Introduction: Development in paediatric and interventional cardiology and cardiac surgery resulted in an increase in the number and average age of adult congenital heart disease patients. Comorbidities may appear with increased age leading to new challenges in the diagnosis and treatment of this complex group of patients.Objective: The aim of this study is to compare clinical and echocardiographic parameters in adult congenital heart disease patients under our care below the age of 40 years, between 40 and 59 years and above the age of 60 years.Method: Data of a total of 346 patients were analyzed; 154 patients were under 40 years of age, 133 patients were between 40 and 59 years of age, and 59 patients were 60 years old or older. All adult congenital heart disease patients who underwent an outpatient examination were included in the study. As part of the physical examination, the New York Heart Association (NYHA) clinical classification of heart failure was determined, electrocardiography, echocar-diography and 6-minute walk test were performed.Results: Above the age of 40, the ratio of comorbidities increased, significantly more patients were classified into NYHA functional classes III-IV and the ratio of patients having a left ventricular ejection fraction below 55% sig-nificantly increased. The prevalence of arrhythmia was similar in all age groups, but an increasing tendency could be seen with age.Conclusion: There is a growing number of elderly adult congenital heart disease patients with comorbidities that play an important role in the management and in the outcome of congenital heart disease. New protocols and recom-mendations are required in the follow-up of these patients to help determining the optimal time for reoperation, intervention or heart transplantation.

Bevezetés: A populációban egyre nagyobb arányban vannak jelen olyan felnőttek, akik szívfejlődési rendellenességgel, köztük Fallot-tetralógiával jöttek világra. Célkitűzés: A jelen vizsgálat célja a Fallot-tetralógiával született betegek echokardiográfiás és cardialis mágneses rezonanciás vizsgálati eredményeinek összehasonlító vizsgálata volt attól függően, hogy korai teljes rekonstrukció történt, vagy a korai palliációt kései teljes korrekció követte. Módszerek: A jelen tanulmányba 17 olyan, Fallot-tetralógiás beteget vontunk be, akik átlagéletkora 28,6 ± 4,6 év volt (10 férfi). Korai teljes rekonstrukció 10 esetben történt (átlagéletkor: 25,0 ± 8,0 év; 8 férfi), míg korai palliációt követően kései teljes korrekció 7 esetben (átlagéletkor: 33,7 ± 11,8 év; 2 férfi). Valamennyi esetben teljes körű kétdimenziós Doppler-echokardiográfiás és cardialis mágneses rezonanciás vizsgálatot végeztek. Eredmények: Korai teljes rekonstrukció esetén a hosszú távú továbbkövetés során alacsonyabb bal kamrai végsystolés (40,50 ± 10,55 ml/m2 vs. 58,14 ± 19,07 ml/m2, p = 0,013) és végdiastolés (86,60 ± 12,62 ml/m2 vs. 116,70 ± 23,70 ml/m2, p = 0,002) volumenindexek és verővolumen-index (46,00 ± 6,77 ml/m2 vs. 58,43 ± 7,11 ml/m2, p = 0,001) igazolható magasabb echokardográfia során mért bal kamrai ejekciós frakció (69,75 ± 6,80% vs. 61,67 ± 8,80%, p = 0,038) mellett a korai palliációra, majd kései korrekcióra kerülő Fallot-tetralógiás esetekhez képest. A jobb szívfél tekintetében magasabb jobb kamrai izomtömeg (72,33 ± 21,03 g vs. 51,33 ± 22,33 g, p = 0,044) igazolható a korai teljes rekonstrukción átesett Fallot-tetralógiás betegekben. Következtetés: Kedvezőbb bal kamrai morfológiai és funkcionális paraméterek, de kifejezettebb jobb kamrai hypertrophia detektálható Fallot-tetralógiás betegekben korai teljes rekonstrukciót követően a korai palliációra, majd kései korrekcióra kerülő esetekhez képest. Orv Hetil. 2023; 164(5): 186–194.

