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Introduction There are numerous studies concerning iatrogenic cardiac tamponade. Those studies are predominantly focused on one cardiac procedure and the follow-up is not always presented. Aim To estimate the rate of cardiac tamponade following 66,812 percutaneous invasive cardiac interventions depending on the procedure. For each group the baseline characteristics and hospital management, as well as in-hospital, 30-day and 1-year mortality, were evaluated. Material and methods The study was a single-center retrospective analysis performed in a tertiary clinical hospital, which encompasses two cardiology departments, assessing a large sample of patients who underwent percutaneous invasive cardiac procedures complicated with cardiac tamponade between January 2006 and December 2018. For this purpose, medical records and hospital databases were analyzed. Long-term follow-up was obtained in cooperation with the Silesian Cardiovascular Base. Results The rate of iatrogenic cardiac tamponade during the 13-year period was 0.176%. The incidence among selected invasive cardiac procedures ranged between 0.09% and 1.42%. The majority of cases (104/118) were treated by pericardiocentesis, 16 had pericardiotomy and 4 patients had both therapies. Inotropes were used in 25-45%, blood transfusion in 45% of patients. The highest in-hospital mortality was observed in patients with cardiac tamponade after transcatheter aortic valve implantation. The highest 30-day and 1-year mortality rates were seen in the group with temporary electrode pacing. Conclusions The low incidence of cardiac tamponade with the high number of patients requiring intensive care supply and high in-hospital mortality tend to confirm that cardiac tamponade is a rare but life-threatening complication.

Background: The prognosis of men and women with chronic coronary syndromes (CCS) remains ambiguous. Aims: This study aimed to compare the clinical characteristics and 12‑month prognosis of women and men with CCS included in the prospective single‑center registry. Methods: The study was based on the Prospective Registry of Stable Angina Management and Treatment (PRESAGE) including 11 021 patients with CCS hospitalized between 2006 and 2016 and subjected to coronary angiography. The composite endpoint included all‑cause death, nonfatal myocardial infarction, acute coronary syndrome with revascularization, unstable coronary artery disease, or stroke. Results: Women were older than men (mean [SD] age, 66.6 [9] vs 63.5 [9.6] years; P < 0.001). Arterial hypertension (85.8% vs 79%; P < 0.001) and type 2 diabetes (38.2% vs 33.7%; P < 0.001) were more often diagnosed in women compared with men. Multivessel disease or left main disease were more frequent in men. Percutaneous coronary intervention and coronary artery bypass grafting were more often performed in men than in women (47.1% vs 36%, P < 0.001 and 10.6% vs 6.1%, P < 0.001, respectively). At 12‑month follow‑up, the composite endpoint was more frequently reached in men (7.4% vs 10.2%; P < 0.001), including death (3.3% vs 4.5%; P = 0.002). In multivariable analysis, sex was not an independent predictor of the composite endpoint (hazard ratio, 1.08; 95% CI, 0.89–1.31, P = 0.45). Conclusions: Women and men with CCS differ in terms of the incidence of risk factors and revascularization treatments received. In men, a higher frequency of death and the composite endpoint was noted at 12‑month follow‑up. However, sex was not an independent predictor of patient outcomes at 12 months.

Mechanical circulatory support (MCS) methods are used in patients with both acute and chronic heart failure, who have exhausted other options for pharmacological or surgical treatments. The purpose of their use is to support, partially or completely, the failed ventricles and ensure adequate organ perfusion, which allows patients to restore full cardiovascular capacity, prolonging their life and effectively improving its quality. The three most popular devices include an intra-aortic balloon pump (IABP), percutaneous assist devices (including Impella, TandemHeart), and venoarterial extracorporeal membrane oxygenation (VA-ECMO). A multidisciplinary approach with the special participation of the Heart Team is required to determine the proper MCS strategy, the choice of the supporting method, and the time of its use. The studies published so far do not allow us to determine which MCS method is the safest and the most effective. Thus, the site experience and accessibility of the method seem to matter most today. MCS finds particular application in patients with acute coronary syndromes complicated by refractory cardiogenic shock, as well as in patients with acute heart failure of the high potential for reversibility. It can also serve as a backup for percutaneous coronary interventions of high risk (complex and high-risk indicated percutaneous coronary intervention [PCI], complex and high-risk indicated PCI [CHIP]). The use of appropriate supportive drugs, precise hemodynamic and echocardiographic monitoring, as well as optimal non-invasive or mechanical ventilation, are extremely important in the management of a patient with MCS. The most serious complications of MCS include bleeding, thromboembolic events, as well as infections, and hemolysis.

IntroductionAccording to single institution studies, patients readmitted to the ICU (Intensive Care Unit) following cardiac surgery are at high risk of death. In our study, we primarily aimed to assess the impact of ICU readmission on postoperative results and to identify the independent risk factors of this complication among patients undergoing isolated coronary artery surgery.Material and methodsFollowing exclusions, we analyzed 89,958 consecutive patients in the Polish National Registry of Cardiac Surgical Procedures (KROK Registry), scheduled for isolated coronary artery surgery between January 2010 and December 2019. Variables that independently influenced ICU readmission were identified by means of the multivariable logistic regression. Data of survivors and non-survivors among patients readmitted to the ICU were compared.ResultsIn the analyzed group, 1,003 patients underwent ICU readmission (1.1%). In-hospital mortality among patients readmitted and not readmitted to the ICU was 29.6% and 2.1%, respectively (p65 years and preoperative NYHA class III or IV were located on the top of this list. Patients who died following ICU readmission were older, more frequently classified NYHA IV, more frequently underwent non-elective surgery or MIDCAB (Minimally Invasive Coronary Artery Bypass).ConclusionsICU readmission following coronary artery surgery is associated with increased in-hospital mortality and the development of postoperative complications. There are many predictors of ICU readmission. Non-survivors of this complication were older, with more advanced heart failure and more frequently underwent non-elective surgery.

