Publications by authors named "Krzysztof S Gołba"

61 Publications

Local electromechanical alterations determine the left ventricle rotational dynamics in CRT-eligible heart failure patients.

Sci Rep 2021 Feb 5;11(1):3267. Epub 2021 Feb 5.

Department of Cardiology and Structural Heart Disease, Medical University of Silesia, Ziołowa 45-47, Katowice, Poland.

Left ventricle, LV wringing wall motion relies on physiological muscle fiber orientation, fibrotic status, and electromechanics (EM). The loss of proper EM activation can lead to rigid-body-type (RBT) LV rotation, which is associated with advanced heart failure (HF) and challenges in resynchronization. To describe the EM coupling and scar tissue burden with respect to rotational patterns observed on the LV in patients with ischemic heart failure with reduced ejection fraction (HFrEF) left bundle branch block (LBBB). Thirty patients with HFrEF/LBBB underwent EM analysis of the left ventricle using an invasive electro-mechanical catheter mapping system (NOGA XP, Biosense Webster). The following parameters were evaluated: rotation angle; rotation velocity; unipolar/bipolar voltage; local activation time, LAT; local electro-mechanical delay, LEMD; total electro-mechanical delay, TEMD. Patients underwent late-gadolinium enhancement cMRI when possible. The different LV rotation pattern served as sole parameter for patients' grouping into two categories: wringing rotation (Group A, n = 6) and RBT rotation (Group B, n = 24). All parameters were aggregated into a nine segment, three sector and whole LV models, and compared at multiple scales. Segmental statistical analysis in Group B revealed significant inhomogeneities, across the LV, regarding voltage level, scar burdening, and LEMD changes: correlation analysis showed correspondently a loss of synchronization between electrical (LAT) and mechanical activation (TEMD). On contrary, Group A (relatively low number of patients) did not present significant differences in LEMD across LV segments, therefore electrical (LAT) and mechanical (TEMD) activation were well synchronized. Fibrosis burden was in general associated with areas of low voltage. The rotational behavior of LV in HF/LBBB patients is determined by the local alteration of EM coupling. These findings serve as a strong basic groundwork for a hypothesis that EM analysis may predict CRT response.Clinical trial registration: SUM No. KNW/0022/KB1/17/15.
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http://dx.doi.org/10.1038/s41598-021-82793-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7865069PMC
February 2021

The beneficial impact of cardiac rehabilitation on obstructive sleep apnea in patients with coronary artery disease.

J Clin Sleep Med 2021 Mar;17(3):403-412

Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland.

Study Objectives: To assess the impact of cardiac rehabilitation for decreasing sleep-disordered breathing in patients with coronary artery disease.

Methods: The study included 121 patients aged 60.01 ± 10.08 years, 101 of whom were men, with an increased pretest probability of OSA. The cardiac rehabilitation program lasted 21-25 days. The improvement in cardiorespiratory fitness was assessed using the changes in peak metabolic equivalents, the maximal heart rate achieved, the proportion of the age- and sex-predicted maximal heart rate, and the Six-Minute Walk Test distance. Level 3 portable sleep tests with respiratory event index assessments were performed in 113 patients on admission and discharge.

Results: Increases were achieved in metabolic equivalents (Δ1.20; 95% confidence interval [CI], 0.95-1.40; P < .0001), maximal heart rate (-Δ7.5 beats per minute; 95% CI, 5.00-10.50; P < .0001), proportion of age- and sex-predicted maximal heart rate (Δ5.50%; 95% CI, 4.00-7.50; P < .0001), and the Six-Minute Walk Test distance (Δ91.00 m; 95% CI, 62.50-120.00; P < .0001). Sleep-disordered breathing was diagnosed in 94 (83.19%) patients: moderate in 28 (24.8%) patients and severe in 27 (23.9%) patients, with a respiratory event index of 19.75 (interquartile range, 17.20-24.00) and 47.50 (interquartile range, 35.96-56.78), respectively. OSA was dominant in 90.40% of patients. The respiratory event index reduction achieved in the sleep-disordered breathing group was -Δ3.65 (95% CI, -6.30 to -1.25; P = .003) and was in parallel to the improvement in cardiorespiratory fitness in the subgroups with the highest effort load and with severe sleep-disordered breathing: -Δ6.40 (95% CI, -11.40 to -1.90; P = .03) and -Δ11.00 (95% CI, -18.65 to -4.40; P = .003), respectively.

Conclusions: High-intensity exercise training during cardiac rehabilitation resulted in a significant decrease in OSA, when severe, in parallel with an improvement in cardiorespiratory fitness in patients with coronary artery disease.
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http://dx.doi.org/10.5664/jcsm.8900DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7927323PMC
March 2021

The impact of cardiac pacemaker implantation on male sexual function.

Pacing Clin Electrophysiol 2020 12 1;43(12):1508-1514. Epub 2020 Sep 1.

Department of Electrocardiology, Upper Silesian Medical Centre, Katowice, Poland.

Background: The possibility of sexual functioning is an important aspect of human life, and sexual disorders have a negative impact on the quality of life and well-being. The aim of the study was to assess the sexuality and occurrence of sexual dysfunction within 6 months after pacemaker implantation.

Methods And Results: The study sample was a group of 80 patients with heart rhythm disorders who had been qualified for cardiac pacemaker implantation. The International Index of Erectile Function (IIEF)-15 was completed by all the patients at least 1 day before and 6 months after cardiac pacemaker implantation. The average results of the IIEF for all those who were included before implantation were 41.87 ± 7.57 and were statistically the worst after pacemaker implantation 46.76 ± 6.64; P < .0001. After the implantation of a pacemaker, there was an improvement in all of the subcategories of sexual life for all the men: erectile function P < .0001, orgasmic function P < .0001, sexual desire P < .0001, intercourse satisfaction P < .0001, and overall satisfaction P < .0001.

Conclusions: Pacemaker implantation had a positive effect on sexual functioning for all the patients. Pacemaker implantation did not affect sexual desire in the patients who were observed. Erectile dysfunction occurred in most of patients both before and after pacemaker implantation.
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http://dx.doi.org/10.1111/pace.14035DOI Listing
December 2020

Modified Frailty as a Novel Factor in Predicting the Maintenance of the Sinus Rhythm After Electrical Cardioversion of Atrial Fibrillation in the Elderly Population.

