Funding Acknowledgements Type of funding sources: None. Introduction Radiofrequency (RF) catheter... more Funding Acknowledgements Type of funding sources: None. Introduction Radiofrequency (RF) catheter ablation in atrioventricular nodal reentry tachycardia (AVNRT) is highly effective. Three-dimensional electroanatomic mapping system (EAMS)-guided procedures are becoming more widespread. Purpose We aimed to compare EAMS-guided procedures to conventionally, only-fluoroscopy approach for slow pathway ablation. Methods 152 patients undergoing electrophysiological study and slow pathway ablation due to documented AV nodal reentrant tachycardia were included in our prospective single-centre study. In 102 patients the procedure was performed conventionally (Group 1) and 50 patients underwent an electroanatomic mapping system (EAMS) -guided approach (Group 2). Results In Group 2, 80% of the procedures were performed without the use of radiation. The procedure time (median (interquartile range): 65 (50-84) min vs. 75 (60-96.3) min, p =0.005) was significantly shorter in Group 1, with longe...
Funding Acknowledgements Type of funding sources: None. Introduction Radiofrequency (RF) catheter... more Funding Acknowledgements Type of funding sources: None. Introduction Radiofrequency (RF) catheter ablation in atrioventricular nodal reentry tachycardia (AVNRT) is highly effective. Three-dimensional electroanatomic mapping system (EAMS)-guided procedures are becoming more widespread. Purpose We aimed to compare EAMS-guided procedures to conventionally, only-fluoroscopy approach for slow pathway ablation. Methods 152 patients undergoing electrophysiological study and slow pathway ablation due to documented AV nodal reentrant tachycardia were included in our prospective single-centre study. In 102 patients the procedure was performed conventionally (Group 1) and 50 patients underwent an electroanatomic mapping system (EAMS) -guided approach (Group 2). Results In Group 2, 80% of the procedures were performed without the use of radiation. The procedure time (median (interquartile range): 65 (50-84) min vs. 75 (60-96.3) min, p =0.005) was significantly shorter in Group 1, with longe...
Clinical observations referring to the “athlete’s heart” are mostly based on echocardiographic st... more Clinical observations referring to the “athlete’s heart” are mostly based on echocardiographic studies. Data obtained by MRI (Magnetic Resonance Imaging) have only been published recently. In the present study data obtained by MRI were compared in young male endurance athletes (n = 9), power and fast-power athletes (n = 9) and young sedentary subjects (n = 8). Relative aerobic power in the endurance athletes was higher than in power and fast-power athletes (67.05 ± 4.58 vs. 56.65 ± 5.15 ml/min/kg), their resting heart rate was lower (52.1 ± 5.8 vs. 57.6 ± 8.2 beats/min). Resting heart rate was significantly lower in both athletic groups than in controls (64.3 ± 9.1 beats/min). In both athletic groups mean body-size related left ventricular muscle mass (LVM/BSA 3/2 : 72.08 ± 10.1 mm/m 3 in the endurance athletes and 66.67 ± 13.7 mm/m 3 in the power and fast-power athletes) and end-diastolic volume (LVEDV/BSA 3/2 : 53.0 ± 10.13 ml/m 3 and 52.44 ± 11.2 ml/m 3 respectively) were higher ...
Clinical observations referring to the “athlete’s heart” are mostly based on echocardiographic st... more Clinical observations referring to the “athlete’s heart” are mostly based on echocardiographic studies. Data obtained by MRI (Magnetic Resonance Imaging) have only been published recently. In the present study data obtained by MRI were compared in young male endurance athletes (n = 9), power and fast-power athletes (n = 9) and young sedentary subjects (n = 8). Relative aerobic power in the endurance athletes was higher than in power and fast-power athletes (67.05 ± 4.58 vs. 56.65 ± 5.15 ml/min/kg), their resting heart rate was lower (52.1 ± 5.8 vs. 57.6 ± 8.2 beats/min). Resting heart rate was significantly lower in both athletic groups than in controls (64.3 ± 9.1 beats/min). In both athletic groups mean body-size related left ventricular muscle mass (LVM/BSA 3/2 : 72.08 ± 10.1 mm/m 3 in the endurance athletes and 66.67 ± 13.7 mm/m 3 in the power and fast-power athletes) and end-diastolic volume (LVEDV/BSA 3/2 : 53.0 ± 10.13 ml/m 3 and 52.44 ± 11.2 ml/m 3 respectively) were higher ...
normal by the "Refined" criteria. Both groups had similar left atrial size and LV end-diastolic d... more normal by the "Refined" criteria. Both groups had similar left atrial size and LV end-diastolic dimension. EA had enhanced diastolic function and global longitudinal strain. Change in ejection fraction ((LVEF), peak oxygen consumption (peak V02) and peak V02 as a % of predicted were higher in the EA. ROC curve analysis revealed stroke volume (SV) and % of predicted peak V02 showed good discriminating ability (AUC of 0.809 and 0.97 respectively).The optimal cutoff for LVEF was 11.5% with an AUC of 0.929. Conclusion: Differentiating AH from DCM requires comprehensive evaluation. The parameters with the highest sensitivity and specificity include SV, peak V02 (% of predicted) and LVEF. Acknowledgement/Funding: Study funded by the charitable organisation 'Cardiac Risk in the young'.
Summary Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is among the major fac... more Summary Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is among the major factors for mortality in young adults. Therefore, early diagnostics and institution of therapy, e.g. antiarrhythmics, radio frequency ablation, or implantable cardioverter/defibrillator, are unavoidable. Cardiac magnetic resonance imaging (MRI) is unique in the diagnosis of ARVD/C, since this non-invasive tool detects tissue-specific information with a simultaneous, direct measurement of the left- and right-ventricular function, regional wall motion abnormalities and morphology. A suitable T1 (spin-lattice relaxation time) sensitive MRI acquisition can differentiate pericardial, epicardial, and patchy or diffuse right ventricle lipid infiltration from the true myocardial tissue. We studied 31 patients with symptomatic ventricular arrhythmia with left bundle branch block morphology and a suspected diagnosis of ARVD/C. Only six out of 31 patients fulfilled the diagnostic criteria for ARVD/C. ...
