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Background According to European guidelines, alcohol septal ablation (ASA) for hypertrophic obstructive cardiomyopathy (HOCM) may be less effective in patients with extensive septal scarring on cardiac magnetic resonance (CMR). This study aimed to analyze the impact of late gadolinium enhancement (LGE) on CMR on the effectiveness of ASA. Method We conducted an observational retrospective study involving adult patients with symptomatic drug-refractory HOCM who underwent CMR before ASA at two European centres from May 2010 through June 2019. Patients were compared in binary format based on LGE presence. Moreover, a subanalysis focused on patients with septal fibrosis was performed. The effectiveness of ASA was evaluated by echocardiographic, ECG and clinical findings. Results Of the 113 study patients, 54 (48%) had LGE on CMR. The LGE quantification performed in 29 patients revealed septal fibrosis in 17. The mean follow-up was 4.4 ± 2.6 years. Baseline parameters were similar between groups except for basal septal thickness that was greater in LGE+ group (21.1 ± 3.9 mm for LGE+ vs. 19.2 ± 3.2 mm for LGE-: p = .005). ASA improved symptoms in all groups and reduced left ventricular outflow tract obstruction (LVOTO) (delta gradient reduction: LGE+: 62 ± 37.3%; septal LGE+: 75.6 ± 20.8%; LGE-: 72.5 ± 21.0%). However, 13% of the LGE+ and 2% of the LGE- group had residual LVOTO above 30 mmHg (p = .027). Conclusion ASA was effective in all patients with HOCM, whether they had LGE on CMR or not and whether they had septal fibrosis or not.

Background: Cardiovascular surgery is confronted by a lack of suitable materials for patch repair. Acellular animal tissues serve as an abundant source of promising biomaterials. The aim of our study was to explore the bio-integration of decellularized or recellularized pericardial matrices in vivo. Methods: Porcine (allograft) and ovine (heterograft, xenograft) pericardia were decellularized using 1% sodium dodecyl sulfate ((1) Allo-decel and (2) Xeno-decel). We used two cell types for pressure-stimulated recellularization in a bioreactor: autologous adipose tissue-derived stromal cells (ASCs) isolated from subcutaneous fat of pigs ((3) Allo-ASC and (4) Xeno-ASC) and allogeneic Wharton’s jelly mesenchymal stem cells (WJCs) ((5) Allo-WJC and (6) Xeno-WJC). These six experimental patches were implanted in porcine carotid arteries for one month. For comparison, we also implanted six types of control patches, namely, arterial or venous autografts, expanded polytetrafluoroethylene (ePTFE Propaten® Gore®), polyethylene terephthalate (PET Vascutek®), chemically stabilized bovine pericardium (XenoSure®), and detoxified porcine pericardium (BioIntegral® NoReact®). The grafts were evaluated through the use of flowmetry, angiography, and histological examination. Results: All grafts were well-integrated and patent with no signs of thrombosis, stenosis, or aneurysm. A histological analysis revealed that the arterial autograft resembled a native artery. All other control and experimental patches developed neo-adventitial inflammation (NAI) and neo-intimal hyperplasia (NIH), and the endothelial lining was present. NAI and NIH were most prominent on XenoSure® and Xeno-decel and least prominent on NoReact®. In xenografts, the degree of NIH developed in the following order: Xeno-decel > Xeno-ASC > Xeno-WJC. NAI and patch resorption increased in Allo-ASC and Xeno-ASC and decreased in Allo-WJC and Xeno-WJC. Conclusions: In our setting, pre-implant seeding with ASC or WJC had a modest impact on vascular patch remodeling. However, ASC increased the neo-adventitial inflammatory reaction and patch resorption, suggesting accelerated remodeling. WJC mitigated this response, as well as neo-intimal hyperplasia on xenografts, suggesting immunomodulatory properties.