Clin Interv Aging 2020 17;15:1193-1199. Epub 2020 Jul 17.

Department of Electrocardiology, Upper Silesian Heart Centre, Katowice, Poland.

Introduction: Frailty is a common geriatric syndrome that causes an elevated risk of catastrophic declines in the health and function among older adults - we hypothesized that frailty may be related to the maintenance of sinus rhythm after cardioversion.

Methods: The study sample was a group of 199 consecutive patients over 60 (average age 71.41 ± 6.99; 40.2% women) with AF who were hospitalized in order to perform electrical cardioversion. The Tilburg Frailty Indicator (TFI) was used to assess frailty before cardioversion. The six-month visit after the electrical cardioversion was a follow-up. The follow-up period for the maintenance of sinus rhythm after electrical cardioversion was 180 ± 14 days.

Results: Patients in whom cardioversion was effective had a statistically significantly lower severity of frailty syndrome (3.44 ± 1.83 vs 5.87 ± 1.12; p=0.000) and its components: physical components (2.14 ± 1.33 vs 3.62 ± 1.05 p=0.000); emotional components (0.92 ± 0.79 vs 1.29 ± 0.86 p=0.037) and social components (0.37 ± 0.56 vs 0.96 ± 0.46; p=0.000) compared to those patients in which cardioversion was ineffective. In the logistic regression, frailty (OR: 0.65, 95% CI:0.5010-0.8330; p=0.000) was observed to be an independent predictor for maintaining sinus rhythm.

Conclusion: Frailty is a novel, independent factor that can be used to predict the effectiveness of electrical cardioversion and the maintenance of sinus rhythm in the elderly population. Modifying the level of recognition in the Tilburg Frailty Indicator to a 4 improved the prediction of the effectiveness of electrical cardioversion as well as the maintenance of sinus rhythm.
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http://dx.doi.org/10.2147/CIA.S255853DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7381784PMC
December 2020

Factors that influence marital satisfaction in men with a heart rhythm disorders.

Aging Male 2020 May 28:1-7. Epub 2020 May 28.

Department of Electrocardiology, Upper Silesian Medical Centre, Katowice, Poland.

: A diagnosis of a cardiac arrhythmia can affect marital relations and diminish libido and satisfaction with a patient's sex life. The aim of the study was to assess the factors that affect marital satisfaction in men with an arrhythmias who had qualified for cardiac pacemaker implantation. The study included 103 men (aged 58.28 ± 8.72) with recognized heart rhythm disorders who were hospitalized in Department of Electrocardiology. The Hospital Anxiety and Depression Scale (HADS), the International Erectile Function Index (IIEF) and the Index of Marital Satisfaction (IMS) were used in this research. The greater the severity of the anxiety ( = 0.2492,  = 0.011) and depression symptoms ( = 0.3735,  = 0.000), the less satisfied a patient was with the relationship. An analysis showed that depression ( = 0.000), sexual desire ( = 0.001), overall satisfaction ( = 0.009), erectile function ( = 0.0162) and intercourse satisfaction ( = 0.026) are important predictors of marital satisfaction. Only sexual desire was an important predictor of marital satisfaction in patients with sinus node dysfunction, while the depression, sexual desire and overall satisfaction results were predictors in patients with atrioventricular blocks. Anxiety and depression symptoms affect the assessment of marital satisfaction in men with a heart rhythm disorder. Different factors influence marital satisfaction for different heart rhythm disorders.
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http://dx.doi.org/10.1080/13685538.2020.1770211DOI Listing
May 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.

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

Successful Defibrillation at a Core Temperature of 18.2 Degrees Celsius.

Wilderness Environ Med 2020 Jun 21;31(2):230-234. Epub 2020 Apr 21.

Department of Anaesthesiology and Intensive Care, Medical University of Silesia, Katowice, Poland. Electronic address:

Both the temperature at which defibrillation can be effectively used and how often it should be repeated in severe accidental hypothermia have not been definitely established. Current recommendations are based mainly on expert opinion and suggest withholding defibrillation after 3 shocks when the core temperature is below 30°C (86°F). However, growing evidence supports the effectiveness of defibrillation in patients with a core temperature below 30°C (86°F). We present a case of successful defibrillation of a 54-y-old, severely hypothermic patient with a core temperature of 18.2°C (64.8°F). The shock was delivered automatically by an implanted cardioverter-defibrillator shortly after the implementation of extracorporeal rewarming. The patient survived and was discharged from the hospital neurologically intact. It might be reasonable to consider defibrillation attempts in severely hypothermic patients despite current guidelines to the contrary. Increasing coronary perfusion using extracorporeal circulation may result in a better response to defibrillation.
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http://dx.doi.org/10.1016/j.wem.2020.01.003DOI Listing
June 2020

Survival of patients with pacing-induced cardiomyopathy upgraded to CRT does not depend on defibrillation therapy.

Pacing Clin Electrophysiol 2020 05 15;43(5):471-478. Epub 2020 Apr 15.

Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland.

Background: Permanent right ventricular pacing (RVP) results in cardiac dyssynchrony that may lead to heart failure and may be an indication for the use of cardiac resynchronization therapy (CRT). The study aimed to evaluate predictors of outcomes in patients with pacing-induced cardiomyopathy (PICM) if upgraded to CRT.

Methods: One hundred fifteen patients, 75.0 years old (IQR 67.0-80.0), were upgraded to CRT due to the decline in left ventricle ejection fraction (LVEF) caused by the long-term RVP. A retrospective analysis was performed using data from hospital and outpatient clinic records and survival data from the National Health System.

Results: The prior percentage of RVP was 100.0% (IQR 97.0-100.0), with a QRS duration of 180.0 ms (IQR 160.0-200.0). LVEF at the time of the upgrade procedure was 27.0% (IQR 21.0-32.75). The mean follow-up was 980 ± 522 days. The primary endpoint, death from any cause, was met by 26 (22%) patients. Age > 82 years (HR 5.96; 95% CI 2.24-15.89; P = .0004) and pre-CRT implantation LVEF < 20% (HR 5.63; 95%CI 2.19-14.47; P = .0003), but neither the cardioverter-defibrillator (ICD) implantation (HR 1.00; 95%CI 0.45-2.22; P = 1.00), nor the presence of atrial fibrillation (HR 1.22; 95%CI 0.56-2.64; P = .62), were independently associated with all-cause mortality.

