Migotanie przedsionków w zaciskającym zapaleniu osierdzia

Atrial fibrillation is the most common chronic arrhythmia, affecting 1–2% of general population. Because of the risk of stroke and thromboembolism, patients with atrial fibrillation need anticoagulation. The World Health Organization estimates that only 50% of patients follow doctors’ recommendations. In many researches it is emphasized that understanding the sense of treatment fosters patients’ acceptation and enhances the effectiveness of therapy. Atrial fibrillation is common in patients with constrictive pericarditis, especially when the disease is long-standing.Migotanie przedsionków (AF), występujące u 1–2% populacji ogólnej, to najczęstsze utrwalone zaburzenie rytmu serca. Ze względu na możliwe powikłania zakrzepowo-zatorowe pacjenci z AF oraz obarczeni czynnikami ryzyka wymagają leczenia przeciwkrzepliwego. Według raportu Światowej Organizacji Zdrowia tylko 50% pacjentów stosuje się do zaleceń lekarskich. W wielu badaniach podkreśla się, że zrozumienie przez chorego sensu działań diagnostycznych i leczniczych sprzyja ich akceptacji i zasadniczo poprawia efektywność terapii. Migotanie przedsionków często występuje u osób z zaciskającym zapaleniem osierdzia, szczególnie jeśli okres trwania choroby jest dłuższy

Primum non nocere. Trudności związane z leczeniem przeciwkrzepliwym pacjentów w podeszłym wieku

The first step of anticoagulant therapy is to make a therapeutic decision based on absolute risk of embolism and bleedings and on patient’s benefit-risk ratio. Clinical case has been analyzed of the elderly patient with numerous comorbidities and high risk of bleeding who requires anticoagulant therapy. The objective of this study was to emphasize the variability of bleeding risk during long-term treatment. Based on clinical trials and current guidelines, novel oral anticoagulants can be considered superior to classical therapy with vitamin K antagonists.Pierwszym krokiem leczenia przeciwkrzepliwego jest podjęcie decyzji terapeutycznej opartej na bezwzględnym ryzyku zatorów i krwawień oraz na względnym stosunku korzyści do ryzyka u danego pacjenta. Przeanalizowano przypadek kliniczny pacjentki w podeszłym wieku, z licznymi obciążeniami oraz wysokim ryzykiem krwawienia, wymagającej terapii antykoagulantem. Celem pracy było zwrócenie uwagi na zmienność ryzyka krwawienia w trakcie długoletniego leczenia. Na podstawie badań klinicznych oraz aktualnych wytycznych można uznać wyższość nowych doustnych leków przeciwkrzepliwych nad klasyczną terapią antagonistami witaminy K

Nagłe zatrzymanie krążenia — możliwości zastosowania defibrylacji w prewencji pierwotnej i wtórnej

Nagła śmierć sercowa (SCD) jest zdarzeniem medycznym, które zwykle pojawia się nagle i niespodziewanie, a najczęstszym mechanizmem jest migotanie komór. Rocznie w Europie i Stanach Zjednoczonych rejestruje się około 750–900 tysięcy SCD. Defibrylacja jest terapią ratującą życie w przypadku migotania komór (VF) i jest istotnym elementem łańcucha przeżycia. Wyzwaniem współczesnej medycyny jest więc poprawawyników resuscytacji, które są wciąż złe oraz określenie czynników wysokiego ryzyka, aby zapobiec SCD w ogóle. Z powodu głównie elektrycznego mechanizmu SCD defibrylacja jest terapią pierwszego rzutu i powinna być zastosowana w ciągu kilku minut od zatrzymania krążenia. Wczesna defibrylacja determinuje szanse przeżycia. Artykuł ten prezentuje elektryczne metody, które mogą być użyte w prewencji pierwotnej i wtórnejSCD, takie jak defibrylacja zewnętrzna (manualna, automatyczna) czy wszczepialny kardiowerter–defibrylator

Echocardiographic assessment of left ventricular systolic and diastolic function in patients with sinus sick sinus syndrome qualified to permanent pacing

