Zatorowość płucna — czy infekcja SARS CoV-2 wpływa na przebieg kliniczny i rokowanie?

Introduction. Coronavirus disease 2019 (COVID-19) is a disease associated with an increased risk of thromboembolic complications up to 5 months after infection. The study aimed to assess the effect of active or recent (defined as within the past 3 months) COVID-19 on the clinical course of pulmonary embolism (PE) and patients’ survival as compared to patients with pulmonary embolism without a history or active COVID-19. Material and methods. Eighty-seven patients diagnosed with pulmonary embolism, and hospitalized from March 2020 to July 2021 were qualified for the study. The patients were divided into two groups: 1. COVID (+): patients with an active severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection confirmed by the polymerase chain reaction (PCR) or antigen test in the period no longer than 3 months before the diagnosis of PE (n = 38); 2. COVID (–): patients tested negative for SARS-CoV-2 and without typical history of infection (n = 49). The following data were analysed: clinical data, results of computed tomography, transthoracic echocardiography, ultrasound of deep veins of lower limbs, and results of laboratory tests (D-dimer, N-termina pro-B-type natriuretic peptide, cardiac troponin I, C-reactive protein [CRP]). For statistical analysis, Statistica version 13 was used. Results. Significant differences between the COVID (+) and COVID (–) groups were observed in the incidence of complete respiratory failure in 39.5% and 6.12% of patients respectively, p = 0.001 and higher in-hospital mortality 26.3% vs. 4.08%; p = 0.003. The Cox regression did not reveal any factor significantly associated with in-hospital mortality besides the previous diagnosis of neoplasm (hazard ratio 3.23; 95% confidence interval: 0.81; 12.95; p = 0.09). The COVID (+) group was characterized by significantly higher levels ​​of CRP (9.43/52.50/113.23 [mg/L] vs. 6.40/24.70/47.40 [mg/L]; p = 0.04). Conclusions. Patients with COVID-19 and PE present higher mortality than patients without concurrent or recent SARS-CoV-2 infection. Further studies are warranted to identify specific factors associated with the observed higher mortality in this population.Wstęp. Choroba koronawirusowa 2019 (COVID-19) jest związana ze zwiększonym ryzykiem powikłań zakrzepowo-zatorowych do 5 miesięcy po zakażeniu. Celem niniejszej pracy była ocena wpływu czynnego lub przebytego niedawno (w ciągu ostatnich 3 miesięcy) COVID-19 na przebieg kliniczny zatorowości płucnej (PE) i przeżycie pacjentów w porównaniu z pacjentami z zatorowością płucną bez wywiadu lub aktywnej COVID-19. Materiały i metody. Do badania zakwalifikowano 87 pacjentów z rozpoznaniem PE, hospitalizowanych od marca 2020 do lipca 2021 roku. Pacjentów podzielono na dwie grupy: 1. COVID (+): pacjenci z czynną infekcją SARS-CoV-2 potwierdzoną łańcuchową reakcją polimerazy (PCR) lub testem antygenowym w okresie nie dłuższym niż 3 miesiące przed rozpoznaniem PE, (n = 38); 2. COVID (–): pacjenci z ujemnym wynikiem testu na SARS-CoV-2 i bez typowej historii infekcji (n = 49). Analizie poddano dane kliniczne, wyniki tomografii komputerowej, echokardiografii przezklatkowej, USG żył głębokich kończyn dolnych, wyniki badań laboratoryjnych (D-dimer, N-końcowy fragment propeptydu natriuretycznego typu B, troponinę sercową I, białko C-reaktywne). Do analizy statystycznej wykorzystano program Statistica w wersji 13. Wyniki. Zaobserwowano istotne różnice między grupami z COVID (+) i COVID (–) w częstości występowania całkowitej niewydolności oddechowej odpowiednio u 39,5%; 6,12% pacjentów, p = 0,001 i wyższej śmiertelności wewnątrzszpitalnej (26,3% vs. 4,08%; p = 0,003). Regresja Coxa nie ujawniła żadnego czynnika istotnie związanego ze śmiertelnością wewnątrzszpitalną poza wcześniejszym rozpoznaniem nowotworu (współczynnik ryzyka 3,23; 95-procentowy przedział ufności: 0,81; 12,95; p = 0,09). Grupa COVID (+) charakteryzowała się istotnie wyższymi stężeniami białka C-reaktywnego (9,43/52,50/113,23 [mg/l] vs. 6,40/24,70/47,40 [mg/l]; p = 0,04). Wnioski. Wśród pacjentów z COVID-19 i PE wykazano wyższą śmiertelność niż u osób bez jednoczesnego lub niedawnego zakażenia SARS-CoV-2. Uzasadnione są dalsze badania w celu zidentyfikowania specyficznych czynników związanych z obserwowaną wyższą śmiertelnością w tej populacji