Conclusion: Advanced age and an extremely low LVEF, but neither the presence of atrial fibrillation nor implanting an additional high voltage lead, influence the all-cause mortality in patients after long-term RVP, when upgraded to CRT.
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http://dx.doi.org/10.1111/pace.13906DOI Listing
May 2020

The Relationship between Frailty Syndrome and Concerns about an Implantable Cardioverter Defibrillator.

Int J Environ Res Public Health 2020 03 17;17(6). Epub 2020 Mar 17.

Department of Electrocardiology, Upper Silesian Heart Centre, Katowice 40-635, Poland.

Frailty syndrome may cause cognitive decline and increased sensitivity to stressors. This can result in an increased incidence of anxiety and depression, and thus, concerns about life with an implantable cardioverter defibrillator (ICD). The aim of the study was to assess the impact of frailty syndrome on the increase in the number of device-related concerns after the implantation of an ICD.

Material And Methods: The study sample was a group of 103 consecutive patients (85 M; aged 71.6 ± 8.2) with an implanted ICD. The ICD Concerns Questionnaire (ICDC) was used to analyze their concerns about life with an ICD, and the Tilburg Frailty Indicator scale (TFI) was used to diagnose frailty.

Results: In the group of patients with an ICD implanted, 73% had recognized frailty (83.3% women, 74.1% men); the average point value was 6.55 ± 2.67. The total ICDC questionnaire score for the patients with an implanted cardioverter defibrillator was 34.06 ± 18.15. Patients with frailty syndrome had statistically ( = 0.039) higher scores (36.14 ± 17.08) compared to robust patients (27.56 ± 20.13). In the logistic regression analysis, the presence of frailty was strongly associated with the total questionnaire score (OR = 1.0265, = 0.00426), the severity of the concerns (OR = 1.0417, = 0.00451), and device-specific concerns (OR = 1.0982, = 0.00424).

Conclusion: Frailty syndrome occurs in about 80% of patients after ICD implantation. The presence of frailty syndrome was strongly associated with concerns about an implantable cardioverter defibrillator.
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http://dx.doi.org/10.3390/ijerph17061954DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7142564PMC
March 2020

Permanent pacemaker implantation after cardiac surgery: Optimization of the decision making process.

J Thorac Cardiovasc Surg 2020 Feb 19. Epub 2020 Feb 19.

Department of Cardiac Surgery, Upper-Silesian Heart Center, Katowice, Poland; Department of Cardiac Surgery, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland. Electronic address:

Background: Conduction disturbances necessitating permanent pacemaker (PPM) implantation after cardiac surgery occur in 1% to 5% of patients. Previous studies have reported a low rate of late PPM dependency, but there is lack of evidence that it might be related to implantation timing. In this study, we sought to determine whether PPM implantation timing and specific conduction disturbances as indications for PPM implantation are associated with late pacemaker dependency and recovery of atrioventricular (AV) conduction.

Methods: Patients with a PPM implanted after cardiac surgery were followed in an outpatient clinic. Two outcomes were assessed: AV conduction recovery and PPM dependency, defined as the absence of intrinsic rhythm on sensing test in VVI mode at 40 bpm.

Results: Of 15,092 patients operated between September 2008 and March 2019, 185 (1.2%) underwent PPM implantation. One hundred seventy-seven of these patients met the criteria for inclusion into this study. Follow-up data were available in 145 patients (82%). Implantation was performed at ≤6 days after surgery in 58 patients (40%) and at >6 days after surgery in 87 patients (60%). The median time from implantation to last follow-up was 890 days (range, 416-1998 days). At follow-up, 81 (56%) patients were not PPM dependent. Multivariable analysis showed that PPM implantation at ≤6 days after surgery is a predictor of being not PPM dependent (odds ratio [OR], 5.40; 95% confidence interval [CI], 2.43-12.04; P < .001) and of AV conduction recovery (OR, 4.96; 95% CI, 2.26-10.91; P < .001). Sinus node dysfunction as indication for PPM implantation was predictive of being not PPM dependent (OR, 6.59; 95% CI, 1.67-26.06; P = .007).

Conclusions: We recommend implanting a PPM on postoperative day 7 to prevent unnecessary implantations and avoid prolonged hospitalization.
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http://dx.doi.org/10.1016/j.jtcvs.2020.01.082DOI Listing
February 2020

Dilated cardiomyopathy with severe arrhythmias in Emery-Dreifuss muscular dystrophy.

Cardiol J 2020 ;27(1):93-94

Department of Electrocardiology and Heart Failure, School of Health Sciences, Medical University of Silesia in Katowice, Ziołowa 47, 40-635 Katowice, Poland.

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http://dx.doi.org/10.5603/CJ.2020.0021DOI Listing
January 2020

The influence of scar on the spatio-temporal relationship between electrical and mechanical activation in heart failure patients.

Europace 2020 05;22(5):777-786

Center for Computational Medicine in Cardiology, Università della Svizzera italiana, Via G. Buffi 13, CH-6900 Lugano, Switzerland.

Aims: The aim of this study was to determine the relationship between electrical and mechanical activation in heart failure (HF) patients and whether electromechanical coupling is affected by scar.

Methods And Results: Seventy HF patients referred for cardiac resynchronization therapy or biological therapy underwent endocardial anatomo-electromechanical mapping (AEMM) and delayed-enhancement magnetic resonance (CMR) scans. Area strain and activation times were derived from AEMM data, allowing to correlate mechanical and electrical activation in time and space with unprecedented accuracy. Special attention was paid to the effect of presence of CMR-evidenced scar. Patients were divided into a scar (n = 43) and a non-scar group (n-27). Correlation between time of electrical and mechanical activation was stronger in the non-scar compared to the scar group [R = 0.84 (0.72-0.89) vs. 0.74 (0.52-0.88), respectively; P = 0.01]. The overlap between latest electrical and mechanical activation areas was larger in the absence than in presence of scar [72% (54-81) vs. 56% (36-73), respectively; P = 0.02], with smaller distance between the centroids of the two regions [10.7 (4.9-17.4) vs. 20.3 (6.9-29.4) % of left ventricular radius, P = 0.02].

