Publications by authors named "Piotr Pruszczyk"

237 Publications

Pulmonary Embolism Response Team - a multidisciplinary approach to pulmonary embolism treatment. Polish PERT Initiative Report.

Kardiol Pol 2021 Oct 13. Epub 2021 Oct 13.

Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warszawa, Poland.

Background: A pulmonary embolism response team (PERT) is a multidisciplinary team established to improve clinical care for patients with pulmonary embolism (PE). However, data regarding detailed institutional experience and clinical outcomes from such teams are sparse.

Aims: We aim to assess the frequency of activations, patients' characteristics, PE severity, applied treatments, and outcomes of PE patients treated by Polish PERTs.

Methods: The survey registry was conducted between June 2018 and July 2020. All consecutive PERT activations of four institutionalized PERTs in Poland were analyzed. Patients' characteristics, therapies applied, and in-hospital outcomes were evaluated.

Results: There were 680 unique PERT activations. The majority of activations originated from emergency departments (44.9%), and the remaining originated from internal medicine/cardiology units (31.1%), surgery/orthopedics (9.1 %), oncology (6.3%), intensive care units (6.0%), and others (2.5%). The origin of activation varied significantly between institutions (P <0.01). Most PERT cases were patients with intermediate-high risk PE (42.9%), whereas high-risk PE occurred in 10% of patients. Anticoagulation alone was delivered to 80.3% patients, and 23.3% patients received at least one advanced therapy: catheter directed therapies (11.3%), systemic thrombolysis (5.3%), surgical embolectomy (2.4%), vena cava filter placement (3.7%), and extracorporeal membrane oxygenation (0.6%). In-hospital mortality in the whole study group was 5.1%, with significant differences between institutions (P = 0.01).

Conclusions: The frequency of PE severity, type of delivered catheter-directed treatment, and in-hospital mortality varies between institutions without significant discrepancies in PERT activations. This variation between expert centers highlights the local differences in PERTs' organizational and operational forms.
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http://dx.doi.org/10.33963/KP.a2021.0130DOI Listing
October 2021

Optimal medical therapy in patients with stable coronary artery disease in Poland. The ISCHEMIA Trial experience.

Pol Arch Intern Med 2021 Sep 29. Epub 2021 Sep 29.

Introduction: Optimal medical therapy (OMT) is the cornerstone of treatment for stable coronary disease with ISCHEMIA Trial showing similar outcomes using OMT with or without an initial invasive approach.

Objectives: To describe OMT goal attainment among ISCHEMIA participants in Poland compared to other countries.

Patients And Methods: Among 5179 trial participants, 333 were randomized in Poland. The median follow-up was 3.2 years. OMT targets were: not smoking, high-intensity statin therapy, LDL-C<70mg/dL, SBP<140mmHg, aspirin therapy, and ACE-I/ARB, beta-blocker therapy if indicated.

Results: Compared to 36 other countries, at randomization participants in Poland were older (67 [62, 75] vs 65 [58, 71] yrs), P<0.001), more often female (30% vs 22%, P=0.002), with a longer angina history (3 [1, 9]yrs vs 1 [0, 3]yrs, P<0.001), more prior myocardial infarction (32% vs 18%, P <0.01) and revascularization (PCI: 40% vs 19%; CABG: 11% vs 3%, P<0.001). Number of OMT goals attained increased from baseline to follow-up (5 [4, 6] vs 6 [5, 6], P<0.001) in Poland and other countries alike (P=0.89, and P=0.14, resp). In Poland, significant improvements were achieved regarding high-intensity statin therapy (27% vs 50%), LDL-C<70mg/dl (29% vs 65%), and SBP<140mmHg (63% vs 81%), P<0.001; whereas not-smoking (89% vs 89%), aspirin (90% vs 88%), ACE-I/ARB (93% vs 95%), and beta-blocker therapy (94% vs 90%) remained high.

Conclusion: With regular surveillance and contemporary medical therapy, high OMT goal attainment was achievable among ISCHEMIA participants in Poland relative to other countries. There is still room for improvement in LDL-C and blood pressure management.
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http://dx.doi.org/10.20452/pamw.16100DOI Listing
September 2021

Association between the geographic region and the risk of familial atrioventricular nodal reentry tachycardia in the Polish population.

Pol Arch Intern Med 2021 Sep 28. Epub 2021 Sep 28.

Introduction: Atrioventricular nodal reentry tachycardia (AVNRT) is one of the most common regular supraventricular arrhythmia referred for catheter ablation (CA). In Poland, several families with familial AVNRT (FAVNRT) were reported in Subcarpathia Province (SP).

Objectives: We aimed to determine the frequency of FAVNRT in SP compared with other southeastern provinces.

Patients And Methods: Between 2010 and 2019, clinical data of 1544 patients with AVNRT diagnosed by invasive electrophysiological study were screened for FAVNRT. From January 2017 to June 2019, patients were asked to provide details on family history and origin to obtain a three-generation pedigree. Families with at least 2 members with previous AVNRT and CA were divided into those from south-eastern provinces (SEPs; including SP and bordering provinces [BPs]) and the remaining parts of Poland (RPPs).

