Prognostic value of red blood cell distribution width in patients with left ventricular systolic dysfunction: Insights from the COMMIT-HF registry

Background: Previous studies have reported that in patients with heart failure, an increased value of red cell distribution width (RDW) is associated with adverse outcomes. Nonetheless, data regarding the association between RDW values and long-term mortality in patients with left ventricular systolic dysfunction (LVSD) are lacking. The aim of this investigation was to examine the relationship between mortality and RDW in patients with ischemic and non-ischemic LVSD. Methods: Under analysis was 1734 patients with a left ventricular ejection fraction (LVEF) ≤ 35% of whom were hospitalized between 2009 and 2013. Patients were divided into three groups based on RDW tertiles. Low, medium and high tertiles were defined as RDW ≤ 13.4%, 13.4% < RDW ≤ 14.6% and RDW > 14.6%, respectively. Results: There was a stepwise relationship between RDW intervals and comorbidities. Patients with the highest RDW values were older and more often diagnosed with anemia, diabetes, atrial fibrillation and chronic kidney disease. The main finding of our analysis was the presence of an 8-fold increase in all-cause mortality in the entire cohort between high and low RDW tertile. Cox hazard analysis identi­fied RDW as an independent predictive factor of mortality in all patients (HR 2.8; 95% CI 2.1–3.8; p < 0.0001) and in subgroups of patients with ischemic (HR 2.8; 95% CI 2.0–3.9; p < 0.0001) and non-ischemic (HR 3.3; 95% CI 2.01–5.5; p < 0.0001) LVSD. Conclusions: The highest RDW tertile was independently associated with higher long-term mortality compared with low and medium tertiles, both in all patients with a LVEF ≤ 35% and in subgroups of patients with ischemic and non-ischemic LVSD

Rewaskularyzacja w skurczowej niedokrwiennej niewydolności serca — prezentacja przypadku i podsumowanie aktualnych wytycznych

Heart failure has become a global pandemic. Despite being identified as the main cause of heart failure, evidence based data on coronary heart disease treatment in this population is scarce. At the same time the clinical characteristics in this group of patients is often very complex and requires an “outside-the-EBM-box” approach. This article is an attempt to summarize the current guidelines. We also present a case of a patient, in whom percutaneous revascularization with support of mechanical circulatory support, despite high risk, has given a very satisfactory short-term result and a good long-term outcome.  Niewydolność serca (NS) stała się światową pandemią. Pomimo że choroba wieńcowa stanowi jej najczęstszą przyczynę, zasób wiedzy opartej na faktach dotyczącej kwalifikacji do diagnostyki inwazyjnej oraz rewaskularyzacji jest ograniczony. Ponadto, wobec często znacznie obciążonej charakterystyki klinicznej pacjentów z NS konieczne do podjęcia w codziennej praktyce decyzje diagnostyczno-terapeutyczne wymykają się wytycznym. Niniejsza praca stanowi próbę podsumowania aktualnych zaleceń oraz przedstawia przypadek kliniczny pacjenta, u którego przeprowadzenie zabiegu przezskórnej rewaskularyzacji z wykorzystaniem mechanicznego wspomagania krążenia, pomimo wysokiego ryzyka, przyniosło bardzo dobry efekt terapeutyczny i pozwoliło na długoterminową poprawę

Complications in recipients of cardioverter-defibrillator or cardiac resynchronization therapy: Insights from Silesian Center Defibrillator registry

Background: Current real-life information from all-comers registries from middle and east Europe about the incidence and type of complications during long-term follow-up of patients with cardioverters-defibrillators (ICD) and cardiac resynchronization devices-defibrillators (CRT-D) is still insufficient. The aim of the study was to assess the incidence and determinants of short- and long-term complications related to implantable ICD and CRT-D. Methods: We studied 1,105 recipients hospitalized in our center in 2009–2013, followed for a mean of 2.4 years (total of 2,652 patient-years). The independent association between ICD and CRT-D recipients’ and implantation-procedures’ characteristics with the incidence of complications was analyzed using multivariable Cox regression analysis. Results: In 2-month post-procedural period, 124 (11.2%) patients developed complications. Independent predictors of short-term complications (within 2 months) were: atrial fibrillation, dual chamber ICD implantation, and use of antiplatelet therapy or coumarin. Twenty-seven (2.44%) patients experienced complications, mostly lead-related (n = 21). Independent predictors of long-term complications (2–12 months after implantation) were atrial fibrillation and dual chamber ICD implantation. Conclusions: Despite significant technological progress and operators’ experience, the occurrence of complications in ICD and CRT-D recipients is still substantial. Majority of complications are recorded in the early post-implantation phase. Analysis of independent predictors of complications seem to be essential in helping to reduce adverse events in the future and strongly supports the need for routine follow-up.  

Factors affecting short- and long-term survival of patients with acute coronary syndrome treated invasively using intravascular ultrasound and fractional flow reserve: Analysis of data from the Polish Registry of Acute Coronary Syndromes 2017–2020

