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Biomedical subjects

A Kuch-Wocial

Publications and source records attributed to A Kuch-Wocial.

15 recordsLinked to original sources
PubMed2001

Diagnostic value of transoesophageal echocardiography in suspected haemodynamically significant pulmonary embolism.

OBJECTIVE: To assess the value of transoesophageal echocardiography (TOE) for diagnosing suspected haemodynamically significant pulmonary embolism and signs of right ventricular overload at standard echocardiography. METHODS: 113 consecutive patients (58 male; 55 female), mean (SD) age 53.6 (13.3) years, in whom there was clinical suspicion of pulmonary embolism and right ventricular overload on transthoracic echocardiography, underwent TOE in addition to routine diagnostic procedures to identify pulmonary artery thrombi. RESULTS: TOE revealed thrombi in 32 of 51 patients who had suspected acute pulmonary embolism and in 31 of 62 with suspected chronic pulmonary embolism. In one patient a pulmonary angiosarcoma rather than chronic pulmonary embolism was found at surgery. The diagnosis of pulmonary embolism was confirmed in 77 patients by scintigraphy, spiral computed tomography, angiography, or necropsy (reference methods). While TOE failed to provide a diagnosis of pulmonary embolism in 15 of these 77 patients, no false positive findings were reported (sensitivity 80.5%, specificity 97.2%). In 11 and 26 cases, respectively, the thrombi were confined to the left or right pulmonary artery. Bilateral thrombi were found in 25 patients. Mobile thrombi were observed only in acute pulmonary embolism (in 19 of 32 patients). No complications of TOE were noted. CONCLUSIONS: TOE permits visualisation of pulmonary arterial thrombi, confirming the diagnosis in the majority of patients with pulmonary embolism and right ventricular overload. This may be useful for prompt decision making in patients with haemodynamic compromise considered for thrombolysis or embolectomy.

Echocardiography↗
PubMed2000

[Transesophageal echocardiography--a method for prompt diagnosis of acute hemodynamically significant pulmonary embolism].

UNLABELLED: Patients with acute pulmonary embolism (PE) may require prompt confirmation of PE before aggressive therapy such as embolectomy or thrombolysis. However, emergency availability of routine diagnostic tests often remains a problem. Therefore, we assessed prospectively the diagnostic value of transesophageal echocardiography (TEE), recently reported to be useful in the diagnosis of PE. TEE was performed in 76 consecutive patients (42 F, 34 M) aged 66.7 +/- 15.8 yrs with suspected acute PE with echocardiographic signs of right ventricular pressure overload, but without known coexisting cardiorespiratory diseases. Pulmonary artery thrombi (TH) were visualized at TEE in 69.7% (53) pts. PE was confirmed by high probability lung scintigraphy and/or spiral CT in all these cases. Additionally, PE was diagnosed in 11 others without TEE-reported TH. In the 12 remaining patients PE was eventually excluded (specificity 100%, sensitivity 82.8%). Therefore, TEE in the diagnosis of hemodynamically significant PE reached 100%. No clinically important adverse events were observed during TEE. CONCLUSION: Transesophageal echocardiography is reliable and safe method of prompt confirmation of hemodynamically significant acute pulmonary embolism with relatively high sensitivity in adequately preselected patients. However, due to topographic limitations negative result of TEE does not exclude PE.

Aged↗
PubMed1999

Effects of the correction of renal artery stenosis on blood pressure, renal function and left ventricular morphology.

The aim of this study was to evaluate the effect of renal artery stenosis (RAS) correction in hypertensive patients on 24 h SBP, 24 h DBP, creatinine clearance (GFR), urinary albumin excretion (UAE) and LV morphology and mass (LVMI). A total of 61 hypertensive patients with RAS undergoing PTRA and/or surgical treatment entered the prospective study. The final analysis was done in 44 patients (age range 45.8 +/- 16.2 years) with RAS (atherosclerosis (ASC) 31 patients, fibromuscular dysplasia (FMD) 12 patients, arteritis 1 patient) who underwent PTRA (34 patients) or surgical treatment (10 patients) and presented no Doppler signs of restenosis (or a new stenosis) during 1-year observation. The pre-interventional assessment repeated after 6 and 12 months included ABPM, GFR, UAE and echocardiography. The results were analysed in the combined group (CG) and in according aetiology. 24 h SBP and 24 h DBP decreased in all groups 6 months post-intervention and did not change further. Cure of HT was observed in 35% and 29% of ASC patients at 6 and 12 months respectively; and in 58% of FMD patients. Failure rate at 12 months was 48% in ASC against 25% in FMD. The mean GFR in CG was higher 12 months after intervention. The increase in GFR was noted in 45% of patients, the decrease in 25% of patients at 12 months. Normal values of UAE were found in 71% of patients, pre- and post-intervention alike. Mean LVMI and number of patients with LVH in CG decreased already during the initial 6 months post-intervention and did not change further. In conclusion, correction of RAS leads to cure of or improved control of hypertension in the majority of the patients with FMD, but in the ASC group in about half of cases no BP cure or improvement was seen. The renal function was improved or stable in two-thirds of patients after revascularization. Successful renal revascularization was followed by regression of LVH, which was evident within 6 months post-intervention.

