Rdzanek A, Piasecki A, Tomaniak M
… +16 more, Pędzich E, Markiewicz A, Chmielecki M, Pręgowski J, Stefaniak S, Streb W, Trębacz J, Reczuch K, Suwalski P, Fijałkowski M, Gackowski A, Szymański P, Kapłon-Cieślicka A, Wojakowski W, Scisło P, Grygier M
BACKGROUND: The treatment of left main coronary artery disease (LMCAD) in acute coronary syndrome patients is challenging in daily clinical practice. Therefore, the question arises whether the clinical outcomes of acute...BACKGROUND: The treatment of left main coronary artery disease (LMCAD) in acute coronary syndrome patients is challenging in daily clinical practice. Therefore, the question arises whether the clinical outcomes of acute coronary syndrome (ACS) patients with LM disease vary between centers with and without cardiac surgery on site. METHODS: The study is a retrospective analysis of ACS patient outcomes using data from the PL-ACS registry, which is a Polish archive of ACS patients. The following analysis considered patients with LMCAD (n=4000) who were divided into two groups: those treated in the centers with the cardiac surgery department on site (CS group, n=427) and those without (non-CS group, n=3573). RESULTS: Patients with ACS in non-CS group more often were not qualified for revascularization than patients in CS group (11.7% in the CS group vs. 19.9% in the non-CS group, p<0.001), however, CABG was more common in non-CS group (18.7% in CS group vs. 25.7% in non-CS group, p<0.001). PCI, including angioplasty of LM, was more common in CS-group than non-CS group (38,6% vs. 30,3%, p<0.001). Among patients with ACS in CS group, major adverse cardiac events (MACE) were observed with greater frequency. CONCLUSIONS: Patients with LM disease admitted to the centers with CS initially had more risk factors for more intensive hospitalization compared to patients in centers without CS on-site. Clinical outcomes and treatment procedures may differ regarding the availability of CS on-site.
BACKGROUND: The diagnosis of dilated cardiomyopathy (DCM) requires exclusion of obstructive coronary artery disease (CAD). However, co-occurrence of DCM and non-obstructive coronary atherosclerotic plaque is frequent. Ou...BACKGROUND: The diagnosis of dilated cardiomyopathy (DCM) requires exclusion of obstructive coronary artery disease (CAD). However, co-occurrence of DCM and non-obstructive coronary atherosclerotic plaque is frequent. Our objective was to evaluate the coronary artery dimensions and their relation to the left ventricle mass in DCM patients with excluded coronary atherosclerosis. METHODS: Out of 426 patients with DCM who underwent computed coronary tomography angiography (CCTA), we identified 34 without signs of coronary atherosclerosis and compared them with 193 consecutive patients without DCM and atherosclerosis in CCTA. They were matched one to three by sex, coronary dominance pattern, and body-surface area (BSA). Left ventricle myocardial mass (LVMM) and proximal and middle coronary artery segment dimensions were evaluated with the use of dedicated, commercially available software. RESULTS: Overall, coronary segment dimensions were not different between groups except for the medial left anterior descending segment and obtuse marginal, which were wider in the DCM group, while the proximal right coronary artery was larger in the non-DCM group. Total coronary artery volume (CAV) and LVMM/CAV ratio were greater in the DCM group (2879 [2535-3508] mm³ vs. 2521 [2120-3115] mm³, p = 0.03) and (0.062 [0.054-0.074] g/mm³ vs. 0.049 [0.039-0.058] mm³, p = 0.0002), respectively. Also, the LVMM/coronary artery ostial area (COA) ratio was larger in patients with DCM (5.4±1.3 g/mm² vs. 3.7 ± 1.1 g/mm², p < 0.0001). The independent positive predictors of a larger LVMM/CAV ratio were DCM and BSA, while age was a negative predictor. LVMM/COA ratio positive predictors were DCM and male sex. CONCLUSIONS: Patients with DCM have altered relationships between LVMM, CAV, and COA.
