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Background: Treatment of acute myocardial infarction has been the subject of studies over the past years. However, the initial months after myocardial infarction are crucial from the perspective of the patient's prognosis. It is extremely important to take care of all cardiovascular risk factors and undergo a full rehabilitation program. Telemedical solutions are becoming more and more relevant in everyday practice. We describe a protocol of a study evaluating the use of the mobile application "afterAMI" in patients after myocardial infarction. The app offers an educational mode, calendar, vital signs diary, medication reminders, medical history card, and healthcare professional contact panel. It offers several solutions, which individually proved to be effective and improve a patient's prognosis. Despite general promising results from previous studies regarding telemedical tools, there is a paucity of evidence when it comes to prospective randomized trials. Our aim was to perform a comprehensive evaluation of a newly developed mobile application in the clinical setting.Methods: A group of 100 patients with myocardial infarction on admission at the 1st Chair and Department of Cardiology, Medical University of Warsaw, will be recruited into the study. The project aims to assess the impact of the application-supported model of care in comparison with standard rehabilitation. At the end of the study, cardiovascular risk factors will be analyzed, along with rehospitalizations, the patients' knowledge regarding cardiovascular risk factors, returning to work, and quality of life. In this prospective, open-label, randomized, single-center study, all 100 patients will be observed for 6 months after discharge from the hospital. Endpoints will be assessed during control visits 1 and 6 months after inclusion into the study.Discussion: This project is an example of a telemedical solution application embracing everyday clinical practices, conforming with multiple international cardiac societies' guidelines. Cardiac rehabilitation process enhancements are required to improve patients' prognosis. The evidence regarding the use of the mobile application in the described group of patients is limited and usually covers a small number of participants. The described study aims to discuss whether telemedicine use in this context is beneficial for the patients.Trial Registration: ClinicalTrials.gov NCT04793425 . Registered on 11 March 2021. [ABSTRACT FROM AUTHOR]

Background: Increased resting heart rate (RHR) after pulmonary vein isolation (PVI) for treatment of atrial fibrillation (AF) is a common observation, possibly resulting from ganglionated plexus modification during ablation. Previous trials have suggested that an increase in RHR after ablation might be related to higher efficacy of the procedure. The aim of this study was to determine whether or not higher increase in RHR after radiofrequency (RF) PVI might predict better long-term outcome of the procedure in a real-life cohort of patients in whom index ablation for paroxysmal AF was performed. Material and methods: The health records of patients who underwent index point-by-point or drag lesion RF PVI for paroxysmal AF in our department between January 2014 and November 2018 were analyzed. Resting heart rate (RHR) was determined from 12-lead ECG recorded prior to the ablation and before discharge to evaluate changes in RHR after PVI. Only patients in sinus rhythm before the procedure and at discharge were included in the analysis. Telephone follow-up was collected for evaluation of arrhythmia recurrence status. Results: A total of 146 patients who underwent PVI for paroxysmal AF were included. Mean follow-up time was 3.5 years. RHR increased from 64 [58.5–70], prior to procedure, to 72 [64.25–80] bpm at discharge (p < 0.001). Higher increase in RHR was not protective from arrhythmia recurrence in long-term observation in both univariable HR = 1.001 (CI 0.99–1.017, p = 0.857) and multivariable analyses HR = 1.001 (CI 0.99–1.02, p = 0.84). Conclusions: RHR after PVI increased in comparison to baseline in our cohort. However, we did not observe higher increase in RHR to be associated with more favorable long-term effectiveness of the procedure. [ABSTRACT FROM AUTHOR]

