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Csanadi B, Fulop G, Szoke S, Szonyi T, Dekany G, Pinter T, Takacs P, Abdelkrim A, Beres A, Fontos G, Andreka P, Nyolczas N, Piroth Z. Correlation of FFR measured after DES implantation with clinical parameters and long-term clinical outcome. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2025] [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
Introduction
The role of fractional flow reserve (FFR) measured directly after drug eluting stent (DES) implantation (post-PCI FFR) is not clear in predicting major adverse cardiac events (MACE), and it is not known which clinical parameters affect post-PCI FFR.
Aim
We aimed to clarify the relationship between post-PCI FFR and clinical parameters, post-PCI FFR and long-term MACE and determine the best post-PCI FFR cut-off in MACE prediction.
Method
Patients who underwent post-PCI (DES) FFR measurement at our center between March 2009 and January 2021 were included. We examined the relationship between post-PCI FFR and gender, age, hypertension, diabetes mellitus, hyperlipidemia, indication (acute (ACS) vs. chronic coronary syndrome (CCS)), stent diameter, in-stent restenosis vs de novo lesion category, proximal vs. non-proximal lesion location, LAD (vs. non-LAD) location, and pre-PCI FFR. We sought to determine the correlation between post-PCI FFR and target vessel-related MACE (cardiovascular death (CVD), non-fatal myocardial infarction (MI), recurrent revascularization (TVR)). Optimal cut-off was determined by ROC curves.
Results
Post-PCI FFR measurement was performed in 500 coronary arteries of 434 patients. LAD location (0.86 vs. non-LAD 0.91, p<0.001), male gender (0.87 vs. 0.89, p=0.001), younger age (p=0.0215), smaller stent diameter (p=0.0028) and lower pre-PCI FFR (p=0.0006) proved to be independent predictors of lower post-PCI FFR, no other parameter showed a significant correlation with post-PCI FFR. During a median follow-up of 37 months, 24 CVD, 15 MI and 47 TVR occurred. Follow-up was complete in 96.2% of patients. There was a significant inverse correlation between post-PCI FFR and MACE (p<0.001). Diabetes mellitus (p=0.0024) and in-stent restenosis (0.0356) were also independent predictors of MACE. The best post-PCI FFR cut-off for the total patient population, LAD and non-LAD lesions were 0.83 (p<0.0001), 0.83 (p<0.0001), and 0.88 (p=0.0091), respectively.
Conclusion
LAD location, male gender, younger age, smaller stent diameter and lower pre-PCI FFR value result in lower post-PCI FFR. There is no significant difference between post-PCI FFR measured in ACS vs. CCS. FFR measured after PCI, diabetes mellitus and in-stent restenosis are significant predictors of MACE-free long-term survival. The best post-PCI FFR cut-off to predict MACE was 0.83 for the whole patient population and for LAD and 0.88 for non-LAD lesions.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- B Csanadi
- Gottsegen National Cardiovascular Center , Budapest , Hungary
| | - G Fulop
- Gottsegen National Cardiovascular Center , Budapest , Hungary
| | - S Szoke
- Gottsegen National Cardiovascular Center , Budapest , Hungary
| | - T Szonyi
- Gottsegen National Cardiovascular Center , Budapest , Hungary
| | - G Dekany
- Gottsegen National Cardiovascular Center , Budapest , Hungary
| | - T Pinter
- Gottsegen National Cardiovascular Center , Budapest , Hungary
| | - P Takacs
- Gottsegen National Cardiovascular Center , Budapest , Hungary
| | - A Abdelkrim
- Gottsegen National Cardiovascular Center , Budapest , Hungary
| | - A Beres
- Gottsegen National Cardiovascular Center , Budapest , Hungary
| | - G Fontos
- Gottsegen National Cardiovascular Center , Budapest , Hungary
| | - P Andreka
- Gottsegen National Cardiovascular Center , Budapest , Hungary
| | - N Nyolczas
- Gottsegen National Cardiovascular Center , Budapest , Hungary
| | - Z Piroth
- Gottsegen National Cardiovascular Center , Budapest , Hungary
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2
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Bence A, Balint H, Borbas S, Denes M, Andreka P. Infective endocarditis in adults with congenital heart disease – 11 years data from Hungary. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1671] [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
Background
Despite recent preventive strategies and advances in antimicrobial and surgical treatment the incidence and mortality rate of infective endocarditis (IE) remains high in adult Congenital Heart Disease (ACHD) patients.
Purpose
The aim of our retrospective study was to assess the clinical and microbiological characteristics, inhospital and one year mortality rates of ACHD patients admitted with IE in our tertiary referral hospital between 2010 and 2020.
Methods
Definitive diagnosis of IE were in agreement with modified Duke's criteria. Inhospital baseline data and up to one year follow-up data were collected from the hospital records. ACHD patients were classified based on their lesion severity (ESC guideline classification). Survival data and mortality predictors were analysed by Kaplan-Meier estimator and by uni- and multivariate model.
Results
60 cases had been treated with IE. Mean age was 37±11.3 years (18–69), and most of them (76.6%, n=46) were men. ACHD complexity was as following: simple 66.7% (n=40), moderate 20% (n=12) and severe 13.3% (n=8). The most common pre-existing congenital cardiac abnormality was bicuspidal aortic valve seen in 52% (n=31) of cases. Sixty four percent (n=37) of patients had previous heart surgery (n=16, artificial heart valve surgery). Majority of patients had a left sided valve endocarditis (85%, n=51). IE related hospital stay was mean 28±9 days. Infection route was presumed in 30% of patients (n=18), they had an invasive procedure within 6 months preceding the IE diagnosis. Besides common bacterinemia caused by Staphylococcus (33%, n=20) and Streptococcus (25%, n=15), 18% (n=11) of patients had a negative blood culture. IE affected 36 patients with a native valve, and all 16 with an artificial valve. Seventy seven percent of patients required surgical intervention, immediate or urgent surgery in 22 and elective in 24 patients. Overall inhospital mortality was 13%, the majority 5 out of 8 patients having an immediate/emergent surgical intervention. IE was complicated by acute heart failure in 17 (28%) and by stroke in 4 (6.7%) patients. During one year follow-up 21 patients (38%) remained with chronic heart failure, and 3 more died. There was no significant difference in mortality between ACHD complexity groups, and no significant predictors of mortality were found.
Conclusion
The most common ACHD lesion affected by IE was bicuspid aortic valve. Two-third of patients required surgical intervention, those with immediate/emergent surgery having a 22% early mortality rate. ACHD complexity was not related to early or late outcome in this population.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Bence
- Gottsegen Gy Hungarian Institute of Cardiolog , Bonyhad , Hungary
| | - H Balint
- Gottsegen Gy Hungarian Institute of Cardiolog , Bonyhad , Hungary
| | - S Borbas
- Gottsegen Gy Hungarian Institute of Cardiolog , Bonyhad , Hungary
| | - M Denes
- Gottsegen Gy Hungarian Institute of Cardiolog , Bonyhad , Hungary
| | - P Andreka
- Gottsegen Gy Hungarian Institute of Cardiolog , Bonyhad , Hungary
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3
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Kecskemeti D, Szabo B, Nagy ZS, Temesvari A, Nagy ZS, Szegedi M, Nyolczas N, Andreka P, Balint H. Patients with congenital heart disease over the age of 60: experiences of a single tertiary centre. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1855] [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: 11/15/2022] Open
Abstract
Abstract
Background
We are currently facing a shift in adult patients with congenital heart disease (ACHD) to older and more complex patients. The growing population of senior patients with congenital heart disease (CHD) is prone to acquired comorbidities.
Purpose
Purpose of our study was to identify the main comorbidities in ACHD patients ≥60 years.
