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1.
Rev Cardiovasc Med ; 23(9): 292, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-39077718

RESUMO

Background: The coronavirus disease-2019 (COVID-19) pandemic is surging across Poland, leading to many direct deaths and underestimated collateral damage. We aimed to compare the influence of the COVID-19 pandemic on hospital admissions and in-hospital mortality in larger vs. smaller cardiology departments (i.e., with ≥ 2000 vs. < 2000 hospitalizations per year in 2019). Methods: We performed a subanalysis of the COV-HF-SIRIO 6 multicenter retrospective study including all patients hospitalized in 24 cardiology departments in Poland between January 1, 2019 and December 31, 2020, focusing on patients with acute heart failure (AHF) and COVID-19. Results: Total number of hospitalizations was reduced by 29.2% in larger cardiology departments and by 27.3% in smaller cardiology departments in 2020 vs. 2019. While hospitalizations for AHF were reduced by 21.8% and 25.1%, respectively. The length of hospital stay due to AHF in 2020 was 9.6 days in larger cardiology departments and 6.6 days in smaller departments (p < 0.001). In-hospital mortality for AHF during the COVID-19 pandemic was significantly higher in larger vs. smaller cardiology departments (10.7% vs. 3.2%; p < 0.001). In-hospital mortality for concomitant AHF and COVID-19 was extremely high in larger and smaller cardiology departments accounting for 31.3% vs. 31.6%, respectively. Conclusions: During the COVID-19 pandemic longer hospitalizations and higher in-hospital mortality for AHF were observed in larger vs. smaller cardiology departments. Reduced hospital admissions and extremely high in-hospital mortality for concomitant AHF and COVID-19 were noted regardless of department size.

2.
Cardiovasc Diabetol ; 20(1): 128, 2021 06 24.
Artigo em Inglês | MEDLINE | ID: mdl-34167520

RESUMO

BACKGROUND: The global burden of atrial fibrillation (AF) and diabetes mellitus (DM) is constantly rising, leading to an increasing healthcare burden of stroke. AF often remains undiagnosed due to the occurrence in an asymptomatic, silent form, i.e., silent AF (SAF). The study aims to evaluate the relationships between DM and AF prevalence using a mobile long-term continuous ECG telemonitoring vest in a representative Polish and European population ≥ 65 years for detection of AF, symptomatic or silent. METHODS: A representative sample of 3014 participants from the cross-sectional NOMED-AF study was enrolled in the analyses (mean age 77.5, 49.1% female): 881 (29.2%) were diagnosed with DM. AF was screened using a telemonitoring vest for a mean of 21.9 ± 9.1days. RESULTS: Overall, AF was reported in 680 (22.6%) of the whole study population. AF prevalence was higher among subjects with concomitant DM (DM+) versus those without DM (DM-) [25%, 95% CI 22.5-27.8% vs 17%; 95% CI 15.4-18.5% respectively, p < 0.001]. DM patients were commonly associated with SAF [9%; 95% CI 7.9-11.4 vs 7%; 95% CI 5.6-7.5 respectively, p < 0.001], and persistent/permanent AF [12.2%; 95% CI 10.3-14.3 vs 6.9%; 95% CI 5.9-8.1 respectively, p < 0.001] compared to subjects without DM. The prolonged screening was associated with a higher percentage of newly established AF diagnosis in DM+ vs DM- patients (5% vs 4.5% respectively, p < 0.001). In addition to shared risk factors, DM+ subjects were associated with different AF and SAF independent risk factors compared to DM- individuals, including thyroid disease, peripheral/systemic thromboembolism, hypertension, physical activity and prior percutaneous coronary intervention/coronary artery bypass graft surgery. CONCLUSIONS: AF affects 1 out of 4 subjects with concomitant DM. The higher prevalence of AF and SAF among DM subjects than those without DM highlights the necessity of active AF screening specific AF risk factors assessment amongst the diabetic population. TRIAL REGISTRATION: NCT03243474.