Conclusion: Scar decreases the association between electrical and mechanical activation, even when scar is remote from late activated regions.
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http://dx.doi.org/10.1093/europace/euz346DOI Listing
May 2020

Attitude towards sexuality and sexual behaviors among men with heart rhythm disorders.

Aging Male 2019 Mar 29:1-6. Epub 2019 Mar 29.

a Department of Electrocardiology , Upper Silesian Medical Centre , Katowice , Poland.

Aim: Symptoms of cardiac arrhythmias and the perception of the implantation of a cardiac pacemaker can negatively affect mental health including sexuality and sexual behaviors. The aim of this study was to assess the attitude towards sexuality and sexual behaviors among men with cardiac arrhythmias.

Methods: The study included 80 men (aged 58.6 ± 9.23 years) with heart rhythm disorders who had qualified for cardiac pacemaker implantation. The International Index of Erectile Function IIEF-15 was completed at least one day before cardiac pacemaker implantation by all of the patients.

Results: The average results of the IIEF for all of the included patients was 41.87 ± 7.57 and were statistically worse in the population with atrioventricular blocks (39.60 ± 7.79) compared to those with sinus node dysfunction (44.15 ± 6.71) (p = .0110). The same relationships were found in the subcategory of orgasmic function (p = .0108) as well as intercourse satisfaction (p = .0111). Erectile dysfunction occurred in 88.75% of the patients with diagnosed arrhythmias. There was no statistically significant difference between the occurrence of erectile dysfunction in patients with sinus node dysfunction (87.5%) compared to patients with atrioventricular blocks (90%); p = .7236 Conclusion: We demonstrated that sexuality and sexual behaviors among men with cardiac arrhythmias was found to be statistically worse in the population with atrioventricular blocks compared to those with sinus node dysfunction. It was especially marked in the area of orgasmic function as well as for intercourse satisfaction.
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http://dx.doi.org/10.1080/13685538.2019.1592152DOI Listing
March 2019

Modified frailty as a novel factor in predicting the response to cardiac resynchronization in the elderly population.

Clin Interv Aging 2019 25;14:437-443. Epub 2019 Feb 25.

Department of Electrocardiology, Upper Silesian Heart Centre, Katowice, Poland,

Background: The response to cardiac resynchronization therapy (CRT) is an important element of the treatment of advanced heart failure, especially in the geriatric population. The aim of the study was to examine the impact of frailty syndrome on the response to treatment with CRT.

Methods: Two hundred and forty-six patients of 60 years or older (aged 73.35±6.95; 22.4% women) with an implanted CRT were included in this single-center prospective study. There was a 12-month follow-up. The Tilburg Frailty Indicator was used to determine frailty (5 or more points). The response to CRT was evaluated based on an analysis of clinical criteria.

Results: One hundred and sixty-nine of 246 (68.9%) patients were found to be clinical CRT responders. Frailty syndrome was recognized in 173 (70.32%). There were 63.0% responders in the frailty-affected group, whereas there were statistically more responders (79.5%) in the robust group (=0.0116). In the logistic regression, frailty emerged as an independent predictor of the response to CRT (OR=0.81, 95% CI=0.71-0.92; =0.0008). The area under the curve of the ROC curve for frailty in the responders to CRT was 0.62. The cut-off value for a designation of frailty was 6 (=0.0014).

Conclusion: Frailty is a novel independent factor that can be used to predict the clinical response to CRT in the elderly population. Modifying the level of recognition in the Tilburg Frailty Indicator can improve the prediction of a response to CRT.
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http://dx.doi.org/10.2147/CIA.S193577DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6394238PMC
April 2019

[Kinesiophobia in patients with cardiovascular disease].

Wiad Lek 2018;71(9):1653-1660

Oddział Elektrokardiologii Górnośląskiego Centrum Medycznego im. Prof. Leszka Gieca Śląskiego Uniwersytetu Medycznego w Katowicach, Katowice, Polska, Katedra Elektrokardiologii, Klinika Elektrokardiologii i Niewydolności Serca Śląskiego Uniwersytetu Medycznego w Katowicach, Katowice, Polska.

Objective: Introduction: Kinesiophobia - a fear of physical activity - is a common and worsening rehabilitation outcomes phenomenon in patients with cardiovascular diseases. The aim: To assess the level of kinesiophobia in relation to heart's function evaluated using echocardiography and clinical parameters in patients with cardiovascular disease.

Patients And Methods: Material and methods:101 patients (28 women) aged 61,9±13,56 years and hospitalized for implantation or replacement of a pacemaker or cardioverter-defibrillator were included in the study. Their heart's function and morphology were evaluated echocardiographically. Level of kinesiophobia was evaluated with the Polish version of Tampa Scale of Kinesiophobia Heart (TSK-Heart) questionnaire.

Results: Results: The TSK score in these patients was 41,6±5,39. It's value was increasing with age (p=0,0264), was higher in women than in men (43,5±5,36 vs. 40,8±5,27, p=0,0287) and in patients with coronary artery disease (42,3±6,28 vs. 40,9±4,62, p=0,031). In patients with heart failure, it was decreasing with an increase of body mass index (p=0,0185). Severe mitral insufficiency resulted in higher index value in comparison with moderate or mild one (42,7±4,05 vs. 40,9 ± 5,58, p=0,0369). The TSK index increases with a decrease in tricuspid annular plane systolic excursion (p=0,0033). Patients in NYHA IV class exhibited higher TSK value than those in lower classes (p<0,001). An inverse dependency of TSK index value and hemoglobin level were established (p=0,0041).

Conclusion: Conclusions: In patients with cardiovascular diseases, kinesiophobia has multicausal nature and is higher in NYHA IV patients. The independent predictors of kinesiophobia are right ventricular dysfunction and anemia.
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June 2019

Burden of medical co-morbidities and benefit from surgical revascularization in patients with ischaemic cardiomyopathy.

Eur J Heart Fail 2019 03 30;21(3):373-381. Epub 2019 Jan 30.

Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.

Aims: The landmark STICH trial found that surgical revascularization compared to medical therapy alone improved survival in patients with heart failure (HF) of ischaemic aetiology and an ejection fraction (EF) ≤ 35%. However, the interaction between the burden of medical co-morbidities and the benefit from surgical revascularization has not been previously described in patients with ischaemic cardiomyopathy.