Methods
2726 patients had at least one visit at our ACHD centre between 2010 and 2021, 287 patients of them being 60 or older. Clinical data about the patients' last visit were obtained retrospectively from digital medical records. Based on the complexity of the CHD patients were classified as mild, moderate, and severe. Survival difference was analysed using the Kaplan-Meier method and the log rank test.
Results
Senior patients included in this study were predominantly female (73.2%) with the median age of 69 years. We included 287 patients with mild (47.4%), moderate (39.4%), and severe (13.2%) underlying heart disease. Median age at first visit in our centre was 60 years (IQR 54–67). Over the median follow-up time of 7.9 years (IQR: 3.2–13.2), 20 patients (7%) died with the incidence of 0.8 deaths/100 patient years. The most common complication in this populations were Heart failure (43.2%) and arrhythmia (12.5%). Meanwhile the highest prevalence of heart failure was seen in patients with Eisenmenger syndrome/Pulmonary Arterial Hypertension (84.8%), Tetralogy of Fallot patients had the highest prevalence of arrhythmias (77.8%). 51% of all patients had at least one cardiovascular risk factor (diabetes, hypertension, hyperlipidaemia, or chronic kidney disease). 42% of the patients underwent a non-coronary intervention over the age of 60. The highest mortality was seen in patients with severely complex lesions (p<0.002). As of the comorbidities, significantly higher mortality was observed in seniors with heart failure (p=0.001) or NYHA functional class III/IV (p<0.002).
Conclusions
Although the number of ACHD patients is growing constantly, the population of elderly patients with CHD is still mainly consists of patients with mild or moderate heart defects. Half of the patients had at least one cardiovascular risk factor by the age of 60. As expected, a significantly higher mortality was seen in those with severe heart defects.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- D Kecskemeti
- Semmelweis University, Racz Karoly Doctoral School of Clinical Medicine , Budapest , Hungary
| | - B Szabo
- Semmelweis University, Racz Karoly Doctoral School of Clinical Medicine , Budapest , Hungary
| | - Z S Nagy
- Gottsegen National Cardiovascular Center , Budapest , Hungary
| | - A Temesvari
- Gottsegen National Cardiovascular Center , Budapest , Hungary
| | - Z S Nagy
- Gottsegen National Cardiovascular Center , Budapest , Hungary
| | - M Szegedi
- Gottsegen National Cardiovascular Center , Budapest , Hungary
| | - N Nyolczas
- Gottsegen National Cardiovascular Center , Budapest , Hungary
| | - P Andreka
- Gottsegen National Cardiovascular Center , Budapest , Hungary
| | - H Balint
- Gottsegen National Cardiovascular Center , Budapest , Hungary
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Vertesaljai M, Denes M, Temesvari A, Fontos G, Andreka P. Percutaneous paravalvular leak closure: a single-centre experience of 54 cases. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.140] [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
Funding Acknowledgements
Type of funding sources: None.
Introduction
Clinically significant paravalvular leak (PVL) occurs in 5-10% of patients undergoing surgical aortic and 5-17% patients undergoing surgical mitral valve replacement and even more often after trancutaneous aortic valve implantation (TAVI). Surgical repair of a PVL is associated with a 30-day mortality of approximately 10%. Percutaneous closure of PVL (pPVLC) has emerged as an alternative to surgical repair.
Aim
We retrospectively analysed the success rate and clinical outcomes of patients with significant PVL, who were turned down from re-do cardiac surgery, and treated with pPVLC at our tertiary referral centre.
Methods
Patients who were admitted for pPVLC between 27th of September, 2009 and 21st of April, 2021 were enrolled into the study. 30-day and 1-year mortality rates were assessed. Technically successful pPVLC was defined as stable device position, and minimum 1 grade reduction in PVL severity.
Results
pPVLC was performed in 54 cases (32 males, 22 females, mean age: 69.5 ± 10.9 yrs). The main indication for closure was heart failure (81%) and haemolysis (19%). The median time since valve surgery was 4.5 yrs (IQR: 0.9-15.2 yrs). Regarding the leaks, 70% (n = 38) were in mitral position (mechanical vale: 33 cases, bioprosthesis: 5 cases) and 30% (n = 16) in aortic position (mechanical valve: 12 cases, bioprosthesis: 2 cases, TAVI: 2 cases). A total of 53 leaks were identified in mitral position (one leak: 25 cases, two leaks: 11 cases, three leaks: 2 cases), and 25 leaks in aortic position (9 cases, 5 cases and two cases resp.). In mitral position 1 device was used in 73% of cases, 2 devices in 21%, and 3 devices in 6%. In aortic position: 62%, 19%, and 19 % resp. Techinal succes was achieved in 49 case (91%). The 30-day mortality was 8%, the 1-year mortality 21%.
Conclusions
Patients with significant PVL represent an extreme or even prohibitive surgical risk cohort. In these high risk individuals percutaneous PVL offers a safe alternative to surgical PVL repair and appears particularly effective in patients presenting with heart failure or haemolysis.
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Affiliation(s)
- M Vertesaljai
- Gottsegen National Cardiovascular Center, Budapest, Hungary
| | - M Denes
- Gottsegen National Cardiovascular Center, Budapest, Hungary
| | - A Temesvari
- Gottsegen National Cardiovascular Center, Budapest, Hungary
| | - G Fontos
- Gottsegen National Cardiovascular Center, Budapest, Hungary
| | - P Andreka
- Gottsegen National Cardiovascular Center, Budapest, Hungary
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5
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Szedlacsek Z, Herczku F, Kozma I, Vertesaljai M, Andreka P. Accidental diagnosis of significant coronary artery disease by cardiac CT scan to rule out left atrial appendage thrombus in patients with atrial fibrillation during COVID19 pandemic. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.410] [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
Funding Acknowledgements
Type of funding sources: None.
Introduction
The exclusion of left atrial appendage (LAA) thrombus prior to urgent electrical cardioversion (DCCV) for atrial fibrillation (AF) is traditionally performed by transesophageal echocardiography (TEE). During the COVID19 pandemic, TEE was replaced by cardiac CT (CCT) due to its high aerosol generating property, which in addition to assessing the anatomy of the heart, can also be used to evaluate the coronary arteries at the same time.
Methods
In our retrospective study, we evaluated the cardiac CT scans of patients undergoing DCCV in our institution between January 1, 2020 and February 28, 2021 for coronary artery disease (CAD). The scans were performed by a GE Revolution 256-slice CT scanner.
Results
CCT scans were performed in 32 patients to rule out LAA thrombus (24 male; 8 female; age: 61.8 ± 11.2 years; BMI: 29.2 ± 4.4; heart rate: 79.2 ± 24.4 1/min; CHA2DS2VASc score: 2.4 ± 1.5). The mean radiation exposure of the scans was DLP: 356.3 ± 130.1 mGy-cm; effective dose: 5.0 ±1.8 mSv, Ca-score: 361.4 ± 883.0. In 4 equivocal cases TEE was also performed with negative results. No CAD was confirmed in 7 cases, mild CAD in 14 patients. CCT was not diagnostic only in 4 cases. Significant (moderate or severe) CAD was detected in 7 cases, invasive coronary angiography (ICA) was also performed in 5 cases. In 2 cases significant one-vessel disease, in 2 other cases borderline (FFR: 0.81 and 0.84) stenosis and in 1 case only mild CAD was diagnosed by ICA.
Conclusions
CCT scans performed by our 256-slice CT scanner for AF can identify patients,
who require further invasive or invasive and functional coronary artery assessment with
satisfactory accuracy. In terms of coronary artery disease, the non-diagnostic scan rate was
low, despite the presence of arrhythmia, suboptimal heart rate and higher than usual Ca-score.
