The assessment of coronary heart disease risk factors correlated with demographic and social data in post-coronary intervention patients in Polish population

Background: Cardiovascular diseases are the main cause of death in Europe, accounting for over 4 million deaths each year. Smoking cigarettes, an unhealthy diet and no physical activity constitute important risk factors. Educational program was conducted among patients after coronary angioplasty. Data on patients’ knowledge of risk factors of coronary heart disease, recommended behavior, secondary prevention methods, and side effects were collected and analyzed in conjunction with demographic and social factors. One questionnaire included details about 20 patients. The questionnaire included demographic data (gender, education, place of residence), epidemiological (height, weight, waist size), interview on coronary heart disease risk factors, medications and side effects. Methods: The educational program involved 19,316 patients above 18 years old after percuta­neous coronary intervention (PCI). The basic tool was a standardized questionnaire consisting of visit forms. Results: Despite PCI, 20.5% of patients smoke cigarettes, more often men, younger, less educated. 35.7% of patients believe that limiting physical activity after successful coronary intervention is beneficial — more often older, lower educated, with higher body mass index, from smaller towns. 85% of patients (mainly women, younger, higher-educated, coming from bigger cities) claim to be aware which products are beneficial for the cardiovascular system and which have a negative influence. 8% of patients after PCI do not control their blood pressure at all — more often men, younger people with lower level of education and coming from smaller towns. 44% of patients happened to forget to take or ran out of some medications — more often those with lower level of education. Conclusions: It is essential to implement to clinical practice educational programs for post-coronary intervention patients. These patients are at highest risk of having cardiovascular events. Educational programs should be addressed to all post-coronary intervention patients, especially to those coming from small towns. A limitation of the survey was that patients were not divided into acute coronary syndrome patients and stable coronary heart disease ones. It was not specified what time after the coronary intervention the patients were included into the research

Concomitant recovery of atrial mechanical and endocrine function after cardioversion in patients with persistent atrial fibrillation

AbstractObjectivesThe purpose of this study was to evaluate left atrial mechanical function recovery and plasma atrial natriuretic peptide (ANP) release following successful cardioversion of persistent atrial fibrillation (AF).BackgroundAtrial fibrillation is characterized by functional deterioration, loss of atrial contraction, and elevation of plasma ANP levels. The response of ANP release toward atrial mechanical function after cardioversion of AF has not been fully examined.MethodsWe examined 29 patients with successfully cardioverted persistent AF in whom sinus rhythm was maintained for at least 30 days after cardioversion. We assessed mechanical function of the left atrium at 24 h and 7 and 30 days after cardioversion and evaluated plasma ANP level at the same time. Atrial mechanical function was assessed during echocardiographic examination by means of the peak velocity of the transmitral A-wave, early transmitral to atrial flow velocity ratio, and atrial filling fraction (AFF). The plasma ANP level was determined by the radioimmunoassay method.ResultsPlasma ANP levels were significantly reduced from 59.4 ± 16.6 pg/ml to 31.1 ± 9.2 pg/ml at 24 h after successful cardioversion. Within 30 days, we noted progressive improvement of atrial systolic function (increase in AFF from 21% to 31%, p < 0.05). At the same time, plasma ANP levels gradually increased from 31.1 ± 9.2 pg/ml at 24 h to 36.9 ± 12.8 pg/ml on day 30 following cardioversion (p < 0.05).ConclusionsPlasma ANP levels significantly decreased in patients with persistent AF after successful cardioversion. In the 30 days after cardioversion, gradual elevation of plasma ANP concentration was observed concomitantly with an increase of AFF. Plasma ANP release after successful cardioversion of persistent AF might be due to recovery of atrial mechanical function