Results: There were 932 patients from SEPs and 612 - from RPPs. FAVNRT was reported in 45 patients (2.91%) from 27 families, with a higher frequency in SEPs than RPPs (4.02% vs 1.17%, P = 0.002) and the highest frequency in SP (6.33% vs 2.47% in BPs, P = 0.004). The risk of FAVNRT was higher in SP compared with BPs (OR=2.67; 95%CI: 1.36-5.23; P = 0.004) and similar in BPs compared with RPP (OR=2.14; 95%CI: 0.86-5.34; P = 0.10).

Conclusion: Relationship exists between the geographical region and increased frequency of FAVNRT. The greater distance from SP the less frequent FAVNRT was. International cooperation and genetic testing are needed to confirm the genetic impact of FAVNRT in this part of Central Europe.
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http://dx.doi.org/10.20452/pamw.16099DOI Listing
September 2021

Reduced-dose intravenous thrombolysis for acute intermediate high-risk pulmonary embolism: Rationale and design of the PEITHO-3 trial.

Thromb Haemost 2021 Sep 24. Epub 2021 Sep 24.

Hopital Europeen Georges Pompidou, Paris, France.

Intermediate high-risk pulmonary embolism (PE) is characterised by right ventricular (RV) dysfunction and elevated circulating cardiac troponin levels despite apparent haemodynamic stability at presentation. In these patients, full-dose systemic thrombolysis reduced the risk of haemodynamic decompensation or death but increased the risk of life-threatening bleeding. Reduced-dose thrombolysis may be capable of improving safety while maintaining reperfusion efficacy. The Pulmonary Embolism International Trial (PEITHO)-3 study (EudraCT 2018-000816-96) is a randomised, placebo-controlled, double-blind, multicentre, multinational trial with long-term follow-up. We will compare the efficacy and safety of a reduced-dose alteplase regimen with standard heparin anticoagulation. Patients with intermediate high-risk PE will also fulfil at least one clinical criterion of severity: systolic blood pressure ≤ 110 mmHg, respiratory rate >20 breaths/min, or history of heart failure. The primary efficacy outcome is the composite of all-cause death, haemodynamic decompensation or PE recurrence within 30 days of randomisation. Key secondary outcomes, to be included in hierarchical analysis, are fatal or GUSTO severe or life-threatening bleeding; net clinical benefit (primary efficacy outcome plus severe or life-threatening bleeding); and all-cause death, all within 30 days. All outcomes will be adjudicated by an independent committee. Further outcomes include PE-related death, haemodynamic decompensation, or stroke within 30 days; dyspnoea, functional limitation or RV dysfunction at 6 months and 2 years; and utilisation of healthcare resources within 30 days and 2 years. The study is planned to enrol 650 patients. The results are expected to have a major impact on risk-adjusted treatment of acute PE and inform guideline recommendations.
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http://dx.doi.org/10.1055/a-1653-4699DOI Listing
September 2021

, , ACUTE PULMONARY EMBOLISM BY AMNIOTIC FLUID - A RARE COMPLICATION OF PERINATAL PERIOD THAT SHOULD NOT BE FORGOTTEN.

Wiad Lek 2021 ;74(8):2011-2015

DEPARTMENT OF INTERNAL MEDICINE AND CARDIOLOGY, MEDICAL UNIVERSITY OF WARSAW, WARSAW, POLAND.

Objective: Amniotic fluid embolism (AFE) is a diagnostically challenging type of pulmonary embolism that occurs when amniotic fluid enters maternal circulation during delivery or postpartum. This obstetric complication is very rare but characterized by high mortality rate. The main symptoms are dyspnea, cardiovascular collapse, disseminated intravascular coagulation (DIC) and even sudden cardiac death. The aim of the article is to draw attention to AFE as a rare but possible and catastrophic complication of perinatal period. The authors present a 28-year-old woman who was admitted to obstetric ward during the first stage of labour. The patient developed sudden deterioration of her medical state with acute respiratory distress symptoms. An emergency cesarean section was performed, complicated by excessive bleeding. After a detailed assessment of the patient's condition and evaluation of the results of additional tests, we diagnosed AFE as the cause of the patient's deterioration.

Conclusion: Conclusions: The case study shows how unpredictable, unpreventable and dangerous is AFE. It is still one of the main causes of maternal deaths in developed countries. Four diagnostic criteria proposed by the Society for Maternal-Fetal Medicine (SMFM) may accelerate diagnosis. AFE as a medical emergency, requires immediate multidisciplinary response and aggressive treatment. The initial medical care may be facilitated by the application of the general guidelines recommended by SMFM. The case report also emphasizes the need for further research on this disease, in particular on early detection and prevention.
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September 2021

Balloon Pulmonary Angioplasty in Chronic Thromboembolic Pulmonary Hypertension: A Multicenter Registry.

