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BACKGROUND The course of COVID-19 disease is associated with immune deregulation and excessive release of pro-inflammatory cytokines. Vitamin D has an immunomodulatory effect. We aimed to assess the possible correlation between the incidence and severity of SARS-CoV-2 infection and serum vitamin D concentration. MATERIAL AND METHODS A total of 505 successive patients admitted to a COVID-19-dedicated hospital were included in the retrospective analysis. Serum 25-hydroxyvitamin D (25-OHD) levels and SARS-CoV-2 RT-PCR throat swab test results were determined for each patient. The course of COVID-19 was assessed on the basis of the serum Vitamin Modified Early Warning Score (MEWS), which includes respiratory rate, systolic blood pressure, heart rate, temperature, and state of consciousness), as well as number of days spent in the intensive care unit (ICU) and need for oxygen therapy. RESULTS There was no difference in 25-OHD concentration between COVID-19-confirmed and negative results of the PCR tests. No correlation was found between serum 25-OHD in the COVID(+) group and the need for and time spend in the ICU, as well as the MEWS score. Multivariate analyses showed a positive correlation between need for oxygen therapy and lower 25-OHD concentration, as well as older age (P0.001) and similar positive correlation between need for ventilation therapy with lower 25-OHD concentration, as well as older age (P=0.005). CONCLUSIONS Our findings do not support a potential link between vitamin D concentrations and the incidence of COVID-19, but low vitamin D serum level in COVID-19 patients might worsen the course of the disease and increase the need for oxygen supplementation or ventilation therapy.

Heart failure is associated with activation of thrombin-related pathways, which predicts a poor prognosis. We hypothesized that treatment with rivaroxaban, a factor Xa inhibitor, could reduce thrombin generation and improve outcomes for patients with worsening chronic heart failure and underlying coronary artery disease.In this double-blind, randomized trial, 5022 patients who had chronic heart failure, a left ventricular ejection fraction of 40% or less, coronary artery disease, and elevated plasma concentrations of natriuretic peptides and who did not have atrial fibrillation were randomly assigned to receive rivaroxaban at a dose of 2.5 mg twice daily or placebo in addition to standard care after treatment for an episode of worsening heart failure. The primary efficacy outcome was the composite of death from any cause, myocardial infarction, or stroke. The principal safety outcome was fatal bleeding or bleeding into a critical space with a potential for causing permanent disability.Over a median follow-up period of 21.1 months, the primary end point occurred in 626 (25.0%) of 2507 patients assigned to rivaroxaban and in 658 (26.2%) of 2515 patients assigned to placebo (hazard ratio, 0.94; 95% confidence interval [CI], 0.84 to 1.05; P=0.27). No significant difference in all-cause mortality was noted between the rivaroxaban group and the placebo group (21.8% and 22.1%, respectively; hazard ratio, 0.98; 95% CI, 0.87 to 1.10). The principal safety outcome occurred in 18 patients who took rivaroxaban and in 23 who took placebo (hazard ratio, 0.80; 95% CI, 0.43 to 1.49; P=0.48).Rivaroxaban at a dose of 2.5 mg twice daily was not associated with a significantly lower rate of death, myocardial infarction, or stroke than placebo among patients with worsening chronic heart failure, reduced left ventricular ejection fraction, coronary artery disease, and no atrial fibrillation. (Funded by Janssen Research and Development; COMMANDER HF ClinicalTrials.gov number, NCT01877915 .).

