1
|
Mizia-Stec K, Grzybowski J, Cegłowska U, Wiśniewska A, Hałgas K, Wybraniec M, Pachciński O, Stec M, Cieśla D, Gąsior M, Hryniewiecki T, Leszek P. Treatment pathways defined as the sequence of visits to the public health system of patients with cardiomyopathies in Poland in the period 2016-2021. Kardiol Pol 2024:VM/OJS/J/100178. [PMID: 38606740 DOI: 10.33963/v.phj.100178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 04/09/2024] [Indexed: 04/13/2024]
Affiliation(s)
- Katarzyna Mizia-Stec
- Department of Cardiology, 1st Chair of Cardiology, Medical University of Silesia in Katowice.
- European Reference Network of Heart Diseases (ERN GUARD-HEART).
| | - Jacek Grzybowski
- Department of Cardiomyopathy, National Institute of Cardiology, Warszawa, Poland
| | - Urszula Cegłowska
- Department of Analysis and Strategy, Ministry of Health of the Republic of Poland
- Department of Epidemiology and Health Promotion, School of Public Health, Centre of Postgraduate Medical Education, Warszawa, Poland
| | - Anna Wiśniewska
- Department of Analysis and Strategy, Ministry of Health of the Republic of Poland
| | - Kacper Hałgas
- Department of Analysis and Strategy, Ministry of Health of the Republic of Poland
| | - Maciej Wybraniec
- Department of Cardiology, 1st Chair of Cardiology, Medical University of Silesia in Katowice
- European Reference Network of Heart Diseases (ERN GUARD-HEART)
| | - Olaf Pachciński
- Department of Cardiology, 1st Chair of Cardiology, Medical University of Silesia in Katowice
- European Reference Network of Heart Diseases (ERN GUARD-HEART)
| | - Maria Stec
- Department of Cardiology, 1st Chair of Cardiology, Medical University of Silesia in Katowice
- European Reference Network of Heart Diseases (ERN GUARD-HEART)
| | - Daniel Cieśla
- 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Silesian Center for Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Mariusz Gąsior
- 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Silesian Center for Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Tomasz Hryniewiecki
- Department of Valvular Cardiac Defects, National Institute of Cardiology, Warszawa, Poland
| | - Przemysław Leszek
- Department of Heart Failure and Transplantology, Mechanical Circulatory Support and Heart Transplant Unit, National Institute of Cardiology, Warszawa, Poland
| |
Collapse
|
2
|
Ojrzyńska-Witek N, Marczak M, Mazurkiewicz Ł, Petryka-Mazurkiewicz J, Miłosz B, Grzybowski J, Śpiewak M. Impact of Cardiac Magnetic Resonance on the Diagnosis of Left Ventricular Noncompaction-A 15-Year Experience. J Clin Med 2024; 13:949. [PMID: 38398262 PMCID: PMC10889560 DOI: 10.3390/jcm13040949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/24/2024] [Accepted: 02/04/2024] [Indexed: 02/25/2024] Open
Abstract
The aim of this study was to assess the impact of cardiac magnetic resonance (CMR) on the diagnosis in patients with known or suspected left ventricular noncompaction (LVNC). We retrospectively reviewed the medical charts of 12,811 consecutive patients who had CMR studies between 2008 and 2022 in a large tertiary center. We included patients referred for CMR because of known or suspected LVNC. The study sample consisted of 333 patients, 193 (58.0%) male, median age 39.0 (26.8-51.0) years. Among 74 patients fulfilling the echocardiographic LVNC criteria, the diagnosis was confirmed in 54 (73.0%) cases. In 259 patients with ultrasound-based suspicion of LVNC, CMR led to an LVNC diagnosis in 82 (31.7%) patients. In both groups, CMR led to a new diagnosis in 89 cases (10 (13.5%) and 79 (30.5%)). A quantity of 38 (5.4%) patients were diagnosed with dilated cardiomyopathy, 11 (1.4%) patients were diagnosed with hypertrophic cardiomyopathy, and 21 (4.1%) patients were diagnosed with unclassified cardiomyopathy. In four patients with suspected LVNC, a myocardial trabeculation was a secondary result of dilatation due to coronary heart disease. In five cases, valvular heart disease was found. Four patients were diagnosed with athlete's heart. Other diagnoses (arrhythmogenic right ventricular cardiomyopathy, peripartum cardiomyopathy, hypokinetic non-dilated cardiomyopathy, sarcoidosis, amyloidosis, and ventricular septum defect) were found in six patients. CMR is a valuable tool in the evaluation of cardiac muscle and in differentiating LVNC and other cardiac diseases.
Collapse
Affiliation(s)
- Natalia Ojrzyńska-Witek
- Department of Cardiomyopathy, National Institute of Cardiology, 04-628 Warsaw, Poland; (Ł.M.); (J.G.)
| | - Magdalena Marczak
- Magnetic Resonance Unit, National Institute of Cardiology, 04-628 Warsaw, Poland; (M.M.); (J.P.-M.); (B.M.); (M.Ś.)
| | - Łukasz Mazurkiewicz
- Department of Cardiomyopathy, National Institute of Cardiology, 04-628 Warsaw, Poland; (Ł.M.); (J.G.)
| | - Joanna Petryka-Mazurkiewicz
- Magnetic Resonance Unit, National Institute of Cardiology, 04-628 Warsaw, Poland; (M.M.); (J.P.-M.); (B.M.); (M.Ś.)
| | - Barbara Miłosz
- Magnetic Resonance Unit, National Institute of Cardiology, 04-628 Warsaw, Poland; (M.M.); (J.P.-M.); (B.M.); (M.Ś.)
| | - Jacek Grzybowski
- Department of Cardiomyopathy, National Institute of Cardiology, 04-628 Warsaw, Poland; (Ł.M.); (J.G.)
| | - Mateusz Śpiewak
- Magnetic Resonance Unit, National Institute of Cardiology, 04-628 Warsaw, Poland; (M.M.); (J.P.-M.); (B.M.); (M.Ś.)
| |
Collapse
|
3
|
Mizia-Stec K, Leszek P, Cegłowska U, Wiśniewska A, Hałgas K, Wybraniec M, Pachciński O, Stec M, Cieśla D, Gąsior M, Grzybowski J. Incidence and prevalence of cardiomyopathies in Poland and outcomes for patients in the years 2016-2020. Kardiol Pol 2024; 82:217-219. [PMID: 38230471 DOI: 10.33963/v.kp.98357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 11/29/2023] [Indexed: 01/18/2024]
Affiliation(s)
- Katarzyna Mizia-Stec
- 1st Department of Cardiology, Medical University of Silesia, Katowice, Poland.
- European Reference Network of Heart Diseases (ERN GUARD-HEART).
| | - Przemysław Leszek
- Department of Heart Failure and Transplantology, Mechanical Circulatory Support and Heart Transplant Unit, Cardinal Stefan Wyszynski National Institute of Cardiology, Warszawa, Poland
| | - Urszula Cegłowska
- Department of Analysis and Strategy, Ministry of Health of the Republic of Poland
- Department of Epidemiology and Health Promotion, School of Public Health, Centre of Postgraduate Medical Education, Warszawa, Poland
| | - Anna Wiśniewska
- Department of Analysis and Strategy, Ministry of Health of the Republic of Poland
| | - Kacper Hałgas
- Department of Analysis and Strategy, Ministry of Health of the Republic of Poland
| | - Maciej Wybraniec
- 1st Department of Cardiology, Medical University of Silesia, Katowice, Poland
- European Reference Network of Heart Diseases (ERN GUARD-HEART)
| | - Olaf Pachciński
- 1st Department of Cardiology, Medical University of Silesia, Katowice, Poland
- European Reference Network of Heart Diseases (ERN GUARD-HEART)
| | - Maria Stec
- 1st Department of Cardiology, Medical University of Silesia, Katowice, Poland
- European Reference Network of Heart Diseases (ERN GUARD-HEART)
| | - Daniel Cieśla
- 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Silesian Center for Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Mariusz Gąsior
- 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Silesian Center for Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Jacek Grzybowski
- Department of Cardiomyopathy, National Institute of Cardiology, Warszawa, Poland
| |
Collapse
|
4
|
Szczygieł JA, Michałek P, Truszkowska G, Drozd-Sokołowska J, Wróbel A, Franaszczyk M, Gawor-Prokopczyk M, Mazurkiewicz Ł, Ziarkiewicz M, Waszczuk-Gajda A, Legatowicz-Koprowska M, Walczak E, Stawiński P, Lutyńska A, Płoski R, Jędrzejczak WW, Bilińska ZT, Grzybowski J. Clinical features, etiology, and survival in patients with restrictive cardiomyopathy: A single-center experience. Kardiol Pol 2023; 81:1227-1236. [PMID: 37937352 DOI: 10.33963/v.kp.97879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 10/17/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND Numerous prognostic factors have been proposed for cardiac amyloidosis (CA). The knowledge about other subtypes of restrictive cardiomyopathy (RCM) is scant. AIMS This study aimed to elucidate the etiology and prognostic factors of RCM as well as assess cardiac biomarkers: high-sensitive troponin T (hs-TnT), growth differentiation factor-15 (GDF-15), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and soluble suppression of tumorigenicity 2, as mortality predictors in RCM. METHODS We enrolled 36 RCM patients in our tertiary cardiac department. All patients were screened for CA. Genetic testing was performed in 17 patients without CA. RESULTS Pathogenic or likely pathogenic gene variants were found in 86% of patients, including 5 novel variants. Twenty patients died, and 4 had a heart transplantation during the study. Median overall survival was 29 months (8-55). The univariate Cox models analysis indicated that systolic and diastolic blood pressure, GDF-15, hs-TnT, NT-proBNP, left ventricular stroke volume, the ratio of the transmitral early peak velocity (E) estimated by pulsed wave Doppler over the early mitral annulus velocity (e'), tricuspid annulus plane systolic excursion, early tricuspid valve annular systolic velocity, the presence of pulmonary hypertension, and pericardial effusion influenced survival (P <0.05). A worse prognosis was observed in patients with GDF-15 >1316 pg/ml, hs-TnT >42 ng/l, NT-proBNP >3383 pg/ml, and pericardial effusion >3.5 mm (Kaplan-Meier analysis, log-rank test, P <0.001). CONCLUSIONS Genetic testing should be considered in every RCM patient where light-chain amyloidosis has been excluded. Survival remains poor regardless of etiology. Increased concentrations of GDF-15, hs-TNT, NT-proBNP, and pericardial effusion are associated with worse prognosis. Further studies are warranted.
Collapse
Affiliation(s)
- Justyna A Szczygieł
- Department of Cardiomyopathy, National Institute of Cardiology, Warszawa, Poland.
| | - Piotr Michałek
- Rapid Diagnosis Department, National Institute of Cardiology, Warszawa, Poland
| | - Grażyna Truszkowska
- Department of Medical Biology, Molecular Biology Laboratory, National Institute of Cardiology, Warszawa, Poland
| | - Joanna Drozd-Sokołowska
- Department of Hematology, Transplantology and Internal Medicine, Medical University of Warsaw, Warszawa, Poland
| | - Aleksandra Wróbel
- Department of Medical Biology, National Institute of Cardiology, Warszawa, Poland
| | - Maria Franaszczyk
- Department of Medical Biology, Molecular Biology Laboratory, National Institute of Cardiology, Warszawa, Poland
- Department of Medical Genetics, Medical University of Warsaw, Warszawa, Poland
| | | | - Łukasz Mazurkiewicz
- Department of Cardiomyopathy, National Institute of Cardiology, Warszawa, Poland
| | - Mateusz Ziarkiewicz
- Department of Hematology, Transplantology and Internal Medicine, Medical University of Warsaw, Warszawa, Poland
| | - Anna Waszczuk-Gajda
- Department of Hematology, Transplantology and Internal Medicine, Medical University of Warsaw, Warszawa, Poland
| | - Marta Legatowicz-Koprowska
- Department of Pathomorphology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warszawa, Poland
| | - Ewa Walczak
- Department of Pathomorphology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warszawa, Poland
| | - Piotr Stawiński
- Department of Medical Genetics, Medical University of Warsaw, Warszawa, Poland
| | - Anna Lutyńska
- Department of Medical Biology, Molecular Biology Laboratory, National Institute of Cardiology, Warszawa, Poland
- Department of Medical Biology, National Institute of Cardiology, Warszawa, Poland
| | - Rafał Płoski
- Department of Medical Genetics, Medical University of Warsaw, Warszawa, Poland
| | - Wiesław W Jędrzejczak
- Department of Hematology, Transplantology and Internal Medicine, Medical University of Warsaw, Warszawa, Poland
| | - Zofia T Bilińska
- Unit for Screening Studies in Inherited Cardiovascular Diseases, National Institute of Cardiology, Warszawa, Poland
| | - Jacek Grzybowski
- Department of Cardiomyopathy, National Institute of Cardiology, Warszawa, Poland
| |
Collapse
|
5
|
Brito D, Albrecht FC, de Arenaza DP, Bart N, Better N, Carvajal-Juarez I, Conceição I, Damy T, Dorbala S, Fidalgo JC, Garcia-Pavia P, Ge J, Gillmore JD, Grzybowski J, Obici L, Piñero D, Rapezzi C, Ueda M, Pinto FJ. World Heart Federation Consensus on Transthyretin Amyloidosis Cardiomyopathy (ATTR-CM). Glob Heart 2023; 18:59. [PMID: 37901600 PMCID: PMC10607607 DOI: 10.5334/gh.1262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 08/12/2023] [Indexed: 10/31/2023] Open
Abstract
Transthyretin amyloid cardiomyopathy (ATTR-CM) is a progressive and fatal condition that requires early diagnosis, management, and specific treatment. The availability of new disease-modifying therapies has made successful treatment a reality. Transthyretin amyloid cardiomyopathy can be either age-related (wild-type form) or caused by mutations in the TTR gene (genetic, hereditary forms). It is a systemic disease, and while the genetic forms may exhibit a variety of symptoms, a predominant cardiac phenotype is often present. This document aims to provide an overview of ATTR-CM amyloidosis focusing on cardiac involvement, which is the most critical factor for prognosis. It will discuss the available tools for early diagnosis and patient management, given that specific treatments are more effective in the early stages of the disease, and will highlight the importance of a multidisciplinary approach and of specialized amyloidosis centres. To accomplish these goals, the World Heart Federation assembled a panel of 18 expert clinicians specialized in TTR amyloidosis from 13 countries, along with a representative from the Amyloidosis Alliance, a patient advocacy group. This document is based on a review of published literature, expert opinions, registries data, patients' perspectives, treatment options, and ongoing developments, as well as the progress made possible via the existence of centres of excellence. From the patients' perspective, increasing disease awareness is crucial to achieving an early and accurate diagnosis. Patients also seek to receive care at specialized amyloidosis centres and be fully informed about their treatment and prognosis.
Collapse
Affiliation(s)
- Dulce Brito
- Department of Cardiology, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL@RISE, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Fabiano Castro Albrecht
- Dante Pazzanese Institute of Cardiology – Cardiac Amyloidosis Center Dante Pazzanese Institute, São Paulo, Brazil
| | | | - Nicole Bart
- St Vincent’s Hospital, Victor Chang Cardiac Research Institute, University of New South Wales, Sydney, Australia
| | - Nathan Better
- Cabrini Health, Malvern, Royal Melbourne Hospital, Parkville, Monash University and University of Melbourne, Victoria, Australia
| | | | - Isabel Conceição
- Department of Neurosciences and Mental Health, CHULN – Hospital de Santa Maria, Portugal
- Centro de Estudos Egas Moniz Faculdade de Medicina da Universidade de Lisboa Portugal, Portugal
| | - Thibaud Damy
- Department of Cardiology, DHU A-TVB, CHU Henri Mondor, AP-HP, INSERM U955 and UPEC, Créteil, France
- Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Reseau amylose, Créteil, France. Filière CARDIOGEN
| | - Sharmila Dorbala
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Cardiac Amyloidosis Program, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- CV imaging program, Cardiovascular Division and Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Pablo Garcia-Pavia
- Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, CIBERCV, Madrid, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Julian D. Gillmore
- National Amyloidosis Centre, University College London, Royal Free Campus, United Kingdom
| | - Jacek Grzybowski
- Department of Cardiomyopathy, National Institute of Cardiology, Warsaw, Poland
| | - Laura Obici
- Amyloidosis Research and Treatment Center, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Claudio Rapezzi
- Cardiovascular Institute, University of Ferrara, Ferrara, Italy
| | - Mitsuharu Ueda
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Japan
| | - Fausto J. Pinto
- Department of Cardiology, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL@RISE, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| |
Collapse
|
6
|
Grzybowski J, Podolec P, Holcman K, Gawor-Prokopczyk M, Jankowska E, Kostkiewicz M, Dąbrowska-Kugacka A, Lipowska M, Mazurkiewicz Ł, Rajtar-Salwa R, Rubiś P, Straburzyńska-Migaj E, Szczygieł J, Mitkowski P. Diagnosis and treatment of transthyretin amyloidosis cardiomyopathy: A position statement of the Polish Cardiac Society. Kardiol Pol 2023; 81:1167-1185. [PMID: 37768101 DOI: 10.33963/v.kp.97648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 09/28/2023] [Indexed: 09/29/2023]
Abstract
Considering the rare incidence of transthyretin amyloidosis cardiomyopathy (ATTR-CM) in Poland, patients encounter difficulties at the stages of diagnosis and treatment. For successful diagnosis, it is vital to raise the suspicion of ATTR-CM, that is, to identify typical clinical scenarios such as heart failure with preserved ejection fraction or the red flags of amyloidosis. In most cases, it is possible to establish the diagnosis on the basis of noninvasive tests. This article presents the recommended diagnostic algorithms including laboratory workup, imaging tests (in particular, isotope scanning), and genetic tests. Since ATTR-CM should be differentiated from light chain amyloidosis, we also discuss aspects related to hematological manifestations and invasive diagnosis. We describe neurological signs and symptoms in patients with amyloidosis and present therapeutic options, including the causative treatment of ATTR-CM with the only currently approved drug, tafamidis. We also discuss drugs that are being assessed in ongoing clinical trials. We outline differences in the symptomatic treatment of heart failure in ATTR-CM and recommendations for nonpharmacological treatment and monitoring of the disease. Finally, we underline the need for providing access to the causative treatment with tafamidis as part of a drug program, as in other rare diseases, so that patients with ATTR-CM can be treated according to the European Society of Cardiology guidelines on heart failure and cardiomyopathy.
