Rola diagnostyki kardiologicznej u pacjentów z udarem kryptogennym — aktualny stan wiedzy

Cryptogenic stroke is a stroke of unknown aetiology. Over two thirds of cryptogenic strokes have an embolic, mainly cardiogenic, source. This is why cardiac imaging and looking for cardiac arrhythmia, especially atrial fibrillation, are so important. In patients with implanted devices, the routine use of recording intracardiac electrocardiography in the device’s memory is recommended in order to find so-called atrial high-rate episodes. The improvements in diagnostic tools and the progress in atrial fibrillation monitoring have lowered the number of strokes of unknown aetiology, and in many cases have allowed the application of appropriate secondary prophylaxis.Udar kryptogenny to udar mózgu o nieznanej etiologii. Ponad 2/3 udarów kryptogennych ma podłoże zatorowe, głównie kardiogenne. Dlatego tak ważne są obrazowa diagnostyka kardiologiczna oraz diagnostyka zaburzeń rytmu serca, zwłaszcza migotania przedsionków. U osób z implantowanymi urządzeniami wszczepialnymi należy rutynowo wykorzystywać zapisy wewnątrzsercowego elektrokardiogramu w pamięci urządzenia, w poszukiwaniu tak zwanych szybkich rytmów przedsionkowych. Udoskonalenie narzędzi diagnostycznych oraz postępy w wykrywaniu migotania przedsionków sprawiają, że coraz mniej udarów mózgu pozostaje bez ustalonej przyczyny, co w wielu przypadkach pozwala na odpowiednio wczesne wdrożenie profilaktyki wtórnej

Rola diagnostyki kardiologicznej u pacjentów z udarem kryptogennym — aktualny stan wiedzy

Cryptogenic stroke is a stroke of unknown aetiology. Over two thirds of cryptogenic strokes have an embolic, mainly cardio­genic, source. This is why cardiac imaging and looking for cardiac arrhythmia, especially atrial fibrillation, are so important. In patients with implanted devices, the routine use of recording intracardiac electrocardiography in the device’s memory is recommended in order to find so-called atrial high-rate episodes. The improvements in diagnostic tools and the progress in atrial fibrillation monitoring have lowered the number of strokes of unknown aetiology, and in many cases have allowed the application of appropriate secondary prophylaxis.Udar kryptogenny to udar mózgu o nieznanej etiologii. Ponad 2/3 udarów kryptogennych ma podłoże zatorowe, głównie kardiogenne. Dlatego tak ważne są obrazowa diagnostyka kardiologiczna oraz diagnostyka zaburzeń rytmu serca, zwłaszcza migotania przedsionków. U osób z implantowanymi urządzeniami wszczepialnymi należy rutynowo wykorzystywać zapisy wewnątrzsercowego elektrokardiogramu w pamięci urządzenia, w poszukiwaniu tak zwanych szybkich rytmów przedsionkowych. Udoskonalenie narzędzi diagnostycznych oraz postępy w wykrywaniu migotania przedsionków sprawiają, że coraz mniej udarów mózgu pozostaje bez ustalonej przyczyny, co w wielu przypadkach pozwala na odpowiednio wczesne wdrożenie profilaktyki wtórnej

