106 results on '"Kapłon-Cieślicka A"'
Search Results
2. Metabolic syndrome — a new definition and management guidelines
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Piotr Dobrowolski, Aleksander Prejbisz, Alina Kuryłowicz, Alicja Baska, Paweł Burchardt, Krzysztof Chlebus, Grzegorz Dzida, Piotr Jankowski, Jerzy Jaroszewicz, Paweł Jaworski, Karol Kamiński, Agnieszka Kapłon-Cieślicka, Marek Klocek, Michał Kukla, Artur Mamcarz, Agnieszka Mastalerz-Migas, Krzysztof Narkiewicz, Lucyna Ostrowska, Daniel Śliż, Wiesław Tarnowski, Jacek Wolf, Mariusz Wyleżoł, Tomasz Zdrojewski, Maciej Banach, Andrzej Januszewicz, and Paweł Bogdański
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Endocrinology, Diabetes and Metabolism ,Internal Medicine ,Cardiology and Cardiovascular Medicine - Published
- 2022
3. Heart failure and the risk of left atrial thrombus formation in patients with atrial fibrillation or atrial flutter
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Maciej T. Wybraniec, Magdalena Mizia‐Szubryt, Małgorzata Cichoń, Karolina Wrona‐Kolasa, Agnieszka Kapłon‐Cieślicka, Monika Gawałko, Monika Budnik, Beata Uziębło‐Życzkowska, Paweł Krzesiński, Katarzyna Starzyk, Iwona Gorczyca‐Głowacka, Ludmiła Daniłowicz‐Szymanowicz, Damian Kaufmann, Maciej Wójcik, Robert Błaszczyk, Jarosław Hiczkiewicz, Katarzyna Łojewska, Katarzyna Kosmalska, Marcin Fijałkowski, Anna Szymańska, Anna Wiktorska, Maciej Haberka, Michał Kucio, Błażej Michalski, Karolina Kupczyńska, Anna Tomaszuk‐Kazberuk, Katarzyna Wilk‐Śledziewska, Renata Wachnicka‐Truty, Marek Koziński, Paweł Burchardt, Katarzyna Mizia‐Stec, RS: Carim - H01 Clinical atrial fibrillation, and Cardiologie
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Medizin ,Cardiology and Cardiovascular Medicine - Abstract
AIMS: The aim of the study was to evaluate the prevalence of left atrial thrombus (LAT) on transoesophageal echocardiography (TOE) in patients with atrial fibrillation or atrial flutter (AF/AFl) with reference to the presence of heart failure (HF) and its subtypes.METHODS AND RESULTS: The research is a sub-study of the multicentre, prospective, observational Left Atrial Thrombus on Transoesophageal Echocardiography (LATTEE) registry, which comprised 3109 consecutive patients with AF/AFl undergoing TOE prior to direct current cardioversion or catheter ablation. TOE parameters, including presence of LAT, were compared between patients with and without HF and across different subtypes of HF, including HF with preserved (HFpEF), mid-range (HFmrEF), and reduced ejection fraction (HFrEF). HF was diagnosed in 1336 patients (43%). HF patients had higher prevalence of LAT than non-HF patients (12.8% vs. 4.4%; P < 0.001). LAT presence increased with more advanced type of systolic dysfunction (HFpEF vs. HFmrEF vs. HFrEF: 7.4% vs. 10.5% vs. 20.3%; P < 0.001). Univariate analysis revealed that HFrEF (odds ratio [OR] 4.13; 95% confidence interval [95% CI]: 3.13-5.46), but not HFmrEF or HFpEF, was associated with the presence of LAT. Multivariable logistic regression indicated that lower left ventricular ejection fraction (OR per 1%: 0.94; 95% CI 0.93-0.95) was an independent predictor of LAT formation. Receiver operator characteristic analysis showed LVEF ≤48% adequately predicted increased risk of LAT presence (area under the curve [AUC] 0.74; P < 0.0001).CONCLUSION: The diagnosis of HFrEF, but neither HFmrEF nor HFpEF, confers a considerable risk of LAT presence despite widespread utilization of adequate anticoagulation.
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- 2022
4. Out-of-hospital cardiac arrest: Do we have to perform coronary angiography?
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Wojciech Wańha, Michalina Kołodziejczak, Mariusz Kowalewski, Rafał Januszek, Łukasz Kuźma, Miłosz Jaguszewski, Mariusz Tomaniak, Szymon Darocha, Karolina Kupczyńska, Piotr Dobrowolski, Agata Tymińska, Aleksandra Ciepłucha, Justyna Sokolska, Agnieszka Kapłon-Cieślicka, Andrzej Kułach, Maciej Wybraniec, Tomasz Roleder, Mateusz Tajstra, Klaudiusz Nadolny, Tomasz Darocha, Katarzyna Sierakowska, Tomasz Pawłowski, Marek Gierlotka, Maciej Leskiak, Krystian Wita, Robert Gil, and Przemysław Trzeciak
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General Medicine ,Cardiology and Cardiovascular Medicine - Published
- 2023
5. Risk of left atrial appendage thrombus in patients with atrial fibrillation and chronic kidney disease
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Olga Jelonek, Marek Kiliszek, Monika Budnik, Agnieszka Kapłon-Cieślicka, Piotr Scisło, Grzegorz Gielerak, Beata Wożakowska-Kapłon, Beata Uziębło-Życzkowska, Agnieszka Jurek, Grzegorz Opolski, Janusz Kochanowski, Katarzyna Starzyk, Anna Michalska, Monika Gawałko, Krzysztof J. Filipiak, Iwona Gorczyca, and Paweł Krzesiński
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Male ,medicine.medical_specialty ,Heart Diseases ,medicine.medical_treatment ,Population ,Administration, Oral ,Renal function ,030204 cardiovascular system & hematology ,Cardioversion ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Diabetes mellitus ,Atrial Fibrillation ,medicine ,Humans ,Atrial Appendage ,Renal Insufficiency, Chronic ,Thrombus ,education ,education.field_of_study ,business.industry ,Anticoagulants ,Thrombosis ,Atrial fibrillation ,General Medicine ,medicine.disease ,Heart failure ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Echocardiography, Transesophageal ,Kidney disease - Abstract
Atrial fibrillation (AF) and chronic kidney disease (CKD) are associated with an increased risk of ischemic stroke. The aim of this study was to compare the clinical characteristics, the incidence of left atrial appendage (LAA) thrombus and its predictors, and spontaneous echo contrast (SEC) in a population of patients with AF depending on estimated glomerular filtration rate (eGFR) values.This study included 1962 patients who underwent transesophageal echocardiographic examination prior to cardioversion or ablation in the years 2014-2018 in three cardiac centers.More than a quarter of AF patients had decreased eGFR (60 mL/min/1.73 m2) and were characterized as a high-risk population, with more comorbidities, higher thromboembolic and bleeding risk compared to those with normal renal function. Oral anticoagulation (OAC) was prescribed in 97% and 93% of patients with decreased and normal eGFR, respectively, with a higher prevalence of prescribed non-vitamin K antagonist oral anticoagulants (NOACs). The incidence of LAA thrombus (24%, 9% and 4%) and SEC (25%, 25% and 19%) increases simultaneously with a decrease in eGFR (30, 30-59 and ≥ 60 mL/min/1.73 m2, respectively). Among patients prescribed reduced doses of NOAC, those with decreased eGFR were more often observed with LAA thrombus (10% vs. 2.5%). Non-paroxysmal AF, heart failure and previous bleeding were predictors of LAA thrombus, irrespective of eGFR value. CKD was the predictor of LAA thrombus in all patients including those with non-paroxysmal AF, males, without diabetes, without hypertension and with CHA2DS2-VASc2.Despite OAC, patients with concomitant AF and CKD remain at high risk for LAA thrombus formation.
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- 2022
6. A comprehensive characterization of acute heart failure with preserved versus mildly reduced versus reduced ejection fraction – insights from the <scp>ESC‐HFA EORP</scp> Heart Failure Long‐Term Registry
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Kapłon-Cieślicka, Agnieszka, Benson, Lina, Chioncel, Ovidiu, Crespo-Leiro, Maria G, Coats, Andrew J S, Anker, Stefan D, Filippatos, Gerasimos, Ruschitzka, Frank, Hage, Camilla, Drożdż, Jarosław, Seferovic, Petar, Rosano, Giuseppe M C, Piepoli, Massimo, Mebazaa, Alexandre, McDonagh, Theresa, Lainscak, Mitja, Savarese, Gianluigi, Ferrari, Roberto, Maggioni, Aldo P, Lund, Lars H, University of Zurich, and Lund, Lars H
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Heart failure with mildly reduced ejection fraction ,Heart Failure ,Heart failure with mid-range ejection fraction ,Aftercare ,610 Medicine & health ,Stroke Volume ,Prognosis ,2705 Cardiology and Cardiovascular Medicine ,Patient Discharge ,Hospitalization ,Treatment ,Heart failure with preserved ejection fraction ,10209 Clinic for Cardiology ,Humans ,Registries ,Cardiology and Cardiovascular Medicine - Abstract
[Abstract] Aims: To perform a comprehensive characterization of acute heart failure (AHF) with preserved (HFpEF), versus mildly reduced (HFmrEF) versus reduced ejection fraction (HFrEF). Methods and results: Of 5951 participants in the ESC HF Long-Term Registry hospitalized for AHF (acute coronary syndromes excluded), 29% had HFpEF, 18% HFmrEF, and 53% HFrEF. Hospitalization reasons were most commonly atrial fibrillation (more in HFmrEF and HFpEF), followed by ischaemia (HFmrEF), infection (HFmrEF and HFpEF), worsening renal function (HFrEF), and uncontrolled hypertension (HFmrEF and HFpEF). Hospitalization characteristics included lower blood pressure, more oedema and higher natriuretic peptides with lower ejection fraction, similar pulmonary congestion, more mitral regurgitation in HFrEF and HFmrEF and more tricuspid regurgitation in HFrEF. In-hospital mortality was 3.4% in HFrEF, 2.1% in HFmrEF and 2.2% in HFpEF. Intravenous diuretic (∼80%) and nitrate (∼15%) use was similar but inotrope use greater in HFrEF (16%, vs. HFmrEF 7.4% vs. HFpEF 5.3%). Weight loss and estimated glomerular filtration rate improvement were greater in HFrEF, whereas reduction in natriuretic peptides was similar. Over 1 year post-discharge, events per 100 patient-years (95% confidence interval) in HFrEF versus HFmrEF versus HFpEF were: all-cause death 22 (20-24) versus 17 (14-20) versus 17 (15-20); cardiovascular (CV) death 12 (10-13) versus 8.6 (6.6-11) versus 8.4 (6.9-10); non-CV death 2.4 (1.8-3.1) versus 3.3 (2.1-4.8) versus 4.5 (3.5-5.9); all-cause hospitalization 48 (45-51) versus 35 (31-40) versus 42 (39-46); HF hospitalization 29 (27-32) versus 19 (16-22) versus 17 (15-20); and non-CV hospitalization 7.7 (6.6-8.9) versus 9.6 (7.5-12) versus 15 (13-17). Conclusion: In AHF, HFrEF is more severe and has greater in-hospital mortality. Post-discharge, HFrEF has greater CV risk, HFpEF greater non-CV risk, and HFmrEF lower overall risk.
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- 2022
7. Jak opiekować się pacjentem z niewydolnością serca i wielochorobowością w POZ? Jakie badania i komu zlecać?
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Dorota Ochijewicz and Agnieszka Kapłon-Cieślicka
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- 2023
8. Czy wynik CHA2DS2-VASc determinuje leczenie przeciwzakrzepowe u pacjentów z migotaniem przedsionków? Dane z POLish Atrial Fibrillation (POL-AF) Registry?
