Editorial

2 pages, 159 KiB

Open AccessEditorial

Forging Ahead in Cardiovascular Disease Management

by Justyna Domienik-Karlowicz and Michał Ciurzynski

J. Clin. Med. 2023, 12(17), 5739; https://doi.org/10.3390/jcm12175739 - 03 Sep 2023

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The common threat of cardiovascular diseases (CVDs) constantly holds a dominant position among the leading causes of global mortality [...] Full article

(This article belongs to the Special Issue Advances in the Management of Cardiovascular Disease)

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10 pages, 535 KiB

Open AccessArticle

Electrocardiogram, Echocardiogram and NT-proBNP in Screening for Thromboembolism Pulmonary Hypertension in Patients after Pulmonary Embolism

by Olga Dzikowska-Diduch, Katarzyna Kurnicka, Barbara Lichodziejewska, Iwona Dudzik-Niewiadomska, Michał Machowski, Marek Roik, Małgorzata Wiśniewska, Jan Siwiec, Izabela Magdalena Staniszewska and Piotr Pruszczyk

J. Clin. Med. 2022, 11(24), 7369; https://doi.org/10.3390/jcm11247369 - 12 Dec 2022

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Abstract

Background: The annual mortality of patients with untreated chronic thromboembolism pulmonary hypertension (CTEPH) is approximately 50% unless a timely diagnosis is followed by adequate treatment. In pulmonary embolism (PE) survivors with functional limitation, the diagnostic work-up starts with echocardiography. It is followed by [...] Read more.

Background: The annual mortality of patients with untreated chronic thromboembolism pulmonary hypertension (CTEPH) is approximately 50% unless a timely diagnosis is followed by adequate treatment. In pulmonary embolism (PE) survivors with functional limitation, the diagnostic work-up starts with echocardiography. It is followed by lung scintigraphy and right heart catheterization. However, noninvasive tests providing diagnostic clues to CTEPH, or ascertaining this diagnosis as very unlikely, would be extremely useful since the majority of post PE functional limitations are caused by deconditioning. Methods: Patients after acute PE underwent a structured clinical evaluation with electrocardiogram, routine laboratory tests including NT-proBNP and echocardiography. The aim of this study was to verify whether the parameters from echocardiographic or perhaps electrocardiographic examination and NT-proBNP concentration best determine the risk of CTEPH. Results: Out of the total number of patients (n = 261, male n = 123) after PE who were included in the study, in the group of 155 patients (59.4%) with reported functional impairment, 13 patients (8.4%) had CTEPH and 7 PE survivors had chronic thromboembolic pulmonary disease (CTEPD) (4.5%). Echo parameters differed significantly between CTEPH/CTEPD cases and other symptomatic PE survivors. Patients with CTEPH/CTEPD also had higher levels of NT-proBNP (p = 0.022) but concentration of NT-proBNP above 125 pg/mL did not differentiate patients with CTEPH/CTEPD (p > 0.05). Additionally, the proportion of patients with right bundle brunch block registered in ECG was higher in the CTEPH/CTED group (23.5% vs. 5.8%, p = 0.034) but there were no differences between the other ECG characteristics of right ventricle overload. Conclusions: Screening for CTEPH/CTEPD should be performed in patients with reduced exercise tolerance compared to the pre PE period. It is not effective in asymptomatic PE survivors. Patients with CTEPH/CTED predominantly had abnormalities indicating chronic thromboembolism in the echocardiographic assessment. NT-proBNP and electrocardiographic characteristics of right ventricle overload proved to be insufficient in predicting CTEPH/CTEPD development. Full article

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9 pages, 508 KiB

Open AccessArticle

Decreased Haemoglobin Level Measured at Admission Predicts Long Term Mortality after the First Episode of Acute Pulmonary Embolism

by Aleksandra Justyna, Olga Dzikowska-Diduch, Szymon Pacho, Michał Ciurzyński, Marta Skowrońska, Anna Wyzgał-Chojecka, Dorota Piotrowska-Kownacka, Katarzyna Pruszczyk, Szymon Pucyło, Aleksandra Sikora and Piotr Pruszczyk

J. Clin. Med. 2022, 11(23), 7100; https://doi.org/10.3390/jcm11237100 - 30 Nov 2022

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Abstract

Background: Decreased hemoglobin concentration was reported to predict long term prognosis in patients various cardiovascular diseases including congestive heart failure and coronary artery disease. We hypothesized that hemoglobin levels may be useful for post discharge prognostication after the first episode of acute pulmonary [...] Read more.

Background: Decreased hemoglobin concentration was reported to predict long term prognosis in patients various cardiovascular diseases including congestive heart failure and coronary artery disease. We hypothesized that hemoglobin levels may be useful for post discharge prognostication after the first episode of acute pulmonary embolism. Therefore, the aim of the current study was to evaluate a potential prognostic value of a decreased hemoglobin levels measured at admission due to the first episode of acute PE for post discharge all cause mortality during at least 2 years follow up. Methods: This was a prospective, single-center, follow-up, observational, cohort study of consecutive survivors of the first PE episode. Patients were managed according to ESC current guidelines. After the discharge, all PE survivors were followed for at least 24 months in our outpatient clinic. Results: During 2 years follow-up from the group of 402 consecutive PE survivors 29 (7.2%) patients died. Non-survivors were older than survivors 81 years (40–93) vs. 63 years (18–97) p < 0.001 presented higher sPESI 2 (0–4) vs. 1 (0–5), p < 0.001 driven by a higher frequency of neoplasms (37.9% vs. 16.6%, p < 0.001); and had lower hemoglobin (Hb) level at admission 11.7 g/dL (6–14.8) vs. 13.1 g/dL (3.1–19.3), p < 0.001. Multivariable analysis showed that only Hb and age significantly predicted all cause post-discharge mortality. ROC analysis for all cause mortality showed AUC for hemoglobin 0.688 (95% CI 0.782–0.594), p < 0.001; and for age 0.735 (95% CI 0.651–0.819) p < 0.001. A group of 59 subjects with hemoglobin < 10.5 g/dL showed mortality rate of 16.9% (OR for mortality 4.19 (95% CI 1.82–9.65), p-value < 0.00, while among 79 patients with Hb > 14.3 g/dL only one death was detected. Interestingly, patients in age > 64 years hemoglobin levels < 13.2 g/dL compared to patients in the same age but with >13.2 g/dL showed OR 3.6 with 95% CI 1.3–10.1 p = 0.012 for death after the discharge. Conclusions: Lower haemoglobin measured in the acute phase especially in patients in age above 64 years showed significant impact on the prognosis and clinical outcomes in PE survivors. Full article