INTRODUCTION Development in paediatric and interventional cardiology and cardiac surgery resulted in an increase in the number and average age of adult congenital heart disease patients. Comorbidities may appear with increased age leading to new challenges in the diagnosis and treatment of this complex group of patients. OBJECTIVE The aim of this study is to compare clinical and echocardiographic parameters in adult congenital heart disease patients under our care below the age of 40 years, between 40 and 59 years and above the age of 60 years. METHOD Data of a total of 346 patients were analyzed; 154 patients were under 40 years of age, 133 patients were between 40 and 59 years of age, and 59 patients were 60 years old or older. All adult congenital heart disease patients who underwent an outpatient examination were included in the study. As part of the physical examination, the New York Heart Association (NYHA) clinical classification of heart failure was determined, electrocardiography, echocardiography and 6-minute walk test were performed. RESULTS Above the age of 40, the ratio of comorbidities increased, significantly more patients were classified into NYHA functional classes III-IV and the ratio of patients having a left ventricular ejection fraction below 55% significantly increased. The prevalence of arrhythmia was similar in all age groups, but an increasing tendency could be seen with age. CONCLUSION There is a growing number of elderly adult congenital heart disease patients with comorbidities that play an important role in the management and in the outcome of congenital heart disease. New protocols and recommendations are required in the follow-up of these patients to help determining the optimal time for reoperation, intervention or heart transplantation. Orv Hetil. 2023; 164(6): 219-226.

Bevezetés: A gyermekkardiológia, az intervenciós kardiológia és a szívsebészet fejlődésével a felnőtt congenitalis szívbetegek száma és a populáció átlagéletkora is nő. A populáció átlagéletkorának növekedésével azonban gyakoribb a társbetegségek megjelenése, amelyek új diagnosztikai és kezelésbeli nehézségeket jelentenek ebben a komplex betegcsoportban. Célkitűzés: A jelen vizsgálat célja a fontosabb klinikai és echokardiográfiás paraméterek összehasonlítása volt az általunk gondozott 40 év alatti, 40 és 59 éves kor közötti és a 60. életévüket betöltött felnőtt congenitalis szívbetegek esetén. Módszer: Összesen 346 beteg adatait dolgoztuk fel, közülük 154 beteg volt 40 év alatti, 133 beteg volt 40 és 59 éves kor közötti, és 59 beteg töltötte be a 60. életévét. A vizsgálatba minden olyan felnőtt congenitalis szívbeteget bevontunk, akinél ambuláns vizsgálat történt. A fizikális vizsgálat részeként meghatároztuk a szívelégtelenség New York Heart Association (NYHA) szerinti funkcionális stádiumát, elektrokardiográfia, echokardiográfia és 6 perces sétateszt is történt. Eredmények: 40 éves kor felett szignifikánsan nagyobb arányban fordultak elő NYHA III–IV. funkcionális stádiumú szívelégtelenségben szenvedő betegek, szignifikánsan nagyobb volt azoknak a betegeknek az aránya, akik bal kamrai ejekciós frakciója 55%-nál alacsonyabb volt, és a társbetegségek gyakorisága is nagyobb volt ebben a csoportban. A ritmuszavarok előfordulási aránya hasonló volt minden korcsoportban, de emelkedő tendenciát lehetett látni az életkor előrehaladtával. Következtetés: A felnőtt korú, congenitalis szívbetegséggel élő betegeknél az életkor növekedésével társbetegségek jelenhetnek meg, amelyek hatással vannak az alapbetegségükre, prognózisukra. A betegek utánkövetésére jelenleg alkalmazott vizsgálómódszerek mellett egyéb vizsgálatok bevezetésére lehet szükség a reoperáció, az intervenció vagy az esetleges szívtranszplantáció idejének kiválasztásában. Orv Hetil. 2023; 164(6): 219–226.

INTRODUCTION:There is an increasing ratio of surviving patients with congenital heart disease including tetralogy of Fallot. OBJECTIVE:The aim of the present study was a comparative assessment of echocardiographic and cardiac magnetic resonance imaging-derived findings in patients with tetralogy of Fallot following early total reconstruction versus early palliation/late correction. METHODS:The study comprised 17 patients with tetralogy of Fallot (mean age: 28.6 ± 10.4 years; 10 males). Early total reconstruction was performed in 10 cases (mean age: 25.0 ± 8.0 years; 8 males), while early palliation/late construction was done in 7 subjects (mean age: 33.7 ± 11.8 years; 2 males). Complete two-dimensional Doppler echocardiography and cardiac resonance imaging were performed in all patients. RESULTS:During long-term follow-up, lower left ventricular end-systolic (40.50 ± 10.55 ml/m2 vs. 58.14 ± 19.07 ml/m2, p = 0.013) and end-diastolic volume indices (86.60 ± 12.62 ml/m2 vs. 116.70 ± 23.70 ml/m2, p = 0.002) and stroke volume index (46.00 ± 6.77 ml/m2 vs. 58.43 ± 7.11 ml/m2, p = 0.001) could be detected, which were associated with higher echocardiographic left ventricular ejection fraction (69.75 ± 6.80% vs. 61.67 ± 8.80%, p = 0.038) in patients with tetralogy of Fallot following early total reconstruction as compared to that of subjects late after early palliation/late correction. In regard with the right heart, larger right ventricular muscle mass (72.33 ± 21.03 g/m2 vs. 51.33 ± 22.33 g/m2, p = 0.044) could be seen in patients with tetralogy of Fallot following early total reconstruction. CONCLUSION:Beneficial left ventricular morphological and functional parameters, but more pronounced right ventricular hypertrophy could be detected in patients with tetralogy of Fallot following early total reconstruction as compared to that of subjects late after early palliation/late correction. Orv Hetil. 2023; 164(5): 186-194.

