Kardiologia polska最新文献

The 2025 European Society of Cardiology (ESC)/European Society of Cardiothoracic Surgery guidelines for the management of valvular heart disease (VHD), presented at the ESC Congress in Madrid, update the 2021 document and respond to the rapid growth of evidence from randomized trials, meta-analyses, and large registries. Developed by a multidisciplinary Heart Team including patient representatives, the guidelines emphasize patient-centered "lifetime" management, shared decision-making, and treatment at high-volume expert Heart Valve Centers, especially for complex surgical and transcatheter procedures. The scope has been broadened to address cancer and radiation-associated VHD, cardiogenic shock and acute heart failure, multiple and mixed VHD, and sex-specific issues. Key changes in indications for imaging, treatment, and follow-up of VHD are discussed in the perspective of evidence-based medicine. Key updates include earlier intervention in severe, high-gradient, asymptomatic aortic stenosis, refined age thresholds favoring transfemoral transcatheter aortic valve implantation, and its use in bicuspid aortic stenosis and aortic regurgitation in high-risk or inoperable patients. Recommendations for secondary mitral regurgitation (MR) distinguish atrial from ventricular mechanisms and upgrade mitral transcatheter edge-to-edge repair to class I in selected cases of ventricular secondary MR. At the same time, surgery remains first-line for primary MR, with defined triggers for early repair and emerging roles for transcatheter edge-to-edge repair and transcatheter mitral valve implantation in high-risk patients. The document also strengthens guidance on tricuspid interventions, structured assessment of right ventricular dysfunction, and simplifies antithrombotic strategies, including restricted use of dual antiplatelet therapy after transcatheter aortic valve implantation in patients without another indication for oral anticoagulation. Implementing these recommendations should streamline care pathways and reduce the burden of VHD.

Background: There is a close association between atrial fibrillation (AF), heart failure (HF) and health-related quality of life (HRQoL).

Aims: We performed a comparative assessment of the HRQoL in patients with HF with preserved ejection fraction (HFpEF), HF with mildly reduced ejection fraction (HFmrEF), and HF with reduced ejection fraction (HFrEF), with and without AF, and their impact on prognosis.

Methods: Hospitalized patients and outpatients with HF were enrolled in the H: E: art failuRe O: bs E: rvational S: tudy (HEROES) from April 2, 2022 to March 27, 2024. The Kansas City Cardiomyopathy Questionnaire-12 Summary Score (KCCQ-12 SS) was used to assess HRQoL. Follow-up, concluded on May 21, 2024, included all-cause mortality.

Results: The total study group consisted of 1199 patients. Patients without AF had a higher median KCCQ-12-SS, 56.3 (34.4-78.1) compared with those with AF, 42.2 (24.0-64.3), P <0.001. Among AF patients with HFpEF (n = 317; 26.4%), HFmrEF (n = 262; 21.9%), and HFrEF (n = 620; 51.7%), the adjusted hazard ratios for all-cause mortality (n = 180; 15%) for each 10-unit KCCQ-12-SS decrement were 1.22 (95% confidence interval [CI], 1.00-1.35; P = 0.07), 1.11 (95% CI, 0.91-1.35; P = 0.30), 1.00 (95% CI, 0.82-1.11; P = 1.00), respectively. Among patients without AF with HFpEF, HFmrEF, HFrEF, the corresponding adjusted hazard ratios were 1.63 (95% CI, 1.10-2.48; P = 0.005), 1.00 (95% CI, 0.83-1.22; P = 1.0), 1.11 (95% CI, 1.00-1.22; P = 0.04), respectively.

Conclusions: HRQoL was higher in patients with AF and HF compared to those without AF. A lower HRQoL score is an independent predictor of all-cause mortality in HF patients, particularly in those without AF (HFpEF and HFrEF subgroups), although associations varied by HF subtype and AF status.