Aspirin (ASA) is an effective antiplatelet drug that reduces the risk of myocardial infarction, stroke, or death by approximately 25% in patients who are at increased risk of cardiovascular events. However, many patients with cardiovascular disease do not respond to ASA treatment and are deemed ASA resistant. The term "ASA resistance" has been used to describe not only the lack of expected pharmacologic effects of ASA on platelets but also poor clinical outcomes, such as recurrent vascular events, in patients treated with ASA.In this prospective observation of patients with stable coronary artery disease (CAD) who received ASA for secondary prevention, we investigated factors responsible for ASA resistance by determining ASA response using the PFA-100 analyser and evaluating relation of ASA resistance to various studied parameters.Platelet function tests with the PFA-100 point-of-care system were performed in 92 patients with CAD (mean age 68 +/- 8 years, 36 females) who had been taking 75-150 mg of ASA daily for secondary prevention for at least 3 months. Each patient had an angiographically documented CAD with stable angina. ASA resistance was defined as a normal collagen/epinephrine closure time (CEPI-CT) on the PFA-100 (or = 150 s). Patients with CTor = 250 s were defined as ASA responders and patients with CT between 150 and 250 s as semi-responders.Using a collagen/epinephrine-coated cartridge on the PFA-100, the prevalence of platelet inhibition failure was 29%, while 30% of patients were semi-responders. In our study population, adequate response to ASA was found in 40% of patients. In multivariate logistic regression analysis, parameters independently related to platelet inhibition failure included compliance to ASA therapy [odds ratio (OR) 0.8, 95% confidence interval (CI) 0.20-0.35, p = 0.001], total cholesterol/HDL cholesterol level ratio2.99 (OR 0.19, 95% CI 0.05-0.81, p = 0.02), and heart rate69 bpm (OR 4.44, 95% CI 1.37-14.38, p = 0.01).In patients with stable CAD, about one third of the subjects were ASA resistant by PFA-100. Our study shows that non-compliance could be one of the most important risk factors responsible for high residual platelet activity in patients with stable CAD taking ASA. Thus, non-compliant patients should be carefully educated about the mechanism of action of this drug to understand the necessity and long-term benefits of treatment with ASA.

Atrial fibrillation (AF) is a risk factor for development of thromboembolic events with an annual stroke rate of 4.5%. In subjects over 80 years AF is the single leading cause of major stroke. Moreover, about 25% of patients with AF in the absence of neurological deficits have tomographic signs of one or more silent cerebral infarcts.To investigate whether cognitive function in patients with permanent AF is significantly worse than in patients with sinus rhythm.We included subjects aged65 years, without previous cerebrovascular events or dementia, with permanent arrhythmia lasting12 months. The AF group comprised 51 patients, aged 75.8 years. The control group consisted of 43 patients with sinus rhythm. The main points of the study protocol were: clinical history recording, physical examination, biochemical analyses, standard 12-lead ECG and transthoracic echocardiography. Cognitive status was assessed by Mini Mental State Examination (MMSE).Patients had established AF with a median duration of 4.9 years (range 1-21 years). Of the 51 patients, 51% had hypertension, 37% coronary artery disease, 12% presented sick sinus syndrome or atrioventricular advanced block with a VVI pacemaker implanted. There were no significant differences between the two groups though AF patients presented left ventricular hypertrophy and history of myocardial infarction more frequently. Patients in the sinus group had a lower-risk profile and received antithrombotic therapy less frequently than the AF group. However, a significant proportion of patients, particularly in the AF group received less than optimal thromboembolic prophylactic treatment with anticoagulants. Cognitive status was found to be significantly lower in the AF group, compared with the sinus rhythm group: 24.8 +/- 3.1 vs. 27.1 +/- 2.6 (p0.05). There were 43% patients with cognitive impairment in the AF group and 14% in the sinus rhythm group.Permanent AF in patients aged over 65 years seems to be associated with lower MMSE score compared with subjects with sinus rhythm. Cognitive impairment in older patients is a multifactorial disorder. One of the causes of low cognitive function in these patients appears to be permanent AF. Further prospective clinical trials should help determine the possible role of inadequate anticoagulant treatment, and its association with the deterioration of cognitive function in AF patients.

