Showing papers in "Kardiologia Polska in 2014"

2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism

Abstract: Stavros Konstantinides, Adam Torbicki, Giancarlo Agnelli, Nicolas Danchin, David Fitzmaurice, Nazzareno Galiè, J. Simon R. Gibbs, Menno Huisman, Marc Humbert†, Nils Kucher, Irene Lang, Mareike Lankeit, John Lekakis, Christoph Maack, Eckhard Mayer, Nicolas Meneveau, Arnaud Perrier, Piotr Pruszczyk, Lars H. Rasmussen, Thomas H. Schindler, Pavel Svitil, Anton Vonk Noordegraaf, Jose Luis Zamorano, and Maurizio Zompatori

2014 ESC Guidelines on the diagnosis and treatment of aortic diseases

Abstract: 3D : three-dimensional AAA : abdominal aortic aneurysm AAS : acute aortic syndrome ACC : American College of Cardiology ACE : angiotensin-converting enzyme AD : Aortic dissection ADAM : Aneurysm Detection and Management AHA : American Heart Association AJAX : Amsterdam Acute Aneurysm AO : aorta AOS : aneurysms-osteoarthritis syndrome ARCH : Aortic Arch Related Cerebral Hazard ATS : arterial tortuosity syndrome BAV : bicuspid aortic valve BSA : body surface area CI : confidence interval CoA : coarctation of the aorta CPG : Committee for Practice Guidelines CSF : cerebrospinal fluid CT : computed tomography DREAM : Dutch Randomized Aneurysm Management DUS : Doppler ultrasound EBCT : electron beam computed tomography ECG : electrocardiogram EDS : Ehlers-Danlos syndrome EDSIV : Ehlers-Danlos syndrome type IV ESC : European Society of Cardiology ESH : European Society of Hypertension EVAR : endovascular aortic repair FDG : 18F-fluorodeoxyglucose FL : false lumen GCA : giant cell arteritis GERAADA : German Registry for Acute Aortic Dissection Type A IAD : iatrogenic aortic dissection IMH : intramural haematoma INSTEAD : Investigation of Stent Grafts in Patients with type B Aortic Dissection IRAD : International Registry of Aortic Dissection IVUS : intravascular ultrasound LCC : left coronary cusp LDS : Loeys-Dietz syndrome MASS : Multicentre Aneurysm Screening Study MESA : Multi-Ethnic Study of Atherosclerosis MPR : multiplanar reconstruction MRA : magnetic resonance angiography MRI : magnetic resonance imaging MSCT : multislice computed tomography NA : not applicable NCC : non-coronary cusp ns-TAAD : non-syndromic thoracic aortic aneurysms and dissection OR : odds ratio OVER : Open Versus Endovascular Repair OxVasc : Oxford Vascular study PARTNER : Placement of AoRtic TraNscathetER Valves PAU : penetrating aortic ulcer PICSS : Patent Foramen Ovale in Cryptogenic Stroke study PET : positron emission tomography RCCA : right common carotid artery RCC : right coronary cusp RCT : randomized, clinical trial RR : relative risk SIRS : systemic inflammatory response SMC : smooth muscle cell TAA : thoracic aortic aneurysm TAAD : thoracic aortic aneurysms and dissection TAI : traumatic aortic injury TEVAR : thoracic endovascular aortic repair TGF : transforming growth factor TI : separate thyroid artery (A. thyroidea) TL : true lumen TOE : transoesophageal echocardiography TS : Turner Syndrome TTE : transthoracic echocardiography UKSAT : UK Small Aneurysm Trial ULP : ulcer-like projection WARSS : Warfarin-Aspirin Recurrent Stroke Study Guidelines summarize and evaluate all available evidence at the time of the writing process, on a particular issue with the aim of assisting health professionals in selecting the best management strategies for an individual patient, with a given condition, taking into account the impact on outcome, as well as the risk-benefit-ratio of particular diagnostic or therapeutic means. Guidelines and recommendations should help the health professionals to make decisions in their daily practice. However, the final decisions concerning an individual patient must be made by the responsible health professional(s) in consultation with the patient and caregiver as appropriate. A great number of Guidelines have been issued in recent years by the European Society of Cardiology (ESC) as well as by other societies and organisations. Because of the impact on clinical practice, quality criteria for the development of guidelines have been established in order to make all decisions …

2014 ESC/EACTS Guidelines on myocardial revascularization

Abstract: Acute coronary syndromes Bare-metal stents Coronary artery bypass grafting Coronary artery disease Drug-eluting stents EuroSCORE Guidelines Heart Team Myocardial infarction Myocardial ischaemia Myocardial revascularization Medical therapy Percutaneous coronary intervention Recommendation Revascularisation Risk stratification Stents Stable angina Stable coronary artery disease ST-segment elevation myocardial infarction SYNTAX score

