Publications by authors named "Katarzyna Mizia-Stec"

189 Publications

Echocardiography during the COVID-19 pandemic, an impact of the vaccination program: a 2021 update of the expert opinion of the Working Group on Echocardiography of the Polish Cardiac Society.

Kardiol Pol 2021 Apr 26. Epub 2021 Apr 26.

Coronavirus disease 2019 (COVID-19) pandemic resulted in an urgent need to reorganize the work of echocardiography laboratories in order to ensure the safety of patients and protection of physicians, technicians, and other staff members. In the previous Expert Opinion of the Working Group on Echocardiography of Polish Cardiac Society we provided recommendations for the echocardiographic services, in order to ensure maximum possible safety and efficiency of imagers facing epidemic threat. Now, with much better knowledge and larger experience in treating COVID-19 patients and with introduction of vaccination programs, we present updated recommendations for performing transthoracic and transesophageal examinations, including information on potential impact of personnel and patient vaccination program as well as the growing number of convalescents on performance of echocardiographic laboratories, with the goal of their ultimate reopening.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.33963/KP.15973DOI Listing
April 2021

Characteristics and outcomes of patients with chronic thromboembolic pulmonary hypertension in the era of modern therapeutic approaches: data from the Polish multicenter registry (BNP-PL).

Ther Adv Chronic Dis 2021 25;12:20406223211002961. Epub 2021 Mar 25.

Pulmonary Circulation Centre Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland, Department of Medical Education, Center for Innovative Medical Education, Jagiellonian University Medical College, Krakow, Poland.

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 ( = 301; 58.3%) were preferred over vitamin K antagonists ( = 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%) patients, and BPA in 124 (48.1%) patients. Persistent CTEPH was present in 46% of PEA patients and in 65% of patients after completion of BPA. Persistent CTEPH after PEA was treated with targeted pharmacotherapy in 72% and with BPA in 27.7% of patients. At a mean time period of 14.3 ± 5.8 months, 26 patients had died. The use of PEA or BPA was associated with better survival than the use of solely medical treatment.

Conclusions: The modern population of CTEPH patients comprises mostly elderly people significantly burdened with comorbid conditions. This calls for treatment decisions that are tailored individually for every patient. The combination of two or three methods is currently a frequent approach in the treatment of CTEPH.

Clinical Trial Registration: clinicaltrials.gov/ct2/show/NCT03959748.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/20406223211002961DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8010818PMC
March 2021

Polish Multicenter Registry (Pol-LAS-SE registry). Stress echocardiography in low-gradient aortic stenosis in Poland: numbers, settings, results, complications, and clinical practice.

Kardiol Pol 2021 04 5. Epub 2021 Apr 5.

Background: The diagnostic workup of low-gradient aortic stenosis (LG AS) is a challenge in clinical practice.

Aims: Therefore, our goal was to assess the diagnostic value of stress echocardiography (SE) performed in patients with undefined LG AS with low and preserved ejection fraction (EF) and the impact of its result on therapeutic decisions in Polish third-degree care facilities.

Methods: All the patients with LG AS and with SE performed were recruited in 16 Polish departments of cardiology between 2017 and 2019. The main exclusion criteria were as follows: moderate or severe aortic or mitral regurgitation, mitral stenosis.

Results: The study group included 163 patients (52 % males) with LG AS who underwent SE for adequate diagnostic and therapeutic decision. In 14 patients DSE were non-diagnostic. The mean aortic valve (AV) pressure gradient was 24.1 (7.3) mmHg, while an AV area was 0.86 (0.2) cm2. Among 149 patients with conclusive DSE, severe AS was found in 59.8%, pseudo-severe in 22% and moderate AS in 18%. There were no cases of death or vascular events related to DSE. Among 142 patients sixty-three (44%) patients had an aortic valve intervention in a follow-up (median - 208 days; lower - upper quartile, 73 - 531 days). Based on the result of DSE test, severe AS was significantly more often associated with qualification to intervention compared to the moderate and pseudo-severe subgroups (P < 0.0001).

Conclusions: DSE test in severe AS is a valuable diagnostic tool in patients with LG AS in Poland.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.33963/KP.15929DOI Listing
April 2021

Pregnant 30-year-old with idiopathic pulmonary arterial hypertension.

Ginekol Pol 2021 10;92(3):252-253. Epub 2021 Mar 10.

1st Department of Cardiology, Medical University of Silesia in Katowice, Poland, Poland.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5603/GP.a2020.0156DOI Listing
March 2021

Impact of percutaneous patent foramen ovale closure on migraine headaches in patients with history of ischemic neurological events.

Postepy Kardiol Interwencyjnej 2020 Sep 2;16(3):315-320. Epub 2020 Oct 2.

Department of Cardiology, Royal Papworth Hospital, Cambridge, United Kingdom.

Introduction: Observational studies have shown that migraine has been associated with patent foramen ovale (PFO). Whilst studies investigating PFO closure for the treatment of migraine have been neutral, there is some evidence that symptoms of migraine may improve if the PFO was closed after ischemic stroke.

Aim: To establish whether closure of PFO in patients with stroke or transient ischemic attack (TIA) is associated with reduction in the severity of co-existent migraine headaches.