Introduction Sudden cardiac death (SCD) is the most common cause of death in athletes occurring u... more Introduction Sudden cardiac death (SCD) is the most common cause of death in athletes occurring usually during intensive training. Cardiac magnetic resonance (CMR) has a crucial role in the detection of structural myocardial abnormalities. Aims Our aim was to investigate the etiology of SCD and to estimate the prevalence of myocardial structural heart diseases among Hungarian athletes using CMR. Methods Between January 2011 and January 2019 we performed CMR scans on 228 athletes (199 males, age: 29.1±13.2) with suspected structural myocardial disease. Twelve athletes were investigated after aborted sudden cardiac death and normal coronary angiography. Results CMR confirmed the diagnosis of structural myocardial disease in 62 athletes (26.2%) (28.8±9.1 years, 59 male): hypertrophic cardiomyopathy (HCM) in 14 cases (22.6%), arrhythmogenic right ventricular cardiomyopathy (ARVC) in 9 cases (14.5%), noncompaction (NCCMP) in 6 cases (9.7%) and dilated cardiomyopathy (DCM) in 5 cases (8.1...
European Heart Journal – Cardiovascular Imaging, 2015
Background: Handheld ultrasound devices allow for a bedside screening although quantitative param... more Background: Handheld ultrasound devices allow for a bedside screening although quantitative parameters are not easily obtained. We aim to assess the reliability of visual qualitative evaluation of left ventricle (LV) compared with standard quantitative evaluation with 2D transthoracic echocardiography (TTE). Methods: Two cardiologists have reviewed 135 consecutive standard TTE examinations. Both observers visually assessed LV size, hypertrophy (LVH) and ejection fraction (EF). LV diameter, volume, wall thickness and EF (Teichholz and Simpson) were also measured by both observers. Visual and quantitative agreement and inter and intraobserver variability were calculated. Results: Image quality allowed for evaluation of 130 examinations. Visually assessed EF compared with Simpson had better consistency (Intraclass correlation coefficient [ICC] 0,91 IC95% 0,88-0,94) than with Teichholz (ICC 0,75 IC95% 0,66-0,82). We have also observed good interobserver agreement regarding visually assessed EF (ICC 0,81 IC95% 0,71-0,87) and Simpson EF (ICC 0,80 IC95% 0,70-0,89) as well as good intraobserver agreement (visual EF: ICC 0,81 IC95% 0,74-0,86; Simpson: ICC 0,89 IC95% 0,84-0,93). Regarding LVH we found moderate agreement between visual and quantitative assessment (weighted Kappa [wK] 0,44 (IC95% 0,32-0,56)), moderate interobserver agreement for quantitative assessment (ICC 0,59 IC95% 0,44-0,71) and poor interobserver agreement for visual assessment (wK 0,19 IC95% 0,08-0,30). Intraobserver variability regarding LVH visual estimation was moderate (wK 0,40 IC95% 0,29-0,52) and regarding LVH quantification was good (ICC 0,78 IC95% 0,70-0,84). LVH was visually overestimated in 25% of examinations. Regarding LV size, we found poor agreement between visual assessment and its quantification with end-diastolic diameter (wK 0,22 IC95% 0,06-0,39) and moderate agreement between visual assessment and end-systolic LV volume (wK 0,62 IC95% 0,47-0,77). Interobserver agreement regarding quantitative volume assessment was good (ICC 0,90 IC95% 0,85-0,94) and regarding visual assessment was moderate (wK 0,43 IC95% 0,26-0,70). We found good intraobserver variability of volume measurement (wK 0,64 IC95% 0,50-0,78) and of visual size assessment (ICC 0,96 IC95% 0,94-0,97). Conclusions: Visual LVEF assessment is consistent with quantitative assessment and should be regarded as a reliable parameter that can be obtained from bedside examination with a handheld device. Visual assessment of LV size and wall thickness is less reliable than its quantification and should be confirmed with standard measurements.
Background: Pulmonary HyperTension (PHT) dramatically impairs quality of life and survival of pat... more Background: Pulmonary HyperTension (PHT) dramatically impairs quality of life and survival of patients suffering systemic sclerosis. Although early recognition is required, it is so far based on pulmonary artery pressures measurement using rest echocardiography. However, resting PHT is a sign of an already advanced stage of the disease. The aim of our study was to assess the profile of pulmonary pressure during exercise echocardiography (EE) in order to detect abnormal pressure response. Methods: We studied a group of twelve patients with systemic sclerosis and normal pulmonary pressure at rest. Ten were symptomatic. All patients underwent rest echocardiography. Systolic pulmonary artery pressure was estimated by systolic gradient between right ventricle and auricle (VA Gr), obtained from tricuspid regurgitation maximal velocity (Vtr) (VA Gr=4 Vtr²). Patients underwent symptom limited semi-supine EE.VA Gr was evaluated at each step and at peak workload. Electrocardiogram and blood pressure were also recorded during exercise. Results: mean age was 56±2.5 years; there was 10 women and 2 men. The number of patients in NYHA class 1, 2 and 3 were respectively 2, 5 and 5 (mean NYHA class: 2.2±0.2). The VA Gr at rest was 24±1 mm Hg (17 to 32 mm Hg). The mean VA Gr in each NYHA group was respectively 24±2, 23±3 and 26±2 mm Hg for NYHA class 1, 2 and 3. Maximal workload during exercise was 83±6 Watts. No adverse effect occurred. The VA Gr at peak exercise was significantly increased, compared to rest, at 44±4 mm Hg (25 to 70 mm Hg) (p<0.0001). The peak VA Gr in each NHYA class group was respectively 35±0, 43±6 and 49±6 mm Hg for NYHA class 1, 2 and 3. No patient in NYHA class 1 developed VA Gr>40 mm Hg. Among symptomatic patients (class 2 or 3), 8/10 (80 %) developed VA Gr>40 mm Hg. Conclusion: exercise echocardiography in patients with systemic sclerosis is safe and useful to evaluate exercise pulmonary pressure. Symptomatic patients without pulmonary hypertension at rest seem to have more elevated pressures at exercise. They might benefit of a closer follow-up to detect pulmonary hypertension earlier and begin treatments.
