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This review is a summary of the European Society of Cardiology (ESC) guidelines focused on dual antiplatelet therapy in patients after percutaneous coronary interventions (PCI). Given a large number of recommendations concerning antiplatelet therapy published in various ESC guidelines, the main goal of this paper was to compile these separate recommendations into one document. In addition, we set out to present the current state of knowledge and create an algorithm that would be based on all of these guidelines in hope that it would allow quick navigation when selecting the type and duration of dual antiplatelet therapy (DAPT) depending on the clinical scenario with a special emphasis on evaluating both ischemic and bleeding risks. The review is based on the ESC guidelines on the diagnosis and management of chronic coronary syndromes (2019), revascularization (2018), acute myocardial infarction in patients presenting with ST-segment elevation myocardial infarction (STEMI) (2017), DAPT (2017), and acute coronary syndromes in patients presenting without persistent ST-segment elevation (NSTE-ACS) (2020). The review also provides brief information on the most important studies and meta-analyses in this area, as well as practical pointers for management in the case of bleeding complications and before urgent surgery in patients on DAPT.

Background: Time delays to reperfusion therapy in ST-segment elevation myocardial infarction (STEMI) still remain a considerable drawback in many healthcare systems. Emergency medical service (EMS) has a critical role in the early management of STEMI. Under investigation herein, was whether the use of physician-staffed ambulances leads to shorter pre-hospital delays in STEMI patients. Methods: This was an observational and retrospective study, using data from the registry of the Silesian regional EMS system in Katowice, Poland and the Polish Registry on Acute Coronary Syndromes (PL-ACS) for a study period of January 1, 2013 to December 31, 2016. The study population (n = 717) was divided into two groups: group 1 (n = 546 patients) — physician-staffed ambulances and group 2 (n = 171 patients) — paramedic-staffed ambulances. Results: Responses during the day and night shifts were similar. Paramedic-led ambulances more often transmitted 12-lead electrocardiogram (ECG) to the percutaneous coronary intervention centers. All EMS time intervals were similar in both groups. The type of EMS dispatched to patients (physicianstaffed vs. paramedic/nurse-only staffed ambulance) was adjusted for ECG transmission, sex had no impact on in-hospital mortality (odds ratio [OR] 1.41; 95% confidence interval [CI] 0.79–1.95; p = 0.4). However, service time exceeding 42 min was an independent predictor of in-hospital mortality (OR 4.19; 95% CI 1.27–13.89; p = 0.019). In-hospital mortality rate was higher in the two upper quartiles of service time in the entire study population. Conclusions: These findings suggest that both physician-led and paramedic-led ambulances meet the criteria set out by the Polish and European authorities. All EMS time intervals are similar regardless of the type of EMS unit dispatched. A physician being present on board did not have a prognostic impact on outcomes.

Aims:The 2017 European Society of Cardiology guidelines for the management of ST-elevation myocardial infarction recommended assessing quality of care to establish measurable quality indicators in order to ensure that every ST-elevation myocardial infarction patient receives the best possible care. We investigated the quality indicators of healthcare services in Poland provided to ST-elevation myocardial infarction patients.Methods and results:The Polish Registry of Acute Coronary Syndromes is a nationwide, multicentre, prospective study of acute coronary syndrome patients in Poland. For the purpose of assessing quality indicators, we included 8279 patients from the Polish Registry of Acute Coronary Syndromes hospitalised with ST-elevation myocardial infarction in 2018. Four hundred and eight of 8279 patients (4.9%) arrived at percutaneous coronary intervention centre by self-transport, 4791 (57.9%) arrived at percutaneous coronary intervention centre by direct emergency medical system transport, and 2900 (37.2%) were transferred from non-percutaneous coronary intervention facilities. Whilst 95.1% of ST-elevation myocardial infarction patients arriving in the first 12 h received reperfusion therapy, the rates of timely reperfusion were much lower (ranging from 39.4% to 55.0% for various ST-elevation myocardial infarction pathways). The median left ventricular ejection fraction was 46% and was assessed before discharge in 86.0% of patients. Four hundred and eighty-nine of 8279 patients (5.9%) died during hospital stay. Optimal medical therapy is prescribed in 50–85% of patients depending on various clinical settings. Only one in two ST-elevation myocardial infarction patients is enrolled in a cardiac rehabilitation program at discharge. No patient-reported outcomes were recorded in the Polish Registry of Acute Coronary Syndromes.Conclusions:The results of this study identified areas of healthcare system that require solid improvement. These include direct transport to percutaneous coronary intervention centre, timely reperfusion, guidelines-based medical therapy (in particular in patients with heart failure), referral to cardiac rehabilitation/secondary prevention programs. Also, there is a need for recording quality indicators associated with patient-reported outcomes.

