Search

Telemedicine involves diagnostic, therapeutic and educational services being offered remotely by healthcare professionals to exchange crucial clinical information. It is a rapidly developing form of medical activity and part of medical industry, with advanced technologies already available in Poland. Cardiology is one of the fields in which telemedicine methods were pioneered and introduced into everyday practice. Some of these methods have already become standard procedures for diagnosis and treatment in some Polish centers, with other soon to follow. Clinical study results not only demonstrate reliability and usefulness of telemedicine technologies but also show that their use in clinical practice improves the patients' prognoses and quality of life. Moreover, study results in highly developed countries show a potential cost-effectiveness of telemedicine from the perspective of healthcare systems. There is an unquestionable need to establish clear rules for telemedicine use in Poland, which would ensure their high quality and adequate clinical application. This paper is a summary of the current status of telemedicine solutions used in cardiology, with a particular focus on the Polish healthcare system, and presents both the commonly available solutions and those that are expected to develop rapidly in the near future.

Cardiopulmonary exercise testing (CPET) is an important diagnostic tool in contemporary clinical practice. This document presents an expert opinion from the Working Group on Cardiac Rehabilitation and Exercise Physiology of the Polish Cardiac Society concerning the indications, performance technique, and interpretation of results for CPET in adult cardiology. CPET is an electrocardiographic exercise test expanded with exercise evaluation of ventilatory and gas exchange parameters. It allows for a global assessment of the exercise performance including the pulmonary, cardiovascular, hematopoietic, neuropsychological, and musculoskeletal systems. It provides a noninvasive dynamic evaluation during exercise and is a reference modality for exercise capacity assessment. Moreover, it allows the measurement of numerous prognostic parameters. It is useful in cardiology, pulmonology, oncology, perioperative assessment, rehabilitation as well as in sports medicine and in the evaluation of healthy people. This test not only helps to diagnose the causes of exercise intolerance but also supports the evaluation of the treatment. New opportunities are offered by combining CPET with imaging such as exercise stress echocardiography. These tests are complementary and synergistic in their diagnostic and prognostic strength.

Background: Risk stratification in acute coronary syndrome (ACS) is usually based on clinical data obtained during hospitalisation. To date, there is a limited number of prospective observational studies assessing long-term prognosis of patients discharged from hospital after ACS., Aim: This study is to investigate long-term follow-up of unselected ACS patients treated at the 24-hour/7-day (24/7) cardiac catheterisation laboratory and discharged from referral university hospital., Methods: We studied 672 consecutive ACS patients (median age 61 years, 66.7% men) hospitalised and discharged between 2002 and 2004. The analysis was done in respect of the type of ACS, i.e. non–ST-segment elevation: unstable angina non-ST-segment elevation myocardial infarction (UA/NSTEMI; n = 255) vs. ST-segment elevation myocardial infarction (STEMI; n = 417). All patients underwent coronarography and, if indicated, primary angioplasty (417 patients with STEMI and 157 patients with UA/NSTEMI). The primary endpoint was defined as all-cause mortality during six years of follow-up. Survival status and date of death were obtained from the National Death Registry of Poland and presented as Kaplan–Meier survival curves., Results: Despite a significantly higher one-year mortality of patients with UA/NSTEMI compared to those with STEMI (7.1% vs. 3.1%, p = 0.018), the overall mortality assessed throughout follow-up until 2009 was comparable between UA/NSTEMI and STEMI patients (18.8% vs. 18%, p = 0.79)., Conclusions: The long-term (several years) survival did not depend on the type of ACS.

For several years, we have observed the dynamic development of technologies that allow patients to access medical care from the comfort of their homes, without direct contact with the doctor. Innovative solutions based on telemedicine improve care coordination and communication among clinicians, patients, and their families, as well as increases patients' security and gives them greater independence, thus eliminating health care inequalities. The rapidly growth of telemedicine and the adoption of new technologies in clinical practice is also observed in Poland. Crucial moment for the telemedicine facilitation process in our country was Baltic Declaration approved by Minister of Health in 2015, as well as the Medical Profession Amendment Act and remote medical care admission. Since then, as part of the work of the Information Technology and Telemedicine Committee of the Polish Cardiac Society and the Telemedical Working Group, important steps have been taken to implement a telemedicine solutions in the Polish healthcare system, resulting in improved quality and efficiency of this system. The presented document reflects the above actions and encompasses following issues: available telemedicine solutions in the world, analysis of their effectiveness based on clinical trials, funding opportunities, legal status and development prospects telecardiology in Poland.