Material And Methods: Patients with ischemic stroke or TIA, PFO suitable for percutaneous closure and migraine, were given migraine severity questionnaires prior to PFO closure. These were followed up at 6 and 12 months after closure with the same questionnaire. The primary endpoint was change in migraine severity using the Migraine Severity Scale (MIGSEV). Migraine episode frequency, disability (using the MIDAS scale), and pain intensity were also assessed.

Results: Sixty-two patients were included in the analysis. MIGSEV scores reduced from 7 (7-8) at baseline to 4 (3.25-6) at 6-month follow-up, and 3 (0-4) at 12-month follow-up ( < 0.001). Other measures of migraine headache were also improved at both 6- and 12-month follow-up. Twenty-four (38%) patients were rendered migraine free at 12 months.

Conclusions: PFO closure for stroke or TIA prevention in patients with migraine was associated with a reduction in markers of migraine headache severity.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5114/aic.2020.99267DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7863799PMC
September 2020

Left ventricular global longitudinal strain in predicting CRT response: one more J-shaped curve in medicine.

Heart Vessels 2021 Feb 6. Epub 2021 Feb 6.

First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, ul Ziolowa 45/47, 40-635, Katowice, Poland.

The aim of the study was: (1) to verify the hypothesis that left ventricular global longitudinal strain (LVGLS) may be of additive prognostic value in prediction CRT response and (2) to obtain such a LVGLS value that in the best optimal way enables to characterize potential CRT responders. Forty-nine HF patients (age 66.5 ± 10 years, LVEF 24.9 ± 6.4%, LBBB 71.4%, 57.1% ischemic aetiology of HF) underwent CRT implantation. Transthoracic echocardiography was performed prior to and 15 ± 7 months after CRT implantation. Speckle-tracking echocardiography was performed to assess longitudinal left ventricular function as LVGLS. The response to CRT was defined as a ≥ 15% reduction in the left ventricular end-systolic volume (∆LVESV). Thirty-six (73.5%) patients responded to CRT. There was no linear correlation between baseline LVGLS and ∆LVESV (r = 0.09; p = 0.56). The patients were divided according to the percentile of baseline LVGLS: above 80th percentile; between 80 and 40th percentile; below 40th percentile. Two peripheral groups (above 80th and below 40th percentile) formed "peripheral LVGLS" and the middle group was called "mid-range LVGLS". The absolute LVGLS cutoff values were - 6.07% (40th percentile) and - 8.67% (80th percentile). For the group of 20 (40.8%) "mid-range LVGLS" patients mean ΔLVESV was 33.3 ± 16.9% while for "peripheral LVGLS" ΔLVESV was 16.2 ± 18.8% (p < 0.001). Among non-ischemic HF etiology, all "mid-range LVGLS" patients (100%) responded positively to CRT (in "peripheral LVGLS"-55% responders; p = 0.015). Baseline LVGLS may have a potential prognostic value in prediction CRT response with relationship of inverted J-shaped pattern. "Mid-range LVGLS" values should help to select CRT responders, especially in non-ischemic HF etiology patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00380-021-01770-wDOI Listing
February 2021

Hyperintense Brain Lesions in Asymptomatic Low Risk Patients with Paroxysmal Atrial Fibrillation Undergoing Radiofrequency Pulmonary Vein Isolation.

J Clin Med 2021 Feb 3;10(4). Epub 2021 Feb 3.

First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, 40-635 Katowice, Poland.

Background: The aim was to determine the occurrence, consequences and risk factors for brain white matter hyperintensities (WMH) assessed in magnetic resonance imaging (MRI) in low-risk patients with paroxysmal atrial fibrillation (AF) undergoing radiofrequency pulmonary vein isolation (PVI-RF).

Methods: 74 patients with AF (median 58.5 years (IQR 50-63), 45 male) were included. Before and after a minimum of 6 months after PVI-RF, a brain MRI and a mini-mental state examination (MMSE) were performed.

Results: Baseline WMH lesions were found in 55 (74.3%) patients and in 48 from 62 (77.4%) patients after PVI-RF. The WMH lesions were more frequent among older patients, with a higher CHA2DS2-Vasc (C-Congestive heart failure/LV dysfunction, H-Hypertension, A-Age, D-Diabetes mellitus, S-Stroke, V-Vascular Disease, Sc-Sex category). Factors affecting the severity of the WMH were: older age, the co-existence of the PFO and coronary artery disease (CAD). After a follow-up period, the factors predisposing to brain WMH lesions occurrence (age, higher BMI and CHA2DS2-Vasc score) and to the more advanced changes (age, higher CHA2DS2-Vasc score, CAD, PFO) were obtained.

Conclusions: The presence and severity of cerebral microembolism are associated with age, higher CHA2DS2-Vasc score and the coexistence of PFO and CAD. PVI-RF procedure and its efficacy does not influence on MRI lesions. In this population, cerebral microembolism is not related to cognitive impairment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/jcm10040565DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7913160PMC
February 2021

Regional Strain Pattern Index-A Novel Technique to Predict CRT Response.

Int J Environ Res Public Health 2021 01 21;18(3). Epub 2021 Jan 21.

First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, ul. Ziolowa 45/47, 40-635 Katowice, Poland.

Background: Cardiac resynchronization therapy (CRT) improves outcome in patients with heart failure (HF) however approximately 30% of patients still remain non-responsive. We propose a novel index-Regional Strain Pattern Index (RSPI)-to prospectively evaluate response to CRT.

