Rapid resolution of large right atrial mass after anticoagulant therapy.
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Biomedical subjects
Lukasz Chrzanowski
Publications and source records attributed to Lukasz Chrzanowski.
[Giant aneurysm of the descending aorta mimicking extracardiac mass].
The case report presents a giant aneurysm of the descending aorta in a 79- year-old female. The echocardiographic study of the patient was substantially impeded, since aortic pathology obscured the left atrium in standard views and produced images mimicking extracardiac mass. Modified imaging planes were necessary to complete the correct echocardiographic visualisation of the heart and the aorta and to establish diagnosis.
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[Intravascular ultrasound imaging and histological evaluation of the aorta].
UNLABELLED: It has been shown in several in-vitro studies that IVUS images correlate well with histology and angioscopy. The existing data on intravascular imaging of large-diameter elastic arteries are scant. The aim of this study was to compare the IVUS images of aorta with the reference method--histological section by evaluating the accuracy of measurements performed at corresponding aortic segments. MATERIALS AND METHODS: 15 human aortic specimens were derived from post-mortem examination and in-vitro IVUS imaging was performed, including measurements of vessel diameters and cross-sectional areas in three specified areas. Corresponding regions of interest obtained with histology were subsequently evaluated and parameters matched to those by IVUS were calculated. RESULTS: Total of 45 pairs of measurement were compared. Mean vessel internal diameter on IVUS was 14.4 mm (SD 2.7 mm) and intima thickness was 0.6 mm (SD 0.8 mm). The corresponding aortic internal diameter observed with histology was 13.2 (SD 2.6 mm) and intima thickness--0.3 mm (SD 0.03). An overall agreement between IVUS and histology specimens was high, yelling correlation ratio of 0.99. The highest level of agreement was observed for external vessel area validation--correlation ratio 0.98. The largest discrepancy was observed for intima and media thickness, with correlation ratios of 0.61 and 0.72, respectively. CONCLUSIONS: Our data suggest that examination of aorta with intravascular ultrasound is feasible and may provide additional information in assessment of cardiovascular pathology. More complete risk stratification, which includes IVUS examination of aorta, is an important factor to determine the necessity for early preventive treatment, especially in patients with normal coronary arteries.
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[Regional aortic function studied by three-dimensional echocardiography].
UNLABELLED: Aortic pulsation is caused by the arterial blood pressure variation during the cardiac cycle. Thickening of arterial intima, as well as the presence of atherosclerotic plaques may influence vessel pulsation by increasing wall stiffness. There is no data available concerning regional changes in aortic elasticity in relation with local wall thickness and the magnitude of atherosclerosis. The study group comprised 36 patients (27 men, 9 women, mean age 53 +/- 10 years) referred to our echocardiographic laboratory for transesophageal echocardiography (TEE). TEE probe was placed at the depth of 35 cm. The spatial interval between acquired images was 3 degrees. The reconstructed data sets were reviewed and the border between the aortic wall, plaque and lumen was determined. The reconstruction of a two-centimeter-long segment of aorta was divided by coaxial planes into four longitudinal sections. Thereafter the diastolic and systolic radius of each section, thickness of atherosclerotic plaques and intima-media thickness in each section were measured. The regional beta-index was calculated as Ln (systolic pressure/diastolic pressure)/relative change in regional aortic lumen, where relative change in regional aortic lumen was calculated as the difference between aortic lumen volume in systole and diastole divided by aortic lumen volume in diastole. In total, 144 aortic sections were analyzed. The volume of two-centimeter-long segments of descending aorta ranged from 6.9 cm3 to 31.5 cm3 (mean 12.8 +/- 5.2 cm3) in systole and from 4.9 cm3 to 29.2 cm3 (mean 11.2 +/- 4.9 cm3) in diastole. The volume of the examined sections of the aortic segments ranged from 1.3 cm3 to 10.6 cm3 (mean 3.2 +/- 2.6 cm3) in systole and from 1.1 cm3 to 8.7 cm3 (mean 2.8 +/- 1.5 cm3) in diastole. The pulsation of the aortic sections varied from 0.01 cm3 to 2.7 cm3 (mean 0.4 +/- 0.3 cm3), which