Purpose-To test whether signal intensity percent infarct mapping (SI-PIM) accurately determines t... more Purpose-To test whether signal intensity percent infarct mapping (SI-PIM) accurately determines the size of myocardial infarct (MI) regardless of its age. Materials and methods-Forty-five swine with reperfused MI underwent 1.5T late gadolinium enhancement (LGE) MRI after bolus injection of 0.2mmol/kg Gd(DTPA) on days 2-62 following MI. Animals were classified into acute, healing, and healed groups by pathology. Infarct volume (IV) and infarct fraction (IF) were determined using binary techniques (including 2-5 standard deviations (SD) above the remote, and full-width at half-maximum) and the SI-PIM method by two readers. Triphenyl-tetrazolium-chloride staining (TTC) was performed as reference. Bias (percent under/overestimation of IV relative to TTC) of each quantification method was calculated. Bland-Altman analysis was done to test the accuracy of the quantification methods, while intraclass correlation coefficient (ICC) analysis was done to assess intra-and interobserver agreement. Results-Bias of the MRI quantification methods do not depend on the age of the MI. FWHM and SI-PIM gave the best estimate of MI volume determined by the reference TTC (p-values for the FWHM and SI-PIM methods were 0.183, 0.26, 0.95 and 0.073, 0.091, 0.73 in Group 1, Group 2 and Group 3, respectively), while using any of the binary thresholds of 2-4SD above the remote myocardium showed significant overestimation. The 5SD method, however, provided similar IV compared to TTC and was shown to be independent of the size and age of MI. ICC analysis showed excellent inter-and intraobserver agreement between the readers.
Objectives: Vascular abnormalities are hallmarks of almost all systemic sclerosis patients. Impai... more Objectives: Vascular abnormalities are hallmarks of almost all systemic sclerosis patients. Impaired relaxation of the left ventricle is also characteristic for scleroderma heart disease. The aim of our study was to determine whether parameters of arterial stiffness correlate with echocardiographic indices of left ventricular relaxation impairment. Material: 21 patients with limited and diffuse scleroderma (18 women, mean age: 55±9 years) were studied. Methods: Parameters of local and systemic arterial stiffness (pulse wave velocity: PWV; augmentation index: Aix) were determined by automatic brachial pulse wave analysis (Arteriograph®). The same parameters and elastic modulus (Ep), stiffness index (ß), arterial compliance (AC) were measured on left brachial and common carotid arteries by echo-tracking (Aloka ProSound 5500). Indices of diastolic function were also determined with the same ultrasound system: in addition to the conventional Doppler parameters of the transmitral flow-early (E) and late (A) diastolic velocities, deceleration time (DT), isovolumic relaxation time (IVRT)-myocardial early (Ea) and late (Aa) diastolic velocities were measured at the lateral border of the mitral annulus using tissue Doppler imaging. E/A and E/Ea ratios were calculated. Simple associations between the variables were estimated by Pearson's method. Results: Carotid Ep showed significant correlations with both A (r=0.537, p<0.05) and E/A (r=-0.500, p<0.05) values, and correlated with IVRT also significantly (r=0.489, p<0.05). Carotid ß correlated with A (r=0.479, p<0.05), E/A (r=-0.548, p<0.05) and IVRT (r=0.564, p<0.01). Carotid AC correlated with A (r=-0.512, p<0.05), E/A (r=0.551, p<0.05) and IVRT values (r=-0.436, p<0.05). Carotid PWV and Aix showed similarly significant correlations with A, E/A, IVRT and with A and E/A values, respectively. Ep, ß and PWV determined by pulse-wave analysis and brachial artery echo-tracking did not correlate with the echocardiographic parameters of the left ventricular diastolic function. Brachial AC showed a significant correlation with A (r=-0.478, p<0.05) and DT (r=0.469, p<0.05). Significant correlation was found between Aix measured by pulse-wave analysis and Aa (r=0.560, p<0.05). Conclusion: Distensibility of elastic arteries correlates well with the echocardiographic indices of the left ventricular diastolic function, but stiffness of muscular type arteries is less useful to predict the degree of diastolic impairment. Selected parameters of arterial stiffness are good predictors of diastolic dysfunction in scleroderma patients ±.
Bicuspid aortic valve and associated congenital cardiac malformations in children LJ. Gong; ZK. Y... more Bicuspid aortic valve and associated congenital cardiac malformations in children LJ. Gong; ZK. Ye; ZW. Zeng; MY. Xia; Y. Zhong; Y. Yao Fuwai cardiovascular hospital, Beijing, China, People's Republic of Objectives: To determine the clinical morphology of congenital bicuspid aortic valves (BAV) and its relationship with congenital cardiac malformations in children. Methods: 252 patients (age,18 years old) with BAV who were identified by transthoracic echocardiography were included. All patients were divided into two groups, group 1 was ≤3 y, and group 2 was .3 y. To estimate the frequency of BAV associated with other cardiac malformations in all patients and to analyze BAV and the frequency of major congenitally cardiac malformations by age and sex roughly. Results: The mean age of the patients was 3y (1 day-17.9 years), males 188 (67.4%), females 64 (32.5%). R-L phenotype (absence of the inter coronary commissure) was the most common(71.4%), both in patients with isolated BAV (58.9%) and in those with additional pathology. L-N phenotype was rarely (1.6%), and 2 of 4 patients with this pattern had no other structural abnormality. The majority of patients with coarctation (82.4 %) and left heart obstructive lesions (80%) had R-L phenotype, non-left heart defects (79.8 %) had R-L phenotype. The difference between the numbers of aortic stenosis(AS) and aortic regurgitation(AR) of BAV patients was not remarkable. AR was observed in 20.2% of BAV patients. In R-L phenotype,most patients associated with AS(80.6%, P,0.05). Compared with the other two BAV types, patients with R-N phenotype were more likely to have at least moderate AR(78.4%, P,0.05) or AS and AR (74%, P,0.05). In male group: intracardiac shunt, coarctation and congenital mitral valve disease were common than female in ,3y group. In group2: Intracardiac shunt and congenital mitral valve disease were most common in male. BAV in conjunction with aortic coarctation was associated with a lower prevalence of valve stenosis and regurgitation. In group 1, inracardiac shun, coarctation and congenital mitral valve disease were common in male than female. In group 2, intracardiac shunt and congenital mitral valve disease were most common in male group than female, but the prevalence of coarctation was not too high. Most aortic coarctation tended to be younger boys. Conclusions: Different morphologies of BAV were associated with different cardiac abnormalities, especially left-heart obstructive lesions. The AS was most often observed in patients with R-L phenotype. Most of AR and/or both of AS and AR could be observed in patients with R-N phenotype. Boys with BAV had higher risk of aortic coarctation and congenital mitral valve abnormalities than girls in ≤3 years group, but this difference decreased between sex in .3 years group.