BACKGROUND: Residual shunt after patent foramen ovale (PFO) occlusion is associated with recurrent stroke, and limited literature address the specific management of such cases. Herein we report our experience with second...BACKGROUND: Residual shunt after patent foramen ovale (PFO) occlusion is associated with recurrent stroke, and limited literature address the specific management of such cases. Herein we report our experience with secondary interventional treatment. METHODS: From July 2020 to January 2023, patients who underwent PFO occlusion for more than one year with residual right-to-left shunting (rRLS) screened by contrast transthoracic echocardiography (cTTE) constituted the study population. A retrospective analysis of the basic, procedural, and follow-up data was performed. RESULTS: A total of 35 patients with large rRLS were admitted to our center. Fourteen patients underwent transcatheter rRLS closure. Transesophageal echocardiography (TEE) clearly showed the color blood flow profile, and cTEE showed a large rRLS in 12 cases. TEE showed a small outlet near the left exit of the rRLS, and cTEE showed a small rRLS in two cases. Type I rRLS accounted for 71.4%, residual PFO, and residual atrial septal defect (ASD) for 14.3%, respectively. Secondary transcatheter interventions were successful in 12 patients (85.7%). No complications were observed. Six cases of type I rRLS were closed with ASD occluders and two with an ADO-II device. Two residual PFO and two residual ASD were implanted with PFO occluders. cTTE was performed six months after the procedure, with complete closure in 12 patients. CONCLUSION: TEE not only helps to improve interventional strategies to reduce residual shunt in primary occlusion but also helps in the screening of patients who are truly suitable for secondary intervention. ASD occluders can be considered as an alternative device for type I rRLS.
Filipiak KJ, Cameli M, Freire SJ
… +9 more, Gabulova R, Khamidullaeva G, Tomaszuk-Kazberuk A, Kuzior A, Martinez-Martin FJ, Mirzoyev U, Nizamov U, Van Tan N, Gąsecka A
The 2024 guidelines of the European Society of Cardiology (ESC) refer to four very important therapeutic areas: arterial hypertension, atrial fibrillation, chronic coronary syndromes and peripheral artery disease. The ES...The 2024 guidelines of the European Society of Cardiology (ESC) refer to four very important therapeutic areas: arterial hypertension, atrial fibrillation, chronic coronary syndromes and peripheral artery disease. The ESC countries and their institutional members share a common goal of reducing the burden of cardiovascular diseases, which remain the leading cause of death worldwide. Experts from these six countries - three from Europe and three from Asia - gathered at the annual meeting to briefly present the epidemiological situation regarding selected issues addressed in the 2024 ESC guidelines, and to create a document highlighting the significant progress in pharmacotherapy. The new guidelines allow us to identify particularly important therapeutic areas and unmet pharmaceutical needs within the four treatment guidelines developed by the ESC in 2024. While discussing each of these four documents, 10 subjectively selected points were chosen to highlight what should be kept in mind in daily clinical practice. Altogether, a range of all-risk categories are represented, and the observations made in this position paper are of a universal nature.
Thromboembolic diseases have long been a leading cause of morbidity and mortality, necessitating advances in anticoagulant drugs. Heparins, vitamin K inhibitors, and direct oral anticoagulants (DOACs) are well-establishe...Thromboembolic diseases have long been a leading cause of morbidity and mortality, necessitating advances in anticoagulant drugs. Heparins, vitamin K inhibitors, and direct oral anticoagulants (DOACs) are well-established drug classes that help prevent thromboembolic complications. While effective, they pose significant risks during long-term therapy, including bleeding, osteoporosis, heparin-induced thrombocytopenia, and the need for frequent monitoring and dose adjustments. Factor XI (FXI) inhibitors represent an innovative approach in anticoagulation therapy, aiming to balance thromboembolic events with the risk of bleeding complications. They include: a) orally administered small molecule inhibitors such as milvexian and asundexian; b) monoclonal antibodies such as abelacimab, osocimab, and xisomab, which specifically bind and inactivate FXI; c) FXI-antisense oligonucleotide (FXI-ASO), which downregulate FXI synthesis at the mRNA level and reduce plasma FXI concentrations. Available data indicate that FXI inhibitors decrease the risk of thromboembolic events and are associated with a lower incidence of major bleeding than current gold standard methods. Hence, FXI inhibitors may become the preferred anticoagulant class, especially for patients with elevated bleeding risk. Their development is an important step in the history of anticoagulant therapy, striving to find a balance between preventing thromboembolism and reducing bleeding risk, ultimately improving patient outcomes. In this context, a discussion on the characteristics of FXI inhibitors, a summary on data regarding the efficacy and safety of FXI inhibitors based on preclinical and clinical studies, and an outline of future perspectives regarding therapeutic strategies of FXI inhibition in venous thrombosis are presented in this study.