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Anna Szpotowicz, Iwona Gorczyca-Głowacka, Beata Uziębło-Życzkowska, Małgorzata Maciorowska, Maciej Wójcik, Robert Błaszczyk, Agnieszka Kapłon-Cieślicka, Monika Gawałko, Monika Budnik, Tomasz Tokarek, Renata Rajtar-Salwa, Jacek Bil, Michał Wojewódzki, Janusz Bednarski, Elwira Bakuła-Ostalska, Anna Tomaszuk-Kazberuk, Anna Szyszkowska, Marcin Wełnicki, Artur Mamcarz, Małgorzata Krzciuk, and Beata Wożakowska-Kapłon
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- 2021
9. Echocardiographic predictors of thrombus in left atrial appendage-The role of novel transthoracic parameters
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Damian Kaufmann, Elżbieta Wabich, Agnieszka Kapłon-Cieślicka, Monika Gawałko, Monika Budnik, Beata Uziębło-Życzkowska, Paweł Krzesiński, Katarzyna Starzyk, Beata Wożakowska-Kapłon, Maciej Wójcik, Robert Błaszczyk, Jarosław Hiczkiewicz, Jan Budzianowski, Katarzyna Mizia-Stec, Maciej T. Wybraniec, Katarzyna Kosmalska, Marcin Fijałkowski, Anna Szymańska, Mirosław Dłużniewski, Maciej Haberka, Michał Kucio, Błażej Michalski, Karolina Kupczyńska, Anna Tomaszuk-Kazberuk, Katarzyna Wilk-Śledziewska, Renata Wachnicka-Truty, Marek Koziński, Paweł Burchardt, Ludmiła Daniłowicz-Szymanowicz, RS: Carim - H01 Clinical atrial fibrillation, and Cardiologie
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Medizin ,Cardiology and Cardiovascular Medicine - Abstract
IntroductionThe left atrium appendage thrombus (LAAT) formation is a complex process. A CHA2DS2-VASc scale is an established tool for determining the thromboembolic risk and initiation of anticoagulation treatment in patients with atrial fibrillation or flutter (AF/AFL). We aimed to identify whether any transthoracic echocardiography (TTE) parameters could have an additional impact on LAAT detection.MethodsThat is a sub-study of multicenter, prospective, observational study LATTEE (NCT03591627), which enrolled 3,109 consecutive patients with AF/AFL referred for transesophageal echocardiography (TEE) before cardioversion or ablation.ResultsLAAT was diagnosed in 8.0% of patients. The univariate logistic regression analysis [based on pre-specified in the receiver operating characteristic (ROC) analysis cut-off values with AUC ≥ 0.7] identified left ventricular ejection fraction (LVEF) ≤ 48% and novel TTE parameters i.e., the ratios of LVEF and left atrial diameter (LAD) ≤ 1.1 (AUC 0.75; OR 5.64; 95% CI 4.03–7.9; p < 0.001), LVEF to left atrial area (LAA) ≤ 1.7 (AUC 0.75; OR 5.64; 95% CI 4.02–7.9; p < 0.001), and LVEF to indexed left atrial volume (LAVI) ≤ 1.1 (AUC 0.75, OR 6.77; 95% CI 4.25–10.8; p < 0.001) as significant predictors of LAAT. In a multivariate logistic regression analysis, LVEF/LAVI and LVEF/LAA maintained statistical significance. Calculating the accuracy of the abovementioned ratios according to the CHA2DS2-VASc scale values revealed their highest predictive power for LAAT in a setting with low thromboembolic risk.ConclusionNovel TTE indices could help identify patients with increased probability of the LAAT, with particular applicability for patients at low thromboembolic risk.
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- 2022
10. The prevalence and association of major ECG abnormalities with clinical characteristics and the outcomes of real-life heart failure patients — Heart Failure Registries of the Eu ropean Society of Cardiology
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Jarosław Drożdż, Marcin Grabowski, Paweł Balsam, Agnieszka Kapłon-Cieślicka, Agata Tymińska, Krzysztof Ozierański, Michał Marchel, Grzegorz Opolski, Aldo P. Maggioni, Cezary Maciejewski, María G. Crespo-Leiro, and Krzysztof J. Filipiak
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Male ,Tachycardia ,QRS duration ,medicine.medical_specialty ,Heart rhythm ,medicine.medical_treatment ,Cardiology ,Cardiac resynchronization therapy ,QT interval ,Electrocardiography ,QRS complex ,Internal medicine ,Prevalence ,Humans ,Medicine ,Registries ,cardiovascular diseases ,Heart Failure ,Ejection fraction ,business.industry ,Left bundle branch block ,Left bundle brunch block ,valvular heart disease ,Stroke Volume ,medicine.disease ,Electrocardiogram ,Heart failure ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
[Abstract] Background: Electrocardiogram (ECG) abnormalities increase the likelihood of heart failure (HF) but have low specificity and their occurrence is multifactorial. Aim: This study aimed to investigate the prevalence and association of major ECG abnormalities with clinical characteristics and outcomes in a large cohort of real-life HF patients enrolled in HF Registries (Pilot and Long-Term) of the European Society of Cardiology. Methods: Standard 12-lead ECG containing at least one of the following simple parameters was considered a major abnormality: abnormal rhythm; >100 bpm; QRS ≥120 ms; QTc ≥450 ms; pathological Q-wave; left ventricle hypertrophy; left bundle branch block. A Cox proportional hazards regression model was used to identify predictors of the primary (all-cause death) and secondary (all-cause death or hospitalization for worsening HF) endpoints. Results: Patients with abnormal ECG (1222/1460; 83.7%) were older, more frequently were male and had HF with reduced ejection fraction, valvular heart disease, comorbidities, higher New York Heart Association class, or higher concentrations of natriuretic peptides as compared to those with normal ECG. In a one-year follow-up, the primary and secondary endpoints occurred more frequently in patients with abnormal ECG compared to normal ECG (13.8% vs 8.4%; P = 0.021 and 33.0% vs 24.7%; P = 0.016; respectively). Abnormal rhythm, tachycardia, QRS ≥120 ms, and QTc ≥450 ms were significant in univariable (both endpoints) analyses but only tachycardia remained an independent predictor of the primary endpoint. Conclusions: HF patients with major ECG abnormalities were characterized by worse clinical status and one-year outcomes. Only tachycardia was an independent predictor of all-cause death.
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- 2021
11. Do Patients with Atrial Fibrillation and a History of Ischemic Stroke Overuse Reduced Doses of NOACs?-Results of the Polish Atrial Fibrillation (POL-AF) Registry
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Anna Szyszkowska, Łukasz Kuźma, Beata Wożakowska-Kapłon, Iwona Gorczyca-Głowacka, Olga Jelonek, Beata Uziębło-Życzkowska, Paweł Krzesiński, Maciej Wójcik, Robert Błaszczyk, Monika Gawałko, Agnieszka Kapłon-Cieślicka, Tomasz Tokarek, Renata Rajtar-Salwa, Jacek Bil, Michał Wojewódzki, Anna Szpotowicz, Małgorzata Krzciuk, Janusz Bednarski, Elwira Bakuła, Marcin Wełnicki, Artur Mamcarz, Anna Tomaszuk-Kazberuk, RS: Carim - H01 Clinical atrial fibrillation, and Cardiologie
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Pyridones ,ANTITHROMBOTIC THERAPY ,Health, Toxicology and Mutagenesis ,Medizin ,Administration, Oral ,WARFARIN ,Fibrinolytic Agents ,ischemic stroke ,Humans ,atrial fibrillation ,Prospective Studies ,Registries ,anticoagulation ,METAANALYSIS ,ORAL ANTICOAGULANTS ,RISK ,Public Health, Environmental and Occupational Health ,Anticoagulants ,reduced dose ,RIVAROXABAN ,EFFICACY ,PREVENTION ,Dabigatran ,SAFETY ,PREDICTING STROKE ,Poland - Abstract
Background: The aim of our study was to assess if patients with AF (atrial fibrillation) and a history of ischemic stroke (IS) excessively receive reduced doses of NOACs (non-vitamin K antagonist oral anticoagulants). Methods: The Polish AF (POL-AF) registry is a prospective, observational, multicenter study, including patients with AF from 10 cardiology hospital centers. In this study we focused on patients with IS in their past. Results: Among 3999 patients enrolled in the POL-AF registry, 479 (12%) had a previous history of IS. Compared to patients without IS history, post-stroke subjects had a higher CHA2DS2-VASc score (median score 7 vs. 4, p < 0.05). Of these subjects, 439 (92%) had anticoagulation therapy, 83 (18.9%) were treated with a vitamin K antagonist (VKA), 135 (30.8%) with rivaroxaban, 112 (25.5%) with dabigatran, and 109 (24.8%) with apixaban. There were a significant number of patients after IS with reduced doses of NOACs (48.9% for rivaroxaban, 45.5% for dabigatran, and 36.7% for apixaban). In many cases, patients were prescribed reduced doses of NOACs without any indication for reduction (28.8% of rivaroxaban use, 56.9% of dabigatran use, and 60.0% of apixaban use—out of reduced dosage groups, p = 0.06). Conclusions: A significant proportion of AF patients received reduced doses of NOAC after ischemic stroke in a sizeable number of cases, without indication for dose reduction.
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- 2022
12. Stand-Alone Left Atrial appendage occlusion for throMboembolism prevention in nonvalvular Atrial fibrillatioN DiseasE Registry (SALAMANDER)
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Mariusz Kowalewski, Wojciech Wańha, Radoslaw Litwinowicz, Michalina Kołodziejczak, Michal Pasierski, Rafal Januszek, Łukasz Kuźma, Marek Grygier, Maciej Lesiak, Agnieszka Kapłon-Cieślicka, Krzysztof Reczuch, Robert Gil, Tomasz Pawłowski, Krzysztof Bartuś, Sławomir Dobrzycki, Roberto Lorusso, Stanislaw Bartuś, Marek Andrzej Deja, Grzegorz Smolka, Wojciech Wojakowski, Piotr Suwalski, MUMC+: MA Cardiothoracale Chirurgie (3), CTC, and RS: Carim - V04 Surgical intervention
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Male ,Anticoagulants ,Urodela ,Hemorrhage ,General Medicine ,Brain Ischemia ,Stroke ,Observational Studies as Topic ,Brain Ischemia/complications ,Treatment Outcome ,Anticoagulants/therapeutic use ,Thromboembolism ,Hemorrhage/chemically induced ,Atrial Fibrillation ,Quality of Life ,Animals ,Humans ,Atrial Appendage ,Female ,Registries ,Atrial Appendage/surgery ,Atrial Fibrillation/complications ,Thromboembolism/etiology ,Stroke/complications - Abstract
IntroductionAtrial fibrillation (AF) is a prevalent disease considerably contributing to the worldwide cardiovascular burden. For patients at high thromboembolic risk (CHA2DS2-VASc ≥3) and not suitable for chronic oral anticoagulation, owing to history of major bleeding or other contraindications, left atrial appendage occlusion (LAAO) is indicated for stroke prevention, as it lowers patient’s ischaemic burden without augmentation in their anticoagulation profile.Methods and analysisStand-Alone Left Atrial appendage occlusion for throMboembolism prevention in nonvalvular Atrial fibrillatioN DiseasE Registry (SALAMANDER) will be conducted in 10 heart surgery and cardiology centres across Poland to assess the outcomes of LAAO performed by fully thoracoscopic-epicardial, percutaneous-endocardial or hybrid endo-epicardial approach. The registry will include patients with nonvalvular AF at a high risk of thromboembolic and bleeding complications (CHA2DS2-VASc Score ≥2 for males, ≥3 for females, HASBLED score ≥2) referred for LAAO. The first primary outcome is composite procedure-related complications, all-cause death or major bleeding at 12 months. The second primary outcome is a composite of ischaemic stroke or systemic embolism at 12 months. The third primary outcome is the device-specific success assessed by an independent core laboratory at 3–6 weeks. The quality of life (QoL) will be assessed as well based on the QoL EQ-5D-5L questionnaire. Medication and drug adherence will be assessed as well.Ethics and disseminationBefore enrolment, a detailed explanation is provided by the investigator and patients are given time to make an informed decision. The patient’s data will be protected according to the requirements of Polish law, General Data Protection Regulation (GDPR) and hospital Standard Operating Procedures. The study will be conducted in accordance with the Declaration of Helsinki. Ethical approval was granted by the local Bioethics Committee of the Upper-Silesian Medical Centre of the Silesian Medical University in Katowice (decision number KNW/0022/KB/284/19). The results will be published in peer-reviewed journals and presented during national and international conferences.Trial registration numberNCT05144958.
