Ablation of Macro-Re-Entrant Atrial Arrhythmia Late after Surgical Aortic Valve Replacement.

BACKGROUND: Re-entrant atrial arrhythmias are common in patients after cardiac surgery. To date, however, no studies have reported the safety and efficacy of radiofrequency (RF) ablation of macro-re-entrant atrial arrhythmias in a unique, homogeneous group of patients after surgical replacement of the aortic valve and single right atriotomy. METHODS: Among over 4,000 RF catheter ablations performed at the authors' center between 2008 and 2014, eight patients (seven males, one female; mean age 55.1 ± 19.9 years) after aortic valve replacement (AVR) and without history of any other cardiosurgical procedures were identified with documented macro-re-entrant atrial arrhythmia. The mechanism of macro-re-entrant arrhythmia was analyzed, as well as the safety and efficacy of RF ablation in a group of patients after AVR and single right atrial free wall atriotomy. RESULTS: The average time from surgery to RF catheter ablation was 11.3 ± 11.3 years (range: 4-35 years). In five patients with permanent arrhythmia, entrainment mapping proved these arrhythmias to be cavotricuspid isthmus- dependent, in three patients with paroxysmal atrial arrhythmia cavotricuspid isthmus-dependent atrial flutter was induced during the electrophysiological study. Intra-atrial re-entrant tachycardia was neither recorded nor induced in any patient. Successful ablation of cavotricuspid isthmus is defined as the termination of arrhythmia, and bidirectional block in cavotricuspid isthmus was achieved in all patients. A long-term follow up, based on a seven-day Holter monitoring, was conducted in all patients, with a mean observation time of 40.1 ± 28.6 months after the procedure. Among the patients, ablated arrhythmia (cavotricuspid isthmusdependent atrial flutter) recurred in one patient, atrial fibrillation occurred in three patients, and an atrial tachycardia in one patient. CONCLUSIONS: In the presented series of patients, cavotricuspid isthmus-dependent atrial flutter was shown to be the mechanism of post-cardiosurgical macro-re-entrant clinical arrhythmia in all subjects. Atrial fibrillation was frequently observed among those patients during follow up.

[Cardiac abnormalities in patients with myotonic dystrophy--preliminary results]. / Zaburzenia kardiologiczne u pacjentów z dystrofia miotoniczna--doniesienie wstepne.

INTRODUCTION: Myotonic dystrophy (DM) is an inherited multisystem disorder associated with myotonia, progressive skeletal muscle weakness and atrophy, involvement of peripheral and central nervous system and sudden death likely due to atrioventricular block and/or ventricular arrhythmia. AIM OF THE STUDY: to assess the type and degree of cardiac and neurological involvement in patients (pts) with DM. MATERIALS AND METHODS: 10 pts (6 male), in mean age of 35 +/- 13 years, treated for DM type I (DM1)--7 pts and type II (DM2)--3 pts. All pts underwent a neurological examination including muscle strength assessment as well as cardiac diagnostics including: standard and 48-hour ambulatory electrocardiogram, echocardiographic examination, magnetic resonance imaging (MRI) of the heart and late potentials assessment. RESULTS: Muscle strength was moderately diminished (46-48 points in MRC sub score) in 3 pts with DM1 and mildly diminished (56-58 points in MRC sub score) in 2 pts with DM2. These patients showed clinical symptoms of myopathy. Cardiovascular examinations revealed: QRS duration above 110 ms in 5 pts, clinically significant supraventricular arrhythmia or atrioventricular block in 3 pts, focal myocardial fibrosis in 3 pts, asymmetric hypertrophy of inter-ventricular septum in 1 patient, presence of late potentials in 5 pts. We have not observed correlation between impaired muscle strength and cardiac abnormalities. However, most pronounced cardiac abnormalities were observed in 2 male DM1 patients with clinical symptoms of myopathy and lowest MRC score. At a mean follow up of 3.2 +/- 1.4 years none of the pts died. CONCLUSIONS: Cardiac involvement in pts with myotonic dystrophy is frequent and is characterized by phenotypic heterogeneity. Detection of cardiac abnormalities may require extensive diagnostics. The most important is the assessment of ECG. Cardiac and neurological abnormalities vary in intensity between patients without close relationship to each other.

