Left atrial (LA) low-voltage areas (LVAs) are frequently observed in patients with atrial fibrillation (AF) and may predict AF recurrence after catheter ablation.
The aim of this study was to develop ...and validate a clinical tool to identify LVAs that are associated with AF recurrence after pulmonary vein isolation (PVI).
In a cohort of 238 patients, voltage maps were created during LA procedures. LVAs were defined as areas with electrogram amplitudes <0.5 mV. On the basis of regression analysis, predictors of LA substrate were identified. These parameters were used to establish a dedicated risk score (DR-FLASH score, based on diabetes mellitus, renal dysfunction, persistent form of AF, LA diameter >45 mm, age >65 years, female sex, and hypertension). This risk score was then prospectively validated in a multicenter cohort of 180 patients. The association of the score with long-term recurrence of atrial arrhythmias after circumferential PVI was tested in a retrospective cohort of 484 patients.
The DR-FLASH score effectively identified LVA substrate (C statistic = 0.801, P < .001). In the prospective multicenter validation cohort, the predictive value of the DR-FLASH score was confirmed (C statistic = 0.767, P < .001). The probability for the presence of LA substrate increased by a factor of 2.2 (95% confidence interval CI 1.6-2.9, P < .001) with each point scored. Furthermore, the risk of AF recurrence after PVI increased by a factor of 1.3 (95% CI 1.1-1.5, P < .001) with every additional point and was almost 2 times higher in patients with a DR-FLASH score >3 (odds ratio 1.7, 95% CI 1.1-2.8, P = .026).
The DR-FLASH score may be useful to identify patients who may require extensive substrate modification instead of PVI alone.
In Poland there are still nearly 20 million individuals with hypercholesterolaemia, most of them are unaware of their condition; that is also why only ca. 5% of patients with familial ...hypercholesterolaemia have been diagnosed; that is why other rare cholesterol metabolism disorders are so rarely diagnosed in Poland. Let us hope that these guidelines, being an effect of work of experts representing 6 main scientific societies, as well as the network of PoLA lipid centers being a part of the EAS lipid centers, certification of lipidologists by PoLA, or the growing number of centers for rare diseases, with a network planned by the Ministry of Health, improvements in coordinated care for patients after myocardial infarction (KOS-Zawał), reimbursement of innovative agents, as well as introduction in Poland of an effective primary prevention program, will make improvement in relation to these unmet needs in diagnostics and treatment of lipid disorders possible.
Long COVID (LC) is characterized by persistent symptoms following SARS-CoV-2 infection, with various mechanisms offered to explain its pathogenesis. This study explored whether adaptive humoral ...anti-SARS-CoV-2 responses differ in LC. Unvaccinated COVID-19 convalescents (n = 200) were enrolled, with 21.5% (n = 43) presenting LC three months post-infection. LC diagnosis was based on persistent symptom(s) and alterations in biochemical/clinical markers; three phenotypes were distinguished: cardiological, pulmonary, and psychiatric LC. All three phenotypes were characterized by significantly decreased seroprevalence of IgG antibodies against nucleocapsid (anti-NP). LC was associated with decreased odds of testing positive for anti-NP (OR = 0.35, 95%CI: 0.16–0.78, p = 0.001). Seropositive LC patients had lower anti-S1 and anti-S2 levels than individuals without LC, and those with pulmonary and psychological phenotypes also revealed decreased anti-RBD concentrations. The results indicate that LC can be characterized by diminished humoral response to SARS-CoV-2. The potential implication of this phenomenon in post-acute viral sequelae is discussed.
•Humoral response in cardiological, pulmonary and psychiatric long COVID was studied.•Long COVID was diagnosed based on symptoms and objective clinical screening.•No enhanced adaptive humoral immunity in Long COVID was confirmed.•Long COVID patients had lower seroprevalence of anti-nucleocapsid IgGs.•Particular Long COVID phenotypes were associated with lower antibody levels.