SARS-CoV-2 infection is associated with diverse clinical manifestations, immune dysfunction, and gut microbiota alterations. The nutritional and biochemical quality of one’s diet can influence the intestinal microbiota, which may play a role in the defense mechanisms against potential pathogens, by promoting a wide variety of immune–host interactions. In the COVID-19 pandemic, besides the development of pharmacological therapies, a healthy balanced diet, rich with food-derived antioxidants, may be a useful strategy. Many studies demonstrated that vitamins and probiotic therapies have positive effects on the treatment and prevention of oxidative stress and inflammation in COVID-19. The ecology of the gut microbiota in the digestive tract has been linked to the transport function of the host receptor known as angiotensin converting enzyme 2 (ACE2), suggesting that COVID-19 may be related to the gut microbiota. The angiotensin converting enzyme (ACE), and its receptor (ACE2), play central roles in modulating the renin–angiotensin system (RAS). In addition, ACE2 has functions that act independently of the RAS. ACE2 is the receptor for the SARS coronavirus, and ACE2 is essential for the expression of neutral amino acid transporters in the gut. In this context, ACE2 modulates innate immunity and influences the composition of the gut microbiota. Malnutrition is one of the leading underlying causes of morbidity and mortality worldwide and, including comorbidities, may be a major cause of worse outcomes and higher mortality among COVID-19 patients. This paper reviews the research on dietary components, with particular emphasis on vitamins, antioxidants, and probiotic therapies, and their impacts on the intestinal microbiota’s diversity during the SARS-CoV-2 pandemic.

Background Weight loss (WL) is an independent predictor of mortality in patients with heart failure (HF). Moderate WL is recommended for overweight or obese patients with type 2 diabetes mellitus (DM). The aim of this study was to assess the prognostic impact of body weight reduction on survival in patients with both HF with reduced ejection fraction (HFrEF) and DM. Methods The study comprised patients with HFrEF at the outpatient clinic. WL was defined as a body weight reduction of at least 7.5% during at least 6 months. Clinical features and 1 year mortality were analysed in WL and DM groups. Multivariate regression model was chosen to assess the predictive role of WL in HF patients with and without DM. The analysis regarding obesity before HF was also performed. Results The study comprised 777 patients with HFrEF. Mean age was 53.2 ± 9.2, 12.0% were women, mean EF was 23.7 ± 6.0 %, and New York Heart Association III or IV class, DM, and WL were found in 60.5%, 33.3%, and 47.1% patients, respectively. WL was more prevalent in diabetic patients, comparing with those without DM (53.7% vs. 43.8%, respectively, 0.01), and was associated with higher 1 year mortality only in non‐diabetic group (17.6% for WL vs. 8.2% for non‐WL, log‐rank 0.001). In the multivariate analysis, WL was associated with a higher risk of 1 year mortality in non‐diabetic patients: HR 1.76 (1.05–2.95), 0.03 and only in the subgroup without obesity: HR 2.35 (1.28–4.32), 0.006. In non‐diabetic patients with obesity and in diabetic patients regardless of weight status, WL was not associated with worse prognosis (thereof, WL was excluded from the multivariate models). Conclusions Overall, WL in HFrEF has emerged as a predictor of unfavourable outcomes only in non‐obese patients without DM. More importantly, this study has identified that the presence of DM (irrespective of weight status) or the presence of obesity in non‐diabetic patients abolished the unfavourable impact of WL on long‐term outcomes.

Iodine is one of the essential bioactive components of a diet and which has an influence on the thyroid hormones synthesis, and these hormones affect the proper development and functioning of the organism. In the situation when the iodides consumption is less than 50 μ g/day, it is unable to maintain the thyroid hormones synthesis at a normal level by the thyroid gland. The 1992/1993 Polish Council for Control of Iodine Deficiency Disorders study results were a direct reason for the compulsory resumption of table salt iodination. Table salt is a, commonly used, iodine carrier. According to the World Health Organization recommendations, the daily salt intake should not exceed 5 g NaCl (2 g Na) per person. Verification of Na content in the diet is a method for cardiovascular diseases prevention. Actions aimed at increasing of the other natural iodine carriers (milk, mineral water) intake are taken. Alternative sources of iodine in the diet are include: codfish, pollock, salmon, eggs, wheat bran, broccoli, dried pea seeds and hazelnuts. Iodination of mineral water and milk, as well as biofortification of the selected vegetables and feeding flock and cattle by food rich in iodine should be concerned according to salt restriction diet.