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- 2022
13. Increased Body Mass Index and Risk of Left Atrial Thrombus in Nonvalvular Atrial Fibrillation Patients-Data from the Left Atrial Thrombus on Transesophageal Echocardiography (LATTEE) Registry
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Beata Uziębło-Życzkowska, Agnieszka Kapłon-Cieślicka, Marek Kiliszek, Monika Gawałko, Monika Budnik, Katarzyna Starzyk, Beata Wożakowska-Kapłon, Ludmiła Daniłowicz-Szymanowicz, Damian Kaufmann, Maciej Wójcik, Robert Błaszczyk, Jarosław Hiczkiewicz, Katarzyna Łojewska, Katarzyna Mizia-Stec, Maciej T. Wybraniec, Katarzyna Kosmalska, Marcin Fijałkowski, Anna Szymańska, Aleksandra Gos, Maciej Haberka, Michał Kucio, Błażej Michalski, Karolina Kupczyńska, Anna Tomaszuk-Kazberuk, Katarzyna Wilk-Śledziewska, Renata Wachnicka-Truty, Marek Koziński, Paweł Burchardt, Paweł Krzesiński, Cardiologie, and RS: Carim - H01 Clinical atrial fibrillation
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Male ,Nutrition and Dietetics ,Heart Diseases ,MORTALITY ,Medizin ,Thrombosis ,body mass index ,APPENDAGE THROMBUS ,PREVALENCE ,THROMBOEMBOLISM ,atrial flutter ,Risk Factors ,OBESITY ,Humans ,Female ,atrial fibrillation ,Prospective Studies ,Registries ,SMOKING ,left atrial thrombus ,Echocardiography, Transesophageal ,Food Science ,Aged - Abstract
An increased body mass index (BMI) is associated with a higher incidence of atrial fibrillation (AF) and a higher risk of thromboembolic complications in AF patients. The aim of this study was to investigate the effect of BMI on the risk of left atrial thrombi (LATs) in patients with nonvalvular AF/atrial flutter (AFl) (NV AF/AFl). Patients diagnosed with NVAF/AFl (between November 2018 and May 2020) were selected from the multicenter, prospective, observational Left Atrial Thrombus on Transesophageal Echocardiography (LATTEE) registry that included AF/AFl patients referred for cardioversion or ablation followed by transesophageal echocardiography. A total of 2816 AF/AFl patients (63.6% males; mean age 65.8 years; mean BMI 29.8 kg/m2) were included in the study. Two hundred and twenty-two of them (7.9%) had LATs. Compared with normal-weight patients, those with BMIs ≥ 25 kg/m2 more frequently presented clinical factors potentially provoking LATs, such as non-paroxysmal AF/AFl (p = 0.04), hypertension (p < 0.001), and diabetes (p < 0.001); had higher CHA2DS2 scores (p < 0.001); and had larger LA dimensions (LA diameter and LA area) (p < 0.001 for both parameters). On the other hand, they showed some features negatively related to thromboembolic risk; for example, they were younger (p < 0.001) and were more often male (p = 0.002). In addition, patients with abnormal BMIs were more likely to be smokers (p = 0.006) and to be treated with oral anticoagulants (p = 0.005). Despite these differences in the prevalence of thromboembolic risk factors, the incidence of LATs was not increased in patients with abnormal body weight (overweight and obese compared to normal-weight patients) in this large real-life cohort of AF/AFl patients. This is probably due to the balanced composition regarding the prevalence of positive and negative thromboembolic risk factors.
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- 2022
14. Differences in the predictors of left atrial appendage thrombus between men and women treated with dabigatran or rivaroxaban
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Agnieszka Ciba-Stemplewska, Iwona Gorczyca-Głowacka, Agnieszka Kapłon-Cieślicka, Beata Uziębło-Życzkowska, Monika Budnik, Monika Gawałko, Paweł Krzesiński, Agnieszka Jurek, Piotr Scisło, Krzysztof J. Filipiak, Grzegorz Opolski, and Beata Wożakowska-Kapłon
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Male ,Heart Diseases ,Rivaroxaban ,Atrial Fibrillation ,Internal Medicine ,Anticoagulants ,Humans ,Atrial Appendage ,Female ,Thrombosis ,Dabigatran ,Retrospective Studies - Abstract
Some patients with atrial fibrillation (AF) develop left atrial appendage thrombus (LAAT) despite receiving anticoagulant treatment. Different scores were proposed to evaluate thromboembolic risk in patients with AF. Risk stratification according to sex is common in clinical practice.We aimed to identify predictors of LAAT separately in men and women treated with dabigatran or rivaroxaban.This retrospective study included 1256 patients (479 women [38.1%]) with AF who underwent transesophageal echocardiography before electrical cardioversion or catheter ablation, between January 2013 and December 2019, and received dabigatran or rivaroxaban for at least 3 weeks.Multivariable logistic regression analysis revealed nonparoxysmal AF to predict LAAT in women (odds ratio [OR], 9.70; P = 0.002). In men, the predictors were heart failure (OR, 4.14; P = 0.001), diabetes (OR, 2.64; P = 0.002), nonparoxysmal AF (OR, 5.61; P = 0.02), and estimated glomerular filtration rate below 60 ml/min/1.73 m2 (OR, 2.77; P = 0.01). In the receiver operating characteristic curve analysis, the CHA2DS2‑VASc-RAF score had the highest value for predicting LAAT in women (area under the curve [AUC] = 0.786). In men, CHA2DS2‑VASc-RAF, CHA2DS2, CHA2DS2‑VASc, and R2CHADS2 had sufficient predictive value (AUC = 0.786, 0.726, 0.734, and 0.780, respectively).The predictors of LAAT differ between men and women treated with dabigatran or rivaroxaban. In women, the CHA2DS2‑VASc‑RAF score had the highest predictive value, while in men all the scores had equally sufficient predictive value.
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- 2022
15. Metabolic syndrome - a new definition and management guidelines: A joint position paper by the Polish Society of Hypertension, Polish Society for the Treatment of Obesity, Polish Lipid Association, Polish Association for Study of Liver, Polish Society of Family Medicine, Polish Society of Lifestyle Medicine, Division of Prevention and Epidemiology Polish Cardiac Society, 'Club 30' Polish Cardiac Society, and Division of Metabolic and Bariatric Surgery Society of Polish Surgeons
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Piotr Dobrowolski, Aleksander Prejbisz, Alina Kuryłowicz, Alicja Baska, Paweł Burchardt, Krzysztof Chlebus, Grzegorz Dzida, Piotr Jankowski, Jerzy Jaroszewicz, Paweł Jaworski, Karol Kamiński, Agnieszka Kapłon-Cieślicka, Marek Klocek, Michał Kukla, Artur Mamcarz, Agnieszka Mastalerz-Migas, Krzysztof Narkiewicz, Lucyna Ostrowska, Daniel Śliż, Wiesław Tarnowski, Jacek Wolf, Mariusz Wyleżoł, Tomasz Zdrojewski, Maciej Banach, Andrzej Januszewicz, and Paweł Bogdański
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General Medicine - Published
- 2022
16. Fifteen-Year Differences in Indications for Cardiac Resynchronization Therapy in International Guidelines—Insights from the Heart Failure Registries of the European Society of Cardiology
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Agata Tymińska, Krzysztof Ozierański, Emil Brociek, Agnieszka Kapłon-Cieślicka, Paweł Balsam, Michał Marchel, Maria G. Crespo-Leiro, Aldo P. Maggioni, Jarosław Drożdż, Grzegorz Opolski, and Marcin Grabowski
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Cardiac resynchronization therapy ,Cardiomyopathy ,Heart failure ,General Medicine ,cardiac resynchronization therapy ,heart failure ,cardiomyopathy ,left bundle branch block ,Left bundle branch block - Abstract
Cardiac resynchronization therapy (CRT) applied to selected patients with heart failure (HF) improves their prognosis. In recent years, eligibility criteria for CRT have regularly changed. This study aimed to investigate the changes in eligibility of real-life HF patients for CRT over the past fifteen years. We reviewed European and North American guidelines from this period and applied them to HF patients from the ESC-HF Pilot and ESC-Long-Term Registries. Taking into consideration the criteria assessed in this study (including all classes of recommendations i.e., class I, IIa and IIb, as well as patients with AF and SR), the 2013 (ESC) guidelines would have qualified the most patients for CRT (266, 18.3%), while the 2015 (ESC) guidelines would have qualified the least (115, 7.9%; p-value for differences between all analyzed papers
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- 2022
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17. Fourth universal definition of myocardial infarction. Selected messages from the European Society of Cardiology document and lessons learned from the new guidelines on ST-segment elevation myocardial infarction and non-ST-segment elevation-acute coronary syndrome
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Szymon Darocha, Justyna Domienik-Karłowicz, Wojciech Wańha, Karolina Kupczyńska, Miłosz Jaguszewski, Błażej Michalski, Maciej T. Wybraniec, Piotr Dobrowolski, and Agnieszka Kapłon-Cieślicka
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Acute coronary syndrome ,medicine.medical_specialty ,business.industry ,Cardiology ,Myocardial Infarction ,Elevation ,MEDLINE ,General Medicine ,medicine.disease ,Editorial ,Internal medicine ,medicine ,Humans ,ST Elevation Myocardial Infarction ,ST segment ,Myocardial infarction ,Acute Coronary Syndrome ,Cardiology and Cardiovascular Medicine ,business - Published
- 2021
18. Antithrombotic therapy in patients with atrial fibrillation undergoing percutaneous coronary intervention, including compliance with current guidelines—data from the POLish Atrial Fibrillation (POL-AF) Registry
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Anna Szyszkowska, Marcin Wełnicki, Robert Błaszczyk, Tomasz Tokarek, Monika Gawałko, Artur Mamcarz, Maciej Wójcik, Paweł Krzesiński, Jacek Bil, Janusz Bednarski, Małgorzata Maciorowska, Elwira Bakuła-Ostalska, Renata Rajtar-Salwa, Agnieszka Kapłon-Cieślicka, Małgorzata Krzciuk, Olga Jelonek, Beata Uziębło-Życzkowska, Michał Wojewódzki, Iwona Gorczyca, Anna Szpotowicz, Anna Tomaszuk-Kazberuk, and Beata Wożakowska-Kapłon
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Acute coronary syndrome ,medicine.medical_specialty ,Rivaroxaban ,business.industry ,medicine.medical_treatment ,Percutaneous coronary intervention ,Atrial fibrillation ,030204 cardiovascular system & hematology ,medicine.disease ,Dabigatran ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Conventional PCI ,Antithrombotic ,medicine ,Original Article ,Apixaban ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
Background Although triple antithrombotic therapy (TAT) is recommended in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI), guidelines allow an option of dual antithrombotic therapy (DAT). This study assesses the everyday practice of 10 cardiology departments in antithrombotic therapy in AF patients undergoing PCI and its agreement with current guidelines. Methods This analysis included medical data of AF patients enrolled in the prospective, observational registry (The POLish Atrial Fibrillation-POL-AF) that underwent PCI [elective or due to acute coronary syndrome (ACS)]. Results Of the 3,999 consecutive subjects included, a final analysis was performed on 359 patients that underwent PCI: 148 with urgent PCI due to ACSand 211 patients with elective PCI. Eighty patients in the ACS-group and 120 patients in the elective-PCI group were treated with TAT, although guidelines also allowed DAT. Of 316 patients treated with oral anticoagulants as a part of combination therapy, 275 were on non-vitamin K antagonist oral anticoagulant (NOAC). Reduced doses of NOAC were used in 74 patients treated with rivaroxaban, 60 patients with dabigatran, and 54 patients with apixaban. The proportion of patients treated with reduced NOAC doses adequately to the guidelines was 29%, 100%, and 33% for rivaroxaban, dabigatran, and apixaban, respectively. Inappropriate low doses of NOACs were used in 71% of subjects on rivaroxaban and 67% on apixaban. Conclusions In patients with AF undergoing PCI, NOACs are definitely preferred over vitamin-K antagonists (VKAs) in TAT/DAT, and an aggressive antithrombotic strategy with TAT is frequently chosen even if DAT is permissible by the guidelines. Label adherence of using reduced NOAC dose during combination therapy is not satisfactory for apixaban and rivaroxaban and probably results from too cautious an approach to the known indications for reduced therapy. The study is registered in the database Clinical Trials-NCT04419012.
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- 2021
19. Do we need a definition of acute heart failure with preserved ejection fraction?
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Lars Lund and Agnieszka Kapłon-Cieślicka
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Male ,medicine.medical_specialty ,animal structures ,heart failure decompensation ,diagnosis ,Heart Ventricles ,Review Article ,Ventricular Function, Left ,Internal medicine ,medicine ,Humans ,Aged ,Aged, 80 and over ,Heart Failure ,business.industry ,Stroke Volume ,General Medicine ,Middle Aged ,medicine.disease ,Dyspnea ,Heart failure with preserved ejection fraction ,Echocardiography ,Heart failure ,Cardiology ,Female ,diastolic dysfunction ,Cardiology & Cardiovascular Disorders ,business - Abstract
Heart failure with preserved ejection fraction (HFpEF) might soon become the most prevalent type of acute heart failure. Still, despite more than 30 years of research on HFpEF, not only do we lack specific treatment, but also a generally accepted definition of HFpEF. Since 2016, several definitions and algorithms have been proposed for diagnosing both diastolic dysfunction and overt HFpEF. However, all of them focus exclusively on chronic (and not acute) HFpEF. Recent studies showed that acute HFpEF may be overdiagnosed in patients presenting with acute dyspnoea. The aim of our article was to address two questions: (1) why there is a need for specific diagnostic criteria for acute HFpEF, and (2) what such definition of acute HFpEF should encompass.KEY MESSAGES:Several scores and algorithms have been proposed for diagnosing chronic heart failure with preserved ejection fraction (HFpEF), however, so far, there is no definition of acute HFpEF.Acute HFpEF seems to be overdiagnosed in patients presenting with acute dyspnoea.Definition of acute HFpEF should comprise both (1) features of chronic HFpEF and (2) markers of increased left ventricular filling pressures and/or of pulmonary congestion.