European Heart Journal - Cardiovascular Imaging, 2014
Introduction: The increase of left auricular volume (LAV) is a robust cardiovascular event predic... more Introduction: The increase of left auricular volume (LAV) is a robust cardiovascular event predictor. Despite that echochardiography is more often used, cardiac MRI is considered more accurate. Our objetives are to validate "fast" LAV measures by MRI vs the considered gold standard (GS) and to compare Echo and MRI in a wide spectrum of patients. Methods: In a non-selected popullation with MRI study previously realized, we measured LAV by biplane method (BPMR) and by area-length in 4 chamber view (ALMR) and compared them with biplane (BPe) and discs method (MDDe) in 4 chamber view in echo. To validate MRI measurements, we measured LAV in short axis slices (Simpson Method, SM) in a group of patients and considered it the GS. Results: 186 patients were included (mean age 51 + 17 age; 123 male; 14 in AF) with clinical indication of cardiac MRI (Philips 1,5 T). In 24 patients SM was calculated. 29% of cardiac MRI were considered normal. Mean underlying pathologies were myocardiopathy (27%), Ischemic myocardiopathy (17%), myopericarditis (10%), prior to AF ablation (4%), valvular disease (6%) and miscellaneous (7%). Excellent correlation was obtained between "fast" MRI measurements and SM in MRI (SM vs BPMR interclass correlation coefficient ICC=0.965 and SM vs ALMR, ICC=0.958; P,0.05) with low interobserver variability (ICC=0.983 for SM; ICC=0.949 for BPMR; ICC=0.931 for ALMR). "Fast" measurements by MRI showed stadistical correlation between them (CCI=0.910) (Figure). Correlation between Echo and MRI measures was only moderate. (BPRM vs BPe CCI=0,469 mean difference-30 ml; ALMR vs MDDe ICC=0,456 mean difference-24 mL). Conclusions: 'fast' LAV measures by MRI are comparable with the MRI GS and also between them. Echo values seem to underestimate compared to MRI, so its use may not be suitable.
Background: The occurrence of hypertrophic cardiomyopathy (HCM) among clinical studies shows larg... more Background: The occurrence of hypertrophic cardiomyopathy (HCM) among clinical studies shows large variations. The predictive power of risk factors to indicate proper clinical outcome also varies among clinical studies. The aim of our study was to determine whether evidence based risk stratification, strengthened by MRI techniques, improved the prediction of clinical outcome. Material and methods: 51 HCM (mean age 49±16, 33 male, HOCM 20) patients (pts) were studied between 2002 and 2005. Detailed anamnestic data, physical exam, ECG, HOLTER, Stress test, echocardiography and cardiac MRI (function and late enhancement) were performed to determine evidence based minor and major risk factors of SCD. Coronary angiography was only performed in cases of clinical indications of IHD. High risk patient group was defined having two or more major risk factors (Group I). The rest of the patients were grouped into the low risk patient group (Group II). The diagnostic powers of risk factors were analyzed while comparing their occurrences. The outcome indicators during follow up were: occurrences of heart failure (HF), cardiac death (CD), necessity of ICD implantation and surgical myectomy. Results: 16 (45±12 y, 5/11 f/m) and 35 (52±15 y, 14/21 f/m) pts were classified into Groups I and II, respectively. The number of high risk pts examined in our heart center was higher then expected based on the literature. In Groups I vs II the occurrences of SCD, NSVT, abnormal exercise BP, LVWT ≥30 mm, and late enhancement were 2 vs 0, 4 vs 1, 3 vs 0, 9 vs 3 and 14 vs 9, respectively. The latter data indicate significantly higher number of risk factors in Group I. Simultaneously in Group I vs II the occurrences of HF, CD and ICD implantation were 4 vs 2, 2 vs 0 and 6 vs 0, respectively. There was no significant difference in the number of HOCM (8 vs 12) pts between Groups I and II. Interestingly, however, more HOCM pts of Group I needed surgical myectomy (4 vs 2). Conclusion: The number of major advanced cardiac events, the necessities of ICD implantations and surgical myectomy were indicated well using our evidence based MRI strengthened risk stratification strategy.
1. Int J Cardiol. 2011 Oct 8. [Epub ahead of print] The Gln1233ter mutation of the myosin binding... more 1. Int J Cardiol. 2011 Oct 8. [Epub ahead of print] The Gln1233ter mutation of the myosin binding protein C gene: Causative mutation or innocent polymorphism in patients with hypertrophic cardiomyopathy? Tóth T, Nagy V, Faludi ...
Catheter ablation of left ventricular outflow tract tachycardia (LVOTT) holds the risk of complic... more Catheter ablation of left ventricular outflow tract tachycardia (LVOTT) holds the risk of complications, if foci are located close to the coronary artery orifices. The use of an accurate three-dimensional electro-anatomic approach is necessary to avoid ablation in the coronaries. We report a case in which we demonstrate the value of the CartoSound system, in the ablation of LVOTT.
Introduction Increased aortic pulse wave velocity (PWV) as a strong predictor of major advanced c... more Introduction Increased aortic pulse wave velocity (PWV) as a strong predictor of major advanced cardiovascular events (MACE) has a prognostic relevance in patients after myocardial infarction (MI). Several non-invasive methods have been proposed for the assessment of arterial stiffness, but the PWV values show significant differences according to the applied techniques. Cardiac magnetic resonance imaging (CMR) provides an accurate method to measure PWV and infarct size in patients after MI. Purpose Calculated PWV values of CMR based phase-contrast (PC) and invasively validated oscillometric methods were compared in this prospective observational study. We aimed to evaluate the cut-off PWV values for each method, while MACE predicted and validated the prognostic value of high PWV in post-infarcted patients in a 6-year follow-up. Methods 3D aortic angiography and PC velocity imaging was performed using a Siemens Avanto 1,5 T CMR device. Oscillometric based Arteriograph (AG) was used t...