2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy

Abstract: 2D : two-dimensional 99mTc-DPD : 99mTechnetium-3,3-diphosphono- 1,2-propanodi-carboxylic acid ACE : angiotensin-converting enzyme AF : atrial fibrillation AL : amyloid light chain AR : aortic regurgitation ARB : angiotensin receptor blocker ATTR : amyloidosis-transthyretin type AV : atrioventricular BiVAD : biventricular assist device BNP : brain natriuretic peptide BPM : Beats per minute CCS : Canadian Cardiovascular Society CFC : cardiofacialcutaneous CHA2DS2-VASc : Congestive Heart failure, hypertension, Age ≥75 (doubled), Diabetes, Stroke (doubled), Vascular disease, Age 65–74, and Sex (female) CMR : cardiac magnetic resonance CRT : cardiac resynchronization therapy CRT-D : cardiac resynchronization therapy-defibrillator CRT-P : Cardiac resynchronization therapy with a pacemaker CT : computed tomography DC : direct current DNA : deoxyribonucleic acid E/A : ratio of mitral peak velocity of early filling (E) to mitral peak velocity of late filling (A) E/e’ : ratio of early transmitral flow velocity (E) to early mitral annulus velocity (e’) EACTS : European Association for Cardio-Thoracic Surgery ECG : electrocardiogram EF : ejection fraction EPS : electrophysiological study ESC : European Society of Cardiology FDA : (US) Food and Drug Administration FHL1 : four and a half LIM domains 1 HAS-BLED : hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile INR, elderly (>65 years), drugs/alcohol concomitantly HCM : hypertrophic cardiomyopathy hs-cTnT : high sensitivity cardiac troponin T HTS : high throughput sequencing ICD : implantable cardioverter defibrillator ILR : implantable loop recorder INR : international normalized ratio IUD : intrauterine device LA : left atrium LAMP-2 : lysosome-associated membrane protein 2 LBBB : left bundle branch block LEOPARD : Lentigines, ECG abnormalities, Ocular hypertelorism, Pulmonary stenosis, Abnormal genitalia, Retardation of growth, and sensory-neural Deafness LGE : late gadolinium enhancement LV : left ventricular LVAD : left ventricular assist device LVH : left ventricular hypertrophy LVOTO : left ventricular outlow tract obstruction MADIT-RIT : Multicenter Automatic Defibrillator Implantation Trial—Reduce Inappropriate Therapy MAPK : mitogen activated protein kinase MELAS : mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes MERFF : myoclonic epilepsy with ragged red fibres MRA : mineralocorticoid receptor antagonist MYBPC3 : myosin-binding protein C, cardiac-type MYH7 : myosin-7 (s-myosin heavy chain) MYL3 : myosin light chain 3 NOAC : new oral anticoagulants NSVT : non-sustained ventricular tachycardia NT-proBNP : N-terminal pro brain natriuretic peptide NYHA : New York Heart Association OAC : oral anticoagulants o.d. : omni die (every day) PC-CMR : phase contrast cardiac magnetic resonance PDE5 : phosphodiesterase type 5 PET : positron emission tomography PRKAG2 : gamma-2 sub-unit of the adenosine monophosphate-activated protein kinase RAAS : renin angiotensin aldosterone system RV : right ventricular SAM : systolic anterior motion SCD : sudden cardiac death SAA : septal alcohol ablation S-ICD™ : Subcutaneous lead implantable cardioverter defibrillator SPECT : single photon emission computed tomography SSFP : steady-state free precession SVT : supraventricular tachycardia TOE : transoesophageal echocardiography TNNI3 : troponin I, cardiac muscle TNNT2 : troponin T, cardiac muscle TPM1 : tropomyosin alpha-1 chain TTE : transthoracic echocardiography TTR : transthyretin VF : ventricular fibrillation VKA : vitamin K antagonist VT : ventricular tachycardia WHO : World Health Organization Guidelines summarize and evaluate all available evidence at the time of the writing process, on a particular issue with the aim of assisting health professionals in selecting the best management strategies for an individual patient, with a given condition, taking into account the impact on outcome, as well as the risk-benefit-ratio of particular diagnostic or therapeutic means. Guidelines and recommendations should help the health professionals to make decisions in their daily practice. However, the final decisions concerning an individual patient must be made by the responsible health professional(s) in consultation with the patient and caregiver as appropriate. A great number of Guidelines have been issued in recent years by the European Society of Cardiology (ESC) as well as by other societies and organisations. Because of the impact on clinical practice, quality criteria for the development of guidelines have been established in order to make all decisions transparent to the user. The recommendations for formulating and issuing ESC Guidelines can be found on the ESC website (http://www.escardio.org/guidelines-surveys/esc-guidelines/about/Pages/rules-writing.aspx). ESC Guidelines represent the official position of the ESC on a given topic and are regularly updated. Members of this Task Force were selected by the ESC to represent professionals involved with the medical care of patients with this pathology. Selected experts in the field undertook a comprehensive review of the published evidence for management (including diagnosis, treatment, prevention and rehabilitation) of a given condition according to ESC Committee for Practice Guidelines (CPG) policy. A critical evaluation of diagnostic and therapeutic procedures was performed including assessment of the risk-benefit-ratio. Estimates of expected health outcomes for larger populations were included, where data exist. The level of evidence and the strength of recommendation of particular management options were weighed and graded according to predefined scales, as outlined in Tables 1 and 2 . The experts of …

[2014 ESC/ESA Guidelines on Non-Cardiac Surgery: Cardiovascular Assessment Andmanagement]

Abstract: Authors/Task Force Members: Steen Dalby Kristensen* (Chairperson) (Denmark), Juhani Knuuti* (Chairperson) (Finland), Antti Saraste (Finland), Stefan Anker (Germany), Hans Erik Bøtker (Denmark), Stefan De Hert (Belgium), Ian Ford (UK), Jose Ramón Gonzalez-Juanatey (Spain), Bulent Gorenek (Turkey), Guy Robert Heyndrickx (Belgium), Andreas Hoeft (Germany), Kurt Huber (Austria), Bernard Iung (France), Keld Per Kjeldsen (Denmark), Dan Longrois (France), Thomas F. Lüscher (Switzerland), Luc Pierard (Belgium), Stuart Pocock (UK), Susanna Price (UK), Marco Roffi (Switzerland), Per Anton Sirnes (Norway), Miguel Sousa-Uva (Portugal), Vasilis Voudris (Greece), Christian Funck-Brentano (France).

3D heart model printing for preparation of percutaneous structural interventions: description of the technology and case report.

Abstract: Background: Structural heart disease, including valvular disease as well as congenital defects, causes important alterations in heart anatomy As a result, individualised planning for both surgical and percutaneous procedures is crucial for procedural optimisation Three dimensional (3D) rapid prototyping techniques are being utilised to aid operators in planning structuralheart procedures Aim: We intend to provide a description of 3D printing as a clinically applicable heart modelling technology for the planning of percutaneous structural heart procedures as well as to report our first clinical use of a 3D printed patient-specific heartmodel in preparation for a percutaneous mitral annuloplasty using the Mitralign percutaneous annuloplasty system Methods: Retrospectively gated, contrast enhanced, multi-slice computed tomography (MSCT) scans were obtained MSCT DICOM data was analysed using software that creates 3D surface files of the blood volume of specific regions of interest in the heart The surface files are rendered using a software package that creates a solid model that can be printed using commercially available stereolithography machines Results: The technique of direct percutaneous mitral annuloplasty requires advancement of a guiding catheter through the aorta, into the left ventricle, and requires the positioning of the tip of the catheter between the papillary muscles in close proximity to the mitral annulus The 3D heart model was used to create a procedural plan to optimise potential device implantation The size of the deflectable guiding catheter was selected on the basis of the patient’s heart model Target locations for annulus crossing wires were evaluated pre-procedurally using the individual patient’s 3D heart model In addition, the ability to position the Bident Catheter at the appropriate locations under the mitral annulus as well as the manoeuvrability between the papillary muscles were analysed on the heart model, enabling safe completion of the procedure, which resulted in a significant reduction in mitral regurgitation Conclusions: 3D printing is a helpful tool in individualised planning for percutaneous structural interventions Future studies are warranted to assess its role in preparing for percutaneous and surgical heart procedures

Clinical characteristics, aetiology and occurrence of type 2 acute myocardial infarction.