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10 pages, 1549 KiB

Open AccessArticle

The Path of a Cardiac Patient—From the First Symptoms to Diagnosis to Treatment: Experiences from the Tertiary Care Center in Poland

by Przemysław Seweryn Kasiak, Barbara Buchalska, Weronika Kowalczyk, Krzysztof Wyszomirski, Bartosz Krzowski, Marcin Grabowski and Paweł Balsam

J. Clin. Med. 2022, 11(18), 5276; https://doi.org/10.3390/jcm11185276 - 07 Sep 2022

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Abstract

Cardiovascular diseases (CVDs) are major concerns in the healthcare system. An individual diagnostic approach and personalized therapy are key areas of an effective therapeutic process. The major aims of this study were: (1) to assess leading patient problems related to symptoms, diagnosis, and [...] Read more.

Cardiovascular diseases (CVDs) are major concerns in the healthcare system. An individual diagnostic approach and personalized therapy are key areas of an effective therapeutic process. The major aims of this study were: (1) to assess leading patient problems related to symptoms, diagnosis, and treatment of CVDs, (2) to examine patients’ opinions about the healthcare system in Poland, and (3) to provide a proposal of practical solutions. The 27-point author’s questionnaire was distributed in the Cardiology Department of the Tertiary Care Centre between 2nd September–13th November 2021. A total of 132 patients were recruited, and 82 (62.12%; n_male = 37, 45.12%; n_female = 45, 54.88%) was finally included. The most common CVDs were arrhythmias and hypertension (both n = 43, 52.44%). 23 (28.05%) patients had an online appointment. Of the patients, 66 (80.49%) positively assessed and obtained treatment, while 11 (13.41%) patients declared they received a missed therapy. The participants identified: (1) waiting time (n = 31; 37.80%), (2) diagnostic process (n = 18; 21.95%), and (3) high price with limited availability of drugs (n = 12; 14.63%) as the areas that needed the strongest improvement. Younger patients more often negatively assessed doctor visits (30–40 yr.; p = 0.02) and hospital interventions (40–50 yr.; p = 0.008). Older patients (50–60 years old) less often negatively assessed the therapeutic process (p = 0.01). The knowledge of the factors determining patient adherence to treatment and satisfaction by Medical Professionals is crucial in providing effective treatment. Areas that require the strongest improvement are: (1) waiting time for an appointment and diagnosis, (2) limited availability and price of drugs, and (3) prolonged, complicated diagnostic process. Providing practical solutions is a crucial aspect of improving CVDs therapy. Full article

(This article belongs to the Special Issue Advances in the Management of Cardiovascular Disease)

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14 pages, 2434 KiB

Open AccessArticle

Prevalence of Cigarette Smoking among Professionally Active Adult Population in Poland and Its Strong Relationship with Cardiovascular Co-Morbidities-POL-O-CARIA 2021 Study

by Anna Rulkiewicz, Iwona Pilchowska, Wojciech Lisik, Piotr Pruszczyk and Justyna Domienik-Karłowicz

J. Clin. Med. 2022, 11(14), 4111; https://doi.org/10.3390/jcm11144111 - 15 Jul 2022

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Abstract

Smoking is a leading cause of preventable mortality. It affects both the health and economic situation within societies. The aim of the study is to perform an epidemiological analysis of smoking among professionally active adults in Poland in the years 2016–2020 and its [...] Read more.

Smoking is a leading cause of preventable mortality. It affects both the health and economic situation within societies. The aim of the study is to perform an epidemiological analysis of smoking among professionally active adults in Poland in the years 2016–2020 and its Strong Relationship with Cardiovascular Co-morbidities. The article retrospectively analyzed the records of 1,450,455 who underwent occupational medicine examinations between 2016 and 2020. Statistical analyses performed using IBM SPSS Statistics 25 software were performed. In general, irrespective of the year of measurement, 11.6% of women and 17.1% of men declared smoking. After sorting by year of measurement, we found that the percentage of female smokers was decreasing, while that of males remained relatively consistent. In the case of BMI, it was found that among tobacco smokers the percentage of people with normal body weight decreases with successive years of measurement, while the percentage of overweight and level I obesity increases. Moreover, we analyzed in detail the occurrence of particular comorbidities in the group of people who declared smoking. The most common diseases in this group were: arterial hypertension (39%), lipid disorders (26.7%), and hypertension and lipid disorders (16.5%). Active preventive measures are necessary to reduce the number of smokers and the negative impact of smoking on the occurrence of comorbid diseases. Full article

(This article belongs to the Special Issue Advances in the Management of Cardiovascular Disease)

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13 pages, 1379 KiB

Open AccessArticle

Prevalence of Obesity and Severe Obesity among Professionally Active Adult Population in Poland and Its Strong Relationship with Cardiovascular Co-Morbidities-POL-O-CARIA 2016–2020 Study

by Anna Rulkiewicz, Iwona Pilchowska, Wojciech Lisik, Piotr Pruszczyk, Michał Ciurzyński and Justyna Domienik-Karłowicz

J. Clin. Med. 2022, 11(13), 3720; https://doi.org/10.3390/jcm11133720 - 27 Jun 2022

Cited by 6 | Viewed by 1471

Abstract

For several decades, a steady increase in the percentage of overweight and obese people has been observed all over the world. There are many studies available in the literature emphasizing the relationship of overweight and obesity with the occurrence of other diseases. The [...] Read more.

