<abstract><title style='display:none'>Summary</title>Neurogenic stress cardiomyopathy (NSC) is defined as transient cardiac dysfunction occurring after primary brain injury, such as aneurysmal subarachnoid haemorrhage, and characterised by left ventricular systolic dysfunction with reduced ejection fraction and abnormalities of regional wall motion. It may also be suspected if elevated levels of cardiac biomarkers and ECG abnormalities are present. It is a reversible condition with favourable long-term prognosis if diagnosed and treated timely, however, NSC is associated with higher rates of early mortality and complications, including pulmonary oedema, cardiogenic shock, delayed cerebral ischaemia. Early diagnosis of the NSC is important in order to prevent these complications and reduce mortality. Management of the NSC is complicated and a multidisciplinary approach is usually required.</abstract>

Neurogenic stress cardiomyopathy following aneurysmal subarachnoid haemorrhage: a literature review

<abstract><title style='display:none'>Summary</title>Cardiovascular diseases are the main cause of premature death worldwide. More than half of deaths were caused by cardiovascular diseases in 2017 in Lithuania. Primary prevention programmes encourage both medical staff and general population to pay attention to potential health issues as well as attempt to eradicate risk factors causing cardiovascular diseases. “A Funding Programme for the Screening and Preventive Management of the High Cardiovascular Risk Individuals” published in Lithuania has been implemented as of 2006.Analysis of the results of the programme shows that the prevalent cases of arterial hypertension are gradually declining. However, the prevalence of dyslipidaemia is still not decreasing. The prevalence of other modifiable cardiovascular disease risk factors has erratic trends with a slight overall decline. Consequently, mortality rate of cardiovascular diseases has decreased by more than one third among middle-age population over the past 10 years.Having higher availability of the anti-hypertensive and anti-lipid medications already achieved, the future plans include the aim of further reducing elevated blood pressure and effectively treating dyslipidaemia. In order to implement a strategy that focuses on smoking prevention, promotion of healthy nutrition and physical activity, a significant contribution is required from the state authorities.</abstract>

Primary prevention strategy for cardiovascular disease in Lithuania

<abstract><title style='display:none'>Summary</title>Real time (RT) three-dimensional (3D) imaging is one of the most significant developments of the last decade and is now being used with increasing frequency in echocardiography and interventional cardiology laboratories. Improvements in transducer technologies and the development of a matrix array transducer were the most important achievements that lead to the new era of real time 3D transoesophageal echocardiography (TEE). RT 3D TEE is ideal for assessing the mitral valve (MV) because of its high spatial resolution altering in improved MV anatomic detail. This imaging modality provides images of high quality which is of a great clinical value inmaking diagnosis of MV disease and a valuable tool for surgeons and interventional cardiologists in planning and guiding interventional procedures. This review is intended to provide data about normal MV anatomy and clinical usefulness of RT 3D TEE in defining acquired MV pathology.</abstract>

Centre of Cardiology and Angiology, Vilnius University Hospital Santariškių Klinikos, Santariškių 2, Vilnius, Lithuania

Centre of Cardiology and Angiology, Vilnius University Hospital Santariškių Klinikos, Vilnius, Lithuania

The role of real time three-dimensional transoesophageal echocardiography in acquired mitral valve disease

<abstract><title style='display:none'>Summary</title>Right ventricular myocardial infarction (RVMI) accompanies about 30–50% of inferior wall myocardial infarction. RVMI is associated with higher rates of cardiogenic shock, atrioventricular block, atrial fibrillation, increased mortality rates. The topic requires a scientific update, as only a few studies have been made on RVMI during the past decade. We aimed to analyse the impact of RVMI on inferior myocardial infarction.<bold>Design and methods</bold>: Retrospective study included 310 patients with documented inferior myocardial infarction (with and without RVMI) between January 2013 and January 2014. Data on baseline characteristics, mortality, in-hospital complications: cardiogenic shock and rhythm and conduction disorders was collected.<bold>Results</bold>: In 102 (32.9%) patients with inferior myocardial infarction, RVMI was present and 208 (67.1%) cases were without RVMI involvement. RVMI patients had higher rate of rhythm and conduction disturbances than patients without RVMI involvement: atrioventricular block (OR 3.8, 95% CI 2.0–7.1, <italic>p</italic> &lt; 0.001), atrial fibrillation (OR 1.6, 95% CI 0.9–2.9, <italic>p</italic> = 0.001), also higher incidence of cardiogenic shock (OR 2.6, 95% CI 1.7–3.9, <italic>p</italic> &lt; 0.001). Mortality rates after 24 months were higher in RVMI group (OR 1.8, 95% CI 1.2–3.8, <italic>p</italic> = 0.034). No significant difference was found on in-hospital mortality.<bold>Conclusions</bold>: Right ventricular involvement complicates the long-term mortality and outcomes after inferior myocardial infarction. It is related to a higher incidence of in-hospital complications, especially I–III degree AV block and atrial fibrillation. However, influence on long-term mortality needs further investigation.</abstract>

