Takotsubo syndrome in a patient after renal transplantation

BACKGROUND

Takotsubo syndrome (TTS) is a transient cardiomyopathy of unknown origin, clinically manifesting as acute coronary syndrome (ACS). This syndrome mainly occurs in postmenopausal women and has a temporary relationship with emotional or physical stress.

CASE REPORT

TTS occurred in 46-year-old female patient on the first day after renal transplantation. The predominant symptoms were connected with ACS, performed with low grade troponin elevation and characteristic shape of left ventricle depicted in echocardiography. Taking into consideration the risk of the development of contrast-induced nephropathy, coronary angiography (CA) was delayed; myocardial perfusion scintigraphy and iodine-123 metaiodobenzylguanidine (¹²³I-mIBG) myocardial uptake were performed to confirm the clinical suspicion. Myocardial perfusion scintigraphy (MPS) performed in rest condition showed normal perfusion but myocardial uptake of ¹²³I-mIBG was impaired. Within 6 months after surgery, full recovery of all biochemical and functional parameters of the left ventricle were observed. At that time CA was done, depicting normal coronary arteries.

CONCLUSIONS

TTS could be diagnosed by the use of non-nephrotoxic tests - ¹²³I-mIBG myocardial scintigraphy, MPS and echocardiography.

Aortic stiffness, left ventricle hypertrophy, and homogeneity of ventricle repolarization in adult dialyzed patients

Aim. Study was designed to assess relationship between aortic compliance and homogeneity of heart electrical activity in dialysis patients. Methods. Study group was consisted of 120 dialyzed patients; 57 (age 50,7 ± 7,1) were on continuous ambulatory peritoneal dialysis (CAPD) and 73 (age 51,6 ± 7,6) were hemodialyzed (HD). Three-dimensional vectorocardiographic (VCG) monitoring was done to assess: QRS-T_angle, T_el and T_az. Echocardiography was performed to assess: Ao_max, Ao_min, ASI (aortic siffness index). Results. ASI in HD as well as in CAPD patients was significantly higher compared to controls [resp., 5,51 (±1,32), 5,83 (±1,41), 3,07 (±1,09)]. Cut-off value of ASI was 5,67. In HD patients strong correlations between ASI and QRS-T_angle, T_el and T_az were determined (resp., r = 0,429, P < 0,001; r = 0,432, P ≤ 0,001 and r = 0,387, P = 0,001). In CAPD group were significant association between ASI and QRS-T_angle, T_el and T_az (resp., r = 0,452, P < 0,001; r = 0,417, P < 0,001 and r = 0,390, P = 0,001). ASI was independently and markedly associated with: QRS-T_angle, T_elev, T_az, ADMA, cTnT, CRP, Total-chol, LDL-chol in HD and CAPD patients. Conclusions. ASI and VCG indices are higher in HD and CAPD patients. Correlation between ASI and VCG parameters may reflect unfavourable influence of poor aortic compliance on the electrical activity of the heart in dialyzed patients. Hypertrophy aggravates repolarization disturbances in hemodialyzed patients.

Left atrial volume index as a predictor of ventricle repolarization abnormalities in adult dialyzed patients