OBJECTIVE: Preoperative atrial fibrillation (AF) increases risk of stroke, heart failure, and all-cause mortality after cardiac surgery. Despite encouraging results and guideline recommendations, surgical ablation (SA) for AF concomitant with other heart surgery remains low. In the current study we aimed to address the long-term mortality after SA concomitant with cardiac surgery.METHODS: This report pertains to the HEart surgery In atrial fibrillation and Supraventricular Tachycardia (HEIST) registry. We identified 20,765 adult patients (62% male) with preoperative AF who underwent conventional sternotomy heart surgery between 2010 and 2021 in 8 tertiary centers in Poland, Netherlands, and Italy. We used Cox proportional hazards models for computations and propensity score matching to minimize differences in baseline characteristics.RESULTS: Of included patients, 2755 (13.4%) underwent SA for AF. The highest rates of SA were observed for mitral interventions (mitral valve repair or replacement and tricuspid intervention, 25.2%), lowest for isolated coronary artery bypass grafting (6.2%). Patients in the SA group were younger (mean age 64.5 ± 9.0 years vs 68.7 ± 16.0 years; P < .001) and lower risk (mean European System for Cardiac Operative Risk Evaluation [EuroSCORE] II, 4.1 vs 5.7; P < .001). During the 11-year study period, there was a mortality reduction associated with SA (hazard ratio, 0.57; 95% CI, 0.52-0.62; P < .001). After propensity matching, 2750 pairs with similar baseline characteristics were identified. SA was associated with 16% mortality decline (hazard ratio, 0.84; 95% CI, 0.75-0.94; P = .003).CONCLUSIONS: In this multicenter, retrospective, propensity matched study, SA concomitant with other cardiac surgery was associated with improved long-term survival regardless of baseline surgical risk.

Background: Available data suggest the important role of ablation of the left atrial posterior wall and epicardial myocardial layers in rhythm control therapy in patients with persistent drug‑refractory atrial fibrillation (AF). However, endocardial ablation is not always effective in transmural substrate modification. The alternative treatment option is minimally invasive hybrid approach (HABL) combining the strengths of surgical and catheter ablation. Aims: This study aimed to assess the periprocedural safety as well as acute and long‑term outcomes of HABL for AF. Methods: This is a retrospective single‑center study of patients who underwent HABL using the minimally invasive transabdominal approach between July 2009 and January 2020. Demographic in‑hospital data and 12‑month follow‑up results were obtained. The number of hospitalizations, cardioversions, re‑ablations, and severe adverse events in a 3‑year period before and after HABL were compared using data from the national healthcare provider. Results: In total, 158 patients (mean [SD] age, 51.02 [10.67] years) who underwent HABL were included; 61.4% had persistent AF. There was a 4.4% incidence of periprocedural complications without any fatalities. In 66% of patients, additional endocardial substrate modification was needed, in 52.6% on the posterior wall. In the 12‑month follow‑up, most patients (78.3%) remained free of arrhythmias. There was a significant reduction in the number of hospitalizations (for AF, 1.65 vs 0.54; or any other cause, 2.56 vs 1.31 per patient), cardioversions, and re‑ablations after HABL (all P < 0.05). Conclusions: The hybrid multidisciplinary approach for treatment of AF is a safe and very effective treatment method in long‑term follow‑up, which reduces healthcare burden. It could be considered as an alternative therapeutic option especially in patients with persistent AF.

Systemically delivered adeno-associated viral vector serotype 9 (AAV9) effectively transduces murine heart, but provides transgene expression also in liver and skeletal muscles. Improvement of the selectivity of transgene expression can be achieved through incorporation of target sites (TSs) for miRNA-122 and miRNA-206 into the 3′ untranslated region (3′ UTR) of the expression cassette. Here, we aimed to generate such miRNA-122- and miRNA-206-regulated AAV9 vector for a therapeutic, heart-specific overexpression of heme oxygenase-1 (HO-1). We successfully validated the vector functionality in murine cell lines corresponding to tissues targeted by AAV9. Next, we evaluated biodistribution of transgene expression following systemic vector delivery to HO-1-deficient mice of mixed C57BL/6J × FVB genetic background. Although AAV genomes were present in the hearts of these animals, HO-1 protein expression was either absent or significantly impaired. We found that miRNA-122, earlier described as liver specific, was present also in the hearts of C57BL/6J × FVB mice. Various levels of miRNA-122 expression were observed in the hearts of other mouse strains, in heart tissues of patients with cardiomyopathy, and in human induced pluripotent stem cell-derived cardiomyocytes in which we also confirmed such posttranscriptional regulation of transgene expression. Our data clearly indicate that therapeutic utilization of miRNA-based regulation strategy needs to consider inter-individual variability., Graphical Abstract, Kraszewska et al. investigated miRNA-122- and miRNA-206-mediated posttranscriptional regulation to restrict AAV9-encoded transgene expression to mouse cardiac tissue. A low level of miRNA-122 present in the investigated murine heart, as well as in human cardiomyocytes, considerably decreased transgene expression, indicating that the use of miRNA target sites should be carefully considered.

