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10 pages, 761 KiB

Open AccessArticle

Long-Term Outcomes after Stroke in Patients with Atrial Fibrillation: A Single Center Study

by Justyna Tracz, Iwona Gorczyca-Głowacka, Anita Rosołowska and Beata Wożakowska-Kapłon

Int. J. Environ. Res. Public Health 2023, 20(4), 3491; https://doi.org/10.3390/ijerph20043491 - 16 Feb 2023

Cited by 5 | Viewed by 1882

Abstract

Atrial fibrillation (AF) is known to be a significant risk factor for poor prognosis after stroke. In this study, we compared differences in long-term outcomes after ischemic stroke among patients with AF and sinus rhythm (SR). We identified patients admitted to the reference [...] Read more.

Atrial fibrillation (AF) is known to be a significant risk factor for poor prognosis after stroke. In this study, we compared differences in long-term outcomes after ischemic stroke among patients with AF and sinus rhythm (SR). We identified patients admitted to the reference Neurology Center between 1 January 2013 and 30 April 2015, inclusive, with acute ischemic stroke. Of the 1959 surviving patients, 892 were enrolled and followed for five years or until death. We analyzed the risk of stroke recurrence and death between patients with AF and SR at 1, 3, and 5 years after stroke. The rates of death and stroke recurrence were estimated using Kaplan–Meier analysis and multivariate Cox regression. During follow-up, 17.8% of patients died and 14.6% had recurrent stroke. The mortality in the AF group increased relative to the SR group with subsequent years. The risk of death was statistically higher in the AF than SR group at 1 year after stroke (13.5 vs. 7%, p = 0.004). After adjusting for age, stroke severity, and comorbidities, there was also no significant effect of AF on mortality in the first year after stroke (OR = 1.59, p = 0.247). There were no significant differences between the groups in stroke recurrence during follow-up. The results of our study showed that post-stroke patients with AF have a more severe prognosis, although AF itself does not have an independent negative effect on long-term outcomes after stroke. Long-term survival after stroke in patients with AF was strongly associated with age, stroke severity, and heart failure. The impact of other factors on prognosis after stroke in patients with AF should be considered. Full article

(This article belongs to the Special Issue Advances in Cardiology and Vascular Health)

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11 pages, 1549 KiB

Open AccessArticle

Cardiovascular Risk in Patients with Dyslipidemia and Their Degree of Control as Perceived by Primary Care Physicians in a Survey—TERESA-Opinion Study

by Vicente Pallarés-Carratalá, Vivencio Barrios, David Fierro-González, Jose Polo-García and Sergio Cinza-Sanjurjo

Int. J. Environ. Res. Public Health 2023, 20(3), 2388; https://doi.org/10.3390/ijerph20032388 - 29 Jan 2023

Cited by 3 | Viewed by 2136

Abstract

Objective: The aim of this study was to evaluate, through a survey, the opinion of primary care (PC) physicians on the magnitude of dyslipidemia and its degree of control in their clinical practice. Materials and methods: An ecological study was carried out, in [...] Read more.

Objective: The aim of this study was to evaluate, through a survey, the opinion of primary care (PC) physicians on the magnitude of dyslipidemia and its degree of control in their clinical practice. Materials and methods: An ecological study was carried out, in which the physicians were invited to participate by means of an online letter. Data were collected at a single timepoint and were based only on the experience, knowledge, and routine clinical practice of the participating physician. Results: A total of 300 physicians answered the questionnaire and estimated the prevalence of dyslipidemia between 2% and 80%. They estimated that 23.5% of their patients were high-risk, 18.2% were very high-risk, and 14.4% had recurrent events in the last 2 years. The PC physicians considered that 61.5% of their patients achieved the targets set. The participants fixed the presence of side-effects to statins at 14%. The statin that was considered safest with regard to side-effects was rosuvastatin (69%). Conclusions: PC physicians in Spain perceive that the CVR of their patients is high. This, together with the overestimation of the degree of control of LDL-C, could justify the inertia in the treatment of lipids. Moreover, they perceive that one-sixth of the patients treated with statins have side-effects. Full article

(This article belongs to the Special Issue Advances in Cardiology and Vascular Health)

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11 pages, 504 KiB

Open AccessArticle

Thrombectomy-Capable Stroke Centre—A Key to Acute Stroke Care System Improvement? Retrospective Analysis of Safety and Efficacy of Endovascular Treatment in Cardiac Cathlab

by Krzysztof Pawłowski, Artur Dziadkiewicz, Anna Podlasek, Jacek Klaudel, Alicja Mączkowiak and Marek Szołkiewicz

Int. J. Environ. Res. Public Health 2023, 20(3), 2232; https://doi.org/10.3390/ijerph20032232 - 26 Jan 2023

Cited by 6 | Viewed by 2640

Abstract

The optimal structure of the acute ischaemic stroke treatment network is unknown and eagerly sought. To make it most effective, different treatment and transportation strategies have been developed and investigated worldwide. Since only a fraction of acute stroke patients with large vessel occlusion [...] Read more.

