Biomedical subjects

Dariusz A Kosior

Publications and source records attributed to Dariusz A Kosior.

13 recordsLinked to original sources

PubMed2006

Long-term sinus rhythm maintenance after cardioversion of persistent atrial fibrillation: is the treatment's success predictable?

The aim of our study was to identify the clinical and echocardiographic predictors of long-term success of cardioversion in patients with persistent atrial fibrillation (AF). Our study comprised 104 patients (F/M 33/71; mean age 60.4 +/- 7.9 years) assigned to SR restoration and maintenance with sequentially administered antiarrhythmic drugs. Their clinical and transthoracic echocardiographic (TTE) variables were recorded prior to cardioversion and examined for correlation with sinus rhythm (SR) maintenance at 1 year. The variables under consideration included age, gender, echo parameters such as long and short left atrial (LA) axis, LA and right atrial (RA) area, fractional shortening (FS) and left ventricular end-diastolic diameter, AF duration, New York Heart Association functional class, and concomitant diseases. Generalized additive logistic regression method was used to investigate impact of the selected variables on long-term SR maintenance. At 1 year, SR was present in 63.5% of patients. Left atrium area (LA(ar)) > 28 cm (P < 0.02) and FS value >26% (P < 0.05), both measured at baseline, were significantly associated with SR maintenance after 1 year. Patients with large LA(ar) values (>28 cm(2)) presented a significant decrease (31.45 +/- 3.07 cm(2) vs 28.94 +/- 3.81 cm(2); P < 0.008) during 30 days following SR maintenance. In patients with LA(ar) >28 cm(2) we noted an atrial decrease of 2.57 +/- 3.2 cm(2) (P < 0.004) during 30 days following SR restoration, which turned out to be an independent factor related to SR presence at 1 year of follow-up (relative risk 1.83; 95% confidence interval: 1.03-2.95; P < 0.01). Of all the considered variables only LA area and FS value seem to be relatively reliable predictors of SR sustainability at 1 year after an effective cardioversion of persistent AF.

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PubMed2006

The cost comparison of rhythm and rate control strategies in persistent atrial fibrillation.

UNLABELLED: Our sub study was designed to analyze the cost effectiveness of two alternative treatment strategies with a view to improved allocation of the limited therapeutic resources. To that effect we conducted detailed analysis of the related costs and other relevant data collected in the course of the HOT CAFE study. METHODS: The prospective costs related to 205 patients randomly assigned to rhythm or rate control were traced over a 12 month period. Since, both strategies produced similar clinical outcomes a cost minimization analysis was undertaken. The cost of diagnostic and treatment procedures, including hospitalization, outpatient visits, drugs and physicians consultations were estimated for both groups. RESULTS: The study population comprised 205 patients (mean age 60.8 year; 35% females). A hundred and one patients were randomly assigned to the rate control group with the pharmacological heart rate frequency optimization treatment combined with Holter monitoring. A hundred and four patients were randomized to sinus rhythm (SR) restoration with its subsequent maintenance with sequential antiarrhythmic drug treatment. There was no significant difference in the composite primary end-point (all-cause mortality, number of thromboembolic and major bleeding events). The hospital admissions rate was significantly higher in the rhythm control than the rate control arm (202 vs. 5, respectively). The conservative strategy involving pharmacological ventricular rate control proved to be less costly than rhythm control (1225 euros vs. 2526 euros; p<0.001). The main cost driver behind the established difference was the cardioversion related hospitalization. CONCLUSIONS: The cost effectiveness appraisal seems to have supported the rate control strategy as less costly due to the lower hospitalization rate as a major cost carrier.

Analysis of Variance↗

PubMed2006

[Unfortunate outcome of subsequent vascular complications in female patients assigned to percutaneous coronary intervention -- case report].