EuroIntervention 2021 07 6. Epub 2021 Jul 6.

Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, European Health Centre Otwock, Centre of Postgraduate Medical Education, Poland.

Background: Balloon pulmonary angioplasty (BPA) is a promising therapy for patients with chronic thromboembolic pulmonary hypertension (CTEPH) who are ineligible for pulmonary endarterectomy.

Aims: The present study evaluated the safety and efficacy of BPA for CTEPH using the first multicentre registry of a single European country.

Methods: Data were obtained from the Database of Pulmonary Hypertension in the Polish Population (NCT:03959748), a prospective, multicentre registry of adult and paediatric PAH and CTEPH, for a total of 236 patients with confirmed CTEPH (124 women; mean age 67 years) who underwent 1056 BPA procedures at eight institutions in Poland.

Results: In 156 patients who underwent follow-up assessments after a median of 5.9 (IQR: 3.0-8.0) months after final BPA, the mean pulmonary arterial pressure decreased from 45.1±10.7 to 30.2±10.2 mmHg (P<0.001) and pulmonary vascular resistance from 642±341 to 324±183 dynes (P<0.001), and 6MWT improved from 341±129 to 423±136 m (P<0.001). Pulmonary injury related to BPA procedure occurred in 6.4% of all sessions. Eighteen patients (7.6%) died during follow-up, including 4 (1.7%) who died within 30 days after BPA. Overall survival was 92.4% (95% confidence interval 87.6%-94.9%) 3 years after the initial BPA procedure.

Conclusions: This multicentre registry confirmed significant improvement of haemodynamic, functional, and biochemical parameters after BPA. Complication rates were low and overall survival comparable to the results of another registry. Therefore, BPA may be an important therapeutic option in patients with CTEPH also in Poland.
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http://dx.doi.org/10.4244/EIJ-D-21-00230DOI Listing
July 2021

Holter-Derived Autonomic Function, Arrhythmias and Carbohydrate Metabolism in Patients with Class III Obesity Treated with Laparoscopic Sleeve Gastrectomy.

J Clin Med 2021 May 15;10(10). Epub 2021 May 15.

Department of Internal Medicine and Cardiology, Medical University of Warsaw, 02-005 Warsaw, Poland.

The effects of weight loss following bariatric surgery on autonomic balance, arrhythmias and insulin resistance are still of interest. We prospectively investigated 50 patients with BMI > 40 kg/m, aged 36.5 (18-56) years who underwent laparoscopic sleeve gastrectomy. Among other examinations, all subjects had 24-h Holter monitoring with heart rate variability (HRV) and heart rate turbulence (HRT) evaluation. After a median of 15 months, BMI decreased from 43.9 to 29.7 kg/m, the incidence of hypertension decreased from 54 to 32% ( = 0.04) and any carbohydrate disorders decreased from 24 to 6% ( = 0.02). Fasting insulin concentration and insulin resistance index improved significantly ( < 0.001). Improvements in HRV parameters related to the sympathetic autonomic division were also observed ( < 0.001), while HRT evaluation was not conclusive. The enhancement of autonomic tone indices was correlated with reduction of BMI (SDNN-I r = 0.281 = 0.04; SDNN r = 0.267 = 0.05), but not with reduction of waist circumference, and it was also associated with decrease of mean heart rate (OR 0.02, 95%CI 0.0-0.1, < 0.001). The incidence of arrhythmias was low and similar before and after follow-up. In conclusion, improvement of homeostasis of carbohydrate metabolism and autonomic function is observed in relatively young patients after weight loss due to laparoscopic sleeve gastrectomy.
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http://dx.doi.org/10.3390/jcm10102140DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8156268PMC
May 2021

Takotsubo cardiomyopathy: a potential complication in the setting of acute prosthetic valve dysfunction. Author's reply.

Kardiol Pol 2021 04 23;79(4):483. Epub 2021 Apr 23.

Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland

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http://dx.doi.org/10.33963/KP.15952DOI 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.
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http://dx.doi.org/10.1177/20406223211002961DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8010818PMC
March 2021

Left ventricular diastolic dysfunction and diseases severity contribute to impaired exercise capacity in systemic lupus erythematosus.

Lupus 2021 Jun 15;30(7):1154-1162. Epub 2021 Apr 15.

Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland.

Objectives: Patients with systemic lupus erythematosus (SLE) have a higher risk of myocardial involvement, which can result in ventricular dysfunction. The aim of our study was to estimate potential relationship between exercise capacity assessed by six minute walk test (6MWT) and echocardiographic parameters of left and right ventricular function in SLE patients.

Methods: We prospectively studied 66 SLE patients (57 F, age 44 (20-75) years) and 27 age matched healthy subjects. In addition to routine evaluation, 6MWT and transthoracic echocardiography including LV diastolic dysfunction parameters (E/A, E/É) were performed.

