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Lidia Tomkiewicz-Pajak

Publications and source records attributed to Lidia Tomkiewicz-Pajak.

18 recordsLinked to original sources
PubMed2004

[Atrial septal defect associated with mitral valve prolapse--prevalence and clinical significance].

AIM: High incidence of mitral valve prolapse (MVP) associated with atrial septal defect (ASD) has been reported. The study aimed to evaluate the prevalence, etiology and clinical significance of MVP in patients with ASD. METHODS: Forty-seven consecutive patients with secundum type ASD (30 F; 17 M; mean age: 37.9 +/- 14.0; range: 16-62 years) were enrolled into the study. All patients underwent M-mode and two dimensional echocardiography to check for MVP, defined as the superior systolic displacement of mitral leaflets > or = 2 mm above annulus with coaptation point at, or superior to the annular plane. Pulmonary to systemic flow ratio (Qp/Qs), diastolic right ventricle dimension (RV), left ventricle dimension (LV) and left to right ventricle ratio (LV/RV) were measured. Furthermore, mitral and tricuspid valve insufficiency and right ventricle systolic pressure (RVSP) were evaluated. A symptom-limited, incremental exercise test (CPX)--modo Bruce on Marquette 2000 Treadmill was performed in every patient. We determined: time of exercise--Time (min), peak oxygen uptake--VO2peak (ml/kg/min), VO2peak expressed as % of predicted value--VO2% and anaerobic threshold--AT (expressed as % VO2 max). The study population was divided into two groups: Group I--patients with ASD and MVP and Group II--patients with ASD without MVP. RESULTS: MVP was recognized in 17 patients (36%); anterior MVP was found in 14, two cases revealed posterior MVP and one was diagnosed with both anterior and posterior MVP. MVP was not associated with significant mitral regurgitation. Echocardiographic and CPX data are summarized in table I. There were no significant differences in age, RVSP, RV and LV diastolic dimensions between groups, although Qp/Qs was significantly higher (p=0.01) and LV/RV significantly lower (p=0.02) in the MVP group. Moreover, there was a significant negative correlation between Qp/Qs and LV/RV ratio (r=-0.70; p<0.001) in a study group. No significant difference in time of exercise, VO2peak, VO2%, and AT was observed between respective groups. CONCLUSIONS: Our data support the thesis that MVP associated with secundum ASD is a functional disorder due to the atrial shunt and leftward shift of interventricular septum. MVP does not affect cardiopulmonary capacity in ASD patients.

Adolescent↗
PubMed2004

[Early haemodynamic changes after transcatheter closure of atrial septal defect].

OBJECTIVE: To evaluate the outcomes of transcatheter closure of secundum atrial septal defect (ASD) using the Amplatzer Septal Occluder (ASO). METHODS: Between December 2000 and December 2002, 27 adult patients (20 females, 7 males) with a mean age of 41.1 +/- 13.3 (range 18-62) years were enrolled for an attempt at ASD closure with the ASO device. All patients had an isolated secundum ASD with a large left-to-right shunt (ratio of pulmonary to systemic blood flow or Qp:Qs >1.5:1). Transthoracic color Doppler echocardiographic examination was performed on all patients before procedure, 24 hours, 1 and 6 months after surgery. Clinical observation (NYHA class) was performed 1 and 6 months after surgery. RESULTS: The ASO device was successfully implanted in all patients (procedure time 19-63 minutes, median 43 minutes, fluoroscopy time 4-40 minutes, median 12.6 minutes), with only 3 patients with a trivial residual shunt. The defect echo diameter was 14.2 +/- 4.3 (7-24). At one month of follow-up transthoracic echocardiography showed that the device was correctly positioned in all cases and no predictors for a residual shunt were identified. Residual trivial shunt in one month follow-up was shaded in 3 patients. Paradoxical septal motion abnormalities normalized in all patients. The right ventricular dimension evaluated by 2D echocardiography decreased in 20 pts (74.1%), mean 5.0 +/- 3.4 mm (range 1.5-8), the right atrium dimension decreased in 21 pts (77.8%), mean 8.65 +/- 4.3 mm (range 2-20) and the left atrium dimension decreased in 15 pts (55.6%), mean 6.36 +/- 3 mm (range 2-21). We didn't find correlations between ratio of left-to-right shunt before ASD closure and the decrease of right heart dimension as well as the decrease of pulmonary artery systolic pressure. CONCLUSIONS: Transcatheter closure of secundum ASD using the ASO is a safe and effective procedure, with excellent short-term follow-up results. During one month observation it caused partial normalization of echocardiographic parameters.

