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Background: Heart transplantation (HTx) is an established therapeutic method for a highly selected group of patients with terminal heart disease, unfavourable prognosis, and exploited options of pharmacological, device or surgical treatment. Morbidity and mortality of HTx recipients is determined by a variety of factors ranging from donor and recipient characteristics, peri-operative circumstances to risks of long-term immunosupressive treatment. There is a lack of data on survival and causes of death of HTx patients in the Slovak Republic. The aim of this paper was to analyse the survival and causes of death in patients who underwent HTx in the Slovak Republic. Patients and methods: The cohort consisted of 363 patients who underwent HTx at the National Cardiovascular Institute in Bratislava from March 21, 1998, to August 31, 2021. The patients are under a regular follow-up by the Centre, which keeps a registry of basic data. Recorded causes of death and selected indicators that are likely to influence the survival after HTx were analysed. Data that were not recorded in the registry were extracted from the available patient health records. Results: As of September 30, 2021, 144 (40%) of 363 patients died. Median survival of all HTx recipients was 14.8 (0 - 23) years. 30-day and one-year mortality rates were 9.6% and 17.1%, resp. The most common cause of death was non-specific graft failure (20%), followed by infection (15%) and sudden death (14%). Other causes included cardiac allograft vasculopathy (11%), malignancy (10%), and acute rejection (6%). In 24% of cases, the cause of death was represented by various and less common conditions (renal failure, bleeding, ileus, ischemic stroke, trauma, and other). In the early period (<30 days post-op, n = 35), graft failure, infection, and bleeding represented the main causes of death (57%, 14%, and 12%, resp.). From 30 days to 1 year (n = 27), infection and sudden death prevailed (44% and 19%, resp.). Sudden death, rejection, and malignancies were the dominant causes of death from 1 year to 5 years (n = 22; 50%, 23%, and 18%, resp.). After 5 years (n = 60), cardiac allograft vasculopathy, malignancies, and graft failure were responsible for most of the deaths (25%, 17%, and 11%, resp.). Recipients with a heart from donors = 40 years of age were statistically significantly less likely to survive than recipients with the graft from a younger donor (median 13.4 years vs. 14.5 years; p <0.05). No statistically significant differences in posttransplant survival depending on recipient's age, gender, primary diagnosis, pre-transplant left ventricular assist device implantation, and donor age and cause of death were found. Conclusion: Survival of the Slovak patients after HTx is comparable to international registries. The structure of causes of death is evolving with the time from surgery and reflects the dynamics of risk in particular periods after HTx. Our results document the high standard of long-term care of patients after HTx in the Slovak Republic. The main areas of potential improvement are immediate peri-operative graft and recipient care, prevention of sudden death, as well as prevention and early diagnosis of malignancies after HTx. [ABSTRACT FROM AUTHOR]

Pharmacological therapy for heart failure (HF) shows the strongest evidence in patients with reduced ejection fraction (HFrEF). The four drug pillars with proven mortality benefit in patients with HFrEF are as follows: a renin-angiotensin-aldosterone blocker (angiotensin receptor – neprilysin inhibitor should be preferred), a beta-blocker, a mineralocorticoid receptor antagonist, and a sodium-glucose cotransporter-2 inhibitor (SGLT2i). Furthermore, their early prescription reduces mortality more markedly. Optimally, they should be prescribed during hospitalization, after hemodynamic stabilization. The goal is to initialize all four drugs but strategy of drug selection, sequence of application and dosage adjustment should follow the individual patient profile. For the treatment of patients with HF with mildly reduced ejection fraction (EF) the same drugs as for HFrEF can be used, in spite of a weaker evidence of benefit. It has been confirmed recently that SGLT2i reduce mortality and hospitalization for HF in patients with HF with preserved ejection fraction. SGLT2i (dapagliflozin and empagliflozin) are drugs with prognostic benefit in patients with HF regardless of the left ventricular EF. Renin-angiotensin-aldosterone blockers, beta-blockers, and mineralocorticoid antagonists show weak evidence of benefit in patients with HF with preserved EF. Diuretics are indicated in all patients with HF and congestion to alleviate symptoms and to maintain euvolemic state. In patients with improved EF, including asymptomatic patients, as well as patients with normalized EF and chamber geometry, continuation of disease- modifying therapy is recommended to avoid relapse of the disease. [ABSTRACT FROM AUTHOR]

Background: A pandemic caused by a new coronavirus particularly threatens the high risk groups of patients, incuding those with pulmonary arterial hypertension. We evaluated the occurrence of COVID-19 in the group of patients with pulmonary arterial hypertension (PAH), course of disease, mortality and the attitude of patients to vaccination. Data collection. During the period of two weeks before May 15th 2021 we collected, by analysis of documentation and telephone survey, data on adult patients managed from 01.03. 2020 to 15.05.2021 in 3 centers for PAH and the Children's Cardiac Centre. Information on deceased patients was provided by medical staff from the particular PAH centre. Results: Out of the total number of 168 adult patients (mean age of 54 ± 22 years, 121 females) 32 (19%) had COVID-19 infection during the first or second wave of the epidemic in Slovakia. During this time period 12 patients died and 1 one lung transplantation was performed. 3 of the 12 patients who died suffered from COVID-19 infection. Of the 32 patients infected 7 (21%) were hospitalized, 10 needed oxygen, one artifitial ventilation, and 3 (9%) patients died. Only 74 (47.7%) were vaccinated to date of data collection, although the availability of vaccination for this group of patients was not limited. Conclusion: Despite the fact that PAH is a severe lung and heart disease with a poor prognosis, the course of the disease and mortality were better than could be expected. Results are limited by low patient numbers, but 6% mortality in people with a mean age of 54 years may still be considered high. Vaccination is low despite good access to the vaccine and clear recommendations. Tab. 2, Ref. 15, on-line full text (Free, PDF) www.cardiologyletters.sk [ABSTRACT FROM AUTHOR]

