Reaktywność płytek krwi we wczesnym okresie po pomostowaniu tętnic wieńcowych bez użycia krążenia pozaustrojowego u pacjentów stosujących małą dawkę kwasu acetylosalicylowego

Introduction. Acetylsalicylic acid (ASA) is the antiplatelet drug most used in the perioperative period in patients undergoing coronary artery bypass grafting (CABG). Off-pump coronary artery bypass grafting (OPCAB) is likely to alter platelet (PLT) function to a lesser extent than CABG with the use of cardiopulmonary bypass and may potentially result in high on-aspirin platelet reactivity (HAPR) in the postoperative period. Materials and methods. The aim of this prospective study was to characterise serum thromboxane B2 (TXB2) variability and ASA-dependent platelet reactivity in patients with stable coronary artery disease undergoing OPCAB treated with a single daily dose of 75 mg of ASA. Blood sampling was performed 2 hours and 24 hours after ASA intake on the day before surgery, and on the 2nd and 7th days after the operation. Results. A PLT counts reduction and a mean platelet volume increase were observed on the 2nd day after OPCAB. A PLT counts increase was found on the 7th postoperative day. A significant increase (p = 0.03) in the percentage of patients with insufficient laboratory ASA efficacy (defined by serum TXB2 ≥ 7.2 ng/mL) was observed on the 7th postoperative day compared to preoperative values (52% vs 20% respectively, p = 0.02). A significant increase in median platelet reactivity and in the percentage of patients with HAPR (defined by VerifyNow® Aspirin test result ≥ 550 ARU) was observed on the 7th postoperative day in comparison with the values before OPCAB (48% vs 12%, p = 0.007). Conclusions. In the group of patients taking a standard daily dose of 75 mg of ASA, a substantial number of patients failed to attain optimal inhibition of serum TXB2 or had HAPR before surgery and on the 7th day after OPCAB. A significant decrease in serum TXB2 levels on the 2nd day after OPCAB did not correlate with PLT reactivity. The optimal dose of ASA is of interest for further studies of efficacy and clinical outcomes after OPCAB.Wstęp. Kwas acetylosalicylowy (ASA) jest podstawowym lekiem przeciwpłytkowym stosowanym w okresie okołooperacyjnym u chorych poddawanych operacjom pomostowania tętnic wieńcowych (CABG). Operacja pomostowania tętnic wieńcowych bez użycia krążenia pozaustrojowego (OPCAB) prawdopodobnie w mniejszym stopniu zaburza funkcję płytek krwi (PLT) niż operacja wykonywana w krążeniu pozaustrojowym i może być przyczyną wysokiej reaktywności płytek mimo leczenia ASA (HAPR) w okresie pooperacyjnym. Materiały i metody. Celem badania była prospektywna analiza zmienności stężenia tromboksanu B2 (TXB2) w surowicy krwi i reaktywności PLT zależnej od ASA u pacjentów ze stabilną chorobą wieńcową, poddanych OPCAB, leczonych standardową, pojedynczą dawką dobową 75 mg ASA. Próbki krwi do analizy pobierano po 2 i 24 h od przyjęcia porannej dawki ASA w dobie poprzedzającej operację, a następnie w 2. i 7. dobie po operacji. Wyniki. W 2. dobie po OPCAB obserwowano istotne zmniejszenie liczby PLT oraz zwiększenie średniej objętości płytekkrwi. W 7. dobie pooperacyjnej stwierdzono zwiększenie liczby PLT wobec wartości przed operacją. W 7. dobie po OPCABobserwowano istotne zwiększenie w odniesieniu do wartości przed operacją odsetka pacjentów z niedostatecznąw analizie laboratoryjnej skutecznością leczenia przeciwpłytkowego ASA (definiowaną jako stężenie TXB2 w surowicy krwi≥ 7,2 ng/ml), odpowiednio 52% w porównaniu z 20%; p = 0,02. W 7. dobie pooperacyjnej stwierdzono znamienny wzrostmediany reaktywności PLT oraz odsetka pacjentów z HAPR (wynik testu VerifyNow® Aspirin ≥ 550 ARU) w porównaniuz wartościami przed OPCAB (odpowiednio 48% v. 12%; p = 0,007). Wnioski. W grupie pacjentów stosujących pojedynczą, dobową dawkę 75 mg ASA u istotnego odsetka badanych(p = 0,03) przed operacją oraz w 7. dobie po OPCAB stwierdzono suboptymalne zahamowanie syntazy TXB2 oraz HAPR.Znamienne obniżenie stężenia TXB2 w surowicy krwi w 2. dobie pooperacyjnej nie korelowało z reaktywnością PLT.W przyszłych badaniach dotyczących efektywności leczenia przeciwpłytkowego oraz wyników klinicznych po OPCABnależy zwrócić szczególną uwagę na optymalizację dawkowania ASA