INTRODUCTION There is an increasing ratio of surviving patients with congenital heart disease including tetralogy of Fallot. OBJECTIVE The aim of the present study was a comparative assessment of echocardiographic and cardiac magnetic resonance imaging-derived findings in patients with tetralogy of Fallot following early total reconstruction versus early palliation/late correction. METHODS The study comprised 17 patients with tetralogy of Fallot (mean age: 28.6 ± 10.4 years; 10 males). Early total reconstruction was performed in 10 cases (mean age: 25.0 ± 8.0 years; 8 males), while early palliation/late construction was done in 7 subjects (mean age: 33.7 ± 11.8 years; 2 males). Complete two-dimensional Doppler echocardiography and cardiac resonance imaging were performed in all patients. RESULTS During long-term follow-up, lower left ventricular end-systolic (40.50 ± 10.55 ml/m2 vs. 58.14 ± 19.07 ml/m2, p = 0.013) and end-diastolic volume indices (86.60 ± 12.62 ml/m2 vs. 116.70 ± 23.70 ml/m2, p = 0.002) and stroke volume index (46.00 ± 6.77 ml/m2 vs. 58.43 ± 7.11 ml/m2, p = 0.001) could be detected, which were associated with higher echocardiographic left ventricular ejection fraction (69.75 ± 6.80% vs. 61.67 ± 8.80%, p = 0.038) in patients with tetralogy of Fallot following early total reconstruction as compared to that of subjects late after early palliation/late correction. In regard with the right heart, larger right ventricular muscle mass (72.33 ± 21.03 g/m2 vs. 51.33 ± 22.33 g/m2, p = 0.044) could be seen in patients with tetralogy of Fallot following early total reconstruction. CONCLUSION Beneficial left ventricular morphological and functional parameters, but more pronounced right ventricular hypertrophy could be detected in patients with tetralogy of Fallot following early total reconstruction as compared to that of subjects late after early palliation/late correction. Orv Hetil. 2023; 164(5): 186-194.

A megtartott ejekciós frakciójú szívelégtelenség (HFpEF) echokardiográfiás diagnosztikájának elemeit foglalja össze a közlemény három különböző szintű lelet kapcsán. A diagnózis fő eleme a bal kamra diasztolés diszfunkciójának a kimutatása. A klinikai gyakorlatban a bal pitvar tágulata (bal pitvari volumen >34 ml/m2), az E/e’ >15 és a tricuspidalis inszufficiencia sebessége >2,8 m/s jelzi a funkciókárosodást. Ha strain-meghatározás is rendelkezésre áll, akkor a GLS és a bal pitvari strain tovább finomítja a diagnózist.

Supplemental Digital Content is available in the text Aims After enhancing the survivorship of cancers, the impact of cardiovascular diseases on mortality is increasing among cancer patients. However, anticancer therapies pose a higher cardiovascular risk to patients. As prevention against cancer therapy-induced cardiomyopathy has yet to be explored, the preventive ability of concomitant cardiovascular medications against incident heart failure was assessed. Methods A retrospective, population-based study was run using anonymized integration of healthcare databases. All the Hungarian patients diagnosed with breast or colorectal carcinoma and undergoing chemotherapy or biological therapy were analysed. Participants were not treated with any anticancer therapy nor suffered from heart failure/dilated cardiomyopathy during the preceding observational period (≥6.5 years). The heart failure endpoint was established by I50 International Classification of Diseases codes upon discharge from hospital or issuance of an autopsy report. Results Among the 9575 patients who were enrolled, the cumulative incidence of heart failure over 4 years was 6.9%. The time until the first heart failure event in the propensity score-matched treated and untreated groups was compared using Cox proportional-hazards models. A significant association between lower heart failure risk and concomitant statin therapy was observed (hazard ratio: 0.748, P = 0.038); the preventive ability was more pronounced in the anthracycline/capecitabine/platinum-treated subgroup (hazard ratio: 0.660, P = 0.032). For angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker therapy, a significantly lower heart failure risk was also observed (hazard ratio: 0.809, P = 0.032). Among beta blockers, nebivolol administered to anthracycline/capecitabine-treated patients was associated with a nonsignificant trend to lower heart failure risk (hazard ratio: 0.584, P = 0.069). Conclusion Only concomitant statin and angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker therapies were associated with significantly lower risk of anticancer therapy-related heart failure.