BACKGROUND: To ascertain the diagnostic value of radiomic features of pericoronary adipose tissue (PCAT) and other coronary computed tomography angiography (CCTA) parameters for differentiating non-ST-segment-elevation m...BACKGROUND: To ascertain the diagnostic value of radiomic features of pericoronary adipose tissue (PCAT) and other coronary computed tomography angiography (CCTA) parameters for differentiating non-ST-segment-elevation myocardial infarction (NSTEMI) from unstable angina (UA). METHODS: This study included NSTEMI and UA patients (n = 102 each). The radiomic features of PCAT were selected according to the intraclass correlation coefficient, Pearson's coefficient, the t test, and least absolute shrinkage and selection operator. Six classifiers-random forest, support vector machine, naive Bayes, K-nearest neighbors, extreme gradient boosting, and light gradient boosting machine (LightGBM)-were used to build radiomics models, and the best were selected. Four CCTA parameter models, encapsulating plaque parameters (model 1), plaque parameters + fatty attenuation index (FAI) (model 2), plaque parameters + CT fractional flow reserve (CT-FFR) (model 3), and plaque parameters + CT-FFR + FAI (model 4), were constructed. Finally, we established a fusion model (nomogram) with all CCTA parameters and radiomics model scores. All models were compared regarding their performance. RESULTS: The LightGBM radiomics model achieved the highest AUC. Among CCTA parameter models, only model 4 achieved a predictive performance similar to that of the radiomics model in the training and test cohorts (AUC = 0.904 vs. 0.898 and 0.860 vs. 0.877). The combined model (nomogram) showed greater predictive efficacy (AUC = 0.963, 0.910) than model 4 or the radiomics model. CONCLUSION: The PCAT-based radiomics model accurately distinguishes between NSTEMI and UA, with similar diagnostic performance as the model that combined all the significant CCTA parameters. The nomogram integrating CCTA parameters and the radiomic score has good clinical application prospects.
BACKGROUND: Balloon pulmonary angioplasty (BPA) and pulmonary endarterectomy (PEA) are established treatments for chronic thromboembolic pulmonary hypertension (CTEPH). In cases where BPA is ineffective, stent implantati...BACKGROUND: Balloon pulmonary angioplasty (BPA) and pulmonary endarterectomy (PEA) are established treatments for chronic thromboembolic pulmonary hypertension (CTEPH). In cases where BPA is ineffective, stent implantation emerges as salvage therapy. However, stent implantation during BPA remains a subject of debate. METHODS: This seven-year case series in Serbia, where PEA is unavailable, examines outcomes in 10 CTEPH patients undergoing BPA with coronary-type stent implantation during BPA. Objectives include assessing the feasibility, safety, and efficacy of this combined approach, identifying optimal patient selection criteria. Criteria for stent placement included persistent unsatisfactory flow post-multiple balloon dilatations. Follow-up assessments were via repeat pulmonary angiography. RESULTS: Stents were successfully deployed, demonstrating sustained patency in 14 of 15 stents over an average 21.5-month (ranging from 11 up to 82 months) follow-up. Outcomes revealed significant reductions in mean pulmonary artery pressure, improvements in WHO Functional Class, and enhanced 6-minute walking distance. For the first 6 months, patients received daily clopidogrel 75 mg and rivaroxaban 15 mg, without significant bleeding. Dual therapy for pulmonary hypertension was consistently upheld. During the follow-up period, no stent thrombosis, restenosis, or other severe acute or chronic complications were observed; however, in one case, additional balloon stent post-dilatation was required. CONCLUSION: Coronary-type stent implantation during BPA for selected CTEPH patients, though not a primary treatment, proved valuable, offering a potential solution when BPA alone falls short. This case series emphasizes the need to refine patient selection criteria for this emerging therapeutic avenue.
