Left ventricular hypertrophy, especially concentric hypertrophy, has been shown to be an independent factor of cardiovascular diseases in patients with hypertension. Obstructive sleep apnea (OSA) ...and/or metabolic syndrome (MS) are common in patients with resistant hypertension (RHTN). The aim of this study was to evaluate factors associated with concentric hypertrophy in patients with RHTN. Data from 155 patients (92M, 63F) was analyzed. All patients underwent a thorough examination including: biochemical evaluations, ambulatory blood pressure monitoring, polysomnography and echocardiography. MS was defined by The Adult Treatment Panel III. Clinically significant OSA was defined as apnea/hypopnea index (AHI)>15 events per hour. Left ventricular mass index (LVMI) and relative wall thickness (RWT) were calculated. Four types of LV geometry were distinguished based on the LVMI and RWT. Patients were divided into four groups based on the LV geometric patterns: group 1 (normal geometry) (n=38, 24.4%); group 2 (concentric remodeling) (n=40, 25.8%); group 3 (eccentric hypertrophy) (n=26, 16.8%); and group 4 (concentric hypertrophy) (n=51, 33%). MS was found in 64% and OSA (AHI>15) in 43.2% of patients. Factors independently associated with concentric hypertrophy were: age (OR-1.51; 95% CI-1.00-2.27; P<0.04), OSA>15 events per hour (OR-2.73; 95% CI-1.26-5.93; P=0.01) and nighttime systolic blood pressure (SBP) (OR-1.69; 95% CI-1.32-2.17; P=0.0001). Concentric hypertrophy was the most common type of left ventricular disorder in patients with RHTN. Nighttime SBP and clinically significant OSA were independently associated with concentric hypertrophy in patients with RHTN.
Composite materials made of glass and carbon fibres have revolutionised many industries. Demand for composites is experiencing rapid growth and global demand is expected to double. As demand for ...composites grows it is clear that waste management will become an important issue for businesses. Technically composite materials evoke difficult recycling challenges due to the heterogeneity of their composition. As current waste management practices in composites are dominated by landfilling, governments and businesses themselves foresee that this will need to change in the future. The recycling of composites will play a vital role in the future especially for the aerospace, automotive, construction and marine sectors. These industries will require different recycling options for their products based on compliance with current legislation, the business model as well as cost effectiveness. In order to be able to evaluate waste management strategies for composites, a review of recycling technologies has been conducted based on technology readiness levels and waste management hierarchy. This paper analyses 56 research projects to identify growing trends in composite recycling technologies with pyrolysis, solvolysis and mechanical grinding as the most prominent technologies. These recycling technologies attained high scores on the waste management hierarchy (either recycling or reuse applications) suggesting potential development as future viable alternatives to composite landfilling. The research concluded that recycling as a waste management strategy is most popular exploration area. It was found mechanical grinding to be most mature for glass fibre applications while pyrolysis has been most mature in the context of carbon fibre. The paper also highlights the need to understand the use of reclaimed material as important assessment element of recycling efforts. This paper contributes to the widening and systematising knowledge on maturity and understanding composites recycling technologies.
•A review of composites recycling practices was performed in the context of TRL's.•Mechanical grinding is the most mature glass fibre recycling technology.•Pyrolysis is the most mature carbon fibre recycling technology.
We present the case of a 60-year-old man who was successfully treated for obstructive fungal infective endocarditis of the ascending aorta caused by Geotrichum capitatum. This extremely rare cause of ...fungal infective endocarditis required surgical and prolonged medical management, facilitated by effective multidisciplinary cooperation. (Level of Difficulty: Intermediate.)
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Abstract
Aims
Patients with systemic right ventricles are at high risk of sudden cardiac death. Arrhythmia is a significant risk factor. Routine Holter monitoring is opportunistic with poor ...adherence. The aim of this study was to determine if continuous rhythm monitoring with an implantable loop recorder (ILR) could allow early detection of clinically important arrhythmias.
Methods and results
Implantable loop recorder implantation was offered to patients with atrial switch repair for transposition of the great arteries. Recordings were made with symptoms or, automatically for pauses, significant bradycardia or tachycardia and reviewed by the multi-disciplinary team. Twenty-four out of 36 eligible patients underwent ILR implantation with no complication. Forty-two per cent had preserved ventricular function, 75% were NYHA functional class I, 88% had low sudden cardiac death risk, 33% had previous intra-atrial re-entrant tachycardia (IART), and none had known conduction disease. Eighteen out of 24 (75%) patients made 52 recordings (52% automated) over 39.5 months (1.6–72.5). Thirty-two out of 52 (62%) recordings in 15/24 (63%) of the cohort were clinically significant and included sinus node disease (two patients), atrioventricular block (two patients), IART (seven patients), and IART with sinus node disease or atrioventricular block (four patients). Implantable loop recorder recordings prompted medication change in 11 patients beta-blockers (n = 9), anti-coagulation (n = 5), and stopping anti-coagulation (n = 1) and device therapy recommendation in seven patients five pacemakers (three: atrioventricular block) and two defibrillators. Two patients declined intervention; one suffered an arrhythmic death. Intra-atrial re-entrant tachycardia and clinically relevant conduction disease were detected in patients irrespective of sudden cardiac death risk.