The aim of the study was to evaluate plasma natriuretic peptides (NPs): atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) concentrations in patients with paroxysmal, persistent and permanent atrial fibrillation (AF).The study groups consisted of 23 patients with paroxysmal AF, 42 patients with permanent AF and 77 patients with persistent AF with normal left ventricular function. The mean ANP level was increased in AF patients in the paroxysmal, persistent and permanent groups: 249 +/- 88.3 pg/mL; 258 +/- 89.7 pg/mL; 208 +/- 76.7 pg/mL, respectively, vs. 67 +/- 21.2 pg/mL in the control subjects (p0.001). The mean BNP level was increased in AF patients in the paroxysmal, persistent and permanent groups: 99.6 +/- 29.8 pg/mL; 82.3 +/- 33 pg/mL; 95.6 +/- 46.4 pg/mL, respectively, vs. 37.5 +/- 13 pg/mL in the control group. Multivariate logistic regression analysis revealed a positive correlation between ANP levels, maximal left atrial volume, heart rate and New York Heart Association (NYHA) classification, in the persistent AF patients. A positive correlation between plasma BNP levels and heart failure stage according to NYHA classification in this group was found. Baseline ANP concentrations were positively correlated with baseline BNP concentrations in AF patients.Plasma NPs levels are increased in patients with paroxysmal, persistent and permanent AF and normal left ventricle function, and positively correlated with left atrial volume, heart rate and heart failure stage according to NYHA classification. Neurohormonal assessment does not distinguish the type of arrhythmia.

Renal function assessment is an important element of management and therapeutic decision-making in patients with chronic heart failure (CHF).To evaluate the prognostic value of renal dysfunction in patients with CHF in 12-month follow-up.639 consecutive patients hospitalised in our department from 1 July 2002 to 31 December 2003 with diagnosis of CHF (NYHA II-IV), based on medical records, were initially enrolled in the study. Patients underwent one-year follow-up. Finally, 498 patients, aged 22-98 years (mean age 69+/-12 years) in whom creatinine concentration was measured and creatinine clearance was estimated at admission with the Cockroft-Gault quotation and with long-term follow-up results obtained, were enrolled in the study. Patients were divided into two groups according to the creatinine level: Group I without renal dysfunction (creatinine level1.4 mg/dl), and Group II--with renal dysfunction (creatinine level1.4 mg/dl).Patients with renal dysfunction were significantly older and more likely to be male and in NYHA class III-IV (p0.001). Analysis of pharmacotherapy for CHF revealed that patients with renal impairment significantly less frequently received beta-blockers (67% vs 81%, p0.005), angiotensin-converting enzyme inhibitors (68% vs 82%, p0.005) and combined treatment of beta-blocker and angiotensin-converting enzyme inhibitor (56% vs 71%, p0.05), whereas loop diuretics were more frequently prescribed in this group (80% vs 70%, p0.05). In patients with renal dysfunction, there was a significantly higher mortality rate at 30 days (32% vs 14%, p0.001) as well as at 12 months (45% vs 20%, p0.001). The incidence of re-hospitalisation for cardiovascular reasons (CHF worsening, myocardial infarction, stroke) was significantly higher in patients with renal dysfunction (70% vs 55%, p0.005). Multivariate analysis of all factors affecting one-year mortality demonstrated that renal dysfunction is a strong and independent risk factor for death in patients with CHF (RR=2.13, 95% CI: 1.31-3.45; p0.05) and it increases the risk of re-hospitalisation (RR=1.53, 95% CI: 1.01-2.14; p0.05).Renal dysfunction is an independent prognostic factor in patients with CHF, which allows identification of a high-risk group and administration of optimal therapy, which in turn can result in a reduction of mortality.

A marked progress in the treatment of chronic heart failure (CHF) took place during the last decade. Large, randomised studies documented the role of angiotensin-converting enzyme inhibitors (ACE-I) and beta-blockers in the reduction of mortality and morbidity in CHF.To assess differences in the management of CHF patients between cardiologists and internists.Medical records of 433 patients with CHF, aged 38-98 years, hospitalised between October 2000 and May 2002 in an academic centre, were retrospectively analysed. Cardiologists treated 241 patients, and internists - 192 patients. In addition, 12 randomly selected physicians who treated CHF patients, filled-in a questionnaire concerning CHF treatment. Next, the answers were compared with the actual treatment, documented in patients medical files.There were significant differences in the CHF treatment between cardiologists and internists. Cardiologists significantly more often prescribed ACE-I in NYHA class III patients (77% vs 58%, p=0.003), beta-blockers in all NYHA classes (80% vs 57%, p0.001), loop diuretics in NYHA classes III and IV (76% vs 42%, p0.001 and 91% vs 44%, p=0.005), and thiazides in NYHA class III patients (36% vs 11%, p0.001). Internists more often used loop diuretics (37% vs 15%, p0.001), digoxin (28% vs 7%, p0.001) and aldosterone antagonists (24% vs 13%, p=0.022) in NYHA class II patients. All cardiologists and almost half of internists declared combined usage of ACE-I and beta-blockers at increasing dosages as the treatment was continued. The highest concordance between declared and actual medication concerned the concomitant use of ACE-I and beta-blockers.Cardiologists used more often ACE-I and beta-blockers than internists in the treatment of CHF patients. A satisfactory knowledge of treatment guidelines was not associated with widespread usage of ACE-I and beta-blockers in every-day practice.