The optimal structure of the acute ischaemic stroke treatment network is unknown and eagerly sought. To make it most effective, different treatment and transportation strategies have been developed and investigated worldwide. Since only a fraction of acute stroke patients with large vessel occlusion are treated, a new entity—thrombectomy-capable stroke centre (TCSC)—was introduced to respond to the growing demand for timely endovascular treatment. The purpose of this study was to present the early experience of the first 70 patients treated by mechanical means in a newly developed cardiac Cathlab-based TCSC. The essential safety and efficacy measures were recorded and compared with those reported in the invasive arm of the HERMES meta-analysis—the largest published dataset on the subject. We found no significant differences in terms of clinical and safety outcomes, such as early neurological recovery, level of functional independence at 90 days, symptomatic intracranial haemorrhage, parenchymal haematoma type 2, and mortality. These encouraging results obtained in the small endovascular centre may be an argument for the introduction of the TCSC into operating stroke networks to increase patient access to timely treatment and to improve clinical outcomes. Full article

(This article belongs to the Special Issue Advances in Cardiology and Vascular Health)

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14 pages, 1334 KiB

Open AccessArticle

Forewarned Is Forearmed: Machine Learning Algorithms for the Prediction of Catheter-Induced Coronary and Aortic Injuries

by Jacek Klaudel, Barbara Klaudel, Michał Glaza, Wojciech Trenkner, Paweł Derejko and Marek Szołkiewicz

Int. J. Environ. Res. Public Health 2022, 19(24), 17002; https://doi.org/10.3390/ijerph192417002 - 18 Dec 2022

Cited by 3 | Viewed by 2288

Abstract

Catheter-induced dissections (CID) of coronary arteries and/or the aorta are among the most dangerous complications of percutaneous coronary procedures, yet the data on their risk factors are anecdotal. Logistic regression and five more advanced machine learning techniques were applied to determine the most [...] Read more.

Catheter-induced dissections (CID) of coronary arteries and/or the aorta are among the most dangerous complications of percutaneous coronary procedures, yet the data on their risk factors are anecdotal. Logistic regression and five more advanced machine learning techniques were applied to determine the most significant predictors of dissection. Model performance comparison and feature importance ranking were evaluated. We identified 124 cases of CID in electronic databases containing 84,223 records of diagnostic and interventional coronary procedures from the years 2000–2022. Based on the f1-score, Extreme Gradient Boosting (XGBoost) was found to have the optimal balance between positive predictive value (precision) and sensitivity (recall). As by the XGBoost, the strongest predictors were the use of a guiding catheter (angioplasty), small/stenotic ostium, radial access, hypertension, acute myocardial infarction, prior angioplasty, female gender, chronic renal failure, atypical coronary origin, and chronic obstructive pulmonary disease. Risk prediction can be bolstered with machine learning algorithms and provide valuable clinical decision support. Based on the proposed model, a profile of ‘a perfect dissection candidate’ can be defined. In patients with ‘a clustering’ of dissection predictors, a less aggressive catheter and/or modification of the access site should be considered. Full article

(This article belongs to the Special Issue Advances in Cardiology and Vascular Health)

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12 pages, 1148 KiB

Open AccessArticle

Incidence and Predictors of Clinically Significant Bleedings after Transcatheter Left Atrial Appendage Closure

by Kamil Zieliński, Radosław Pracoń, Marek Konka, Mariusz Kruk, Cezary Kępka, Piotr Trochimiuk, Mariusz Dębski, Edyta Kaczmarska, Jakub Przyłuski, Ilona Kowalik, Zofia Dzielińska, Andrzej Kurowski, Adam Witkowski and Marcin Demkow

Int. J. Environ. Res. Public Health 2022, 19(21), 13802; https://doi.org/10.3390/ijerph192113802 - 24 Oct 2022

Cited by 1 | Viewed by 1617

Abstract

Background: Transcatheter left atrial appendage closure (LAAC) is performed in patients unsuitable for long-term anticoagulation, predominantly due to prior bleeding events. The study aimed to investigate the incidence and predictors of clinically significant bleeding (CSB) post-LAAC. Methods: Consecutive patients after LAAC with an [...] Read more.

Background: Transcatheter left atrial appendage closure (LAAC) is performed in patients unsuitable for long-term anticoagulation, predominantly due to prior bleeding events. The study aimed to investigate the incidence and predictors of clinically significant bleeding (CSB) post-LAAC. Methods: Consecutive patients after LAAC with an Amplatzer or WATCHMAN device were analyzed (05.2014–11.2019). Bleeding was classified as CSB when associated with at least one of the following: death, ≥2 g/dL hemoglobin drop, ≥2 blood units transfusion, critical anatomic site, or hospitalization/invasive procedure. Results: Among 195 patients (age 74 (68–80), 43.1% females, HAS-BLED score 2.0 (2.0–3.0)), during median follow-up of 370 (IQR, 358–392) days, there were 15 nonprocedural CSBs in 14 (7.2%) patients. Of those, 9 (60.0%) occurred during postprocedural dual antiplatelet therapy (DAPT) (median 46 (IQR: 16–60) days post-LAAC) vs. 6 (40%) after DAPT discontinuation (median 124 (81–210) days post-LAAC), translating into annualized CSB rates of 14.0% (per patient-year on DAPT) vs. 4.6% (per patient-year without DAPT). In 92.9% (13/14) of patients, the post-LAAC nonprocedural CSB was a recurrence from the same site as bleeding pre-LAAC. In the multivariable model, admission systolic blood pressure (SBP) > 127 mmHg (HR = 10.73, 1.37–84.26, p = 0.024), epistaxis history (HR = 5.84, 1.32–25.89, p = 0.020), permanent atrial fibrillation (AF) (HR = 4.55, 1.20–17.20, p = 0.025), and prior gastrointestinal bleeding (HR = 3.35, 1.01–11.08, p = 0.048) predicted post-LAAC CSB. Conclusions: Nonprocedural CSBs after LAAC, with a similar origin as the pre-LAAC bleedings, were observed predominantly during postprocedural DAPT and predicted by elevated admission SBP, prior epistaxis, permanent AF, and gastrointestinal bleeding history. Whether a more reserved post-LAAC antiplatelet regimen and stringent blood pressure control may improve LAAC outcomes remains to be studied. Full article