The ageing society and the growing problem of fragility syndrome necessitate the long-term use of cardiac drugs, thereby increasing the risk from drug/food interactions. The aim of this study was to present the interaction between foods and those drugs used in the clinical practice of cardiologists. The effect of vitamin K antagonists is intensified by food and drink such as sage, camomile, parsley, aniseed, liquorice, ginger, ginseng, cranberry juice, and grapefruit juice, among others. However, products rich in vitamin K inhibit the therapeutic effect of coumarin derivatives. Due to the increased risk of bleeding, antiplatelet drugs should not be combined with dietary supplements containing Ginkgo biloba which inhibits platelet activating factor. The literature indicates the occurrence of a similar risk when combining antiplatelet drugs with garlic-containing supplements. Numerous scientific studies have looked at the impact of food on the absorption of antihypertensive drugs. The best known of these is grapefruit/grapefruit juice. It was recently found that grapefruit acts by interfering in the activity of cytochrome P450 3A4 (CYP3A4) enzyme. People who regularly take cardiac drugs are exposed to food/drug interactions, and should be aware of the possible complications. There is an urgent need to educate patients in the area of food/drug interactions. Therefore, a therapeutic team should be created consisting of a general practitioner, a cardiologist, a psychologist, a nurse and a dietician.

Introduction: The accumulation of visceral abdominal tissue (VAT) seems to be a hallmark feature of abdominal obesity and substantially contributes to metabolic abnormalities. There are numerous factors that make the body-mass index (BMI) a suboptimal measure of adiposity. The visceral adiposity index (VAI) may be considered a simple surrogate marker of visceral adipose tissue dysfunction. However, the evidence comparing general to visceral adiposity in CAD is scarce. Therefore, we have set out to investigate visceral adiposity in relation to general adiposity in patients with stable CAD. Material and methods: A total of 204 patients with stable CAD hospitalized in the Department of Medicine and the Department of Geriatrics entered the study. Based on the VAI-defined adipose tissue dysfunction (ATD) types, the study population (N = 204) was divided into four groups: (1) no ATD (N = 66), (2) mild ATD (N = 50), (3) moderate ATD (N = 48), and (4) severe ATD (N = 40). Nutritional status was assessed using the Controlling Nutritional Status (CONUT) score. Results: Patients with moderate and severe ATD were the youngest (median 67 years), yet their metabolic age was the oldest (median 80 and 84 years, respectively). CONUT scores were similar across all four study groups. The VAI had only a modest positive correlation with BMI (r = 0.59 p &lt, 0.01) and body adiposity index (BAI) (r = 0.40 p &lt, 0.01). There was no correlation between VAI and CONUT scores. There was high variability in the distribution of BMI-defined weight categories across all four types of ATD. A total of 75% of patients with normal nutritional status had some form of ATD, and one-third of patients with moderate or severe malnutrition did not have any ATD (p = 0.008). In contrast, 55–60% of patients with mild, moderate, or severe ATD had normal nutritional status (p = 0.008). ROC analysis demonstrated that BMI and BAI have poor predictive value in determining no ATD. Both BMI (AUC 0.78 p &lt, 0.0001) and BAI (AUC 0.66 p = 0.003) had strong predictive value for determining severe ATD (the difference between AUC 0.12 being p = 0.0002). However, BMI predicted mild ATD and severe ATD better than BAI. Conclusions: ATD and malnutrition were common in patients with CAD. Notably, this study has shown a high rate of misclassification of visceral ATD via BMI and BAI. In addition, we demonstrated that the majority of patients with normal nutritional status had some form of ATD and as much as one-third of patients with moderate or severe malnutrition did not have any ATD. These findings have important clinical ramifications for everyday practice regarding the line between health and disease in the context of malnutrition in terms of body composition and visceral ATD, which are significant for developing an accurate definition of the standards for the intensity of clinical interventions.

Interventional cardiology has witnessed tremendous changes over the years from a mainly diagnostic approach in an elective population to therapeutic strategies in critically ill patients. Currently, we can treat a broad spectrum of coronary artery, peripheral artery, and structural heart diseases with less invasive, percutaneous approaches that we did not anticipate to be possible just a decade ago. It is certain that the interventional techniques will see further development and we will be able to treat by percutaneous methods more conditions previously thought beyond our reach. Regardless of the advances in catheter-based diagnostic and therapeutic techniques, one thing remains constant. They all require vascular access. And, vascular access is the first technical part of any percutaneous cardiovascular procedure that can determine its overall success. High-quality data together with the availability of training courses for interventional cardiologists and fellows-in-training ensure systematic use of the transradial approach (TRA) which has demonstrated a considerable benefit compared to transfemoral approach both in chronic and acute coronary syndromes. Constant improvement of TRA techniques will further facilitate transradial endovascular and structural interventions, and the growing use for high-risk and complex percutaneous coronary interventions. A continuously growing body of evidence is focused on surpassing current TRA limitations (specifically radial artery occlusion) and expanding alternative vascular accesses such as transulnar approach or distal TRA (“snuff-box” technique). Should this downsizing trend continue, we could see a further paradigm shift toward using the snuff-box technique.

