[Ocena zwiazku stezenia kwasu moczowego z przebiegiem zakazenia SARS-CoV-2]. / Ocena zwiazku stezenia kwasu moczowego z przebiegiem zakazenia SARS-CoV-2.

The disease caused by the SARS-CoV-2 (COVID-19) is currently one of the leading causes of hospitalization and death. It has been shown that early assessment of selected laboratory parameters: blood count parameters, concentration of protein C (CRP), D-dimers, ferritin, cardiac troponins or interleukin 6 (IL-6) in patients hospitalized due to COVID- 19 may facilitate predicting its severe course. However, the relationship between uric acid (UA) levels and the prognosis in COVID-19 is unclear. AIM: The aim of the study was to determine the relationship between hyperuricemia and the course of SARS-CoV-2 infection and the prognosis of patients hospitalized due to COVID-19, taking into account concomitant cardiovascular diseases. MATERIALS AND METHODS: Retrospective analysis of consecutive COVID- 19 patients admitted to the hospital, whose parameters of inflammation were measured on admission: C-reactive protein (hs-CRP), procalcitonin, interleukin-6, d-dimers, estimated glomerular filtration rate (eGFR) and UA concentration. The clinical course of the infection was assessed in regard to the presence of comorbidities. Based on the concentration of UA in the blood serum (greater than 360 emol/l), the group of patients with hyperuricemia was selected. Analysis of the interaction between arterial hypertension and cardiovascular diseases and the concentration of UA and the course of COVID-19 was performed. In all statistical analyzes, a significant level of p <0.05 was assumed. RESULTS: The analysis included 252 patients,101 (40.0%) with hyperuricemia. Patients with hyperuricemia had lower hs-CRP and eGFR values compared to patients with normal UA levels. Hyperuricemia did not affect the course of COVID-19 infection or increase mortality. People with comorbid cardiovascular diseases (ischemic heart disease, heart failure, chronic kidney disease, a history of stroke) had twofold higher in-hospital mortality (31% vs 15%) compared to subjects without these diseases. CONCLUSIONS: The diagnosis of hyperuricemia on admission to hospital is not associated with a worse prognosis in patients with COVID-19. The presence of overt cardiovascular diseases is the strongest risk factor for death in the course of SARS-CoV-2 infection. Higher concentration of UA is associated with the presence of cardiovascular diseases, however, it is not an independent factor affecting the course and mortality in COVID-19.

Blood pressure changes in patients with chronic heart failure undergoing slow breathing training.

BACKGROUND: Slow breathing training (SBT) has been proposed as a new non-pharmacological treatment able to induce favorable effects in patients with chronic heart failure (CHF). However, no information is available regarding its effects on orthostatic blood pressure (BP) changes in these patients, an issue of practical relevance given the reported BP-lowering effect of SBT. The aim of this study is to evaluate the influence of SBT on BP and whether SBT induces orthostatic hypotension (OH) or changes in quality of life (QoL) in CHF patients. METHODS: The analysis was performed as part of an ongoing crossover open trial aimed at assessing the clinical effectiveness of SBT in treated patients with CHF. The patients underwent 10-12 weeks of SBT with the RESPeRATE device and 10-12 week follow-up under usual care. Patients were randomly divided into two groups: group I began with SBT, followed by usual care; group II began with usual care, followed by SBT. Patients undergoing SBT were asked to perform each day two separate 15 min sessions of device-guided SBT at a breathing frequency of 6 breaths/min. In all patients, before the enrollment and after each study phase, clinical data collection and BP measurements in sitting, supine and standing position were performed. OH was defined as a decrease of ≥ 20 mmHg in systolic blood pressure (SBP) or ≥ 10 mmHg in diastolic blood pressure (DBP) within 3 min of standing. QoL was assessed three times at the beginning, and after each phase of the study by the Minnesota Living with Heart Failure (MLHF) questionnaire. RESULTS: Forty patients (two equal groups) completed the study, with the following baseline characteristics: 32 males/eight females, age 63.3 ± 13.4 years, 25 with ischemic CHF, 37 in New York Heart Association class II and three in class III, left ventricular ejection fraction 30.8 ± 6.7%, mean BP 138.7 ± 16.5/83.1 ± 11.5 mmHg, 23 with arterial hypertension and four with a history of stroke. There were no significant differences between the groups in clinical characteristics, SBP and DBP at rest, while seated and before and after standing up. OH prevalence was low and did not change during the study (10% vs 10%). No significant difference in average SBP and DBP changes secondary to body position were found when comparing the two study phases. Decrease in MLHF score was observed in group I during SBT (p = 0.002), but not in group II. CONCLUSIONS: Our data indicate that SBT is safe, does not affect the prevalence of OH in CHF patients and shows a non-significant tendency to improve QoL. These results should be confirmed in a larger sample of patients to support the safety of SBT and its possible benefits as a novel component of cardiorespiratory rehabilitation programs in CHF.

