Sleep disordered breathing in patients with heart failure

Sleep disordered breathing (SDB) is a common co-morbidity in patients with heart failure(HF). Both its forms — central and obstructive sleep apnea — are highly prevalent in thispopulation. SDB fragments sleep, impairs life quality, worsens exercise tolerance, worsens HFand is an independent predictor of poor prognosis. Still, SDB remains largely undiagnosed.Therefore, early detection of SDB seems to be of primary importance, especially in the presenceof new diagnostic and therapeutic methods. Treatment with continuous positive airwaypressure (CPAP) increases left ventricular ejection fraction and stroke volume in virtually allHF patients with obstructive and in 50% with central sleep apnea. For those in whom centralsleep apnea is not suppressed by CPAP, a trial of adaptive servoventilation is recommended.Although no randomized, controlled trials have shown improvement in mortality, several observationalstudies have shown that effective treatment of both forms of sleep apnea with variouspositive airway pressure devices improves survival of HF patients. Currently, 2 large trials withnewer masked based therapies with adaptive servoventilation are in progress. This article isa brief overview of present knowledge, the pathophysiology, diagnostic approach and therapy ofSDB

Zastosowanie lewosimendanu u chorych z ostrą niewydolnością serca z objawami małego rzutu minutowego serca: opis serii przypadków

The report presents single centre experience in application of levosimendan in patients with acute heart failure with low cardiacoutput. All patients underwent haemodynamic measurement before and after administration of the drug. Levosimendanimproved haemodynamics and was useful in this subpopulation of patients

Digital health and modern technologies applied in patients with heart failure: Can we support patients' psychosocial well-being?

Despite advances in the treatment of heart failure (HF), the physical symptoms and stress of the disease continue to negatively impact patients' health outcomes. Technology now offers promising ways to integrate personalized support from health care professionals via a variety of platforms. Digital health technology solutions using mobile devices or those that allow remote patient monitoring are potentially more cost effective and may replace in-person interaction. Notably, digital health methods may not only improve clinical outcomes but may also improve the psycho-social status of HF patients. Using digital health to address biopsychosocial variables, including elements of the person and their context is valuable when considering chronic illness and HF in particular, given the multiple, cross-level factors affecting chronic illness clinical management needed for HF self-care

Skrzepliny wewnątrzsercowe w zatorowości płucnej a priori niewysokiego ryzyka: dylematy terapeutyczne

Pulmonary embolism (PE) of a priori non high risk according to ESC guidelines, but coexisting with intracardiac thrombi ispotentially a life threatening disease. The recommendations regarding therapy in such situations are not clear. We report twocases of PE with coexisting intracardiac thrombi. The 74 year-old woman was admitted after previous cardiac arrest in thecourse of PE with the presence of intracardiac thrombi in right ventricle. Due to lack of clinical improvement during heparinadministration she was treated with thrombolysis. The 72 year-old obese woman with hypertension, diabetes and previousstroke with right-sided paresis was admitted after 2 episodes of loss of consciousness, with intracardiac thrombus in bothright and left heart. Due to contraindications to both surgery and thrombolysis, she was treated with heparin. Both womenrecovered successfully. These cases illustrate the importance of individual treatment strategy

The spectrum of malignancies among adult HIV cohort in Poland between 1995 and 2012 : a retrospective analysis of 288 cases