The effects of graduated medical compression stockings (MCS) on cardiovascular responses are poorly investigated. A simple study was undertaken to investigate whether the application of below-knee leg MCSs with different pressures could influence aortic pulse wave velocity (PWV) as the gold standard for aortic stiffness measurement evaluated by arteriography. Ten volunteers underwent PWV measurement at baseline, then in below-knee compression class (ccl) 1 (18-21 mm Hg), 2 (23-32 mm Hg) and 3 (34-46 mm Hg) MCSs in a consecutive manner. Baseline PWV (mean value: 7.86 +/- 1.70 m.s(-1)) was significantly reduced by ccl 1 MCSs (mean value: 6.55 +/- 0.88 m.s(-1), p = 0.04). ccl 2 and ccl 3 stockings also notably decreased baseline PWV (mean values: 6.63 +/- 0.65 m.s(-1), p = 0.058 and 6.62 +/- 1.00 m.s(-1), p = 0.067; respectively). The application of low compression MCSs (ccl 1) leads to a significant decrease in PWV indicating a beneficial cardiovascular influence.

Abstract Introduction Classic echocardiographic methodologies offer limited opportunities in assessing right atrial (RA) morphology and function. Three-dimensional (3D) speckle-tracking echocardiography (3DSTE) is a novel imaging method with objective 3D capability in assessing volumetric and functional properties of heart chambers. Normal reference values of different 3DSTE-derived RA strains are not available, therefore the aim of this prospective study was to establish these parameters in healthy subjects. Methods The present study comprised 295 healthy volunteers, from which 110 were excluded due to inadequate image quality. The final population consisted of 185 healthy subjects in the present study (mean age: 32.1 ± 12.2 years, 89 males). Complete two-dimensional echocardiography and 3DSTE have been performed in all cases. Results While radial strain (RS) does not change significantly over the years in males, RS increases with age most significantly between 40-49 years, and it starts to decline at the age of 50 years in females. While females have higher circumferential strain (CS) and area strain (AS) values, RS decreases with age in both gender. While longitudinal strain (LS) remains almost unchanged in females until 40-49 years and declines above the age of 50 years in females, it decreases over decades in males. 3D strain (3DS) increases with ages in both gender, but almost doubles in females in older ages. While RS at atrial contraction does not change over decades in males, an obvious increase could be seen in females with a higher value between 40-49 years and a decline over 50 years. A decrease could be seen in CS at atrial contraction in males over decades, it is almost tripled in value between 40-49 years in females. Although LS at atrial contraction is higher in females, it decreases over decades in both genders. AS decreases over decades in males, while females have almost doubled AS values at the ages 40-49 years. 3DS is almost unchanged in males, while doubled in older ages in females. During evaluations, 110 subjects were excluded due to inferior image quality from the total of 295 enrolled subjects, therefore the overall feasibility of 3DSTE-derived RA quantification was 185 out of 295 (63% overall feasibility). Conclusion 3DSTE-derived RA normal reference values with age- and gender-dependency are demonstrated in a healthy population.