Assuntos
Fibrilação Atrial/epidemiologia , Diabetes Mellitus/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Doenças Assintomáticas , Fibrilação Atrial/diagnóstico , Comorbidade , Estudos Transversais , Diabetes Mellitus/diagnóstico , Diagnóstico Precoce , Eletrocardiografia Ambulatorial/instrumentação , Feminino , Humanos , Masculino , Polônia/epidemiologia , Valor Preditivo dos Testes , Prevalência , Estudos Prospectivos , Tecnologia de Sensoriamento Remoto/instrumentação , Medição de Risco , Fatores de Risco , Dispositivos Eletrônicos Vestíveis
3.
Heart Vessels ; 36(6): 853-862, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33386923

RESUMO

It was hypothesised that left atrial (LA) fibrosis identified by the presence of low-voltage areas (LVA) may influence the mechanical and electrical function of the left (LAA) and right (RAA) atrial appendage among the long-standing persistent atrial fibrillation (LSPAF) population. 140 consecutive patients underwent voltage mapping of LA with a multielectrode catheter following pulmonary vein isolation and restoration of sinus rhythm with cardioversion. Echocardiography determined LAA peak outflow and inflow velocities and intracardiac catheter-based mean LAA and RAA AF cycle length (AFCL) were obtained during AF before ablation. The impact of flow velocities and AFCL on the prevalence and location of LVA was further evaluated. LVA were detected in 54% of the patients. 14% of the patients presented severe global LVA burden > 20% of the total LA surface area. 29% of the patients presented a disseminated pattern of remodelling as 3 out of 5 LA segments were affected. LAA AFCL, RAA AFCL, LAA flow velocities did not predict the absolute presence of LVA. However LAA AFCL > 155 ms predicted disseminated LVA pattern and LAA AFCL > 165 ms severe LVA incidence. LAA AFCL > 155 ms was predictive for existence of LVA within antero-septal LA segments whilst LAA emptying velocity ≤ 0.2 m/s within lateral wall. Moreover RAA AFCL > 165 ms was strongly related to the presence of LAA AFCL > 15 ms and > 165 ms. LAA and RAA functional assessment was predictive of the presence of advanced stages of voltage-defined LA fibrosis and its regional distribution among LSPAF population.


Assuntos
Apêndice Atrial/fisiopatologia , Fibrilação Atrial/fisiopatologia , Função do Átrio Esquerdo/fisiologia , Função do Átrio Direito/fisiologia , Remodelamento Atrial/fisiologia , Ablação por Cateter/métodos , Adulto , Idoso , Apêndice Atrial/diagnóstico por imagem , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/cirurgia , Ecocardiografia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo
4.
Sensors (Basel) ; 22(1)2021 Dec 23.
Artigo em Inglês | MEDLINE | ID: mdl-35009603

RESUMO

The possibility of using a smartwatch as a rehabilitation tool to monitor patients' heart rates during exercise has gained the attention of many researchers. This study aimed to evaluate the accuracy and precision of the HR measurement performed by two wrist monitors: the Fitbit Charge 4 and the Xiaomi Mi Band 5. Thirty-one healthy volunteers were asked to perform a stress test on a treadmill. Their heart rates were recorded simultaneously by the wristbands and an electrocardiogram (ECG) at 1 min intervals. The mean absolute error percentage (MAPE), Lin's concordance correlation coefficient (LCCC), and Bland-Altman analysis were calculated to compare the precision and accuracy of heart rate measurements. The estimated validation criteria were MAPE < 10% and LCCC < 0.8. The overall MAPE and LCCC of the Fitbit were 10.19% (±11.79%) and 0.753 (95% CI: 0.717-0.785), respectively. The MAPE and LCCC of the Xiaomi were 6.89% (±9.75) and 0.903 (0.886-0.917), respectively. The precision and accuracy of both devices decreased with the increased exercise intensity. The accuracy of wearable wrist-worn heart rate monitors varies and depends on the intensity of training. Therefore, the decision to use such a device as a heart rate monitor during in-home rehabilitation should be made with caution.