Retrospective analysis of complications and survival in patients with acute inferior myocardial infarction accompanied by right ventricular myocardial infarction

<abstract><title style='display:none'>Summary</title>We present a case of probably unreported aortic stenosis evolution in a patient with primary antiphospholipid syndrome (APS). A female patient, 54 years old, with a history of recurrent deep venous thrombosis, an episode of pulmonary embolism and was positive for APS antibodies. She was kept on warfarin and aspirin. The patient was admitted with acute pulmonary edema and severe aortic stenosis. While preparing for aortic valve surgery, the patient developed acute stroke, and a week later developed concurrent acute ischemia of both lower limbs. Emergency surgery salvaged the lower limbs and follow up transthoracic echocardiography showed marked regression of the thickening of the aortic valve leaflets, only mild aortic stenosis and moderate aortic regurgitation. Aortic valve surgery was cancelled, and the patient was kept on warfarin and aspirin.<bold>Conclusion</bold>Development of severe aortic stenosis is uncommon in primary APS, and this scenario of spontaneous improvement from a severe to a mild aortic stenosis, is probably unreported before.</abstract>

Spontaneous regression of severe aortic stenosis after massive embolization in a patient with antiphospholipid syndrome

<abstract xml:lang="en"><title style='display:none'>Comparison of retrospectively ECG-gated coronary computed tomography with and without adaptive tube voltage, tube current parameters and individualized contrast media injection protocol to reduce ionizing radiation dose</title><bold>Objective:</bold> The aim of the study was to estimate the decrease in ionizing radiation exposure dose using adaptive tube voltage, tube current parameters and individualized contrast media injection protocol compared to basic retrospectively ECG-gated CCTA protocol and to compare image quality.<bold>Methods:</bold> This retrospective study consisted of 30 consecutive patients who had body mass index (BMI) between 25 kg/m2 and 30 kg/m2 and underwent retrospectively ECG-gated CCTA. We have enrolled 15 patients which were scanned with an adaptive tube voltage, tube current and an individualized contrast media injection protocol (study group), the other 15 patients underwent basic retrospectively ECG-gated CCTA protocol (control group). Comparison of ionizing radiation effective dose, subjective and objective image quality was accomplished. Differences in ionizing radiation effective dose were deemed statistically significant if <italic>p</italic> &lt; 0.01, for other variables we considered a <italic>p</italic> value of less than 0.05 to be statistically significant.<bold>Results:</bold> he difference of a mean effective dose between study and control groups was statistically significant (6.39 ± 0.88 mSv and 17.44 ± 2.45 mSv, <italic>p</italic> &lt; 0.01). Despite significantly higher image noise, significantly lower contrast-to-noise ratio and signal-to-noise ratio in a study group, both groups showed comparable average image quality (62.03±16.85 and 39.98±8.79, <italic>p</italic> &lt; 0.01; 5.16±2.03 and 7.71±1.28, <italic>p</italic> &lt; 0.01; 3 (2.5-3) and 2.75 (2.75-3), <italic>p</italic> = 0.95).<bold>Conclusions:</bold> Despite higher image noise compared to basic retrospectively ECG-gated CCTA protocol, adaptive tube voltage, tube current parameters and individualized contrast media injection protocol allows substantial reduction in ionizing radiation exposure dose to a patient (up to 63%) with an adequate image quality for the evaluation of coronary arteries.</abstract>