Results: While E/A was similar in both groups, E/E' was higher in patients with SLE than in controls, 7.5 (4-22) vs 6.8 (1.6-9.4), p = 0.018. The mean 6MWT distance was significantly shorter in SLE (561.6 ± 150.7 vs 682.6 ± 98.1 m, p < 0.002). Among SLE patients only 53 (80.3%) were capable to walk at least 450 m, while in controls 27 (100%) (p = 0.013). We observed significant correlations between 6MWT distance and SLICC/ACR-DI (rho=-0.44, p < 0.001), E/A (rho = 0.30, p = 0.004), E/E' (rho=-0.36, p < 0.001) in SLE patients. Univariable logistic regression models revealed that SLICC/ACR-DI, E/E', tricuspid regurgitant peak gradient (TRPG), and right ventricular systolic pressure (RVSP) were associated with 6MWT distance lower than < 450 m. ROC curves shown high predictive value of E/E' ratio, TRPG, RVSP in the prediction for 6MWT distance < 450 m.

Conclusion: Impaired exercise tolerance seems to result mainly from the severity of SLE and LV diastolic dysfunction.
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http://dx.doi.org/10.1177/09612033211006900DOI Listing
June 2021

Non-invasive early exclusion of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism: the InShape II study.

Thorax 2021 Oct 23;76(10):1002-1009. Epub 2021 Mar 23.

Department of Thrombosis and Hemostasis, Leiden Universitair Medisch Centrum, Leiden, The Netherlands

Background: The current diagnostic delay of chronic thromboembolic pulmonary hypertension (CTEPH) after pulmonary embolism (PE) is unacceptably long, causing loss of quality-adjusted life years and excess mortality. Validated screening strategies for early CTEPH diagnosis are lacking. Echocardiographic screening among all PE survivors is associated with overdiagnosis and cost-ineffectiveness. We aimed to validate a simple screening strategy for excluding CTEPH early after acute PE, limiting the number of performed echocardiograms.

Methods: In this prospective, international, multicentre management study, consecutive patients were managed according to a screening algorithm starting 3 months after acute PE to determine whether echocardiographic evaluation of pulmonary hypertension (PH) was indicated. If the 'CTEPH prediction score' indicated high pretest probability or matching symptoms were present, the 'CTEPH rule-out criteria' were applied, consisting of ECG reading and N-terminalpro-brain natriuretic peptide. Only if these results could not rule out possible PH, the patients were referred for echocardiography.

Results: 424 patients were included. Based on the algorithm, CTEPH was considered absent in 343 (81%) patients, leaving 81 patients (19%) referred for echocardiography. During 2-year follow-up, one patient in whom echocardiography was deemed unnecessary by the algorithm was diagnosed with CTEPH, reflecting an algorithm failure rate of 0.29% (95% CI 0% to 1.6%). Overall CTEPH incidence was 3.1% (13/424), of whom 10 patients were diagnosed within 4 months after the PE presentation.

Conclusions: The InShape II algorithm accurately excluded CTEPH, without the need for echocardiography in the overall majority of patients. CTEPH was identified early after acute PE, resulting in a substantially shorter diagnostic delay than in current practice.
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http://dx.doi.org/10.1136/thoraxjnl-2020-216324DOI Listing
October 2021

Comprehensive non-invasive assessment of electrocardiographic abnormalities and cardiac arrhythmias in patients with genetically confirmed mitochondrial diseases.

J Electrocardiol 2021 Mar-Apr;65:136-142. Epub 2021 Feb 15.

Department of Internal Medicine and Cardiology, Medical University of Warsaw, Poland.

Background: There is limited data on cardiac arrhythmias and ventricular repolarization and dispersion abnormalities in patients with mitochondrial diseases (MitD).

Methods: Consecutive 40 patients with genetically proven MitD and 35 healthy controls were studied. Among other examinations all subjects underwent 24-h Holter recording and 12‑lead electrocardiography (ECG) with corrected QT (QTc), QT dispersion (QTd), Tp-e and Tp-e/QT ratio assessment.

Results: Patients with MitD were 55.4 ± 15.7 years old, the disease duration was 18.5 ± 10.3 years, presented 6 clinical syndromes while mitochondrial and nuclear DNA type of mutation was present in 40 and 60% of cases, respectively. In MitD more frequently 1st degree atrioventricular block and intraventricular conduction defects were observed and also QRS complex duration was increased. Mean values of QTc (p = 0.001), QTd (p = 0.02), Tp-e (p < 0.00001) and Tp-e/QT (p < 0.00001) were significantly higher in MitD than in controls. Correlations between disease duration and PR interval duration (p = 0.003) and Creatine Kinase MB isoenzyme activity (p = 0.02) were found. No differences in depolarization and dispersion parameters were observed according to type of mutation or dominant clinical syndromes. In addition to supraventricular extrasystoles, nonsustained supraventricular tachycardias occurred more frequently in MitD (in 45.0 vs 14.3%, p = 0.0004). Ventricular arrhythmias were rare and observed almost exclusively in subjects with mitochondrial DNA mutation.

