Kardiologia polska最新文献

Mitral valve prolapse (MVP) is the most common cause of primary (degenerative) mitral regurgitation and represents a heterogeneous disease spectrum with generally benign prognosis but potentially serious complications. Advances in imaging have refined diagnostic criteria, reducing historical overdiagnosis and clarifying the morphologic continuum from fibroelastic deficiency to extensive myxomatous degeneration (Barlow's disease). Beyond mitral regurgitation and infective endocarditis, a small but clinically important subset of patients is at increased risk of malignant ventricular arrhythmias and sudden cardiac death, giving rise to the concept of arrhythmogenic MVP. This phenotype is characterized by a combination of clinical, anatomical, myocardial, and electrical features rather than a single abnormality. Key associated findings include bileaflet prolapse, female sex, electrocardiographic repolarization changes, frequent or complex ventricular ectopy, myocardial fibrosis detectable by cardiac magnetic resonance, abnormal tissue Doppler signals, and mitral annular disjunction (MAD). MAD, including both true MAD and the more common pseudo-MAD, contributes to excessive mobility of the mitral valve apparatus, abnormal systolic annular motion ("curling"), and repetitive mechanical stress on the papillary muscles and inferobasal left ventricular myocardium, promoting fibrosis and arrhythmogenesis. Importantly, arrhythmic risk may persist even after surgical correction of mitral regurgitation, likely due to established myocardial substrate. Contemporary registry data confirm the heterogeneity of MVP and suggest that true primary arrhythmogenic MVP is relatively uncommon but identifiable using detailed echocardiographic and electrocardiographic assessment. Overall, arrhythmogenic MVP should be viewed as a syndrome spanning a spectrum from benign to malignant, underscoring the need for integrated risk stratification and targeted follow-up. This review summarizes the recent progress in understanding of this complex entity summarizing recent expert recommendations and novel registry data.

Background: High body mass index and abdominal obesity are associated with an increased risk of cardiometabolic diseases.

Aims: We aimed to investigate the prevalence of obesity in 45 591 individuals included in the LIPIDOGRAM cohort studies conducted in 2004, 2006, and 2015 and to examine the relationship between obesity and cardiometabolic risk factors such as diabetes, hypertension, and dyslipidemia.

Methods: To analyze the changes in the prevalence of central obesity, diabetes, hypertension, and dyslipidemia, age standardization was carried out according to the general population for the years 2004, 2006, and 2015.

Results: We observed a significant (P <0.001 in all groups) increase in the prevalence of abdominal obesity (39% of patients in 2004 to 51% in 2015), age-standardized obesity (26.8% in 2004 to 30.8% in 2015), and central obesity (30.1% in 2004 to 42.2% in 2015). Between 2004 and 2015, there was observed a significant increase in the age-standardized prevalence of diabetes (7.8% in 2004 to 9.8% in 2015) and an increase in the age-standardized prevalence of dyslipidemia (74.4% in 2004 to 76.4% in 2015). For hypertension, a decrease in age-standardized prevalence was observed (38.1% in 2004 to 37.8% in 2015).

Conclusions: An increase in body mass index and visceral obesity was observed among Polish primary health care patients included in the LIPIDOGRAM study from 2004 to 2015. As patients age, the number of cases of diabetes and dyslipidemia increases. These changes cause an increase in cardiometabolic risk.

The widespread adoption of leadless pacemakers has introduced new clinical and technical challenges related to device management at end of service and in the setting of device-related complications. While transvenous lead extraction is an established treatment strategy for conventional pacing systems, there is currently no standardized framework for transvenous leadless pacemaker extraction (TLLE). With increasing numbers of leadless pacemakers approaching end of service and expanding indications for leadless pacing, a structured approach to TLLE has become clinically relevant. This review proposes a systematic concept of TLLE, including definitions, clinical indications, procedural strategies, risk assessment, and institutional requirements. Indications for TLLE including device end-of-life, dislocation, interactions, infection, or the need for upgrade to a different device were summarized. Procedural strategies, primarily based on the extraction most frequently from the femoral approach, with the use of snare-based techniques, with the choice of other tools and access tailored to device type, dwell time, fixation mechanism, and degree of encapsulation, have been summarized. Literature findings reporting high success rates were presented, with potential complications, such as cardiac perforation, tamponade, tricuspid valve injury, embolization, and vascular access complications, being summarized as well. Patient selection, pre-procedural imaging have also been evaluated, and factors influencing decision-making, including balance of periprocedural risk against long-term implications of device abandonment have been presented.

Artificial intelligence (AI) can detect subtle patterns in data and therefore has the potential to improve patient care. This promise has inspired the development of numerous AI algorithms intended for use in cardiovascular medicine. The rapid evolution of AI technology has made it difficult for clinicians to critically evaluate AI-based clinical decision support tools. This review provides an overview of modern AI models and how they compare with traditional machine learning approaches. Also discussed are metrics for evaluating AI model performance and kay AI limitations, notably bias, generalizability, and lack of explainability.