Cardiology journal最新文献

Background: There has been increasing interest in drug-coated balloons (DCB) within the scientific and medical community in recent years. The aim of this study was to investigate the temporal trends of DCB utilization stratified by the type of target lesion, based on a large prospective national registry.

Methods: The data for conducting the current analysis were obtained from the National Registry of Percutaneous Coronary Interventions (ORPKI, Ogólnopolski Rejestr Procedur Kardiologii Inwazyjnej), maintained in cooperation with the Association of Cardiovascular Interventions (AISN, Asocjacja Interwencji Sercowo-Naczyniowych) of the Polish Cardiac Society. The study covered data collected between January 2014 and December 2022. During this period, there were 170 active catheterization laboratories in which 899,635 percutaneous coronary intervention (PCI) procedures were performed. Among them, 5827 (0.65%) patients were treated with DCB and drug-eluting stents, 11,649 (1.29%) were treated with DCB only, and 882,159 (98.06%) were treated without DCB.

Results: The frequency of DCB use during PCI increased across all main angiographic indications as follows: from 0.54% in 2014 to 1.02% in 2022 (p < 0.001) for de novo lesions, from 15.31% in 2014 to 33.95% in 2022 (p < 0.001) for in-stent restenosis, and from 2.41% in 2014 to 5.29% in 2022 (p < 0.001) for in-stent thrombosis. Similarly, there was a statistically significant increase in the frequency of DCB use among the following selected clinical presentations: acute heart failure (p = 0.037), cardiac arrest (p = 0.015), non-ST segment elevation myocardial infarction (p < 0.001), chronic coronary syndromes (p < 0.001), and unstable angina (p < 0.001).

Conclusions: The frequency of DCB use has been constantly increasing in recent years, regardless of angiographic indications and across different clinical scenarios.

Background: Both cancer itself and cancer treatment (i.e., chemotherapy [CT] and radiotherapy [RT]) are associated with an increased risk of cardiovascular disease. The influence of cancer treatment on the coronary plaque profile was examined as assessed by integrated-backscatter intravascular ultrasound (IB-IVUS).

Methods: The patients analyzed were those who had undergone surgery, CT, or RT for cancer prior to undergoing percutaneous coronary intervention (PCI) using IVUS between 2010 and 2020. Grayscale and IB-IVUS analyses were performed for the culprit lesion of a coronary artery just before PCI. To determine the association of cancer treatment with outcomes (% plaque volume index [PVI] and % lipid plaque volume [LV]), we used regression models while adjusting for covariates.

Results: A total of 162 chronic coronary syndrome patients who underwent PCI using IVUS were included: 89 received either or both CT and RT ± surgery (CT/RT group), and 73 received surgery alone (surgery group). Compared to the surgery group, the CT/RT group had a high cancer stage, low creatinine and high % LV. By a univariate regression, % PVI was associated with cancer stage (β = -0.16, p = 0.02), RT (β = 0.4, p = 0.02) and HbA1c (β = 0.15, p = 0.01), and % LV was associated with CT/RT (β = 6.93, p = 0.01) and HbA1c (β = 3.65, p = 0.01). After adjustment for covariates, CT/RT was significantly associated with % LV (β = 6.77, p = 0.02), but not with % PVI (β = 0.25, p = 0.15).

Conclusions: Chemotherapy and RT were associated with the coronary plaque profile, but not with the coronary plaque volume. CT and RT may influence coronary plaque vulnerability in patients with chronic coronary syndrome.

Background: It was sought to compare the effectiveness of two methods 7-day ECG Holter or 14-day event-Holter monitoring in detection of arrythmias and ischemia in a heart failure (HF) population far from academic centers treated by a primary care physician under cardiologist supervision.

Methods: In the prospective, non-randomized, 3-month pilot program carried out between June and December 2023 recruited were 429 HF patients from villages and small cities in 14 primary care units, far from academic centers. Of them, 124 (28.9%) patients were additionally monitored by either 7-day ECG Holter (7H-group) or 14-day event Holter (14eH-group). The cumulative percentage of patients with non-sustained ventricular tachycardia, new atrial fibrillation or ischemic changes was a primary composite endpoint.

