Showing papers by "Adam Torbicki published in 1999"

Proximal pulmonary emboli modify right ventricular ejection pattern

Abstract: Analysis of the systolic flow velocity curve (SFVC) in the right ventricular outflow tract is considered as an alternative to the tricuspid valve pressure gradient (TVPG) method for echo-Doppler assessment of pulmonary arterial pressure (P(pa)). The present study checked whether or not SFVC is affected by the cause of pulmonary hypertension. Doppler recordings of 86 patients (39 female, aged 55.5+/-15.2 yrs) with acute (AP-PE) or chronic (CP-PE) proximal pulmonary embolism, chronic obstructive pulmonary disase (COPD) or primary pulmonary hypertension (PPH) were retrospectively analysed by two observers unaware of the purpose of the study. Despite having the lowest TVPG (48+/-13 mmHg), patients with AP-PE had the shortest acceleration time (t(acc); 56+/-15 ms) and time to midsystolic deceleration (t(msd); 105+/-16 ms). t(acc)

Imaging venous thromboembolism with emphasis on ultrasound, chest CT, angiography and echocardiography.

Abstract: Introduction: The clinical diagnosis of venous thromboembolism (VTE) is difficult and sometimes unreliable. Pulmonary angiography and contrast venography are used as reference tests for pulmonary embolism (PE) and deep vein thrombosis (DVT), respectively.1,2 However, due to the invasive nature of these reference tests, the optimal and clinically acceptable diagnosis of VTE remains a matter of some debate. Until recently, standard diagnostic strategy in suspected pulmonary embolism (PE) consisted of a lung perfusion scan, followed by venous ultrasound (VUS), if a lung perfusion scan did not produce a definitive diagnosis. Eventually, pulmonary angiography was performed.3,4 In clinical practice, this strategy has rarely been respected because it required many pulmonary angiographic examinations. Diagnostic management was often halted prematurely without performing pulmonary angiography and, thus, without final confirmation or exclusion of PE.5-7 In addition, suspected DVT is often managed only on the basis of single VUS examination, which, unfortunately, has a relatively low sensitivity when used to visualize the vasculature below the knee.8 This chapter focuses on newer, noninvasive diagnostic tests that permit direct imaging of venous thromboemboli. While the place of those tests in diagnostic algorithms remains to be fully determined, they may already be helpful in simplifying the diagnostic management of patients in many clinical situations, including those patients at high-risk of venous thromboembolism. These patients represent a non-homogeneous group, such as patients with recent major surgery, serious medical diseases, or a concomitant history of VTE or thrombophilia. According to a recent consensus statement, screening for VTE is technically possible, but, in the presence of effective prophylaxis, neither was demonstrated to be necessary or cost effective.9 Therefore, the main effort should be focused on effective diagnostic management of those patients who present with symptoms and/or signs suggestive of VTE.

[Should sinus rhythm be restored in patients with chronic atrial fibrillation? Preliminary results from the Polish "Hot Cafe" study].

Abstract: Atrial fibrillation (AF) is the most common arrhythmia occurring in clinical practice. It is the most frequent cause of hospitalization in cardiac rhythm disturbance. Despite comprehensive progress in the research into electrophysiological mechanisms leading to this loss of normal rhythm and new procedures dealing with it, the main problem being the conversion to and maintaining the normal sinus rhythm (SR) has not been solved. The polish study "Hot Cafe" is trying to evaluate the advantages and risks of the two procedures widely used in clinical practice in patients (pts) with chronic AF, i.e. conversion and maintaining SR vs leaving pts with the arrhythmia. Pts with non-valvular chronic AF fulfilling the criteria for including them into the sample are randomly assigned to two procedures: conversion to SR by means of direct current cardioversion and maintaining it or leaving pts with AF. Pts left with AF are treated by rate control and antithrombotic treatment. The project is of prospective kind and it will be carried out by many medical institutions. It is planned to include 200 pts. The observation period will last at least 12 months. Preliminary results after inclusion of the first 121 pts are shown.