First-year follow-up costs of myocardial infarction management in Poland from the payer's perspective.

BACKGROUND: Myocardial infarction (MI) remains a major burden for healthcare systems. Therefore, we intended to analyze the determinants of cost management of patients hospitalized for MI in Poland. METHODS: Data on patients hospitalized and discharged with the diagnosis of acute MI were derived from the public payer claims database. Adult patients, reported between October 1, 2017 and December 31, 2019, were included. Costs of hospitalization for acute MI and cumulative one-year follow-up were analyzed. RESULTS: The median (IQR) of the total direct cost was €3804.7 (2674.1-5712.7) per patient and 29% (€1113.6 [380.5-2490.4]) of these were costs related to the use of post-hospitalization healthcare resources. The median cost of cardiovascular disease management was €3624.7 (2582.1-5258.5), and 26% of this sum were follow-up costs. The analysis of the total cost for individual years showed a slight increase in median costs in subsequent years: €3450.7 (2407.8-5205.2) in 2017, €3753.8 (2642.6-5681.9) in 2018, and €3944.9 (2794.8-5844.4) in 2019. Male sex, heart failure, atrial fibrillation, diabetes, kidney disease, chronic obstructive pulmonary disease, and history of stroke in addition to hospitalization in a department other than cardiology or internal disease were independently related to the cost of MI patient management. CONCLUSIONS: The high cost of management of MI patients was independently related to sex, heart failure, atrial fibrillation, diabetes, kidney disease, chronic obstructive pulmonary disease, and history of stroke as well as hospitalization in other than cardiology or internal disease department.

PI3K/Akt/mTOR Signaling Pathway in Blood Malignancies-New Therapeutic Possibilities.

Blood malignancies remain a therapeutic challenge despite the development of numerous treatment strategies. The phosphatidylinositol-3 kinase (PI3K)/protein kinase B/mammalian target of rapamycin (PI3K/Akt/mTOR) signaling pathway plays a central role in regulating many cellular functions, including cell cycle, proliferation, quiescence, and longevity. Therefore, dysregulation of this pathway is a characteristic feature of carcinogenesis. Increased activation of PI3K/Akt/mTOR signaling enhances proliferation, growth, and resistance to chemo- and immunotherapy in cancer cells. Overactivation of the pathway has been found in various types of cancer, including acute and chronic leukemia. Inhibitors of the PI3K/Akt/mTOR pathway have been used in leukemia treatment since 2014, and some of them have improved treatment outcomes in clinical trials. Recently, new inhibitors of PI3K/Akt/mTOR signaling have been developed and tested both in preclinical and clinical models. In this review, we outline the role of the PI3K/Akt/mTOR signaling pathway in blood malignancies' cells and gather information on the inhibitors of this pathway that might provide a novel therapeutic opportunity against leukemia.

The Prevalence of Tobacco, Heated Tobacco, and E-Cigarette Use in Poland: A 2022 Web-Based Cross-Sectional Survey.

Monitoring tobacco use on a regular schedule is a basic tool of tobacco control policy. This study aimed (1) to assess the current prevalence and patterns of tobacco and e-cigarette use, as well as (2) to identify socioeconomic factors associated with smoking behavior among adults in Poland. This cross-sectional study was carried out in March 2022 on a nationwide, representative sample of 1090 adults in Poland. The computer-assisted web interview (CAWI) technique was used. Daily tobacco smoking was declared by 28.8% of respondents (27.1% of females and 30.8% of males; p = 0.2) and 4.2% were occasional smokers (4.2% of females and 4.3% of males; p = 0.8). Most of the current smokers (62.1%) smoked regular cigarettes and 25.2% smoked hand-rolled cigarettes. The prevalence of daily e-cigarette use was 4.8% (4.0% among females and 5.6% among males; p = 0.2). Daily heated tobacco use was declared by 4.0% of respondents (5.1% of females and 2.9% of males; p = 0.07). Age, having children, and educational level were significantly associated with current daily tobacco smoking. This study revealed a high prevalence of tobacco and e-cigarette use among adults in Poland. The presented data underscore the importance of further improvements in adopting a comprehensive tobacco control strategy in Poland.