Abstract: Background: Cardiovascular diseases are the leading cause of death worldwide. One of the most important diseases in this group is myocardial infarction (MI). According to the universal definition developed by the European Society of Cardiology (ESC), MI is divided into five main types based on its cause. Type 2 MI is secondary to ischaemia due to either increased demand or decreased supply of oxygen (for example due to coronary artery spasm, anaemia, arrhythmia, coronary embolism, hypertension, or hypotension). Aim: To assess the occurrence and aetiology of type 2 acute MI (AMI), and to describe the clinical characteristics and prognosisof study patients. Methods: Into a retrospective study, we enrolled 2,882 patients in the Cardiology Department with an initial diagnosis of AMI between 2009 and 2012. Diagnosis of AMI was made based on ESC criteria. In all patients, coronary angiography was performed in order to exclude haemodynamically significant coronary lesions. Results: Among 2,882 patients hospitalised in the described time period, 58 (2%) patients were diagnosed with type 2 AMI.The mean age of the study group was 67.3 ± 13.2 years; and the majority of the study group, 60.3%, were women. Out of them, 23 (39.6%) patients experienced AMI due to coronary artery spasm, 15 (25.9%) due to arrhythmias, 11 (19%) due to severe anaemia, and nine (15.5%) due to hypertension, without significant coronary artery disease. 42 (72.4%) patients, were diagnosed as non-ST-segment elevation MI, 14 (24.1%) as ST-segment elevation MI, and two (3.5%) as AMI in the presence of ventricular paced rhythm. History of classical cardiovascular risk factors including hypertension, diabetes, dyslipidaemia, family history of heart diseases, and smoking was reported in 42 (72.4%), 14 (24.1%), 23 (39.7%), 24 (41.4%), and 16 (27.6%) cases, respectively. All-cause 30-day mortality rate was 5.2%, and six-month was 6.9%. Conclusions: Type 2 AMI patients were more often female, and they were more often diagnosed as non-ST-segment elevation MI. The prevalence of classical cardiovascular risk factors in this subgroup of patients was very high. The leading causeof AMI was coronary artery spasm.

Haematological indices as predictors of atrial fibrillation following isolated coronary artery bypass grafting, valvular surgery, or combined procedures: a systematic review with meta-analysis.

Abstract: Background: New postoperative atrial fibrillation (POAF) is one of the most critical and common complications after cardio¬vascular surgery precipitating early and late morbidities. Complete blood count (CBC) is an imperative blood test in clinical practice, routinely used in the examination of cardiovascular diseases. Aim: This systematic review with meta-analysis aimed to determine the strength of evidence for evaluating the association of haematological indices in CBC tests with atrial fibrillation following isolated coronary artery bypass graft (CABG), isolated valvular surgery, or a combination of these treatments. Methods: We conducted a meta-analysis of studies evaluating pre- and postoperative haematological indices in patients with POAF. A comprehensive subgroup analysis was performed to explore potential sources of heterogeneity. Results: A literature search of all major databases retrieved 732 studies. After screening, 22 studies were analysed including a total of 6098 patients. Pooled analysis showed preoperative platelet count (PC) (weighted mean difference [WMD] = –7.07 × 109/L and p < 0.001), preoperative mean platelet volume (MPV) (WMD = 0.53 FL and p < 0.001), preoperative white blood cell count (WBC) (WMD = 0.130 × 109/L and p < 0.001), preoperative neutrophil-to-lymphocyte ratio (NLR) (WMD = 0.33 and p < 0.001), preoperative red blood cell distribution width (RDW) (WMD = 0.36% and p < 0.001), postoperative WBC (WMD = 1.36 × 109/L and p < 0.001), and postoperative NLR (WMD = 0.74 and p < 0.001) as associated factors with POAF. Conclusions: Haematological indices may predict the risk of POAF before surgery. These easily-performed tests should defi¬nitely be taken into account in patients undergoing isolated CABG, valvular surgery, or combined procedures.

Cardiac magnetic resonance feature tracking: a novel method to assess myocardial strain. Comparison with echocardiographic speckle tracking in healthy volunteers and in patients with left ventricular hypertrophy.

Abstract: Background: Left ventricular longitudinal strain (LV-LS) and strain rate (SR) are sensitive markers of early systolic dysfunction. Aim: To evaluate the feasibility of a novel, cardiac magnetic resonance (CMR) based method known as feature tracking (FT) for the assessment of strain and SR, and to compare the CMR based results to those obtained on standard transthoracic echocardiography (TTE) in healthy volunteers and in patients with left ventricular hypertrophy cardiomyopathy (HCM). Methods: Overall, 20 healthy volunteers (ten male, mean age 24 ± 3 years) and 20 consecutive patients with HCM (12 male, mean age 47 ± 19 years) were included. Longitudinal and circumferential strain and SR of the left ventricle were measured on CMR at 1.5 Tesla and TTE and interobserver variability was assessed. Results: FT measurements were feasible in all subjects. A good agreement between global LV-LS measured on CMR (controls: 20.8 ± 3.0; HCM: 17.6 ± 3.8) and TTE (controls: 19.4 ± 2.1; HCM: 16.6 ± 2.9) was found, while the agreement was worse for circumferential strain and all SR measurements. For the left and right ventricles, interobserver reproducibility was higher for strain measurements compared to SR. Coefficients of variation were lowest for LV-LS (13.2%) by CMR. Conclusions: FT analysis is a novel CMR based method for the analysis of myocardial strain and SR that is simple and correlates well with the echocardiographic measurements. Since CMR is unaffected by inadequate acoustic windows, FT may represent an attractive alternative to echocardiography in assessing the increasingly important parameters of myocardial deformation.

Inflammatory activity of pericoronary adipose tissue may affect plaque composition in patients with acute coronary syndrome without persistent ST-segment elevation: preliminary results.

Abstract: Background: The extravascular expression of inflammatory mediators may adversely influence coronary lesion formation and plaque stability through outside-to-inside signalling. It has been shown that the maximal standardised uptake value (SUV) of 18-fluorodeoxyglucose detected by positron emission tomography (PET/CT) is proportional to macrophage density. Aim: To investigate whether the inflammatory activity of pericoronary adipose tissue (PVAT) may influence plaque composition in acute coronary syndrome without persistent ST-segment elevation (NSTE-ACS) patients. Methods: In a prospective study, 36 coronary arteries (LM, RCA, LCX, LAD) were investigated in non-diabetic patients with a low or intermediate risk of NSTE-ACS (GRACE ≤ 140). SUV was measured in fat surrounding coronary arteries on the sections corresponding to proximal and medial segments (Siemens biograph 64-PET/CT system). Additionally, SUV was measured in subcutaneous fat (SC), visceral thoracic fat (VS), and epicardial fat over the right ventricle (EPI). Virtual histology intravascular ultrasound (VH-IVUS) was performed to assess plaque composition (Volcano, USA). PET/CT sections were further examined in segments corresponding to coronary plaques. Results: PVAT SUV in NSTE-ACS patients was significantly greater than in other fat locations (LM SUV: 1.60; RCA SUV: 1.54; LCX SUV: 1.94; LAD SUV: 2.37 vs. SC SUV: 0.57; VS SUV: 0.77; EPI SUV: 0.98; p < 0.001; ANOVA). PVAT SUV positively correlated with plaque burden (r = 0.49, p < 0.05) and necrotic core plaque rate (r = 0.68, p < 0.05), and negatively correlated with fibrous plaque rate (r = –0.52, p < 0.05). Conclusions: The inflammatory activity of PVAT reflected by SUV is greater than in subcutaneous, visceral thoracic, or epicardial tissue in NSTE-ACS patients; PVAT SUV correlates with the plaque burden and necrotic core component of coronary plaque.