[Health-related quality of life in women with chronic heart failure].

Chronic heart failure (CHF) negatively influences health-related quality of life (HRQoL) of women, significantly restricting them in many spheres of activity and social role functioning. The main CHF symptoms influencing everyday activity and leading to HRQoL include dyspnea, fatigue, weakness, limited exercise tolerance and peripheral edema. Beyond these typical symptoms, the majority of CHF patients experience anxiety and depressive symptoms, excessive stress, chronic pain, sleep disturbances and cognitive dysfunction. The HRQoL of CHF women is worse not only compared to that of healthy individuals, but also to those suffering from other chronic diseases. Several drugs used to treat patients with heart failure can slighty improve HRQoL. The impact of well known as well as some new drugs or nonpharmacological methods of treatment on HRQoL in heart failure women is discussed in the paper.

[Consumption of polyunsaturated fatty acids by young hypertensive adults].

Background: A properly balanced diet is a key factor in preventing the development of diet-related diseases and may assist the pharmacological treatment of many conditions. Some studies indicate on relationship between consumption of polyunsaturated fatty acids (PUFA) and positive health outcomes. Aim: To evaluate sources in diet and frequency of consumption of PUFA by young adults suffering from arterial hypertension and to identify differences in PUFA and saturated fatty acids intake de-pending on gender, age, education, BMI, history of hypertension, BP values and the number of an-tihypertensive drugs used. Material and methods: The study group consisted of 100 hypertensive patients, 60 males and 40 females, aged 20 ­ 45 years (mean age 33.4±6.6 years), without concomitant diseases. Study tool constituted the self-reported questionnaire of food products intake, its frequency and intensity assessed during last one month period. The questionnaire involved 7 groups of typical food products, which were also divided into 2 baskets: "basket of 10 healthy" and "basket of 10 unhealthy" products. Results: Patients more often consumed products containing saturated fatty acids than PUFA. In the study group dairy products and meat dominated the diet, especially in hypertensive men. Olive oil was the most popular healthy product consumed by patients (42% of responders). People living in the city ate more often fish and plant products than those from rural areas, but overall fish consump-tion was low ­ only 6 to 12% of patients consumed omega-3 rich fish at least once a week. Regard-less of gender, place of living, education and other clinical factors our hypertensive patients choose more products from the "unhealthy" than "healthy" basket in the last month. Conclusion: Young people suffering from hypertension are characterized by unfavorable eating habits, especially low frequency of PUFA containing products consumption. Intensive educational programs to increase knowledge of young hypertensives about diet beneficial for health are still required.

[Hypertension during pregnancy--how to manage effectively?]. / Nadcisnienie tetnicze w ciazy--jak leczyc skutecznie?

Arterial hypertension affects 5-10% of all pregnant women and may be present in women with pre-existing primary or secondary chronic hypertension, and in women who develop newonset hypertension in the second half of pregnancy. Hypertensive disorders during pregnancy carry risks for the woman and the baby. Hypertension in pregnancy is diagnosed when SBP is > or = 140 or/and DBP > or = 90 mmHg. According to the guidelines, the decision to start pharmacological treatment of hypertension in pregnancy depends on the type of hypertension: in pregnancy-induced hypertension, developing after 20 weeks of pregnancy (with or without proteinuria) drug treatment is indicated when BP is > or = 140/90 mmHg, in chronic hypertension observed before pregnancy pharmacotherapy is indicated when BP is > or = 150/95 mmHg. For pregnant women with severe hypertension (> or =160 / 110 mmHg) antihypertensive therapy should be initiated immediately. Oral methyldopa, labetalol, other beta-adrenoreceptor blockers and calcium channel blockers are used most commonly. In pre-eclampsia parental labetalol, nitroglycerine, urapidyl and other drugs may also be needed.

