Papers by Olga Dzikowska-Diduch
Journal of Clinical Medicine, Nov 30, 2022
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Background: The annual mortality of patients with untreated chronic thromboembolism pulmonary hyp... more Background: The annual mortality of patients with untreated chronic thromboembolism pulmonary hypertension (CTEPH) is approximately 50% unless a timely diagnosis is followed by adequate treatment. In pulmonary embolism (PE) survivors with functional limitation the diagnostic work-up starts with echocardiography. It is followed by lung scintigraphy and right heart catheterization. However, noninvasive test providing diagnostic clues to CTEPH, or ascertain this diagnosis as very unlikely, would be extremely useful since the majority of post PE functional limitations is caused by deconditioning. Methods: Patients after acute PE underwent a structured clinical evaluation with electrocardiogram, routine laboratory tests including NT-proBNP and echocardiography. The aim of study was to verify whether the parameters from echocardiographic or perhaps electrocardiographic examination and NT-proBNP concentration best determine the risk of CTEPH. Results: A total (n = 261, male n = 123) patien...
Sustainability
Large-scale usage of oxygen therapy (OT) may lead to increased oxygen concentrations (OC) in plac... more Large-scale usage of oxygen therapy (OT) may lead to increased oxygen concentrations (OC) in places where COVID-19 patients are treated. The aim of the study was to establish in an empirical way the OC in COVID-19 at the patient’s bedside and to assess the relationships and reactions that occur during OT in an uncontrolled oxygen-enriched environment. We analyzed and took into account the OC, the technical conditions of the buildings and the air exchange systems. Based on the results, we performed a Computational Fluid Dynamics analysis to assess evacuation conditions in the event of a fire outbreak in the COVID-19 zone. A total of 337 measurements of OC were carried out, and three safety thresholds were then defined and correlated with fire effects. The highest ascertained oxygen concentration was 25.2%. In the event of a fire outbreak at 25.2% oxygen in the atmosphere, the response time and evacuation of medical staff and patients is no longer than 2.5 min. Uncontrolled oxygen enr...
International Journal of Environmental Research and Public Health
We aimed to evaluate the clinical course and impact of the SARS-CoV-2 pandemic on the rate of dia... more We aimed to evaluate the clinical course and impact of the SARS-CoV-2 pandemic on the rate of diagnosis and therapy in the complete Polish population of patients (pts) with pulmonary arterial hypertension (PAH-1134) and CTEPH (570 pts) treated within the National Health Fund program and reported in the national BNP-PL database. Updated records of 1704 BNP-PL pts collected between March and December 2020 were analyzed with regard to incidence, clinical course and mortality associated with COVID-19. Clinical characteristics of the infected pts and COVID-19 decedents were analyzed. The rates of new diagnoses and treatment intensification in this period were studied and collated to the proper intervals of the previous year. The incidence of COVID-19 was 3.8% (n = 65) (PAH, 4.1%; CTEPH, 3.2%). COVID-19-related mortality was 28% (18/65 pts). Those who died were substantially older and had a more advanced functional WHO class and more cardiovascular comorbidities (comorbidity score, 4.0 ± ...
Journal of Clinical Medicine, 2022
Background: We hypothesized that a Doppler index, the ratio of tricuspid regurgitation peak gradi... more Background: We hypothesized that a Doppler index, the ratio of tricuspid regurgitation peak gradient (TRPG) to pulmonary ejection acceleration time (AcT), improves the assessment of the echocardiographic probability of pulmonary hypertension in the identification of CTEPH and chronic thromboembolic pulmonary disease (CTED) in symptomatic patients after PE. Doppler echocardiography is recommended as the initial imaging tool for the diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH) after acute pulmonary embolism (PE). Methods: We analyzed the data from 845 consecutive PE (468 women; 61 ± 18 years) survivors who completed at least 6 months of anticoagulation therapy. Here, 555 patients (325 women; 66 ± 16 years) reporting functional impairment (FI) underwent transthoracic echocardiography. We included 506 patients (297 women; age 63.4 ± 16.6 years) in whom both AcT and TRPG were available into the current study. The presence of a minimum of intermediate echocardiograph...