Assuntos
Monitores de Aptidão Física , Determinação da Frequência Cardíaca , Exercício Físico , Teste de Esforço , Frequência Cardíaca , Humanos
5.
Neurol Neurochir Pol ; 53(3): 181-189, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31145466

RESUMO

INTRODUCTION: Stroke remains one of the main causes of death and the most common cause of long-term disability in adults. Embolic strokes of undetermined source (ESUS) amount to a significant proportion of all ischaemic strokes. Detection of atrial fibrillation (AF) in this group of patients would allow for a major therapeutic decision to switch from antiplatelets to oral anticoagulants and therefore significantly reduce the risk of recurrence. STATE OF THE ART: Current technology allows long-term continuous ECG monitoring with different systems, including implantable cardiac monitors (ICM). However, in Poland lack of reimbursement does not allow their use in everyday clinical practice. CLINICAL IMPLICATIONS: This is a statement by a Working Group conceived by the Polish National Consultants in Cardiology and Neurology addressing the use of ICM in patients after ischaemic embolic strokes of undetermined source. The aim was to develop reasonable and comprehensive guidance on how to select and manage candidates for ICM in order to obtain the maximum benefit for Polish public health. FUTURE DIRECTIONS: This expert opinion is not intended as a guideline but it provides advice as to how to optimise the potential use of ICM in patients after ESUS in the Polish setting.


Assuntos
Fibrilação Atrial , Embolia Intracraniana , Acidente Vascular Cerebral , Doenças do Sistema Nervoso Central , Consultores , Cardiopatias , Humanos , Polônia , Fatores de Risco
6.
Ann Noninvasive Electrocardiol ; 23(5): e12532, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29380919

RESUMO

Polymyositis (PM) is an autoimmune disease characterized by the involvement of multiple internal organs, including the cardiovascular system. The involvement of heart is observed in up to 75% of patients with PM. Conduction and rhythm disorders are one of the most common cardiological abnormalities in these patients. The presented clinical case is the patient where ventricular arrhythmia (in the form of multiple premature ventricular extrasystoles) was the first symptom of polymyositis.


Assuntos
Eletrocardiografia/métodos , Polimiosite/complicações , Complexos Ventriculares Prematuros/diagnóstico , Complexos Ventriculares Prematuros/etiologia , Adulto , Colagogos e Coleréticos/uso terapêutico , Glucocorticoides/uso terapêutico , Humanos , Polimiosite/diagnóstico , Polimiosite/terapia , Prednisona , Ablação por Radiofrequência/métodos , Ácido Ursodesoxicólico/uso terapêutico , Complexos Ventriculares Prematuros/terapia
7.
Doc Ophthalmol ; 131(1): 53-62, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25910475

RESUMO

PURPOSE: To evaluate the effects of atrial fibrillation (AF) and ablation procedures on electrophysiological function in the retina and optic nerve. METHODS: Thirty two eyes of 17 patients with AF were analyzed. The full-field electroretinogram (ERG), pattern electroretinogram (PERG) and pattern visual evoked potential (PVEP) were performed. The results were compared to age-matched healthy controls (n = 30). In 12 eyes, electrophysiological tests were performed before and 3 months after ablation treatment. RESULTS: Statistically significant differences between AF patients and healthy controls were detected. In the full-field ERG, a reduction in the oscillatory potentials wave index (OPs WI; p = 0.012) and scotopic (0 dB) a-wave amplitude (p = 0.009) was observed. The amplitude of b-waves, scotopic (24 dB; p = 0.011), photopic single flash (p = 0.008) and photopic flicker (p = 0.009), was decreased. The photopic flicker b-wave peak time was increased (p = 0.005). Other parameters of ERG/PERG/PVEP did not differ significantly from controls. After the ablation procedure, the only statistically significant change was an increase in the OPs WI (p = 0.002). CONCLUSIONS: In the analyzed series of AF patients, retinal dysfunction was detected in the ERG test. The AF ablation may improve the retinal function as indicated by an increase in the OPs WI. The OPs WI has a potential value in the estimation of the effectiveness of AF ablation.