Management and predictors of clinical events in 75 686 patients with acute myocardial infarction.

BACKGROUND: Although mortality in patients with acute myocardial infarction (MI) has decreased substantially over the last few decades in many countries, MI remains a major threat to public health. AIMS: To assess the number and outcomes of patients hospitalized for acute MI in Poland in 2018 as well as proportions of patients participating in cardiac rehabilitation and undergoing invasive cardiac procedures following discharge. METHODS: We used public databases. We included all patients hospitalized for acute MI in Poland in 2018 and assessed event-free survival along with uptake of invasive cardiac procedures, cardiac rehabilitation, and consultations with cardiologists. RESULTS: A total of 75868 patients (mean age, 68.8 years) were hospitalized for acute MI in Poland in 2018 (the admission rate, 197.0 per 100000 inhabitants). In-hospital mortality was 8.4%, while one-year mortality was 17.3% (one-year post-discharge mortality was 9.8%). Approximately 75% and 96% of discharged patients consulted a general practitioner, whereas 12% and 62% consulted a cardiologist, 5% and 19% underwent percutaneous coronary intervention, 0.6% and 2.9% un-derwent coronary artery bypass grafting, while 0.04% and 1.9% had an implantable cardioverter defibrillator implanted within 30 days and 365 days following discharge. The participation rate in cardiac rehabilitation within the first 14 days following discharge was 11%, within the first 30 days was 19%, and within 365 days was 35%. CONCLUSIONS: In-hospital and post-discharge mortality is still high in Poland. The access to cardiac consultations and cardiac rehabilitation following MI is insufficient. There is considerable potential for a further decrease in mortality in patients suffering from MI in Poland.

A subjective sense of the quality of life in adolescents from the Swietokrzyskie Voivodship.

OBJECTIVES: The measurement of the health-related quality of life (HRQOL) is one of the most important methods for self-assessment of health, which makes it possible to identify irregularities in the physical, mental and social functioning. The aim of the research was to determine HRQOL using the Health Related Quality of Life Questionnaire for Children and Young People (the KIDSCREEN-52 questionnaire) - the instrument recommended by the World Health Organization - which makes it possible to distinguish groups of adolescents with a diversified subjective sense of the quality of life. MATERIAL AND METHODS: The study involved a group of 871 adolescents, 411 boys and 460 girls, aged 13-16 years, residing in the Swietokrzyskie Voivodship. The method of a diagnostic survey was used in the research. The KIDSCREEN-52 questionnaire, which is an instrument for examining the HRQOL of adolescents, was employed in the study. The k-means clustering method was applied, which made it possible to establish 3 groups of adolescents with a different subjective sense of the quality of life. RESULTS: Three groups of adolescents with a diversified subjective sense of the quality of life (high, average, low) were identified using the KIDSCREEN-52 questionnaire. The subjective quality of life in the majority of the respondents was high, in particular in those living in rural areas. The surveyed boys with a high subjective quality of life showed a significantly higher self-esteem, acceptance and peer support than the surveyed girls. CONCLUSIONS: The KIDSCREEN-52 questionnaire is an accurate and sensitive tool for assessing HRQOL. It allows identifying 3 groups of adolescents with a diversified subjective sense of the quality of life. It can form the basis for further diagnosis of the bio-psycho-social functioning of adolescents. Int J Occup Med Environ Health. 2021;34(3):415-25.

Burden of multimorbidity in a Polish cohort of ambulatory and hospitalized heart failure patients from 2 large European registry programs: prognostic implications.