Methods And Results: The STICH trial (ClinicalTrials.gov Identifier: NCT00023595) enrolled patients ≥ 18 years of age with coronary artery disease amenable to coronary artery bypass grafting (CABG) and an EF ≤ 35%. Eligible participants were randomly assigned 1:1 to receive medical therapy (MED) (n = 602) or MED/CABG (n = 610). A modified Charlson co-morbidity index (CCI) based on the availability of data and study definitions was calculated by summing the weighted points for all co-morbid conditions. Patients were divided into mild/moderate (CCI 1-4) and severe (CCI ≥ 5) co-morbidity. Cox proportional hazards models were used to evaluate the association between CCI and outcomes and the interaction between severity of co-morbidity and treatment effect. The study population included 349 patients (29%) with a mild/moderate CCI score and 863 patients (71%) with a severe CCI score. Patients with a severe CCI score had greater functional limitations based on 6-min walk test and impairments in health-related quality of life as assessed by the Kansas City Cardiomyopathy Questionnaire. A total of 161 patients (Kaplan-Meier rate = 50%) with a mild/moderate CCI score and 579 patients (Kaplan-Meier rate = 69%) with a severe CCI score died over a median follow-up of 9.8 years. After adjusting for baseline confounders, patients with a severe CCI score were at higher risk for all-cause mortality (hazard ratio 1.44, 95% confidence interval 1.19-1.74; P < 0.001). There was no interaction between CCI score and treatment effect on survival (P = 0.756).

Conclusions: More than 70% of patients had a severe burden of medical co-morbidities at baseline, which was independently associated with increased risk of death. There was not a differential benefit of surgical revascularization with respect to survival based on severity of co-morbidity.
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http://dx.doi.org/10.1002/ejhf.1404DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6818499PMC
March 2019

Capability for self-care of patients with heart failure.

Clin Interv Aging 2018 8;13:1919-1927. Epub 2018 Oct 8.

Department of Electrocardiology, Upper Silesian Heart Centre, Katowice, Poland,

Background: A thorough analysis of the capability for self-care in patients with heart failure (HF) reduces the frequency of hospitalizations that are caused by decompensation. The aim of the study was to assess the effect of the method of therapy for HF, the degree of the acceptance of illness, and the occurrence of frailty syndrome on adherence to the therapeutic recommendations and self-care in patients with HF.

Methods: The study included 180 patients who were hospitalized after being diagnosed with HF. In all, we used the Polish versions of three validated instruments: the nine-item European Heart Failure Self-care Behavior Scale, Illness Acceptance Scale, and The Tilburg Frailty Indicator.

Results: The capability for self-care of patients with HF was 27.8%. More than 65% of the patients followed the recommendations for taking medication and also followed a low-sodium diet, while only 5.5% of the patients followed the recommendations for physical exercise. Positive correlations were found between the capability for self-care and frailty syndrome and its components: general frailty components vs the capability for self-care: =0.4449, =0.0000; physical frailty components vs the capability for self-care: =0.3974, =0.0000; emotional frailty components vs the capability for self-care: =0.2831, =0.0001; social frailty components vs the capability for self-care: =0.2180, =0.0032, and a negative correlation between the capability for self-care and the degree of the acceptance of the illnesses (=-0.4662, =0.0000).

Conclusion: A relatively low capability for self-care was found in patients with HF. The presence of frailty syndrome and a low level of the acceptance of illness are connected with a low capability for self-care.
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http://dx.doi.org/10.2147/CIA.S178393DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6183697PMC
December 2018

[How to avoid cardiovascular consequences of the obstructive sleep apnea syndrome?]

Wiad Lek 2018;71(6):1254-1261

1 Oddział Elektrokardiologii, Górnośląskie Centrum Medyczne Im. Prof. Leszka Gieca Śląskiego Uniwersytetu Medycznego W Katowicach, Katowice, Polska, Klinika Elektrokardiologii I Niewydolności Serca Śląskiego Uniwersytetu Medycznego W Katowicach, Katowice, Polska.

Obstructive sleep apnea syndrome (OSAS) is caused by periodical upper airway occlusion during sleep resulting in snoring, episodes of apnea and excessive daytime sleepiness. OSAS is a risk factor for hypertension, arrhythmias, conduction disorders as well as stroke, coronary artery disease, chronic heart failure and pulmonary hypertension. Early polygraphy and polysomnography and continuous positive airway pressure (CPAP) treatment reduce risks of cardiovascular diseases (CVD) in patients with OSAS.
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June 2019

Visualisation of the oblique vein of the left atrium (vein of Marshall) using cardiac computed tomography: is the game worth the candle?

Kardiol Pol 2018;76(9):1344-1349

Department of Electrocardiology, Upper Silesian Medical Centre, Poland.

Background: The vein of Marshall (VoM) is a small vessel that descends obliquely on the back of the left atrium and ends in the coronary sinus near the area where the great cardiac vein continues into the coronary sinus.

Aim: The aim of the study was to examine the frequency of occurrence and anatomical aspects as well as the possibility of visualising the VoM, including an evaluation of the quality of the visualisation, on computed tomography (CT).

Methods: Three hundred patients aged 58.8 ± 11.5 years (111 women) were included into this single-centre study. Cardiac CT was performed in all patients. The search for the VoM was performed by two experienced researchers using two- and three-dimensional techniques. A dedicated Likert-based scale was used to evaluate the quality of the visualisations.

Results: The VoM was found in 61 (20.33%) of 300 patients. Its average diameter was 1.72 ± 0.69 mm with no sex-related differences (men: 1.71 ± 0.69 mm; women: 1.73 ± 0.57 mm; p = 0.91). The average length of the vessel was 9.24 ± 7.58 mm. The VoM was more frequently (p = 0.01) visualised in the systolic phases (68.85% of cases) compared to the diastolic phases (27.86% of cases). Occasionally it was visualised in other phases (3.29%).

Conclusions: Although it was possible to visualise the VoM using cardiac CT in about 20% of the population, this method of visualisation requires that special attention be paid to the quality of the images, especially in the systolic phases. Visualisation may be useful before certain electrophysiology procedures.
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http://dx.doi.org/10.5603/KP.a2018.0131DOI Listing
December 2018

Opioidergic conditioning of the human heart muscle in nitric oxide-dependent mechanism.