[Blood pressure and polycystic ovary syndrome (PCOS)]. / Cisnienie tetnicze krwi a zespól policystycznych jajników (PCOS).

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder occurring in women of childbearing age. The literature describes the relationship between PCOS and high blood pressure levels and increased risk of arterial hypertension development, which is an important and strong risk factor for adverse cardiovascular events in the future. Among the main causes of hypertension in PCOS women insulin resistance, hyperandrogenism, greater sympathetic nerve activity and concomitance of obesity are stressed. Because PCOS may contribute to earlier development of hypertension, as well as pre-hypertension, therefore it is advisable to monitor blood pressure systematically, to control known risk factors, and to initiate the treatment of hypertension when the disease occur.

[Changes in blood pressure and heart rate by an increase in serum estradiol in women undergoing controlled ovarian hyperstimulation]. / Zmiany cisnienia tetniczego i czestosci serca pod wplywem wzrostu stezenia estradiolu w surowicy u pacjentek poddanych kontrolowanej stymulacji jajeczkowania.

UNLABELLED: The aim of the study was to evaluate changes in blood pressure and heart rate in women undergoing controlled ovarian stimulation (COH) in preparation for assisted reproduction techniques. Material and method: The comparison of blood pressure and heart rate measurements obtained from 5 women (age 35.3 +/- 9.4 years) was performed. The data were collected during the 24-hour ambulatory blood pressure monitoring (ABPM) using Holcard sphygmomanometer CR-07 Aspel S.A. at the beginning and in the last day of short protocol of COH with the use of triptorelin (Decapeptyl 0.1 mg/day--Ferring GmbH) and the total supply of Gonalu F 225 U/day--Merck Serono) and Menotropiny 75j FSH + LH 75 U/day (Merional Imed/lBSA). RESULTS: During COH the increase in the serum estradiol level was detected (54.03 +/- 9.4 pg/ml at baseline vs. 1128.7 +/- 208.6 pg/ml after COH, p < 0.001). However, there were no differences in SBP and DBP values before stimulation and on the day of its completion. Only the decrease of mean arterial pressure measured by oscillometric method was observed during the study (95.1 +/- 25.3 mmHg vs. 87.6 +/- 27.8 mmHg, p<0.02). Mean arterial pressure measured by oscillometric method decreased in the daytime measurements (98 +/- 27.3 mmHg vs. 92.8 +/- 26.5 mmHg, p<0.05) as well as in the nighttime measurements (84.4 +/- 17.4 mmHg vs. 78.8 +/- 14, 4 mmHg, p <0.05). After COH, the higher heart rate (HR) was measured (in overall ABPM statistics: baseline HR 68.5 +/- 12.8/min vs. 73.6 +/- 13.7/ min after COH, p<0.002 and also in daytime statistics: baseline HR70.8 +/- 13.6 / min vs. 76.3 +/- 15.5 / min after COH, p<0.002). CONCLUSIONS: The increase in serum estradiol level caused by COH leads to increase in heart rate and reduction in mean arterial pressure measured by oscillometric method. However, short-term increase in serum estradiol during COH is not associated with significant changes in systolic and diastolic blood pressure in women preparing for the in vitro procedure.

[Metformin and changes in blood pressure and heart rate in lean patients with polycystic ovary syndrome (PCOS)--preliminary study]. / Metformina, a zmiany cisnienia tetniczego krwi i czestosci akcji serca u szczuplych pacjentek z zespolem policystycznych jajników (PCOS)--doniesienie wstepne.