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Affiliation(s)
- Z Szedlacsek
- Gottsegen Gy Hungarian Institute Of Cardiolog, Department of Cardiac Imaging, Bonyhad, Hungary
| | - F Herczku
- Gottsegen Gy Hungarian Institute Of Cardiolog, Department of Cardiac Imaging, Bonyhad, Hungary
| | - I Kozma
- Gottsegen Gy Hungarian Institute Of Cardiolog, Department of Cardiac Imaging, Bonyhad, Hungary
| | - M Vertesaljai
- Gottsegen Gy Hungarian Institute Of Cardiolog, Department of Cardiac Imaging, Bonyhad, Hungary
| | - P Andreka
- Gottsegen Gy Hungarian Institute Of Cardiolog, Adult Cardiology Department, Bonyhad, Hungary
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6
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Abstract
Abstract
Background
We are currently facing a growing and aging population of adults with complex congenital heart disease. However, long-term survival in these patients remained reduced.
Purpose
To identify the main causes of death and compare mortality based on the complexity of the underlying congenital heart defect.
Methods
Patients with at least one visit in our adult congenital heart disease (ACHD) clinic between 2010 and 2020 were reviewed. Clinical data were obtained from digital medical records. Based on the complexity of the underlying heart defect patients were classified as mild, moderate, and severe. Data about the median age at death in the general population was collected from the National Statistical Office. Survival difference between the groups was analysed using the Kaplan-Meier method along with the log rank test.
Results
We included 2658 patients (53% female, overall median age of 35.6 years) with severe (21.2%), moderate (46.2%), and mild (32.6%) lesions. Over the median follow-up of 8.5 years (IQR 5.2–12.2) 125 patients (4.7%) died with an incidence of 0.51 deaths/100 patient years. The median age at death was 39.1 years (severe: 37.2 years, moderate: 50.3 years, mild: 83.1 years, p<0.001) Heart failure was the leading cause of death (35.2%) followed by non-cardiac causes (12.8%), perioperative/periprocedural death (11.2%), arrhythmia (7.4%), sudden cardiac death (4.1%) and endocarditis (2.4%). Heart failure related death was the most likely present in severely complex lesions (mild: 2.3%, moderate: 13.6%, severe: 84.1%). Underlying CHD with the highest mortality were univentricular heart (26.3%), pulmonary atresia (24.3%), Eisenmenger syndrome (22.7%), Ebstein anomaly (15.2%), and transposition of the great arteries after Senning procedure (13.4%).
Conclusions
Adult patients with moderately to severely complex congenital heart disease die at a relatively young age. The highest mortality rates were observed in patients with severely complex defects, with heart failure being the most common cause of death.
Funding Acknowledgement
Type of funding sources: None. Kaplan-Meier survival curve
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Affiliation(s)
| | - M Szegedi
- Gottsegen National Cardiovascular Center, Budapest, Hungary
| | - A Temesvari
- Gottsegen National Cardiovascular Center, Budapest, Hungary
| | - P Andreka
- Gottsegen National Cardiovascular Center, Budapest, Hungary
| | - H Balint
- Gottsegen National Cardiovascular Center, Budapest, Hungary
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7
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Hellgren T, Blondal M, Ainla T, Jortveit J, Eha J, Loiveke P, Marandi T, Saar A, Veldre G, Lewinter C, Halvorsen S, Ferenci T, Andreka P, Janosi A, Edfors R. Gender differences in characteristics, treatment and outcomes in ST elevation myocardial infarction patients in four European countries. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1114] [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
Women receive less evidence-based care than men and have higher mortality after myocardial infarctions than men. But it is not known how the gender difference in risk factors, treatments and outcomes differs between European countries.
Purpose
In order to investigate the gender differences in European countries with different economic predispositions we aimed to describe and compare baseline characteristics, in-hospital management, medications at discharge and death outcomes of man and woman ST-elevation infarction (STEMI) patients following routine clinical practice in Sweden, Norway, Hungary and Estonia.
Methods
The study population is patients over the age of 18 with STEMI who were treated in hospital 2014–2017 (for Norway between 2013–2016) and registered in one of the national myocardial infarction registers. Patients with non-ST elevation infarction and unstable angina were excluded. Risk factors, hospital treatment, and prescription medications were obtained from the national myocardial infarction registries from each country. Mortality in-hospital, after 30 days and after 1 year, was obtained from national death registers.
Results
Women were on average older, had more comorbidities and higher mortality in hospital, after 30 days and one year after hospitalization. Women received coronary angiography, percutaneous coronary intervention, left ventricular ejection fraction assessment and evidence-based drugs to a lesser extent than men.
Conclusions
The study illustrates that there are differences in characteristics, management, treatments and outcomes between men and women in all of the studied countries no matter economic predispositions. Generally, women are treated with guideline recommended therapy to a lesser extent than men in the studied countries.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - M Blondal
- University of Tartu, Department of Cardiology, Tartu, Estonia
| | - T Ainla
- University of Tartu, Department of Cardiology, Tartu, Estonia
| | - J Jortveit
- Sorlandet Hospital, Department of Cardiology, Arendal, Norway
| | - J Eha
- University of Tartu, Department of Cardiology, Tartu, Estonia
| | - P Loiveke
- University of Tartu, Department of Cardiology, Tartu, Estonia
| | - T Marandi
- University of Tartu, Department of Cardiology, Tartu, Estonia
| | - A Saar
- North Estonia Medical Centre, Centre of Cardiology, Tallinn, Estonia
| | - G Veldre
- Tartu University Hospital, Estonian Myocardial Infarction Registry, Tartu, Estonia
| | - C Lewinter
- Karolinska University Hospital, Heart and Vascular Theme, Stockholm, Sweden
| | - S Halvorsen
- University of Oslo, Department of Cardiology, Oslo, Norway
| | - T Ferenci
- Obuda University, John von Neumann Faculty of Informatics, Budapest, Hungary
| | - P Andreka
- Gottsegen National Institute of Cardiology, Hungarian Myocardial Infarction Registry, Budapest, Hungary
| | - A Janosi
- Gottsegen National Institute of Cardiology, Hungarian Myocardial Infarction Registry, Budapest, Hungary
| | - R Edfors
- Karolinska Institute, Stockholm, Sweden
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8
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Antal A, Szegedi M, Takacs E, Szabo B, Solymosi B, Vincze V, Ablonczy L, Kornyei L, Temesvari A, Andreka P, Balint H. Outcome of patients with tetralogy of Fallot repair over 50 years of age. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2223] [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
Purpose
To report the outcomes of patients with repaired tetralogy of Fallot (TOF) above 50 years of age.
Methods
We reviewed records of TOF patients who were followed in our institution since 2000. Demographic data, surgical reports and long-term outcomes were analyzed retrospectively.
Results
Thirty-five of 297 (12%) patients who underwent TOF repair were above 50 years of age (25 men [60%]) at the last follow-up. Eighteen patients (48%) had prior palliative surgery. The mean age at the first repair was 18±13 years (5 patients after 40 years of age). Reoperation with pulmonary valve replacement was performed in 10 (28%) patients, and a second redo surgery in 6 (17%) patients. During a mean 17± 2 years follow-up 7 (8.5%) patients died (n=6 end-stage heart failure, n=1 infective endocarditis). At the last follow-up 21/35 patients (60%) were treated with tachyarrhythmia, 19/35 (54%) with chronic heart failure and 17/35 (48%) with comorbidities (hypertension, coronary artery disease/peripherial artery disease, diabetes mellitus, renal failure). Using multivariate analysis the only predictor of death was heart failure (OR: 6.8). Furthermore atrial tachycardia (OR: 8.8) and at least grade II tricuspid regurgitation (OR: 5.0) were identified as predictors of heart failure.
