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[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.

Background: Despite results of the PROTECT AF trial, many patients undergoing left atrial appendage closure (LAAC) have unconditional contraindications to warfarin. Aim: We sought to investigate whether double antiplatelet therapy (DAPT) is safe in patients after LAAC. Methods: Forty-four consecutive patients (22 males, mean age 74 ± 7.8 years) with non-valvular atrial fibrillation (NVAF) underwent LAAC procedure using a Watchman device followed by DAPT (75 mg/d aspirin and 75 mg/d clopidogrel). After the procedure and during 98 days’ follow-up including transoesophageal echocardiography, peri-procedural complications and clinical outcomes were investigated. Results: Mean CHA2DS2-VASc score was 4.9 ± 1.5 and mean HAS-BLED score was 3.6 ± 0.8. The main LAAC indication was contraindication to anticoagulation reflected by HAS-BLED score ≥ 3 observed in 95.5% cases (among them history of bleeding in 38 patients, 90.5%). 36.4% of patients have history of stroke or transient ischaemic attack. The procedure was successful in 97.7%. Peri-procedural complications were tamponade (2.3%) and one death (2.3%) unrelated to the procedure with no bleeding or vascular complications. During follow-up neither stroke nor bleeding were observed, whereas two device related thrombi and two unrelated deaths occurred. Conclusions: LAAC followed by DAPT seems to be a safe and efficient alternative for stroke prevention in patients with NVAF who have contraindications to anticoagulation therapy. This strategy may provide a significant reduction of events such as stroke and bleeding versus the score-predicted rate.

Differential diagnosis of intracardiac tumours should include i.a. thrombi, vegetations and neoplasms. We present a case of a 72-year-old male with paroxysmal atrial fibrillation, who had been previously treated with dabigatran and whose anticoagulant treatment was subsequently changed to enoxaparin during hospitalisation due to acute pancreatitis. Initially, tumour of the ampulla of Vater was suspected. Echocardiography revealed a polycyclic, balloting tumour in the right atrium, originating from the inferior vena cava. Based on computed tomography, magnetic resonance imaging and gastroscopy, carcinoma of the ampulla of Vater was ruled out. Positron emission tomography was performed, showing no signs of metabolically active neoplastic growth. Anticoagulation with acenocoumarol was initiated, leading to a complete resolution of the mass in the right atrium and inferior vena cava.

Background: Atrial fibrillation (AF) frequently coexists with heart failure (HF). Aim: To assess clinical characteristics and to identify predictors of one-year outcome of patients hospitalised for HF, depending on whether they were in sinus rhythm (SR) or had AF. Methods: The study included Polish patients hospitalised for HF, participating in the Heart Failure Pilot Survey of the European Society of Cardiology, who were followed for 12 months after discharge. Patients with paced heart rhythm were excluded from the study. The primary endpoint was all-cause death at 12 months. Results: The final analysis included 587 patients. AF occurred in 215 (36.6%) patients. Compared to patients in SR, patients with AF were older, more often had a history of previous HF hospitalisation, were characterised by a higher New York Heart Association (NYHA) class, higher heart rate, and lower diastolic blood pressure at hospital admission, and had higher serum creatinine and lower haemoglobin concentration at admission. In-hospital mortality was higher in AF patients compared to SR patients (5.1% vs. 2.4%, respectively), but the difference did not reach statistical significance (p = 0.1). The primary endpoint occurred in 41 of 215 AF patients (19.1%) and in 40 of 372 SR patients (10.8%; p = 0.006). In a multivariate analysis, predic­tors of the primary endpoint in AF patients were: higher NYHA class at hospital admission (p = 0.02), higher admission heart rate (p = 0.04), lower admission serum sodium concentration (p = 0.0001), and higher heart rate at discharge (p = 0.01). In patients with SR, independent predictors of the primary endpoint included: older age (p = 0.007), lower serum sodium concentration at admission (p = 0.0006), and higher heart rate at discharge (p = 0.008). Conclusions: Patients with HF and concomitant AF differ significantly from HF patients in SR. In the studied group of real-world HF patients, serum sodium concentration at hospital admission and heart rate at hospital discharge were independent prog­nostic factors in patients with AF and in patients in SR. In contrast to SR patients, heart rate at hospital admission in AF patients was also predictive of long-term mortality.