Introduction: Individual comorbidities have been shown to adversely affect prognosis in heart failure (HF). However, our knowledge of multimorbidity in HF and understanding of its prognostic implications still remain incomplete. Objectives: We aimed to analyze the prevalence of multimorbidity in Polish HF patients and to investigate the quantitative and qualitative impact of comorbidity burden on 12-month outcomes in that population. Patients and methods: We retrospectively analyzed data of 1765 Polish patients with ambulatory or acute (requiring hospitalization) HF from 2 multicenter observational European Society of Cardiology registries: the ESC-HF Pilot Survey (2009­2010) and ESC-HF-LT Registry (2011­2013). Results: Arterial hypertension and coronary artery disease were the most prevalent comorbidities, similarly to the entire European cohort. The great majority of HF patients had more than 1 predefined comorbidity and the most frequent number of comorbidities was 3. Importantly, in almost half of the patients, 4 or more comorbidities were reported. The best accuracy for predicting the adjusted 12-month rate of all-cause death was ensured by the model including only anemia and kidney dysfunction. The model including 4 comorbidities­anemia, kidney dysfunction, diabetes, and coronary artery disease­provided best accuracy for predicting 12-month rate of composite all-cause death or HF hospitalization. Conclusions: Multimorbidity is highly prevalent in a real-world cohort of Polish HF patients and the quantitative burden of comorbidities is related to increased mortality. In such patients, the clinical profile characterized by pathophysiological continuum of diabetes, kidney dysfunction, and anemia is particularly associated with unfavorable outcomes.

The Potential Benefits of the Influenza Vaccination on COVID-19 Mortality Rate-A Retrospective Analysis of Patients in Poland.

In this study,we used publicly available data from the Centrum e-Zdrowia (CeZ) Polish Databank proposing a possible correlation between influenza vaccination and mortality due to COVID-19. We limited our search to the patients with positive COVID­19 laboratory tests from 1 January 2020 to 31 March 2021 and who filled a prescription for any influenza vaccine during the 2019-2020 influenza season. In total, we included 116,277 patients and used a generalized linear model to analyze the data.We found out that patients aged 60+ who received an influenza vaccination have a lower probability of death caused by COVID-19 in comparison to unvaccinated, and the magnitude of this difference grows with age. For people below 60 years old, we did not observe an influence of the vaccination. Our results suggest a potential protective effect of the influenza vaccine on COVID-19 mortality of the elderly. Administration of the influenza vaccine before the influenza season would reduce the burden of increased influenza incidence, the risk of influenza and COVID­19 coinfection and render the essential medical resources accessible to cope with another wave of COVID-19. To our knowledge, this is the first study showing a correlation between influenza vaccination and the COVID-19 mortality rate in Poland.

Statins in COVID-19 Therapy.

Inhibitors of 3-hydroxy-3methylgultaryl-coenzyme A reductase (statins) are one of the main groups of drugs used in preventing and treating cardiovascular diseases worldwide. They are widely available, cheap, and well-tolerated. Based on statins' pleiotropic properties, including improvement of endothelial dysfunction, antioxidant properties, atherosclerotic plaque stabilization, and inhibition of inflammatory responses, it can be hypothesized that the use of statins, at least as an adjuvant in antiviral therapy, may be justified. All these effects might be especially beneficial in patients with COVID-19, suffering from endothelial dysfunction, microvascular and macrovascular thrombosis, and cytokine storm. Here, we review the recent data regarding the pathophysiology of SARS-CoV-2 activity in host cells, proposed COVID-19 therapy, the pleiotropic activity of statins, and statins in clinical trials in respiratory infections. According to the guidelines of the European and American Cardiac Societies, in patients with cardiovascular disease or high cardiovascular risk with concomitant COVID-19 it is recommended to continue statin treatment. However, the initiation of statin therapy de novo in COVID-19 treatment should only be done as part of a clinical trial.

Prediction of early death after myocardial infarction in patients with reduced left ventricular ejection fraction. The search for new indications for cardioverter-defibrillator implantation (ICD).