Leczenie ostrej niewydolności serca

Acute heart failure (AHF) is a major and growing public health problem worldwide with ten million patients in Europe andeight hundred thousand patients in Poland. AHF is defined as the rapid onset of, or change in, signs and symptoms ofheart failure (HF) requiring urgent therapy and hospitalization. It arises from a rapid appearance for the first time or asa result of deterioration in patients with a previous diagnosis of HF. Fast diagnosis and treatment, initially focused onsymptom relief and causal treatment is crucial. This article is the summary of the new European Society of Cardiologyguidelines for the diagnosis and treatment of acute and chronic heart failure and short overview of ongoing multicenterstudies are still lacking on the pharmacotherapy of AHF.Ostra niewydolność serca (AHF) stanowi poważny problem socjoekonomiczny współczesnego świata. Niewydolnośćserca (HF) występuje u około 10 mln osób w Europie i u około 800 tys. w Polsce. W opiece nad chorym wysiłki lekarzyzmierzają jednocześnie do zmniejszenia objawów związanych z HF, odpowiedniego leczenia chorób prowadzących do jejrozwoju oraz do obniżenia ryzyka śmiertelności i rehospitalizacji. Artykuł ten stanowi podsumowanie aktualnej wiedzyna temat leczenia AHF opartej na wytycznych Europejskiego Towarzystwa Kardiologicznego z 2016 roku oraz trwającychwieloośrodkowych badaniach klinicznych

Randomized controlled clinical trials versus real-life atrial fibrillation patients treated with oral anticoagulants. Do we treat the same patients?

Background: The aim of the study was to compare clinical characteristics of real-life atrial fibrillation (AF) patients with populations included in randomized clinical trials (ROCKET AF and RE-LY).Methods: The analysis included 3528 patients who are participants of the ongoing, multicentre, retrospective CRAFT study. The study is registered in ClinicalTrials.gov: NCT02987062. The study is based on a retrospective analysis of hospital records of AF patients treated with vitamin K antagonists (VKAs) (acenocoumarol, warfarin) and non-vitamin K oral anticoagulants (NOACs) (dabigatran, rivaroxaban). CHADS2 score was used for risk of stroke stratification.Results: VKA was prescribed in 1973 (56.0%), while NOAC in 1549 (44.0%), including dabigatran — 504 (14.3%) and rivaroxaban — 1051 (29.8%), of the 3528 patients. VKA patients in the CRAFT study were at significantly lower risk of stroke (CHADS2 1.9 ± 1.3), compared with the VKA population from the RE-LY (2.1 ± 1.1) and the ROCKET-AF (3.5 ± 1.0). Patients in the CRAFT study treated with NOAC (CHADS2 for patients on dabigatran 150 mg — 1.3 ± 1.2 and on rivaroxaban — 2.2 ± 1.4) had lower risk than patients from the RE-LY (2.2 ± 1.2) and the ROCKET AF (3.5 ± 0.9).Conclusions: Real-world patients had a lower risk of stroke than patients included in the RE-LY and ROCKET AF trials

Comparative effectiveness of torasemide versus furosemide in symptomatic therapy in heart failure patients: Preliminary results from the randomized TORNADO trial

Background: Recent reports suggest that torasemide might be more beneficial than furosemide inpatients with symptomatic heart failure (HF). The aim was to compare the effects of torasemide andfurosemide on clinical outcomes in HF patients.Methods: This study pilot consisted of data from the ongoing multicenter, randomized, unblindedendpoint phase IV TORNADO (NCT01942109) study. HF patients in New York Heart Association(NYHA) II–IV class with a stable dose of furosemide were randomized to treatment with equipotentialdose of torasemide (4:1) or continuation of unchanged dose of furosemide. On enrollment andcontrol visit (3 months after enrollment) clinical examination, 6-minute walk test (6MWT) andassessment of fluid retention by ZOE Fluid Status Monitor were performed. The primary endpoint wasa composite of improvement of NYHA class, improvement of at least 50 m during 6MWT and decreasein fluid retention of at least 0.5 W after 3-months follow-up.Results: The study group included 40 patients (median age 66 years; 77.5% male). During follow-up7 patients were hospitalized for HF worsening (3 in torasemide and 4 in furosemide-treated patients).The primary endpoint reached 15 (94%) and 14 (58%) patients on torasemide and furosemide, respectively(p = 0.03).Conclusions: In HF patients treated with torasemide fluid overload and symptoms improved more thanin the furosemide group. This positive effect occurred already within 3-month observation

ABC Effect in Basic Double-Pionic Fusion --- Observation of a new resonance?