Obstructive sleep apnoea in patients with atrial fibrillation: prevalence, determinants and clinical characteristics of patients in Polish population

Abstract: Background: Obstructive sleep apnoea (OSA) and atrial fibrillation (AF) are two conditions highly prevalent in the general population. OSA is known to cause haemodynamic changes, oxidative stress, and endothelial damage, and therefore promote vascular and heart remodelling which results in AF triggering and exacerbation. Coexistence of OSA and AF influences the course of both diseases, and therefore should be taken into consideration in patient management strategy planning. Aim: To assess the prevalence of OSA in Polish AF patients, and to describe the clinical characteristics of patients with concomitant OSA and AF. Methods: We enrolled into the study 289 consecutive patients hospitalised in a tertiary, high-volume Cardiology Department with a primary diagnosis of AF. In addition to standard examination, all patients underwent an overnight sleep study to diagnose OSA, which was defined as apnoea–hypopnoea index (AHI) ≥ 5 per hour. Results: After applying exclusion criteria, the final analysis covered 266 patients (65.0% male, mean age 57.6 ± 10.1 years). OSA was present in 121 (45.49%) patients. Patients with OSA were older (59.6 ± 8.0 vs. 56.0 ± 11.4 years; p = 0.02), had higher body mass index (BMI; 30.9 ± 5.4 vs. 28.7 ± 4.4 kg/m 2 ; p 0.05). OSA patients were less likely than non-OSA patients to have paroxysmal AF (62.0% vs. 75.9%; p = 0.02). Dividing newly diagnosed OSA patients according to the disease severity showed that mild OSA (AHI ≥ 5/h and 30/h) in 4.51% of patients. No significant differences in terms of comorbidities and anthropometric features were seen between mild and moderate, between moderate and severe, and between mild and severe OSA. Conclusions: OSA is highly prevalent in patients with AF in the Polish population, and affects approximately half of the patients. OSA patients are more likely to be older, have higher BMI, and greater waist and neck circumference. Persistent AF is the most common form of the arrhythmia in patients with OSA, while patients without OSA are more likely to have paroxysmal AF.

Short- and intermediate-term improvement of patient quality of life after transcatheter aortic valve implantation: a single-centre study.

Abstract: Background: Transcatheter aortic valve implantation (TAVI) is a treatment option for elderly high-risk patients with symptomatic severe aortic stenosis. Improvement of quality of life (QoL) is a relevant issue in this group of patients. Aim: To assess changes in QoL after TAVI. Methods: Forty patients who underwent TAVI in our institution were included in this QoL study. All subjects were screened for TAVI in a standard fashion, including QoL assessment with the EQoL (EQ-5D-3L). The pre- and postprocedural scores obtained up to a 12-month follow-up were assessed. Results: Median of logistic EuroScore I was 21.5% (13.5–26.75%), and Society of Thoracic Surgeons score was 5.5% (4.0–10.75%). Comparison of baseline values with follow-up data at one, six and 12 months after TAVI showed significant improvement of QoL (p < 0.001). Visual Analogue Scale score (VAS score) was assessed. There was an incremental increase in VAS score during follow-up (p < 0.001). Median of six-minute walk test distance at baseline was 200 m (IQR 150–300) and 325 m (IQR 250–400) 12 months after TAVI (p < 0.001). Conclusions: TAVI provides improved QoL and effectively relieves symptoms.

Neuropsychological and neurological sequelae of out-of-hospital cardiac arrest and the estimated need for neurorehabilitation: a prospective pilot study.

Abstract: Background: Diffuse brain injury is a key component of post-cardiac arrest syndrome reported in 30–80% of survivors of out-of-hospital cardiac arrest (OHCA). It is responsible for a high mortality rate, and is a common cause of cognitive and neurological deficits and disability. Symptom variability and dynamics and the rehabilitation potential remain poorly understood. Aim: To investigate symptom prevalence, type, and severity and the natural course of recovery within 12 months after OHCA, and to estimate neurorehabilitation needs. Methods: Study participants were selected from OHCA survivors admitted consecutively to a cardiac intensive care unit (CICU) serving 250,000 of Warsaw’s inhabitants, according to the following inclusion criteria: first ever nontraumatic, normothermic cardiac arrest, age ≤ 75 years; cardiology ward survival until discharge, and no history of pre-existing brain disease. Patients’ cognitive and neurological status and disability were evaluated in the first days after onset and three, six and 12 months later. Neuropsychological assessment focused on attention, memory, executive, linguistic and visuo-spatial abilities. Neurological examination included assessment of cranial nerves, muscle strength and tone, deep tendon reflexes, cerebellar function, sensory function, and gait. The general psychophysical state was classified using the Disability Rating Scale. Patients’ neurorehabilitation needs were determined using data collected three months post-OHCA. This data was used to estimate future demands for such resources in Poland. Results: During a 28-month study period, of 69 OHCA patients admitted to the CICU, 29 met the study criteria (33 survived until discharge from cardiology unit; four did not meet further criteria). Severe consciousness disorders were most frequentin the early post-OHCA phase (28%); no unresponsive patients were identified 12 months later. Of responsive patients who were capable of at least minimal co-operation, 100% (early after OHCA) to 57% (12 months after OHCA) had cognitive impairment, usually with neurological symptoms. Memory impairment was the most common and severe problem, followed by executive, attentional, language and visuo-spatial dysfunctions. The prevalence of neurological deficits ranged from 88% (early after OHCA) to 43% (12 months after OHCA). Due to acquired deficits, between 71% (early post-OHCA) and 36% (12 months post-OHCA) of patients were significantly disabled and often dependent. Although dysfunctions tended to improve, over 50% of the patients remained impaired 12 months post-OHCA, and over 30% were significantly disabled. We estimated that about 800 OHCA survivors/year in Poland will develop symptoms requiring neurorehabilitation. Conclusions: Cognitive and neurological symptoms are common after cardiac arrest brain injury. Establishing specialised neurorehabilitation centres is essential for treating these patients.

Ten-year experience of an invasive cardiology centre with out-of-hospital cardiac arrest patients admitted for urgent coronary angiography.