Heart failure as a subject for palliative care

Heart failure (HF) is a common end stage in any structural or functional cardiac disease advanced enough to impair the filling of the ventricles or blood ejection. If the degree of impairment makes the heart unable to cope with the actual demands of pumping blood, the diagnosis of heart failure is justified. The heart first disables the circulation during exercise and finally, in end-stage HF, even at rest. HF is a progressive process, usually only slowed by the treatment currently available. Thus from diagnosis, the disease will accompany patients for the rest of their lives, sometimes becoming the cause of death. A patient reaching end-stage heart failure should be considered for one of four treatment options: mechanical circulatory support; continuous intravenous positive inotropic therapy; a referral for cardiac transplantation; or hospice care. Before the patient is considered to have end-stage HF, all curable factors potentially causing a deterioration in cardiac function have to be actively explored and corrected. This paper focuses on patients for whom methods to improve prognosis and heart function have been exhausted. The number of such patients is increasing continuously. This is caused by the growing incidence of heart failure, improvement in the medical care prolonging survival, and progress in decreasing the number of sudden cardiac deaths in the early stages of the disease.Heart failure (HF) is a common end stage in any structural or functional cardiac disease advanced enough to impair the filling of the ventricles or blood ejection. If the degree of impairment makes the heart unable to cope with the actual demands of pumping blood, the diagnosis of heart failure is justified. The heart first disables the circulation during exercise and finally, in end-stage HF, even at rest. HF is a progressive process, usually only slowed by the treatment currently available. Thus from diagnosis, the disease will accompany patients for the rest of their lives, sometimes becoming the cause of death. A patient reaching end-stage heart failure should be considered for one of four treatment options: mechanical circulatory support; continuous intravenous positive inotropic therapy; a referral for cardiac transplantation; or hospice care. Before the patient is considered to have end-stage HF, all curable factors potentially causing a deterioration in cardiac function have to be actively explored and corrected. This paper focuses on patients for whom methods to improve prognosis and heart function have been exhausted. The number of such patients is increasing continuously. This is caused by the growing incidence of heart failure, improvement in the medical care prolonging survival, and progress in decreasing the number of sudden cardiac deaths in the early stages of the disease

Cardioversion differences among first detected episode, paroxysmal, and persistent atrial fibrillation patients in the RHYTHM AF registry in Poland

Background: The aim of the publication is to show differences among patients with the first detected episode of atrial fibrillation (AF), paroxysmal, and persistent AF patients, for whom cardioversion was planned in the hospital setting in Poland. Methods: We present an analysis of the Polish cohort of the multicenter, multinational RHYTHM-AF registry. Consecutive patients in the hospital setting, aged ≥ 18 years, with documented AF at the time of enrollment, and for whom cardioversion of AF is one of the planned therapeutic options were recruited. Follow-up data was collected 60 days after enrollment. Results: Five-hundred-and-one patients were recruited, 483 with a defined AF type: 88 — first detected, 191 paroxysmal, and 204 persistent AF. CHA2DS2VASc scores were not significantly different between the groups, while treatment with vitamin K antagonists (VKA) was significantly lower in paroxysmal AF group than in persistent AF patients. Primary electrical cardioversion was most commonly performed in patients with persistent AF (90.4%), while primary pharmacological cardioversion — in the first detected AF (80.0%) and paroxysmal AF patients (76.7%). During 2 months of follow-up, the rate of rehospitalization and complications was comparable among the groups. Conclusions: Despite their comparable CHA2DS2VASc scores, patients with persistent AF were more frequently treated with VKA antagonists than other groups. Recurrence of AF within 2 months after restoring sinus rhythm was present in about 25% of the patients, and the rate of complications was not different among the three groups.

Safety and efficacy of cryoablation without the use of fluoroscopy

Background: Development of electroanatomical systems make it possible to perform ablations without the use of fluoroscopy. The aim of this study was to evaluate the efficacy and safety of cryoablation pro­cedures without the use of fluoroscopy. Methods: The study group consisted of 45 patients (14 female; age 36 ± 15 years) treated with cry­oablation using the EnSite electroanatomical system: 10 with ventricular extrasystoly from the right ventricle, 6 with the arrhythmogenic site near the left coronary artery, 17 patients with Wolff-Parkinson- -White syndrome (WPW), 2 patients with atrioventricular nodal reentrant tachycardia (AVNRT) type 2, 7 patients with AVNRT type 1, 3 patients with atrial tachycardia. Results: In 38 of the 45 patients (84%) cryoablation procedure was performed without the use of fluoroscopy. Cryoablation efficacy was 78.9%. In 5 patients unsuccessful cryoablation was fallowed by radiofrequency applications. Finally, efficacy reached 92.1%. There were no deaths. In 1 patient a small adverse event — right bundle branch block was observed after ablation of para-Hisian accessory path­way. No other adverse events were observed. In the long term follow-up efficacy was 89.5%. Conclusions: Cryoablation using electroanatomical system without the use of fluoroscopy is a safe and efficient procedure and it is a possible alternative in most patients qualified for cryoablation