INTRODUCTION. The study is a prospective clinical observation of patients after orthotopic heart transplantation in a large academic medical center in relation to COVID-19 morbidity. The study population was comprised of 552 patients. All patients were consulted and advised by telephone as regards the prophylaxis of SARS-CoV-2 infection. Hospital and outpatient follow-ups were limited to the minimum. Preventive modification of immunosuppression was not recommended in relation to the pandemic. Three patients with multiple comorbidities (a woman aged 60, a man aged 59, and another man aged 83; 2.25 years, 5.5 years, and 7.5 years after heart transplantation, respectively) and one patient with concomitant arterial hypertension (a woman aged 48, 5.5 years after heart transplantation) presented with a symptomatic COVID-19 infection. Three of the patients were on tacrolimus immunosuppression, and both female patients were additionally on therapy with mycophenolate mofetil, which was discontinued following the diagnosis of infection. One male patient received combined therapy of cyclosporine A and mycophenolate mofetil. The 60-year-old woman presented with gastrointestinal manifestations of the COVID-19 infection which were of moderate severity. The recovery was achieved. The 59-year-old man presented with myocardial infarction, exacerbated renal insufficiency that required hemodialysis and cardiorespiratory failure complicated by bacterial sepsis. As a result, the patient died. The 83-year-old male patient reporting fever, myalgia, fatigue, cough and dyspnea was admitted to hospital and deceased due to septic shock two days after admission. The 48-year old woman who presented with mild symptoms of the upper respiratory tract infection recovered after two weeks. Symptomatic treatment was used in all the patients. Another male patient (aged 45 years, 8 years after orthotopic heart transplant with no significant comorbidities) was an asymptomatic carrier of SARS-CoV-2 and remained under hospital care. Conclusions: Of 552 patients after orthotopic heart transplantation, two SARS-CoV-2-related deaths were reported.

INTRODUCTION Transcatheter aortic valve-in-valve implantation (ViV-TAVI) emerged recently as an alternative to re-do surgery for patients with failed surgical aortic valve (SAV). OBJECTIVES To evaluate the safety and efficacy of transcatheter aortic valves (TAV) in failed SAV in Poland. PATIENTS AND METHODS Data was acquired using a nationwide, multicenter (n=14) Polish Transcatheter Aortic Valve-in-Valve Implantation (ViV-TAVI) Registry (ClinicalTrials.gov Identifier, NCT03361046) with online form collection and 1-year follow-up. RESULTS ViV-TAVI procedures (n=130) constituted 1.9% of all TAVI in Poland with increasing numbers since 2018 (n=59, 45% of all). Hancock II® (21%), Freestyle® (13%), and homograft (11.5%) were identified as the most frequently treated SAV's with self-expanding, supra-annular Corevalve/Evolut® TAV used in the majority of cases (76%). Average post-procedural pressure gradient (average PG) >20 mmHg was found in 21% and 1-year all-cause mortality was 10.8%. SAV stenosis compared to regurgitation/mixed disease was associated with higher average (16, IQR 13.5 - 22.5 vs 14.5, IQR 10-19 mmHg, p=0.004) whereas implantation of supra-annular TAV resulted in lower average PG (14, IQR 10.5-20 vs. intra-annular 19, IQR 16-26 mmHg, P=0.004). After introduction of 2nd generation TAV, shorter procedure time (120, IQR 80-165 min. vs. 135, IQR 108-200 min., P=0.04), less frequent need for additional TAV (2% vs. 10%, P=0.04) and better 1-year freedrom from cardiovascular deaths (95% vs. 82.8%, hazard ratio 0.25, 95% confidence intervals 0.17-0.88, P=0.03) was observed vs. 1st generation. CONCLUSIONS Transcatheter treatment of failed SAV is becoming more frequent, showing the best hemodynamic effect with the use of supra-annular TAV and improved procedural as well as clinical results with the introduction of 2nd generation TAV.

Continuous-flow left ventricular assist devices (LVADs) have been extensively used in a strategy of bridge to orthotopic heart transplant and destination therapy. The usage of LVAD, however, is not free from limitations such as device-related adverse events, including pump thrombosis (PT). We aimed to develop an algorithm of early PT detection based on the maintenance parameters monitored by the implanted device.We analyzed log files of 101 patients implanted with HeartWare pump (HVAD) with 18 PT events among them. For signal processing, we used the open-high-low-close format transformation and typical price (TP) technical analysis indicator. Model parameters were tuned with 5-fold cross-validation, and the final performance was measured on a separate group of patients.Our algorithm achieved 100% sensitivity and 100% specificity of indications. In the final evaluation, alarms preceded the clinical acknowledgement of events by 2 days and 20 h on average. In the worst-case scenario, an alarm was raised 1 day and 8 h prior to the event.The proposed algorithm could be installed to work directly with the device controller and provide clinicians with automatic readings analysis, raising an alarm when there is a high probability of thromboembolism. Early event detection could enable better thrombosis management and improve prognosis in patients implanted with HVAD.