# The Author(s) 2014. This article is published with open access at Springerlink.com Objective Th... more # The Author(s) 2014. This article is published with open access at Springerlink.com Objective The objective of this study was to assess the emerg-ing biochemical markers of arterial remodeling in patients with morbid obesity before and after surgical treatment and to compare the results to a control group. Material and Methods The prospective study included 40 patients with BMI 47.73±6.18 kg/m2, qualified for elective bariatric surgery and re-examined 6 months after the surgery. The control group consisted of non obese, age and sex matched 15 subjects. Following laboratory examinations were performed in all patients: basic laboratory examinations, MMP-2, MMP-9, adiponectin, PAI-1, CD40L, E-selectin. Results Examination of patients 6 m after bariatric surgery revealed a 34.57±9.71 reduction in excess body weight. Comparison of the study group at two time points revealed differences in adiponectin, MMP-2 and MMP-9 levels. Hypoadiponectinemiawas observed in 35%patients 6months after bariatric surgery compared to 90 % patients before the surgery. In addition, a strong correlation was observed be-tween body fat mass and adiponectin levels (r=−0.504, p=0.055). Moderate correlations were demonstrated between E-selectin levels and BMI (r=0.361; p=0.022), and metalloproteinase-9 levels (r=0.326; p=0.040). In addition, strong relationship was demonstrated between MMP-2 and MMP-9 (r=0.502; p=0.001), and moderate between MMP-2 and adiponectin levels (r=0.449; p=0.003). MMP-9 levels were moderately correlated with HDL-cholesterol levels (r= 0.316; p=0.046). Conclusions Assessment of laboratory markers of arterial remodeling and metabolism suggest their adverse changes in patients with morbid obesity. However, body mass reduction due to bariatric surgery decreases inflammatory status, im-proves biochemical markers of arterial remodeling as well as to beneficial changes in the metabolism.
European Heart Journal, 2020
Background The current diagnostic delay of chronic thromboembolic pulmonary hypertension (CTEPH) ... more Background The current diagnostic delay of chronic thromboembolic pulmonary hypertension (CTEPH) after acute pulmonary embolism (PE) is unacceptably long exceeding 1 year, causing loss of quality-adjusted life years and excess mortality. Validated screening strategies to diagnose CTEPH earlier are lacking. Importantly, performing echocardiography in all PE patients for this purpose has a low diagnostic yield, is associated with overdiagnosis and is not cost-effective. Moreover, expertise in performing high-quality PH-dedicated echocardiograms may not be available outside expert centers. Aim To validate a simple screening strategy aimed at identifying CTEPH early in the course after acute PE, avoiding echocardiography if possible (Figure 1). Methods In this prospective, international, multicenter management study, consecutive PE survivors were managed according to the predefined algorithm starting three months after acute PE. All were followed for a total period of two years. The stu...
European Heart Journal, 2017
treated patients was comparable: 0.35% (95% CI 0.18-0.69) in YEARS versus 0.73% (0.49-1.1) in the... more treated patients was comparable: 0.35% (95% CI 0.18-0.69) in YEARS versus 0.73% (0.49-1.1) in the Christopher study. Figure 1. the YEARS algorithm Conclusion: The prevalence of isolated ssPE diagnoses is lower in the YEARS algorithm compared to the Christopher study for suspected PE, without compromising the safety of the algorithm. This is likely a consequence of the lower sensitivity of YEARS for ssPE due to the significant reduction in the number of necessary CTPA examinations.