Adolescent↗
PubMed1999

Proximal pulmonary emboli modify right ventricular ejection pattern.

Analysis of the systolic flow velocity curve (SFVC) in the right ventricular outflow tract is considered as an alternative to the tricuspid valve pressure gradient (TVPG) method for echo-Doppler assessment of pulmonary arterial pressure (P(pa)). The present study checked whether or not SFVC is affected by the cause of pulmonary hypertension. Doppler recordings of 86 patients (39 female, aged 55.5+/-15.2 yrs) with acute (AP-PE) or chronic (CP-PE) proximal pulmonary embolism, chronic obstructive pulmonary disase (COPD) or primary pulmonary hypertension (PPH) were retrospectively analysed by two observers unaware of the purpose of the study. Despite having the lowest TVPG (48+/-13 mmHg), patients with AP-PE had the shortest acceleration time (t(acc); 56+/-15 ms) and time to midsystolic deceleration (t(msd); 105+/-16 ms). t(acc) <60 ms in patients with TVPG <60 mmHg had 98% specificity and 48% sensitivity for AP-PE. In PPH, SFVC was less abnormal (t(acc) 64+/-14 ms, t(msd) 125+/-25 ms, both p<0.03) despite having a TVPG twice as high (92+/-12 mmHg, p< 0.001). In contrast to t(acc), TVPG showed strong correlation with direct P(pa) measurements whenever performed (r=-0.43, p=0.02, versus r=0.80, p<0.001; n=30). There was no correlation between t(acc) and TVPG in a pooled study group and SFVC seemed strongly affected by the presence of both AP-PE and CP-PE. While potentially useful for evaluation of the true right ventricular afterload during pulsatile flow conditions, the systolic flow velocity curve does not provide a reliable estimate of pulmonary arterial pressure.

Adult↗
PubMed1999

[Electrical instability of the heart in patients with left ventricular hypertrophy in the course of hypertension].

UNLABELLED: Left ventricular hypertrophy (LVH) in course of the systemic hypertension (HT) is found as independent risk factor for ventricular arrhythmia and sudden cardiac death. OBJECTS: The aim of the study was to evaluate the relationship between occurrence of LVH and electrical instability. Study group included 64 patients (pts) with mild to moderate HT, without clinical signs of coronary artery disease. Pts were divided into two group: with and without LVH (LVH was diagnosed by echocardiography (ECHO) when left ventricular mass index (LVMI) was > 106 g/m2 for women, and > 111 g/m2 for men). By 12-lead ECG QTc, dispersion QT (QTd) were calculated. From SAECG the QRS duration (tQRS), the root mean square of the last 40 ms of the filtered QRS complex (RMS40) and the duration of the terminal low amplitude QRS signal < 40 microV (LAS 40) were calculated. Ventricular arrhythmias were recorded during 24 hour Holter monitoring and classified into the Lown classification. RESULTS: No difference in QTd between two groups was observed. Nobody has nonsustained ventricular tachycardia in 24-hour Holter monitoring. In group with LVH tQRS was longer and RMS higher in SAECG than in group without LVH. CONCLUSION: LVH in hypertensive pts influences the increase of electrical instability that is evaluated by SAECG.

Adult↗
PubMed1998

Regression of left ventricular hypertrophy in hypertensive patients after 1 year of treatment with rilmenidine: a double-blind, randomized, controlled (versus nifedipine) study.

