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, a...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) (≥ 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 Swiss National Device Registry (SwissEPnet) provides a comprehensive database for implantation procedures. The purpose of this study was to provide an in-depth look at device statistics and changing trend...BACKGROUND: The Swiss National Device Registry (SwissEPnet) provides a comprehensive database for implantation procedures. The purpose of this study was to provide an in-depth look at device statistics and changing trends over the last 20 years. METHODS: The database was analyzed between January 1, 2003 and December 31, 2022. RESULTS: During the study period, 124,458 pacemaker and cardiac resynchronization therapy (CRT) procedures (mean age: 77.7 years; 59.7% male) were performed in 73 centers while 29,133 implantable cardioverter defibrillators (ICDs) and cardiac resynchronization therapy with defibrillator (CRT-D) procedures (mean age: 63.63 years; 80.2% male) were performed in 56 centers in Switzerland. While the number of pacemaker procedures has doubled in 20 years and there has been a constant increase in the mean age of patients receiving a pacemaker, the number of ICD procedures has more than tripled and recently plateaued with a mean age which has remained stable. Fluoroscopy and procedure durations remained stable over time for pacemaker and ICD procedures. Newer technologies, leadless pacemakers and CRT procedures require more fluoroscopy time, but this has also decreased over time. While regular battery changes remained stable, the proportion of DDD and CRT upgrades increased. The overall reintervention rate due to device-associated infections was stable over time. CONCLUSIONS: There was a pronounced increase in the number of pacemaker procedures in Switzerland in the last two decades and a marked increase in ICD procedures, which have plateaued recently. Overall, there is a constant increase in mean age of patients receiving a pacemaker, while the mean age of patients receiving an ICD did not change during follow up.
Heart failure (HF) is a leading cause of hospitalization and mortality worldwide, presenting significant management challenges due to its heterogeneity and frequent comorbidities. Despite advancements in treatment, heart...Heart failure (HF) is a leading cause of hospitalization and mortality worldwide, presenting significant management challenges due to its heterogeneity and frequent comorbidities. Despite advancements in treatment, heart failure poses significant burdens on healthcare, increased by the aging of populations and rising prevalence. Recent developments in artificial intelligence (AI) and machine learning are transforming HF management by improving diagnosis, risk stratification, personalized treatment, and remote monitoring. AI enhances diagnostic accuracy through tools like echocardiogram and electrocardiogram analysis and identifies phenotypic subgroups to better target therapies. AI algorithms integrate data from electronic health records, biomarkers, and wearable devices to predict exacerbations and tailor treatments, while AI-driven Clinical Decision Support Systems (AI-CDSS) improve guideline-directed medical therapy (GDMT) adherence and enable timely interventions. However, barriers such as data integrity, ethical considerations, and insufficient clinician training impede AI adoption. Potential solutions include federated learning to safeguard data privacy and interdisciplinary efforts to establish regulatory frameworks. This review synthesizes current research on AI's applications in HF management, emphasizing its potential to improve patient outcomes, reduce hospitalizations, and address the growing healthcare burden while highlighting the need to confront these challenges to fully realize its benefits.
BACKGROUND: Studies of animal and human aortic tissue samples showed that sirtuins may protect against aortic aneurysm (AA). However, to date, no studies have assessed plasma or serum sirtuin levels in humans. Therefore,...BACKGROUND: Studies of animal and human aortic tissue samples showed that sirtuins may protect against aortic aneurysm (AA). However, to date, no studies have assessed plasma or serum sirtuin levels in humans. Therefore, the aim of this study was to evaluate associations between plasma sirtuin 1 (SIRT1) and sirtuin 2 (SIRT2) levels and the presence of ascending AA. METHODS: Plasma SIRT1 and SIRT2 levels were assessed in patients with and without ascending AA using an enzyme-linked immunosorbent assay. RESULTS: The study included 32 patients with ascending AA (median age: 67 years) and 37 controls without AA (median age: 68 years). Plasma SIRT1 and SIRT2 levels did not differ between groups (p > 0.05). However, slightly higher sirtuin levels were observed in patients with ascending AA than in controls, particularly for SIRT1 in the subgroups of patients without coronary artery disease, atrial fibrillation, and chronic obstructive pulmonary disease (COPD). Among patients with ascending AA, higher SIRT2 levels were noted for those without COPD vs. those with COPD (p = 0.04). CONCLUSIONS: The study showed no significant differences in SIRT1 and SIRT2 levels between patients with and without ascending AA. However, there was a trend towards higher SIRT1 levels in patients with AA, especially in those without comorbidities.