This study was performed to investigate the relationship between left atrium (LA) volume index (LAVI) and left ventricle electrical activity presumably repolarization in end-stage renal disease patients. Study group was consisted of 120 dialyzed patients divided into two subgroups: 57 (age 50.7 ± 7.1) were on continuous ambulatory peritoneal dialysis (CAPD) and 73 (age 51.6 ± 7.6) were hemodialyzed (HD). All patients were undergoing three-dimensional vectorcardiographic (VCG) monitoring to assess parameters concerning T vector: QRS-T angle, Tel, and Taz. Standard echocardiography was performed to assess: LAmax, LAshort, LAlong. LAVI was calculated due to formula: LAVI = (π/6X [LAmax × LAshort × LAlong])/m2. LAVI in HD as well as in CAPD patients was significantly higher compared with controls (respectively: 36.29 ± 10.92; 36.41 ± 11.06; 20.64 ± 6.77 mL/m2). The calculated cutoff value of LAVI was 36.32 mL/m2. In HD patients, the strong correlations between LAVI and QRS-T angle and Tel were determined (respectively: r = 0.407, P < 0.001 and r = 0.359, P = 0.006). Similarly in CAPD group were significant associations between LAVI and QRS-T angle and Tel (respectively: r = 0.423, P < 0.001 and r = 0.374, P = 0.004). The QRS-T angle, Tel and Taz are independently and markedly associated with LAVI in both HD and CAPD patients. LAVI and VCG indices are higher in both HD and CAPD patients. Correlation between QRS-T angle and LAVI may reflect unfavorable influence on the electrical activity of the heart in dialyzed patients with left ventricle diastolic dysfunction. LAVI cutoff value is useful biomarker for stratification of ventricle repolarization disturbances in those patients.

Major determinants of myocardial injury after pulmonary vein isolation with radiofrequency ablation

BACKGROUND

Radiofrequency (RF) current is used as a common energy source to perform pulmonary vein isolation (PVI) in patients with atrial fibrillation. We applied measurements of the blood concentration of cTnI as a surrogate parameter for the injured cell mass.

AIM

To clarify which parameters are major determinants of myocardial injury, estimated by cTnI, after PVI with RF ablation.

METHODS

The study population consisted of 82 consecutive patients in whom PVI with RF ablation was performed. In 41 patients, additional linear lesions (LL) were needed. Blood samples were obtained during venous puncture before a procedure and a further one, six and 24 hours after ablation.

RESULTS

Pathological cTnI values were observed in all patients in the first hour and further increased in time. The median of peak cTnI value in the LL group was significantly (p 〈 0.05) higher than the respective value in patients without LL made: 1.16 (0.85;1.98) and 0.94 (0.65;1.14) ng/mL, respectively. Significantly higher cTnI values (p = 0.043) were observed in patients who maintained sinus rhythm in long term follow-up.

CONCLUSIONS

The only independent predictor of myocardial injury after PVI with RF ablation, expressed as an increase in cTnI level, is cumulative energy applied. The larger the myocardial injury, the greater the PVI effectiveness.

[Myocardial infarction in the course of ethylene glycol poisoning--a case report]

The following paper describes the case of the 59-year-old patient moved from Clinical Cardiology to the Centre of Clinical Toxicology because of severe ethylene glycol poisoning, which occurred in the course of myocardial infarction of inferior wall. Ethylene glycol concentration was 85 mg/dl, the blood pH - 6.9, troponin >50 ng/ml, CK-MB 297.1 U/L. ECG current of injury was found at the bottom of the wall cuts reflective reductions in section ST in leads I, aVL and the precordial leads. In the coronarography was RCA occlusion, OM critical stenosis and suspected mouth of LAD stenosis. RCA urgent angioplasty was performed with implantation of bare metal stents 5. In addition, toxicological treatment consisted of mechanical ventilation, hemodialysis, ethanol, and intensive medical care. On 19 day of hospitalization the patient in good general condition was discharged home.

[The interdependence of coronary pain control and level of anxiety in women with ischiaemic heart disease]

Interdependences between pain and anxiety in cardiac ischaemia are multidimensional and complex. Both of these phenomena share a lot of traits and they tend to reinforce each other at physiological level. Apart from arduousness of pain, cognitive understanding of its nature becomes an important mediating factor. One of important characteristics of the patient's attitude towards their illness is localization of pain control. The aim of the study was to analyze an interdependence between an anxiety as a state and as a trait and the localization of pain control in women with coronary heart decease.

MATERIAL AND METHODS

The study included 52 female patients hospitalised at The Department of Cardiology of The Medical University of Lublin who underwent coronarography. The used methods included an interview, State - Trait Anxiety Inventory of Spielberger (STAI) and The Beliefs about Pain Control Questionnaire (BPCQ).

