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Biomedical subjects

Marek Maciejewski

Publications and source records attributed to Marek Maciejewski.

16 recordsLinked to original sources
PubMed2006

Pacing and sensing disturbances in patients with DDD pacemakers in the early period after implantation.

OBJECTIVES: We sought to determine the usefulness of ambulatory 24-hour Holter monitoring in detecting asymptomatic pacemaker (PM) malfunction episodes in patients with dual-chamber pacemakers whose pacing and sensing parameters were proper, as seen in routine post-implantation follow-ups. This aspect has not been widely discussed so far. METHODS AND RESULTS: Ambulatory 24-hour Holter recordings [HM] were performed in 100 patients with DDD pacemakers one day after the implantation. Only asymptomatic patients with proper pacing and sensing parameters (assessed on PM telemetry on the first day post-implantation) were enrolled in the study. The following parameters were assessed: failure to pace, failure to sense (both oversensing and undersensing episodes) as well as the percentage of all PM disturbances. Despite proper sensing and pacing parameters, HM revealed PM disturbances in 23% of the patients.Atrial undersensing episodes were found in 12 patients and failure to capture in I patient. T wave oversensing was the most common ventricular channel disorder (9 patients). Malfunction episodes occurred sporadically, leading to pauses of up to 1.6 s or temporary bradycardia, which were, nevertheless, not accompanied by clinical symptoms. No ventricular pacing disturbances were found. CONCLUSION: Asymptomatic pacemaker dysfunction may be observed in nearly 25% of patients with proper DDD parameters after implantation.Thus, ambulatory HM during the early post-implantation period may be a useful tool to detect the need to reprogramme PM parameters.

Aged↗
PubMed2006

[Primary cardiac amyloidosis -- condition which can be diagnosed by a cardiologist].

Primary amyloidosis is a systemic disorder caused by the clonal production and tissue deposition of immunoglobulin light chain proteins. The disease symptoms are typical of multisystem failure. Common presenting features include nephrotic syndrome, hepatomegaly, sensomotor peripheral neuropathy and, in the case of cardiac involvement, congestive heart failure. This last sign appears very seldom as alone, without any others. Cardiac involvement generally denotes a poor prognosis, regardless of the method of treatment. The median survival rate from onset of congestive heart failure is 6 months. Only the patients with earliest diagnosis made and advanced treatment (chemotherapy, autologous stem-cell transplantation, heart transplantation) introduced have the chance of the lengthening of life. The authors present a case of 52-year-old man with a primary amyloidosis, who suffered from severe, not responding to treatment, congestive heart failure. Because of lack of the other organ involvement symptoms, the correct diagnosis was made very late. The authors place emphasis on a simple diagnostic tool such as the correlation between the low voltage in the limb ECG leads and the echocardiographic sings of left ventricular hypertrophy. The combination of specific ECG, echocardiographic findings and positive extracardiac tissue biopsy may be sufficient to reach correct diagnosis. These examinations are easy accessible in non-specialist hospitals.

Amyloidosis↗
PubMed2006

[Effect of chronic therapy with low dose of angiotensin converting enzyme inhibitors on mortality in patients with left ventricular dysfunction after acute myocardial infarction].

UNLABELLED: Angiotensin converting enzyme inhibitors (ACE-I) used in patients with postinfarction left ventricular dysfunction reduce the risk of death. Some patients do not tolerate high dose of medications which benefit was well documented in multicentre trials. THE AIM OF THIS STUDY: was to evaluate the effect of low doses of ACE-I on mortality rate in patients with ejection fraction (EF) below < or = 35% after acute myocardial infarction (MI) in long-term observation. MATERIAL AND METHODS: Study population consisted of 84 patients (pts) (67 men and 17 women) aged 38-79 (mean age 61 +/- 11) years with post-MI left ventricular dysfunction (EF < or = 35%). Patients were divided into 2 groups according to applied treatment: the group ACE-I (+) - 50 pts who received captopril, enalapril, trandolapril, perindopril or quinapril at doses not exceeding half of target dose in chronic heart failure and the group ACE-I (-) - 34 pts not treated with ACE-I. The end point of this observation was total mortality during 48 month follow-up. RESULTS: During long-term observation 33 from 84 patients died (39%). Mortality from all causes in the group ACE-I (+) was non significantly reduced as compared with the group ACE-I (-) (36% vs. 44%). CONCLUSION: In patients with left ventricular dysfunction (EF < or = 35%) after acute myocardial infarction chronic treatment with low doses of ACE-I do not reduce total mortality rate.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed2006

[Thrombo-embolic events in patients with mechanical prosthetic valves--echocardiography in diagnostic and therapeutic decision making].