Collapse
Affiliation(s)
- Jacek Grzybowski
- Department of Cardiomyopathy, Cardinal Wyszynski National Institute of Cardiology, Warszawa, Poland.
| | - Piotr Podolec
- Department of Cardiovascular Disease, Jagiellonian University Medical College, Centre for Rare Cardiovascular Diseases, John Paul II Hospital, Kraków, Poland
| | - Katarzyna Holcman
- Department of Cardiovascular Disease, Jagiellonian University Medical College, Centre for Rare Cardiovascular Diseases, John Paul II Hospital, Kraków, Poland
- Nuclear Medicine Laboratory, John Paul II Hospital, Kraków, Poland
| | - Monika Gawor-Prokopczyk
- Department of Cardiomyopathy, Cardinal Wyszynski National Institute of Cardiology, Warszawa, Poland
| | - Ewa Jankowska
- Institute of Heart Diseases, Wroclaw Medical University, Wrocław, Poland
| | - Magdalena Kostkiewicz
- Department of Cardiovascular Disease, Jagiellonian University Medical College, Centre for Rare Cardiovascular Diseases, John Paul II Hospital, Kraków, Poland
- Nuclear Medicine Laboratory, John Paul II Hospital, Kraków, Poland
| | | | - Marta Lipowska
- Department of Neurology, Medical University of Warsaw, Warszawa, Poland
| | - Łukasz Mazurkiewicz
- Department of Cardiomyopathy, Cardinal Wyszynski National Institute of Cardiology, Warszawa, Poland
| | - Renata Rajtar-Salwa
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | - Paweł Rubiś
- Department of Cardiovascular Disease, Jagiellonian University Medical College, Centre for Rare Cardiovascular Diseases, John Paul II Hospital, Kraków, Poland
| | - Ewa Straburzyńska-Migaj
- 1st Department of Cardiology, Poznan University of Medical Sciences, University Clinical Hospital, Poznań, Poland
| | - Justyna Szczygieł
- Department of Cardiomyopathy, Cardinal Wyszynski National Institute of Cardiology, Warszawa, Poland
| | - Przemysław Mitkowski
- 1st Department of Cardiology, Poznan University of Medical Sciences, University Clinical Hospital, Poznań, Poland
| |
Collapse
|
7
|
Kuryła M, Skrzyńska-Kowalczyk M, Kurnicka K, Perzanowska-Brzeszkiewicz K, Pruszczyk P, Grzybowski J, Ciurzyński M. Amyloidosis with phenotype of hypertrophic cardiomyopathy. Cardiol J 2023; 30:854-855. [PMID: 37933406 PMCID: PMC10635711 DOI: 10.5603/cj.94041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 08/23/2023] [Accepted: 08/26/2023] [Indexed: 11/08/2023] Open
Affiliation(s)
- Martyna Kuryła
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Poland.
| | | | - Katarzyna Kurnicka
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Poland
| | | | - Piotr Pruszczyk
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Poland
| | - Jacek Grzybowski
- Department of Cardiomyopathy National Institute of Cardiology, Warsaw, Poland
| | - Michał Ciurzyński
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Poland
| |
Collapse
|
8
|
Gawor M, Holcman K, Franaszczyk M, Lipowska M, Michałek P, Teresińska A, Bilińska ZT, Rubiś P, Kostkiewicz M, Szot W, Podolec P, Grzybowski J. Spectrum of transthyretin gene mutations and clinical characteristics of Polish patients with cardiac transthyretin amyloidosis. Cardiol J 2022; 29:985-993. [PMID: 32789836 PMCID: PMC9788745 DOI: 10.5603/cj.a2020.0104] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 06/29/2020] [Accepted: 07/13/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Transthyretin amyloidosis (ATTR) is a rare, life-threatening systemic disorder. We present first findings on the cardiac hereditary ATTR in Poland. METHODS Sixty-eight consecutive patients with suspected or known cardiac amyloidosis were evaluated, including blood tests, standard 12-lead electrocardiography (ECG) and transthoracic echocardiography. ATTR was confirmed histologically or non-invasively using 99mTc-DPD scintigraphy. Transthyretin (TTR) gene sequencing was performed. RESULTS In 2017-2019, 10 unrelated male patients were diagnosed with hereditary ATTR. All patients had very uncommon TTR gene mutations: 7 patients had p.Phe53Leu mutation, 2 patients had p.Glu109Lys mutation and 1 patient had p.Ala101Val mutation. The age of onset ranged from 49 to 67 years (mean [SD] age, 58.7 [6.4] years). On ECG, most patients (70%) had pseudoinfarct pattern and/or low QRS voltage. The maximal wall thickness (MWT) on echocardiography varied considerably among the patients from moderate (16 mm) to massively increased (30 mm). Most patients (90%) had decreased left ventricular ejection fraction (mean [SD], 43 [11] %). On follow-up, we observed progressive heart failure in almost all cases. The first patient with p.Phe53Leu mutation died of heart failure, the second died suddenly, the third successfully underwent combined heart and liver transplant with 15 months survival from the surgery. The patient with p.Ala101Val mutation died of stroke. CONCLUSIONS According to available data, this is the first time that the types of TTR mutations and the clinical characteristics of Polish patients with cardiac hereditary ATTR have been described. Previous literature data about Polish background in families with p.Phe53Leu mutation and the present results, suggest that this TTR mutation might be endemic in the Polish population.
Collapse
Affiliation(s)
- Monika Gawor
- Department of Cardiomyopathy, Institute of Cardiology, Warsaw, Poland
| | - Katarzyna Holcman
- Department of Cardiac and Vascular Diseases, John Paul II Hospital, Jagiellonian University Medical College, Krakow, Poland
| | - Maria Franaszczyk
- Department of Medical Biology, Institute of Cardiology, Warsaw, Poland
| | - Marta Lipowska
- Department of Neurology, Medical University of Warsaw, Poland
| | - Piotr Michałek
- Rapid Diagnosis Department, Emergency Room, Institute of Cardiology, Warsaw, Poland
| | - Anna Teresińska
- Department of Nuclear Medicine, Institute of Cardiology, Warsaw, Poland
| | - Zofia T. Bilińska
- Unit for Screening Studies in Inherited Cardiovascular Diseases, The Cardinal Stefan Wyszynski Institute of Cardiology, Warsaw, Poland
| | - Paweł Rubiś
- Department of Cardiac and Vascular Diseases, John Paul II Hospital, Jagiellonian University Medical College, Krakow, Poland
| | - Magdalena Kostkiewicz
- Department of Cardiac and Vascular Diseases, John Paul II Hospital, Jagiellonian University Medical College, Krakow, Poland,Department of Nuclear Medicine, John Paul II Hospital, Jagiellonian University Medical College, Krakow, Poland
| | - Wojciech Szot
- Department of Nuclear Medicine, John Paul II Hospital, Jagiellonian University Medical College, Krakow, Poland
| | - Piotr Podolec
- Department of Cardiac and Vascular Diseases, John Paul II Hospital, Jagiellonian University Medical College, Krakow, Poland
| | - Jacek Grzybowski
- Department of Cardiomyopathy, Institute of Cardiology, Warsaw, Poland
| |
Collapse
|
9
|
Holcman K, Dziuk M, Grzybowski J, Teresinska A, Malkowski B, Jedrzejuk D, Brockhuis B, Czepczynski R, Tomkiewicz-Pajak L, Kostkiewicz M. The scintigraphic diagnosis of cardiac amyloidosis. An expert opinion endorsed by the Section of Nuclear Medicine of the Polish Cardiac Society and the Polish Nuclear Medicine Society. Nucl Med Rev Cent East Eur 2022; 25:142-147. [PMID: 35929128 DOI: 10.5603/nmr.a2022.0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 06/24/2022] [Indexed: 11/25/2022] Open
Abstract
Amyloid transthyretin cardiomyopathy is a progressive disease that confers significant mortality. While it is relatively rare, the frequency of diagnoses has risen with the increased contribution of novel diagnostic approach over the last decade. Traditionally tissue biopsy was considered to be a gold standard for amyloidosis diagnosis. However, there are significant limitations in the wide application of this approach. A noninvasive imaging-based diagnostic algorithm has been substantially developed in recent years. Establishing radionuclide imaging standards may translate into a further enhancement of disease detection and improving prognosis in the group of patients. Therefore we present in the following document current evidence on the scintigraphic diagnosis of cardiac transthyretin amyloidosis. Moreover, we present standardized protocol for the acquisition and interpretation criteria in the scintigraphic evaluation of cardiac amyloidosis.
Collapse
Affiliation(s)
- Katarzyna Holcman
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland. .,Department of Nuclear Medicine, John Paul II Hospital, Krakow, Poland.
| | - Miroslaw Dziuk
- Department of Nuclear Medicine, Military Institute of Medicine, Warsaw, Poland
| | - Jacek Grzybowski
- Department of Cardiomyopathy, National Institute of Cardiology, Warsaw, Poland
| | - Anna Teresinska
- Department of Nuclear Medicine, National Institute of Cardiology, Warsaw, Poland
| | - Bogdan Malkowski
- Department of Nuclear Medicine,Nicolaus Copernicus University in Torun, Oncology Center, Bydgoszcz, Poland
| | - Diana Jedrzejuk
- Department of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, Wroclaw, Poland
| | - Bogna Brockhuis
- Department of Nuclear Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Rafał Czepczynski
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, Poznan, Poland
| | - Lidia Tomkiewicz-Pajak
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Magdalena Kostkiewicz
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland.,Department of Nuclear Medicine, John Paul II Hospital, Krakow, Poland
| |
Collapse
|
10
|
Ojrzyńska-Witek N, Marczak M, Mazurkiewicz Ł, Petryka-Mazurkiewicz J, Miłosz-Wieczorek B, Grzybowski J, Śpiewak M. Role of cardiac magnetic resonance in heart failure of initially unknown etiology: A 10-year observational study. Kardiol Pol 2021; 80:278-285. [PMID: 34936084 DOI: 10.33963/kp.a2021.0186] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 12/20/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND The heart failure (HF) population is estimated to be 64.3 million people worldwide and continues to grow. Identifying the underlying cause of HF is crucial for patient management and prognosis. AIMS We sought to evaluate the role of cardiac magnetic resonance (CMR) imaging to identify the etiology of HF and to evaluate the impact on diagnosis and patient management. METHODS We retrospectively reviewed the medical charts of 8630 consecutive patients referred for CMR in a large tertiary centre between 2008 and 2017 (10 years). In this study, we only included patients referred for CMR due to HF of unknown etiology whose diagnostic work-up did not reveal suspicion of any specific cardiac disease leading to HF. We also analyzed the changes in patient management that were guided by the CMR findings which were defined as changes in treatment and/or the necessity of further tests. RESULTS The study sample consisted of 243 patients: 173 (71.2%) patients were male, and the mean (SD) age was 44.0 (15.2) years. All patients underwent contrast-enhanced CMR. Late gadolinium enhancement (LGE) was detected in 74.9% of cases. In 94 patients (38.7%), CMR led to a new diagnosis. In 41 patients (16.9%), patient management was changed by CMR. The latter group consisted of patients with coronary artery disease, amyloidosis, valvular disease and cardiomyopathies other than dilated, namely hypertrophic, restrictive, and left ventricular noncompaction. CONCLUSIONS Our study strongly suggests that CMR imaging is a valuable tool for determining the etiology of HF and impacts patient management.
Collapse
Affiliation(s)
| | - Magdalena Marczak
- Magnetic Resonance Unit, National Institute of Cardiology, Warszawa, Poland
| | - Łukasz Mazurkiewicz
- Department of Cardiomyopathy, National Institute of Cardiology, Warszawa, Poland
| | | | | | - Jacek Grzybowski
- Department of Cardiomyopathy, National Institute of Cardiology, Warszawa, Poland
| | - Mateusz Śpiewak
- Magnetic Resonance Unit, National Institute of Cardiology, Warszawa, Poland
| |
Collapse
|
11
|
Ozierański K, Tymińska A, Marchel M, Januszkiewicz Ł, Maciejewski C, Główczyńska R, Marcolongo R, Caforio AL, Wojnicz R, Mizia-Stec K, Grzybowski J, Gąsior M, Nowalany-Kozielska E, Pawlak A, Kaczmarek K, Żegarska J, Pączek L, Balsam P, Opolski G, Grabowski M. A multicenter, randomized, double-blind, placebo-controlled study to evaluate the efficacy of immunosuppression in biopsy-proven virus-negative myocarditis or inflammatory cardiomyopathy (IMPROVE-MC). Cardiol J 2021; 29:329-341. [PMID: 34897632 PMCID: PMC9007472 DOI: 10.5603/cj.a2021.0166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 11/03/2021] [Accepted: 11/20/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Myocarditis is frequently associated with poor prognosis as there is no evidence-based treatment. Therefore, current international recommendations indicate that a well-designed prospective trial to confirm benefits from immunosuppressive therapy is highly warranted. The aim of the IMPROVE-MC study is to assess the efficacy and safety of immunosuppressive treatment compared with placebo on top of the guideline-recommended medical therapy in patients with biopsy-proven virus-negative myocarditis/inflammatory cardiomyopathy. METHODS The IMPROVE-MC (ClinicalTrials.gov: NCT04654988) is a prospective, randomized, double-blind, placebo-controlled, parallel-group, multicenter trial that will recruit 100 adults, with biopsy-proven myocarditis/inflammatory cardiomyopathy, with left ventricular ejection fraction (LVEF) ≤ 45% and ≥ 3-month history of symptoms. Patients will be randomized (1:1 ratio) to a group treated with prednisone and azathioprine vs. placebo. Patients will undergo 1-year double-blind therapy followed by a 1-year observation period to assess the long-term effects of the treatment. Apart from a routine clinical work-up, all patients will undergo cardiac magnetic resonance (CMR) and biopsy during screening and 1 year after applying the therapy. Primary endpoint is a change from baseline in LVEF at 12 months. Secondary endpoints are related to clinical evaluation (including New York Heart Association class, distance in 6-minute walk test, number of patients with the need for hospitalization), laboratory findings (biomarkers of fibrosis and myocardial necrosis, concentration of anti-heart auto-antibodies, heart tissue immunohistologic assessment), diagnostic tools (e.g., changes of echocardiographic, CMR and Holter-ECG parameters) and quality of life. CONCLUSIONS The IMPROVE-MC study will provide high-quality scientific data on the efficacy and safety of immunosuppressive therapy for patients with biopsy-proven myocarditis. Trial registration number and date of registration: ClinicalTrials.gov:NCT04654988; 04/12/2020.
Collapse
Affiliation(s)
| | - Agata Tymińska
- First Department of Cardiology, Medical University of Warsaw, Poland.
| | - Michał Marchel
- First Department of Cardiology, Medical University of Warsaw, Poland
| | | | | | | | - Renzo Marcolongo
- Division of Cardiology, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy.,Haematology and Clinical Immunology Unit and Cardio-immunology outpatient Clinic, University of Padova, Padova, Italy
| | - Alida Lp Caforio
- Division of Cardiology, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Romuald Wojnicz
- Department of Histology and Cell Pathology in Zabrze, School of Medicine with the Division of Dentistry, Medical University of Silesia in Katowice, Katowice, Poland
| | - Katarzyna Mizia-Stec
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Jacek Grzybowski
- Department of Cardiomyopathy, National Institute of Cardiology, Warsaw, Poland
| | - Mariusz Gąsior
- Third Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Ewa Nowalany-Kozielska
- Second Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Agnieszka Pawlak
- Department of Invasive Cardiology, Central Clinical Hospital of the Ministry of the Interior and Administration, Warsaw, Poland
| | - Krzysztof Kaczmarek
- Department of Electrocardiology, Central University Hospital, Medical University of Lodz, Poland
| | - Jolanta Żegarska
- Department of Immunology, Transplant Medicine and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Leszek Pączek
- Department of Immunology, Transplant Medicine and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | | | - Grzegorz Opolski
- First Department of Cardiology, Medical University of Warsaw, Poland
| | - Marcin Grabowski
- First Department of Cardiology, Medical University of Warsaw, Poland
| |
Collapse
|
12
|
Ojrzyńska-Witek N, Marczak M, Mazurkiewicz Ł, Petryka-Mazurkiewicz J, Miłosz-Wieczorek B, Grzybowski J, Śpiewak M. Sudden cardiac arrest: focus on cardiac magnetic resonance. Kardiol Pol 2021; 80:87-89. [PMID: 34734410 DOI: 10.33963/kp.a2021.0151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 11/03/2021] [Indexed: 11/23/2022]
Affiliation(s)
| | - Magdalena Marczak
- National Institute of Cardiology, Magnetic Resonance Unit, Warszawa, Poland
| | - Łukasz Mazurkiewicz
- National Institute of Cardiology, Department of Cardiomyopathy, Warszawa, Poland
| | | | | | - Jacek Grzybowski
- National Institute of Cardiology, Department of Cardiomyopathy, Warszawa, Poland
| | - Mateusz Śpiewak
- National Institute of Cardiology, Magnetic Resonance Unit, Warszawa, Poland
| |
Collapse
|
13
|
Szczygiel JA, Michalek P, Franaszczyk M, Truszkowska G, Ziarkiewicz M, Gawor M, Legatowicz-Koprowska M, Walczak E, Mazurkiewicz L, Stawinski P, Jedrzejczak WW, Lutynska A, Ploski R, Bilinska ZT, Grzybowski J. Diagnostic utility of genetic testing in restrictive cardiomyopathy a single refferal centre experience. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Restrictive cardiomyopathy (RCM) is considered to have a genetic background in approximately 50–60% of patients (pts) [1,2,3].
Purpose
The aim of the study was to assess the frequency of pathogenic gene variants in Polish patients with RCM.
Methods
Restrictive cardiomyopathy was diagnosed by transthoracic echocardiography. The analysis included all consecutive unrelated pts with RCM admitted to the cardiology department from January 2015 to December 2016. Light-chain (AL) amyloidosis was diagnosed using tissue biopsy, concentration of serum free light chains and bone marrow biopsy. A genetic test was offered to every patient without AL amyloidosis. In 4 pts coding regions of TTR or GLA genes were screened by Sanger sequencing. Next Generation Sequencing (NGS) was performed: a panel covering coding regions of >4800 disease-associated genes in 18 pts and Whole Exome Sequencing (WES) in 2 pts. Classification of rare variants was made according to ACMG criteria [4].
Results
Forty-four pts were enrolled. Eighteen pts were diagnosed with AL amyloidosis. One patient was diagnosed with histologically-proven myocarditis and one patient with transthyretin (ATTR) amyloidosis declined genetic test. The other 24 pts (median age 48 yrs, 6 males) underwent genetic testing, their median values (interquartile ranges) of the following parameters were: NT-proBNP, 2508 (995–5895) pg/mL; hs-TnT, 25 (18–46) ng/L; E/A ratio, 2.5 (1.8–4.5); E wave deceleration time, 135 (98–167) ms; E/e' ratio, 16 (12–19); left ventricular (LV) posterior wall, 13 (12–14.5) mm; interventricular septum, 14 (13–17) mm and LV end-diastolic dimension, 48 (43–49) mm. Pathogenic or likely pathogenic variants were detected in 16 probands: 5 in MYH7 gene, 3 in TNNI3 gene, 2 in MYBPC3 gene, 1 in BAG3 gene, 1 in PRAKG2 gene, 2 in GLA gene and 2 in TTR gene.