Effect of β-blockers on 1-year survival and hospitalizations in patients with heart failure and atrial fibrillation: results from ESC-HF pilot and ESC-HF long-term registry

[Abstract] Introduction The positive effect of β-blocker therapy in patients with heart failure (HF) and atrial fibrillation (AF) has been questioned. Objectives We aimed to assess the effect of β-blockers and heart rate (HR) control on 1-year outcomes in patients with HF and AF. Patients and methods Of the 2019 Polish patients enrolled in ESC-HF Pilot and ESC-HF Long-Term Registry, 797 patients with HF and AF were classified into 2 groups depending on β-blocker use. Additionally, patient survival was compared between 3 groups classified according to HR: lower than 80 bpm, between 80 and 109 bpm, and of 110 bpm or higher. The primary endpoint was all-cause death and the secondary endpoint was all-cause death or HF hospitalization. Results In patients treated with β-blockers, the primary and secondary endpoints were less frequent than in patients not using β-blockers (10.9% vs 25.6%, P = 0.001 and 30.6% vs 44.2%, P = 0.02, respectively). Absence of β-blocker treatment was a predictor of both endpoints in a univariate analysis but remained an independent predictor only of the primary endpoint in a multivariate analysis (hazard ratio for β-blocker use, 0.52; 95% CI, 0.31–0.89; P = 0.02). The primary and secondary endpoints were more frequent in patients with a HR of 110 bpm or higher, but the HR itself did not predict the study endpoints in the univariate analysis. Conclusions β-blocker use might decrease mortality in patients with HF and AF, but it seems to have no impact on the risk of HF hospitalization. An HR of 110 bpm or higher may be related to worse survival in these patients

Ischemic cardiomyopathy versus non-ischemic dilated cardiomyopathy in patients with reduced ejection fraction-clinical characteristics and prognosis depending on heart failure etiology (data from European Society of Cardiology heart failure registries)

[Abstract] Personalized management involving heart failure (HF) etiology is crucial for better prognoses for HF patients. This study aimed to compare patients with ischemic cardiomyopathy (ICM) and patients with non-ischemic dilated cardiomyopathy (NIDCM) in terms of baseline characteristics and prognosis. We assessed 895 patients with HF with reduced left ventricular ejection fraction participating in the Polish part of the European Society of Cardiology (ESC)-HF registries. ICM was present in 583 patients (65%), NIDCM in 312 patients (35%). The ICM patients were older (p < 0.001) and had more comorbidities. The NIDCM patients more frequently had atrial fibrillation (p = 0.04) and lower LVEF (p = 0.01); therefore, they were treated more often with anticoagulants (p = 0.01) and digitalis (p < 0.001). The NIDCM patients were prescribed aldosterone antagonists more often (p = 0.01). There were no other differences as regards the use of HF guideline-recommended medications, implantable cardioverter defibrillators or cardiac resynchronization therapy. The ICM patients were more likely to be treated with statins (p < 0.001) and antiplatelet agents (p < 0.001). All-cause death, as well as all-cause death and readmissions for HF at 12 months, occurred more often in the ICM group compared with the NIDCM group (15.9% vs. 10%, p = 0.016; and 40.9% vs. 28.6%, p = 0.00089, respectively). ICM etiology was an independent predictor of the composite endpoint in the total cohort (p = 0.003). The ICM patients were older and had more comorbidities, whereas the NIDCM patients had lower LVEF. One-year prognosis was worse in the ICM patients than in the NIDCM patients. ICM etiology was independently associated with a worse one-year outcome

Heart failure patients with a previous coronary revascularisation: results from the ESC-HF registry

