Béla Merkely

A szervtranszplantáció folyamata kihívásokkal teli, speciális út mind az érintettek, mind hozzátartozóik számára. A pszichoszociális tényezőkről közel fél évszázada tudjuk, hogy jelentősen befolyásolják a transzplantációs folyamatot. A szívtranszplantált populáció gondozása során a recipiens együttműködése (adherencia) nélkülözhetetlen, ennek egyik befolyásoló faktora a társas támogatás. Számos más betegcsoportban alkalmaznak sorstársi támogatásra épülő intervenciókat, úgynevezett sorstársi mentorprogramokat. Ezek fő céljai az ellenőrzött információátadás, valamint a lelki támogatás. Összefoglaló közleményünk célja a sorstársi mentorprogramokról szóló nemzetközi publikációk áttekintése a felnőtt-szívtranszplantációs programok gyakorlatában. Orv Hetil. 2024; 165(10): 379–384.

Methods: Consecutive severe AS (AVA≤ 1 cm 2) patients, who underwent CT angiography before transcatheter aortic valve implantation (TAVI) between March 2016 and April 2019 were retrospectively enrolled. In LGAS, the severity of AS was assessed by a multiparametric algorithm. To specify the predictors of low AVCS among patients with severe HGAS, logistic regression analysis was used. Patients were followed for 50 months. Kaplan-Meyer curves of all-cause mortality were used to visualize and compare the cumulative outcomes between groups.

Frailty is a complex clinical syndrome associated with aging and comorbidities, which correlates with unfavorable outcomes. However, in heart failure patients, frailty is very common, data is scarce about those, who are eligible for Cardiac Resynchronization Therapy (CRT) implantation. We investigated the incidence of frailty and the association of Frailty Index (FI) with the outcome. Thirty baseline clinical parameters were used by the Rockwood cumulative deficit method to determine patients' FI in our single-center cohort. Based on previous studies, patients with FI≤ 0.210 were considered as non-frail, those with FI 0.10–0.210 were classified in Frail-1, with FI> 0.10 in Frail-2 groups, respectively. Echocardiographic response after 12 months and all-cause mortality were investigated by frailty groups. Among 1004 included patients, 75 (7%) were considered Non-frail, 271 (27%) grouped in Frail-1, and 658 (66%) in …

The aim of this study was to characterize the right ventricular (RV) contraction pattern and its associations with exercise capacity in a large cohort of adolescent athletes using resting three-dimensional echocardiography (3DE). We enrolled 215 adolescent athletes (16±1 years, 169 males, 12±6 hours of training/week) and compared them to 38 age- and sex-matched healthy, sedentary adolescents. We measured the 3DE-derived biventricular ejection fractions (EF). We also determined the relative contributions of longitudinal EF (LEF/RVEF) and radial EF (REF/RVEF) to the RVEF. Same-day cardiopulmonary exercise testing was performed to calculate VO2/kg. Both LV and RVEFs were significantly lower (athletes vs controls; LVEF: 57±4 vs 61±3, RVEF: 55±5 vs 60±5%, p<0.001). Interestingly, while the relative contribution of radial shortening to the global RV EF was also reduced (REF/RVEF: 0.40±0.10 vs 0.49±0 …

De novo versus upgrade cardiac resynchronization therapy: A different patient population and outcome? - Abstract - Europe PMC Sign in | Create an account https://orcid.org Europe PMC Menu About Tools Developers Help Contact us Helpdesk Feedback Twitter Blog Tech blog Developer Forum Europe PMC plus Search life-sciences literature (43,488,775 articles, preprints and more) Search Advanced search Feedback This website requires cookies, and the limited processing of your personal data in order to function. By using the site you are agreeing to this as outlined in our privacy notice and cookie policy. Abstract Full text De novo versus upgrade cardiac resynchronization therapy: A different patient population and outcome? Merkely B 1 , Kosztin A 1 Author information Affiliations 1. Heart and Vascular Center, Semmelweis University, Budapest, Hungary. (2 authors) European Journal of Heart Failure, 18 Jan …