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- 2021
20. Is transoesophageal echocardiography necessary before electrical cardioversion in patients treated with non-vitamin K antagonist oral anticoagulants? Current evidence and practical approach
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Iwona Gorczyca, Beata Uziębło-Życzkowska, Paweł Krzesiński, and Agnieszka Kapłon-Cieślicka
- Abstract
Background: According to current guidelines, non-vitamin K antagonist oral anticoagulants (NOACs) should be used at least 3 weeks before planned ECV. In accordance with international atrial fibrillation (AF) guidelines, transoesophageal echocardiography (TOE) is a pre-procedural examination recommended as an alternative to the adequate oral anticoagulation. Hypothesis: The strategy related to qualifying patients treated with NOACs for pre-procedural TOE differs in individual centers. Therefore, it is necessary to create an algorithm that will standardize estimation of left atrial appendage thrombus (LAAT) prevalence risk and thereby qualify NOAC treated patients to TOE in the most effective way. Methods: We assessed the available studies on LAAT predictors. Results: Risk factors for LAAT formation are not necessarily the same as the risk factors for thromboembolic events in patients with AF. The main risk factor for LAAT are: previous intracardiac thrombus, irregular use of NOAC, inappropriate dose reduction of NOAC, previous stroke, CHA2DS2-VASc score ≥ 3 points, GFR
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- 2022
21. Do Patients With Acute Heart Failure and Preserved Ejection Fraction Have Heart Failure at Follow-Up: Implications of the Framingham Criteria
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Lars Lund, Camilla Hage, U. Lofstrom, Jean-Claude Daubert, Cecilia Linde, Agnieszka Kapłon-Cieślicka, Emmanuel Oger, Erwan Donal, Karolinska Institutet [Stockholm], CIC-IT Rennes, Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pontchaillou [Rennes], Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Medical University of Warsaw - Poland, MedtronicMedtronic, St. Jude MedicalSt. Jude Medical, Jonchère, Laurent, Université de Rennes 1 (UR1), and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM)
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Tachycardia ,medicine.medical_specialty ,Diastolic function ,Pleural effusion ,Aftercare ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Aged ,Heart Failure ,[SDV.IB] Life Sciences [q-bio]/Bioengineering ,Framingham Risk Score ,Ejection fraction ,Framingham criteria ,business.industry ,Stroke Volume ,Odds ratio ,Prognosis ,HFpEF ,Heart failure diagnosis ,medicine.disease ,Patient Discharge ,[SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,3. Good health ,Valsartan ,Heart failure ,Ambulatory ,Cardiology ,[SDV.IB]Life Sciences [q-bio]/Bioengineering ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
International audience; Background - Heart failure (HF) with preserved ejection fraction (HFpEF) may be misdiagnosed. We assessed prevalence and consistency of Framingham criteria signs and symptoms in acute vs subsequent stable HFpEF. Methods - Three hundred ninety-nine patients with acute HFpEF according to Framingham criteria were re-assessed in stable condition. Four definitions of HFpEF at follow-up: (1) Framingham criteria alone, (2) Framingham criteria and natriuretic peptides (NPs), (3) Framingham criteria, NPs, and European Society of Cardiology HF guidelines echocardiographic criteria, (4) Framingham criteria, NPs, and the Efficacy and Safety of LCZ696 Compared to Valsartan, on Morbidity and Mortality in Heart Failure Patients With Preserved Ejection Fraction (PARAGON) trial echocardiographic criteria. Results - At follow-up, HFpEF was still present in 27%, 22%, 21%, and 22%, respectively. Most prevalent in acute HFpEF were dyspnea at exertion (90%), pulmonary rales (71%), persisting at follow-up in 70% and 13%, respectively. Characteristics at acute HF with greater or lesser odds of stable HFpEF; (1) jugular venous distention (odds ratio [OR] 1.80, 95% confidence interval [CI] 1.13-2.87; P = .013) and pleural effusion (OR 0.45, 95% CI 0.24-0.85; P = .014) and (4), older age (1.04, 95% CI 1.01-1.08; P = .014) and tachycardia (>100 bpm) 0.52, 95% CI 0.27-1.00; P = .048). Conclusions - In patients with acute HFpEF, one-quarter met the HF definition according to Framingham criteria at ambulatory follow-up. The proportion of patients with postdischarge HFpEF was largely unaffected by additional echocardiographic or NP criteria Older age and jugular venous distention at acute presentation predicted persistent HFpEF at follow-up, whereas pleural effusion and tachycardia may yield false HFpEF diagnoses. This finding has implications for HFpEF trial design.
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- 2020
22. Safety of rosuvastatin and ezetimibe combination therapy
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Agnieszka Kapłon-Cieślicka and Karolina Semczuk-Kaczmarek
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medicine.medical_specialty ,Combination therapy ,Ezetimibe ,business.industry ,Urology ,Medicine ,Rosuvastatin ,General Medicine ,business ,medicine.drug - Published
- 2020
23. Thrombus in the left atrial appendage in patients with atrial fibrillation treated with non‐vitamin K antagonist oral anticoagulants in clinical practice—A multicenter registry
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Piotr Scisło, Magdalena Chrapek, Marek Kiliszek, Katarzyna Starzyk, Beata Uziębło-Życzkowska, Iwona Gorczyca, Olga Jelonek, Agnieszka Jurek, Anna Michalska, Paweł Krzesiński, Monika Budnik, Agnieszka Kapłon-Cieślicka, Janusz Kochanowski, Grzegorz Gielerak, Beata Wożakowska-Kapłon, Grzegorz Opolski, Monika Gawałko, and Krzysztof J. Filipiak
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medicine.medical_specialty ,medicine.drug_class ,medicine.medical_treatment ,Administration, Oral ,Renal function ,Catheter ablation ,030204 cardiovascular system & hematology ,Dabigatran ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Physiology (medical) ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,Atrial Appendage ,Registries ,030212 general & internal medicine ,Thrombus ,Rivaroxaban ,business.industry ,Anticoagulants ,Thrombosis ,Atrial fibrillation ,Middle Aged ,Vitamin K antagonist ,medicine.disease ,Cardiology ,Female ,Apixaban ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
BACKGROUND The prevalence and predictors of left atrial appendage thrombus (LAAT) in patients with non-valvular atrial fibrillation (AF) who have been treated with non-vitamin K antagonist oral anticoagulants (NOACs) are not well defined. We aimed to assess the occurrence and predictors of LAAT on transesophageal echocardiography (TOE) in patients with non-valvular AF treated with NOACs for at least 3 weeks. METHODS Consecutive patients with non-valvular AF who underwent TOE before catheter ablation or electrical cardioversion in three high-reference centers between 2014 and 2018 were included. Patients on apixaban were excluded from the study due to low numbers in this category. All patients received NOACs for at least 3 weeks before TOE. RESULTS A total of 1148 patients (female, 38.1%; mean age, 62.1 years) referred to our centers for catheter ablation of AF (52.1%) or electrical cardioversion (47.9%) were included. Patients were on rivaroxaban (51.9%) or dabigatran (48.1%). Preprocedural TOE revealed LAAT in 4.4% of all patients. Multivariable logistic regression analysis showed the CHA2DS2-VASc score ≥2 points (OR = 2.11; 95% CI, 1.15-3.88; P = .0161), non-paroxysmal AF (OR = 6.30; 95% CI, 2.22-17.91; P = .0005), and GFR
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- 2020
24. Left Ventricular Ejection Fraction Is Associated with the Risk of Thrombus in the Left Atrial Appendage in Patients with Atrial Fibrillation
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Grzegorz Gielerak, Beata Wożakowska-Kapłon, Agnieszka Kapłon-Cieślicka, Marek Kiliszek, Agnieszka Jurek, Iwona Gorczyca, Piotr Scisło, Janusz Kochanowski, Beata Uziębło-Życzkowska, Olga Jelonek, Monika Budnik, Paweł Krzesiński, Krzysztof J. Filipiak, Katarzyna Starzyk, Monika Gawałko, Grzegorz Opolski, and Anna Michalska
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Male ,medicine.medical_treatment ,Administration, Oral ,030204 cardiovascular system & hematology ,Cardioversion ,Ventricular Function, Left ,Ventricular Dysfunction, Left ,0302 clinical medicine ,Risk Factors ,Atrial Fibrillation ,Pharmacology (medical) ,030212 general & internal medicine ,Aged, 80 and over ,Ejection fraction ,Incidence ,Incidence (epidemiology) ,Atrial fibrillation ,General Medicine ,Stroke volume ,Middle Aged ,Prognosis ,Ablation ,cardiovascular system ,Cardiology ,Atrial Function, Left ,Female ,Cardiology and Cardiovascular Medicine ,Research Article ,circulatory and respiratory physiology ,Adult ,medicine.medical_specialty ,Adolescent ,Article Subject ,RM1-950 ,Risk Assessment ,Young Adult ,03 medical and health sciences ,Internal medicine ,medicine ,Humans ,Diseases of the circulatory (Cardiovascular) system ,Atrial Appendage ,cardiovascular diseases ,Thrombus ,Aged ,Retrospective Studies ,Pharmacology ,business.industry ,Anticoagulants ,Stroke Volume ,Thrombosis ,Retrospective cohort study ,Atrial Remodeling ,medicine.disease ,RC666-701 ,Poland ,Therapeutics. Pharmacology ,business ,Echocardiography, Transesophageal - Abstract
Introduction. Atrial fibrillation (AF) is associated with high risk of ischemic stroke. The most frequent thrombus location in AF is the left atrial appendage (LAA). Transthoracic echocardiography (TTE) is a basic diagnostic examination in patients (pts) with AF. Objectives. To analyse the relations between basic echocardiographic features, well-established stroke risk factors, type of AF, and anticoagulation therapy with the incidence of left atrial appendage thrombus (LAAT). Patients and Methods. The study group consisted of 768 pts with AF (mean age, 63 years), admitted to three high-reference cardiology departments. Five hundred and twenty-three pts were treated with non-vitamin K antagonist oral anticoagulants (NOACs) and 227 (30%) with vitamin K antagonists (VKAs). The subjects underwent TTE and transesophageal echocardiography (TEE) before cardioversion or ablation. Results. LAAT was significantly more frequent in pts with reduced left ventricular ejection fraction (LVEF): in 10.6% (7 pts) with LVEF<40% and in 9.0% (9 pts) with LVEF 40-49%, while only in 5.5% (33 pts) with LVEF>50%. Compared to pts without LAAT, those with LAAT presented with lower LVEF and higher left atrial diameter (LAD). Multivariate logistic regression revealed the following variables as independent predictors of LAAT: previous bleeding, treatment with VKA, and LVEF. Conclusion. LAAT is related to lower LVEF and higher LAD. LVEF is one of the independent predictors of LAAT. Even in the case of adequate anticoagulant therapy, it might be prudent to consider TEE before cardioversion or ablation in patients with low LVEF and LA enlargement, especially in the coexistence of other thromboembolic risk factors.
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- 2020
25. Heart rate control and its predictors in patients with heart failure and sinus rhythm. Data from the European Society of Cardiology Long-Term Registry
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Agata Tymińska, Krzysztof Ozierański, Marek Wawrzacz, Paweł Balsam, Cezary Maciejewski, Magdalena Kleszczewska, Magdalena Zawadzka, Michał Marchel, Maria G. Crespo-Leiro, Aldo P. Maggioni, Jarosław Drożdż, Grzegorz Opolski, Marcin Grabowski, and Agnieszka Kapłon-Cieślicka
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General Medicine ,Cardiology and Cardiovascular Medicine - Abstract
Higher resting heart rate (HR) in patients with heart failure (HF) and sinus rhythm (SR) is associated with increased mortality. In patients hospitalized for HF, the aim herein, was to assess the use and dosage of guideline-recommended HR lowering medications, HR control at discharge and predictors of HR control.In the present study, were Polish participants of the European Society of Cardiology HF Long-Term (ESC-HF-LT) Registry. Those selected were hospitalized for HF, with reduced ejection fraction (HFrEF) and SR at discharge (n = 236). The patients were divided in two groups (70 and ≥ 70 bpm). Logistic regression was used to identify the predictors of HR ≥ 70 bpm.Of patients with HFrEF and SR, 59% had HR ≥ 70 bpm at hospital discharge. At discharge, 96% and only 0.5% of the patients with HFrEF and SR received beta-blocker and ivabradine, respectively. In the HF groups70 and ≥ 70 bpm, only 11% and 4% of patients received beta-blocker target doses, respectively. There was no difference in the use of other guideline-recommended medications. Age, New York Heart Association class, HR on admission and lack of HR lowering medications were predictors of discharge HR ≥ 70 bpm.Heart rate control after hospitalization for HFrEF is unsatisfactory, which may be attributed to suboptimal doses of beta-blockers, and negligence in use other HR lowering drugs (including ivabradine).
