RESUMEN

OBJECTIVE: The echocardiographic assessment of the systemic right ventricle (sRV) performance during stress testing is limited and evaluation is not routinely performed. The aim of the study is to investigate sRV myocardial performance at rest and with exercise in patients with complete transposition of the great arteries (dTGA) who have undergone atrial switch operation. METHODS: In a single-center cross-sectional study, 41 patients with dTGA following the atrial switch operation and gender-matched 20 healthy volunteers underwent exercise echocardiography on a bicycle ergometer in the semi-supine position to assess sRV systolic function indices: tricuspid annular plane systolic excursion (TAPSE), right ventricular area change (FAC), global longitudinal strain (GLS) and systemic velocity time integral (VTI). RESULTS: Patients with sRV were characterized by lower systolic function assessed by TAPSE, s', FAC, GLS both at baseline and at peak exercise, compared with the control group. sRV GLS decreased during exercise in patients with sRV (-6 + 2.84) compared to increased in patients with systemic left ventricle (0.47 + 2.74), p < 0.001. There was no increase in VTI during exercise in patients with sRV, compared to controls (Δ VTI -0.01 ± 2.96 cm vs. Δ VTI 4.50 ± 3.13 cm, p < 0.001). There was a trend towards higher chronotropic incompetence in patients with sRV vs. control (61% vs. 45%, p = 0.28). CONCLUSION: Our results confirmed that patients with dTGA have reduced ability to increase myocardial contractility and stroke volume during exercise. Chronotropic incompetence was prevalent in dTGA patients.

RESUMEN

Purpose: This study aims to adapt and verify the psychometric properties of the Craving for Internet Gaming Scale (CIGS) in a Polish sample. Craving, although observed as significantly associated with Internet Gaming Disorder, is not currently included in its diagnostic criteria. This research addresses the need for scales to measure craving in this particular context. Methods: The research involved a sample of 575 participants. Psychometric analysis, including confirmatory factor analysis, was conducted to assess the CIGS' reliability and validity. Additional scales, such as the Game Transfer Phenomena Scale, Motives for Online Gaming Questionnaire, and the Depression Anxiety Stress Scales, were used for concurrent validity analysis. Results: The study results demonstrate the excellent psychometric properties of the Polish adaptation of the CIGS. It showed high reliability in terms of internal consistency and provided evidence for construct validity. Furthermore, it exhibited a positive correlation with various scales associated with problematic video game use and gaming addiction, while also showing a moderate negative correlation with self-control. Conclusions: Our findings suggest that the CIGS retains its psychometric properties in different cultures, making it a valuable instrument for comprehending craving within the context of Internet gaming disorder. Future research should focus on the adaptation of the CIGS to various cultural settings and the exploration of potential intergroup differences.

RESUMEN

Background and aims of the study A functionally single ventricle (FSV) refers to a group of congenital heart defects that are not amenable for biventricular correction. The Fontan operation is utilized as surgical treatment for most of FSV patients. The evaluation of FSV function is extremely difficult due to its unique pathophysiology. This study aimed to explore the efficacy of speckle tracking echocardiography (STE) parameters measured at rest and during exercise for comprehensive assessment of univentricular heart. METHODS: We enrolled 37 patients with a functionally single ventricle after the Fontan operation, hospitalized in the Department of Congenital Heart Defects between years 2019 and 2021.The echocardiographic stress tests were performed in the Echocardiography Laboratory of the Congenital Heart Defects Department. The study was conducted on a bicycle ergometer in a semi-recumbent position. The parameters obtained by speckle tracking echocardiography (STE): the longitudinal strain of the FSV free wall (Ɛ) and the longitudinal strain of myocardial layers: subendocardial, medial and subepicardial were analyzed. A transmural longitudinal strain gradient (TG) was calculated as the difference between longitudinal deformation of the subendocardial and subepicardial layers. Current results of cardiac magnetic resonance imaging (CMR) and cardio-pulmonary test (CPET) were also incorporated. Demographic data, past interventions, pharmacological treatment and comorbidities were extracted from medical records. RESULTS: Ɛ at rest and during exercise were not related to the parameters of physical capacity obtained on CPET nor to the CMR results. The transmural strain gradient was dependent on physical performance parameter- peak oxygen uptake- and related to the FSV ejection fraction calculated by magnetic resonance imaging. CONCLUSIONS: The transmural strain gradient and FSV free wall strain are readily measurable and suitable for evaluating single ventricle function. The TG is positively correlated with peak oxygen uptake during the cardiopulmonary test and with the ejection fraction derived from cardiac magnetic resonance imaging. The applicability of these findings in patients undergoing the Fontan procedure warrants further exploration.