Abstract Funding Acknowledgements None Hypertrophic obstructive cardiomyopathy (HOCM) is characterized by muscle hypertrophy and fibrosis, interfering with force generation and relaxation. Abnormal ventricular (LV) myocardial deformation have been demonstrated in patients with HOCM at rest, but there is lack of data regarding the deformational mechanics in exercise. AIMS: We wanted to assess the adaptability of LV deformational behaviour to physical exercise in HCM patients as compared to healthy control subjects. METHODS 24 obstructive HOCM (age 51.2 ± 14.2yrs; 16 men, LVOT-obstruction 56 ± 19mmHg at rest or on Valsalva maneuver) and 32 control subjects (50.9 ± 6.8 yrs, 19 men from the MAGYAR-PATH Registry) underwent supine bicycle stress echocardiography (ESE) with measurements of 2D- and Doppler, 2D-Speckle Tracking Tracking Imaging and 3D-Full Volume Analysis. Beyond conventional LV/RV functional measurements; peak longitudinal (LS), circumferential (CS) Strain values; peak Twist and Torsion angles; post-systolic shortening index (PSS) and diastolic phase indices (Untwisting time - UTT and rate - UTR) calculated; the UTR/Twist ratio was given as "coupling index". The LV/RV-EF calculated by 3D-Full Volume Analysis off-line by TomTec Arena™ software both at rest and on submaximal ESE. RESULTS The HOCM group had lower resting LS (-14.6 ± 4.5 vs 18.4 ± 2.6%, p < 001) but higher CS (-32.9 ± 5.1 vs 28.8 ± 2.3%, p < 0.001) and Twist angles (9.9 ± 2.6 vs 6.1 ± 2.2º, p < 0.01) than control subjects. Exercise induced an increase in all strains in control subjects, but much less in HOCM (LS: -21.4 ± 3.5 vs 15.1 ± 3.0% and CS: -33.9 ± 3.6 vs 34.1 ± 4.2% in HOCM, p < 0.02 in controls, NS in HOCM); the increase of Twist angle was minimal in HOCM (Δ1.2 ± 1.2 vs Δ3.6 ± 2.3º in controls, p < 0.01). The PSS was more pronounced on ESE in HOCM than in controls (46.6 ± 12 vs 21.2 ± 9.6% in controls, p < 0.001). Peak UTR was slower (118 ± 2.1 vs 133.1 ± 14.1 º/s) during ESE and occured later (141 ± 19 vs 121 ± 9.1% of systolic time, p < 0.02) in HOCM than in controls. There was significant relationship between the Twist and UTR in control subjects (β=-0.0807, p < 0.001), but not in HOCM (β=-0.0046, p = 0.05). The UTR/Twist ratio diminished only in HOCM but not in controls (-8.0 ± 0.6 vs -13.1 ± 2.5 1/s, p < 0.02). CONCLUSIONS The HOCM patients had significantly impaired strain-adaptability; developed post-systolic shortening and no LV Torsional reserve was found on exercise. Also, I detected decreased and delayed UTR indices in the HOCM group. These findings support evidence for reduced systolic-diastolic coupling efficiency, assessed by Twist-Untwist mechanics in HOCM patients, which can contribute to the development of exercise-related symptoms and the dynamic LVOT-obstruction. This unique pattern of deformational behaviour to exercise can help in the differential diagnostic workup in patients with LV hypertrophy of unknown aetiology and also would hold additional value in the risk stratification process for patients with HCM-phenotypes.

Abstract Introduction The right atrium (RA) has several roles including a systolic reservoir, early diastolic conduit and late-diastolic booster pump functions. The present study aimed to assess normal reference values of three-dimensional speckle-tracking echocardiography (3DSTE)-derived RA volumetric data and volume-based functional properties (stroke volumes, SVs and emptying fractions, EFs) in healthy adult subjects. Methods 260 healthy adult subjects in sinus rhythm with complete clinical and demographic dataset have been included in the present study. However, due to inferior image quality 110 subjects have been excluded. The remaining population comprised 150 cases (31.0 ± 11.6 years, 79 males). Complete two-dimensional Doppler echocardiography and 3DSTE have been performed in all subjects. Results While systolic maximum RA volume did not change over age decades, early and late-diastolic RA pre-atrial contraction volume and minimum RA volume increased over time. Significantly larger values could be detected in more than 50 year-old healthy subjects as compared to younger subjects. Total atrial SV remained almost unchanged over age decades with a significant reduction in subjects aged >50 years. Passive atrial SV showed a continuous reduction over age decades and significant difference could be demonstrated between subjects aged 18-29 years and >50 years. Active atrial SV increased over age decades with a significant reduction in subjects aged >50 years. Total atrial EF did not show any changes over age decades, but a significant reduction could be demonstrated in cases aged >50 years. Passive atrial EF showed significant continuous reduction over age decades. Active atrial EF did not change in younger ages, it was the highest at ages 40-49 years with a significant impairment after 50 years. Females proved to have tendentiously higher RA volumes respecting the cardiac cycle regardless of age. No significant differences could be demonstrated between RA stroke volumes between genders except between 40-49 years when females had tendentiously higher values. RA emptying fractions were non-significantly, but tendentiously higher in females as compared to that of males regardless of age. Conclusions Normal reference values of 3DSTE-derived RA volumes and volume-based functional properties and their age- and gender dependency were defined in healthy adult subjects.