Adv Clin Exp Med 2018 Aug;27(8):1069-1073

Department of Cardiac and Vascular Diseases, the John Paul II Hospital, Jagiellonian University Medical College, Kraków, Poland.

Background: Opioidergic conditioning is well documented to trigger cardioprotection against ischemia/ reperfusion (I/R) injury. Previous studies on animal models have suggested that nitric oxide (NO) mediates the beneficial effect of opioids, but the role of NO in humans seems to be controversial.

Objectives: The aim of the study was to assess the influence of NO modulators on opioid-induced cardioprotection in the human myocardium.

Material And Methods: Trabeculae of the human right atria were electrically driven in an organ bath and subjected to simulated I/R injury. The non-selective inhibitor of nitric oxide synthase (NOS) - N-methyl-l-arginine (LNMMA), the donor of NO - S-Nitroso-N-acetylpenicillamine (SNAP) or morphine (in the amount of 10-4 M) were used at the time of re-oxygenation. The additional trabecula was subjected to the hypoxia protocol only (control). The contractility of the myocardium was assessed as the maximal force of a contraction (Amax), the rate of rise of the force of a contraction (Slope L) and the cardiac muscle relaxation - as the rate of decay of the force of a contraction (Slope T).

Results: The application of 100 μM LNMMA resulted in the decrease of Amax, Slope L and Slope T during the re-oxygenation period as compared to control. The application of 10-4 M morphine and/or 100 μM SNAP resulted in a partial reversal of the detrimental influence of LNMMA.

Conclusions: At the re-oxygenation period, the blockade of NO synthesis has a deleterious effect on the systolic and diastolic function of the human myocardium as well as attenuates the beneficial effect of morphine conditioning.
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http://dx.doi.org/10.17219/acem/70192DOI Listing
August 2018

Frailty as a predictor of negative outcomes after cardiac resynchronization therapy.

Pacing Clin Electrophysiol 2018 06 23;41(6):572-577. Epub 2018 Apr 23.

Department of Electrocardiology, Upper Silesian Heart Centre, Katowice, Poland.

Aim: To assess the prevalence of frailty among patients who had cardiac resynchronization as well as the influence of frailty on the main endpoints during follow-up.

Methods: The study included 156 patients (aged 74.33 ± 6.75; 27 W) with diagnosed heart failure who were hospitalized for the implantation of a cardiac resynchronization device. The Tilburg Frailty Indicator questionnaire was used to evaluate frailty syndrome.

Results: Frailty syndrome was diagnosed in 75.64% of patients who were included. The average value of frailty for the whole group was 6.21 ± 1.94, for the physical domain 4.29 ± 1.32, for the psychological domain 1.40 ± 1.04, and for the social domain 0.51 ± 0.57. During the follow-up period, 5.7% of the patients died, and the mortality rate was not statistically higher (P  =  0.5795) among patients who were diagnosed with frailty syndrome (6.78%) compared to robust patients (2.63%). Analysis of the complications and first electrical storm episodes demonstrated that these events did not occur in patients with no identifiable frailty syndrome. These occurred at a rate of 4.24% (complications) and 2.54% (electric storm) in patients with frailty syndrome.

Conclusions: Frailty syndrome can be an important predictor of negative outcomes in patients with heart failure who undergo cardiac resynchronizations.
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http://dx.doi.org/10.1111/pace.13329DOI Listing
June 2018

Three-dimensional visualisation of coronary sinus ostium from the inside right atrium perspective.

Kardiol Pol 2018 19;76(3):536-541. Epub 2018 Jan 19.

Department of Electrocardiology, Upper Silesian Medical Centre.

Background: There is no in vivo method of coronary sinus visualisation from the right atrium perspective.

Aim: The objective of the study was to create a cardiac computed tomography (CT) angiography-based method of visualising the coronary sinus ostium and the Thebesian valve from the inside right atrium perspective.

Methods: In 78 consecutive patients, a cardiac CT angiography (Aquilion 64, Toshiba) with retrospective gating (slice 0.5 mm) was performed. Raw data were reconstructed on Vitrea 2 workstations (Vital Images). In order to create the three-dimensional (3D) coronary sinus visualisation from the "inside view" perspective, patented "Fly Through" algorithms were used, and the anatomical positions on the multiplanar reconstruction images were marked. A dedicated, Likert-based five-point scale was developed and used to evaluate the quality of the visualisations.

Results: The average quality of the visualisations of the coronary sinus ostium in two-dimensional multiplanar reconstruction images was good (4.17 ± 0.85 points) and was clinically interpretable in all cases. The image quality of the "inside view" 3D images was 3.61 ± 1.12 points. In 57.7% of cases we obtained high scores (4 and 5 points). The main diameter was 10.72 ± 2.48 mm, and the entrance angle of the coronary sinus into the right atrium was 103.76 ± 10.71°.

Conclusions: Cardiac CT angiography is a useful method that permits the coronary sinus ostium and Thebesian valve to be visualised in vivo from the inside of the right atrium in a comparable manner.
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http://dx.doi.org/10.5603/KP.a2017.0246DOI Listing
November 2018

Anxiety, age, education and activities of daily living as predictive factors of the occurrence of frailty syndrome in patients with heart rhythm disorders.

Aging Ment Health 2018 09 10;22(9):1179-1183. Epub 2017 Jul 10.

b Department of Electrocardiology , Upper Silenian Heart Center , Katowice , Poland.

Objectives: Frailty is one of the geriatric syndromes that are caused by subclinical impairment of many organs, leading to the loss of reserves and the ability to maintain homeostasis. Aim of the study was to assess which factors including anxiety and depression can be predictive factors for the occurrence of frailty syndrome in patients with heart rhythm disorders.

Methods: The study included 171 consecutive patients >64 years (73.91 ± 6.72; 48.5% W) with diagnosed cardiac arrhythmias who had been qualified for pacemaker implantation. The Tilburg Frailty Indicator scale as well as the Hospital Anxiety and Depresion Scale (HADS) were used.

Results: The average HADS results in the frailty group was significantly higher 7.42 ± 2.63 compared to the robust patients 6.33 ± 2.83; p =0.0019. Similar results were observed in patients with atrio-ventricular blocks (AVB): HADS-A: frail 8.23 ± 2.13 vs. robust 6.62 ± 2.27; p = 0.0036 and HADS-D: frail 8.84 ± 2.85 vs. robust 7.17 ± 2.48; p =0.0086. The multiple regression model showed that age (p =0.0023), education (p =0.0001), ADL (p =0.0001) and the severity of the anxiety (p = 0.0414) were important predictors of the dependent variable and predicted higher levels of frailty syndrome.