INTRODUCTION: The aim of our study was to assess the value of blood pressure and heart rate using the 24-hour blood pressure monitoring (ABPM) before and after treatment with metformin to patients with polycystic ovary syndrome (PCOS) and normal lean. MATERIAL AND METHODS: 5 patients received metformin 1500 mg per day in three divided doses. ABPM was performed to each patient with PCOS twice: before and after 6 months of treatment with metformin. RESULTS: In patients with PCOS and normal lean after treatment with metformin we observed: statistically significant lower systolic blood pressure (120.2 ± 22.33 mmHg vs 113.22 ± 21.43 mm Hg, p = 0.0248); lower systolic blood pressure of daily measurements (127.1 ± 32.13 mmHg vs 116.1 ± 22.08 mmHg, p = 0.0062); reduction in average arterial pressure MAP in the measurement of the day (95.52 ± 22.76 mmHg vs 88.36 ± 16.41 mmHg, p = 0.048); oscillometric pressure reduction (96.27 ± 27.93 mmHg vs 87.82 ± 21.61, p = 0.0004 mmHg); oscillometric pressure reduction of daily measurements (102.1 ± 27.93 mmHg vs 91.85 ± 21.61 mmHg, p = 0.0032); oscillometric pressure reduction in the measure- ment of the night (88.81 ± 24.85 mmHg vs 82.22 ± 20.54 mmHg, p = 0.0089). In women after treatment with metformin has also been observed higher average heart rate (65.82 ± 13.48 / min vs. 70.71 ± 16.04 min; p < 0.01). The calculations included 500 measurements. CONCLUSION: Treatment with metformin in patients with PCOS and normal lean leads to lower blood pressure and increases the frequency of heart rate.

[Pharmacotherapy of cardiac arrhythmias in women--what do we know, do we have a choice?]. / Farmakoterapia zaburzen rytmu serca u kobiet--co wiemy, czy mamy wybór?

The paper presents basic epidemiological, electrophysiological and therapeutical differences of cardiac arrhythmias depended on gender. Inadequate sinus tachycardia, orthostatic tachycardia syndrome and atrioventricular nodal reentrant tachycardia are more common in women as well as prolongation of QT interval and proarrhythmic phenomenon (especially torsade de pointes). Atrial fibrillation, although significantly less common in women, is more onerous, therapeutic aims are worse to achieve and outcomes are less favourable than in men. European guidelines do not recommend different pharmacological treatement of supraventricular and ventricular arrhythmias in relation to gender. Older antyarrhythmic drugs (beta-adrenolytics, amiodarone, sotalol) and as well as newer ones (dronedarone, ivabradine, vernakalant and ranolazine) seem to have the same influence on arrthythmias both in men and women, althouth their long-term safety may be different and depend on influence on QT interval. The paper presents the state of the art of antiarrhythmic drugs that might be prefered among woman in different clinical situations.

Characteristics, Mortality, and Clinical Outcomes of Hospitalized Patients with COVID-19 and Diabetes: A Reference Single-Center Cohort Study from Poland.

Background: Diabetes is a risk factor for a severe course of COVID-19. We evaluated the characteristics and risk factors associated with undesirable outcomes in diabetic patients (DPs) hospitalized due to COVID-19. Materials and Methods: The data analysis of patients admitted between March 6, 2020, and May 31, 2021, to the University Hospital in Krakow (Poland), a reference center for COVID-19, was performed. The data were gathered from their medical records. Results: A total number of 5191 patients were included, of which 2348 (45.2%) were women. The patients were at the median age of 64 (IQR: 51-74) years, and 1364 (26.3%) were DPs. DPs, compared to nondiabetics, were older (median age: 70 years, IQR: 62-77 vs. 62, IQR: 47-72, and p < 0.001) and had a similar gender distribution. The DP group had a higher mortality rate (26.2% vs. 15.7%, p < 0.001) and longer hospital stays (median: 15 days, IQR: 10-24 vs. 13, IQR: 9-20, and p < 0.001). DPs were admitted to the ICU more frequently (15.7% vs. 11.0%, p < 0.001) and required mechanical ventilation more often (15.5% vs. 11.3%, p < 0.001). In a multivariate logistic regression, factors associated with a higher risk of death were age >65 years, glycaemia >10 mmol/L, CRP and D-dimer level, prehospital insulin and loop diuretic use, presence of heart failure, and chronic kidney disease. Factors contributing to lower mortality were in-hospital use of statin, thiazide diuretic, and calcium channel blocker. Conclusion: In this large COVID-19 cohort, DPs constituted more than a quarter of hospitalized patients. The risk of death and other outcomes compared to nondiabetics was higher in this group. We identified a number of clinical, laboratory, and therapeutic variables associated with the risk of hospital death in DPs.

Prevalence and clinical implications of atrial fibrillation in patients hospitalized due to COVID-19: Data from a registry in Poland.