Abstract Introduction Acromegaly is a chronic, rare hormonal disease associated with major cardiovascular comorbidities. The disease, in the majority of the cases, is caused by a benign human growth hormone secreting adenoma. Cardiovascular involvement is especially common in acromegaly patients from the most common hypertension to cardiomyopathy. It was set out to quantify right atrial (RA) morphology and function in a group of acromegaly patients using three-dimensional (3D) speckle-tracking echocardiography (3DSTE). Methods The study comprised 30 patients from which 8 patients were excluded due to inadequate image quality. Mean age of the remaining acromegaly patients were 53.7 ± 14.5 years (7 males). Ten patients were in active phase, while 12 subjects had inactive acromegaly. In the control group 40 healthy adults were enrolled (mean age: 52.3 ± 8.2 years, 15 males). In each case, complete two-dimensional Doppler echocardiography was performed followed by 3DSTE. Results Maximum (54.5 ± 14.4 ml vs. 47.2 ± 11.6 ml, p <0.05) and minimum (35.5 ± 10.2 ml vs. 29.2 ± 9.1 ml, p <0.05) RA volumes and RA volume before atrial contraction (45.1 ± 11.1 ml vs. 38.2 ± 10.3 ml, p <0.05) were significantly higher in case of acromegaly compared to the healthy controls. Both global and mean segmental peak 3D strain (-11.94 ± 7.52% vs. -8.07 ± 5.03%, p <0.05 and -17.16 ± 6.13% vs. -13.78 ± 5.35%, p <0.05) were higher in the acromegaly group compared to the controls. At atrial contraction, mean segmental radial strain (-13.22 ± 6.45% vs. -9.74 ± 4.58%, p <0.05) was significantly higher and mean segmental 3D strain (-9.78 ± 5.44% vs. -13.78 ± 5.35%, p <0.05) was significantly lower in the acromegaly group compared to the controls. Between the active and inactive group of acromegaly patients, mean segmental longitudinal strain (28.17 ± 4.89% vs. 35.34 ± 9.75%, p <0.05) was significantly different. Numerous independent strain parameters had significant correlations with different hormonal variables in the active acromegaly group. These correlations were not present in the inactive acromegaly subgroup. Conclusion Acromegaly is associated with significant RA volumetric and functional abnormalities.

Introduction: Acromegaly is a relatively rare chronic hormonal disease resulting in disfigurement. In 90% of cases, acromegaly is caused by a benign pituitary monoclonal human growth hormone-secreting tumor. The aim of the present study was to determine the presence of left ventricular (LV) deformation abnormalities using three-dimensional speckle-tracking echocardiography in a group of acromegalic patients. Methods: Thirty-eight acromegalic patients were involved in the study. Thirteen patients were excluded due to inadequate image quality. The mean age of the remaining patients was 57.2±13.6 years and seven were male. Their data were compared to an age- and gender-matched control population, which consisted of 34 healthy volunteers (mean age: 52.7±4.9 years, 15 male). Results: Global and mean segmental LV radial strain (RS) (33.2±13.4% vs. 25.2±10.8%, p=0.01 and 36.0±12.1% vs. 28.2±10.0%, p=0.009, respectively) proved to be significantly higher in acromegaly compared to controls. Active acromegalic patients had significantly higher global and mean segmental LV-RS (35.5±14.4% vs. 25.2±10.8%, p=0.03 and 37.9±13.3% vs. 28.2±10.0%, p=0.03, respectively) compared to controls. Between the active and inactive acromegaly groups, only basal LV circumferential strain (-30.2±4.8% vs. -26.7±4.1%, p=0.02) was found to be significantly different. Conclusion: The presented clinical, demographic, therapeutic and echocardiographic features demonstrate that active acromegaly is associated with enhanced LV RS as compared to healthy controls and those with inactive acromegaly. Resumo: Introdução: A acromegalia é uma doença hormonal crónica relativamente rara, associada a dismorfismos somáticos. Em 90% dos casos, ela é causada por um tumor benigno monoclonal da hipófise, secretor de hormona do crescimento. O objetivo do presente estudo foi detetar a presença de alterações da deformação miocárdica do ventrículo esquerdo (VE) através de ecocardiografia tridimensional por speckle tracking num grupo de doentes portadores de acromegalia. Métodos: Foram incluídos 38 doentes portadores de acromegalia. Treze foram excluídos devido à má qualidade de imagem. A idade média dos restantes foi de 57,2±13,6 anos (7 homens). Os seus dados foram comparados com uma população controlo emparelhada por idade e género, que compreendeu 34 voluntários saudáveis (idade média: 52,7±4,9 anos, sendo 15 indivíduos do sexo masculino). Resultados: O strain radial (SR) global e segmentar VE (respetivamente 33,2±13,4% versus 25,2±10,8%, p=0,01 e 36,0±12,1% versus 28,2±10,0%, p=0,009) foi significativamente superior nos casos de acromegalia em relação aos casos controlo. Os doentes portadores de acromegalia ativa tiveram um SR global e segmentar significativamente superior (35,5±14,4% versus 25,2±10,8%, p=0,03 e 37,9±13,3% versus 28,2±10,0%, p=0,03, respetivamente), quando comparados com os grupos controlo. Entre os grupos portadores de acromegalia ativos e inativos, só foi considerado significativamente diferente o strain circunferencial basal VE (-30,2±4,8% versus -26,7±4,1%, p=0,02). Conclusões: Com base nas características clínicas, demográficas, terapêuticas e ecocardiográficas apresentadas, a acromegalia ativa apresenta SR-VE aumentado em relação à população saudável e ao grupo de portadores de acromegalia inativa.