(This article belongs to the Special Issue Advances in Cardiology and Vascular Health)

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11 pages, 885 KiB

Open AccessArticle

The Reduction of Left Ventricle Ejection Fraction after Multi-Vessel PCI during Acute Myocardial Infarction as a Predictor of Major Adverse Cardiac Events in Long-Term Follow-Up

by Michał Chyrchel, Tomasz Gallina, Rafał Januszek, Oskar Szafrański, Monika Gębska and Andrzej Surdacki

Int. J. Environ. Res. Public Health 2022, 19(20), 13160; https://doi.org/10.3390/ijerph192013160 - 13 Oct 2022

Cited by 4 | Viewed by 1803

Abstract

Background: Revascularisation strategy in patients with multi-vessel coronary disease and acute myocardial infarction (AMI) remains challenging. One of the potential treatment options is complete percutaneous revascularisation during index hospitalisation. This strategy could positively influence left ventricle ejection fraction (LVEF). Aim: To investigate the [...] Read more.

Background: Revascularisation strategy in patients with multi-vessel coronary disease and acute myocardial infarction (AMI) remains challenging. One of the potential treatment options is complete percutaneous revascularisation during index hospitalisation. This strategy could positively influence left ventricle ejection fraction (LVEF). Aim: To investigate the long-term changes in LVEF and clinical outcome among patients with AMI after complete coronary revascularisation (CCR). Methods: Records of 171 patients with a diagnosis of AMI and multi-vessel coronary artery disease (CAD) on index angiography, in whom CCR was performed as a staged procedure during initial hospitalisation, were analysed. Clinical data were collected from in-hospital medical records and discharge letters. Cardiac ultrasound (CU), with particular assessment of LVEF, was performed one day before discharge. Follow-up (FU) CU was collected from the out-patient department at least six months ± one week after discharge. Follow-up data, including major adverse cardiac events (MACE), were collected during follow-up visits by telephone. Depending on the LVEF change during the follow-up period, patients were divided into two groups. Patients with a decrease in the LVEF (D-LVEF group) were compared with patients with no changes (preserved) or improvement regarding LVEF (P/I-LVEF). Results: The median duration of the follow-up was 19 months (14–24 months). The median change in LVEF during observation was –5.0p% (IQR (–7.0)–(-2.75p.%)) in the D-LVEF group and +4.0% (IQR 1.0–5.0p%) in the P/I-LVEF group. Among patients in the P/I-LVEF group, there was a sub-group of patients with no change in LVEF (28 patients), and one demonstrating improvement in LVEF (104 patients). In the subgroup of patients with improved LVEF, the median change in LVEF was 4.5p% (IQR 2–6.25p%). Among patients with decreasing LVEF, there was a significantly higher risk of MACE (15 vs. 2.3%, p = 0.031), especially non-fatal AMI (10 vs. 0%, p = 0.017). We found the following among predictors concerning increased risk of MACE occurrence: urgent PCI (p = 0.004), hospitalisations regardless of cause (p = 0.028), EF worsening (p = 0.025), fasting glucose serum concentration (p = 0.024) and fasting triglyceride serum concentration (p = 0.027). Conclusions: Complete revascularisation (CR) at baseline (one stage) in patients with AMI and multi-vessel disease is associated with LVEF improvement and MACE rate reduction. Patients with worse LVEF have poor clinical outcome and a higher rate of MACE. Full article

(This article belongs to the Special Issue Advances in Cardiology and Vascular Health)

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10 pages, 1185 KiB

Open AccessArticle

Patient-Reported Quality of Life, Depression, Anxiety, and Physical Activity in Patients Receiving an Implantable Cardioverter-Defibrillator for Primary versus Secondary Prevention: A Single-Centre, Prospective, Observational Cohort Study

by Natasza Krauze, Edyta Smolis-Bąk, Ilona Kowalik and Maciej Sterliński

Int. J. Environ. Res. Public Health 2022, 19(19), 12830; https://doi.org/10.3390/ijerph191912830 - 7 Oct 2022

Cited by 2 | Viewed by 2070

Abstract

Study objectives: The aim of the study was to evaluate of the quality of life, depression, anxiety levels, and physical activity in the groups after the implantation of an ICD or CRT-D. Methods: All subjects (111 CHF patients) underwent tests to assess the [...] Read more.