Conclusion
This historical cohort of TOF patients with late repair has a high morbidity rate later in life. Approximately half of the patients require treatment for chronic heart failure, arrhythmias and cardiovascular related comorbidities. Atrial tachycardia and tricuspid regurgitation are strong predictors for heart failure. In this population the strongest predictor for death is heart failure.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- A Antal
- Gottsegen Gy Hungarian Institute of Cardiolog, Bonyhad, Hungary
| | - M Szegedi
- Gottsegen Gy Hungarian Institute of Cardiolog, Bonyhad, Hungary
| | - E Takacs
- Gottsegen Gy Hungarian Institute of Cardiolog, Bonyhad, Hungary
| | - B Szabo
- Gottsegen Gy Hungarian Institute of Cardiolog, Bonyhad, Hungary
| | - B Solymosi
- Gottsegen Gy Hungarian Institute of Cardiolog, Bonyhad, Hungary
| | - V Vincze
- Gottsegen Gy Hungarian Institute of Cardiolog, Bonyhad, Hungary
| | - L Ablonczy
- Gottsegen Gy Hungarian Institute of Cardiolog, Bonyhad, Hungary
| | - L Kornyei
- Gottsegen Gy Hungarian Institute of Cardiolog, Bonyhad, Hungary
| | - A Temesvari
- Gottsegen Gy Hungarian Institute of Cardiolog, Bonyhad, Hungary
| | - P Andreka
- Gottsegen Gy Hungarian Institute of Cardiolog, Bonyhad, Hungary
| | - H Balint
- Gottsegen Gy Hungarian Institute of Cardiolog, Bonyhad, Hungary
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9
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Bloendal M, Ainla T, Andreka P, Edfors R, Halvorsen S, Jernberg T, Jortveit J, Marandi T, Janosi A. Comparison of management and outcomes of ST-segment elevation myocardial infarction patients in Estonia, Hungary, Norway and Sweden according to national ongoing registries. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1604] [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
There is a high need for real-world international comparisons of management of patients with acute myocardial infarction. In Europe Estonia, Hungary, Norway and Sweden are among the few countries with national ongoing acute myocardial infarction registries with a high degree of completeness of data.
Purpose
To compare the management and outcome of hospitalized ST-segment elevation myocardial infarction (STEMI) patients in four European countries with a national ongoing myocardial infarction registry.
Methods
We compared patient baseline characteristics, use of in-hospital procedures and medications at discharge as well as 30-day and 1-year mortality for all patients admitted with STEMI during 2014–2017 using EMIR (Estonia; n=4,584), HUMIR (Hungary; n=23,685), NOMIR (Norway; n=12,414; data available for years 2013–2016) and SWEDEHEART (Sweden; n=23,342). Country-level results were compared as aggregated data.
Results
Mean age ranged from 65 to 69 years (table 1). Estonia and Hungary had compared to Norway and Sweden a higher proportion of women (resp. 39%; 38% vs. 29%; 31%), as well as patients with hypertension (resp. 79%; 72% vs. 39%; 50%), diabetes (resp. 21%; 27% vs. 14%; 19%) and peripheral artery disease (resp. 9% vs. 6%; 4%). Proportion of current smokers was highest in Norway (38%) and lowest in Sweden (27%). Rates of discharge medications were generally high. The results for in-hospital procedures and mortality are shown in table 1. Estonia had the lowest rates of dual antiplatelet treatment (78%) and statins (86%). Norway had the lowest rates of beta-blockers (80%) and angiotensin converting enzyme inhibitors/ angiotensin II receptor blockers (61%).
Conclusions
This cross-country comparison of four national European registries provide new insights into differences in risk factors, treatment regiments and outcomes of patients with STEMI. There are several possible reasons for the observed differences, including differences in underlying expected mortality in the populations, inclusion-criteria and coverage of the registries and variable definitions, that need to be further explored.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Estonian Research Council
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Affiliation(s)
- M Bloendal
- University of Tartu, Faculty of Medicine, Department of Cardiology, Tartu, Estonia
| | - T Ainla
- North Estonia Medical Centre, Department of Cardiology, Tallinn, Estonia
| | - P Andreka
- Gottsegen National Institute of Cardiology, Hungarian Myocardial Infarction Registry, Budapest, Hungary
| | - R Edfors
- Danderyd University Hospital, Department of Clinical Sciences, Stockholm, Sweden
| | - S Halvorsen
- University of Oslo, Department of Cardiology; Oslo University Hospital, Oslo, Norway
| | - T Jernberg
- Danderyd University Hospital, Department of Clinical Sciences, Stockholm, Sweden
| | - J Jortveit
- Sorlandet Hospital, Department of Cardiology, Arendal, Norway
| | - T Marandi
- North Estonia Medical Centre, Quality Department, Tallinn, Estonia
| | - A Janosi
- Gottsegen National Institute of Cardiology, Hungarian Myocardial Infarction Registry, Budapest, Hungary
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10
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Edfors R, Jernberg T, Lewinter C, Eha J, Asser P, Andreka P, Janosi A, Jortveit J, Halvorsen S. European differences in characteristics, treatments and outcomes in patients with non-ST-elevation myocardial infarction – novel insights from four national real-world registries. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1312] [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
Large-scale collection of standardized variables in patients with myocardial infarction (MI) in national real-world registries are only available in a few European countries and there is lack of cross-country comparisons.
Purpose
To compare demography, risk factors, hospital treatment and short- and long-term survival in patients hospitalized for non-ST elevation MI (NSTEMI) in four different European countries.
Methods
NSTEMI patients hospitalized and enrolled in national MI registries; EMIR (Estonia), HUMIR (Hungary), NORMI (Norway (2013–2016)) and SWEDEHEART (Sweden) from 2014 to 2017 were included.
Results
In total 119,191 patients with NSTEMI were included. The mean age at admission ranged from 70 years (Hungary) to 75 years (Estonia). The proportion of women was 36% in Sweden and 44% in Estonia. In Norway 24% were smokers, as compared to 17% in Sweden. Patients in Hungary had a high rate of diabetes mellitus (37%) and antihypertensive treatment (84%) but a low rate of lipid lowering treatment (32%). The proportion of patients with prior MI ranged from 28% (Norway) to 37% (Sweden). The presence of previous peripheral artery disease ranged from 7% (Sweden) to 17% (Hungary). The absolute proportion of performed coronary angiographies (58% versus 75%) and percutaneous coronary interventions (38% versus 56%), differed most between Norway and Hungary. Dual antiplatelet therapy ranged from 60% (Estonia) to 81% (Hungary) and statins from 78% (Norway) to 89% (Hungary), at discharge. The crude mortality rates at 1 month and 1 year are listed in table 1.
Conclusion
Cross-comparison of four national European MI registries provide new insights in differences in risk factors, treatment and outcomes. Possible reasons for the observed differences, include differences in the underlying expected mortality in the populations, inclusion-criteria and coverage of the registries and variable definitions, that need to be further explored.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Estonian Research Council
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Affiliation(s)
- R Edfors
- Karolinska Institute, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | - T Jernberg
- Karolinska Institute, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | - C Lewinter
- Karolinska University Hospital, Section of Cardiology, Stockholm, Sweden
| | - J Eha
- Tartu University Hospital, Heart Clinic, Tartu, Estonia
| | - P Asser
- University of Tartu, Department of Cardiology, Tartu, Estonia
| | - P Andreka
- Gottsegen Hungarian Institute of Cardiology, Hungarian Myocardial Infarction Registry, Budapest, Hungary
| | - A Janosi
- Gottsegen Hungarian Institute of Cardiology, Hungarian Myocardial Infarction Registry, Budapest, Hungary
| | - J Jortveit
- Sorlandet Hospital, Department of Cardiology, Arendal, Norway
| | - S Halvorsen
- Oslo University Hospital Ulleval, Department of Cardiology, Oslo, Norway
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11
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Denes M, Bence A, Ferenci T, Borbas S, Prinz G, Temesvari A, Vertesaljai M, Andreka P. P346 The changing epidemiology of infective endocarditis in a tertiary center. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.199] [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
Despite the adequate antibiotic prophylaxis, the incidence and mortality rate of infective endocarditis (IE) is still high. In the past few decades, several studies have noted an increase in the proportion of IE caused by staphylococcal species.