Purpose End-stage heart failure (HF) is a major global clinical problem with a growing number of patients worldwide. Heart transplantation (HTx) and mechanical circulatory support (MCS) represent the two most effective procedural options for the treatment of end-stage HF. HTx remains the treatment of choice in patients who reach maximal medical therapy, but, remain incapacitated by their symptoms. The COVID-19 pandemic caused by SARS-CoV-2 has significantly affected the delivery of medical care across all specialties, therefore, it is not a surprise that the number of HTx has drastically diminished worldwide during the pandemic. We developed in our Center of Heart Diseases effective safety measures and team approach in order to perform HTx with excellent outcomes. Methods All patients with reduced ejection fraction, heart failure at presentation and had been adequately investigated had been evaluated by a multidisciplinary team and when appropriate entered into a waiting list for HTx. Results From March2020 to March 2021, 96 patients underwent orthotopic HTx. The age range was 33 - 66 yrs and a median of 54 yr. Both donor and recipient were tested for SARS-CoV-2 within 48 hrs of the procedure, and none tested positive. All recipients were regularly tested following the procedure, too, and none were positive. 53 patients with INTERMACS 4 class have been treated, 31 with INTERMACS 3 class and 11 patients with INTERMACS 2. Only one patient with INTERMACS 1 underwent HTx. 6 (10%) patients died within the first 30 days following HTx. All staff caring for those patients were screened for SARS-CoV-2 at regular intervals. There was liberal use of PPE at all stages of the care of the patients, with strict hand hygiene. All surviving patients were subjected to the normal protocol of post-operative management in terms of immunosuppression and other medications. Conclusion Heart transplantation remains the treatment of choice for advanced heart failure. About 85% of heart transplant patients survive one year following the procedure thus giving them a better quality of life. We have shown that successful heart transplantation may be performed during the SARS-CoV-2 pandemic. Funding Acknowledgement Type of funding sources: None.

With the development of less invasive techniques ministernotomy has become an increasingly popular choice for minimally invasive aortic valve replacement (MIAVR). However, a large discrepancy in the published results, often derived from the center's own experience, intensifies the need for further re-evaluation in order to better define the real impact of the ministernotomy approach on postoperative clinical condition in short- and long-term observation.To assess the safety and efficacy of MIAVR in comparison to a reference full sternotomy AVR (FSAVR).Between January 2004 and January 2018, 2386 patients underwent isolated surgical aortic valve replacement (AVR) at our institution. 620 patients were treated minimally invasively (MIAVR) and 1766 patients received FSAVR. Forced propensity score 1 : 1 matching and conditional regressive methods were introduced, ensuring valid comparison and correct estimation. Ultimately, 557 well allocated pairs of treated and control patients were included.In-hospital mortality was low and comparable (1.26% for MIAVR, 1.62% for FSAVR). No significant differences in terms of serious adverse events were found, although in patients undergoing MIAVR there tended to be lower incidence of neurological complications (OR = 0.72;MIAVR is a safe, effective and reproducible procedure providing at least as good results as FSAVR. Nevertheless, it should be especially recommended to obese, diabetic patients with pulmonary and mobility disorders in order to improve their early recovery.

Coronary artery disease (CAD), due to common risk factors, often accompanies aortic stenosis (AS) [1]. CAD occurs in 50–75% of patients undergoing transcatheter aortic valve implantation (TAVI) [1]. However, there are no data on the necessity and the extent of revascularization in CAD patients referred for TAVI. According to the ESC/EACTS guidelines for myocardial revascularization published in 2018, percutaneous coronary intervention (PCI) should be considered in patients with stenoses > 70% in proximal segments of coronary arteries, undergoing TAVI [2]. Optimal timing (before, simultaneously or after TAVI) and the mode of revascularization have not yet been established [2].

OBJECTIVE To assess the suitability of nanocrystalline-coated silver dressings versus standard wound dressings in patients with type 2 diabetes after coronary revascularization. METHODS The study involved 194 patients who were divided into two homogeneous groups. The control group (n = 97) received a standard sterile dressing. The intervention group (n = 97) received silver dressings. Glycosylated hemoglobin, fructosamine, and creatinine were assessed in all patients. The emergence of superficial wound infection within 30 days was the primary endpoint of the study, and deep wound infections were a secondary endpoint. MAIN RESULTS Superficial wound infections were documented in 26 patients: 11 patients in the study group and 15 in the control group. There were no statistically significant differences between the analyzed groups regarding the occurrence of the primary endpoint. No deep wound infections were found in either the study or control group. CONCLUSIONS The frequency of sternotomy wound infection in patients with type 2 diabetes is comparable between patients treated with traditional dressings and those receiving silver dressings; therefore, to maximize cost savings, providers should consider using standard wound dressings in this patient population.

Introduction Before the operation each cardiosurgery geriatric patient is assessed by the Vulnerable Elders-13 Survey (VES-13) and European System for Cardiac Operative Risk Evaluation (EuroSCORE) scales. Aim To compare the applicability of the VES-13 and EuroSCORE scale in the assessment of postoperative risk among operated patients > 60 years old qualified most often for coronary artery bypass grafting. Material and methods VES-13 is a questionnaire containing 13 questions, including patient’s age and a health self-assessment. The EuroSCORE includes age, sex and cardiological assessment and vascular changes, respiratory diseases, neurological and nephrological disorders. In both scales the risk of death is high when the patient has > 6 points. The study included 100 patients ≥ 60 (60.83 ±6.18) years old who were divided into subgroups with < 6 points and ≥ 6 points. Results The number of VES-13 points = 3.06 ±2.25, EuroSCORE = 5.50 ±3.19. In patients > 75 years old VES score was 4.32 ±2.6 vs. 2.707 ±2.02 and EuroSCORE 8.09 ±3.02 vs. 4.77 ±2.83. The most frequent postoperative complication was atrial fibrillation. The most frequent complications were the following: death (5%), delirium (3.64%), bleeding (3.54%), stroke (3.54%), renal failure (3.32%), pacemaker implantation (3.28%), difficult healing of the wound (2.64%), intestinal ischemia (2.56%). The correlation between the VES-13 and EuroSCORE was moderate. Conclusions In cardiosurgery patients who obtained before the operation ≥ 6 points on the VES-13 or EuroSCORE the risk of postoperative complications is high. VES-13 and EuroSCORE cannot be used interchangeably because the correlation is at a medium level.