Assuntos
Fibrilação Atrial/fisiopatologia , Eletrorretinografia , Potenciais Evocados Visuais/fisiologia , Nervo Óptico/fisiopatologia , Retina/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Fenômenos Eletrofisiológicos , Eletrorretinografia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Acuidade Visual/fisiologia
8.
Pol Arch Intern Med ; 134(3)2024 03 27.
Artigo em Inglês | MEDLINE | ID: mdl-38164644

RESUMO

INTRODUCTION: Although atrial fibrillation (AF) is a well­known risk factor for ischemic stroke and hospitalization, its effect on mortality has not been clearly established. OBJECTIVES: We aimed to assess whether AF is an independent risk factor for death. A secondary objective was to evaluate the role of oral anticoagulation in the prevention of stroke and death in 1­year follow­up of patients included in the NOMED­AF (Noninvasive Monitoring for Early Detection of Atrial Fibrillation) study. PATIENTS AND METHODS: The NOMED­AF study included 3014 patients. The participants underwent continuous long­term electrocardiographic monitoring using a wearable vest for up to 30 days. The present analysis involved 2795 patients who completed the 1­year follow­up. The median (interquartile range) follow­up time was 365 (365-365) days. AF was diagnosed in 617 participants. RESULTS: Independent risk factors for death in the patients who completed the 1­year follow­up were AF, age equal to or above 65 years, and chronic kidney disease. The individuals with diagnosed AF had an almost 2­fold higher risk of death (odds ratio [OR], 1.7; 95% CI, 1.18-2.44; P <0.001) and a 2.5­fold higher risk of stroke (OR, 2.53; 95% CI, 1.41-4.44; P <0.001), as compared with those without an AF diagnosis. The participants with AF who received oral anticoagulants had an almost 5­fold lower risk of death than those who were not on anticoagulation (2.9% vs 14.2%, respectively; P <0.001). CONCLUSIONS: AF is an independent risk factor for death and cardiovascular hospitalization. The risk of death and stroke in patients with AF is significantly higher than in the patients without this arrhythmia. Oral anticoagulation in patients with AF significantly reduces the rates of death and stroke; however, its use is suboptimal in this group of patients.


Assuntos
Fibrilação Atrial , Acidente Vascular Cerebral , Humanos , Idoso , Fibrilação Atrial/complicações , Seguimentos , Acidente Vascular Cerebral/prevenção & controle , Fatores de Risco , Anticoagulantes
9.
J Clin Med ; 12(15)2023 Jul 28.
Artigo em Inglês | MEDLINE | ID: mdl-37568361

RESUMO

BACKGROUND: Left ventricular diastolic dysfunction (LV DD) is the most dominant cause of heart failure with preserved ejection fraction (HFpEF) worldwide. This pathological condition may contribute to postcapillary pulmonary hypertension (pcPH) development. Hypoxemia, often observed in pcPH, may significantly negatively impact the course of hospitalization in patients after cardiac surgery. The aim of our study was to investigate the impact of LV DD on the frequency of postoperative respiratory adverse events (RAE) in patients undergoing Coronary Artery Bypass Grafting (CABG). METHODS: The left ventricular (LV) diastolic function was assessed in 56 consecutive patients admitted for CABG. We investigated the relationship between LV DD and postoperative respiratory adverse events (RAE) in groups with normal LV diastolic function and LV DD stage I, II, and III. RESULTS: Left ventricular diastolic dysfunction stage I was observed in 11 patients (19.6%) and LV DD stage II or III in 19 patients (33.9%). Arterial blood partial pressure of oxygen (PaO2) to the fraction of inspired oxygen (FiO2) index during postoperative mechanical ventilation was significantly lower in LV DD stage II or III than in the group with normal LV diastolic function. Patients with DD stage II or III had a higher occurrence of postoperative pneumonia than the group with normal LV diastolic function. CONCLUSIONS: Left ventricular diastolic dysfunction is widespread in cardiac surgery patients and is an independent risk factor for lower minimal PaO2/FiO2 index during mechanical ventilation and higher occurrence of pneumonia.