Department of Radiology, Nuclear Medicine and Medical Physics, Faculty of Medicine, Vilnius University

Centre of Radiology and Nuclear Medicine, Vilnius University Hospital Santariškiu Klinikos

Department of Clinical Radiation Monitoring, Vilnius University Hospital Santariškiu Klinikos

Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Vilnius University

Centre of Cardiology and Angiology, Vilnius University Hospital Santariškiu Klinikos

Comparison of retrospectively ECG-gated coronary computed tomography with and without adaptive tube voltage, tube current parameters and individualized contrast media injection protocol to reduce ionizing radiation dose

<abstract>
<title style='display:none'>Summary</title>
We report the case of a 62-year-old woman who was admitted to Vilnius University Hospital Santaros klinikos suffering from week-long shortness of breath during minimal physical activity. Computed tomography angiography and echocardiogram findings led to a diagnosis of pulmonary embolism and large pericardial effusion. The patient was previously diagnosed with a base of tongue cancer with lung metastasis. The patient received low-molecular-weight-heparin, and pericardiocentesis was performed. As a result, the patient’s general condition improved, and she was discharged from the hospital. In this case, pulmonary embolism and pericardial effusion coincided as complications of malignancy. The concurrent presentation of these conditions is rare and poses a clinical dilemma regarding the treatment, including anticoagulant therapy.
</abstract>

Simultaneous presentation of pulmonary embolism and pericardial effusion as complications of cancer: a case report

<abstract>
<title style='display:none'>Summary</title>
<sec><title style='display:none'>Background</title>Deep sternal wound infection (DSWI) after orthotopic heart transplantation (OHT) is not a common but known complication and carries high mortality and morbidity rates. This report identifies a successful management strategy for recurrent DSWI, and it is a valuable addition to the medical literature supporting the management of sternal wound infections (SWI) along with negative pressure wound therapy (NPWT).</sec>
<sec><title style='display:none'>Case presentation</title>This report describes the successful management of recurrent DSWI after OHT in a 52-year-old patient. We performed secondary sternotomy closure along with NPWT for the immunosuppressed patient.</sec>
<sec><title style='display:none'>Conclusion</title>Our case demonstrates that a combination of reduced immunosuppression, adequate antimicrobial treatment, and NPWT can effectively treat complicated DSWI.</sec>
</abstract>

Sternotomy closure using negative pressure wound therapy after heart transplantation

<abstract>
<title style='display:none'>Summary</title>
Non-compaction cardiomyopathy (NCC) is a rare pathology, but the exact rates of its prevalence are not known due to the lack of a diagnostic gold standard. The purpose of this article is to analyse the available cardiovascular magnetic resonance (CMR) diagnostic criteria of non-compaction described in the literature and to compare their sensitivity and specificity in the diagnosis of NCC. A search of available literature related to the CMR diagnostic criteria of myocardial non-compaction was conducted in the medical database PubMed in February of 2022. The period of publication of scientific articles covered the years from 1996 to 2022. A total of 7 full-text scientific articles were included in the final literature review. The main diagnostic criteria were used: the maximum non-compact (NCM) to compact myocardial layers (CM) ratio (NCM:CM), the percentage of trabeculated left ventricular (LV) myocardial mass, the percentage of trabeculated LV myocardial volume, the non-compact myocardial mass index of the total LV, and the determination of the total LV and the maximal fractal dimension (FD) of the apex with the use of fractal analysis. The lack of accurate diagnostic criteria results in an overdiagnosis of NCC. The highest sensitivity and specificity are associated with the maximum FD &gt; 1.30 of the apex established by applying the fractal analysis method. Fractal analysis requires dedicated software, and this method is difficult to apply in routine clinical practice. Thus, the diagnostic criteria for the NCC using magnetic resonance imaging with higher diagnostic value remain to be sought.
</abstract>

Magnetic resonance diagnostic criteria of non-compaction cardiomyopathy: new diagnostic criteria still needed?