Adult↗
PubMed2004

[Early results of atrial septal defect closure with the Amplatzer Septal Occluder are impacted by tricuspid insufficiency].

OBJECTIVE: Our study reports the results of a comparison of transcatheter closure of secundum atrial septal defect (ASD) using the Amplatzer Septal Occluder (ASO) in patients with and without tricuspid insufficiency. METHODS: Consecutive 27 adult patients (20 females, 7 males) with a mean age of 41.1 +/- 13.3 (range 18-62) years having an ASD II and a transcatheter closure between December 2000 and December 2002 were analyzed. All the patients had an isolated secundum ASD with a significant left-to-right shunt (ratio of pulmonary to systemic blood flow or Qp:Qs >1.5:1). Patients were divided in two groups: group I--without tricuspid abnormalities (8 patients, 29.6%), group II--patients with tricuspid insufficiency I-III stage, (19 patients, 70.4%). Transthoracic color Doppler echocardiographic study was performed in all patients before discharge and was repeated one month after discharge. RESULTS: The mean age, the diameter of defect, the degree of left-to-right shunt, the diameter of implanted device were comparable in both groups. Before implantation the dimension of right heart cavities differed between groups. The right ventricular dimension was larger in group II (mean 36.2 mm vs. 29.1 mm; p<0.009), the right atrium diameter was larger in group II (46.2 mm vs. 24.3 mm; p<0.007). Pulmonary artery systolic pressure before the procedure was higher in group II (36.6 mmHg vs. 20.43 mmHg; p<0.006). The ASO device was successfully implanted in all the patients. At one month follow-up septal motion abnormalities normalized in all patients in both groups. The mean decrease of right atrium diameter in group I was 6.2 mm (range 1.5-12 mm) compared to 9.6 mm (range 2-20) in group II, (p<0.001), the mean decrease of right ventricular diameter in group I was 5.8 mm (range 2-8 mm) compared to 3.1 mm (range 1-5.9) in group II, (p<0.006). CONCLUSIONS: Short-term follow-up demonstrated excellent results of ASD closure in both groups. In one month follow-up the decrease of right cavities dimensions was significantly higher in the patients without tricuspid abnormalities. The pulmonary artery systolic pressure before ASD closure was significantly higher in the patients with tricuspid abnormality.

Adult↗
PubMed2004

[Echocardiographic prediction of outcome in patients with congestive heart failure and mitral regurgitation].

BACKGROUND: Congestive heart failure is associated with the increase risk of death or cardiac transplantation. The ability of current techniques to predict outcome in heart failure is rather limited. Identification of the patients at risk of cardiac death or requiring heart transplantation is clinically important. The changing rate of left ventricular pressure during the cardiac cycle is an important parameter in the assessment of myocardial systolic function. Non-invasive echocardiographic method--dP/dt has been proposed to determine the isovolumic phase of cardiac function. The aim of this study was to evaluate the ability of Doppler-derived dP/dt to predict survival in patients with congestive heart failure. MATERIAL AND METHODS: Thirty one patients (22M, 9W), mean age 55 +/- 11.2 years, with CHF (LVEF < 45%, NYHA II-IV class) and chronic mitral regurgitation were analyzed. The echocardiography, cardiopulmonary exercise test and clinical follow-up were performed in all of them. The ejection fraction was calculated using the Simpson's method from apical 4-chamber view. The dP/dt index was derived from the continuous-wave Doppler spectrum. The mean follow-up period was 28.5 +/- 12 months. According to the clinical status the patients were divided into two groups: group I--21 event-free patients and group II--10 patients who experienced primary events (5 died and 5 underwent heart transplantation). RESULTS: In the group of primary events patients there was noted a significant decrease of the dP/dt index in comparison to the event-free patients: 463 mmHg/s vs 839 mmHg/s (p=0.0001). The correlation between dP/dt and ejection fraction, left ventricular end-diastolic diameter as well as between the parameters of cardiopulmonary exercise test VO2peak, VO2AT, VE/VCO2peak was found. CONCLUSIONS: Doppler echocardiographic index of dP/dt can predict the outcome in patients with congestive heart failure. Dp/dt can be useful as a prognostic factor in patients with CHF. A significant correlation was observed between dP/dt and VO2peak as well as VE/VCO2peak which are independent prognostic predictors.