European Heart Journal, 2017
The purpose of this study was to investigate the 3-year outcome and efficacy in pulmonary hemodyn... more The purpose of this study was to investigate the 3-year outcome and efficacy in pulmonary hemodynamics after PTPA. Methods: This study retrospectively included 180 patients with inoperable CTEPH patients who underwent PTPA until October 2016. Firstly, we investigated the 3-year survival and restenosis. Secondary, hemodynamic parameters such as mean pulmonary arterial pressure (PAP), pulmonary vascular resistance (PVR) and cardiac index (CI) at baseline, after short-term (0.5-1.5 years), midterm (1.5-3.5 years) and long-term (>3.5 years) Results: A median of age, PTPA session performed per person and dilated vessels per person was 66 [55-74] years old, 4 [2-4] and 15 [10-20] respectively. 1-year, 3-year, and 5-year survival (all-cause) were 98.9% (95% confidence interval [CI], 94.9-99.7), 98.1% (95% CI, 93.7-99.3), and 95.8% (95% CI, 85.9-98.6), respectively. Time-course changes of hemodynamics after percutaneous transluminal pulmonary angioplasty (PTPA) in patients with chronic thromboembolic pulmonary hypertension. Mean pulmonary arterial pressure (PAP) was least squares mean of 37.9 mmHg (95% confidence interval [CI], 36.6-39.3) at baseline, and changed to 22.3 mmHg (95% CI, 20.8-23.7) at short-term, 20.8 mmHg (95% CI, 19.1-22.5) at mid-term, and 19.3 mmHg (95% CI, 16.5-22.0) at longterm after PTPA (all P<0.001 vs. baseline, respectively). Pulmonary vascular resistance (PVR) was 7.9 Wood units (95% CI, 7.4-8.4) at baseline, and changed to 2.9 Wood units (95% CI, 2.4-3.5) at short-term, 2.9 Wood units (95% CI, 2.3-3.6) at mid-term, and 2.4 Wood units (95% CI, 1.3-3.5) at long-term after PTPA (all P<0.001 vs. baseline, respectively). Cardiac index was 2.7 L/min/m 2 (95% CI, 2.6-2.8) at baseline, and changed to 3.2 L/min/m 2 (95% CI, 3.1-3.3) at short-term (P<0.001 vs. baseline), 3.0 L/min/m 2 (95% CI, 2.8-3.1) at mid-term (P=0.036 vs. baseline), and 2.7 L/min/m 2 (95% CI, 2.6-2.8) at long-term after PTPA (P=1.000 vs. baseline). Conclusions: The findings of the present study demonstrate that long-term favorable outcomes after PTPA can be expected in patients with CTEPH.
Journal of Ultrasonography, 2019
Transthoracic echocardiography is the primary non-invasive modality for anatomical and functional... more Transthoracic echocardiography is the primary non-invasive modality for anatomical and functional cardiac assessment. All one-, two-dimensional and Doppler modes use the same phenomenon, i.e. the piezoelectric effect, to visualize mobile cardiac structures and blood flow in cardiac cavities. Novel techniques for myocardial imaging, such as tissue Doppler and acoustic marker tracing, allow for the assessment of regional myocardial contractility of the left and the right ventricle. Cardiac assessment is performed in standard views characterized by an optimal acoustic window. The goal of each cardiac echo is to assess cardiac function and morphology using all available imaging modes. The evaluation of acquired valvular heart diseases should include morphological and functional changes indicative of the type (stenosis, regurgitation, complex defect) and the mechanism (Carpentier's classification of mitral regurgitation) of the defect, as well as its stage (mild, moderate, severe). The assessment of left and right ventricular function should involve the measurement of global and regional parameters. An echocardiographic report should also include information on septal continuity and the presence of additional structures or intracardiac masses.