Methods: Echocardiography was performed in 49 patients with HF (66.5 ± 10 years, LVEF 24.9 ± 6.4%, QRS width 173.1 ± 19.1 ms) two times: before CRT implantation and 15 ± 7 months after. At baseline, dyssynchrony was assessed including RSPI and strain pattern. RSPI was calculated from all three apical views across 12 segments as the sum of dyssynchronous components. From every apical view, presence of four components were assessed: (1) contraction of the early-activated wall; (2) prestretching of the late activated wall; (3) contraction of the early-activated wall in the first 70% of the systolic ejection phase; (4) peak contraction of the late-activated wall after aortic valve closure. Each component scored 1 point, thus the maximum was 12 points.

Results: Responders reached higher mean RSPI values than non-responders (5.86 ± 2.9 vs. 4.08 ± 2.4; = 0.044). In logistic regression analysis value of RSPI ≥ 7 points was a predictor of favorable CRT effect (OR: 12; 95% CI = 1.33-108.17; = 0.004).

Conclusions: RSPI could be a valuable predictor of positive outcome in HF patients treated with CRT.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/ijerph18030926DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7908216PMC
January 2021

Current use of cardiac magnetic resonance in tertiary referral centres for the diagnosis of cardiomyopathy: the ESC EORP Cardiomyopathy/Myocarditis Registry.

Eur Heart J Cardiovasc Imaging 2021 Jan 8. Epub 2021 Jan 8.

Members of the European Reference Network on Heart Diseases (ERN GUARD-HEART), Coordinating Centre: Academic Medical Center, Amsterdam, the Netherlands.

Aims : Cardiac magnetic resonance (CMR) is recommended in the diagnosis of cardiomyopathies, but it is time-consuming, expensive, and limited in availability in some European regions. The aim of this study was to determine the use of CMR in cardiomyopathy patients enrolled into the European Society of Cardiology (ESC) cardiomyopathy registry [part of the EURObservational Research Programme (EORP)].

Methods And Results : Three thousand, two hundred, and eight consecutive adult patients (34.6% female; median age: 53.0 ± 15 years) with cardiomyopathy were studied: 1260 with dilated (DCM), 1739 with hypertrophic (HCM), 66 with restrictive (RCM), and 143 with arrhythmogenic right ventricular cardiomyopathy (ARVC). CMR scans were performed at baseline in only 29.4% of patients. CMR utilization was variable according to cardiomyopathy subtypes: from 51.1% in ARVC to 36.4% in RCM, 33.8% in HCM, and 20.6% in DCM (P < 0.001). CMR use in tertiary referral centres located in different European countries varied from 1% to 63.2%. Patients undergoing CMR were younger, less symptomatic, less frequently had implantable cardioverter-defibrillator (ICD)/pacemaker implanted, had fewer cardiovascular risk factors and comorbidities (P < 0.001). In 28.6% of patients, CMR was used along with transthoracic echocardiography (TTE); 67.6% patients underwent TTE alone, and 0.9% only CMR.

Conclusion : Less than one-third of patients enrolled in the registry underwent CMR and the use varied greatly between cardiomyopathy subtypes, clinical profiles of patients, and European tertiary referral centres. This gap with current guidelines needs to be considered carefully by scientific societies to promote wider availability and use of CMR in patients with cardiomyopathies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/ehjci/jeaa329DOI Listing
January 2021

Cardiovascular risk factors among cancer patients qualified for systemic treatment. Analysis of a cardiovascular disease-free cohort from the Polish multicentre study ONCOECHO.

Arch Med Sci 2020 2;16(6):1295-1303. Epub 2020 Nov 2.

Department of Cardiology, Medical University of Lodz, Lodz, Poland.

Introduction: Cancer therapies are currently more efficient at increasing the survival of patients (pts) with cancer. Unfortunately, the cardiovascular (CV) complications of cancer therapies may adversely affect improving results of treatment. The aim of the study was to evaluate the prevalence of classical CV risk factors among pts with de novo diagnosis of cancer and thus identify the cohort of pts with potentially increased future risk of CV complications.

Material And Methods: The analysis is based on the database of the multicentre ONCOECHO study. Pts before systemic treatment (chemotherapy or targeted therapy) were included. The diagnostic datasets of resting electrocardiogram, blood samples, and transthoracic echocardiogram were analysed in 343 consecutive pts who were free from any cardiovascular disease that could adversely affect the introduced treatment.

Results: Our cohort included 4.4% of pts with kidney cancer, 7.3% with colorectal cancer, 26.5% with haematological malignancies (HM), and 61.8% with breast cancer. The risk estimated by SCORE was 4.56 ±5.07%. Breast cancer pts had lower cardiovascular risk than those with HM ( = 0.001) and kidney cancer ( = 0.002). Additionally, the HM group had much higher levels of natriuretic peptides ( < 0.001) and creatinine ( = 0.008) than pts with breast cancer. The comparison with the NATPOL population data showed that our pts were more often smokers, hypertensives, and diabetics, but less frequently presented with hypercholesterolaemia.

