Biomedical subjects

Magdalena Kostkiewicz

Publications and source records attributed to Magdalena Kostkiewicz.

At least 19 recordsLinked to original sources

PubMed2006

Transcoronary stem cell delivery using physiological endothelium-targeting perfusion technique: the rationale and a pilot study involving a comparison with conventional over-the-wire balloon coronary occlusions in patients after recent myocardial infarction.

INTRODUCTION: Recent evidence shows poor efficacy of over-the-wire balloon catheter (OTW) coronary occlusive technique adopted widely for intracoronary bone marrow stem cell (BMSC) delivery. The waterfall effect of OTW-balloon inflation/deflation with reactive > or = 2-fold flow velocity increase might be partly responsible for poor BMSC retention. AIM: To evaluate the safety, feasibility and tolerability of perfusion-infusion BMSC delivery with the facilitation of cell rolling in contact with the coronary endothelium (a pre-requisite for downstream transmigration). METHODS: We randomly assigned 11 patients (age 41-72 years) with first anterior myocardial infarction treated with PTCA+stent and LVEF < or =45% at 6-9 days to OTW in-stent occlusive (3 x 3 min.) BMSC delivery or cell infusion via a perfusion catheter with multiple side holes (SH-PC). RESULTS: OTW and SH-PC patients had a similar infarct size (mean peak CK 4361 vs 4717 U/L), LVEF (41.2% vs 40.3%), infused mononuclear cell number (2.99 x 108 range 0.61-7.48 x 108 vs 3.28 x 108 range 1.64-4.39 x 108), CD 34(+) number (1.79 x 106 vs 1.62 x 106), cell viability (91.5% vs 91.8%) and clonogenicity (CFU assay). None of the SH-PC, but 67% of OTW patients, had ST-segment elevation with chest pain (and nsVT in one) that limited OTW occlusion tolerance to 50-110 sec. At 6 months DLVEF in the OTW vs SH-PC patients was +4.2% (2-6) vs +8.8% (5-16) by MRI and +4.8 (2-7) vs +13.8% (2-24) by SPECT. CONCLUSIONS: Our work indicates that the SH-PC technique can be used safely for intracoronary BMSC transplantation. Further research is needed to determine whether the putative advantages of physiological SH-PC delivery translate into enhanced BMSC homing.

Adult↗

PubMed2006

[Comparison of myocardial contrast echocardiography and 99mTc MIBI single photon emission computed tomography in the assessment of myocardial perfusion in patients with acute myocardial infarction].

UNLABELLED: The myocardial perfusion assessment in myocardial infarction is crucial to proper therapeutical decisions and patient's prognosis. The aim of the study to assess the efficacy of intravenous contrast echocardiography (MCE) in detecting myocardial perfusion defects in patients with acute myocardial infarction compared with 99mTc MIBI SPECT study. MATERIAL AND METHODS: 86 patients (mean age 58.4 +/- 11.2) underwent primary percutaneous coronary (PCI) for acute anterior myocardial infarction. TIMI grade flow, myocardial blush grade (TMPG), corrected TIMI frame count (cTFC) and segmental contractility and segmental perfusion were estimated in real time before and immediately after PCI, using injections of intravenous Optison. MCE performed before PCI described the risk area as the sum of segments with the lack of perfusion. A MCE perfusion defect size after PCI < 25% of the MCE perfusion defect size before PCI was used to define myocardial reperfusion. MCE was repeated on the third day after PCI. All patients underwent a rest 99mTc MIBI SPECT study (SPECT) on the third day after PCI. RESULTS: Based on MCE, 54 patients had reperfusion ("reflow" group) and 32 had non-reperfusion ("no-reflow" group). Patients from the non-reperfusion group showed a higher creatine kinase peak (p = 0.0034), higher kinase-MB (p = 0.0033) and higher troponine level (p = 0.0629), longer time span between the onset of pain and reperfusion (p = 0.003), and worse baseline regional contractile function (p = 0.0022). All angiographic parameters were worse in this group before as well as after PCI: more often TIMI 0 or 1, TMPG 0 or 1 in patients from "no-reflow" group was observed. These patients had higher cTFC than ones from "reflow" group. The agreement between MCE and SPECT for detecting perfusion abnormality was 87%. CONCLUSIONS: MCE facilitated identification of myocardial perfusion abnormalities in patients with acute myocardial infarction, whereas serial MCE facilitated identification of patients with early and late improvement of myocardial perfusion. MCE correlated very well with SPECT images in assessing perfusion defect.