Heart failure is a clinical syndrome of multifactorial aetiology with typical symptoms and diverse prevalence depending on the world region, reaching more than 10% in the population over 70 years of age. The prognosis, in spite of a dynamic improve- ment in medical therapy, remains poor. The only treatment for these patients is heart transplantation, however, its availability is highly limited because of the shortage of donor organs. Mechanical circulatory support can offer an alternative treatment for this patient cohort. In this review the authors discuss the present indications for, as well as results and complications of different types of long-term mechanical circulatory support. The long-term survival in patients receiving this therapy, in spite of many complication, is much better than in those receiving medical treatment. The use of mechanical circulatory support is an established treatment option for many patients with end-stage heart failure. The most important issue for the cardiologist is to identify patients eligible for this therapy in order to give them a chance for a longer life and better quality of life.

Aims Mesenchymal stromal cells isolated from different tissues are claimed to demonstrate similar therapeutic potential and are often incorrectly named mesenchymal stem cells. However, through comparison of such cells is lacking. This study aimed to compare the transcriptome of mesenchymal cells of the same phenotype isolated from the heart muscle and epicardial fat of the same patient, before and after culture. Methods and results Cells were isolated from biopsies of the right ventricle and epicardial fat collected from five patients (three men and two women, mean age 59.4 ± 2.6) who underwent heart transplantation due to ischaemic cardiomyopathy. In both tissues, immunophenotyping revealed three distinct populations: (i)CD31- CD45- CD90+ CD34+ CD146- , (ii) CD31- CD45- CD90+ CD34- CD146+ , and (iii) CD31- CD45- CD90- CD34- CD146+ , of which only the first one could be grown after sorting. Material for RNA-seq was collected from these cells before culture (250 cells) and at passage 6 (5000 cells). Transcriptomic analysis revealed that cells of the same phenotype (CD31- CD45- CD90+ CD34+ CD146- ) upon isolation preferentially clustered according to the tissue of origin, not to the patient from whom they were isolated. Genes up-regulated in the right ventricle-derived cells were related to muscle physiology while down-regulated genes included those encoding proteins with transmembrane signalling receptor activity. After six passages, heart-derived and fat-derived cells did not acquire similar transcriptome. Cells isolated from the right ventricle in comparison with their epicardial fat-derived counterparts demonstrated higher level of transcripts related, among others, to RNA processing and muscle development. The down-regulated genes were involved in the nucleosome assembly, DNA packaging and replication, and interleukin-7-mediated signalling pathway. Cells from epicardial fat demonstrated higher heterogeneity both before and after culture. Cell culture significantly changed gene expression profile within both tissues. Conclusions This study is an essential indication that mesenchymal cells isolated from different tissues do not demonstrate similar properties. Phenotypic identification and ease of isolation cannot be considered as a criterion in any therapeutic utilization of such cells.

Cardiocyte myofibrillolysis and interstitial fibrosis belong to histopathological changes in cardiomyopathies, leading to heart failure.To evaluate these changes in apical resection during left ventricular assist device (LVAD) implantation.The studied group consisted of 40 patients with cardiomyopathy, and apical samples excised during left ventricular assist device implantation were studied (CM/VAD group, mean: 48.1 ±10 y/o). A control group consisted of 6 apical samples from healthy heart graft donors (mean: 29 ±2.3 years old). Area fraction (AF) was calculated for: fibrosis, cardiocytes with myofibrillolysis (MFL), non-myofibrillolytic cardiocytes (non-MFL).Single lymphocytes were seen in 18 (45%) cases in the CM/VAD group. Cardiomyopathy grade evaluated semiquantitatively in CM/VAD was: slight (25% of a group), moderate (35.5%), advanced (35.5%). CM/VAD cases showed nearly ten times higher fibrosis than the control group. The MFL cells occupied nearly a five times larger area in CM/VAD than in the control group, whereas non-MFL cells were found in the control group, as a predominant pattern. The linear regression calculated between fibrosis AF and types of cardiocytes indicated the depletion of cardiomyocytes with fibrosis increase. The control group presented insignificant dependency between fibrosis and MFL cells, suggesting the lack of replacement fibrosis. Significant negative dependence between fibrosis and non-MFL cardiocytes suggested remodeling in controls. Correlation analysis showed a strong relation between depletion of normal cardiocytes and progression of fibrosis.Progression of cardiomyopathy and fibrosis depends on the loss of cardiocytes rather than degeneration of these cells.Tkanka koniuszka lewej komory zawiera większą ilość mięśnia sercowego w porównaniu z materiałem z biopsji przegrody międzykomorowej, dlatego ma duże znaczenie diagnostyczne.Określenie kluczowych zmian w niewydolnym sercu na podstawie analizy morfometrycznej.Badana grupa składała się z 40 pacjentów z kardiomiopatią, którym wszczepiono urządzenie wspomagające pracę serca (grupa CM/VAD, średnia: 48,1 ±10 lat). Tkankę koniuszka lewej komory uzyskano podczas implantacji LVAD. Materiał kontrolny stanowiło 6 analogicznych fragmentów serca uzyskanych od osób po śmierci samobójczej (średnia: 29 ±2,3 roku). Tkanki barwiono rutynowymi metodami (HE, Masson trichrome). Morfologię kardiomiocytów i nacieki zapalne oceniano półilościowo. Frakcję pola powierzchni (AF) mierzono dla: tkanki włóknistej, kardiocytów z miofibrylolizą (MFL) i kardiocytów prawidłowych (non-MFL).W grupie CM/VAD obecne były nieaktywne nacieki zapalne w 18 (45%) przypadkach. We wszystkich przypadkach stwierdzono morfologię kardiomiopatyczną w nasileniu niewielkim (25% grupy), umiarkowanym (35,5%) lub ciężkim (35,5%). W grupie CM/VAD obserwowano prawie 10-krotnie większe włóknienie niż w grupie kontrolnej. Kardiomiocyty miofibrylolityczne zajmowały prawie 5-krotnie większą AF niż w grupie kontrolnej. W grupie kontrolnej stwierdzono dominującą prawidłową sarkoplazmę, która zajmowała 2-krotnie większą AF powierzchni niż w grupie CM/VAD. Wyliczony stosunek powierzchni kardiocytów z miofibrylolizą do powierzchni prawidłowych kardiocytów wskazywał na dominację miofibrylolizy w grupie CM/VAD, podczas gdy w grupie kontrolnej obserwowano zjawisko odwrotne. W grupie CM/VAD stwierdzono postępujące zmniejszanie się obu typów kardiomiocytów wraz ze wzrostem zwłóknienia. W grupie kontrolnej stwierdzono nieistotną zależność między zwłóknieniem a kardiocytami miofibrylolitycznymi, co wskazuje na brak aktywnego włóknienia pomartwiczego. Znamienna ujemna korelacja między włóknieniem a miofibrylolizą może świadczyć o przebudowie w grupie kontrolnej.Włóknienie pomartwicze w kardiomiopatii jest ściśle i liniowo zależne od uszkodzenia kardiocytów.