Conclusions: Patients with new diagnosis of cancer, who are candidates for potentially cardiotoxic medical treatment, have increased prevalence of significant cardiovascular risk factors and therefore should be followed by a multidisciplinary team during the therapeutic process.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5114/aoms.2020.100401DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7667439PMC
November 2020

Cerebral microembolism during atrial fibrillation ablation can result from the technical aspects and mostly does not cause permanent neurological deficit.

Arch Med Sci 2020 25;16(6):1288-1294. Epub 2020 Apr 25.

First Department of Cardiology, School of Medicine, Medical University of Silesia, Katowice, Poland.

Introduction: Atrial fibrillation ablation can be associated with microembolism detected in the intracranial arteries and risk of neurological incidents. The aims of this study were to evaluate microembolic signals (MES) during pulmonary vein isolation (PVI) and establish the potential significance of MES for damage of the brain in radiological investigation and neurological state.

Material And Methods: In the prospective study we included patients with atrial fibrillation undergoing percutaneous pulmonary vein isolation (radiofrequency ablation/balloon cryoablation) with ultrasound monitoring of microembolisms in the middle cerebral artery. Neurological examination and MRI of the head were performed in all participants.

Results: The study enrolled 80 patients at a mean age of 58 years. Microembolisms during the monitoring of the flow in the right middle cerebral artery were recorded in 61 (76.3%) patients in the amount of 51-489 (mean: 239). Most often the microembolic signals were registered during the trans-septal puncture and the stage of ablation. In 89%, microembolisms were gaseous. Mean score on the Fazekas scale for the whole group before ablation: 0.87 ±0.7 (0-3, med. 1); after: 0.93 ±0.71. In 3 (4.3%) patients the lesions worsened during the follow-up period. None of the patients revealed a cardiovascular event during the follow-up period and no changes were observed in the neurological status.

Conclusions: The majority of cerebral microembolisms generated during PVI are gaseous in nature. The cerebral microembolisms associated with PVI probably result from the technical aspects of the procedure and do not cause either permanent brain damage in the radiological investigation or neurological deficit.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5114/aoms.2020.94747DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7667434PMC
April 2020

Loose Fibrin Clot Structure and Increased Susceptibility to Lysis Characterize Patients with Central Acute Pulmonary Embolism: The Impact of Isolated Embolism.

Thromb Haemost 2021 Apr 13;121(4):529-537. Epub 2020 Nov 13.

Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland.

Background:  Prothrombotic fibrin clot properties are associated with higher early mortality risk in acute pulmonary embolism (PE) patients. It is unknown whether different types of PE are associated with particular clot characteristics.

Methods:  We assessed 126 normotensive, noncancer acute PE patients (median age: 59 [48-70] years; 52.4% males), who were categorized into central versus peripheral PE with or without concomitant deep vein thrombosis (DVT). Plasma fibrin clot permeability (), clot lysis time (CLT), thrombin generation, platelet-derived markers, and fibrinolytic parameters were measured on admission. Plasma fibrin clot morphology was assessed by scanning electron microscopy (SEM).

Results:  Patients with central PE ( = 76; 60.3%) compared with peripheral PE ( = 50; 39.7%) had 17.8% higher and 14.3% shortened CLT (both  < 0.01 after adjustment for potential confounders including fibrinogen), with no differences between segmental and subsegmental PE. SEM analysis demonstrated larger fibrin fiber diameter and pore size in central PE compared with peripheral PE (both  < 0.01). For isolated PE, there was 23.3% higher in central PE than in peripheral PE ( = 24; 19%) with no differences in other variables. Central PE combined with DVT ( = 45; 35.7%), as compared with central isolated PE ( = 31; 24.6%), was associated with shortened CLT (all  < 0.05).

Conclusion:  Our findings suggest that looser fibrin networks composed of thicker fibers with increased susceptibility to lysis characterize patients with central PE, suggesting that fibrin clot phenotype affects the size of thrombi occluding the pulmonary arteries, highlighting the role of fibrin structures in thrombus formation and stability.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0040-1718762DOI Listing
April 2021

Biomarkers of left atrial overload in obese and nonobese patients with atrial fibrillation qualified for electrical cardioversion.

Kardiol Pol 2021 Mar 4;79(3):269-276. Epub 2020 Nov 4.

Background: Biomarkers of left atrial (LA) overload are considered factors affecting the efficacy of atrial fibrillation (AF) treatment. Increasing obesity rates contribute to a growing number of obese patients qualified for electrical cardioversion (CVE).Biomarkers of left atrial (LA) overload are considered as factors influencing efficacy of atrial fibrillation (AF) treatment. The increasing rate of obesity contributes to obese patients constituting a significant group of subjects qualified to electrical cardioversion (CVE).

Aims: The aim of the study was to evaluate serum concentrations of biomarkers of LA overload and their impact on the efficacy of CVE.

Methods: A total of 82 patients with persistent AF who underwent successful CVE were prospectively enrolled in the study. The study population was divided into the obese group (OG) and the nonobese group (NOG). The serum levels of the following biomarkers were measured on the day of admission and at follow‑up: high‑sensitivity C‑reactive protein (hs‑CRP), N‑terminal pro‑B‑type natriuretic peptide, copeptin, galectin 3, growth differentiation factor 15 (GDF‑15), and renalase.