Abstract. Background: Treating great and small saphenous vein trunk insufficiency with cyanoacrylate glue is the least taxing treatment method of all available techniques. Due to long-term unavailability of commercial kits with n-butyl-2-cyanoacrylate (histoacryl) in the Czech Republic, we used a modified technique. Patients and methods: Fifty-six limbs in 49 patients suffering from great saphenous vein or small saphenous vein insufficiency in combination with symptomatic chronic venous insufficiency and complicating comorbidities were treated with a modified endovascular cyanoacrylate glue application technique. Results: The immediate success rate of the treatment was 98 %. In follow-up intervals of six weeks, six months, one year, and two years, the anatomical success rates of embolization (recanalization of no more than 5 cm of the junction) were 98, 96, 94, and 94 %, respectively. At identical intervals the venous insufficiency was scored according to the Aberdeen Varicose Vein Questionnaire and the American Venous Clinical Severity Score. In both cases, improvement was demonstrated over the two-year follow-up, with a 0.5 % significance level. Specific clinical signs of venous insufficiency were also evaluated, such as pain, oedema, clearance of varicose veins, and healing of venous ulceration. One severe complication – a pulmonary embolism – was reported, without consequences. Conclusions: We demonstrated that treating insufficient saphenous veins with modified histoacryl application brought a relief from symptoms of venous insufficiency and that the efficiency of this technique is comparable to commonly used methods.

Myocardial diseases are often encountered in cardiology and pose a significant diagnostic challenge. Myocarditis is an acute inflammatory disease of the heart muscle. Pathophysiology of myocarditis is a complex interplay of genetic background, innate immunity, viral or bacterial agents and formation of autoreactive antibodies and lymphocytes that maintain the inflammation after the infection was eliminated. Differentiation of myocardial infarction or heart failure of different etiology is crucial in the acute stage. Cardiac magnetic resonance imaging (MRI) enables with sufficient sensitivity and specificity diagnosis of myocardial inflammation and scar. Endomyocardial biopsy (EMB) with histology and immunohistochemistry is a gold standard for detection of myocarditis. EMB is indicated in selected patients with life-threatening symptoms where EMB may have therapeutic consequences. Giant cell myocarditis and eosinophilic myocarditis are specific examples of such a condition. Polymerase chain reaction (PCR) of the myocardial sample is used to detect viral genome. Serum antibodies or PCR from blood are not helpful in determining the etiology of myocarditis. Viral presence in myocardium is found in patients who do not have histological evidence of myocarditis which makes the association of positive PCR and etiology of myocarditis obscure. Cardiomyopathies (CMP) are characterized by structural and functional cardiac abnormalities that cannot be explained by coronary artery disease or abnormal loading conditions (valvular disease, arterial hypertension, congenital heart disease). CMP are classified based on the prevailing morphology regardless of primary (genetic, idiopathic) or secondary (systemic disease) etiology. European Society of Cardiology defines five types of CMP: hypertrophic, dilated, restrictive, arrhythmogenic and unclassified. CMP diagnosis is based on the imaging with echocardiography, coronary angiography, invasive hemodynamics and cardiac MRI. EMB is rarely indicated in dilated or restrictive CMP. Genetic testing is used to determine pathogenic mutations in phenotype positive patients and in familiar screening. Genetically determined CMP are mostly monogenic and autosomal dominant. Incomplete penetrance and variable expressivity cause variable or even negative phenotypes in genotype positive individuals. Genetic screening of a large number of genes and non-coding DNA results in findings of many variants of uncertain significance which make the interpretation of the genetic testing difficult.

Background The presence and extent of ventricular dyssynchrony are currently assessed from the QRS complex morphology and width. However, similar electrocardiography (ECG) pattern may be caused by variable ventricular activation sequence. This may then contribute to interindividually different response to cardiac resynchronization therapy (CRT). Methods Electroanatomical mapping and magnetic resonance imaging scan were performed in 11 patients with left bundle branch block (LBBB, QRS 170 ± 14 ms) and heart failure of ischemic (coronary artery disease (CAD), n = 2) and nonischemic (dilated cardiomyopathy (DCM), n = 9) etiology. Ventricular activation sequence was studied during LBBB and final CRT programming. Presence and extent of scarring were analyzed in the 17-segment left-ventricular (LV) model. Results Regardless of etiology, presence of typical LBBB was associated with diffuse prolongation of impulse conduction with right-to-left activation sequence. Basal lateral wall was constant site of late activation. This activation pattern was present in "true LBBB," but also in LBBB-like pattern (persistent S wave in V5-6) and left axis deviation. Activation started in right vetricular (RV) apex in patients with left axis deviation at RV free wall in normal axis. Individuals with CAD and DCM patient displayed focal scar. Despite that they exhibited typical LBBB and activation sequence mirrored findings in other LBBB individuals. Reverse remodeling (∆LVESV > 15% after 6 months) was evident in 10 patients. Conclusions Both typical LBBB and LBBB-like pattern might be associated with constant activation sequence regardless of etiology and scar localization. Activation initiation in RV apex, not LV activation sequence can be surrogate for left axis deviation. CRT caused inter- and intraventricular LV resynchronization without significantly changed RV activation sequence and duration.