Thorax, 2021
BackgroundThe current diagnostic delay of chronic thromboembolic pulmonary hypertension (CTEPH) a... more BackgroundThe current diagnostic delay of chronic thromboembolic pulmonary hypertension (CTEPH) after pulmonary embolism (PE) is unacceptably long, causing loss of quality-adjusted life years and excess mortality. Validated screening strategies for early CTEPH diagnosis are lacking. Echocardiographic screening among all PE survivors is associated with overdiagnosis and cost-ineffectiveness. We aimed to validate a simple screening strategy for excluding CTEPH early after acute PE, limiting the number of performed echocardiograms.MethodsIn this prospective, international, multicentre management study, consecutive patients were managed according to a screening algorithm starting 3 months after acute PE to determine whether echocardiographic evaluation of pulmonary hypertension (PH) was indicated. If the ‘CTEPH prediction score’ indicated high pretest probability or matching symptoms were present, the ‘CTEPH rule-out criteria’ were applied, consisting of ECG reading and N-terminalpro-br...
Therapeutic Advances in Chronic Disease, 2021
Background:Significant achievements in the treatment of chronic thromboembolic pulmonary hyperten... more Background:Significant achievements in the treatment of chronic thromboembolic pulmonary hypertension (CTEPH) have provided effective therapeutic options for most patients. However, the true impact of the changed landscape of CTEPH therapies on patients’ management and outcomes is poorly known. We aimed to characterize the incidence, clinical characteristics, and outcomes of CTEPH patients in the modern era of CTEPH therapies.Methods:We analyzed the data of CTEPH adults enrolled in the prospective multicenter registry.Results:We enrolled 516 patients aged 63.8 ± 15.4 years. The incidence rate of CTEPH was 3.96 per million adults per year. The group was burdened with several comorbidities. New oral anticoagulants ( n = 301; 58.3%) were preferred over vitamin K antagonists ( n = 159; 30.8%). Pulmonary endarterectomy (PEA) was performed in 120 (23.3%) patients and balloon pulmonary angioplasty (BPA) in 258 (50%) patients. PEA was pretreated with targeted pharmacotherapy in 19 (15.8%) p...
Advances in Dermatology and Allergology, 2020
Introduction: Cardiac abnormalities revealed in patients suffering from epidermolysis bullosa (EB... more Introduction: Cardiac abnormalities revealed in patients suffering from epidermolysis bullosa (EB) include dilated cardiomyopathy (DC) and aortopathy. DC is a rare but serious complication associated with an increased mortality, predominantly observed in recessive dystrophic EB. Echocardiography is the most available diagnostic tool used to detect heart disease in EB patients. Aim: To analyse echocardiographic results obtained in Polish EB patients and compare them between the EB group and healthy persons. Material and methods: We analysed retrospectively echocardiograms of 23 patients with EB (14 F, mean age 17.3 years) performed from 2017 to 2019. The incidence of left ventricular (LV) systolic and diastolic dysfunction, right heart disease and congenital heart disease was evaluated. A comparison of echo-parameters between EB patients and 20 matched healthy subjects was performed. Results: We did not find any cases of DC and aortopathy in the EB group. One bicuspid aortic valve case was revealed. Analysis of LV diastolic parameters showed that the mean value of mitral A velocity was significantly higher and the pulmonary venous flow D velocity was lower in the EB group than in controls. Tissue Doppler analysis revealed lower values of E' velocities of mitral annulus in the EB group, what may suggest discreetly slower LV relaxation, however, this will definitely require further research. Conclusions: Although most EB patients do not present cardiac symptoms, there is still a risk of developing cardiomyopathy associated with poor prognosis. It seems reasonable to perform a scheduled echocardiographic screening including LV systolic and diastolic function assessment to detect preclinical cardiac abnormalities.