For several decades, a steady increase in the percentage of overweight and obese people has been observed all over the world. There are many studies available in the literature emphasizing the relationship of overweight and obesity with the occurrence of other diseases. The aim of this study is to characterize the prevalence of obesity and severe obesity, as well as their changes over time, among professionally active adults who underwent occupational medicine examinations in Poland in 2016–2020, for the POL-O-CARIA 2016–2020 study. In total, the results of 1,450,455 initial, control and periodic visits as part of the occupational medicine certificate were analyzed. Statistical calculations were performed with the use of IBM SPSS Statistics 25. In both groups (men/women), a significant decrease was observed every year for people who had normal body weight. In addition, the tendency to increase in people with I and III degrees of obesity was more strongly observed in the male group. A significant relationship was also observed between BMI categories and the occurrence of all analyzed comorbidities: hypertension, type 2 diabetes, lipid disorders and coronary artery disease (chi² (70) = 12,228.11; p < 0.001). Detailed results showed that in the group of patients diagnosed with hypertension or lipid disorders, significant differences were observed between all groups; it turned out that as the BMI level increased (I, I, III), there was an increase in the percentage of occurrence of hypertension (38.1%, 41% and 45.3%, respectively) and type 2 diabetes (3.2%, 4.6% and 5.8%, respectively) (p < 0.001). Our analysis indicates that the prevalence of adult obesity and severe obesity will continue to increase nationwide, with an accompanying large increase in comorbidities. Full article

(This article belongs to the Special Issue Advances in the Management of Cardiovascular Disease)

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7 pages, 743 KiB

Open AccessArticle

Transversal Arch Clamping for Complete Resection of Aneurysms of the Distal Ascending Aorta without Open Anastomosis

by Andreas Rukosujew, Arash Motekallemi, Konrad Wisniewski, Raluca Weber, Fernando De Torres-Alba, Abdulhakim Ibrahim, Raphael Weiss, Sven Martens and Angelo Maria Dell’Aquila

J. Clin. Med. 2022, 11(10), 2698; https://doi.org/10.3390/jcm11102698 - 10 May 2022

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Abstract

Background: The extent of aortic replacement for aneurysms of the distal ascending aorta remains controversial and opinions vary between standard cross-clamp resection and open hemiarch anastomosis in circulatory arrest and selective cerebral perfusion. As the deleterious effects of extended circulatory arrest are well-known, [...] Read more.

Background: The extent of aortic replacement for aneurysms of the distal ascending aorta remains controversial and opinions vary between standard cross-clamp resection and open hemiarch anastomosis in circulatory arrest and selective cerebral perfusion. As the deleterious effects of extended circulatory arrest are well-known, borderline indication for distal ascending aorta aneurysm repair must be outweighed against the potential risk of complications related to the open anastomosis. In the present study, we describe our own approach consisting of “transversal arch clamping” for exhaustive resection of aneurysms of the distal ascending aorta without open anastomosis and we present the postoperative outcomes. Methods: Between May 2017 and December 2019, 35 patients with aneurysm of the ascending aorta (20 male, 15 female) underwent replacement with repair of the lesser curvature without circulatory arrest. Pre-operative, intraoperative, and postoperative clinical outcomes were retrospectively withdrawn from our institutional database and analyzed. Results: Maximal diameter of distal ascending aorta was 47.5 mm. Patient median age was 66 years (IQR 14) (range 42–86). Preoperative logistic median EuroSCORE II was 17% (IQR 11.3). Median duration of cardiopulmonary bypass and cardiac arrest were 137 (IQR 64) and 93 (IQR 59) min, respectively. In-hospital and 30-day mortality were 0%. There were no cases with acute low output syndrome, surgical re-exploration for bleeding, kidney injury requiring dialysis, or wound infection. Disabling stroke was observed in one patient (2.9%). There was one case of major ventricular arrhythmia (2.9%). Conclusions: Our institutional experience suggests that this novel technique is safe and feasible. It facilitates complete resection of the aortic ascending aneurysm avoiding circulatory arrest, antegrade cerebral perfusion, additional peripheral cannulation, and all related complications. Full article

(This article belongs to the Special Issue Advances in the Management of Cardiovascular Disease)

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13 pages, 1803 KiB

Open AccessArticle

Prognostic Impact of Hybrid Comprehensive Telerehabilitation Regarding Diastolic Dysfunction in Patients with Heart Failure with Reduced Ejection Fraction—Subanalysis of the TELEREH-HF Randomized Clinical Trial

by Robert Irzmański, Renata Glowczynska, Maciej Banach, Dominika Szalewska, Ryszard Piotrowicz, Ilona Kowalik, Michael J. Pencina, Wojciech Zareba, Piotr Orzechowski, Slawomir Pluta, Zbigniew Kalarus, Grzegorz Opolski and Ewa Piotrowicz

J. Clin. Med. 2022, 11(7), 1844; https://doi.org/10.3390/jcm11071844 - 26 Mar 2022

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Abstract

Aims: The objective of the study was to evaluate the effects of individually prescribed hybrid comprehensive telerehabilitation (HCTR) implemented at patients’ homes on left ventricular (LV) diastolic function in heart failure (HF) patients. Methods and results: The Telerehabilitation in Heart Failure Patients trial [...] Read more.

Aims: The objective of the study was to evaluate the effects of individually prescribed hybrid comprehensive telerehabilitation (HCTR) implemented at patients’ homes on left ventricular (LV) diastolic function in heart failure (HF) patients. Methods and results: The Telerehabilitation in Heart Failure Patients trial (TELEREH-HF) is a multicenter, prospective, randomized (1:1), open-label, parallel-group, controlled trial involving HF patients assigned either to HCTR involving a remotely monitored home training program in conjunction with usual care (HCTR group) or usual care only (UC group). The patient in the HCTR group underwent a 9-week HCTR program consisting of two stages: an initial stage (1 week) conducted in hospital and the subsequent stage (eight weeks) of home-based HCTR five times weekly. Due to difficulties of proper assessment and differences in the evaluation of diastolic function in patients with atrial fibrillation, we included in our subanalysis only patients with sinus rhythm. Depending on the grade of diastolic dysfunction, patients were assigned to subgroups with mild diastolic (MDD) or severe diastolic dysfunction (SDD), both in HCTR (HCTR-MDD and HCTR-SDD) and UC groups (UC-MDD and UC-SDD). Changes from baseline to 9 weeks in echocardiographic parameters were seen only in A velocities in HCTR-MDD vs. UC-MDD; no significant shifts between groups of different diastolic dysfunction grades were observed after HCTR. All-cause mortality was higher in UC-SDD vs. UC-MDD with no difference between HCTR-SDD and HCTR-MDD. Higher probability of HF hospitalization was observed in HCTR-SDD than HCTR-MDD and in UC-SDD than UC-MDD. No differences in the probability of cardiovascular mortality and hospitalization were found. Conclusions: HCTR did not influence diastolic function in HF patients in a significant manner. The grade of diastolic dysfunction had an impact on mortality only in the UC group and HF hospitalization over a 12–24-month follow-up in HCTR and UC groups. Full article