Mechanical prosthetic valves (PV) are prone to thrombosis which may result in death or cripple hood due to PV blockade and embolisation (EM). In most pts with clinical symptoms of PV thrombosis (TPV) and in pts with a history of EM transthoracic echocardiography (TTE) and Doppler echocardiography are sufficient in diagnosing but not in stating the exact mechanism of PV stenosis. Transesophageal echocardiography (TEE) is a method of choice in the therapeutic decision making in this group of pts. PV replacement is indicated in pts with a thrombus floating in the left atrium (LA), large, peduncle-like thrombus in LA, TPV in mitral or aortic position with blockade of the disc and symptoms of heart failure < III NYHA, TPV with a high risk of spontaneous or post-thrombolytic EM (large thrombus on the PV annulus >5 mm or >0.8 cm2, highly mobile thrombus, history of EM). Thrombolysis is recommended in tricuspid TPV, TPV in mitral or aortic position with blockade of the disc and symptoms of heart failure III/IV NYHA. Intravenous heparin infusion can be effective as a short-term bridging to PV replacement or an alternative for thrombolysis in case of TPV with no signs of disc blockade. The results of thrombolysis and heparin infusion should be controlled by TEE. In pts with proper function of PV on clinical examination and negative history of EM, TTE/TEE should be considered if the risk factors of EM are present: incorrect INR control, atrial fibrillation, left ventricular dysfunction, III/IV NYHA, diabetes, certain types of PV cage PV, pivoting-disc PV other than Medtronic-Hall valve.

Anticoagulants↗
PubMed2005

[Heart condition before and after surgical treatment of atrial septal defect type II in adults].

UNLABELLED: ASD t. II is one of the common congenital heart abnormalities in adults. Early surgical or percutaneous correction in childhood is recommended, but in adults indications to surgical treatment are still controversial. With age physical functional class (NYHA) deteriorating is observed. In the natural course of the defect some patients could be asymptomatic up to third or fourth decade of life and in the middle aged we can observe clinical symptoms. PURPOSE: The aim of the study was to assess a condition of the heart and analyse some dependences between a value of PASP and degree of NYHA class and other echocardiographic parameters in patients before and after surgical repair of ASD t.ll. MATERIAL AND METHODS: 93 patients were involved in research (24.7% male, mean age 43.8+/-11 years ) with history of isolated ASD t.II. All patients were observed in follow-up (mean range--6.6+/-3.1 years). In all pts. before and after surgery the history of the specific symptoms of dyspnea on exertion, level of fatigue, physical examination with assessment a degree of heart failure (NYHA class), a value of PASP (mmHg), the pulmonary to systemic ratio (Qp/Qs) were performed. The patients were divided into two groups according to their age at the time of surgical correction: I group < 40 years and II group > 40 years. In statistic analysis Chp test, Fisher test, t-Student test and logistic regression model were performed. RESULTS: In our study we observe a significant improvement of NYHA class in both groups. A marked recovery from class III or IV to class I or II after operation was documented in 24 pts. (47%) in I group (p<0.00001) and 14 pts. (33%) in group II. (p<0.0001). The pulmonary artery pressure decreased significantly after surgery in both groups (33.1+/-7.7 vs 21.9+/-5.1 mmHg; (p<0.0001--I group) and 41.3+/-11.5 vs 23.4+/-6.2 mmHg; (p<0.0001--II group). We did not observe any significant correlations between NYHA class and PASP and also between PASP and Qp/Qs ratio before surgery in studied groups. (p>0.05). CONCLUSIONS: 1. Surgical repair of ASD t.II is an useful treatment in adult pts. because it improves hemodynamic status and normalise PASP independently of age at the time of repair. 2. More intensive symptoms of dyspnea or fatigue assessed by NYHA class do not correspondence with value of PASP in any age before repair. 3. With advanced age a higher degree of NYHA class correlates with increased value of Qp/Qs ratio. 4. Age over 40 years is not a contraindication to surgical treatment.