Conclusions
Genetic testing is justified in every patient with RCM, in whom AL amyloidosis is excluded. The molecular diagnosis in RCM may result in causal treatment of Anderson-Fabry disease and ATTR amyloidosis or improve disease management in other types of RCM. MYH7 gene is the most common causative gene in Polish patients with RCM.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): National Institute of Cardiology
Collapse
Affiliation(s)
- J A Szczygiel
- National Institute of Cardiology, Department of Cardiomyopathy, Warsaw, Poland
| | - P Michalek
- National Institute of Cardiology, Emergency Room, Rapid Diagnosis Department, Warsaw, Poland
| | - M Franaszczyk
- National Institute of Cardiology, Department of Medical Biology, Warsaw, Poland
| | - G Truszkowska
- National Institute of Cardiology, Department of Medical Biology, Warsaw, Poland
| | - M Ziarkiewicz
- Medical Uniwersity of Warsaw, Department of Haematology, Transplantology and Internal Medicine, Warsaw, Poland
| | - M Gawor
- National Institute of Cardiology, Department of Cardiomyopathy, Warsaw, Poland
| | - M Legatowicz-Koprowska
- National Institute of Geriatrics Rheumatology and Rehabilitation, Department of Pathomorphology, Warsaw, Poland
| | - E Walczak
- National Institute of Geriatrics Rheumatology and Rehabilitation, Department of Pathomorphology, Warsaw, Poland
| | - L Mazurkiewicz
- National Institute of Cardiology, Department of Cardiomyopathy, Warsaw, Poland
| | - P Stawinski
- National Institute of Cardiology, Department of Medical Biology, Warsaw, Poland
| | - W W Jedrzejczak
- Medical Uniwersity of Warsaw, Department of Haematology, Transplantology and Internal Medicine, Warsaw, Poland
| | - A Lutynska
- National Institute of Cardiology, Department of Medical Biology, Warsaw, Poland
| | - R Ploski
- Medical University of Warsaw, Department of Medical Genetics, Warsaw, Poland
| | - Z T Bilinska
- National Institute of Cardiology, Unit for Screening Studies in Inherited Cardiovascular Diseases, Warsaw, Poland
| | - J Grzybowski
- National Institute of Cardiology, Department of Cardiomyopathy, Warsaw, Poland
| |
Collapse
|
14
|
Śpiewak M, Kłopotowski M, Kowalik E, Kubik A, Ojrzyńska-Witek N, Petryka-Mazurkiewicz J, Michalak E, Mazurkiewicz Ł, Gawor M, Kożuch K, Miłosz-Wieczorek B, Grzybowski J, Bilińska Z, Witkowski A, Klisiewicz A, Marczak M. Sudden cardiac death risk in hypertrophic cardiomyopathy: comparison between echocardiography and magnetic resonance imaging. Sci Rep 2021; 11:7146. [PMID: 33785804 PMCID: PMC8009882 DOI: 10.1038/s41598-021-86532-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 03/17/2021] [Indexed: 12/12/2022] Open
Abstract
In hypertrophic cardiomyopathy (HCM) patients, left ventricular (LV) maximal wall thickness (MWT) is one of the most important factors determining sudden cardiac death (SCD) risk. In a large unselected sample of HCM patients, we aimed to simulate what changes would occur in the calculated SCD risk according to the European HCM Risk-SCD calculator when MWT measured using echocardiography was changed to MWT measured using MRI. All consecutive patients with HCM who underwent cardiac MRI were included. MWT measured with echocardiography and MRI were compared, and 5-year SCD risk according to the HCM Risk-SCD calculator was computed using four different models. The final population included 673 patients [389 (57.8%) males, median age 50 years, interquartile range (36-60)]. The median MWT was lower measured by echocardiography than by MRI [20 (17-24) mm vs 21 (18-24) mm; p < 0.0001]. There was agreement between echocardiography and MRI in the measurement of maximal LV wall thickness in 96 patients (14.3%). The largest differences between echo and MRI were - 13 mm and + 9 mm. The differences in MWT by echocardiography and MRI translated to a maximal difference of 8.33% in the absolute 5-year risk of SCD, i.e., the echocardiography-based risk was 8.33% lower than the MRI-based estimates. Interestingly, 13.7% of patients would have been reclassified into different SCD risk categories if MRI had been used to measure MWT instead of echocardiography. In conclusion, although there was high general intermodality agreement between echocardiography and MRI in the MWT measurements, the differences in MWT translated to significant differences in the 5-year risk of SCD.
Collapse
Affiliation(s)
- Mateusz Śpiewak
- Magnetic Resonance Unit, Department of Radiology, National Institute of Cardiology, ul. Alpejska 42, 04-628, Warsaw, Poland.
| | - Mariusz Kłopotowski
- Department of Cardiology and Interventional Angiology, National Institute of Cardiology, Warsaw, Poland
| | - Ewa Kowalik
- Department of Congenital Heart Diseases, National Institute of Cardiology, Warsaw, Poland
| | - Agata Kubik
- Magnetic Resonance Unit, Department of Radiology, National Institute of Cardiology, ul. Alpejska 42, 04-628, Warsaw, Poland
| | | | - Joanna Petryka-Mazurkiewicz
- Department of Coronary Artery Disease and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland
| | - Ewa Michalak
- Unit for Screening Studies in Inherited Cardiovascular Diseases, National Institute of Cardiology, Warsaw, Poland
| | - Łukasz Mazurkiewicz
- Department of Cardiomyopathies, National Institute of Cardiology, Warsaw, Poland
| | - Monika Gawor
- Department of Cardiomyopathies, National Institute of Cardiology, Warsaw, Poland
| | - Katarzyna Kożuch
- Department of Congenital Heart Diseases, National Institute of Cardiology, Warsaw, Poland
| | - Barbara Miłosz-Wieczorek
- Magnetic Resonance Unit, Department of Radiology, National Institute of Cardiology, ul. Alpejska 42, 04-628, Warsaw, Poland
| | - Jacek Grzybowski
- Department of Cardiomyopathies, National Institute of Cardiology, Warsaw, Poland
| | - Zofia Bilińska
- Unit for Screening Studies in Inherited Cardiovascular Diseases, National Institute of Cardiology, Warsaw, Poland
| | - Adam Witkowski
- Department of Cardiology and Interventional Angiology, National Institute of Cardiology, Warsaw, Poland
| | - Anna Klisiewicz
- Department of Congenital Heart Diseases, National Institute of Cardiology, Warsaw, Poland
| | - Magdalena Marczak
- Magnetic Resonance Unit, Department of Radiology, National Institute of Cardiology, ul. Alpejska 42, 04-628, Warsaw, Poland
| |
Collapse
|
15
|
Małek ŁA, Mazurkiewicz Ł, Marszałek M, Barczuk-Falęcka M, Simon JE, Grzybowski J, Miłosz-Wieczorek B, Postuła M, Marczak M. Deformation Parameters of the Heart in Endurance Athletes and in Patients with Dilated Cardiomyopathy-A Cardiac Magnetic Resonance Study. Diagnostics (Basel) 2021; 11:diagnostics11020374. [PMID: 33671723 PMCID: PMC7926616 DOI: 10.3390/diagnostics11020374] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/11/2021] [Accepted: 02/19/2021] [Indexed: 12/22/2022] Open
Abstract
A better understanding of the left ventricle (LV) and right ventricle (RV) functioning would help with the differentiation between athlete's heart and dilated cardiomyopathy (DCM). We aimed to analyse deformation parameters in endurance athletes relative to patients with DCM using cardiac magnetic resonance feature tracking (CMR-FT). The study included males of a similar age: 22 ultramarathon runners, 22 patients with DCM and 21 sedentary healthy controls (41 ± 9 years). The analysed parameters were peak LV global longitudinal, circumferential and radial strains (GLS, GCS and GRS, respectively); peak LV torsion; peak RV GLS. The peak LV GLS was similar in controls and athletes, but lower in DCM (p < 0.0001). Peak LV GCS and GRS decreased from controls to DCM (both p < 0.0001). The best value for differentiation between DCM and other groups was found for the LV ejection fraction (area under the curve (AUC) = 0.990, p = 0.0001, with 90.9% sensitivity and 100% specificity for ≤53%) and the peak LV GRS diastolic rate (AUC = 0.987, p = 0.0001, with 100% sensitivity and 88.4% specificity for >-1.27 s-1). The peak LV GRS diastolic rate was the only independent predictor of DCM (p = 0.003). Distinctive deformation patterns that were typical for each of the analysed groups existed and can help to differentiate between athlete's heart, a nonathletic heart and a dilated cardiomyopathy.
Collapse
Affiliation(s)
- Łukasz A. Małek
- Department of Epidemiology Cardiovascular Disease Prevention and Health Promotion, National Institute of Cardiology, 04-635 Warsaw, Poland
- Correspondence:
| | - Łukasz Mazurkiewicz
- Department of Cardiomyopathy, National Institute of Cardiology, 04-628 Warsaw, Poland; (Ł.M.); (J.G.)
| | - Mikołaj Marszałek
- Medical University of Warsaw, 02-091 Warsaw, Poland; (M.M.); (J.E.S.)
| | | | - Jenny E. Simon
- Medical University of Warsaw, 02-091 Warsaw, Poland; (M.M.); (J.E.S.)
| | - Jacek Grzybowski
- Department of Cardiomyopathy, National Institute of Cardiology, 04-628 Warsaw, Poland; (Ł.M.); (J.G.)
| | - Barbara Miłosz-Wieczorek
- Department of Radiology, National Institute of Cardiology, 04-628 Warsaw, Poland; (B.M.-W.); (M.M.)
| | - Marek Postuła
- Department of Experimental and Clinical Pharmacology Centre for Preclinical Research and Technology (CEPT), Medical University of Warsaw, 02-097 Warsaw, Poland;
| | - Magdalena Marczak
- Department of Radiology, National Institute of Cardiology, 04-628 Warsaw, Poland; (B.M.-W.); (M.M.)
| |
Collapse
|
16
|
Ojrzynska N, Marczak M, Mazurkiewicz Ł, Petryka-Mazurkiewicz J, Milosz-Wieczorek B, Grzybowski J, Spiewak M. Identify cause of heart failure of unknown aetiology using cardiac magnetic resonance - a 10-year observational study. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Heart failure (HF) is a clinical syndrome caused by structural or functional cardiac abnormality and is diagnosed on the basis of typical symptoms. It is associated with significant morbidity and mortality and affects more than 25 million people worldwide.
HF of unknown aetiology is managed with symptomatic treatment. Patients with reduced (HFrEF) or mid-reduced ejection fraction (HFmrEF) and no clear cause of systolic dysfunction are usually classified as having DCM. In HFpEF group ejection fraction is preserved but diastolic dysfunction is present leading to HF symptoms.
Purpose
The aim of this study was to investigate the clinical significance of cardiac magnetic resonance (CMR) imaging to identify heart failure (HF) aetiology.
Methods
We retrospectively reviewed all medical charts of patients referred for CMR due to heart failure of unknown aetiology admitted to our hospital between 2008 and 2017. Only patients with no specific pre-CMR initial diagnosis were included. Patients with suspicion of any specific disease leading to HF were excluded. If a referring physician suspected myocarditis, cardiomyopathy, previous myocardial infarction or advanced stable coronary disease (based on clinical signs and symptoms, the patient’s and family history or all pre-CMR studies), these patients were omitted from our analysis. Thus, we included only patients whose diagnostic work-up did not reveal suspicion of any specific cardiac disease leading to HF.
Results
The study sample consisted of 243 patients (173 (71.2%) male, mean age 44.0 ± 14.2%). All patients underwent contrast-enhanced CMR. Late gadolinium enhancement (LGE) was detected in 74.9% cases. Cardiomyopathies comprised the main aetiology (174 cases, 71.6%), in particular dilated cardiomyopathy (143 patients, 58.8%). 17 patients (7.0%) were diagnosed with myocarditis and in 24 patients (9.9%) CMR-based diagnosis was ambiguous – pointing out myocarditis or dilated cardiomyopathy. In 23 cases (9.5%) CMR indicated the presence of prior infarction undetected by pre-CMR testing. In five patients (2.1%) valvular disease was revealed as the sole cause of HF.
We analysed the change in patients’ management guided by the CMR results defined as change of treatment and/or necessity of further tests leading to therapeutic consequences. Change of pre-CMR diagnosis occurred in 94 patients (38.7%) and was judged crucial in 41 patients (16,9%).
As crucial we adjudicated the diagnosis associated with a need immediately further investigation and treatment changing, as follows: newly diagnosed amyloidosis, ischaemic heart disease or complex advanced valvular disease and cardiomyopathies other than dilated, hypertrophic and restrictive.
Conclusion
Our study strongly suggests that cardiac magnetic resonance imaging is a valuable tool for determining the aetiology of heart failure and impacts patients" management.
Abstract Figure.
Collapse
Affiliation(s)
- N Ojrzynska
- National Institute of Cardiology, Department of Cardiomyopathy, Warsaw, Poland
| | - M Marczak
- National Institute of Cardiology, Magnetic Resonance Unit, Warsaw, Poland
| | - Ł Mazurkiewicz
- National Institute of Cardiology, Department of Cardiomyopathy, Warsaw, Poland
| | | | - B Milosz-Wieczorek
- National Institute of Cardiology, Magnetic Resonance Unit, Warsaw, Poland
| | - J Grzybowski
- National Institute of Cardiology, Department of Cardiomyopathy, Warsaw, Poland
| | - M Spiewak
- National Institute of Cardiology, Magnetic Resonance Unit, Warsaw, Poland
| |
Collapse
|
17
|
Lipowska M, Drac H, Rowczenio D, Gilbertson J, Hawkins PN, Lasek-Bal A, Szewczuk J, Grzybowski J, Gawor M, Stępień-Wojno M, Franaszczyk M, Brydak-Godowska J, Śmierciak R, Ptasińska-Perkowska A, Chandoga J, Petrovic R, Kostera-Pruszczyk A. Transthyretin-related familial amyloid polyneuropathy (ATTR-FAP) in Poland - genetic and clinical presentation. Neurol Neurochir Pol 2020; 54:552-560. [PMID: 33373035 DOI: 10.5603/pjnns.a2020.0100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 09/27/2020] [Accepted: 12/01/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Transthyretin-related familial amyloid polyneuropathy (ATTR-FAP) is a rare, progressive, hereditary, highly disabling multisystem disorder. ATTR-FAP phenotypes differ according to the type of TTR mutation, geographic region and other as yet unidentified factors. The aim of this study was to establish the clinical and genetic characteristics of Polish patients. METHODS AND PATIENTS Clinical data and necessary examinations were collected from patients diagnosed with ATTR-FAP at the Department of Neurology of Medical University of Warsaw between 1970 and 2019. RESULTS 16 patients from eight unrelated families with five different TTR mutations were identified. The family with Val71Ala TTR mutation presented with early onset severe progressive polyneuropathy, with marked visual symptoms in a few patients. The next family with Ile73Val TTR mutation developed symptoms in middle age, and presented with mixed neuropathic and cardiologic phenotype. Four unrelated families were found to have the Phe33Leu TTR mutation with mixed neuropathic and cardiologic phenotype and late onset of symptoms. Other TTR mutations identified were: Val30Met and Asp38Val, both with late onset sensory, motor and autonomic neuropathy. CONCLUSION Polish ATTR-FAP cases presented with heterogeneity typical for non-endemic areas. Phe33Leu TTR mutation was the most common, found in four unrelated families.
Collapse
Affiliation(s)
- Marta Lipowska
- Department of Neurology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland.
| | - Hanna Drac
- Department of Neurology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland
| | - Dorota Rowczenio
- National Amyloidosis Centre, University College London, Rowland Hill Street, London, United Kingdom
| | - Janet Gilbertson
- National Amyloidosis Centre, University College London, Rowland Hill Street, London, United Kingdom
| | - Philip N Hawkins
- National Amyloidosis Centre, University College London, Rowland Hill Street, London, United Kingdom
| | - Anetta Lasek-Bal
- Department of Neurology, School of Health Sciences, Medical University of Silesia, Katowice, Poland
| | - Janusz Szewczuk
- Department of Neurology, Specialist Hospital, Słupsk, Poland
| | - Jacek Grzybowski
- Department of Cardiomyopathy, Institute of Cardiology, Warsaw, Poland
| | - Monika Gawor
- Department of Cardiomyopathy, Institute of Cardiology, Warsaw, Poland
| | - Małgorzata Stępień-Wojno
- Unit for Screening Studies in Inherited Cardiovascular Diseases, Institute of Cardiology, Warsaw, Poland
| | - Maria Franaszczyk
- Department of Medical Biology,Institute of Cardiology, Warsaw, Poland
| | | | | | - Agnieszka Ptasińska-Perkowska
- Department of Transplantation Medicine, Nephrology, Internal Diseases, T. Orłowski Institute of Transplantation Medical University of Warsaw, Warsaw, Poland
| | - Jan Chandoga
- Institute of Medical BiolGenetics and Clinical Genetics, Comenius University, Faculty of Medicine & University Hospital, Bratislava, Slovakia
| | - Robert Petrovic
- Institute of Medical BiolGenetics and Clinical Genetics, Comenius University, Faculty of Medicine & University Hospital, Bratislava, Slovakia
| | - Anna Kostera-Pruszczyk
- Department of Neurology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland
| |
Collapse
|
18
|
Szczygiel J, Michalek P, Drozd-Sokolowska J, Ziarkiewicz M, Bilinska Z, Gawor M, Mazurkiewicz L, Ojrzynska N, Legatowicz-Koprowska M, Walczak E, Waszczuk-Gajda A, Dwilewicz-Trojaczek J, Jedrzejczak W, Basak G, Grzybowski J. Comparison of lambda and kappa light-chain cardiac amyloidosis in Polish patients diagnosed in cardiology department. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Lambda (λ) and kappa (κ) types of light-chain amyloidosis (AL amyloidosis) are believed to have a similar prognosis. Data on the comparison of these two types of cardiac amyloidosis is scanty.
Objectives
The aim of the study was to investigate wether lambda light-chain cardiac amyloidosis indicates worse prognosis than the kappa variety.
Methods
The initial analysis covered all consecutive pts with cardiac AL amyloidosis diagnosed in the cardiology department from August 2011 to August 2019. Diagnosis was confirmed by increased serum free light-chains and positive tissue biopsy. Amyloid type was identified using immunohistochemical reactions. Blood pressure and heart rate (HR) were measured on admission. The difference between involved and uninvolved serum free light chains (dFLC), NT-proBNP, high-sensitivity troponin T (hs-TnT), creatinine, potassium, albumin and total protein were measured. During echocardiography, tissue Doppler imaging was used to assess early lateral (e' lat) and septal mitral annulus velocities and longitudinal myocardial velocities of ventricles. Standard parameters were measured. The presence of pleural effusion was assessed in chest X-ray.