Background: Atrial fibrillation (AF) is a common arrhythmia with increasing prevalence with respect to age and comorbidities. AF may influence the prognosis in patients hospitalized with Coronavirus disease 2019 (COVID-19). We aimed to assess the prevalence of AF among patients hospitalized due to COVID-19 and the association of AF and in-hospital anticoagulation treatment with prognosis. Methods and results: We assessed the prevalence of AF among patients hospitalized due to COVID-19 and the association of AF and in-hospital anticoagulation treatment with prognosis. Data of all COVID-19 patients hospitalized in the University Hospital in Krakow, Poland, between March 2020 and April 2021, were analyzed. The following outcomes: short-term (30-days since hospital admission) and long-term (180-days after hospital discharge) mortality, major cardiovascular events (MACEs), pulmonary embolism, and need for red blood cells (RBCs) transfusion, as a surrogate for major bleeding events during hospital stay were assessed. Out of 4,998 hospitalized patients, 609 had AF (535 pre-existing and 74 de novo). Compared to those without AF, patients with AF were older and had more cardiovascular disorders. In adjusted analysis, AF was independently associated with an increased risk of short-term {p = 0.019, Hazard Ratio [(HR)] 1.236; 95% CI: 1.035-1.476} and long-term mortality (Log-rank p < 0.001) as compared to patients without AF. The use of novel oral anticoagulants (NOAC) in AF patients was associated with reduced short-term mortality (HR 0.14; 95% CI: 0.06-0.33, p < 0.001). Moreover, in AF patients, NOAC use was associated with a lower probability of MACEs (Odds Ratio 0.3; 95% CI: 0.10-0.89, p = 0.030) without increase of RBCs transfusion. Conclusions: AF increases short- and long-term risk of death in patients hospitalized due to COVID-19. However, the use of NOACs in this group may profoundly improve prognosis.

Serial echocardiographic evaluation of COVID-19 patients without prior history of structural heart disease: a 1-year follow-up CRACoV-HHS study.

Background: It is a well-known fact that COVID-19 affects the cardiovascular system by exacerbating heart failure in patients with preexisting conditions. However, there is a poor insight into the cardiovascular involvement and sequelae in patients without preexisting conditions. The aim of the study is to analyse the influence of COVID-19 on cardiac performance in patients without prior history of structural heart disease. The study is part of the CRACoV project, which includes a prospective design and a 12-month follow-up period. Material and methods: The study included 229 patients hospitalised with a diagnosis of COVID-19 (median age of 59 years, 81 were women). A standard clinical assessment and laboratory tests were performed in all participants. An extended echocardiographic image acquisition was performed at baseline and at a 3-, 6-, and 12-month follow-up. All analyses were performed off-line. A series of echocardiographic parameters was compared using repeated measures or Friedman analysis of variance. Results: In all subjects, the left ventricular (LV) ejection fraction at baseline was preserved [63.0%; Q1:Q3 (60.0-66.0)]. Elevated levels of high-sensitivity cardiac troponin T were detected in 21.3% of the patients, and elevated NT-proBNP levels were detected in 55.8%. At the 1-year follow-up, no significant changes were observed in the LV diameter and volume (LV 48.0 ± 5.2 vs. 47.8 ± 4.8 mm, p = 0.08), while a significant improvement of the parameters in the biventricular strain was observed (LV -19.1 ± 3.3% vs. -19.7 ± 2.5%, p = 0.01, and right ventricular -19.9 ± 4.5% vs. -23.2 ± 4.9%, p = 0.002). In addition, a decrease in the LV wall thickness was also observed (interventricular septum 10.4 ± 1.6 vs. 9.7 ± 2.0 mm, p < 0.001; LV posterior wall 9.8 ± 1.4 vs. 9.1 ± 1.5 mm, p < 0.001). Conclusions: In an acute phase of COVID-19, the elevation of cardiac biomarkers in patients with normal left ventricular ejection fraction is a frequent occurrence; however, it does not translate into clinically significant cardiac dysfunction after 1 year. The serial echocardiographic evaluations conducted in patients without preexisting structural heart disease demonstrate an overall trend towards an improved cardiac function and a reduced myocardial thickening at 1-year follow-up. This suggests that the acute cardiac consequences of COVID-19 are associated with systemic inflammation and haemodynamic stress in patients without preexisting conditions.

The role of artificial intelligence technology analysis of high-resolution computed tomography images in predicting the severity of COVID-19 pneumonia.