OBJECTIVE: To assess the effect of 1-year treatment with rilmenidine, an oxazoline compound that exerts its antihypertensive effects through binding to imidazoline receptors in the brainstem, on left ventricular hypertrophy (LVH) secondary to essential, mild-to-moderate hypertension [supine diastolic blood pressure (DBP)95-115 mmHg]. METHODS: We performed a double-blind, randomized, controlled (versus slow-release nifedipine) trial. Adjustment of treatment took place every month (M) between inclusion (MO) and an evaluation after 6 months (M6), then during M9 and after 1 year (M12) to achieve supine DBP values < or = 90 mmHg. Patients were dropped from our study if they had DBP> 95mmHg during two consecutive visits or DBP>115 mmHg on one occasion. The daily dosage of rilmenidine was 1 mg, and could be increased to 2 mg/day. The daily dosage of slow-release nifedipine was started from the beginning at the maximum dosage of 40 mg/day, so that there was no true adjustment of treatment despite the allocation of patients to a different unit in the case of DBP> 95 mmHg. The primary criterion was the change in left ventricular mass index (LVMI, g/m2), assessed by echocardiography, between MO and M12 for patients who completed the trial. RESULTS: After a 1-month placebo run-in period, 76 patients were selected and 73 were included (35 treated with rilmenidine and 38 treated with nifedipine). Fifteen patients withdrew from the study and two completed the study with a major deviation from protocol, leaving 56 patients (24 treated with rilmenidine and 32 treated with nifedipine) for a per-protocol analysis. Baseline demographic characteristics and history of arterial hypertension for the rilmenidine and nifedipine groups were similar, for included patients and for those taken into account for the per-protocol analysis. Between MO and M12, DBP in members of the per-protocol population was adequately controlled for those in the rilmenidine group (102.7+/-4.6 versus 88.5+/-7.1 mmHg, respectively) and for those in the nifedipine group (102.7+/-5.1 versus 85.6+/-79 mmHg, respectively). During MO, LVMI of patients in the rilmenidine group (176.9+/-41.3 g/m2) was slightly higher than that of patients in the nifedipine group (172.6+/-35.1 g/m2). During M12, LVMI was observed to have decreased both for patients in the rilmenidine group (to 154.8+/-40.2 g/m2, a decrease of 22.1+/-23.3 g/m2, P< 0.001) and for those in the nifedipine group (to 145.6+/-36.4 g/m2, a decrease of 26.9+/-29.5 g/m2, P< 0.001) but the difference between these two groups was not significant (P= 0.5). CONCLUSION: One-year treatment with a daily dosage of 1 or 2 mg rilmenidine achieves a significant reduction of left ventricular mass, which is not statistically different than that occurring with a daily dosage of 40 mg of slow-release nifedipine.

Adult↗
PubMed1997

Noninvasive diagnosis of suspected severe pulmonary embolism: transesophageal echocardiography vs spiral CT.

OBJECTIVE: Patients with pulmonary embolism (PE) and echocardiographic signs of right ventricular overload have worse prognosis and may require aggressive therapy. Unequivocal confirmation of PE is required before thrombolysis or embolectomy. This study compares the value of transesophageal echocardiography (TEE) and spiral CT (sCT) in direct visualization of pulmonary artery thromboemboli in patients with suspected PE and echocardiographic signs of right ventricular overload. MATERIAL AND METHODS: Forty-nine consecutive patients (29 men and 20 women), aged 52.2+/-18.3 years, with clinical suspicion of acute (23) or chronic (26) PE and otherwise unexplained right ventricular overload at transthoracic echocardiography underwent TEE and sCT. Main and lobar (central) pulmonary arteries were searched for emboli with both TEE and sCT, while segmental and subsegmental (distal) pulmonary arteries were searched only with sCT. RESULTS: Of 40 patients with PE confirmed by high-probability lung scan (27) or angiography (13), central pulmonary arterial emboli were found at TEE and sCT in 32 (80%) and 36 (90%) patients, respectively. Neither method reported false central PE (specificity, 100%). When distal pulmonary arteries were analyzed, sensitivity of sCT increased to 97.5%, but three patients with primary pulmonary hypertension according to standard tests were misclassified as having distal PE (specificity, 90.1%). Most patients had bilateral PE according to sCT (34/36) and standard tests (40/40) but not TEE (15/32), probably due to its topographic limitations. CONCLUSIONS: Because of high prevalence of bilateral central pulmonary thromboemboli in patients with hemodynamically significant PE, both sCT and TEE allow its definitive confirmation in most cases. Thrombi reported by sCT distally to lobar arteries should be interpreted with caution.

Acute Disease↗
PubMed1995

Transoesophageal echocardiography for definitive diagnosis of haemodynamically significant pulmonary embolism.

Transesophageal echocardiographic evaluation of right and left pulmonary arteries, up to the origin of their lobar branches, was prospectively performed with a single plane probe in 32 consecutive patients (18 M, 14 F, aged 55.5 +/- 14.6, from 32 to 80 years) with clinical or echocardiographic suspicion of pulmonary embolism, who met transthoracic echocardiographic criteria of right ventricular overload. Transoesophageal echocardiography showed unequivocal (20 patients) or suspected (three patients) intraluminar thrombi in 88.5% of 26 patients with haemodynamically significant acute or chronic pulmonary embolism, confirmed with reference methods. The sensitivity of the unequivocal transoesophageal echocardiographic diagnosis was 80% for acute and 73% for chronic haemodynamically significant pulmonary embolism. No false-positive results were found (specificity 100%). Additionally, in three cases, transoesophageal echocardiography disclosed the cause of the right ventricular overload revealing a previously undiagnosed atrial septal defect or Ebstein anomaly. Direct visualization of proximal pulmonary arterial thrombi by transoesophageal echocardiography emerges as a useful new method of prompt and definite diagnosis of haemodynamically important pulmonary embolism.

