Management of patients with valvular and non-valvular atrial fibrillation in Poland: Results from Reference Cardiology University Center

Background: Information on epidemiology of atrial fibrillation (AF) in Middle European Countries such as Poland is limited. Methods: We studied 1,556 patients with AF. We focused on different types of AF in terms of clinical features and management. Results: CHA2DS2-VASc score was 3.5 ± 1.7 and HAS-BLED score — 2.4 ± 1.1. In-hospital mortality was 2%. The CHA2DS2-VASc score was the highest in permanent AF (p < 0.001) and the HAS-BLED score was the highest in paroxysmal and permanent AF (p < 0.001). The CHA2DS2-VASc score ≥ 2 was found in the majority of non-valvular AF patients. Permanent AF was associated with the highest thromboembolic risk (p < 0.001). Valvular AF was more commonly observed in patients with permanent AF (p = 0.004). Seventy-one percent of pa­tients who had CHA2DS2-VASc > 2 received antithrombotic therapy. Acetylsalicylic acid alone was most common in paroxysmal AF (p < 0.001). Patients with valvular AF had more often permanent AF (p < 0.004). Valvular AF patients were more often prescribed antithrombotic therapy (p = 0.001). The in-hospital mortality did not differ between patients with valvular and non-valvular AF (p = 0.3). In multivariate logistic regression, odds of in-hospital death were higher for patients > 75 years old (OR = 6.26, p = 0.001, 95% CI 2.06–19.02) and with ejection fraction < 35% (OR = 5.25, p < 0.001, 95% CI 2.24–12.32). Conclusions: Our population with AF have similar risk of stroke and bleeding as in Euro­pean registries. The need for anticoagulation in AF patients is well established in daily medical care in Poland similarly to Western Europe. Patients with valvular AF are more frequently prescribed antithrombotic therapy than patients with non-valvular AF. In-hospital mortality is relatively low in both valvular and non-valvular AF patients and is connected with old age and diminished ejection fraction

Dializy ratują życie, ale niszczą serce

W ciągu ostatnich 20 lat obserwuje się stały wzrost liczby chorych poddawanych leczeniu nerkozastępczemu, ratującemu życie chorych z przewlekłą, schyłkową chorobą nerek. Chorzy dializowani umierają 3-krotnie częściej z powodu powikłań sercowo-naczyniowych niż w wyniku bezpośrednich następstw samej choroby podstawowej oraz 15-krotnie częściej niż osoby z populacji ogólnej. Do najczęstszych przyczyn zgonu należą: nagłe zatrzymanie krążenia, zawał serca, udar mózgu oraz ostra niewydolność serca, które stanowią 50% wszystkich przyczyn zgonów. Mimo wielkiego postępu, jaki w ostatnich latach dokonał się w technice dializ, wciąż stwierdza się niezwykle wysoką śmiertelność, szczególnie z przyczyn sercowo-naczyniowych

KDIGO Controversies Conference on onco-nephrology: understanding kidney impairment and solid-organ malignancies, and managing kidney cancer

The association between kidney disease and cancer is multifaceted and complex. Persons with chronic kidney disease (CKD) have an increased incidence of cancer, and both cancer and cancer treatments can cause impaired kidney function. Renal issues in the setting of malignancy can worsen patient outcomes and diminish the adequacy of anticancer treatments. In addition, the oncology treatment landscape is changing rapidly, and data on tolerability of novel therapies in patients with CKD are often lacking. Caring for oncology patients has become more specialized and interdisciplinary, currently requiring collaboration among specialists in nephrology, medical oncology, critical care, clinical pharmacology/pharmacy, and palliative care, in addition to surgeons and urologists. To identify key management issues in nephrology relevant to patients with malignancy, KDIGO (Kidney Disease: Improving Global Outcomes) assembled a global panel of multidisciplinary clinical and scientific expertise for a controversies conference on onco-nephrology in December 2018. This report covers issues related to kidney impairment and solid organ malignancies as well as management and treatment of kidney cancer. Knowledge gaps, areas of controversy, and research priorities are described