The aim of the study was to investigate the association of adipokines (resistin, leptin and adiponectin) with obesity, insulin resistance (IR) and inflammation in type 2 diabetes mellitus (T2DM). A total of 284 patients with T2DM were included. Concentrations of resistin, leptin, adiponectin, and inflammatory markers [high sensitivity C-reactive protein (hsCRP), tumor necrosis factor α (TNF-α), and interleukin 6 (IL-6)] were measured and homeostatic model assessment for IR (HOMA-IR) index was calculated. Resistin correlated negatively with estimated glomerular filtration rate (eGFR) and positively with hsCRP, TNF-α, IL-6, and white blood cell count (WBC). Leptin correlated positively with HOMA-IR, whereas adiponectin correlated negatively. Leptin also correlated positively with body mass index (BMI), waist circumference, IL-6, WBC and negatively with eGFR. Adiponectin correlated negatively with waist circumference, WBC, and eGFR. Multivariate logistic regression indicated lower eGFR and higher WBC and IL-6 as independent predictive factors of resistin concentration above the upper quartile (CAQ3), whereas female sex and higher BMI and HOMA-IR of leptin CAQ3, and lower HOMA-IR and older age of adiponectin CAQ3. In conclusion, in contrast to leptin and adiponectin, in T2DM patients, resistin is not associated with BMI and IR, but with inflammation and worse kidney function. [ABSTRACT FROM AUTHOR]

Background: Since arrhythmia treatment in patients with autoimmune disease (AD) is challenging, we aimed to assess the common "real‐world" practice in the electrophysiology centers. Methods: Twenty‐four young electrophysiologists being part of European Heart Rhythm Association filled questionnaire regarding arrhythmia management in AD. Results: Rheumatoid arthritis was the most commonly reported AD accompanied by cardiac arrhythmias. The most frequent observed arrhythmias were atrial fibrillation and premature atrial/ventricular contractions. Most often electrocardiographic abnormalities observed were increased heart rate variability, QT interval prolongation, and P‐wave dispersion, whereas echocardiographic abnormalities included left atrial enlargement, pericardial infusion, and left ventricular dysfunction. The most useful tool for arrhythmia management was guidelines and evidence‐based medicine, while training courses and websites were at least useful. A close collaboration with other specialists in arrhythmia management was reported in 58.3% of respondents. Glucocorticoids and cytostatic were the most reported arrhythmia‐induced drugs, whereas amiodarone and beta‐blockers were most effective antiarrhythmic drugs. The main reason that discouraged respondents from cardiac implantable devices implantation and catheter ablation was high infection complications risk and recurrences during long‐term follow‐up, respectively. Conclusions: Scant data and guidelines enforce exchange of experience to improve the arrhythmia treatment in AD. [ABSTRACT FROM AUTHOR]

mHealth solutions optimize cardiovascular risk factor control in coronary artery disease. The aim of this study was to investigate the influence of mobile app AfterAMI on quality of life in patients after myocardial infarction. 100 participants were randomized (1:1 ratio) into groups: (1) with a rehabilitation program and access to afterAMI or (2) standard rehabilitation alone (control group, CG). 3 questionnaires (MacNew, DASS21 and EQ-5D-5L) were used at baseline, 1 month and 6 months after discharge. Median age was 61 years; 35% of patients were female. At 1 month follow up patients using AfterAMI had higher general quality of life scores both in MacNew [5.78 vs. 5.5 in CG, p = 0.037] and EQ-5D-5L [80 vs. 70 in CG, p = 0.007]. At 6 months, according to MacNew, the app group had significantly higher scores in emotional [6.09 vs. 5.45 in CG, p= 0.017] and physical [6.2 vs. 6 in CG, p = 0.027] aspects. The general MacNew quality of life score was also higher in the AfterAMI group [6.11 vs. 5.7 in CG, p = 0.015], but differences in EQ-5D-5L were not significant. There were no differences between groups in the DASS21 questionnaire. mHealth interventions may improve quality of care in secondary prevention, however further studies are warranted. [ABSTRACT FROM AUTHOR]

Cardiac rehabilitation after acute myocardial infarction is crucial and improves patients' prognosis. It aims to optimize cardiovascular risk factors' control. Providing additional support via mobile applications has been previously suggested. However, data from prospective, randomized trials evaluating digital solutions are scarce. In this study, we aimed to evaluate a mobile application—afterAMI—in the clinical setting and to investigate the impact of a digitally-supported model of care in comparison with standard rehabilitation. A total of 100 patients after myocardial infarction were enrolled. Patients were randomized into groups with either a rehabilitation program and access to afterAMI or standard rehabilitation alone. The primary endpoint was rehospitalizations and/or urgent outpatient visits after 6 months. Cardiovascular risk factors' control was also analyzed. Median age was 61 years; 65% of the participants were male. This study failed to limit the number of primary endpoint events (8% with app vs. 27% without app; p = 0.064). However, patients in the interventional group had lower NT-proBNP levels (p = 0.0231) and better knowledge regarding cardiovascular disease risk factors (p = 0.0009), despite no differences at baseline. This study showcases how a telemedical tool can be used in the clinical setting. [ABSTRACT FROM AUTHOR]