Acute Disease↗

PubMed2005

Prognostic value of carotid intima-media thickness in detection of coronary atherosclerosis in patients with calcified aortic valve stenosis.

OBJECTIVE: Aortic stenosis (AS) coexists with coronary artery disease (CAD) in at least 30% of patients. Patients with concomitant CAD may benefit from simultaneous coronary bypass grafting. This study aimed to evaluate the prognostic value of carotid intima-media thickness (IMT) in patients with AS in assessing concomitant CAD. METHODS: Group I consisted of 33 patients (mean age +/- SD, 61.0 +/- 8.2 years; 18 men and 15 women) with AS but without CAD on angiograms. Group II consisted of 34 patients (64.4 +/- 8.0 years; 25 men and 9 women) with AS and CAD confirmed angiographically. A control group included 36 patients (61.2 +/- 4.9 years; 18 men and 18 women) with normal coronary arteries and no AS. Maximal IMT was assessed in all patients at the common carotid artery, bulb, and internal carotid artery and expressed as a mean value. RESULTS: There were no differences among the respective groups with regard to age, sex, frequency of hypertension, diabetes, and smoking habit, although patients with CAD were more often hyperlipemic (P = .038). The IMT of the common carotid artery, bulb, and internal carotid artery was significantly higher in patients with AS and CAD compared with both the control group and patients with AS only. The multivariable regression model revealed that CAD (P < .001), AS (P = .006), male sex (P = .034), age (P < .001), and diabetes mellitus (P = .047) were independent risk factors for IMT thickening. A mean IMT value of greater than 1.2 mm was predictive (sensitivity, 73.5%; specificity, 72.7%) of concomitant CAD in patients with AS. CONCLUSIONS: Intima-media thickness increases in patients with AS. The greatest IMT values are observed in patients with both AS and CAD. Patients with AS might be suspected of having CAD when the IMT value exceeds 1.2 mm.

Aged↗

PubMed2005

[Systolic and diastolic left ventricle function assessment by tissue Doppler echocardiography in patients with perfusion defects in SPECT study].

INTRODUCTION: Tissue Doppler imaging (TDI) facilitates the quantitative assessment of the regional systolic and diastolic left ventricle function. Heart scintigraphy (SPECT) facilitates the assessment of regional perfusion of the myocardium. The aim of the study was the evaluation of the correlation between the regional myocardial perfusion defects observed in the SPECT study and the regional systolic and diastolic left ventricle function observed in TDI examination in the ischaemic heart disease patients. MATERIAL AND METHODS: In 40 patients (33 men and 7 women) aged 43-74 years (mean age 56 years) diagnosed of ischaemic heart disease on the basis of coronary angiography, rest TDI examination was performed. Maximal systolic and maximal early-diastolic myocardial velocities were assessed in 13 myocardial segments of the left ventricle, supplied by respective coronary arteries (left anterior descending artery--LAD, circumflex artery--Cx, right coronary artery--RCA). During rest and exercise perfusion scintigraphy of the heart (Tc99 MIBI SPECT) myocardial perfusion was evaluated in the segments analysed previously during TDI study. On the basis of the SPECT examination results the patients were divided into three groups: group I) patients with fixed perfusion defects, group II) patients with exercise-induced perfusion defects and normal rest perfusion, group III) patients with normal perfusion during rest and exercise. RESULTS: Systolic and diastolic myocardial velocity in LAD and Cx supplied segments were significantly higher in group II and group III as compared with group I. Systolic and diastolic velocities of myocardium supplied by LAD were significantly lower in group II as compared with group III. In Cx supplied region the diastolic myocardial velocity was significantly lower in group II as compared with group Ill. CONCLUSIONS: In the left ventricle myocardial regions with fixed perfusion defects, statistically significant decrease of systolic and diastolic myocardial velocities was observed. Moreover, the decrease of diastolic myocardial velocity in the rest TDI examination was found in patients with normal rest perfusion and exercise-induced perfusion defects.