Adult↗
PubMed2004

[Relationship between Doppler indices of diastolic function and exercise capacity in patients with congestive heart failure].

UNLABELLED: Exercise intolerance is a major symptom in patients (pts) with congestive heart failure (CHF). A lack of correlation between the left ventricular systolic dysfunction and exercise capacity was found. Recently, it has been proposed that diastolic dysfunction may contribute to significant impairment of exercise tolerance in pts with CHF. The aim of the study was to compare the relationship between Doppler indices of diastolic function and exercise capacity in patients with CHF. MATERIAL AND METHODS: The study included 29 pts (20 M, 9 F) 14 with idiopathic and 15 with ischaemic cardiomyopathy. The mean left ventricular ejection fraction (LVEF) was 31 +/- 8%, VO2peak was 16.4 +/- 4.6 ml/kg/min. The mean age was 55.4 +/- 12.1, ranged from 30 to 73 years. All pts underwent complete echocardiography study. Diastolic performance was estimated using conventional Doppler mitral inflow (E, A) velocities, E/A ratio, deceleration time of E velocity (E-DT), isovolumetric relaxation time (IVRT) and color Doppler M-mode flow propagation velocity (Vp). Resting spirometry and cardiopulmonary exercise test (CPX) were performed in all pts. Exercise capacity was measured as oxygen consumption at peak exercise (VO2peak). The association between echocardiography parameters and VO2peak was evaluated by Spearman's correlation coefficients (r). RESULTS: We found that VO2peak correlated significantly with the LV filling pattern estimated by the transmitral Doppler E/A ratio (r=-0.4, p=0.03), A-wave velocity (r=0.4, p=0.03) and velocity flow propagation (r=0.4, p=0.05). There was no correlation between VO2peak and following mitral inflow parameters: (E-wave, DT, IVRT). There was no correlation between VO2peak and LVEF. CONCLUSIONS: 1. Doppler indices of diastolic function are important determinants of exercise capacity in CHF pts. 2. Assessment of transmitral flow velocities holds a substantial diagnostic potential, which may be utilized in everyday clinical practice as a alternative in routine monitoring of systolic heart failure.

Adult↗
PubMed2002

[Cardiopulmonary exercise capacity in adult patients with atrial septal defect].

UNLABELLED: The aim of the study was to evaluate cardiopulmonary exercise capacity (WTS) in adult patients with atrial septal defect (ASD). After excluding 10 patients with additional cardiac, pulmonary or muscle diseases, 53 patients with ASD (Gr-ASD; mean age 37.8 +/- 14.9 years; 35 women, 19 men) were enrolled in our study. In addition, we evaluated 22 healthy age and gender matched control subjects (Gr-K; mean age 36.6 +/- 14.9 years; 13 women, 9 men). First, all subjects underwent resting spirometry and forced vital capacity--(FVC; % of predicted value), one-second forced expiratory volume--(FEV1; % of predicted value) and FEV1/FVC (%) were determined. Then each subject performed a symptom-limited, incremental exercise test (modo Bruce). We evaluated the following parameters of resting metabolism: respiratory rate--(RR; L/min), minute ventilation--(VE; L/min), tidal volume--(Vt; L), oxygen uptake--(VO2; ml/kg/min), end-tidal carbon dioxide pressure--(PET CO2; mmHg), end tidal oxygen pressure--(PET O2; mmHg), ventilatory equivalent for carbon dioxide--(VE/VCO2) and ventilatory equivalent for oxygen--(VE/VO2). The following exercise parameters were analysed: peak oxygen uptake--(VO2 peak; ml/kg/min), VO2 peak expressed as % of predicted value--(VO2 %N), anaerobic threshold--(AT; % VO2 max), ventilatory equivalent for carbon dioxide--(VE/VCO2), end-tidal carbon dioxide pressure--(PET CO2; mmHg), O2 pulse, time of exercise--(T; min) and time to AT--(TAT; min). In addition, we performed a subgroup analysis for ASD patients below and > or = 40 years of age. All values were expressed as mean +/- SD. RESULTS: Although there was no significant difference in FVC, FEV1, FEV1/FVC, VO2, VE, Vt, RR between ASD patients and controls, the ASD patients aged 40 or older showed significantly lower FEV1/FVC and significantly higher RR. Expiratory gas exchange analysis showed significant differences between the ASD patients and controls (higher VE/VCO2, VE/VO2, PET CO2, and lower PET O2 respectively). Moreover, VO2 peak, VO2%N, AT, PET CO2 and O2 pulse were significantly lower while VE/VCO2 was significantly higher in ASD patients than in normal subjects. On average, VO2%N in ASD patients was only 61% of the predicted value for age and sex. Total time of exercise and time to AT were significantly shorter in ASD patients as well. CONCLUSIONS: WTS allows appropriate evaluation of cardiopulmonary capacity in ASD patients, though the mechanisms underlying ventilatory and hemodynamic abnormalities are still not fully understood. Adult patients with ASD reveal ventilatory abnormalities with an age-related trend towards deterioration. Cardiopulmonary exercise capacity in adults with ASD is markedly reduced in comparison with healthy population and deteriorates with age. WTS complements echocardiographic and hemodynamic evaluation of patients with ASD, and is helpful in indicating patients for ASD closure and their follow up.