Asunto(s)

RESUMEN

INTRODUCTION: With advancing age, adults with congenital heart disease (ACHD) are at a higher risk of developing atherosclerotic coronary artery disease (CAD). OBJECTIVES: We aimed to determine the prevalence of CAD, its risk factors, and use of guideline­directed pharmacotherapy among older patients with ACHD.  Patients and methods: We studied all ACHD patients aged 60 years or older hospitalized in our department between the years 2013 and 2020. CAD was defined as a history of acute coronary syndrome or coronary revascularization, or more than 50% diameter stenosis on coronary angiography. Data regarding the underlying heart defect, prevalence of cardiovascular risk factors, and drug prescriptions were collected. RESULTS: A total of 198 patients with known coronary artery status (mean [SD] age, 66.2 [5.3] years; 43.3% men) were included in the analysis. Of them, 54 (27.3%) had CAD. The individuals with CAD were more often men, and they were more likely to have a mild heart defect, dyslipidemia, and a history of hypertension and tobacco use. Multivariable analysis showed that male sex (P = 0.001), dyslipidemia (P = 0.003), and hypertension (P = 0.04) were positive independent predictors of CAD, whereas overweight / obesity was identified as a negative independent predictor (P = 0.04). The proportion of CAD patients on antiplatelet and / or anticoagulant drugs was 92.6%. ß­Blockers were prescribed to 87% of the patients, and a lipid­lowering agent to 96% of the study population. CONCLUSIONS: CAD is common in older patients with ACHD. Our results underline the importance of identification and treatment of modifiable CAD risk factors in individuals with ACHD. The obesity paradox might also play a role in this population. The rate of guideline­recommended pharmacotherapy implementation seems to be satisfactory.

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)

RESUMEN

This article argues that Christianity has the potential to strengthen people's health when solving the forgiveness dilemma. However-paradoxically-the starting point for the analysis is the presumption that a hasty and imprudent decision to forgive may negatively impact the health of the decision-maker, and that Christianity may contribute to people making unconsidered decisions by prompting them to forgive. In the first part of the analysis, the concept of health and its biblical understanding are discussed. The second part includes both a reflection on forgiveness-related dilemmas and the tension between the decision to forgive and the feeling of regret that may negatively influence health. In the third part, the Christian concept of forgiveness with reference to the aforementioned issues is discussed.

Asunto(s)

RESUMEN

The topic of this article is the research that was carried out at the Opole University of Management and Administration during the pandemic. The aim of the research was to answer the question whether and to what extent the COVID-19 pandemic affected the completion of studies by students of the Opole University of Management and Administration. The analysis included the assessment of students from the last semester in the academic year 2018/2019 (before the COVID-19 pandemic) and 2019/2020 (during the COVID-19 pandemic), as well as the results from the diploma examination, the coefficient of similarity of the works to others in the uniform anti-plagiarism system and the planned date of taking the final examination. The research was conducted using the data analysis method. The results showed that the students who were supposed to graduate in the time when the pandemic started, much more often than their predecessors did not take the final examination and were not able to finish writing their diploma papers. Additionally, they had lower grades in their practical subjects.

RESUMEN

BACKGROUND: The number of adults with congenital heart disease (ACHD) surviving to old age is increasing worldwide. Acquired cardiovascular comorbidities may complicate the course and treatment of the underlying congenital disease and worsen the prognosis. AIMS: The study aimed to assess the burden of cardiovascular (CV) risk factors among elderly patients with ACHD. METHODS: A retrospective analysis of data on all patients ≥60 years of age hospitalized in a tertiary clinic for ACHD was performed from July 2013 to March 2020. We collected information on smoking status, body mass index, and the presence of dyslipidemia, systemic hypertension, and diabetes. RESULTS: The most common CV risk factors among 322 patients ≥60 years of age (median age 66 years; 34% men) were: being overweight/obesity (65.5%), dyslipidemia (64.9%), and arterial hypertension (60.6%). Over 21% of patients suffered from diabetes, and 25.8% were smokers. Over 54% of patients had two or 3 CV risk factors. Patients above 70 years of age were healthier in terms of being overweight/obesity, dyslipidemia, and smoking status. Patients with mild ACHD were more likely hypertensive compared to individuals with complex defects. The highest CV burden was noted in younger men with mild ACHD. CONCLUSIONS: We demonstrated a high burden of CV risk factors in seniors with ACHD. Special attention should be paid to the identification and control of classical CV risk factors in order to prevent acquired CV disease in this population.