Adult↗

PubMed2004

The value of myocardial contrast echocardiography compared with SPECT in detecting myocardial perfusion abnormalities in patients with anterior acute myocardial infarction.

BACKGROUND: Microvasculature damage after myocardial infarction (MI), known as "no-reflow" phenomenon, may occur in some patients with acute MI in spite of invasive treatment and opened infarct-related coronary artery. There are several non-invasive and invasive methods used for the coronary flow assessment at the tissue level. AIM: To compare the value of intravenous contrast echocardiography (MCE) in detecting myocardial perfusion defects in patients with acute MI with (99m)Tc MIBI SPECT study. METHODS: Sixteen patients (11 males, 5 females, mean age 55.4+/-10.2 years) underwent primary coronary angioplasty or facilitated angioplasty (with reduced dose of a fibrinolytic drug and glycoprotein IIb/IIIa inhibitor) (PCI) for acute anterior MI. TIMI grade flow, TIMI Myocardial Perfusion Grade (TMPG), corrected TIMI frame count (cTFC), wall motion score index (WMSI) and segmental perfusion by myocardial contrast echocardiography (MCE) were estimated in real time before and immediately after PCI. MCE was repeated on the third day after PCI. All patients underwent (99m)Tc MIBI SPECT study (SPECT) while at rest on the third day after PCI. The area at risk was defined as the number of segments with no perfusion before angioplasty. Reflow was defined as an increase in contrast score in the same segments after angioplasty. RESULTS: Baseline MCE showed 95 segments with perfusion defects. Immediately after PCI, 77 segments were found with perfusion defect; in 10 patients improvement of myocardial perfusion was observed whereas in 6 patients perfusion defect remained unchanged. On the third day further improvement was observed in 8 patients. The number of segments with perfusion defect decreased to 53. SPECT detected perfusion defect in 54 segments. The agreement between MCE and SPECT for detecting perfusion abnormality was 98% (kappa 0.94). CONCLUSIONS: MCE is a safe technique for detecting myocardial perfusion in patients with acute MI. MCE proves that both primary and facilitated angioplasty improve myocardial perfusion in two thirds of patients with acute MI. Serial MCE allows identification of patients with both early and late improvement of myocardial perfusion. There is a very strong correlation between MCE and SPECT in the assessment of perfusion defects.

Aged↗

PubMed2004

[Assessment of ejection fraction by cardiovascular magnetic resonance in comparison with 99mTc gated SPECT].

BACKGROUND: Impaired left ventricular (LV) function with decreased ejection fraction (EF) is a frequent finding in patients with ischaemic heart disease. As a non-invasive method, cardiovascular magnetic resonance (CMR) has become an important diagnostic method in cardiology within the past decade, especially for assessing myocardial function. AIM: The purpose of this study is to compare EF estimated with 99mTc gated SPECT (GSPECT) and with CMR. METHODS: The study was performed in a group of 35 patients (11 F, 24 M; mean age 57 SD 10) after myocardial infarction. EF in CMR procedure was calculated using cine gradient echo sequences. GSPECT measured EF was estimated by Tc 99. RESULTS: The mean value of EF measured with scintigraphy was 50.5 +/- 17%, and measured with CMR 48.3 +/- 15%. The difference in mean values of EF was not statistically significant. CONCLUSIONS: 1. EF in CMR was highly concordant with GSPECT. 2. The mean value of EF measured with CMR in 75% of study patients was smaller than in the scintigraphy group, but the difference was not statistically significant. 3. CMR is a simple, precise and reproducible diagnostic method for monitoring left ventricle systolic function, and which is an additional non-invasive imaging technique in cardiac diagnosis.

Adult↗

PubMed2004

[Comparison of myocardial perfusion assessed by Tc99m MIBI single photon emission computer tomography (SPECT) with the Coronary Calcium Score (CS) assessed by multi-slice computer tomography (MSCT)].