Results
Sixty-four pts were diagnosed with AL amyloidosis. Four pts were excluded from the final analysis due to ambiguous amyloid typing. Median (interquartile range, IQR) age was 61 (52–67) yrs. Median (IQR) dFLC was 19.9 (5.5–50.6) mg/dL. Median NT-proBNP and hs-TnT concentrations were 4948 (2251–10206) pg/ml and 77 (39–139) ng/l, respectively. Forty-four pts had a λ type AL amyloidosis (73.3%). There were significant differences (p<0.05) between the λ and the κ groups in regard to: HR (80 vs. 73.5 BPM), systolic blood pressure (102 vs. 117 mmHg), serum creatinine (88 vs. 116 umol/L) and potassium (4.4 vs. 4.9 mmol/L), e' lat (5 vs. 7.5 cm/sec), left ventricular end-diastolic diameter (LVEDD, 42 vs. 46 mm), right ventricular end-diastolic diameter (RVEDD, 35 vs. 40 mm) and right ventricular wall thickness (8 vs. 6 mm). Pleural and pericardial effusions were more frequent in the λ group (59% vs. 19% and 80% vs. 44%, respectively) according to Fisher's exact test (p<0.05). Median (IQR) survivals for the λ and the κ groups were 3 (2–9) and 16 (5.5–22) months, respectively (p=0.03). The Kaplan-Meier curves analysis showed a trend towards worse survival of the λ group (Log rank test, p=0.08).
Conclusions
Cardiologists should be aware that lambda light-chain cardiac amyloidosis may indicate shorter survival than the kappa variety, although kappa AL amyloidosis may be associated with worse kidney function. Further research would be worth considering.
Kaplan-Meier curves, Time (months)
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Institute of Cardiology
Collapse
Affiliation(s)
- J.A Szczygiel
- Institute of Cardiology, Department of Cardiomyopathy, Warsaw, Poland
| | - P Michalek
- Institute of Cardiology, Emergency Room, Rapid Diagnosis Department, Warsaw, Poland
| | - J Drozd-Sokolowska
- Medical University of Warsaw, Department of Hematology, Oncology and Internal Medicine, Warsaw, Poland
| | - M Ziarkiewicz
- Medical University of Warsaw, Department of Hematology, Oncology and Internal Medicine, Warsaw, Poland
| | - Z.T Bilinska
- Institute of Cardiology, Unit for Screening Studies in Inherited Cardiovascular Diseases, Warsaw, Poland
| | - M Gawor
- Institute of Cardiology, Department of Cardiomyopathy, Warsaw, Poland
| | - L Mazurkiewicz
- Institute of Cardiology, Department of Cardiomyopathy, Warsaw, Poland
| | - N Ojrzynska
- Institute of Cardiology, Department of Cardiomyopathy, Warsaw, Poland
| | - M Legatowicz-Koprowska
- National Institute of Geriatrics Rheumatology and Rehabilitation, Pathomorphology Department, Warsaw, Poland
| | - E.M Walczak
- National Institute of Geriatrics Rheumatology and Rehabilitation, Pathomorphology Department, Warsaw, Poland
| | - A Waszczuk-Gajda
- Medical University of Warsaw, Department of Hematology, Oncology and Internal Medicine, Warsaw, Poland
| | - J Dwilewicz-Trojaczek
- Medical University of Warsaw, Department of Hematology, Oncology and Internal Medicine, Warsaw, Poland
| | - W.W Jedrzejczak
- Medical University of Warsaw, Department of Hematology, Oncology and Internal Medicine, Warsaw, Poland
| | - G.W Basak
- Medical University of Warsaw, Department of Hematology, Oncology and Internal Medicine, Warsaw, Poland
| | - J Grzybowski
- Institute of Cardiology, Department of Cardiomyopathy, Warsaw, Poland
| |
Collapse
|
19
|
Kowalik E, Kuśmierczyk-Droszcz B, Klisiewicz A, Wróbel A, Lutyńska A, Gawor M, Niewiadomska J, Lipczyńska M, Biernacka EK, Grzybowski J, Hoffman P. Galectin-3 plasma levels in adult congenital heart disease and the pressure overloaded right ventricle: reason matters. Biomark Med 2020; 14:1197-1205. [PMID: 33021383 DOI: 10.2217/bmm-2020-0250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To assess galectin-3 (Gal-3) levels and their relationship with clinical status and right ventricular (RV) performance in adults with RV pressure overload of various mechanisms due to congenital heart disease. Materials & methods: A cross-sectional study was conducted. Patients underwent clinical examination, blood testing and transthoracic echocardiography. Results: The study included 63 patients with congenitally corrected transposition of the great arteries, 41 patients with Eisenmenger syndrome and 20 healthy controls. Gal-3 concentrations were higher in patients compared with controls (7.83 vs 6.11 ng/ml; p = 0.002). Biomarker levels correlated with age, New York Health Association class, N-terminal probrain natriuretic peptide and RV function only in congenitally corrected transposition of the great arteries patients. Conclusion: Gal-3 profile in congenital heart disease patients and pressure-overloaded RV differs according to the cause of pressure overload.
Collapse
Affiliation(s)
- Ewa Kowalik
- Department of Congenital Heart Disease, National Institute of Cardiology, Alpejska, Warsaw 04-628, Poland
| | - Beata Kuśmierczyk-Droszcz
- Department of Congenital Heart Disease, National Institute of Cardiology, Alpejska, Warsaw 04-628, Poland
| | - Anna Klisiewicz
- Department of Congenital Heart Disease, National Institute of Cardiology, Alpejska, Warsaw 04-628, Poland
| | - Aleksandra Wróbel
- Department of Medical Biology, National Institute of Cardiology, Alpejska, Warsaw 04-628, Poland
| | - Anna Lutyńska
- Department of Medical Biology, National Institute of Cardiology, Alpejska, Warsaw 04-628, Poland
| | - Monika Gawor
- Department of Cardiomyopathy, National Institute of Cardiology, Alpejska 42, Warsaw 04-628, Poland
| | - Julita Niewiadomska
- Department of Congenital Heart Disease, National Institute of Cardiology, Alpejska, Warsaw 04-628, Poland
| | - Magdalena Lipczyńska
- Department of Congenital Heart Disease, National Institute of Cardiology, Alpejska, Warsaw 04-628, Poland
| | - Elżbieta K Biernacka
- Department of Congenital Heart Disease, National Institute of Cardiology, Alpejska, Warsaw 04-628, Poland
| | - Jacek Grzybowski
- Department of Cardiomyopathy, National Institute of Cardiology, Alpejska 42, Warsaw 04-628, Poland
| | - Piotr Hoffman
- Department of Congenital Heart Disease, National Institute of Cardiology, Alpejska, Warsaw 04-628, Poland
| |
Collapse
|
20
|
Wortmann M, Layland AS, Frese N, Kahmann U, Grothe T, Storck JL, Blachowicz T, Grzybowski J, Hüsgen B, Ehrmann A. On the reliability of highly magnified micrographs for structural analysis in materials science. Sci Rep 2020; 10:14708. [PMID: 32895411 PMCID: PMC7477546 DOI: 10.1038/s41598-020-71682-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 08/20/2020] [Indexed: 11/09/2022] Open
Abstract
Highly magnified micrographs are part of the majority of publications in materials science and related fields. They are often the basis for discussions and far-reaching conclusions on the nature of the specimen. In many cases, reviewers demand and researchers deliver only the bare minimum of micrographs to substantiate the research hypothesis at hand. In this work, we use heterogeneous poly(acrylonitrile) nanofiber nonwovens with embedded nanoparticles to demonstrate how an insufficient or biased micrograph selection may lead to erroneous conclusions. Different micrographs taken by transmission electron microscopy and helium ion microscopy with sometimes contradictory implications were analyzed and used as a basis for micromagnetic simulations. With this, we try to raise awareness for the possible consequences of cherry-picking for the reliability of scientific literature.
Collapse
Affiliation(s)
- Martin Wortmann
- Faculty of Engineering and Mathematics, Bielefeld University of Applied Sciences, 33619, Bielefeld, Germany
| | | | - Natalie Frese
- Faculty of Physics, Bielefeld University, 33615, Bielefeld, Germany
| | - Uwe Kahmann
- Zentrum für Ultrastrukturelle Diagnostik, 33615, Bielefeld, Germany
| | - Timo Grothe
- Faculty of Engineering and Mathematics, Bielefeld University of Applied Sciences, 33619, Bielefeld, Germany
| | - Jan Lukas Storck
- Faculty of Engineering and Mathematics, Bielefeld University of Applied Sciences, 33619, Bielefeld, Germany
| | - Tomasz Blachowicz
- Institute of Physics - Centre for Science and Education, Silesian University of Technology, 44-100, Gliwice, Poland
| | - Jacek Grzybowski
- Institute of Physics - Centre for Science and Education, Silesian University of Technology, 44-100, Gliwice, Poland
| | - Bruno Hüsgen
- Faculty of Engineering and Mathematics, Bielefeld University of Applied Sciences, 33619, Bielefeld, Germany
| | - Andrea Ehrmann
- Faculty of Engineering and Mathematics, Bielefeld University of Applied Sciences, 33619, Bielefeld, Germany.
| |
Collapse
|
21
|
Śpiewak M, Kłopotowski M, Ojrzyńska N, Petryka-Mazurkiewicz J, Miłosz-Wieczorek B, Mazurkiewicz Ł, Grzybowski J, Bilińska Z, Witkowski A, Marczak M. Impact of cardiac magnetic resonance on the diagnosis of hypertrophic cardiomyopathy - a 10-year experience with over 1000 patients. Eur Radiol 2020; 31:1194-1205. [PMID: 32876838 PMCID: PMC7880911 DOI: 10.1007/s00330-020-07207-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/03/2020] [Accepted: 08/19/2020] [Indexed: 12/12/2022]
Abstract
Objectives To assess the value of cardiac MRI in comparison to echocardiography in consecutive patients with previously diagnosed and new suspected hypertrophic cardiomyopathy (HCM). Methods All MRI studies of patients with HCM or suspected disease performed at our centre within a 10-year time period were evaluated. Initial diagnoses (echocardiography-based) and final (MRI-based) diagnoses were compared in subgroups, and the discrepancies were recorded. Results A total of 1006 subjects with HCM or suspected HCM were identified (61% males, 39% females; median age, 49.1 years; interquartile range, 34.9–60.4). In 12 (2.2%) out of 550 patients with known HCM, MRI indicated a diagnosis other than HCM, including but not limited to the subaortic membrane (n = 1, 8.3%) or mild left ventricular hypertrophy (n = 5, 41.7%). Among all patients with suspected HCM (n = 456), MRI diagnosis was different from HCM in 5.3% (n = 24) of patients. In an additional 20.4% of patients (n = 93), no significant hypertrophy was present. In total, among patients with suspected HCM, MRI led to clear HCM diagnosis in 204 (44.7%) patients. Among patients with a history of uncontrolled hypertension suspected of having HCM, MRI aided in identifying cardiomyopathy in 47.9% of patients. This subgroup contained the largest proportion of patients with an ambiguous diagnosis, namely, 29.6% compared with 13.8% in the remaining groups of patients with suspected HCM (p = 0.0001). Conclusions In a small but important group of patients with ultrasound-based HCM, cardiac MRI can diagnose previously unknown conditions and/or refute suspected cardiomyopathy. The diagnostic yield of MRI when compared to echocardiography in patients suspected of having HCM is 44.7%. Key Points • Out of 550 patients previously diagnosed with echocardiography but without magnetic resonance imaging (MRI) as having hypertrophic cardiomyopathy (HCM), we diagnosed a different disease in 12 (2.2%) patients using MRI. • Among patients with suspected HCM based on echocardiography, MRI led to clear HCM diagnosis in 44.7% of patients. • In patients with a history of uncontrolled hypertension suspected, based on an echocardiogram, of having HCM, MRI aided in identifying cardiomyopathy in 47.9% of patients. This subgroup contained the largest proportion of patients with an ambiguous diagnosis.
Collapse
Affiliation(s)
- Mateusz Śpiewak
- Magnetic Resonance Unit, National Institute of Cardiology, ul. Alpejska 42, 04-628, Warsaw, Poland.
| | - Mariusz Kłopotowski
- Department of Cardiology and Interventional Angiology, National Institute of Cardiology, Warsaw, Poland
| | - Natalia Ojrzyńska
- Department of Cardiomyopathies, National Institute of Cardiology, Warsaw, Poland
| | - Joanna Petryka-Mazurkiewicz
- Department of Coronary Artery Disease and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland
| | - Barbara Miłosz-Wieczorek
- Magnetic Resonance Unit, National Institute of Cardiology, ul. Alpejska 42, 04-628, Warsaw, Poland
| | - Łukasz Mazurkiewicz
- Department of Cardiomyopathies, National Institute of Cardiology, Warsaw, Poland
| | - Jacek Grzybowski
- Department of Cardiomyopathies, National Institute of Cardiology, Warsaw, Poland
| | - Zofia Bilińska
- Unit for Screening Studies in Inherited Cardiovascular Diseases, National Institute of Cardiology, Warsaw, Poland
| | - Adam Witkowski
- Department of Cardiology and Interventional Angiology, National Institute of Cardiology, Warsaw, Poland
| | - Magdalena Marczak
- Magnetic Resonance Unit, National Institute of Cardiology, ul. Alpejska 42, 04-628, Warsaw, Poland
| |
Collapse
|
22
|
Chmielewski P, Michalak E, Kowalik I, Franaszczyk M, Sobieszczanska-Malek M, Truszkowska G, Stepien-Wojno M, Biernacka EK, Foss-Nieradko B, Lewandowski M, Oreziak A, Bilinska M, Kusmierczyk M, Tesson F, Grzybowski J, Zielinski T, Ploski R, Bilinska ZT. Can Circulating Cardiac Biomarkers Be Helpful in the Assessment of LMNA Mutation Carriers? J Clin Med 2020; 9:jcm9051443. [PMID: 32408651 PMCID: PMC7290314 DOI: 10.3390/jcm9051443] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/27/2020] [Accepted: 05/08/2020] [Indexed: 12/20/2022] Open
Abstract
Mutations in the lamin A/C gene are variably phenotypically expressed; however, it is unclear whether circulating cardiac biomarkers are helpful in the detection and risk assessment of cardiolaminopathies. We sought to assess (1) clinical characteristics including serum biomarkers: high sensitivity troponin T (hsTnT) and N-terminal prohormone brain natriuretic peptide (NT-proBNP) in clinically stable cardiolaminopathy patients, and (2) outcome among pathogenic/likely pathogenic lamin A/C gene (LMNA) mutation carriers. Our single-centre cohort included 53 patients from 21 families. Clinical, laboratory, follow-up data were analysed. Median follow-up was 1522 days. The earliest abnormality, emerging in the second and third decades of life, was elevated hsTnT (in 12% and in 27% of patients, respectively), followed by the presence of atrioventricular block, heart failure, and malignant ventricular arrhythmia (MVA). In patients with missense vs. other mutations, we found no difference in MVA occurrence and, surprisingly, worse transplant-free survival. Increased levels of both hsTnT and NT-proBNP were strongly associated with MVA occurrence (HR > 13, p ≤ 0.02 in both) in univariable analysis. In multivariable analysis, NT-proBNP level > 150 pg/mL was the only independent indicator of MVA. We conclude that assessment of circulating cardiac biomarkers may help in the detection and risk assessment of cardiolaminopathies.
Collapse
Affiliation(s)
- Przemyslaw Chmielewski
- Unit for Screening Studies in Inherited Cardiovascular Diseases, National Institute of Cardiology, 04-628 Warsaw, Poland; (P.C.); (E.M.); (M.S.-W.); (B.F.-N.)
| | - Ewa Michalak
- Unit for Screening Studies in Inherited Cardiovascular Diseases, National Institute of Cardiology, 04-628 Warsaw, Poland; (P.C.); (E.M.); (M.S.-W.); (B.F.-N.)
| | - Ilona Kowalik
- Department of Coronary Artery Disease and Cardiac Rehabilitation, National Institute of Cardiology, 04-628 Warsaw, Poland;
| | - Maria Franaszczyk
- Molecular Biology Laboratory, Department of Medical Biology, National Institute of Cardiology, 04-628 Warsaw, Poland; (M.F.); (G.T.)
| | | | - Grazyna Truszkowska
- Molecular Biology Laboratory, Department of Medical Biology, National Institute of Cardiology, 04-628 Warsaw, Poland; (M.F.); (G.T.)
| | - Malgorzata Stepien-Wojno
- Unit for Screening Studies in Inherited Cardiovascular Diseases, National Institute of Cardiology, 04-628 Warsaw, Poland; (P.C.); (E.M.); (M.S.-W.); (B.F.-N.)
| | | | - Bogna Foss-Nieradko
- Unit for Screening Studies in Inherited Cardiovascular Diseases, National Institute of Cardiology, 04-628 Warsaw, Poland; (P.C.); (E.M.); (M.S.-W.); (B.F.-N.)
| | - Michal Lewandowski
- 2nd Department of Arrhythmia, National Institute of Cardiology, 04-628 Warsaw, Poland;
| | - Artur Oreziak
- 1st Department of Arrhythmia, National Institute of Cardiology, 04-628 Warsaw, Poland; (A.O.); (M.B.)
| | - Maria Bilinska
- 1st Department of Arrhythmia, National Institute of Cardiology, 04-628 Warsaw, Poland; (A.O.); (M.B.)
| | - Mariusz Kusmierczyk
- Department of Cardiac Surgery and Transplantology, National Institute of Cardiology, 04-628 Warsaw, Poland;
| | - Frédérique Tesson
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada;
| | - Jacek Grzybowski
- Department of Cardiomyopathy, National Institute of Cardiology, 04-628 Warsaw, Poland;
| | - Tomasz Zielinski
- Department of Heart Failure and Transplantology, National Institute of Cardiology, 04-628 Warsaw, Poland; (M.S.-M.); (T.Z.)
| | - Rafal Ploski
- Department of Medical Genetics, Medical University of Warsaw, 02-106 Warsaw, Poland;
| | - Zofia T. Bilinska
- Unit for Screening Studies in Inherited Cardiovascular Diseases, National Institute of Cardiology, 04-628 Warsaw, Poland; (P.C.); (E.M.); (M.S.-W.); (B.F.-N.)
- Correspondence: ; Tel.: +48-223434711
| |
Collapse
|
23
|
Gawor M, Franaszczyk M, Kowalik E, Śpiewak M, Michałowska I, Grzybowski J. A young patient with left ventricular hypertrophy and accidentally discovered aortic dissection: hypertensive heart disease or hypertrophic cardiomyopathy? Kardiol Pol 2020; 78:171-173. [DOI: 10.33963/kp.15159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
24
|
Gawor M, Franaszczyk M, Kowalik E, Spiewak M, Michalowska I, Grzybowski J. P881 Young patient with left ventricular hypertrophy and accidentally discovered aortic dissection: hypertensive heart or hypertrophic cardiomyopathy? Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
A 36-year-old male with positive family history of sudden cardiac death (his uncle"s son died suddenly at the age of 25), hospitalized a month ago in a local hospital due to acute hypertensive cardiogenic pulmonary edema, was referred to our institution for further evaluation with suspicion of hypertrophic cardiomyopathy.
On admission patient was asymptomatic, without fatigue, exertional dyspnoea, chest pain or syncope. On physical examination his BP was significantly elevated (180/100 mmHg). The lungs were clear on auscultation, liver was not enlarged, jugular veins were normal, there was no oedema of lower extremities. Abdominal auscultation revealed vascular murmur in umbilical region.