Aims
The aim of our retrospective study was to assess the clinical and microbiological characteristics, trends, and the 1, 6 and 12-month cardiovascular (CV) mortality rate of patients administered for IE in our tertiary hospital between January 1, 2006 and December 31, 2016.
Results
We identified 465 cases (311 men, 154 women) of 448 patients, mean age was 56,1 ± 16,4 years (14-92). Native left-sided IE (NLIE) was assessed in 286 cases (61,5%, mitral in 117, aorta in 116, combined in 53 cases), prosthetic valve IE (PVIE) was in 111 cases (24%, early in 44, late in 67), right-sided IE (RIE) in 12 cases (2,5%), cardiac device related IE (CDRIE) in 50 cases (11%), other in 6 cases (1%). The underlying infection was caused by streptococci in 124 cases (27%), Staphylococcus aureus (SA) in 112 cases (24%, out of them 23 had MRSA), coagulase negative Staphylococcus (CoNS) in 39 cases (8%), enterococci in 75 cases (16%). Blood culture negative cases found in 61 patients (13%), in 38 cases (8%) other, diversified germs and in 16 cases (4%) there were no data on the pathogen agent.
The mortality rates of the total population were
one-month was 12.8%, six-month was 26.4%, one-year was 29.7%, and five-year was 40%. There was a significant difference in the mortality rate regarding both of the type of IE and in terms of the underlying microorganism (log-rank p = 0.03 and p = 0.04 resp). The worst survival rate was detected among patients with PVIE, and patients with staphylococcal infection, especially with MRSA. Cox regression found that age (HR: 1.4; CI:1.3-1.6; p <0.001), ejection fraction (HR: 1.4; CI:1.2-1.5; p <0.001), hemoglobin and creatinin levels (HR: 0.9; CI:0.8-0.97 p = 0.01; HR: 1.3; CI: 1.1-1.5; p = 0.001 resp.), MRSA compared to streptococcal infection (HR: 2.5; CI:1.4-4.5; p <0.001), stroke as complication (HR: 1.98; CI:1.4-2.8; p <0.001) were independent risk factors of mortality.
In terms of temporal trends the rate of combined NLIE decreased over time (14.5% to 5.1%, p = 0.03), while the rate of other types of IE did not changed. Regarding the type of underlying microorganism the rate of SA infection increased (17% to 41%, p = 0.002) and the rate of CoNS decreased (16.1% - 1.3% p < 0.001) over time. The 1-year mortality rate did not change through the years.
Conclusions
During the observed 11 years 465 cases were administered with IE to our tertiary hospital, out of which two-third were NLIE. One-quarter of the underlying microorganism were streptococci, and the rate of Staphylococcus aureus infection was increased over time, which was associated with a worse prognosis. In addition IE had a high mortality, which unfortunately did not improve through the years.
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Affiliation(s)
- M Denes
- Gottsegen Gy Hungarian Institute Of Cardiolog, Bonyhad, Hungary
| | - A Bence
- Gottsegen Gy Hungarian Institute Of Cardiolog, Bonyhad, Hungary
| | - T Ferenci
- Óbuda University, John von Neumann Faculty of Informatics, Budapest, Hungary
| | - S Borbas
- Gottsegen Gy Hungarian Institute Of Cardiolog, Bonyhad, Hungary
| | - G Prinz
- Szent Laszlo Hospital, Budapest, Hungary
| | - A Temesvari
- Gottsegen Gy Hungarian Institute Of Cardiolog, Bonyhad, Hungary
| | - M Vertesaljai
- Gottsegen Gy Hungarian Institute Of Cardiolog, Bonyhad, Hungary
| | - P Andreka
- Gottsegen Gy Hungarian Institute Of Cardiolog, Bonyhad, Hungary
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12
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Pal M, Dekany G, Mandzak A, Piroth ZS, Fontos G, Andreka P. P1811 Prognostic impact of different subtypes of severe aortic stenosis undergoing transcatheter aortic valve implantation. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.1162] [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
Outcomes for different subtypes of aortic stenosis defined by transvalvular flow and gradient after transcatheter aortic valve implantation (TAVI) are still subjects of debate.
Purpose
The aim of the study was to evaluate the prognostic impact of the initial transvalvular flow rate and aortic mean gradient on survival and to assess the changes of left ventricular function after TAVI.
Patients and Methods
From 2008. to 2017.06.30. TAVI was performed in 300 cases in our Institute (127 men, 173 women, mean age 80,0 ± 5,8 years) with severe (aortic valve area <1,0 cm²) symptomatic aortic stenosis (AS) and contraindication or high risk for surgery. Median time for follow-up was 28 (0-115) months, Echocardiography was performed before and 12 months after TAVI. Patients were divided into four groups according to flow (F) , aortic mean gradient (Gr) and ejection fraction (EF):
HG
Gr ≥ 40 mmHg (n = 237)
LF-LG : F ≤ 35 ml/m2, Gr < 40 mmHg and EF < 50% (n = 41)
PLF-LG: F ≤ 35 ml/m2, Gr < 40 mmHg and EF ≥50% (n = 9)
NF-LG: F > 35 ml/m2 and Gr < 40 mmHg (n = 13)
Our primary objective was the analysis of 30-day, 1-year and 3-year all-cause mortality of these groups, secondary goal was to observe the changes in EF after 12 months in the survivors.
Results
In the whole patient group 30-day all-cause mortality was 4,3%, 1-year 17,0% and 3-year 62,0%. The NFLG group had the most favourable outcomes (mortality: 30d 0, 1-year: 7,7%, 3-year: 46,2%). Mortality was low in the HG group in the 1st year (30-day: 3,8%, 1-y: 14,3%), but it increased to 62,8% at 3-year. Mortality rates were intermediate in the PLF-LG group (30-day 0, 1-year 22,2%, 3-year 55,6%) and were the highest in LF-LG (30-day 12,2%, p = 0,03 vs HG, 1-year 34,2% p = 0,005 vs. HG, 3-year 75,6%).
Among clinical and echocardiographic variables only moderate or severe paravalvular aortic regurgitation (p = 0,03) and severe renal dysfunction (GFR <30 ml/min, p = 0,02) were independent predictors of all-cause 1-year mortality.
In patients with severe (EF < 30%) , moderate (EF 30-40%) or mild ( EF 41-50%) systolic dysfunction the EF improved after TAVI (23,5 ± 3,5% vs. 30,3 ± 7,9% p < 0,001, 33,6 ±3,6% vs. 43,0 ± 10,5% p = 0,003, 45,5 ± 3,1% vs. 54,3 ± 8,7% p < 0,001) regardless of the initial flow and gradient subtype of AS.
Conclusions
Low flow-low gradient aortic stenosis is associated with worse short or long term prognosis after TAVI, therefore this subtype of AS needs detailed risk stratification before-, and careful management after TAVI. Improvement of initial left ventricular dysfuncion can be expected after TAVI.