Wśród pacjentów z chorobą węzła zatokowego są chorzy z bradykardią zatokową i chorzy z utrwalonym/przewlekłym migotaniem przedsionków. Celem badania jest echokardiograficzna ocena funkcji skurczowej i rozkurczowej lewej komory (LV) serca u pacjentów z chorobą węzła zatokowego (SSS) przed wszczepieniem stymulatora serca oraz porównanie wyników grupy z rytmem zatokowym (SR) do wyników grupy z przewlekłym migotaniem przedsionków (CAF). Do badania włączono 110 kolejnych pacjentów z SSS (78 z SR i 32 z CAF) zakwalifikowanych do wszczepienia stałego układu stymulującego serce. W ocenie funkcji skurczowej wykorzystano frakcję wyrzutową LV (LVEF). Oceniając funkcję rozkurczową u pacjentów z SR, oznaczano objętość lewego przedsionka odnoszoną do powierzchni ciała (LAVI) i wartości prędkości rozkurczowych pierścienia mitralnego (E’med i E’lat), a u chorych z CAF prędkość maksymalną fali E wczesnego napływu mitralnego i E’med. U pacjentów z SSS zakwalifikowanych do leczenia stałą stymulacją serca stwierdzono dość dobrą funkcję skurczową LV z przewagąna korzyść SR, natomiast funkcja rozkurczowa była istotnie upośledzona zarówno u pacjentówz SR, jak i z CAF. Echokardiograficzna ocena pacjentów z dysfunkcją węzła zatokowego powinna obejmować zarówno analizę funkcji skurczowej, jak i rozkurczowej lewej komory.Among patients with sick sinus syndrome there are both, patients with sinus bradycardia, and with permanent chronic atrial fibrillation. The aim of this study is echocardiographic evaluation of left ventricular systolic and diastolic function in patients with sick sinus syndrome (SSS) before pacemaker implantation, and comparing results of the group with sinus rhythm (SR) to the group with chronic atrial fibrillation (CAF). The study included110 consecutive patients with SSS (78 with SR and 32 with CAF) qualified for pacemaker implantation. We used left ventricular ejection fraction to evaluate left ventricular systolicfunction (LVEF). To analyze left ventricular diastolic function in SR group we estimated leftatrial volume index (LAVI) and diastolic velocities of mitral annulus (part medial — E’medand lateral — E’lat). To analyze left ventricular diastolic function in CAF group we estimated maximum velocity of early mitral inflow wave E and E’med. We found relatively normal leftventricular systolic function in group of patients with SSS qualified for permanent pacing therapy, especially in the SR group, and significantly impaired left ventricular diastolicfunction both in patients with SR and with CAF. Echocardiographic evaluation of patients with sinus node dysfunction should include the analysis of both systolic and diastolic left ventricular function

Prothrombotic fibrin clot properties associated with NETs formation characterize acute pulmonary embolism patients with higher mortality risk

Abstract Venous thromboembolism is associated with formation of denser fibrin clots resistant to lysis. We investigated whether prothrombotic plasma clot properties are associated with the severity of acute pulmonary embolism (PE). We enrolled 126 normotensive acute PE patients (aged 58 ± 14 years) and 25 age- and sex-matched healthy controls. Plasma fibrin clot permeability (Ks), clot lysis time (CLT), endogenous thrombin potential (ETP), plasminogen activator inhibitor-1 (PAI-1), and citrullinated histone H3 (citH3) were evaluated on admission. PE patients compared to controls had 370% higher citH3 levels, 41% higher ETP, 16.5% reduced Ks, and 25.6% prolonged CLT. Patients with intermediate-high (n = 29) and intermediate-low (n = 77) PE mortality risk had reduced Ks and prolonged CLT, increased PAI-1 and ETP as compared to low-risk PE (n = 20) patients. Prolonged CLT was predicted by PAI-1 and citH3, while low Ks by C-reactive protein. During a 12-month follow-up 9 (7.1%) patients who had 24% higher ETP, 45% higher citH3 levels, and 18% prolonged CLT at baseline died. High ETP combined with elevated citH3 levels and prolonged CLT was associated with eightfold increased risk of PE-related death. Prothrombotic fibrin clot properties and enhanced neutrophil extracellular traps formation are associated with higher early mortality risk in acute PE patients, which suggests a prognostic role of these biomarkers

Polish regional differences in patient knowledge on atrial fibrillation and its management as well as in patterns of oral anticoagulant prescription

Background: The Jessa Atrial Fibrillation Knowledge Questionnaire (JAKQ) was successfully used to assess knowledge gaps in patients with atrial fibrillation (AF). Aims: To evaluate the regional differences among Polish patients in their awareness of AF diagnosis and oral anticoagulation use. Methods: A total of 1583 patients with AF at a median (IQR) age of 72 (66–79) years completed the JAKQ in 3 cardiology centers (center I, Kraków; center II, Toruń; center III, Kielce) from January 2017 to June 2018. The final analysis included 1525 patients, 32.9% were on vitamin K antagonists (VKAs) and 67.1% on non-VKA oral anticoagulants (NOACs), that is, rivaroxaban and dabigatran (28.9% each), and apixaban (9.3%). Results: The mean (SD) score on the JAKQ was 55.5% (18.4%) with better results among patients on VKAs compared with NOACs (58% [18.3%] vs 54.3% [18.4%]; P = 0.0002) with time from AF diagnosis more than 12 months (57.4% [17.5%] vs 50% [19.9%]; P < 0.0001). There was a significant difference in the knowledge scores between the 3 centers (I, 59.5%; II, 48.5%; III, 54.3%; P < 0.0001). In all centers the number of correct answers correlated inversely with patient’s age (r = –0.20; P < 0.0001). NOACs were more frequently used in center III. The percentage of correct responses was lower in patients on reduced NOAC doses (35.4% of patients on NOACs), compared with the full-dose NOAC groups in center I (56.9% vs 62.5%; P = 0.012) and II (48.1% vs 56.2%; P = 0.003). Conclusions: Patients from a high-volume academic center showed better knowledge than their peers from district hospitals. There are large regional differences in prescription patterns of oral anticoagulants, including the preferred NOAC