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- 2022
26. Personalized Management of Myocarditis and Inflammatory Cardiomyopathy in Clinical Practice
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Agata Tymińska, Krzysztof Ozierański, Aleksandra Skwarek, Agnieszka Kapłon-Cieślicka, Anna Baritussio, Marcin Grabowski, Renzo Marcolongo, and Alida LP Caforio
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Inflammation ,Anti-heart autoantibodies ,Individualized ther-apy ,Endomyocardial biopsy ,Heart failure ,Immunosuppressive treatment ,Personalized medicine ,Medicine (miscellaneous) - Abstract
Myocarditis is an inflammatory heart disease induced by infectious and non-infectious causes frequently triggering immune-mediated pathologic mechanisms leading to myocardial damage and dysfunction. In approximately half of the patients, acute myocarditis resolves spontaneously while in the remaining cases, it may evolve into serious complications including inflammatory cardiomyopathy, arrhythmias, death, or heart transplantation. Due to the large variability in clinical presentation, unpredictable course of the disease, and lack of established causative treatment, myocarditis represents a challenging diagnosis in modern cardiology. Moreover, an increase in the incidence of myocarditis and inflammatory cardiomyopathy has been observed in recent years. However, there is a growing potential of available non-invasive diagnostic methods (biomarkers, serum anti-heart autoantibodies (AHA), microRNAs, speckle tracking echocardiography, cardiac magnetic resonance T1 and T2 tissue mapping, positron emission tomography), which may refine the diagnostic workup and/or noninvasive follow-up. Personalized management should include the use of endomyocardial biopsy and AHA, which may allow the etiopathogenetic subsets of myocarditis (infectious, non-infectious, and/or immune-mediated) to be distinguished and implementation of disease-specific therapies. In this review, we summarize current knowledge on myocarditis and inflammatory cardiomyopathy, and outline some practical diagnostic, therapeutic, and follow-up algorithms to facilitate comprehensive individualized management of these patients.
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- 2022
27. Diagnostic challenges to determine the cause of pulmonary hypertension in a patient with heart failure with preserved ejection fraction and borderline pulmonary artery wedge pressure
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Katarzyna Pieniak, Aleksandra Gąsecka, Arkadiusz Pietrasik, Piotr Scisło, Szymon Darocha, Marta Banaszkiewicz, Marcin Kurzyna, Agnieszka Kapłon-Cieślicka, and Laboratory Specialized Diagnostics & Research
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Heart Failure ,Hypertension, Pulmonary ,Humans ,Stroke Volume ,Pulmonary Wedge Pressure ,Pulmonary Artery ,Cardiology and Cardiovascular Medicine ,Ventricular Function, Left - Published
- 2022
28. Metabolic risk reduction in patients with schizophrenia treated with antipsychotics: recommendations of the Polish Psychiatric Association
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Przemyslaw Bienkowski, Jerzy Samochowiec, Adam Wichniak, Janusz Heitzman, Dominika Dudek, Agata Szulc, Agnieszka Kapłon-Cieślicka, and Artur Mamcarz
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education.field_of_study ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Population ,Metabolic risk ,Physical examination ,General Medicine ,medicine.disease ,030227 psychiatry ,03 medical and health sciences ,Psychiatry and Mental health ,0302 clinical medicine ,Schizophrenia ,medicine ,Life expectancy ,Medical history ,Antipsychotic ,Risk assessment ,education ,Psychiatry ,business - Abstract
Chorzy na schizofrenię są podatni na schorzenia somatyczne, co powoduje, że ich oczekiwana długość życia jest o około 20 lat krótsza niż w populacji ogólnej. Spośród schorzeń somatycznych występujących u chorych na schizofrenię do najczęstszych należą zaburzenia metaboliczne i choroby układu sercowo-naczyniowego. Celem artykułu jest przedstawienie rekomendacji na temat redukcji ryzyka metabolicznego u chorych na schizofrenię przyjmujących leki przeciwpsychotyczne, przyjętych jako stanowisko Polskiego Towarzystwa Psychiatrycznego z zaleceniem ich stosowania w leczeniu osób chorych na schizofrenię w Polsce. Rutynowa ocena ryzyka metabolicznego u chorych na schizofrenię zalecana jest w celu wczesnego wykrywania zaburzeń metabolicznych oraz monitorowania bezpieczeństwa leczenia przeciwpsychotycznego. Ocena obejmuje: dane z wywiadu, badanie przedmiotowe, badania laboratoryjne. U każdego chorego należy wykonać taką ocenę przed rozpoczęciem leczenia, po 6 i 12 tygodniach po jego włączeniu, a następnie przynajmniej raz w roku. Ponadto, u mężczyzn powyżej 40. roku życia oraz u kobiet powyżej 50. roku życia chorujących na schizofrenię zaleca się ocenę ryzyka sercowo-naczyniowego z zastosowaniem karty ryzyka SCORE. W celu redukcji ryzyka metabolicznego u chorych na schizofrenię należy stosować leki przeciwpsychotyczne z niskim ryzykiem powodowania zaburzeń metabolicznych i zalecać je we właściwej dawce. W przypadku stosowania innych leków i wystąpienia zaburzeń metabolicznych modyfikować leczenie poprzez augmentację lub zmianę leczenia na inny lek przeciwpsychotyczny o niskim ryzyku powodowania zaburzeń metabolicznych. Kierować pacjentów na konsultacje internistyczną i stosować leczenie somatyczne. Zachęcać chorych do regularnej aktywności fizycznej i kształtować u nich właściwe nawyki żywieniowe. Motywować pacjentów do zaprzestania palenia tytoniu, picia alkoholu i stosowania substancji psychoaktywnych.
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- 2019
29. Influence of Apnea Hypopnea Index and the Degree of Airflow Limitation on Endothelial Function in Patients Undergoing Diagnostic Coronary Angiography
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Dorota Ochijewicz, Adam Rdzanek, Tadeusz Przybyłowski, Renata Rubinsztajn, Monika Budnik, Ewa Pędzich, Katarzyna Białek-Gosk, Piotr Bielicki, and Agnieszka Kapłon-Cieślicka
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General Immunology and Microbiology ,General Agricultural and Biological Sciences ,General Biochemistry, Genetics and Molecular Biology ,obstructive sleep apnea ,endothelial dysfunction ,chronic coronary syndrome - Abstract
Background: Obstructive sleep apnea is associated with an increased prevalence of cardiovascular disease. The mechanism of these associations is not completely understood. We aimed to investigate the association of the apnea hypopnea index and the degree of airflow limitation with endothelial dysfunction. Methods: This was a single-center prospective study of patients admitted for diagnostic coronary angiography (CAG). Endothelial function was assessed by the non-invasive EndoPAT system by reactive hyperemia index (RHI) and divided into two groups: endothelial dysfunction and normal endothelial function. Sleep apnea signs were detected by WatchPAT measuring the respiratory disturbance index (pRDI), the apnea and hypopnea index (pAHI), and the oxygen desaturation index (ODI). Patients underwent spirometry and body plethysmography. Based on CAG, the severity of coronary artery disease was assessed as follows: no significant coronary artery disease, single-, two- and three-vessel disease. Results: A total of 113 patients were included in the study. Breathing disorders measured by WatchPAT and spirometry were more severe in patients with endothelial dysfunction: pRDI (27.3 vs. 14.8, p = 0.001), pAHI (24.6 vs. 10.3, p < 0.001), ODI (13.7 vs. 5.2, p = 0.002), forced expiratory volume in one second (FEV1) (81.2 vs. 89, p = 0.05). In a multivariate regression analysis, pAHI and FEV1 were independent predictors of endothelial dysfunction assessed by RHI. There was no correlation between the severity of coronary artery disease and endothelial dysfunction. Conclusions: Obstructive sleep apnea signs and greater airflow limitation were associated with endothelial dysfunction regardless of the severity of the coronary artery disease.
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- 2021
30. Trimethylamine-N-oxide (TMAO) versus echocardiographic, biochemical and histopathological indices of heart failure in patients with severe aortic stenosis: Rationale and design of the prospective, observational TASTE study
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Aleksandra Gąsecka, Łukasz Rzepa, Michał Konwerski, Magdalena Zawadzka, Karol Wysocki, Monika Budnik, Paweł Czub, Radosław Wilimski, Mateusz Wondołkowski, Joanna Wilczyńska-Burlikowska, Piotr Scisło, Marek Konop, Zenon Huczek, Janusz Kochman, Janusz Kochanowski, Grzegorz Opolski, Krzysztof J. Filipiak, Marcin Ufnal, and Agnieszka Kapłon-Cieślicka
- Subjects
Heart Failure ,Methylamines ,Echocardiography ,Taste ,Humans ,Oxides ,General Medicine ,Aortic Valve Stenosis ,Prospective Studies ,Cardiology and Cardiovascular Medicine - Published
- 2021
31. Is transesophageal echocardiography necessary before electrical cardioversion in patients treated with non-vitamin K antagonist oral anticoagulants? Current evidence and practical approach
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Iwona Gorczyca, Beata Uziębło-Życzkowska, Agnieszka Major, Agnieszka Kapłon-Cieślicka, and Paweł Krzesiński
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medicine.medical_specialty ,Ejection fraction ,medicine.drug_class ,business.industry ,Renal function ,Atrial fibrillation ,General Medicine ,Vitamin K antagonist ,medicine.disease ,Internal medicine ,medicine ,Left atrial enlargement ,Cardiology ,Risk factor ,Thrombus ,Cardiology and Cardiovascular Medicine ,business ,Stroke - Abstract
According to current guidelines, non-vitamin K antagonist oral anticoagulants (NOACs) should be used at least 3 weeks before planned electrical cardioversion. In accordance with international atrial fibrillation (AF) guidelines, transesophageal echocardiography (TEE) is a pre-procedural examination recommended as an alternative to adequate oral anticoagulation. The strategy related to qualifying patients treated with NOACs for pre-procedural TEE differs in individual centers. Therefore, it is necessary to create an algorithm that will standardize estimation of left atrial appendage thrombus (LAAT) prevalence risk and thereby qualify NOAC-treated patients to TEE in the most effective way. We assessed the available studies on LAAT predictors. Risk factors for LAAT formation are not necessarily the same as the risk factors for thromboembolic events in patients with AF. The main risk factor for LAAT are as follows: previous intracardiac thrombus, irregular use of NOAC, inappropriate dose reduction of NOAC, previous stroke, CHA₂DS₂-VASc score ≥ 3 points, glomerular filtration rate < 60 mL/min/1.73 m2, reduced left ventricular ejection fraction, or left atrial enlargement. Based on available evidence, we proposed algorithm guarantees more systematic approach to performing TEE in patients undergoing electrical cardioversion.
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- 2021
32. Why Did All Patients with Atrial Fibrillation and High Risk of Stroke Not Receive Oral Anticoagulants? Results of the Polish Atrial Fibrillation (POL-AF) Registry
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Marcin Wełnicki, Elwira Bakuła-Ostalska, Małgorzata Maciorowska, Jacek Bil, Beata Uziębło-Życzkowska, Robert Błaszczyk, Janusz Bednarski, Tomasz Tokarek, Agnieszka Kapłon-Cieślicka, Maciej Wójcik, Monika Gawałko, Iwona Gorczyca, Anna Tomaszuk-Kazberuk, Monika Budnik, Anna Szpotowicz, Beata Wożakowska-Kapłon, Małgorzata Krzciuk, Olga Jelonek, Anna Szyszkowska, Michał Wojewódzki, Artur Mamcarz, and Renata Rajtar-Salwa
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medicine.medical_specialty ,Acute coronary syndrome ,Gastrointestinal bleeding ,Anemia ,business.industry ,non-vitamin K antagonist oral anticoagulants ,Medizin ,Cancer ,Atrial fibrillation ,General Medicine ,medicine.disease ,stroke risk ,Article ,vitamin K antagonists ,Internal medicine ,medicine ,Population study ,Medicine ,atrial fibrillation ,oral anticoagulants ,Medical prescription ,business ,Stroke - Abstract
Background: Most atrial fibrillation (AF) patients are at high risk of thromboembolic, and the use of oral anticoagulants (OACs) is advised in such cases. The aim of the study was to evaluate the frequency at which OACs were used in patients with AF and high risk thromboembolic complications, and identify factors that result in OACs not being used in the researched group of patients. Methods: The prospective, multicenter and non-interventional POL-AF registry is a study that includes AF patients from ten Polish cardiology centers. They were consecutively hospitalized between January and December of 2019. All the patients in the study were of high stroke risk. Results: A total of 3614 patients with AF and high stroke risk were included. Among the total study population, 91.5% received OAC therapy, antiplatelet therapy was prescribed for 3.7% of patients, heparin for 2.7%, and 2.1% of patients did not receive any stroke prevention therapy. Independent predictors of no OAC prescription were intracranial bleeding (OR 0.15, 95%CI 0.07–0.35, p <, 0.001), gastrointestinal bleeding (OR 0.25, 95%CI 0.17–0.37, p <, 0.001), cancer (OR 0.37, 95%CI 0.25–0.55, p <, 0.001), hospitalization due to acute coronary syndrome (OR 0.48, 95%CI 0.33–0.69, p <, 0.001), and anemia (OR 0.62, 95%CI 0.48–0.81, p <, 0.001). Conclusions: Most AF patients with a high thromboembolic risk received OACs. The factors predisposing a lack of OAC use in these patients were conditions that significantly increased the risk of bleeding complications.