Background: For patients experiencing an acute coronary syndrome (ACS), a crucial time to assess their prognosis and to plan management is at discharge from hospital., Aim: The aim of the study was to identify risk factors of mortality during post-discharge period following a hospitalisation for ACS., Methods: We studied 672 consecutive ACS patients hospitalised and discharged alive between 2002 and 2004. The analysis was done with respect to the type of ACS, i.e. unstable angina/non-ST-segment elevation myocardial infraction (UA/NSTEMI; n = 255) vs. ST-segment elevation myocardial infarction (STEMI; n = 417). All patients underwent coronary angiography and, if indicated, primary angioplasty (STEMI: 417 patients; UA/NSTEMI: 157 patients). The Cox proportional hazards regression model was used to evaluate the independent effect of the risk factors on the occurrence of primary endpoint, i.e. all-cause mortality during six-year follow-up. Survival status and date of death were obtained from the National Registry of Population (PESEL database)., Results: A total of 123 patients (18.3%) died within the post-discharge period. The multivariate analysis identified 11 highly significant independent predictors of mortality (in order of predictive strength): diabetes mellitus (all types), higher creatinine level, older age, and more frequent occurrence of: supraventricular arrhythmias during hospitalisation, peripheral artery disease, recurrent angina pectoris with documented ischaemia on electrocardiogram, male sex, prior myocardial infarction, treatment with intra-aortic balloon pump counterpulsation, heart failure, and higher peak levels of creatine kinase-MB., Conclusions: The risk factors obtained from the medical history and during the hospitalisation improve the risk stratification during the post-discharge period after hospitalisation for ACS.

Background: Endothelial dysfunction (ED) may indirectly influence the outcome of patients with coronary artery disease., Aim: To assess the influence of cardiac rehabilitation (CR) on endothelial function in patients after ST-segment elevation myocardial infarction (STEMI)., Methods: Twenty-nine patients scheduled for CR were included in the study. CR began at least four weeks after STEMI and consisted of 12 or 24 training sessions. Endothelial function assessment was performed before and after CR, using reactive hyperaemia peripheral arterial tonometry., Results: Before the CR, ED was diagnosed in 16 of 29 (55.2%) patients. A total of 25 patients had two assessments of endothelial function: before and after CR. In univariate analysis the factors of negative response of endothelial function to CR were: higher baseline hyperaemia index (lnRHI) (odds ratio [OR] for positive response to CR 0.01; 95% confidence interval [CI] 0.00-0.33; p = 0.01) and higher peak serum troponin I level during index hospitalisation (OR 0.97; 95% CI 0.94-1.00; p = 0.04). The independent, negative predictor of response to CR was lnRHI (OR 0.01; 95% CI 0.01-0.16; p = 0.03). Patients training for 24 sessions (n = 16) had similar lnRHI changes to those of patients training for 12 sessions (n = 9); [0.16 (-0.06)-0.30 vs. 0.10 (0.05-0.15); p = 0.44, respectively]., Conclusions: ED is a frequent abnormality in STEMI survivors. Despite the lack of statistically significant improvement of endothelial function after CR in the analysed group of patients, some factors can influence the efficacy of this type of physical activity. The best effect of CR on endothelial function was observed in patients with baseline ED.

Background: In the era of combination antiretroviral therapy (cART), life expectancy of HIV-infected patients is the same as that of the general population, resulting in increasing prevalence of cardiovascular disease in this patient group., Aim: To assess the prevalence of endothelial dysfunction in HIV-infected patients and to identify factors which affect endothelial function and arterial stiffness., Methods: Thirty-seven adult HIV-infected patients, regardless of the fact and the type of cART, were enrolled into the study. In patient, reactive hyperaemia peripheral arterial tonometry assessment was performed using the Endo-PAT2000 device (ITAMAR®). This method allows evaluation of endothelial function ant arterial stiffness., Results: Final analysis included 37 patients (median age 38 years, range 32-45 years), including 89.2% men. Endothelial dysfunction was found in 13 (35.1%) HIV-infected patients. We found no differences in demographic and clinical characteristics, laboratory data, and cardiovascular drug therapy between patients with or without endothelial dysfunction, except for platelet count which was higher in patients with endothelial dysfunction (174 [119-193] × 10³/mm3 vs. 222 [168-266] × 10³/mm³, p = 0.03). No demographic or clinical variables were identified as predictors of endothelial dysfunction in HIV-infected patients. In addition, no association was found between factors related to HIV infection, chronic drug therapy and the risk of endothelial dysfunction. Statistically significant correlations were found between arterial stiffness and age (rs = 0.53, p < 0.001), red blood cell count (rs = -0.39, p = 0.018), and platelet count (rs = 0.42, p = 0.009). CD4+ and CD8+ lymphocyte count and viral load were similar in patients with or without endothelial dysfunction. Arterial stiffness was significantly higher in patients with higher viral load (rs = -0.39, p = 0.0018) and in those with established AIDS (9.5 [1.0-16.0] vs. -5 [-10-5], p = 0.009). cART had no effect on endothelial dysfunction, while arterial stiffness was higher in patients treated with cART (10 [0-15] vs. -5 [-10-3], p = 0.014)., Conclusions: Endothelial dysfunction is common in HIV-infected patients. In general, none of the analysed factors had an effect on endothelial function but cART had a negative effect on arterial stiffness.