A new approach to ticagrelor-based de-escalation of antiplatelet therapy after acute coronary syndrome. A rationale for a randomized, double-blind, placebo-controlled, investigator-initiated, multicenter clinical study

© 2021 Via Medica. This article is available in open access under Creative Common Attribution-Non-Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0) license. https://creativecommons.org/licenses/by/4.0/The risk of ischemic events gradually decreases after acute coronary syndrome (ACS), reaching a stable level after 1 month, while the risk of bleeding remains steady during the whole period of dual antiplatelet treatment (DAPT). Several de-escalation strategies of antiplatelet treatment aiming to enhance safety of DAPT without depriving it of its efficacy have been evaluated so far. We hypothesized that reduction of the ticagrelor maintenance dose 1 month after ACS and its continuation until 12 months after ACS may improve adherence to antiplatelet treatment due to better tolerability compared with the standard dose of ticagrelor. Moreover, improved safety of treatment and preserved anti-ischemic benefit may also be expected with additional acetylsalicylic acid (ASA) withdrawal. To evaluate these hypotheses, we designed the Evaluating Safety and Efficacy of Two Ticagrelor-based De-escalation Antiplatelet Strategies in Acute Coronary Syndrome — a randomized clinical trial (ELECTRA-SIRIO 2), to assess the influence of ticagrelor dose reduction with or without continuation of ASA versus DAPT with standard dose ticagrelor in reducing clinically relevant bleeding and main-taining anti-ischemic efficacy in ACS patients. The study was designed as a phase III, randomized, multicenter, double-blind, investigator-initiated clinical study with a 12-month follow-up.Peer reviewedFinal Published versio

Efficacy of double vs. standard empagliflozin dose for METabolic syndromE tReatment (DEMETER — SIRIO 11) study. Rationale and protocol of the study

Complex metabolic disorders associated with obesity and diabetes pose a serious therapeutic challenge. The DEMETER-SIRIO 11 study is a phase III, multicenter, randomized, open-label, investigator-initiated clinical trial with a 6-month follow-up aimed at performing a comparative evaluation of the effect of two empagliflozin doses (10 mg vs. 20 mg) on selected metabolic parameters in patients with metabolic syndrome. The primary hypothesis of the study is that a higher dose of empagliflozin will result in a significant reduction of BMI and HbA1c in patients with obesity and MS receiving empagliflozin 20 mg as compared to 10 mg. Sample size and power calculation were based on a superiority assumption for the primary efficacy endpoint (the difference in decrease of body weight by > 1.5 kg and HbA1c by > 0.4%) for the higher vs. standard dose arm at 6-months of follow-up. Therefore, a sample size of 79 patients per arm is required to provide 80% power to detect a higher decrease in BMI, and 85 patients per arm is required to provide 80% power to detect a higher decrease in HbA1c in the 20 mg versus 10 mg arm with a type I error rate of 0.05. Summing up, enrollment of a total of 200 patients (100 in each arm) is planned to compensate for the potential drop-out rate from the study of up to 15%. Prespecified subanalyses will be performed according to: 1) diabetes mellitus; 2) chronic kidney disease (GFR < 60 mL/min/1.73 m2); 3) gender; and 4) age. A greater comprehensive improvement in biochemical, functional, and anthropometric parameters reflecting favorable metabolic changes is expected at the higher dose of empagliflozin compared to the standard dose

Comparison of reorganized versus unaltered cardiology departments during the COVID-19 era: a subanalysis of the COV-HF-SIRIO 6 study

Background: Since the beginning of the coronavirus disease-2019 (COVID-19) pandemic, numerous cardiology departments were reorganized to provide care for COVID-19 patients. We aimed to compare the impact of the COVID-19 pandemic on hospital admissions and in-hospital mortality in reorganized vs. unaltered cardiology departments. Methods: The present subanalysis is a multicenter retrospective COV-HF-SIRIO 6 study that includes all patients (n = 101,433) hospitalized in 24 cardiology departments in Poland between January 1, 2019 and December 31, 2020, with a focus on patients with acute heart failure (AHF). Results: Reduction of all-cause hospitalizations was 50.6% vs. 21.3% for reorganized vs. unaltered cardiology departments in 2020 vs. 2019, respectively (p < 0.0001). Considering AHF alone respective reductions by 46.5% and 15.2% were registered (p < 0.0001). A higher percentage of patients was brought in by ambulance to reorganized vs. unaltered cardiology departments (51.7% vs. 34.6%; p < 0.0001) alongside with a lower rate of self-referrals (45.7% vs. 58.4%; p < 0.0001). The rate of all-cause in-hospital mortality in AHF patients was higher in reorganized than unaltered cardiology departments (10.9% vs. 6.4%; p < 0.0001). After the exclusion of patients with concomitant COVID-19, the mortality rates did not differ significantly (6.9% vs. 6.4%; p = 0.55). Conclusions: In cardiology departments reorganized to provide care for COVID-19 patients vs. unaltered ones, observed: i) a greater reduction in hospital admissions in 2020 vs. 2019; ii) higher rates of patients brought by ambulance and lower rates of self-referrals; and iii) higher all-cause in-hospital mortality for AHF due to COVID-19 related deaths