constituted 0 to 37% (mean 13 +/- 8%) of the section volume. The thickness of atherosclerotic plaques in the studied aortic sections ranged from 0.0 mm to 1.1 mm (mean 0.3 +/- 0.2 mm) and the intima-media thickness was within the range 1.3 mm to 2.5 mm (mean 1.9 +/- 0.3 mm). The regional beta-index of the individual section ranged from 1.1 to 253.9 (mean 9.3 +/- 24.3). The regional beta-index was statistically significantly dependent on the intima-media thickness (p=0.02). We found no significant correlation between beta-index and the thickness of atherosclerotic plaques in the studied segments (p=0.38). CONCLUSIONS: Transoesophageal three-dimensional echocardiography facilitates quantitative analysis of aortic wall stiffness and regional beta-index measurements. The local variability of beta-index is correlated with intima-media thickness, whereas the correlation with the thickness of atherosclerotic plaques is not statistically significant. These measurements may be of importance in the assessment of the degree of atherosclerosis advancement. It forms new perspectives in diagnostics with the ability to evaluate the influence of pharmacotherapy and life-style modifications.
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Different expressions of X-linked cardiomyopathy in monozygotic triplets with Becker's dystrophy.
Cardiac involvement is common in skeletal muscles disorders associated with dystrophin defect. It has been suggested however, that X-linked dilated cardiomyopathies with minimal or absent skeletal disease are distinct entities, resulting from mutations in cardiac-specific regions of dystrophin gene. This study presents a unique observation of phenotypic variability in monozygotic triplets with Becker's muscular dystrophy. The expressions of the disease range from severe peripheral myopathy to severe congestive heart failure. No deletion in dystrophin gene was observed and the mechanisms responsible for selective impairment of morphologically and functionally different muscles in three monozygotic siblings remain unclear.
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Predictors of long term outcome in medically treated patients with unstable angina.
BACKGROUND: The choice of invasive or noninvasive strategy for low risk patients with unstable angina is a challenge. OBJECTIVES: To investigate the impact of clinical factors on adverse outcomes in patients receiving successful medical treatment and referred from the hospital without invasive procedures. METHODS: The study group consisted of 166 patients (54% men, age 63+/-11 years) who were discharged symptom free after pharmacological treatment of unstable angina. The authors analyzed demographic, clinical, electrocardiographic, echocardiographic and laboratory parameters. RESULTS: During two years of follow-up, the mortality rate was 4.2%. A composite end point (coronary disease hospitalization, recurrent unstable angina, necessity for revascularization or death) occurred in 99 patients (60%). In multivariate logistic regression, the Canadian Cardiovascular Society (CCS) class (P=0.015) and the left ventricular ejection fraction (P=0.01) were independently predictive for the adverse events. A scoring system was proposed for simple risk stratification, with one point assigned to the patient for CCS class III or IV and left ventricular ejection fraction below 40%, thus yielding a score in the range of 0 to 2. The adverse event rates for total scores of 0, 1 and 2 were 37%, 64% and 86%, respectively. CONCLUSIONS: Uncomplicated follow-up in medically treated patients with unstable angina is rare. Patients with CCS class III and IV or left ventricular ejection fraction below 40% have particularly high rates of recurrent ischemia.
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Intravascular ultrasound assessment of blood vessel morphology.
Intravascular ultrasound (IVUS) is an invasive imaging technique, characterized by the ability to depict the tomographic section of blood vessels' lumen and wall. Thus, it enables the performance of a unique in-vivo assessment of the luminal area and three-layer wall morphology, as well as atherosclerosis within the vessel. The typical composition of an IVUS image and the measurements of observed structures have been shown to correlate well with histology and angioscopy in several in vitro studies. The existing data on intravascular imaging of the aorta are scant. In this study, the preliminary results of in-vitro IVUS examination of human descending aorta morphology are presented, with reference to the corresponding histological section.
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