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- 2021
33. Hyponatraemia in heart failure: time for new solutions?
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Agnieszka Kapłon-Cieślicka, Anzhela Soloveva, Yura Mareev, Irina Cabac-Pogorevici, Frederik Hendrik Verbrugge, Panagiotis Vardas, Clinical sciences, Cardiology, and Intensive Care
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drug monitoring ,Heart Failure ,Sodium Potassium Chloride Symporter Inhibitors ,Sodium ,nutritional and metabolic diseases ,Humans ,Cardiology and Cardiovascular Medicine ,Antidiuretic Hormone Receptor Antagonists ,Hyponatremia - Abstract
Hyponatraemia is very common in heart failure (HF), especially in decompensated patients. It is associated with increased mortality and morbidity and considered a marker of advanced disease. Recognition of hyponatraemia and its causes may help guide treatment strategy. Historically, therapy has primarily focused on water restriction, decongestion with loop diuretics in case of volume overload (dilutional hyponatraemia) and sodium repletion in case of depletion. In this review, we summarise the potential benefits of established and emerging HF therapies on sodium homeostasis, with a focus on dual vasopressin antagonists, angiotensin receptor-neprilysin inhibitors, sodium-glucose cotransporter 2 inhibitors and hypertonic saline, and propose a potential therapeutic approach for hyponatraemia in HF.
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- 2021
34. Is heart failure misdiagnosed in hospitalized patients with preserved ejection fraction? From the European Society of Cardiology - Heart Failure Association EURObservational Research Programme Heart Failure Long-Term Registry
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Agnieszka Kapłon‐Cieślicka, Cécile Laroche, Maria G. Crespo‐Leiro, Andrew J.S. Coats, Stefan D. Anker, Gerasimos Filippatos, Aldo P. Maggioni, Camilla Hage, Antonio Lara‐Padrón, Alessandro Fucili, Jarosław Drożdż, Petar Seferovic, Giuseppe M.C. Rosano, Alexandre Mebazaa, Theresa McDonagh, Mitja Lainscak, Frank Ruschitzka, Lars H. Lund, Heart Failure Association (HFA) of the European Society of Cardiology (ESC) and the ESC Heart Failure Long‐Term Registry Investigators, University of Zurich, and Kapłon-Cieślicka, Agnieszka
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medicine.medical_specialty ,Overdiagnosis ,medicine.drug_class ,Cardiology ,610 Medicine & health ,Comorbidity ,030204 cardiovascular system & hematology ,2705 Cardiology and Cardiovascular Medicine ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Natriuretic peptide ,Humans ,Diseases of the circulatory (Cardiovascular) system ,Mass index ,Registries ,030212 general & internal medicine ,Diagnostic Errors ,Heart Failure ,Ejection fraction ,business.industry ,Stroke Volume ,Atrial fibrillation ,medicine.disease ,Death ,Hospitalization ,Heart failure with preserved ejection fraction ,Heart failure ,RC666-701 ,10209 Clinic for Cardiology ,Diastolic dysfunction ,Cardiology and Cardiovascular Medicine ,business - Abstract
[Abstract] Aims. In hospitalized patients with a clinical diagnosis of acute heart failure (HF) with preserved ejection fraction (HFpEF), the aims of this study were (i) to assess the proportion meeting the 2016 European Society of Cardiology (ESC) HFpEF criteria and (ii) to compare patients with restrictive/pseudonormal mitral inflow pattern (MIP) vs. patients with MIP other than restrictive/pseudonormal. Methods and results. We included hospitalized participants of the ESC‐Heart Failure Association (HFA) EURObservational Research Programme (EORP) HF Long‐Term Registry who had echocardiogram with ejection fraction (EF) ≥ 50% during index hospitalization. As no data on e', E/e' and left ventricular (LV) mass index were gathered in the registry, the 2016 ESC HFpEF definition was modified as follows: elevated B‐type natriuretic peptide (BNP) (≥100 pg/mL for acute HF) and/or N‐terminal pro‐BNP (≥300 pg/mL) and at least one of the echocardiographic criteria: (i) presence of LV hypertrophy (yes/no), (ii) left atrial volume index (LAVI) of >34 mL/m2), or (iii) restrictive/pseudonormal MIP. Next, all patients were divided into four groups: (i) patients with restrictive/pseudonormal MIP on echocardiography [i.e. with presumably elevated left atrial (LA) pressure], (ii) patients with MIP other than restrictive/pseudonormal (i.e. with presumably normal LA pressure), (iii) atrial fibrillation (AF) group, and (iv) ‘grey area’ (no consistent description of MIP despite no report of AF). Of 6365 hospitalized patients, 1848 (29%) had EF ≥ 50%. Natriuretic peptides were assessed in 28%, LV hypertrophy in 92%, LAVI in 13%, and MIP in 67%. The 2016 ESC HFpEF criteria could be assessed in 27% of the 1848 patients and, if assessed, were met in 52%. Of the 1848 patients, 19% had restrictive/pseudonormal MIP, 43% had MIP other than restrictive/pseudonormal, 18% had AF and 20% were grey area. There were no differences in long‐term all‐cause or cardiovascular mortality, or all‐cause hospitalizations or HF rehospitalizations between the four groups. Despite fewer non‐cardiac comorbidities reported at baseline, patients with MIP other than restrictive/pseudonormal (i.e. with presumably normal LA pressure) had more non‐cardiovascular (14.0 vs. 6.7 per 100 patient‐years, P < 0.001) and cardiovascular non‐HF (13.2 vs. 8.0 per 100 patient‐years, P = 0.016) hospitalizations in long‐term follow‐up than patients with restrictive/pseudonormal MIP. Conclusions. Acute HFpEF diagnosis could be assessed (based on the 2016 ESC criteria) in only a quarter of patients and confirmed in half of these. When assessed, only one in three patients had restrictive/pseudonormal MIP suggestive of elevated LA pressure. Patients with MIP other than restrictive/pseudonormal (suggestive of normal LA pressure) could have been misdiagnosed with acute HFpEF or had echocardiography performed after normalization of LA pressure. They were more often hospitalized for non‐HF reasons during follow‐up. Symptoms suggestive of acute HFpEF may in some patients represent non‐HF comorbidities.
- Published
- 2020
35. The rationale and design of the LATTEE registry – the first multicenter project on the Scientific Platform of the 'Club 30' of the Polish Cardiac Society
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Magdalena Mizia-Szubryt, Damian Kaufmann, Anna Szymanska, Krzysztof J. Filipiak, Agnieszka Kapłon-Cieślicka, Marek Koziński, Monika Gawałko, Maciej Wójcik, Ludmiła Daniłowicz-Szymanowicz, Iwona Gorczyca, Maciej T. Wybraniec, Błażej Michalski, Andrzej Tomaszewski, Beata Uziębło-Życzkowska, Piotr Scisło, Paweł Burchardt, Anna Tomaszuk-Kazberuk, Grzegorz Opolski, Katarzyna Starzyk, Kinga Gościńska-Bis, Katarzyna Łojewska, Mirosław Dłużniewski, Paweł Krzesiński, Monika Budnik, Katarzyna Wilk, Janusz Kochanowski, Robert Błaszczyk, Maciej Haberka, Michał Kucio, and Jarosław Hiczkiewicz
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Cardiology ,Electric Countershock ,MEDLINE ,Catheter ablation ,Electric countershock ,Multicenter study ,Atrial Fibrillation ,Catheter Ablation ,medicine ,Humans ,Medical physics ,Observational study ,Poland ,Registries ,Club ,Cardiology and Cardiovascular Medicine ,business ,Societies, Medical - Published
- 2019
36. Dlaczego warto stosować walsartan i jego skojarzenia u pacjentów z nadciśnieniem tętniczym?
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Agata Tymińska and Agnieszka Kapłon-Cieślicka
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Angiotensin receptor ,medicine.medical_specialty ,business.industry ,Peripheral edema ,General Medicine ,medicine.disease ,Coronary artery disease ,Hydrochlorothiazide ,Blood pressure ,Valsartan ,Internal medicine ,Heart failure ,Cardiology ,Medicine ,Amlodipine ,medicine.symptom ,business ,medicine.drug - Abstract
The most recent guidelines for the treatment of arterial hypertension have set blood pressure targets of below 130/80 mm Hg in most patients, recommending a single-pill combination (SPC) consisting of two drugs for treatment initiation. In addition to its strong antihypertensive effect, the use of valsartan is associated with a reduction in metabolic risk and in the incidence of hypertension-mediated organ damage and cardiovascular events. Valsartan is the only angiotensin receptor blocker of choice both in patients with hypertension and concomitant coronary artery disease, and in patients with heart failure. The combination of valsartan with amlodipine or hydrochlorothiazide is associated with a proven stronger hypotensive effect due to the synergistic effect of both molecules on the one hand, and a reduction in the frequency of side effects (such as peripheral oedema with amlodipine monotherapy or hypokalemia with hydrochlorothiazide monotherapy) on the other.
- Published
- 2019
37. Wiek naczyń — u kogo i jak go oceniać? Czy możemy 'odmłodzić' naczynia naszych pacjentów?
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Agnieszka Kapłon-Cieślicka and Agata Tymińska
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medicine.medical_specialty ,Cholesterol ,Cvd risk ,business.industry ,Absolute risk reduction ,General Medicine ,Disease ,chemistry.chemical_compound ,Pharmacotherapy ,chemistry ,Internal medicine ,Relative risk ,Primary prevention ,medicine ,Risk assessment ,business - Abstract
Total cardiovascular risk assessment plays a key role in the prevention of cardiovascular disease (CVD). It facilitates identification of patients with increased CVD risk and allows to plan appropriate actions to reduce or eliminate risk factors. The SCORE chart is a practical tool for estimation of individual 10-year risk of fatal CVD. However, in young patients with risk factors, the absolute risk calculated with the SCORE chart may be low despite significantly elevated relative risk. In this group of patients, assessment of cardiovascular risk age (heart age, vascular age) may be useful for identification of individuals in whom intensive preventive measures should be implemented. These measures should focus on reducing existing risk factors, which in some patients might require the use of pharmacotherapy. Statins were proven to be effective in CVD risk reduction, including primary prevention. Statins significantly lower concentrations of low-density lipoproteins, which are crucial for the development of atherosclerosis. Moreover, beyond their cholesterol- -lowering properties, statins exert pleiotropic effects, leading to inhibition or even partial reversal of unfavorable changes within the vessel wall, and to a reduction of cardiovascular risk age.
- Published
- 2019
38. Left Atrial Thrombus in Atrial Fibrillation/Flutter Patients in Relation to Anticoagulation Strategy: LATTEE Registry
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Agnieszka Kapłon-Cieślicka, Monika Gawałko, Monika Budnik, Beata Uziębło-Życzkowska, Paweł Krzesiński, Katarzyna Starzyk, Iwona Gorczyca-Głowacka, Ludmiła Daniłowicz-Szymanowicz, Damian Kaufmann, Maciej Wójcik, Robert Błaszczyk, Jarosław Hiczkiewicz, Katarzyna Łojewska, Katarzyna Mizia-Stec, Maciej T Wybraniec, Katarzyna Kosmalska, Marcin Fijałkowski, Anna Szymańska, Mirosław Dłużniewski, Maciej Haberka, Michał Kucio, Błażej Michalski, Karolina Kupczyńska, Anna Tomaszuk-Kazberuk, Katarzyna Wilk-Śledziewska, Renata Wachnicka-Truty, Marek Koziński, Paweł Burchardt, Piotr Scisło, Radosław Piątkowski, Janusz Kochanowski, Grzegorz Opolski, Marcin Grabowski, Cardiologie, and RS: Carim - H01 Clinical atrial fibrillation
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APPENDAGE CLOSURE ,transesophageal echocardiography ,Medizin ,apixaban ,thromboembolic risk ,dabigatran ,rivaroxaban ,General Medicine ,EFFICACY ,PREVENTION ,WARFARIN ,SAFETY ,METAANALYSIS ,STROKE ,ORAL ANTICOAGULANTS - Abstract
BACKGROUND: Atrial fibrillation (AF) and flutter (AFl) increase the risk of thromboembolism. The aim of the study was to assess the prevalence of left atrial thrombus (LAT) in AF/AFl in relation to oral anticoagulation (OAC).METHODS: LATTEE (NCT03591627) was a multicenter, prospective, observational study enrolling consecutive patients with AF/AFl referred for transesophageal echocardiography before cardioversion or ablation.RESULTS: Of 3109 patients enrolled, 88% were on chronic, 1.5% on transient OAC and 10% without OAC. Of patients on chronic OAC, 39% received rivaroxaban, 30% dabigatran, 14% apixaban and 18% vitamin K antagonists (VKA). Patients on apixaban were oldest, had the worst renal function and were highest in both bleeding and thromboembolic risk, and more often received reduced doses. Prevalence of LAT was 8.0% (7.3% on chronic OAC vs. 15% without OAC; p < 0.01). In patients on VKA, prevalence of LAT was doubled compared to patients on non-VKA-OACs (NOACs) (13% vs. 6.0%; p < 0.01), even after propensity score weighting (13% vs. 7.5%; p < 0.01). Prevalence of LAT in patients on apixaban was higher (9.8%) than in those on rivaroxaban (5.7%) and dabigatran (4.7%; p < 0.01 for both comparisons), however, not after propensity score weighting.CONCLUSIONS: The prevalence of LAT in AF is non-negligible even on chronic OAC. The risk of LAT seems higher on VKA compared to NOAC, and similar between different NOACs.
