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- Samarai, Daniel, et al.
(author)
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Global longitudinal strain correlates to systemic right ventricular function
- 2020
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In: Cardiovascular Ultrasound. - : Springer Science and Business Media LLC. - 1476-7120. ; 18:1
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Journal article (peer-reviewed)abstract
- Background: The aim of this retrospective study was to evaluate the relationship between right ventricular function derived from cardiac magnetic resonance imaging (CMR), echocardiography and exercise stress test performance, NT-proBNP (N-terminal proB-type natriuretic peptide) level and NYHA class in patients with a systemic right ventricle. Methods: All patients with congenitally corrected transposition of the great arteries (ccTGA), or transposition of the great arteries after Mustard or Senning procedures, (TGA) followed at our centre who had undergone CMR, echocardiography, an exercise stress test and blood sampling, were included in the study. Results: We examined 11 patients (six after the Senning procedure, one after the Mustard procedure, and four ccTGA) who have a median age of 32 years (22-67 years). A significant correlation was observed between the systemic ventricular function, expressed as the CMR-derived right ventricular ejection fraction and the right ventricular global longitudinal strain (r= -0.627; p=0.039). Conclusion: We have demonstrated that in patients with ccTGA or TGA right ventricular global longitudinal strain may be useful in the evaluation of the systemic right ventricular function.
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| 2. |
- Samarai, Daniel
(author)
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Management of Adults with Congenital Heart Disease
- 2022
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Doctoral thesis (other academic/artistic)abstract
- Adults with congenital heart disease (ACHD) are a completely new and rapidly growing specialty comprising patients who require specialist knowledge regarding their care and treatment. Challenges involve diagnostics and treatment as studies are scarce and include small and heterogenous study populations.The first aim with this thesis was to evaluate the relationship between the systemic right ventricular function determined by cardiac magnetic resonance (CMR) imaging, biomarkers, echocardiographic parameters, New York Heart Association class and performance on stress test.The second aim of this thesis was to evaluate anticoagulation treatment with vitamin K antagonists (VKA) in ACHD. This involved determining the quality of VKA therapy by evaluating time in therapeutic range (TTR) and variability of international normalised ratio of prothrombin time. Furthermore, studying the efficacy and safety of VKA and non-vitamin K oral antagonists (NOAC) in ACHD by evaluating the incidence of thromboembolism (TE), major bleeding and potential risk factors.Paper I A correlation was observed between the systemic ventricular function determined with CMR and echocardiographic ventricular global longitudinal strain in patients with systemic right ventricle.Paper II-III Anticoagulation with VKA was of high quality in ACHD in the South of Sweden. A low incidence of TE and major bleeding events was seen in ACHD patients with high quality VKA treatment. Younger age, female gender and cardiac failure were risk factors for poor anticoagulation and thus may be cause for cautiosness and when suitable, consideration of alternative non-VKA anticoagulants. History of TE was associated with complcations (TE and major bleeding).Paper IV In this retrospective study reports a single-center experience of NOAC use in ACHD patients we found no thromboembolic and one major bleeding events during a median duration of 17 months of therapy.In conclusion, right ventricular global longitudinal strain by echocardiography may be useful in the evaluation of the systemic right ventricular function in patients with congenitally corrected transposition of the great arteries (TGA) or TGA after atrial switch.Anticoagulation therapy with oral VKA is of good quality in ACHD patients with a high TTR, low INR variability, low incidence of TE and major bleeding events. We recommend the applicable target of TTR>65% for ACHD patients. Young age and female gender may be considerable factors to consider when initiating anticoagulation therapy. NOAC therapy may be considerable in the absence of highly specialized organization in regard to VKA medication where close monitoring of the patient is not possible. NOAC appear safe and effective in ACHD patients without mechanical valve protheses.Larger prospective trials on efficacy and safety of VKA and NOAC in ACHD would be needed to develop and further improve the treatment guidelines.
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| 3. |
- Samarai, Daniel, et al.
(author)
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Novel oral anticoagulant use in adults with congenital heart disease : a single-center experience report
- 2023
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In: Egyptian Heart Journal. - : Springer Science and Business Media LLC. - 1110-2608 .- 2090-911X. ; 75:1
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Journal article (peer-reviewed)abstract
- Background: Adults with congenital heart disease (ACHD) are a group with an increased risk of thromboembolic complications and arrhythmias. Vitamin K antagonists are the most commonly used thromboprophylaxis therapy in this population. Studies on the efficacy and safety of novel oral anticoagulants (NOAC) are scare in ACHD. A retrospective study on ACHD patients on NOAC treatment registered in the National Quality Registry for Congenital Heart Disease, SWEDCON, and National Quality Registry for Atrial fibrillation and Anticoagulation, AuriculA, from Southern Sweden. Results: Thirty patients who had been taking NOAC treatment for a minimum of 3 months were included. Their median age was 55 years (SD 17 years) and 57% were male. Median follow-up was 17 months (IQR: 10–41). Eliquis was the most used NOAC (47%). Median CHA2DS2-VASc score was 2 (IQR: 0–3) and HAS-BLED was 1 (IQR: 0–2). Complex ACHD was prevalent in 27% of the patients. No thromboembolic events were recorded; however, one major bleeding, unspecified, was reported during the total cumulative patient follow-up time of 64 years. Conclusions: The results of our study, although limited in size, suggest that NOAC appear safe and effective in ACHD patients. Further and larger studies on NOAC in ACHD patients are warranted.
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| 4. |
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| 5. |
- Samarai, Daniel, et al.
(author)
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Rate and risk factors for thromboembolism and major bleeding in adults with congenital heart disease taking vitamin K antagonist therapy
- 2022
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In: Thrombosis Update. - : Elsevier BV. - 2666-5727. ; 9
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Journal article (peer-reviewed)abstract
- Background: The risk of adults with a congenital heart defect (ACHD) developing heart failure, stroke, arrhythmias, and the need for valve replacement is increased compared to healthy peers. Evidence for the use of novel oral anticoagulants (NOAC) in this patient group is still lacking and vitamin K antagonists (VKA) are the primary choice for patients with a mechanical valve. The present aim was to determine the rate of thromboembolic and major bleeding events in ACHD patients on VKA therapy. Methods: This was a retrospective study on ACHD patients on VKA treatment registered in the National Quality Registry for Congenital Heart Disease, SWEDCON, and Atrial fibrillation and Anticoagulation, AuriculA, from Southern Sweden. Results: 213 patients were included with a mean age of 50 years (±18) years and a mean follow-up of 6.6 years (±3.3 years), 16% had complex defects and 41% had valvular VKA therapy indication. In total, 34 complications were registered, of which 14 were thromboembolic events and 20 were major bleeding events. The rate of thromboembolism and major bleeding events was 1.0 (95% CI: 0.6–1.6) and 1.4 (95% CI: 0.9–2.2) per 100 patient-years, respectively. Forty-three patients died during the study period. The mortality rate was 3.1 per 100 patient-years (95% CI: 2.2–4.1). Conclusion: We found a low rate of thromboembolic events and major bleeding events for low-moderate risk ACHD patients with good quality of VKA anticoagulation. The target of TTR>65% for ACHD patients is recommended.
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