Mężczyzna w wieku 84 lat z dusznością, podejrzeniem guza w lewym przedsionku i rozpoznaną przepukliną rozworu przełykowego przepony

This article discusses the case of an 84-year-old patient who presented to the Clinic of Cardiology due to worsening dyspnoea. The patient’s echocardiogram revealed a tumour in the left atrium, suggestive of myxoma.Omówiono przypadek 84-letniego chorego, który zgłosił się do kliniki kardiologii z powodu nasilającej się duszności. U pacjenta w badaniu echokardiograficznym opisano zmianę guzowatą w lewym przedsionku sugerującą śluzaka

Metabolic associated fatty liver disease and cardiovascular risk: The expert opinion of the Working Group on Cardiovascular Pharmacotherapy of the Polish Cardiac Society

The diagnosis of metabolic associated fatty liver disease (MAFLD) is significant for patients’ prognosis, as the disease accelerates the development of cardiovascular complications and, on the other hand, cardiometabolic conditions are risk factors for the development of fatty liver diseases. This expert opinion presents principles of MAFLD diagnosis and standards of management to reduce cardiovascular risks in patients with MAFLD

Pharmacotherapy of heart failure A.D. 2023. Expert opinion of Working Group on Cardiovascular Pharmacotherapy, Polish Cardiac Society

Heart failure (HF) remains one of the most common causes of hospitalization and mortality among Polish patients. The position of the Section of Cardiovascular Pharmacotherapy presents the currently applicable options for pharmacological treatment of HF based on the latest European and American guidelines from 2021–2022 in relation to Polish healthcare conditions. Treatment of HF varies depending on its clinical presentation (acute/chronic) or left ventricular ejection fraction. Initial treatment of symptomatic patients with features of volume overload is based on diuretics, especially loop drugs. Treatment aimed at reducing mortality and hospitalization should include drugs blocking the renin-angiotensin-aldosterone system, preferably angiotensin receptor antagonist/neprilysin inhibitor, i.e. sacubitril/valsartan, selected beta-blockers (no class effect — options include bisoprolol, metoprolol succinate, or vasodilatory beta-blockers — carvedilol and nebivolol), mineralocorticoid receptor antagonist, and sodium-glucose cotransporter type 2 inhibitor (flozin), constituting the 4 pillars of pharmacotherapy. Their effectiveness has been confirmed in numerous prospective randomized trials. The current HF treatment strategy is based on the fastest possible implementation of all four mentioned classes of drugs due to their independent additive action. It is also important to individualize therapy according to comorbidities, blood pressure, resting heart rate, or the presence of arrhythmias. This article emphasizes the cardio- and nephroprotective role of flozins in HF therapy, regardless of ejection fraction value. We propose practical guidelines for the use of medicines, profile of adverse reactions, drug interactions, as well as pharmacoeconomic aspects. The principles of treatment with ivabradine, digoxin, vericiguat, iron supplementation, or antiplatelet and anticoagulant therapy are also discussed, along with recent novel drugs including omecamtiv mecarbil, tolvaptan, or coenzyme Q10 as well as progress in the prevention and treatment of hyperkalemia. Based on the latest recommendations, treatment regimens for different types of HF 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

Mężczyzna w wieku 84 lat z dusznością, podejrzeniem guza w lewym przedsionku i rozpoznaną przepukliną rozworu przełykowego przepony

Omówiono przypadek 84-letniego chorego, który zgłosił się do kliniki kardiologii z powodu nasilającej się duszności. U pacjenta w badaniu echokardiograficznym opisano zmianę guzowatą w lewym przedsionku sugerującą śluzaka

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

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