Kardiologia polska最新文献

Background: Advanced heart failure (HF) is characterized by progressive cardiac remodeling and recurrent episodes of decompensation, highlighting the need for biomarkers reflecting disease severity. Coagulation factor XI (FXI), beyond its established role in hemostasis, may influence inflammatory and remodeling pathways in the heart, but its relevance in advanced HF remains unclear.

Aims: This study evaluated the association between FXI activity and clinical, laboratory, and echocardiographic parameters in patients with advanced HF.

Methods: We prospectively enrolled 91 patients with advanced HF (New York Heart Association class III-IV) from a tertiary HF day-care service between November 2024 and February 2025. FXI activity was measured using a PTT-based assay, and patients were stratified by the median FXI level ( < 89% vs. ≥89%).

Results: Patients with lower FXI activity required higher intravenous diuretic doses (120 vs. 60 mg/week; P = 0.02), had more frequent HF clinic visits (2 vs. 1 per week; P = 0.01), and exhibited higher N-terminal pro-B-type natriuretic peptide levels (3350 vs. 2000 pg/ml; P = 0.01). Prolonged PT-international normalized ratio ( > 1.5) was more prevalent in the low-FXI group (24% vs. 2%; P = 0.006). Echocardiographic findings included larger LV end-diastolic diameter (5.5 vs. 5.03 cm; P = 0.01), greater left atrial area (29 vs. 25 cm²; P = 0.007), higher prevalence of pulmonary hypertension (41% vs. 20%; P = 0.04), and more frequent moderate-to-severe mitral regurgitation (34% vs. 13%; P = 0.02).

Conclusions: Reduced FXI activity is associated with adverse clinical and echocardiographic profiles in advanced HF. These findings support a potential biomarker or cardioprotective role for FXI and call for caution in applying FXI-targeted therapies in this population.

Background: Heart failure affects over 1.2 million Polish citizens. Although the current implantation rate of 3.3 left ventricular assist devices (LVADs) per million population remains below the European average, if the upward trend is maintained, Poland may soon reach the level of mid-range European countries (4-6 LVADs per million).

Aims: The national registry aimed to provide systematic oversight of the Polish LVAD population along with treatment outcomes.

Methods: A prospective multicenter observational registry of all consecutive LVAD patients undergoing LVAD implantation between January 1, 2022 and December 31, 2024. Data were compared to the Society of Thoracic Surgeons (STS) registry.

Results: From January 2022 to December 2024, 266 adult patients received LVAD in Poland. There has been approximately 40% year-to-year increase in LVAD utilization. The cohort consisted predominantly of men (96.1%) with a median age of 57.76 (49.80-64.53) years. In contrast, in the STS-Intermacs registry women represented 21.9%. Ischemic cardiomyopathy was markedly more common (60.8%) in POL-LVAD registry on contrary to non-ischemic on STS registry (54.2%). Polish recipients presented with a significantly lower clinical acuity, with Intermacs profiles 1-3 accounting only for 55%-68% of implants, compared with nearly 90% in the STS cohort. Moreover, unlike the STS registry - where destination therapy accounted for over 80% of implants-the Polish cohort was dominated with a bridge-to-transplantation strategy (72%). During median follow-up of 471 days (interquartile range 283-729) 69 patients died, and 26 underwent heart transplantation, which translates into an actual probability of survival of 81%, 71% and 64% at 1, 2 and 3 years, respectively, and is comparable to STS-Intermacs registry. Age was the main survival discriminator in the Polish cohort.

Conclusions: This is the first report of the Polish National Mechanical Circulatory Support Registry. The POL-LVAD registry shows a dynamic growth of LVAD therapy in Poland, with survival outcomes comparable to the STS registry.

Background: Patent foramen ovale (PFO) is the most common inherited cardiac abnormality, with intermittent right-to-left (R-L) shunt of variable size.

Aims: To study the quantification of R-L shunt (shunt) in PFO patients using an original thermodilution method in relationship to the morphology of the interatrial septum, measured by echocardiography and cardiopulmonary exercise tests before and after the occlusion of a PFO.

Results: A multicenter study enrolled a population of 151 patients, eligible for PFO closure in secondary prevention, underwent transthoracic echocardiography and contrast transesophageal echocardiography, cardiopulmonary exercise tests before and 6 months after the closure. The size of the shunt was measured by catheterization using the thermodilution Inntherm® system. Shunt was detected in 133 (90%) patients. Size of shunt >20% was present in 41 (28%) patients, 10%-20% in 33 (22%), and <10% in 49 (40%) patients. Shunt size >10% was associated with greater atrial septal separation during the Valsalva (P = 0.03) and respiration (P = 0.04), amplitude of septal displacement (P = 0.009), amount of contrast media in the left atrium (LA) (P = 0.03) and hypermobility of septum (P = 0.03). After PFO closure, work capacity increased in patients with shunt ≥20% (Δ +6.8; standard deviation [SD] 16.9 [W]) compared with those with <10% (Δ -2.1; SD 24.5 [W]; P = 0.02). Migraine occurrence decreased in 8 patients (62%) (P = 0.008). A decrease in saturation on exercise occurred in 12 cases (9%), after the PFO closure saturation normalized from 90.5% to 95.0% (P = 0.009), with no effect on exercise.

Conclusions: We proved safe use of thermodilution for R-L shunt measurement. The main cause of inducible shunt severity is atrial septal mobility. A severe PFO shunt impacts work capacity.

Background: Transesophageal echocardiography (TEE) is the standard method for excluding left atrial appendage (LAA) thrombus before atrial fibrillation (AF) ablation. Intracardiac echocardiography (ICE), used during ablation, allows LAA assessment at the procedure's beginning. Preliminary data suggest ICE may provide thrombus visualization, but evidence remains limited.

Aims: To compare ICE and TEE for LAA thrombus detection and procedural outcomes in AF ablation.

Methods: This retrospective cohort study included 610 adults undergoing catheter ablation for AF or atrial flutter between 2017 and 2024. Patients treated in 2017-2020 underwent preprocedural TEE (n = 289), while those in 2020-2024 underwent ICE (n = 321) for LAA assessment during the ablation. All patients received uninterrupted anticoagulation, predominantly direct oral anticoagulants (86.5% vs. 92.2%; P = 0.02). The primary outcome was LAA thrombus detection. Secondary outcomes included procedure duration, in-hospital complications, hospitalization length, acute procedural success and AF recurrence at 3 and 12 months.

Results: Baseline characteristics were comparable, although patients in the ICE group had higher HAS-BLED scores and longer AF duration. Radiofrequency ablation was more frequent in the ICE group, while cryoballoon ablation predominated in the TEE group (P <0.001). LAA thrombus was detected in 1% of TEE patients and in none of the ICE patients (P = 0.11). Complication rates were low and similar between groups. Hospital stay was shorter in the ICE group, whereas procedural success, procedure time, and AF recurrence did not differ.

Conclusions: ICE may allow for LAA thrombus detection comparable to TEE with similar safety outcomes.