BACKGROUND: There is growing evidence regarding evaluation of Coronary Artery Calcium Score (CS) using the multi-slice computer tomography (MSCT), but as a new method it still need for verification in comparison with other, non-invasive modalities, with established rationale. One of these is SPECT, which value in evaluation of patients with coronary artery disease is well known. We tried to compare these two studies and their usefulness in diagnosis of patients with confirmed coronary artery disease. MATERIAL AND METHODS: 72 patients (53 males and 19 females, mean age 59.9 +/- 8.66), all after coronary angiography, with coronary artery disease (CCS II or III) were included into our study. SPECT and exercise treadmill results were compared with the coronary artery calcium score (CS) as assessed by MSCT. Both studies were performed with maximal 7-days intervals at most between the studies. Image reconstruction was performed using the Autoperfusion protocol, with the VISUAL Score analysis (5-point scale) of extent of perfusion defect. MSCT was evaluated using the Calcium Score protocol. For the statistical analysis we used Student's T-test and Pearson correlation analysis. RESULTS: The correlation between total CS and the score of the reversible and non-reversible perfusion defects in Tc 99mMIBI SPECT was not found. Following the analysis for the 3 main coronary arteries separately, and number of perfusion defects, a correlation was observed for LAD and RCA perfusion regions. CONCLUSIONS: 1. Statistically significant correlation between CS by MSCT and SPECT perfusion deficiencies in the left descending artery (LAD) and right coronary artery (RCA) perfusion regions were found. 2. The correlation between high CS (>400) and the presence of hemodynamically significant changes in coronary angiography was found. 3. We conclude that CS by MSCT may be a screening-tool of some value for risk stratification.

Aged↗

PubMed2004

[Left ventricular systolic function in patients with refractory angina pectoris treated with percutaneous myocardial laser revascularisation, results of long-term follow-up].

INTRODUCTION: Percutaneous myocardial laser revascularisation (PMLR) has been developed for treatment of patients with refractory angina pectoris. This study was designed to evaluate long-term impact of PMLR on left ventricular systolic function. MATERIAL AND METHODS: Ten patients with refractory angina pectoris who underwent PMLR were studied with dobutamine stress echocardiography before procedure, at early follow-up after 1-3 months and at long-term follow-up after 2-3 years post procedure. Wall motion score index (WMSI) and ejection fraction (EF) were calculated at rest as well during infusion of dobutamine with low and high rate. RESULTS: Mean WMSI at rest decreased significantly from 1.71 +/- 0.24 before PMLR to 1.55 +/- 0.21 at early follow-up (p=0.0189) and 1.48 +/- 0.26 (p=0.009) at long-term follow-up. Mean WMSI during low-rate dobutamine infusion decreased significantly from 1.39 +/- 0.29 to 1.25 +/- 0.25 (p=0.0276) at early follow-up, but was not significantly different in long-term. Mean WMSI during high-rate dobutamine infusion decreased significantly from 1.83 +/- 0.21 before PMLR to 1.56 +/- 0.2 at early follow-up and 1.57 +/- 0.29 (p<0.03) at long-term evaluation. Mean EF at rest increased significantly from 48 +/- 8.6% before PMLR to 56.9 +/- 7.9% (p=0.0189) at early follow-up. At long-term follow-up mean EF at rest was 52.7 +/- 8.3% and was not significantly different from baseline. Mean EF during low-rate dobutamine infusion was not significantly different from baseline both at early and long-term follow-up. Mean EF during high-rate dobutamine infusion increased significantly from 44.5 +/- 8.6% before PMLR to 58.1 +/- 7.0% (p=0.0093) at early follow-up while in long-term it was 51.3 +/- 9.8%, which was not significantly different from baseline. These changes were accompanied by significant decrease of mean CCS score from 3.52 +/- 0.51 before procedure to 2.54 +/- 0.78 (p<0.0001) after 1 month and 2.78 +/- 0.65 after 24 months. CONCLUSIONS: In patients with refractory angina pectoris treated with PMLR significant early improvement of systolic left-ventricular function is observed with trend toward improvement in long-term. It is accompanied with significant long-term angina relief.

