Search

Introduction Despite the growing number of studies on the epidemiology of out-of-hospital cardiac arrest (OHCA) in Poland, this issue has not been sufficiently studied. Notably, there has been a lack of uniform Utstein-style data reporting. Aim To evaluate the epidemiology of OHCA, patient characteristics, the laypeople and emergency medical service (EMS) response to cardiac arrest, and outcomes of OHCA patients, based on a prospective registry encompassing a population of 2.7 million Poles. Material and methods Consecutive, adult, EMS-treated OHCA cases in 2018 were analyzed. Prehospital data were collected using case report forms by EMS. Information on in-hospital procedures and outcomes was based on data from the public payer of health care services. Multivariable logistic regression analysis was performed to find independent predictors of survival to discharge. Results A total of 1392 patients were included. Most OHCA occurred at home (74.7%). In 66.8% of OHCA cases, the cardiac arrest was witnessed by bystanders and in another 20.4% by EMS. Laypeople performed cardiopulmonary resuscitation (CPR) in 54.4% of non-EMS-witnessed events, and an automated external defibrillator (AED) was used in 4.6% of patients who received bystander CPR. Finally, 30.7% of all patients were transported to the hospital, and 9.2% survived to hospital discharge. Epinephrine administration, unwitnessed OHCA, longer response time, older age, and initial non-shockable rhythm were independently associated with lower survival to discharge. Conclusions The prognosis of OHCA patients in Poland is poor. There is still room for improvement in increasing the prevalence of bystander CPR and AED use before EMS arrival.

Introduction Revascularization of patients with heavily calcified coronary arteries can be a challenge for interventional cardiologists. The procedural success rate in these patients can be improved by using rotational atherectomy (RA). Aim To compare in-hospital outcomes and those at 12-month follow-up between patients who underwent RA as a bailout procedure secondary to failed conventional angioplasty or as an elective procedure. Material and methods This is a retrospective analysis of 156 consecutive patients hospitalized at a high-volume percutaneous coronary intervention (PCI) center who underwent RA. In 43 (27.6%) patients, RA was performed on an elective basis (group 1). In 113 (72.4%) patients RA was carried out after unsuccessful traditional angioplasty (group 2). Results Patients in group 1 more often had a history of peripheral vascular disease (32.6% vs. 15.9%; p = 0.03). Group 1 was dominated by patients with multivessel disease (62.8% vs. 33.6%; p < 0.001). The left main coronary artery was more often treated in group 1 (25.6% vs. 2.7%; p < 0.001). Success rates in the two groups were similar: 93.0% for group 1 and 91.2% for group 2 (p = 0.71). The rate of in-hospital complications did not significantly differ between the groups. Twelve-month MI, TLR, and TVR rates were similar in both groups. There was no difference in the 12-month survival rate (86.1% vs. 92.0% in group 2; p = 0.27) or MACE (16.3% vs. 15.0%; p = 0.8). Conclusions Rotational atherectomy is associated with high efficacy and a relatively low risk of complications, with no significant differences in outcomes between patients treated with primary and secondary RA procedures.

Mechanical circulatory support (MCS) therapy is associated with the improvement of long-term prognosis in patients with end-stage heart failure. For years it has been used as a bridge to transplant. However, more recently it is even being used as a destination therapy. Recently, clinicians have identified common MCS therapy-associated complications: pump thrombosis, bleeding, and hemolysis. These complications are very challenging with regard to both diagnosis and management.To determine time-dependant changes of selected hemostasis/coagulation parameters in patients with end-stage heart failure treated with MCS and antithrombotic therapy.Sixteen patients with end-stage heart failure on left ventricular assist device (LVAD) were followed for 6 weeks (six blood samples for each patient). Every week an extended hemostasis panel was assessed, including activated partial thromboplastin time, prothrombin time, international normalized ratio, von Willebrand factor (vWF) activity, factor VIII activity, fibrinogen level, D-dimer, platelet response to arachidonic acid (ASPI test) and adenosine diphosphate (ADP test), thrombin receptor activating peptide-6 (TRAP test) and collagen (COL test).The study population comprised 16 men. The median time from LVAD implantation was 120 days (100-150 days). During the study period the D-dimer and fibrinogen concentrations were elevated but remained similar throughout all six measurements. Meanwhile factor VIII and vWF activities were elevated in the first two measurements and then subsequently declined. Inhibition of platelet aggregation was greater early after LVAD implantation. During subsequent weeks the inhibition of platelet aggregation was less pronounced. No patient developed any bleeding or thrombo-embolic event during the study period.Patients on MCS therapy demonstrate significant time-dependant changes in hemostasis parameters (both in the coagulation system and platelet aggregation).Mechaniczne wspomaganie układu krążenia (MCS) poprawia rokowanie chorych ze schyłkową niewydolnością serca. Przez lata metodę tę uznawano za leczenie pomostowe do transplantacji serca. Od niedawna stosuje się ją jako leczenie docelowe. Do częstych powikłań MCS należą: incydenty zakrzepowe (w tym zakrzepica urządzenia), incydenty krwotoczne oraz hemoliza. Powikłania te stanowią złożony problem kliniczny zarówno pod względem diagnostyki, jak i leczenia.Ocena zmian w czasie wybranych parametrów układu krzepnięcia u chorych ze schyłkową niewydolnością serca leczonych za pomocą MCS i terapii przeciwzakrzepowej.Przez 6 tygodni obserwowano 16 pacjentów ze schyłkową niewydolnością serca (sześć pobrań krwi dla każdego pacjenta). Co tydzień oceniano rozszerzony panel badań układu krzepnięcia, w tym czas częściowej tromboplastyny po aktywacji, czas protrombinowy, międzynarodowy współczynnik znormalizowany, aktywność czynnika von Willebranda (vWF), aktywność czynnika VIII, stężenie fibrynogenu, D-dimeru, czynność płytek pod wpływem kwasu arachidonowego (ASPI test) i dwufosforanu adenozyny (ADP test), aktywującego receptora trombinowego peptydu 6 (TRAP test) i kolagenu (COL test).W badaniu wzięło udział 16 mężczyzn. Mediana czasu od momentu wszczepienia urządzenia wspomagającego pracę lewej komory serca (LVAD) wynosiła 120 dni (100–150 dni). Podczas badania stężenia D-dimeru oraz fibrynogenu były podwyższone we wszystkich sześciu oznaczeniach, nie stwierdzono istotnych różnic między kolejnymi oznaczeniami. Aktywność vWF i czynnika VIII były podwyższone w pierwszych dwóch oznaczeniach, w kolejnych oznaczeniach obserwowano ich zmniejszenie. Zahamowanie agregacji płytek krwi było większe zaraz po implantacji LVAD. W następnych tygodniach stwierdzono zmniejszenie stopnia zahamowania agregacji płytek krwi. Podczas trwania badania u żadnego chorego nie wystąpił incydent zakrzepowo-zatorowy ani krwotoczny.U pacjentów stosujących MCS wykazano znaczne zmiany w parametrach hemostazy zarówno w układzie krzepnięcia, jak i aktywności płytek krwi.