Plasma concentration of atrial natriuretic peptide (ANP) is elevated in patients with atrial fibrillation (AF) and in patients with chronic heart failure (CHF).Aim. To assess ANP level in patients with permanent AF and advanced CHF.The study group consisted of 41 patients (27 males, mean age 62+/-8 years) with AF of a mean duration of 8.8 months. Twenty six (63%) patients were in NYHA class II, and 15 (37%) - in NYHA class III or IV. All patients underwent clinical and echocardiographic evaluation as well as ANP plasma concentration assessment. Multiple regression analysis was used to identify factors which determine ANP plasma concentration.Mean ANP plasma concentration was 52.4+/-22.7 pg/ml in the whole study group; 38.6+/-10.8 pg/ml in NYHA class II patients and 74.9+/-18.7 pg/ml in NYHA class III-IV subjects (p0.0001). Among echocardiographic parameters, patients with NYHA class III or IV had significantly lower left ventricular ejection fraction and greater left atrial volume than patients with NYHA class II (32% versus 56%, p0.0001 and 101.0+/-23.8 cm(3) versus 83.4+/-16.1 cm(3), p0.006, respectively). Multiple regression analysis revealed a significant negative correlation between AF duration and ANP level (p=0.0013) in a group of patients with NYHA class III or IV and identified AF duration as an independent predictor of ANP plasma concentration in this group of patients.ANP plasma concentration in patients with persistent AF and advanced CHF is determined by AF duration - the longer the AF duration the lower the ANP level.

We performed direct comparison of safety and efficacy of monophasic and biphasic shock cardioversion (CV) of atrial fibrillation (AF). Troponin I (cTnl) and myoglobin (My) were used as markers of potential myocardial and skeletal muscle damage during the procedure.63 patients (p.t.s.) with persistent, nonvalvular AF (F/M 18/45; mean age 61.6 +/- 11.4 years) were randomized to CV either with monophasic (F/M 10/24, Group I) or biphasic (F/M 8/21, Group II) shock. Plasma levels of cTnl and My were measured before CV, 6 hours and 24 hours after CV.The efficacy of CV was significantly higher in Group II (93% vs 85%, p0.04). Sinus rhythm restoration required lower total energy used during procedure with biphasic shock (379.8 +/- 301.5 vs 192.8 +/- 100.6 J; p 0.001). There was no significant difference in mean values of cTnl before CV in both groups (0.3 +/- 0.2 vs 0.2 +/- 0.1 ng/mL, p0.15). In 14 pts (41%) from Group I and 3 pts (10%) from Group II plasma cTnl concentration above discriminatory level (0.9 ng/mL) were noted. There was a significant increase in mean plasma cTnl level (0.3 +/- 0.2 vs 1.9 +/- 0.9 ng/mL, p0.04) 24 hours after the procedure in Group I. We did not observed significant differences in cTnl plasma concentration 6 and 24 hours after CV in Group II (0.2 +/- 0.1 vs 0.4 +/- 0.2 ng/mL, p0.15). Both study groups did not significantly differ in mean serum My level at baseline (39.1 +/- 14.2 vs 43.1 +/- 20.9 ng/mL). In Group I mean My serum concentration increased during the first 6 hours after CV (43.1 +/- 20.9 vs 247.9 +/- 53.3 ng/mL, p0.02) and there was a significant decreasing in My serum level during the further observation (247.9 +/- 53.3 vs 104.5 +/- 46.1 ng/mL, p0.03). Mean serum My concentration remained within normal ranges during the 24 hour follow-up after the biphasic shock CV (43.1 +/- 20.9 vs 43.6 +/- 29.1 ng/mL). Increased of cTnl and My in Group I may be due to myocardial and skeletal muscle damage and correlate closely with cumulative energy delivered (Spearmann correlation index (r) = 0.55, p0.01 for My and r = 0.66, p0.01 for cTnl). In Group I positive correlation between cumulative energy used during CV and increase of studied markers indexed with left ventricular mass (r = 0.6, p0.05 for My and r = 0.74, p0.04 for cTnl) was observed. There was no significant correlation between delivered energy and increase of heart markers in Group II noted.We observed the significant increase in mean serum cTnl and My level 24 hours after CV with monophasic shock and its positive correlation with total energy used during the procedure. There is a conclusion that biphasic shock used during CV of AF is more efficient and may cause less myocardial and skeletal muscle damage due to lower energy delivered.

