Short- and mid-term outcome of transcatheter aortic valve implantation in patients with advanced age

Background: In patients treated with transcatheter aortic valve implantation (TAVI), age is recognized as one of the most important risk factors. The aim of our study was to evaluate whether early and mid-term results of TAVI were worse in patients over 85 year old compared with the younger population. Methods: From September 2010 to November 2015, 162 consecutive patients (mean age 78.4 ± 7.1 years, 47.5% females) underwent TAVI in our Institution. Patients were divided into two groups: 1) elderly (≥ 85 year old) and 2) younger patients (< 85 year old). Primary clinical study endpoints were the fol­lowing: death, myocardial infarction, stroke, major and minor access site, and bleeding complications. The secondary endpoints included: pacemaker implantation rate, paravalvular leakage, acute kidney injury, and duration of hospitalization. Results: Twenty-six patients were 85 or older (mean 87.5 ± 2.1). In the remaining 136 (84%), the average age was 76.7 ± 6.4. Baseline clinical profiles were similar in both groups, though history of pre­vious cardiac surgery (p = 0.0047) and chronic obstructive pulmonary disease (p = 0.0099) were more common in the younger group, and glomerular filtration rate was lower in the older group (p = 0.045). Major, life threatening and minor bleeding complications, as well as vascular access site complications did not differ between the two groups. Rates of myocardial infarction and stroke were comparably low in both groups. Similar results were also found in the incidence of secondary endpoints. In-hospital mortality and 1-year mortality did not differ between groups. Conclusions: TAVI in patients aged 85 and older is still a relatively safe procedure and age itself should not be a discriminatory factor in TAVI qualification. (Cardiol J 2017; 24, 4: 358–363

Diagnostic approach to light-chain cardiac amyloidosis and its differential diagnosis

Cardiac amyloidosis is a rare and often-misdiagnosed disorder. Among other forms of deposits affecting the heart, immunoglobulin-derived light-chain amyloidosis (AL amyloidosis) is the most serious form of the disease. Delay in diagnosis and treatment may have a major impact on the prognosis and outcomes of patients. This review focuses on the presentation of the disorder and current novel approaches to the diagnosis of cardiac involvement in AL amyloidosis

Predictive value of systemic inflammatory response index (SIRI) for complex coronary artery disease occurrence in patients presenting with angina equivalent symptoms

Background: Currently, atherosclerotic cardiovascular disease is the major cause of mortality world-wide. Inflammatory processes are postulated to be a major driving force for coronary plaque initiation and progression and can be evaluated by simple inflammatory markers from whole blood count analysis. Among hematological indexes, systemic inflammatory response index (SIRI) is defined as a quotient of neutrophils and monocytes, divided by lymphocyte count. The aim of the present retrospective analysis was to present the predictive role of SIRI for coronary artery disease (CAD) occurrence. Methods: There were 256 patients (174 [68%] men and 82 [32%] women) in the median (Q1–Q3) age of 67 (58–72) years enrolled into retrospective analysis due to angina pectoris equivalent symptoms. A model for predicting CAD was created based on demographic data and blood cell parameters reflecting an inflammatory response. Results: In patients with single/complex coronary disease the logistic regression multivariable analysis revealed predictive value of male gender (odds ratio [OR]: 3.98, 95% confidence interval [CI]: 1.38–11.42, p = 0.010), age (OR: 5.57, 95% CI: 0.83–0.98, p = 0.001), body mass index (OR: 0.89, 95% CI: 0.81–0.98, p = 0.012), and smoking (OR: 3.66, 95% CI: 1.71–18.22, p = 0.004). Among laboratory parameters, SIRI (OR: 5.52, 95% CI: 1.89–16.15, p = 0.029) and red blood cell distribution width (OR: 3.66, 95% CI: 1.67–8.04, p = 0.001) were found significant. Conclusions: Systemic inflammatory response index, a simple hematological index, may be helpful in patients with angina equivalent symptoms to diagnose CAD. Patients presenting with SIRI above 1.22 (area under the curve: 0.725, p < 0.001) have a higher probability of single and complex coronary disease

The Osteometry of Equine Third Phalanx by the Use of Three-Dimensional Scanning: New Measurement Possibilities

This study consisted in analyzing the asymmetry between bilateral third phalanges (coffin bones) in cold-blood horses based on the angle range of the plantar margin of the bone. The study employed a scanner projecting a hybrid set of images, consisting of sinusoidal stripes preceded by a Gray code sequence. As it turned out, three-dimensional scanning can be used to effectively determine the angle range for a selected portion of the studied bone. This provides broad possibilities for osteometric studies, as it enables the determination of angle distribution in a given fragment. The results obtained indicate a weak correlation between age and bilateral third-phalanx asymmetry in terms of the angle range of the plantar margins and no correlation between body weight and the asymmetry described

Znaczna poprawa kliniczna pacjenta leczonego sildenafilem z powodu nadciśnienia płucnego związanego z nadciśnieniem wrotnym