<abstract>
<title style='display:none'>Summary</title>
Intracardiac blood cysts are generally observed in infants and regress spontaneously with time. Blood cysts are mainly located on the left side of the heart and atrioventricular valves. These findings are extremely rare in older children and adults. We report a rare case of a 45-year-old female patient with a cardiac blood cyst in the right atrium and hypertrophic obstructive cardiomyopathy. To the best of our knowledge, this is the first-ever case report in the literature of blood cyst and hypertrophic cardiomyopathy.
</abstract>

Right atrial blood cyst of a patient with hypertrophic cardiomyopathy

<abstract>
<title style='display:none'>Summary</title>
We report a case of a 36-year-old man who was admitted to the Vilnius University Hospital Santaros clinics emergency department suffering from acute chest pain and experienced cardiac arrest. Changes in the electrocardiogram, elevated troponin level, and clinical symptoms lead to ST-elevation myocardial infarction (MI) diagnosis. The patient was diagnosed with systemic lupus erythematosus (SLE). He was in a remission state of SLE and was not taking drugs for one year before MI happened. SLE may be associated with antiphospholipid syndrome, which can cause cardiovascular complications such as MI. Although it is a usual practice to stop treatment in remission, in some cases, clinicians should consider continuing SLE treatment to avoid cardiovascular complications. In this case, the exacerbation of SLE and myocardial infarction occurred almost simultaneously with no previous thrombotic or cardiovascular events.
</abstract>

Heart arrest due to systemic lupus erythematosus relapse: case report

<abstract xml:lang="en"><title style='display:none'>Lithuanian High Cardiovascular Risk (LitHiR) primary prevention programme - rationale and design</title><bold>Objectives:</bold> According to the latest WHO data, coronary heart disease deaths in Lithuania reached 38.3% of total deaths. Based on the unfavourable situation with cardiovascular morbidity and mortality in Lithuania the Lithuanian High Cardiovascular Risk (LitHiR) programme aimed at estimation and aggressive managing of cardiovascular risk factors. This paper describes the Lithuanian High Cardiovascular Risk programme protocol.<bold>Design and methods:</bold> In 2006 the Lithuanian High Cardiovascular Risk programme was started. LitHiR programme recruited men - at the age of 40-54 years and women - 50-64 years without overt cardiovascular disease. The two-level approach - primary health care institutions (PHCI) and specialized cardiovascular prevention units (CVPU) - was applied. The subjects selected were tested for cardiovascular risk and those with high cardiovascular risk were sent to secondary (CVPU) level, for other the plan of preventive measures of risk factor reduction was created. In years 2006-2010 overall 266,391 persons (36.9% from all target population) were examined. Among them 164,657 subjects (61.8%) were tested for the first time, 68,832 (25.8%) were tested repeatedly one time, 32,848 subjects (12.3%) were tested repeatedly for two and more times.<bold>Conclusions:</bold> The programme aimed at estimation and managing of cardiovascular risk factors striving to reduce acute cardiovascular event related morbidity and mortality, to slow down the progression of sub-clinical atherosclerosis into overt cardiovascular disease, to increase the number of newly identified cases of diabetes, metabolic syndrome and latent course of atherosclerosis related diseases, to decrease hospitalizations for treatment of arterial hypertension and coronary heart disease.</abstract>

Vilnius University Hospital Santariškių Klinikos, Vilnius, Lithuania

Department of Cardiovascular, Medicine Vilnius University, Vilnius, Lithuania

Lithuanian University of Health Sciences, Kaunas, Lithuania

Lithuanian High Cardiovascular Risk (LitHiR) primary prevention programme - rationale and design