Background Dyssynchronous activation of the heart is a prerequisite for cardiac resynchronization (CRT) efficacy. Although the main goal of CRT is to resynchronize ventricular contraction, our abilities to quantify mechanical dyssynchrony are still limited. However, so called “internal stretch fraction” (ISF) might serve as a marker of global discoordination of ventricular contraction. Methods and aim of the study Thirty-six CRT candidates and 7 healthy controls underwent MRI scanning. Feature tracking data (in short axis) were analysed using Segment software and cicrumferential strain (S)/ strainrate (SR) was obtained for each of the 16 left-ventricular (LV) segments. ISF was calculated as an extent of stretch (product of number of stretched regions and their mean amount of stretch, integrated over given time period; ie. area under the positive part of the global SR curve) in relation to the extent of shortening (area under the negative part of the global SR curve) in 6 basal LV segments during the ejection time (ET). The onset and end of ejection for ISF calculation were set from the global S curve (obtained by the averaging of S curves in 6 basal LV segments). For flow-derived ISF (FISF) parameter, ET was defined from the MRI-flow through pulmonic and aortic valve (Fig-1). Higher ISF and FISF marks more ineffective ventricular contraction. Aim of our study was to assess the ability of ISF and FISF to distinguish healthy controls from CRT candidates and to predict CRT responders (↓LVESV>15% after 6 months of CRT). Results ISF and FISF were significantly higher in CRT candidates than in healthy controls, greater difference between the two groups exhibited FISF (Fig-2). There were 37% of nonresponders among CRT recipients. Both parameters (ISF and FISF) were higher in future CRT responders. Cut-off value discriminating CRT responders from CRT nonresponders was >0,045 for ISF and >0,174 for FISF, however FISF had higher sensitivity than ISF (Fig-3; sensitivity 71% (ISF) versus 79% (FISF) and specificity 70% for both ISF and FISF). Conclusion Internal stretch fraction might be a useful parameter for selection of patients with discoordinated ventricular contraction who might profit from CRT. Higher sensitivity of FISF compared to ISF may be explained by the fact that ET derived from global S curve reflects only part of the ejection phase whereas FISF describes presence of ventricular discoordination in the entire ejection phase. Acknowledgement/Funding Supported by Ministry of Health of the Czech Republic, grant nr. 15-31398A. All rights reserved.

Hypertension is known to be a strong risk factor for coronary atherosclerosis. We aimed to investigate the prevalence, severity, and plaque characteristics of coronary atherosclerosis according to grade of blood pressure (BP) using coronary CT angiography (CCTA) in asymptomatic adults. We enrolled 8,238 asymptomatic subjects who underwent coronary artery calcium scoring (CACS) and CCTA for health screening purposes. Subjects were classified according to JNC 7 guidelines (normal, systolic BP/diastolic BP 120/80; pre-hypertension [PH], 120-139/80-89; hypertension stage 1 [H1], 140-159/90-99; hypertension stage 2 [H2],160/100). Isolated systolic hypertension (ISH; systolic BP 140, diastolic BP 80) was additionally categorized. With CCTA, the presence of plaques, severity of stenosis, and plaque types were assessed. Using multiple logistic regression analysis, the adjusted odds ratios (AORs) for plaque, obstructive coronary artery disease (CAD) (luminal stenosis ≥50 %), non-calcified plaque (NCP), and CACS 100 were assessed according to BP grade. After adjustment for clinical risk factors, the risk of subclinical atherosclerosis, NCP, and CACS 100 gradually increased from PH stage (all P values for trend0.05), while the risk of obstructive CAD increased from the H1 stage (AORs of H1 and H2: 1.70 and 2.33, respectively). In the ISH group, the AOR of subclinical atherosclerosis (1.64) was higher than in the H1 group (1.55), while the AOR of obstructive CAD (2.58) was higher than in the H2 group (2.33). Therefore, our study strongly suggests that coronary atherosclerosis in asymptomatic adults shows a grade-response relationship according to hypertension grade.