Absztrakt: Bevezetés: Az antraciklinkezeléshez kapcsolódó szívelégtelenség kialakulását jelentősen befolyásolja az alkalmazott kumulatív dózis. Korábban publikált adatok szerint doxorubicin esetén, 450 mg/m2 alatti kumulatív dózis mellett, alacsony a szívelégtelenség kialakulásának rizikója. Mivel a jelenlegi gyakorlatban a doxorubicinterápia során általában nem érik el ezt a dózist, a kezelés következtében kialakuló szívelégtelenség kiváltásában egyéb tényezők játszanak jelentős szerepet. Célkitűzés: Célunk a jelenlegi gyakorlat szerint alkalmazott doxorubicinkezeléshez kapcsolódó szívelégtelenség rizikótényezőinek részletes feltárása volt. Módszer: A hazai egészségügyi finanszírozási adatbázisok és a Nemzeti Rákregiszter adatainak felhasználásával retrospektív elemzést végeztünk, melybe azokat a betegeket vontuk be, akiknél 2004 és 2015 között emlődaganat igazolódott szövettani vizsgálattal. Kizárólag azokat a betegeket elemeztük, akiknél a kórelőzményben nem szerepelt kemoterápia vagy szívelégtelenségre utaló adat a daganat igazolódása előtt. A szívelégtelenségi végpontot az I50-es diagnóziskódnak a fekvőbeteg- vagy a boncolási dokumentumban való megjelenésével definiáltuk. Statisztikai analízis: A szívelégtelenség kialakulásának esélyét befolyásoló tényezőket többváltozós bináris logisztikus regresszió alkalmazásával azonosítottuk. A társbetegségek és a demográfiai adatok mellett az onkológiai stádiumot és az onkológiai kezelések kumulatív dózisait is figyelembe vettük az elemzésben. Eredmények: A 3288, doxorubicinnel kezelt betegnél a szívelégtelenségi végpont kumulatív incidenciája 6,2%-nak adódott. A szívelégtelenség előfordulása fokozódott 400 mg/m2 fölötti doxorubicin kumulatív dózis esetén. Nagymértékben nőtt a rizikó az életkor előrehaladtával is, már 50 év felett szignifikáns kockázatnövekedés volt megfigyelhető. Emellett magasabb rizikóval kapcsolódott a cukorbetegség, a pirimidinanalógok, a karboplatin (platinaalapú szer) és a bevacizumab jelenléte. Következtetés: A hazai finanszírozási adatbázisok és a Rákregiszter adatbázisának integrált elemzése révén a jelenlegi gyakorlatnak megfelelően alkalmazott doxorubicinkezeléshez kapcsolódó szívelégtelenség rizikótényezői populációszinten azonosíthatók voltak. Orv Hetil. 2020; 161(26): 1094–1102.