10.
J Clin Med ; 12(15)2023 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-37568458

RESUMO

BACKGROUND: An adequate interlesion distance (ILD) applied during point-by-point pulmonary vein (PV) isolation for atrial fibrillation (AF) has never been established. We hypothesized that maximum tolerated ILD may differ between PV regions and may influence long-term ablation outcomes. METHODS: A total of 260 AF patients underwent PV isolation with 3D electroanatomical platform. Postablation, ILD values were classified into 5 groups (6-5.5 mm, 5.5-5.0 mm, 5.0-4.5 mm, 4.5-4.0 mm and <4.0 mm); the number of tags in each group was calculated and correlated with postablation AF recurrence (AFR). All measurements were performed globally for the entire encirclement around each individual PV and regionally for designated PV anatomic segments. RESULTS: Single-procedure freedom from AF was 81% for paroxysmal and 66% for persistent AF at 12 months. Global analysis showed that AFR was not related to median ILD nor the number of lesions within each ILD tag group for any PV. Segmental analysis showed that AFR was not related to median ILD. However, the presence of tags from the 5.5-6.0 mm ILD group located on the posterior aspect of right upper PV (RUPV) correlated with AFR. This was confirmed in a multivariable logistic regression model. CONCLUSIONS: Maximum tolerated ILD of 6.0 mm translated into well-accepted ablation results. However, the study suggests that it may be inadequate at the posterior aspect of RUPV.

11.
Sci Rep ; 13(1): 17252, 2023 10 12.
Artigo em Inglês | MEDLINE | ID: mdl-37828071

RESUMO

Diabetes mellitus (DM) is a well-known risk factor for atrial fibrillation (AF), but the mechanism(s) by which DM affects AF prevalence remains unclear. This study aims to evaluate the impact of diabetes mellitus severity (expressed as its known duration), antihyperglycemic treatment regimen and glycaemic control on AF prevalence. From the representative sample of 3014 participants (mean age 77.5, 49.1% female) from the cross-sectional NOMED-AF study, 881 participants (mean age 77.6 ± 0.25, 46.4% female) with concomitant DM were involved in the analysis. AF was screened using a telemonitoring vest for a mean of 21.9 ± 9.1 days. The mean DM duration was 12 ± 0.35 years, but no significant impact of DM timespan on AF prevalence was observed. No differences in the treatment pattern (oral medication vs insulin vs both oral + insulin) among the study population with and without AF were shown (p = 0.106). Metabolic control reflected by HbA1c levels showed no significant association with AF and silent AF prevalence (p = 0.635; p = 0.094). On multivariate analyses, age (Odds Ratio (OR) 1.35, 95%CI: 1.18-1.53, p < 0.001), p = 0.042), body mass index (BMI; OR 1.043, 95%CI: 1.01-1.08, p = 0.027) and LDL < 100 mg/dl (OR 0.64, 95%CI: 0.42-0.97, p = 0.037) were independent risk factors for AF prevalence, while age (OR 1.45, 95%CI: 1.20-1.75, p < 0.001), LDL < 100 mg/dl (OR 0.43, 95%CI 0.23-0.82, p = 0.011), use of statins (OR 0.51, 95%CI: 0.28-0.94, p = 0.031) and HbA1c ≤ 6.5 (OR 0.46, 95%CI: 0.25-0.85, p = 0.013) were associated with silent AF prevalence. Diabetes duration, diabetic treatment pattern or metabolic control per se did not significantly impact the prevalence of AF, including silent AF detected by prospective continuous monitoring. Independent predictors of AF were age, BMI and low LDL levels, with statins and HbA1c ≤ 6.5 being additional independent predictors for silent AF.Trial registration: NCT03243474.


Assuntos
Fibrilação Atrial , Diabetes Mellitus , Inibidores de Hidroximetilglutaril-CoA Redutases , Insulinas , Humanos , Feminino , Masculino , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/complicações , Hemoglobinas Glicadas , Prevalência , Controle Glicêmico/efeitos adversos , Estudos Prospectivos , Estudos Transversais , Polônia/epidemiologia , Diabetes Mellitus/epidemiologia , Fatores de Risco
12.
Kardiol Pol ; 81(1): 14-21, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36043418