Funding Acknowledgements Type of funding sources: None. Introduction Radiofrequency (RF) catheter... more Funding Acknowledgements Type of funding sources: None. Introduction Radiofrequency (RF) catheter ablation in atrioventricular nodal reentry tachycardia (AVNRT) is highly effective. Three-dimensional electroanatomic mapping system (EAMS)-guided procedures are becoming more widespread. Purpose We aimed to compare EAMS-guided procedures to conventionally, only-fluoroscopy approach for slow pathway ablation. Methods 152 patients undergoing electrophysiological study and slow pathway ablation due to documented AV nodal reentrant tachycardia were included in our prospective single-centre study. In 102 patients the procedure was performed conventionally (Group 1) and 50 patients underwent an electroanatomic mapping system (EAMS) -guided approach (Group 2). Results In Group 2, 80% of the procedures were performed without the use of radiation. The procedure time (median (interquartile range): 65 (50-84) min vs. 75 (60-96.3) min, p =0.005) was significantly shorter in Group 1, with longe...
Funding Acknowledgements Type of funding sources: None. Introduction Radiofrequency (RF) catheter... more Funding Acknowledgements Type of funding sources: None. Introduction Radiofrequency (RF) catheter ablation in atrioventricular nodal reentry tachycardia (AVNRT) is highly effective. Three-dimensional electroanatomic mapping system (EAMS)-guided procedures are becoming more widespread. Purpose We aimed to compare EAMS-guided procedures to conventionally, only-fluoroscopy approach for slow pathway ablation. Methods 152 patients undergoing electrophysiological study and slow pathway ablation due to documented AV nodal reentrant tachycardia were included in our prospective single-centre study. In 102 patients the procedure was performed conventionally (Group 1) and 50 patients underwent an electroanatomic mapping system (EAMS) -guided approach (Group 2). Results In Group 2, 80% of the procedures were performed without the use of radiation. The procedure time (median (interquartile range): 65 (50-84) min vs. 75 (60-96.3) min, p =0.005) was significantly shorter in Group 1, with longe...
Clinical observations referring to the “athlete’s heart” are mostly based on echocardiographic st... more Clinical observations referring to the “athlete’s heart” are mostly based on echocardiographic studies. Data obtained by MRI (Magnetic Resonance Imaging) have only been published recently. In the present study data obtained by MRI were compared in young male endurance athletes (n = 9), power and fast-power athletes (n = 9) and young sedentary subjects (n = 8). Relative aerobic power in the endurance athletes was higher than in power and fast-power athletes (67.05 ± 4.58 vs. 56.65 ± 5.15 ml/min/kg), their resting heart rate was lower (52.1 ± 5.8 vs. 57.6 ± 8.2 beats/min). Resting heart rate was significantly lower in both athletic groups than in controls (64.3 ± 9.1 beats/min). In both athletic groups mean body-size related left ventricular muscle mass (LVM/BSA 3/2 : 72.08 ± 10.1 mm/m 3 in the endurance athletes and 66.67 ± 13.7 mm/m 3 in the power and fast-power athletes) and end-diastolic volume (LVEDV/BSA 3/2 : 53.0 ± 10.13 ml/m 3 and 52.44 ± 11.2 ml/m 3 respectively) were higher ...
Clinical observations referring to the “athlete’s heart” are mostly based on echocardiographic st... more Clinical observations referring to the “athlete’s heart” are mostly based on echocardiographic studies. Data obtained by MRI (Magnetic Resonance Imaging) have only been published recently. In the present study data obtained by MRI were compared in young male endurance athletes (n = 9), power and fast-power athletes (n = 9) and young sedentary subjects (n = 8). Relative aerobic power in the endurance athletes was higher than in power and fast-power athletes (67.05 ± 4.58 vs. 56.65 ± 5.15 ml/min/kg), their resting heart rate was lower (52.1 ± 5.8 vs. 57.6 ± 8.2 beats/min). Resting heart rate was significantly lower in both athletic groups than in controls (64.3 ± 9.1 beats/min). In both athletic groups mean body-size related left ventricular muscle mass (LVM/BSA 3/2 : 72.08 ± 10.1 mm/m 3 in the endurance athletes and 66.67 ± 13.7 mm/m 3 in the power and fast-power athletes) and end-diastolic volume (LVEDV/BSA 3/2 : 53.0 ± 10.13 ml/m 3 and 52.44 ± 11.2 ml/m 3 respectively) were higher ...
normal by the "Refined" criteria. Both groups had similar left atrial size and LV end-diastolic d... more normal by the "Refined" criteria. Both groups had similar left atrial size and LV end-diastolic dimension. EA had enhanced diastolic function and global longitudinal strain. Change in ejection fraction ((LVEF), peak oxygen consumption (peak V02) and peak V02 as a % of predicted were higher in the EA. ROC curve analysis revealed stroke volume (SV) and % of predicted peak V02 showed good discriminating ability (AUC of 0.809 and 0.97 respectively).The optimal cutoff for LVEF was 11.5% with an AUC of 0.929. Conclusion: Differentiating AH from DCM requires comprehensive evaluation. The parameters with the highest sensitivity and specificity include SV, peak V02 (% of predicted) and LVEF. Acknowledgement/Funding: Study funded by the charitable organisation 'Cardiac Risk in the young'.
Summary Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is among the major fac... more Summary Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is among the major factors for mortality in young adults. Therefore, early diagnostics and institution of therapy, e.g. antiarrhythmics, radio frequency ablation, or implantable cardioverter/defibrillator, are unavoidable. Cardiac magnetic resonance imaging (MRI) is unique in the diagnosis of ARVD/C, since this non-invasive tool detects tissue-specific information with a simultaneous, direct measurement of the left- and right-ventricular function, regional wall motion abnormalities and morphology. A suitable T1 (spin-lattice relaxation time) sensitive MRI acquisition can differentiate pericardial, epicardial, and patchy or diffuse right ventricle lipid infiltration from the true myocardial tissue. We studied 31 patients with symptomatic ventricular arrhythmia with left bundle branch block morphology and a suspected diagnosis of ARVD/C. Only six out of 31 patients fulfilled the diagnostic criteria for ARVD/C. ...