Background: Over the last few decades, the incidence and prevalence of chronic heart failure (HF) have been constantly increasing. Aim: To identify predictors of one-year mortality and hospital readmissions in patients discharged after hospitalisation for HF. Methods: The study included Polish patients who agreed to participate in the Heart Failure Pilot Survey of the European Society of Cardiology and were followed for 12 months. The primary endpoint was all-cause death at 12 months. The secondary endpoint was a composite of all-cause death and readmission for cardiac causes at 12 months. Results: The final analysis included 629 patients. The primary end point occurred in 68 of 629 patients (10.8%). In multivariate analysis, independent predictors of one-year mortality were: higher New York Heart Association (NYHA) class at admission (odds ratio [OR] 1.90; 95% confidence interval [CI] 1.01–3.59; p = 0.0478), inotropic support during hospitalisation (OR 3.95; 95% CI 1.49–10.47; p = 0.0056), and lower glomerular filtration rate at discharge (OR 0.978; 95% CI 0.961–0.995; p = 0.0117). The secondary endpoint occurred in 278 of 503 patients (55.3%). In multivariate analysis, predictors of secondary endpoint were a history of previous coronary revascularisation (OR 2.403; 95% CI 1.221–4.701; p = 0.002) and inotropic support during hospitalisation (OR 2.521; 95% CI 1.062–5.651; p = 0.009). Conclusions: Patients discharged after hospitalisation for HF remained at high risk of death and hospital readmission. A previous history of coronary revascularisation, decreased renal function, and worse clinical status at admission with the need for inotropic support were predictors of one-year outcome in Polish patients hospitalised for HF.

Wstep: Migotanie przedsionkow (AF) jest najczestszą utrwaloną tachyarytmią nadkomorową. Jedną z metod zapobiegania nawrotom AF jest ablacja prądem o wysokiej czestotliwości. Mimo dokladnej analizy w dostepnym piśmiennictwie nie wykazano jednoznacznego związku miedzy ocenianą echokardiograficznie wielkością lewego przedsionka (LA) a czestością nawrotow AF po zabiegu izolacji zyl plucnych (PVI). Cel: Celem pracy byla ocena związku miedzy wymiarem LA ocenianym echokardiograficznie a skutecznością zabiegu PVI. Metody: Grupe badaną stanowilo 175 pacjentow poddanych zabiegowi PVI w okresie od czerwca 2011 r. do marca 2012 r. Kryteria wlączenia obejmowaly: objawowe AF bez uchwytnej odwracalnej przyczyny, wiek < 70 lat, wymiar LA < 5,5 cm (przednio-tylny). Zabieg PVI wykonywano za pomocą klasycznego cewnika z 4-mm koncowką lub cewnikiem chlodzonym na podstawie zapisow z okreznego cewnika mapującego (system elektroanatomiczny LocaLisa lub CARTO). Nawrot arytmii definiowano jako wystąpienie po 3-miesiecznym okresie wygaszania jakiejkolwiek tachyarytmii przedsionkowej trwającej ponad 30 s. Po zabiegu PVI przeprowadzano standardową ocene echokardiograficzną LA w wymiarze przednio-tylnym oraz dodatkowo powierzchni skurczowej i rozkurczowej oraz objetości LA (pomiary podczas rytmu zatokowego). Wyniki: Analizie poddano 198 procedur PVI u 175 pacjentow. Mediana okresu obserwacji wyniosla 17 miesiecy, a mediana wieku badanej grupy — 56 lat. Nawrot AF po pierwszej procedurze wystąpil u 88 (52,4%) osob. Skutecznośc z uwzglednieniem ostatniego zabiegu PVI wyniosla 55,2% (43,5% w grupie przetrwalego AF, 59,7% w grupie napadowego AF). Nie stwierdzono istotnego statystycznie związku miedzy zadnym z analizowanych parametrow LA i nawrotem AF. Na podstawie analizy wieloczynnikowej Coxa stwierdzono, ze jedynym czynnikiem prognostycznym nawrotu AF w okresie obserwacji odleglej jest bardzo wczesny nawrot AF po zabiegu PVI. Wnioski: W grupie pacjentow z AF nie wykazano zalezności miedzy nawrotem AF po zabiegu PVI a echokardiograficznym i parametrami LA.

