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Andrzej Gackowski

Publications and source records attributed to Andrzej Gackowski.

14 recordsLinked to original sources
PubMed2006

[Alcohol ablation of the interventricular septum in a patient with hypertrophic obstructive cardiomyopathy complicated by an increase in the pressure gradient in the left ventricular outflow tract. A case report].

A case of a 70 year old female with hypertrophic obstructive cardiomyopathy who underwent alcohol ablation of the interventricular septum, is presented. Following the procedure, the pressure gradient decreased from 120 mmHg to 80 mmHg. However, 30 minutes after ablation the patients developed hypotension and pulmonary oedema. Echocardiography revealed a significant systolic anterior movement of the anterior leaflet of the mitral valve and elevated pressure gradient up to 200 mmHg. The patient underwent urgent surgery (myectomy), followed by the mitral valve replacement with a favourable outcome.

Aged↗
PubMed2005

Value of lead aVR in the detection of significant left main coronary artery stenosis in acute coronary syndrome.

BACKGROUND: Electrocardiographic lead aVR is usually ignored in patients with chest pain. ST segment elevation in aVR may have diagnostic value in patients with acute coronary syndrome (ACS) and significant stenosis or obstruction of the left main coronary artery (LMCAS), especially when accompanied by ST segment elevation in lead V(1). AIM: To asses the value of lead aVR and V1 for the detection of LMCAS in patients with ACS. METHODS: The study group consisted of 150 patients (mean age 60.6+/-9.5 years, range 33-78 years) with ACS, including 46 with LMCAS and 104 without LMCAS. ECG recordings obtained on admission were compared between these two groups. RESULTS: In patients with LMCAS, ST segment elevation in lead aVR was two times more frequent than in remaining patients (69.6% vs 34.6% p=0.0001) whereas there were no differences in lead V(1). Sensitivity of ST elevation in aVR in detection of LMCAS was 69.6%, specificity - 65.4%, positive predictive value - 47.1%, and negative predictive value - 82.9%. In patients with LMCAS, ST segment depression was significantly more often present in ECG leads other than aVR (45.6% vs 23.1% p<0.01). Patients with LMCAS more often had hypertension (95.6% vs 77.9% p<0.05) and three-vessel disease (78.3% vs 31.8%, p<0.0001). CONCLUSIONS: The assessment of lead aVR in patients with ACS may indicate LMCAS. Additional analysis of lead V(1) does not improve diagnostic accuracy.

Acute Disease↗
PubMed2004

Comparison of echocardiography and plasma B-type natriuretic peptide for monitoring the response to treatment in acute heart failure.

AIMS: Comparison of the value of echocardiography and B-type natriuretic peptide (BNP) in monitoring response to treatment in patients admitted for acute heart failure (HF). METHODS AND RESULTS: Ninety-five consecutive patients admitted with acute HF underwent bedside Doppler echocardiography and BNP measurements on admission, after 24 h of intravenous treatment, and at day 7. We then studied the association between the clinical status, the Doppler echocardiographic findings, the BNP measurements and subsequent 60-day adverse outcome (death, resuscitated cardiac arrest, urgent heart transplantation, readmission). On admission and during hospitalisation, relationships were found between plasma BNP and Doppler echocardiographic findings, and between their changes. During a 60 day follow-up, 37 events occurred. Multivariable analysis taking into account clinical factors, Doppler echocardiography and BNP showed that the two best models to predict outcome were (1) early evaluation at day 2 (previous CHF treatment, dobutamine use, relative BNP change during first 24 h) and (2) late evaluation at day 7 (previous CHF treatment, dobutamine use, BNP at day 7). Patients with a decrease in plasma BNP >10% at day 2, or with plasma BNP <300 pg/ml at day 7 had a better outcome than the others (19% versus 65% and 16% versus 72% events, respectively, p<0.0001). CONCLUSIONS: Serial BNP measurements during the treatment of acute HF provide incremental prognostic information over clinical presentation and repetitive echocardiographic examination.

Acute Disease↗
PubMed2004

[Implication of probability analysis for diagnosis of stable coronary diseases. Comparison of non-invasive diagnostic tests].

UNLABELLED: A prospective collection of clinical (history), electrocardiography (ECG), exercise electrocardiography (EE), dobutamine stress echocardiography (SE) and catheterization data was performed in 551 patients with chest pain regarded as definite or probable stable angina pectoris. All patients (65% male) without prior history of myocardial infarction undergone clinical evaluation: chest pain classification according to Diamond, ECG, EE (regarded as positive on the basis of > or = 1 mm ST-depression), SE (ischemia was defined as new or worsening wall motion abnormalities using a 16-segment model) and coronary angiography (CA):CAD was defined as > or = 50% narrowing of at least one major vessel. Sensitivity and specificity of ECG, EE, SE was calculated: and results are as follows respectively: 23% and 87%, 93% and 21%, 85% and 69%. On the basis of these results with implication of probability analysis two algorithms were developed by computer program. They incorporated pretest variables: age, gender, chest pain classification, ECG and results of one or two non-invasive tests: EE and (or) SE. The sensitivity and specificity of the algorithm is 96% and 44%. CONCLUSIONS: 1. Chest pain characteristics remains an effective tool for estimating probability of CAD. 2. The diagnostic value of resting electrocardiography in stable CAD is low. 3. SE has comparably sensitivity but significantly higher specificity than EE. 4. We demonstrated that when the likelihood of CAD is high on the basis of initial evaluation, diagnostic non-invasive testing is not indicated before CA. 5. When the probability is intermediate or low, implementation of first choice test should be different in women (SE) and men (EE).