Background and Aims: Body-mass index (BMI) is a popular method implemented to define weight status. However, describing obesity by BMI may result in inaccurate assessment of adiposity. The Body Adiposity Index (BAI) is intended to be a directly validated method of estimating body fat percentage. We set out to compare body weight status assessment by BMI and BAI in a cohort of elderly patients with stable coronary artery disease (CAD). Methods: A total of 169 patients with stable CAD were enrolled in an out-patient cardiology clinic. The National Research Council (US) Committee on Diet and Health classification was used for individuals older than 65 years as underweight BMI &lt, 24 kg/m2, normal weight BMI 24–29 kg/m2, overweight BMI 29–35 kg/m2, and obesity BMI &gt, 35 kg/m2. In case of BAI, we used sex- and age-specific classification of weight status. In addition, body fat was estimated by bioelectrical impedance analysis (BImpA). Results: Only 72 out of 169 patients (42.6%) had concordant classification of weight status by both BMI and BAI. The majority of the patients had their weight status either underestimated or overestimated. There were strong positive correlations between BMI and BImpA (FAT%) (R = 0.78 p &lt, 0.001), BAI and BImpA (FAT%) (R = 0.79 p &lt, and BMI and BAI (R = 0.67 p &lt, 0.001). BMI tended to overestimate the rate of underweight, normal weight or overweight, meanwhile underestimating the rate of obesity. Third, BMI exhibited an average positive bias of 14.4% compared to the reference method (BImpA), whereas BAI exhibited an average negative bias of −8.3% compared to the reference method (BImpA). Multivariate logistic regression identified independent predictors of discordance in assessing weight status by BMI and BAI: BImpA (FAT%) odds ratio (OR) 1.29, total body water (%) OR 1.61, fat mass index OR 2.62, and Controlling Nutritional Status (CONUT) score OR 1.25. Conclusions: There is substantial rate of misclassification of weight status between BMI and BAI. These findings have significant implications for clinical practice as the boundary between health and disease in malnutrition is crucial to accurately define criteria for intervention. Perhaps BMI cut-offs for classifying weight status in the elderly should be revisited.

Left ventricular assist devices are a treatment option for end-stage heart failure patients. Despite advancing technologies, bleeding and thromboembolic events strongly decrease the survival and the quality of life of these patients. Little is known about prognostic factors determining these adverse events in this group of patients. Therefore, we plan to investigate 90 consecutive left ventricular assist device (LVAD) patients and study in vitro fibrin clot properties (clot lysis time, clot permeability, fibrin ultrastructure using a scanning electron microscope) and the calibrated automated thrombogram in addition to the von Willebrand factor antigen, fibrinogen, D-dimer, prothrombin time/international normalized ratio (PT/INR), and activated partial thromboplastin time (APTT) to identify prognostic factors of adverse outcomes during the course of therapy. We plan to assess the hemostasis system at four different time points, i.e., before LVAD implantation, 3–4 months after LVAD implantation, 6–12 months after LVAD implantation, and at the end of the study (at 5 years or at the time of the adverse event). Adverse outcomes were defined as bleeding events (bleeding in general or in the following subtypes: severe bleeding, fatal bleeding, gastrointestinal bleeding, intracranial bleeding), thromboembolic events (stroke or transient ischemic attack, pump thrombosis, including thrombosis within the pump or its inflow or outflow conduits, arterial peripheral thromboembolism), and death.

Background. Generally, most vitamin D in the human body (90–95%) is produced in the skin during exposure to sunlight. The effectiveness of this process depends on several biological and physical factors, e.g., age or latitude. Skin synthesis of vitamin D among elderly people is reduced. The aim of the study was to assess serum 25-hydroxyvitamin D [25(OH)D] seasonal variations in elderly patients hospitalized at the geriatric department. Methods. The study was carried out on 242 patients aged 60 years or older hospitalized at the geriatric department. The study group was categorized by four seasons as well as month. Results. The median (interquartile range) 25(OH)D concentration among all patients (n = 242) was 33.95 (26.96–45.18) nmol/L. There was no statistical significance in the median serum 25(OH)D concentration with regard to each of the four seasons: in the spring 32.95 (25.96–43.68) nmol/L, in the summer 38.69 (27.46–50.67) nmol/L, in the autumn 33.45 (27.08–44.18) nmol/L, in the winter 34.57 (23.46–43.93) nmol/L, (p = 0.48). Conclusion. Vitamin D deficiency was observed in all geriatric patients, irrespective of the season. The results of the study indicate no significant differences in median vitamin D concentration among the hospitalized patients across all four seasons. Even in the summer months, in our climate, it is fairly difficult for an elderly person to produce an adequate amount of vitamin D through the skin. Therefore, proper vitamin D supplementation is recommended and should be implemented in the elderly irrespective of the season.

