43 research outputs found
Echocardiography in modern cardiology: diagnosis, prognosis and therapeutic guidelines
No full textEditorial comment Редакционен комента
Early Detection and Prediction of Cardiotoxicity - Biomarker and Echocardiographic Evaluation
No full textNon
Cardiac amyloidosis – an underestimated etiology for heart failure with preserved ejection fraction. A literary review
No full textСърдечната амилоидоза, доскоро приемана за рядко заболяване, е сериозна и прогресираща кардиомиопатия, отличаваща се с екстрацелуларно натрупване на неправилно нагънати протеини в камерния миокард. Диагностицирането на сърдечната амилоидоза в ранен етап е ключово за прогнозата на пациентите, предоставяйки именно тогава широк спектър от терапевтични възможности, свързани с подобряване на прогнозата и/или предотвратяване на потенциално необратима загуба на физическа функция и качеството на живот, като съвременните данни сочат, че по-голямата част от пациентите не получават навременна диагноза. Пациентите със сърдечна амилоидоза в ранен етап не показват редукция на левокамерната глобална систолна функция, но могат да развият симптоми на сърдечна недостатъчност със запазена фракция на изтласкване (HFpEF), като СА се счита за една от пренебрегваните етиологии на HFpEF при възрастни. Сърдечната амилоидоза е прогресивно заболяване с лоша прогноза, ако се остави без лечение. Средната продължителност на живот на нелекуваните пациенти с AL-сърдечна амилоидоза е по-малка от 6 месеца, а тази на пациентите с ATTR-CA е 2.5-3.5 години. Следователно ранната клинична идентификация е от съществено значение. Cardiac amyloidosis, once considered a rare disease, is a severe and progressive cardiomyopathy characterized by extracellular deposition of misfolded proteins in the ventricular myocardium. Early diagnosis of cardiac amyloidosis is essential for improving patient prognosis, as it allows for a broader range of therapeutic options that can enhance outcomes and/or prevent potentially irreversible loss of physical function and quality of life. Current data suggest that a majority of patients do not get a timely diagnosis. Patients with early-stage CA do not exhibit reduced global left ventricular systolic function but may develop symptoms of heart failure with preserved ejection fraction (HFpEF), with CA considered as one of the overlooked etiologies of HFpEF in the elderly. Cardiac amyloidosis is a progressive disease with a poor prognosis if left untreated. The average life expectancy of untreated patients with AL cardiac amyloidosis is less than 6 months, while that of patients with ATTR-CA is 2.5-3.5 years. Therefore, early clinical identifi cation is essential
Sleep disorders in patients with acute and exacerbated chronic heart failure
No full textHeart failure is often accompanied by sleep disorders. Continuous Positive Airway Pressure (CPAP) therapy has proven in the treatment of obstructive sleep apnea, but the benefits associated with comorbid patients and patients with heart failure is still under research. On the other hand, central sleep apnea is also with high frequency in these patients and more difficult to treat. The aim of the current publication is to make a brief review of acute and exacerbated chronic heart failure in patients with sleep disorders – frequency, severity, and types to treat
Revolutionizing cardiometabolic health: the dual power of GLP-1 receptor agonists and SGLT2 inhibitors: a review article
No full textМетаболитните нарушения като неалкохолна мастна чернодробна болест (NAFLD/NASH) и хронична сърдечна недостатъчност (ХСН) непрекъснато нарастват и с тях нараства необходимостта от комбинирани терапии. Промените в начина на живот са основният подход към метаболитните нарушения. Въпреки това употребата на агонисти на глюкагон-подобен пептид-1 рецептор (GLP1RA) и инхибитори на натриево-глюкозен котранспортер-2 (SGLT2) доказва все по-категорично подобряването на кардиометаболитния статус при пациенти със и без диабет. В настоящия обзор се фокусирахме върху проучвания с недиабетни метаболитни нарушения. Резултатите подчертават хепатопротективния ефект на GLP1RAs при хистологичното разделяне на NASH/NAFLD и подобрение в серумните чернодробни ензими. GLP1RAs, особено Liraglutide, помагат за намаляване на