Adult↗
PubMed2004

[Value of dobutamine stress echocardiography for the diagnosis of coronary artery disease in women with aortic valve stenosis].

UNLABELLED: Dobutamine stress echocardiography (DSE) is widely used for diagnosis of coronary artery disease (CAD). However, data regarding the diagnosis of coronary artery disease in patients with moderately elevated maximal gradient across the stenosed aortic valve (AS) are limited. This study was designed to the value of DSE in the diagnosis of CAD in women with moderately elevated maximal gradient across the AS. PATIENTS AND METHODS: DSE was performed in 162 patients within the multicentre study. The group included 58 (mean age 61 +/- 13 years) females and 104 (mean age 58 +/- 13 years) males. DSE was performed with step-wise infusion every three minutes (5, 10, 20, 30 and 40 microg/kg/min). If the target heart rate was not reached, a further dose of 40 mcg/kg/min. together with atropine 0.25-1 mg was administered, in the absence of signs and symptoms of ischemia. Ischaemia was defined as new or worsened wall motion abnormalities at echocardiography. Coronarography was performed according to generally accepted indications. The significant coronary artery disease (>1 = 50% luminal diameter stenosis) of one of the major epicardial vessel was accepted as positive result for making the diagnosis of CAD. RESULTS: There was significant difference at rest between women and men with regard to left ventricular diastolic diameter (47.7 +/- 6.5 vs 55.6 +/- 8.8 mm), systolic diameter (30.1 +/- 7.9 vs 38.1 +/- 11.5 mm), ejection fraction (67 +/- 12 vs 55 +/- 17%), wall motion score index (1.05 +/- 0.17 vs 1.22 +/- 0.36) p<0.001. There were also a significant difference in left ventricular mass index and diastolic septum diameter (131 +/- 48 vs 152 +/- 46) and (12.5 + 2.7 vs 13.5 +/- 2.6 mm). Dobutamine peak dose was 31 +/- 11 microg/kg/min. The mean heart rate, mean systolic pressure and diastolic pressure were 114 +/- 26/min, 143 +/- 26 and 81 +/- 15 mmHg respectively. Sensitivity, specificity, and accuracy of DSE for the diagnosis of CAD in women were 77.8%, 95.8% and 90.9%. Those in men were 72.7%, 78.8% and 75.6%, respectively (NS). CONCLUSION: The diagnostic value of dobutamine stress echocardiography for the diagnosis of coronary artery disease in women with stenosed aortic valve is high. DSE is good method for the diagnosis.

Adolescent↗
PubMed2004

[Difficulties in the differential diagnosis of left ventricular aneurysm -- a case report].

Difficulties in the differential diagnosis of left ventricular aneurysm - a case report. A case of a 55-year-old male with a post- infarction left ventricular aneurysm is described. The results of such non-invasive tests as echocardiography, angiography and magnetic resonance did not allow to differentiate between true and false aneurysm. The patient underwent successful surgery which revealed the presence of true left ventricular aneurysm. Difficulties in the differentiation between true aneurysm and pseudoaneurysm are discussed.

Coronary Angiography↗
PubMed2004

[Current knowledge on diastolic heart failure].

Heart failure (HF) is still one of the most common causes of hospitalisation. Originally it was understood as systolic function impairment, but it is prooved that 40 to 50 percent of patients with clinical symptoms of HF have normal systolic function. These data lead to diagnosis of diastolic heart failure (DHF). The diastoly of the left ventricle consists of four stages: isovolumetric relaxation, early mitral inflow, slow mitral inflow and left atrium contraction. Authors have presented definition, epidemiology and basic pathophysiology of DHF. The categories of myocardial and non-myocardial pathogenic mechanisms have also been described. The clinical symptoms that allow to distinguish diastolic from systolic heart failure (SHF) have been pointed. The most common disorders that affect diastolic function like hypertension, coronary artery disease and diabetes have been described. Recent guidelines on therapy in diastolic heart failure have been also presented.

Diagnosis, Differential↗
PubMed2003

[The diagnostic value of stress dobutamine echocardiography in stable coronary artery diseases].