Study objectives: The aim of the study was to evaluate of the quality of life, depression, anxiety levels, and physical activity in the groups after the implantation of an ICD or CRT-D. Methods: All subjects (111 CHF patients) underwent tests to assess the quality of life (NHP), the level of physical activity (IPAQ), the level of perceived stress (PSS), and the incidence of depression (BDI). Results: After the implantation, physical activity (PA) of the patients from the primary prevention (PP) group remains unchanged, whereas in the secondary prevention (SP) group, it decreases noticeably. Physical activity is lower in the SP group in comparison with the PP group. There are no statistically significant differences in the level of depression. The scores in the second part of the NHP questionnaire indicate that the SP group significantly more often declare problems with housework and with social life than the PP group. Conclusions: 1. The type of prevention does not have an influence on the level of anxiety, stress, or depression. 2. The patients after implantation as SP are physically less active; lower PA is associated additionally with the higher NYHA class and chronic kidney disease. 3. The quality of life of the patients from SP group is at a lower level than patients from PP group. Full article

(This article belongs to the Special Issue Advances in Cardiology and Vascular Health)

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13 pages, 3487 KiB

Open AccessArticle

Nine-Year Trends in Prevention of Thromboembolic Complications in Elderly Patients with Atrial Fibrillation Treated with NOACs

by Bernadetta Bielecka, Iwona Gorczyca-Głowacka and Beata Wożakowska-Kapłon

Int. J. Environ. Res. Public Health 2022, 19(19), 11938; https://doi.org/10.3390/ijerph191911938 - 21 Sep 2022

Cited by 1 | Viewed by 1910

Abstract

Background: Atrial fibrillation (AF) is the most common disease in elderly patients and thromboembolic complication prophylaxis significantly improves the prognosis in these patients. The study assessed the frequency of individual non-vitamin K antagonist oral anticoagulant (NOAC) use among patients ≥75 years and attempted [...] Read more.

Background: Atrial fibrillation (AF) is the most common disease in elderly patients and thromboembolic complication prophylaxis significantly improves the prognosis in these patients. The study assessed the frequency of individual non-vitamin K antagonist oral anticoagulant (NOAC) use among patients ≥75 years and attempted to identify factors predisposing to their prescription. Methods: The data of patients with non-valvular AF hospitalized in the reference cardiology center between 2011 and 2019 were analyzed. Results: Out of 1443 analyzed patients, 329 (22.8%) received apixaban, 618 (42.8%) dabigatran, and 496 (34.4%) rivaroxaban. The entire population mean age was 82.3 ± 5 years, and 57.9% were females. Independent predictors of apixaban use were age, and bleeding history. Hospitalization for the implantation/reimplantation of a cardiac implantable electronic device (CIED) reduced the chance of apixaban use. Hypertension was a predictor of dabigatran prescription. The chance of using dabigatran decreased with age. Hypertension and bleeding history decreased the chance of rivaroxaban application. Conclusions: In hospitalized AF patients ≥75 years, dabigatran was the most frequently used NOAC. Age, comorbidities and bleeding risk determined the selection of individual NOACs. Full article

(This article belongs to the Special Issue Advances in Cardiology and Vascular Health)

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9 pages, 1289 KiB

Open AccessArticle

Cluster Analysis to Distinguish Patients Most Likely to Benefit from Outpatient Cardiac Rehabilitation—A Prospective, Multicenter Study

by Jacek Hincz, Maciej Sterliński, Dariusz Kostrzewa, Rafał Dąbrowski and Edyta Smolis-Bąk

Int. J. Environ. Res. Public Health 2022, 19(17), 11000; https://doi.org/10.3390/ijerph191711000 - 2 Sep 2022

Cited by 1 | Viewed by 1471

Abstract

Offering cardiac rehabilitation to people who can benefit most could improve the outcomes in the context of limited availability. We used cluster analysis to distinguish three patient groups based on clinical and laboratory variables and then compared the outcomes of 6-month outpatient cardiac [...] Read more.

Offering cardiac rehabilitation to people who can benefit most could improve the outcomes in the context of limited availability. We used cluster analysis to distinguish three patient groups based on clinical and laboratory variables and then compared the outcomes of 6-month outpatient cardiac rehabilitation between these groups. The outcomes included blood pressure, blood lipids, fasting blood glucose, and uric acid concertation in serum. Group 1 consisted primarily of men with obesity, increased blood pressure, favourable lipid profiles and increased fasting glucose. Group 2 consisted of men or women with normal weight, normal blood pressure, favourable lipid profiles, and normal fasting glucose. Group 3 consisted primarily of women with overweight, normal blood pressure, unfavourable lipid profiles, and normal fasting glucose. After 6 months of cardiac rehabilitation, blood lipids improved in group 3, whereas blood pressure improved in groups 1 and 3, but the outcomes did not change significantly in group 2. We did not see any effect of cardiac rehabilitation on fasting blood glucose and serum uric acid concentration in any group. Concentrations of glucose and uric acid did not change significantly in any group. In conclusion, an adequate selection of patients should maximise the benefits of cardiac rehabilitation. Full article

(This article belongs to the Special Issue Advances in Cardiology and Vascular Health)

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11 pages, 2580 KiB

Open AccessArticle

Comparing Atrial-Fibrillation Validated Rapid Scoring Systems in the Long-Term Mortality Prediction in Patients Referred for Elective Coronary Angiography: A Subanalysis of the Białystok Coronary Project

by Ewelina Rogalska, Anna Kurasz, Łukasz Kuźma, Hanna Bachórzewska-Gajewska, Sławomir Dobrzycki, Marek Koziński, Bożena Sobkowicz and Anna Tomaszuk-Kazberuk

Int. J. Environ. Res. Public Health 2022, 19(16), 10419; https://doi.org/10.3390/ijerph191610419 - 21 Aug 2022

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Abstract

Rapid scoring systems validated in patients with atrial fibrillation (AF) may be useful beyond their original purpose. Our aim was to assess the utility of CHA₂DS₂-VASc, HAS–BLED, and 2MACE scores in predicting long-term mortality in the population of the [...] Read more.