(This article belongs to the Special Issue Advances in the Management of Cardiovascular Disease)

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18 pages, 1164 KiB

Open AccessArticle

Assessment of Selected Baseline and Post-PCI Electrocardiographic Parameters as Predictors of Left Ventricular Systolic Dysfunction after a First ST-Segment Elevation Myocardial Infarction

by Tomasz Fabiszak, Michał Kasprzak, Marek Koziński and Jacek Kubica

J. Clin. Med. 2021, 10(22), 5445; https://doi.org/10.3390/jcm10225445 - 22 Nov 2021

Cited by 6 | Viewed by 1692

Abstract

Objective: To assess the performance of ten electrocardiographic (ECG) parameters regarding the prediction of left ventricular systolic dysfunction (LVSD) after a first ST-segment-elevation myocardial infarction (STEMI). Methods: We analyzed 249 patients (74.7% males) treated with primary percutaneous coronary intervention (PCI) included into a [...] Read more.

Objective: To assess the performance of ten electrocardiographic (ECG) parameters regarding the prediction of left ventricular systolic dysfunction (LVSD) after a first ST-segment-elevation myocardial infarction (STEMI). Methods: We analyzed 249 patients (74.7% males) treated with primary percutaneous coronary intervention (PCI) included into a single-center cohort study. We sought associations between baseline and post-PCI ECG parameters and the presence of LVSD (defined as left ventricular ejection fraction [LVEF] ≤ 40% on echocardiography) 6 months after STEMI. Results: Patients presenting with LVSD (n = 52) had significantly higher values of heart rate, number of leads with ST-segment elevation and pathological Q-waves, as well as total and maximal ST-segment elevation at baseline and directly after PCI compared with patients without LVSD. They also showed a significantly higher prevalence of anterior STEMI and considerably wider QRS complex after PCI, while QRS duration measurement at baseline showed no significant difference. Additionally, patients presenting with LVSD after 6 months showed markedly more severe ischemia on admission, as assessed with the Sclarovsky-Birnbaum ischemia score, smaller reciprocal ST-segment depression at baseline and less profound ST-segment resolution post PCI. In multivariate regression analysis adjusted for demographic, clinical, biochemical and angiographic variables, anterior location of STEMI (OR 17.78; 95% CI 6.45–48.96; p < 0.001), post-PCI QRS duration (OR 1.56; 95% CI 1.22–2.00; p < 0.001) expressed per increments of 10 ms and impaired post-PCI flow in the infarct-related artery (IRA; TIMI 3 vs. <3; OR 0.14; 95% CI 0.04–0.46; p = 0.001) were identified as independent predictors of LVSD (Nagelkerke’s pseudo R² for the logistic regression model = 0.462). Similarly, in multiple regression analysis, anterior location of STEMI, wider post-PCI QRS, higher baseline number of pathological Q-waves and a higher baseline Sclarovsky-Birnbaum ischemia score, together with impaired post-PCI flow in the IRA, higher values of body mass index and glucose concentration on admission were independently associated with lower values of LVEF at 6 months (corrected R² = 0.448; p < 0.00001). Conclusions: According to our study, baseline and post-PCI ECG parameters are of modest value for the prediction of LVSD occurrence 6 months after a first STEMI. Full article

(This article belongs to the Special Issue Advances in the Management of Cardiovascular Disease)

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10 pages, 450 KiB

Open AccessArticle

Preoperative Predictors of Adverse Clinical Outcome in Emergent Repair of Acute Type A Aortic Dissection in 15 Year Follow Up

by Miriam Freundt, Philipp Kolat, Christine Friedrich, Mohamed Salem, Matthias Gruenewald, Gunnar Elke, Thomas Pühler, Jochen Cremer and Assad Haneya

J. Clin. Med. 2021, 10(22), 5370; https://doi.org/10.3390/jcm10225370 - 18 Nov 2021

Cited by 5 | Viewed by 1555

Abstract

Background: Acute type A aortic dissection (AAAD) has high mortality. Improvements in surgical technique have lowered mortality but postoperative functional status and decreased quality of life due to debilitating deficits remain of concern. Our study aims to identify preoperative conditions predictive of undesirable [...] Read more.

Background: Acute type A aortic dissection (AAAD) has high mortality. Improvements in surgical technique have lowered mortality but postoperative functional status and decreased quality of life due to debilitating deficits remain of concern. Our study aims to identify preoperative conditions predictive of undesirable outcome to help guide perioperative management. Methods: We performed retrospective analysis of 394 cases of AAAD who underwent repair in our institution between 2001 and 2018. A combined endpoint of parameters was defined as (1) 30-day versus hospital mortality, (2) new neurological deficit, (3) new acute renal insufficiency requiring postoperative renal replacement, and (4) prolonged mechanical ventilation with need for tracheostomy. Results: Total survival/ follow-up time averaged 3.2 years with follow-up completeness of 94%. Endpoint was reached by 52.8%. Those had higher EuroSCORE II (7.5 versus 5.5), higher incidence of coronary artery disease (CAD) (9.2% versus 3.2%), neurological deficit (ND) upon presentation (26.4% versus 11.8%), cardiopulmonary resuscitation (CPR) (14.4% versus 1.6%) and intubation (RF) before surgery (16.9% versus 4.8%). 7-day mortality was 21.6% versus 0%. Hospital mortality 30.8% versus 0%. Conclusions: This 15-year follow up shows, that unfavorable postoperative clinical outcome is related to ND, CAD, CPR and RF on arrival. Full article

(This article belongs to the Special Issue Advances in the Management of Cardiovascular Disease)

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16 pages, 1636 KiB

Open AccessArticle

Predicting Mortality in Patients with Atrial Fibrillation and Obstructive Chronic Coronary Syndrome: The Bialystok Coronary Project

by Łukasz Kuźma, Anna Tomaszuk-Kazberuk, Anna Kurasz, Sławomir Dobrzycki, Marek Koziński, Bożena Sobkowicz and Gregory Y. H. Lip

J. Clin. Med. 2021, 10(21), 4949; https://doi.org/10.3390/jcm10214949 - 26 Oct 2021

Cited by 1 | Viewed by 1370

Abstract

Over the next decades, the prevalence of atrial fibrillation (AF) is estimated to double. Our aim was to investigate the causes of the long-term mortality in relation to the diagnosis of atrial fibrillation (AF) and chronic coronary syndrome (CCS). The analysed population consisted [...] Read more.