We present a case of a 58-year-old female who underwent elective PCI of the left anterior descending coronary artery. The procedure was complicated by vessel dissections and myocardial infarction. Cardiogenic shock complicated acute coronary syndrome required intraaortic balloon pumping what led to descending aortic dissection successfully treated with stent-graft implantation. However, the patient died due to intractable cardiogenic shock.

Aortic Dissection↗

PubMed2006

Value of transesophageal dobutamine stress echocardiography for selection of the type of cardiac surgery in significant ischaemic mitral insufficiency.

BACKGROUND: Ischaemic mitral regurgitation (IMR) may be surgically treated by isolated myocardial revascularisation or in combination with valve repair. Dobutamine stress echocardiography (DSE) may be helpful in selecting an optimal surgical strategy. AIM: To develop the optimal surgical approach to patients (pts) with significant (ERO łO2 cm(2)) IMR on the basis of TEE-DSE. An attempt was undertaken to select patients in whom coronary revascularisation should be performed alone or in combination with reconstruction of mitral apparatus. METHODS: The study group comprised 212 pts (M/F--134/78; mean age 65+/-10 years) with a history of Q-wave myocardial infarction qualified to elective surgical revascularisation on the basis of coronary angiography. In 25 pts with significant IMR (ejection fraction <40%, wall motion score index 1.8+/-0.3) TEE-DSE was performed. Based on TEE-DSE results pts were divided into the following groups: Group I--7 pts with significant reduction of MR and improvement of left ventricular contractility following dobutamine infusion and qualified to CABG; and Group II (n=18) without significant changes of IMR (9 pts) or with significant reduction of IMR without significant influence on WMSI (9 pts) who were qualified to CABG with mitral valve surgery. RESULTS: In 4 pts from Group II valve replacement was performed and the remaining 14 pts had mitral annuloplasty. Echocardiographic assessments performed 2-7 days, 6 months and 12 months following the surgical procedure revealed IMR intensity as follows (number of patients is given): Group I--small 5/4/4, moderate 2/2/2, severe 0/0/0, Group II--small 15/14/13, moderate 2/3/3, severe 0/0/0. CONCLUSIONS: TEE-DSE seems to be a useful tool for optimal selection of surgical treatment in patients with significant IMR and qualification for CABG.

Adult↗

PubMed2005

Serial antiarrhythmic therapy: role of amiodarone in prevention of atrial fibrillation recurrence--a lesson from the HOT CAFE Polish Study.

UNLABELLED: Antiarrhythmic drug prophylaxis is known to improve long-term success of electrical cardioversion (CV) in persistent atrial fibrillation (AF). This prospective study evaluates the efficacy of sequential antiarrhythmic drug therapy in sinus rhythm (SR) maintenance after successful elective CV in patients with persistent nonvalvular AF. MATERIALS AND METHODS: One hundred and twenty-eight patients (61+/-8 years old) with persistent AF underwent CV. Mean AF duration preceding CV was 268+/-99 days. Following SR restoration, patients were treated sequentially with either of the following antiarrhythmic drugs: propafenone, sotalol or disopyramide. Where arrhythmia recurred, patients received another CV and a new drug from the range defined above. Where such treatment failed, patients were loaded with 14.0- to 16.0-gram doses of amiodarone and a third CV was performed. If the first CV failed to restore SR, patients received a loading dose of amiodarone followed by another CV. When successful, amiodarone was administered on continuous basis. RESULTS: The first CV proved successful in 55.5% of patients. During 1-year of follow-up, 31 patients (43.7%) presented with SR were treated with one antiarrhythmic agent (median does not exist). Application of the second drug proved to be effective in 6 patients (15.0%; median 13 days). Amiodarone was administered as the third antiarrhythmic agent to patients who had AF recurrence on the first two antiarrhythmic agents (propafenone, sotalol or disopyramide). It proved to be effective in 18 patients (52.9%; median does not exist) remaining free from AF for a period of 1 year as of commencement of the sequential antiarrhythmic therapy. Fifty-seven patients, in whom the first CV was ineffective, received amiodarone. During the loading period, SR was restored in 7 patients (12.3%). The remaining 50 patients underwent repeated CV, with SR restored in 37 (74.0%) of them. Long-term amiodarone treatment maintained SR in 30 (68.2%) patients during the follow-up period. Amiodarone helped to maintain SR in a total of 56.5% of patients. CONCLUSIONS: Amiodarone seems to be the drug most effectively restoring and maintaining SR in patients with persistent AF resistant to CV and standard antiarrhythmic drug prophylaxis.