Abstract Introduction Hypereosinophilic syndrome (HES) is a very heterogeneous group of disorders with varied etiologies characterized by peripheral eosinophilia and eosinophilic tissue/end-organ damage. In the present study, the ability of a novel non-invasive clinical tool, three-dimensional speckle-tracking echocardiography (3DSTE) was investigated to reveal any change in left ventricular (LV) rotational mechanics in clinically asymptomatic HES patients without manifest organ damage as determined by conventional diagnostic methods. Methods The present study comprised 13 patients established diagnosis of HES. However, one patient with idiopathic HES has been excluded due to insufficient image quality. The remaining patient population contained 11 cases with idiopathic HES and one patient with acute T-lymphoma associated HES (mean age: 59.7 ± 13.7 years, 8 males). The control group consisted of 36 healthy volunteers (mean age: 52.9 ± 8.3 years, 23 males). All HES patients and controls underwent complete two-dimensional Doppler echocardiography and 3DSTE. Results Both LV apical rotation (4.86 ± 1.92 degree vs. 10.07 ± 3.92 degree, p < 0.0001) and LV twist (8.52 ± 2.79 degree vs. 14.41 ± 4.26 degree, p < 0.0001) showed significant deteriotations in most of HES patients. In 2 subjects absence of LV twist called as LV „rigid body rotation’ (RBR) was detected. One patient had 1.77 degree counterclockwise (abnormally directed) LV basal rotation and 14.29 degree counterclockwise (normally directed) LV apical rotation resulting in 12.59 degree LV apico-basal gradient. The other patient had normally directed -2.09 degree LV basal rotation and almost zero (-0.27 degree) LV apical rotation resulting in 1.82 degree LV apico-basal gradient. Conclusions Reduced LV apical rotation and twist could be demonstrated in HES. LV-RBR could be detected in some HES patients.

Abstract Introduction Three-dimensional speckle-tracking echocardiography (3DSTE) is a new promising imaging method based on block-matching algorithm. The present study was designed to define normal reference values of 3DSTE-derived LA volumes, stroke volumes and emptying fractions respecting the cardiac cycle and to determine their age- and gender-dependency in healthy adults. Methods The present study involved 256 healthy adult subjects in sinus rhythm, who underwent complete two-dimensional Doppler echocardiography and 3DSTE at the same time. However, due to inferior image quality 87 subjects have been excluded. The remaining population comprised 169 cases who gave informed consent to participate in the study (mean age: 33.2 ± 12.8 years, 77 males). Complete two-dimensional Doppler echocardiography and 3DSTE have been performed in all subjects. Results While systolic maximum LA volume (Vmax) and early diastolic LA volume before atrial contraction (VpreA) did not change over age decades, late-diastolic minimum LA volume decreased over age decades and was lowest in subjects aged 40-49 years with an increase after 50 years. Total atrial stroke volume (TASV) remained unchanged over age decades. Passive atrial stroke volume (PASV) showed a continuous increase over age decades and a significant difference could be demonstrated between subjects aged 18-29 years and >50 years. Active atrial stroke volume (AASV) did not change over age decades with a non-significant reduction in subjects aged >50 years. Total atrial emptying fraction (TAEF) increased over age decades with a reduction after 50 years. Passive atrial emptying fraction (PAEF) showed a significant continuous increase over age decades. Active atrial emptying fraction (AAEF) did not change in younger ages, was highest at ages 40-49 years with a significant impairment after 50 years. Females have tendentiously higher LA volumes than males. Significant difference could be demonstrated in Vmax and VpreA of females versus males at ages 30-39 years. No significant differences were found between genders in LA stroke volumes, while indexed TASV and indexed AASV were higher in females as compared to males at ages 30-39 years. Similarly, no significant differences were found between genders in LA emptying fractions, while indexed TAEF were higher in females as compared to males at ages 18-29 years and 30-39 years, indexed PAEF at ages 18-29 years and indexed AAEF at ages 30-39 years. No correlations could be demonstrated between transmitral flow E and A velocities as well as their ratio and any of LA volumes neither in younger age group (less than 50 year) nor in older age group (more than 50 years). Conclusions Age- and gender-dependency of normal values of 3DSTE-derived LA volumes, stroke volumes and emptying fractions respecting the cardiac cycle were defined in healthy adult subjects.

ban HCM-es betegekben vizsgáltuk a BKH jellemzésére tradicionálisan használt paraméterek és a szív-MRI-vel pontosan meghatározott bal kamrai izomtömeg (BKIT) közötti összefüggést