Conclusions: In contrast to healthy controls, in MitD patients intraventricular, repolarization and dispersion disturbances were more frequently observed. In addition to bradyarrhythmias observed in some defined MitD syndromes, supraventricular rather than ventricular arrhythmias are more common.
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http://dx.doi.org/10.1016/j.jelectrocard.2021.01.021DOI Listing
July 2021

The analysis of echocardiographic results in patients suffering from epidermolysis bullosa.

Postepy Dermatol Alergol 2020 Dec 6;37(6):871-878. Epub 2021 Jan 6.

Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland.

Introduction: Cardiac abnormalities revealed in patients suffering from epidermolysis bullosa (EB) include dilated cardiomyopathy (DC) and aortopathy. DC is a rare but serious complication associated with an increased mortality, predominantly observed in recessive dystrophic EB. Echocardiography is the most available diagnostic tool used to detect heart disease in EB patients.

Aim: To analyse echocardiographic results obtained in Polish EB patients and compare them between the EB group and healthy persons.

Material And Methods: We analysed retrospectively echocardiograms of 23 patients with EB (14 F, mean age 17.3 years) performed from 2017 to 2019. The incidence of left ventricular (LV) systolic and diastolic dysfunction, right heart disease and congenital heart disease was evaluated. A comparison of echo-parameters between EB patients and 20 matched healthy subjects was performed.

Results: We did not find any cases of DC and aortopathy in the EB group. One bicuspid aortic valve case was revealed. Analysis of LV diastolic parameters showed that the mean value of mitral A velocity was significantly higher and the pulmonary venous flow D velocity was lower in the EB group than in controls. Tissue Doppler analysis revealed lower values of E' velocities of mitral annulus in the EB group, what may suggest discreetly slower LV relaxation, however, this will definitely require further research.

Conclusions: Although most EB patients do not present cardiac symptoms, there is still a risk of developing cardiomyopathy associated with poor prognosis. It seems reasonable to perform a scheduled echocardiographic screening including LV systolic and diastolic function assessment to detect preclinical cardiac abnormalities.
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http://dx.doi.org/10.5114/ada.2020.102101DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7874876PMC
December 2020

Rheolytic thrombectomy with local thrombolysis in a patient with COVID-19 pneumonia and acute pulmonary embolism.

Pol Arch Intern Med 2021 03 11;131(3):292-294. Epub 2021 Feb 11.

Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland.

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http://dx.doi.org/10.20452/pamw.15807DOI Listing
March 2021

Does kidney function matter in pulmonary thromboembolism management?

Cardiol J 2021 Jan 20. Epub 2021 Jan 20.

Medical University of Warsaw, Department of Internal Medicine & Cardiology, Lindleya Street 4, 02-005 Warsaw, Poland.

Cardiovascular circulation and kidney function are closely interrelated. The impairment of renal function is a well-known hazard of increased mortality and morbidity of patients with heart failure or coronary artery disease. Acute pulmonary embolism (APE) impacts pulmonary and systemic circulation, and can severely impair functions of other organs, including kidneys, as a result of hypoxemia and increased venous pressure. Previous studies indicate that renal dysfunction predicts short- and long-term outcomes and can improve the risk assessment in APE. However, renal function should also be cautiously considered during the diagnostic workup because the contrast-induced nephropathy after computed tomography pulmonary angiography (CTPA) is noticed more frequently in APE. Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare but imminent complication of APE. This condition promotes renal impairment by increasing venous pressure and decreasing glomerular filtration. The renal function improvement and serum creatinine concentration reduction were noted in CTEPH subgroup with glomerular filtration rate ≤ 60 mL/min/1.73 m² after successful treatment. In this review, we present the essential research results on the kidney function in thromboembolism disease.
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http://dx.doi.org/10.5603/CJ.a2021.0005DOI Listing
January 2021

COVID-19 and its implication for venous thromboembolism.

Cardiol J 2020 ;27(5):481-484

Department of Internal Medicine and Cardiology, Medical University of Warsaw, Poland.

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http://dx.doi.org/10.5603/CJ.2020.0153DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8078986PMC
November 2020

Assessment of arrhythmias and cardiac autonomic tone at a relatively young age patients with obesity class III.

Clin Obes 2021 Feb 31;11(1):e12424. Epub 2020 Oct 31.

Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland.