Results: Baseline and follow‑up hs‑CRP levels were increased in the OG compared with the NOG. Four‑week CVE efficacy was 38.8% in the OG and 60.6% in the NOG. Time of the observation, allocation to the groups, and CVE outcomes showed no associations with most LA biomarkers during follow‑up. Baseline concentrations of 2 biomarkers of LA overload were associated with clinical characteristics of the study group, that is, log10 serum GDF‑15 and log10 serum renalase levels correlated positively with the CHA2DS2‑VASc score.

Conclusions:  Although obesity modifies the long‑term efficacy of CVE, the OG and NOG did not differ significantly in most biomarkers of LA overload, except hs‑CRP. The efficacy of CVE seems to be independent of the levels of biomarkers. A favorable procedure outcome did not affect their blood concentrations.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.33963/KP.15673DOI Listing
March 2021

On the search for the right definition of heart failure with preserved ejection fraction.

Cardiol J 2020 28;27(5):449-468. Epub 2020 Sep 28.

"Club 30", Polish Cardiac Society, Poland.

The definition of heart failure with preserved ejection fraction (HFpEF) has evolved from a clinically based "diagnosis of exclusion" to definitions focused on objective evidence of diastolic dysfunction and/or elevated left ventricular filling pressures. Despite advances in our understanding of HFpEF pathophysiology and the development of more sophisticated imaging modalities, the diagnosis of HFpEF remains challenging, especially in the chronic setting, given that symptoms are provoked by exertion and diagnostic evaluation is largely conducted at rest. Invasive hemodynamic study, and in particular - invasive exercise testing, is considered the reference method for HFpEF diagnosis. However, its use is limited as opposed to the high number of patients with suspected HFpEF. Thus, diagnostic criteria for HFpEF should be principally based on non-invasive measurements. As no single non-invasive variable can adequately corroborate or refute the diagnosis, different combinations of clinical, echocardiographic, and/or biochemical parameters have been introduced. Recent years have brought an abundance of HFpEF definitions. Here, we present and compare four of them: 1) the 2016 European Society of Cardiology criteria for HFpEF; 2) the 2016 echocardiographic algorithm for diagnosing diastolic dysfunction; 3) the 2018 evidence-based H2FPEF score; and 4) the most recent, 2019 Heart Failure Association HFA-PEFF algorithm. These definitions vary in their approach to diagnosis, as well as sensitivity and specificity. Further studies to validate and compare the diagnostic accuracy of HFpEF definitions are warranted. Nevertheless, it seems that the best HFpEF definition would originate from a randomized clinical trial showing a favorable effect of an intervention on prognosis in HFpEF.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5603/CJ.a2020.0124DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8078979PMC
September 2020

Small vessel coronary artery disease: How small can we go with myocardial revascularization?

Cardiol J 2020 Sep 28. Epub 2020 Sep 28.

First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Ziolowa 45/47, 40-635 Katowice, Poland.

The issue of small coronary artery atherosclerosis represents an intriguing aspect of coronary artery disease, which is related with higher rates of peri- and post-procedural complications and impaired long-term outcome. This problem is further complicated by the unclear definition of small coronary vessel. Recent randomized controlled trials have provided new data on possible novel interventional treatment of small coronary vessels with drug-coated balloons instead of traditional new-generation drug-eluting stent implantation. Also, the conservative management represents a therapeutic option in light of the results of the recent ISCHEMIA trial. The current article provides an overview of the most appropriate definition, interventional management, and prognosis of small coronary artery atherosclerosis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5603/CJ.a2020.0127DOI Listing
September 2020

Atrial fibrillation, anticoagulation management and risk of stroke in the Cardiomyopathy/Myocarditis registry of the EURObservational Research Programme of the European Society of Cardiology.

ESC Heart Fail 2020 Sep 17. Epub 2020 Sep 17.

Department of Cardiology and Structural Heart Disease, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland.

Aims: Cardiomyopathies are a heterogeneous group of disorders that increase the risk for atrial fibrillation (AF). The aim of the study is to assess the prevalence of AF, anticoagulation management, and risk of stroke/transient ischaemic attack (TIA) in patients with cardiomyopathy.

Methods And Results: Three thousand two hundred eight consecutive adult patients with cardiomyopathy (34.9% female; median age: 55.0 years) were prospectively enrolled as part of the EURObservational Research Programme Cardiomyopathy/Myocarditis Registry. At baseline, 903 (28.2%) patients had AF (29.4% dilated, 27.5% hypertrophic, 51.5% restrictive, and 14.7% arrhythmogenic right ventricular cardiomyopathy, P < 0.001). AF was associated with more advanced New York Heart Association class (P < 0.001), increased prevalence of cardiovascular risk factors and co-morbidities, and a history of stroke/TIA (P < 0.001). Oral anticoagulation was administered in 71.7% of patients with AF (vitamin K antagonist: 51.6%; direct oral anticoagulant: 20.1%). At 1 year follow-up, the incidence of cardiovascular endpoints was as follows: stroke/TIA 1.85% (AF vs. non-AF: 3.17% vs. 1.19%, P < 0.001), death from any cause 3.43% (AF vs. non-AF: 5.39% vs. 2.50%, P < 0.001), and death from heart failure 1.67% (AF vs. non-AF: 2.44% vs. 1.31%, P = 0.033). The independent predictors for stroke/TIA were as follows: AF [odds ratio (OR) 2.812, P = 0.005], history of stroke (OR 7.311, P = 0.010), and anaemia (OR 3.119, P = 0.006).