RESUMO

BACKGROUND: Atrial fibrillation (AF) is the most common cardiac arrhythmia, characterized by an increased risk of thromboembolic complications that can be markedly reduced with anticoagulation. There is a paucity of studies assessing the total prevalence of AF in national populations. AIMS: To assess the nationwide prevalence of AF in a population of adults ≥65 old and to determine the impact of duration of electrocardiogram (ECG) monitoring on the number of newly detected AF episodes. METHODS: The NOMED-AF study (ClinicalTrials.gov; NCT: 0324347) was a cross-sectional study performed on a nationally representative random sample of 3014 Polish citizens 65 years or older. Final estimates were adjusted to the national population. All participants underwent up to 30 days of continuous ECG monitoring. Total AF prevalence was diagnosed based on the patient's medical records or the presence of AF in ECG monitoring. RESULTS: The prevalence of AF in the Polish population ≥65 years was estimated as 19.2% (95% confidence interval [CI], 17.9%-20.6%). This included 4.1% (95% CI, 3.5%-4.8%) newly diagnosed cases and 15.1% (95% CI, 13.9%-16.3%) previously diagnosed cases and consisted of 10.8% (95% CI, 9.8%-11.9%) paroxysmal AF and 8.4% (95% CI, 7.5%-9.4%) persistent/permanent AF. The incidence of all paroxysmal AF events as a function of ECG monitoring duration increased from 1.9% (95% CI, 1.4%-2.6%) at 24 hours to 6.2% (95% CI, 5.3%-7.2%) at 4 weeks. CONCLUSIONS: The prevalence of AF in elderly adults is higher than estimated based on medical records only. Four weeks of monitoring compared to 24-hour ECG Holter allow detection of 7-fold more cases of previously undiagnosed paroxysmal AF.


Assuntos
Fibrilação Atrial , Adulto , Humanos , Idoso , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/complicações , Estudos Transversais , Prevalência , Polônia/epidemiologia , Eletrocardiografia Ambulatorial , Eletrocardiografia
13.
Pol Arch Intern Med ; 133(7-8)2023 08 30.
Artigo em Inglês | MEDLINE | ID: mdl-36861462

RESUMO

INTRODUCTION: Although it is well­known that longer electrocardiographic (ECG) monitoring allows for detection of paroxysmal silent atrial fibrillation (SAF), it is still unknown how long the ECG monitoring should last to increase the probability of SAF diagnosis. OBJECTIVES: Our aim was to analyze ECG acquisition parameters and timing to detect SAF during the Noninvasive Monitoring for Early Detection of Atrial Fibrillation study. PATIENTS AND METHODS: The protocol assumed up to 30 days of ECG telemonitoring of each participant in order to reveal AF / atrial flutter (AFL) episodes lasting at least 30 seconds. SAF was defined as AF detected and confirmed by cardiologists in asymptomatic individuals. The ECG signal analysis was based on the results of 2974 participants (98.67%). AF/AFL episodes were registered and confirmed by cardiologists in 515 individuals, that is, 75.7% of all patients (n = 680) in whom AF/AFL diagnosis was established. RESULTS: The median monitoring time to detect the first SAF episode was 6 days (interquartile range [IQR], 1-13). Fifty percent of the patients with this type of arrhythmia were identified by 6th day (IQR, 1-13) of the monitoring, and 75% by the 13th day of the study. Paroxysmal AF was registered on average on 4th day (IQR, 1-10). CONCLUSIONS: The ECG monitoring time to detect the first episode of SAF in at least 75% of patients at risk of this arrhythmia was 14 days. Detection of 1 patient with de novo AF, SAF, or de novo SAF, required monitoring of, respectively, 17, 11, and 23 patients.


Assuntos
Fibrilação Atrial , Flutter Atrial , Humanos , Fibrilação Atrial/diagnóstico , Eletrocardiografia Ambulatorial , Eletrocardiografia/métodos , Flutter Atrial/diagnóstico
14.
Cardiol J ; 30(3): 344-352, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36651570