Aged↗

PubMed2004

[Acute coronary syndrome or perimyocarditis?--case report].

Acute coronary syndrome or perimyocarditis? A case report. A case of a 25-year-old male with a severe chest pain associated with ST segment changes, elevated serum C-reactive protein, myocardial necrosis markers and normal epicardial coronary arteries is presented. The patient recently recovered from upper respiratory infection. Differential diagnosis between acute coronary syndrome and perimyocarditis is discussed.

Adult↗

PubMed2003

Assessment of myocardial perfusion in patients with coronary artery disease. Comparison of myocardial contrast echocardiography and 99mTc MIBI single photon emission computed tomography.

BACKGROUND: Myocardial perfusion (MP) can be assessed in real time when using a low mechanical index (MI) and harmonic imaging following an intravenous injection of contrast agent. The aim of the study was to determine the feasibility and accuracy of the real-time imaging of contrast echocardiography (MCE) for detecting myocardial perfusion defects at rest and during dobutamine stress echocardiography (DE) compared with 99m Tc MIBI SPECT. The study group consisted of 44 patients (24 men, 20 women, mean age 58.9+/-7.8) with suspected coronary artery disease (CAD). All patients underwent DE. Wall motion (WM) and segmental perfusion were estimated in real time before and at peak stress using a low MI (0.4) after 0.3 ml bolus injections of intravenous Optison. All patients underwent a rest and exercise 99mTc MIBI SPECT study (SPECT). A 16-segment model of the left ventricle was used for the analysis of MP, WM and SPECT by a blinded reviewer. All patients underwent coronary angiography. Significant coronary artery disease was defined as >60% luminal diameter stenosis. RESULTS: All patients had significant CAD. Twenty-nine patients had single-vessel and 15 patients had double-vessel disease. For all patients, agreement between MCE and SPECT was 89%, between MCE and WM -86%, and between SPECT and WM -82%. The agreement between MCE and SPECT for LAD, RCA and Cx territories was 81, 91 and 73%, respectively. The sensitivity of MCE and SPECT for detecting perfusion defects due to significant CAD (confirmed angiographically) was 97% and 93%, respectively, and the specificity was 93 and 84%, respectively. CONCLUSION: MCE in real-time imaging with Optison has significant potential for the identification of MP abnormalities. MCE correlates very well with SPECT images.

Aged↗

PubMed2003

Prognostic value of nitrate enhanced Tc99m MIBI SPECT study in detecting viable myocardium in patients with coronary artery disease.

BACKGROUND: Assessing the viability in akinetic myocardium is vital for predicting functional recovery after therapeutic management in patients with chronic coronary artery disease (CAD) and depressed left ventricular (LV) function. The present study aimed to evaluate the efficacy of Tc99m MIBI SPECT enhanced with nitroglycerine infusion in detecting myocardial viability, as well as to asses the relationship between the myocardial viability and the subsequent treatment and outcome of patients. METHODS AND RESULTS: Sixty-seven consecutive patients with CAD and LV dysfunction (LV ejection fraction 36.6 +/- 8.4%) underwent Tc99m MIBI imaging--at rest and during intravenous nitroglycerine infusion--for viability assessment. Fourteen patients were treated pharmacologically (Group I), and fifty-three (Group II) were submitted to coronary revascularization (PTCR or CABG). Fifteen major cardiac events were observed during 25 months of the follow-up. A significantly worse event-free survival was registered in the subjects of Group I than in Group II subjects. The prognostic predictors of cardiac events were: (1) the number of viable, non-revascularized segments in perfusion imaging (p < 0.001), (2) the severity of the disease assessed by coronary angiography (p < 0.05). CONCLUSIONS: Viability detection in nitroglycerine infusion enhanced Tc99m MIBI imaging offers significant prognostic value in patients with CAD after myocardial infarction. Patients with preserved viability showed better prognosis after revascularization than those treated pharmacologically.