Introduction Sudden cardiac death (SCD) is the most common cause of death in athletes occurring u... more Introduction Sudden cardiac death (SCD) is the most common cause of death in athletes occurring usually during intensive training. Cardiac magnetic resonance (CMR) has a crucial role in the detection of structural myocardial abnormalities. Aims Our aim was to investigate the etiology of SCD and to estimate the prevalence of myocardial structural heart diseases among Hungarian athletes using CMR. Methods Between January 2011 and January 2019 we performed CMR scans on 228 athletes (199 males, age: 29.1±13.2) with suspected structural myocardial disease. Twelve athletes were investigated after aborted sudden cardiac death and normal coronary angiography. Results CMR confirmed the diagnosis of structural myocardial disease in 62 athletes (26.2%) (28.8±9.1 years, 59 male): hypertrophic cardiomyopathy (HCM) in 14 cases (22.6%), arrhythmogenic right ventricular cardiomyopathy (ARVC) in 9 cases (14.5%), noncompaction (NCCMP) in 6 cases (9.7%) and dilated cardiomyopathy (DCM) in 5 cases (8.1...
European Heart Journal – Cardiovascular Imaging, 2015
Background: Handheld ultrasound devices allow for a bedside screening although quantitative param... more Background: Handheld ultrasound devices allow for a bedside screening although quantitative parameters are not easily obtained. We aim to assess the reliability of visual qualitative evaluation of left ventricle (LV) compared with standard quantitative evaluation with 2D transthoracic echocardiography (TTE). Methods: Two cardiologists have reviewed 135 consecutive standard TTE examinations. Both observers visually assessed LV size, hypertrophy (LVH) and ejection fraction (EF). LV diameter, volume, wall thickness and EF (Teichholz and Simpson) were also measured by both observers. Visual and quantitative agreement and inter and intraobserver variability were calculated. Results: Image quality allowed for evaluation of 130 examinations. Visually assessed EF compared with Simpson had better consistency (Intraclass correlation coefficient [ICC] 0,91 IC95% 0,88-0,94) than with Teichholz (ICC 0,75 IC95% 0,66-0,82). We have also observed good interobserver agreement regarding visually assessed EF (ICC 0,81 IC95% 0,71-0,87) and Simpson EF (ICC 0,80 IC95% 0,70-0,89) as well as good intraobserver agreement (visual EF: ICC 0,81 IC95% 0,74-0,86; Simpson: ICC 0,89 IC95% 0,84-0,93). Regarding LVH we found moderate agreement between visual and quantitative assessment (weighted Kappa [wK] 0,44 (IC95% 0,32-0,56)), moderate interobserver agreement for quantitative assessment (ICC 0,59 IC95% 0,44-0,71) and poor interobserver agreement for visual assessment (wK 0,19 IC95% 0,08-0,30). Intraobserver variability regarding LVH visual estimation was moderate (wK 0,40 IC95% 0,29-0,52) and regarding LVH quantification was good (ICC 0,78 IC95% 0,70-0,84). LVH was visually overestimated in 25% of examinations. Regarding LV size, we found poor agreement between visual assessment and its quantification with end-diastolic diameter (wK 0,22 IC95% 0,06-0,39) and moderate agreement between visual assessment and end-systolic LV volume (wK 0,62 IC95% 0,47-0,77). Interobserver agreement regarding quantitative volume assessment was good (ICC 0,90 IC95% 0,85-0,94) and regarding visual assessment was moderate (wK 0,43 IC95% 0,26-0,70). We found good intraobserver variability of volume measurement (wK 0,64 IC95% 0,50-0,78) and of visual size assessment (ICC 0,96 IC95% 0,94-0,97). Conclusions: Visual LVEF assessment is consistent with quantitative assessment and should be regarded as a reliable parameter that can be obtained from bedside examination with a handheld device. Visual assessment of LV size and wall thickness is less reliable than its quantification and should be confirmed with standard measurements.
Background: Pulmonary HyperTension (PHT) dramatically impairs quality of life and survival of pat... more Background: Pulmonary HyperTension (PHT) dramatically impairs quality of life and survival of patients suffering systemic sclerosis. Although early recognition is required, it is so far based on pulmonary artery pressures measurement using rest echocardiography. However, resting PHT is a sign of an already advanced stage of the disease. The aim of our study was to assess the profile of pulmonary pressure during exercise echocardiography (EE) in order to detect abnormal pressure response. Methods: We studied a group of twelve patients with systemic sclerosis and normal pulmonary pressure at rest. Ten were symptomatic. All patients underwent rest echocardiography. Systolic pulmonary artery pressure was estimated by systolic gradient between right ventricle and auricle (VA Gr), obtained from tricuspid regurgitation maximal velocity (Vtr) (VA Gr=4 Vtr²). Patients underwent symptom limited semi-supine EE.VA Gr was evaluated at each step and at peak workload. Electrocardiogram and blood pressure were also recorded during exercise. Results: mean age was 56±2.5 years; there was 10 women and 2 men. The number of patients in NYHA class 1, 2 and 3 were respectively 2, 5 and 5 (mean NYHA class: 2.2±0.2). The VA Gr at rest was 24±1 mm Hg (17 to 32 mm Hg). The mean VA Gr in each NYHA group was respectively 24±2, 23±3 and 26±2 mm Hg for NYHA class 1, 2 and 3. Maximal workload during exercise was 83±6 Watts. No adverse effect occurred. The VA Gr at peak exercise was significantly increased, compared to rest, at 44±4 mm Hg (25 to 70 mm Hg) (p<0.0001). The peak VA Gr in each NHYA class group was respectively 35±0, 43±6 and 49±6 mm Hg for NYHA class 1, 2 and 3. No patient in NYHA class 1 developed VA Gr>40 mm Hg. Among symptomatic patients (class 2 or 3), 8/10 (80 %) developed VA Gr>40 mm Hg. Conclusion: exercise echocardiography in patients with systemic sclerosis is safe and useful to evaluate exercise pulmonary pressure. Symptomatic patients without pulmonary hypertension at rest seem to have more elevated pressures at exercise. They might benefit of a closer follow-up to detect pulmonary hypertension earlier and begin treatments.