Background: No previous study has investigated the association between gamma glutamyltransferase (GGT) and vitamin D in patients with stable coronary artery disease (CAD). We investigated the cross-sectional associations between vitamin D status as assessed by serum 25(OH)D and GGT. Methods: 169 patients were enrolled. Study population was divided into three groups: 1: 25(OH)D &lt, 10 ng/mL (n = 59), 2: 25(OH)D 10&ndash, 20 ng/mL (n = 82), and 3: 25(OH)D &gt, 20 ng/mL (n = 28). Based on a cut-off GGT value identified in ROC analysis, we also divided the study population to compare the following groups: GGT &le, 19 (n = 66) and GGT &gt, 19 (n = 103). Results: GGT activity was the highest in vitamin D severely deficient patients and the lowest in vitamin D insufficient patients. GGT was inversely correlated with 25(OH)D concentrations (R = &minus, 0.23, p = 0.002). The receiver operating characteristics curve identified the discrimination threshold of GGT of &gt, 19 U/L in predicting vitamin D deficiency. Higher leukocyte and neutrophil counts and lower 25(OH)D concentration were found in patients with GGT &gt, 19 U/L. Conclusions: We identified an interaction between declining 25(OH)D levels and rising GGT levels with increasing age, which resulted in an unfavorable 25(OH)D-to-GGT ratio in stable CAD patients. These results suggest that these changes might further contribute to a high cardiovascular risk in the elderly.

We try to determine the association between weight changes (WC), both loss or gain, body composition indices (BCI) and serum levels of 25[OH]D during heart failure (HF). WC was determined in 412 patients (14.3% female, aged: 53.6 &plusmn, 10.0 years, NYHA class: 2.5 &plusmn, 0.8). Body fat, fat percentage and fat-free mass determined by dual energy X-rays absorptiometry (DEXA) and serum levels of 25[OH]D were analyzed. Logistic regression was used to calculate odds ratios for 25[OH]D insufficiency (&lt, 30 ng/mL) or deficiency (&lt, 20 ng/mL) by quintiles of WC, in comparison to weight-stable subgroup. The serum 25[OH]D was lower in weight loosing than weight stable subgroup. In fully adjusted models the risk of either insufficient or deficient 25[OH]D levels was independent of BCI and HF severity markers. The risk was elevated in higher weight loss subgroups but also in weight gain subgroup. In full adjustment, the odds for 25[OH]D deficiency in the top weight loss and weight gain subgroups were 3.30, 95%CI: 1.37&ndash, 7.93, p = 0.008 and 2.41, 95%CI: 0.91&ndash, 6.38, p = 0.08, respectively. The risk of 25[OH]D deficiency/insufficiency was also independently associated with potential UVB exposure, but not with nutritional status and BCI. Metabolic instability in HF was reflected by edema-free WC, but not nutritional status. BCI is independently associated with deficiency/insufficiency of serum 25[OH]D.

Wprowadzenie. Ostatnie doniesienia wskazują, że zmiana wydzielania hormonów w poszczególnych fazach cyklu u kobiet niestosujących terapii hormonalnej wpływa na ich zachowania żywieniowe. Cel pracy. Ocena zachowań żywieniowych kobiet w poszczególnych fazach cyklu menstruacyjnego w grupie kobiet niestosujących antykoncepcji hormonalnej. Materiał i metody. Do badania wykorzystano kwestionariusz składający się z 2 części. Oceny żywienia dokonano za pomocą wywiadu o spożyciu z 24 godzin. Obliczono dzienną podaż energetyczną diety (kcal) oraz zawartość białka, tłuszczu, węglowodanów i sacharozy (g, %). Grupę badaną stanowiły studentki jednej ze szkół wyższych. Do badania włączono 77 kobiet mających regularny cykl menstruacyjny. Kryterium wykluczenia z badania było przyjmowanie każdego rodzaju doustnej antykoncepcji hormonalnej, jakichkolwiek leków stosowanych w leczeniu chorób przewlekłych, zaburzenia odżywiania oraz brak zgody na udział w badaniu. Wyniki. Mediana podaży energii ze składników odżywczych była najwyższa w fazie lutealnej. W tej fazie zaobserwowano również najwyższe (mediana) spożycie białka, tłuszczu, węglowodanów i sacharozy. Procentowy udział energii pochodzącej z białka był najniższy w fazie lutealnej, a najwyższy w fazie folikularnej. Z kolei procentowy udział energii pochodzącej z sacharozy był najwyższy w fazie lutealnej i znacząco przewyższał udział energii z tego składnika w fazie owulacyjnej. Wnioski. Zachowania żywieniowe mogą być kształtowane przez hormony wydzielane podczas cyklu menstruacyjnego. Wzrost apetytu zaobserwowano w fazie lutealnej. Wartość energetyczna diety oraz spożycie tłuszczu, węglowodanów i białka ulega wahaniom w trakcie cyklu menstruacyjnego. Spożycie tłuszczu, białek, węglowodanów i sacharozy było najwyższe w fazie lutealnej. Background. Recent studies have reported that hormonal changes during the menstrual cycle in women who do not receive hormonal therapy have a significant influence on their eating habits. Objectives. The aim of this study was to evaluate the eating habits of women not receiving hormonal contraception in relation to menstrual cycle phases. Material and methods. A two-part survey questionnaire was used as a study tool. Eating habits were analyzed with a 24-hour dietary recall questionnaire. The following macronutrients were calculated: daily energy value (kcal), and amounts (g, %) of protein, fat, carbohydrates, and sucrose. The study group comprised 77 college students with regular menstrual cycles. Exclusion criteria included the use of any oral contraceptive, the use of medication for any chronic disease, any eating disorder, and a lack of written informed consent. Results. The median total energy intake from macronutrients was highest during the luteal phase. Median protein, fat, carbohydrate, and sucrose intake were also highest during the luteal phase. The percentage of energy intake from protein was lowest during the luteal phase and highest during the follicular phase. The percentage of energy intake from sucrose was highest during the luteal phase, which was significantly greater than that during the ovulation phase. Conclusions. Eating habits could be influenced by hormone secretion throughout the menstrual cycle. Increased appetite was observed in the luteal phase. Total energy, fat, carbohydrate, and protein intake fluctuated across the menstrual cycle. Fat, protein, carbohydrate, and sucrose intake were highest in the luteal phase.