Background: Feature tracking strain analysis allows for a comprehensive understanding of the intricate mechanics of the heart without the need for additional sequences or extended image acquisition durations. We assessed the relationship between functional, including strain parameters, of the left atrium (LA) and right atrium (RA) with sports activity and demographic traits in a voluminous group of competitive athletes and controls.Methods: We retrospectively analysed native CMR cine images obtained from 2009 to 2021 at a tertiary centre. We utilised Medis Suite (v4. 0) to analyse standard two-chamber and four-chamber long-axis cine sequences. Images exhibiting foreshortening or apparent planning errors were excluded. Subsequently, all subjects were divided into four groups based on their weekly training durations, categorised as< 6, 6-10, 11-20, and 21 hours or more.Results: We performed CMR on 596 …

In the abstract of the article cited above, the clinical trial number for DISCHARGE (NCT02400229) was inadvertently omitted. The abstract has been revised to include the ClinicalTrials.gov identification. The editors apologize for the error. The online version of the article (https://doi.org/10.2337/dc23-0710) has been updated to correct the error.

Background3D echocardiography (3DE)-derived left and right ventricular ejection fractions (LVEF and RVEF) are known to have incremental value over 2D echocardiographic indices. We aimed to apply deep learning (DL) for predicting 3DE-derived LVEF and RVEF from 2D apical 4-chamber (A4C) view videos and assess the predictions’ associations with all-cause mortality in a community-based cohort.MethodsWe trained and internally validated two separate spatiotemporal convolutional neural networks using 3,583 A4C videos from 944 echocardiographic studies to predict 3DE-derived LVEF and RVEF. To enhance performance, we applied contrastive learning to pre-train both models on 28,441 A4C videos from 15,734 studies. Lastly, we evaluated the models on a low-risk, community-based cohort (1,734 A4C videos of 1,456 individuals) with a 10-year follow-up to investigate the associations between the …

BackgroundIn the STEP-HFpEF (NCT04788511) and STEP-HFpEF DM (NCT04916470) trials, the GLP-1 receptor agonist semaglutide improved symptoms, physical limitations, bodyweight, and exercise function in people with obesity-related heart failure with preserved ejection fraction. In this prespecified pooled analysis of the STEP-HFpEF and STEP-HFpEF DM trials, we aimed to provide a more definitive assessment of the effects of semaglutide across a range of outcomes and to test whether these effects were consistent across key patient subgroups.MethodsWe conducted a prespecified pooled analysis of individual patient data from STEP-HFpEF and STEP-HFpEF DM, randomised, double-blind, placebo-controlled trials at 129 clinical research sites in 18 countries. In both trials, eligible participants were aged 18 years or older, had heart failure with a left ventricular ejection fraction of at least 45%, a BMI of at …

Methods: Coronary CT angiography (CTA) was performed on a dual-source PCCT system using standard (reconstructed at 70 keV, with slice thickness of 0.4 and 0.6 mm, kernels Bv40 and Bv44 and QIR levels 0-4) and UHR acquisition (reconstructed with 0.2 and 0.4 mm slice thickness, using Bv44 and Bv56 kernels with QIR levels 0-4). Qualitative image quality was assessed using a 4-point Likert scale. Quantitative image quality analysis was performed by calculating image noise, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). Image quality parameters for coronary stents were also assessed using CNR and the difference between in-stent and peri-stent attenuation (ΔHU stent).Results: We analyzed 45 coronary CTA images, including 23 coronary stents. Highest overall image quality based on qualitative assessment was found on images with Bv44 kernel and QIR 3 or 4 with both 0.4 mm and 0.6 …