There is a paucity of real‑world registries concerning patients with chronic coronary syndromes (CCS).We aimed to assess the long‑term outcomes of patients with CCS and after coronary angiography performed in accordance with the treatment strategy.The analysis involved 11 021 patients treated in a single center between 2006 and 2016 who were enrolled into the ongoing PRESAGE registry. Based on the results of coronary angiography and the treatment strategy adopted, patients were classified into 4 groups: with nonsignificant lesions (n = 3637), undergoing percutaneous coronary intervention (n = 4678), undergoing coronary artery bypass grafting (CABG; n = 997), and receiving conservative treatment (notwithstanding significant lesions on an angiogram; n = 1709). All‑cause death, assessed in every study group at 1-, 3-, and 5‑year follow‑up, was regarded as the primary outcome measure.The mean (SD) age of the study patients was 64.6 (9.5) years, and women constituted 35% of the cohort. Patients treated conservatively were the oldest (mean [SD] age, 64.9 [9.3] years) in the group and showed the highest prevalence of previous myocardial infarction (50.5%), CABG (31.8%), diabetes (40.3%), chronic total occlusion (65.5%), and left ventricular ejection fraction below 35% (24.4%). Death from any cause in patients with nonsignificant lesions, undergoing percutaneous coronary intervention, undergoing CABG, and receiving conservative treatment occurred 5 years following the index hospitalization in 11.2%, 16.2%, 9.7%, and 21% of those patients, respectively.The PRESAGE registry provides valuable information about the clinical characteristics and long‑term outcomes of patients with CCS. The population of CCS patients is heterogeneous, and long‑term prognosis is also varied. The poorest characteristics and outcomes were reported in patients with significant lesions and ineligible for revascularization procedures.

Introduction There is a paucity of real‑world registries concerning patients with chronic coronary syndromes (CCS). Objectives We aimed to assess the long‑term outcomes of patients with CCS and after coronary angiography performed in accordance with the treatment strategy. Patients and methods The analysis involved 11 021 patients treated in a single center between 2006 and 2016 who were enrolled into the ongoing PRESAGE registry. Based on the results of coronary angiography and the treatment strategy adopted, patients were classified into 4 groups: with nonsignificant lesions (n = 3637), undergoing percutaneous coronary intervention (n = 4678), undergoing coronary artery bypass grafting (CABG; n = 997), and receiving conservative treatment (notwithstanding significant lesions on an angiogram; n = 1709). All‑cause death, assessed in every study group at 1-, 3-, and 5‑year follow‑up, was regarded as the primary outcome measure. Results The mean (SD) age of the study patients was 64.6 (9.5) years, and women constituted 35% of the cohort. Patients treated conservatively were the oldest (mean [SD] age, 64.9 [9.3] years) in the group and showed the highest prevalence of previous myocardial infarction (50.5%), CABG (31.8%), diabetes (40.3%), chronic total occlusion (65.5%), and left ventricular ejection fraction below 35% (24.4%). Death from any cause in patients with nonsignificant lesions, undergoing percutaneous coronary intervention, undergoing CABG, and receiving conservative treatment occurred 5 years following the index hospitalization in 11.2%, 16.2%, 9.7%, and 21% of those patients, respectively. Conclusions The PRESAGE registry provides valuable information about the clinical characteristics and long‑term outcomes of patients with CCS. The population of CCS patients is heterogeneous, and long‑term prognosis is also varied. The poorest characteristics and outcomes were reported in patients with significant lesions and ineligible for revascularization procedures.