Aged↗

PubMed2005

A decrease of enlarged left atrium following cardioversion of atrial fibrillation predicts the long-term maintenance of sinus rhythm.

BACKGROUND: Although increased left atrial size (LA) has been long regarded as one of the factors negatively influencing the long-term maintenance of sinus rhythm (SR) following cardioversion (CV) of atrial fibrillation (AF), some reports suggested that CV might be effective also in patients with large LA.Aim. We sought to determine the role of LA enlargement in long-term SR maintenance after CV of persistent AF. METHODS: 104 consecutive patients (33 females, 71 males, mean age 60.4+/-7.4 years) were assigned to SR restoration and maintenance with serial antiarrhythmic drugs. Transthoracic echocardiographic (TTE) variables were recorded prior to CV. Generalised additive logistic regression was used to investigate the impact of LA enlargement on the long-term SR maintenance. RESULTS: SR was present in 63.5% of patients after one year of follow-up. Increased LA area >28 cm (RR 1.72; 1.09-2.71; p<0.02) and increased fractional shortening values in ranges between 26-40% (1.2; 1.01-1.44; p<0.05) were significantly associated with SR maintenance after one year. In order to determine the influence of the LA diameter on the probability of SR maintenance, we analysed mean LA(ar) values prior to and after CV. Patients with large LA(ar) (28 cm(2)) presented a significant decrease of LA size (31.45+/-3.07 cm(2) vs 28.94+/-3.81 cm(2); p<0.008) during the first 30 days after SR restoration. In the group of patients with LA(ar) 28 cm(2) we noted decrease in LA size by 2.57+/-3.2 cm(2), whereas in patients with a smaller LA volume this decrease was significantly lower, being 0.47+/-2.9 cm(2) (p<0.004). CONCLUSIONS: LA enlargement does not preclude a favourable outcome after CV of AF. The decrease in LA area occurring during 30 days following CV favours long term SR maintenance.

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PubMed2005

[Influence of sinus rhythm restoration and maintenance on left ventricle diameter and function in patients with persistent atrial fibrillation--one year follow-up].

UNLABELLED: Aim of our study was to determine the dynamics of selected echocardiographic parameters after sinus rhythm (SR) restoration and maintenance in pts with persistent nonvalvular atrial fibrillation (AF) during one year follow-up period. MATERIAL AND METHODS: Our study population comprised 104 pts (F/M 33/71; mean age 60.4 +/- 7.4) assigned to SR restoration and maintenance with serial antiarrhythmic drug usage, for whom transthoracic echocardiographic (TTE) variables were recorded prior to, 2 and 12 months after cardioversion (CD). Left ventricle diastolic diameter and fractional shortening were variables of interest. RESULTS: SR was presented in 66 (63.5%) pts at one year. There was no significant differences in left ventricle diastolic diameter during the follow up. A significant increase in left ventricular fractional shortening (29.9 +/- 6.9% vs 34.5 +/- 8.9%; p < 0.001) was found in pts assigned to the sinus rhythm restoration according to intention-to-treat analysis. Such trend was noted only in pts who maintained SR during the follow up (29.9 +/- 7.6% vs 35.6 +/- 9.3%; p < 0.001). CONCLUSIONS: Among all considered variables only value of left ventricular fractional shortening increased after successful CV of persistent AF in one year follow-up.