The baseline level of NT-proBNP was 811.4 (range 0–125) pg/mL, and high-sensitivity cardiac troponin T was 20.2 (range 0–14) ng/L. The standard 12-lead electrocardiogram demonstrated sinus rhythm, left atrial enlargement and left ventricular (LV) hypertrophy with nonspecific ST segment and T-wave changes (Fig. 1A). No significant pathology was present on chest X-ray (Fig. 1B).
Transthoracic echocardiography revealed significant concentric LV hypertrophy with preserved LV ejection fraction (EF 70%) and moderately decreased global longitudinal strain (GLS-13.7%). There was mild dilatation of left atrium. Ascending aorta diameter was in normal range (Fig. 1C-D). Cardiac magnetic resonance (CMR) scan confirmed concentric LV hypertrophy with the maximal wall thickness of 18 mm at interventricular septum, and increased myocardial mass (LV mass index 124 ml/m2, range 59–92). Moreover, small areas of late gadolinium enhancement were found in LV segments (Fig. 1E-F).
Due to presence of vascular murmur in abdomen, ultrasound imaging was performed. The exam revealed abdominal aortic dissection (Fig. 1G-H). Patient was transferred to the computed tomography (CT) unit to confirm the diagnosis. Aortic dissection originated below renal arteries and involving common illiac arteries was detected (Stanford B). The presence of thrombi within the lumen created by the aortic dissection suggested chronic presentation.
Patient was managed conservatively with strict blood pressure control and close follow up arranged. We decided to perform genetic analysis. Currently we are awaiting the results in hope that it will help us to establish the diagnosis and differentiate hypertensive heart from hypertrophic cardiomyopathy.
In conclusion, aortic dissection typically presents with tearing chest pain and severe hemodynamic compromise. Painless dissection, like in this case, is relatively rare. Differential diagnosis between hypertensive heart and hypertrophic cardiomyopathy is crucial as it has direct therapeutic impact.
Abstract P881 Figure 1
Collapse
Affiliation(s)
- M Gawor
- Institute of Cardiology, Department of Cardiomyopathies, Warsaw, Poland
| | - M Franaszczyk
- Institute of Cardiology, Department of Medical Biology, Warsaw, Poland
| | - E Kowalik
- Institute of Cardiology, Department of Congenital Heart Diseases, Warsaw, Poland
| | - M Spiewak
- Institute of Cardiology, Department of Congenital Heart Diseases, Warsaw, Poland
| | - I Michalowska
- Institute of Cardiology, Department of Radiology, Warsaw, Poland
| | - J Grzybowski
- Institute of Cardiology, Department of Cardiomyopathies, Warsaw, Poland
| |
Collapse
|
25
|
Ojrzynska N, Kowalik E, Kowalski M, Klisiewicz A, Demkow M, Witkowski A, Grzybowski J. P925 An analysis of the impact of etiology vs. impact of hemodynamic variables on the right ventricular free wall deformation in patients with pulmonary hypertension. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Purpose
Pulmonary hypertension (PH) is a deadly disease leading to right ventricular (RV) failure. The aim of this study was to establish whether aetiology of PH has a greater impact on RV longitudinal deformation than cardiac catherization parameters.
Methods
We retrospectively analyzed echocardiographic studies and cardiac catherization parameters of 25 patients with pulmonary hypertension : 13 pts with precapillary PH associated with atrial/ventricular septum defect and 12 pts with postcapillary PH due to dilated cardiomyopathy. We measured regional strain and regional systolic and diastolic strain rates (SR) in right ventricular free wall in basal, mid and apical segments.
Results
Aside from TAPSE, echocardiographic parameters indicate no difference. Even though mean pulmonary arterial pressure and pulmonary vascular residence significantly higher in patients with precapillary PH, strain was significantly decreased in patients with postcapillary PH. Statistically significant differences were observed between pre- and postcapillary PH patients" strain in apical and mid myocardial segments. Early diastolic strain rate (SR) in apical RV segment in precapillary PH patients was significantly higher than in patients with postcapillary PH. In other myocardial segments there were no differences between systolic, early diastolic and late diastolic SR.
Conclusion
Our study suggests that RV free wall strain in patients with PH moderately correlate with aetiology of PH. We did not find correlation between higher RA pressure or PVR and worsening of RV function in PH of different aetiologies.
Precapillary PH Postcapillary PH p value PA mean pressure (mmHG) 75,2 ± 17,7 42,0 ± 7,3 <0,05 PWR (WU) 15,8 ± 6,7 4,7 ± 2,6 <0,05 RV wall thickenss (mm) 11,0 ± 2,5 5,5 ± 1,0 NS RVIT (mm) 42,7 ± 10,4 42,8 ± 8,1 NS TAPSE (mm) 19,2 ± 4,2 15,6 ± 4,9 <0,05 S" 10,8 ± 2,0 9,4 ± 2,1 NS basal segment strain -16 ± 7 -17 ± 5 NS mid segment strain -18 ± 8 -15 ± 4 <0,05 apical segment strain -19 ± 8 -14 ± 4 <0,05
Collapse
Affiliation(s)
- N Ojrzynska
- Institute of Cardiology, Department of Cardiomyopathy, Warsaw, Poland
| | - E Kowalik
- Institute of Cardiology, Department of Congenital Heart Diseases, Warsaw, Poland
| | - M Kowalski
- Institute of Cardiology, Department of Congenital Heart Diseases, Warsaw, Poland
| | - A Klisiewicz
- Institute of Cardiology, Department of Congenital Heart Diseases, Warsaw, Poland
| | - M Demkow
- Institute of Cardiology, Department of Coronary and Structural Heart Diseases, Warsaw, Poland
| | - A Witkowski
- Institute of Cardiology, Department of Interventional Cardiology and Angiology, Warsaw, Poland
| | - J Grzybowski
- Institute of Cardiology, Department of Cardiomyopathy, Warsaw, Poland
| |
Collapse
|
26
|
Gawor M, Wnuk J, Michalek P, Marczak M, Teresinska A, Grzybowski J. P825 Multi-modality imaging for noninvasive diagnosis of transthyretin amyloid cardiomyopathy-single centre experience. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Thransthyretin amyloidosis (ATTR) is a rare progressive disease that may present as heart failure with preserved ejection fraction, severe aortic stenosis, hypertrophic cardiomyopathy (HCM) or resctrictive cardiomyopathy. There are two types of ATTR: hereditary ATTR (hATTR) caused by mutations in the TTR gene and wild-type ATTR (wtATTR) resulting from deposition of wild-type TTR protein.
Purpose
We describe the clinical heterogeneity of ATTR patients from our centre diagnosed noninvasively in 2018-2019.
Methods
All patients presented intensive cardiac uptake at 99mTc-DPD scintigraphy. Light chain amyloidosis was excluded.
Results
8 patients were diagnosed with ATTR (Table 1). Three unrelated male patients were diagnosed with hATTR due to rare mutations: 2 of them had Phe33Leu, 1 patient had Glu89Lys mutation. Five
patients (males) were diagnosed with wtATTR. Age of onset differed among the patients. Characteristic clinical features included cardiomyopathy with increased left and right ventricular wall thickness. Only 2 patients had restrictive filling pattern, 3 patients had atrial fibrillation. Laboratory examination showed increased level of troponin T and NT-proBNP. Three patients had bilateral carpal tunnel syndrome. Thanks to DPD-scintygraphy we excluded ATTR in two patients with false-positive results of histological exam for TTR-related amyloid deposits.
Conclusions
Although ATTR is known for its broad clinical spectrum, patients from our center presented mostly as HCM phenocopies but in different stages of heart failure. Appropriate diagnosis of ATTR is crucial and have direct therapeutic impact. Echocardiography raise the suspicion of amyloid cardiomyopathy, while other imaging technique (DPD-scintigraphy) confirm it or exclude it in noninvasive way.
Patient 1 2 3 4 5 6 7 8 Mutation Glu89Lys Phe33Leu Phe33Leu wild type wild type wild type wild type wild type Sex male male male male male male male male Age of onset 57 56 55 77 78 80 77 76 Electrocardiogram AF low QRS voltage low QRS voltage AF, RBBB LVH LVH pseudoinfarct pattern, low QRS voltage AF, LVH Maximal wall thickness [mm] 23 20 18 28 22 23 18 20 LVEF% 45 40 40 60 65 60 45 55 Asymmetric hypertrophy pattern + - - - + + - + NYHA III II II II III II II II NT-proBNP pg/ml 2122 1200 1500 2755 222 2630 2426 hs-Troponin T ng/l 50 98 42 65 35 63 64
Abstract P825 Figure 1
Collapse
Affiliation(s)
- M Gawor
- Institute of Cardiology, Department of Cardiomyopathies, Warsaw, Poland
| | - J Wnuk
- Institute of Cardiology, Department of Nuclear Medicine, Warsaw, Poland
| | - P Michalek
- Institute of Cardiology, Emergency Room Rapid Diagnosis Department, Warsaw, Poland
| | - M Marczak
- Institute of Cardiology, CMR Unit, Warsaw, Poland
| | - A Teresinska
- Institute of Cardiology, Department of Nuclear Medicine, Warsaw, Poland
| | - J Grzybowski
- Institute of Cardiology, Department of Cardiomyopathies, Warsaw, Poland
| |
Collapse
|
27
|
Stępień-Wojno M, Franaszczyk M, Bodalski R, Śpiewak M, Baranowski RS, Grzybowski J, Płoski R, Bilińska ZT. A different background of arrhythmia in siblings with a positive family history of sudden death at young age. Ann Noninvasive Electrocardiol 2019; 25:e12707. [PMID: 31609036 PMCID: PMC7358827 DOI: 10.1111/anec.12707] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 09/14/2019] [Indexed: 12/03/2022] Open
Abstract
We present two symptomatic sisters who had a positive family history of sudden death. None of them had structural heart disease. In the 25‐year‐old proband, complex ventricular arrhythmia, cardiac conduction system disease, and skeletal muscle weakness were found. Genetic examination showed a pathogenic intronic variant in the desmin gene in the proband only. In the elder sister with palpitations, complex ventricular arrhythmia (>46 000 ectopic beats) was removed by radiofrequency ablation. This family case shows that complex ventricular arrhythmia may have different background within one family, genetic examinations should be performed in a person with broadest spectrum of symptoms.
Collapse
Affiliation(s)
- Małgorzata Stępień-Wojno
- Unit for Screening Studies in Inherited Cardiovascular Diseases, The Cardinal Stefan Wyszynski Institute of Cardiology, Warsaw, Poland
| | - Maria Franaszczyk
- Department of Medical Biology, The Cardinal Stefan Wyszynski Institute of Cardiology, Warsaw, Poland
| | - Robert Bodalski
- Department of Arrhythmia, The Cardinal Stefan Wyszynski Institute of Cardiology, Warsaw, Poland
| | - Mateusz Śpiewak
- Department of Radiology, The Cardinal Stefan Wyszynski Institute of Cardiology, Warsaw, Poland
| | - Rafał S Baranowski
- Department of Arrhythmia, The Cardinal Stefan Wyszynski Institute of Cardiology, Warsaw, Poland
| | - Jacek Grzybowski
- Department of Cardiomyopathy, The Cardinal Stefan Wyszynski Institute of Cardiology, Warsaw, Poland
| | - Rafał Płoski
- Department of Medical Genetics, Warsaw Medical University, Warsaw, Poland
| | - Zofia T Bilińska
- Unit for Screening Studies in Inherited Cardiovascular Diseases, The Cardinal Stefan Wyszynski Institute of Cardiology, Warsaw, Poland
| |
Collapse
|
28
|
Franaszczyk M, Podgorska A, Dabrowski M, Poninska J, Spiewak M, Oreziak A, Sobieszczanska-Malek M, Zielinski T, Kusmierczyk M, Grzybowski J, Ploski R, Bilinska ZT, Witkowski A, Lutynska A, Klopotowski M. P1610The genetic background of the disease in a group of patients with severe course of hypertrophic cardiomyopathy. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
End-stage hypertrophic cardiomyopathy (esHCM) indicates the most progressive form of HCM with progression to left ventricle remodeling and systolic dysfunction and is common indication to heart transplant. It affects 2.4–15.7% of HCM cases and is associated with a poor prognosis (mortality in this group of patients reaches 11%).
Purpose
In this study patients with esHCM were investigated using next generation sequencing in order to examine the genetic causes of the most severe course of the disease. Despite huge amount of data from many studies, a clear genotype-phenotype correlation is still lacking and predictive value of genetic testing is sometimes undermined. However, there is an ongoing need for a prediction factors in HCM patients.
Methods
Fifty seven patients (21 male, 36.8%) with esHCM were genetically investigated with next generation sequencing of a TruSight Cardio panel by Illumina that provides coverage of 174 genes with known associations to cardiac conditions including cardiomyopathies (n=52) or custom panel of 35 cardiomyopathies genes (n=5).
Results
Disease-causing variants where found in 47 probands (82.5%). Thirty-two probands (77.2%) had a single pathogenic or potentially pathogenic mutation in one of the sarcomeric genes: MYBPC3 (13, 22.8%), MYH7 (11, 19.3%), TNNT2 (3, 5.3%), TNNI3 (3, 5.3%), MYL3 (1, 1.8), TPM1 (1, 1.8%). In 13 (22.8%) probands we found a double mutation: in 7 (12.3) both variants sarcomeric (MYBPC3 and TNNT2 with MYH7, MYBPC3 and ACTA1) and in 5 (8.8%) one sarcomeric and the second non-sarcomeric cardiomyopathy variant (BAG3, ILK, PRKAG2, RBM20, SCN5A). In 3 (5.3%) probands we identified mutations or potentially disease-causing variants in genes associated Danon disease (LAMP2), glycogen storage disease of heart (PRKAG2) and double mutation FHL1 + PTPN11 (myopathy/Emery-Dreifuss muscular dystrophy and Noonan syndrome). In 10 (17.5%) patients, genetic examination did not reveal a candidate for disease-causing mutation. Surprisingly, a half of them had documented familial history of the disease. The majority of mutations in MYBPC3 were truncating variants (14/18, 78%). Thirty-three probands (57.9%) had a heart transplant or qualification to the procedure.
Conclusion
Despite a similar background of typical HCM and esHCM and still ambiguous genotype-phenotype correlation, results may indicate that certain mutations (and not genes) may determine a more severe course of the disease. The majority of truncating variants in MYBPC3 gene may suggest their very strong impact on the course of the disease. Also, 3 neighboring variants in TNNT2 gene indicate a hot spot region for esHCM in our population. As expected, in single cases esHCM was related to specific non-sarcomeric genes (LAMP2, PRKAG2, FHL1). 17.5% of unsolved cases suggests that in such cases whole exome/genome sequencing might be needed to recognize the disease-causing mutation, especially when disease is familial.
Acknowledgement/Funding
This work was supported by a grant 2.7/II/17 from the Institute of Cardiology, Warsaw, Poland.
Collapse
Affiliation(s)
- M Franaszczyk
- Institute of Cardiology, Department of Medical Biology, Warsaw, Poland
| | - A Podgorska
- Institute of Cardiology, Department of Medical Biology, Warsaw, Poland
| | - M Dabrowski
- Institute of Cardiology, Department of Interventional Cardiology and Angiology, Warsaw, Poland
| | - J Poninska
- Institute of Cardiology, Department of Medical Biology, Warsaw, Poland
| | - M Spiewak
- Institute of Cardiology, Department of Radiology, Warsaw, Poland
| | - A Oreziak
- Institute of Cardiology, Department of Arrhythmia, Warsaw, Poland
| | - M Sobieszczanska-Malek
- Institute of Cardiology, Department of Heart Failure and Transplantology, Warsaw, Poland
| | - T Zielinski
- Institute of Cardiology, Department of Heart Failure and Transplantology, Warsaw, Poland
| | - M Kusmierczyk
- Institute of Cardiology, Department of Cardiac Surgery and Transplantology, Warsaw, Poland
| | - J Grzybowski
- Institute of Cardiology, Department of Cardiomyopathy, Warsaw, Poland
| | - R Ploski
- Medical University of Warsaw, Department of Medical Genetics, Warsaw, Poland
| | - Z T Bilinska
- Institute of Cardiology, Unit for Screening Studies in Inherited Cardiovascular Diseases, Warsaw, Poland
| | - A Witkowski
- Institute of Cardiology, Department of Interventional Cardiology and Angiology, Warsaw, Poland
| | - A Lutynska
- Institute of Cardiology, Department of Medical Biology, Warsaw, Poland
| | - M Klopotowski
- Institute of Cardiology, Department of Interventional Cardiology and Angiology, Warsaw, Poland
| |
Collapse
|
29
|
Ojrzynska N, Mazurkiewicz Ł, Milosz-Wieczorek B, Sioma A, Grzybowski J. P91Unexpected cause of dilated cardiomyopathy: CMR findings. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez110.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- N Ojrzynska
- Institute of Cardiology, Department of Cardiomyopathy, Warsaw, Poland
| | - Ł Mazurkiewicz
- Institute of Cardiology, Department of Cardiomyopathy, Warsaw, Poland
| | | | - A Sioma
- Institute of Cardiology, Department of Cardiomyopathy, Warsaw, Poland
| | - J Grzybowski
- Institute of Cardiology, Department of Cardiomyopathy, Warsaw, Poland
| |
Collapse
|
30
|
Gawor M, Śpiewak M, Mazurkiewicz Ł, Marczak M, Michałowska I, Grzybowski J. Many disorders of one heart: Accidentally discovered aortic dissection, bicuspid aortic valve and hypertrophic cardiomyopathy in young patient with hypertension. Cardiol J 2019; 26:202-203. [PMID: 31032873 DOI: 10.5603/cj.2019.0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 07/07/2018] [Indexed: 11/25/2022] Open
Affiliation(s)
- Monika Gawor
- Department of Cardiomyopathy, Institute of Cardiology, Warsaw, Poland.