<abstract><title style='display:none'>Summary</title><bold>Objectives:</bold> Metabolic syndrome (MetS) is linked to the development of type 2 diabetes and increased risk of cardiovascular disease (CVD). Physical inactivity is one of the main pathophysiological factors of MetS subjects. The aim of this study was to evaluate if 4-week supervised aerobic training had any impact on anthropometric, metabolic, hemodynamic and arterial wall parameters in MetS subjects.<bold>Design and methods:</bold> 57 MetS subjects were randomly selected from a Lithuanian High Cardiovascular Risk (LitHiR) national primary prevention programme. Hemodynamic, cardiometabolic risk and arterial wall parameters were evaluated after the 4-week supervised aerobic training.<bold>Results:</bold> After 4 weeks of aerobic training there was statistically significant decrease in body mass index from 30.58 <italic>±</italic> 3.7 to 30.3 <italic>±</italic> 3.55 kg/m2 (<italic>p</italic> = 0.010), waist circumference from 104.24 <italic>±</italic> 9.46 to 102.9 <italic>±</italic> 9.48 cm (<italic>p</italic> = 0.003), decrease of LDL cholesterol from 4.21 <italic>±</italic> 1.15 to 3.78 <italic>±</italic> 1 mmol/l (<italic>p</italic> = 0.032) and high sensitivity C-reactive protein from 2.01 <italic>±</italic> 2.36 to 1.64 <italic>±</italic> 1.92 mg/l (<italic>p</italic> = 0.009), decrease of diastolic blood pressure (BP) from 83.06 <italic>±</italic> 10.18 to 80.38 <italic>±</italic> 8.98 mmHg (<italic>p</italic> = 0.015), mean BP from 100.03 <italic>±</italic> 10.70 to 97.31 <italic>±</italic> 8.88 mmHg (<italic>p</italic> = 0.027) and aortic stiffness, assessed as carotid-femoral pulse wave velocity, from 8.34 <italic>±</italic> 1.26 to 7.91 <italic>±</italic> 1.15 m/s (<italic>p</italic> = 0.034).<bold>Conclusions:</bold> In subjects with MetS even short-duration (4-week) supervised aerobic exercise training is associated with improvement of some anthropometric, metabolic and hemodynamic parameters as well as the decrease in aortic stiffness. This training modality could be recommended for initiation of physical training and could increase motivation for further physical activity.</abstract>

Positive impact of a 4-week duration supervised aerobic training on anthropometric, metabolic, hemodynamic and arterial wall parameters in metabolic syndrome subjects

<abstract><title style='display:none'>Summary</title>The aim of this study was to determine the frequency of extracardiac pathology in neonatal patients with suspected congenital heart disease referred to undergo multidetector computed tomography (MDCT) angiography in Vilnius University Hospital Santariskiu Klinikos. The safety of MDCT angiography (intravenous contrast media volume injected, scanning time and exposure to ionising radiation) was also evaluated. Patients and Methods: During the period of 2006-2012, in Vilnius University Hospital Santariskiu Klinikos 186 pediatric patients were referred to undergo MDCT angiography of whom 71 were neonates with suspected complex congenital heart disease (CHD) and extracardiac pathology. Results: Sixty nine (97.2%) of referred neonates were found to have extracardiac pathology (36 had extracardiac vascular pathology only, 4 - extracardiac non-vascular pathology only and 29 - both extracardiac vascular and non-vascular pathology). In 47 patients diagnosis of extracardiac pathology was verified intraoperatively. Remainder (n = 24) of the group were not operated (12 patients died because of hemodynamic instability and inoperable complex CHD, 9 patients were scheduled for later surgery, in 3 patients surgery was not indicated). Mean contrast media volume used was 4.18±1.03 ml, mean scanning time was 1.07±0.77 s and mean effective radiation dose was 2.8± 0.69 mSv. No adverse reactions or complications were observed. Conclusions: MDCT angiography is accurate and safe method in diagnosis of complex congenital heart disease with extracardiac pathology.</abstract>

Department of Radiology, Nuclear Medicine and Medical Physics, Faculty of Medicine, Vilnius University, Vilnius, Lithuania

Centre of Radiology and Nuclear Medicine, Vilnius University Hospital Santariškių Klinikos, Vilnius, Lithuania

Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania

Multidetector computed tomographic angiography in evaluation of neonates with suspected extracardiac congenital heart disease: experience in Vilnius University Hospital Santariškių Klinikos

Open Access License

Seminars in Cardiovascular Medicine

The Journal of Lithuanian Heart Association

 The journal covers all fields of cardiovascular medicine and mostly reflects status of cardiovascular medicine in the Baltic States, but also publishes papers submitted by authors...

 The journal covers all fields of cardiovascular medicine and mostly reflects status of cardiovascular medicine in the Baltic States, but...