Stress in adults with congenital heart disease : preliminary results on anxiety, life events, coping and socioeconomic factors (RCD code: IV)

We performed pilot analysis of the anxiety level, frequency of life events and their interactions among adults with congenital heart disease (CHD), and evaluated their coping strategies and socioeconomic functioning. In a cross-sectional questionnaire study on 30 consecutive ambulatory patients with CHD we addressed these issues by a custom-designed tool incorporating state-anxiety scale of the State-Trait Anxiety Inventory, the brief-COPE questionnaire (Polish versions) and 10 selected life events. We found that state-anxiety level adjusted for sex, age and life events di ered by CHD defect category (R2 = 0,51; p<0,001). Other factors are characterized and brie y discussed. JRCD 2014; 1 (6): 10-1

Transcranial doppler ultrasonography should it be the first choice for persistent foramen ovale screening?

BACKGROUND: Persistent foramen ovale (PFO) is considered a cause of cryptogenic stroke and a risk factor for neurological events in young patients. The reference standard for identifying a PFO is contrast-enhanced transesophageal echocardiography (TEE). The goal of this study was to evaluate the feasibility of transcranial color Doppler (TCD) and its diagnostic sensitivity compared with TEE. METHODS: We investigated 420 patients admitted to our department with cryptogenic stroke, transient ischemic attacks or other neurological symptoms. All patients underwent TCD and TEE evaluation. TCD and TEE examinations were performed according to a standardized procedure: air-mixed saline was injected into the right antecubital vein three times, while the Doppler signal was recorded during the Valsalva maneuver. During TCD the passage of contrast into the right-middle cerebral artery was recorded 25 seconds following the Valsalva maneuver. RESULTS: We detected a right-to-left shunt in 220 patients (52.3%) and no-shunts in 159 patients (37.9%) with both TCD and TEE. In 20 (4.8%) patients TEE did not reveal contrast passage which was then detected by TCD. In 21 (5.0%) patients only TEE revealed a PFO. The feasibility of both methods was 100%. TCD had a sensitivity of 95% and a specificity of 92% in the diagnosis of PFO. CONCLUSIONS: TCD has a relatively good sensitivity and specificity. TCD and TEE are complementary diagnostic tests for PFO, but TCD should be recommended as the first choice for screening because of its simplicity, non-invasive character, low cost and high feasibility

Progressive bradycardia with increasing doses of dobutamine leading to stress echo interruption

Dobutamine stress testing is an important non-invasive method for evaluating patients with known or suspected coronary artery disease who are unable to adequately exercise. We present a case of a paradoxical, progressive bradycardia occurring with increasing doses of dobutamine that resulted in stress test interruption. (Cardiol J 2012; 19, 1: 79&#8211;80

Improvement of physical capacity in patients undergoing transcatheter closure of atrial septal defects

Introduction: Atrial septal defect (ASD) is the most common congenital cardiac anomaly diagnosed in adults. It often remains asymptomatic until the fourth or fifth decade of life. Significant left-to-right interatrial shunting is associated with the risk of heart failure, pulmonary hypertension and atrial fibrillation. Percutaneous ASD closure is a recognized method of treatment. Aim: To evaluate the clinical outcomes and physical capacity in patients undergoing transcatheter closure of ostium secundum ASD. Material and methods: One hundred and twenty adult patients (75 females and 45 males) with a mean age of 43.1 ±13.3 (17–78) years who underwent transcatheter device closure of ostium secundum ASD were analyzed. Clinical evaluation and transthoracic color Doppler echocardiographic study were repeated in all patients before as well as 1 and 24 months after the procedure. To assess the physical capacity symptom-limited treadmill exercise tests with respiratory gas-exchange analysis were performed in all patients before the procedure and after 24 months of follow-up. Results: The devices were successfully implanted in all patients. During 24 months of follow-up all patients showed significant clinical and spiroergometric improvement of exercise capacity, and a significant decrease of right heart chamber overload features on echocardiography. Conclusions: Transcatheter closure of ASD in patients with significant shunt resulted in significant clinical and hemodynamic improvement regardless of the baseline functional class

Ischaemic aetiology predicts exercise dyssynchrony in patients with heart failure with reduced ejection fraction

Background: Left ventricular (LV) dyssynchrony is common in patients with heart failure with reduced ejection fraction (HFREF). However, various conditions including exercise may alter its presence. LV dyssynchrony at exercise (ExDYS) has been associated with lower cardiac performance and exercise capacity but with higher cardiac resynchronization therapy (CRT) response. Therefore, understanding mechanisms underlying ExDYS may improve patient selection for CRT. Aims: To investigate for predictors of ExDYS among patients with HFREF and prolonged QRS duration. Methods: Consecutive patients with stable, chronic HF, LVEF&lt;35%, sinus rhythm and QRS≥120ms were eligible. 2D echocardiography and tissue-Doppler were performed at rest and peak cyclo-ergometer exercise to assess LV systolic (LVEF) and diastolic function [mitral E-to-e’-wave velocities (E/e’)] and dyssynchrony. Dyssynchrony was defined as a maximal difference between time-to-peak systolic velocities of≥65ms from opposing basal segments. Results: We included 48 patients (aged 63.7±12.2, 81.3% male). Ischaemic aetiology (ICM) was present in 23 (47.9%). Dyssynchrony at rest (rDYS) was present in 32 (66.6%) patients, while ExDYS in 23 (47.9%). ExDYS correlated with ICM, lower LVEF and higher E/e’ ratio. ICM remained significant predictor of ExDYS in multiple regression model (OR:4.3, 95%CI:1.2–15.7, p=003). On exercise, 19 (39.5%) patients changed the rDYS status. While, exercise-induced dyssynchronization was observed only in ICM patients, exercise-induced resynchronization was more likely in patients with lower rest E/e’ ratio (OR:0.85, 95%CI:0.75–0.97, p=0.02). Conclusions: Ischaemic aetiology of HFREF is an important predictor of ExDYS. Restoration of LV synchronicity during exercise is more likely in patients with less advanced LV diastolic dysfunction