Abstract Background Three-vessel coronary artery disease is associated with high mortality in patients with non-ST-segment elevation myocardial infarction (NSTEMI). The purpose of this study was to ...assess the impact on 12‐month mortality of chronic total occlusion (CTO) in the non-infarct-related artery (non-IRA), as assessed by coronary angiography during percutaneous coronary intervention (PCI) for NSTEMI, of patients with 3-vessel disease. Methods The study included all of the NSTEMI patients with 3-vessel disease by coronary angiogram who were treated by PCI and who were registered in the prospective Polish Registry of Acute Coronary Syndromes (PL-ACS) from July 2007 to November 2009. The patients with prior coronary artery bypass grafting and those with significant stenosis of the left main coronary artery were excluded. The 12-month mortality was obtained from a government database. Results Of the 925 patients fulfilling the inclusion and exclusion criteria, 438 (47.4%) patients had 1 or more CTO of a major non-IRA coronary artery (+ CTO), and 487 (52.6%) patients had 3-vessel disease without CTO (− CTO). The in-hospital mortality for the + CTO and − CTO patients was 5.3% and 2.1%, respectively (p = 0.009), whilst the 12-month mortality was 21.1% and 11.9%, respectively (p = 0.0001). After multivariate adjustment for differences in the baseline characteristics, the presence of CTO remained significantly associated with higher 12-month mortality (relative risk = 1.42, 95%CI = 1.01–2.00, p = 0.047). Conclusions The presence of CTO in non-IRA in patients with NSTEMI and 3‐vessel coronary disease predicts higher 12-month mortality.
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 < 10 ng/mL (
N
= 22), group 2—25(OH)D 10–20 ng/mL (
N
= 42), and group 3—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
< 0.001). There was a negative correlation between MPV and 25(OH)D (
R
= − 0.38,
P
= 0.001). ROC analysis demonstrated a moderate predictive value (AUC 0.70) in identifying the discrimination thresholds of MPV (> 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.
Data regarding the clinical outcomes of covered stents (CSs) used to seal coronary artery perforations (CAPs) in the all-comer population are scarce. The aim of the CRACK Registry was to evaluate the ...procedural, 30-days and 1-year outcomes after CAP treated by CS implantation.
This multicenter all-comer registry included data of consecutive patients with CAP treated by CS implantation. The primary endpoint was the composite of major adverse cardiac events (MACEs), defined as cardiac death, target lesion revascularization (TLR), and myocardial infarction (MI).
The registry included 119 patients (mean age: 68.9 ± 9.7 years, 55.5% men). Acute coronary syndrome, including: unstable angina 21 (17.6%), NSTEMI 26 (21.8%), and STEMI 26 (21.8%), was the presenting diagnosis in 61.3%, and chronic coronary syndromes in 38.7% of patients. The most common lesion type, according to ACC/AHA classification, was type C lesion in 47 (39.5%) of cases. A total of 52 patients (43.7%) had type 3 Ellis classification, 28 patients (23.5%) had type 2 followed by 39 patients (32.8%) with type 1 perforation. Complex PCI was performed in 73 (61.3%) of patients. Periprocedural death occurred in eight patients (6.7%), of which two patients had emergency cardiac surgery. Those patients were excluded from the one-year analysis. Successful sealing of the perforation was achieved in 99 (83.2%) patients. During the follow-up, 26 (26.2%) patients experienced MACE 7 (7.1%) cardiac deaths, 13 (13.1%) TLR, 11 (11.0%) MIs. Stent thrombosis (ST) occurred in 6 (6.1%) patients 4(4.0%) acute ST, 1(1.0%) subacute ST and 1(1.0%) late ST.
The use of covered stents is an effective treatment of CAP. The procedural and 1-year outcomes of CAP treated by CS implantation showed that such patients should remain under follow-up due to relatively high risk of MACE.