UNLABELLED: The relation of stress dobutamine echocardiography test results to angiographic features was assessed in 551 patients with chest pain regarded as definite or probable stable angina pectoris. The indications for catheterization in each patient were determined at the discretion of the attending physician. All patients underwent diagnostic coronary angiography (clinically important coronary artery disease was defined as > 50 per cent narrowing of the diameter of at least one major vessel or > or = 50 per cent of the left main coronary artery) and stress dobutamine echocardiography (DSE): Ischemia was defined as new or worsening wall motion abnormalities using a 16-segment model. Sensitivity and specificity of DSE was calculated: 85% and 69% respectively for the entire group, 79% and 71% in women, 87% and 66% in men and compared with diagnostic value of the electrocardiographic exercise test (EE) in the same population. Sensitivity and specificity of the EE was respectively: 93% and 21% for the entire group, 91% and 16% in women, 94% and 27% in men. CONCLUSIONS: 1. DSE has comparable sensitivity but significantly higher specificity than EE. 2. Variables determining false positive result of DSE are as follows: mean maximal heart rate, reached % of the target heart rate and wall motion abnormalities present in single segment. 3. Variables determining false negative results are: sex (male) and one vessel disease. 4. Treatment with beta-adrenolytic agents increases incidence of nondiagnostic results of DSE.

Angina Pectoris↗
PubMed2003

[Characteristics of coronary diseases in women].

Clinical picture of coronary artery disease is different in men and women. Later incidence of coronary disease in women than in men, presence of less typical symptoms, lower specificity of non invasive diagnostic tests as well as higher mortality during percutaneous or surgical revascularization are underlined. Aim of the study was to examine clinical variables, diagnostic and treatment methods in women with coronary disease on the basis of retrospective analysis of patients hospitalized in the Department of Coronary Artery Disease of the Jagiellonian University Medical School in Cracow between 1991 and 1999. 929 patients aged 31-95 years mean 56.95 +/- 10.02 years were enrolled in the study. Clinical usefulness in women with coronary disease of diagnostic tests: electrocardiographic exercise test, exercise thalium-201 scintigraphy and stress echo-cardiography with dobutamine were analyzed. The highest sensitivity was found in exercise scintigraphy (92.9%) compared to ECG exercise test (80.6%) and stress echocardiography with dobutamine (76.9%). The highest specificity characterized stress echocardiography with dobutamine (76.9%) versus exercise scintigraphy (34.7%) and ECG exercise test (25.9%). Between 1991 and 1999 women with coronary artery disease consisted 19.4% of all patients hospitalized in the Department of Coronary Artery Disease in Cracow. Among patients investigated with coronary angiography there were 18.2% of women. Among percutaneously revascularized patients women constituted 17.8%. In the analyzed period 3.5-fold increase of the number of women with CAD hospitalized in the Department of Coronary Artery Disease in Cracow, 7.5-fold increase of the number of women investigated with coronary angiography and 10.5-fold increase of the number of percutaneously or surgically revascularized women was observed. On the basis of performed diagnostic tests 650 women (69.9%) were treated pharmacologically. In 157 patients (16.9%) percutaneous coronary angioplasty was performed, in 118 patients (12.7%) coronary artery bypass surgery was done. In 4 women (4.3%) heart transplantation was performed.

Adult↗
PubMed2002

[Safety of stress echocardiography with dobutamine used in patients with aortic stenosis and left ventricular dysfunction].

THE AIMS: The aim of the study was to assess the safety of dobutamine echocardiography (DE) in patients with aortic stenosis and left ventricular ejection fraction < or = 45%. METHODS: 162 patients (mean age 59 +/- 13, 64% males) with resting transvalvular peak gradient < 70 mmHg underwent standard DE (doses 5-40 micrograms/kg/min) in a multicenter study involving 10 centers from Poland and Hungary. This analysis involves a subset of 39 pts (34 M, 5 F, age 59 +/- 13) identified according to the criterion of EF < or = 45% and mean aortic gradient < or = 35 mmHg. Clinically indicated coronary arteriography was performed in all patients with left ventricular dysfunction. RESULTS: Peak dobutamine dose was 29 +/- 10 micrograms/kg/min. Peak heart rate was 112 +/- 26 bpm. Systolic arterial pressure was 148 +/- 20 mmHg and diastolic pressure 86 +/- 14 mmHg. Transaortic mean gradient and aortic valve area increased 35 +/- 34% and 19 +/- 15% during peak dobutamine dose, respectively. Ejection fraction improved 16 +/- 14%. The test was positive in 17 (43.6%) patients, negative in 11 (28.2%) patients and non diagnostic in 11 (28.2%) patients. There were no deaths, myocardial infarctions or episodes of sustained ventricular tachycardia as a result of DE. The test was terminated when the following conditions were met: Target heart rate (23.%). Left ventricular asynergy (46.2%). Maximal established dose achieved (7.7%). Side effects (20.5%). The most common side effects were ventricular arrhythmias (35.9%), dyspnea (20.5%) and hypotension < 20 mmHg (10.3%). CONCLUSION: Despite frequent side effects, DE can be safely performed in patients with aortic stenosis and depressed left ventricular contractility.

Adult↗