BACKGROUND: The highest rate of death is in the first few weeks after myocardial infarction (MI). However, the assessment of indications for primary prevention implantable cardioverter-defibrillator (ICD) implantation should be postponed until at least 40 days after MI. AIMS: Our aim was to identify the subgroup of high-risk patients with reduced left ventricular ejection fraction (LVEF) who would benefit from primary prevention ICD implantation within 40 days of MI. METHODS: Out of 205 606 patients with MI, in this study, we included 18 736 patients treated invasively, with LVEF <40%, who survived until hospital discharge. Patients were divided into two groups according to the survival status at 40 days - patients who died within this period (n = 1331) and patients who survived (n = 17405). RESULTS: Among all patients who died within 12-months after MI, 37.7% did die during the first 40 days. Patients with cardiac arrest before hospital admission or within the first 48 hours of hospitalization (hazard ratio [HR], 3.35; 95% confidence interval [CI], 2.82-3.98; P <0.0001], cardiogenic shock before admission or during hospitalization (HR, 3.06; 95% CI, 2.62-3.59; P <0.0001), unsuccessful percutaneous coronary interventions (PCI; HR, 2.42; 95% CI, 2.11-2.84; P <0.0001), LVEF <20% (ref. LVEF ≥30%; HR, 2.75; 95% CI, 2.25-3.36; P <0.0001) had approximately threefold and patients with chronic kidney disease almost 1.5-times (HR, 1.25; 95% CI, 1.47-3.59; P = 0.0053) higher 40-day mortality compared to patients without these risk factors. The most striking differences in mortality between these subgroups were observed shortly after discharge. CONCLUSIONS: The highest risk of death in patients with reduced LVEF who survived until hospital discharge occurred within the first 40 days after MI. There is a possibility to select patients with the worst prognosis and treat them more aggressively.

Innovative Managed Care May Be Related to Improved Prognosis for Acute Myocardial Infarction Survivors.

BACKGROUND: Mortality following discharge in myocardial infarction survivors remains high. Therefore, we compared outcomes in myocardial infarction survivors participating and not participating in a novel, nationwide managed care program for myocardial infarction survivors in Poland. METHODS: We used public databases. We included all patients hospitalized due to acute myocardial infarction in Poland between October 1, 2017 and December 31, 2018. We excluded from the analysis all patients aged <18 years as well as those who died during hospitalization or within 10 days following discharge from hospital. All patients were prospectively followed. The primary end point was defined as death from any cause. RESULTS: The mean follow-up was 324.8±140.5 days (78 034.1 patient-years; 340.0±131.7 days in those who did not die during the observation). Participation in the managed care program was related to higher odds ratio of participating in cardiac rehabilitation (4.67 [95% CI, 4.44-4.88]), consultation with a cardiologist (7.32 [6.83-7.84]), implantable cardioverter-defibrillator (1.40 [1.22-1.61]), and cardiac resynchronization therapy with cardioverter-defibrillator implantation (1.57 [1.22-2.03]) but lower odds of emergency (0.88 [0.79-0.98]) and nonemergency percutaneous coronary intervention (0.88 [0.83-0.93]) and coronary artery bypass grafting (0.82 [0.71-0.94]) during the follow-up. One-year all-cause mortality was 4.4% among the program participants and 6.0% in matched nonparticipants. The end point consisting of all-cause death, myocardial infarction, or stroke occurred in 10.6% and 12.0% (P<0.01) of participants and nonparticipants respectively, whereas all-cause death or hospitalization for cardiovascular reasons in 42.2% and 47.9% (P<0.001) among participants and nonparticipants, respectively. The difference in outcomes between patients participating and not participating in the managed care program could be explained by improved access to cardiac rehabilitation, cardiac care, and cardiac procedures. CONCLUSIONS: Managed care following myocardial infarction may be related to improved prognosis as it may facilitate access to cardiac rehabilitation and may provide a higher standard of outpatient cardiac care.

Iron deficiency contributes to resistance to endogenous erythropoietin in anaemic heart failure patients.