Long-term maintenance of sinus rhythm (SR) after successful cardioversion (CV) of persistent atrial fibrillation (AF) carries a low risk of stroke and may avoid the risks associated with anticoagulation.To determine the clinical and echocardiographic predictors of maintaining SR during one-year follow-up.The initial study group consisted of 205 patients with persistent AF of whom 104 (33 females, 71 males, mean age 60.4+/-7.4 years) were randomised to SR restoration and maintenance. The results of transthoracic echocardiography, obtained before CV, were compared between patients who remained in SR and those in whom AF recurred during a one-year follow-up period, using the linear and logistic regression analysis.SR was present in 63.5% of patients at the end of the follow-up period. Of several analysed echocardiographic parameters, an increased left atrial area (28 cm(2)) (p0.02; RR 1.72, OR 1.09-2.71) and an increase in the fractional shortening of the left ventricle (range 25-40%, p0.05, RR 1.2, OR 1.01-1.44) were significantly associated with SR maintenance during a 12-month follow-up period.Left atrial area and left ventricular fractional shortening are the independent predictors of the maintenance of SR after successful CV in patients with persistent AF.

Patients with atrial fibrillation (AF) can be managed either by maintaining sinus rhythm using antiarrhythmic drugs and/or electrical cardioversion, or by leaving patients in AF and controlling ventricular rate without attempts to restore sinus rhythm. Which of these two strategies is superior, has not yet been definitively established.HOT CAFE Polish Study (How To Treat Chronic Atrial Fibrillation) was designed to evaluate in a randomised, multicentre and prospective manner the risks and advantages of two therapeutical strategies - rate control or rhythm control, in patients with persistent AF.The study group consisted of 205 patients (71 females and 134 males; mean age 60.8+/-11.2 years) with a mean time of AF duration of 273.7+/-112.4 days; 101 patients were randomly assigned to rate control (Group I) whereas 104 patients were randomised to sinus rhythm (SR) restoration by DC cardioversion (CV) and subsequent antiarrhythmic drug treatment (Group II). At the end of follow-up (12 months) SR was present in 75% of patients.The incidence of hospital admissions was higher in group II in comparison to group I (12% vs 74%; p0.001). Mortality was similar in both groups (1.0% versus 2.9%, NS). In both groups a significant improvement of heart failure symptoms was observed during the first 2 months (p0.02 and p0.001). In group II exercise tolerability measured by maximal workload during treadmill test significantly improved compared with baseline (5.2+/-5.1 vs 7.6+/-3.3 MET; p0.0001). In patients in whom SR was restored, the left ventricular function improved and an increase in the shortening fraction was observed (29+/-7% vs 31+/-7%; p0.01). No thromboembolic complications were observed in patients left with AF. Three patients from group II suffered ischaemic stroke; in two cases stroke was associated with CV whereas in the third patient - with late AF recurrence.The HOT CAFE Polish Study did not reveal significant differences in mortality between the two treatment strategies in patients with persistent AF. Although patients with SR had better improvement in some haemodynamical parameters, the hospitalisation rate was higher and the incidence of stroke was not reduced compared with the rate control group.