Abstract: Wstep i cel: Celem pracy byla ocena wynikow leczenia interwencyjnego pacjentow po naglym zatrzymaniu krązenia (NZK) pozaszpitalnym o prawdopodobnie wiencowej etiologii, przyjmowanych do pilnej diagnostyki inwazyjnej naczyn wiencowych. Metody: Retrospektywną (2000–2010) i prospektywną (2010–2011) analizą objeto dane medyczne chorych po NZK pozaszpitalnym przyjmowanych do centrum kardiologii interwencyjnej. Chorzy stanowiący populacje badaną nie byli (z wyjątkiem kilku pacjentow pod koniec okresu obserwacji) poddawani lagodnej hipotermii terapeutycznej, ktora zostala wprowadzona w centrum kardiologii inwazyjnej dopiero od 1.09.2011 r. Analizie poddano okoliczności NZK i przebieg resuscytacji, dane demograficzne oraz przeszlośc chorobową pacjentow, zapis EKG po przywroceniu tetna (ROSC), wyniki koronarografii oraz angioplastyki, wyniki badania echokardiograficznego i EKG po interwencji wiencowej, przebieg i komplikacje wystepujące w trakcie hospitalizacji oraz przezycie i stan neurologiczny w momencie wypisu ze szpitala, a takze w obserwacji odleglej. Wyniki: W analizowanym okresie przyjeto 405 chorych po NZK, 340 w grupie retrospektywnej i 65 w grupie prospektywnej. Średni wiek pacjentow wyniosl 61 lat. 81% stanowili mezczyźni, u 78% stwierdzono migotanie komor lub czestoskurcz komorowy jako mechanizm NZK, 70% chorych bylo nieprzytomnych, a u 11% zaobserwowano wstrząs kardiogenny w chwili przyjecia. Średni czas od NZK do ROSC wyniosl 26,7 min. W koronarografii u 48% osob wstepowala świeza okluzja tetnicy wiencowej, a u 26% pacjentow stwierdzano zwezenia krytyczne. Ostatecznie ostry zespol wiencowy (OZW) jako przyczyne NZK rozpoznano u 82% chorych (STEMI 75%, NSTEMI 25%), drugą najczestszą przyczyną byla kardiomiopatia niedokrwienna. Angioplastyke wiencową wykonano u 90% chorych z OZW, a pomostownie aortalno-wiencowe u 4% osob. Angioplastyka zakonczyla sie sukcesem u 70% pacjentow. Przezycie do wypisu ze szpitala w calej grupie wynioslo 63%, a przezycie w korzystnym stanie neurologicznym odnotowano u 49% pacjentow. W grupie chorych wyjściowo nieprzytomnych przezycie i dobry stan neurologiczny zaobserwowano odpowiednio u 52% i 33% osob. W trakcie obserwacji odleglej (do 12 lat po NZK) 49% pacjentow przezylo, a 42% bylo w dobrym stanie neurologicznym (87% chorych, ktorzy przezyli). Niezaleznymi czynnikami decydującymi o przezyciu w dobrym stanie neurologicznym byly: zachowany stan przytomności w chwili przyjecia, mechanizm defibrylacyjny NZK, zatrzymanie krązenia w obecności personelu medycznego, brak wstrząsu kardiogennego i zachowana funkcja nerek. Skuteczna angioplastyka wiencowa wiązala sie z poprawą przezycia do wypisu ze szpitala, jezeli nie uwzgledniano stanu neurologicznego chorych. Wnioski: Najwazniejszą przyczyną pozaszpitalnego NZK jest choroba wiencowa, a zwlaszcza ostre zespoly wiencowe. Koronarografia i angioplastyka wiencowa są waznymi elementami wlaściwej opieki poresuscytacyjnej, poniewaz mogą poprawiac przezywalnośc chorych po NZK, choc ich wplyw na osiągany stan neurologiczny pozostaje niejasny.

Access for percutaneous coronary intervention in ST segment elevation myocardial infarction: radial vs. femoral--a prospective, randomised clinical trial (OCEAN RACE)

Abstract: Background: Percutaneous treatment of patients with ST segment elevation myocardial infarction (STEMI) has become the standard and default mode of management as recommended by the European Society of Cardiology guidelines for managing acute myocardial infarction in patients presenting with STEMI. The choice of vascular access is made by the operator and has a potential impact on the safety and efficacy of the procedure and outcomes. Aim: To understand the influence of a radial approach on bleeding complications and angiographic success, we performed a prospective, controlled randomised trial. Methods: Patients were allocated to radial (TR) or femoral (TF) vascular access. The primary endpoints were major bleeding by the REPLACE-2 scale and minor bleeding by the EASY scale (TR arm) or the FEMORAL scale (TF arm). Other outcomes included procedural data, in-hospital and long-term survival. Results: There were 103 patients analysed in total, 52 in the TR arm and 51 in the TF arm. The demographic and clinical baseline characteristics were well matched between the two study groups. The frequency of the primary endpoint was the same in both arms (TR: 25.0% vs. TF: 33.3%, p = 0.238). In per protocol analysis, there was a significant benefit of the TR approach among independent operators (17.4% vs. 36.8%, p = 0.038). Major bleeding by the REPLACE-2 scale occurred in 4.2% of patients (TR: 5.8% vs. TF: 3.9%, p = 0.509). There were no differences in terms of the rate of major cardiac adverse events, which happened in 10.7% of the study population (TR: 9.6% vs. TF: 11.8%, p = 0.48). In the TF arm, there was a trend towards a higher risk of local bleedings (TR: 22.4% vs. TF: 37.7%, p = 0.081) and a significantly higher frequency of local haematoma (class III, EASY/FEMORAL) (TR: 0% vs. TF: 9.8%, p = 0.027). Conclusions: There were no significant differences between the TR and TF approaches in terms of clinical efficacy and patient safety. However, patients treated by independent operators might benefit from TR access. The overall complication risk of percutaneous coronary intervention treatment of STEMI patients remains low.

Usefulness of HATCH score as a predictor of atrial fibrillation after coronary artery bypass graft.

Abstract: Background: Atrial fibrillation (AF) after coronary artery bypass graft (CABG) surgery is associated with increased morbidity and mortality. The HATCH score was originally devised to predict the progression of paroxysmal AF to persistent AF. Aim: To determine whether the HATCH score predicts the development of AF after CABG surgery. Methods: The medical records of 284 consecutive patients, who underwent CABG surgery between January 2013 and December 2014, were retrospectively reviewed for the development of AF in the postoperative (POAF) period. The HATCH score, and clinical and echocardiographic parameters were evaluated for all patients. Results: Seventy (25%) patients developed POAF. The HATCH scores were higher in the POAF group (2.8 ± 1.8 vs. 1.1 ± 1.2, p < 0.001). The area of the HATCH score under the curve in the receiver operating characteristics analysis was 773 (95% CI 706–841, p < 0.001). When the HATCH score was 2 or more as a threshold, there was for POAF 72% sensitivity and 75% specificity. Conclusions: The results of the present study suggest that the HATCH score can be used to predict the development of POAF.

Endurance sport and cardiac injury

Abstract: Since years there are constantly appearing reports about a potential myocardial injury induced by intensive sporting activities. The spectacular sudden deaths during marathon, football and, just recently, in the trend discipline triathlon seem to support that view. In addition, reports about the “athlete`s heart” and complications in the elderly causes uncertainty among those, hoping that sporting activity will lead to weight reduction or will improve diabetes or general fitness. Endurance athletes – professionals as well as hobby-athletes – and many sports physicians feel also insecure. Here the mental attitude can make the difference between victory and defeat. The complex issue makes it difficult to give direct answers and recommendations. Some reports capture for themselves having found the answers for “negative cardiac remodeling” caused by sporting activities, partially with spectacular results concerning a right ventricular overload or a left ventricular dysfunction directly after physical activity. This report tries to reflect in a critical way to what extent the statements of these studies are objectively justified, how far sporting activities could be dangerous and what kind of cardiac damage might be expected.

The effect of emotional status and health-related quality of life on the severity of coronary artery disease.