Background Serum N-terminal pro-brain natriuretic peptide (NT-proBNP) concentration is elevated in patients with pulmonary hypertension (PH); however, its role in the detection of PH associated with lung disease is not well established. Aim The aim of this study was to assess the value of NT-proBNP in the detection of PH in patients with end-stage lung disease (esLD) referred for lung transplantation. Materials and methods The study population consisted of 65 patients: 37 with idiopathic pulmonary fibrosis (IPF), 20 with chronic obstructive pulmonary disease, and 8 patients with other interstitial lung diseases (75% men, mean age 53.3 ± 9.5 years). Serum concentration of NT-proBNP was assessed with an immunoradiometric assay kit. The mean pulmonary artery pressure (mPAP) was measured using a Swan-Ganz catheter. PH was defined as mPAP ≥ 25 mm Hg. Results Median NT-proBNP concentrations were significantly higher in patients with PH than in patients without PH: 139 (49–1236) pg/mL vs 67 (38–116) pg/mL, respectively; P = .016. Receiver operating characteristic (ROC) analysis revealed that NT-proBNP concentration higher than 131.5 pg/mL was a predictor of PH with good specificity (81%) and positive predictive value (78.9%) but low sensitivity (55.6%) and negative predictive value (58.6%). The area under the ROC curve of serum NT-proBNP concentration for PH was 0.71 (95% confidence interval 0.57–0.85, P = .039). Conclusion Serum concentration of NT-proBNP may be useful in the diagnosis of PH in patients with esLD referred for lung transplantation.

Aim: Albumin-to-globulin ratio (AGR) is emerged as a marker of impaired prognosis. We determined the predictive value of AGR in patients with heart failure with reduced ejection fraction (HFrEF). Methodology: 999 patients with HFrEF were enrolled. Rates of 1-year all-cause mortality were compared between AGR quartiles (Q). Moreover, multivariate survival analysis in Cox's regression model and receiver operating characteristic analyses were performed. Results: 90-day and 1-year mortality was the highest in AGR Q1. AGR was an independent predictor of 90-day and 1-year mortality. Receiver operating characteristic analysis revealed moderate diagnostic value in predicting 90-day (AGR cutoff

There is little published data on the association of platelet function and 25(OH)D concentration. We investigated the associations between mean platelet volume (MPV) and 25(OH)D concentration in patients with stable coronary artery disease. Study population was divided into three groups: group 1—25(OH)D 20 ng/mL (N = 14). Study groups shared similar demographics. MPV values were the highest in group 1, moderate in group 2, and the lowest in group 3 (11.1 vs 10.4 vs 9.8 fL P 10.5 fL) for vitamin D deficiency and a weak predictive value (AUC 0.65) in identifying the discrimination thresholds of 25(OH)D concentration (≤ 15.5 ng/mL) for the presence of large platelets (MPV over the upper limit of normal). In conclusion, even though the effect of vitamin D on platelet size and function is probably multifactorial, our study provides further evidence linking vitamin D to thrombosis and hemostasis. Platelets are another potential element through which vitamin D deficiency could exert adverse cardiovascular outcomes.

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.

In recent years, epidemiological studies have suggested that metabolic disorders are nutritionally dependent. A healthy diet that is rich in polyphenols may be beneficial in the treatment of metabolic diseases such as polycystic ovary syndrome, metabolic syndrome, non-alcoholic fatty liver disease, cardiovascular disease, and, in particular, atherosclerosis. Curcumin is a polyphenol found in turmeric and has been reported to have antioxidant, anti-inflammatory, hepatoprotective, anti-atherosclerotic, and antidiabetic properties, among others. This review summarizes the influence of supplementation with curcumin on metabolic parameters in selected metabolic disorders.