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Affiliation(s)
- M Pal
- Gottsegen Gy Hungarian Institute Of Cardiolog, Bonyhad, Hungary
| | - G Dekany
- Gottsegen Gy Hungarian Institute Of Cardiolog, Bonyhad, Hungary
| | - A Mandzak
- Gottsegen Gy Hungarian Institute Of Cardiolog, Bonyhad, Hungary
| | - Z S Piroth
- Gottsegen Gy Hungarian Institute Of Cardiolog, Bonyhad, Hungary
| | - G Fontos
- Gottsegen Gy Hungarian Institute Of Cardiolog, Bonyhad, Hungary
| | - P Andreka
- Gottsegen Gy Hungarian Institute Of Cardiolog, Bonyhad, Hungary
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13
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Denes M, Bence A, Ferenci T, Borbas S, Som Z, Prinz G, Foldesi C, Temesvari A, Vertesaljai M, Andreka P. 472 Epidemiology and temporal trends of cardiac device related infective endocarditis. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.251] [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
Background
Infective endocarditis (IE) is a rare, but life-threatening complication of cardiac device implantation. Despite recent preventive strategies, and advances in antimicrobial and surgical treatment, morbidity and mortality rates are still high.
Aims
The objective of our study was to assess the epidemiological characteristics, temporal tends and mortality rate of cardiac device related IE (CDRIE) in our high-volume, tertiary referral center.
Methods
retrospective data collection was performed from January 1, 2006 to December 31, 2016. Thirty-day, 6-month and 1-year mortality was estimated, which were compared to left-sided native valve endocarditis (LSNIE). Patients administered between 2006 and 2010 and between 2011 and 2016 were compared to assess temporal trends.
Results
465 cases of IE were administered, out of whom 54 patients had CDRIE (39 males [72%], mean age: 55.8 ±19 yrs; 4 VVI, 7 VDD, 7 VVI-ICD, 20 DDD, 5 DDD-ICD and 11 CRT devices; median time since first implantation: 1558 days [IQR: 470 days – 8.6 yrs]). The infection was caused by streptococci in 3 cases (5.5%), Staphylococci were the most prevalent infective agents (70%), S. aureus (SA) in 28 cases (52%, out of whom 10 were MRSA), coagulase negative Staphylococcus in 10 cases (18.5%), blood culture negative cases in 8 patients (15%), and in 5 cases other pathogens were responsible. 266 patients had LSNIE (201 males [75%], mean age: 54.4 ± 15.6 yrs). There was no difference between the two groups in age or in portion of males. Mortality rates were the same in CDRIE group compared to LSNIE group (30-day: 13% vs 13%, 6-month: 20% vs 25%, 1-year: 26% vs 29% and long-term: 44% vs 44%, ns resp.) Patients who died in the CDRIE group (n = 25) were older (64 yrs [IQR:59-71 yrs] vs 52 yrs [IQR: 27-69 yrs], p = 0.02), male sex was less common (52% vs 79%, p = 0.03), had lower ejection fraction (39.6 ±16.6% vs 54.6 ±14.5%, p < 0.001), had worse renal function (GFR: 46.3 ± 15.3 vs 60.2 ± 23.5 ml/min/1.73m2, p = 0.04), shorter time since first device implantation (2.1 yrs [IQR: 1.1-4.8 yrs] vs 6.7 yrs [4.1-12.9 yrs], p = 0.006), and CRT device implantation were more prevalent (32% vs 10%, p < 0.05).
Patients admitted before 2011 (n = 22) did not differ from patients admitted after 2011 (n = 32) in terms of age, male gender, concomitant valve infection, pocket infection, or embolic event. The 30-day (0% vs 6%) and the 1-year mortality (18% vs 31%) were the same before and after 2011, but the 6-month mortality was better before 2011 (4.5% vs 31%, p = 0.01). CRT device implantation was more prevalent over time (5% vs 31%, p = 0.01), and SA infection became more frequent (36% vs 63%, p = 0.05)
Conclusions
During the last decade patients with CDRIE had a same survival as patients with LSNIE, every fourth patient died one year after the diagnosis. Almost three-quarter of the infections were caused by Staphylococci, and the portion of S. aureus infection increased over time.
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Affiliation(s)
- M Denes
- Gottsegen Gy Hungarian Institute Of Cardiolog, Bonyhad, Hungary
| | - A Bence
- Gottsegen Gy Hungarian Institute Of Cardiolog, Bonyhad, Hungary
| | - T Ferenci
- Óbuda University, John von Neumann Faculty of Informatics, Budapest, Hungary
| | - S Borbas
- Gottsegen Gy Hungarian Institute Of Cardiolog, Bonyhad, Hungary
| | - Z Som
- Gottsegen Gy Hungarian Institute Of Cardiolog, Bonyhad, Hungary
| | - G Prinz
- Szent Laszlo Hospital, Budapest, Hungary
| | - C Foldesi
- Gottsegen Gy Hungarian Institute Of Cardiolog, Bonyhad, Hungary
| | - A Temesvari
- Gottsegen Gy Hungarian Institute Of Cardiolog, Bonyhad, Hungary
| | - M Vertesaljai
- Gottsegen Gy Hungarian Institute Of Cardiolog, Bonyhad, Hungary
| | - P Andreka
- Gottsegen Gy Hungarian Institute Of Cardiolog, Bonyhad, Hungary
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14
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Pataki S, Szegedi M, Temesvari A, Ablonczy L, Andreka P, Balint H. P5353Pregnancy in congenital heart disease - risk stratificaton. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0320] [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
Maternal congenital heart disease is a leading cause of peripartum maternal mortality, which is also associated with increased risk of fetal morbidity and mortality. We aimed to provide risk stratification for congenital heart disease patients using the recently introduced CARPREG (Cardiac Disease in Pregnancy) II score at our Institute.
Patients and methods
We enrolled 191 pregnant women with congenital heart disease (mean age at pregnancy 29.2±5,7 years). We recorded all foetal (premature birth, abortion, congenital heart abnormalities) and maternal (postpartum heart failure, stroke, hypertension) events in 276 pregnancies. High-risk pregnancy was defined as a CARPREG II score of 4≤.
Results
High-risk pregnancy was detected in 14.1%. We found fetal and maternal events in 13.8% and 14.5% of all pregnancies, respectively, which both were more prevalent in the high-risk group (p<0.001). No maternal death occurred, whereas premature birth and abortion was detected in 7.6 and 2.9%, respectively, both complications were more frequent in the high-risk patient population as compared to the lower risk patients (30.8 vs. 7.2%, p<0.001). In univariate analysis, CARPREG II of 4≤ was significantly associated with fetal (p<0.001, OR: 4.2) and maternal (p<0.001, OR: 5.3) events. Risk factors of the CARPREG II were further analyzed using multivariate logistic regression analysis: prior cardiac events or arrhythmias (p=0.027) and cyanosis (p=0.026) were independent predictors of fetal complications. Left ventricular outflow tract obstruction (p<0.001), cardiac interventions (p=0.024) and prior cardiac events or arrhythmias (p=0.001) demonstrated significant association with maternal events.
Conclusion
The CARPREG II could help in the identification of high-risk pregnancies and thus aids the selection of patients for strict monitoring and special therapies. In line with previous studies we detected higher rates of fetal and maternal events among patients with CARPREG II of 4≤ score.
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Affiliation(s)
- S Pataki
- Gottsegen Gyorgy Hungarian Institute of Cardiology, Budapest, Hungary
| | - M Szegedi
- Gottsegen Gyorgy Hungarian Institute of Cardiology, Budapest, Hungary
| | - A Temesvari
- Gottsegen Gyorgy Hungarian Institute of Cardiology, Budapest, Hungary
| | - L Ablonczy
- Gottsegen Gyorgy Hungarian Institute of Cardiology, Budapest, Hungary
| | - P Andreka
- Gottsegen Gyorgy Hungarian Institute of Cardiology, Budapest, Hungary
| | - H Balint
- Gottsegen Gyorgy Hungarian Institute of Cardiology, Budapest, Hungary
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15
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Mladoniczky S, Szegedi M, Piroth ZS, Nemeth J, Ablonczy L, Andreka P, Temesvari A, Balint OH. P2267CTEPH patients long term follow-up: results from a single center. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0744] [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
Background
Chronic thromboembolic pulmonary hypertension (CTEPH) is a thrombotic pulmonary disease associated with pulmonary vasculopathy. Pulmonary endarterectomy (opus, PEA) is the first treatment choice in CTEPH, and specific PAH medication when there is a contraindication for surgery or residual pulmonary arterial hypertension (rPAH) occurs. In the presence of PAH balloon pulmonary angioplasty (BPA) might be also recommended if available.