Over the next decades, the prevalence of atrial fibrillation (AF) is estimated to double. Our aim was to investigate the causes of the long-term mortality in relation to the diagnosis of atrial fibrillation (AF) and chronic coronary syndrome (CCS). The analysed population consisted of 7367 consecutive patients referred for elective coronary angiography enrolled in a large single-centre retrospective registry, out of whom 1484 had AF and 2881 were diagnosed with obstructive CCS. During follow-up (median = 2029 days), 1201 patients died. The highest all-cause death was seen in AF(+)/CCS(+) [194/527; 36.8%], followed by AF(+)/CCS(−) [210/957; 21.9%], AF(−)/CCS(+) [(459/2354; 19.5%)] subgroups. AF ([HR]_AC = 1.48, 95%CI, 1.09–2.01; HR_CV = 1.34, 95%CI, 1.07–1.68) and obstructive CCS (HR_AC = 1.90, 95%CI, 1.56–2.31; HR_CV = 2.27, 95%CI, 1.94–2.65) together with age, male gender, heart failure, obstructive pulmonary disease, diabetes were predictors of both all-cause and CV mortality. The main findings are as follow among patients referred for elective coronary angiography, both AF and obstructive CCS are strong and independent predictors of the long-term mortality. Mortality of AF without CCS was at least as high as non-AF patients with CCS. CV deaths were more frequent than non-CV deaths in AF patients with CCS compared to those with either AF or CCS alone. Full article

(This article belongs to the Special Issue Advances in the Management of Cardiovascular Disease)

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20 pages, 1389 KiB

Open AccessArticle

Impact of Bundle Branch Block on Permanent Pacemaker Implantation after Transcatheter Aortic Valve Implantation: A Meta-Analysis

by Justine M. Ravaux, Michele Di Mauro, Kevin Vernooy, Silvia Mariani, Daniele Ronco, Jorik Simons, Arnoud W. Van't Hof, Leo Veenstra, Suzanne Kats, Jos G. Maessen and Roberto Lorusso

J. Clin. Med. 2021, 10(12), 2719; https://doi.org/10.3390/jcm10122719 - 19 Jun 2021

Cited by 7 | Viewed by 2659

Abstract

Data regarding the impact of infra-Hisian conduction disturbances leading to permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation (TAVI) remain limited. The aim of this study was to determine the impact of right and/or left bundle branch block (RBBB/LBBB) on post-TAVI PPI. [...] Read more.

Data regarding the impact of infra-Hisian conduction disturbances leading to permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation (TAVI) remain limited. The aim of this study was to determine the impact of right and/or left bundle branch block (RBBB/LBBB) on post-TAVI PPI. We performed a systematic literature review to identify studies reporting on RBBB and/or LBBB status and post-TAVI PPI. Study design, patient characteristics, and the presence of branch block were analyzed. Odds ratios (ORs) with 95% CI were extracted. The final analysis included 36 studies, reporting about 55,851 patients. Data on LBBB were extracted from 33 studies. Among 51,026 patients included, 5503 showed pre-implant LBBB (11.9% (10.4%–13.8%)). The influence of LBBB on post-TAVI PPI was not significant OR 1.1474 (0.9025; 1.4588), p = 0.2618. Data on RBBB were extracted from 28 studies. Among 46,663 patients included, 31,603 showed pre-implant RBBB (9.2% (7.3%–11.6%)). The influence of RBBB on post-TAVI PPI was significant OR 4.8581 (4.1571; 5.6775), p < 0.0001. From this meta-analysis, the presence of RBBB increased the risk for post-TAVI PPI, independent of age or LVEF, while this finding was not confirmed for patients experimenting with LBBB. This result emphasizes the need for pre-operative evaluation strategies in patient selection for TAVI. Full article

(This article belongs to the Special Issue Advances in the Management of Cardiovascular Disease)

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11 pages, 1095 KiB

Open AccessArticle

Patients with Non-Obstructive Coronary Artery Disease Require Strict Control of All Cardiovascular Risk Factors: Results from the Polish Local Population Medical Records

by Jarosław Hiczkiewicz, Paweł Burchardt, Jan Budzianowski, Konrad Pieszko, Dariusz Hiczkiewicz, Bogdan Musielak, Anna Winnicka-Zielińska, Daria M. Keller, Wojciech Faron and Janusz Rzeźniczak

J. Clin. Med. 2021, 10(12), 2704; https://doi.org/10.3390/jcm10122704 - 18 Jun 2021

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Abstract

The aim of the project was to compare patients treated with percutaneous transluminal coronary angioplasty (PTCA), who also had undergone PTCA in the past, with a group of people who had had no angiographic stenosis in the lumen of the coronary arteries in [...] Read more.