Czynniki ryzyka zwiększonego drenażu klatki piersiowej u pacjentów poddawanych operacji pomostowania aortalno-wieńcowego bez użycia krążenia pozaustrojowego

Introduction. The aim of the study is to identify risk factors of increased postoperative bleeding after off-pump surgical treatment of coronary artery disease (OPCAB). Material and methods. A retrospective study including all patients undergoing OPCAB (2004–2008) at a single-center institution, who were analyzed with statistical methods to find risk factors increasing postoperative bleeding. Statistical significance was determined at the level of p &lt; 0.05. Results. One thousand two hundred and fifty-three patients aged 65.5 ± 9.6 were enrolled into the study. The average amount of drained blood on the first day after the surgery was 716.74 ± 430.12 mL. Seventy-six patients (6%) underwent surgical re-exploration due to postoperative bleeding. Factors elevating mediastinal drainage on the first day after the surgery included: advanced coronary artery disease, administration of clopidogrel at least 5 days before surgery and arterial grafts. Patients also had a higher mediastinal drainage when grafted: left internal mammary artery (LIMA), LIMA and right internal mammary artery (RIMA) as well as LIMA and left radial artery (LRA) (p &lt; 0.001). Factors elevating mediastinal drainage were: lower body mass index (BMI) (according to World Health Organization groups) of operated patients (p = 0.023), even lower value of the additive EuroScore (p &lt; 0.001) and logistical EuroScore (p = 0.001), longer duration of operations (p &lt; 0.001) and increasing number of grafts (p &lt; 0.001). When analyzed according to deciles of BMI and body surface area, the higher drainage was found, the higher decile of BMI was noted (p &lt; 0.0001), but the lower drainage was found, the higher decile of BSA was noted (p &lt; 0.0001). Finally, no differences were found between deciles 2 and 3, 3 and 4, 4 and 5, 5 and 6, 6 and 7 and the results were similar to non-indexed values (p &lt; 0.001). The overall regression model showed that patients who had greater amounts of blood drained had: lower value of BMI (p &lt; 0.001), received clopidogrel more often (p &lt; 0.001), grafted bilateral internal mammary arteries (BIMA) (p &lt; 0.001) and longer lasting operation (p &lt; 0.001). Conclusions. Our results suggest that overweight and obese patients have a significantly lower risk of elevated blood drainage. Lost blood should be probably considered an indexed parameter, however our observation needs further evaluation. Surgeons should pay special attention to patients with diabetes, patients with multivessel disease and those who had BIMA used as grafts.  Wstęp. Celem pracy jest identyfikacja czynników ryzyka krwawienia pooperacyjnego po zabiegu pomostowania aortalno-wieńcowego bez użycia krążenia pozaustrojowego (OPCAB). Materiały i metody. Badanie to retrospektywna, przekrojowa analiza obejmująca wszystkich pacjentów leczonych w Klinice Kardiochirurgii Warszawskiego Uniwersytetu Medycznego (WUM) w latach 2004–2008 (2827 chorych). Kryterium włączenia do badania stanowił OPCAB z dostępu przez sternotomię pośrodkową; operatorem był ten sam kardiochirurg. Kryteriami wykluczającymi z badania były: konieczność rozszerzenia zakresu operacji o dodatkowe procedury kardiochirurgiczne, konwersja z zabiegu bez zastosowania krążenia pozaustrojowego do zabiegu w krążeniu pozaustrojowym, zabieg wykonywany przez innego kardiochirurga. Do badania włączono ostatecznie 1253 pacjentów przyjętych z powodu choroby wieńcowej. Analizę statystyczną przeprowadzono na podstawie danych mierzalnych i niemierzalnych w analizowanych podgrupach. Wykonano również regresję logistyczną, w której mierzalnym parametrem był drenaż krwi w pierwszej dobie po operacji. Za istotne statystycznie uznano parametry, których p było niższe od 0,05. analiza danych dotyczących tak powszechnego czynnika ryzyka krwawień pooperacyjnych, jakim jest standardowe leczenie kwasem acetylosalicylowym u pacjentów z przewlekłą chorobą wieńcową, jak należy sądzić, także w badanej grupie [5]. Pragnę pogratulować Autorom dobrego artkułu; z prawdziwą przyjemnością rekomendowałem Redaktor Naczelnej, Pani prof. Beacie Wożakowskiej-Kapłon, i Radzie Redakcyjnej „Folia Cardiologica” przyjęcie tej pracy do druku z wysokim priorytetem. Biorąc pod uwagę wciąż dominującą liczbę operacji wieńcowych w corocznie raportowanym dorobku polskiej kardiochirurgii, wszelkie wysiłki służące obniżeniu ryzyka powikłań, w tym wczesnych krwawień pooperacyjnych w grupie pacjentów po OPCAB, mają wielkie znaczenie dla jakości opieki i poprawy bezpieczeństwa leczonych chorych [6]. Mam nadzieję na kontynuację i szerszą analizę czynników ryzyka tak ważnego zagadnienia, jaki jest krwawienie pooperacyjne w kardiochirurgii, nie tylko u pacjentów operowanych z powodu choroby wieńcowej. Pragnę zaprosić i zachęcić do dyskusji na łamach nowego działu „Kardiochirurgia” w „Folia Cardiologica”.