Objective
We investigated the long term outcome of our CTEPH patients.
Methods
CTEPH from our institution retrospectively analyzed (data between 2003 and 2018). Baseline, treatment and outcome data were documented. We compared the outcome, together with mortality in those with and without surgery (PEA vs. non PEA group). NYHA class, 6 minutes walking distance (6MWD) and NT-proBNP were also reported during follow-up.
Results
Of 29 CTEPH patients (mean age was 62±19 years, 52% male) 16 (55%) were accepted for PEA, and further 12 of them had a long term follow-up post surgery (n=3 periop exit, n=1 waiting for surgery). Half of the PEA patients were cured (n=6) and the other half (n=6) required specific PAH treatment (n=1, in combination with BPA) for rPAH. All patients from the non-PEA group (n=13) were started on specific PAH treatment (n=1 in combination with BPA). Patients with or without PEA did not differ hemodynamically. At the late follow-up there was a significant improvement in PEA group for NYHA class and NT-proBNP (p<0,001, and p=0,046), and in non PEA group for NYHA class and the 6MWD (p=0,012, and 0,006). We found significant difference in mortality at 1,3,5 year (Kaplan-Meier survival analysis) follow-up, for PEA group 100%-100%-100% and non PEA group 100%-85%-78% (p=0,013), respectively.
Conclusions
55% of CTEPH patients were suitable for PEA, and those who survived the surgery 50% were cured. Non PEA patients improved functionally on the long term, but had worse survival.
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Affiliation(s)
| | - M Szegedi
- Gottsegen Gyorgy Hungarian Institute of Cardiology, Budapest, Hungary
| | - Z S Piroth
- Gottsegen Gyorgy Hungarian Institute of Cardiology, Budapest, Hungary
| | - J Nemeth
- Gottsegen Gyorgy Hungarian Institute of Cardiology, Budapest, Hungary
| | - L Ablonczy
- Gottsegen Gyorgy Hungarian Institute of Cardiology, Budapest, Hungary
| | - P Andreka
- Gottsegen Gyorgy Hungarian Institute of Cardiology, Budapest, Hungary
| | - A Temesvari
- Gottsegen Gyorgy Hungarian Institute of Cardiology, Budapest, Hungary
| | - O H Balint
- Gottsegen Gyorgy Hungarian Institute of Cardiology, Budapest, Hungary
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16
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Kohalmi DK, Szabo B, Takacs E, Andreka P, Balint OH, Temesvari A. P5452Pregnancy risk in women with severe aortic stenosis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5452] [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: 11/12/2022] Open
Affiliation(s)
- D K Kohalmi
- Gottsegen Gyorgy Hungarian Institute of Cardiology, Budapest, Hungary
| | - B Szabo
- Gottsegen Gyorgy Hungarian Institute of Cardiology, Budapest, Hungary
| | - E Takacs
- Gottsegen Gyorgy Hungarian Institute of Cardiology, Budapest, Hungary
| | - P Andreka
- Gottsegen Gyorgy Hungarian Institute of Cardiology, Budapest, Hungary
| | - O H Balint
- Gottsegen Gyorgy Hungarian Institute of Cardiology, Budapest, Hungary
| | - A Temesvari
- Gottsegen Gyorgy Hungarian Institute of Cardiology, Budapest, Hungary
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17
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Piroth Z, Ferenci T, Fontos G, Szonyi T, Nemeth J, Szoke S, Chaurasia AK, Andreka P. Five-year outcome of consecutive unprotected left main percutaneous coronary interventions. Acta Cardiol 2016; 71:654-662. [PMID: 27920452 DOI: 10.2143/ac.71.6.3178183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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18
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Koschutnik M, Ionin VA, Boeckstaens S, Zakhama L, Hinojar R, Chiu DYY, Kovacs A, Kochmareva EA, Saliba E, Stanojevic D, Aalen J, Chen XH, Zito C, Demerouti E, Smarz K, Krljanac G, Christensen NL, Cavalcante JL, Pal M, Magne J, Giannakopoulos G, Liu D, Chien CY, Moustafa TAMER, Schwaiger M, Zotter-Tufaro C, Aschauer S, Duca F, Kammerlander A, Bonderman D, Mascherbauer J, Zaslavskaya EL, Soboleva AV, Listopad OV, Malikov KN, Baranova EI, Shlyakhto EV, Van Der Hoogstraete M, Coltel N, De Laet N, Beernaerts C, Desmet K, Gillis K, Droogmans S, Cosyns B, Antit S, Herbegue B, Slama I, Belaouer A, Chenik S, Boussabah E, Thameur M, Masmoudi M, Benyoussef S, Fernandez-Golfin C, Gonzalez-Gomez A, Casas E, Garcia Martin A, Pardo A, Del Val D, Ruiz S, Moya JL, Barrios V, Jimenez Nacher JJ, Zamorano JL, Kalra PA, Green D, Hughes J, Sinha S, Abidin N, Muraru D, Lakatos BK, Surkova E, Peluso D, Toser Z, Tokodi M, Merkely B, Badano LP, Volkova AL, Rusina VA, Kokorin VA, Gordeev IG, Baudet M, Chartrand Lefebvre C, Chen-Tournoux A, Hodzic A, Tournoux F, Apostolovic S, Jankovic-Tomasevic R, Djordjevic-Radojkovic D, Salinger-Martinovic S, Kostic T, Tahirovic E, Dungen HD, Andersen OS, Gude E, Andreassen A, Aalen OO, Larsen CK, Remme EW, Smiseth OA, Xu HG, Liu FC, Zha DG, Cui K, Zhang AD, Trio O, Soraci E, Cusma Piccione M, D'amico G, Ioppolo A, Alibani L, Falanga G, Todaro MC, Oreto L, Nucifora G, Vizzari G, Pizzino F, Di Bella G, Carerj S, Boutsikou M, Perreas K, Katselis CH, Samanidis G, Antoniou TH, Karatasakis G, Zaborska B, Jaxa-Chamiec T, Maciejewski P, Bartoszewicz Z, Budaj A, Trifunovic D, Asanin M, Savic L, Matovic D, Petrovic M, Zlatic N, Mrdovic I, Dahl JS, Carter-Storch R, Bakkestroem R, Soendergaard E, Videbaek L, Moeller JE, Rijal S, Abdelkarim I, Althouse AD, Sharbaugh MS, Fridman Y, Han W, Soman P, Forman DE, Schindler JT, Gleason TG, Lee JE, Schelbert EB, Dekany G, Mandzak A, Chaurasia AK, Gyovai J, Hegedus N, Piroth ZS, Szabo GY, Fontos G, Andreka P, Cosyns B, Popescu BA, Carstensen HG, Dahl J, Desai M, Kearney L, Marwick T, Sato K, Takeuchi M, Zito C, Mohty D, Lancellotti P, Habib G, Noble S, Frei A, Mueller H, Hu K, Liebner E, Weidemann F, Herrmann S, Ertl G, Voelker W, Gorski A, Leyh R, Stoerk S, Nordbeck P, Tsai WC, Moustafa TAMER, Aldydamony MOHAMD, Aldydamony MOHAMD. Poster Session 5The imaging examination and quality assessmentP1064The natural course of heart failure with preserved ejection fraction (HFpEF) - insights from an exploratory echocardiographic registryP1065Epicardial fat and effectiveness of catheter radiofrequency ablation in patients with atrial fibrillation and metabolic syndromeP1066Systematic disinfection of echocardiographic probe after each examination to reduce the persistence of pathogens as a potential source of nosocomial infectionsP1067Left atrial mechanical function assessed by two-dimensional echocardiography in hypertensive patientsP1068Real live applications of three-dimensional echocardiographic quantification of the left ventricular volumes and function using an automated adaptive analytics algorithmP10693D echocardiographic left ventricular dyssynchrony indices in end stage kidney disease: associations and outcomesP1070Relative contribution of right ventricular longitudinal shortening and radial displacement to global pump function in healthy volunteersP1071ECHO-parameters, associated with short-term mortality and long-term complications in patients with pulmonary embolism of high and intermediate riskP1072Increased epicardial fat is an independent marker of heart failure with preserved ejection fraction.P1073Influence of optimized beta-blocker therapy on diastolic dysfunction determined echocardiographically in heart failure patientsP1074Early diastolic mitral flow velocity/ annular velocity ratio is a sensitive marker of elevated filling pressure