Background: Cirrhosis causes alterations in the cardiovascular and autonomic nervous systems and leads to cirrhotic cardiomyopathy (CCM). CCM is defined as cardiac dysfunction characterized by an impaired systolic responsiveness to stress or exercise, and/or impaired diastolic function, as well as electrophysiological abnormalities, including chronotropic incompetence (CI), in the absence of other known cardiac disease. CI is a common feature of autonomic neuropathy in cirrhosis. The aim of the study is to assess the role of cardiac exercise stress test in the diagnosis of CCM. Methods: The analysis included 160 end-stage liver disease (ESLD) patients who underwent a cardiac exercise stress test prior to the orthotopic liver transplantation. CI was defined as the inability to achieve the heart rate reserve (HRR). Pertaining to the therapy with beta-blockers: 80% of HRR was achieved in patients not taking beta-blockers and 62% in patients taking beta-blockers. Results: In the analyzed population, 68.8% of patients met the criteria for CI. CI was more frequent in the more severe ESLD (with a higher MELD score and in a higher Child-Pugh class). In comparison to the viral hepatitis and other etiologies of ESLD, patients with alcoholic cirrhosis had a significantly lower rest heart rate (HR), lower maximal HR, lower median achieved percentage of maximal predicted HR (MPHR), a smaller percentage of patients achieved ≥ 85% of MPHR and a lower heart rate reserve. No significant relationship between the survival of OLT recipients and presence of chronotropic incompetence regarding to class of Child-Pugh scale, MELD score and etiology of ESLD were found. Conclusions: The prevalence of CI is higher among liver transplant candidates than previously described. The altered chronotropic response may differ in regard to the severity of liver disease correlating with both the Child-Pugh and MELD scores, however CI does not seem to influence the long-term survival post OLT. Exercise stress test is a reliable, safe and useful tool for the diagnosis of CCM in liver transplant candidates and should be included in the standard cardiovascular assessment prior to OLT. [ABSTRACT FROM AUTHOR]

Background: There was increased risk of mental disturbances during the COVID-19 pandemic. Patients with chronic diseases, including pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH), were particularly vulnerable. Our previous study showed high levels of fear of COVID-19 (FCV-19S), anxiety (HADS-A), and depression (HADS-D) in the second year of the pandemic among PAH/CTEPH patients. The aim of the present study was to assess changes in the levels of FCV-19S, HADS-A, and HADS-D after removing restrictions related to the COVID-19 pandemic. Methods: In this prospective, single-center study, 141 patients (62% females, 64% PAH) with a median age of 60 (range 42–72) years were included. Patients completed appropriate surveys in the second year of the pandemic, and then, after the restrictions were lifted in Poland (after 28 March 2022). Results: FVC-19S decreased significantly from 18 (12–23) to 14 (9–21), p < 0.001. The levels of anxiety (HADS-A ≥ 8 points) and depression (HADS-D ≥ 8 points) were abnormal in 26% and 16% of patients, respectively; these did not change at follow-up (p = 0.34 for HADS-A and p = 0.39 for HADS-D). Conclusions: Among PAH/CTEPH patients, fear of COVID-19 decreased significantly after the COVID-19 pandemic restrictions were removed, but anxiety and depression remained high, indicating that the COVID-19 pandemic was not a major factor in causing these disorders. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to analyze electrophysiologists' radiation-protective devices for occupational exposure across European countries. Methods: Data reported herein were gathered from the international, multicenter prospective Go for Zero Fluoroscopy registry performed in years 2018–2019. The registry encompassed 25 European electrophysiological centers from 14 countries and up to 5 operators from each center. Results: The analysis included 95 operators (median age: 39 years, 85% of male, median training time: 5 years). The most frequently used X-ray protection tools (used by ≥80% of the group) were lead aprons, thyroid shields, screens below the table, glass in the laboratory, and least often (<7%) protective gloves and cabin. No statistically significant differences regarding the number of procedures performed monthly, electrophysiologists' experience and gender, and radiation exposure dose or radiation protection tools were observed, except lead thyroid shields and eyeglasses, which were more often used in case of fewer electrophysiological procedures performed (<20 procedures per month). Operators who were protected by >4 X-ray protection tools were exposed to lower radiation levels than those who were protected by ≤4 X-ray protection tools (median radiation exposure: 0.6 [0.2–1.1] vs. 0.2 [0.1–0.2] mSv per month, p < 0.0001; 1.1 [0.1–12.0] vs. 0.5 [0.1–1.1] mSv per year, p < 0.0001), respectively. Conclusions: Electrophysiologists' radiation-protective devices for occupational exposure are similar across European centers and in accordance with the applicable X-ray protection protocols, irrespective of the level of experience, number of monthly performed EP procedures, and gender. [ABSTRACT FROM AUTHOR]