Background and Aim: To compare the long-term predictive value of six risk scores in a seven-year follow-up of acute coronary syndrome (ACS) patients., Methods: We followed 906 patients diagnosed with ACS for seven years prospectively. The following risk scores (RS) were calculated: TIMI STEMI, TIMI NSTEMI, GRACE, SIMPLE, ZWOLLE and BANACH. Based on the survival data, the predictive value for each RS was calculated with receiver operating characteristics (ROC) curve analysis and presented as area under curve (AUC)., Results: The seven-year survival was 71%. The RS showed diverse long-term predictive values and AUC. The best estimation was demonstrated by the TIMI STEMI (0.779 [95% CI 0.743-0.812]), GRACE RS (0.766 [95% CI 0.737-0.794]) and BANACHRS (0.743 [95% CI 0.713-0.771]). Other scores presented were SIMPLE (0.714 [95% CI 0.683-0.743], TIMI NSTEMI (0.635 [95% CI 0.580-0.688]) and ZWOLLE (0.739 [95% CI 0.697-0.779]., Conclusions: The predictive values of currently recommended RSs are good for long-term perspective (seven years). RSs with high usability, such as BANACH RS, demonstrate accuracy similar to the more advanced RS.

Background: Cardiac rehabilitation in patients after myocardial infarction (MI) is a component of secondary prevention that has an established role in the current guidelines., Aim: To determine the effect of physical training on exercise capacity parameters determined on the basis of cardiopulmonary exercise test (CPET) in patients after MI. We also evaluated the relationship between the number of training sessions and exercise capacity., Methods: We prospectively evaluated 52 patients after MI who underwent percutaneous coronary intervention of the infarct-related artery. At the start of the training, patients had no symptoms of heart failure and coronary artery disease. Electrocardiographic exercise test was performed 4 to 6 weeks after MI, followed by CPET in patients with a negative stress test. After determination of the initial exercise capacity, patients underwent 12 training sessions on a cycle ergometer with a workload determined on the basis of anaerobic threshold or heart rate reserve. After 12 training sessions, CPET was performed, followed by another 12 training sessions and a follow-up CPET., Results: All patients showed a significant increase in exercise capacity parameters: energy expenditure during CPET increased from 9.39 to 11.79 METs, peak oxygen uptake (VO₂peak) increased from 32.32 to 39.25 mL/kg/min (p < 0.001), and oxygen uptake at the anaerobic threshold increased from 18.34 to 24.65 mL/kg min (p < 0.001). The initial 12 training sessions resulted in a statistically significant increase in VO₂peak from 32.32 to 36.75 mL/kg/min (p = 0.003), while subsequent 12 training sessions were related with an insignificant increase in VO₂peak from 36.75 to 39.25 mL/kg/min (p = 0.065)., Conclusions: Regular physical activity improves exercise capacity as measured by CPET. A statistically significant improvement in exercise capacity was seen already after initial 12 training sessions, while another 12 training sessions were associated with smaller benefits.

Introduction: Persistent platelet function while on antiplatelet therapy affects outcomes in patients with acute coronary syndromes (ACS)., Aim: To evaluate whether platelet reactivity measured by collagen-epinephrine (CEPI) or collagen-ADP (CADP) closure times (CT) with Platelet Function Analyzer 100 (PFA-100) is related to very early, in-hospital cardiovascular events in patients with ACS., Methods: The study included 91 patients with ACS undergoing percutaneous coronary intervention (PCI) with stent implantation who were treated with aspirin and clopidogrel. Patients were stratified in accordance with both CEPI-CT (<190 s or >190 s), reflecting aspirin resistance, and our own cut-off point for CADP-CT measured at a mean of 6 days after admission. In-hospital events included re-infarction, cardiac arrest, recurrent angina, severe arrythmias, pulmonary oedema and cardiogenic shock., Results: Patients were divided into 4 study groups: group 1 with CADP-CT <104 s (n=10, 11.0%), group 2 with CEPI-CT <190 s (n=10, 11.0%), group 3 with CADP-CT <104 s and CEPI-CT <190 s (n=9, 9.9%) and a control group with both CT values above the cut-off limits (n=62, 68.1%). The baseline clinical characteristics and received treatment of each subgroup were similar. A test for a trend between controls, group 1 or 2 and group 3 disclosed statistical significance (p <0.001). When analysed separately, only patients from group 3 had a higher incidence of negative outcomes compared to controls (p <0.005; relative risk RR - 9.0; 95% CI 2.4-33.9)., Conclusions: Enhanced platelet function after PCI when measured under high shear rates by both PFA-100 cartridges is independently associated with the most unfavourable in-hospital clinical outcome.