in left ventricular dyssynchronyP1075Left ventricular diastolic function in STEMI patients receiving early and late reperfusion by percutaneous coronary intervention P1076Could anatomical and functional features predict cerebrovascular events in patients with patent foramen ovale?P1077Efficacy of endarterectomy of the left anterior descending artery: evaluation by adenosine echocardiography?P1078Left ventricular diastolic dysfunction after acute myocardial infarction with preserved ejection fraction is related to lower exercise capacityP1079Potentially predictors of ventricular arrhythmia during six months follow up in STEMI patientsP1080Association between left atrial dilatation and invasive haemodynamics at rest and during exercise in asymptimatic aortic stenosisP1081Cardiac amyloidosis and aortic stenosis - the convergence of two aging processes and its association with outcomesP1082Prognostic impact of initial left ventricular dysfunction and mean gradient after transcatheter aortic valve implantationP1083Distribution and prognostic significance of left ventricular global longitudinal strain in asymptomatic significant aortic stenosis: an individual participant data meta-analysisP1084Discrepancies between echocardiographic and invasive assessment of aortic stenosis in multimorbid elderly patientsP1085Echocardiographic determinants and outcome of patients with low-gradient moderate and severe aortic valve stenosis: implications for aortic valve replacementP1086Atrial deformation correlated with functional capacity in mitral stenosisP1087Net atrioventricular compliance can predict reduction of pulmonary artery pressure after percutaneous mitral balloon commissurotomy. Eur Heart J Cardiovasc Imaging 2016. [DOI: 10.1093/ehjci/jew262] [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: 11/14/2022] Open
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Andreka P, Nadhazi Z, Muzes G, Szantho G, Vandor L, Konya L, Turner MS, Tulassay Z, Bishopric NH. Possible therapeutic targets in cardiac myocyte apoptosis. Curr Pharm Des 2004; 10:2445-61. [PMID: 15320755 DOI: 10.2174/1381612043383908] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Since Kerr described programmed cell death (apoptosis) as a process distinct from necrosis, there have been many studies of apoptosis in disease, especially of immunological origin. Because cardiac myocytes are terminally differentiated cells, they have typically been assumed to die exclusively by necrosis. However, during the last decade this view has been challenged by several studies demonstrating that a significant number of cardiac myocytes undergo apoptosis in myocardial infarction, heart failure, myocarditis, arrhythmogenic right ventricular dysplasia, and immune rejection after cardiac transplantation, as well as in other conditions of stress. These are potentially relevant observations, because apoptosis--unlike necrosis--can be blocked or reversed at early stages. Specific inhibition of this process may confer a considerable degree of cardioprotection, but requires a thorough understanding of the underlying mechanisms. Recent progress includes a better understanding of the importance of mitochondria-initiated events in cardiac myocyte apoptosis, of factors inducing apoptosis in heart failure and during hypoxia, and of the dual pro-apoptotic and anti-apoptotic effects of hypertrophic stimuli such as beta-adrenoceptor agonists, angiotensin converting enzyme inhibitors, nitric oxide and calcineurin. The investigation of cytoprotective and apoptotic signal transduction pathways has revealed important new insights into the roles of the mitogen-activated protein kinases p38, extracellular signal regulated kinase and c-Jun N-terminal kinase in cardiac cell fate. Our present review focuses on the intracellular signal transduction pathways of cardiac myocyte apoptosis and the possibility of specific inhibition of the process.
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Affiliation(s)
- P Andreka
- Semmelweis University of Medicine, 2nd Department of Medicine, 46. Szentkiralyi Str., Budapest H-1088, Hungary.
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Abstract
Cardiac myocytes can undergo programmed cell death in response to a variety of insults and apoptotic elimination of myocytes from the adult myocardium can lead directly to cardiomyopathy and death. Although it remains to be shown that therapy specifically targeting apoptosis will improve the prognosis of ischemic heart disease or heart failure, a number of studies in the past year have shed light on potential ways to intervene in the process. Progress in the past year includes a better understanding of the importance of mitochondria-initiated events in cardiac myocyte apoptosis, of factors inducing apoptosis during hypoxia, and of the dual pro-apoptotic and anti-apoptotic effects of hypertrophic stimuli such as beta-adrenoceptor agonists, nitric oxide and calcineurin. Further evidence supports the pathophysiologic relevance of apoptosis in human heart disease. The tracking of cytoprotective and apoptotic signal transduction pathways has revealed important new insights into the roles of the mitogen-activated protein (MAP) kinases p38, extracellular signal regulated kinase (ERK) and c-Jun N-terminus kinase (JNK) in cardiac cell fate.
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Affiliation(s)
- N H Bishopric
- Department of Molecular and Cellular Pharmacology, University of Miami School of Medicine, Miami, Florida 33101, USA.
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Abstract
Nitric oxide (NO) induces apoptosis in cardiac myocytes through an oxidant-sensitive mechanism. However, additional factors appear to modulate the exact timing and rate of NO-dependent apoptosis. In this study, we investigated the role of mitogen-activated protein kinases (MAPKs) (extracellular signal-regulated kinase [ERK] 1/2, c-Jun N-terminal kinase [JNK] 1/2, and p38MAPK) in NO-mediated apoptotic signaling. The NO donor S:-nitrosoglutathione (GSNO) induced caspase-dependent apoptosis in neonatal rat cardiac myocytes, preceded by a rapid (<10-minute) and significant (approximately 50-fold) activation of JNK1/2. Activation of JNK was cGMP dependent and was inversely related to NO concentration; it was maximal at the lowest dose of GSNO (10 micromol/L) and negligible at 1 mmol/L. NO slightly increased ERK1/2 beginning at 2 hours but did not affect p38MAPK activity. Inhibitors of ERK and p38MAPK activation did not affect cell death rates. In contrast, expression of dominant-negative JNK1 or MKK4 mutants significantly increased NO-induced apoptosis at 5 hours (56.77% and 57.37%, respectively, versus control, 40.5%), whereas MEKK1, an upstream activator of JNK, sharply reduced apoptosis in a JNK-dependent manner. Adenovirus-mediated expression of dominant-negative JNK1 both eliminated the rapid activation of JNK by NO and accelerated NO-mediated apoptosis by approximately 2 hours. These data indicate that NO activates JNK as part of a cytoprotective response, concurrent with initiation of apoptotic signaling. Early, transient activation of JNK serves both to delay and to reduce the total extent of apoptosis in cardiac myocytes.
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Affiliation(s)
- P Andreka
- Department of Molecular and Cellular Pharmacology, University of Miami, FL, USA
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