BackgroundEmpagliflozin reduces the risk of heart failure (HF) hospitalizations but not all-cause mortality when started within 14 days of acute myocardial infarction (AMI).ObjectiveTo evaluate the association between left ventricular ejection fraction (LVEF), congestion, or both on outcomes and the impact of empagliflozin in reducing HF risk post-MI.MethodsIn the EMPACT-MI trial, patients were randomized within 14 days of an AMI complicated by either newly reduced LVEF<45%, congestion, or both to empagliflozin 10 mg daily or placebo and followed for a median of 17.9 months.ResultsAmong 6522 patients, the mean baseline LVEF was 41%+9%; 2648 patients (40.6%) presented with LVEF<45% alone, 1483 (22.7%) presented with congestion alone, and 2181 (33.4%) presented with both. Among patients in the placebo arm, multivariable adjusted risk for each 10-point reduction in LVEF included all-cause …

Both heart failure with preserved ejection fraction (HFpEF) and non-alcoholic fatty liver disease (NAFLD) develop due to metabolic dysregulation, has similar risk factors (eg, insulin resistance, systemic inflammation) and are unresolved clinical challenges. Therefore, the potential link between the two disease is important to study. We aimed to evaluate whether NASH is an independent factor of cardiac dysfunction and to investigate the age dependent effects of NASH on cardiac function. C57Bl/6 J middle aged (10 months old) and aged mice (24 months old) were fed either control or choline deficient (CDAA) diet for 8 weeks. Before termination, echocardiography was performed. Upon termination, organ samples were isolated for histological and molecular analysis. CDAA diet led to the development of NASH in both age groups, without inducing weight gain, allowing to study the direct effect of NASH on cardiac …

Methods: The data of 35 patients were analyzed who underwent dynamic myocardial CTP in our institution between January 2019 and September 2021. Image reconstruction was performed using FBP, HIR and IMR algorithms. Qualitative and quantitative analysis of myocardial perfusion was achieved by visual assessment and measurement of myocardial blood flow (MBF) applying a 16-segment model on all reconstructed datasets. Furthermore, image quality was assessed on all reconstructed images by quantifying image noise by measuring the standard deviation of the attenuation in the aortic root (SD aorta). Interobserver variability was evaluated for quantitative and qualitative myocardial perfusion analysis on HIR images.

Aims Quality-of-care and safety of patients with suspected acute coronary syndrome (ACS) would benefit if management was independent of which high-sensitivity cardiac troponin (hs-cTn) assay was used for risk stratification. We aimed to determine the concordance of hs-cTn assays to risk-stratify patients with suspected ACS according to the European Society of Cardiology (ESC) 2020 Guidelines. Methods and results Blood samples were obtained at arrival and at 2 h from patients with suspected ACS using four hs-cTn assays. The patients were classified into rule-out/observe/rule-in strata based on the ESC 2020 Guidelines. Concordance was determined among the assays for rule-out/observe/rule-in strata. The prevalences of significant underlying disease (≥ 50% stenosis on coronary computed tomography or inducible myocardial ischaemia on stress testing) and adjudicated ACS, plus quality-of-care …

Background Atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI) is predominantly attributed to pulmonary vein reconnection (PVR). Predictors of AF recurrence have been widely studied; however, data are scarce on procedural parameters that predict chronic PVR. We aimed to study PVR rates and predictors of PVR. Methods We retrospectively included 100 patients who underwent repeated ablation due to AF recurrence after initial PVI with the CARTO system. PVR was determined during the repeated procedure by electrophysiological evaluation, and initial procedural characteristics predicting PVR were studied, including adherence to the CLOSE protocol, use of high power, first-pass isolation (FPI), and baseline generator impedance (BGI). Results Thirty-eight patients underwent initial CLOSE-guided PVI, and sixty-two underwent initial non-CLOSE PVI. A repeat procedure was performed 23 ± 16 months after the initial procedure. In total, PVR was found in 192 of 373 PVs (51.5%), and all PVs were isolated in 17/100 (17%) patients. Factors associated with all PVs being isolated were adherence to the CLOSE protocol, a higher power setting, the presence of bilateral FPI, and lower BGI (88% vs. 28%, p < 0.0001; 37.5 W vs. 30 W, p = 0.0276; 88.2% vs. 40.4%, p = 0.0007; and 127.6 Ω vs. 136.6 Ω, p = 0.0027, respectively). In initial procedures with adherence to the CLOSE protocol, the FPI rate was significantly higher (73.7% vs. 25%, p < 0.0001), while there were no significant differences in terms of procedure time and left atrial dwell time (81 vs. 85 min, p = 0.83; and 60 vs. 58 min, p = 0.08, respectively). BGI ≥ 130 Ω (AUC = 0 …