Coronary Artery Disease↗

PubMed2003

Myocardial ischemia assessed by Tc99m MIBI SPECT and left ventricle regional systolic and diastolic function evaluated by tissue Doppler echocardiography.

BACKGROUND: Tc99m MIBI single-photon emission computed tomography (SPECT) study facilitates the evaluation of the regional myocardial perfusion and tissue Doppler echocardiography imaging facilitates the quantitative assessment of the regional systolic and diastolic function of the myocardium. The aim of the study was an assessment of the correlation between regional rest myocardial perfusion defects and regional rest systolic and diastolic myocardial velocities in patients with ischemic heart disease (IHD). MATERIAL AND METHODS: In 40 IHD patients (33 men, 7 women) aged 43-74 years (mean 56 years) rest SPECT imaging with Tc99m MIBI and rest tissue Doppler examinations were performed. The control group consisted of 35 healthy sex and age matched pesons. The left ventricle was divided into 13 segments. The number of non-perfused segments in three myocardial perfusion regions (left anterior descending artery, circumflex artery, right coronary artery) was assessed in IHD patients. During tissue Doppler examination the maximal systolic and maximal early diastolic velocity of the myocardium in each segment were established in both examined groups. RESULTS: The systolic and diastolic myocardial velocities were significantly lower in IHD group as compared to control group. In the IHD group statistically significant decrease of systolic and diastolic velocities in relation to the number of non-perfused segments was found. In comparing the linear regression slopes for systolic and for diastolic myocardial velocities in terms of intensification of perfusion defects, a more pronounced decrease in diastolic velocity was encountered. CONCLUSIONS: Both systolic and diastolic myocardial velocities are decreased in the myocardial regions with perfusion defects, but the reduction of the diastolic velocity is higher than the reduction of the systolic velocities. Thus our results indicate a good correlation between the intensity of perfusion abnormalities and myocardial velocities. The levels of diastolic dysfunction is more pronounced than the level of systolic dysfunction in the ischemic myocardium.

Adult↗

PubMed2003

[Relationship between carotid intima-media thickness, atherosclerosis risk factors and angiography findings in patients with coronary artery disease].

UNLABELLED: The aim was to determine relationship between carotid intima-media thickness and atherosclerosis risk factors and angiographic findings in patients with coronary artery disease. METHODS: We examined 172 consecutive patients, men and women, aged 58.5 +/- 9.35 years. Eligibility criteria included presence of coronary artery disease that was defined as a history of a heart attack or cardiac catheterization demonstrating > 50% stenosis of at least 1 coronary artery. B-mode ultrasound quantification of carotid artery intima-media thickness was obtained in all patients. Intima-media thickness was measured at left and right carotid arteries and expressed as the mean of the maxima in the common carotid artery, bifurcation and the internal carotid artery. Moreover, the mean of the maxima (IMT) was calculated at all sites. A grade of stenosis was identified and quantified by analyzing Doppler velocity spectrum in combination with measurement of stenosis area in all patients with severe lesions. Obtained results were compared with risk factors of atherosclerosis and angiographic findings on coronary artery angiograms. RESULTS: There was a statistically significant positive correlation between age (p = 0.0001), hypertension (p = 0.0001), hyperlipidaemia (p = 0.008), non-insulin-dependent-diabetes mellitus (p = 0.043) and intima-media thickness. In 157 (91.3%) patients intima-media thickening and plaques were present in carotid arteries. We observed high-grade stenosis of carotid arteries in 15 patients (8.7%) with coronary artery disease, furthermore all these patients have had at least two-vessel coronary artery disease. CONCLUSIONS: Alterations within carotid arteries: intia-media thickening and plagues were identified in 91.3% patients. We observed statistically significant correlation between IMT and advancing coronary artery disease. High-grade stenosis of carotid arteries was observed in 8.7% patients with coronary artery disease, furthermore in 13.7% patients with advanced coronary artery disease. IMT increases with age. Hypertension, hyperlipidemia and non-insulin-dependent diabetes mellitus are related to a greater IMT, whereas other risk factors didn't reveal that correlation.

Angioplasty, Balloon, Coronary↗

PubMed2002