Background Risk stratification is a critical component of selection process of the patients with end-stage heart failure (HF) who are considered for heart transplantation (HT). Due to the constantly increasing number of the patients placed on the transplant waiting lists and a global shortage of organs available for HT, the key issue becomes an accurate risk stratification of death and proper organ allocation to these patients who will benefit the most from this form of treatment. Purpose The aim of this study was to identify the factors associated with mortality during a 1.5-year follow-up in patients with end-stage HF awaiting HT. Methods We prospectively analysed 72 patients with advanced HF awaiting HT at our institution between 2015 and 2016. At the time of inclusion in the study routine laboratory tests, cardiopulmonary exercise test, echocardiography, and right heart catheterisation were performed in all patients. During right heart catheterisation, 10 ml of coronary sinus blood was collected. Fetuin serum concentration was measured by the sandwich enzyme-linked immunosorbent assay (ELISA) with the commercially available kit.The end-point was defined as all-cause mortality during a 1.5 years follow-up. Our medical university local Institutional Review Board approved the study protocol, and all patients provided informed consent. The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments. Results Patients' median age was 53.00 (46.00–58.00) years, and 91.7% were men. During the 1.5-year follow-up, 31 (43.1%) patients died. The area under the receiver operating characteristic curve indicated a good discriminatory power of fetuin (AUC: 0.917 [95% CI: 0.858–0.977]). The cut-off point for fetuin ( Conclusions Our study demonstrated that a low coronary sinus fetuin and peripheral blood sodium levels are associated with mortality patients with advanced HF accepted for HT. In addition, fetuin level, with excellent prognostic strength, allows for the risk stratification of death in analysed group of patients. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Medical University of Silesia

Background Cardiac allograft vasculopathy (CAV) is one of the main risk factors influencing graft loss and patients survival. An important element of monitoring the patient after heart transplantation (HT) is the assessment of non-invasive indicators associated with the occurrence and progression of CAV. Therefore, new noninvasive sensitive and specific tools are necessary for detecting CAV early, which may result in the modification of immunosuppressive therapy, increase in statin doses, and intensive treatment of CAV-related comorbidities. Purpose The aim of the study was to research for factors associated with occurrence of moderate to severe CAV in heart transplant recipients. Methods Our analysis included consecutive adult patients after HT with CAV who underwent routine visits in our institution between 2015–2017. Exclusion criteria included history of kidney diseases, hepatitis B and C, autoimmune diseases, chronic pancreatitis or thyroid diseases, and cerebrovascular accidents. During each visit, all patients underwent echocardiography, laboratory tests, immunosuppressive drugs serum concentration analyses, and coronary angiographies. In addition, Klotho protein concentration was measured in all patients using sandwich enzyme-linked immunosorbent assay (ELISA) with the commercially available kit. Coronary angiographies of all patients enrolled to the study were reviewed by two independent interventional cardiologists to accurately classify coronary artery lesions according to International Society for Heart and Lung Transplantation (ISHLT) guidelines. Then, patients were divided into a group with mild CAV (1) and moderate to severe CAV (2/3). The local institutional review board of the Medical University of Silesia approved the study protocol, and all patients provided informed consent. Results The final group consisted of 141 patients with CAV. The age of the patients was 60.0 (53.0–66.0) and 77.5% of them were male. The median time from HT to include in the study was 11.6 (8.5–15.0) years. The frequency of CAV 2/3 in the analysed population was 36.6%. All included patients received optimal immunosuppressive therapy consisting of a calcineurin inhibitor (tacrolimus or cyclosporin) and mycophenolate mofetil. Multivariate analysis of logistic regression showed that Klotho protein (OR = 0.719 [0.598–0.866], p Conclusions Lower Klotho and albumin levels, as well as left ventricular and left atrium dimensions are the independent factors of moderate to severe CAV presence. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): MEdical University of Silesia, Katowice, Poland

Background Oxidative stress is a cause of cardiac diseases and contribute to apoptosis, cardiac remodeling, cardiac growth and repair. The end-stage heart failure (HF) is associated with ischemia-reperfusion, increased neurohumoral activity, cytokine stimulation and presence of inflammatory cells. Above factors are stimuli which generate free radicals and can induce oxidative stress in the heart and cause damage to essential myocardial structures and function. However, the role of oxidative stress in end-stage HF has not been fully understood. Purpose This study aimed to evaluate the prognostic value of the oxidative stress markers in ambulatory patients with end-stage HF awaiting heart transplantation (HT) during a 1.5 year follow-up period. Method The study was a prospective analysis of 85 optimally treated adult patients with end-stage HF, who were added to the HT waiting list at the Cardiology Department between 2015 and 2016. At the time of enrollment to the study routine laboratory tests, cardiopulmonary exercise test, echocardiography, spirometry and right heart catheterization were performed in all patients. During right heart catheterization, 10 ml of coronary sinus blood was additionally collected to determine total oxidant status (TOS) and total antioxidant capacity (TAC) levels. TOS and TAC were measured by Erel's method. The endpoint was all-cause mortality during a 1.5 years follow-up. The Medical University of Silesia's local Institutional Review Board approved the study protocol, and all patients provided informed consent. Results Median age of the patients was 53.0 (43.0–56.0) years and 90.6% of them were male. During the observation period, the mortality rate was 40%. The area under the receiver operating characteristics (ROC) curves indicated an acceptable discriminatory power of TAC (AUC: 0.780 [CI: 0.677–0.883]; sensitivity 56%, and specificity 90%); and excellent power of TOS (AUC: 0.9530 [CI: 0.9279–0.9781]; sensitivity 88%, and specificity 94%) for 1.5 years mortality. Patients with a low TAC level (≤1.10) had a significantly worse 1.5-year survival compared to the group with a high TAC level (>1.10) (1.5 year survival: 20.8% versus 75.4%; (long rank p Conclusion TAC with acceptable prognostic power and TOS with excellent prognostic power allows assessment of the prognosis in end-stage HF during a 1.5 year follow-up period. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Medical University of Silesia, Katowice, Poland