RESULTS

The results did not confirm an often suggested opinion that internal localization of pain control reduces anxiety and activates the patient. The intensity of the internal localization of pain control correlates significantly with the intensity of the dependence of pain of activity of the doctors as well as on the anxiety as trait. It is higher in women with lower education. Perhaps better educated patients, not so ready to react with anxiety, can treat pain more realistically as a sign of a pathological process which can be understood and evaluated not so much as a catastrophe. They do not feel personally responsible for the pain, either, and are able to accept the limits of the doctor's assistance, having no unrealistic expectations with regard to the pain treatment.

CONCLUSIONS

The results of the research indicate that in women with ischiaemic heart decease better adjustment to the illness and a lower level of anxiety as a trait are connected with the understanding and acceptance of their situation by the patient, rather than with too big extent of expectations towards the control of pain by the patients themselves or medical staff.

[The concomitance of pericarditis constrictiva in patient with Silver-Russell syndrome, primary hyperparathyroidism and oncologic history: causal coincidence or pathogenetic sequence?]

The most common cause of calcific pericarditis is idiopathic. We report a case of a 24 year-old woman with Silver-Russell syndrome, history of Wilms' tumour in childhood, constrictive pericarditis and primary hyperparathyroidism. We analyse pathologic mechanisms of disseminated calcification and possible genetic factors that may contribute to aetiology and clinical presentation of calcific pericarditis.

Uric acid as a link between renal dysfunction and both pro-inflammatory and prothrombotic state in patients with metabolic syndrome and coronary artery disease

BACKGROUND

Hyperuricaemia has long been known to be associated with cardiovascular disease, and it is particularly common in patients with kidney disease, metabolic syndrome and diabetes mellitus. Metabolic syndrome is associated with pro-inflammatory and prothrombotic state.

AIM

To examine the association between renal function, serum uric acid and markers of both pro-inflammatory and prothrombotic state in patients with diabetes mellitus (DM), metabolic syndrome and coronary artery disease.

METHODS

The study population consisted of 91 patients (58 men, 33 women) aged 57.6 ± 10.3 years with metabolic syndrome and type 2 DM. Patients were selected from a large group of patients scheduled for routine coronary angiography between 2006 and 2009. The patients were evaluated for the common risk factors for atherosclerosis: smoking, hypertension, DM, family history and hyperlipidaemia. Laboratory tests included complete blood counts, serum urea and creatinine, aminotransferases, C-reactive protein (CRP), fibrinogen, uric acid, total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, fasting glucose, glycated haemoglobin (HbA1c), glomerular filtration rate (GFR) and urinary protein. We also measured body mass, height, waist circumference, hip circumference and calculated body mass index (BMI) and waist-to-hip ratio (WHR).

RESULTS

The following significant correlations were observed: body mass vs serum creatinine (r = 0.291; p = 0.009), WHR vs serum creatinine (r = 0.672; p < 0.001), WHR vs GFR (r = -0.706; p < 0.001), WHR vs uric acid (r = -0.341; p = 0.001), WHR vs uric acid (r = 0.295; p = 0.05), BMI vs CRP (r = 0.231; p = 0.031), WHR vs CRP (r = 0.236; p = 0.024), serum creatinine vs uric acid (r = 0.362; p < 0.001), GFR vs uric acid (r = -0.341; p = 0.001), uric acid vs CRP (r = 0.251; p = 0.016), CRP vs fibrinogen (r = 0.470; p < 0.001), CRP vs platelet count (r = 0.282; p = 0.04) and HbA(1c) vs platelet count (r = 0.263; p = 0.0112). Multiple stepwise regression analysis showed that uric acid level was independently associated with WHR, GFR and CRP.