AIMS: Abnormal endogenous erythropoietin (EPO) constitutes an important cause of anaemia in chronic diseases. We analysed the relationships between iron deficiency (ID) and the adequacy of endogenous EPO in anaemic heart failure (HF) patients, and the impact of abnormal EPO on 12-month mortality. METHODS AND RESULTS: We investigated 435 anaemic HF patients (age: 74 ± 10 years; males: 60%; New York Heart Association class I or II: 39%; left ventricular ejection fraction: 43 ± 17%). Patients with EPO higher than expected for a given haemoglobin were considered EPO-resistant whereas those with EPO lower than expected - EPO-deficient. ID was defined as serum ferritin <100 µg/L or 100-299 µg/L with transferrin saturation <20%. EPO-resistant patients (22%) had more advanced HF whereas those with EPO deficiency (57%) were more frequently females and had worse renal function. Lower serum ferritin (indicating depleted body iron stores) was related to higher EPO observed/predicted ratio when adjusted for significant clinical confounders, including C-reactive protein. One year all-cause mortality was 28% in patients with EPO resistance compared to 17% in patients with EPO deficiency and 10% in patients with adequate EPO (log-rank test for the comparison EPO resistance vs. adequate EPO: P = 0.02). When adjusted for other prognosticators, there was still a trend towards increased 12-month mortality in patients with higher EPO level. CONCLUSION: Anaemic HF patients with endogenous EPO deficiency vs. resistance have different clinical and laboratory characteristics. In such patients, ID contributes to EPO resistance independently of inflammation.

High soluble transferrin receptor in patients with heart failure: a measure of iron deficiency and a strong predictor of mortality.

AIMS: Iron deficiency (ID) is frequent in heart failure (HF), linked with exercise intolerance and poor prognosis. Intravenous iron repletion improves clinical status in HF patients with left ventricular ejection fraction (LVEF) ≤45%. However, uncertainty exists about the accuracy of serum biomarkers in diagnosing ID. The aims of this study were (i) to identify the iron biomarker with the greatest accuracy for the diagnosis of ID in bone marrow in patients with ischaemic HF, and (ii) to establish the prevalence of ID using this biomarker and its prognostic value in HF patients. METHODS AND RESULTS: Bone marrow was stained for iron in 30 patients with ischaemic HF with LVEF ≤45% and 10 healthy controls, and ID was diagnosed for 0-1 grades (Gale scale). A total of 791 patients with HF with LVEF ≤45% were prospectively followed up for 3 years. Serum ferritin, transferrin saturation, soluble transferrin receptor (sTfR) were assessed as iron biomarkers. Most patients with HF (n = 25, 83%) had ID in bone marrow, but none of the controls (P < 0.001). Serum sTfR had the best accuracy in predicting ID in bone marrow (area under the curve 0.920, 95% confidence interval 0.761-0.987, for cut-off 1.25 mg/L sensitivity 84%, specificity 100%). Serum sTfR was ≥1.25 mg/L in 47% of HF patients, in 56% and 46% of anaemics and non-anaemics, respectively (P < 0.05). The reclassification methods revealed that serum sTfR significantly added the prognostic value to the baseline prognostic model, and to the greater extent than plasma N-terminal pro B-type natriuretic peptide. Based on internal derivation and validation procedures, serum sTfR ≥1.41 mg/L was the optimal threshold for predicting 3-year mortality, independent of other established variables. CONCLUSIONS: High serum sTfR accurately reflects depleted iron stores in bone marrow in patients with HF, and identifies those with a high 3-year mortality.

Occupational risks for SARS-CoV-2 infection: the Polish experience.

OBJECTIVES: The disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), termed COVID-19, is asymptomatic or mild in most cases. These patients do not need treatment in hospital and can be isolated at home. To date, most studies have been conducted among inpatients with severe COVID-19. In this study, the authors surveyed patients with mild COVID-19 who remained in home isolation, and analyzed the sources and occupational risk factors for SARS-CoV-2 infections. MATERIAL AND METHODS: This cross-sectional study was carried out on April 17-18, 2020, among patients infected with SARS-CoV-2 who remained in home isolation in Poland. Data were acquired through a structured interview that included questions about the isolation course, symptoms, comorbidities, infection source, household characteristics, occupation, and workplace. Data were presented with descriptive statistics. RESULTS: Of the 4878 patients in home isolation, the authors were able to contact 3313. Of them, 1191 patients declined their invitation, and 2122 agreed to take part. The median age of the patients included in the study was 50 years; 59% were female. Most patients (92%) had not been abroad before the infection. More than half (55%) knew how they became infected; of them, 75% became infected at work. Of all patients, 70% were occupationally active. Nearly half of the occupationally active patients (48%) worked in healthcare, 3% worked in public administration or defense, 3% worked in transportation, and 2% worked in education. Sixty-five percent of the occupationally active patients worked in companies with >100 employees. CONCLUSIONS: Most of the patients with COVID-19 in home isolation in Poland were occupationally active, wherein the majority of people who were aware of the source of SARS-CoV-2 infection worked in healthcare. As most of the infected patients worked in companies with >100 employees, which is not a Polish employment pattern, the authors expect that smaller companies may have a lower risk of SARS-CoV-2 infections. Int J Occup Med Environ Health. 2020;33(6):781-9.

