A case of a patient treated with percutaneous edge-to-edge mitral valve repair, percutaneous left atrial appendage occlusion and implantable cardioverter-defibrillator

The article presents the case of a 55-year-old woman who suffered from anterior myocardial infarction andchronic complications of the underlying disease, heart failure with reduced left ventricular ejection fraction,severe secondary mitral regurgitation, and paroxysmal atrial fibrillation. Due to the severity of symptoms,which persisted despite the optimal pharmacotherapy, after exclusion of reversible causes, the patient wasqualified for different advanced percutaneous treatment methods. Within two years from the onset of thedisease, three percutaneous procedures were performed: mitral valve correction with the MitraClip system,left atrial appendage occlusion using the Watchman system, and implantation of cardioverter-defibrillator

Self-reported questionnaires for assessment adherence to treatment in patients with cardiovascular diseases

Introduction: The treatment of acute coronary syndromes, besides coronary interventions, includes pharmaco-therapy and lifestyle changes, which together determine a favourable prognosis. Adherence to treatment is a term describing a patient’s behaviour in respect to the patient’s maintenance of the health care provider’s recommendations. Unfortunately, according to WHO data, adherence to long-term therapies for chronic illnesses in developed countries averages only 50%. Covered areas: Our study focused on available questionnaires for adherence assessment in everyday practice. A comprehensive search of data bases was conducted using appropriate keywords. Out of an initially identified 2081 citations, 93 articles were considered eligible for further analysis. Eventually, nine adherence scales were identified and reviewed. Expert opinion: There is no so-called “gold standard survey” allowing accurate assessment of every patient for medication adherence. The use of a specific scale must be justified by its validation in a similar group of patients in well designed and properly conducted studies

Influence of QRS duration and axis on response to cardiac resynchronization therapy in chronic heart failure with reduced left ventricular ejection fraction: A single center study including patients with left bundle branch block

Background: The aim of the study was to evaluate QRS duration and axis as predictors of response to cardiac resynchronization therapy (CRT) in order to reduce the proportion of non-responders.Methods: Retrospective single-center study including 42 CRT recipients, with left bundle branch block (LBBB), left ventricular ejection fraction (LVEF) < 40%, in New York Heart Association (NYHA) class ≥ II. Response to CRT was declared as NYHA class improvement ≥ 1 (symptomatic) and LVEF improvement by ≥ 10% (echocardiographic) > 6 months post implantation.Results: Symptomatic responders had longer pre- (172.3 ± 17.9 vs. 159.0 ± 18.3 ms; p = 0.027) and postimplantation (157.2 ± 24.1 vs. 136.7 ± 23.2 ms; p = 0.009) QRS duration. Preimplantation QRS < 150 ms predicted poor response (odds ratio [OR] for response vs. lack of response 0.04; 95% confidence interval [CI] 0.001–0.74). Predictors of symptomatic response included: postimplantation QRS > 160 ms (OR 7.2; 95% CI 1.24–41.94), longer QRS duration before (OR for a 1 ms increase 1.04, 95% CI 1.00–1.08) and post implantation (OR for a 1 ms increase 1.04; 95% CI 1.01–1.07). Area under the curve (AUC) for pre- and postimplantation QRS duration was 0.672 (95% CI 0.51–0.84) and 0.727 (95% CI 0.57–0.89), respectively, with cut-off points of 178.5 ms and 157 ms. For post implantation QRS axis, AUC was 0.689 (95% CI 0.53–0.85), with cut-off points of –60.5° or –38.5°. Preimplantation QRS axis was the only predictor of echocardiographic response (OR 0.98; 95% CI 0.96–1.00), with AUC of 0.693 (95% CI 0.54–0.85) and a threshold of –36°.Conclusions: Marked pre- and postimplantation QRS prolongation and preimplantation negative QRS axis deviation are moderate predictors of response to CRT

75-year-old man with lung cancer obscured by an implantable cardioverter-defibrillator — case report

We present a case of a 75-year-old man, who underwent a scheduled implantable cardioverter-defibrillatorreoperation and has had a lung cancer found in a chest X-ray taken after the procedure, that wascompletely obscured by the previous device

Genetic determinants of platelet response to clopidogrel

Antiplatelet agents are the mainstay treatment in the prevention and management of atherothrombotic complications. However, a substantial interpatient variability in response to clopidogrel has been reported. Furthermore, patients with coronary artery disease and lesser platelet inhibition in response to clopidogrel are at increased risk for cardiovascular events. Clopidogrel after absorption requires two-step oxidation by the hepatic cytochrome P450 to generate its active metabolite. Polymorphisms of genes encoding the cytochrome enzymes and P-glycoprotein involved in clopidogrel absorption are regarded as major determinants of the interindividual variability in the clopidogrel-induced platelet inhibition. In our review we discuss the prevalence and clinical significance of various alleles of the genes: CYP2C19 and ABCB1 in the setting of coronary artery disease. Allele CYP2C19*2 is associated with excess of ischaemic events including myocardial infarction and stent thrombosis. On the other hand, CYP2C19*17 allele poses a serious threat of bleeding. Data concerning the prognostic value of genetic variant 3435C?T of ABCB1 remain inconclusive

The impact of readiness to discharge from hospital on adherence to treatment in patients after myocardial infarction