The aim of the project was to compare patients treated with percutaneous transluminal coronary angioplasty (PTCA), who also had undergone PTCA in the past, with a group of people who had had no angiographic stenosis in the lumen of the coronary arteries in the past, and who also required PTCA during index hospitalization. The secondary aim was to compare the obtained data with the characteristics of a group of people who had undergone angiography twice and for whom no significant stenosis had been found in their coronary arteries. The study used registry data concerning 3085 people who had undergone at least two invasive procedures. Acute coronary syndrome (ACS) was significantly more often observed (Non-ST-segment elevation myocardial infarction (NSTEMI) OR 2.76 [1.91–3.99] and ST-segment elevation myocardial infarction (STEMI) OR 2.35 [1.85–2.99]) in patients with no significant coronary stenosis in the past (who required coronary angioplasty at the time of the study), compared to patients who had already had PTCA. They also demonstrated more frequent occurrence of ‘multivessel disease’. This was probably most likely caused by inadequate control of cardiovascular risk factors, as determined by higher total cholesterol levels ([mg/dL] 193.7 ± 44.4 vs. 178.2 ± 43.7) and LDL (123.4 ± 36.2 vs. 117.7 ± 36.2). On the other hand, patients in whom no significant stenosis was found in two consecutive angiographies were more likely to be burdened with chronic obstructive pulmonary disease, atrial fibrillation and chronic kidney disease. Full article

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15 pages, 934 KiB

Open AccessArticle

Predictors of Early-Recurrence Atrial Fibrillation after Catheter Ablation in Women and Men with Abnormal Body Weight

by Jan Budzianowski, Jarosław Hiczkiewicz, Katarzyna Łojewska, Edyta Kawka, Rafał Rutkowski and Katarzyna Korybalska

J. Clin. Med. 2021, 10(12), 2694; https://doi.org/10.3390/jcm10122694 - 18 Jun 2021

Cited by 3 | Viewed by 1560

Abstract

Our study aimed to select factors that affect the rate of early recurrence (up to 3 months) of atrial fibrillation (AF) (ERAF) following pulmonary veins isolation (PVI) in obese women and men. The study comprised 114 patients: 54 women (age: 63.8 ± 6.3, [...] Read more.

Our study aimed to select factors that affect the rate of early recurrence (up to 3 months) of atrial fibrillation (AF) (ERAF) following pulmonary veins isolation (PVI) in obese women and men. The study comprised 114 patients: 54 women (age: 63.8 ± 6.3, BMI 31 ± 4 kg/m²), and 60 men (age: 60.7 ± 6.7; BMI 31 ± 3 kg/m²) with paroxysmal, persistent and long-standing persistent AF. They had been scheduled to undergo cryoballoon (men n = 30; women n = 30) and radiofrequency (RF) ablation (men n = 30; women n = 24) using the CARTO-mapping. The blood was collected at baseline and 24 h after ablation. The rate of ERAF was comparable after cryoballoon and RF ablation and constituted 18% in women and 22% in men. Almost 70 parameters were selected to perform univariate and multivariate analysis and to create a multivariate logistic regression (MLR) model of ERAF in the obese men and women. The MLR analysis was performed by forward stepwise logistic regression with three variables. It was only possible to create the MLR model for the group of obese men. It revealed a poor predictive value with an unsatisfactory sensitivity of 31%. Men with ERAF: smokers (OR 39.25, 95% CI 1.050–1467.8, p = 0.0021), with a higher ST2 elevation (OR 1.68, 95% CI 1.115–2.536, p = 0.0021) who received dihydropyridine calcium channel blockers (OR 0.042, 95% CI 0.002–1.071, p = 0.0021) less frequently. Our results indicate a complex pathogenesis of ERAF dependent on the patients’ gender. Full article

(This article belongs to the Special Issue Advances in the Management of Cardiovascular Disease)

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10 pages, 1115 KiB

Open AccessArticle

Holter-Derived Autonomic Function, Arrhythmias and Carbohydrate Metabolism in Patients with Class III Obesity Treated with Laparoscopic Sleeve Gastrectomy

by Piotr Bienias, Zuzanna Rymarczyk, Justyna Domienik-Karłowicz, Wojciech Lisik, Piotr Sobieraj, Piotr Pruszczyk and Michał Ciurzyński

J. Clin. Med. 2021, 10(10), 2140; https://doi.org/10.3390/jcm10102140 - 15 May 2021

Viewed by 1649

Abstract

The effects of weight loss following bariatric surgery on autonomic balance, arrhythmias and insulin resistance are still of interest. We prospectively investigated 50 patients with BMI > 40 kg/m², aged 36.5 (18–56) years who underwent laparoscopic sleeve gastrectomy. Among other examinations, [...] Read more.

The effects of weight loss following bariatric surgery on autonomic balance, arrhythmias and insulin resistance are still of interest. We prospectively investigated 50 patients with BMI > 40 kg/m², aged 36.5 (18–56) years who underwent laparoscopic sleeve gastrectomy. Among other examinations, all subjects had 24-h Holter monitoring with heart rate variability (HRV) and heart rate turbulence (HRT) evaluation. After a median of 15 months, BMI decreased from 43.9 to 29.7 kg/m², the incidence of hypertension decreased from 54 to 32% (p = 0.04) and any carbohydrate disorders decreased from 24 to 6% (p = 0.02). Fasting insulin concentration and insulin resistance index improved significantly (p < 0.001). Improvements in HRV parameters related to the sympathetic autonomic division were also observed (p < 0.001), while HRT evaluation was not conclusive. The enhancement of autonomic tone indices was correlated with reduction of BMI (SDNN-I r = 0.281 p = 0.04; SDNN r = 0.267 p = 0.05), but not with reduction of waist circumference, and it was also associated with decrease of mean heart rate (OR 0.02, 95%CI 0.0–0.1, p < 0.001). The incidence of arrhythmias was low and similar before and after follow-up. In conclusion, improvement of homeostasis of carbohydrate metabolism and autonomic function is observed in relatively young patients after weight loss due to laparoscopic sleeve gastrectomy. Full article

(This article belongs to the Special Issue Advances in the Management of Cardiovascular Disease)

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Review

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20 pages, 2261 KiB

Open AccessReview

Left Main Coronary Artery Disease—Current Management and Future Perspectives

by Emil Julian Dąbrowski, Marcin Kożuch and Sławomir Dobrzycki

J. Clin. Med. 2022, 11(19), 5745; https://doi.org/10.3390/jcm11195745 - 28 Sep 2022

Cited by 9 | Viewed by 4061

Abstract

Due to its anatomical features, patients with an obstruction of the left main coronary artery (LMCA) have an increased risk of death. For years, coronary artery bypass grafting (CABG) has been considered as a gold standard for revascularization. However, notable advancements in the [...] Read more.