честотата на изпражненията при пациенти, страдащи от малабсорбция на жлъчни киселини. SGLT2 инхибиторите подобряват сърдечно-съдовите и бъбречните резултати и редуцират честотата на хоспитализация за сърдечна недостатъчност, независимо от диабетния статус. GLP1RA намалява телесната маса и съдовото възпалението. В заключение, най-актуалните проучвания по съответните теми показват, че GLP1RA и SGLT2 инхибиторите имат обещаващи системни благопри-ятни ефекти върху пациенти с метаболитни нарушения със или без захарен диабет тип 2. In a world where metabolic disorders such as non-alcoholic fatty liver disease (NAFLD/NASH) and chronic heart failure (CHF) steadily increase, the limitations of current therapies become even more apparent. Lifestyle changes have been the primary approach to metabolic disorders. However, the new use of glucagon-like peptide-1 receptor agonists (GLP1RA) and sodium-glucose cotransporter-2 (SGLT2) – inhibitors seem to present a breakthrough in improving the outcome of metabolic disorders in diabetic and non-diabetic patients. In the current review, we focused on studies with non-diabetic metabolic disorders. The results underlined the hepatoprotective effect of GLP1RAs on the histological resolution of NASH/NAFLD and improved serum liver enzyme. GLP1RAs, especially Liraglutide, also seem benefi cial in reducing stool frequency in patients suffering from bile acid malabsorption (BAM). SGLT2 inhibitors improve cardiovascular and renal outcomes and decrease the hospitalization rate for heart failure, regardless of the diabetes status. GLP1RA reduce body mass and infl ammation . In conclusion, the most up-to-date studies on the respective topics show that GLP1RAs and SGLT2 inhibitors have promising systemic benefi cial effects on patients with metabolic disorders with or without type 2 diabetes mellitus
Torsion Mechanics as an Indicator of More Advanced Left Ventricular Systolic Dysfunction in Secondary Mitral Regurgitation in Patients with Dilated Cardiomyopathy: A 2D Speckle-Tracking Analysis
No full textLeft ventricular (LV) twist serves as a compensatory mechanism in systolic dysfunction and its degree of reduction may reflect a more advanced stage of disease. <b><i>Aim:</i></b> The aim was to investigate twist alterations depending on the degree of functional mitral regurgitation (MR) by speckle-tracking echocardiography. <b><i>Methods:</i></b> Sixty-three patients with symptomatic dilated cardiomyopathy (DCM) were included. Patients were divided according to MR vena contracta width (VCW): group 1 with VCW &#x3c;7 mm (mild/moderate MR) and group 2 with VCW ≥7 mm (severe MR). <b><i>Results:</i></b> There were no differences in LV geometry and function between groups. Group 2 showed lower endocardial basal rotation (BR) (–2.04° ± 1.83° vs. –3.23° ± 1.83°, <i>p</i> = 0.012); epicardial BR (–1.54° ± 1.18° vs. –2.31° ± 1.22°, <i>p</i> = 0.015); endocardial torsion (0.41°/cm ± 0.36°/cm vs. 0.63°/cm ± 0.44°/cm, <i>p</i> = 0.033) and mid-level circumferential strain (CSmid) (–6.12% ± 2.64% vs. –7.75% ± 2.90%, <i>p</i> = 0.028), when compared with group 1. Multivariable linear regression analysis identified endocardial BR, torsion and CSmid, as the best predictors of larger VCW. In the ROC curve analysis, endocardial BR and CSmid values greater than or equal to –3.63° and –9.35%, respectively, can differentiate patients with severe MR. <b><i>Conclusions:</i></b> In DCM patients, torsional profile was more altered in severe MR. Endocardial BR, endocardial torsion, and CSmid, can be used as indicators of advanced structural wall architecture damage.</jats:p
Complete Left-Sided Pericardial Congenital Absence