Background: The healthcare professionals involved in in-hospital treatment of myocardial infarction (MI) are also responsible to patients for their education before leaving the hospital.   This education aims to modify patient behaviour in order to reduce relevant risk factors and improve self-control and adherence to medications. The aim of the study was to analyse the relationship between readiness for discharge from hospital and adherence to treatment at follow-up in MI patients. Methods: An observational, single-center, MI cohort study with  6-month follow-up was conducted between May 2015 and July 2016.  The Readiness for Hospital Discharge after Myocardial Infarction Scale (RHD-MIS) and the Adherence in Chronic Diseases Scale (ACDS) were applied. Results: Two hundred and thirteen patients aged 30–91 years (62.91 ± 11.26) were enrolled in the study. The RHD-MIS general score ranged from 29 to 69 points (51.16 ± 9.87).   A high level of readiness was found in 66 patients (31%), intermediate in 92 (43.2%), and low in 55 (25.8%) of patients. Adherence level assessed with the ACDS 6-months after discharge from hospital ranged from 7 to 28 points (23.34 ± 4.06). An increase in objective assessment of patient knowledge according to RHD-MIS subscale resulted in significantly higher level of adherence at the follow-up visit (p = 0.0154); R Spearman = 0.16671, p = 0.015; p for trend = 0.005. During the 6-month follow-up 3 (1.41%) patients died and 17 (7.98%) were hospitalized for a subsequent acute coronary syndrome. Conclusions: This study provided preliminary evidence of a long-term association between the results of assessment of readiness for discharge from hospital and adherence to treatment in patients after MI

Relation of the Readiness for Hospital Discharge after Myocardial Infarction Scale to socio-demographic and clinical factors. An observational study

Introduction: The aim of the study was to analyse the relationship between the Readiness for Hospital Discharge after Myocardial Infarction Scale (RHD MIS) scores and socio-demographic and clinical factors in patients after acute myocardial infarction (AMI) treated with percutaneous coronary angioplasty. Material and methods: The study was conducted as a single-centre, prospective, cohort, 6-month observa-tion, including 213 patients: 59 women and 154 men aged 30–91 years (average age of 62,91 ± 11.26 years). Results: Patients’ economic status was found to have a significant impact on the readiness for discharge measured by RHD-MIS general score. Among all three investigated RHD-MIS subscales, objective assessment of knowledge was influenced by gender (p = 0.012) and place of residence (p = 0.025). There was a linear trend for increase of knowledge along with increase in education level (p = 0.030). The only factor influencing patients’ expectations was their economic status (p value for heterogeneity: 0.014). A linear correlation between growing of patients’ expectations and worsening of their economic status (p = 0.008) was observed. Conclusion: Readiness to discharge should be routinely assessed in all patients hospitalized with myo-cardial infarction. The result of this assessment should be used to identify patients requiring additional education. Further research is prompted to determine the cut-off values of RHD-MIS results qualifying patients for additional educational interventions

Validation of the Functioning in Chronic Illness Scale (FCIS)

Diagnosis of deficient areas in the functioning of patient with chronic disease is necessary to undertake the adequate therapeutic actions. The aim of the study was to validate a new self-reported questionnaire for patients with chronic disease assessing the impact of the disease on the patient, the patient’s impact on the disease and the impact of the disease on patient’s attitudes. Results: The internal consistency of the questionnaire expressed by a-Cronbach coefficient = 0.855, indicates its high reliability and homogeneity. The set of 24 items fulfilled the assumption of factor analysis: the determinant of correlation matrix was 0.001, Kaiser-Mayer-Olkin (K-M-O) statistic was 0.843 and the Bartlett’ test of sphericity was statistically significant. The factor analysis was conducted using the principal component analysis with Varimax rotation. The scale and subscale levels were determined based on the percentiles scale. Conclusion: The validation procedure revealed that FCIS is a reliable and homogeneous tool to measure patient’s physical and mental functioning in the chronic illness. The set of items divided into 3 subscales allows evaluation of: the impact of the disease on the patient, the patient’s impact on the disease and the impact of the disease on the patient’s attitudes

Effectiveness of therapeutic education in patients with myocardial infarction

Introduction. Notwithstanding the development of modern diagnostic-therapeutic techniques, cardiovascular diseases still pose a grave health, social, and economic issue. Patients hospitalised for acute coronary syndrome should, in addition to establishing an optimal pharmacotherapy, be made aware of how to prevent this disease and recognise it using its typical symptoms and signs. Objective. The objective of the study was to evaluate the effectiveness of educational intervention based on educational brochures in patients with myocardial infarction with regard to socio-demographic factors and baseline patients’ knowledge. Material and methods. The single-centre, prospective, observational study was conducted in a cohort of 248 patients with myocardial infarction (women n = 72, men n = 176), hospitalised between May 2015 and July 2016. Consistently with the results of univariate analysis, multivariate analysis identified age (–3.73/10 years; p < 0.0006) and the level of education (10.37; p < 0.0001) as independent factors influencing patients’ prehospital knowledge. Results. According to multivariate analysis of the level of knowledge following the educational intervention, the only factors affecting the process of learning were age (–2.04/10 years; p < 0.03) and remaining in a steady relationship (9.7; p = 0.0003). Among factors influencing the increase of knowledge, only the level of education was of statistical significance (–6.09; p < 0.02). Conclusions. The educational brochure proved to be an effective tool for therapeutic education, allowing minimisation of the disparities between the examined groups and improvement of the breadth of patients’ knowledge