Abstract: Background: Coronary artery disease (CAD) is the most common form of heart disease and a leading cause of death worldwide. Extensive clinical and statistical studies have identified several factors that increase the risk of CAD and myocardial infarction. Aim: To investigate the relationship between severity of CAD, anxiety, depression, and health-related quality of life (HRQoL). Methods: A total of 225 patients (116 men, 109 women) who underwent elective coronary angiography were included. All patients were assessed for the presence of cardiovascular risk factors and ongoing medications. A biochemical examination of blood was performed in all patients before the procedure. The 225 patients were divided into three groups (a control group, and minimal and significant CAD groups) based on their Gensini score, which evaluates the severity of CAD. The Nottingham Health Profile (NHP) was used to measure HRQoL. Anxiety and depression were assessed by the Hospital Anxiety and Depression Scale (HADS). Results: A significant positive correlation was found between HADS and Gensini scores (HADS-anxiety: r = 0.139, p = 0.038; HADS-depression: r = 0.156, p = 0.019). A significant positive correlation was also determined between NHP-total and Gensini scores (r = 0.145, p = 0.029). According to the NHP, energy (p = 0.048) and physical mobility status (p = 0.021) were better in the control group than they were in the CAD groups. Conclusions: Our study demonstrates that anxiety, depression, and HRQoL are related to CAD severity. Therefore, emotional status and HRQoL should be evaluated during routine clinical treatment of CAD.

Use of bioresorbable vascular scaffolds in patients with stable angina and acute coronary syndromes. Polish National Registry.

Abstract: Background: Current revascularisation guidelines recommend coronary stenting with either a bare metal stent or a drug eluting stent. The results of bioresorbable vascular scaffold (BVS) implantation in the setting of both stable angina and acute coronary syndrome (ACS) have proven to be both safe and efficacious. Aim: To describe current use and real life experience among Polish percutaneous coronary intervention (PCI) operators in using BVS since they were made commercially available on our market. Methods: We performed a one-arm retrospective observational registry study which enrolled patients in 30 invasive cardiology centres in Poland who had their PCI procedure performed between October 2012 and November 2013. All patients who received at least one BVS stent during index PCI were included in the registry. There were no additional inclusion or exclusion criteria. Results: There were 591 patients enrolled in the registry in 30 centres in Poland. Of these, 48% were with stable angina (CCS I–III) and 52% with ACS (23% unstable angina, 18% NSTEMI and 11% STEMI). Radial access for PCI was used in 70% of cases. Left anterior descending was the target lesion in 48% of patients and predilatation used in 90%. PCI complications occurred very rarely with dissection in 2.9% of patients, slow-flow in 0.5%, no-reflow in 0.17%, and side branch occlusion in 0.33%. Technical success, defined as successful BVS delivery to the lesion, was achieved in all cases (100%). There were no periprocedural deaths. Conclusions: The early in-hospital results of this large scale national registry of ‘real world’ utilisation of BVS in Poland present excellent device performance in a properly selected group of patients with appropriate lesion preparation.

Raised red cell distribution width as a prognostic marker in aortic valve replacement surgery

Abstract: Background and aim: Several studies have reported that elevated red cell distribution width (RDW) is associated with poor outcomes in patients with coronary artery disease, chronic heart failure and aortic stenosis following transcatheter aortic valve replacement. Their prognostic utility in patients undergoing aortic valve replacement (AVR) surgery is unknown. Methods: We prospectively evaluated the prognostic value of RDW in a group of 191 consecutive patients with severe symptomatic aortic stenosis undergoing AVR. The pre-defined primary endpoint at the 30-day follow-up was composed of: all cause mortality, perioperative myocardial infarction, perioperative renal failure, prolonged mechanical ventilation, stroke, heart failure, successfully resuscitated cardiac arrest, the occurrence of multiple-organ failure, and the need for additional surgery for any reason. The secondary endpoint was total mortality. Results: The composite endpoint occurred in 54 patients. In univariate analysis RDW (p < 0.0001), haemoglobin level (p = 0.005), haematocrit (p = 0.01), red blood cell count (RBC; p = 0.002), glomerular filtration rate (p = 0.003), New York Heart Association classification (p = 0.02), atrial fibrillation (p = 0.0044), and pulmonary blood pressure (p = 0.004) were associated with the occurrence of the composite endpoint. RDW (p = 0.0005), haemoglobin level (p = 0.004), haematocrit (p = 0.004), RBC (p = 0.0009) and mean corpuscular volume (p = 0.01) were associated with an increased risk of death. In multivariate analysis, RDW (OR 3.274; 95% CI 1.285–8.344; p = 0.0003) and RBC (OR 0.373; 95% CI 0.176–0.787; p = 0.0097) remained independent predictors of the composite endpoint. Receiver operating characteristic analysis determined a cut-off value of RDW for the prediction of the occurrence of the combined endpoint at 14.1%. Conclusions: Elevated RDW is associated with a worse outcome following AVR, independent of RBC.

The impact of individualised nutritional therapy according to DASH diet on blood pressure, body mass, and selected biochemical parameters in overweight/obese patients with primary arterial hypertension: a prospective randomised study.

Abstract: Background and aim: The aim of the study was to assess the impact of individualised nutritional intervention based on the DASH diet (Dietary Approaches to Stop Hypertension) on the nutritional status, blood pressure, and selected biochemical parameters of obese/overweight patients with primary arterial hypertension. Methods: A total of 131 participants were randomised to the DASH intervention group (DIG; n = 69, 33 males) or the control group (CG; n = 62, 32 males). A three-month nutritional intervention was carried out in the DIG group, while the control group received only standard recommendations. Body weight, height, waist and hip circumference, body composition, blood pressure, serum glucose, and insulin and leptin concentrations were measured at the baseline and after the intervention. Results: Sixty-four (92.8%) participants in the intervention and 62 (100%) in the control group completed the study. In the DIG group a significant decrease in body mass, systolic and diastolic blood pressure, body fat content, fasting glucose, insulin, and leptin concentrations were observed in comparison to the control group (p < 0.05). Conclusions: The DASH dietary intervention provides significant benefits to overweight/obese patients with primary hyper¬tension.

Type D personality and quality of life in subjects after myocardial infarction.

Abstract: Wstep: Osobowośc typu D, zwana osobowością stresową ( distressed personality ) — określana jako polączenie negatywnej emocjonalności i hamowania spolecznego — oraz obnizona jakośc zycia są predyktorami zapadalności na choroby ukladu sercowo-naczyniowego i śmiertelności z ich powodu, jednak niewiele wiadomo na temat roli typu D jako predyktora jakości zycia pacjentow kardiologicznych. Cel: Podjete badania mialy na celu ustalenie związku miedzy osobowością typu D a jakością zycia u pacjentow po zawale serca. Metody: Analizie poddano wyniki 86 osob, ktore przezyly zawal serca, w wieku 36–87 lat (60,5 ± 10,05). Wiekszośc badanych (72,1%) stanowili mezczyźni. W badaniach wykorzystano dwa narzedzia: skale DS-14 Denolleta do oceny typu osobowości oraz Kwestionariusz Zadowolenia z Życia Fahrenberga i wsp. Wyniki: Typem D charakteryzowalo sie 46,5% badanych. Takie jednostki, w porownaniu z osobami typu nie-D, ujawniają nizszą jakośc zycia. Spośrod dwoch wymiarow typu D predykcyjną role dla obnizonej jakości zycia okazalo sie pelnic hamowanie spoleczne. Wnioski: W procesie rehabilitacji pacjentow kardiologicznych powinno sie uwzgledniac oddzialywanie mające na celu zmniejszanie nasilenia cech osobowości stresowej, zwlaszcza hamowania spolecznego.