Purpose-To test whether signal intensity percent infarct mapping (SI-PIM) accurately determines t... more Purpose-To test whether signal intensity percent infarct mapping (SI-PIM) accurately determines the size of myocardial infarct (MI) regardless of its age. Materials and methods-Forty-five swine with reperfused MI underwent 1.5T late gadolinium enhancement (LGE) MRI after bolus injection of 0.2mmol/kg Gd(DTPA) on days 2-62 following MI. Animals were classified into acute, healing, and healed groups by pathology. Infarct volume (IV) and infarct fraction (IF) were determined using binary techniques (including 2-5 standard deviations (SD) above the remote, and full-width at half-maximum) and the SI-PIM method by two readers. Triphenyl-tetrazolium-chloride staining (TTC) was performed as reference. Bias (percent under/overestimation of IV relative to TTC) of each quantification method was calculated. Bland-Altman analysis was done to test the accuracy of the quantification methods, while intraclass correlation coefficient (ICC) analysis was done to assess intra-and interobserver agreement. Results-Bias of the MRI quantification methods do not depend on the age of the MI. FWHM and SI-PIM gave the best estimate of MI volume determined by the reference TTC (p-values for the FWHM and SI-PIM methods were 0.183, 0.26, 0.95 and 0.073, 0.091, 0.73 in Group 1, Group 2 and Group 3, respectively), while using any of the binary thresholds of 2-4SD above the remote myocardium showed significant overestimation. The 5SD method, however, provided similar IV compared to TTC and was shown to be independent of the size and age of MI. ICC analysis showed excellent inter-and intraobserver agreement between the readers.
Objectives: Vascular abnormalities are hallmarks of almost all systemic sclerosis patients. Impai... more Objectives: Vascular abnormalities are hallmarks of almost all systemic sclerosis patients. Impaired relaxation of the left ventricle is also characteristic for scleroderma heart disease. The aim of our study was to determine whether parameters of arterial stiffness correlate with echocardiographic indices of left ventricular relaxation impairment. Material: 21 patients with limited and diffuse scleroderma (18 women, mean age: 55±9 years) were studied. Methods: Parameters of local and systemic arterial stiffness (pulse wave velocity: PWV; augmentation index: Aix) were determined by automatic brachial pulse wave analysis (Arteriograph®). The same parameters and elastic modulus (Ep), stiffness index (ß), arterial compliance (AC) were measured on left brachial and common carotid arteries by echo-tracking (Aloka ProSound 5500). Indices of diastolic function were also determined with the same ultrasound system: in addition to the conventional Doppler parameters of the transmitral flow-early (E) and late (A) diastolic velocities, deceleration time (DT), isovolumic relaxation time (IVRT)-myocardial early (Ea) and late (Aa) diastolic velocities were measured at the lateral border of the mitral annulus using tissue Doppler imaging. E/A and E/Ea ratios were calculated. Simple associations between the variables were estimated by Pearson's method. Results: Carotid Ep showed significant correlations with both A (r=0.537, p<0.05) and E/A (r=-0.500, p<0.05) values, and correlated with IVRT also significantly (r=0.489, p<0.05). Carotid ß correlated with A (r=0.479, p<0.05), E/A (r=-0.548, p<0.05) and IVRT (r=0.564, p<0.01). Carotid AC correlated with A (r=-0.512, p<0.05), E/A (r=0.551, p<0.05) and IVRT values (r=-0.436, p<0.05). Carotid PWV and Aix showed similarly significant correlations with A, E/A, IVRT and with A and E/A values, respectively. Ep, ß and PWV determined by pulse-wave analysis and brachial artery echo-tracking did not correlate with the echocardiographic parameters of the left ventricular diastolic function. Brachial AC showed a significant correlation with A (r=-0.478, p<0.05) and DT (r=0.469, p<0.05). Significant correlation was found between Aix measured by pulse-wave analysis and Aa (r=0.560, p<0.05). Conclusion: Distensibility of elastic arteries correlates well with the echocardiographic indices of the left ventricular diastolic function, but stiffness of muscular type arteries is less useful to predict the degree of diastolic impairment. Selected parameters of arterial stiffness are good predictors of diastolic dysfunction in scleroderma patients ±.
Bicuspid aortic valve and associated congenital cardiac malformations in children LJ. Gong; ZK. Y... more Bicuspid aortic valve and associated congenital cardiac malformations in children LJ. Gong; ZK. Ye; ZW. Zeng; MY. Xia; Y. Zhong; Y. Yao Fuwai cardiovascular hospital, Beijing, China, People's Republic of Objectives: To determine the clinical morphology of congenital bicuspid aortic valves (BAV) and its relationship with congenital cardiac malformations in children. Methods: 252 patients (age,18 years old) with BAV who were identified by transthoracic echocardiography were included. All patients were divided into two groups, group 1 was ≤3 y, and group 2 was .3 y. To estimate the frequency of BAV associated with other cardiac malformations in all patients and to analyze BAV and the frequency of major congenitally cardiac malformations by age and sex roughly. Results: The mean age of the patients was 3y (1 day-17.9 years), males 188 (67.4%), females 64 (32.5%). R-L phenotype (absence of the inter coronary commissure) was the most common(71.4%), both in patients with isolated BAV (58.9%) and in those with additional pathology. L-N phenotype was rarely (1.6%), and 2 of 4 patients with this pattern had no other structural abnormality. The majority of patients with coarctation (82.4 %) and left heart obstructive lesions (80%) had R-L phenotype, non-left heart defects (79.8 %) had R-L phenotype. The difference between the numbers of aortic stenosis(AS) and aortic regurgitation(AR) of BAV patients was not remarkable. AR was observed in 20.2% of BAV patients. In R-L phenotype,most patients associated with AS(80.6%, P,0.05). Compared with the other two BAV types, patients with R-N phenotype were more likely to have at least moderate AR(78.4%, P,0.05) or AS and AR (74%, P,0.05). In male group: intracardiac shunt, coarctation and congenital mitral valve disease were common than female in ,3y group. In group2: Intracardiac shunt and congenital mitral valve disease were most common in male. BAV in conjunction with aortic coarctation was associated with a lower prevalence of valve stenosis and regurgitation. In group 1, inracardiac shun, coarctation and congenital mitral valve disease were common in male than female. In group 2, intracardiac shunt and congenital mitral valve disease were most common in male group than female, but the prevalence of coarctation was not too high. Most aortic coarctation tended to be younger boys. Conclusions: Different morphologies of BAV were associated with different cardiac abnormalities, especially left-heart obstructive lesions. The AS was most often observed in patients with R-L phenotype. Most of AR and/or both of AS and AR could be observed in patients with R-N phenotype. Boys with BAV had higher risk of aortic coarctation and congenital mitral valve abnormalities than girls in ≤3 years group, but this difference decreased between sex in .3 years group.