Conclusions: The study reveals a high prevalence and diverse distribution of AF in patients with cardiomyopathies, inadequate anticoagulation regimen, and high risk of stroke/TIA in this population.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/ehf2.12854DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7754739PMC
September 2020

Left internal mammary spasm mimicking graft dissection in the course of percutaneous coronary intervention of anastomotic in-stent restenosis.

Cardiol J 2020 ;27(4):435-436

First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland, 47 Ziołowa St., 40-635 Katowice, Poland.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5603/CJ.2020.0116DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8016009PMC
January 2020

Prothrombotic fibrin clot properties associated with NETs formation characterize acute pulmonary embolism patients with higher mortality risk.

Sci Rep 2020 07 10;10(1):11433. Epub 2020 Jul 10.

Institute of Cardiology, Jagiellonian University Medical College, 80 Pradnicka St.,, 31-202, Krakow, Poland.

Venous thromboembolism is associated with formation of denser fibrin clots resistant to lysis. We investigated whether prothrombotic plasma clot properties are associated with the severity of acute pulmonary embolism (PE). We enrolled 126 normotensive acute PE patients (aged 58 ± 14 years) and 25 age- and sex-matched healthy controls. Plasma fibrin clot permeability (K), clot lysis time (CLT), endogenous thrombin potential (ETP), plasminogen activator inhibitor-1 (PAI-1), and citrullinated histone H3 (citH3) were evaluated on admission. PE patients compared to controls had 370% higher citH3 levels, 41% higher ETP, 16.5% reduced K, and 25.6% prolonged CLT. Patients with intermediate-high (n = 29) and intermediate-low (n = 77) PE mortality risk had reduced K and prolonged CLT, increased PAI-1 and ETP as compared to low-risk PE (n = 20) patients. Prolonged CLT was predicted by PAI-1 and citH3, while low K by C-reactive protein. During a 12-month follow-up 9 (7.1%) patients who had 24% higher ETP, 45% higher citH3 levels, and 18% prolonged CLT at baseline died. High ETP combined with elevated citH3 levels and prolonged CLT was associated with eightfold increased risk of PE-related death. Prothrombotic fibrin clot properties and enhanced neutrophil extracellular traps formation are associated with higher early mortality risk in acute PE patients, which suggests a prognostic role of these biomarkers.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41598-020-68375-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7351737PMC
July 2020

Coronary interventions via radial artery without pre-procedural routine use of spasmolytic agents.

Postepy Kardiol Interwencyjnej 2020 Jun 23;16(2):138-144. Epub 2020 Jun 23.

First Department of Cardiology, Medical University of Silesia, Katowice, Poland.

Introduction: Radial access reduces the number of vascular complications. Radial artery spasm (RAS) can be prevented by the use of spasmolytic agents. However, use of these drugs can be possibly limited to certain groups of patients.

Aim: To assess the feasibility and safety of coronary angiography and percutaneous coronary interventions through the radial artery without the routine use of spasmolytic agents.

Material And Methods: A group of 293 patients (M/F 180/113, mean age: 67 ±10 years) who underwent coronary angiography and interventions through the radial artery approach was studied. Spasmolytic agents were applied in case of RAS. Every patient had ultrasound assessment of the radial artery on the next day to assess its diameter and detect occlusion.

Results: RAS was observed in 55 patients (18.8%, M/F 28/27) and radial artery occlusion (RAO) in 47 (16%, M/F: 24/23) cases. RAS was followed by RAO in 17 cases, which constituted 17/55 (30.9%) of all RAS. Two patients had symptomatic occlusion, which required prolonged anticoagulation with complete restoration of patency. The RAS was higher in prolonged procedures (angiography time 32.6 ±12.8 vs. 29 ±13.5 min, = 0.03; intervention time 40 ±23.5 vs. 26.3 ±25 min, = 0.0035) and was dependent on time of the local pressure (7.5 ±2.3 vs. 6.5 ±2.8 h, = 0.03). The RAO increased proportionally to the number of catheters used ( = 0.01) and was dependent on time of the local pressure (8.6 ±3.5 vs. 6.4 ±2.7 h, < 0.001).

Conclusions: Our study showed that angiography and interventions without routine use of spasmolytic agents were feasible and safe. RAS and RAO are related to independent risk factors and comparable to data from the literature when spasmolytics were used.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5114/aic.2020.96056DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7333200PMC
June 2020

Renal resistive index and long-term outcome in patients with coronary artery disease.

BMC Cardiovasc Disord 2020 07 6;20(1):322. Epub 2020 Jul 6.

First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, 47 Ziołowa St., 40-635, Katowice, Poland.

Background: The study aimed to evaluate the application of intra-renal Doppler flow indices for the prediction of major adverse cardiac and cerebrovascular events (MACCE) during 24-month follow-up in patients with coronary artery disease (CAD) subject to coronary angiography (CA).

Methods: This prospective study comprised 111 consecutive patients with stable and unstable CAD (68.5% men; median age 65 years), referred for CA. Ultrasonographic parameters of intra-renal blood flow in arcuate/interlobular arteries, including renal resistive index (RRI) and pulsatility index (RPI), were acquired directly before and 1 h after the procedure. Endpoint of MACCE (cardiovascular death, myocardial infarction, myocardial revascularization or stroke) were recorded during 24-month follow-up.