Polish Archives of Internal Medicine, 2020
INTROduCTION Echocardiography proved to be very useful in the management of patients with acute d... more INTROduCTION Echocardiography proved to be very useful in the management of patients with acute dyspnea or chest pain. 1,2 Visualization of typical echocardiographic abnormalities, including the 60/60 sign, or detection of right heart thrombi in a patient with suspected acute pulmonary embolism (PE) confirms the diagnosis, even at the bedside. 3-7 Moreover, echocardiography helps to assess prognosis and guide therapeutic
Cardiology Journal, 2013
Background: Chronic thromboembolic pulmonary hypertension (CTEPH) is a complication of venous thr... more Background: Chronic thromboembolic pulmonary hypertension (CTEPH) is a complication of venous thromboembolism (VTE) resulting from non-dissolving thromboemboli in the pulmonary arteries. Previous observations indicate a higher prevalence of atherosclerosis and cardiovascular risk factors in patients with VTE and CTEPH. The purpose of the present study was to evaluate the arterial stiffening assessed by pulse wave velocity (PWV), a marker of arterial stiffness, in CTEPH patients in comparison with a matched control group (CG). Methods: The study group consisted of 26 CTEPH patients (9 male and 17 female, age 69 ± 10 years) and 22 CG (10 male, 12 female, age 67 ± 8 years). In all subjects a physical examination, carotidfemoral PWV and transthoracic echocardiography were performed. Right heart catheterization was done in all CTEPH. Results: Chronic tromboembolic pulmonary hypertension patients had significantly higher PWV than CG (10.3 ± 2.5 m/s vs. 9 ± 1.3 m/s, p < 0.05), even though systolic blood pressure was higher in CG (120 ± 11 vs. 132 ± 14 mmHg, p = 0.002). PWV correlated only with age and pulmonary vascular resistance (PVR) in CTEPH (r = 0.45, p = 0.03 and r = 0.43, p = 0.03, respectively). Arterial stiffening defined as PWV > 10 m/s was found in 11 (42%) CTEPH patients and in 5 (23%) cases from CG (p = 0.13). CTEPH patients with PWV > 10 m/s were older (74 ± 8 vs. 66 ± 10 years, p < 0.05), had decreased oxygen saturation
Thrombosis Research, 2020
INTRODUCTION The concept of post Pulmonary Embolism syndrome includes various combinations of fun... more INTRODUCTION The concept of post Pulmonary Embolism syndrome includes various combinations of functional, haemodynamic or imaging abnormalities in patients after pulmonary embolism (PE). Although residual obstruction of pulmonary vascular bed is suggested to be a major cause of post Pulmonary Embolism syndrome (post-PE syndrome) other cardiopulmonary abnormalities can be responsible for functional impairment. Therefore, we analyzed the frequency of post-PE syndrome and its potential causes. MATERIAL AND METHODS We report data of consecutive 845 PE survivors (468 F, aged 62 ± 18 yrs) who were anticoagulated, and followed for at least 6 months. All symptomatic subjects at follow up underwent diagnostic workup. RESULTS 35% (290/845) of PE survivors recovered functionally, while 65% patients reported a decreased exercise tolerance compatible with post-PE syndrome. One hundred and five symptomatic cases were lost to follow up. After diagnostic workup, chronic thromboembolic pulmonary hypertension (CTEPH) was diagnosed in 38 of 450 (8.4%) symptomatic subjects and chronic thromboembolic pulmonary disease (CTED) was diagnosed in 15/450 (3.3%) of them. Chronic heart failure with reduced ejection fraction (EF) was found in 6.9% (31/450) of patients and 154 patients (34.2%) had leftsided diastolic dysfunction. Valve heart disease was detected in 6.2% (28/450), atrial fibrillation in 31/450 (6.9%), Other causes of reduced exercise tolerance include coronary artery disease in 31/450 (6.9%), pulmonary disease 42/450 (9.3%), morbid obesity 15/450 (3.3%), neoplasms 15/450 (3.3%), psychiatric disorders 1%, rheumatoid disease 1%, anemia 1%. CONCLUSIONS Approximately 65% of PE survivors report functional impairment, despite at least 6 months of anticoagulation. Persistent pulmonary artery thromboemboli resulting in CTEPH or CTED were detected in 7.2% of PE survivors and 11.8% of symptomatic patients. Leftsided diastolic dysfunction was the most prevalent echocardiographic abnormality, and remained the most common cause of functional limitation affected 34.2% of symptomatic cases.
