Mitral valve regurgitation is the second most common valve defect in Europe among adults. Primary mitral regurgitation (MR) results from structural abnormalities of the valve apparatus (e.g., leaflet prolapse, chordae ru...Mitral valve regurgitation is the second most common valve defect in Europe among adults. Primary mitral regurgitation (MR) results from structural abnormalities of the valve apparatus (e.g., leaflet prolapse, chordae rupture), often due to myxomatous degeneration or congenital defects. Secondary MR arises from left ventricular remodeling (e.g., after myocardial infarction or heart failure), leading to functional valve incompetence despite normal valve structure. The choice of treatment depends on the degree of valve regurgitation and the severity of the patient's clinical symptoms. The focus herein is on discussing the anatomy of the mitral valve, the pathophysiology of regurgitation, and diagnostic methods. The qualification process is then outlined for invasive treatment and various methods of mitral valve repair, including new minimally invasive techniques. Transcatheter mitral valve repair methods are discussed, among other methods, "edge-to-edge" repair and transcatheter mitral valve replacement. Publicly available data confirms that the latter is a widely available and safe treatment method, that represents a promising alternative to surgical treatment.
BACKGROUND: Excessive salt consumption is one of the most important and modifiable risk factors for cardiovascular disease (CVD). Despite general awareness of its cardiovascular impact, knowledge about other health conse...BACKGROUND: Excessive salt consumption is one of the most important and modifiable risk factors for cardiovascular disease (CVD). Despite general awareness of its cardiovascular impact, knowledge about other health consequences of excess sodium varies considerably, even among medical professionals. This study was conducted to examine whether domain-specific knowledge about salt-related health effects is predictive of professional affiliation with the medical community (medical education/degree) and explored its implications for cardiovascular prevention. METHODS: An international online survey (PoLA/ILEP) of 668 adults was conducted using the CAWI method. The questionnaire included 17 items assessing knowledge in five domains - cardiovascular, metabolic, renal, neuropsychiatric, and bone health - as well as awareness of dietary salt sources and self-monitoring of personal health parameters. Associations between domain-specific knowledge and medical education were analyzed using proportional odds logistic regression (POLR), adjusting for age, sex, place of residence, and number of cardiovascular risk factors. RESULTS: Knowledge of cardiovascular and neuropsychiatric consequences was strongly associated with medical education (OR = 21.7 and 1.66; p < 0.05). In contrast, a better understanding of metabolic, renal, and bone effects was linked with lower odds of medical education (OR = 0.28-0.54). The strongest predictor was self-awareness of personal cardiovascular parameters (OR = 37.97; p < 0.0001). Among rural residents, these relationships were particularly pronounced. CONCLUSIONS: Medical professional identity is associated with structured, domain-specific knowledge about the health effects of salt consumption, particularly in relation to CVD. Expanding educational efforts to address under-recognized consequences of sodium excess may improve salt-reduction strategies and enhance cardiovascular disease prevention.
BACKGROUND: Diagnosis of coronary microcirculatory dysfunction with wire-based methodology imposes a risk of unplanned revascularization in patients with ischemia and no obstructive coronary arteries (INOCA). Non-invasiv...BACKGROUND: Diagnosis of coronary microcirculatory dysfunction with wire-based methodology imposes a risk of unplanned revascularization in patients with ischemia and no obstructive coronary arteries (INOCA). Non-invasive, angiography-based methods are introduced to alleviate this risk. The angiography-based index of microcirculatory resistance (IMRangio) is a computational fluid dynamics (CFD)-based index utilizing high-quality angiography and aortic pressures to calculate a surrogate of the index of microcirculatory resistance (IMR). AIM OF THE STUDY: This study aims to assess the correlation between IMRangio and invasive thermodilution-based IMR in INOCA patients qualified to the MOSAIC-COR registry. METHODS: Data from 74 patients (92 coronaries including 52 left anterior descending arteries) from the MOSAIC-COR registry were used for this sub-analysis. All patients had undergone complex coronary physiology assessment using a thermistor-equipped wire and thermodilution-based methodology with subsequent vasomotor acetylcholine vasospasm testing. Post-hoc, CFD-based angiogram analysis was performed to calculate IMRangio values. RESULTS: The median age of patients was 64 years, and 59.3% were female. The median calculated value of IMRangio was 29 (Q1-Q3: 22-46), whereas the invasively measured IMR median value was 17 (Q1-Q3: 13-26). A significant correlation between IMRangio and invasive-IMR was observed (Spearman rho 0.29, < 0.001). Angiography based index of microcirculatory resistance area under the curve (AUC) was 62.2, and a value > 46.5 U was identified as the best cut-off for prediction of IMR > 25 and provided 38% sensitivity and 82% specificity to detect coronary microcirculatory dysfunction (CMD). CONCLUSIONS: The angiography-based index of microcirculatory resistance significantly correlates with invasively measured IMR; however, a higher cut-off value should be considered to improve the specificity of the method to detect CMD.
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...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: 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 t...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.
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...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: 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 st...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: 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 center...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.
An emerging field in cardiovascular research is the translational investigation of transfer RNA-derived small RNAs (tsRNAs). TsRNAs, a class of small non-coding RNA molecules, have been shown to modulate cellular functio...An emerging field in cardiovascular research is the translational investigation of transfer RNA-derived small RNAs (tsRNAs). TsRNAs, a class of small non-coding RNA molecules, have been shown to modulate cellular functions by regulating gene expression post-transcriptionally. They are implicated in diverse pathological conditions, including cancer, cardiovascular disease (CVD), infectious disease, diabetes, neurological disease, and metabolic disorder. Accumulating evidence suggests tsRNAs as important players and biomarkers in CVD. Dysregulated tsRNAs are identified in atherosclerosis, heart failure, hypertension and other types of CVD. Bioinformatics and in vitro experimental analyses reveal that tsRNAs may participate in the regulation of endothelial and inflammatory cell interactions, endothelial cell and vascular smooth muscle cell proliferation and migration, and cardiac metabolism, mitophagy and remodeling, contributing to the pathogenesis of CVD. In addition, altered tsRNAs possess great diagnostic and prognostic potential in CVD. Nevertheless, there are currently no in vivo mechanistic studies using animal models, and the small sizes of reported clinical studies that examined tsRNAs limit their diagnostic and prognostic value. Although of promise, further research is needed to address the utility of tsRNAs in cardiovascular care.
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 plaqu...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. Chemotherapy and RT.
Galas AA, Krzesiński P, Włochacz A
… +10 more, Kapłon-Cieślicka A, Gierlotka M, Kasprzak JD, Krakowiak B, Nessler J, Niedziela J, Pawlak A, Tomaszuk-Kazberuk A, Wita K, Lelonek M
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...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.
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 t...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.