Conclusion
Continuous monitoring with an ILR in patients with systemic right ventricle following atrial switch detects clinically relevant arrhythmias that impact decision-making. In this cohort, clinically relevant arrhythmias did not correlate with sudden cardiac death risk.
Graphical Abstract
Graphical Abstract
Heart failure (HF) is the leading cause of death in adults with congenital heart disease (ACHD). Heart transplantation can be an effective therapy for them, albeit unfavourable anatomy, end-organ ...damage, pulmonary vascular disease, HLA sensitization and lack of robust selection criteria currently limit its application.
Consecutive CHD patients considered for heart or combined heart and lung transplantation at our tertiary ACHD centre between 2000 and 2018 constitute our study population. Baseline characteristics and outcome, including transplantation and death, were obtained for all patients from designated databases, medical records and the UK Office for National Statistics.
From a total of more than 9000 active ACHD patients under follow-up, 166 (median age 40.4 years) fulfilled inclusion criteria, with a broad spectrum of underlying diagnosis: univentricular heart 22.3%, systemic right ventricle 22.3%, systemic-to-pulmonary shunts and Eisenmenger syndrome 16.3%, left sided valvular lesions 14.5%, tetralogy of Fallot 12.7%, CHD associated with cardiomyopathy 4.8% and other 7.2%. There was a high overall mortality with 39.2% of patients dying over a median follow-up of 2.7 years. A minority of patients (22.9%) were eventually listed and only 13.3% from the 166 patients were actually transplanted. Survival at 1 year after transplantation was 81.8% and remained high long-term (65.5% at 15 years). We describe herewith in detail characteristics and outcome of our cohort and present the transplantation pathway followed.
Of the small number of patients with ACHD considered for heart transplantation at a large tertiary centre, there was high overall mortality, with only a fraction of patients being actually transplanted. Patients who received transplantation, however, had a good outcome. Better patient selection and timing are clearly warranted so that more ACHD patients are considered and potentially benefit from this effective form of therapy.
•Heart failure is the leading cause of death in adults with congenital heart disease (CHD).•Heart transplantation can be an effective therapy, but there is uncertainty about patient selection criteria and timing for transplantation.•There is high overall mortality among CHD patients with heart failure, with good long-term outcomes after transplantation.•Only a small percentage of patients assessed finally undergo transplantation.
We employed echocardiographic tissue characterization for the assessment of single ventricle systolic function and examined its relationship with cardiopulmonary exercise testing (CPET) performance ...in the Fontan circulation.
40 consecutive adult Fontan patients (16 female, 24 male; mean age 26.3 ± 5.9) were enrolled in our prospective cross-sectional study. All patients underwent echocardiographic assessment including tissue characterization and CPET within 3 days from each other.
LAPSE (lateral annular plane systolic excursion) was higher in patients with a dominant left ventricle compared to a dominant right ventricle (12.3 + −2.6 vs 9.8 + −1.1 mm, p = .008) and in patients with AP (right atrium-pulmonary artery) connection than with lateral tunnel or extracardiac conduits (13.9 ± 1.7 vs 11.3 ± 2.6 and 10.9 ± 2.2 mm, p = .014 and p = .014, respectively). Maximal oxygen pulse (O2 pulse max) was significantly higher in patients with a dominant left or common ventricle compared to patients with a dominant right ventricle (10.3 and 12.0 vs 6.6 ml/beat, p = .002 and p = .032, respectively). There was a positive correlation between O2 pulse max and LAPSE (r = 0.442, p = .009), atrioventricular valve annulus systolic velocity (S′) (r = 0.606, p < .0001), lateral wall basal segment systolic velocity (bas vel s) (r = 0.469, p = .009) and lateral wall mid segment systolic velocity (mid vel s) (r = 0.452, p = .012). In the multivariable regression model, S′ (r = 0.606, p < .0001) remained predictive of O2 pulse max.
LAPSE and S′ are suitable parameters for the assessment of systolic function in Fontan patients. Subclinical systolic dysfunction of longitudinal fibers is associated with worse CPET performance. O2 pulse max seems to be the best parameter reflecting Fontan patients' physical performance.