Introduction The aim of this prospective study was to evaluate the diagnostic accuracy of dual-source computed tomography coronary angiography (CTCA) compared to intravascular ultrasound (IVUS) for the detection of restenosis in patients who underwent coronary stenting for bifurcation left main (LM) stenosis. Material and methods Twenty-four patients underwent percutaneous intervention of the LM and were subsequently examined (median 9.2 months after procedure) using IVUS and CTCA for the detection of restenosis. Results Significant restenosis was detected according to IVUS examination in 6 patients (25%) and 8 segments (13%). Based on segment analysis, sensitivity, specificity, positive and negative predictive values of CTCA for the detection of restenosis were 89%, 68%, 32%, 97%, respectively. There was moderate to good correlation between the minimal luminal area (MLA), measured by CTCA and IVUS for LM, the left anterior descending artery (LAD) and the left circumflex artery (LCx) (r=0.64, p

Computed tomography (CT) angiography can augment conventional coronary angiography relative to length of vessel occlusion and quality of distal run-off. In this case report we describe the significance of CT angiography in the revascularization decision-making process of a patient following occlusion of both coronary artery bypass grafts.

Anomalous origin of the right coronary artery from the contralateral aortic sinus is a rare but potentially fatal congenital abnormality. We analyzed 8.066 consecutive coronary angiograms and found 4 cases demonstrating this anomaly. In 2 cases the right coronary artery was without significant atherosclerotic lesions and coursed between the aorta and pulmonary trunk. In the 2 other cases the right coronary artery was significantly stenosed. In the last case, diagnosis was based on angiographic and dual-source computed tomographic examinations. Dual-source computed tomography showed precisely the origin and course of the right coronary artery between the ascending aorta and pulmonary artery. Moreover, stenoses of the anomalous coronary artery were depicted. Subsequent coronary interventions required modification of the Amplatz left guiding catheter, which enabled a sufficient support even for coronary artery stenting. Both methods seem to be complementary in the diagnostic and therapeutic process of this coronary anomaly.

Objectives: The purpose of this longitudinal study was to assess hemodynamics and exercise capacity in patients after Senning operation and to determine its limiting factors. Methods: 87 long-term survivors of the Senning operation for transposition of great arteries were recruited for a longitudinal follow-up study consisting of two cross-sectional evaluations at a mean of 12.6 and 22.6 years after surgery, respectively. The protocol included a questionnaire, echocardiography, radionuclide angiocardiography, magnetic resonance imaging and cardiopulmonary exercise test. Decreased exercise capacity was defined as maximum oxygen uptake

Four diagnostic modalities are used to image the following internal carotid artery: digital subtraction angiography (DSA), duplex ultrasound (DUS), computed tomography angiography (CTA), and magnetic resonance angiography (MRA). The aim of this article is to describe the potentials of these techniques and to discuss their advantages and disadvantages. Invasive DSA is still considered the gold standard and is an indivisible part of the carotid stenting procedure. DUS is an inexpensive but operator-dependent tool with limited visibility of the carotid artery course. Conversely, CTA and MRA allow assessment of the carotid artery from the aortic arch to intracranial parts. The disadvantages of CTA are radiation and iodine contrast medium administration. MRA is without radiation but contrast-enhanced MRA is more accurate than noncontrast MRA. The choice of methods depends on the clinical indications and the availability of methods in individual centers. However, the general approach to patient with suspected carotid artery stenosis is to first perform DUS and then other noninvasive methods such as CTA, MRA, or transcranial Doppler US.

A 53-year-old woman, nonsmoking patient, with a history of surgically corrected anomalous origin of the right coronary artery from the pulmonary artery 17 years prior to admission, presented to our department complaining of mild, left-sided exertional chest pain for the past 3 months. She underwent a computed tomography examination of the heart and coronary angiography revealing postsurgical changes to the coronary vasculature and severe stenosis of the left circumflex artery, which was successfully treated by percutaneous stent implantation.

A 59-year-old hypertensive male, 1 year after uncomplicated mitral annuloplasty for regurgitation with MAZE procedure, with a history of chronic obstructive pulmonary disease and repeated pulmonary embolism, returned to our intensive care unit for a transient episode of dyspnoea and chest pain, which quickly subsided on treatment. Echocardiography revealed a bizarre pulsating sac in …