Aged↗

PubMed2005

Impact of sinus rhythm restoration and maintenance on left ventricular function and exercise tolerance in patients with persistent atrial fibrillation.

BACKGROUND: Although early improvement of haemodynamic parameters following successful cardioversion of atrial fibrillation (AF) has been well documented, the long-term benefits of sinus rhythm (SR) restoration are less obvious, mainly due to a high rate of AF relapses. AIM: To determine the impact of SR restoration and maintenance on exercise tolerance and heart failure progression in patients with persistent non-valvular AF during a one year follow-up period. METHODS AND RESULTS: We studied 104 patients (33 females, 71 males, mean age 60.4+/-7.4 years) with mild to moderate stable heart failure and persistent AF with well-controlled ventricular rate who were scheduled for cardioversion. They underwent submaximal exercise testing 24 hours before cardioversion, as well as 1 and 12 months afterwards. Exercise capacity was determined during symptom-limited exercise testing, according to a modified Bruce protocol. Heart failure symptoms were assessed at the same time-points of follow-up. RESULTS: SR was presented in 66 (63.5%) patients one year after cardioversion. In patients with SR, a significant improvement in left ventricular (LV) performance, exercise capacity and heart failure symptoms was noted. There was an increase in LV fractional shortening (29.9+/-7.6% vs 35.6+/-9.3%; p<0.001), maximal workload (4.7+/-2.3 vs 8.5+/-3.0 MET; p<0.001), exercise duration (125.3+/-115.3 vs 294.7+/-216.7 sec.; p<0.001), and improvement in the NYHA functional class (p<0.001). No such changes were observed in patients who had AF relapse during follow-up or in those who had unsuccessful cardioversion. CONCLUSIONS: Successful cardioversion of persistent AF resulted in a significant improvement of exercise capacity and a decrease in heart failure symptoms during one year follow-up period only in patients who maintained SR.

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PubMed2005

Amiodarone after unsuccessful direct-current cardioversion of persistent atrial fibrillation.

AIM: To assess the safety and efficacy of amiodarone used after unsuccessful direct current (DC) cardioversion of persistent atrial fibrillation (AF). METHODS: The study group comprised 67 patients (F/M 26/41; mean age 61.3+/-11.2 years) after unsuccessful DC cardioversion (DCC) of persistent AF (mean arrhythmia duration 212.6+/-135.2 days) in whom another attempt of DCC was intended. Repeat DC cardioversion was performed after loading with oral amiodarone, for a period necessary to achieve a cumulative dose of up to 12.0-16.0 g. Pretreatment was an outpatient procedure. After successful DC cardioversion all study subjects received a maintenance dose of amiodarone, 100-200 mg daily, aimed at preventing AF. The follow-up period was 12 months. RESULTS: Spontaneous conversion to sinus rhythm (SR) during amiodarone pretreatment was observed in 13 pts (19.2%). DCC was performed in 54 pts and SR was restored in 41 of the study pts (76%). Complications occurred in 3 pts, including 1 case of apparent hyperthyroidism and 2 cases of decreased TSH level, and required amiodarone withdrawal. After 12 months, 72.2% of pts maintained SR on low dose (179.2+/-42.1 mg/day) amiodarone. Spontaneous conversion to SR during amiodarone loading was significantly related to long-term SR maintenance after successful DC cardioversion (p<0.013; RR 2.01; 95% CI 1.34-3.03). CONCLUSION: Pretreatment with amiodarone and repeat DC cardioversion results in sinus rhythm restoration in about 80.6% of pts with persistent AF after an initial unsuccessful attempt. Direct-current cardioversion can be performed safely taking standard precautions for patients receiving amiodarone. At 12 months after successful repeated DC cardioversion, more than 72.2% of pts on low-dose amiodarone maintain SR.

Amiodarone↗

PubMed2005

[Feasibility of home self-administration of low molecular weight heparin by patients with atrial fibrillation recurrence. A new approach to thromboembolic prophyllaxis].

