who ...underwent total hip or knee replacement surgery in the period between July 2010 and February 2011 at Sveti Duh University Hospital were retrospectively evaluated. Seventeen patients underwent the operation in general anesthesia and 63 patients in regional anesthesia. They were allocated into groups of normotensive (n=24) or hypertensive patients (n=56). The anthropologic and hematologic parameters of normotensive and hypertensive patients were compared, as well as their blood pressures immediately before and during the operation. Blood pressure immediately before anesthesia induction, the highest and the lowest intraoperative blood pressures were recorded. Blood pressure immediately before anesthesia induction was significantly higher in hypertensive patients who underwent the operation in regional anesthesia compared to normotensive patients (158.48 mm Hg vs. 144.71 mm Hg, P<0.01). The highest intraoperative systolic blood pressure was also significantly higher in hypertensive patients operated on in regional anesthesia compared to normotensive patients (161.20 mm Hg vs. 146.76 mm Hg, P<0.01). The difference between the highest and the lowest intraoperative systolic blood pressure was significantly greater in hypertensive patients undergoing the operation in regional anesthesia compared to normotensive patients (46.41 mm Hg vs. 35.88 mm Hg, P<0.05). The results presented in this paper indicate that the fluctuations of intraoperative blood pressure were greater and the highest intraoperative systolic blood pressure was higher in hypertensive compared to normotensive patients undergoing the operation in regional anesthesia. In our study, there were no significant differences in intraoperative blood pressure between hypertensive and normotensive patients who underwent the operation in general anesthesia.
Heart failure is the leading cause of morbidity and mortality worldwide, with ischemic heart disease being one of the most important etiologic factors. Heart failure develops due to ventricular ...remodeling, which leads to increases in left ventricular end-systolic and end-diastolic volumes. In this prospective observational study, we included 101 patients with first episode of ST-segment elevation myocardial infarction in whom percutaneous coronary intervention was conducted within 12 h and Thrombolysis in Myocardial Infarction III flow was achieved. The aim was to determine which clinical and biochemical parameters can help predict pathologic ventricular remodeling 1 year after myocardial infarction. We created a nomogram based on routinely used blood tests and vital parameters which showed highest correlation with pathologic ventricular remodeling. The nomogram included NTproBNP value 12 h after reperfusion, aspartate transaminase value 12 h after reperfusion, systolic blood pressure value on admission, and culprit coronary artery. We performed ROC analysis which yielded great predictive value of the nomogram. The area under curve was 0.907 (95% CI 0.842-0.973). The nomogram value of -3.54 had 91.4% sensitivity and 74.0% specificity. We believe that this nomogram, once validated, could offer a widely available, low-cost option that would help identify patients at risk of developing pathologic left ventricular remodeling and achieve this at a very early stage of myocardial infarction (12 h after reperfusion has been achieved).
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