Antiarrhythmic drugs prophylaxis may improve late outcome of electrical cardioversion (CV) in persistent atrial fibrillation (AF). We conducted a prospective study of the efficacy of sequential antiarrhythmic drug therapy in sinus rhythm (SR) maintenance after a successful elective CV in patients (pts) with persistent nonvalvular AF. Investigated group and methods. 104 pts (60.4 +/- 7.9 years old) with persistent AF underwent CV. Following SR restoration pts received one of these antiarrhythmic drugs (Drug I): propafenone, sotalol, disopyramide. In case of arrhythmia recurrence we performed a second CV and pts received another drug from the mentioned before (Drug II). If treatment proved to be unsuccessful pts received amiodarone (Drug III) and a third CV was attempted. Following an unsuccessful first CV pts received loading dose amiodarone and another CV was attempted. In case of SR restoration amiodarone was administered continuously.First CV was successful in 53.8% pts. Following 1 year 27 pts (48.2%) presented with SR treated with Drug I (median not exist); Drug II proved to be effective in 2 pts (7.0%) (median 14 days). Amiodarone as the third antiarrhythmic agent (Drug III), administered in pts who had previously AF recurrence during the first two antiarrhythmic agents, occurred effective in additional 13 pts (median 307 days) who remained free from AF for one year from the initiation of sequential antiarrhythmic therapy. 48 pts in whom the first CV was ineffective, received amiodarone. During the loading period SR was restored in 10 pts (20.8%). The remaining 38 pts underwent repeated CV and SR was restored in 24 (62.3%) of them. Long-term amiodarone treatment maintained SR during the follow-up period in 24 (70.6%) pts. In total, amiodarone helped to maintain SR in 56.0% of pts.Sequential antiarrhythmic drug therapy improve arrhythmia prognosis in AF within a 12 months observation period. Amiodarone seems to be the most effective antiarrhythmic drug also in pts who required a second CV proceeded by amiodarone treatment to restore SR.

Reversible complete atrioventricular block in patient with Wegener's granulomatosis - a report on a positive outcome with long term follow-up. Atrioventricular (AV) block is a rare complication of Wegener's granulomatosis (WG), thus there are no standards of management in such cases. We present a case of a patient with a dual-chamber pacemaker (DDD) implanted due to complete AV block in the course of Wegener's granulomatosis (WG). An immunosuppressive therapy resulted in the resolution of non-cardiac and AV conduction disorders. The diagnostic functions of the pacemaker enabled us to evaluate AV conduction over a five-year follow-up period. The resolution of AV conduction disorders, which accompanied WG remission, suggests that careful monitoring with temporary cardiac pacing may be considered in some patients before permanent pacemaker implantation.

Hypertensive patients with poor blood pressure (BP) control are commonly referred to tertiary centers with a diagnosis of resistant hypertension (RH). The aim of the study was to identify the causes of insufficient BP control and to assess the incidence of true resistant hypertension.We ran a questionnaire-based, multicenter study (10 high volume tertiary centers in Poland) of patients referred with an initial diagnosis of RH. Only patients with ABPM-confirmed uncontrolled hypertension (systolic ≥140 mmHg and/or diastolic ≥90mmHg despite maximal doses of ≥3 medications, including a diuretic) were included. We assessed the causes of non-optimal BP control, a proportion of patients with excluded secondary hypertension, and the burden of hypertension-related complications.We analyzed 124 patients aged 41-88, with a history of hypertension of 17.5±9 years. 90% of them had developed systemic complications, the most common being LV hypertrophy (73.4%) and LV diastolic dysfunction (63.4%). In only 47% all major causes of secondary hypertension were excluded. In 90.3% of subjects, at least one factor affecting BP control was identified. The most frequent factors were medication noncompliance (52.4%), metabolic syndrome (43.6%) excessive sodium intake (66.1%) and chronic administration of non-steroid anti-inflammatory drugs (40%). The incidence of real resistant hypertension was only 4.8%.Among patients referred with uncontrolled hypertension, the incidence of real resistant hypertension is small. A majority of these patients have multiple factors potentially responsible for poor BP control, the most common being medication non-adherence, use of drugs increasing BP, excessive salt intake and metabolic syndrome.