Rapid scoring systems validated in patients with atrial fibrillation (AF) may be useful beyond their original purpose. Our aim was to assess the utility of CHA₂DS₂-VASc, HAS–BLED, and 2MACE scores in predicting long-term mortality in the population of the Białystok Coronary Project, including AF patients. The initial study population consisted of 7409 consecutive patients admitted for elective coronary angiography between 2007 and 2016. The study endpoint was all-cause mortality, which occurred in 1244 (16.8%) patients during the follow-up, ranging from 1283 to 3059 days (median 2029 days). We noticed substantially increased all-cause mortality in patients with higher values of all compared scores. The accuracy of the scores in predicting all-cause mortality was also assessed using the receiver operator characteristic (ROC) curves. The greatest predictive value for mortality was recorded for the CHA₂DS₂-VASc score in the overall study population (area under curve [AUC] = 0.665; 95% confidence interval [95%CI] 0.645–0.681). We observed that the 2MACE score (AUC = 0.656; 95%CI 0.619–0.681), but not the HAS–BLED score, had similar predictive value to the CHA₂DS₂-VASc score for all-cause mortality in the overall study population. In AF patients, all scores did not differ in all-cause mortality prediction. Additionally, we found that study participants with CHA₂DS₂-VASc score ≥3 vs. <3 had a 3-fold increased risk of long-term all-cause mortality (odds ratio 3.05; 95%CI 2.6–3.6). Our study indicates that clinical scores initially validated in AF patients may be useful for predicting mortality in a broader population (e.g., in patients referred for elective coronary angiography). According to our findings, all compared scores have a moderate predictive value. However, in our study, the CHA₂DS₂-VASc and 2MACE scores outperformed the HAS–BLED score in terms of the long-term all-cause mortality prediction. Full article

(This article belongs to the Special Issue Advances in Cardiology and Vascular Health)

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11 pages, 952 KiB

Open AccessArticle

Contact Laxative Use and the Risk of Arteriovenous Fistula Maturation Failure in Patients Undergoing Hemodialysis: A Multi-Center Cohort Study

by Trung Hoang Anh, Phung-Anh Nguyen, Anh Duong, I-Jen Chiu, Chu-Lin Chou, Yu-Chen Ko, Tzu-Hao Chang, Chih-Wei Huang, Mai-Szu Wu, Chia-Te Liao and Yung-Ho Hsu

Int. J. Environ. Res. Public Health 2022, 19(11), 6842; https://doi.org/10.3390/ijerph19116842 - 3 Jun 2022

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Abstract

Laxatives are commonly prescribed for constipation management; however, they are recognized as an independent factor associated with cardiovascular diseases. Arteriovenous fistula (AVF) is the closest to the ideal model of hemodialysis (HD) vascular access and part of the cardiovascular system. Our study aims [...] Read more.

Laxatives are commonly prescribed for constipation management; however, they are recognized as an independent factor associated with cardiovascular diseases. Arteriovenous fistula (AVF) is the closest to the ideal model of hemodialysis (HD) vascular access and part of the cardiovascular system. Our study aims to explore the association of contact laxative use with AVF maturation outcomes in patients undergoing HD. We conducted a multi-center cohort study of 480 contact laxative users and 472 non-users who had undergone initial AVF creation. All patients were followed until the outcomes of AVF maturation were confirmed. Multivariable logistic regression models were performed to evaluate the risk of AVF maturation failure imposed by laxatives. Here, we found that patients who used contact laxatives were significantly associated with an increased risk of AVF maturation failure compared to non-users (adjusted odds ratio, 1.64; p = 0.003). Notably, the risk of AVF maturation failure increased when increasing their average daily doses and cumulative treatment days. In conclusion, our study found a significant dose- and duration-dependent relationship between contact laxative use and an increased risk of AVF maturation failure. Thus, laxatives should be prescribed with caution in this population. Further studies are needed to validate these observations and investigate the potential mechanisms. Full article

(This article belongs to the Special Issue Advances in Cardiology and Vascular Health)

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13 pages, 694 KiB

Open AccessArticle

Safety and Effectiveness of Transvenous Lead Extraction in Patients with Infected Cardiac Resynchronization Therapy Devices; Is It More Risky than Extraction of Other Systems?

by Paweł Stefańczyk, Dorota Nowosielecka, Anna Polewczyk, Łukasz Tułecki, Konrad Tomków, Wojciech Jacheć, Ewa Lewicka, Andrzej Tomaszewski and Andrzej Kutarski

Int. J. Environ. Res. Public Health 2022, 19(10), 5803; https://doi.org/10.3390/ijerph19105803 - 10 May 2022

Cited by 3 | Viewed by 1658

Abstract

Background: Transvenous lead extraction (TLE) in patients with implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy (CRT) devices is considered as more risky. The aim of this study was to assess the safety and effectiveness of TLE in patients with infected CRT systems. [...] Read more.