Results: MACCE occurred in 14 patients (12.6%). Patients with MACCE had more diffuse CAD reflected by Syntax score (23.6 vs.14.4 pts., p = 0.02), higher platelet level (242.4 vs. 207.2 × 1000/μl, p = 0.01), higher rate of left main CAD (42.9% vs.5.2%, p < 0.001) and left ventricular ejection fraction < 50% (50% vs.23.7%,p = 0.045). Patients with MACCE had higher pre-procedural (0.68 ± 0.06 vs. 0.62 ± 0.06, p < 0.001) and post-procedural RRI (0.72 ± 0.06 vs.0.66 ± 0.06, p = 0.01), but comparable RPI (p = 0.63 and p = 0.36, respectively). Cox proportional hazards model revealed that pre-procedural RRI (OR = 1.11 per 0.01; p = 0.02) and left main CAD (OR = 5.75, p = 0.002) were the only independent predictors of MACCE occurrence. Receiver operator characteristic curve analysis revealed that preprocedural RRI > 0.645 accurately predicted the composite endpoint (AUC = 0.78, p = 0.001) and identified patients with impaired 24-month prognosis according to Kaplan-Meier curve (log-rank p < 0.001).

Conclusions: Increased pre-procedural RRI, together with left main CAD, are associated with worse 24-month prognosis in patients with CAD referred for CA.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12872-020-01607-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7339420PMC
July 2020

Clinical application of stress echocardiography in valvular heart disease: an expert consensus of the Working Group on Valvular Heart Disease of the Polish Cardiac Society.

Kardiol Pol 2020 06 18;78(6):632-641. Epub 2020 May 18.

Department of Cardiology, Medical University of Bialystok, Białystok, Poland. Reviewer on behalf of the Polish Cardiac Society

Valvular heart diseases (VHDs) constitute an increasing problem both as a consequence of population aging and as the sequelae of other heart diseases. Accurate diagnosis is essential for correct clinical decision‑making; however, in many patients, transthoracic and transesophageal echocardiography is insufficient. Stress echocardiography (SE) proved to be a useful tool allowing for simultaneous assessment of left ventricular contractile reserve and HVD hemodynamics under conditions of physiological or pharmacological stress. It is recommended for assessing the severity of VHD, guiding the choice of treatment, as well as for surgical risk stratification. It can be applied both in asymptomatic patients with severe VHD and in symptomatic individuals with moderate disease. In patients with VHD, SE can be performed either as exercise stress echocardiography (ESE) or dobutamine stress echocardiography (DSE). The first modality is recommended to unmask symptoms or abnormal blood pressure response in patients with aortic stenosis (AS) who report to be asymptomatic or in those with mitral stenosis with discordance between clinical symptoms and the severity of valve disease on transthoracic echocardiography. In asymptomatic patients with paradoxical low‑flow, low‑gradient (LFLG) AS, ESE can be used to assess the severity of stenosis. On the other hand, low‑dose DSE can be a useful diagnostic tool in classical LFLG AS, providing information on stenosis severity and contractile reserve. Moreover, SE is indicated in patients with prosthetic valve when there is discordance between symptoms and echocardiographic findings. It is also recommended in high‑risk surgical patients with VHD with poor functional capacity and more than 2 clinical risk factors. The present paper discusses in detail the use of SE in VHD.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.33963/KP.15360DOI Listing
June 2020

Long-term effects of the Managed Care After Acute Myocardial Infarction program: an update on a complete 1-year follow-up.

Kardiol Pol 2020 05 24;78(5):458-460. Epub 2020 Mar 24.

1st Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland; Upper Silesia Medical Center, Katowice, Poland.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.33963/KP.15256DOI Listing
May 2020

Temporal trends in the availability and efficacy of catheter ablation for atrial fibrillation and atrial flutter in a highly populated urban area.

Kardiol Pol 2020 06 2;78(6):537-544. Epub 2020 Apr 2.

1st Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Upper Silesia Medical Center, Katowice, Poland.

Background: Pulmonary vein isolation has become one of the core modalities of the rhythm control strategy in patients with atrial fibrillation (AF).

Aims: The aim of the study was to analyze temporal trends in the availability and efficacy of AF and atrial flutter (AFL) catheter ablation in an urban area of Upper Silesia in Poland.

Methods: The source data were obtained from the SILCARD (Silesian Cardiovascular Database) covering an adult population of 3.8 million. The final study population included patients with diagnosis code I48 referred for catheter ablation between 2006 and 2017. The data included total number of procedures, patient sex, age, comorbidities, number of hospital admissions, and mortality rate.

Results: A total of 2745 patients were enrolled. The number of ablated patients increased more than 10‑fold (43 in 2006 vs 507 in 2017; P = 0.008) in the follow‑up period. The analysis showed an upward trend in the proportion of women (P = 0.02), hypertension prevalence (P = 0.004), and percentage of patients implanted (P = 0.02). A decrease was observed in the percentage of patients with stable angina (P <0.005) and hospitalization length (P <0.005). The all‑cause hospital readmissions rate decreased from 55.8% to 25.4% (P <0.005). There were significant reductions in the 12‑month all‑cause mortality (2.3% in 2006 vs 0.2% in 2017; P <0.005), stroke (2.3% in 2006 vs 0.2% in 2017; P = 0.047), and myocardial infarction rates (2.3% in 2006 vs 0.4% in 2017; P = 0.03).