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)

RESUMEN

PURPOSE: Right ventricular (RV) outflow tract obstruction (RVOTO) was demonstrated to be protective against RV dilatation in patients with repaired tetralogy of Fallot and chronic pulmonary regurgitation (PR). We hypothesised that the presence of additional haemodynamic abnormalities (more than mild tricuspid regurgitation, residual ventricular septal defect) reduces this protective association. Accordingly, we aimed to assess the impact of PR on RV size and function in this population. MATERIAL AND METHODS: Consecutive patients with additional haemodynamic abnormalities after tetralogy of Fallot (TOF) repair, who had undergone cardiovascular magnetic resonance, were included. RESULTS: Out of 90 patients studied, 18 individuals (mean age 32.5 ± 10.7 years, 72.2% males) met the inclusion criteria. There were no differences in RV volumes and ejection fraction between patients with and without RVOTO. Neither PR fraction (PRF) nor PR volume (PRV) correlated with RV end-diastolic volume (r = 0.36; p = 0.15 and r = 0.37; p = 0.14, respectively, for PRF and PRV) or RV end-systolic volume (r = 0.2; p = 0.42 and r = 0.19; p = 0.45, respectively, for PRF and PRV). Similarly, no significant correlations were observed between PRF or PRV and RV ejection fraction (r = -0.04; p = 0.87 and r = -0.03; p = 0.9, respectively). CONCLUSIONS: Additional haemodynamic abnormalities are associated with the abolition of the protective effect of RVOTO on RV size. There was no significant relationship between measures of PR and RV volumes in patients after TOF repair with concomitant haemodynamic abnormalities. These abnormalities acted as confounding factors in the assessment of the impact of pulmonary regurgitation on RV size and function.

RESUMEN

A coronary sinus (CS) interatrial connection is a rare congenital anomaly which can be in various types from atrial septal defect type unroofing CS to the total absence of the CS. The pathology usually accompanies the left superior caval vein (LSCV) draining to CS and in case of its absence directly to the left atrium (LA). We present a 53-year-old woman after surgical correction of a secundum atrial septal defect in 1974, with a CS interatrial connection and paroxysmal atrial fibrillation (PAF). She gave a history of PAF and was admitted to our clinic due to progressive exertional intolerance, peripheral edema, and mild hypoxia (SatO2 92%) with subsequent cyanosis. Transthoracic echocardiography showed a left-to-right shunt in the posteroinferior part of the atrial septum. Computed tomography revealed a persistent LSCV draining directly into the LA, the absence of the CS, and cardiac veins draining into the LA. The right atrium (RA) and the LA were connected via a tunnel with a visible contrast passage from the left to the right side-the persisting mouth of the coronary sinus. The patient was qualified for surgical correction. A glutaraldehyde-treated autologous pericardial patch was used to construct the tunnel connecting the LSVC and the RA. The second part of the patch was used to close the atrial communication at the inferior vena cava level. The patient had an uncomplicated postoperative course and is now classified in New York Heart Association Class II.

Asunto(s)

RESUMEN

OBJECTIVE: The number of patients with congenitally corrected transposition of the great arteries (ccTGA) surviving to old age is increasing. This study therefore sought to characterize 'geriatric' systemic right ventricle (sRV) in terms of clinical profile, cardiac biomarkers, and echocardiography-derived function when compared with findings in younger patients. METHODS: A single-center cross-sectional study of adults with ccTGA was performed. Patients underwent clinical assessment; transthoracic echocardiography; and venous blood sampling including N-terminal pro-B-type natriuretic peptide (NTproBNP), galectin-3, and soluble suppression of tumorgenicity 2 (sST2) measurements. In the echocardiographic study, the sRV function was assessed using fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), systolic pulsed-wave Doppler velocity (s'), and longitudinal strain (LS). RESULTS: Ten patients with ccTGA aged 60 years or older and 53 patients younger than 60 years of age were included. There were significantly more individuals with hypertension (40% vs. 5.7%), dyslipidaemia (50% vs. 5.7%), and atrial fibrillation (70% vs. 20.7%) in the older group; similarly, we found higher NTproBNP (2706 pg/mL vs. 784.7 pg/mL; p<0.001), and galectin-3 (10.15 ng/mL vs. 7.24 ng/mL; p=0.007) concentrations in elderly ccTGA individuals, while sST2 content did not vary significantly according to age. Upon echocardiographic assessment, lower sRV FAC (28.6% vs. 36.1%; p=0.028) and LS (-12% vs. -15.5%; p=0.017) values were observed in patients aged 60 years or older. TAPSE and s' did not differ between the age groups. CONCLUSION: Careful screening for acquired comorbidities, particularly atrial fibrillation, in elderly ccTGA patients is warranted. Examining selected cardiac biomarkers and echocardiography-derived parameters are useful in the assessment of the aging sRV.