INTRODUCTION: High-resolution computed tomography (HRCT) is usually used only for qualitative analysis of COVID-19 pneumonia. However, when coupled with artificial intelligence (AI) it can also automatically provide quantitative data. OBJECTIVES: The purpose of the study was to analyze the role of automatic assessment of COVID­19 pneumonia severity on HRCT images by AI technology. PATIENTS AND METHODS: We retrospectively studied medical records of consecutive patients admitted to the Krakow University Hospital due to COVID­19. Of the 1729 patients, 804 underwent HRCT with automatic analysis of such radiological parameters as absolute inflammation volume, absolute ground glass volume, absolute consolidation volume (ACV), percentage inflammation volume, percentage ground glass volume, percentage consolidation volume (PCV), and severity of pneumonia classified as none, mild, moderate, or critical. RESULTS: The automatically assessed radiological parameters correlated with the clinical parameters that reflected the severity of pneumonia (P <0.05). The patients with critical pneumonia, as compared with mild or moderate one, were more frequently men, had significantly lower oxygen saturation, higher respiratory rate, higher levels of inflammatory markers, as well as more common need for mechanical ventilation and admission to the intensive care unit. They were also more likely to die during hospitalization. Notably, as determined by the receiver operating characteristic curve analysis, radiological parameters above or equal to the cutoff points were independently associated with in­hospital mortality (ACV odds ratio [OR], 4.08; 95% CI, 2.62-6.35; PCV OR, 4.05; 95% CI, 2.60-6.30). CONCLUSIONS: Using AI to analyze HRCT images is a simple and valuable approach to predict the severity of COVID­19 pneumonia.

Cardiac biomarkers on admission and in­hospital mortality in COVID-19 patients with or without concomitant heart failure.

INTRODUCTION: High­sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro-B type natriuretic peptide (NT­ proBNP) are known markers of cardiac injury. However, their role in predicting the severity of COVID­19 remains to be investigated. OBJECTIVES: We aimed to analyze the association between hs­cTnT and NT-proBNP levels and in hospital mortality in patients with COVID­19, with emphasis on those with concomitant chronic heart failure (CHF). PATIENTS AND METHODS: A total of 1729 consecutive patients with COVID­19 were enrolled. Demographic data, laboratory parameters, and clinical outcomes (discharge or death) were analyzed. Receiver operating characteristic (ROC) and logistic regression analyses were performed to evaluate the association between hs­cTnT and NT-proBNP values and the risk of death. RESULTS: Evaluation of hs­cTnT was performed in 1041 patients, while NT-proBNP was assessed in 715 individuals. CHF was present in 179 cases (10.4% of the cohort). Median values of hs­cTnT and NT-proBNP and in­hospital mortality were higher in CHF patients than in those without CHF. Among patients without CHF, mortality was the highest in those with hs­cTnT or NT-proBNP values in the fourth quartile. In ROC analysis, hs­cTnT equal to or above 142 ng/l and NT-proBNP equal to or above 969 pg/ml predicted in­hospital death. In patients without CHF, each 10-ng/l increase in hs-cTnT or 100-pg/ml increase in NT­proBNP was associated with a higher risk of death (odds ratio [OR], 1.01 and OR, 1.02, respectively; P <0.01 for both). CONCLUSION: The level of hs­cTnT or NT-proBNP predicts in hospital mortality in COVID-19 patients. Both hs­cTnT and NT-proBNP should be routinely measured on admission in all patients hospitalized due to COVID­19 for early detection of individuals with an increased risk of in hospital death, even if they do not have concomitant heart failure.

Impact of concomitant COVID-19 on the outcome of patients with acute myocardial infarction undergoing coronary artery angiography.