THE AIM OF THE STUDY: The aim of the study was to evaluate the spectrum of AIDS-defining malignancies (ADMs) and non-AIDS-defining malignancies (NADMs) in HIV-infected patients in Poland. MATERIAL AND METHODS: A retrospective observational study was conducted among HIV-infected adult patients who developed a malignancy between 1995 and 2012 in a Polish cohort. Malignancies were divided into ADMs and NADMs. Non-AIDS-defining malignancies were further categorised as virus-related (NADMs-VR) and unrelated (NADMs-VUR). Epidemiological data was analysed according to demographic data, medical history, and HIV-related information. Results were analysed by OR, EPITools package parameters and Fisher's exact test. RESULTS: In this study 288 malignancies were discovered. The mean age at diagnosis was 41.25 years (IQR20-81); for ADMs 38.05 years, and for NADMs-VURs 46.42 years; 72.22% were male, 40.28% were co-infected with HCV. The risk behaviours were: 37.85% IDU, 33.33% MSM, and 24.31% heterosexual. Mean CD4+ at the diagnosis was 282 cells/mm(3) (for ADMs 232 and for NADMs-VUR 395). Average duration of HIV infection at diagnosis was 5.69 years. There were 159 (55.2%) ADMs and 129 (44.8%) NADMs, among whom 58 (44.96%) NADMs-VR and 71 (55.04%) NADMs-VUR. The most frequent malignancies were: NHL (n = 76; 26.39%), KS (n = 49; 17.01%), ICC (n = 34; 11.81%), HD (n = 23; 7.99%), lung cancer (n = 18; 6.25%) and HCC (n = 14; 4.86%). The amount of NADMs, NADMs-VURs in particular, is increasing at present. Male gender (OR = 1.889; 95% CI: 1.104–3.233; p = 0.024), advanced age: 50–60 years (OR = 3.022; 95% CI: 1.359–6.720; p = 0.01) and ≥ 60 years (OR = 15.111; 95% CI: 3.122–73.151; p < 0.001), longer duration of HIV-infection and successful HAART (OR = 2.769; 95% CI: 1.675–4.577; p = 0) were independent predictors of NADMs overall, respectively. CONCLUSIONS: In a Polish cohort NHL was the most frequent malignancy among ADMs, whereas HD was the most frequent among NADMs. Increased incidence of NADMs appearing in elderly men with longer duration of HIV-infection and with better virological and immunological control was confirmed. As HIV-infected individuals live longer, better screening strategies, especially for NADMs-VUR, are needed. The spectrum of cancer diagnoses in Poland currently does not appear dissimilar to that observed in other European populations

Iron status and myocardial injury while recovering from acute myocarditis

Introduction. The pathophysiology of acute myocarditis (MCD) and subsequent recovery involves complex interplay between the virulence of pathogen, host immunity with possible genetic-based immune dysregulation, comorbidities and environmental factors. Precise identification of patients with increased risk of subsequent post-inflammatory cardiomyopathy is challenging. Abnormal iron status not only is a hallmark of immune activation but also plays a role in the development of cardiomyopathy, hence we investigated whether iron indices relate to myocardial injury in patients with acute MCD. Material and methods. Consecutive patients hospitalized for acute MCD in two cardiology centers were prospectively enrolled. We analyzed clinical characteristics, cardiac magnetic resonance (CMR) findings and biomarkers of myocardial necrosis, neurohormonal activation, inflammation, and comprehensive systemic iron status from index hospitalization and an ambulatory control visit after 6 months. Healthy volunteers were control group. Results. We enrolled 40 patients hospitalized for acute myocarditis (age: 32 ± 9 years, male gender: 98%). In-hospital serum ferritin correlated with CMR late gadolinium enhancement (LGE) mass (r = 0.537, p &lt; 0.001) and global T2 ratio (r = 0.360, p = 0.03). LGE, regional abnormalities in myocardial T1 relaxation time and elevated extracellular volume persisted after 6 months of recovery in comparison to healthy controls. Persistent LGE mass correlated with lower transferrin saturation and serum iron at the ambulatory visit (r = –0.520, p = 0.03; and r = –0.465, p = 0.04; respectively). Conclusions. Acute-phase reactant ferritin relates to myocardial injury in the acute phase of MCD, whereas in the recovery phase residual fibrosis is greater in subjects with more profound functional iron deficiency, the latter reflecting, to some extent, systemic low-grade inflammation.Introduction. The pathophysiology of acute myocarditis (MCD) and subsequent recovery involves complex interplay between the virulence of pathogen, host immunity with possible genetic-based immune dysregulation, comorbidities and environmental factors. Precise identification of patients with increased risk of subsequent post-inflammatory cardiomyopathy is challenging. Abnormal iron status not only is a hallmark of immune activation but also plays a role in the development of cardiomyopathy, hence we investigated whether iron indices relate to myocardial injury in patients with acute MCD. Material and methods. Consecutive patients hospitalized for acute MCD in two cardiology centers were prospectively enrolled. We analyzed clinical characteristics, cardiac magnetic resonance (CMR) findings and biomarkers of myocardial necrosis, neurohormonal activation, inflammation, and comprehensive systemic iron status from index hospitalization and an ambulatory control visit after 6 months. Healthy volunteers were control group. Results. We enrolled 40 patients hospitalized for acute myocarditis (age: 32 ± 9 years, male gender: 98%). In-hospital serum ferritin correlated with CMR late gadolinium enhancement (LGE) mass (r = 0.537, p < 0.001) and global T2 ratio (r = 0.360, p = 0.03). LGE, regional abnormalities in myocardial T1 relaxation time and elevated extracellular volume persisted after 6 months of recovery in comparison to healthy controls. Persistent LGE mass correlated with lower transferrin saturation and serum iron at the ambulatory visit (r = –0.520, p = 0.03; and r = –0.465, p = 0.04; respectively). Conclusions. Acute-phase reactant ferritin relates to myocardial injury in the acute phase of MCD, whereas in the recovery phase residual fibrosis is greater in subjects with more profound functional iron deficiency, the latter reflecting, to some extent, systemic low-grade inflammation