| | - Mateusz Śpiewak
- Cardiac Magnetic Resonance Unit, Institute of Cardiology, Warsaw, Poland
| | - Łukasz Mazurkiewicz
- Department of Cardiomyopathy, Institute of Cardiology, Warsaw, Poland.,Cardiac Magnetic Resonance Unit, Institute of Cardiology, Warsaw, Poland
| | - Magdalena Marczak
- Cardiac Magnetic Resonance Unit, Institute of Cardiology, Warsaw, Poland
| | | | - Jacek Grzybowski
- Department of Cardiomyopathy, Institute of Cardiology, Warsaw, Poland
| |
Collapse
|
31
|
Gawor M, Śpiewak M, Kubik A, Wróbel A, Lutyńska A, Marczak M, Grzybowski J. Circulating biomarkers of hypertrophy and fibrosis in patients with hypertrophic cardiomyopathy assessed by cardiac magnetic resonance. Biomarkers 2018; 23:676-682. [DOI: 10.1080/1354750x.2018.1474261] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Monika Gawor
- Department of Cardiomyopathy, Institute of Cardiology, Warsaw, Poland
| | - Mateusz Śpiewak
- Cardiac Magnetic Resonance Unit, Institute of Cardiology, Warsaw, Poland
| | - Agata Kubik
- Cardiac Magnetic Resonance Unit, Institute of Cardiology, Warsaw, Poland
| | - Aleksandra Wróbel
- Department of Medical Biology, Institute of Cardiology, Warsaw, Poland
| | - Anna Lutyńska
- Department of Medical Biology, Institute of Cardiology, Warsaw, Poland
| | - Magdalena Marczak
- Cardiac Magnetic Resonance Unit, Institute of Cardiology, Warsaw, Poland
| | - Jacek Grzybowski
- Department of Cardiomyopathy, Institute of Cardiology, Warsaw, Poland
| |
Collapse
|
32
|
Charron P, Elliott PM, Gimeno JR, Caforio ALP, Kaski JP, Tavazzi L, Tendera M, Maupain C, Laroche C, Rubis P, Jurcut R, Calò L, Heliö TM, Sinagra G, Zdravkovic M, Kavoliūnienė A, Felix SB, Grzybowski J, Losi MA, Asselbergs FW, García-Pinilla JM, Salazar-Mendiguchia J, Mizia-Stec K, Maggioni AP, Anastasakis A, Biagini E, Bilinska Z, Castro FJ, Celutkiene J, Chakova N, Chmielewski P, Drago F, Frigy A, Frustaci A, Garcia-Pavia P, Hinic S, Kindermann I, Limongelli G, Medrano C, Monserrat L, Olusegun-Joseph A, Ripoll-Vera T, Rocha Lopes L, Saad A, Sala S, Seferovic PM, Sepp R, Urbano-Moral JA, Villacorta E, Wybraniec M, Yotti R, Zachara E, Zorio E. The Cardiomyopathy Registry of the EURObservational Research Programme of the European Society of Cardiology: baseline data and contemporary management of adult patients with cardiomyopathies. Eur Heart J 2018; 39:1784-1793. [DOI: 10.1093/eurheartj/ehx819] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 01/09/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Philippe Charron
- Centre de Référence des Maladies Cardiaques Héréditaires, Assistance Publique-Hôpitaux de Paris, ICAN, Hôpital Pitié-Salpêtrière, 47 Bvd de l’hôpital, 75013 Paris, France
- Université Versailles Saint Quentin & AP-HP, CESP, INSERM U1018, Hôpital Ambroise Paré, 9, Avenue Charles de Gaulle, 92100 Boulogne-Billancourt, France
| | - Perry M Elliott
- University College London and Inherited Cardiac Diseases Unit, Barts Heart Centre, St Bartholomew’s Hospital, West Smithfield, EC1A 7BE London, UK
| | - Juan R Gimeno
- Cardiac Department, Hospital Universitario Virgen de la Arrixaca, Ctra. Murcia-Cartagena s/n, 30120 El Palmar Murcia, Spain
- CIBER in Cardiovascular Diseases, Instituto Carlos III, Av. de Monforte de Lemos 5, 28029 Madrid, Spain
| | - Alida L P Caforio
- Division of Cardiology, Department of Cardiological Thoracic and Vascular Sciences, University of Padova, via N Giustiniani 2, 35100 Padova, Italy
| | - Juan Pablo Kaski
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, Great Ormond Street, WC1N 3JH London, UK
| | - Luigi Tavazzi
- GVM Care and Research, E.S. Health Science Foundation, Maria Cecilia Hospital, Via Corriera, 1, 48010 Cotignola, Italy
| | - Michal Tendera
- Department of Cardiology and Structural Heart Diseases, School of Medicine in Katowice, Medical University of Silesia, Ziolowa Street 45/47, 40-635 Katowice, Poland
| | - Carole Maupain
- Centre de Référence des Maladies Cardiaques Héréditaires, Assistance Publique-Hôpitaux de Paris, ICAN, Hôpital Pitié-Salpêtrière, 47 Bvd de l’hôpital, 75013 Paris, France
| | - Cécile Laroche
- EURObservational Research Programme, European Society of Cardiology, 2035 Route des colles, CS 80179 Biot, 06903 Sophia-Antipolis Cedex, France
| | - Pawel Rubis
- Department of Cardiac and Vascular Diseases, John Paul II Hospital, Institute of Cardiology, Jagiellonian University Medical College, Pradnicka street 80, 31-202 Krakow, Poland
| | - Ruxandra Jurcut
- Institute of Emergency for Cardiovascular Diseases “Prof.dr.C.C.Iliescu”, UMF “Carol Davila”, Sos. Fundeni 258, 22328 Bucharest, Romania
| | - Leonardo Calò
- Policlinico Casilino, U.O. Cardiologia, Via Casilina, 1049, 00169 Roma, Italy
| | - Tiina M Heliö
- Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, 00290 Helsinki, Finland
| | - Gianfranco Sinagra
- Cardiovascular Department, Center for Cardiomyopathies, Azienda Sanitaria Universitaria Integrata, University of Trieste, Via P. Valdoni 7, 34100 Trieste, Italy
| | - Marija Zdravkovic
- University Hospital Medical Center Bezanijska kosa, Faculty of Medicine, University of Belgrade, Dragise Brasovana 13/8, 11077 Belgrade, Serbia
| | - Aušra Kavoliūnienė
- Lithuanian University of Health Sciences, Eiveniu Str. 2, 50009 Kaunas, Lithuania
| | - Stephan B Felix
- Department for Internal Medicine B, University Medicine Greifswald, Ferdinand-Sauerbruch Strasse, 17475 Greifswald, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
| | - Jacek Grzybowski
- Department of Cardiomyopathies, Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland
| | - Maria-Angela Losi
- Department of Advanced Biomedical Sciences, University Federico II of Naples, Via S. Pansini 5, 80131 Naples, Italy
| | - Folkert W Asselbergs
- Department of Cardiology, Division Heart & Lungs, UMC Utrecht, 3508 GA Utrecht, The Netherlands
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, Gower Street, WC1E 6BT London, UK
| | - José Manuel García-Pinilla
- CIBER in Cardiovascular Diseases, Instituto Carlos III, Av. de Monforte de Lemos 5, 28029 Madrid, Spain
- Heart failure and familial cardiomyopathies division, Cardiology department, Hospital Universitario Virgen de la Victoria, IBIMA, Campus Universitario Teatinos, 29010 Málaga, Spain
| | - Joel Salazar-Mendiguchia
- Cardiomyopathy, Heart Failure and Transplant Program, Hospital Universistari de Bellvitge, Heart Diseases Institute, Av. Feixa Llarga s/n, 08907 L’Hospitalet de Llobregat, Barcelona, Spain
| | - Katarzyna Mizia-Stec
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Ochojec, Ziolowa Street 45/47, 40-635 Katowice, Poland
| | - Aldo P Maggioni
- EURObservational Research Programme, European Society of Cardiology, 2035 Route des colles, CS 80179 Biot, 06903 Sophia-Antipolis Cedex, France
- ANMCO Research Center, Via La Marmora, 34 50121 Firenze, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Ojrzyńska N, Bilińska ZT, Franaszczyk M, Płoski R, Grzybowski J. Restrictive cardiomyopathy due to novel desmin gene mutation. Kardiol Pol 2018; 75:723. [PMID: 28703267 DOI: 10.5603/kp.2017.0129] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 01/25/2017] [Indexed: 11/25/2022]
Affiliation(s)
| | | | | | | | - Jacek Grzybowski
- Department of Cardiomyopathy, Institute of Cardiology, Warsaw, Poland, Poland.
| |
Collapse
|
34
|
Szczygieł JA, Wieczorek PZ, Drozd-Sokołowska J, Michałek P, Mazurkiewicz Ł, Legatowicz-Koprowska M, Walczak E, Jędrzejczak WW, Dwilewicz-Trojaczek J, Grzybowski J. Impaired right ventricular function as a predictor of early mortality in patients with light‑ chain cardiac amyloidosis assessed in a cardiology department. Pol Arch Intern Med 2017; 127:854-864. [PMID: 29112180 DOI: 10.20452/pamw.4135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Light‑chain (AL) amyloidosis is the most common cardiac amyloidosis. Despite progress in treatment, early mortality remains a substantial problem in these patients. OBJECTIVES The aim of this study was to determine a clinical profile of patients diagnosed with AL amyloidosis in a cardiology department, as well as to define the cut‑off point for early mortality and identify predictors of early mortality in this population. PATIENTS AND METHODS The study included 30 patients (14 women; median age, 61.5 years) with AL amyloidosis confirmed by echocardiography and biopsy of 2 organs. RESULTS Six patients were diagnosed with stage II amyloidosis according to the Mayo 2004 classification, and 24 patients-with stage III. Early mortality was defined as death during 102 days after diagnosis and was observed in 14 patients. Patients who died earlier were younger and more frequently reported a weight loss of more than 10 kg and orthostatic hypotension than patients who died later. Moreover, they had higher concentrations of high‑sensitivity troponin T and N‑terminal pro‑B‑type natriuretic peptide (NT‑proBNP) and worse left and right ventricular (RV) contractility. In the Cox models, the age of less than 64 years, NT‑proBNP levels exceeding 4968 pg/ml, RV end‑diastolic diameter of less than 34 mm, and tricuspid annular plane systolic excursion lower than 13 mm were significant predictors of mortality within 102 days after diagnosis. CONCLUSIONS We presented the results of the first Polish prospective noninterventional study on AL amyloidosis diagnosed in the cardiology department. We found that patients have advanced disease at the time of diagnosis. Younger age, impaired RV function, and higher concentrations of cardiac markers are predictors of worse prognosis.
Collapse
|
35
|
Śpiewak M, Kłopotowski M, Gawor M, Kubik A, Kowalik E, Miłosz-Wieczorek B, Dąbrowski M, Werys K, Mazurkiewicz Ł, Kożuch K, Polańska-Skrzypczyk M, Petryka-Mazurkiewicz J, Klisiewicz A, Bilińska ZT, Grzybowski J, Witkowski A, Marczak M. Quantification of mitral regurgitation in patients with hypertrophic cardiomyopathy using aortic and pulmonary flow data: impacts of left ventricular outflow tract obstruction and different left ventricular segmentation methods. J Cardiovasc Magn Reson 2017; 19:105. [PMID: 29268761 PMCID: PMC5740710 DOI: 10.1186/s12968-017-0417-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 11/23/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) imaging in patients with hypertrophic cardiomyopathy (HCM) enables the assessment of not only left ventricular (LV) hypertrophy and scarring but also the severity of mitral regurgitation. CMR assessment of mitral regurgitation is primarily based on the difference between LV stroke volume (LVSV) and aortic forward flow (Ao) measured using the phase-contrast (PC) technique. However, LV outflow tract (LVOT) obstruction causing turbulent, non-laminar flow in the ascending aorta may impact the accuracy of aortic flow quantification, leading to false conclusions regarding mitral regurgitation severity. Thus, we decided to quantify mitral regurgitation in patients with HCM using Ao or, alternatively, main pulmonary artery forward flow (MPA) for mitral regurgitation volume (MRvol) calculations. METHODS The analysis included 143 prospectively recruited subjects with HCM and 15 controls. MRvol was calculated as the difference between LVSV computed with either the inclusion (LVSVincl) or exclusion (LVSVexcl) of papillary muscles and trabeculations from the blood pool and either Ao (MRvolAoi or MRvolAoe) or MPA (MRvolMPAi or MRvolMPAe). The presence or absence of LVOT obstruction was determined based on Doppler echocardiography findings. RESULTS MRvolAoi was higher than MRvolMPAi in HCM patients with LVOT obstruction [47.0 ml, interquartile range (IQR) = 31.5-60.0 vs. 35.5 ml, IQR = 26.0-51.0; p < 0.0001] but not in non-obstructive HCM patients (23.0 ml, IQR = 16.0-32.0 vs. 24.0 ml, IQR = 15.3-32.0; p = 0.26) or controls (18.0 ml, IQR = 14.3-21.8 vs. 20.0 ml, IQR = 14.3-22.0; p = 0.89). In contrast to controls and HCM patients without LVOT obstruction, in HCM patients with LVOT obstruction, aortic flow-based MRvol (MRvolAoi) was higher than pulmonary-based findings (MRvolMPAi) (bias = 9.5 ml; limits of agreement: -11.7-30.7 with a difference of 47 ml in the extreme case). The differences between aortic-based and pulmonary-based MRvol values calculated using LVSVexcl mirrored those derived using LVSVincl. However, MRvol values calculated using LVSVexcl were lower in all the groups analyzed (HCM with LVOT obstruction, HCM without LVOT obstruction, and controls) and with all methods of MRvol quantification used (p ≤ 0.0001 for all comparisons). CONCLUSIONS In HCM patients, LVOT obstruction significantly affects the estimation of aortic flow, leading to its underestimation and, consequently, to higher MRvol values than those obtained with MPA-based MRvol calculations.
Collapse
Affiliation(s)
- Mateusz Śpiewak
- Magnetic Resonance Unit, Department of Radiology, Institute of Cardiology, Warsaw, Poland
| | - Mariusz Kłopotowski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Monika Gawor
- Department of Cardiomyopathy, Institute of Cardiology, Warsaw, Poland
| | - Agata Kubik
- Magnetic Resonance Unit, Department of Radiology, Institute of Cardiology, Warsaw, Poland
| | - Ewa Kowalik
- Department of Congenital Heart Diseases, Institute of Cardiology, Warsaw, Poland
| | | | - Maciej Dąbrowski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Konrad Werys
- Oxford Centre for Clinical Magnetic Resonance Research, John Radcliffe Hospital, Headington, Oxford, UK
| | | | - Katarzyna Kożuch
- Department of Congenital Heart Diseases, Institute of Cardiology, Warsaw, Poland
| | | | - Joanna Petryka-Mazurkiewicz
- Magnetic Resonance Unit, Department of Radiology, Institute of Cardiology, Warsaw, Poland
- Department of Coronary and Structural Heart Diseases, Institute of Cardiology, Warsaw, Poland
| | - Anna Klisiewicz
- Department of Congenital Heart Diseases, Institute of Cardiology, Warsaw, Poland
| | - Zofia T. Bilińska
- Unit for Screening Studies in Inherited Cardiovascular Diseases, Institute of Cardiology, Warsaw, Poland
| | - Jacek Grzybowski
- Department of Cardiomyopathy, Institute of Cardiology, Warsaw, Poland
| | - Adam Witkowski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Magdalena Marczak
- Magnetic Resonance Unit, Department of Radiology, Institute of Cardiology, Warsaw, Poland
| |
Collapse
|
36
|
Sioma A, Mazurkiewicz Ł, Marczak M, Kucharczyk-Petryka E, Grzybowski J. Asymptomatic course of arrhythmogenic right ventricular cardiomyopathy. Kardiol Pol 2017; 75:935. [DOI: 10.5603/kp.2017.0173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 04/12/2017] [Indexed: 01/18/2023]
|
37
|
Gawor M, Spiewak M, Kubik A, Janas J, Wrobel A, Marczak M, Grzybowski J. P4508Circulating biomarkers of hypertrophy and fibrosis in patients with hypertrophic cardiomyopathy assessed by cardiac magnetic resonance. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
38
|
Tita C, Gilbert EM, Van Bakel AB, Grzybowski J, Haas GJ, Jarrah M, Dunlap SH, Gottlieb SS, Klapholz M, Patel PC, Pfister R, Seidler T, Shah KB, Zieliński T, Venuti RP, Cowart D, Foo SY, Vishnevsky A, Mitrovic V. A Phase 2a dose-escalation study of the safety, tolerability, pharmacokinetics and haemodynamic effects of BMS-986231 in hospitalized patients with heart failure with reduced ejection fraction. Eur J Heart Fail 2017; 19:1321-1332. [PMID: 28677877 PMCID: PMC6607490 DOI: 10.1002/ejhf.897] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 04/25/2017] [Accepted: 04/26/2017] [Indexed: 12/28/2022] Open
Abstract
Aims This study was designed to evaluate the safety, tolerability and haemodynamic effects of BMS‐986231, a novel second‐generation nitroxyl donor with potential inotropic, lusitropic and vasodilatory effects in patients hospitalized with decompensated heart failure and reduced ejection fraction (HFrEF). Methods and results Forty‐six patients hospitalized with decompensated HFrEF were enrolled into four sequential dose‐escalation cohorts in this double‐blind, randomized, placebo‐controlled Phase 2a study. Patients with baseline pulmonary capillary wedge pressure (PCWP) of ≥20 mmHg and a cardiac index of ≤2.5 L/min/m2 received one 6‐h i.v. infusion of BMS‐986231 (at 3, 5, 7 or 12 µg/kg/min) or placebo. BMS‐986231 produced rapid and sustained reductions in PCWP, as well as consistent reductions in time‐averaged pulmonary arterial systolic pressure, pulmonary arterial diastolic pressure and right atrial pressure. BMS‐986231 increased non‐invasively measured time‐averaged stroke volume index, cardiac index and cardiac power index values, and decreased total peripheral vascular resistance. There was no evidence of increased heart rate, drug‐related arrhythmia or symptomatic hypotension with BMS‐986231. Analyses of adverse events throughout the 30‐day follow‐up did not identify any toxicities specific to BMS‐986231, with the potential exception of infrequent mild‐to‐moderate headaches during infusion. There were no treatment‐related serious adverse events. Conclusions BMS‐986231 demonstrated a favourable safety and haemodynamic profile in patients hospitalized with advanced heart failure. Based on preclinical data and these study's findings, it is possible that the haemodynamic benefits may be mediated by inotropic and/or lusitropic as well as vasodilatory effects. The therapeutic potential of BMS‐986231 should be further assessed in patients with heart failure.