- Published
- 2022
39. Hyperuricemia as a Marker of Reduced Left Ventricular Ejection Fraction in Patients with Atrial Fibrillation: Results of the POL-AF Registry Study
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Anna Tomaszuk-Kazberuk, Agnieszka Kapłon-Cieślicka, Monika Gawałko, Robert Błaszczyk, Beata Wożakowska-Kapłon, Maciej Wójcik, Anna Szpotowicz, Małgorzata Maciorowska, Artur Mamcarz, Beata Uziębło-Życzkowska, Marcin Wełnicki, Renata Rajtar-Salwa, Tomasz Tokarek, Iwona Gorczyca, Małgorzata Krzciuk, Olga Jelonek, Janusz Bednarski, Wiktor Wójcik, Elwira Bakuła-Ostalska, Jacek Bil, Anna Szyszkowska, and Michał Wojewódzki
- Subjects
medicine.medical_specialty ,heart failure ,hyperuricemia ,030204 cardiovascular system & hematology ,Article ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Clinical significance ,atrial fibrillation ,Hyperuricemia ,Risk factor ,030203 arthritis & rheumatology ,Ejection fraction ,business.industry ,Atrial fibrillation ,left ventricular ejection fraction ,General Medicine ,medicine.disease ,Heart failure ,Cardiology ,Medicine ,Biomarker (medicine) ,Population study ,business - Abstract
Background: Hyperuricemia is an established risk factor for cardiovascular disease, including atrial fibrillation (AF). The prevalence of hyperuricemia and its clinical significance in patients with already diagnosed AF remain unexplored. Methods: The Polish Atrial Fibrillation (POL-AF) registry includes consecutive patients with AF hospitalized in 10 Polish cardiology centers from January to December 2019. This analysis included patients in whom serum uric acid (SUA) was measured. Results: From 3999 POL-AF patients, 1613 were included in the analysis. The mean age of the subjects was 72 ± 11.6 years, and the mean SUA was 6.88 ± 1.93 mg/dL. Hyperuricemia was found in 43% of respondents. Eighty-four percent of the respondents were assigned to the high cardiovascular risk group, and 45% of these had SUA >, 7 mg/dL. Comparison of the extreme SUA groups (<, 5 mg/dL vs. >, 7 mg/dL) showed significant differences in renal parameters, total cholesterol concentration, and left ventricular ejection fraction (EF). Multivariate regression analysis showed that SUA >, 7 mg/dL (OR 1.74, 95% CI 1.32–2.30) and GFR <, 60 mL/min/1.73 m2 (OR 1.94, 95% CI 1.46–2.48) are significant markers of EF <, 40% in the study population. Female sex was a protective factor (OR 0.74, 95% CI 0.56–0.97). The cut-off point for SUA with 60% sensitivity and specificity indicative of an EF <, 40% was 6.9 mg/dL. Conclusions: Although rarely assessed, hyperuricemia appears to be common in patients with AF. High SUA levels may be a significant biomarker of reduced left ventricular EF in AF patients.
- Published
- 2021
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40. Risk of left atrial appendage thrombus in older patients with atrial fibrillation
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Agnieszka Kapłon-Cieślicka, Monika Gawałko, Monika Budnik, Paweł Krzesiński, Piotr Scisło, Janusz Kochanowski, Olga Jelonek, Marek Kiliszek, Krzysztof J. Filipiak, Katarzyna Starzyk, Grzegorz Gielerak, Beata Wożakowska-Kapłon, Beata Uziębło-Życzkowska, Agnieszka Jurek, Anna Michalska, Grzegorz Opolski, and Iwona Gorczyca
- Subjects
Appendage ,medicine.medical_specialty ,business.industry ,Atrial fibrillation ,General Medicine ,medicine.disease ,Thromboembolic risk ,Older patients ,Left atrial ,Stroke prevention ,Internal medicine ,Cardiology ,medicine ,Thrombus ,business ,Oral anticoagulation - Abstract
IntroductionWe aimed to compare the prevalence of left atrial appendage (LAA) thrombus and its predictors between old and young patients with atrial fibrillation (AF).Material and methodsThe study included 1970 patients aged ≥ 65 (n = 822 [41.7%]) and < 65 (n = 1148 [58.3%]) referred for AF cardioversion or ablation preceded by transoesophageal echocardiography (TEE).ResultsOral anticoagulation (OAC) was prescribed in 799 (97.2%) patients aged ≥ 65 years and in 1054 (91.8%) of those aged < 65 years (p < 0.001). In patients treated with OAC, those aged ≥ 65 years less often received vitamin K antagonist (VKA) (267 [33.4%] vs. 416 [39.5%]) and more often non-VKA-OAC (NOAC) (532 [66.6%] vs. 638 [60.5%], p = 0.008, p = 0.008) compared to patients < 65 years. On TEE, LAA thrombus was more often observed in patients aged ≥ 65 years than those aged < 65 years (63 [7.7%] vs. 46 [4.0%], p < 0.001), with an absolute but not statistically significant difference between patients aged 65–74 and ≥ 75 years (47 [7.3%] vs. 16 [8.8%], p = 0.528). In patients aged ≥ 65 years, there was no difference in the prevalence of LAA thrombus between patients treated with VKA and NOAC, in contrast to patients aged < 65 years, in whom such a difference was observed (27 [6.5%] vs. 16 [2.5%], p = 0.002). In multivariate logistic regression, predictors of LAA thrombus in both age groups were older age, non-paroxysmal AF, and heart failure, whereas only in patients aged < 65 years – VKA use, and in those aged ≥ 65 years – lower glomerular filtration rate and platelet count.ConclusionsDespite OAC use, older patients with AF remain at high risk of LAA thrombus formation. Older age, non-paroxysmal AF, and heart failure are predictors of LAA thrombus, irrespective of age.
- Published
- 2021
41. Vascular disease in patients with atrial fibrillation. A report from Polish participants in the EORP-AF General Long-Term Registry
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Paweł Balsam, Marcin Grabowski, Monika Budnik, Agnieszka Kapłon-Cieślicka, Monika Gawałko, Gregory Y.H. Lip, Radosław Lenarczyk, Krzysztof Ozierański, Agata Tymińska, Grzegorz Opolski, Piotr Lodziński, Zbigniew Kalarus, and Anna Wancerz
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medicine.medical_specialty ,Administration, Oral ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Thromboembolism ,Internal medicine ,Diabetes mellitus ,Atrial Fibrillation ,medicine ,Humans ,Registries ,030212 general & internal medicine ,Adverse effect ,Vascular disease ,business.industry ,Anticoagulants ,Atrial fibrillation ,General Medicine ,medicine.disease ,Stroke ,Exact test ,Heart failure ,Concomitant ,Cardiology ,Poland ,business ,Kidney disease - Abstract
Aims: This study aimed to (1) define the prevalence of vascular disease (VD; coronary (CAD) and/or peripheral artery disease (PAD)) and associated risk factors in patients with atrial fibrillation (AF); (2) establish the relationship of VD and associated treatment patterns on adverse events in AF. Methods: Data from 701 Polish AF patients enrolled in the EORP-AF General Long-Term Registry in the years 2013-2016 were included in this analysis. During the one-year follow-up, the occurrence of major adverse events (MAE; all-cause death, thromboembolic event, myocardial infraction) and its components was evaluated. Results: VD was recorded in 293 (44%) patients and based on multivariate logistic analysis was associated with age >75, diabetes, hypercholesterolemia, heart failure (HF). There was no significant difference in rates of MAE between patients with and without VD based on Fisher's exact test (8.8% vs 5.7%, P =.16), as well as between patients with concomitant CAD and PAD, PAD and CAD alone based on the Chi-square test (21% vs 7.5% vs 6.7%; P =.09). A higher risk of MAE was associated with HF, chronic kidney disease (in all study group), age >75, HF, diabetes (VD group),chronic obstructive pulmonary disease (non-VD group) based on the multivariate logistic analysis. Relative to patients with VD on vitamin K antagonists (VKA), those treated with non-VKA-oral anticoagulants (NOAC) had lower absolute rate of MAE according to Fisher's exact test (1.4% vs 10%, P =.02) but similar risks for thromboembolic and hemorrhagic events. The concomitant use of triple therapy was associated with increased risk of MAE as compared with those on OAC alone or dual therapy based on the Chi-square test (20% vs 4.8%, 3.2%, P =.02). Conclusion: VD was prevalent in almost two-fifths of AF patients. The incidence of MAE was higher in patients with VD on VKA (vs NOAC) and on triple therapy (vs dual therapy, OAC alone) within one-year follow-up.
- Published
- 2021
42. Cardiac magnetic resonance in myocarditis. Authors’ reply
- Author
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Agnieszka Kapłon-Cieślicka, Renzo Marcolongo, Marcin Grabowski, Anna Baritussio, Krzysztof Ozierański, Michał Marchel, Krzysztof J. Filipiak, Alida L.P. Caforio, Grzegorz Opolski, and Agata Tymińska
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medicine.medical_specialty ,Magnetic Resonance Spectroscopy ,Myocarditis ,business.industry ,Myocardium ,Heart ,medicine.disease ,Internal medicine ,Internal Medicine ,Cardiology ,Humans ,Medicine ,business ,Cardiac magnetic resonance - Published
- 2021
43. Myocarditis and inflammatory cardiomyopathy in 2021: An update
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Renzo Marcolongo, Krzysztof Ozierański, Marcin Grabowski, Grzegorz Opolski, Krzysztof J. Filipiak, Alida L.P. Caforio, Agata Tymińska, Agnieszka Kapłon-Cieślicka, Michał Marchel, and Anna Baritussio
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2019-20 coronavirus outbreak ,Myocarditis ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Cardiomyopathy ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Myocardium ,MEDLINE ,Humans ,Cardiomyopathy, Dilated ,medicine.disease ,Virology ,Dilated ,Internal Medicine ,Medicine ,business - Published
- 2021
44. Symptomatic and asymptomatic patients in the Polish Atrial Fibrillation (POL-AF) registry
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Janusz Bednarski, Małgorzata Maciorowska, Michał Wojewódzki, Artur Mamcarz, Maciej Wójcik, Marek Kiliszek, Beata Wożakowska-Kapłon, Paweł Krzesiński, Jacek Bil, Anna Tomaszuk-Kazberuk, Monika Gawałko, Iwona Gorczyca, Robert Błaszczyk, Anna Szpotowicz, Małgorzata Krzciuk, Olga Jelonek, Elwira Bakuła-Ostalska, Renata Rajtar-Salwa, Beata Uziębło-Życzkowska, Anna Szyszkowska, Marcin Wełnicki, Tomasz Tokarek, and Agnieszka Kapłon-Cieślicka
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medicine.medical_specialty ,lcsh:Medicine ,030204 cardiovascular system & hematology ,registry ,Asymptomatic ,Article ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,atrial fibrillation ,030212 general & internal medicine ,Paroxysmal AF ,Ejection fraction ,business.industry ,lcsh:R ,Atrial fibrillation ,General Medicine ,medicine.disease ,EHRA class ,Multicenter study ,Heart failure ,Cardiology ,medicine.symptom ,business ,Heart failure with preserved ejection fraction - Abstract
Background: Atrial fibrillation (AF) can cause severe symptoms, but it is frequently asymptomatic. We aimed to compare the clinical features of patients with asymptomatic and symptomatic AF. Methods: A prospective, observational, multicenter study was performed (the Polish Atrial Fibrillation (POL-AF) registry). Consecutive hospitalized AF patients over 18 years of age were enrolled at ten centers. The data were collected for two weeks during each month of 2019. Results: A total of 2785 patients were analyzed, of whom 1360 were asymptomatic (48.8%). Asymptomatic patients were more frequently observed to have coronary artery disease (57.5% vs. 49.1%, p <, 0.0001), heart failure with preserved ejection fraction (39.8% vs. 26.5%, p <, 0.0001), a previous thromboembolic event (18.2% vs. 13.1%, p = 0.0002), and paroxysmal AF (52.3% vs. 45.2%, p = 0.0002). In multivariate analysis, history of electrical cardioversion, paroxysmal AF, heart failure, coronary artery disease, previous thromboembolic event, and higher left ventricular ejection fraction were predictors of a lack of AF symptoms. First-diagnosed AF was a predictor of AF symptoms. Conclusions: In comparison to symptomatic patients, more of those hospitalized with asymptomatic AF had been previously diagnosed with this arrhythmia and other cardiovascular diseases. However, they presented with better left ventricular function and were more frequently treated with cardiovascular medicines.