Adult↗
PubMed2002

[Evaluation of the respiratory system in patients with heart failure based on spiro-ergometric exercise test parameters].

UNLABELLED: The objective of this study was to assess the ventilatory parameters of cardiopulmonary exercise test (CPX) in patients with moderate and severe heart failure (HF). MATERIAL AND METHODS: We investigated 110 patients (pts) (mean age 52.1 +/- 11.1 years) with chronic HF due to dilated cardiomyopathy (42 pts) or coronary artery disease (68 pts). Resting spiro-metry, CPX on a treadmill (modified Naughton protocol, 83 pts, or modified Bruce protocol, 26 pts) and echocardiography were performed. The following parameters were analyzed: left ventricle ejection fraction (EF), forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC). Both FEV1 and FVC are expressed as a percentage of predicted normal values (FEV1-%N, FVC-%N), FEV1/FVC ratio, rest and peak parameters of CPX ratio of physiological dead space to tidal volume (VD/VTrest, VD/VTpeak), respiratory rate (RRrest, RRpeak), minute ventilation (VErest, VEpeak), tidal volume (VTrest, VTpeak), endtidal Pco2 (PETCO2rest, PETCO2peak), endtidal Po2 (PETO2rest, PETO2peak), ventilatory equivalent for carbon dioxide (VE/VCO2rest, VE/VCO2peak) and oxygen (VE/VO2rest' VE/VO2peak), exercise time (T), peak oxygen uptake VO2peak' VO2peak%N, heart rate reserve HRR, peak heart rate HRpeak%N. After the mean follow-up period of 28.5 +/- 12 months, the patients were divided into groups: Group I: n = 78 pts who survived without heart transplantation (HTX) and Group II: n = 32 pts; n = 20 pts who died while on the transplant list; n = 12 pts who underwent urgent HTX. RESULTS: The patients in the group II had lower EF, more reduced peak oxygen consumption and shorter duration of exercise. We found that FEV1, FVC, FEV1-%N, FVC-%N were more severely impaired in group II. The patients in group II also had lower PETCO2rest and higher PETO2rest. There were no differences in the FEV1/FVC ratio, VD/VTrest, RRrest, VTrest, VErest, VE/VCO2rest, VE/VO2rest between the groups. The value of VD/VTpeak, VE/VCO2peak, VE/VO2peak, PETCO2peak were significantly higher in group II when compared with group I, but the values of PETO2 were lower. Despite a shorter duration of CPX in group II there were no differences in HRpeak%N, HRR, RRpeak, VTpeak, or VEpeak, between the groups. CONCLUSION: At rest the patients with more severe HF appear to have a more restrictive pulmonary pattern and impaired pulmonary gas exchange. During exercise, the patients with severe HF have an increased dead space in the lung; more impaired pulmonary gas exchange and increased ventilatory response at a given workload.