Conclusion: Anxiety, age, education and the activities of daily living can be predictive factors of the occurrence of frailty syndrome in patients with heart rhythm disorders who have been qualified for pacemaker implantation.
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http://dx.doi.org/10.1080/13607863.2017.1348468DOI Listing
September 2018

Influence of frailty on the quality of life patients qualified for pacemaker implantation.

J Clin Nurs 2018 Feb 17;27(3-4):555-560. Epub 2017 Jul 17.

Department of Electrocardiology, Upper Silesian Heart Centre, Katowice, Poland.

Aims And Objectives: An important question is whether frailty syndrome affects the assessment of quality of life or whether frailty syndrome may reduce the benefits of a cardiac pacemaker implantation.

Background: Frailty syndrome is known risk factor for quality of life evaluation after selected cardiology invasive procedures.

Design: The study was designed as single-centre prospective study.

Methods: The study included 171 patients aged ≥60 years who were qualified for pacemaker implantation. Quality of life was evaluated twice-before and 6 months after implantation using MLHF questionnaire. A frailty syndrome evaluation using the Tilburg Frailty Indicator (TFI) was performed prior to pacemaker implantation. A DDDR pacemaker was implanted in each patient.

Results: Frailty syndrome was identified in half of the patients with indications for cardiac pacemaker implantation. There was an improvement in quality of life in the six months after pacemaker implantation in all of the robust and frailty syndrome-affected patients that were included into the study-in general, physical and emotional domains.

Conclusion: Implantation of cardiac pacemaker influences the compensation quality of life evaluation in patients with sinus node dysfunction. Presence of frailty influences worse quality of life of patients when evaluated before cardiac pacemaker implantation.

Relevance To Clinical Practice: Frailty should be evaluated in all older patients qualified for pacemaker implantation to evaluate high-risk group, optimise therapeutic approach and to intense education activities for patients and family.
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http://dx.doi.org/10.1111/jocn.13897DOI Listing
February 2018

Effects of endogenous cardioprotective mechanisms on ischemia-reperfusion injury.

Postepy Hig Med Dosw (Online) 2017 Jan 10;71(0):20-31. Epub 2017 Jan 10.

Oddział Elektrokardiologii i Niewydolności Serca, Górnośląskie Centrum Medyczne w Katowicach.

Ischemic heart disease have been remarked as a leading cause of morbidity and mortality in adults. Early restoration of cardiac perfusion is necessary to restore perfusion of ischemic heart muscle. Effective revascularization reduce mortality by limiting myocardial necrosis at the acute phase of the cardiac infarction. However, reperfusion may induce a cascade of pathophysiological reactions causing the increase of the infarct area of the myocardium This phenomenon known as ischemia-reperfusion injury is responsible for up to 50% of the final infarct size. Sequences of brief episodes of nonlethal ischemia and reperfusion applied before (preconditioning - IPC) or after (postconditioning - POC) the coronary occlusion are well documented to reduce the ischemiareperfusion injury. These phenomena improve cardiac function by mobilizing the molecular and cellular mechanisms limiting reperfusion injury. The mechanisms underlying IPC or POC are still not clarified, but strong experimental evidence suggests that opioids may be the part of the endogenous cardioprotective response to I/R injury. Stimulation of opioid receptors activates related to POC mechanisms affecting protection to the ischemic myocardium, while the use of non-selective opioid receptor antagonist - naloxone reduces this effect. There is no consensus that the subtype of opioid receptor is responsible for the protection of the human heart muscle. Morphine may reduce cardiac preload by peripheral vasodilatation. Numerous studies show a direct cardioprotective effect of the opioid pathway in ischemic conditions. Opioids act via membrane receptors: μ, δ, κ. The predominant subtype in the human cardiac cells are μ- and δ - opioid receptors. It has been hypothetized that opioid receptor activation exerts cardioprotection in human heart muscle pathway what may give insight into the explanation of the protective mechanisms in the acute myocardial infarction.
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http://dx.doi.org/10.5604/17322693.1228267DOI Listing
January 2017

Older age and a higher EHRA score allow higher levels of frailty syndrome to be predicted in patients with atrial fibrillation.

Aging Male 2017 Mar 12;20(1):23-27. Epub 2016 Nov 12.

c Department of Electrocardiology and Heart Failure , School of Health Sciences, Medical University of Silesia , Katowice , Poland.

Background: There is no research that evaluates the relationship between the severity of the symptoms of atrial fibrillation (AF), the presence of frailty syndrome and acceptance of the illness.

Methods: The study included 132 patients aged 72.7 ± 6.73 with diagnosed AF. The severity of the symptoms of AF was determined according to European Heart Rhythm Association (EHRA) guidelines, frailty syndrome was assessed using the Tilburg frailty indicator (TFI) and the acceptance of the illness was assessed using the acceptance of illness scale (AIS). A standard statistical comparison and multiple regression analysis using the stepwise method were performed.

Results: In patients with AF, frailty was 5.31 ± 2.69 (TFI). Frailty syndrome was diagnosed in 59.8% of the AF patients who had a score of 7.17 ± 1.72. A higher level of EHRA score was connected with a smaller degree of the acceptance of the illness p = 0.0000. The multiple regression model indicated that age (p = 0.0009) and the severity of the symptoms (p = 0.0001) are important predictors of frailty syndrome.

Conclusions: There is a relationship between the presence of frailty syndrome and the intensity of the symptoms and the acceptance of AF. Age and the EHRA score permitted higher levels of frailty syndrome to be predicted.
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http://dx.doi.org/10.1080/13685538.2016.1241761DOI Listing
March 2017

Ten-Year Outcomes After Coronary Artery Bypass Grafting According to Age in Patients With Heart Failure and Left Ventricular Systolic Dysfunction: An Analysis of the Extended Follow-Up of the STICH Trial (Surgical Treatment for Ischemic Heart Failure).

Circulation 2016 Nov 29;134(18):1314-1324. Epub 2016 Aug 29.