We checked the feasibility of self-screening for atrial fibrillation (AF) by instructed patients pts and prompt home self-administration of an initial dose of low-molecular weight heparin (LMWH) prior to seeking medical attention. INVESTIGATED GROUP AND METHODS: Pts with persistent AF and low risk of systemic embolisation qualified to elective cardioversion (CV) were the subjects of our interest. All pts were trained to identify AF by palpation of the radial pulse and to self-inject LMWH in case of arrhythmia recurrence. 232 pts (mean age 59.8 +/- 8.6 years) who maintained sinus rhythm (SR) during 4 weeks following successful cardioversion (CV) and correctly recognized AF recurrence and those without episodes of AF were equipped with nadroparine after acenocoumarol discontinuation. Thromboembolic prophylaxis was continued with antiplatelets agents or those no additional risk factors of systemic embolisation were left without medical therapy. RESULTS: 191 pts had AF recurrence during the mean 2.6 +/- 1.7 years observation period, 172 of them correctly identified AF episode, including 162 who performed LMWH injections at home. 7 pts, who had performed LMWH injections, presented with SR on arrival to hospital, 6 pts had AF1.2 out of 21 pts who failed to identify their AF episodes and 1 pt of those who correctly detected the AF recurrence but failed to perform LMWH self-injection suffered from ischemic stroke (sensitivity 96.1%, specificity 60.4%). No side effects of domiciliary LMWH self-injection were found. CONCLUSION: When properly trained, the majority of pts can accurately diagnose AF recurrence and self-inject initial dose of LMWH, what is feasible and may represent an attractive anti-thromboembolic strategy.

Acenocoumarol↗

PubMed2005

[Value of electrocardiographic treadmill test for rate control strategy in permanent atrial fibrillation].

AIM: of our study was to determine the correlation between physical activity tolerance assesed by exercise tolerance test (ETT) and dynamics of change of echocardiographic parameters of left atrium (LA) and left ventricle (LV) in standard transtoracic echocardiography (TTE) in long-term follow up of patients with persistent nonvalvular atrial fibrillation (AF). MATERIALS AND METHODS: We studied 67 patients (W/M: 23/44; mean age 63.2 +/- 7.1 years) with persistent AF lasting longer than 1 month. Rate control strategy targeted resting heart rate 70-90/min. All study subject underwent ETT in order to assess their exercise capacity. Before ETT we performed TTE in all patients and calculated the area of LA (LAar), longitudinal and saggital diameter of LA (LAlax, LAsax), LV end-diastolic diameter (LVEDD) and LV shortening fraction (FS). TTE was performed again in 2 and 12 months after beginning of observation. RESULTS: Using variation analysis we established the correlation between time of ETT in patients with persistent AF and dynamics of change of specific echocardiographic parameters in 12 months follow-up. In patients with ETT time <60 sec we observed statistically significant rise of LAar from 26.5 +/- 6.1 to 29.6 +/- 4.9 cm2 (p < 0.05; ANOVA) and deterioration of LV function assessed with FS from 35.6 +/- 5.3% on the beginning to 31.7 +/- 7.4% at the end of study (p < 0.02; ANOVA). There was no correlation between time of ETT and dynamics of change of other echocardiographic parameters in patients with time of ETT >60 sec. CONCLUSIONS: Time of exercise tolerance test limited with heart failure symptoms is an independent factor predicting dynamics of change of chosen echocardiographic parameters of left heart in long-term observation of patients with persistent atrial fibrillation.

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PubMed2004

Rate control vs rhythm control in patients with nonvalvular persistent atrial fibrillation: the results of the Polish How to Treat Chronic Atrial Fibrillation (HOT CAFE) Study.