Meeting the WHO 90% target : antiretroviral treatment efficacy in Poland is associated with baseline clinical patient characteristics

Introduction: Modern combined antiretroviral therapies (cART) allow to effectively suppress HIV-1 viral load, with the 90% virologic success rate, meeting the WHO target in most clinical settings. The aim of this study was to analyse antiretroviral treatment efficacy in Poland and to identify variables associated with virologic suppression. Methods: Cross-sectional data on 5152 (56.92% of the countrywide treated at the time-point of analysis) patients on cART for more than six months with at least one HIV-RNA measurement in 2016 were collected from 14 Polish centres. Patients’ characteristics and treatment type-based outcomes were analysed for the virologic suppression thresholds of <50 and <200 HIV-RNA copies/ml. CART was categorized into two nucleos(t)ide (2NRTI) plus non-nucleoside reverse transcriptase (NNRTI) inhibitors, 2NRTI plus protease (PI) inhibitor, 2NRTI plus integrase (InI) inhibitor, nucleos(t)ide sparing PI/r+InI and three drug class regimens. For statistics Chi-square and U-Mann Whitney tests and adjusted multivariate logistic regression models were used. Results: Virologic suppression rates of <50 copies/mL were observed in 4672 (90.68%) and <200 copies/mL in 4934 (95.77%) individuals. In univariate analyses, for the suppression threshold <50 copies/mL higher efficacy was noted for 2NRTI+NNRTI-based combinations (94.73%) compared to 2NRTI+PI (89.93%), 2NRTI+InI (90.61%), nucleos(t)ide sparing PI/r+InI (82.02%) and three drug class regimens (74.49%) (p < 0.0001), with less pronounced but significant differences for the threshold of 200 copies/mL [2NRTI+NNRTI-97.61%, 2NRTI+PI-95.27%, 2NRTI+InI-96.61%, PI/r+InI- 95.51% and 86.22% for three drug class cART) (p < 0.0001). However, in multivariate model, virologic efficacy for viral load <50 copies/mL was similar across treatment groups with significant influence by history of AIDS [OR:1.48 (95%CI:1.01–2.17) if AIDS diagnosed, p = 0.046], viral load < 5 log copies/mL at care entry [OR:1.47 (95%CI:1.08–2.01), p = 0.016], baseline lymphocyte CD4 count ≥200 cells/µL [OR:1.72 (95%CI:1.04–2.78), p = 0.034] and negative HCV serology [OR:1.97 (95%CI:1.29–2.94), p = 0.002]. For viral load threshold <200 copies/mL higher likelihood of virologic success was only associated with baseline lymphocyte CD4 count ≥200 cells/µL [OR:2.08 (95%CI:1.01–4.35), p = 0.049] and negative HCV status [OR:2.84 (95%CI:1.52–5.26), p = 0.001]. Conclusions: Proportion of virologically suppressed patients is in line with WHO treatment target confirming successful application of antiretroviral treatment strategy in Poland. Virological suppression rates depend on baseline patient characteristics, which should guide individualized antiretroviral tre0atment decisions