The effects of cardiac rehabilitation on overall physical capacity and myocardial perfusion in women with microvascular angina

Abstract: Background: Cardiac syndrome X (CSX) is linked with changes in microcirculation, without significant changes in main coronary vessels. According to European Society of Cardiology 2013 stable coronary artery disease (CAD) criteria, CSX was replaced by microvascular angina (MA). The main feature of MA should be regional myocardial ischaemia; however, there are several works on this subject which failed to demonstrate the presence of perfusion defects. Aim: To determine the effect of non-pharmacological procedures (cardiac rehabilitation) in patients diagnosed with MA on changes in left ventricular perfusion as assessed by myocardial single photon emission computed tomography, along with potential related improvements in exercise capacity. Methods: Toward this goal we screened for the presence of CAD in a group of 528 women, of whom 55 were not only diagnosed with MA but also agreed to participate in our study, which involved myocardial perfusion imaging (MPI) studies, during which exercise tests and cardiac rehabilitation were performed. Results: Comparison of results obtained at the beginning of the study with data obtained after completion of a three month period of cardiac rehabilitation showed improvements in both exercise test parameters (length of test, metabolic equivalents, blood pressure control during extortion) and MPI parameters for the left ventricle (both at rest and stress, global and regional). Conclusions: Cardiac rehabilitation is a very useful tool of choice in the treatment of patients with MA.

Factors influencing high-quality chest compressions during cardiopulmonary resuscitation scenario, according to 2015 American Heart Association Guidelines.

Abstract: Background and aim: Recent American Heart Association guidelines from 2010 and 2015 stressed the importance of high-quality chest compression and defined standards for compression rate, depth, recoil, and maximal acceptable time for interruptions. High-quality cardiopulmonary resuscitation (CPR) is the “cornerstone” of a system of care that can optimise outcomes beyond the return of spontaneous circulation. Methods: One hundred medical students were enrolled to the study. Study participants, after attending a Basic Life Support Course according to American Heart Association 2015 guidelines, performed 2-min CPR on a Resusci Anne ® QCPR Mani­kin. The following data were collected: age, sex, and health status. The study made use of a Tanita MC-980 MA for body composition analysis. Results: Mean height of participants was 170.2 ± 8.3 cm, and mean weight was 65 ± 11.8 kg. Mean body mass index was 22.1 ± 2.7, and mean fat-free mass (FFM) was 50.1 ± 10.5 kg. The mean fat mass (FAT%) was 22.9 ± 7.6. Basal metabolic rate, FFM, trunk muscle mass, left arm muscle mass, and right arm muscle mass were positively correlated with compression depth (all p for trend < 0.05). Mean compression depth was 49.7 ± 8.4 (for female 48.7 ± 7.9 mm, for male 42.4 ± 9.5 mm; p = 0.144). Compression rate for males and females was the same, at 114 ×/min (p = 0.769). Conclusions: In our study, basal metabolic rate, FFM, trunk muscle mass, and left and right arm muscle mass were positively correlated with compression depth. Moreover, an arm muscle mass rise of 1 kg caused a rise of compression depth param­eter of 7.3 mm, while when chest compression was performed by females, a fall of compression depth of 3.3 mm was seen.

Primary safety and effectiveness feasibility study after surgical aortic valve replacement with a new generation bioprosthesis: one-year outcomes

Abstract: Background: Structural valve deterioration (SVD) is a major obstacle to lifetime durability for bioprosthetic heart valves. A bio­prosthetic valve created with RESILIA™ tissue was designed to produce long-term resistance to SVD. Aim: The objective of this study was to evaluate the safety and performance of this new class of RESILIA™ tissue aortic bio­prosthesis. Methods: A nonrandomised, prospective, multi-centre, single-arm, observational study was performed in 133 patients who underwent surgical aortic valve replacement between July 2011 and February 2013. Patients were assessed at 3–6 months and one year for haemodynamic performance, clinical outcomes, and functional improvement. Results: The mean age was 65.3 ± 13.5 years, with 34 (25.6%) of patients 30 day) all-cause mortality rates were 2.3% (n = 3) and 4.5% (n = 6), respectively. Early events included thromboembolism in three (2.3%) patients and major bleeding events requiring transfusion in six (4.5%) patients. Late events included one endocarditis leading to explant. Mean gradients were reduced across all valve sizes and were maintained at one year of follow-up. The mean effective orifice area and effective orifice area index increased across all valve sizes postoperatively and were maintained at one year. The rates of paravalvular leak (> 2+) at 3–6 months and one-year follow-up were 0.7% and 0.7%, respectively. Conclusions: The new generation RESILIA™ tissue aortic valve bioprosthesis demonstrated excellent haemodynamic per­formance and safety outcomes at one year of follow-up. Longer follow-up of these patients will provide further insight on long-term durability.

Predictors of post-operative atrial fibrillation in patients undergoing isolated coronary artery bypass grafting.

Abstract: Background: Post-operative atrial fibrillation (POAF) is the most common cardiac arrhythmia occurring after coronary artery bypass grafting (CABG). Arrhythmia leads to prolonged hospitalisation and may have an impact on both short-term and long-term prognoses. Aim: The aim of this paper was to evaluate the incidence of POAF in patients after CABG as well as to identify its predictors. Methods: The study was performed on 791 patients (selected from a group of 1031 patients who underwent CABG in the Clinical Department of Cardiology in the years 2009–2011) who did not suffer from atrial fibrillation (AF) prior to isolated CABG. Data on co-existing diseases, as well as data collected at the time of surgery and in the post-operative period, were evaluated. Results: The average age of patients in the examined group was 64.6 ± 9.1 years. Emergency CABG was performed on 38% of patients, whereas 75.1% of patients underwent CABG with the use of extracorporeal circulation. Based on the incidence of POAF, the post-CABG patients were classified into a POAF(+) group that comprised 166 (21%) patients, and a POAF(–) group involving 625 (79%) patients. The first occurrence of arrhythmia during the first three days after surgery was observed in 76.5% of patients. The average age of POAF(+) and POAF(–) patients was 68.7 ± 8.8 years and 63.5 ± 8.9 years, respectively (p < 0.0001). The respective incidence rates of co-existing diseases in patients with POAF and those without POAF were as follows: arterial hypertension, 80.1% vs. 75.8% (p = 0.29); heart failure, 18.7% vs. 21.1% (p = 0.56); type 2 diabetes, 24.1% vs. 26.2% (p = 0.64). Stable angina pectoris was diagnosed in 22.3% of patients with POAF and 15% of patients without POAF (p = 0.034). The following conditions were more frequently observed in patients with POAF compared with those without POAF: low cardiac output syndrome, 28.9% vs. 14.2% (p < 0.0001) and cardiac tamponade, 9% vs. 4.6% (p = 0.044), respectively. Red blood cell transfusions were performed more often in patients with POAF compared to those without POAF (70.5% vs. 55.7%, respectively, p = 0.0008). Multivariate analysis revealed the following potential predictors of POAF: age ≥ 70 years (HR 2.3), preoperative stable angina pectoris (HR 1.7), and post-CABG low cardiac output syndrome (HR 1.8). Conclusions: POAF was diagnosed in 21% of post-CABG patients, and the major predictors were: age ≥ 70 years, preoperative stable angina, as well as low cardiac output syndrome following CABG.

