BackgroundFluoroscopy has been an essential part of every electrophysiological procedure since its inception. However, till now no clear standards regarding acceptable x‐ray exposure nor recommendation how to achieve them have been proposed.HypothesisCurrent norms and quality markers required for optimal clinical routine can be identified.MethodsCenters participating in this Europe‐wide multicenter, prospective registry were requested to provide characteristics of the center, operators, technical equipment as well as procedural settings of consecutive cases.ResultsTwenty‐five centers (72% university clinics, with a mean volume of 526 ± 348 procedures yearly) from 14 European countries provided data on 1788 cases [9% diagnostic procedures (DP), 38% atrial fibrillation (AF) ablations, 44% other supraventricular (SVT) ablations, and 9% ventricular ablations (VT)] conducted by 95 operators (89% male, 41 ± 7 years old).Mean dose area product (DAP) and time was 304 ± 608 cGy*cm2, 3.6 ± 4.8 minutes, 1937 ± 608 cGy*cm2, 15.3 ± 15.5 minutes, 805 ± 1442 cGy*cm2, 10.6 ± 10.7 minutes, and 1277 ± 1931 cGy*cm2, 10.4 ± 12.3 minutes for DP, AF, SVT, and VT ablations, respectively. Seven percent of all procedures were conducted without any use of fluoroscopy.Procedures in the lower quartile of DAP were performed more frequently by female operators (OR 1.707, 95%CI 1.257‐2.318, P = .001), in higher‐volume center (OR 1.001 per one additional procedure, 95%CI 1.000‐1.001, P = .002), with the use of 3D‐mapping system (OR 2.622, 95%CI 2.053‐3.347, P < .001) and monoplane x‐ray system (OR 2.945, 95%CI 2.149‐4.037, P < .001).ConclusionExposure to ionizing radiation varies widely in daily practice for all procedure. Significant opportunities for harmonization of exposure toward the lower range has been identified.

Objective:The aim of the study was to investigate whether the deformation of left atrium (LA) measured by speckle-tracking analysis (STE) is associated with the presence of LA appendage thrombus (LAAT) during non-valvular atrial fibrillation (AF).Methods:Eighty-seven patients (mean age 67 years, 59% men) were included to retrospective cross-sectional study. On top of standard echocardiography we assessed: LA longitudinal systolic strain (LS), systolic (LSSR) and early diastolic strain rate (LESR) in four-chamber and two-chamber apical views. All patients underwent transesophageal echocardiography disclosing LAAT in 36 (41%) patients.Results:Subgroups with and without thrombi did not differ with regard to clinical characteristics. Univariate factors associated with LAAT were as follows: CH2ADS2-VASc Score, left ventricular ejection fraction (LVEF), LV mass, and STE measurements. In a multivariate model only LVEF (p=0.002), LS (p=0.02), LESR (p=0.008), and LSSR (p=0.045) were independently associated with LAAT presence. Moreover, LVEF and LA STE measurements provided incremental value over the CH2ADS2-VASc Score.Conclusion:Speckle-tracking TTE may be used to describe LA reservoir and conduit function during AF, allowing the identification of patients with higher risk of LAAT and providing incremental value over the CH2ADS2-VASc Score.

Left ventricular systolic dysfunction characterized by both LVEF and LVGLS is an independent factor for LAAT. LA asynchrony provides additional diagnostic value for discriminating between patients with and without LAAT.

PSLS although diminished in both groups with CAD was lower in diabetics at all DSE stages, and DM was an independent predictor of this impairment. However, the dobutamine challenge did not deepen the resting differences, suggesting that the direct impact of coronary stenoses effaces the influence of DM during DSE. The comparison with our previous data revealed synergistic, detrimental effect of coexisting CAD and DM on myocardial strain.

Women undergoing isolated CABG are subject to higher 30-day mortality. Female sex is an independent risk factor for death after isolated CABG. Further studies are necessary to identify causes of differences in prognoses among women.

RL BAV phenotype is associated with larger SVD than RN BAV, and the observed differences are independent from aortic valve dysfunction degree, age, and gender.

