Initiation of hemodialysis and sudden cardiac death — a constant challenge on the threshold of new therapy

The risk of death from cardiovascular diseases in patients initiating hemodialysis therapy is 50% higher than in patients with stage 5 chronic kidney disease before starting renal replacement therapy. Sudden cardiac death is the leading cause of death within the first months after initiation of renal replacement therapy. Identification of risk factors for early mortality in patients with end-stage renal disease is important for their future care. Myocardial stunning, intradialytic hypotension, or pulmonary hypertension in patients with arteriovenous fistula have been known for years to cause deterioration in myocardial function. On the other hand, based on observational studies conducted so far, it is not clear whether diabetes promotes early mortality in patients treated with renal replacement therapy. In addition to standard tests performed routinely in dialysis patients, it is recommended to measure high-sensitivity troponin and natriuretic peptide as well as obtain an echocardiography study during both pre-dialysis care and after the initiation of renal replacement therapy for both prognostic and diagnostic purposes. However, the main focus should be on the dynamics of changes in those parameters rather than single measurements

A new approach to ticagrelor-based de-escalation of antiplatelet therapy after acute coronary syndrome. A rationale for a randomized, double-blind, placebo-controlled, investigator-initiated, multicenter clinical study

© 2021 Via Medica. This article is available in open access under Creative Common Attribution-Non-Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0) license. https://creativecommons.org/licenses/by/4.0/The risk of ischemic events gradually decreases after acute coronary syndrome (ACS), reaching a stable level after 1 month, while the risk of bleeding remains steady during the whole period of dual antiplatelet treatment (DAPT). Several de-escalation strategies of antiplatelet treatment aiming to enhance safety of DAPT without depriving it of its efficacy have been evaluated so far. We hypothesized that reduction of the ticagrelor maintenance dose 1 month after ACS and its continuation until 12 months after ACS may improve adherence to antiplatelet treatment due to better tolerability compared with the standard dose of ticagrelor. Moreover, improved safety of treatment and preserved anti-ischemic benefit may also be expected with additional acetylsalicylic acid (ASA) withdrawal. To evaluate these hypotheses, we designed the Evaluating Safety and Efficacy of Two Ticagrelor-based De-escalation Antiplatelet Strategies in Acute Coronary Syndrome — a randomized clinical trial (ELECTRA-SIRIO 2), to assess the influence of ticagrelor dose reduction with or without continuation of ASA versus DAPT with standard dose ticagrelor in reducing clinically relevant bleeding and main-taining anti-ischemic efficacy in ACS patients. The study was designed as a phase III, randomized, multicenter, double-blind, investigator-initiated clinical study with a 12-month follow-up.Peer reviewedFinal Published versio

Comparison of reorganized versus unaltered cardiology departments during the COVID-19 era: a subanalysis of the COV-HF-SIRIO 6 study

Background: Since the beginning of the coronavirus disease-2019 (COVID-19) pandemic, numerous cardiology departments were reorganized to provide care for COVID-19 patients. We aimed to compare the impact of the COVID-19 pandemic on hospital admissions and in-hospital mortality in reorganized vs. unaltered cardiology departments. Methods: The present subanalysis is a multicenter retrospective COV-HF-SIRIO 6 study that includes all patients (n = 101,433) hospitalized in 24 cardiology departments in Poland between January 1, 2019 and December 31, 2020, with a focus on patients with acute heart failure (AHF). Results: Reduction of all-cause hospitalizations was 50.6% vs. 21.3% for reorganized vs. unaltered cardiology departments in 2020 vs. 2019, respectively (p < 0.0001). Considering AHF alone respective reductions by 46.5% and 15.2% were registered (p < 0.0001). A higher percentage of patients was brought in by ambulance to reorganized vs. unaltered cardiology departments (51.7% vs. 34.6%; p < 0.0001) alongside with a lower rate of self-referrals (45.7% vs. 58.4%; p < 0.0001). The rate of all-cause in-hospital mortality in AHF patients was higher in reorganized than unaltered cardiology departments (10.9% vs. 6.4%; p < 0.0001). After the exclusion of patients with concomitant COVID-19, the mortality rates did not differ significantly (6.9% vs. 6.4%; p = 0.55). Conclusions: In cardiology departments reorganized to provide care for COVID-19 patients vs. unaltered ones, observed: i) a greater reduction in hospital admissions in 2020 vs. 2019; ii) higher rates of patients brought by ambulance and lower rates of self-referrals; and iii) higher all-cause in-hospital mortality for AHF due to COVID-19 related deaths

Rozpoczęcie leczenia hemodializą a nagła śmierć sercowa – nieustające wyzwanie u progu nowej terapii.

Ryzyko zgonu z powodu przyczyn sercowo-naczyniowych u chorych rozpoczynających leczenie hemodializami jest o 50% wyższe niż u chorych w 5 stadium przewlekłej choroby nerek przed rozpoczęciem leczenia nerkozastępczego. Nagła śmierć sercowa jest dominującą przyczyną zgonów w pierwszych miesiącach od rozpoczęcia terapii nerkozastępczej. Zidentyfikowanie czynników ryzyka wczesnej śmiertelności u pacjentów ze schyłkową niewydolności nerek ma ważne znaczenie dla ich przyszłej opieki. Ogłuszenie mięśnia sercowego, hipotensja śróddializacyjna, czy wystąpienie nadciśnienia płucnego u chorych po wytworzeniu przetoki tętniczo-żylnej to znane od lat stany powodujące pogorszenie funkcji mięśnia sercowego. Z kolei z badań obserwacyjnych wynika, że nie stwierdzono wyższej wczesnej śmiertelności u chorych z cukrzycą włączonych do programu dializ w porównaniu do chorych bez cukrzycy. W celach prognostycznych i rokowniczych, oprócz rutynowych badań wykonywanych w opiece nad chorymi dializowanymi, wskazane jest zarówno w okresie przeddializacyjnym jaki i po włączeniu do leczenia nerkozastępczego oznaczenie stężenia wysokoczułej troponiny, peptydu natriuretycznego oraz wykonanie badania echokardiograficznego. Uwagę należy jednak koncentrować na dynamice zmian wymienionych parametrów, a nie na ocenie pojedynczych oznaczeń

Ostra zatorowość płucna pośredniego ryzyka z ruchomą skrzepliną w prawym sercu, przebiegająca z zespołem uogólnionej reakcji zapalnej, zespołem niewydolności wielonarządowej, rozsianym krzepnięciem wewnątrznaczyniowym i ostrym niedokrwieniem kończyny

A case of a 64 year-old woman admitted to ICCU because of severe dyspnoea and oedema of left lower limb is presented. We diagnosed coincidence of acute pulmonary embolism with right-sided free-floating heart thrombi, systemic inflammatory reaction syndrome, multiple organ dysfunction syndrome, disseminated intravascular coagulation and acute ischaemia of the right lower limb. Due to atypical clinical presentation therapeutic strategies were discussed with ZATPOL registry coordinator. The patient was treated pharmacologically, underwent cardiosurgical evacuation of right-sided intracardiac thrombus and lower limb amputation. At follow up visit 6 months after discharge from hospital she was in good general condition with no complaints. Kardiol Pol 2010; 68, 10: 1140-114