Gąsecka A, Pindlowski P, Szczerba M
… +8 more, Zimodro JM, Błażejowska E, Pietrasik A, Lesiak M, Iannaccone M, Henriques JPS, van der Schaaf RJ, Kochman J
Drug-coated balloons (DCB) have been developed as an alternative to drug-eluting stents (DES) as a part of the "leave nothing behind" strategy following percutaneous coronary interventions (PCI). DCBs facilitate revascul...Drug-coated balloons (DCB) have been developed as an alternative to drug-eluting stents (DES) as a part of the "leave nothing behind" strategy following percutaneous coronary interventions (PCI). DCBs facilitate revascularization and delivery of an antiproliferative agent directly to a coronary artery lesion, without the need for DES implantation. Subsequently, DCBs promote positive vascular remodeling and allow for a shorter duration of dual antiplatelet therapy. Since the first reports on the successful treatment of coronary in-stent restenosis (ISR) with paclitaxel-coated balloon catheters in the year 2006, the use of DCBs has been growing, driven by reports of DCB application to treat ISR, bifurcation lesions, and small vessel disease. Contemporary clinical trials evaluating DCBs in large vessel disease and chronic total occlusions might further expand the indications for this technology. Attention has also been brought to the use of DCBs in patients with diabetes mellitus and acute coronary syndrome, especially those at high bleeding risk. This review aims to discuss the existing evidence and emerging hopes associated with DCBs, including technical aspects of DCB PCI and the use of DCBs in different clinical scenarios.
Skorupski WJ, Pietrasik A, Gąsecka A
… +45 more, Sacha J, Pawłowski T, Bielawski G, Balak W, Sukiennik A, Burzyńska P, Witkowski A, Warniełło M, Rzeszutko Ł, Bartuś S, Pawlik A, Kaczyński M, Gil R, Kuliczkowski W, Reczuch K, Protasiewicz M, Legutko J, Kleczyński P, Wańczura P, Gurba S, Kochanowska A, Łomiak M, Krajsman M, Skorupski W, Zarębiński M, Pawluczuk P, Włodarczak S, Włodarczak A, Ściborski K, Telichowski A, Pluciński M, Hiczkiewicz J, Konsek K, Hawranek M, Gąsior M, Peruga J, Fiutowski M, Romanek R, Kasprzyk P, Ciećwierz D, Ochała A, Wojakowski W, Kochman J, Lesiak M, Grygier M
BACKGROUND: The Impella percutaneous mechanical circulatory support device provides improved support in treating patients with high-risk percutaneous coronary interventions (HR-PCI) or in cardiogenic shock. IMPELLA-PL is...BACKGROUND: The Impella percutaneous mechanical circulatory support device provides improved support in treating patients with high-risk percutaneous coronary interventions (HR-PCI) or in cardiogenic shock. IMPELLA-PL is a multicenter registry developed to share clinical data and experiences using Impella technology in Poland. The retrospective analysis conducted in this study aims to fill the knowledge gap of Impella performance in patients with multivessel coronary artery disease (CAD) and depressed left ventricular ejection fraction (EF) (≤30%) treated with HR-PCI. METHODS: Retrospective data were analyzed from patients presenting with multivessel coronary disease and low EF treated with Impella CP collected from 20 Polish interventional cardiology centers registered with IMPELLA-PL to assess the safety and efficacy in short- and long-term clinical outcomes. RESULTS: A total of 115 patients with low EF received Impella CP support during HR-PCI. The success rate of Impella supported HR-PCI was high (99.1%) with an average hospital stay of 15.6 ± 10.7 days. The right femoral artery was the most common access (55.7%) followed by the left femoral artery (37.4%). The in-hospital mortality rate was 6.1%, and the all-cause mortality rate at one year was 13.9%. CONCLUSIONS: High-risk PCI with Impella CP periprocedural support was safe and effective in patients with low EF (≤30%). The all-cause mortality rate (6.1% and 13.9%, respectively, for in-hospital and at 12-months) was comparable with other Impella registries.