Adult↗
PubMed2004

Flame synthesis of calcium carbonate nanoparticles.

Calcium carbonate nanoparticles of 20-50 nm size were obtained from a flame spray process where combustion of specific calcium-containing precursors results in amorphous or crystalline calcium carbonate particles depending on the spray flow conditions.

Journal Article↗
PubMed2004

Paradoxical arterial and pulmonary embolism in a patient with a thrombus between atrial septum and patent foramen ovale.

We describe a 50-year-old woman with an incident of systemic and pulmonary embolism in whom transoesophageal examination (TEE) with the aid of contrast echocardiography (CE) identified a patent foramen ovale (PFO) with a residual thrombus between atrial septum and PFO valve suggesting paradoxical systemic embolization. The patient was diagnosed as heterozygous for prothrombin G20210A mutation. Control TEE performed after fibrinolysis, 2 months of heparin treatment followed by oral anticoagulation did not show any embolic material within the PFO.

Anticoagulants↗
PubMed2004

[The impact of comprehensive cardiac rehabilitation in patients up to 55 years old after acute myocardial infarction treated with primary coronary intervention].

UNLABELLED: The aim of our study was to evaluate the impact of comprehensive 3-phases cardiac rehabilitation in patients aged up to 55 years after acute myocardial infarction treated with primary coronary intervention (PCI) of the infarction related artery on the cardiovascular status, modification of coronary risk factors, psychological and physical status and exercise tolerance. METHODS: Out of 106 consecutive patients aged up to 55 years with acute myocardial infarction (AMI) with ST-segment elevation, treated with primary coronary intervention (PCI) of the infarction related artery 71 patients entered the study and were randomized either to the Study Group (GB) or to the Control Group (GK). 31 patients of GB underwent 3-phases cardiac rehabilitation program and 40 patients of GK did not participate in phase III of the program. At phase I of the rehabilitation and 6 months after myocardial infarction physical examination, echocardiography and treadmill exercise test were performed. RESULTS: At 6-months follow-up chest pain and symptoms of heart failure were significantly less common (p < 0.001) and a tendency for fewer new cardiac events and re-PCI was noted in GB. Self-evaluated, significantly greater improvement in the emotional and physical status as well as in physical activity (p < 0.001) was achieved in GB. In GB better exercise tolerance on treadmill exercise test, greater improvement in left ventricular ejection fraction (p < 0.05) and contractile index (p < 0.05) on echocardiography were observed. The effects of the secondary prevention in terms of smoking cessation and obesity were not satisfactory in both groups. CONCLUSION: 3-phases comprehensive cardiac rehabilitation in patients with AMI treated with PCI of the infarction related artery improves recovery at 6-month follow-up. It has a favorable impact on the anginal and heart failure symptoms, cardiac risk factors (especially physical activity, restrictive diet), psychological and physical status. It contributes towards maintaining a further event-free period. It improves selected cardiovascular parameters such as exercise tolerance, segmental and global left ventricular function.

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

[Patent foramen ovale--demographic, clinical and echocardiographic characteristics].

UNLABELLED: Patent foramen ovale (PFO) represents the most common persistent abnormality of fetal origin. The aim of the study was to analyze the incidence and characteristics of PFO and to assess PFO as the risk factor of paradoxical embolism. 945 consecutive pts (442F and 503M aged 13-85, mean 53.02 +/- 14.42 years) in whom TEE was performed and flow through PFO was detected in basal conditions (colour-Doppler) and/or during provocation (Valsalva/cough manoeuvre) with contrast (saline infusion) at the period 1998-2002 was retrospectively analyzed. 183 pt had a history of systemic embolisation (SE) or transient ischemic attack (TIA). PFO was diagnosed [PFO(+)] in 57 pts (6%)-22F, 35M aged 14-77 years, mean 52.44 +/- 14.84 years. 888 pts without PFO [PFO(-)] created a control group. Two subgroups were analyzed in the study group: xPFO(+) - 28 pts with PFO as the only abnormality, yPFO(+) - 29 pts with PFO and other heart/aortic disease. Similarly, in the control group two subgroups were analysed: xPFO(-) - pts with normal TEE and negative history of heart/aortic disease and yPFO(-) - pts without PFO but with other heart/aortic disease. Aneurysmal formation of interatrial septum was detected in 24 pts, and in 6 pts it coexisted with PFO. The intensity of shunt was significantly higher in yPFO(+) than in xPFO(+) group. In 5 pts permanent shunt through PFO at the basal stage was observed (4 pts with significant regurgitation of the atrio-ventricular valves and one patient with tricuspid stenosis). Percentage of pts with the history of SE/TIA was significantly higher in group xPFO(+) than in xPFO(-) (p < 0.01). CONCLUSIONS: (1) PFO is a risk factor of SE/TIA only in group xPFO(+). (2) Flow through PFO in group xPFO(+) is generally minimal. (3) In case of coexisting heart pathology PFO may provoke significant right-to-left or even left-to-right shunt.