A szervtranszplantáció folyamata kihívásokkal teli, speciális út mind az érintettek, mind hozzátartozóik számára. A pszichoszociális tényezőkről közel fél évszázada tudjuk, hogy jelentősen befolyásolják a transzplantációs folyamatot. A szívtranszplantált populáció gondozása során a recipiens együttműködése (adherencia) nélkülözhetetlen, ennek egyik befolyásoló faktora a társas támogatás. Számos más betegcsoportban alkalmaznak sorstársi támogatásra épülő intervenciókat, úgynevezett sorstársi mentorprogramokat. Ezek fő céljai az ellenőrzött információátadás, valamint a lelki támogatás. Összefoglaló közleményünk célja a sorstársi mentorprogramokról szóló nemzetközi publikációk áttekintése a felnőtt-szívtranszplantációs programok gyakorlatában. Orv Hetil. 2024; 165(10): 379–384.

BACKGROUND High-power short-duration ablation has shown impressive efficacy and safety for pulmonary vein isolation (PVI); however, initial efficacy results with very high power short-duration ablation were discouraging. This study compared the long-term durability of PVI performed with a 90- versus 50-W power setting. METHODS Patients were randomized 1:1 to undergo PVI with the QDOT catheter using a power setting of 90 or 50 W. Three months after the index procedure, patients underwent a repeat electrophysiology study to identify pulmonary vein reconnections. Patients were followed for 12 months to detect AF recurrences. RESULTS We included 46 patients (mean age, 64 years; women, 48%). Procedure (76 versus 84 minutes; P =0.02), left atrial dwell (63 versus 71 minutes; P =0.01), and radiofrequency (303 versus 1040 seconds; P <0.0001) times were shorter with 90- versus 50-W …

Background Safety, efficacy, and patient comfort are the expectations during pulmonary vein isolation (PVI). We aimed to validate the combined advantages of pre- and periprocedural anticoagulation with non-vitamin K anticoagulants (NOACs) and rigorous left atrial appendage thrombus (LAAT) exclusion with computed tomography (CT). Methods This study included a population of consecutive patients, between March 2018 and June 2020, who underwent cardiac CT within 24 h before PVI to guide the ablation and rule out LAAT. NOAC was omitted 24 h before the ablation. Results A total of 187 patients (63% male) underwent CT before PVI. None of the patients experienced stroke during or after the procedure. The complication rate was low, with no thromboembolic events and 2.1% of patients experiencing a major bleeding event. Conclusions Omitting NOAC 24 h before the ablation might be safe if combined with left atrial thrombus exclusion with computed tomography.

Background Recent trials support the role of cardiac CT in the evaluation of symptomatic patients suspected of having coronary artery disease (CAD); however, body mass index (BMI) has been reported to negatively impact CT image quality. Purpose To compare initial use of CT versus invasive coronary angiography (ICA) on clinical outcomes in patients with stable chest pain stratified by BMI category. Materials and Methods This prospective study represents a prespecified BMI subgroup analysis of the multicenter Diagnostic Imaging Strategies for Patients with Stable Chest Pain and Intermediate Risk of Coronary Artery Disease (DISCHARGE) trial …

Background: Regular and vigorous exercise leads to a constellation of structural and functional cardiovascular adaptations. Cardiopulmonary exercise testing (CPET) is the most accurate method to assess these changes and measure cardiorespiratory fitness (CRF). Cardiac Magnetic Resonance (CMR) represents the gold standard for morpho-functional evaluation and for myocardial tissue characterization.