Due to its anatomical features, patients with an obstruction of the left main coronary artery (LMCA) have an increased risk of death. For years, coronary artery bypass grafting (CABG) has been considered as a gold standard for revascularization. However, notable advancements in the field of percutaneous coronary intervention (PCI) led to its acknowledgement as an important treatment alternative, especially in patients with low and intermediate anatomical complexity. Although recent years brought several random clinical trials that investigated the safety and efficacy of the percutaneous approach in LMCA, there are still uncertainties regarding optimal revascularization strategies. In this paper, we provide a comprehensive review of state-of-the-art diagnostic and treatment methods of LMCA disease, focusing on percutaneous methods. Full article

(This article belongs to the Special Issue Advances in the Management of Cardiovascular Disease)

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31 pages, 1790 KiB

Open AccessReview

An Up-to-Date Article Regarding Particularities of Drug Treatment in Patients with Chronic Heart Failure

by Valentina Buda, Andreea Prelipcean, Dragos Cozma, Dana Emilia Man, Simona Negres, Alexandra Scurtu, Maria Suciu, Minodora Andor, Corina Danciu, Simina Crisan, Cristina Adriana Dehelean, Lucian Petrescu and Ciprian Rachieru

J. Clin. Med. 2022, 11(7), 2020; https://doi.org/10.3390/jcm11072020 - 04 Apr 2022

Cited by 6 | Viewed by 6501

Abstract

Since the prevalence of heart failure (HF) increases with age, HF is now one of the most common reasons for the hospitalization of elderly people. Although the treatment strategies and overall outcomes of HF patients have improved over time, hospitalization and mortality rates [...] Read more.

Since the prevalence of heart failure (HF) increases with age, HF is now one of the most common reasons for the hospitalization of elderly people. Although the treatment strategies and overall outcomes of HF patients have improved over time, hospitalization and mortality rates remain elevated, especially in developed countries where populations are aging. Therefore, this paper is intended to be a valuable multidisciplinary source of information for both doctors (cardiologists and general physicians) and pharmacists in order to decrease the morbidity and mortality of heart failure patients. We address several aspects regarding pharmacological treatment (including new approaches in HF treatment strategies [sacubitril/valsartan combination and sodium glucose co-transporter-2 inhibitors]), as well as the particularities of patients (age-induced changes and sex differences) and treatment (pharmacokinetic and pharmacodynamic changes in drugs; cardiorenal syndrome). The article also highlights several drugs and food supplements that may worsen the prognosis of HF patients and discusses some potential drug–drug interactions, their consequences and recommendations for health care providers, as well as the risks of adverse drug reactions and treatment discontinuation, as an interdisciplinary approach to treatment is essential for HF patients. Full article

(This article belongs to the Special Issue Advances in the Management of Cardiovascular Disease)

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7 pages, 1333 KiB

Open AccessReview

Adaptive Servo-Ventilation as a Novel Therapeutic Strategy for Chronic Heart Failure

by Teruhiko Imamura, Nikhil Narang and Koichiro Kinugawa

J. Clin. Med. 2022, 11(3), 539; https://doi.org/10.3390/jcm11030539 - 21 Jan 2022

Cited by 1 | Viewed by 1861

Abstract

The introduction of new therapeutics for patients with chronic heart failure, including sacubitril/valsartan, sodium-glucose cotransporter 2 inhibitors, and ivabradine, in addition to beta-blockers, angiotensin converting enzyme inhibitors, and mineralocorticoid receptor antagonists, lends an opportunity for significant clinical risk reduction compared to what was [...] Read more.

The introduction of new therapeutics for patients with chronic heart failure, including sacubitril/valsartan, sodium-glucose cotransporter 2 inhibitors, and ivabradine, in addition to beta-blockers, angiotensin converting enzyme inhibitors, and mineralocorticoid receptor antagonists, lends an opportunity for significant clinical risk reduction compared to what was available just one decade ago. Further clinical options are needed, however, for patients with residual clinical congestion refractory to these therapies. Adaptive servo-ventilation is a novel therapeutic option to address significant clinical volume in cases resistant to medical therapy. The aggregate benefit of these additional therapeutic strategies in addition to foundational medical therapy may be a promising option in the selected candidates who do not achieve acceptable clinical and quality-of-life improvements with oral medical therapy alone. Now is the era to reconsider the implication of an adaptive servo-ventilation-therapy-incorporated medical therapeutic strategy for patients with congestive heart failure. Full article

(This article belongs to the Special Issue Advances in the Management of Cardiovascular Disease)

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13 pages, 1112 KiB

Open AccessReview

A Systematic Review of the Efficacy and Safety of Direct Oral Anticoagulants in Atrial Fibrillation Patients with Diabetes Using a Risk Index

by Domenico Acanfora, Marco Matteo Ciccone, Valentina Carlomagno, Pietro Scicchitano, Chiara Acanfora, Alessandro Santo Bortone, Massimo Uguccioni and Gerardo Casucci

J. Clin. Med. 2021, 10(13), 2924; https://doi.org/10.3390/jcm10132924 - 29 Jun 2021

Cited by 3 | Viewed by 2101

Abstract

Diabetes mellitus (DM) represents an independent risk factor for chronic AF and is associated with unfavorable outcomes. We aimed to evaluate the efficacy and safety of direct oral anticoagulants (DOACs) in patients with atrial fibrillation (AF), with and without diabetes mellitus (DM), using [...] Read more.