Results: Of 126 patients, 54 (43.5%) were monitored by 7-day ECG Holter while 70 (56.5%) by 14-day event Holter. At baseline, there were no significant differences between 7H- vs. 14eH-group in terms of demographics and cardiovascular risk factors. A history of PCI was more frequent in 7H- vs. 14eH-group (33 vs. 15%, p = 0.039). The cumulative percentage of the primary composite endpoint was significantly higher in 7H- vs. 14eH-group (24 vs. 2.9%, p < 0.001) and was driven by silent ischemia. The number of therapeutic interventions, including introduction of an oral anticoagulant or coronary angioplasty was numerically higher in 7H- vs. 14eH-group (11.1 vs. 4.3%, p = 0.27).

Conclusions: In this pilot study, 7-day ECG Holter was more effective in detection of non-sustained ventricular tachycardia, new atrial fibrillation or ischemic changes than 14-day event-Holter in HF patients in social exclusion regions.

The 2023 ESH Guidelines recommend renal denervation (RDN) for patients with uncontrolled blood pressure (BP) and preserved kidney function despite optimal antihypertensive therapy, or intolerance to such therapy. Early trials (Symplicity HTN-1 and HTN-2) showed substantial BP reductions without serious complications, indicating a promising safety profile. However, subsequent trials revealed inconsistent results regarding BP reductions, highlighting the need for further investigation into RDN efficacy and patient selection criteria. RDN works by ablating sympathetic nerves in the renal artery adventitia, leading to thrombus formation, endothelial edema, vasospasm, and dissections. Intravascular imaging techniques like optical coherence tomography have advanced the understanding of these lesions. The previous discrepancies in clinical studies on RDN may stem not only from differences in procedural techniques, patient selection and study designs, but also by lack of standardized procedural outcomes, identified by intravascular imaging. The routine use of optical coherence tomography during RDN is still under debate and currently there is no clear correlation between focal vascular lesions and long-term BP reduction. However, recent data suggest that the use of intravascular imaging might potentially improve procedural outcomes by identifying the (desired) vascular changes directly after RDN. Here, the pathophysiology and imaging methods of RDN-induced vascular lesions are summarized, the association between vascular lesions and clinical effects of RDN, as well as current guidelines for peri- and postoperative pharmacotherapy after RDN.

Background: Heart failure (HF) is a leading cause of hospitalization and mortality, regardless of left ventricular ejection fraction (LVEF). The prevalence of HF with preserved and mildly reduced ejection fraction (HFpEF and HFmrEF) is rising, along with increasing hospitalizations. Patients with HF exhibit varied clinical presentations and therapeutic needs, which depend on HF status rather than solely on LVEF. The study aimed to compare the general characteristics, clinical presentation, and diagnostic features of ambulatory and hospitalized (HOSPs) patients enrolled in the HF-POL study.

Methods: HF-POL was a multicenter observational study in 14 Polish clinical centers, enrolling adult patients with HF and LVEF > 40%, either hospitalized for HF decompensation or under ambulatory care. Data collected included demographics, comorbidities, medications, physical exams, echocardiography, and additional diagnostics.

Results: Among the 1497 patients, 52.5% were men, with a mean age of 75 years and an LVEF of 50%. HOSPs (63.4%) were older, more likely to be women, and more frequently had a new HF diagnosis compared to ambulatory (36.6%). HOSPs had fewer previous HF hospitalizations and lower rates of coronary artery disease and prior myocardial infarction. However, they had higher rates of chronic obstructive pulmonary disease, cancer, and depression. HOSPs were more often treated with beta blockers, mineralocorticoid receptor antagonists, calcium blockers, nitrates, amiodarone, and digoxin, but less often with sodium glucose cotransporter 2 inhibitors.

Conclusions: The HF-POL registry highlighted important differences between hospitalized and ambulatory HF patients, underscoring the need for individualized management, particularly during transitions from hospital to ambulatory care.

Background: Lipoprotein(a) [Lp(a)] is a highly atherogenic particle that significantly increases overall cardiovascular risk. Evidence regarding concentrations of Lp(a) in the Polish general population remains limited, as well as the association between Lp(a) and various clinical characteristics. The aim in this study was to analyze Lp(a) concentration in a Polish population hospitalized in a tertiary referral hospital, compare clinical characteristics between patients with low and high Lp(a) and find the predictors of increased Lp(a) concentrations.

