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  • Author: Jelena Čelutkienė x
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Open access

Tomas Daukšas, Rita Sudikienė, Radvilė Malickaitė and Jelena Čelutkienė

Summary

Background: There has been a continued search for an accurate noninvasive technique for detecting subclinical acute rejection in heart transplant recipients. Ultrasonic deformation imaging - strain/strain rate (SR) - is sensitive in detecting sub-clinical abnormalities in regional myocardial function and could potentially be sensitive tool to detect changes in deformation induced by graft rejection. There is an evidence of the importance of immunophenotyping in determining transplant rejection as well.

Aim: to assess the potential role of cardiac ultrasound velocity/strain imaging and immunological testing (alterations in peripheral blood T-cells subsets activation) in the detection of acute allograft rejection proven by endomyocardial biopsy.

Patients and methods: A retrospective observational study was carried out involving 28 patients (22 men and 6 women) who underwent a total of 167 routine follow up endomyocardial biopsies with correlative cardiac ultrasound and immunophenotyping data. Myocardial velocity derived from pulsed wave tissue Doppler imaging (PW-TDI) was calculated in the longitudinal direction in basal lateral segment of left ventricle (LV) in 4-chamber view and in the radial direction in basal posterior LV segment in long parasternal axis view. Global systolic strain by speckle tracking was calculated in the longitudinal, radial and circumferential directions.

Results: According to the International Society of Heart and Lung Transplantation criteria, 90 biopsies (Group 1) had grade 0, 1R or 2R rejection, and 30 biopsies (Group 2) had grade 3R rejection. The results of the forward selection revealed that the best indicator to predict the rejection was the amount of CD4+/HLA-DR+ cells. Univariate logistic regression analysis showed that global radial systolic strain performs better in terms of receiver-operator-characteristic curves (ROC) than the rest of the measurements (area-under-curve 0.83, where a cut-off value of 32.4% had 91.7% sensitivity and 77.8% specificity).

Conclusions: One of the best non-invasive parameters in the detection of acute sub-clinical rejection appears to be the expression of CD4+/HLA-DR+ cells. Among ultrasound markers the best predictor of acute rejection is global radial systolic strain.

Open access

Jolita Badarienė, Jelena Čelutkienė, Dovilė Petrikonytė, Jūratė Balsytė, Egidija Rinkūnienė, Ligita Ryliškytė, Vilma Dženkevičiūtė, Alma Čypienė, Romualdas Kizlaitis, Roma Puronaitė and Aleksandras Laucevičius

Summary

Objectives:The aim of this study was to assess the diagnostic value of exercise stress testing to detect coronary heart disease (CHD) in the group of patients with metabolic syndrome.

Design and methods: 2803 patients without prior diagnosis of CHD and identified metabolic syndrome were investigated. Subjects underwent electrocardiogram (ECG) stress testing and, depending on the results, coronary angiography and/or coronary computed tomography angiography to detect hemodynamically significant stenosis. CHD was confirmed, if lumen narrowing ≥ 50% of coronary arteries was found.

Results: Exercise stress testing was interpreted as positive in 12% patients (71.7% women and 28.3% men). CHD was diagnosed in 45 patients (1.6%), 23 of them had positive exercise stress testing. ECG stress testing was more frequently positive in patients, who had typical/atypical anginal chest pain, dyspnea and/or non-anginal chest pain, in comparison to asymptomatic patients (16.6% vs 8.9%, p <0.001). CHD was more often diagnosed in symptomatic patients compared to patients with no symptoms (6.1% vs 0.7%, p < 0.001, women 5.3% vs 0.6%, p < 0.001, men respectively 8% vs 0.8%, p < 0.001).

Conclusions: Diagnostic value of exercise stress testing for detecting CHD is limited in population with metabolic syndrome. CHD was more prevalent in patients with chest pain or dyspnea than in asymptomatic patients.

Open access

Gytis Grigaliūnas, Edita Lycholip, Greta Burneikaitė, Asta Grigaliūnienė, Gintarė Kaklauskaitė, Romualdas Mačiūnas, Mindaugas Balčiūnas, Rima Steponenienė, Aušra Kavoliūniene, Jelena Čelutkienė and Stefan Störk

Abstract

Heart failure (HF) is an increasing cause of cardiovascular morbidity and mortality. However, the lay public awareness about HF is shown to be inferior to the knowledge of myocardial infarction or stroke. The vast majority of HF patients lack basic comprehension of HF and self-care, which translates into suboptimal treatment outcomes. Therefore this study aimed to establish the present level of knowledge about HF of the lay public and to evaluate the effects of a single public lecture for the consideration of implementing further steps to raise public awareness. Design and methods: We performed a cross sectional survey study using an anonymous questionnaire designed by the German Competence Network Heart Failure (CNHF). Respondents were selected randomly and fulfilled the questionnaire free-willingly prior to and after a standardized lecture on HF. The CNHF questionnaire consisted of two sets of questions focusing on individual characteristics of the respondent and HF-related knowledge. The gathered data were verified by a standardized procedure in Wurzburg, Germany. Results: Among 1025 respondents 60% were females: 15% of the participants had occupational experience in the medical field. The majority (79%) of the study population had heard about HF previously. Typical complaints and symptoms of HF were correctly identified as ‘shortness of breath’ by 69%, ‘swelling of feet’ by 56%, ‘fatigue’ by 56%, and ‘weakness’ by 54% survey participants. The lecture resulted in 22% (from 26% to 48%) increase of correct identification of the combination all three HF symptoms (shortness of breath, swelling of feet and tiredness). The lecture significantly increased the proportion of correct answers for most of the questions. Particularly notable gains were observed in respondents without prior medical experience. Conclusion: The study population’s initial awareness of HF was insufficient. Standardized lecture improved the short-term knowledge about HF symptoms and nature of the disease. Regular educational activities increasing the HF awareness of general population and HF patients can increase the overall HF treatment success.