STUDY OBJECTIVES: The relative risks and benefits of strategies of rate control vs rhythm control in patients with atrial fibrillation (AF) remain to be fully explored. DESIGN: The How to Treat Chronic Atrial Fibrillation (HOT CAFE) Polish trial was designed to evaluate in a randomized, multicenter, and prospective manner the feasibility and long-term outcomes of rate control vs rhythm control strategies in patients with persistent AF. PATIENTS: Our study population comprised 205 patients (134 men and 71 women; mean [+/- SD] age, 60.8 +/- 11.2 years) with a mean AF duration of 273.7 +/- 112.4 days. The mean observation period was 1.7 +/- 0.4 years. One hundred one patients were randomly assigned to the rate control group and received rate-slowing therapy guided by repeated 24-h Holter monitoring. Direct current cardioversion and atrioventricular junctional ablation with pacemaker placement were alternative nonpharmacologic strategies for patients with tachycardia that was resistant to medical therapy. One hundred four patients were randomized to sinus rhythm restoration and maintenance using serial cardioversion supported by a predefined stepwise antiarrhythmic drug regimen (ie, disopyramide, propafenone, sotalol, and amiodarone). In both groups, thromboembolic prophylaxis followed current guidelines. MEASUREMENTS AND RESULTS: At the end of follow-up, 63.5% of patients in the rhythm control arm remained in sinus rhythm. No significant differences in the composite end point (ie, all-cause mortality, number of thromboembolic events, or major bleeding) were found between the rate control group and the rhythm control group (odds ratio, 1.98; 95% confidence interval, 0.28 to 22.3; p > 0.71). The incidence of hospital admissions was much lower in the rate control arm (12% vs 74%, respectively; p < 0.001). New York Heart Association functional class improved in both study groups, while mean exercise tolerance, as measured by the maximal treadmill workload, improved only in the rhythm control group (5.2 +/- 5.1 vs 7.6 +/- 3.3 metabolic equivalents, respectively; p < 0.001). The rhythm control strategy led to an increased mean left ventricular fractional shortening (29 +/- 7% vs 31 +/- 7%, respectively; p < 0.01). One episode of pulmonary embolism occurred in the rate control group despite oral anticoagulation therapy, while three patients in the rhythm control arm of the study experienced ischemic strokes (not significant). CONCLUSIONS: The Polish HOT CAFE study revealed no significant differences in major end points between the rate control group and the rhythm control group.

Anti-Arrhythmia Agents↗

PubMed2003

Tryptase levels in patients after acute coronary syndromes: the potential new marker of an unstable plaque?

BACKGROUND: Mast cells (MCs) are multifunctional immune cells that produce a number of vasoactive or thromboactive mediators. Elevated numbers of human heart MCs are observed in the shoulder regions of coronary atherosclerotic plaques, suggesting that they play a role in plaque rupture. Cardiac MC degranulation after myocardial ischemia has been documented in animal models. Cardiac MCs are highly profibrinolytic cells and release tryptase, their specific protease, after ischemic events. HYPOTHESIS: Mast cell activation and release of tryptase may differentiate among patients with acute coronary syndromes (ACS), potentially determining the clinical course of ACS. Tryptase levels may indirectly reflect the fibrinolytic status of patients. METHODS: Mast cell activation after ACS was estimated in 10 controls and 52 patients by measuring the serum levels of tryptase in the acute phase, at 2 weeks, and at 3 months after the ACS episode. Total tryptase levels were determined by using the UniCAP system and analyzed with respect to the patients' clinical types of ACS on admission (ACS with persistent ST-segment elevation on electrocardiogram or with ST-segment depression). RESULTS: Significant differences in serum tryptase levels between the groups were found, with higher serum tryptase concentrations in the ST-segment depression group in the acute phase, and at follow-up. CONCLUSIONS: Serum tryptase concentration differences among patients with distinct types of ACS may indicate a more important role of human heart MCs in ACS with ST-segment depression pathogenesis. To our knowledge, this is the first report indicating that serum tryptase levels may differentiate patients with distinct types of ACS.

Adult↗