Background: Coronary revascularization is common in heart failure (HF). Aims: Clinical characteristic and assessment of in-hospital and long-term outcomes in patients hospitalized for HF with or without a previous percutaneous coronary intervention (PCI) or a coronary artery bypass grafting (CABG). Methods: The primary endpoint (PE) (all-cause death) and the secondary endpoint (SE) (all-cause death or hospitalization for HF-worsening) were assessed at one-year in 649 inpatients of the ESC-HF Pilot Survey. Additionally, occurrence of death during index hospitalization was evaluated. Results: PCI/CABG-patients (32.7%) were more frequently male, smokers, had myocardial infarction, hypertension (HT), peripheral artery disease and diabetes. The non-PCI/CABG-patients more often had a cardiogenic shock and died in-hospital. The PE occurred in 33 of the 212 PCI/CABG-patients (15.6%) and in 56 of the 437 non-PCI/CABG-patients (12.8%; P=0.3). The SE occurred in 82 of the 170 PCI/CABG-patients (48.2%) and in 122 of the 346 non-PCI/CABG-patients (35.3%; P=0.01). Independent predictors of the PE in the PCI/CABG-patients were: lower left ventricular ejection fraction, use of antiplatelets; in the non-PCI/CABG-patients were: age, ACS at admission. Independent predictors of the SE in the PCI/CABG-patients were: diabetes, NYHA (New York Heart Association) class at admission, HT; in the non-PCI/CABG-patients were: NYHA class, haemoglobin at admission. Serum sodium concentration at admission was a predictor of the PE and the SE in both groups. Heart rate at discharge was a predictor of the PE and the SE in the non-PCI/CABG patients. Conclusions: The revascularized HF patients had a similar mortality and higher risk of death or hospitalizations at 12 months compared with the non-PCI/CABG-patients. The revascularized patients had more comorbidities, while the non-PCI/CABG-patients had a higher incidence of cardiogenic shock and in-hospital mortality.Background: Coronary revascularisation is common in heart failure (HF). Aim: Clinical characteristic and assessment of in-hospital and long-term outcomes in patients hospitalised for HF with or without a previous percutaneous coronary intervention (PCI) or a coronary artery bypass grafting (CABG). Methods: The primary endpoint (PE) (all-cause death) and the secondary endpoint (SE) (all-cause death or hospitalisation for HF-worsening) were assessed at one year in 649 inpatients of the ESC-HF Pilot Survey. Additionally, occurrence of death during index hospitalisation was evaluated. Results: PCI/CABG-patients (32.7%) were more frequently male, smokers, and had myocardial infarction, hypertension, pe¬ripheral artery disease, and diabetes. The non-PCI/CABG-patients more often had cardiogenic shock and died in-hospital. The PE occurred in 33 of the 212 PCI/CABG-patients (15.6%) and in 56 of the 437 non-PCI/CABG-patients (12.8%; p = 0.3). The SE occurred in 82 of the 170 PCI/CABG-patients (48.2%) and in 122 of the 346 non-PCI/CABG-patients (35.3%; p = 0.01). Independent predictors of the PE in the PCI/CABG-patients were: lower left ventricular ejection fraction and use of anti¬platelets; in the non-PCI/CABG-patients were: age and acute coronary syndrome at admission. Independent predictors of SE in the PCI/CABG-patients were: diabetes, New York Heart Association (NYHA) class at admission, and hypertension; in the non-PCI/CABG-patients they were: NYHA class and haemoglobin at admission. Serum sodium concentration at admission was a predictor of PE and SE in both groups. Heart rate at discharge was a predictor of PE and SE in the non-PCI/CABG patients. Conclusions: The revascularised HF patients had a similar mortality and higher risk of death or hospitalisation at 12 months compared with the non-PCI/CABG-patients. The revascularised patients had more comorbidities, while the non-PCI/CABG-patients had a higher incidence of cardiogenic shock and in-hospital mortality

Subjective Psychophysical Experiences in the Course of Inflammatory Bowel Disease—A Comparative Analysis Based on the Polish Pediatric Crohn’s and Colitis Cohort (POCOCO)

No gold standard is available to evaluate subjective psychophysical experiences in pediatric inflammatory bowel disease (IBD). We aimed to assess pain, anxiety, and limitations in social activities at diagnosis and the worst flare of the disease in relation to clinical expression, treatment and IBD severity. A total of 376 children completed the survey (Crohn&rsquo;s disease (CD) n = 196; ulcerative colitis (UC) n = 180). The questionnaire included 12 questions regarding pain, anxiety, and social activity, all assessed at recruitment and retrospectively at diagnosis and worst flare using a numeric rating scale. Patients that had ever been treated with systemic glucocorticosteroids scored higher in pain (p &lt; 0.001), anxiety (p = 0.015), and social activity domains (p &lt; 0.016) at worst flare, and the answers correlated with the number of steroid courses (p &lt; 0.0392). The perception of social activity limitations also correlated independently with the number of immunosuppressants (p &lt; 0.0433) and biological agents (p &lt; 0.0494). There was no difference in retrospective perception of pain, anxiety and social activity limitations between CD and UC patients at diagnosis and the worst flare. The level of limitations in social activity correlated with hospitalisations due to relapse, days spent in the hospital, number of relapses, and severe relapses with the strongest association of rho = 0.39 (p = 0.0004). Subjective and retrospective perception of pain, anxiety, and limitations in social activity differs depending on therapy, correlates with treatment modalities, and severity measures such as hospitalisations