Abstract Objectives This study sought to assess the influence of direct admission versus transfer via regional hospital to a percutaneous coronary intervention (PCI) center on time delays and ...12-month mortality in ST-segment elevation myocardial infarction (STEMI) patients from a real-life perspective. Background Reduction of delays to reperfusion is crucial in a STEMI system of care. However, it is still debated whether direct admission to a PCI center is superior to interhospital transfer in terms of long-term prognosis. The authors hypothesized that compared with interhospital transfer, direct admission shortens the total ischemic time, limits the loss of left ventricular systolic function, and finally, reduces 12-month mortality. Methods Prospective nationwide registry data of STEMI patients admitted to PCI centers within 12 h of symptom onset and treated with PCI between 2006 and 2013 were analyzed. Patients admitted directly were compared with patients transferred to a PCI center via a regional non–PCI-capable facility in terms of time delays, left ventricular ejection fraction (LVEF), and 12-month mortality. Data were adjusted using propensity-matched and multivariate Cox analyses. Results Of the 70,093 patients eligible for analysis, 39,144 (56%) were admitted directly to a PCI center. Direct admission was associated with a shorter median symptoms-to-admission time (by 44 min; p < 0.001) and total ischemic time (228 vs. 270 min; p < 0.001), higher LVEF (47.5% vs. 46.3%; p < 0.001), and lower propensity-matched 12-month mortality (9.6% vs. 10.4%; p < 0.001). In propensity-matched multivariate Cox analysis, direct admission (hazard ratio HR: 1.06, 95% confidence interval CI: 1.01 to 1.11) and shorter symptoms-to-admission time (HR: 1.03; 95% CI: 1.01 to 1.06) were significant predictors of lower 12-month mortality. Conclusions In a large, community-based cohort of patients with STEMI treated by PCI, direct admission to a primary PCI center was associated with lower 12-month mortality and should be preferred to transfer via a regional non–PCI-capable facility.
Standard modifiable cardiovascular risk factors (SMuRFs) remain well-established elements of assessing cardiovascular risk scores. However, there is growing evidence that patients presented without ...known SMuRFs at admission demonstrate worse post-myocardial outcomes. The aim of the study was to assess the influence of the SMuRF status on short- and long-term mortality rates in patients with first-time ST-segment elevation myocardial infarction (STEMI).
This observational, cross-sectional study covered 182,726 patients admitted between 2003-2020 to the CathLabs, according to data from the Polish Registry of Acute Coronary Syndrome. Both baseline characteristics and mortality (in-hospital, 30-day, and 12-month) were examined and stratified by SMuRF status. The predictors of mortality were assessed at selected time points by multivariable analysis.
The majority of STEMI patients had at least one SMuRF (88.7%), however, mortality rates of SMuRF-less individuals were greater at selected time points of the follow-up (p < 0.001), and persisted at a higher level during each year of the follow-up period compared to the SMuRF group and general population. Furthermore, the SMuRFs status constituted an independent predictor of mortality at the 30-day (OR: 1.345; 95% CI: 1.142-1.585, p < 0.001) and 12-month (OR: 1.174; 95% CI: 1.054-1.308, p < 0.001) follow-ups.
SMuRF-less individuals presented with STEMI are at an increased risk of all-cause mortality compared to those with at least one SMuRF. Consequently, further investigations regarding the recognition and treatment of risk factors, irrespective of SMuRF status, are indicated.
SARS‑CoV‑2 infection is associated with an increased risk of thromboembolic complications. Thromboembolism is one of the possible causes of myocardial infarction with nonobstructive coronary arteries ...(MINOCA).
We aimed to compare the characteristics and 12‑month clinical outcomes of patients with MINOCA treated before and during the COVID‑19 pandemic.
We retrospectively analyzed data of 51 734 patients with acute myocardial infarction registered in the nationwide Polish Registry of Acute Coronary Syndromes database in 2019 and 2020. The final study group included 3178 patients with MINOCA. We compared the baseline characteristics, management strategies, and 12‑month clinical outcomes of the MINOCA patients treated before (2019) and during the COVID‑19 pandemic (2020).
The rate of MINOCA was higher in 2019 than in 2020 (6.3% vs 5.9%; P = 0.03). The only difference between the groups was a higher hypercholesterolemia rate before the pandemic (33.9% vs 28.2%; P <0.001). In‑hospital stroke was observed more frequently during the pandemic (0% vs 0.3%; P = 0.01), whereas other in‑hospital complications were similar between the groups. Most patients were discharged on aspirin (85.6%), a β‑blocker (73.1%), an angiotensin‑converting enzyme inhibitor / angiotensin receptor blocker (70.2%), and a statin (62.7%), but only 50.6% of the participants received a P2Y12 inhibitor. There was no difference in 12‑month all‑cause mortality between the patients with MINOCA treated before and during the pandemic (9.2% vs 11%; P = 0.09).
We observed a lower percentage of MINOCA cases and higher in‑hospital stroke rates in the MINOCA patients treated during the COVID‑19 pandemic (2020). The possible association between worse clinical outcomes of the MINOCA patients treated during the pandemic and the increased risk for thromboembolic complications of SARS‑CoV‑2 infection needs further evaluation.
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