Purpose Pulmonary vein isolation is a well established method of definite treatment of atrial fibrillation (AF). Periprocedural onset of AF usually terminates spontaneously within minutes, but not in all cases. Antazoline is an antihistaminic agent with antiarrhythmic properties. The aim of our retrospective study was to evaluate the efficacy of antazoline in termination of AF in patients undergoing pulmonary vein isolation. Materials and methods Consecutive 141 patients who received antazoline to terminate AF during pulmonary vein isolation were analyzed. The antazoline was administered at the rate of 30–50 mg/min (max. 500 mg) after the circumferential ablation in the ostia of pulmonary veins and before confirmation of isolation. Success was defined as restoration of sinus rhythm within 20 min after antazoline infusion. Results The efficacy of antazoline was 83.6% in paroxysmal and 31.1% in persistent AF patients. Clinical variables that were independently predictive of antazoline ineffectiveness were female (odds ratio [OR]: 4.35; 95% confidence interval [CI]: 1.26–14.3; p = 0.018) and AF at the beginning of procedure (OR 28.4; 95% CI 3.89–208.0; p = 0.001). Due to antazoline related side effects infusion was discontinued in 7 patients (5%). Conclusions Antazoline seems to be safe agent in termination of AF in patients undergoing pulmonary vein isolation. We also observed satisfying efficacy, which needs to be proved in a randomized clinical trial. [ABSTRACT FROM AUTHOR]

Purpose. To investigate the association of galectin-3 (Gal-3) and soluble ST2 (sST2) and their follow-up changes with the development of heart failure (HF) and echocardiographic parameters of HF (ejection fraction, atrial and ventricular size, left ventricular hypertrophy, e′, and E/e′) in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI). Methods. A prospective, observational study, BIOSTRAT (Biomarkers for Risk Stratification After STEMI), enrolled 117 patients between October 2014 and April 2017. Gal-3 and sST2 serum collection and echocardiography were performed twice (during index hospitalization and on a control visit at one-year follow-up). The primary endpoint was HF onset at one-year follow-up. Secondary assessments included associations of biomarker concentration with echocardiographic indices of systolic and diastolic dysfunction at baseline and at one year. Results. Mean baseline concentrations of Gal-3 and sST2 (7.5 and 26.4 ng/mL, respectively) were significantly increased at one-year follow-up (8.5 ng/mL and p<0.001 and 31.4 ng/mL and p=0.001, respectively). Patients who reached the primary endpoint (50 patients (48%)) had significantly higher baseline concentrations of both biomarkers and a higher Gal-3 level at one year compared to patients who did not. Both Gal-3 and sST2 were predictors of the primary endpoint in univariate logistic regression analysis, but only Gal-3 remained significant in multivariate analysis. There was no clear association between both biomarkers and echocardiographic parameters. Conclusions. Baseline, but not one-year, changes of Gal-3 and sST2 concentrations may be useful for risk stratification after STEMI. However, only Gal-3 was the independent predictor of HF development at one-year observation. This trial is registered with NCT03735719. [ABSTRACT FROM AUTHOR]