Introduction Cardiac allograft vasculopathy (CAV) is a major threat to long-term survival after heart transplantation (HT). The frequency of CAV is estimated to be 8% at 1 year after HT, 30% at the 5-year follow-up, and as high as 50% within 10 years after the procedure. Therefore, it is necessary to select those factors that are closely associated with the presence of CAV and facilitate the proper, fast and minimally invasive diagnosis of this disease. Purpose The aim of this study was determine risk factors associated with CAV detection in patients after HT. Material and methods We analyzed 299 consecutive patients after HT who underwent routine visits in our institution between 2015 and 2017. During the visit, echocardiography, routine coronary angiography, laboratory tests and immunosuppressive drug serum concentrations were performed in all patients. In addition, 10 ml of peripheral blood was collected to determine human interleukin 33 (IL-33) and IL-1 Receptor Like 1 (IL1RL1). IL-33 and IL1RL1 concentrations were measured by sandwich enzyme-linked immunosorbent assay (ELISA) with the commercially available kit. The diagnosis of CAV was based on the results of coronary angiography and defined according to the current International Society for Heart and Lung Transplantation (ISHLT) criteria.The Medical University Local Institutional Review Board approved the study protocol, and all patients provided informed consent. Results Patients' median age was 59.00 (45.00–66.00) years, and 74.2% were men. The median time from HT to study inclusion was 9.03 (6.02–13.01) years. The frequency of CAV according to the ISHLT criteria in the analysed population was 47.5%. At the time of enrolment all patients were receiving immunosuppressive therapy with calcineurin inhibitor and mycophenolate mofetil, and were free from acute rejection (diagnosed either by echocardiography or biopsy), clinical signs of infection or symptoms of acute heart failure. Multivariate analysis using logistic regression confirmed that IL-33 OR 0.958 (0.944–0.972), p Conclusions Lower IL-33 and higher IL1RL1 serum concentrations, as well as donor age, left ventricular diastolic dimension and time from HT to blood collection are independently associated with CAV. This study provides non-invasive, low-cost, and simple indicators for CAV detection. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Medical University of Silesia, Katowice, Poland

Oxidative stress is defined as an imbalance between the production of free radicals and their elimination by the antioxidant defense system. However, the role of oxidative stress in cardiac allograft vasculopathy (CAV) has not been fully understood. Therefore, this study is aimed at determining the role of oxidative-antioxidative balance disturbances in patients after HT. Furthermore, we sought to analyze factors associated with the presence of CAV, with particular emphasis placed on oxidative stress markers. The study analyzed data of 194 consecutive patients after HT who underwent routine visits in the Transplantation Clinic between 2015 and 2016. Total oxidant status (TOS) and total antioxidant capacity (TAC) were measured by the method described by Erel. The oxidative stress index (OSI) was defined as the ratio of the TOS to TAC levels. Patients’ mean age was 55.4±15.0 years, and 73.4% were men. The frequency of CAV was 50%. The area under the receiver operating characteristic curves indicated a good discriminatory power of TAC and TOS (0.8940 (0.8515-0.9365); 0.8620 (0.8126-0.9114), respectively) as well as excellent discriminatory power of OSI (0.9530 (0.9279-0.9781)) for CAV detection. Multivariate analysis of the Cox proportional hazard model confirmed that OSI (hazard ratio HR=1.294 (1.204-1.391), p<0.0001), age (HR=1.023 (1.006-1.041), p=0.0091), and high-sensitivity C-reactive protein (HR=1.049 (1.016-1.083), p=0.0151) were independently associated with CAV presence. In conclusion, TAC and TOS had a good discriminatory power and OSI had excellent strength for detecting CAV. The independent factors of CAV were higher OSI and CRP levels, as well as older recipient age.

Introduction An increasing number of patients with end‑stage heart failure, along with a shortage of heart donors, necessitates the use of mechanical circulatory support. Objectives This single‑center retrospective study evaluated short- and long term outcomes of continuous‑flow left ventricular assist device (CF LVAD) therapy in patients with end stage heart failure. Patients and methods We collected and assessed data of 79 patients (77 men, 2 women; mean age, 50.3 years; mean INTERMACS profile, 3.1) implanted with a CF‑LVAD between 2009 and 2017 (HeartMate 3 in 19 patients [24%]; HeartMate 2 in 9 [11.4%]; and HeartWare in 51 [64.6%]). Results The mean time on CF-LVAD support was 604 days (range, 1–1758 days). There were 2 device exchanges due to pump thrombosis and 1 explantation due to heart regeneration; 9 patients (11.4%) underwent heart transplant. Stroke (nondisabling, 48%) occurred in 27.8% of patients (ischemic in 9 patients; hemorrhagic, in 14; both types, in 1) despite the standardized anticoagulation regimen. Major gastrointestinal bleeding and pump thrombosis were reported in 13 patients (16.5%), while 18 patients (22.8%) developed driveline infections (recurrent in 15 patients [19%]). Hemorrhagic stroke and bacteremia had a negative impact on survival. Hemorrhagic stroke was the main cause of death. Survival probability was 0.9 at 1 month and 0.81, 0.71, 0.61, and 0.53 at 1, 2, 3, and 4 years, respectively. Conclusions Although CF‑LVAD support is associated with substantial adverse events, they do not significantly affect mortality (except hemorrhagic stroke and bacteremia). Novel devices seem to overcome these limitations, but larger studies are needed to support these findings.