Cardiovascular diseases remain the leading cause of death in Poland and other countries of the European Union. Patients with end-stage heart failure constitute a patient subgroup for whom the treatment of choice is heart transplantation. Despite advances in immunosuppressive therapy, acute or chronic graft rejection occurs in 20-30% of cases in the first six months after transplantation. The significance of the immune response and inflammation in graft rejection implies the important role of cytokines. Molecular markers are sought to facilitate risk assessment and improve patient care. At present, genetic tests are not used for this purpose, but studies aiming to rectify that have been conducted for years, including studies on single nucleotide polymorphisms of cytokine genes. This paper presents the results of research on the single nucleotide polymorphisms (SNPs) of the IL-2, IL-4, IL-6, IL-10, TGF-β1, PDGF, VEGF, and TNF-α genes in conjunction with heart transplantation. The analyzed data do not allow for reliable application of these genetic tests in clinical practice, but suggest that it is a promising direction which may improve the options of treatment individualization in the future.

INTRODUCTION The activation of the renin-angiotensin-aldosterone (RAA) system is a main element of the pathophysiology of chronic heart failure (CHF), determining its symptoms and prognosis. Vitamin D is an RAA inhibitor, and its deficiency frequently accompanies CHF. The factors determining the concentration of 25-hydroxyvitamin D [25(OH)D] in CHF are not well understood, although an association has been suggested between the deficiency and the advancement of CHF. Also unknown is the influence of therapeutic escalation using recommended agents on the serum level of 25(OH)D. The aim of this study was to examine the incidence of abnormal 25(OH)D concentrations in CHF patients and to establish the clinical and laboratory determinants of low activity of this metabolite. MATERIAL AND METHODS The retrospective analysis included the data of 412 CHF patients not receiving optimal pharmacological treatment who were initially in NYHA (New York Heart Association) class III or IV. Over the period of 3 months the therapy was escalated until reaching maximum tolerated doses or those recommended by the current guidelines. After optimizing the therapy, the incidence of 25(OH)D deficiency (< 30 ng/ml) and insufficiency (< 20 ng/ml) was established, and clinical and laboratory determinants for these abnormal concentrations were analyzed. RESULTS Normal serum level, insufficiency, and deficiency of 25(OH)D were observed in, respectively, 41.5%, 26.0% and 32.5% of patients. The NYHA class improved by at least 1 class in 63.6% of patients, remained unchanged in 32.8% of patients, and deteriorated in 3.6% of patients. In multivariables analysis, low availability of natural ultraviolet B (UVB) radiation, loss of body mass during the CHF, higher concentrations of phosphates and albumins, and the presence of diabetes increased the risk of 25(OH)D deficiency, while higher concentrations of uric acid reduced this risk. In patients with a positive response to therapy, the concentration of 25(OH)D was borderline significantly higher (p = 0.055), while insufficiency and deficiency were less frequent (p = 0.02) than in patients without a treatment response, but this pertained only to patients with higher exposure to UVB. These differences were not observed in patients with low UVB exposure. CONCLUSIONS The concentration of 25(OH)D in CHF patients is not associated with the advancement of the disease, but is strongly determined by the potential availability of UVB radiation. A positive response to therapy increases the concentration of 25(OH)D only in the case of high UVB exposure; other determinants of 25(OH)D level include the patient's metabolic profile and the presence of diabetes.