There is no sufficient data on arrhythmias occurrence in obesity class III. The influence of hyperinsulinemia and insulin resistance on arrhythmias and cardiac autonomic tone is also of ongoing interest in these subjects. We prospectively studied 81 selected patients with body mass index >40 kg/m , aged 34 (18-65) years. Among other examinations all subjects underwent electrocardiography and Holter monitoring with heart rate variability (HRV) and turbulence (HRT) evaluation. Controls consisted of 45 healthy, sex- and aged-matched lean volunteers. In patients median BMI was 44.5 kg/m (40.1-58.1), benign arterial hypertension was present in 43.2% and dysglycemia in 27.2% of cases. In the group with obesity longer PR interval (P < .001) and corrected QT interval (P < .001) were observed, while in Holter monitoring no significant differences in supraventricular or ventricular arrhythmias and also bradyarrhythmias prevalence were observed in comparison to controls. In individuals with obesity HRV indices associated with sympathetic tone were significantly impaired and also abnormal HRT values (21.9 vs 0%, P = .04) were more frequently observed. There were no significant correlations between anthropometric obesity parameters and fasting insulin concentration, insulin resistance index and also HRV/HRT parameters in studied individuals. Univariate regression analysis revealed that only age influenced abnormal HRT occurrence (OR 1.69, 95%CI 1.08-2.98, P = .04). In conclusions, patients with obesity class III at a relatively young age who reported they felt healthy, do not present increased prevalence of arrhythmias, including life-threatening ones. Cardiac autonomic dysfunction is observed in these patients, however it has not been shown to be associated with anthropometric measurements.
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http://dx.doi.org/10.1111/cob.12424DOI Listing
February 2021

Plasma growth differentiation factor 15 levels for predicting serious adverse events and bleeding in acute pulmonary embolism: a prospective observational study.

Pol Arch Intern Med 2020 09 16;130(9):757-765. Epub 2020 Jul 16.

Department of Internal Medicine and Cardiology with the Centre for Management of Venous Thromboembolic Disease, Medical University of Warsaw, Warsaw, Poland

Introduction: Growth differentiation factor 15 (GDF‑15), a cytokine induced in the myocardium by pressure overload and ischemia, has a well‑established prognostic role for diseases of the left ventricle. Plasma GDF‑15 concentrations were shown to predict bleeding events in patients with atrial fibrillation on anticoagulation.

Objectives: To investigate the prognostic value of GDF‑15 in acute pulmonary embolism (PE).

Patients And Methods: This was a prospective observational study of 77 patients hospitalized for PE. The median length of hospital stay and follow-up was 9 days. Plasma GDF‑15 levels were measured using an automated sandwich electrochemiluminescence immunoassay. The outcome measures were: 1) in‑hospital serious adverse events (SAE; death, cardiopulmonary resuscitation, need for urgent reperfusion therapy, catecholamine administration), and 2) major bleeding or nonmajor clinically relevant bleeding.

Results: There were 12 SAE and 5 bleeding events. The median (interquartile range) GDF‑15 concentration at admission was 2354 ng/l (1151-4750 ng/l). GDF‑15 concentrations increased according to risk subgroup. Patients with serious adverse events or bleeding events had higher baseline concentrations of GDF‑15 (median [interquartile range], 3460 ng/l [2 531-12 363 ng/l] vs 2034 ng/l [1121-4449 ng/l]; P = 0.01). The area under the curve for GDF‑15, high‑sensitivity cardiac troponin T, and N‑terminal pro-brain natriuretic peptide concentrations for predicting SAE was similar, the area under the curve of GDF‑15 levels for predicting bleeding was 0.783 (95% CI, 0.62-0.946; P = 0.001) and 0.71 (95% CI, 0.567-0.853; P = 0.004) for predicting any adverse event. In the multivariable analysis, GDF‑15 greater than 1680 ng/l emerged as an independent predictor of adverse outcomes (odds ratio, 8.9; P = 0.047).

Conclusions: Plasma GDF‑15 concentrations may be a promising biomarker for predicting hemodynamic destabilization and bleeding complications in PE.
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http://dx.doi.org/10.20452/pamw.15515DOI Listing
September 2020

Refined balloon pulmonary angioplasty as the first-line therapy of complex thromboembolic lesions in patients with chronic thromboembolic pulmonary hypertension.

Pol Arch Intern Med 2020 09 4;130(9):805-806. Epub 2020 Jul 4.

Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland;

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http://dx.doi.org/10.20452/pamw.15480DOI Listing
September 2020

Defining right ventricular dysfunction by echocardiography in normotensive patients with pulmonary embolism.

Pol Arch Intern Med 2020 09 24;130(9):741-747. Epub 2020 Jun 24.

Center for Thrombosis and Hemostasis and Center for Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; Clinic of Cardiology and Pneumology, University Medical Center Goettingen, Goettingen, Germany; Department of Internal Medicine and Cardiology, Campus Virchow Klinikum, Charité – University Medicine, Berlin, Germany

Introduction: Although the prognostic value of various echocardiographic parameters of right ventricular dysfunction (RVD) was reported in normotensive patients with acute pulmonary embolism (PE), there is no generally accepted definition of RVD.

Objectives: The aim of the study was to compare echocardiographic parameters for the prediction of an adverse 30‑day outcome and create an optimal definition of RVD.                                     Patients and methods: Echocardiographic parameters including the right ventricular to left ventricular diameter ratio (RV to LV ratio) and tricuspid annular plane systolic excursion (TAPSE) to predict PE‑related mortality, hemodynamic collapse, or rescue thrombolysis within the first 30 days were directly compared in 490 normotensive patients with PE.