Background: The aim of the study was to assess the correlation of the selected biomarkers and collagen turn-over indices with advanced echocardiographic parameters among patients with preserved and reduced ejection fraction (EF .6). Clinical evaluation included 6-min walk test, biochemistry, procollagen type I N-terminal propeptide (PINP), procollagen type III N-terminal propetide (PIIINP), matrix metaloproteinase-2 (MMP2), ghrelin, and galectin-3 levels measurements. Echocardiographic examination was performed with analysis of diastolic function and global longitudinal strain (GLS). Results: The GLS in the HFrEF group was significantly lower than in the HFpEF group at the baseline (GLS: 9.56 vs. 16.03, p < 0.01). There was a strong negative correlation of the p = 0.005), but only a moderate negative correlation in p = 0.02). In the HFrEF group, there was a moderate negative correlation between the baseline level of p = 0.03). The correlation of ghrelin and tissue inhibitor of matrix metalloproteinase-1 with EF in the HFrEF group was moderate and statistically significant (r = 0.62, p = 0.02 and r = -0.63, p = 0.02, respectively). Conclusions: Procollagen type III peptide has a strong negative correlation with left ventricular GLS. Galectin-3 relationship with strain may indicate novel pathophysiological pathways and requires further investigation. (Cardiol J 2017; 24, 1: 35-42)

A b s t r a c tBackground: Bicuspid aortic valve (BAV) is strongly associated with aortopathy. Previous studies have suggested that various types of bicuspid aortic valve morphology may differently affect the aortic dilatation. Aim:To evaluate the impact of BAV cusp fusion morphology (type I -right-left coronary cusp fusion; type II -right-noncoronary cusp fusion) on the diameters of the aorta.Methods: BAV morphology was evaluated retrospectively in a group of 67 consecutive patients with BAV. The control group comprised 1000 randomly selected patients with normal tricuspid aortic valve. Aortic dimensions and other echocardiographic parameters were obtained from the echocardiography database of our department. The diameters of aorta in both BAV subtypes were evaluated at the level of: annulus, the sinus of Valsalva, the sinotubular junction, and the ascending aorta and at the level of the ascending aorta in the control group.Results: Patients with BAV were mainly male (78%), with a mean age of 55.3 ± 16.7 years. The dominant morphology of BAV in the study group was type I (n = 46; 69%). It was associated with increased aortic dimension in comparison to type II BAVs at the level of the sinuses of Valsalva (38.4 ± 5.2 vs. 34.0 ± 4.6 mm, p = 0.002), the sinotubular junction (33.1 ± 5.8 vs. 29.6 ± 5.0 mm, p = 0.035), and the ascending aorta (41.6 ± 7.1 vs. 36.6 ± 6.1 mm, p = 0.006). Indexed aortic diameter was also increased in type I BAV at the level of sinuses of Valsalva (19.6 ± 2.7 vs. 18.1 ± 1.6 mm/m 2 , p = 0.008) and the ascending aorta (21.3 ± 3.4 vs. 19.3 ± 3.4 mm/m 2 , p = 0.048). The dimensions of the ascending aorta exceeding the upper normal range limit based on control-group measurements (44.3 mm) were observed more frequently in type I than in type II (33% vs. 10%, p = 0.044). Aortic regurgitation (moderate or severe) occurred in similar percentages of both BAV subtypes (type I: 37% vs. type II: 33%, p = 0.774). There were also no significant differences in aortic valve area (2.2 ± 1.1 vs. 2.0 ± 1.4 cm 2 , p = 0.163), indexed aortic valve area (1.1 ± 0.6 vs. 1.0 ± 0.6, p = 0.337), peak transvalvular gradient (35.3 ± 20.5 vs. 39.1 ± 28.9 mm Hg, p = 0.862), and mean gradient (18.6 ± 12.3 vs. 22.7 ± 18.2 mm Hg, p = 0.571) and left ventricular ejection fraction (51.8 ± 11.6 vs. 51.8 ± 12.2%, p = 0.978) between type I and type II BAV groups.Conclusions: Type I BAV cusp fusion morphology is more commonly associated with dilatation of the aorta than type II, especially at the level of the sinus of Valsalva and the ascending aorta.