CONCLUSIONS

In patients with ischaemic heart disease, DM and metabolic syndrome, obesity, particularly visceral obesity, is associated with renal dysfunction and elevated markers of pro-inflammatory state. Renal dysfunction co-exists with elevated serum uric acid. Elevated serum uric acid is associated with markers of pro-inflammatory state. Markers of pro-inflammatory state correlate with prothrombotic markers such as serum fibrinogen and platelet count. Uric acid should be taken into consideration as a link between renal dysfunction and both pro-inflammatory and prothrombotic state in patients with metabolic syndrome and coronary artery disease.

[Degenerative aortic valvular stenosis, coronary atherosclerosis, and coronary artery aneurysms: different anatomical manifestations of the same disease]

We report a rare combination of valvular aortic stenosis, coronary atherosclerosis and numerous coronary artery aneurysms. A 80 year-old man with previously diagnosed aortic valvular stenosis was admitted to our department for coronary angiography before planned aortic valve replacement. Coronary angiography, apart from critical stenosis of proximal part of left anterior descendent branch of left coronary artery, revealed several large coronary artery aneurysms. We discuss the potential mechanisms responsible for coronary aneurysm formation.

Which standard biomarkers are useful for the evaluation of myocardial injury after pulmonary vein isolation with cryoballoon?

BACKGROUND

Many studies have used creatinine kinase (CK), myocardial bound for CK (CK-MB), and cardiac troponin I (cTnI) and T (cTnT) to evaluate myocardial cells injury after ablation. We applied measurements of the blood concentration of cardio-specific biomarkers as surrogates for the injured cell mass.

AIM

To clarify which of the standard biomarkers are useful in the evaluation and quantification of lesions produced by cryoballoon ablation (CBA) during pulmonary vein isolation.

METHODS

The CBA was performed in 33 patients with atrial fibrillation. Blood samples were obtained before CBA and one, six, and 24 h after CBA. We analysed CK, CK-MB and cTnI.

RESULTS

A significant increase of all biomarkers was observed at each hour of collection as compared to the baseline measurement. Maximum median peak levels occurred at 6 h. Pathological values of CK, CK-MB and cTnI were observed in 94%, 100% and 100% of patients, respectively. Both maximum CK and CK-MB values correlated with median temperature (p < 0.05) reached during CBA. Additionally, CK-MB correlated with total cryo-time (p < 0.03).

CONCLUSIONS

The CK-MB is the best biochemical marker for the evaluation of myocardial injury after CBA. The cTnI can be useful as an additional parameter of myocardial injury after CBA.

[Papillary fibroelastoma of the left atrial appendage]

Primary cardiac tumours are very rare (0.02%). Typically fibroelastoma arises from valvular endocardium, nonvalvular locations occur occasionally. Usually fibroelastoma is asymptomatic, however in some cases it may produce small superficial thrombi with substantial risk of embolisation. We report 59 year-old male with left atrial appendage location of papillary fibroelastoma diagnosed during transesophageal echocardiography. Computed tomography confirmed morphological signs typical for this tumour.

[Thermography in cardiology]

Thermography is a diagnostic method which is totally non-invasive, painless and safe for both a patient and a diagnostician. It enables to define the physiological condition of the examined tissues or organs basing on the emission of the infrared radiation. Thermography examination has its application in almost every branch of medicine. For a few years in cardiology, there has been an intensive research on introducing the new methods of identifying the high risk atherosclerotic plaques which is largely based on evaluating the degree of escalation of the inflammation process within the atherosclerotic changes. Thanks to applying thermography within the vessels, it is possible to measure the temperature of the wall of the vessel in order to detect the high risk atherosclerotic plaques and evaluate the potential risk of occurrence of the acute coronary syndrome.

Acute coronary syndrome - a frequent clinical manifestation of bare metal in-stent restenosis

BACKGROUND

In-stent restenosis (ISR) complicates 20-30% of percutaneous coronary interventions (PCI) with bare metal stent (BMS) implantation. Although the widespread use of drug eluting stents (DES) across Europe caused a considerable reduction of BMS implantations, their number is still lower than the number of BMS implantations in several countries.