The microbiota is of interest for the development of a therapeutic strategy against SARS-CoV-2 coronavirus disease 2019 (COVID-19) due to its impact on the host immune system. Proven communications of the gut microbiota with the pulmonary microbiota (gut–lung axis) and the pathway of neural connections between the gut and brain (gut–brain axis) may be important in the face of the pandemic. SARS-CoV-2 was shown to affect almost all organs because of the presence of a host receptor known as angiotensin converting enzyme 2 (ACE2). The ACE2 receptor is mainly present in the brush border of intestinal enterocytes, ciliary cells, and type II alveolar epithelial cells in the lungs. The transport function of ACE2 has been linked to the ecology of gut microbes in the digestive tract, suggesting that COVID-19 may be related to the gut microbiota. The severity of COVID-19 may be associated with a number of comorbidities, such as hypertension, diabetes, obesity, and/or old age; therefore, attention is also paid to multiple morbidities and the modulation of microbiota through comorbidities and medications. This paper reviews the research in the context of the state of the intestinal microbiota and its impact on the cells of the immune system during the SARS-CoV-2 pandemic.

Ischemic heart disease has been the leading cause of death in developed countries for years. Mechanical complications of myocardial infarction are rare, but they have a very high mortality rate. The present paper outlines the epidemiology, clinical presentation, diagnosis and treatment of the most common of them: left ventricular free wall rupture, ventricular septal rupture, and acute mitral regurgitation in the course of papillary muscle rupture.

Aims Diabetes mellitus (DM) is one of the most frequently detected conditions in multimorbid disease clusters. Platelet activation is one of the key mechanisms underlying atherothrombosis in acute myocardial infarction. Available data link mean platelet volume (MPV) to poor prognosis not only in cardiovascular and non-cardiovascular disease. Given the lack of research data on the association between disease clusters and MPV, we have set out to investigate the link between multimorbidity and MPV in diabetic patients with acute myocardial infarction. Methods A total of 277 patients with DM and STEMI undergoing primary percutaneous coronary intervention were enrolled. Based on the number of comorbidities the study population was divided into two groups: group 1 (N = 58) with ≤ 1 comorbidity and group 2 (N = 219) with ≥ 2 comorbidities. A subanalysis was performed within the multimorbidity group: group 2A with two or three comorbidities (N = 156) and group 2B with at least four comorbidities (N = 63). Results In the study population, 15.9% of patients had one comorbidity, and 22.0, 34.3, and 22.7% of patients had two, three, or at least four comorbid conditions, respectively. Both MPV and PDW were elevated in multimorbid patients (9.3 vs 10.8 fl and 9.5 vs 10.3 fl, respectively). The highest platelet volume indices were observed in patients with at least four comorbid conditions. There was a moderate positive correlation between MPV and the total number of comorbidities, the number of CVD comorbidities, and the number of non-CVD comorbidities. Conclusions These findings indicate that multimorbidity is associated with an increase in platelet volume indices. MPV values increased with the increasing number of comorbid conditions. Importantly, MPV values were elevated in some, but not all CVD and non-CVD conditions.