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 t...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.
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...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.
Kietlińska M, Krawczyk A, Witkowski G
… +10 more, Pruc M, Tomaszewska M, Kurek K, Yildirim M, Nucera G, Solecki M, Umińska JM, Navolokina A, Szarpak Ł, Cander B
BACKGROUND: Sudden cardiac arrest (SCA) in pediatric populations is a rare yet critical medical emergency characterized by high mortality and significant neurological impairment among survivors. This systematic review an...BACKGROUND: Sudden cardiac arrest (SCA) in pediatric populations is a rare yet critical medical emergency characterized by high mortality and significant neurological impairment among survivors. This systematic review and meta-analysis aim to synthesize existing evidence on pediatric resuscitation techniques, focusing on survival rates, neurological outcomes, and the effectiveness of chest compression-only resuscitation (HCPR) versus standard resuscitation (CCPR), thereby addressing current gaps in clinical understanding and informing future guidelines. METHODS: Following PRISMA guidelines, we systematically searched the PubMed, Cochrane Library, and Embase databases for trials comparing HCPR versus CCPR during pediatric resuscitation. We used a comparative meta-analysis to estimate the odds ratio of prehospital return of spontaneous circulation (ROSC), 1-month survival rate, and survival with favorable neurological outcome. Study level odds ratios (ORs) and their 95% confidence intervals (CI) were pooled using random effects. RESULTS: Prehospital ROSC incidence did not significantly differ between HCPR and CCPR, including subgroup analysis based on cause of cardiac arrest. One-month survival rate was 12.3% in HCPR and 18.0% in CCPR (p = 0.04). Additionally, HCPR was less effective in non-cardiac arrest cases and in children over one year of age. Favorable neurological outcomes at one month were also lower for HCPR (6.3%) compared to CCPR (9.0%; p < 0.001), with similar trends observed across subgroups of non-cardiac arrest origin and varying age groups. CONCLUSIONS: A pediatric resuscitation technique based solely on chest compressions shows lower efficacy in terms of survival at one month and quality of return of neurological function compared to standard resuscitation.
BACKGROUND: Angiography-derived radial wall strain (RWS) estimates the radial coronary wall deformation caused by pulsatile blood pressure, whereas superficial wall stress (SWS) summarizes the comprehensive wall deformat...BACKGROUND: Angiography-derived radial wall strain (RWS) estimates the radial coronary wall deformation caused by pulsatile blood pressure, whereas superficial wall stress (SWS) summarizes the comprehensive wall deformation caused by both blood pressure and cardiac motion. This study sought to investigate the difference between RWS and SWS for the association with plaque vulnerability and the impact of cardiac motion on RWS. METHODS: Concurrent RWS, cardiac motion-induced bending angle change (ΔCBA), SWS, and optical coherence tomography image analyses were retrospectively performed in 49 eligible intermediate coronary lesions. Correlation and multivariate linear regression analyses were applied to investigate the difference in the correlations of RWS and SWS with plaque characteristics and the impact of ΔCBA on RWS assessment. RESULTS: Lipid-to-cap ratio (LCR), a novel vulnerable plaque indicator, was found to be correlated with both maximum RWS (RWSmax) (r = 0.58, p < 0.001) and peak SWS (r = 0.29, p = 0.041). RWSmax tended to be more relevant to LCR in comparison with peak SWS, albeit statistically nonsignificant (z = 1.75, p = 0.080). With multivariate linear regression, LCR was independently associated with both RWSmax (normalized β = 0.49, p = 0.001) and peak SWS (normalized β = 0.34, p = 0.012), whereas ΔCBA could only affect peak SWS (normalized β = 0.29, p = 0.035). Peak time-averaged SWS showed similar results to peak SWS. CONCLUSIONS: RWS tended to be more relevant to plaque vulnerability and less affected by cyclic bending as compared with SWS.