BMC Pulmonary Medicine, 2018
Background: Approximately a quarter of patients with advanced sarcoidosis develop pulmonary hyper... more Background: Approximately a quarter of patients with advanced sarcoidosis develop pulmonary hypertension (PH), which affects their prognosis. We report unusual case of confirmed chronic thromboembolic pulmonary hypertension (CTEPH) in a patient with stage IV sarcoidosis successfully treated with balloon pulmonary angioplasty (BPA). Case presentation: A 65 years old male with a history of colitis ulcerosa, and pulmonary sarcoidosis diagnosed in 10 years before, on long term oral steroids, with a history of deep vein thrombosis and acute pulmonary embolism chronically anticoagulated was referred to our center due to severe dyspnea. On admission he presented WHO functional class IV, mean pulmonary artery pressure (mPAP) in right heart catheterization (RHC) was elevated to 54 mmHg. Diagnosis of CTEPH was definitely confirmed with typical V/Q scan, and with selective pulmonary angiography (PAG) completes by intravascular imagining (intravascular ultrasound, optical coherent tomography). The patient was deemed inoperable by CTEPH team and two sessions of BPA with multimodal approach resulted in significant clinical and haemodynamical improvement to WHO class II and mPAP decrease to 27 mmHg. Conclusions: Balloon pulmonary angioplasty, rapidly developing method of treatment of inoperable CTEPH patients, is also extremely useful therapeutic tool in complex PH patients.
Cardiology Journal, 2013
Background: Tricuspid annular plane systolic excursion (TAPSE) is an established index of right v... more Background: Tricuspid annular plane systolic excursion (TAPSE) is an established index of right ventricular (RV) systolic function and a significant predictor in normotensive patients with pulmonary embolism (PE). Recently, Doppler tissue imaging-derived tricuspid annular systolic velocity (TV S'), a modern parameter of RV function was reported to be useful in the diagnosis and prognosis of a broad spectrum of heart diseases. Therefore, herein, is an analysis of the prognostic value of both parameters in normotensive PE patients. Methods: 139 consecutive PE patients (76 female, age 56.4 ± 19.5 years) were included in this study. All patients were initially anticoagulated. Transthoracic echocardiography was performed on admission. The study endpoint (SE) was defined as PE-related 30-day mortality and/or need for rescue thrombolysis. Results. Seven (5%) patients who met the criteria for SE presented more severe RV dysfunction at echocardiography. Univariable Cox regression analysis showed that RV/LV ratio predicted SE with hazard risk (
Circulation journal : official journal of the Japanese Circulation Society, Jan 26, 2018
Patients with intermediate-risk acute pulmonary embolism (APE) are a heterogeneous group with an ... more Patients with intermediate-risk acute pulmonary embolism (APE) are a heterogeneous group with an early mortality rate of 2-15%. The tricuspid annulus plane systolic excursion (TAPSE) and tricuspid regurgitation peak gradient (TRPG) can be used for risk stratification, so we analyzed the prognostic value of a new echo parameter (TRPG/TAPSE) for prediction of APE-related 30-day death or need for rescue thrombolysis in initially normotensive APE patients.Methods and Results:The study group consists of 400 non-high-risk APE patients (191 men, age: 63.1±18.9 years) who had undergone echocardiography within the first 24 h of admission. The TRPG/TAPSE parameter was calculated. The clinical endpoint (CE) was a combination of 30-day APE-related death and/or rescue thrombolysis. The CE occurred in 8 (2%) patients. All patients with TAPSE ≥20 mm (n=193, 48.2%) had a good prognosis. Among 206 patients with TAPSE <20 mm, 8 cases of the CE occurred (3.9%). NPV and PPV for TRPG/TAPSE >4.5 we...
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Papers by Olga Dzikowska-Diduch