AIM

The clinical presentation of ISR has not been well characterissed. Thus, we attempted to analyze this condition and assess the treatment of ISR in everyday clinical practice.

METHODS

We searched our database for all cases of bare metal ISR between 1999 and 2007. Follow-up angiography after PCI was not a routine procedure but a clinically driven examination. Clinical presentations of ISR were divided into: stable angina, and acute coronary syndromes (ACS), i.e. unstable angina (UA) and myocardial infarction (MI) (further subdivided into NSTEMI and STEMI). Analysis included variables associated with different clinical manifestations, methods of ISR treatment and in-hospital complications of ISR.

RESULTS

In-stent restenosis was identified in 432 (3%) of 15,910 patients who underwent PCI. The mean age was 61.6 + or - 15.6 (27-86) years, and 295 (68.3%) patients were men. Risk factor distribution was typical for a Caucasian population. Recurrent clinical episode occurred at a mean of 7 (1-108) months after PCI. Exertional angina was present in 245 (56.7%) patients, UA in 128 (29.6%) patients and MI in 59 (13.7%) patients, including STEMI in 28 (6.5%) and NSTEMI in 31 (7.2%) patients. Overall, ACS was diagnosed in 187 patients or 43.3% of all cases of ISR. Multivariate analysis showed a positive correlation between previous MI and younger age and ACS as the clinical manifestation of ISR, and a negative correlation between more severe restenosis and ACS manifestation. The incidence of clinical complications (MI or death) was higher in patients with ACS as the clinical manifestation of ISR (6.9% vs 1.6%).

CONCLUSIONS

In-stent restenosis after BMS implantation is a serious clinical problem. More than 40% of patients with ISR present with ACS, including 13.7% patients with MI, more frequently among younger patients and patients with previous MI. Most patients with ISR are treated with repeated PCI with high success rate (97.7%), although the risk of clinical complications is considerably higher in patients presenting with ACS.

[Thermography in medical diagnostics]

Measuring the body temperature belongs to the oldest and the most frequently performed diagnostic examination. Current technical progress enables for measurment of body temperature on its surface not only in one particular place, but in lots of different places at the same time and it can also be done from some distance. Invisible for the eye temperature dispersion, which is presented in the form of thermographic photographs, is becoming more popular in medical diagnostics. Thermography is a totally non-invasive, painless and safe for both the patient and the diagnostician examining. The method allows for defining the physiological condition of the tissues or organs on the basis of emitted ultrared radiation.

Safety of pharmacotherapy of osteoporosis in cardiology patients

The commonest medical conditions following menopause are osteoporosis and atherosclerotic disease. This review considers the safety of pharmacotherapy of osteoporosis in cardiology patients. Drugs used for osteoporosis treatment may have adverse effects on the cardiovascular system. This article has detailed analysed of current drug classes, such as the bisphosphonates and strontium ranelate, as well as reviewed of the controversy surrounding hormone replacement therapy (HRT) and the selective estrogen receptor modulators (SERMs). Additionally, we discuss the adverse effects on the heart of calcium and drugs influencing calcium metabolism such as vitamin D, parathormone and calcitonin. We look at the interference between osteoporosis treatment and the drugs used for atherosclerosis. Moreover, the side effects on bones of cardiology drugs are analysed. Lastly, the possible advantages of selected drugs used for cardiovascular diseases in terms of osteoporosis prevention are evaluated.

[Tako-tsubo syndrome without typical anamnesis]

A 77-year-old female in severe emotional distress was admitted to Coronary Care Unit with typical features of acute coronary syndrome, namely severe chest pain, high cardiac necrosis markers and ST-elevation in ECG. Due to the lack of significant changes in coronary arteries in coronary angiography the contractile function of the heart muscle was assessed in echocardiographic examination. That allowed to diagnose tako-tsubo cardiomyopathy. This condition is commonly triggered by stress. This case report puts emphasis on anamnesis, which is often underestimated when diagnosing tako-tsubo syndrome.