Introduction: Our aim was to compare in a prospective randomized study the safety, direct results and periprocedural data of ablation using an nMARQ catheter, a PVAC catheter used with the EnSite system, or a PVAC catheter only under fluoroscopy control.Material and Methods: One hundred two patients (70 male, 57 ±11 years) with atrial fibrillation (AF) were prospectively randomized to: group 1 - ablation performed with an nMARQ catheter and the CARTO 3 system; group 2 - a PVAC catheter used with the EnSite system; group 3 - ablation with a PVAC catheter without a 3D system.Results: Complete isolation of 400/402 pulmonary veins (PV) (99.5%). Linear ablation was performed in 23 patients in group 1 (small distance between lines isolating PV), in 3 patients in group 2, in 1 patient in group 3. The superior vena cava was isolated in 1 patient, 9 patients, and 9 patients respectively. Duration of fluoroscopy and dose area product were significantly smaller in group 1 (6.5 ±2.9 min/808.8 ±393.9 cGy/cm2 vs. 13.6 ±5.6 min/1662.6 ±677.8 cGy/cm2 and 18.8 ±7.6 min/2327.9 ±975.5 cGy/cm2; p < 0.001). Procedure duration was shorter in group 1 (82.9 ±18.8 min vs. 101.2 ±19.6 min, p < 0.001 and 99.8 ±20.8 min, NS). Contrast injection was necessary in 2 patients in group 1, in 8 patients in group 2 and in all patients in group 3. Because nMARQ is a thermocool catheter, the volume of fluid injection was significantly greater (2348.5 ±543.5 ml vs. 1077.9 ±280.5 ml and 1076.5 ±375.6 ml, p < 0.001). There were no periprocedural deaths. We observed no cardiac tamponade, neurological complications and no atrioesophageal fistula during follow-up.Conclusions: The lowest radiological exposure was observed during ablation performed with an nMARQ catheter. 3D systems reduced fluoroscopy duration and the necessity of contrast injection. The nMARQ catheter requires injection of a large volume of fluid. [ABSTRACT FROM AUTHOR]

Background: Approximately 50% of heart failure patients are readmitted to hospital within 6 months, owing to deterioration of their condition. Thus, symptomatic treatment of heart failure requires significant improvement. The aim of this study is to compare the effects of torasemide and furosemide on biochemical parameters of haemodynamic and neurohormonal compensation, myocardial remodelling, clinical outcomes and quality of life in patients with chronic heart failure.Methods: This is a multicentre, randomized, open, blinded endpoint phase-IV trial. The study includes 120 heart failure patients in NYHA (New York Heart Association) functional class II-IV, treated with optimal heart failure therapy, with indications for use of loop diuretics. At enrolment, patients are stable, with a fixed dose of loop diuretics. Patients are randomized to treatment with furosemide or torasemide (randomization 1:1). After randomization, the current fixed dose of furosemide is continued or is replaced by an equipotential dose of torasemide (4:1). The study consists of two control visits (3 and 6 months after enrolment) with minimal follow-up of 6 months. Assessment involves clinical examination, Quality of Life Questionnaire, laboratory tests, echocardiography, electrocardiography, 24 h Holter-electrocardiography monitoring, 6 -min walk test and assessment of fluid retention. Any need for dose adjustment is assessed during the observation. The primary objective is to compare the effects of torasemide and furosemide on clinical and biochemical parameters of haemodynamic and neurohormonal compensation and myocardial remodelling. Secondary objectives include monitoring of: changes in signs and symptoms of heart failure, NYHA functional class, quality of life, dosage changes, rate of readmissions and mortality.Discussion: Despite decades of the diuretic's history, knowledge about diuretic therapy is still unsatisfactory. The most widely used diuretic, furosemide, has a stormy pharmacokinetics and pharmacodynamics, and is associated with a high risk of mortality and hospitalization for worsening heart failure. Reports are very encouraging and suggest beneficial effects of torasemide. Hence, there is a need for further studies of the overall effect of torasemide, compared with furosemide. This can translate into improved quality of life and better prognosis of patients with heart failure.Trial Registration: ClinicalTrials.gov, NCT01942109 . Registered on 24 August 2013. [ABSTRACT FROM AUTHOR]