Znaczenie rokownicze EKG u chorych dializowanych

Wstęp: W związku z dużą chorobowością i śmiertelnością u osób dializowanych ważne jest zidentyfikowanie pacjentów z wysokim ryzykiem powikłań sercowo-naczyniowych. Jednak określenie czułych i specyficznych wskaźników prognostycznych jest niezwykle trudne, co wynika z wieloczynnikowego podłoża obrazu klinicznego przewlekłej choroby nerek. Celem pracy była analiza spoczynkowego zapisu elektrokardiograficznego (EKG) chorych dializowanych oraz ocena wartości prognostycznej zmian patologicznych w 3-letniej obserwacji. Wyniki: W badanej 100-osobowej grupie dializowanych pacjentów śmiertelność całkowita po 3 latach wynosiła 52%, a niekorzystne zdarzenia sercowe (zgon z jakiejkolwiek przyczyny, nagłe zatrzymanie krążenia, zawał serca, udar, potrzeba rewaskularyzacji) zarejestrowano u 57%. Nagłe zatrzymanie krążenia wystąpiło u 12% osób, zawał serca u 12%, udar u 3%, rewaskularyzacja wieńcowa u 5%. Ryzyko zgonu z każdej przyczyny rosło w sposób istotny statystycznie wraz z wystąpieniem rytmu pozazatokowego (p = 0,045), obecnością obniżenia odcinka ST (p = 0,04) oraz przerostu prawej komory (p = 0,03), zwłaszcza definiowanego według kryterium R/S V5/6 < 1 (p = 0,02). Nagłe zatrzymanie krążenia korelowało jedynie z obecnością bloku prawej odnogi pęczka Hisa (p = 0,002). Zawał serca istotnie częściej występował u pacjentów z obecnością R/S V5/6 < 1 (p = 0,01), a także u chorych z wydłużonym odstępem QTc (p = 0,04). Średnia wartość QTc wynosiła 510 ms. Stwierdzono istotną statystycznie korelację między potrzebą rewaskularyzacji a obecnością przerostu lewej komory definiowanego kryterium RI + SIII > 2,5 mV (p = 0,03) oraz przerostu lewego przedsionka (p = 0,01). W analizie nie wykazano istotnej statystycznie zależności między patologicznymi zmianami w zapisie EKG a udarem mózgu. Wystąpienie rytmu pozazatokowego, obniżenia odcinka ST oraz przerostu prawej komory według kryterium R/S V5/6 < 1 korelowało ze złożonym punktem końcowym (p = 0,03, p = 0,01 oraz p = 0,03, odpowiednio). Obecność w EKG bloku lewej odnogi pęczka Hisa nie miała istotnego wpływu na ryzyko zgonu oraz wystąpienia pozostałych analizowanych punktów końcowych. Wnioski: Wybrane nieprawidłowe zmiany w spoczynkowym zapisie elektrokardiograficznym u dializowanych chorych w istotny sposób korelują ze śmiertelnością ogólną oraz z wystąpieniem niekorzystnych zdarzeń sercowych. Badanie elektrokardiograficzne będące metodą nieinwazyjną, powszechnie dostępną i tanią może służyć jako wskaźnik ryzyka powikłań sercowo- -naczyniowych w tej szczególnie zagrożonej populacji

Do we know more about hypertension in Poland after the May Measurement Month 2017?-Europe

Elevated blood pressure (BP) is a worldwide burden, leading to over 10 million deaths yearly. May Measurement Month (MMM) is a global initiative organized by the International Society of Hypertension aimed at raising awareness of hypertension and the need for BP screening. An opportunistic cross-sectional survey of volunteers aged ≥18 was carried out in May 2017. BP measurement, the definition of hypertension and statistical analysis followed the globally approved MMM17 Study Protocol. In Poland 5834 (98.9%, Caucasian) individuals were screened. After multiple imputation, 2601 (35.3%) had hypertension. Of individuals not receiving anti-hypertensive medication, 976 (20.6%) were hypertensive. Of individuals receiving anti-hypertensive medication, 532 (49.1%) had uncontrolled BP. In the crude screened group, 81.4% declared to not receive any anti-hypertensive treatment, while the remaining 18.6% were on such medications. In overweight and obese patients both systolic and diastolic BP were significantly higher than in normal weight and underweight subjects. In addition, BP measured on Sundays was significantly lower than on Mondays. MMM17 was one of the largest recent BP screening campaigns in Poland. We found that over 1/3 of participants were hypertensive. Almost half of the treated subjects had uncontrolled BP. These results suggest that opportunistic screening can identify substantial numbers with raised BP