Immature platelet fraction in cardiovascular diagnostics and antiplatelet therapy monitoring

Immature platelet fraction (IPF), circulating platelets still containing RNA, can be easily calculated by automated flow cytometry, this makes them an accessible biomarker. Higher IPF concentrations were reported in patients with thrombocytopenia, patients who were smokers, and also those who were diabetics. Several studies have reported their diagnostic and prognostic importance in patients presenting with acute coronary syndromes, especially ST-segment myocardial infarction, where increased IPF level is an independent predictor of cardiovascular death. In addition, higher IPF were reported in patients with inadequate response to either clopidogrel or prasugrel, suggesting their potential role in antiplatelet therapy monitoring. Their prognostic significance was also observed in both coronary artery disease and postcardiac surgery status, where their higher levels correlated with the risk of major adverse cardiac events. The present review aims to present the current evidence on diagnostic, prognostic and potentially therapeutic roles of IPF in cardiovascular medicine

Incidence of end-stage renal disease after heart transplantation and effect of its treatment on survival

Aims: Many heart transplant recipients will develop end-stage renal disease in the post-operative course. The aim of this study was to identify the long-term incidence of end-stage renal disease, determine its risk factors, and investigate what subsequent therapy was associated with the best survival. Methods and results: A retrospective, single-centre study was performed in all adult heart transplant patients from 1984 to 2016. Risk factors for end-stage renal disease were analysed by means of multivariable regression analysis and survival by means of Kaplan–Meier. Of 685 heart transplant recipients, 71 were excluded: 64 were under 18 years of age and seven were re-transplantations. During a median follow-up of 8.6 years, 121 (19.7%) patients developed end-stage renal disease: 22 received conservative therapy, 80 were treated with dialysis (46 haemodialysis and 34 peritoneal dialysis), and 19 received a kidney transplant. Development of end-stage renal disease (examined as a time-dependent variable) inferred a hazard ratio of 6.45 (95% confidence interval 4.87–8.54, P < 0.001) for mortality. Tacrolimus-based therapy decreased, and acute kidney injury requiring renal replacement therapy increased the risk for end-stage renal disease development (hazard ratio 0.40, 95% confidence interval 0.26–0.62, P < 0.001, and hazard ratio 4.18, 95% confidence interval 2.30–7.59, P < 0.001, respectively). Kidney transplantation was associated with the best median survival compared with dialysis or conservative therapy: 6.4 vs. 2.2 vs. 0.3 years (P < 0.0001), respectively, after end-stage renal disease development. Conclusions: End-stage renal disease is a frequent complication after heart transplant and is associated with poor survival. Kidney transplantation resulted in the longest survival of patients with end-stage renal disease

Temporal patterns of macrophage- and neutrophil-related markers are associated with clinical outcome in heart failure patients

Aims: Evidence on the association of macrophage- and neutrophil-related blood biomarkers with clinical outcome in heart failure patients is limited, and, with the exception of C-reactive protein, no data exist on their temporal evolution. We aimed to investigate whether temporal patterns of these biomarkers are related to clinical outcome in patients with stable chronic heart failure (CHF). Methods and Results: In 263 patients with CHF, we performed serial plasma measurements of scavenger receptor cysteine-rich type 1 protein M130 (CD163), tartrate-resistant acid phosphatase type 5 (TRAP), granulins (GRN), spondin-1 (SPON1), peptidoglycan recognition protein 1 (PGLYRP1), and tissue factor pathway inhibitor (TFPI). The Cardiovascular Panel III (Olink Proteomics AB, Uppsala, Sweden) was used. During 2.2 years of follow-up, we collected 1984 samples before the occurrence of the composite primary endpoint (PE) or censoring. For efficiency, we selected 567 samples for the measurements (all baseline samples, the last two samples preceding the PE, and the last sample before censoring in event-free patients). The relationship between repeatedly measured biomarker levels and the PE was evaluated by joint models. Mean (±standard deviation) age was 67 ± 13 years; 189 (72%) were men; left ventricular ejection fraction (%) was 32 ± 11. During follow-up, 70 (27%) patients experienced the PE. Serially measured biomarkers predicted the PE in a multivariable model adjusted for baseline clinical characteristics [hazard ratio (95% confidence interval) per 1-standard deviation change in biomarker]: CD163 [2.07(1.47–2.98), P < 0.001], TRAP [0.62 (0.43–0.90), P = 0.009], GRN [2.46 (1.64–3.84), P < 0.001], SPON1 [3.94 (2.50–6.50), P < 0.001], and PGLYRP1 [1.62 (1.14–2.31), P = 0.006]. Conclusions: Changes in plasma levels of CD163, TRAP, GRN, SPON1, and PGLYRP1 precede adverse cardiovascular events in patients with CHF