Results: An adverse outcome (AO) was present in 31 patients (6.3%); 8 of them (1.6%) died due to PE. Systolic blood pressure, RV to LV ratio, and TAPSE were independent predictors of AO. The receiver operator characteristic yielded an area under the curve of 0.737 (0.654-0.819; P <0.001) for the RV to LV ratio and 0.75 (0.672-0.828; P <0.001) for TAPSE with regard to an AO. The hazard ratio for AO was 2.5 for the RV to LV ratio of more than 1 (95% CI, 1.2-5.7; P <0.03) and 3.8 for TAPSE of less than 16 mm (95% CI, 1.74-8.11; P = 0.001). A combined RVD criterion (TAPSE <16 mm and RV to LV ratio >1) was present in 60 patients (12%), and showed a positive predictive value of 23.3% with a high negative predictive value of 95.6% regarding an AO (HR, 6.5; 95% CI, 3.2-13.3; P <0.001).

Conclusions: Defining RVD on echocardiography by the RV to LV ratio of more than 1 combined with TAPSE of less than 16 mm identified patients with an increased risk of 30‑day PE‑related mortality, hemodynamic collapse, or rescue thrombolysis, while patients without this sign had a very good 30‑day prognosis.
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http://dx.doi.org/10.20452/pamw.15459DOI Listing
September 2020

Guidance for anticoagulation management in venous thromboembolism during the coronavirus disease 2019 pandemic in Poland: an expert opinion of the Section on Pulmonary Circulation of the Polish Cardiac Society.

Kardiol Pol 2020 06 8;78(6):642-646. Epub 2020 Jun 8.

Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland

The coronavirus disease 2019 (COVID-19) pandemic affects anticoagulation not only in those infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) but also in most patients who require daily anticoagulant therapy and are facing substantial limitations in medical care these days. Concomitant venous thromboembolism (VTE), a potential cause of unexplained deaths, has frequently been reported in patients with COVID-19, but its management is still challenging due to the complexity between antithrombotic therapy and hematological alterations. In the era of COVID-19 pandemic, it is highly recommended for patients who require chronic anticoagulation to continue therapy to prevent thromboembolic events. To avoid regular and frequent blood tests and unnecessary exposure to SARS-CoV-2 during contacts with medical personnel, direct oral anticoagulants should be strongly preferred whenever possible. Current evidence is insufficient to recommend routine pharmacological antithrombotic prophylaxis in all hospitalized patients with COVID-19. In patients with COVID-19 who are suspected of VTE or in whom the diagnosis is confirmed, parenteral therapy with low-molecular-weight heparin should be initiated in the absence of contraindications. If heparin-induced thrombocytopenia is suspected, nonheparin anticoagulants should be used such as bivalirudin or fondaparinux. In case of confirmed acute pulmonary embolism, treatment should be guided by risk stratification as defined in the current guidelines.
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http://dx.doi.org/10.33963/KP.15425DOI Listing
June 2020

Influence of disease severity and cardiac autonomic tone on ventricular repolarization and dispersion in electrocardiographic assessment of patients with systemic lupus erythematosus.

Lupus 2020 Jul 2;29(8):913-923. Epub 2020 Jun 2.

Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland.

Background: There are no data on the influence of disease severity and cardiac autonomic tone on ventricular repolarization and dispersion in 24-hour Holter monitoring in systemic lupus erythematosus (SLE).

Methods: Consecutive 92 SLE and 51 healthy subjects were studied. The standard 12-lead electrocardiography (ECG), Holter monitoring with heart rate turbulence (HRT) and QT, Tp-e and Tp-e/QT ratio assessment (including corrected values) were performed. Subjects with conditions causing repolarization abnormalities or insufficient number of beats suitable for QT evaluation were excluded (17 SLE and 8 controls).

Results: Finally, 75 SLE and 43 sex- and age-matched controls were included to the study. In SLE patients, the median disease severity score (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SLICC/ACR-DI)) was 3.0. The mean values of QTc, cTp-e and cTp-e/QTc were significantly higher in SLE patients than in controls. QTc ≥ 460 ms was observed in 18.7% of patients using standard ECG and in 58.7% using Holter monitoring. With Holter monitoring, patients with SLICC/ACR-DI >3.0 presented longer QTc than those with SLICC/ACR-DI ≤3.0 (418±15 vs. 409 ± 16,  = 0.04), while cTp-e and cTp-e/QTc values were similar. Patients with abnormal HRT presented longer cTp-e and higher cTp-e/QTc than those with normal HRT (92 ± 52 vs. 71 ± 16 ms,  = 0.04; 0.244 ± 0.126 vs. 0.187 ± 0.035,  = 0.03), while QTc values were similar. No differences in QT and Tp-e parameters were observed according to disease duration.

Conclusion: In SLE patients, Holter monitoring revealed QTc prolongation more frequently than standard ECG. Longer QTc values were observed in patients with more advanced disease, while increased cTp-e and cTp-e/QTc were related to cardiac autonomic dysfunction expressed by abnormal HRT.
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http://dx.doi.org/10.1177/0961203320928402DOI Listing
July 2020

Acute pulmonary embolism and right atrial thrombus as a complication of the central venous access port device for the delivery of chemotherapy.