Maritime Operations and Emergency Preparedness in the Arctic–Competence Standards for Search and Rescue Operations Contingencies in Polar Waters

Emergencies on large passenger ships in the remote High North may lead to a mass rescue operation with a heavy strain on the emergency preparedness systems of the Arctic countries. This study focuses on the need for competencies related to large-scale Search and Rescue operations (SAR operations) amongst the shipping companies, vessels and governments involved. A SAR operation is the activity related to finding and rescuing people in distress. Several international standards, in particular the conventions by the International Maritime Organization (IMO), provide direction for education and training of seafarers and rescue staff. This study elaborates on the operational competence requirements for key personnel involved in large scale SAR operations. Findings from real SAR incidents and exercises provide in-depth understanding on the operational challenges. The chapter gives directions for competence programs, beyond obligatory international standards, and recommendations for further research

Functional cyclophilin D moderates platelet adhesion, but enhances the lytic resistance of fibrin

In the course of thrombosis, platelets are exposed to a variety of activating stimuli classified as ‘strong’ (e.g. thrombin and collagen) or ‘mild’ (e.g. ADP). In response, activated platelets adhere to injured vasculature, aggregate, and stabilise the three-dimensional fibrin scaffold of the expanding thrombus. Since ‘strong’ stimuli also induce opening of the mitochondrial permeability transition pore (MPTP) in platelets, the MPTP-enhancer Cyclophilin D (CypD) has been suggested as a critical pharmacological target to influence thrombosis. However, it is poorly understood what role CypD plays in the platelet response to ‘mild’ stimuli which act independently of MPTP. Furthermore, it is unknown how CypD influences platelet-driven clot stabilisation against enzymatic breakdown (fibrinolysis). Here we show that treatment of human platelets with Cyclosporine A (a cyclophilin-inhibitor) boosts ADP-induced adhesion and aggregation, while genetic ablation of CypD in murine platelets enhances adhesion but not aggregation. We also report that platelets lacking CypD preserve their integrity in a fibrin environment, and lose their ability to render clots resistant against fibrinolysis. Our results indicate that CypD has opposing haemostatic roles depending on the stimulus and stage of platelet activation, warranting a careful design of any antithrombotic strategy targeting CypD

Chronic kidney disease and valvular heart disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Chronic kidney disease (CKD) is a major risk factor for valvular heart disease (VHD). Mitral annular and aortic valve calcifications are highly prevalent in CKD patients and commonly lead to valvular stenosis and regurgitation, as well as complications including conduction system abnormalities and endocarditis. VHD, especially mitral regurgitation and aortic stenosis, is associated with significantly reduced survival among CKD patients. Knowledge related to VHD in the general population is not always applicable to CKD patients because the pathophysiology may be different, and CKD patients have a high prevalence of comorbid conditions and elevated risk for periprocedural complications and mortality. This Kidney Disease: Improving Global Outcomes (KDIGO) review of CKD and VHD seeks to improve understanding of the epidemiology, pathophysiology, diagnosis, and treatment of VHD in CKD by summarizing knowledge gaps, areas of controversy, and priorities for research

Chronic kidney disease and valvular heart disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies conference

Chronic kidney disease (CKD) is a major risk factor for valvular heart disease (VHD). Mitral annular and aortic valve calcifications are highly prevalent in CKD patients and commonly lead to valvular stenosis and regurgitation, as well as complications including conduction system abnormalities and endocarditis. VHD, especially mitral regurgitation and aortic stenosis, is associated with significantly reduced survival among CKD patients. Knowledge related to VHD in the general population is not always applicable to CKD patients because the pathophysiology may be different, and CKD patients have a high prevalence of comorbid conditions and elevated risk for periprocedural complications and mortality. This Kidney Disease: Improving Global Outcomes (KDIGO) review of CKD and VHD seeks to improve understanding of the epidemiology, pathophysiology, diagnosis, and treatment of VHD in CKD by summarizing knowledge gaps, areas of controversy, and priorities for research