Collapse
Affiliation(s)
- Cristina Tita
- Division of Cardiovascular Medicine, Department of Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Edward M Gilbert
- Division of Cardiology, Faculty of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Adrian B Van Bakel
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Jacek Grzybowski
- Department of Cardiomyopathy, Institute of Cardiology, Warsaw, Poland
| | - Garrie J Haas
- Division of Cardiology and Vascular Medicine, Faculty of Medicine, Ohio State University, Columbus, OH, USA
| | - Mohammad Jarrah
- Department of Cardiology, King Abdullah University Hospital, Irbid, Jordan
| | - Stephanie H Dunlap
- Division of Cardiology, Faculty of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Stephen S Gottlieb
- Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Marc Klapholz
- Division of Cardiology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Parag C Patel
- Department of Transplant, Mayo Clinic, Jacksonville, FL, USA
| | - Roman Pfister
- Department III of Internal Medicine, Heart Centre, University Hospital of Cologne, Cologne, Germany
| | - Tim Seidler
- Division of Cardiology and Pulmonology, Medical University of Göttingen, Göttingen, Germany
| | - Keyur B Shah
- Department of Cardiology, Faculty of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Tomasz Zieliński
- Department of Heart Failure and Transplantology, Institute of Cardiology, Warsaw, Poland
| | - Robert P Venuti
- formerly of Cardioxyl Pharmaceuticals, Inc., Chapel Hill, NC, USA
| | - Douglas Cowart
- formerly of Cardioxyl Pharmaceuticals, Inc., Chapel Hill, NC, USA
| | - Shi Yin Foo
- formerly of Cardioxyl Pharmaceuticals, Inc., Chapel Hill, NC, USA
| | - Alexander Vishnevsky
- Intensive Care Unit, Cardiology Department, Pokrovskaya City Hospital, St Petersburg, Russia
| | - Veselin Mitrovic
- Department of Cardiology, Kerckhoff-Klinik, Bad Nauheim, Germany
| |
Collapse
|
39
|
Gawor M, Śpiewak M, Janas J, Kożuch K, Wróbel A, Mazurkiewicz Ł, Baranowski R, Marczak M, Grzybowski J. The usefulness of sST2 and galectin-3 as novel biomarkers for better risk stratification in hypertrophic cardiomyopathy. Kardiol Pol 2017; 75:997-1004. [PMID: 28612913 DOI: 10.5603/kp.a2017.0118] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 05/07/2017] [Accepted: 05/17/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Estimation of sudden cardiac death (SCD) risk is an integral part of clinical management of patients with hypertrophic cardiomyopathy (HCM). Identification of novel biomarkers of this disease can provide additional criteria for SCD risk stratification. Soluble suppression of tumourigenicity (sST2) and galectin-3 (Gal-3) are useful biomarkers for prognosis of heart failure (HF). Both of them appear to mediate cardiac fibrosis - an important pathogenetic process in HCM. Data about sST2 and Gal-3 usefulness in patients with HCM are limited. AIM The aim of this study was to evaluate sST2 and Gal-3 as potential novel biomarkers for better risk stratification in hypertrophic cardiomyopathy. METHODS Serum sST2 and serum Gal-3 levels were measured in 57 patients with HCM and in 18 healthy controls. The patients with HCM underwent routine evaluation including medical history, physical examination, blood tests (including N-terminal pro-B-type natriuretic peptide [NT-proBNP] and high-sensitivity cardiac troponin T [hs-cTnT] measurements), 12-lead electrocardiography (ECG), 48-h Holter monitoring and two-dimensional (2D) echocardiography with the assessment of the maximal left ventricular wall thickness, left atrial diameter, maximal left ventricular outflow tract gradient, and left ventricular ejection fraction. Risk of SCD at five years according to HCM SCD-risk calculator was evaluated. The control group underwent ECG, 2D echocardiography, and NT-proBNP measurements to exclude asymptomatic heart disease. RESULTS Concentrations of sST2 and Gal-3 were significantly higher in patients with HCM than in controls (14.9 ± 5.8 ng/mL vs. 11.7 ± 3.3 ng/mL, p = 0.03 and 8.4 ng/mL [6.8-10.0] vs. 6.2 ng/mL [5.8-7.7], p = 0.005, respectively). Levels of sST2 and Gal-3 were considerably different in the New York Heart Association (NYHA) groups (p = 0.008, p = 0.009, respectively). Patients who presented non-sustained ventricular tachycardia (nsVT) on 48-h Holter monitoring had higher levels of sST2 (19.1 ng/mL [12.2-24.2] vs. 13.2 ng/mL [10.0-17.1], p = 0.02). There were no significant relationships between sST2 and Gal-3 levels and HCM SCD-risk, history of syncope presence, family history of SCD, and echocardio-graphic parameters. CONCLUSIONS Gal-3 levels and sST2 levels were higher in patients with HCM than in the control group. There were significant differences in Gal-3 levels between NYHA classes, but no correlations between Gal-3 levels and other parameters were found. Apart from differences in sST2 levels between NYHA classes, we demonstrated higher levels of sST2 in patients with nsVT. These findings suggest that sST2 may be useful as an additional biomarker for better risk stratification in hypertrophic cardiomyopathy.
Collapse
|
40
|
Mazurkiewicz Ł, Petryka J, Śpiewak M, Miłosz-Wieczorek B, Małek ŁA, Jasińska A, Jarmus E, Marczak M, Misko J, Grzybowski J. Clinical and prognostic relevancy of left ventricular trabeculation assessed by cardiac magnetic resonance in patients with dilated cardiomyopathy. Kardiol Pol 2017; 75:794-803. [PMID: 28541593 DOI: 10.5603/kp.a2017.0097] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 03/03/2017] [Accepted: 03/09/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIM We sought to search for factors associated with the magnitude of trabeculation by cardiac magnetic resonance, and evaluate the impact of trabeculations on outcomes in patients with dilated cardiomyopathy (DCM). METHODS We evaluated clinical profiles and outcomes of 276 subjects with DCM (age: 33.2 ± 13.3 years, 160 males). Trabeculation was quantified as trabeculated/total myocardial mass ratio (TM/M). Subjects were stratified into three subgroups (A, B, and C) according to the tertiles of rising TM/M values (33% ranges). A group of 30 healthy subjects served as controls. Patients were prospectively followed-up in search of major adverse cardiovascular events for 2.4 years on average (range 0.2-3.9 years). RESULTS Dilated cardiomyopathy patients had more trabeculation than controls (27.1 ± 16.9% vs. 17.3 ± 8.1, p < 0.01). Group C subjects had lowest N-terminal pro-B-type natriuretic peptide (NT-proBNP) (1445 [984-3843] vs. 873 [440-2633] vs. 529 [206-1221] pg/mL, p < 0.01), higher ejection fraction (23.9 ± 10.4 vs. 25.0 ± 9.2 vs. 32.4 ± 2.7%, p = 0.03), and lower left ventricular mass index (LVMI) (91.3 ± 21.5 vs. 74.3 ± 31.1 vs. 55.7 ± 23.2 g/m2, p < 0.01). They also had fewer areas of late gadolinium enhancement (69 [46.3%] vs. 31 [38.2%] vs. 15 [32.6%], p = 0.01). Male sex (b = 0.21, SE = 0.13; p = 0.01), LVMI (b = -0.32, SE = 0.08, p < 0.01) and NT-proBNP (b = -0.05, SE = 0.02, p = 0.02) were independently related to TM/M. The magnitude of trabeculation was not a predictor of major adverse cardiovascular events. Prognosis was impacted by left ventricular end-diastolic volume index only (HR 2.538, 95% CI -1.734-3.218, p < 0.01). CONCLUSIONS Trabeculation patterns relate to cardiac function and neurohormonal activation but not to survival.
Collapse
Affiliation(s)
- Łukasz Mazurkiewicz
- Department of Cardiomyopathies, Institute of Cardiology, Warsaw, Poland, Poland; CMR Unit, Department of Radiology, Institute of Cardiology, Warsaw, Poland, Poland.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Mazurkiewicz Ł, Petryka J, Spiewak M, Miłosz-Wieczorek B, Werys K, Małek ŁA, Polanska-Skrzypczyk M, Ojrzynska N, Kubik A, Marczak M, Misko J, Grzybowski J. Biventricular mechanics in prediction of severe myocardial fibrosis in patients with dilated cardiomyopathy: CMR study. Eur J Radiol 2017. [PMID: 28629574 DOI: 10.1016/j.ejrad.2017.03.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE The purpose of this study was to compare the ability of various parameters of myocardial mechanics to predict large amounts of biventricular fibrosis assessed via T1 mapping in patients with dilated cardiomyopathy (DCM). MATERIAL Cardiovascular magnetic resonance feature tracking analysis and T1 mapping were performed in 26 patients with DCM [mean age: 34.4±9.1years, 15 (57.6%) males]. The values of various parameters of myocardial mechanics at predicting advanced left-ventricle (LV) and right-ventricle (RV) fibrosis were compared using logistic regression analysis and receiver operating characteristic curve (ROC) analysis. RESULTS There were 7 (26.9%) patients with a large amount of LV fibrosis and 9 (34.6%) patients with severe RV fibrosis. ROC curve analysis revealed that the model of combined LV strain rates (AUC=0.902) offered superb ability at predicting large amounts of LV fibrosis. The models including RV strain rates (AUC=0.974), a combination of RV strains, strain rates and clinical parameters (AUC=0.993) as well as the RV radial strain rate alone model (AUC=0.961) yielded outstanding performance in discriminating large and small amounts of RV fibrosis. In multivariate analysis, the LV circumferential strain (LVCR) and RV radial (RVR) strain rate were the only independent predictors of large amounts of LV and RV fibrosis, respectively. CONCLUSIONS Indices of myocardial deformation, especially combined with clinical features, offered a superlative ability to differentiate high from low degrees of fibrosis in DCM patients. Among all analyzed parameters of myocardial mechanics, LVCR and RVR rate alone were the independent predictors of high degrees of LV and RV fibrosis, respectively.
Collapse
Affiliation(s)
- Łukasz Mazurkiewicz
- Department of Cardiomyopathies, CMR Unit, Institute of Cardiology, Warsaw, Poland.
| | - Joanna Petryka
- Department of Coronary and Structural Heart Diseases, CMR Unit, Institute of Cardiology, Warsaw, Poland
| | - Mateusz Spiewak
- Department of Radiology, CMR Unit, Institute of Cardiology, Warsaw, Poland
| | | | - Konrad Werys
- Department of Radiology, CMR Unit, Institute of Cardiology, Warsaw, Poland
| | | | | | - Natalia Ojrzynska
- Department of Cardiomyopathies, Institute of Cardiology, Warsaw, Poland
| | - Agata Kubik
- Department of Radiology, CMR Unit, Institute of Cardiology, Warsaw, Poland
| | - Magdalena Marczak
- Department of Radiology, CMR Unit, Institute of Cardiology, Warsaw, Poland
| | | | - Jacek Grzybowski
- Department of Cardiomyopathies, Institute of Cardiology, Warsaw, Poland
| |
Collapse
|
42
|
Mazurkiewicz Ł, Rużyłło W, Chmielak Z, Opalińska-Ciszek E, Janas J, Hoffman P, Hryniewiecki T, Grzybowski J. ANP and BNP plasma levels in patients with rheumatic mitral stenosis after percutaneous balloon mitral valvuloplasty. Postepy Kardiol Interwencyjnej 2017; 13:18-25. [PMID: 28344613 PMCID: PMC5364278 DOI: 10.5114/aic.2017.66182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 08/19/2016] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Atrial (ANP) and B-type (BNP) natriuretic peptides are hormones secreted by the heart as a response to volume expansion and pressure overload. AIM To assess the changes of ANP and BNP after percutaneous balloon mitral valvuloplasty (PBMV) and to investigate factors associated with endpoints. MATERIAL AND METHODS The study included 96 patients (90.7% females, age 51.6 ±12.2 years) with rheumatic mitral valve stenosis (mitral valve area (MVA) 1.18 (1.01-1.33) cm2, mean mitral gradient (MMG) 8.2 (7.1-9.2) mm Hg, NYHA 2.09 (1.9-2.5)). Patients were followed up for 29.1 months for the search of endpoints. RESULTS The PBMV was successful in all cases. After the procedure MVA increased (1.18-1.78 cm2, p < 0.01) and pulmonary capillary wedge pressure (PCWP) decreased (29.8-21.8 mm Hg, p < 0.01). Concentration of ANP significantly rose 30 min after the PBMV (79.2 vs. 134.2 pg/ml, p = 0.012) and dropped significantly after 24 h (134.2 vs. 70.4 pg/ml, p = 0.01). Furthermore, after 36 months concentration of ANP did not differ from the baseline value (p = NS). BNP concentration at day 1 was lower than at baseline (94.5 vs. 80.2 pg/ml, p = 0.032). Moreover, during the follow-up period BNP continued to fall at all time points. In univariate analysis parameters associated with endpoint occurrence were baseline PAP (p = 0.023), baseline PCWP (p = 0.022), baseline NYHA (p = 0.041) and increase in 6-minute walk test (6MWT) (p = 0.043). In multivariate analysis the only factor associated with endpoint occurrence was baseline NYHA (HR = 1.52, 95% CI: -1.3-1.91, p = 0.022). CONCLUSIONS Patients with MS had increased levels of both BNP and ANP. Baseline NYHA class was found to be associated with outcomes after the procedure.
Collapse
Affiliation(s)
- Łukasz Mazurkiewicz
- Department of Cardiomyopathies, CMR Unit, Institute of Cardiology, Warsaw, Poland
| | | | - Zbigniew Chmielak
- Department of Cardiology and Interventional Angiology, Institute of Cardiology, Warsaw, Poland
| | | | | | - Piotr Hoffman
- Department of Congenital Cardiac Defects, Institute of Cardiology, Warsaw, Poland
| | - Tomasz Hryniewiecki
- Department of Acquired Cardiac Defects, Institute of Cardiology, Warsaw, Poland
| | - Jacek Grzybowski
- Department of Cardiomyopathies, Institute of Cardiology, Warsaw, Poland
| |
Collapse
|
43
|
Gawor M, Mazurkiewicz Ł, Milanowska B, Grzybowski J. Recovery from heart failure in a patient with cardiac amyloidosis treated with autologous stem cell transplantation. Kardiol Pol 2017; 75:83. [PMID: 28124791 DOI: 10.5603/kp.2017.0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 10/19/2016] [Indexed: 11/25/2022]
Affiliation(s)
- Monika Gawor
- Department of Cardiomyopathy, Institute of Cardiology, Warsaw, Poland.
| | | | | | | |
Collapse
|
44
|
Mazurkiewicz Ł, Orłowska-Baranowska E, Petryka J, Śpiewak M, Gawor M, Miłosz-Wieczorek B, Werys K, Małek ŁA, Marczak M, Grzybowski J. Systolic myocardial volume gain in dilated, hypertrophied and normal heart. CMR study. Clin Radiol 2017; 72:286-292. [PMID: 28069158 DOI: 10.1016/j.crad.2016.10.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 08/18/2016] [Accepted: 10/10/2016] [Indexed: 12/26/2022]
Abstract
AIM To investigate changes in myocardial tissue volume during the cardiac cycle to verify the hypothesis of non-compressibility of the myocardium in healthy individuals (HI) as well as in patients with hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM), and aortic stenosis (AS). MATERIALS AND METHODS The study group included 30 HI, and patients with HCM (n=110), DCM (n=89), and AS (n=78). Left ventricular (LV) function, end-diastolic, and end-systolic volumes were calculated based on cardiac magnetic resonance imaging (CMR) for all participants. RESULTS End-systolic myocardial volumes were higher than end-diastolic in both controls (91.2±26.6 versus 85.1±24.3 ml, p<0.001) and in all patient groups: HCM (214.3±81.6 versus 176±64.2 ml, p<0.01), DCM (128.4±43.1 versus 115.4±42.9 ml, p<0.001) and AS (155.1±37.1 versus 129.4±34.6 ml, p<0.001). HCM and AS patients had significantly higher systolic volume gain than HI (21.5±8.3 versus 10.6±6.3%, p<0.01 and 18.3±5.7 versus 10.6±6.3% p=0.013, respectively). Conversely, DCM patients had lesser increases in myocardial systolic volume than HCM patients (11.2±4.8% versus 21.5±8.3, p=0.01) and AS patients (11.2±4.8% versus 18.3±5.7, p=0.02). No differences were found in systolic volume gain between AS and HCM patients (p=ns) or between DCM patients and HI (p=ns). CONCLUSION End-systolic myocardial volume was significantly higher than end-diastolic volume in all subsets of patients. The systolic volume gain was greater in individuals with hypertrophy than in those without.
Collapse
Affiliation(s)
- Ł Mazurkiewicz
- Department of Cardiomyopathies, CMR Unit, Institute of Cardiology, Warsaw, Poland.
| | | | - J Petryka
- Department of Coronary and Structural Heart Diseases, CMR Unit, Institute of Cardiology, Warsaw, Poland
| | - M Śpiewak
- CMR Unit, Institute of Cardiology, Warsaw, Poland
| | - M Gawor
- Department of Cardiomyopathies, Institute of Cardiology, Warsaw, Poland
| | | | - K Werys
- CMR Unit, Institute of Cardiology, Warsaw, Poland
| | - Ł A Małek
- Institute of Cardiology, Warsaw, Poland
| | - M Marczak
- CMR Unit, Institute of Cardiology, Warsaw, Poland
| | - J Grzybowski
- Department of Cardiomyopathies, Institute of Cardiology, Warsaw, Poland
| |
Collapse
|
45
|
Franaszczyk M, Chmielewski P, Truszkowska G, Stawinski P, Michalak E, Rydzanicz M, Sobieszczanska-Malek M, Pollak A, Szczygieł J, Kosinska J, Parulski A, Stoklosa T, Tarnowska A, Machnicki MM, Foss-Nieradko B, Szperl M, Sioma A, Kusmierczyk M, Grzybowski J, Zielinski T, Ploski R, Bilinska ZT. Titin Truncating Variants in Dilated Cardiomyopathy - Prevalence and Genotype-Phenotype Correlations. PLoS One 2017; 12:e0169007. [PMID: 28045975 PMCID: PMC5207678 DOI: 10.1371/journal.pone.0169007] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 12/09/2016] [Indexed: 11/18/2022] Open
Abstract
TTN gene truncating variants are common in dilated cardiomyopathy (DCM), although data on their clinical significance is still limited. We sought to examine the frequency of truncating variants in TTN in patients with DCM, including familial DCM (FDCM), and to look for genotype-phenotype correlations. Clinical cardiovascular data, family histories and blood samples were collected from 72 DCM probands, mean age of 34 years, 45.8% FDCM. DNA samples were examined by next generation sequencing (NGS) with a focus on the TTN gene. Truncating mutations were followed up by segregation study among family members. We identified 16 TTN truncating variants (TTN trunc) in 17 probands (23.6% of all cases, 30.3% of FDCM, 17.9% of sporadic DCM). During mean 63 months from diagnosis, there was no difference in adverse cardiac events between probands with and without TTN truncating mutations. Among relatives 29 mutation carriers were identified, nine were definitely affected (31%), eight probably affected (27.6%) one possibly affected (3.4%) and eleven were not affected (37.9%). When relatives with all affected statuses were combined, disease penetrance was still incomplete (62.1%) even after exclusion of unaffected relatives under 40 (82%) and was higher in males versus females. In all mutation carriers, during follow-up, 17.4% had major adverse cardiac events, and prognosis was significantly worse in men than in women. In conclusion, TTN truncating variants were observed in nearly one fourth of young DCM patient population, in vast majority without conduction system disease. Incomplete penetrance suggests possible influence of other genetic and/or environmental factors on the course of cardiotitinopathy. Counseling should take into account sex and incomplete penetrance.