We report a case of the 59-year-old men with portal hypertension and liver cirrhosis, who developed pulmonary arterial hypertension. The first line treatment with sildenafil 20 mg 3 times daily was introduced as part of a Polish National Treatment Program. At a 6-month follow-up we noticed a significant clinical improvement: the patient’s exercise capacity and echocardiographic parameters were substantially better. In addition, the B-type natriuretic propeptide significantly decreased.W pracy zaprezentowano przypadek 59-letniego pacjenta z nadciśnieniem wrotnym w przebiegu marskości wątroby, u którego doszło do rozwoju tętniczego nadciśnienia płucnego. Pacjenta zakwalifikowano do leczenia pierwszego rzutu lekiem sildenafil w dawce 20 mg 3 razy/dobę w ramach Programu Narodowego Funduszu Zdrowia Leczenia Tętniczego Nadciśnienia Płucnego. Po 6 miesiącach leczenia w badaniach kontrolnych stwierdzono znaczną poprawę kliniczną — zarówno wydolności fizycznej, jak i parametrów echokardiograficznych. Uzyskano także istotne obniżenie stężenia propeptydu natriuretycznego typu B

Optimal duration and combination of antiplatelet therapies following percutaneous coronary intervention: a meta-analysis.

Abstract Introduction The ideal duration of dual antiplatelet therapy (DAPT) following percutaneous coronary intervention (PCI) is still unknown. In this meta-analysis, we aimed to compare very short-term (1–3 months), short-term (6 months), standard-term (12 months) and long-term (>12 months) DAPT durations for efficacy and safety. Methods Overall DAPT comparisons were classified as "any shorter-term"/"any longer-term" DAPT. The primary outcome was a composite of major adverse cardiovascular events (MACE: non-fatal myocardial infarction, non-fatal stroke and cardiovascular death). The primary safety outcome was major bleeding. Results Twenty-six studies comprising 103.394 patients were included. Compared with standard-term DAPT duration, very short-term DAPT duration with subsequent drop of aspirin (RR 1.06, 95% CI, 0.95–1.18, p = 0.26) or drop of the P2Y12 inhibitor (RR 0.92, 95% CI, 0.72-1.16, p = 0.47) was not associated with a higher risk of MACE. Any longer-term compared with any shorter-term DAPT durations led to a significantly lower risk of MACE (RR 0.88, 95% CI, 0.81–0.96, p = 0.002), but a significantly higher risk of BARC 3-5 major bleeding events (RR 1.63, 95% CI, 1.22–2.17, p = 0.001). In the ACS subgroup receiving prasugrel or ticagrelor but not clopidogrel, any longer-term DAPT duration was associated with a significantly lower risk of MACE compared to any shorter-term DAPT duration (RR 0.84, 95% CI, 0.77–0.92, p = 0.0001). Conclusion DAPT may be shortened to 1-3 months in patients with low ischemic but high bleeding risk followed by aspirin or P2Y12 monotherapy. Prasugrel or ticagrelor based DAPT may be extended to >12 months in case of high ischemic and low bleeding risk. PROSPERO registration no CRD42020163719

Predictive role of monocyte count for significant coronary artery disease identification in patients with stable coronary artery disease

Background: The coronary artery disease (CAD) remains the leading cause of morbidity that is characterized by broad spectrum of symptoms. Up to 30% of performed angiographies reveal normal coronary arteries. The aim of the study was to find simple predictor for significant epicardial artery stenosis among patients with chronic coronary syndrome. Methods: There were 187 patients (131 (709%) men and 56 (30%) women) in the median (Q1–Q3) age of 67 [58–72] presenting with stable CAD symptoms enrolled into the present retrospective analysis. The demographical, clinical and laboratory characteristics between patients with normal and significant coronary artery stenosis were compared. Results: The multivariable analysis revealed coexistence of hypercholesterolemia as significant differentiation factor (odds ratio [OR]: 4.38, 95% confidence interval [CI]: 1.78–10.80, p = 0.001) for significant CAD and inverse relation to serum high density lipoprotein (OR: 0.19, 95% CI: 0.05–0.72, p = 0.015) and relation to creatinine concentration (OR: 1.03, 95% CI: 1.00–1.05, p = 0.012). Among whole peripheral blood count analysis, the significant relation was noticed to be hemoglobin concentration (OR: 1.09, 95% CI: 1.10–1.18, p = 0.022) and monocyte count (OR: 32.3, 95% CI: 1.09–653.6, p = 0.017). Receiver operator curve revealed (AUC: 0.641, p = 0.001) with the optimal cut-off value above 0.45 K/uL for monocyte, yelding sensitivity of 81.82% and specificity of 58.06%. Conclusions: The peripheral monocyte count above 0.45 k/uL may be considered as a predictor of significant coronary artery disease in symptomatic patients with chronic coronary syndrome