Kardiol Pol 2020 08 2;78(7-8):778-779. Epub 2020 Jun 2.

Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland

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http://dx.doi.org/10.33963/KP.15404DOI Listing
August 2020

Management of valvular and structural heart diseases during the coronavirus disease 2019 pandemic: an expert opinion of the Working Group on Valvular Heart Diseases, the Working Group on Cardiac Surgery, and the Association of Cardiovascular Interventions of the Polish Cardiac Society.

Kardiol Pol 2020 05 15;78(5):498-507. Epub 2020 May 15.

1st Department of Cardiology, Biegański Hospital, Medical University of Lodz, Łódź, Poland

The ongoing pandemic of coronavirus disease 2019 (COVID‑19), caused by severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2), represents a major challenge for healthcare. The involvement of cardiovascular system in COVID‑19 has been proven and increased healthcare system resources are redirected towards handling infected patients, which induces major changes in access to services and prioritization in the management of patients with chronic cardiovascular disease unrelated to COVID‑19. In this expert opinion, conceived by the task force involving the Working Groups on Valvular Heart Diseases and Cardiac Surgery as well as the Association of Cardiovascular Intervention of the Polish Cardiac Society, modification of diagnostic pathways, principles of healthcare personnel protection, and treatment guidelines regarding triage and prioritization are suggested. Heart Teams responsible for the treatment of valvular heart disease should continue their work using telemedicine and digital technology. Diagnostic tests must be simplified or deferred to minimize the number of potentially dangerous aerosol‑generating procedures, such as transesophageal echocardiography or exercise imaging. The treatment of aortic stenosis and mitral regurgitation has to be offered particularly due to urgent indications and in patients with advanced disease and poor prognosis. Expert risk stratification is essential for triage and setting the priority lists. In each case, an appropriate level of personal protection must be ensured for the healthcare personnel to prevent spreading infection and preserve specialized manpower, who will supply the continuing need for handling serious chronic cardiovascular disease. Importantly, as soon as the local epidemic situation improves, efforts must be made to restore standard opportunities for elective treatment of valvular heart disease and occluder‑based therapies according to existing guidelines, thus rebuilding the state ‑of ‑the ‑art cardiovascular services.
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http://dx.doi.org/10.33963/KP.15358DOI Listing
May 2020

Prognostic value of respiratory index in haemodynamically stable patients with acute pulmonary embolism: The Respiratory Index model study.

Eur Heart J Acute Cardiovasc Care 2020 Jun 13;9(4):286-292. Epub 2020 Mar 13.

Internal Vascular and Emergency Medicine - Stroke Unit, University of Perugia, Italy.

Background: Current strategies for prognostic stratification in haemodynamically stable patients with acute pulmonary embolism require improvement. The aims of this study in haemodynamically stable patients with acute pulmonary embolism were (a) to evaluate the prognostic value of a novel respiratory index (oxygen saturation in air to respiratory rate ratio) and (b) to derive a risk model which includes the respiratory index and evaluate its value in predicting 30-day mortality.

Methods: Prospective cohorts of haemodynamically stable patients with acute pulmonary embolism were merged to a collaborative database that served to create two subsequent derivation and validation cohorts based on a temporal criterion. The study outcome was 30-day all-cause death.

Results: Thirty-day all-cause death occurred in 7.5% and in 6.9% of patients in the derivation and validation cohorts (each composed of 319 patients). In the derivation cohort, the respiratory index (odds ratio 0.66, 95% confidence interval 0.48-0.90) and simplified Pulmonary Embolism Severity Index (odds ratio 9.16, 95% confidence interval 1.22-68.89) were predictors of 30-day mortality. The cut-off value of the respiratory index ⩽3.8 was identified to best predict 30-day all-cause death (15.4% vs 5.0%, odds ratio 2.94, 95% confidence interval 1.22-7.11). The respiratory index ⩽3.8 was combined with the simplified Pulmonary Embolism Severity Index to create the Respiratory Index model that showed a good discriminatory power in the derivation (c-statistic 0.703, 95% confidence interval 0.60-0.80) and in the validation cohort (c-statistic 0.838, 95% confidence interval 0.768-0.907).

Conclusion: In hemodynamically stable patients with acute pulmonary embolism, the respiratory index was an independent predictor of 30-day all-cause death. The Respiratory Index model which includes the simplified Pulmonary Embolism Severity Index and the respiratory index, provides a good risk stratification of haemodynamically stable patients with acute pulmonary embolism.
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http://dx.doi.org/10.1177/2048872620913849DOI Listing
June 2020

A valvular or atrial tumor? Echocardiography and successful treatment in a patient with an abnormal cardiac mass.

Kardiol Pol 2020 05 21;78(5):463-464. Epub 2020 Feb 21.

Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland

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http://dx.doi.org/10.33963/KP.15209DOI Listing
May 2020
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