No full textBackground: Congenital absence of pericardium is a rare cardiac disorder with a reported incidence of less than 1 in 10,000. Although most of the cases are of little clinical significance, some of them are associated with serious complications, including risk of herniation and strangulation or coronary artery compression. Detailed Case Description: We report a case of a 36-year-old male referred for routine cardiovascular examination. He had a medical history of a heart murmur since childhood. Electrocardiogram (ECG) revealed sinus rhythm, normal axis, poor R-wave progression in the precordial leads and repolarization abnormalities with negative T waves in leads V1–V4. On 2D transthoracic echocardiography (TTE), an unusual heart position was noted with poor image quality from the standard acoustic windows. The parasternal long axis view gave the impression of right ventricular dilatation. The findings raised the suspicion of left to right shunt and possible atrial septal defect. For further evaluation, the patient was referred for cardiac magnetic resonance which demonstrated complete left-sided absence of the pericardium. Discussion: Due to indistinct and atypical symptoms and lack of clinical awareness, pericardial congenital absence is frequently misdiagnosed. Patients may complain of atypical chest pain. Patient’s history and physical examination are often nonspecific. In cases with complete pericardial absence, ECG findings may include right axis deviation, right bundle block and sinus bradycardia. Echocardiography findings are also not characteristic, but some may raise the clinical suspicion of this diagnosis. The imaging modalities of choice are computed tomography and cardiac magnetic resonance. Treatment depends on the type of defect and clinical symptoms
Heart failure due to apical intramyocardial dissecting hematoma and compressing pleural hematoma in polytraumatic patient
No full textAtrial cardiomyopathy in postmenopausal female healthcare professionals – a single-center study
No full textВъведение: Добре проучено е разпространението на затлъстяването и хипертонията сред здравните работници. И двете заболявания са известни като рискови фактори за предсърдна кардиомиопатия (ПКМП) – нова клинична единица с потенциал да предизвиква сърдечна недостатъчност, предсърдно мъждене и тромбоемболични усложнения. В тази връзка е необходимо планирането на превантивни стратегии и интервенции при тази специфична популация. Цел: Да се дефинира ПКМП при здравни работници от женски пол в менопауза. Материал и методи: Сто и пет жени на средна възраст, здравни работници, разделени в три групи: с централно затлъстяване (n = 50, 47%), със затлъстяване и хипертония (n = 24, 23%) и здрави контроли (n = 31, 30%), преминаха през ехокардиографско изследване с волуметричен и speckle tracking анализ. Резултати: Установиха се значителни разлики в обемите на лявото предсърдие (ЛП) между трите групи. Фазовата функция на ЛП беше значително намалена, а stiffness индексът значително увеличен при групите със затлъстяване. По-високият индекс на телесната маса беше свързан с увеличен индексиран максимален обем на ЛП (p < 0.001, r = 0.56) и редуциран пиков лонгитудинален стрейн на ЛП (p < 0.001, r = -0.59) и пиков контрактилен стрейн на ЛП (p < 0.001, r = -0.56). Заключение: Здравните работници от женски пол в менопауза със затлъстяване и хипертония са в риск от асимптомна ПМКП. Необходими са допълнителни изследвания за потвърждаване на тази концепция. Background: The prevalence of obesity and hypertension among healthcare professionals has been previously described. Both diseases are known risk factors for atrial cardiomyopathy (ACM), a new clinical entity with potential to be a determinant of heart failure, atrial fi brillation and thromboembolic complications. In this perspective, early preventive strategy should be initiated in this special population. Aim: To defi ne ACM in middle-aged women healthcare professionals. Material and methods: Hundred and fi ve middle-aged women healthcare professionals, separated in 3 groups: with central obesity (n = 50,47%), obesity and hypertension (n = 24,23%), healthy control (n = 31,30%), underwent echocardiographic examination with volumetric and speckle-tracking analysis. Results: There were signifi cant differences in LA volumes between 3 groups. LA phasic function was signifi cantly reduced, and LA stiffness index was signifi cantly increased in obese groups compared to control. Higher body mass index was associated with increased LA volume index (p < 0.001, r = 0.56) and with reduced Peak atrial longitudinal strain (p < 0.001, r = -0.59) and Peak atrial contractile strain (p < 0.001, r= -0.56). Conclusion: Postmenopausal women, healthcare professionals with obesity and hypertension are at risk for asymptomatic ACM. Further investigations are needed to confi rm this concept