Diagnostic role of chest computed tomography in coronavirus disease 2019.

Coronavirus disease 2019 (COVID­19) is an infectious disease caused by a novel strain of coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS­CoV­2), that appeared in China in December 2019 and spread globally, evolving into the currently observed pandemic. The laboratory diagnosis of SARS­CoV­2 infection is currently based on real­time reverse transcriptase-polymerase chain reaction (RT­PCR) testing, and imaging cannot replace genetic testing in patients with suspected COVID­19. However, with predominant respiratory manifestations of COVID­19, particularly in more severe cases, chest imaging using computed tomography (CT) plays a major role in detecting viral lung infection, evaluating the nature and extent of pulmonary lesions, and monitoring the disease activity. The role of chest CT as a diagnostic tool may be increased when the laboratory testing capacities using RT­PCR prove inaccurate or insufficient during a major outbreak of the disease. In these settings, a rapid presumptive diagnosis of COVID­19 potentially offered by CT might be an advantage, in addition to obvious benefits of delineating the nature and extent of pulmonary lesions. In the present paper, we reviewed the diagnostic role of chest CT in patients with COVID­19.

New hope for patients and challenges for the multidisciplinary arrhythmia team: a hybrid convergent approach for atrial fibrillation treatment.

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 drug­refractory 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. AIM: This study aimed to assess the periprocedural safety as well as acute and long­term outcomes of HABL for AF. METHODS: This is a retrospective single­center study of patients who underwent HABL using the minimally invasive transabdominal approach between July 2009 and January 2020. Demographic in­hospital data and 12­month follow­up results were obtained. The number of hospitalizations, cardioversions, re­ablations, and severe adverse events in a 3­year 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 12­month follow­up, 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 re­ablations after HABL (all P <0.05). CONCLUSIONS: The hybrid multidisciplinary approach for treatment of AF is a safe and very effective treatment method in long­term follow­up, which reduces healthcare burden. It could be considered as an alternative therapeutic option especially in patients with persistent AF.

Sex differences in the frequency of gastrointestinal symptoms and olfactory or taste disorders in 1942 nonhospitalized patients with coronavirus disease 2019 (COVID-19).

INTRODUCTION: The coronavirus disease 2019 (COVID 19) is a communicable disease caused by a novel coronavirus. OBJECTIVES: This study aimed to assess self­reported frequency of gastrointestinal symptoms and olfactory or taste disorders in nonhospitalized patients with COVID­19 in Poland. PATIENTS AND METHODS: This cross­sectional survey was conducted between April 17 and 18, 2020, in 4516 nonhospitalized patients with COVID­19 in Poland. The questionnaire included 8 questions related to the health status, symptoms of COVID­19, comorbidities, and smoking status. RESULTS: Completed questionnaires were obtained from 1942 patients with COVID­19 with a response rate of 43%. The median age of the respondents was 50 years; 60.2% were women. Among nonhospitalized patients with COVID­19, 21.3% had hypertension, 4.5% had diabetes, and 3.1% had a chronic respiratory disease. Regular tobacco use was declared by 11.2% of patients with COVID­19. At least one gastrointestinal symptom was reported by 53.6% of patients. Almost half of patients (47%) with COVID­19 reported lack of appetite and 24.2% reported diarrhea. Among 1942 interviewed patients, 54.2% reported at least 1 olfactory or taste disorder and 42.5% reported both alterations. Self­reported olfactory and taste disorders were 49.2% and 47.5%, respectively. Self­reported frequency of gastrointestinal symptoms and olfactory or taste disorders during COVID­19 was significantly higher (P <0.001) in women than men. CONCLUSIONS: This study demonstrated that olfactory and taste disorders are frequent symptoms in patients with mild­to­moderate COVID­19. Moreover, our study indicated sex differences in the frequency of gastrointestinal symptoms and olfactory or taste disorders among nonhospitalized patients with COVID­19.