Background: Transvenous lead extraction (TLE) in patients with implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy (CRT) devices is considered as more risky. The aim of this study was to assess the safety and effectiveness of TLE in patients with infected CRT systems. Methods: Data of 3468 patients undergoing TLE in a single high-volume center in years 2006–2021 were analyzed. The clinical and procedural parameters as well as the efficacy and safety of TLE were compared between patients with infected CRT and pacemakers (PM) and ICD systems. Results: Infectious indications for TLE occurred in 1138 patients, including 150 infected CRT (112 CRT-D and 38 CRT-P). The general health condition of CRT patients was worse with higher Charlson’s comorbidity index. The number of extracted leads was higher in the CRT group, but implant duration was significantly longer in the PM than in the ICD and CRT groups (98.93 vs. 55.26 vs. 55.43 months p < 0.01). The procedure was longer in duration, more difficult, and more complex in patients with pacemakers than in those in the CRT group. The occurrence of major complications and clinical and procedural success as well as procedure-related death did not show any relationship to the type of CIED device. Mortality at more than one-year follow-up after TLE was significantly higher among patients with CRT devices (22.7% vs. 8.7%) than among those in the PM group. Conclusion: Despite the greater burden of lead and comorbidities, the complexity and efficiency of removing infected CRT systems is no more dangerous than removing other infected systems. The duration of the implant seems to play a dominant role. Full article

(This article belongs to the Special Issue Advances in Cardiology and Vascular Health)

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10 pages, 1765 KiB

Open AccessArticle

Pharmacological Cardioversion in Patients with Recent-Onset Atrial Fibrillation and Chronic Kidney Disease Subanalysis of the CANT II Study

by Beata Ceynowa-Sielawko, Maciej T. Wybraniec, Aleksandra Topp-Zielińska, Aleksander Maciąg, Dawid Miśkowiec, Paweł Balsam, Maciej Wójcik, Wojciech Wróbel, Michał M. Farkowski, Edyta Ćwiek-Rębowska, Krzysztof Ozierański, Robert Błaszczyk, Karolina Bula, Tomasz Dembowski, Michał Peller, Bartosz Krzowski, Wojciech Wańha, Marek Koziński, Jarosław D. Kasprzak, Hanna Szwed, Katarzyna Mizia-Stec and Marek Szołkiewicz Show full author list Hide full author list

Int. J. Environ. Res. Public Health 2022, 19(8), 4880; https://doi.org/10.3390/ijerph19084880 - 17 Apr 2022

Cited by 3 | Viewed by 2065

Abstract

Pharmacological cardioversion (PCV) is commonly a primary option for termination of recent-onset atrial fibrillation (AF) in emergency departments (ED). This is a subanalysis of the CANT II study, evaluating the effectiveness and safety of antazoline in patients (n = 777) at three [...] Read more.

Pharmacological cardioversion (PCV) is commonly a primary option for termination of recent-onset atrial fibrillation (AF) in emergency departments (ED). This is a subanalysis of the CANT II study, evaluating the effectiveness and safety of antazoline in patients (n = 777) at three stages of chronic kidney disease (CKD): Group I > 60 mL/min (n = 531), Group II 45–59 mL/min (n = 149), and Group III < 45 mL/min (n = 97). Patients in Group III were older and with a higher prevalence of co-morbidities; however, we did not find statistically significant differences in the overall effectiveness of PCV in comparison with the other groups. In patients receiving amiodarone, the PCV success rate was similar in all the studied groups, but along with a renal function decline, it decreased in patients receiving antazoline (79.1 vs. 35%; p < 0.001), and it increased almost significantly in patients receiving propafenone (69.9 vs. 100%; p = 0.067). In patients in Group I, antazoline restored a sinus rhythm as effectively as propafenone and amiodarone; however, in patients in Group III, both antazoline and amiodarone became less effective in restoring a sinus rhythm than propafenone (p = 0.002 and p = 0.034, respectively). The rate of safety endpoint was the highest in patients in Group III (eGFR < 45 mL/min), and it was significantly higher than in patients in Groups I and II (p = 0.008 and p = 0.036, respectively). We did not observe antazoline-related adverse events in any of the studied groups of patients. This real-world registry analysis revealed a different influence of CKD on the effectiveness of individual drugs, and while propafenone and amiodarone maintained their AF termination efficacy, antazoline became significantly less effective in restoring sinus rhythm. Full article

(This article belongs to the Special Issue Advances in Cardiology and Vascular Health)

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12 pages, 1217 KiB

Open AccessArticle

Optimal Management of Patients with Severe Coronary Artery Disease following Multidisciplinary Heart Team Approach—Insights from Tertiary Cardiovascular Care Center

by Szymon Jonik, Michał Marchel, Ewa Pędzich-Placha, Arkadiusz Pietrasik, Adam Rdzanek, Zenon Huczek, Janusz Kochman, Monika Budnik, Radosław Piątkowski, Piotr Scisło, Paweł Czub, Radosław Wilimski, Jakub Maksym, Marcin Grabowski, Grzegorz Opolski and Tomasz Mazurek

Int. J. Environ. Res. Public Health 2022, 19(7), 3933; https://doi.org/10.3390/ijerph19073933 - 25 Mar 2022

Cited by 5 | Viewed by 2910

Abstract

Background: The purpose of this retrospective study was to investigate outcomes of patients with severe coronary artery disease (CAD) after implementing various treatment strategies following multidisciplinary Heart Team (MHT) discussion. Methods Primary and secondary endpoints and quality of life during a mean (SD) [...] Read more.