Background: The impact of COVID-19 on the outcome of patients with MI has not been studied widely. We aimed to evaluate the relationship between concomitant COVID-19 and the clinical course of patients admitted due to acute myocardial infarction (MI). Methods: There was a comparison of retrospective data between patients with MI who were qualified for coronary angiography with concomitant COVID-19 and control group of patients treated for MI in the preceding year before the onset of the pandemic. In-hospital clinical data and the incidence of death from any cause on 30 days were obtained. Results: Data of 39 MI patients with concomitant COVID-19 (COVID-19 MI) and 196 MI patients without COVID-19 in pre-pandemic era (non-COVID-19 MI) were assessed. Compared with non-COVID-19 MI, COVID-19 MI was in a more severe clinical state on admission (lower systolic blood pressure: 128.51 ± 19.76 vs. 141.11 ± 32.47 mmHg, p = 0.024), higher: respiratory rate [median (interquartile range), 16 (14-18) vs. 12 (12-14)/min, p < 0.001], GRACE score (178.50 ± 46.46 vs. 161.23 ± 49.74, p = 0.041), percentage of prolonged (>24 h) time since MI symptoms onset to coronary intervention (35.9 vs. 15.3%; p = 0.004), and cardiovascular drugs were prescribed less frequently (beta-blockers: 64.1 vs. 92.8%, p = 0.009), angiotensin-converting enzyme inhibitors/angiotensin receptor blockers: 61.5 vs. 81.1%, p < 0.001, statins: 71.8 vs. 94.4%, p < 0.001). Concomitant COVID-19 was associated with seven-fold increased risk of 30-day mortality (HR 7.117; 95% CI: 2.79-18.14; p < 0.001). Conclusion: Patients admitted due to MI with COVID-19 have an increased 30-day mortality. Efforts should be focused on infection prevention and implementation of optimal management to improve the outcomes in those patients.

Impact of Arterial Hypertension and Use of Antihypertensive Pharmacotherapy on Mortality in Patients Hospitalized due to COVID-19: The CRACoV-HHS Study.

BACKGROUND: Cardiovascular diseases including arterial hypertension are common comorbidities among patients hospitalized due to COVID-19. We assessed the influence of preexisting hypertension and its pharmacological treatment on in-hospital mortality in patients hospitalized with COVID-19. METHODS: We studied all consecutive patients who were admitted to the University Hospital in Krakow, Poland, due to COVID-19 between March 2020 and May 2021. Data of 5191 patients (mean age 61.9±16.7 years, 45.2% female) were analyzed. RESULTS: The median hospitalization time was 14 days, and the mortality rate was 18.4%. About a quarter of patients had an established cardiovascular disease including coronary artery disease (16.6%) or stroke (7.6%). Patients with hypertension (58.3%) were older and had more comorbidities than patients without hypertension. In multivariable logistic regression analysis, age above median (64 years), male gender, history of heart failure or chronic kidney disease, and higher C-reactive protein level, but not preexisting hypertension, were independent risk factors for in-hospital death in the whole study group. Patients with hypertension already treated (n=1723) with any first-line antihypertensive drug (angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, calcium channel blockers, or thiazide/thiazide-like diuretics) had a significantly lower risk of in-hospital death (odds ratio, 0.25 [95% CI, 0.2-0.3]; P<0.001) compared to nontreated hypertensives (n=1305). CONCLUSIONS: Although the diagnosis of preexisting hypertension per se had no significant impact on in-hospital mortality among patients with COVID-19, treatment with any first-line blood pressure-lowering drug had a profound beneficial effect on survival in patients with hypertension. These data support the need for antihypertensive pharmacological treatment during the COVID-19 pandemic.

Association between cardiovascular disease, cardiovascular drug therapy, and in-hospital outcomes in patients with COVID-19: data from a large single-center registry in Poland.

BACKGROUND: The coronavirus disease 19 (COVID-19) recently became one of the leading causes of death worldwide, similar to cardiovascular disease (CVD). Coexisting CVD may influence the prognosis of patients with COVID-19. AIMS: We analyzed the impact of CVD and the use of cardiovascular drugs on the in-hospital course and mortality of patients with COVID-19. METHODS: We retrospectively studied data for consecutive patients admitted to our hospital, with COVID-19 between March 6th and October 15th, 2020. RESULTS: 1729 patients (median interquartile range age 63 [50-75] years; women 48.8%) were included. Overall, in-hospital mortality was 12.9%. The most prevalent CVD was arterial hypertension (56.1%), followed by hyperlipidemia (27.4%), diabetes mellitus (DM) (25.7%), coronary artery disease (16.8%), heart failure (HF) (10.3%), atrial fibrillation (13.5%), and stroke (8%). Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEIs/ARBs) were used in 25.0% of patients, ß-blockers in 40.7%, statins in 15.6%, and antiplatelet therapy in 19.9%. Age over 65 years (odds ratio [OR], 6.4; 95% CI, 4.3-9.6), male sex (OR, 1.4; 95% CI, 1.1-2.0), pre-existing DM (OR, 1.5; 95% CI, 1.1-2.1), and HF (OR, 2.3; 95% CI, 1.5-3.5) were independent predictors of in-hospital death, whereas treatment with ACEIs/ARBs (OR, 0.4; 95% CI, 0.3-0.6), ß-blockers (OR, 0.6; 95% CI, 0.4-0.9), statins (OR, 0.5; 95% CI, 0.3-0.8), or antiplatelet therapy (OR, 0.6; 95% CI: 0.4-0.9) was associated with lower risk of death. CONCLUSIONS: Among cardiovascular risk factors and diseases, HF and DM appeared to increase in-hospital COVID-19 mortality, whereas the use of cardiovascular drugs was associated with lower mortality.