Collapse
Affiliation(s)
- Maria Franaszczyk
- Department of Medical Biology, Molecular Biology Laboratory, Institute of Cardiology, Warsaw, Poland
| | - Przemyslaw Chmielewski
- Unit for Screening Studies in Inherited Cardiovascular Diseases, Institute of Cardiology, Warsaw, Poland
| | - Grazyna Truszkowska
- Department of Medical Biology, Molecular Biology Laboratory, Institute of Cardiology, Warsaw, Poland
| | - Piotr Stawinski
- Department of Genetics, Institute of Physiology and Pathology of Hearing, Kajetany/Warsaw, Poland
| | - Ewa Michalak
- Unit for Screening Studies in Inherited Cardiovascular Diseases, Institute of Cardiology, Warsaw, Poland
| | | | | | - Agnieszka Pollak
- Department of Genetics, Institute of Physiology and Pathology of Hearing, Kajetany/Warsaw, Poland
| | - Justyna Szczygieł
- Department of Cardiomyopathies, Institute of Cardiology, Warsaw, Poland
| | - Joanna Kosinska
- Department of Medical; Genetics, Medical University of Warsaw, Warsaw, Poland
| | - Adam Parulski
- Department of Cardiac Surgery and Transplantology, Institute of Cardiology, Warsaw, Poland
| | - Tomasz Stoklosa
- Department of Immunology, Center for Biostructure Research, Medical University of Warsaw, Warsaw, Poland
| | - Agnieszka Tarnowska
- Department of Heart Failure and Transplantology, Institute of Cardiology, Warsaw, Poland
| | - Marcin M. Machnicki
- Department of Immunology, Center for Biostructure Research, Medical University of Warsaw, Warsaw, Poland
- Postgraduate School of Molecular Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Bogna Foss-Nieradko
- Unit for Screening Studies in Inherited Cardiovascular Diseases, Institute of Cardiology, Warsaw, Poland
| | - Malgorzata Szperl
- Department of Medical Biology, Molecular Biology Laboratory, Institute of Cardiology, Warsaw, Poland
| | - Agnieszka Sioma
- Department of Cardiomyopathies, Institute of Cardiology, Warsaw, Poland
| | - Mariusz Kusmierczyk
- Department of Cardiac Surgery and Transplantology, Institute of Cardiology, Warsaw, Poland
| | - Jacek Grzybowski
- Department of Cardiomyopathies, Institute of Cardiology, Warsaw, Poland
| | - Tomasz Zielinski
- Department of Heart Failure and Transplantology, Institute of Cardiology, Warsaw, Poland
| | - Rafal Ploski
- Department of Medical; Genetics, Medical University of Warsaw, Warsaw, Poland
- * E-mail: (RP); (ZTB)
| | - Zofia T. Bilinska
- Unit for Screening Studies in Inherited Cardiovascular Diseases, Institute of Cardiology, Warsaw, Poland
- * E-mail: (RP); (ZTB)
| |
Collapse
|
46
|
Gawor M, Bilińska ZT, Franaszczyk M, Michalak E, Płoski R, Grzybowski J. A new missense mutation, p.Arg719Leu, of the beta-myosin heavy chain gene in a patient with familial hypertrophic cardiomyopathy. Minerva Cardiol Angiol 2016; 65:96-102. [DOI: 10.23736/s0026-4725.16.04208-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
47
|
Poninska JK, Bilinska ZT, Franaszczyk M, Michalak E, Rydzanicz M, Szpakowski E, Pollak A, Milanowska B, Truszkowska G, Chmielewski P, Sioma A, Janaszek-Sitkowska H, Klisiewicz A, Michalowska I, Makowiecka-Ciesla M, Kolsut P, Stawinski P, Foss-Nieradko B, Szperl M, Grzybowski J, Hoffman P, Januszewicz A, Kusmierczyk M, Ploski R. Next-generation sequencing for diagnosis of thoracic aortic aneurysms and dissections: diagnostic yield, novel mutations and genotype phenotype correlations. J Transl Med 2016; 14:115. [PMID: 27146836 PMCID: PMC4855821 DOI: 10.1186/s12967-016-0870-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 04/19/2016] [Indexed: 11/23/2022] Open
Abstract
Background Thoracic aortic aneurysms and dissections (TAAD) are silent but possibly lethal condition with up to 40 % of cases being hereditary. Genetic background is heterogeneous. Recently next-generation sequencing enabled efficient and cost-effective examination of gene panels. Aim of the study was to define the diagnostic yield of NGS in the 51 TAAD patients and to look for genotype–phenotype correlations within families of the patients with TAAD. Methods 51 unrelated TAAD patients were examined by either whole exome sequencing or TruSight One sequencing panel. We analyzed rare variants in 10 established thoracic aortic aneurysms-associated genes. Whenever possible, we looked for co-segregation in the families. Kaplan–Meier survival curve was constructed to compare the event-free survival depending on genotype. Aortic events were defined as acute aortic dissection or first planned aortic surgery. Results and discussion In 21 TAAD patients we found 22 rare variants, 6 (27.3 %) of these were previously reported, and 16 (73.7 %) were novel. Based on segregation data, functional analysis and software estimations we assumed that three of novel variants were causative, nine likely causative. Remaining four were classified as of unknown significance (2) and likely benign (2). In all, 9 (17.6 %) of 51 probands had a positive result when considering variants classified as causative only and 18 (35.3 %) if likely causative were also included. Genotype-positive probands (n = 18) showed shorter mean event free survival (41 years, CI 35–46) than reference group, i.e. those (n = 29) without any plausible variant identified (51 years, CI 45–57, p = 0.0083). This effect was also found when the ‘genotype-positive’ group was restricted to probands with ‘likely causative’ variants (p = 0.0092) which further supports pathogenicity of these variants. The mean event free survival was particularly low (37 years, CI 27–47) among the probands with defects in the TGF beta signaling (p = 0.0033 vs. the reference group). Conclusions This study broadens the spectrum of genetic background of thoracic aneurysms and dissections and supports its potential role as a prognostic factor in the patients with the disease. Electronic supplementary material The online version of this article (doi:10.1186/s12967-016-0870-4) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- J K Poninska
- Molecular Biology Laboratory, Institute of Cardiology, Warsaw, Poland
| | - Z T Bilinska
- Unit for Screening Studies in Inherited Cardiovascular Diseases, Institute of Cardiology, Warsaw, Poland.
| | - M Franaszczyk
- Molecular Biology Laboratory, Institute of Cardiology, Warsaw, Poland
| | - E Michalak
- Unit for Screening Studies in Inherited Cardiovascular Diseases, Institute of Cardiology, Warsaw, Poland
| | - M Rydzanicz
- Department of Medical Genetics, Centre of Biostructure, Medical University of Warsaw, Warsaw, Poland
| | - E Szpakowski
- Department of Cardiac Surgery and Transplantation, Institute of Cardiology, Warsaw, Poland
| | - A Pollak
- Department of Genetics, Institute of Physiology and Pathology of Hearing, Warsaw, Poland
| | - B Milanowska
- Unit for Screening Studies in Inherited Cardiovascular Diseases, Institute of Cardiology, Warsaw, Poland
| | - G Truszkowska
- Molecular Biology Laboratory, Institute of Cardiology, Warsaw, Poland
| | - P Chmielewski
- Unit for Screening Studies in Inherited Cardiovascular Diseases, Institute of Cardiology, Warsaw, Poland
| | - A Sioma
- Unit for Screening Studies in Inherited Cardiovascular Diseases, Institute of Cardiology, Warsaw, Poland
| | | | - A Klisiewicz
- Department of Congenital Cardiac Defects, Institute of Cardiology, Warsaw, Poland
| | - I Michalowska
- Department of Radiology, Institute of Cardiology, Warsaw, Poland
| | | | - P Kolsut
- Department of Cardiac Surgery and Transplantation, Institute of Cardiology, Warsaw, Poland
| | - P Stawinski
- Department of Medical Genetics, Centre of Biostructure, Medical University of Warsaw, Warsaw, Poland.,Department of Genetics, Institute of Physiology and Pathology of Hearing, Warsaw, Poland
| | - B Foss-Nieradko
- Unit for Screening Studies in Inherited Cardiovascular Diseases, Institute of Cardiology, Warsaw, Poland
| | - M Szperl
- Molecular Biology Laboratory, Institute of Cardiology, Warsaw, Poland
| | - J Grzybowski
- Department of Cardiomyopathy, Institute of Cardiology, Warsaw, Poland
| | - P Hoffman
- Department of Congenital Cardiac Defects, Institute of Cardiology, Warsaw, Poland
| | - A Januszewicz
- Department of Hypertension, Institute of Cardiology, Warsaw, Poland
| | - M Kusmierczyk
- Department of Cardiac Surgery and Transplantation, Institute of Cardiology, Warsaw, Poland
| | - R Ploski
- Department of Medical Genetics, Centre of Biostructure, Medical University of Warsaw, Warsaw, Poland.
| |
Collapse
|
48
|
Truszkowska GT, Bilińska ZT, Kosińska J, Śleszycka J, Rydzanicz M, Sobieszczańska-Małek M, Franaszczyk M, Bilińska M, Stawiński P, Michalak E, Małek ŁA, Chmielewski P, Foss-Nieradko B, Machnicki MM, Stokłosa T, Ponińska J, Szumowski Ł, Grzybowski J, Piwoński J, Drygas W, Zieliński T, Płoski R. A study in Polish patients with cardiomyopathy emphasizes pathogenicity of phospholamban (PLN) mutations at amino acid position 9 and low penetrance of heterozygous null PLN mutations. BMC Med Genet 2015; 16:21. [PMID: 25928149 PMCID: PMC4421997 DOI: 10.1186/s12881-015-0167-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 03/23/2015] [Indexed: 12/16/2022]
Abstract
Background In humans mutations in the PLN gene, encoding phospholamban - a regulator of sarcoplasmic reticulum calcium ATPase (SERCA), cause cardiomyopathy with prevalence depending on the population. Our purpose was to identify PLN mutations in Polish cardiomyopathy patients. Methods We studied 161 unrelated subjects referred for genetic testing for cardiomyopathies: 135 with dilated cardiomyopathy, 22 with hypertrophic cardiomyopathy and 4 with other cardiomyopathies. In 23 subjects multiple genes were sequenced by next generation sequencing and in all subjects PLN exons were analyzed by Sanger sequencing. Control group included 200 healthy subjects matched with patients for ethnicity, sex and age. Large deletions/insertions were screened by real time polymerase chain reaction. Results We detected three different heterozygous mutations in the PLN gene: a novel null c.9_10insA:(p.Val4Serfs*15) variant and two missense variants: c.25C > T:(p.Arg9Cys) and c.26G > T:(p.Arg9Leu). The (p.Val4Serfs*15) variant occurred in the patient with Wolff-Parkinson-White syndrome in whom the diagnosis of cardiomyopathy was not confirmed and his mother who had concentric left ventricular remodeling but normal left ventricular mass and function. We did not detect large deletions/insertions in PLN in cohort studied. Conclusions In Poland, similar to most populations, PLN mutations rarely cause cardiomyopathy. The 9thPLN residue is apparently a mutation hot spot whereas a single dose of c.9_10insA, and likely other null PLN mutations, cause the disease only with low penetrance or are not pathogenic. Electronic supplementary material The online version of this article (doi:10.1186/s12881-015-0167-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Grażyna T Truszkowska
- Laboratory of Molecular Biology, Institute of Cardiology, ul. Alpejska 42, 04-628, Warszawa, Poland.
| | - Zofia T Bilińska
- Unit for Screening Studies in Inherited Cardiovascular Diseases, Institute of Cardiology, ul. Alpejska 42, 04-628, Warszawa, Poland.
| | - Joanna Kosińska
- Department of Medical Genetics, Warsaw Medical University, ul. Pawińskiego 3C, 02-106, Warszawa, Poland.
| | - Justyna Śleszycka
- Department of Cardiomyopathies, Institute of Cardiology, ul. Alpejska 42, 04-628, Warszawa, Poland.
| | - Małgorzata Rydzanicz
- Department of Medical Genetics, Warsaw Medical University, ul. Pawińskiego 3C, 02-106, Warszawa, Poland.
| | | | - Maria Franaszczyk
- Laboratory of Molecular Biology, Institute of Cardiology, ul. Alpejska 42, 04-628, Warszawa, Poland.
| | - Maria Bilińska
- Department of Arrhythmia, Institute of Cardiology, ul. Alpejska 42, 04-628, Warszawa, Poland.
| | - Piotr Stawiński
- Department of Immunology, Center for Biostructure Research, Medical University of Warsaw, Warszawa, Poland.
| | - Ewa Michalak
- Unit for Screening Studies in Inherited Cardiovascular Diseases, Institute of Cardiology, ul. Alpejska 42, 04-628, Warszawa, Poland.
| | - Łukasz A Małek
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, ul. Alpejska 42, 04-628, Warszawa, Poland.
| | - Przemysław Chmielewski
- Unit for Screening Studies in Inherited Cardiovascular Diseases, Institute of Cardiology, ul. Alpejska 42, 04-628, Warszawa, Poland.
| | - Bogna Foss-Nieradko
- Unit for Screening Studies in Inherited Cardiovascular Diseases, Institute of Cardiology, ul. Alpejska 42, 04-628, Warszawa, Poland.
| | - Marcin M Machnicki
- Department of Immunology, Center for Biostructure Research, Medical University of Warsaw, Warszawa, Poland.
| | - Tomasz Stokłosa
- Department of Immunology, Center for Biostructure Research, Medical University of Warsaw, Warszawa, Poland.
| | - Joanna Ponińska
- Laboratory of Molecular Biology, Institute of Cardiology, ul. Alpejska 42, 04-628, Warszawa, Poland.
| | - Łukasz Szumowski
- Department of Arrhythmia, Institute of Cardiology, ul. Alpejska 42, 04-628, Warszawa, Poland.
| | - Jacek Grzybowski
- Department of Cardiomyopathies, Institute of Cardiology, ul. Alpejska 42, 04-628, Warszawa, Poland.
| | - Jerzy Piwoński
- Department of Epidemiology, Cardiovascular Diseases Prevention and Promotion of Health, Institute of Cardiology, ul. Niemodlińska 33, 04-635, Warszawa, Poland.
| | - Wojciech Drygas
- Department of Epidemiology, Cardiovascular Diseases Prevention and Promotion of Health, Institute of Cardiology, ul. Niemodlińska 33, 04-635, Warszawa, Poland.
| | - Tomasz Zieliński
- Department of Heart Failure and Transplantology, Institute of Cardiology, ul. Alpejska 42, 04-628, Warszawa, Poland.
| | - Rafał Płoski
- Department of Medical Genetics, Warsaw Medical University, ul. Pawińskiego 3C, 02-106, Warszawa, Poland.
| |
Collapse
|
49
|
Franaszczyk M, Bilinska ZT, Sobieszczańska-Małek M, Michalak E, Sleszycka J, Sioma A, Małek ŁA, Kaczmarska D, Walczak E, Włodarski P, Hutnik Ł, Milanowska B, Dzielinska Z, Religa G, Grzybowski J, Zieliński T, Ploski R. The BAG3 gene variants in Polish patients with dilated cardiomyopathy: four novel mutations and a genotype-phenotype correlation. J Transl Med 2014; 12:192. [PMID: 25008357 PMCID: PMC4105391 DOI: 10.1186/1479-5876-12-192] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 06/25/2014] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND BAG3 gene mutations have been recently implicated as a novel cause of dilated cardiomyopathy (DCM). Our aim was to evaluate the prevalence of BAG3 mutations in Polish patients with DCM and to search for genotype-phenotype correlations. METHODS We studied 90 unrelated probands by direct sequencing of BAG3 exons and splice sites. Large deletions/insertions were screened for by quantitative real time polymerase chain reaction (qPCR). RESULTS We found 5 different mutations in 6 probands and a total of 21 mutations among their relatives: the known p.Glu455Lys mutation (2 families), 4 novel mutations: p.Gln353ArgfsX10 (c.1055delC), p.Gly379AlafsX45 (c.1135delG), p.Tyr451X (c.1353C>A) and a large deletion of 17,990 bp removing BAG3 exons 3-4. Analysis of mutation positive relatives of the probands from this study pooled with those previously reported showed higher DCM prevalence among those with missense vs. truncating mutations (OR = 8.33, P = 0.0058) as well as a difference in age at disease onset between the former and the latter in Kaplan-Meier survival analysis (P = 0.006). Clinical data from our study suggested that in BAG3 mutation carriers acute onset DCM with hemodynamic compromise may be triggered by infection. CONCLUSIONS BAG3 point mutations and large deletions are relatively frequent cause of DCM. Delayed DCM onset associated with truncating vs. non-truncating mutations may be important for genetic counseling.
Collapse
Affiliation(s)
- Maria Franaszczyk
- Laboratory of Molecular Biology, Institute of Cardiology, Warsaw, Alpejska 42 04-628, Poland
| | - Zofia T Bilinska
- Unit for Screening Studies in Inherited Cardiovascular Diseases, Institute of Cardiology, Warsaw, Alpejska 42 04-628, Poland
| | | | - Ewa Michalak
- Unit for Screening Studies in Inherited Cardiovascular Diseases, Institute of Cardiology, Warsaw, Alpejska 42 04-628, Poland
| | - Justyna Sleszycka
- Department of Cardiomyopathies, Institute of Cardiology, Warsaw, Alpejska 42 04-628, Poland
| | - Agnieszka Sioma
- Unit for Screening Studies in Inherited Cardiovascular Diseases, Institute of Cardiology, Warsaw, Alpejska 42 04-628, Poland
| | - Łukasz A Małek
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Alpejska 42 04-628, Poland
| | - Dorota Kaczmarska
- Unit for Screening Studies in Inherited Cardiovascular Diseases, Institute of Cardiology, Warsaw, Alpejska 42 04-628, Poland
| | - Ewa Walczak
- Department of Pathology, Institute of Rheumatology, Warsaw, Spartańska 1 02-637, Poland
| | - Paweł Włodarski
- The Department of Histology and Embryology, Centre of Biostructure, Medical University of Warsaw, Warsaw, Chałubińskiego 5 02-004, Poland
| | - Łukasz Hutnik
- The Department of Histology and Embryology, Centre of Biostructure, Medical University of Warsaw, Warsaw, Chałubińskiego 5 02-004, Poland
| | - Blanka Milanowska
- Unit for Screening Studies in Inherited Cardiovascular Diseases, Institute of Cardiology, Warsaw, Alpejska 42 04-628, Poland
| | - Zofia Dzielinska
- Department of Structural Heart Diseases, Institute of Cardiology, Warsaw, Alpejska 42 04-628, Poland
| | - Grzegorz Religa
- Department of Cardiac Surgery, Institute of Cardiology, Warsaw, Alpejska 42 04-628, Poland
| | - Jacek Grzybowski
- Department of Cardiomyopathies, Institute of Cardiology, Warsaw, Alpejska 42 04-628, Poland
| | - Tomasz Zieliński
- Department of Heart Failure and Transplantology, Institute of Cardiology, Warsaw, Alpejska 42 04-628, Poland
| | - Rafal Ploski
- Department of Medical Genetics, Centre of Biostructure, Medical University of Warsaw, Warsaw, Pawinskiego 3C 02-106, Poland
| |
Collapse
|
50
|
Sleszycka JA, Sioma A, Mazurkiewicz L, Klisiewicz A, Michalowska I, Kocanda S, Walczak E, Langfort R, Klimczak A, Grzybowski J. Cardiac angiosarcoma with the presence of mycobacterium tuberculosis complex genetic material. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht312.954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|