Adult↗
PubMed1994

Elevated endothelin-1 plasma concentration in patients with essential hypertension.

BACKGROUND: Endothelin-1 (ET-1) may play an important role in the development and maintenance of hypertensive states. In patients with essential hypertension, ET-1 plasma concentration increases or remains unchanged. The aim of the present study was to investigate ET-1 plasma concentration in patients with mild-to-moderate essential hypertension and its interrelationship with catecholamines, neuropeptide Y and atrial natriuretic peptide (ANP). METHODS: The study included 37 patients (mean age 38.2 +/- 1.6 years) with mild-to-moderate essential hypertension. The control group consisted of 21 healthy volunteers (mean age 35.6 +/- 1.4 years). ET-1, neuropeptide Y and ANP were determined by radioimmunoassay methods and catecholamine plasma concentration was determined radioenzymatically. RESULTS: Our study shows that plasma ET-1 and neuropeptide Y levels are elevated in patients with essential hypertension compared with a control group. No correlation was found in either of the groups between plasma ET-1 level and plasma neuropeptide Y, catecholamine or ANP concentrations. CONCLUSION: Our results suggest that ET-1 is relevant in the development and maintenance of elevated blood pressure.

Adult↗
PubMed1994

[Giant cell arteritis--presentation of 3 cases].

Three patients with giant cell arteritis (GCA) observed recently in our department are described. One of them demonstrated clinical picture of polymyalgia rheumatica, the other two presented with clinical symptoms of GCA. This presentation seems to be very helpful for correct diagnosis in cases with difficult recognition.

Aged↗
PubMed1992

[Primary arterial hypertension. Treatment with captopril and function of the left heart ventricle, concentration of catecholamine in blood and activity of renin].

We evaluated the effect of captopril treatment on left ventricular mass (LVM) and function in sustained mild-to-moderate primary hypertension. In 16 men aged 34.5 +/- 6.4 yrs. M-mode echo and pulsed wave Doppler recordings were obtained prior to and after 2 months captopril treatment (50-150 mg daily). No significant changes in heart rate, systolic blood pressure, ejection fraction, fractional shortening, cardiac output, LVM and Doppler-derived indices of mitral inflow were observed. Diastolic blood pressure measured during examination fell from 102.2 +/- 13.3 to 90.3 +/- 9 mmHg (p less than 0.026). No consistent correlations between catecholamines and indexes of left ventricular function were found. Two-month captopril therapy in mild-to-moderate hypertension results in diastolic blood pressure lowering with no effect on LVM or left ventricular function.

Adult↗
PubMed1991

[Atrial natriuretic peptide level in acute myocardial infarction].

Concentration of atrial natriuretic peptide (ANP) was studied in acute myocardial infarction (AMI), its association with ventricular arrhythmias (VA), left ventricular dysfunction and infarct size. Plasma ANP concentrations were measured at time: 0, 4, 8, 16, 24, 48 and 72 hours after admission in 11 patients (pts) with first AMI, up to 6 hours after the first symptoms. Ventricular arrhythmia was assessed by 24 hour Holter monitoring, left ventricular dysfunction by echocardiography and infarct size by serial CK-MB measurement in first 72 hours of AMI. In subsequent measurements the average plasma concentration of ANP (mean +/- SEM) was elevated: 42.2 +/- 9.9, 35.3 +/- 12.5, 33.9 +/- 8.3, 42.3 +/- 8.3, 36.9 +/- 6.4, 60.7 +/- 9.3, 47.8 +/- 12.0 fmol/ml. The maximal plasma ANP concentration was significantly higher (p less than 0.01) in 4 pts with VA 4th grade acc. to Lown than in 7 pts without VA (102.6 +/- 17.9 vs 41.1 +/- 6.4). The maximal level of ANP--153.3 fmol/ml in a patient with paroxysmal supraventricular tachycardia was observed. There were no significant correlations between plasma ANP and infarct size, size of left atrium and contractility disturbances of left ventricle.

Adult↗
PubMed1989

[Atrial natriuretic peptide in patients with primary arterial hypertension].

Atrial natriuretic peptide (ANP) activity was studied in 33 males with borderline and established essential hypertension. No significant differences of serum ANP concentration were stated in patients with borderline and established uncomplicated hypertension in comparison with the control group.

Adolescent↗