We report on a high-statistics measurement of the basic double pionic fusion reaction $pn \to d\pi^0\pi^0$ over the energy region of the so-called ABC effect, a pronounced low-mass enhancement in the $\pi\pi$-invariant mass spectrum. The measurements were performed with the WASA detector setup at COSY. The data reveal the ABC effect to be associated with a Lorentzian shaped energy dependence in the integral cross section. The observables are consistent with a resonance with $I(J^P) =0(3^+)$ in both $pn$ and $\Delta\Delta$ systems. Necessary further tests of the resonance interpretation are discussed

Niewłaściwe przepisywanie zredukowanej dawki NOAC w praktyce klinicznej — wyniki Polskiego Rejestru Migotania Przedsionków (POL-AF) u hospitalizowanych pacjentów

Introduction. Prescribing non-vitamin K antagonist oral anticoagulants (NOACs) in a reduced or full dosage is important for providing patients with atrial fibrillation (AF) with efficacious and safe treatment. The study aimed to evaluate the administration frequency of reduced NOAC dosages against the guidelines and analysis of factors predisposing to such a choice in patients with AF included in the Polish Atrial Fibrillation (POL-AF) Registry. Material and methods. The study included 1003 patients with AF treated with reduced dosages of NOACs hospitalized in ten Polish cardiology centers from January to December 2019. The criteria for appropriately reduced NOAC dosages was a dosage reduction of individual NOAC from the clinical studies, which was the basis for their registration. Results. Among the 1003 patients who were treated with a reduced dosage of NOACs, inappropriately reduced dosages were observed in 242 patients (24.1%): in 120 patients (29.3%) treated with rivaroxaban, in 93 patients (33.8%) treated with apixaban and in 29 patients (9.1%) treated with dabigatran (p &lt; 0.0001). Independent predictors of the use of inappropriately reduced dosages of NOACs were heart failure (odds ratio [OR] 1.55, confidence interval [CI]: 1.08–2.22) and hospitalization due to cardiac implantable electronic device (CIED) implantations/reimplantations (OR 2.01, CI: 1.27–3.17). Factors diminishing the chances of using inappropriately reduced dosages of NOACs were age (OR 0.98, CI: 0.97–0.998), vascular disease (OR 0.29, CI: 0.21–0.40) and creatinine clearance (CrCl) &lt; 60 mL/min (OR 0.37, CI: 0.27–0.52). Conclusions. In the group of patients treated with a reduced dosage of NOAC, 24.1% of patients had an inappropriately reduced dosage prescription, most frequently the patients receiving apixaban and rivaroxaban. The factor predisposing to prescribing an inappropriately reduced dosage of NOAC was heart failure and hospitalization due to CIED implantation/reimplantation. Label adherence to NOAC dosage is important to improve clinical outcomes in AF patients, and further investigation is needed to assess the best dosage of NOACs in the AF population.Wstęp. Przepisywanie doustnych przeciwkrzepliwych leków niebędących antagonistami witaminy K (NOAC) w dawce zredukowanej lub pełnej jest istotne dla zapewnienia pacjentom z migotaniem przedsionków (AF) skutecznego i bezpiecznego leczenia. Celem badania było ocenienie częstości stosowania zredukowanych dawek NOAC w stosunku do wytycznych oraz analiza czynników predysponujących do takiego wyboru u pacjentów z AF zarejestrowanych w Polskim Rejestrze Migotania Przedsionków (POL-AF). Materiał i metody. Badanie obejmowało 1003 pacjentów z AF leczonych zredukowanymi dawkami NOAC, hospitalizowanych w 10 polskich ośrodkach kardiologicznych od stycznia do grudnia 2019 roku. Kryterium stosowania odpowiednio zredukowanych dawek NOAC była redukcja dawki indywidualnego leku NOAC na podstawie badań klinicznych, które były podstawą ich rejestracji. Wyniki. Spośród 1003 pacjentów leczonych zredukowanymi dawkami NOAC, nieodpowiednio zredukowane dawki zaobserwowano u 242 pacjentów (24,1%): u 120 pacjentów (29,3%) leczonych rywaroksabanem, u 93 pacjentów (33,8%) leczonych apiksabanem oraz u 29 pacjentów (9,1%) leczonych dabigatranem (p < 0,0001). Niezależnymi czynnikami predykcyjnymi stosowania nieodpowiednio zredukowanych dawek NOAC były: niewydolność serca (iloraz szans [OR] 1,55; przedział ufności [CI]: 1,08–2,22) oraz hospitalizacja związana z wszczepieniem/reimplantacją kardioelektronicznych urządzeń wszczepialnych (CIED) (OR 2,01; CI: 1,27–3,17). Czynnikiem zmniejszającym szanse na stosowanie nieodpowiednio zredukowanych dawek NOAC były: wiek (OR 0,98; CI: 0,97–0,998), choroba naczyniowa (OR 0,29; CI: 0,21–0,40) i klirens kreatyniny (CrCl) < 60 ml/min (OR 0,37; CI: 0,27–0,52). Wnioski. W grupie pacjentów leczonych zredukowaną dawką NOAC, 24,1% pacjentów miało nieodpowiednio przepisane dawki, najczęściej pacjenci otrzymujący apiksaban i rywaroksaban. Czynnikami predysponującymi do przepisywania nieodpowiednio zredukowanej dawki NOAC były niewydolność serca oraz hospitalizacja związana z wszczepieniem/reimplantacją CIED. Przestrzeganie zaleceń dotyczących dawek NOAC jest istotne dla poprawy wyników klinicznych u pacjentów z AF, konieczne jest również dalsze badanie w celu oceny optymalnej dawki NOAC w populacji z AF