BACKGROUND: The aim of this study was to investigate whether serum uric acid to serum creatinine ratio (SUA/SCr) predicts the early major adverse cardiovascular and cerebrovascular events (MACCEs) in patients with ST ele...BACKGROUND: The aim of this study was to investigate whether serum uric acid to serum creatinine ratio (SUA/SCr) predicts the early major adverse cardiovascular and cerebrovascular events (MACCEs) in patients with ST elevation myocardial infarction (STEMI) and multivessel coronary artery disease (MVCAD). METHODS: This study was designed retrospectively and included 572 patients with a mean age of 61.9 ± 12.3 years who presented with STEMI and had MVCAD. The patients were divided into 2 groups as those with and without MACCEs, taking into account the 30-day follow-up period. Serum uric acid, and serum creatinine were obtained at admission. The SUA/SCr of all patients were calculated and evaluated the relationship of SUA/SCr with the 30-day MACCEs. RESULTS: During the mean 27.0 ± 7.7 day follow-up period, 58 (10.1%) patients died, and 84 patients (14.7%) suffered MACCEs. According to multivariable cox regression analysis, advanced age (HR: 1.020, p = 0.028), smoking (HR: 2.513, p = 0.001), lower left ventricular ejection fraction (HR: 0.962, p = 0.001), TIMI < 3 flow (HR: 0.425, p < 0.001), higher syntax score (HR: 1.067, p < 0.001), and higher SUA/SCr (HR: 1.1029, p = 0.011) independently predicted the 30-day MACCEs. The area under the curve for SUA/SCr was 0.606 with a p value of 0.002. The Kaplan Meier curves represented that high-risk patients with SUA/SCr greater than 4.58 had significantly higher MACCEs than low-risk group during the follow up period after index hospitalization (p = 0.001). CONCLUSIONS: Newly defined promising oxidative and inflammatory biomarker, SUA/SCr can be a potential predictor of MACCEs within 30 days and decision-making treatment in STEMI and MVCAD patients.
BACKGROUND: Severe aortic stenosis (AS) often coexists with mitral regurgitation (MR). This study evaluated the significant evolution of MR in patients undergoing transcatheter aortic valve replacement (TAVR) for AS. MET...BACKGROUND: Severe aortic stenosis (AS) often coexists with mitral regurgitation (MR). This study evaluated the significant evolution of MR in patients undergoing transcatheter aortic valve replacement (TAVR) for AS. METHODS: This multi-center China Degenerative Valve Disease II Cohort (China-DVD2) Study enrolled patients undergoing TAVR for AS from January 2020 to October 2023. MR severity was assessed at baseline and 12 months post-TAVR. Composite endpoints included all-cause death, heart failure rehospitalization, myocardial infarction, and angina. RESULTS: Among 424 enrolled patients, 130 (31%) had significant MR at baseline. At 12 months, MR improved in 56 (70%) of 80 patients with follow-up, and greater improvement in left ventricular ejection fraction (LVEF) was associated with MR improvement [odds ratios (OR): 0.97, 95% confidence interval (CI): 0.95-1.00, p = 0.04)]. Patients with MR improvement showed significant New York Heart Association (NYHA) functional class improvement at 12-month follow-up. No survival benefit disparity was observed between patients with and without significant baseline MR, but a trend toward lower composite endpoint rate (12.5% vs. 20.8%, log-rank p = 0.49) was observed in patients with MR improvement. Older age [hazard ratios (HR): 1.12, 95% CI: 1.01-1.24, p = 0.04)] and higher systolic pulmonary arterial pressure (SPAP) (HR: 1.05, 95% CI: 1.00-1.09, p = 0.04) were linked to worse outcomes. CONCLUSIONS: Most patients with significant MR experienced improvement of NYHA class and MR post TAVR. Baseline significant MR was not linked to worse outcomes, but MR improvement showed a trend toward better prognosis. Older age and higher SPAP predicted worse outcomes.