Adolescent↗
PubMed2004

Early and long-term results of surgical treatment of type A aortic dissection.

BACKGROUND: Acute aortic dissection is one of the most serious life-threatening conditions, with mortality during the first 48 hours reaching 50%. AIM: To assess short and long-term effects as well as safety of surgical treatment of aortic dissection combined with aortic valve repair. METHODS: The study group consisted of 57 patients (38 males, 19 females, mean age 47.9 +/- 13 years) with dissection of the ascending part of the aorta (type A aortic dissection) who underwent surgery in our institution between 1985 and 1999. Follow-up duration ranged from 2 to 16 years -- mean 6 years. Control transthoracic or transesophageal echocardiography was performed in 37 patients. RESULTS: Early mortality was 21%. There were 12 perioperative deaths and 3 late non-cardiovascular deaths. Three patients underwent repeated surgery due to (1) aortic valve insufficiency, (2) pseudoaneurysm at the site of the anastomosis between proximal part of the vascular prosthesis and the aorta, and (3) fistula between aorta and right atrium. CONCLUSIONS: Aortic dissection type A is more frequent in males than females. The main causative factor is hypertension. Early mortality is significantly higher in patients undergoing emergency surgery compared with elective procedures. Heart failure symptoms (NYHA class) improve postoperatively in the majority of patients. Aortic valve repair is effective and relatively safe, and is an alternative to the aortic valve replacement with coronary arteries reimplantation.

Acute Disease↗
PubMed2003

[Discitis caused by Kingella kingae--case report].

The patient with acute infection and the presence of bacterium Kingella kingae cultured from cerebrospinal fluid is presented. The analysis of clinical picture and the results of all performed tests did not allow to diagnose cerebrospinal meningitis. Despite of being not sure if Kingella kingae was an etiopathogenetic factor in the described subject, we decided to discuss this interesting case.

Acute Disease↗
PubMed2002

[Dobutamine stress echocardiography in symptomatic patients with non-diagnostic or negative treadmill test].

UNLABELLED: In patients suffering from angina like exertional pain or dyspnea with a negative or undiagnosed exercise treadmill test (u/n TET), controversy exists regarding indications to perform coronary angiography. This study was performed in order to evaluate the diagnostic significance of dobutamine echo-stress (DSE) in assessing the possible causes of symptoms in such patients. We retrospectively analysed 550 patients. Out of this number, 128 patients had a u/nTET (study group--SG) and 422 patients had a positive TET--control group (CG). The exercise treadmill test was performed according to the Bruce protocol. Dobutamine stress echocardiography was performed according to a standard protocol. RESULTS: In patients that were DSE(+), no significant differences in the analysed parameters were found between study and control groups. In patients that were DSE(-), monovariate analysis detected that gender, age, history of hypertension, LVH, sigmoid IVS, small LV and EF as factors predicting clinical symptoms. Multivariate analysis revealed that middle-aged women, elderly men, and history of hypertension were independent predictors of exertional symptoms. Multivariate analysis also showed that intracavitary LV obstruction or LV outflow tract obstruction in hypertensive females was an independent predictor of reproducibility of symptoms. CONCLUSIONS: 1. Angina-like symptoms in patients with non-diagnostic/negative TET and negative DSE depends on several clinical and echocardiographic factors. 2. Dynamic intracavitary LV obstruction or LV outflow tract obstruction, especially with a hypotensive reaction, are potential causes of symptoms in patients with non-diagnostic/negative TET and negative DSE. 3. Reproducibility of symptoms during negative DSE occurred in hypertensive females with dobutamine-induced intracavitary LV obstruction or LV outflow tract obstruction.

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↗