// Bartosz Hudzik 1, 2 , Ilona Korzonek-Szlacheta 2 , Janusz Szkodzinski 1 , Marek Gierlotka 1 , Andrzej Lekston 1 , Barbara Zubelewicz-Szkodzinska 2 and Mariusz Gąsior 1 1 Third Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Silesian Center for Heart Disease, Zabrze, Poland 2 Department of Nutrition-Related Disease Prevention, School of Public Health in Bytom, Medical University of Silesia in Katowice, Katowice, Poland Correspondence to: Bartosz Hudzik, email: bartekh@mp.pl Keywords: myocardial infarction; diabetes mellitus; comorbidity; multimorbidity; prognosis Received: May 30, 2017 Accepted: September 13, 2017 Published: November 06, 2017 ABSTRACT Introduction: There is an increasing body of evidence on the clinical importance of multimorbidity, which is defined as the coexistence of two or more chronic conditions. Type 2 diabetes (T2DM) is one of the most frequent chronic conditions. Most adults with type 2 diabetes have at least 1 coexisting chronic condition and approximately 40% have 3 or more. Prior studies have suggested that cardiovascular (CVD) and non-CVD comorbid conditions yield worse outcomes in patients hospitalized with ST-elevation myocardial infarction (STEMI). It is unclear, however, the extent to which multimorbidity has a cumulative effect on long-term risk. Therefore we have set out to determine the prognostic value of multiple comorbidity on long-term outcomes in this population of patients. Methods: A total of 277 patients with T2DM and STEMI undergoing primary percutaneous coronary intervention (PCI) were enrolled. Based on the number of comorbidities the study population was divided into two groups: group 1 (N=58) with ≤ 1 comorbidity and group 2 (N=219) with ≥ 2 comorbidities. Results: Comorbid conditions were prevalent among study participants ( Figure 1 ). The median number of comorbidities was three. 15.9% of patients had one comorbidity and 22.0%, 34.3%, and 22.7% of patients had two, three or at least four comorbid conditions respectively. A majority of patients had at least one CVD comorbidity (6.1% of patients had none), whereas 53.1% of patients did not have any non-CVD comorbidity. During hospitalization 3 out of 58 patients (5.2%) died in group 1 and 25 of 219 patients (11.4%) died in group 2. The number of comorbid conditions was not an independent predictor of in-hospital death. During 12-month follow-up, 5 of 58 patients (8.6%) and 42 of 219 patients (19.9%) died, respectively in group 1 and 2 (P=0.05). The number of comorbid conditions proved in ROC analysis that for 12-month mortality, the prognostic value was modest, but for 12-month acute coronary syndromes the prognostic value was good. Increase in the number of comorbid conditions by one was associated with a 15% increase in the relative risk of 12-month mortality and a 41% increase in the relative risk of 12-month acute coronary syndromes (ACS). Conclusions: Comorbid conditions are highly prevalent among these groups of patients. Majority of patients have at least 2 other cardiovascular comorbidities and one or two non-cardiovascular comorbidities. In terms of long-term follow-up, multimorbidity was associated with worse outcomes. The risk of both long-term mortality and ACS increased with the increasing number of comorbidities. In summary, our findings highlight the importance of indentifying patients with multimorbidity. This, in turn, could allow for provision of better care to these high-risk and complex group of patients.

Few reports have analyzed the effect of pentraxin 3 (PTX3) on platelets and their activation. We explored the association between plasma PTX3 and platelet indices. Forty-nine patients with stable coronary artery disease (CAD) were enrolled. Based on median PTX3, the study population was divided into group 1 (n = 25; PTX3 ≤ 0.98 ng/mL) and group 2 (n = 24; PTX3 > 0.98 ng/mL). Platelet indices investigated included mean platelet volume (MPV), platelet distribution width (PDW), platelets and large cell ratio (P-LCR), MPV to platelet count ratio (MPV/PC), platelet to lymphocyte ratio (PLR), and MPV to lymphocyte ratio (MPVLR). Patients with lower PTX3 had a higher lymphocyte count. Platelet count was similar in both groups. Notwithstanding, patients with higher PTX3 concentrations had elevated MPV (8.3 vs 10.0 fL; P < .001) and PDW (9.4 vs 12.4 fL; P < .001). However, the MPV/PC ratio was similar in both groups. Thromboinflammatory biomarkers (PLR, MPVLR) were also elevated in group 2. Pentraxin 3showed a strong, positive correlation with MPV ( r = .75, P < .01) and PDW ( r = .80, P < .01), and weak to moderate correlation with MPVLR. In conclusion, PTX3 is associated with larger platelet size as assessed by platelet volume indices. There is a strong correlation between plasma PTX3 level and MPV and PDW.

Type 2 diabetes (T2D) is a recognized risk factor for acute coronary syndromes. There is currently no consensus concerning the intensification of antihyperglycemic treatment. According to the available guidelines, it seems that the goal is to achieve glycated hemoglobin (HbA1c) levels below 7% and avoid hypoglycemia. The choice of a revascularization method is influenced by many factors, such as the anatomy of the coronary arteries, severity of atherosclerosis, anatomical location of lesions, and presence of comorbidities. However, in non-ST elevation myocardial infarction, determining the culprit lesion is often difficult based on ECG or angiography. Experts recommend coronary artery bypass grafting (CABG) in patients with type 2 diabetes and multivessel or complex (SYNTAX score exceeding 22 points) coronary artery disease in order to improve survival. Percutaneous coronary intervention should be considered as an alternative to CABG to control symptoms in patients with type 2 diabetes and less complex forms of the disease (i.e., SYNTAX score of 22 or lower).

Trimetazidine (TMZ) exhibits metabolic and cardioprotective effects. The aim of this study was to assess the effects of TMZ on interleukin-2 (IL-2) and interleukin-8 (IL-8) serum concentrations in 156 patients with stable coronary artery disease. They underwent a treadmill exercise test (TET) before and after 3 months of TMZ treatment. IL-2 and IL-8 concentrations were determined before and after each TET. Before treatment, TET did not influence IL-2 concentrations, whereas IL-8 concentrations increased. TMZ treatment led to a decrease in IL-2 concentrations before TET, as well as it prevented the increase of IL-8 following the second TET. Obtained results confirmed the improvement in TET performance during TMZ treatment and they revealed a significant influence of TMZ on IL-2 and IL-8 concentrations both before and after TET. These changes may reflect potential anti-inflammatory effects of TMZ.