Asunto(s)

RESUMEN

OBJECTIVE: We employed echocardiographic tissue characterization for the assessment of single ventricle systolic function and examined its relationship with cardiopulmonary exercise testing (CPET) performance in the Fontan circulation. METHODS: 40 consecutive adult Fontan patients (16 female, 24 male; mean age 26.3 ± 5.9) were enrolled in our prospective cross-sectional study. All patients underwent echocardiographic assessment including tissue characterization and CPET within 3 days from each other. RESULTS: LAPSE (lateral annular plane systolic excursion) was higher in patients with a dominant left ventricle compared to a dominant right ventricle (12.3 + -2.6 vs 9.8 + -1.1 mm, p = .008) and in patients with AP (right atrium-pulmonary artery) connection than with lateral tunnel or extracardiac conduits (13.9 ± 1.7 vs 11.3 ± 2.6 and 10.9 ± 2.2 mm, p = .014 and p = .014, respectively). Maximal oxygen pulse (O2 pulse max) was significantly higher in patients with a dominant left or common ventricle compared to patients with a dominant right ventricle (10.3 and 12.0 vs 6.6 ml/beat, p = .002 and p = .032, respectively). There was a positive correlation between O2 pulse max and LAPSE (r = 0.442, p = .009), atrioventricular valve annulus systolic velocity (S') (r = 0.606, p < .0001), lateral wall basal segment systolic velocity (bas vel s) (r = 0.469, p = .009) and lateral wall mid segment systolic velocity (mid vel s) (r = 0.452, p = .012). In the multivariable regression model, S' (r = 0.606, p < .0001) remained predictive of O2 pulse max. CONCLUSIONS: LAPSE and S' are suitable parameters for the assessment of systolic function in Fontan patients. Subclinical systolic dysfunction of longitudinal fibers is associated with worse CPET performance. O2 pulse max seems to be the best parameter reflecting Fontan patients' physical performance.

Asunto(s)

RESUMEN

AIMS: Long QT syndrome (LQTS) is an inherited cardiac ion channelopathy predisposing to life-threatening ventricular arrhythmias and sudden cardiac death. The aim of this study was to investigate left ventricular mechanical abnormalities in LQTS patients and establish a potential role of strain as a marker of arrhythmic risk. METHODS AND RESULTS: We included 47 patients with genetically confirmed LQTS (22 LQT1, 20 LQT2, 3 LQT3, and 2 SCN3B) and 25 healthy controls. A history of cardiac events was present in 30 LQTS subjects. Tissue Doppler and speckle tracking echocardiography were performed and contraction duration was measured by radial and longitudinal strain. The radial strain characteristic was subdivided into two planes - the basal and the apical. Left ventricular ejection fraction and global longitudinal strain were normal in LQTS patients. Mean contraction duration was longer in LQTS patients compared with controls in regard to basal radial strain (491 ± 57 vs. 437 ± 55 ms, P < 0.001), apical radial strain (450 ± 53 vs. 407 ± 53 ms, P = 0.002), and longitudinal strain (445 ± 34 vs. 423 ± 43 ms, P = 0.02). Moreover, contraction duration obtained from apical radial strain analysis was longer in symptomatic compared with asymptomatic LQTS mutation carriers (462 ± 49 vs. 429 ± 55 ms, P = 0.024), as well as in subject with mutations other than LQT1 considered to be at higher risk (468 ± 50 vs. 429 ± 49 ms, P = 0.01). CONCLUSION: Myocardial contraction duration is prolonged for both radial and longitudinal directions in LQTS patients. Regional left ventricular function analysis may contribute to risk stratification. Apical radial deformation seems to select subjects at higher risk of arrhythmic events.

Asunto(s)

RESUMEN

Introduction: Transcatheter pulmonary valve implantation (TPVI) is a non-surgical method of treatment for patients with right ventricular outflow tract (RVOT) dysfunction after surgical repair of congenital heart defects (CHD). Aim: To evaluate the long-term results of TPVI performed in a single center.Material and methods: Over 10 years, TPVI was performed in 100 patients (mean age: 26.4 ±8.1 years), using Melody Medtronic or Sapien Edwards valves. Results: The initial success rate of TPVI was 93%. In 7 cases (5 urgent), a switch to surgical intervention was necessary due to periprocedural complications (all patients survived). Following TPVI, none of the 93 patients had severe pulmonary regurgitation. The pulmonary gradient decreased from 49.0 ±37.8 before to 27.6 ±14.9 mm Hg directly after TPVI (p < 0.0001). Right ventricular end-diastolic volume decreased, while NYHA class and pVO2 uptake significantly improved in 1 year after TPVI. Freedom from reintervention was 100% in 1 year. Freedom from serious adverse events was 86% in mean 5.5 years of observation. The main reason for reintervention was infective endocarditis (IE) (1.6% patients/year). Increased risk of IE was associated with severe PS before valve implantation and the suboptimal result of TPVI. The incidence of IE seems to be lower in patients treated permanently with antiplatelet therapy (1.8% vs. 0.9% patients/year, NS). Conclusions: TPVI is a safe and effective method of treatment in patients with RVOT dysfunction after surgical correction of CHD. To achieve a good outcome, precise patient selection and rigorous IE prevention are necessary.