RESUMO

BACKGROUND: Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, numerous cardiology departments were reorganized to provide care for COVID-19 patients. We aimed to compare the impact of the COVID-19 pandemic on hospital admissions and in-hospital mortality in reorganized vs. unaltered cardiology departments. METHODS: The present research is a subanalysis of a multicenter retrospective COV-HF-SIRIO 6 study that includes all patients (n = 101,433) hospitalized in 24 cardiology departments in Poland between January 1, 2019 and December 31, 2020, with a focus on patients with acute heart failure (AHF). RESULTS: Reduction of all-cause hospitalizations was 50.6% vs. 21.3% for reorganized vs. unaltered cardiology departments in 2020 vs. 2019, respectively (p < 0.0001). Considering AHF alone respective reductions by 46.5% and 15.2% were registered (p < 0.0001). A higher percentage of patients was brought in by ambulance to reorganized vs. unaltered cardiology departments (51.7% vs. 34.6%; p < 0.0001) alongside with a lower rate of self-referrals (45.7% vs. 58.4%; p < 0.0001). The rate of all-cause in-hospital mortality in AHF patients was higher in reorganized than unaltered cardiology departments (10.9% vs. 6.4%; p < 0.0001). After the exclusion of patients with concomitant COVID-19, the mortality rates did not differ significantly (6.9% vs. 6.4%; p = 0.55). CONCLUSIONS: A greater reduction in hospital admissions in 2020 vs. 2019, higher rates of patients brought by ambulance together with lower rates of self-referrals and higher all-cause in-hospital mortality for AHF due to COVID-19 related deaths were observed in cardiology departments reorganized to provide care for COVID-19 patients vs. unaltered ones.


Assuntos
COVID-19 , Cardiologia , Insuficiência Cardíaca , Humanos , COVID-19/epidemiologia , Pandemias , Estudos Retrospectivos , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/terapia , Mortalidade Hospitalar
15.
Pacing Clin Electrophysiol ; 35(5): e124-6, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-21535033

RESUMO

We describe a case of a patient with the history of a monomorphic postinfarction ventricular tachycardia that exhibited a right bundle branch block morphology and a superior axis. Because of electrical and hemodynamic instability of arrhythmia, classical mapping techniques were not applied. An electroanatomic voltage map during sinus rhythm was performed. A Purkinje potential (PP) preceding the QRS complex was recorded at posteroseptal area of a scar. Radiofrequency energy delivery at sites where a PP was detected resulted in a successful ablation.


Assuntos
Mapeamento Potencial de Superfície Corporal/métodos , Bloqueio de Ramo/etiologia , Ablação por Cateter/métodos , Infarto do Miocárdio/complicações , Infarto do Miocárdio/cirurgia , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/cirurgia , Bloqueio de Ramo/diagnóstico , Bloqueio de Ramo/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Taquicardia Ventricular/diagnóstico , Resultado do Tratamento
16.
Cardiol J ; 29(4): 660-669, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-32419127

RESUMO

BACKGROUND: Left atrial (LA) arrhythmogenic substrate beyond the pulmonary veins (PV) seems to play a crucial role in the maintenance of atrial fibrillation (AF). The aim of this study was to evaluate the association of selected parameters with the presence and extent of voltage-defined LA fibrosis in patients with long-standing persistent AF (LSPAF) undergoing catheter ablation. METHODS: One hundred and sixteen consecutive patients underwent high density-high resolution voltage mapping of the LA with a multielectrode catheter following PV isolation and restoration of sinus rhythm with cardioversion. A non-invasive dataset, such as clinical variables, two-and three-dimensional echocardiography determined LA size and function and fibrillatory-wave amplitude on a standard surface electrocardiogram were obtained during AF before ablation. RESULTS: Low-voltage areas (LVA; 15 cm² [IQR 8-31]) were detected in 56% of patients. Twenty nine percent of them presented mild, 43% moderate and 28% severe global LVA burden. In univariate analysis, age ≥ 57 years old, female sex, body surface area ≤ 1.76 m², valvular heart disease, moderate mitral regurgitation, chronic coronary syndrome, hypothyroidism, CHA2DS2-VASc score ≥ 3 and ≥ 4 predicted the presence of LVA. In multivariate analysis only female sex, valvular heart disease and CHA2DS2-VASc ≥ 4 remained statistically significant. AF duration, LA size and function and fibrillatory-waves amplitude were neither associated with the prediction of the LVA, nor severe LVA burden. CONCLUSIONS: A LSPAF diagnosis does not indicate the presence of voltage defined fibrosis in many cases. Simple non-invasive screening of the LSPAF population could predict LVA prevalence.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Doenças das Valvas Cardíacas , Veias Pulmonares , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Feminino , Fibrose , Átrios do Coração/diagnóstico por imagem , Doenças das Valvas Cardíacas/cirurgia , Humanos , Pessoa de Meia-Idade , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/cirurgia , Resultado do Tratamento
17.
J Cardiovasc Dev Dis ; 9(5)2022 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-35621853