BACKGROUND: Cumulative data has highlighted the efficacy of intra-vascular lithotripsy (IVL) in patients with stent failure (SF). However, it remains unclear whether the effectiveness of IVL, and subsequent clinical outc...BACKGROUND: Cumulative data has highlighted the efficacy of intra-vascular lithotripsy (IVL) in patients with stent failure (SF). However, it remains unclear whether the effectiveness of IVL, and subsequent clinical outcomes, are influenced by the timing of SF. We aimed to evaluate the outcomes of patients with SF undergoing IVL according to the age of index stent implantation. METHODS: This is a pre-specified subgroup analysis of the COIL registry (coronary intravascular lithotripsy in patients with stent failure), which included patients who underwent IVL treatment for SF, divided according to the timing of SF, i.e., early (≤12 months), mid-term (12-36 months), and late SF (>36 months). Procedural and clinical outcomes up to 12 months following IVL treatment were recorded. The primary endpoint was defined as the composite of cardiovascular death, spontaneous myocardial infarction, or target vessel revascularization (TVR). RESULTS: There were 88 patients included in this sub-study, of whom 40 (45%), 17 (19%), and 31 (35%) had early, mid-term, and late SF, respectively. Final procedural results were better in those with early compared to mid-term or late SF. At one-year follow-up, the incidence of the primary endpoint was associated with the timing of SF (8% vs. 12% vs. 29%, p = 0.042). The difference among the subgroups was driven by TVR (3% vs. 12% vs. 29%, p = 0.005). CONCLUSIONS: Procedural and clinical outcomes following IVL treatment for patients with SF were influenced by the timing of index stent implantation. Further studies are needed to better understand the mechanisms behind recurrent SF.
BACKGROUND: Eustachian valve endocarditis (EVE) is a rare right-sided infective endocarditis (RSIE) manifestation. This condition has scattered and limited clinical characteristics that require collection and systematiza...BACKGROUND: Eustachian valve endocarditis (EVE) is a rare right-sided infective endocarditis (RSIE) manifestation. This condition has scattered and limited clinical characteristics that require collection and systematization. This meta-analysis evaluates the predisposing factors, pathogens, and associated risk profiles in EVE cases. METHODS: The meta-analysis included 68 cases of EVE from 57 reports published between 1986 and 2024 from PubMed, Embase, Scopus, Cochrane, and Web of Science. Data on demographics, clinical characteristics, risk factors, and microbiological findings were extracted and analyzed using descriptive and univariate statistical methods. Pooled prevalence rates from observational studies were calculated using a fixed effects model. RESULTS: The pooled prevalence of EVE in RSIE among the analyzed cases was 2.54%. Single-valve infections accounted for 70.6% of cases, with the Eustachian valve as the sole affected structure. The most common pathogen was Staphylococcus aureus (60%), predominantly affecting younger intravenous drug users (IVDU) with an odds ratio [OR (odds ratio) = 6.27; 95% CI (confidence interval): 1.62-24.31] in univariate logistic regression analysis. Other predisposing factors, including central venous catheters (CVCs) and cardiac implantable electronic devices (CIED), were not significantly associated with Staphylococcus aureus or other bacterial non-Staphylococcus aureus or fungal infections. CONCLUSIONS: Eustachian valve endocarditis is relatively rare and primarily associated with IVDU and younger age, whereas CVCs and CIEDs are insignificant predictors. Identifying embryonic remnants like the Eustachian valve or Chiari network using echocardiography may facilitate early diagnosis in at-risk populations.