Methods: This was an observational, cross-sectional study. All patients hospitalized in the Clinical Department of Internal Medicine, Endocrinology, Diabetology, and Nephrology in the Czerniakowski Hospital between 01.03.2024 and 08.10.2024 and with measured Lp(a) concentration were consecutively included. Patients were divided into two groups: those with high Lp(a) (³ 30 mg/dL) and those with low Lp(a) (< 30 mg/dL). The groups were compared in terms of multiple clinical characteristics. Multiple logistic regression was used to determine independent predictors of high Lp(a). The p-value below 0.05 was considered statistically significant.

Results: Out of 562 patients, 117 had high Lp(a) concentration (20.8%). The groups did not differ in terms of age, sex, or clinical examination findings. In a multiple logistic regression, male sex was associated with a decreased odds ratio of high Lp(a) (OR 0.2857, 95% CI 0.1107 to 0.6468, p = 0.01).

Conclusions: High Lp(a) is prevalent in the Polish population, and thus it is important to measure it routinely in each individual at least once in a lifetime and control all other known cardiovascular risk factors to decrease the overall risk.

Background: The potential of optical coherence tomography (OCT) is limited by incomplete validation with histopathology. The study aimed to assess whether OCT can identify a completely healed coronary stent.

Material and methods: The study included 40 swine and total of 106 stents (82 DES, 24 BMS). Follow-up OCT and histopathology examination was done after 28 days (n = 53) and 90-days (n = 53). 273 frames were matched between histopathology and OCT. Histopathologic criteria for completed healing: high endothelialization score (2-3), low inflammation score (0-1), low fibrin score (0-1), high neointimal smooth muscle score (2-3) and lack of binary restenosis.

Results: Predictors of a well healed stent were presence of homogenous neointima (OR: 2.53) and the total number of struts per section (OR: 1.11). The presence of microvessels (OR: 0.28) and increasing neointimal area (OR: 0.65) predicted incomplete healing. Cutoff values were identified: inflammation score was the highest in segments with neointima thickness over 0.35 mm. Persistent fibrin deposits were found at 28-day follow-up in DES with less than 13 embedded struts per section and neointima area less than 2.234 mm². The number of embedded struts per section showed a positive correlation with the healing score, while both protruding covered and protruding uncovered struts showed a negative correlation.

Conclusions: OCT demonstrated moderate ability to predict completed stent healing.

Background: As a result of increased life expectancy, the number of octa- and nonagenarians presenting with myocardial infarction is on the rise. These patients are often underrepresented in clinical trials. The aim of this study was to compare the presentation and outcomes of ST-elevation (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) in patients older than 80 years.

Methods: This retrospective study included 14758 patients above 80 years of age hospitalized with STEMI or NSTEMI who were selected from the Polish Registry of Acute Coronary Syndromes using propensity score matching (two equal size groups).

Results: Patients with STEMI were more likely to undergo coronary angiography (87.80% vs. 77,03%) and revascularization (80.50% vs. 54.26%); in STEMI the culprit lesion was more likely to be located in left anterior descending artery (LAD) (31.76% vs. 44.43%) or right coronary artery (RCA) (18.41% vs. 35.29%), and NSTEMI more likely to be located in left main (4.59% vs. 1.76%) or other native artery (23.3% vs. 6.02%). Elderly patients with STEMI had higher all-cause mortality at 30-days (19.62% vs. 14.51%) and 1-year (32.00% vs. 29.54%). The difference was highly influenced by initial in-hospital mortality (17.96% vs. 12.48%). Among hospital survivors there was no difference in 30-days mortality and 1-year mortality was higher for NSTEMI hospital survivors (17.06% vs. 14.04%).

Conclusions: In patients older than 80 years of age with similar baseline characteristics, STEMI and NSTEMI had different presentation, outcomes and required different treatment strategy. ST-elevation patients had higher in-hospital mortality and NSTEMI patients had higher post-hospital mortality after 1 year.