Adult↗
PubMed2002

[Prognostic value of results from clinical tests, echocardiographic, electrocardiographic and spiro-ergometric exercise test examinations in patients with heart failure].

UNLABELLED: The aim of this study was to assess the importance of the non invasive procedures in determinating prognosis of patients with heart failure (HF). MATERIAL AND METHODS: We investigated 110 patients with a mean age of 52.1 (65 patients--59%) with chronic (HF) due to coronary artery diseases and dilated cardiomyopathy (45 patients--41%). All the patients underwent baseline evaluations including a clinical status, echocardiography, Holter monitoring and a cardiopulmonary exercise test (CPX). After the mean follow-up period of 28.5 +/- 12 months, the patients were divided into 2 groups: Group I--in which 78 patients survived without heart transplantation (HTX) and Group II--in which 20 patients died and 12 underwent HTX. The relationship between the variables derived from noninvasive procedures was assessed using multivariate Cox proportional hazards models. RESULTS: Compared to group I, Group II had a significantly higher number of patients that were classified into NYHA class III. In addition, a third heart tone was identified more often in group II and an increased number of HF etiology was due to ischemia. Electrocardiographic recording showed an increased frequency of left bundle branch block and complex ventricular arrythmias. Markedly increased values of WSLK, OKSLK, WLP, OKRLK and FW were found in group II, as compared to group I. Cardiopulmonary exercise tests in group II revealed lower values of T, VO2AT, SBPpeak, VO2peak, VO2peak%N, PETCO2peak as well as VD/VTpeak, VE/VO2peak, and VE/VCO2peak. After multivariate analysis lope VE/VCO2peak (p = 0.009), peak oxygen uptake VO2peak-%N (p = 0.035), (p = 0.036), left ventricle end systolic volume (p = 0.045) and left bundle branch block (p = 0.046) were independent predictors of survival without heart transplantation. CONCLUSION: On multivariate analysis by the Cox proportional hazards method, the variables: VE/VCO2peak, VO2peak%N, etiology--CAD, OKSLK, and left bundle branch block were independent prognostic predictors. The echocardio-graphic evaluation play a significant role in the assessment of prognosis in patients, with HF. The ejection fraction of the left ventricle was not confirmed as an independent prognostic factor in HF.

Adult↗
PubMed2002

[Reproducibility of spiro-ergometric exercise test parameters in patients with heart failure].

UNLABELLED: The aim of the study was to determine the degree of reproducibility of parameters of cardiopulmonary exercise (CPX) tests in patients with chronic heart failure (HF). MATERIAL AND METHODS: We investigated 30 patients (7 women, 23 men) with ages ranging from 44 to 68 and a mean age of 56 +/- 14.5 years with HF due to dilated cardiomyopathy (5 patients) and coronary artery diseases (25 patients). The mean ejection fraction was 24 +/- 6.2%. All the patients were symptomatically stable during the preceding 4 weeks. After a preliminary test, the patients underwent two treadmill CPX tests using modified Naughton protocol with a 1-week interval between tests. CPX tests were performed at the same time of the day, using the same equipment and the patients were receiving constant medication. The reproducibility was assessed for: Rest heart rate (HRrest), oxygen uptake at the anaerobic threshold (VO2AT) and peak exercise (VO2peak), carbon dioxide production (VCO2peak), ventilatory equivalent of carbon dioxide (VE/VCO2peak) and oxygen (VE/VO2peak), end-tidal partial pressure for carbon dioxide (PETCO2peak), exercise time (T) and respiratory exchange ratio (RER). RESULTS: The reproducibility was found for all analyzed parameters of CPX tests: HRpeak (p < 0.0001), VO2AT (p < 0.0001), T (p < 0.001), HRpeak (p < 0.0001), VO2peak (p < 0.0001), VO2peak%N (p < 0.0001), VE/VCO2peak (p < 0.0001), VE/VO2peak (p < 0.0001), PETCO2peak (p < 0.0001), RER (p < 0.004). CONCLUSION: On adherence to standardized conditions, an excellent reproducibility exists for the most important parameters of cardiopulmonary exercise tests. CPX tests provide a useful and objective method of assessing functional capacity and diseases progression in patients with heart failure.

Adult↗