Background: The purpose of this retrospective study was to investigate outcomes of patients with severe coronary artery disease (CAD) after implementing various treatment strategies following multidisciplinary Heart Team (MHT) discussion. Methods Primary and secondary endpoints and quality of life during a mean (SD) follow-up of 37 (14) months of patients with severe CAD (three-vessel [3-VD] or/and left main [LM] disease) qualified after MHT discussion to optimal medical treatment (OMT) alone, OMT and coronary artery bypass grafting (CABG), or OMT and percutaneous coronary intervention (PCI) were evaluated. As the primary endpoint, major adverse cardiac or cerebrovascular events (MACCE) (i.e., death from any cause, stroke, myocardial infarction, or repeat/need for revascularization) were considered. Result: From 2016 to 2019, 176 MHT meetings were held, and a total of 1286 participants with severe CAD and completely implemented MHT decisions (OMT, CABG, or PCI for 251, 356, and 679 patients, respectively) were included. The occurrence of the primary endpoint was significantly increased in OMT-group (154 (61.4%) vs. CABG and PCI groups—110 (30.9%) and 302 (44.5%) patients, respectively (p < 0.05). For interventional strategies only—CABG was associated with reduced rates of MACCE and repeat revascularization, while the superiority of PCI for stroke and disabling stroke was observed (p < 0.05). The general health status assessed at the end of the follow-up was significantly better for patients who underwent CABG or PCI than in the OMT group (p < 0.05). Conclusions: In this real-life study, we presented a single-center experience of providing optimal medical care for patients with severe CAD following MHT discussion. Full article

(This article belongs to the Special Issue Advances in Cardiology and Vascular Health)

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12 pages, 651 KiB

Open AccessArticle

ARNI in HFrEF—One-Centre Experience in the Era before the 2021 ESC HF Recommendations

by Rafał Niemiec, Irmina Morawska, Maria Stec, Wiktoria Kuczmik, Andrzej S. Swinarew, Arkadiusz Stanula and Katarzyna Mizia-Stec

Int. J. Environ. Res. Public Health 2022, 19(4), 2089; https://doi.org/10.3390/ijerph19042089 - 13 Feb 2022

Cited by 1 | Viewed by 3383

Abstract

Background: Sacubitril/valsartan, an angiotensin receptor–neprilysin inhibitor (ARNI), has demonstrated a survival benefit and reduces heart failure hospitalization in patients with heart failure with reduced left ventricular ejection fraction (HFrEF); however, our experience in this field is limited. This study aimed to summarize a [...] Read more.

Background: Sacubitril/valsartan, an angiotensin receptor–neprilysin inhibitor (ARNI), has demonstrated a survival benefit and reduces heart failure hospitalization in patients with heart failure with reduced left ventricular ejection fraction (HFrEF); however, our experience in this field is limited. This study aimed to summarize a real clinical practice of the use of ARNI in HFrEF patients hospitalized due to HFrEF in the era before the 2021 ESC HF recommendations, as well as assess their clinical outcome with regard to ARNI administration. Methods and Materials: Overall, 613 patients with HFrEF hospitalized in 2018–2020 were enrolled into a retrospective one-centre cross-sectional analysis. The study population was categorized into patients receiving (82/13.4%) and not-receiving (531/82.6%) ARNI. Clinical outcomes defined as rehospitalization, number of rehospitalizations, time to the first rehospitalization and death from any cause were analysed in the 1–2 year follow-up in the ARNI and non-ARNI groups, matched as to age and LVEF. Results: Clinical characteristics revealed the following differences between ARNI and non-ARNI groups: A higher percentage of cardiovascular implantable electronic devices (CIED) (p = 0.014) and defibrillators with cardiac resynchronization therapy (CRT-D) (p = 0.038), higher frequency of atrial fibrillation (p = 0.002) and history of stroke (p = 0.024) were in the ARNI group. The percentage of patients with HFrEF NYHA III/IV presented an increasing trend to be higher in the ARNI (64.1%) as compared to the non-ARNI group (51.5%, p = 0.154). Incidence of rehospitalization, number of rehospitalizations and time to the first rehospitalization were comparable between the groups. There were no differences between the numbers of deaths of any cause in the ARNI (28%) and non-ARNI (28%) groups. The independent negative predictor of death in the whole population of ARNI and non-ARNI groups was the coexistence of coronary artery disease (CAD) (beta= −0.924, HR 0.806, p = 0.011). Conclusions: Our current positive experience in ARNI therapy is limited to extremely severe patients with HFrEF. Regardless of the more advanced HF and HF comorbidities, the patients treated with ARNI presented similar mortality and rehospitalizations as the patients treated by standard therapy. Full article

(This article belongs to the Special Issue Advances in Cardiology and Vascular Health)

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Review

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20 pages, 901 KiB

Open AccessReview

Heart Failure with Improved Ejection Fraction: Insight into the Variable Nature of Left Ventricular Systolic Function

by Maciej T. Wybraniec, Michał Orszulak, Klaudia Męcka and Katarzyna Mizia-Stec

Int. J. Environ. Res. Public Health 2022, 19(21), 14400; https://doi.org/10.3390/ijerph192114400 - 3 Nov 2022

Cited by 13 | Viewed by 5713

Abstract

The progress of contemporary cardiovascular therapy has led to improved survival in patients with myocardial disease. However, the development of heart failure (HF) represents a common clinical challenge, regardless of the underlying myocardial pathology, due to the severely impaired quality of life and [...] Read more.