10 year trends in hospitalization rates due to heart failure and related in-hospital mortality in Poland (2010-2019).

AIMS: Heart failure (HF) remains a major public health challenge worldwide. Contemporary epidemiological data on HF hospitalization rates and related in-hospital mortality are scarce also in Poland. The aim of the study was to determine the trends in hospitalization rates due to HF and related in-hospital mortality in Poland in the recent decade. METHODS AND RESULTS: Data on HF hospitalizations and in-hospital mortality in patients aged >17 years in Poland between 2010 and 2019 were obtained from the central database of the Polish National Health Fund. Hospitalizations with either primary or secondary diagnosis of HF were identified using the 10th revision of the International Statistical Classification of Diseases and Related Health Problems codes (I50, I42, J81 with extensions, and R57.0). There were 4 259 698 HF hospitalizations and 608 577 in-hospital deaths (14% in-hospital mortality) reported during 2010-2019 in Poland. During this period, there was a steady increase in the number of HF hospitalizations per 1000 inhabitants in subsequent years, being more pronounced in men than in women (in 2019: 16 and 13 HF hospitalizations per 1000 inhabitants in men and women, respectively). The relative risk of HF hospitalization was higher in men than in women, and this gender-related difference steadily increased from 9% in 2010 to 25% in 2019. During 2010-2019, there was an increase in the number of HF hospitalizations per 1000 inhabitants in subsequent age groups, with a trend being more pronounced in men than in women (129 and 99 HF hospitalizations per 1000 inhabitants in men and women aged ≥80 years, respectively). During this period, there was a slight increase in in-hospital mortality during HF hospitalization in subsequent years, being more pronounced in women than in men (in 2019: 16% and 14% of in-hospital mortality in women and men, respectively). The relative risk of in-hospital mortality during HF hospitalization was higher in women than in men, and this gender-related difference steadily increased from 8% in 2010 to 18% in 2019. During this period, in-hospital mortality during HF hospitalization was ~12% for women and men aged 18-29 years, whereas the highest values of in-hospital mortality reached ~19% for patients aged ≥80 years. CONCLUSIONS: We have observed steady growing trends in HF hospitalization rates and related in-hospital mortality in Poland over the last decade. Both age and gender have differentiated the reported epidemiological patterns.

Dynamics of the coronavirus disease 2019 outbreak in Poland: an epidemiological analysis of the first 2 months of the epidemic.

INTRODUCTION: Coronavirus disease 2019 (COVID­19) is an infectious disease caused by the novel severe acute respiratory syndrome coronavirus 2. OBJECTIVES: Our aim was to present an epidemiological analysis of the first 2 months (March and April 2020) of the COVID­19 epidemic in Poland. PATIENTS AND METHODS: This analysis was based on data from epidemiological reports collected between March 4 and April 30, 2020, by the Chief Sanitary Inspectorate. These epidemiological reports include data on sociodemographic characteristics of new laboratory­confirmed COVID 19 cases, the number of COVID­19-related deaths, the number of recovered COVID-19 patients as well as the number of laboratory tests performed. RESULTS: From March 4 to April 30, 2020, a total of 12 877 laboratory­confirmed COVID 19 cases were registered in Poland (55.7% women; mean [SD] age, 50.6 [20.5] years). The RT­ PCR test was performed in 338 000 patients. The notification rate for COVID­19 was 33.2 per 100 000 inhabitants. One third of laboratory­confirmed COVID 19 cases were among quarantined persons, 26.1% were related to the healthcare system (hospital or clinic), and 13.3% occurred in nursing homes. As of April 30, 2020, 644 COVID­19-related deaths were registered in Poland (46.5% women). The death rate for the whole country was 1.7 per 100 000 inhabitants. CONCLUSIONS: Our data showed higher notification rate for COVID­19 among women than men, but men were more likely to die from COVID­19. The notification rate for COVID-19 in Poland among women aged 45 to 54 years was 2­fold higher than among men.