Wełnicki M, Gorczyca-Głowacka I, Kapłon-Cieślicka A
… +17 more, Janiszewski M, Kasprzak JD, Leszek P, Tomaszuk-Kazberuk A, Łukasiewicz M, Tomaniak M, Surma S, Mickiewicz A, Narkiewicz K, Jaguszewski M, Krasiński Z, Śliż D, Mamcarz A, Szymański FM, Barylski M, Wożakowska-Kapłon B, Filipiak KJ
BACKGROUND: Infections related to cardiac implantable electronic devices (CIED) are associated with significant morbidity and mortality. Antibiotic-eluting envelopes have been introduced as a technology to prevent CIED i...BACKGROUND: Infections related to cardiac implantable electronic devices (CIED) are associated with significant morbidity and mortality. Antibiotic-eluting envelopes have been introduced as a technology to prevent CIED infections. The aim of this study was to evaluate the effectiveness of the antibacterial envelope in the real-world population of a tertiary center. METHODS: This cohort study includes consecutively enrolled patients undergoing a device procedure from 01/2014 to 12/2020 at the University Hospital in Zurich. During period A (01/2014-12/2019) antibacterial envelopes were not used, whereas during period B (01/2020-12/2020) antibacterial envelopes were used in all device interventions. Follow-up was conducted by assessing all available patient records from patient visits and hospitalization. RESULTS: 1757 patients (male 70.5%, mean age 67.1 ± 16 years), were analyzed during a follow-up of 24 months. In 302 patients (17.2%) an antibacterial envelope was used. The overall occurrence of a device infection was low (n = 15, 0.85%). Factors that were associated with the incidence of an infection were not undergoing a primary implantation procedure (p = 0.024) and a CRT-P/D intervention (p = 0.022). There was no difference in the rate of infection between patients in whom a bacterial envelope was implanted vs. those in whom it was not used (0.6 vs. 0.9%, p = 0.693). CONCLUSION: In a contemporary cohort of consecutive, unselected patients undergoing a device intervention at a large tertiary care center, the rate of device infection was low and not significantly different with vs. without the use of an antibacterial envelope. The data have important practical as well as economic implications for physicians performing such procedures.
The 2023 ESC guidelines changed previously recommended a strategy of early treatment in patients with STEMI. Pre-treatment with a P2Y12 receptor inhibitor may be considered in patients undergoing a primary PCI strategy (...The 2023 ESC guidelines changed previously recommended a strategy of early treatment in patients with STEMI. Pre-treatment with a P2Y12 receptor inhibitor may be considered in patients undergoing a primary PCI strategy (Class IIb, Level of evidence B). However, the available scientific evidence justifies a personalized approach differentiating the indications for pre-treatment with oral P2Y12 receptor inhibitors depending on the concomitant administration of opioids. In our opinion, in patients undergoing primary PCI not treated with opioids, pre-treatment with an oral P2Y12 receptor inhibitor should be applied, while in patients undergoing primary PCI treated with opioids, pre-treatment with an oral P2Y12 receptor inhibitor should be considered.
Gąsecka A, Gniot M, Rajewska B
… +16 more, Dykacz W, Kisielewska W, Błażejowska E, Zimodro JM, Grabowski M, Rymuza B, Huczek Z, Kochman J, Wilimski R, Kuśmierczyk M, Budzianowski J, Hiczkiewicz J, Olasińska-Wiśniewska A, Grygier M, Filipiak KJ, Ufnal M
BACKGROUND: Intestinal microbial metabolites, such as trimethylamine-N-oxide (TMAO) and indoxyl sulfate (IS), have been suggested as markers for the progression of aortic stenosis (AS). However, the impact of transcathet...BACKGROUND: Intestinal microbial metabolites, such as trimethylamine-N-oxide (TMAO) and indoxyl sulfate (IS), have been suggested as markers for the progression of aortic stenosis (AS). However, the impact of transcatheter aortic valve implantation (TAVI) on these intestinal bacterial metabolites has not been evaluated in a multicenter clinical study. The aim of this study was to determine the effect of TAVI on plasma levels of intestinal bacterial metabolites and to assess the predictive value of these metabolites for major adverse cardiovascular events (MACE) following TAVI. M: ETHODS: Consecutive patients with AS referred for TAVI were enrolled in this study. Blood samples were collected one day before TAVI and at hospital discharge. The concentrations of intestinal microbial metabolites were measured using ultra performance liquid chromatograph coupled with a mass spectrometer. RESULTS: Plasma levels of TMAO and IS decreased after TAVI, compared to baseline (p ≤ 0.004 for all). Among 128 patients included in the study, 21 patients (16.4%) developed MACE during the median follow-up time of 404 days. Baseline plasma IS level was higher in patients with MACE, compared to those without MACE (p = 0.001). Increased baseline IS level predicted MACE with 75.0% sensitivity and 74.3% specificity independent of other clinical variables (OR 14.264, 95% CI 3.442-59.117, p < 0.001) and decreased the chance of event-free survival (plog rank < 0.001). CONCLUSIONS: Plasma concentrations of TMAO and IS decreased after TAVI, compared to baseline. Elevated plasma IS levels were associated with a 14-fold increase in the odds of post-TAVI MACE during a median follow-up period of 404 days.