European Heart Journal - Cardiovascular Imaging, 2014
Introduction: The increase of left auricular volume (LAV) is a robust cardiovascular event predic... more Introduction: The increase of left auricular volume (LAV) is a robust cardiovascular event predictor. Despite that echochardiography is more often used, cardiac MRI is considered more accurate. Our objetives are to validate "fast" LAV measures by MRI vs the considered gold standard (GS) and to compare Echo and MRI in a wide spectrum of patients. Methods: In a non-selected popullation with MRI study previously realized, we measured LAV by biplane method (BPMR) and by area-length in 4 chamber view (ALMR) and compared them with biplane (BPe) and discs method (MDDe) in 4 chamber view in echo. To validate MRI measurements, we measured LAV in short axis slices (Simpson Method, SM) in a group of patients and considered it the GS. Results: 186 patients were included (mean age 51 + 17 age; 123 male; 14 in AF) with clinical indication of cardiac MRI (Philips 1,5 T). In 24 patients SM was calculated. 29% of cardiac MRI were considered normal. Mean underlying pathologies were myocardiopathy (27%), Ischemic myocardiopathy (17%), myopericarditis (10%), prior to AF ablation (4%), valvular disease (6%) and miscellaneous (7%). Excellent correlation was obtained between "fast" MRI measurements and SM in MRI (SM vs BPMR interclass correlation coefficient ICC=0.965 and SM vs ALMR, ICC=0.958; P,0.05) with low interobserver variability (ICC=0.983 for SM; ICC=0.949 for BPMR; ICC=0.931 for ALMR). "Fast" measurements by MRI showed stadistical correlation between them (CCI=0.910) (Figure). Correlation between Echo and MRI measures was only moderate. (BPRM vs BPe CCI=0,469 mean difference-30 ml; ALMR vs MDDe ICC=0,456 mean difference-24 mL). Conclusions: 'fast' LAV measures by MRI are comparable with the MRI GS and also between them. Echo values seem to underestimate compared to MRI, so its use may not be suitable.
Background: The occurrence of hypertrophic cardiomyopathy (HCM) among clinical studies shows larg... more Background: The occurrence of hypertrophic cardiomyopathy (HCM) among clinical studies shows large variations. The predictive power of risk factors to indicate proper clinical outcome also varies among clinical studies. The aim of our study was to determine whether evidence based risk stratification, strengthened by MRI techniques, improved the prediction of clinical outcome. Material and methods: 51 HCM (mean age 49±16, 33 male, HOCM 20) patients (pts) were studied between 2002 and 2005. Detailed anamnestic data, physical exam, ECG, HOLTER, Stress test, echocardiography and cardiac MRI (function and late enhancement) were performed to determine evidence based minor and major risk factors of SCD. Coronary angiography was only performed in cases of clinical indications of IHD. High risk patient group was defined having two or more major risk factors (Group I). The rest of the patients were grouped into the low risk patient group (Group II). The diagnostic powers of risk factors were analyzed while comparing their occurrences. The outcome indicators during follow up were: occurrences of heart failure (HF), cardiac death (CD), necessity of ICD implantation and surgical myectomy. Results: 16 (45±12 y, 5/11 f/m) and 35 (52±15 y, 14/21 f/m) pts were classified into Groups I and II, respectively. The number of high risk pts examined in our heart center was higher then expected based on the literature. In Groups I vs II the occurrences of SCD, NSVT, abnormal exercise BP, LVWT ≥30 mm, and late enhancement were 2 vs 0, 4 vs 1, 3 vs 0, 9 vs 3 and 14 vs 9, respectively. The latter data indicate significantly higher number of risk factors in Group I. Simultaneously in Group I vs II the occurrences of HF, CD and ICD implantation were 4 vs 2, 2 vs 0 and 6 vs 0, respectively. There was no significant difference in the number of HOCM (8 vs 12) pts between Groups I and II. Interestingly, however, more HOCM pts of Group I needed surgical myectomy (4 vs 2). Conclusion: The number of major advanced cardiac events, the necessities of ICD implantations and surgical myectomy were indicated well using our evidence based MRI strengthened risk stratification strategy.
1. Int J Cardiol. 2011 Oct 8. [Epub ahead of print] The Gln1233ter mutation of the myosin binding... more 1. Int J Cardiol. 2011 Oct 8. [Epub ahead of print] The Gln1233ter mutation of the myosin binding protein C gene: Causative mutation or innocent polymorphism in patients with hypertrophic cardiomyopathy? Tóth T, Nagy V, Faludi ...
Catheter ablation of left ventricular outflow tract tachycardia (LVOTT) holds the risk of complic... more Catheter ablation of left ventricular outflow tract tachycardia (LVOTT) holds the risk of complications, if foci are located close to the coronary artery orifices. The use of an accurate three-dimensional electro-anatomic approach is necessary to avoid ablation in the coronaries. We report a case in which we demonstrate the value of the CartoSound system, in the ablation of LVOTT.
Introduction Increased aortic pulse wave velocity (PWV) as a strong predictor of major advanced c... more Introduction Increased aortic pulse wave velocity (PWV) as a strong predictor of major advanced cardiovascular events (MACE) has a prognostic relevance in patients after myocardial infarction (MI). Several non-invasive methods have been proposed for the assessment of arterial stiffness, but the PWV values show significant differences according to the applied techniques. Cardiac magnetic resonance imaging (CMR) provides an accurate method to measure PWV and infarct size in patients after MI. Purpose Calculated PWV values of CMR based phase-contrast (PC) and invasively validated oscillometric methods were compared in this prospective observational study. We aimed to evaluate the cut-off PWV values for each method, while MACE predicted and validated the prognostic value of high PWV in post-infarcted patients in a 6-year follow-up. Methods 3D aortic angiography and PC velocity imaging was performed using a Siemens Avanto 1,5 T CMR device. Oscillometric based Arteriograph (AG) was used t...
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