Secondary prevention in patients after hospitalisation due to coronary artery disease: what has changed since 2006?

Abstract: Background: The evidence concerning the quality of secondary prevention of coronary artery disease (CAD) in Poland inrecent years is scarce. Aim: To compare the implementation of secondary prevention guidelines into everyday clinical practice between 2006–2007 and 2011–2012 in patients after hospitalisation due to CAD. Methods: Five hospitals with departments of cardiology serving a city and its surrounding districts in the southern part of Poland participated in the study. Consecutive patients aged ≤ 80 years, hospitalised from April 1, 2005 to July 31, 2006 (first survey) and from April 1, 2010 to June 30, 2011 (second survey) due to acute coronary syndrome or for a myocardial revascularisation procedure were recruited and interviewed 6–18 months after hospitalisation. Results: Medical records of 640 patients were reviewed and included in the first survey and 466 in the second survey. The proportion of medical records with available information on smoking did not differ between the surveys, whereas the proportion of medical records with available information on blood pressure and total cholesterol was lower in patients hospitalised in 2010–2011. The prescription rate of β-blockers at discharge decreased from 90% to 84% (p 0.05). Conclusions: We noted a modest improvement in the implementation of CAD secondary prevention guidelines in everyday clinical practice: blood pressure was better controlled, although the control of all other main risk factors did not change significantly. Our data provides evidence that there is a considerable potential for further reduction of cardiovascular risk in CAD patients.

The impact of the use of a CPRMeter monitor on quality of chest compressions: a prospective randomised trial, cross-simulation.

Abstract: Background: Drowning is a common issue at many pools and beaches, and in seas all over the world. Lifeguards often act as bystanders, and therefore adequate training in high-quality cardiopulmonary resuscitation (CPR) and use of adequate equip­ment by lifeguards is essential. Aim: The aim of this study was to evaluate the impact of the recently introduced CPRMeter (Laerdal, Stavanger, Norway) on quality of CPR, if used by moderately experienced CPR providers. In particular, we tested the hypothesis that using the CPRMeter improves quality of chest compression by lifeguards compared to standard non-feedback CPR. Methods: The study was designed as prospective, randomised, cross-over manikin trial. Fifty lifeguards of the Volunteer Water Rescue Service (WOPR), a Polish nationwide association specialised in water rescue, participated in this study. Participants were randomly assigned 1:1 to one of two groups: a feedback group and a non-feedback group. Participants swim a distance of 25 m in the pool, and then they were asked to haul a manikin for the second 25 m, simulating rescuing a drowning victim. Once participants finished the second 25-m distance, participants were asked to initiate 2-min basic life support according to the randomisation. Results: The median quality of CPR score for the 2-min CPR session without feedback was 69 (33–77) compared to 84 (55–93) in the feedback group (p < 0.001). Compression score, mean depth, rate of adequate chest compressions/min, and overall mean rate during the CPR session improved significantly in the feedback group, compared to the non-feedback group. Conclusions: Using the visual real-time feedback device significantly improved quality of CPR in our relatively unexperienced CPR providers. Better quality of bystander CPR is essential for clinical outcomes, and therefore feedback devices should be considered. Further clinical studies are needed to assess the effect of real-time visual devices, especially in bystander-CPR.

The presence of fragmented QRS on 12-lead ECG in patients with coronary slow flow.

Abstract: Background: Coronary slow flow (CSF) is characterised by delayed opacification of coronary arteries in the absence of epicardial occlusive disease. It has been reported that CSF may cause angina, myocardial ischaemia, and infarction. Fragmentation of QRS complex (fQRS) is an easily evaluated non-invasive electrocardiographic parameter. It has been associated with alternation of myocardial activation due to myocardial scar and/or ischaemia. Whether CSF is associated with fQRS is unknown. The presence of fQRS on ECG may be an indicator of myocardial damage in patients with CSF. Aim: To investigate the presence of fQRS in patients with CSF. Methods: Sixty patients (mean age 55.5 ± 10.5 years) with CSF and 44 patients with normal coronary arteries without associated CSF (mean age 53 ± 8.4 years) were included in this study. The fQRS was defined as the presence of an additional R wave or notching of R or S wave or the presence of fragmentation in two contiguous leads corresponding to a major coronary artery territory. Results: The presence of fQRS was higher in the CSF group than in the controls (p = 0.005). Hypertension was significantly more common in the CSF group (p < 0.001). There was no significant association between the presence of fQRS and an increasing number of vessel involvements. Logistic regression analysis demonstrated that the presence of CSF was the independent determinant of fQRS (OR = 10.848; 95% CI 2.385–49.347; p = 0.002). Conclusions: Fragmented QRS, indicating increased risk for arrhythmias and cardiovascular mortality, was found to be significantly higher in patients with CSF. We have not found an association between the presence of fragmented QRS and the degreeof CSF. Further prospective studies are needed to establish the significance as a possible new risk factor in patients with CSF.

The effect of rosuvastatin and atorvastatin on erectile dysfunction in hypercholesterolaemic patients.

Abstract: Background and aim: The aim of this study was to evaluate the effect of atorvastatin and rosuvastatin on erectile dysfunction in hypercholesterolaemic patients. Methods: Ninety consecutive male hypercholesterolaemic patients (mean age 50.4 ± 7.9 years) who were otherwise healthy were included into the study prospectively. None of the patients had any cardiovascular risk factors except hypercholesterolaemia.The patients were divided into two groups. One group received atorvastatin while the other group was given rosuvastatin. All patients were followed for six months and International Index of Erectile Function-5 (IIEF-5) score and blood samples were re-evaluated. Results: Patients were in similar ages in both groups. There were also no statistical differences in terms of blood glucose levels, total cholesterol, low density lipoprotein, high density lipoprotein, triglyceride and mean IIEF score in both groups at the beginning. After six months, no IIEF score changes were observed in the rosuvastatin group after the medication. However, the IIEF score was significantly lower in the atorvastatin group (p = 0.019). Conclusions: Rosuvastatin showed no effect on erectile dysfunction, while we observed increased erectile dysfunction with atorvastatin. Our study reveals that different statin types may have different effects on erectile dysfunction.