The ODYSSEY OUTCOMES (Evaluation of Cardiovascular Outcomes after an Acute Coronary Syndrome during Treatment with Alirocumab) study compared alirocumab with placebo in 18 924 patients after acute coronary syndrome, where all patients had excellent secondary preventive treatment (maximum-tolerated statin treatment included). Alirocumab reduced the first occurrence of the primary composite endpoint [first cardiovascular (CV) events/mortality]. In this analysis the benefit of alirocumab treatment was evaluated on all CV events/mortality. These events were included: nonfatal myocardial infarction, non-fatal stroke, unstable angina pectoris with hospitalization, heart failure with hospitalization, ischemia-driven coronary revasculatization. The joint semiparametric model was used for analysis, as it allows us to evaluate the occurrence of many non-fatal CV events in a given patient, while simultaneously adjusting for possible informative censoring of the non-fatal event process by death. Results: a) There were 3064 "first" CV events/deaths and in the alirocumab treatment arm these were 190 less than in the placebo arm. b) There were 5425 "total" CV events/deaths and in the alirocumab treatment arm there were 385 events less. c) Alirocumab reduced total non-fatal CV events by the relative risk (RR) of 0.87 (CI: 0.82 - 0.93) and d) deaths by RR 0.83 (CI: 0.71 - 0.97). e) There was a strong association between non-fatal and fatal risk events. In the ODYSSEY OUTCOMES study there was a total occurrence of CV events/deaths twice as frequent as the occurrence of first events/deaths. The benefit of alirocumab treatment is better evaluated here when we focus more on total CV events/deaths. [ABSTRACT FROM AUTHOR]

Aim: To assess the impact to their short-term prognosis of the system time delay to primary percutaneous coronary intervention (pPCI) in patients with STEMI. Methods: Retrospective analysis of documentation of 340 patients with STEMI and primary PCI in the Prešov Cardiocentre in 2014. Short-term prognosis in patients was studied in three indicators: in-hospital mortality, in-hospital cardiac decompensation and systolic left ventricular function judged by echocardiography during hospitalisation. Chí-quadrat tests (χ2) and Fisher exact test, analyses of variance or Mann-Whitneyho U test were calculated to test association between variables. Results: According to the latest guidelines laid down by the European Society of Cardiology (ESC) and by the Slovak Society of Cardiology (SKS), the system delay (refers to time delay from first medical contact to primary PCI) should be less than 120 minutes. A longer system delay had significant negative impact on short-term prognosis of patients including their in-hospital mortality (3.9% vs 10%, p=0.028) and in-hospital signs of acute heart failure (21.3% vs 39.1%, p=0.001). The impact of longer system delay on left ventricular systolic function was statistically not significant. The time delay in cardiocentre was acceptable since the median of door-to-balloon (D2B) interval was only 25 minutes (±13.4). There was no significant difference in short-term prognosis between study groups with D2B within 30 minutes in comparison to the group with D2B over 30 minutes as to mortality, heart failure and ejection fraction. Conclusion: Longer system delay for primary PCI (over 120 minutes) has a significant negative impact on short-term prognosis patients including their in-hospital mortality and in-hospital appearance of acute heart failure. The most important subperiod responsible for time delay was the "FMC-to-door" interval. [ABSTRACT FROM AUTHOR]

Diuretics are an essential and regular part of the treatment of symptomatic heart failure patients regardless of left ventricular systolic function. The objective of diuretic administration is to remove the congestion which is not only the dominating cause of the symptoms and signs of heart failure but also an important factor of adverse remodeling and progression of myocardial dysfunction. Patients with persistent or recurrent symptoms of congestion have a poor prognosis. On the other hand a higher mortality was observed in the patients with high doses of diuretics. A principle of safe and effective diuretic therapy is to maintain the optivolemic state using the lowest possible doses. The practical implementation of this principle is difficult because of the low sensitivity and specificity of the clinical examination for the detection and quantification of congestion, and also because of the unconstant diuretic response for the same dose of drug. The dosage of diuretics should therefore be flexible, with regular monitoring of electrolytes and renal function, particularly after the change of doses of diuretics, ACE inhibitors and aldosterone receptor antagonists. The review article is devoted to the mechanism of the action, hemodynamic and metabolic effects of diuretics in general, and their individual classes. The authors discuss the views and evidence on the effect of diuretics on the survival of patients with heart failure and perspectives for optimizing their use. [ABSTRACT FROM AUTHOR]

The renin-angiotensin-aldosterone system (RAAS), essential for the regulation of blood pressure, cardiovascular and renal function, is a key therapeutic target in hypertension. A series of the latest metaanalyses from large hypertension trials has shown that RAAS inhibitors significantly reduce relative risk for all-cause and cardiovascular mortality. Separately, angiotensin-converting enzyme (ACE) inhibitors produce a significant reduction in relative risk for all-cause mortality and a trend toward a significant reduction in cardiovascular mortality, whereas angiotensin II receptor blockers (ARBs) have no effect. All meta-analyses almost consistently have found that, while ACE inhibitors prevent coronary events with reductions in cardiovascular morbidity and all-cause mortality, ARBs are, at best, efficient only for the prevention of stroke. These results provide proof of clear differences in the cardioprotection afforded by these two antihypertensive classes. The evidence from meta-analyses suggests that in hypertension ACE inhibitors should be considered ahead of ARBs, and ARBs restricted to patients intolerant of ACE inhibitors. [ABSTRACT FROM AUTHOR]