Cardiology journal最新文献

Background: Myocarditis poses a great diagnostic challenge to clinicians, as the most sensitive diagnostic tools are not easily accessible in many hospitals. Clinical suspicion of myocarditis is based on clinical symptoms and additional tests' abnormalities. The diagnosis should be confirmed by endomyocardial biopsy (EMB) - the gold standard for the diagnosis of myocarditis. The study aimed to assess trends in the use of diagnostic procedures performed in all patients hospitalized with suspected myocarditis in Poland between 2011-2019.

Methods: The nationwide MYO-PL database was derived from the database of the national healthcare insurer and created to identify hospitalization records with a primary diagnosis of myocarditis. We evaluated the use of recommended diagnostic procedures in this group of 19 978 patients within 6 months of the diagnosis of myocarditis.

Results: Echocardiography was the most frequently used imaging technique among patients, and the number of patients who underwent this procedure between 2011-2019 rose every year (71.3-86.1%). Use of nuclear medicine procedures remained < 1% regardless of the year. Biomarkers measurements during primary hospitalization were performed in 13.8% (brain natriuretic peptides) and 41.3% (troponins) of patients. Interestingly, EMB was performed in less than 1% of patients. The most sensitive noninvasive test (cardiac magnetic resonance) was performed in 16.4% of patients (7.2-29.2% within 10 years). Most diagnostic tests were less frequently performed in females.

Conclusions: The results highlight that the management of patients with myocarditis could be significantly improved if state-of-the-art diagnostic methods were followed according to guidelines.

Background: Aortic stenosis (AS) is the most common valvular pathology in Europe and North America, with its prevalence rising due to age-related degeneration and calcification of the aortic valve. The global number of transcatheter aortic valve replacement (TAVR) procedures is rapidly increasing. Nevertheless, the ischemic cerebrovascular events remain among the most significant complications of this procedure. This study aimed to assess the long-term incidence of neurological events and identify the most powerful predictors of stroke following TAVR in a high-volume cardiovascular care center.

Methods: 705 patients who underwent TAVR between January 2016 and September 2022, with a median follow-up of 60 months were analyzed. Baseline patient characteristics, procedural data, and long-term neurological outcomes were evaluated.

Results: At five years the cumulative incidence of any neurological events, strokes and disabling strokes reached 28.5%, 20.3% and 13.2%, respectively. Periprocedural strokes occurred in 1.4% of patients. The multivariable analysis performed was aimed at identifying the relationship between a range of clinical and procedural variables and the incidence of stroke within five years following TAVR.

Conclusions: The findings highlight the importance of long-term neurological follow-up after TAVR, as stroke mechanisms evolve over time - from periprocedural embolization to thrombus formation or chronic conditions like frailty and atherosclerosis. Future research should focus on more targeted stroke prevention and long-term management strategies enhancing safety for the TAVR recipient population.

Sinus rhythm (SR) maintenance strategies after electrical or pharmacological cardioversion in patients with atrial fibrillation (AF) may be only temporarily effective, leading to AF recurrence. Identifying predictors of AF recurrence after effective electrical cardioversion (ECV) may help personalize treatment, for instance, by affecting modifiable factors of unsuccessful long-term rhythm control. Disseminating information on this topic may benefit individual patients, lower the risk of subsequent procedures and the associated complications, and decrease health care costs. The purpose of this paper was to present the current state of knowledge on the predictors of failed ECV, with a particular focus on the most recent relevant research.

Background: Iron deficiency (ID) impacts prognosis and quality of life for heart failure (HF) patients. It is essential to actively search for ID in this group and establish its relationship with nutritional status. The aim was to determine the relationship between nutritional status according to the Mini Nutritional Assessment (MNA) questionnaire and the presence of ID in heart failure patients with reduced ejection fraction (HFrEF).

Methods: The study sample comprized 272 HFrEF patients. Collected on admission were: medical history, echocardiographic and biochemical parameters. Iron deficiency was diagnosed if ferritin was < 100 ng/mL or < 300 ng/mL with transferrin saturation (TSAT) < 20%. Nutritional status was assessed using the MNA form and body mass index (BMI).

Results: The cohort was 81.6% male and 18.4% female. The median age was 59 (IQR 50-64) years, and the mean BMI was 28.8 ± 5.3 kg/m². 54.4% of patients showed New York Heart Association (NYHA) class III or IV HF symptoms. Iron deficiency was detected in 55.5% of patients. Participants at risk of malnutrition constituted 45.2%, while 1.8% were malnourished. In the ID group 45% were at risk of malnutrition and 2.6% were malnourished, compared with 45.4% (p = 1.00) and 0.8% (p = 0.39) in the no-ID group. Female sex and atrial fibrillation(AF) were associated with ID.

Conclusions: Nutritional status assessed by the MNA questionnaire is not related to the presence of ID in HFrEF. Female sex and AF are risk factors for ID in this group.

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.

Background: The global mortality rates due to cardiovascular diseases (CVD) are still alarmingly high, highlighting the need for accurate assessment of the risk of severe cardiovascular (CV) events. To address this, the Pol-SCORE and SCORE2 scales have been developed.

Methods: We conducted an observational and retrospective analysis of 450 patients with LDL ≥ 100 mg/dL admitted to the Clinical Hospital of the Medical University of Warsaw between 2019 and 2020. The objective of our study was to assess the treatment in patients with high levels of LDL cholesterol, without pre-existing CVD, by estimating their CV risk using the Pol-SCORE and SCORE2 scales.

Result: We enrolled a total of 150 patients in the study: 86 women (57.3%) and 64 men (42.7%), with an average age of 55.1 years. The high-risk category in the SCORE2 scale included patients with low, moderate, high, and very high risk estimated in the Pol-SCORE scale. It was statistically significant (p < 0.0001) in the distribution of risk assessment results between groups of CV risk.

Conclusions: According to research, the Pol-SCORE scale has been found to potentially underestimate the likelihood of CV events occurring when compared to the SCORE2 scale, which has a more cautious and restrictive approach. Patients with high and very high risk of fatal and non-fatal CVD are not receiving appropriate treatment. To identify and implement proper recommendations and treatments for patients with elevated risk, the SCORE2 scale should be utilized to estimate CV risk events.

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.