Diabetes mellitus (DM) represents an independent risk factor for chronic AF and is associated with unfavorable outcomes. We aimed to evaluate the efficacy and safety of direct oral anticoagulants (DOACs) in patients with atrial fibrillation (AF), with and without diabetes mellitus (DM), using a new risk index (RI) defined as: RI

= \frac{Rate of Events}{Rate of Patients at Risk}

. In particular, an RI lower than 1 suggests a favorable treatment effect. We searched MEDLINE, MEDLINE In-Process, EMBASE, PubMed, and the Cochrane Central Register of Controlled Trials. The risk index (RI) was calculated in terms of efficacy (rate of stroke/systemic embolism (stroke SEE)/rate of patients with and without DM; rate of cardiovascular death/rate of patients with and without DM) and safety (rate of major bleeding/rate of patients with and without DM) outcomes. AF patients with DM (n = 22,057) and 49,596 without DM were considered from pivotal trials. DM doubles the risk index for stroke/SEE, major bleeding (MB), and cardiovascular (CV) death. The RI for stroke/SEE, MB, and CV death was comparable in patients treated with warfarin or DOACs. The lowest RI was in DM patients treated with Rivaroxaban (stroke/SEE, RI = 0.08; CV death, RI = 0.13). The RIs for bleeding were higher in DM patients treated with Dabigatran (RI110 = 0.32; RI150 = 0.40). Our study is the first to use RI to homogenize the efficacy and safety data reported in the DOACs pivotal studies against warfarin in patients with and without DM. Anticoagulation therapy is effective and safe in DM patients. DOACs appear to have a better efficacy and safety profile than warfarin. The use of DOACs is a reasonable alternative to vitamin-K antagonists in AF patients with DM. The RI can be a reasonable tool to help clinicians choose between DOACs or warfarin in the peculiar set of AF patients with DM. Full article

(This article belongs to the Special Issue Advances in the Management of Cardiovascular Disease)

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15 pages, 1130 KiB

Open AccessReview

Pleiotropic Effects of Acetylsalicylic Acid after Coronary Artery Bypass Grafting—Beyond Platelet Inhibition

by Dominika Siwik, Magdalena Gajewska, Katarzyna Karoń, Kinga Pluta, Mateusz Wondołkowski, Radosław Wilimski, Łukasz Szarpak, Krzysztof J. Filipiak and Aleksandra Gąsecka

J. Clin. Med. 2021, 10(11), 2317; https://doi.org/10.3390/jcm10112317 - 26 May 2021

Cited by 4 | Viewed by 3422

Abstract

Acetylsalicylic acid (ASA) is one of the most frequently used medications worldwide. Yet, the main indications for ASA are the atherosclerosis-based cardiovascular diseases, including coronary artery disease (CAD). Despite the increasing number of percutaneous procedures to treat CAD, coronary artery bypass grafting (CABG) [...] Read more.

Acetylsalicylic acid (ASA) is one of the most frequently used medications worldwide. Yet, the main indications for ASA are the atherosclerosis-based cardiovascular diseases, including coronary artery disease (CAD). Despite the increasing number of percutaneous procedures to treat CAD, coronary artery bypass grafting (CABG) remains the treatment of choice in patients with multivessel CAD and intermediate or high anatomical lesion complexity. Taking into account that CABG is a potent activator of inflammation, ASA is an important part in the postoperative therapy, not only due to ASA antiplatelet action, but also as an anti-inflammatory agent. Additional benefits of ASA after CABG include anticancerogenic, hypotensive, antiproliferative, anti-osteoporotic, and neuroprotective effects, which are especially important in patients after CABG, prone to hypertension, graft occlusion, atherosclerosis progression, and cognitive impairment. Here, we discuss the pleiotropic effects of ASA after CABG and provide insights into the mechanisms underlying the benefits of treatment with ASA, beyond platelet inhibition. Since some of ASA pleiotropic effects seem to increase the risk of bleeding, it could be considered a starting point to investigate whether the increase of the intensity of the treatment with ASA after CABG is beneficial for the CABG group of patients. Full article

(This article belongs to the Special Issue Advances in the Management of Cardiovascular Disease)

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Other

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13 pages, 2471 KiB

Open AccessSystematic Review

Fractional Flow Reserve versus Angiography–Guided Management of Coronary Artery Disease: A Meta–Analysis of Contemporary Randomised Controlled Trials

by Annette M. Maznyczka, Connor J. Matthews, Jonathan M. Blaxill, John P. Greenwood, Abdul M. Mozid, Jennifer A. Rossington, Murugapathy Veerasamy, Stephen B. Wheatcroft, Nick Curzen and Heerajnarain Bulluck

J. Clin. Med. 2022, 11(23), 7092; https://doi.org/10.3390/jcm11237092 - 30 Nov 2022

Cited by 4 | Viewed by 1534

Abstract

Background and Aims: Randomised controlled trials (RCTs) comparing outcomes after fractional flow reserve (FFR)-guided versus angiography-guided management for obstructive coronary artery disease (CAD) have produced conflicting results. We investigated the efficacy and safety of an FFR-guided versus angiography-guided management strategy among patients with [...] Read more.

Background and Aims: Randomised controlled trials (RCTs) comparing outcomes after fractional flow reserve (FFR)-guided versus angiography-guided management for obstructive coronary artery disease (CAD) have produced conflicting results. We investigated the efficacy and safety of an FFR-guided versus angiography-guided management strategy among patients with obstructive CAD. Methods: A systematic electronic search of the major databases was performed from inception to September 2022. We included studies of patients presenting with angina or myocardial infarction (MI), managed with medications, percutaneous coronary intervention, or bypass graft surgery. A meta-analysis was performed by pooling the risk ratio (RR) using a random-effects model. The endpoints of interest were all-cause mortality, MI and unplanned revascularisation. Results: Eight RCTs, with outcome data from 5077 patients, were included. The weighted mean follow up was 22 months. When FFR-guided management was compared to angiography-guided management, there was no difference in all-cause mortality [3.5% vs. 3.7%, RR: 0.99 (95% confidence interval (CI) 0.62–1.60), p = 0.98, heterogeneity (I²) 43%], MI [5.3% vs. 5.9%, RR: 0.93 (95%CI 0.66–1.32), p = 0.69, I² 42%], or unplanned revascularisation [7.4% vs. 7.9%, RR: 0.92 (95%CI 0.76–1.11), p = 0.37, I² 0%]. However, the number patients undergoing planned revascularisation by either stent or surgery was significantly lower with an FFR-guided strategy [weighted mean difference: 14 (95% CI 3 to 25)%, p =< 0.001]. Conclusion: In patients with obstructive CAD, an FFR-guided management strategy did not impact on all-cause mortality, MI and unplanned revascularisation, when compared to an angiography-guided management strategy, but led to up to a quarter less patients needing revascularisation. Full article

(This article belongs to the Special Issue Advances in the Management of Cardiovascular Disease)

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