Background: Coronary revascularization is common in heart failure (HF). Aims: Clinical characteristic and assessment of in-hospital and long-term outcomes in patients hospitalized for HF with or without a previous percutaneous coronary intervention (PCI) or a coronary artery bypass grafting (CABG). Methods: The primary endpoint (PE) (all-cause death) and the secondary endpoint (SE) (all-cause death or hospitalization for HF-worsening) were assessed at one-year in 649 inpatients of the ESC-HF Pilot Survey. Additionally, occurrence of death during index hospitalization was evaluated. Results: PCI/CABG-patients (32.7%) were more frequently male, smokers, had myocardial infarction, hypertension (HT), peripheral artery disease and diabetes. The non-PCI/CABG-patients more often had a cardiogenic shock and died in-hospital. The PE occurred in 33 of the 212 PCI/CABG-patients (15.6%) and in 56 of the 437 non-PCI/CABG-patients (12.8%; P=0.3). The SE occurred in 82 of the 170 PCI/CABG-patients (48.2%) and in 122 of the 346 non-PCI/CABG-patients (35.3%; P=0.01). Independent predictors of the PE in the PCI/CABG-patients were: lower left ventricular ejection fraction, use of antiplatelets; in the non-PCI/CABG-patients were: age, ACS at admission. Independent predictors of the SE in the PCI/CABG-patients were: diabetes, NYHA (New York Heart Association) class at admission, HT; in the non-PCI/CABG-patients were: NYHA class, haemoglobin at admission. Serum sodium concentration at admission was a predictor of the PE and the SE in both groups. Heart rate at discharge was a predictor of the PE and the SE in the non-PCI/CABG patients. Conclusions: The revascularized HF patients had a similar mortality and higher risk of death or hospitalizations at 12 months compared with the non-PCI/CABG-patients. The revascularized patients had more comorbidities, while the non-PCI/CABG-patients had a higher incidence of cardiogenic shock and in-hospital mortality.

Transcatheter aortic valve implantation (TAVI) is an alternative method of treatment for severe symptomatic aortic stenosis in patients who are at high risk of surgical aortic valve replacement (AVR). In randomised clinical trials TAVI was shown to be superior to standard medical therapy in a cohort of inoperable patients and non-inferior to AVR in high-risk operable patients. Additionally, in a recent trial with self-expandable prosthesis use, TAVI was associated with lower mortality compared with surgery. Usually, femoral arteries are the most common vascular access to deliver the bioprosthesis; however, in some cases (up to 20%) this route may not be applied because of significant peripheral artery disease or tortuosity. In this article, we present the first two TAVI procedures in Poland performed via the left common carotid artery.

Background: Individuals with diabetes are at 2- to 4-fold higher risk of cardiovascular disease than those without diabetes. Highplatelet reactivity (HPR) plays a pivotal role in atherothrombotic complications of diabetes. Polish and American diabetes associationsrecommend treating high-risk diabetic patients with low doses of acetylsalicylic acid (ASA) in primary and secondary prevention of cardiovascular events. Unfortunately, some patients show HPR despite treatment with ASA. Aim: To determine the effect of doubling the dose of ASA on platelet reactivity in patients with type 2 diabetes and HPR despite treatment of with 75 mg of ASA. Methods: 304 type 2 diabetes patients treated with 75 mg of ASA were enrolled into the prospective, randomised, open-label Aspirin Versus/Or Clopidogrel in Aspirin-resistant Diabetics inflammation Outcomes (AVOCADO) study. Platelet reactivity was assessed by Platelet Function Analyser (PFA)-100®, VerifyNow® Aspirin Assay, and serum thromboxane B2 (sTXB2) and urinary 11-dehydrothromboxane B2 (u11dhTXB2) level measurements. Patients with HPR determined by collagen/epinephrine-inducedclosure time (CEPI-CT) measured by PFA-100® were randomised in a 2:3 ratio to receive 150 mg of ASA (Group 1) or 75 mg of clopidogrel (Group 2), respectively. Platelet reactivity was assessed at baseline and after 8 weeks of treatment. Results: Complete clinical data and blood samples were ultimately available for 260 of 304 patients initially enrolled tothe study. Subsequently, six patients were excluded from the analysis based on suspected ASA non-compliance (sTXB2 level > 7200 pg/mL). Among 254 patients finally included into analysis, HPR was found in 90 (35.4%) patients of whom 38 patientswere randomised to Group 1 and 52 patients to Group 2. Doubling the dose of ASA resulted in a significant CEPI-CTprolongation (D 111 s, p < 0.001) and reduction of sTXB2 level (D –101.3 pg/mL, p = 0.001) but did not significantly affectresults of other platelet function tests. Conclusions: Doubling the dose of ASA improved platelet reactivity in patients with type 2 diabetes and HPR.