Insolation and Disease Severity in Paediatric Inflammatory Bowel Disease—A Multi-Centre Cross-Sectional Study

This study was to investigate whether the clinical course of inflammatory bowel disease (IBD) in a Polish paediatric cohort fits a seasonal pattern and depends on insolation. Two hundred and fourteen patients diagnosed with Crohn&rsquo;s disease (CD) and 192 with ulcerative colitis (UC) aged from 3 to 18 years, were recruited in seven centres of similar latitude. The seasons were defined as winter (December&ndash;February), spring (March&ndash;May), summer (June&ndash;August), autumn (September&ndash;November). The year was also divided depending on insolation threshold (3.0 kWh/m2/day). Patients diagnosed with IBD when the isolation was &gt;3 kWh/m2/day had poorer nutritional status than those diagnosed while insolation was below threshold (lower standardised BMI at diagnosis (&minus;0.81 ([&minus;1.34]&ndash;[&minus;0.03]) vs. &minus;0.52 ([&minus;1.15]&ndash;0.15); p = 0.0320) and worst flare (&minus;0.93 ([&minus;1.37]&ndash;[&minus;0.05]) vs. &minus;0.66 ([&minus;1.23]&ndash;0.17); p = 0.0344), with the need for more frequent biological treatment (45.5% vs. 32.7%, p = 0.0100). Patients diagnosed in winter were significantly younger at diagnosis (11.4 vs. 13.0; padj = 0.0180) and first immunosuppressive treatment (11.3 vs. 13.3; padj = 0.0109) than those diagnosed in other seasons. CD patients diagnosed in months with higher insolation spent more days in hospital than those diagnosed in months with lower insolation [4.6 (1.8&ndash;11.8) vs. 2.9 (1.3&ndash;6.2); p = 0.0482]. CD patients diagnosed in summer had significantly more concomitant diseases. In patients with CD, the occurrence of the worst flare was more frequent in autumn. Furthermore, the season of birth was associated with Pediatric Crohn&rsquo;s Disease Activity Index at worst flare and earlier surgery. In conclusion, several clinical parameters are associated with insolation, the season of diagnosis and season of birth in the clinical course of Crohn&rsquo;s disease

Heart failure in patients with atrial fibrillation:Insights from Polish part of the EORP-AF general long-term registry

AIMS: This study aimed to determine the impact of heart failure (HF) on clinical outcomes in patients with atrial fibrillation (AF). METHODS AND RESULTS: We analysed data from Polish participants of the EURObservational Research Programme-AF General Long-Term Registry. The primary endpoint was all-cause death, and the secondary endpoints included hospital readmissions, cardiovascular (CV) interventions, thromboembolic and haemorrhagic events, rhythm control interventions, and other CV or non-CV diseases development during one-year follow up. Overall, 688 patients with available data on HF were included into analysis; 51% (n = 351) had HF; of these 48% (n = 168) had reduced ejection fraction (HFrEF), 22% (n = 77) mid-range EF (HFmrEF), and 30% (n = 106) preserved EF (HFpEF). Compared with patients without HF, those with HF had higher mortality rate (aHR 5.61; 95% CI 1.94-16.22, P < 0.01). Patients with HF (vs. without HF) had more often CV interventions (10% vs. 5.4%, P = 0.046) and events (14% vs. 7.1%, P = 0.02), and had less often atrial arrhythmia-related hospital admissions (6.8% vs. 15%, P < 0.01). Over follow-up, patients with HFmrEF and HFpEF had similar mortality rate versus HFrEF (aHR 0.45, 95% CI 0.13-1.57, P = 0.45 for HFmrEF and aHR 0.54, 95% CI 0.20-1.48, P = 0.54 for HFpEF). Mortality rate was similar among rhythm versus rate control group (aHR 0.34; 95% CI 0.10-1.16; P = 0.34). CONCLUSIONS: AF patients with HF have greater mortality rate and more CV interventions/events. No statistically significant difference in long-term outcomes between patients with HFrEF, HFmrEF, and HFpEF highlights the need to develop therapeutic strategies targeting functional status and survival for patients with HF and AF