Impact of renal function on clinical outcomes after PCI in ACS and stable CAD patients treated with ticagrelor: a prespecified analysis of the GLOBAL LEADERS randomized clinical trial

Background: Impaired renal function (IRF) is associated with increased risks of both ischemic and bleeding events. Ticagrelor has been shown to provide greater absolute reduction in ischemic risk following acute coronary syndrome (ACS) in those with versus without IRF. Methods: A pre-specified sub-analysis of the randomized GLOBAL LEADERS trial (n = 15,991) comparing the experimental strategy of 23-month ticagrelor monotherapy (after 1-month ticagrelor and aspirin dual anti-platelet therapy [DAPT]) with 12-month DAPT followed by 12-month aspirin after percutaneous coronary intervention (PCI) in ACS and stable coronary artery disease (CAD) patients stratified according to IRF (glomerular filtration rate < 60 ml/min/1.73 m2). Results: At 2 years, patients with IRF (n = 2171) had a higher rate of the primary endpoint (all-cause mortality or centrally adjudicated, new Q-wave myocardial infarction [MI](hazard ratio [HR] 1.64, 95% confidence interval [CI] 1.35–1.98, padj = 0.001), all-cause death, site-reported MI, all revascularization and BARC 3 or 5 type bleeding, compared with patients without IRF. Among patients with IRF, there were similar rates of the primary endpoint (HR 0.82, 95% CI 0.61–1.11, p = 0.192, pint = 0.680) and BARC 3 or 5 type bleeding (HR 1.10, 95% CI 0.71–1.71, p = 0.656, pint = 0.506) in the experimental versus the reference group. No significant interactions were seen between IRF and treatment effect for any of the secondary outcome variables. Among ACS patients with IRF, there were no between-group differences in the rates of the primary endpoint or BARC 3 or 5 type bleeding; however, the rates of the patient-oriented composite endpoint (POCE) of all-cause death, any stroke, MI, or revascularization (pint = 0.028) and net adverse clinical events (POCE and BARC 3 or 5 type bleeding) (pint = 0.045), were lower in the experimental versus the reference group. No treatment effects were found in stable CAD patients categorized according to presence of IRF. Conclusions: IRF negatively impacted long-term prognosis after PCI. There were no differential treatment effects found with regard to all-cause death or new Q-wave MI after PCI in patients with IRF treated with ticagrelor monotherapy. Clinical trial regis

Circulating and Platelet MicroRNAs in Cardiovascular Risk Assessment and Antiplatelet Therapy Monitoring

Micro-ribonucleic acids (microRNAs) are small molecules that take part in the regulation of gene expression. Their function has been extensively investigated in cardiovascular diseases (CVD). Most recently, miRNA expression levels have been suggested as potential biomarkers of platelet reactivity or response to antiplatelet therapy and tools for risk stratification for recurrence of ischemic evens. Among these, miR-126 and miR-223 have been found to be of particular interest. Despite numerous studies aimed at understanding the prognostic value of miRNA levels, no final conclusions have been drawn thus far regarding their utility in clinical practice. The aim of this review is to critically appraise the evidence on the association between miRNA expression, cardiovascular risk and on-treatment platelet reactivity as well as provide insights on future developments in the field

Crosstalk between microRNA and Oxidative Stress in Heart Failure: A Systematic Review

Heart failure is defined as a clinical syndrome consisting of key symptoms and is due to a structural and/or functional alteration of the heart that results in increased intracardiac pressures and/or inadequate cardiac output at rest and/or during exercise. One of the key mechanisms determining myocardial dysfunction in heart failure is oxidative stress. MicroRNAs (miRNAs, miRs) are short, endogenous, conserved, single-stranded non-coding RNAs of around 21–25 nucleotides in length that act as regulators of multiple processes. A systematic review following the PRISMA guidelines was performed on the evidence on the interplay between microRNA and oxidative stress in heart failure. A search of Pubmed, Embase, Scopus, and Scopus direct databases using the following search terms: ‘heart failure’ AND ‘oxidative stress’ AND ‘microRNA’ or ‘heart failure’ AND ‘oxidative stress’ AND ‘miRNA’ was conducted and resulted in 464 articles. Out of them, 15 full text articles were eligible for inclusion in the qualitative analysis. Multiple microRNAs are involved in the processes associated with oxidative stress leading to heart failure development including mitochondrial integrity and function, antioxidant defense, iron overload, ferroptosis, and survival pathways