RESUMO

Background: The incidence and influence of vagal response (VR) observed during cryoballoon-based pulmonary vein isolation (CBA-based PVI) on the cardiac autonomic nervous system (CANS) and ablation outcomes in paroxysmal atrial fibrillation (PAF) remain unknown. Methods: 296 patients were treated with a 28 mm second-generation cryoballoon (Medtronic). A total of 74 patients without structural heart disease and concomitant diseases were chosen for a detailed CANS assessment with a heart rate variability (HRV) analysis. All patients were screened over a 2-year post-ablation period. Results: VR was detected in 30% of patients and included sinus arrest (64%) or severe sinus bradycardia (46%). The presence of VR was not related to PV ostial dimension, patient clinical characteristics or intraprocedural ablation details. CANS modulation, manifesting as increased median HR and decreased HRV parameters with intact sympatho-vagal balance occurred independently of VR presence or absence and sustained for at least 12 months following ablation. VR was not related with more intensive CANS modulation and did not translate into better ablation outcomes when compared to the non-VR group (74% vs. 71% at 12 months and 69% vs. 65% at 24 months respectively). Conclusions: VR is frequent during CBA-based PVI for PAF and unrelated to any additional clinical benefit.

18.
J Clin Med ; 11(18)2022 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-36143077

RESUMO

The decline in cardiac contractility due to damage or loss of cardiomyocytes is intensified by changes in the extracellular matrix leading to heart remodeling. An excessive matrix response in the ischemic cardiomyopathy may contribute to the elevated fibrotic compartment and diastolic dysfunction. Fibroproliferation is a defense response aimed at quickly closing the damaged area and maintaining tissue integrity. Balance in this process is of paramount importance, as the reduced post-infarction response causes scar thinning and more pronounced left ventricular remodeling, while excessive fibrosis leads to impairment of heart function. Under normal conditions, migration of progenitor cells to the lesion site occurs. These cells have the potential to differentiate into myocytes in vitro, but the changed micro-environment in the heart after infarction does not allow such differentiation. Stem cell transplantation affects the extracellular matrix remodeling and thus may facilitate the improvement of left ventricular function. Studies show that mesenchymal stem cell therapy after infarct reduces fibrosis. However, the authors did not specify whether they meant the reduction of scarring as a result of regeneration or changes in the matrix. Research is also necessary to rule out long-term negative effects of post-acute infarct stem cell therapy.

19.
Artigo em Inglês | MEDLINE | ID: mdl-35162123

RESUMO

BACKGROUND: Due to the unpredictable nature of COVID-19, there is a need to identify patients at high risk of severe course of the disease and a higher mortality rate. OBJECTIVE: This study aims to find the correlation between frailty and mortality in adult, hospitalized patients with COVID-19. METHODS: Clinical records of 201 patients who suffered from COVID-19 and were hospitalized between October 2020 and February 2021 were retrospectively analyzed. Demographic, clinical, and biochemical data were collected. Patients were assessed using Clinical Frailty Scale (CFS) and were divided into three groups: CFS 1-3 fit; CFS 4-6 vulnerable and with mild to moderate frailty; CSF 7-9, severe frailty. The association between frailty and in-hospital mortality was the primary outcome. RESULTS: Severe frailty or terminal illness was observed in 26 patients (12.94%) from a cohort of 201 patients. Those patients were older (median age 80.73, p < 0.001) and had more comorbidities. Frailty was also associated with higher requirement for oxygen supplementation, greater risk of in-hospital complications and worse biochemical laboratory results. An increase in CFS score also correlated with higher mortality (OR = 1.89, p < 0.001). The Conclusions: Clinical Frailty Scale (CFS) can be used as a potentially useful tool in predicting mortality in patients with COVID-19.


Assuntos
COVID-19 , Fragilidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Idoso Fragilizado , Humanos , Prognóstico , Estudos Retrospectivos , SARS-CoV-2
20.
Kardiol Pol ; 80(4): 468-475, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35188220

RESUMO

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.


Assuntos
Infarto do Miocárdio , Intervenção Coronária Percutânea , Assistência ao Convalescente , Idoso , Ponte de Artéria Coronária , Humanos , Alta do Paciente , Resultado do Tratamento
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