Dyspnea as a dominant clinical manifestation in a patient with takotsubo cardiomyopathy treated for chronic obstructive pulmonary disease and hyperthyroidism

This paper discusses the case of a female patient treated for chronic obstructive pulmonary disease and hyperthyroidism, who also had takotsubo cardiomyopathy with dyspnea at rest as a dominant clinical manifestation.

Aortic stiffness and valvular calcifications in patients with end-stage renal disease

OBJECTIVES

To evaluate the presence and extent of cardiac calcifications and aortic stiffness in patients with end-stage renal disease (ESRD).

PATIENTS AND METHODS

The study group consisted of 60 patients with ESRD with a mean age of 51.7 years, treated with peritoneal dialysis. In all patients transthoracic echocardiogram was performed to assess the following parameters: left ventricular end-systolic diameter, left ventricular end-diastolic diameter (LVEDd), interventricular septum end-diastolic diameter (IVSDd), posterior wall end-diastolic diameter (PWDd), ejection fraction (EF), fractional shortening (FS), aortic maximal and minimal diameter, aortic valve area, mitral valve area (MVA), left ventricular ejection time (LVET), maximal aortic velocity. Aortic stiffness index (AS) was calculated. Aortic and mitral valve calcifications were assessed.

RESULTS

Patients with ESRD had a larger left ventricle (LVEDd 5.4 cm vs. 4.76 cm) and its wall was thicker (IVSDd 1.36 cm vs. 1.02 cm; PWDd 1.31 cm vs. 0.94 cm). Patients had poorer left ventricle contractility (EF 56.1 vs. 61.6%; FS 28.5 vs. 33.2%). Atherosclerotic plaques, calcified plaques and valvular calcifications were more frequently detected in patients with ESRD. Patients with ESRD had significantly higher values of the AS index: (5.34 vs. 3.24). Among ESRD subjects with the stiffer aorta, atherosclerotic plaques including calcificones and the aortic valve damage were more frequently detected.

CONCLUSIONS

Patients with ESRD are characterized by increased aortic stiffness. Atherosclerotic plaques in the aorta as well as cardiac and large vessels calcifications are more common among patients with ESRD. In patients with ESRD there is a correlation between an increase in aortic stiffness and damage of aortic valvular leaflets as well as calcifications of atherosclerotic plaques in the aorta. The degree of aortic stiffness is not related to impairment of mitral valvular leaflets and extravalvular calcifications. A relationship between aortic stiffness and aortic or aortic valve calcifications suggest a different pathogenesis of aorta calcification as compared to that underlying calcifications of other localizations.

Relationship between aortic valve calcification and aortic atherosclerosis: a transoesophageal echocardiography study

INTRODUCTION

Clinical and laboratory data provide an increasing amount of information regarding the common aetiopathogenetic background of acquired heart defects with calcification and arterial atherosclerosis.

AIM

To evaluate the relationship between presence and severity of calcifications of the aortic semilunar valves and the intensity of atherosclerotic lesions in the aorta and aortic stiffness (AS).

METHODS

The study group comprised 80 subjects (49 males and 31 females) aged 72.2 (+/-8.0) years with an aortic valve defect found on echocardiography. Patients were divided into two subgroups depending on the severity of valvular disease. Subgroup I comprised 42 patients with small valvular lesions (0--absence of calcification of the valve, or +--trivial valvular calcifications, possible to find on detailed evaluation of the valve). Subgroup II consisted of 38 patients with intense calcifications (++--large, easily found valve calcifications, +++--massive calcifications affecting leaflet mobility). All patients underwent transoesophageal echocardiography to evaluate atherosclerotic lesions in the aorta. The assessment included the following: location of the lesions in the aorta, intimal thickness, presence of calcifications and mobile parts of plaques and possible associated thrombi. Aortic stiffness was also measured using the formula: AS=log (SBP/DBP)/Ao(max)-Ao(min)/Ao(min).