Duke Clinical Research Institute and Departments of Biostatistics and Bioinformatics (KLL) and Medicine (EJV), Duke University School of Medicine, Durham, North Carolina, USA.

Background: Advancing age is associated with a greater prevalence of coronary artery disease in heart failure with reduced ejection fraction and with a higher risk of complications after coronary artery bypass grafting (CABG). Whether the efficacy of CABG compared with medical therapy (MED) in patients with heart failure caused by ischemic cardiomyopathy is the same in patients of different ages is unknown.

Methods: A total of 1212 patients (median follow-up, 9.8 years) with ejection fraction ≤35% and coronary disease amenable to CABG were randomized to CABG or MED in the STICH trial (Surgical Treatment for Ischemic Heart Failure).

Results: Mean age at trial entry was 60 years; 12% were women; 36% were nonwhite; and the baseline ejection fraction was 28%. For the present analyses, patients were categorized by age quartiles: quartile 1, ≤54 years; quartile, 2 >54 and ≤60 years; quartile 3, >60 and ≤67 years; and quartile 4, >67 years. Older versus younger patients had more comorbidities. All-cause mortality was higher in older compared with younger patients assigned to MED (79% versus 60% for quartiles 4 and 1, respectively; log-rank P=0.005) and CABG (68% versus 48% for quartiles 4 and 1, respectively; log-rank P<0.001). In contrast, cardiovascular mortality was not statistically significantly different across the spectrum of age in the MED group (53% versus 49% for quartiles 4 and 1, respectively; log-rank P=0.388) or CABG group (39% versus 35% for quartiles 4 and 1, respectively; log-rank P=0.103). Cardiovascular deaths accounted for a greater proportion of deaths in the youngest versus oldest quartile (79% versus 62%). The effect of CABG versus MED on all-cause mortality tended to diminish with increasing age (P=0.062), whereas the benefit of CABG on cardiovascular mortality was consistent over all ages (P=0.307). There was a greater reduction in all-cause mortality or cardiovascular hospitalization with CABG versus MED in younger compared with older patients (P=0.004). In the CABG group, cardiopulmonary bypass time or days in intensive care did not differ for older versus younger patients.

Conclusions: CABG added to MED has a more substantial benefit on all-cause mortality and the combination of all-cause mortality and cardiovascular hospitalization in younger compared with older patients. CABG added to MED has a consistent beneficial effect on cardiovascular mortality regardless of age.

Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00023595.
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http://dx.doi.org/10.1161/CIRCULATIONAHA.116.024800DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5089908PMC
November 2016

Gender-related differences in coronary venous anatomy: a potential basis for various response to cardiac resynchronisation therapy.

Kardiol Pol 2017 17;75(3):247-254. Epub 2016 Oct 17.

Department of Internal Nursing, School of Health Sciences, Medical University of Silesia, Katowice, Poland Department of Electrocardiology, Upper Silesian Cardiology Centre, Katowice, Poland.

Background And Aim: We hypothesised that small differences in the anatomy of the coronary venous tree might be one of the factors responsible for the differences in the response for cardiac resynchronisation depending on a patient's gender.

Methods: Cardiac computed tomography scans with retrospective gating were performed on 315 subjects (aged 58.3 ± 11.6 years; 117 women) according to the clinical criteria. The standard protocol for coronary arteries was used during scanning. Additional reconstructions that were focused on the coronary veins during post processing were used to analyse the data. Gender-related anatomical variants were identified.

Results: The average of 3.6 ± 1.4 veins per case were visualised. The posterolateral vein was visualised more frequently in men than in women (p < 0.05). Eight variants were identified as being more frequent - they were found in 237 out of 315 cases (75.24%). Those variants occurred in 95 (81.19%) of the women and in 142 (71.72%) of the men, p = 0.080. Six variants occurred more frequently in women; however, the differences were not significant.

Conclusions: In women a more frequent presence of favourable coronary vein variants in the target area for cardiac resynchronisation can be seen. Anatomical findings may help to explain why women more frequently respond to cardiac resyn-chronisation therapy compared to men.
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http://dx.doi.org/10.5603/KP.a2016.0153DOI Listing
May 2017

'Opioidergic postconditioning' of heart muscle during ischemia/reperfusion injury.

Cardiol J 2017 13;24(4):419-426. Epub 2016 Oct 13.

John Paul II Hospital, Department of Cardiac and Vascular Diseases, Krakow..

Background: Ischemic preconditioning and postconditioning are the novel strategies of attaining cardioprotection against ischemia/reperfusion (I/R) injury. Previous studies suggested the role of opioid pathway, however the class of opioid receptors responsible for this effect in humans remains unknown. The aim of the study was to assess the influence of opioids on simulated I/R injury outcomes in the hu-man myocardium.

Methods: Trabeculae of the human right atrium were electrically driven in organ bath and subjected to simulated I/R injury. Morphine (10-4M, 10-5M, 10-6M) or d-opioid receptor agonist DADLE (10-8M, 10-7M, 10-6M) was used at the time of re-oxygenation. Additional trabecula was subjected to hypoxia protocol only (Control). Contractive force of the myocardium was assessed as the maximal force of a contraction (Amax), the rate of rise of the force of a contraction (Slope L) and relaxation as the rate of decay of the force of a contraction (Slope T).

Results: Application of morphine 10-4M resulted in increase of Amax, Slope L and Slope T during re-oxygenation period as compared to Control (77.99 ± 1.5% vs. 68.8 ± 2.2%, p < 0.05; 45.72 ± 2.9% vs. 34.12 ± 5.1%, p < 0.05; 40.95 ± 2.5% vs. 32.37 ± 4.3%, p < 0.05). Parameters were not significantly different in the lower morphine concentrations. Application of DADLE 10-6M resulted in decrease of Amax and Slope L as compared to Control (68.13 ± 5.5% vs. 76.62 ± 6.6%, p < 0.05; 28.29 ± 2.2 vs. 34.80 ± 3.9%, p < 0.05).

Conclusions: At re-oxygenation, morphine improves systolic and diastolic function of the human myo-cardium in the dose-dependent manner. Delta-opioid receptor stimulation attenuates systolic function of human heart muscle which remains in contrast to previous reports with animal models of I/R injury. (Cardiol J 2017; 24, 4: 419-425).
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http://dx.doi.org/10.5603/CJ.a2016.0090DOI Listing
May 2018