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- 2021
45. Does the CHA2DS2-VASc score determine anticoagulant treatment in atrial fibrillation patients? Data from the POLish Atrial Fibrillation (POL-AF) Registry
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Szpotowicz, Anna, Gorczyca-Głowacka, Iwona, Uziębło-Życzkowska, Beata, Maciorowska, Małgorzata, Wójcik, Maciej, Błaszczyk, Robert, Kapłon-Cieślicka, Agnieszka, Gawałko, Monika, Budnik, Monika, Tokarek, Tomasz, Rajtar-Salwa, Renata, Bil, Jacek, Wojewódzki, Michał, Bednarski, Janusz, Bakuła-Ostalska, Elwira, Tomaszuk-Kazberuk, Anna, Szyszkowska, Anna, Wełnicki, Marcin, Mamcarz, Artur, Krzciuk, Małgorzata, and Wożakowska-Kapłon, Beata
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- 2021
46. Clinical characteristics of patients based on the POL-AF registry compared to the registries of the pre - NOACs era. Do we still treat the same individuals?
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Monika Gawałko, Maciej Wójcik, Beata Wożakowska-Kapłon, Anna Szyszkowska, Anna Szpotowicz, Iwona Gorczyca, Tomasz Tokarek, Elwira Bakuła-Ostalska, Beata Uziębło-Życzkowska, Jacek Bil, Agnieszka Kapłon-Cieślicka, Michał Wojewódzki, Marcin Wełnicki, Renata Rajtar-Salwa, Anna Tomaszuk-Kazberuk, Robert Błaszczyk, Małgorzata Krzciuk, Małgorzata Maciorowska, Olga Jelonek, Artur Mamcarz, and Janusz Bednarski
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- 2021
47. Plasma Concentrations of Extracellular Vesicles are Decreased in Patients with Post-Infarct Cardiac Remodelling
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Grzegorz Opolski, Bartłomiej Rydz, Rienk Nieuwland, Aleksandra Gąsecka, Katarzyna Solarska, Marek Postuła, Janusz Kochanowski, Łukasz Szarpak, Edwin van der Pol, Agnieszka Kapłon-Cieślicka, Miłosz Jaguszewski, Krzysztof J. Filipiak, Monika Budnik, Ceren Eyileten, Tomasz Mazurek, Kinga Pluta, Laboratory for Experimental Clinical Chemistry, Laboratory for General Clinical Chemistry, Biomedical Engineering and Physics, ACS - Atherosclerosis & ischemic syndromes, and ACS - Microcirculation
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0301 basic medicine ,medicine.medical_specialty ,Cellular homeostasis ,heart failure ,acute myocardial infarction ,030204 cardiovascular system & hematology ,Biology ,Article ,General Biochemistry, Genetics and Molecular Biology ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Internal medicine ,medicine ,Platelet ,Platelet activation ,Myocardial infarction ,cardiovascular diseases ,lcsh:QH301-705.5 ,left-ventricular remodelling ,extracellular vesicles ,flow cytometry ,General Immunology and Microbiology ,Phosphatidylserine ,medicine.disease ,030104 developmental biology ,Endocrinology ,chemistry ,lcsh:Biology (General) ,Heart failure ,General Agricultural and Biological Sciences ,CD61 ,Homeostasis - Abstract
Simple Summary A heart attack may lead to the remodelling of the cardiac muscle, which negatively affects patient’s prognosis. At present, the mechanisms of cardiac remodelling remain unclear. In patients with heart attack, many body cells become activated and release small particles, called extracellular vesicles, which can either aggravate cardiac injury, or contribute to healing of heart muscle. In our study, we hypothesized that the concentrations of these small particles in plasma allow to determine which patients will experience remodelling of the cardiac muscle after the heart attach. We found that concentrations of extracellular vesicles from endothelial cells, erythrocytes and platelets, measured directly the heart attack, were lower in patients who developed cardiac remodelling 6 months later, compared to patients who had no remodelling. Vesicles from endothelial cells and erythrocytes allowed to determine remodelling independently of other clinical features. Hence, decreased concentrations of these vesicles may on one hand be a sign of inappropriate cardiac repair mechanisms, and on the other hand may allow to identify patients, who will develop cardiac remodelling after the heart attack. Abstract Background, the mechanisms underlying left ventricular remodelling (LVR) after acute myocardial infarction (AMI) remain obscure. In the course of AMI, blood cells and endothelial cells release extracellular vesicles (EVs). We hypothesized that changes in EV concentrations after AMI may underlie LVR. Methods, plasma concentrations of EVs from endothelial cells (CD146+), erythrocytes (CD235a+), leukocytes (CD45+), platelets (CD61+), activated platelets (P-selectin+), and EVs exposing phosphatidylserine after AMI were determined by flow cytometry in 55 patients with the first AMI. LVR was defined as an increase in left ventricular end-diastolic volume by 20% at 6 months after AMI, compared to baseline. Results, baseline concentrations of EVs from endothelial cells, erythrocytes and platelets were lower in patients who developed LVR (p ≤ 0.02 for all). Concentrations of EVs from endothelial cells and erythrocytes were independent LVR predictors (OR 8.2, CI 1.3–54.2 and OR 17.8, CI 2.3–138.6, respectively) in multivariate analysis. Combining the three EV subtypes allowed to predict LVR with 83% sensitivity and 87% specificity. Conclusions, decreased plasma concentrations of EVs from endothelial cells, erythrocytes and platelets predict LVR after AMI. Since EV release EVs contributes to cellular homeostasis by waste removal, decreased concentrations of EVs may indicate dysfunctional cardiac homeostasis after AMI, thus promoting LVR.
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- 2021
48. Jak rozpoznawać niewydolność serca z zachowaną frakcją wyrzutową. Praktyczny przewodnik Klubu 30 Polskiego Towarzystwa Kardiologicznego
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Kapłon-Cieślicka, Agnieszka, Tymińska, A., Kupczyńska, Karolina, Dobrowolski, Piotr, Michalski, Błażej, Jaguszewski, Miłosz J., Banasiak, Waldemar, Burchardt, Paweł, Chrzanowski, Łukasz, Darocha, Szymon, Domienik-Karłowicz, Justyna, Drożdż, J., Fijałkowski, Marcin, Filipiak, Krzysztof J., Gruchała, Marcin, Jankowska, Ewa Anita, Jankowski, Piotr, Kasprzak, Jarosław D., Kosmala, Wojciech, Lipiec, Piotr, Mitkowski, Przemysław, Mizia-Stec, Katarzyna, Szymański, P., Tycińska, A., Wańha, Wojciech, Wybraniec, M., Witkowski, A., and Ponikowski, Piotr
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- 2021
49. Characteristics and Treatment of Atrial Fibrillation with Respect to the Presence or Absence of Heart Failure. Insights from the Multicenter Polish Atrial Fibrillation (POL-AF) Registry
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Maciej Wójcik, Marcin Wełnicki, Tomasz Tokarek, Michał Wojewódzki, Janusz Bednarski, Małgorzata Maciorowska, Artur Mamcarz, Robert Błaszczyk, Agnieszka Kapłon-Cieślicka, Anna Szpotowicz, Renata Rajtar-Salwa, Elwira Bakuła-Ostalska, Jacek Bil, Iwona Gorczyca, Monika Budnik, Anna Tomaszuk-Kazberuk, Monika Gawałko, Anna Szyszkowska, Małgorzata Krzciuk, Olga Jelonek, and Beata Uziębło-Życzkowska
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medicine.medical_specialty ,medicine.medical_treatment ,heart failure ,lcsh:Medicine ,030204 cardiovascular system & hematology ,Cardioversion ,Article ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,atrial fibrillation ,Sinus rhythm ,030212 general & internal medicine ,anticoagulation ,Oral anticoagulation ,Ejection fraction ,business.industry ,lcsh:R ,Atrial fibrillation ,General Medicine ,medicine.disease ,Heart failure ,Hospital admission ,Cardiology ,Apixaban ,business ,medicine.drug - Abstract
Background: We aimed to assess characteristics and treatment of AF patients with and without heart failure (HF). Methods: The prospective, observational Polish Atrial Fibrillation (POL-AF) Registry included consecutive patients with AF hospitalized in 10 Polish cardiology centers in 2019–2020. Results: Among 3999 AF patients, 2822 (71%) had HF (AF/HF group). Half of AF/HF patients had preserved ejection fraction (HFpEF). Compared to patients without HF (AF/non–HF), AF/HF patients were older, more often male, more often had permanent AF, and had more comorbidities. Of AF/HF patients, 98% had class I indications to oral anticoagulation (OAC). Still, 16% of patients were not treated with OAC at hospital admission, and 9%—at discharge (regardless of the presence of HF and its subtypes). Of patients not receiving OAC upon admission, 61% were prescribed OAC (most often apixaban) at discharge. AF/non–HF patients more often converted from AF at admission to sinus rhythm at discharge compared to AF/HF patients (55% vs. 30%), despite cardioversion performed as often in both groups. Class I antiarrhythmics were more often prescribed in AF/non–HF than in AF/HF group (13% vs. 8%), but still as many as 15% of HFpEF patients received them. Conclusions: Over 70% of hospitalized AF patients have coexisting HF. A significant number of AF patients does not receive the recommended OAC.
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- 2021
50. Echocardiographic assessment of tricuspid regurgitation and pericardial effusion after cardiac device implantation
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Marcin Michalak, Monika Budnik, Przemysław Stolarz, Agata Tymińska, Piotr Scisło, Agnieszka Kapłon-Cieślicka, Dominika Hołowaty, Marcin Grabowski, Roman Steckiewicz, Krzysztof Jakubowski, Bartosz Wiechecki, Grzegorz Opolski, Katarzyna Wiechecka, Krzysztof J. Filipiak, Elżbieta Barbara Świętoń, and Janusz Kochanowski
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medicine.medical_specialty ,Pacemaker, Artificial ,medicine.medical_treatment ,Regurgitation (circulation) ,030204 cardiovascular system & hematology ,Hemoglobin levels ,Clinical Cardiology ,Pericardial effusion ,Pericardial Effusion ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine ,Humans ,Cardiac device ,Aged ,Retrospective Studies ,Complications early ,business.industry ,Cardiac Resynchronization Therapy Devices ,General Medicine ,Implantable cardioverter-defibrillator ,medicine.disease ,Tricuspid Valve Insufficiency ,Defibrillators, Implantable ,Echocardiography ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background: The frequency of cardiac implantable electronic device (CIED) implantations is constantly increasing. Pericardial effusion (PE) and tricuspid regurgitation (TR) may occur after CIED implantation. The aim of the present study is to evaluate the prevalence and risk factors for new occurrences or progression of TR and PE early after CIED implantation. Methods: This is an on-going, single-center, observational study of patients after their first CIED implantation, with an echocardiographic evaluation within 60 days before and 7 days after the procedure. Data are presented for first 110 consecutive patients who underwent CIED implantation from August 2015 to July 2016. Results: Median age was 75 years, and 44% were women. In total, 87 (79%) pacemakers, 21 (19%) implantable cardioverter-defibrillators and 2 cardiac resynchronization therapy devices were implanted. After CIED implantation, there was TR progression in 17 (16%) patients: 5 patients developed moderate TR, none developed severe TR. An increase in TR was more often observed after implantations performed by operators in training than by certified operators (35% vs. 12%, p = 0.02). New PE after the procedure was observed in 8 (7%) patients and was trivial ( < 5 mm) in all cases. Patients with new PE after implantation had lower baseline hemoglobin levels and tended to be women. Conclusions: New PE and an increase in TR severity are rare complications early after CIED implantation. Operator experience might be related to TR progression. Increasing the number of patients in the current on-going study will allow a more reliable assessment of the prevalence and risk factors of these complications.
- Published
- 2020
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