•LAPSE and S′ are suitable for assessing systolic function in Fontan patients.•O2 pulse max is the best cardiopulmonary parameter reflecting Fontan haemodynamics•LAPSE, S′ and O2 pulse max reflect limited functional reserve.
Contemporarily modified Ross procedure continues to deliver excellent outcomes and remains part of the treatment strategy for aortic valve disease in the young adult population. The aim of this study ...was to assess whether Ross procedure carried out as a second or subsequent intervention for aortic valve disease carries similar risk and long-term benefit, when compared to Ross procedure for the first-time aortic valve replacement.
A total of 158 patients aged 16-60 years from a single congenital cardiac centre between 1997 and 2020 were included. The sample was split into 2 subgroups, based on the history of previous aortic valve interventions prior to the Ross procedure. Primary outcomes were defined as survival and pulmonary autograft failure. Coarsened exact matching was used to balance for covariates.
A total of 103 patients underwent primary Ross and 55 underwent secondary Ross with a mean follow-up of 7.8 years. Twenty-two patients underwent 28 reoperations during follow-up. Forty-nine well-matched pairs were obtained through matching. Freedom from pulmonary autograft failure at 10 years was 84.5% in the primary group vs 100% in the secondary group (P = 0.021). Five- and ten-year survival were identical, 97.5% in the primary group vs 95.6% in the secondary group (P = 0.53). Male sex and era were found to be predictors of neoaortic root dilatation.
The lower incidence of graft failure seen in secondary Ross could justify a stepwise approach to aortic valve intervention. Ross procedure delivers excellent outcomes in the adult population with no difference in survival for primary or secondary Ross.
Abstract Background High sensitive troponin T (hsTnT), a marker of myocardial injury, appears to be a promising diagnostic tool in patients with congenital heart disease. However, little is known ...about its distribution among adults with systemic right ventricle (sRV). We aimed to assess the distribution of hsTnT concentrations in patients with congenitally corrected transposition of the great arteries (ccTGA) and to evaluate its relationship with sRV function and NT-proBNP. Methods A cross-sectional study of adults with ccTGA was conducted. Patients underwent transthoracic echocardiography, hs-TnT and NTproBNP measurements. In the echocardiographic study, the sRV function was assessed qualitatively and quantitatively using fractional area change (FAC), TAPSE, myocardial performance index (MPI), systolic pulsed Doppler velocity (s′) and global longitudinal strain (GLS. Results Fifty patients with ccTGA (20F/30M) and a mean age of 34.8 ± 13.6 years (range 18-63 years) were included, with 27 of them (54%) having detectable hsTnT. Patients with detectable hsTnT were older and more often had NYHA class > I. Detectable hsTnT was associated with lower FAC (0.35 vs. 0.41, p < 0.01) and GLS (− 14.4% vs. -17.8%, p < 0.01)) and higher MPI (0.67 vs. 0.48, p < 0.01)). Hs-TnT correlated weekly with NT-proBNP ( r = 0.38; p < 0.001). The area under the curve for the detection of sRV dysfunction (FAC < 0.35) was higher for hs-TnT (0.839; CI 0.713-0.952) than for NT-proBNP (0.709; CI 0.545-0.873). Conclusion HsTnT was detectable in over half of the ccTGA population and was related to the sRV function. Compared to NTproBNP, hsTnT level seems to be superior biomarker in discriminating patients with sRV dysfunction.
Abstract Background Left aberrant subclavian artery (LASA), is a type of right aortic arch (RAA) branching, which takes-off distally to the right subclavian artery and usually crosses behind the ...esophagus to the left upper limb. Taking into account the rarity of RAA, LASA is much more rarely seen than the right aberrant subclavian artery (RASA) originating from the left aortic arch. However, RAA may be associated with much more frequent presence of LASA, than left aortic arch with RASA. Anatomical LASA characteristics were not described up to date. Methods Individual patient records filed in the electronic database from a single high-volume tertiary cardiac center were retrospectively screened for the presence of RAA in the patients who underwent chest computed tomography or magnetic resonance imaging from 2008 to 2016. Results 16 patients with LASA were identified. Only 3 were free of coexisting intra- or extra-cardiac anomalies. The most common defect was tetralogy of Fallot (4 patients). One patient had five congenital defects. Kommerell's diverticulum was present in 10 patients. In all patients the LASA course was retrotracheal and retroesophageal. In all but one patients esophageal modelling or compression by KD or LASA was present. Conclusions Knowledge of Kommerell's diverticulum presence and morphology as well as the LASA course during preinterventional work-up of patients with congenital heart defects is critical, since it may have surgical implications during corrective procedures.
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