Conclusions: A considerable increase in the availability and efficacy of AF / AFL ablations was documented over the 12‑year follow‑up period.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.33963/KP.15275DOI Listing
June 2020

A large amount of pericardial fluid: determining consecutive steps in the diagnosis and treatment of pulmonary arterial hypertension.

Pol Arch Intern Med 2020 06 16;130(6):539-540. Epub 2020 Mar 16.

1st Department of Cardiology, Leszek Giec Upper‑Silesian Medical Centre, Medical University of Silesia, Katowice, Poland

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.20452/pamw.15232DOI Listing
June 2020

Anterior wall myocardial infarction in a young man caused by spontaneous dissection and hematoma of coronary artery.

Interv Med Appl Sci 2019 Jun;11(2):125-127

Department of Cardiology, Medical University of Silesia, Katowice, Poland.

A 55-year-old man without any cardiac history has been admitted to Ist Department of Cardiology due to anterior wall infarction. In echocardiography (ECG), local anterior wall dysfunction has been observed, with good left ventricle ejection fraction. In angiography performed immediately after transfer to hospital, long lesion in left anterior descending coronary artery has been visualized with high angiographic suspicion of dissection and intramural coronary hematoma. Intravascular ultrasound (IVUS) has been performed and further confirmed the diagnosis of hematoma - LAD was stented using three coronary stents. IVUS has confirmed good position of stents. Integrillin has been used. Periprocedural time was uncomplicated. ECG showed resolution of myocardial infarction pattern and evolution of infarction has been observed. The patient was discharged home in good clinical condition. Coronary dissection and coronary hematoma are the potential cause of infarction and IVUS, despite optical coherence tomography being reference nowadays, is still a very valuable tool in diagnosis and treatment guiding in such cases.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1556/1646.10.2018.27DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7044538PMC
June 2019

A questionnaire-based, multicenter registry of resistant and pseudo-resistant arterial

Wiad Lek 2019 Oct;72(10):1866-1871

First Department of Cardiology, School of Medicine, Medical University of Silesia, Katowice, Poland

Introduction: Hypertensive patients with poor blood pressure (BP) control are commonly referred to tertiary centers with a diagnosis of resistant hypertension (RH). The aim of the study was to identify the causes of insufficient BP control and to assess the incidence of true resistant hypertension.

Material And Methods: We ran a questionnaire-based, multicenter study (10 high volume tertiary centers in Poland) of patients referred with an initial diagnosis of RH. Only patients with ABPM-confirmed uncontrolled hypertension (systolic ≥140 mmHg and/or diastolic ≥90mmHg despite maximal doses of ≥3 medications, including a diuretic) were included. We assessed the causes of non-optimal BP control, a proportion of patients with excluded secondary hypertension, and the burden of hypertension-related complications.

Results: We analyzed 124 patients aged 41-88, with a history of hypertension of 17.5±9 years. 90% of them had developed systemic complications, the most common being LV hypertrophy (73.4%) and LV diastolic dysfunction (63.4%). In only 47% all major causes of secondary hypertension were excluded. In 90.3% of subjects, at least one factor affecting BP control was identified. The most frequent factors were medication noncompliance (52.4%), metabolic syndrome (43.6%) excessive sodium intake (66.1%) and chronic administration of non-steroid anti-inflammatory drugs (40%). The incidence of real resistant hypertension was only 4.8%.

Conclusions: Among patients referred with uncontrolled hypertension, the incidence of real resistant hypertension is small. A majority of these patients have multiple factors potentially responsible for poor BP control, the most common being medication non-adherence, use of drugs increasing BP, excessive salt intake and metabolic syndrome.
View Article and Find Full Text PDF

Download full-text PDF

Source
October 2019

Characterization of Patients with Pulmonary Arterial Hypertension: Data from the Polish Registry of Pulmonary Hypertension (BNP-PL).

J Clin Med 2020 Jan 8;9(1). Epub 2020 Jan 8.

Department of Congenital Heart Disease Institute of Cardiology, 04-628 Warsaw, Poland.

Current knowledge of pulmonary arterial hypertension (PAH) epidemiology is based mainly on data from Western populations, and therefore we aimed to characterize a large group of Caucasian PAH adults of Central-Eastern European origin. We analyzed data of incident and prevalent PAH adults enrolled in a prospective national registry involving all Polish PAH centers. The estimated prevalence and annual incidence of PAH were 30.8/mln adults and 5.2/mln adults, respectively and they were the highest in females ≥65 years old. The most frequent type of PAH was idiopathic ( = 444; 46%) followed by PAH associated with congenital heart diseases (CHD-PAH, = 356; 36.7%), and PAH associated with connective tissue disease (CTD-PAH, = 132; 13.6%). At enrollment, most incident cases (71.9%) were at intermediate mortality risk and the prevalent cases had most of their risk factors in the intermediate or high risk range. The use of triple combination therapy was rare (4.7%). A high prevalence of PAH among older population confirms the changing demographics of PAH found in the Western countries. In contrast, we found: a female predominance across all age groups, a high proportion of patients with CHD-PAH as compared to patients with CTD-PAH and a low use of triple combination therapy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/jcm9010173DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7019268PMC
January 2020