Dietary supplements, nutraceuticals and functional foods use after myocardial infarction depend on the age, sex, BMI and professional activity – a pilot study

Objectives To assess dietary supplements, functional foods and nutraceuticals use among the patients after myocardial infarction (MI). Material and Methods The authors prospectively enrolled 100 consecutive patients hospitalized due to MI and remaining under coordinated outpatient care after MI in the authors’ cardiology department. Results The authors showed that patients within median (interquartile range) 12.30 (10.18–14.57) months after MI use dietary supplements, nutraceuticals and functional foods in their everyday diet. Vitamins (53% patients), especially vitamin D (35%), were the most frequently used dietary supplements. In contrary to common usage of dietary supplements (59%), smaller proportion of patients use functional foods (21%) and nutraceuticals (5%), especially phytosterols. The authors found that the use of over-the-counter (OTC) drugs and dietary supplements is associated with age (participants &lt;60 years old vs. participants ≥60 years old: OTC drugs: N = 8 [20.0%] vs. N = 32 [53.3%], p &lt; 0.001; herbals: N = 3 [7.5%] vs. N = 16 [26.7%], p = 0.019), sex of the patients following MI (females vs. males: vitamins: N = 17 [70.8%] vs. N = 36 [47,4%], p = 0.045; vitamin D: N = 13 [54.2%] vs. N = 22 [28.9%], p = 0.024; omega-3 fatty acids: N = 3 [12.5%] vs. N = 1 [1.3%], p = 0.042; herbals: N = 8 [33.3%] vs. N = 11[14.5%], p = 0.040), as well as the BMI of the participants (BMI &lt; 24.9 vs. BMI ≥ 25.0: multivitamin/ multimineral dietary supplements: N = 3 [15.0%] vs. N = 31 [42.5%], p = 0.035; vitamin B6: N = 1 [5.0%] vs. N = 21 [28.8%], p = 0.035). In the study group all participants with the age above retirement age have already withdrawn from professional activity and they more often used OTC drugs (N = 14 [25.9%] before retirement age vs. N = 26 [56.5%] above retirement age, p = 0.002). Conclusions The patients following MI use supplements, functional foods and nutraceuticals. Their use depends on sex, age, BMI and professional activity. The authors believe that their potential beneficial effects require further evaluation in clinical longitudinal studies

Incidence of end‐stage renal disease after heart transplantation and effect of its treatment on survival

Abstract Aims Many heart transplant recipients will develop end‐stage renal disease in the post‐operative course. The aim of this study was to identify the long‐term incidence of end‐stage renal disease, determine its risk factors, and investigate what subsequent therapy was associated with the best survival. Methods and results A retrospective, single‐centre study was performed in all adult heart transplant patients from 1984 to 2016. Risk factors for end‐stage renal disease were analysed by means of multivariable regression analysis and survival by means of Kaplan–Meier. Of 685 heart transplant recipients, 71 were excluded: 64 were under 18 years of age and seven were re‐transplantations. During a median follow‐up of 8.6 years, 121 (19.7%) patients developed end‐stage renal disease: 22 received conservative therapy, 80 were treated with dialysis (46 haemodialysis and 34 peritoneal dialysis), and 19 received a kidney transplant. Development of end‐stage renal disease (examined as a time‐dependent variable) inferred a hazard ratio of 6.45 (95% confidence interval 4.87–8.54, P < 0.001) for mortality. Tacrolimus‐based therapy decreased, and acute kidney injury requiring renal replacement therapy increased the risk for end‐stage renal disease development (hazard ratio 0.40, 95% confidence interval 0.26–0.62, P < 0.001, and hazard ratio 4.18, 95% confidence interval 2.30–7.59, P < 0.001, respectively). Kidney transplantation was associated with the best median survival compared with dialysis or conservative therapy: 6.4 vs. 2.2 vs. 0.3 years (P < 0.0001), respectively, after end‐stage renal disease development. Conclusions End‐stage renal disease is a frequent complication after heart transplant and is associated with poor survival. Kidney transplantation resulted in the longest survival of patients with end‐stage renal disease