[The safety of 5-phosphodiesterase inhibitors in the treatment of erectile dysfunction in patients with cardiovascular disease]. / Bezpieczenstwo stosowania inhibitorów 5-fosfodiesterazy w leczeniu zaburzen erekcji u pacjentów z chorobami ukladu krazenia.

Erectile dysfunction (ED) is a highly prevalent disorder which adversely affects quality of life. The prevalence of erectile dysfunctions affects more than half of the male population over 60 years. Cardiovascular diseases are also highly prevalent conditions and frequently occur concommitantly with ED, mainly because of common several pathophysiological and risk factors. Impressive advances in the management of erectile dysfunction have occurred over the past decade when oral therapy with vasoactive agents has become a first-line treatment. The most widely used class of agents for these kind of disorders is 5-phosphodiesterase inhibitors (5-PDEI). Because the enzyme that they inhibit--PDE-5 is found in smooth muscle cells of the systemic arteries and veins throughout the body, these agents have mild vasodilator effects and thus, have the potential to impact the cardiovascular system. In this article, we review the physiology and the pathophysiology of erection, the influence of 5-PDEI over circulatory system and interactions with drugs commonly used in circulatory disorders. The other purpose of the review (based on the Princeton Consensus I and II) is to present guidelines for safe management of cardiac patients regarding sexual activity and the treatment of ED. We also imply that the recognition of ED is a warning sign of silent vascular disease. Thus a man with ED and no cardiac symptoms may be a cardiac or vascular patient. The conclusion is that, with regard to described rules, PDE-5 inhibitors are safe and effective for the treatment of ED patients with cardiac diseases, including patients with chronic coronary artery disease and hypertension.

Comparison of aortic pulse wave velocity measured by three techniques: Complior, SphygmoCor and Arteriograph.

BACKGROUND: New 2007 European Society of Hypertension guidelines recommend measuring arterial stiffness in patients with arterial hypertension, suggesting a carotid-femoral pulse wave velocity over 12 m/s as an estimate of subclinical organ damage. Considering this cutoff point, it is worth exploring whether or not there are significant differences in results obtained using various techniques for measuring aortic pulse wave velocity. The aim of the study was to compare aortic pulse wave velocity measurements using Complior, SphygmoCor, and Arteriograph devices, and to assess the effect of pulse wave transit time and traveled distance on pulse wave velocity values. METHODS: Aortic pulse wave velocity was measured on a single visit, using these devices, in randomized order, in a group of 64 patients with grade 1 or 2 arterial hypertension. RESULTS: Aortic pulse wave velocity measured using Complior (10.1 +/- 1.7 m/s) was significantly higher than that obtained using SphygmoCor (8.1 +/- 1.1 m/s) or Arteriograph (8.6 +/- 1.3 m/s). No differences were noted between pulse wave velocity measurements using SphygmoCor and Arteriograph. Between-method comparison revealed that differences in traveled distance were significant: Complior versus Arteriograph [0.09 m, Confidence interval (CI): 0.08-0.12 m, P < 0.05], Complior versus SphygmoCor (0.15 m, CI: 0.13-0.16 m, P < 0.05), Arteriograph versus SphygmoCor (0.05 m, CI: 0.03-0.07 m, P < 0.05). No between-method differences were found for transit times. CONCLUSION: Differences in pulse wave velocity obtained by compared devices resulted primarily from using various methods for measuring traveled distance. It appears reasonable to establish uniform principles for the measurement of traveled distance. Because a large number of prognosis/survival studies used direct distance between carotid and femoral sites of pulse wave recording, this distance should be mostly recommended.