Background: Intravascular ultrasound (IVUS) and fractional flow reserve (FFR) are invasive procedures increasingly used in acute coronary syndrome (ACS). Aims: The aim of this study was to evaluate the prevalence of IVUS and FFR use in patients with ACS in Poland and to assess the safety of these procedures, as well as their impact on short- and long-term survival. Methods and results: The retrospective study included 103849 patients enrolled in the PL-ACS registry in 2017-2020. IVUS was performed in 1,727 patients, FFR in 1,537 patients, both procedures in 37 patients. The frequency of performing FFR in ACS over the years increased from 1.3% to 1.8% (p <0.0001) and IVUS from 1.7% to 2.3% (p <0.0001). In the FFR and/or IVUS group, a similar incidence of stroke, reinfarction, target vessel revascularization and major bleeding was observed, while in-hospital mortality was lower (0% for IVUS + FFR vs. 0.9% for FFR vs. 2.3% for IVUS vs. 3.7 for no procedure; p <0.0001). FFR and IVUS did not affect the 30-day and one-year prognosis. Conclusion: In the consequent years, the number of FFR and IVUS procedures performed in patients with ACS in Poland increased. There was lower in-hospital mortality in the FFR and/or IVUS group in ACS, no differences in the incidence of stroke, reinfarction, target vessel revascularization and major bleeding were observed. Performing FFR and IVUS in ACS does not significantly affect 30-day or one-year mortality

Periprocedural checklist in the catheterisation laboratory is associated with decreased rate of treatment complications

Wstęp: Współczesne oddziały kardiologii wyposażone w pracownię hemodynamiki i elektroterapii muszą stawić czoła rosnącym wymaganiom związanym z dynamicznym rozwojem zarówno procedur przezskórnych, jak i elektrofizjologicznych, które wiążą się z ryzykiem wystąpienia wielu komplikacji. Cel: Celem badania była ocena skuteczności i zasadności wprowadzenia karty bezpieczeństwa okołozabiegowego w prewencji niekorzystnych zdarzeń wśród pacjentów poddanych planowej inwazyjnej diagnostyce i leczeniu. Metody: Przeanalizowano dane 2064 pacjentów skierowanych do leczenia w okresie od maja 2011 r. do sierpnia 2012 r. Chorzy, którzy byli hospitalizowani bez inwazyjnej diagnostyki lub leczenia, nie zostali włączeni do badania. Pacjentów podzielono na dwie grupy: grupę kontrolną — 1011 chorych poddanych inwazyjnej diagnostyce i terapii przed wprowadzeniem okołozabiegowej karty bezpieczeństwa; grupę badaną — 1053 chorych poddanych inwazyjnej diagnostyce i terapii po wprowadzeniu okołozabiegowej karty bezpieczeństwa. W badanych grupach przeanalizowano występowanie niekorzystnych zdarzeń związanych z hospitalizacją i wykonanymi procedurami. Przeprowadzono również subiektywną analizę karty bezpieczeństwa przez zespół medyczny na podstawie anonimowego kwestionariusza. Wyniki: Wyjściowa charakterystyka między badanymi grupami była porównywalna, z wyjątkiem wyższego odsetka stabilnej choroby wieńcowej (50,7% vs. 39,6%; p ≤ 0,001) oraz zabiegów elektrofizjologicznych w grupie kontrolnej. Wprowadzenie karty bezpieczeństwa miało korzystny wpływ na zredukowanie niekorzystnych zdarzeń sercowo-naczyniowych (6,8% vs. 3,9%; p = 0,004), zwłaszcza krwawień (2,3% vs. 0,3%; p < 0,001). W analizie wieloczynnikowej brak okołozabiegowej karty bezpieczeństwa był niezależnym czynnikiem wpływającym na wystąpienie niekorzystnych zdarzeń sercowo-naczyniowych (OR = 2,97; 95% CI 1,60–5,53; p = 0,001). Subiektywna ocena opinii personelu medycznego pokazała, że wprowadzenie karty bezpieczeństwa koreluje z poprawą zdolności komunikacyjnych, organizacją pracy, zapobieganiem występowania błędów medycznych i zredukowanej liczby kompilacji związanych z przeprowadzonymi zabiegami. Wnioski: Wprowadzenie okołozabiegowej karty bezpieczeństwa wiązało się z istotną redukcją niekorzystnych zdarzeń sercowo-naczyniowych wśród pacjentów poddanych zabiegom inwazyjnym. Miała także pozytywny wpływ na komunikację w zespole, organizację i jakość leczenia w opinii personelu medycznego.Background: Interventional cardiology and electrophysiology are disciplines with a growing number of complex procedures, which are exposed to the occurrence of many complications. Aim: To assess efficacy and legitimacy of the periprocedural checklist in prevention of cardiovascular adverse events, in elective patients undergoing invasive diagnostic and treatment. Methods: A total of 2064 patients directed to treatment in the catheterisation laboratory between May 2011 to August 2012 were analysed. Patients who were hospitalised without invasive diagnostics and treatment were not included in the study. Patients were divided into two groups: a control group — 1011 patients with invasive diagnostics and treatment before introduction of periprocedural checklist; and an intervention group — 1053 patients with invasive diagnostics and treatment after introduction of periprocedural checklist. We analysed the studied groups, assessing adverse events associated with hospitalisation and performed procedures. We also conducted subjective evaluation of checklists by medical staff on the basis of a questionnaire. Results: Baseline characteristics between the studied groups were comparable except for a higher rate of stable coronary artery disease (50.7% vs. 39.6%, p £ 0.001) and electrophysiology procedures in the control group. Implementation of a checklist was favourable in cases of decreased adverse events (6.8% vs. 3.9%, p = 0.004) especially bleedings (2.3% vs. 0.3%, p < 0.001). Multivariate analysis confirmed that lack of a periprocedural checklist during hospitalisation was an independent factor associated with a higher rate of adverse events (OR = 2.97, 95% CI 1.60–5.53, p = 0.001). Subjective evaluation of medical staff opinions showed that implementation of a checklist seems to be associated with improved communication skills, work organisation, prevention of the occurrence of medical errors, and reduced rate of complications associated with procedures. Conclusions: Introduction of a periprocedural checklist was associated with significant reduction of adverse events among patients undergoing invasive procedures. It also showed a positive influence on team communication, and organisation and quality of treatment, according to the opinions of medical staff