RESULTS

Atherosclerotic plaques were more frequent in patients with more prominent calcifications of the aortic valve (19 vs 10 patients, p <0.05). Intimal thickness was larger in patients with more pronounced valve calcifications (3.9+/-0.8 mm vs 2.2+0.6 mm, p <0.05). Presence of calcifications in the aortic wall was also more frequent in patients from group II, as they were found in 10 subjects compared to only 3 cases in group I. Mobile plaque parts were observed in 3 patients from group II; also thrombi were found in 3 individuals from this group. Patients with more prominent calcifications of the aortic valve had decreased aortic wall elasticity (AS 5.5+/-1.2 cm vs 3.4+/-0.9 cm, p <0.05).

CONCLUSIONS

Severity of aortic valve calcification indicates simultaneous changes in the thoracic aorta. Stiffness of the aortic wall is greater in patients with a more pronounced defect of the aortic valve. Prevalence of atherosclerosis risk factors is increased in patients with aortic valve defect, enhanced atherosclerosis and rigidity of the aorta. Defect of the aortic valve and increased aortic rigidity may be different manifestations of atherosclerosis.

[Influence of age of patients with atrial fibrillation on left atrium function]

Frequency of occurrence of atrial fibrillation (FA) increases with age. In the elderly this arrhythmia might influence the enlargement and function of left atrium (LA) and its appendage (LAA). The aim of this study was to assess the association between age of patients and selected echocardiographic parameters concerning left atrium.

MATERIAL AND METHODS

120 consecutive patients (52 women and 68 men) with FA were studied 36-89 years old (mean 68.7 +/- 10.9). Patients were divided into two groups using a cut-off value age of 70 years. Older than 70 years were 64 patients, whereas below this age were 56 persons. Duration time of arrhythmia did not differ significantly between studied groups. In all patients transthoracic (TTE) and transoesophageal (TEE) echocardiography were performed to assess selected echocardiographic parameters concerning left atrium (LA) and its appendage (LAA). During TTE were measured: LA maximal diameter in M-mode (LAmax), LA transversal diameter in 4-CH (LAtrans), LA longitudinal diameter in 4-CH (LAlong), LA circulum in 4-CH (LAcirc), LA area in 4-CH (LAarea). Consequently TEE was done to assess LAA transversal diameter (LAAtrans), LAA longitudinal diameter (LAAlong), LAA circulum (LAAcirc), LAA area (LAAarea), spontaneous echocardiographic contrast (SEC), thrombus (THR), maximal LAA outflow velocity (LAAF), maximal LAA inflow velocity (LAAB), integral of LAA outflow velocity (LAAFintg) and integral of LAA inflow velocity (LAABintg).

RESULTS

LAmax (4.91 +/- 0.61 vs. 4.22 +/- 0.49), LAtrans (4.75 +/- 0.71 vs. 4.11 +/- 0.44) and LAarea (31.85 +/- 6.9 vs. 27.51 +/- 6.54) were significantly greater in older patients compared to those below 70 years old. LAlong, LAcirc, LAarea, LAA trans, LAAlong, LAAcirc did not differ between studied groups. Thrombi in LAA were detected rarely in study population and were found often in older patients (in 2 vs. 6 patients). In almost 2/3 older patients SEC in LAA was visualized, which was markedly frequent when compared to younger group. In older patients parameters characterizing LAA function had significantly lower values than in younger patients (LAAF respectively 19.8 +/- 9.16 vs. 28.57 +/- 10.7, LAAB respectively 21.6 +/- 8.12 vs. 31.81 +/- 10.88).

CONCLUSIONS

In patients with atrial fibrillation left atrium and its appendage diameters are greater in the elderly. Left atrium appendage function is more deteriorated in older patients with atrial fibrillation. During atrial fibrillation thrombus formation and appearance of spontaneous echocardiographic contrast is more often in the elderly.