Natriuretic peptides in patients with atrial fibrillation

Background: The aim of the study was to evaluate plasma natriuretic peptides (NPs): atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) concentrations in patients with paroxysmal, persistent and permanent atrial fibrillation (AF). Methods and results: The study groups consisted of 23 patients with paroxysmal AF, 42 patients with permanent AF and 77 patients with persistent AF with normal left ventricular function. The mean ANP level was increased in AF patients in the paroxysmal, persistent and permanent groups: 249 &#177; 88.3 pg/mL; 258 &#177; 89.7 pg/mL; 208 &#177; 76.7 pg/mL, respectively, vs. 67 &#177; 21.2 pg/mL in the control subjects (p < 0.001). The mean BNP level was increased in AF patients in the paroxysmal, persistent and permanent groups: 99.6 &#177; 29.8 pg/mL; 82.3 &#177; 33 pg/mL; 95.6 &#177; 46.4 pg/mL, respectively, vs. 37.5 &#177; 13 pg/mL in the control group. Multivariate logistic regression analysis revealed a positive correlation between ANP levels, maximal left atrial volume, heart rate and New York Heart Association (NYHA) classification, in the persistent AF patients. A positive correlation between plasma BNP levels and heart failure stage according to NYHA classification in this group was found. Baseline ANP concentrations were positively correlated with baseline BNP concentrations in AF patients. Conclusions: Plasma NPs levels are increased in patients with paroxysmal, persistent and permanent AF and normal left ventricle function, and positively correlated with left atrial volume, heart rate and heart failure stage according to NYHA classification. Neurohormonal assessment does not distinguish the type of arrhythmia

Cardioversion of Atrial Fibrillation (RHYTHM-AF) International Registry in Poland

Background: A key procedure of the rhythm control strategy in atrial fibrillation (AF) is cardioversion to normal sinus rhythm. The aim of the present study was to provide a review of treatment patterns for the cardioversion of patients with AF in a hospital setting in Poland and document the success rate of various cardioversion procedures.Methods: We herein present the results from Poland of a prospective observational study to characterize patients with recent onset episodes of AF for whom cardioversion is one of the planned therapeutic options — the RHYTHM-AF registry. Consecutive patients in the hospital setting, age &gt; 18 years, with documented AF at the time of enrollment, excluding those with atrial flutter and those treated with vernakalant, were recruited. No treatment was recommended nor discouraged.Results: Five hundred and one patients were recruited (mean age 64.2 ± 12.1), with 294 (58.7%) patients finally undergoing cardioversion. Primary electrical cardioversion (ECV) was successful in 131 (88.5%) patients. Primary pharmacological cardioversion (PCV) was successful in 110 (75.3%) patients. Amiodarone and propafenone were most commonly used (52.1% and 24.7%, respectively). Fourteen complications and adverse events were recorded (no stroke was observed).Conclusions: Conversion to sinus rhythm was attempted in &lt; 60% of the patients with AF admitted to the hospital with an intention to terminate arrhythmia. ECV was successful in ~90% of the patients, while PCV in ~75% of the patients (amiodarone and propafenone were most commonly used). The rate of complications was low (2.8%).