BACKGROUND: Heart failure (HF) nurses play an important role in heart failure management. This study aimed to assess the knowledge of HF nurses in Poland regarding HF management. METHODS: 97 nurses from Poland provided t...BACKGROUND: Heart failure (HF) nurses play an important role in heart failure management. This study aimed to assess the knowledge of HF nurses in Poland regarding HF management. METHODS: 97 nurses from Poland provided their consent and completed an online questionnaire comprised of 20 questions. The study was conducted from January 2023 to May 2023. The questionnaire was divided into three parts: general information, practical issues, and the impact of the Polish online educational platform on clinical practice. The inclusion criteria were: a registered nursing license, age under 60, and participation in the Association of Heart Failure of Polish Cardiac Society's online learning platform course for HF nurses. The study group was divided into two subgroups: cardiovascular (CV) nurses (n = 37) and non-CV nurses (n = 60). Statistical analysis was performed using STATISTICA software, with p < 0.05 considered statistically significant. RESULTS: CV nurses showed a higher initial level of education and greater involvement in hospital settings and patient education in comparison to non-CV nurses. Knowledge levels regarding HF management were similar in both groups. Significant differences were found in the work settings and engagement in patient education between CV and non-CV nurses. CONCLUSIONS: The study highlights the importance of the HF nurse educational program in Poland, emphasizing the role of CV nurses and the impact of an online educational platform. Findings contribute to ongoing efforts to enhance HF management and improve the quality of care for patients with heart failure.
Roh JW, Heo SJ, Lee OH
… +17 more, Im E, Cho DK, Lee JW, Lee BK, Yoo SY, Lee SY, Kim CJ, Jin HY, Park JS, Heo JH, Kim DH, Lee JB, Kim DK, Bae JH, Lee SY, Lee SH, Kim Y
BACKGROUND: There is limited data on the impact of body mass index (BMI) on distal radial access (DRA). Using a large-scale prospective registry, the influence of obesity on DRA outcomes was evaluated, including cannulat...BACKGROUND: There is limited data on the impact of body mass index (BMI) on distal radial access (DRA). Using a large-scale prospective registry, the influence of obesity on DRA outcomes was evaluated, including cannulation and complications. METHODS: Using data from the prospective, multicenter KODRA (Korean Prospective Registry for Evaluating the Safety and Efficacy of Distal Radial Approach) registry data, 4,638 patients who planned palpation-guided distal radial artery puncture were enrolled into two groups, both with body mass index (BMI) information available: obese (n = 2,205; BMI ≥ 25 kg/m²) and non-obese (n = 2,433). The primary endpoint was the success rate of distal radial artery cannulation. Secondary endpoints included cannulation time, crossover rate, and DRA-related complications. RESULTS: The mean age was 66.6 ± 11.7 years and 67.2% were men. No significant difference existed in the success rate of distal radial artery cannulation between the two groups (94.5% in the obese group vs. 94.3% in the non-obese group, p = 0.787). This tendency in cannulation success rate was consistently observed in multiple sensitivity analyses, including multivariable and propensity score-matched analyses. Crossover rate (6.6% vs. 6.7%, p = 0.962) and DRA-related complications (4.3% vs. 4.6%, p = 0.630) were not significantly different between groups. However, cannulation time was significantly longer in the obese group compared to the non-obese group [105 (101-109) sec vs. 100 (97-103) sec, p = 0.046]. CONCLUSIONS: In this subgroup analysis of the KODRA registry, obesity was not associated with the success rate for palpation-guided distal radial artery cannulation, crossover rate, and DRA-related complications.