The progress of contemporary cardiovascular therapy has led to improved survival in patients with myocardial disease. However, the development of heart failure (HF) represents a common clinical challenge, regardless of the underlying myocardial pathology, due to the severely impaired quality of life and increased mortality comparable with malignant neoplasms. Left ventricular ejection fraction (LVEF) is the main index of systolic function and a key predictor of mortality among HF patients, hence its improvement represents the main indicator of response to instituted therapy. The introduction of complex pharmacotherapy for HF, increased availability of cardiac-implantable electronic devices and advances in the management of secondary causes of HF, including arrhythmia-induced cardiomyopathy, have led to significant increase in the proportion of patients with prominent improvement or even normalization of LVEF, paving the way for the identification of a new subgroup of HF with an improved ejection fraction (HFimpEF). Accumulating data has indicated that these patients share far better long-term prognoses than patients with stable or worsening LVEF. Due to diverse HF aetiology, the prevalence of HFimpEF ranges from roughly 10 to 40%, while the search for reliable predictors and genetic associations corresponding with this clinical presentation is under way. As contemporary guidelines focus mainly on the management of HF patients with clearly defined LVEF, the present review aimed to characterize the definition, epidemiology, predictors, clinical significance and principles of therapy of patients with HFimpEF. Full article

(This article belongs to the Special Issue Advances in Cardiology and Vascular Health)

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12 pages, 2031 KiB

Open AccessReview

Safety and Efficacy of DOACs in Patients with Advanced and End-Stage Renal Disease

by Sylwester Rogula, Aleksandra Gąsecka, Tomasz Mazurek, Eliano Pio Navarese, Łukasz Szarpak and Krzysztof J. Filipiak

Int. J. Environ. Res. Public Health 2022, 19(3), 1436; https://doi.org/10.3390/ijerph19031436 - 27 Jan 2022

Cited by 17 | Viewed by 5893

Abstract

The prevalence of chronic kidney disease (CKD) is increasing due to the aging of the population and multiplication of risk factors, such as hypertension, arteriosclerosis and obesity. Impaired renal function increases both the risk of bleeding and thrombosis. There are two groups of [...] Read more.

The prevalence of chronic kidney disease (CKD) is increasing due to the aging of the population and multiplication of risk factors, such as hypertension, arteriosclerosis and obesity. Impaired renal function increases both the risk of bleeding and thrombosis. There are two groups of orally administered drugs to prevent thromboembolic events in patients with CKD who require anticoagulation: vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs). Although VKAs remain the first-line treatment in patients with advanced CKD, treatment with VKAs is challenging due to difficulties in maintaining the appropriate anticoagulation level, tendency to accelerate vascular calcification and faster progression of CKD in patients treated with VKAs. On the other hand, the pleiotropic effect of DOACs, including vascular protection and anti-inflammatory properties along with comparable efficacy and safety of treatment with DOACs, compared to VKAs observed in preliminary reports encourages the use of DOACs in patients with CKD. This review summarizes the available data on the efficacy and safety of DOACs in patients with CKD and provides recommendations regarding the choice of the optimal drug and dosage depending on the CKD stage. Full article

(This article belongs to the Special Issue Advances in Cardiology and Vascular Health)

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Other

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5 pages, 960 KiB

Open AccessCase Report

Leadless AV Pacemaker in Patient with Complete Heart Block and Bilaterally Implanted Two Deep Brain Stimulators Can Be Safe Therapeutic Option

by Jędrzej Michalik, Jonasz Kozielski, Mateusz Węclewicz, Roman Moroz, Maciej Sterliński and Marek Szołkiewicz

Int. J. Environ. Res. Public Health 2023, 20(1), 388; https://doi.org/10.3390/ijerph20010388 - 26 Dec 2022

Cited by 2 | Viewed by 1438

Abstract

There are reports documenting that electromagnetic waves generated by deep brain stimulation devices can interfere with cardiac pacemakers. This might be even a life-threatening problem in cardiac pacemaker-dependent patients. Herein, we present a case report on a patient with bilaterally implanted deep brain [...] Read more.

There are reports documenting that electromagnetic waves generated by deep brain stimulation devices can interfere with cardiac pacemakers. This might be even a life-threatening problem in cardiac pacemaker-dependent patients. Herein, we present a case report on a patient with bilaterally implanted deep brain stimulation devices, who concomitantly had the indications for permanent cardiac pacing. The report shows that a leadless AV pacemaker may be a safe and reasonable option in these cases. Full article

(This article belongs to the Special Issue Advances in Cardiology and Vascular Health)

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5 pages, 1713 KiB

Open AccessCase Report

A Successful Heart Transplantation Coupled with Temporary Right Ventricular Assist Device Implantation in a Patient with (ir)Reversible Pulmonary Hypertension

by Agnieszka Dyla, Wojciech Mielnicki, Jacek Waszak, Hubert Szurmiak, Krystian Jakimowicz, Roch Pakuła and Michał Oskar Zembala

Int. J. Environ. Res. Public Health 2022, 19(19), 12206; https://doi.org/10.3390/ijerph191912206 - 26 Sep 2022

Viewed by 1508

Abstract

Pulmonary hypertension (PH) constitutes one of the main contraindications to heart transplantation (OHT), and elevated pulmonary vascular resistance (PVR) is associated with high risk of posttransplant right heart failure (RVF). In the present case report, a patient with PH is introduced who qualified [...] Read more.

Pulmonary hypertension (PH) constitutes one of the main contraindications to heart transplantation (OHT), and elevated pulmonary vascular resistance (PVR) is associated with high risk of posttransplant right heart failure (RVF). In the present case report, a patient with PH is introduced who qualified for heart lung transplantation (HLT) and underwent successful OHT with temporary right ventricle assist device (tRVAD) due to the lack of a suitable heart-lung donor. Temporary RVAD support coupled with optimal medical management may help reverse pulmonary vascular resistance, which was previously deemed as permanent in patients requiring heart transplantation. Full article

(This article belongs to the Special Issue Advances in Cardiology and Vascular Health)

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