\pi^0 \pi^0 Production in Proton-Proton Collisions at Tp=1.4 GeV

The reaction pp->pppi0pi0 has been investigated at a beam energy of 1.4 GeV using the WASA-at-COSY facility. The total cross section is found to be (324 +- 21_systematic +- 58_normalization) mub. In order to to study the production mechanism, differential kinematical distributions have been evaluated. The differential distributions indicate that both initial state protons are excited into intermediate Delta(1232) resonances, each decaying into a proton and a single pion, thereby producing the pion pair in the final state. No significant contribution of the Roper resonance N*(1440) via its decay into a proton and two pions is foundComment: Submitted to PL

Clinical characteristic of 100 patients from pilot registry of heart failure patients hospitalized in the district hospital in Poland

Nowadays heart failure (HF) presents are enormous and rapidly growing public health problem. HF is characterized by high morbidity and mortality and high costs. The analysis included 100 consecutives discharge records patients with HF, treated in Cardiology Ward during the first quarter of 2015. The mean age of the whole investigated population was 73 years (63% males). The most prevalent concomitant diseases were: arterial hypertension (58%), coronary artery disease (46%), the presence at least the moderate insufficiency of the mitral or aortic valve (34%), atrial fibrillation (38%), diabetes mellitus (29%). Data from hospitalized HF registries are useful to better understand the clinical characteristics, patient management and outcomes after discharge.Introduction. Nowadays heart failure (HF) presents an enormous and rapidly growing public health problem. HF is characterized by high morbidity and mortality and high costs. Material and methods. The analysis included medical records of 100 consecutive patients with HF treated in the Department of Cardiology during the first quarter of 2015. Results. The mean age of the whole investigated population was 73 years (63% males). The most prevalent concomitant diseases were: arterial hypertension (58%), coronary artery disease (46%), the presence of moderate or severe mitral or aortic valvular defect (34%), atrial fibrillation (38%), and diabetes mellitus (29%). Conclusions. Data from hospitalized HF registries are useful to better understand the clinical characteristics, patient management and outcomes after discharge