Predictors of target lesion failure after treatment of left main, bifurcation, or chronic total occlusion lesions with ultrathin-strut drug-eluting coronary stents in the ULTRA registry.

BACKGROUND: Data about the long-term performance of new-generation ultrathin-strut drug-eluting stents (DES) in challenging coronary lesions, such as left main (LM), bifurcation, and chronic total occlusion (CTO) lesions are scant. METHODS: The international multicenter retrospective observational ULTRA study included consecutive patients treated from September 2016 to August 2021 with ultrathin-strut (<70 µm) DES in challenging de novo lesions. Primary endpoint was target lesion failure (TLF): composite of cardiac death, target-lesion revascularization (TLR), target-vessel myocardial infarction (TVMI), or definite stent thrombosis (ST). Secondary endpoints included all-cause death, acute myocardial infarction (AMI), target vessel revascularization, and TLF components. TLF predictors were assessed with Cox multivariable analysis. RESULTS: Of 1801 patients (age: 66.6 ± 11.2 years; male: 1410 [78.3%]), 170 (9.4%) experienced TLF during follow-up of 3.1 ± 1.4 years. In patients with LM, CTO, and bifurcation lesions, TLF rates were 13.5%, 9.9%, and 8.9%, respectively. Overall, 160 (8.9%) patients died (74 [4.1%] from cardiac causes). AMI and TVMI rates were 6.0% and 3.2%, respectively. ST occurred in 11 (1.1%) patients while 77 (4.3%) underwent TLR. Multivariable analysis identified the following predictors of TLF: age, STEMI with cardiogenic shock, impaired left ventricular ejection fraction, diabetes, and renal dysfunction. Among the procedural variables, total stent length increased TLF risk (HR: 1.01, 95% CI: 1-1.02 per mm increase), while intracoronary imaging reduced the risk substantially (HR: 0.35, 95% CI: 0.12-0.82). CONCLUSIONS: Ultrathin-strut DES showed high efficacy and satisfactory safety, even in patients with challenging coronary lesions. Yet, despite using contemporary gold-standard DES, the association persisted between established patient- and procedure-related features of risk and impaired 3-year clinical outcome.

Impact of Remote Monitoring on Long-Term Prognosis in Heart Failure Patients in a Real-World Cohort: Results From All-Comers COMMIT-HF Trial.

BACKGROUND: Randomized controlled trials demonstrate that remote monitoring (RM) of implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy devices (CRT-Ds) may improve quality of care and prognosis in heart failure (HF) patients. However, the impact of RM on long-term mortality in a real-world cohort is still not well examined. METHODS AND RESULTS: This study was designed as a matched cohort study based on the COMMIT-HF trial--a single-center, ongoing prospective observational registry (NCT02536443). Complete patient demographics, medical history, in-hospital results, hospitalizations, and mortality data were collected based on institutional registries and healthcare providers' records. Patients were divided into 2 groups based on RM presence and matched by means of propensity scores according to clinical characteristics. The primary endpoint of this study was the long-term all-cause mortality. Out of 1,429 consecutive patients, 822 patients with a first implantation of an ICD/CRT-D were included in the analysis. The final matched study population contained 574 patients in RM and in a control group. Although demographic and echocardiographic parameters as well as pharmacological treatments were similar in both groups, a significantly lower 1-year mortality was detected in the RM group (2.1% vs. 11.5%, P < 0.0001). This was also maintained during a 3-year follow-up (4.9% vs. 22.3%, P < 0.0001). Multivariate analysis showed that RM was associated with an improved prognosis (hazard ratio 0.187, 95% confidence interval 0.075-0.467, P = 0.0003). CONCLUSION: RM of HF patients with ICDs/CRT-Ds significantly reduced long-term mortality in a real-world clinical condition.

Prognostic implications of mean platelet volume on short- and long-term outcomes among patients with non-ST-segment elevation myocardial infarction treated with percutaneous coronary intervention: A single-center large observational study.

BACKGROUND: Mean platelet volume (MPV) is a simple and reliable indicator of platelet size that correlates with platelet activation and their ability to aggregate. We studied the predictive value of MPV in patients with non-ST-segment elevation myocardial infarction (NSTEMI) treated with percutaneous coronary intervention (PCI). METHODS: We analyzed the consecutive records of 1001 patients who were hospitalized due to NSTEMI at our center. The primary end point was a composite end point that included the rates of all-cause death, non-fatal myocardial infarction, and acute coronary syndrome (ACS) driven revascularization at 12 months. The enrolled patients were stratified according to the quartile of the MPV level at admission. RESULTS: Along with the increasing quartile of MPV, the 12-month composite end point increased significantly (p = 0.010), and this association remained significant after the risk-adjusted analyses (per 1 fL higher MPV; adjusted hazard ratio [HR] 1.13; 95% confidence interval [CI] 1.02-1.27; p = 0.026). In the multivariate analysis, the MPV was also an independent factor of all-cause mortality (per 1 fL increase; adjusted HR 1.34; 95% CI 1.12-1.61; p = 0.0014) and death or non-fatal myocardial infarction (per 1 fL increase; adjusted HR 1.16; 95% CI 1.03-1.31; p = 0.017). CONCLUSION: In patients with NSTEMI treated with PCI, a high MPV value was associated with a significantly increased incidence of long-term adverse events, particularly for all-cause mortality.

Characteristics and outcomes for patients with heart failure diagnosed according to the universal definition and classification of heart failure. Data from a single-center registry.

BACKGROUND: There are no data on the characteristics and outcomes for patients with heart failure (HF) with reduced (HFrEF), mildly reduced (HFmrEF), and preserved (HFpEF) ejection fraction diagnosed according to the universal definition and classification of HF. AIMS: We used the universal HF definition to compare baseline characteristics, hospital readmission and mortality rates in individuals with HFrEF, HFmrEF, and HFpEF diagnosed retrospectively. RESULTS: The study was designed as a single-center retrospective analysis of all consecutive 40732 hospital admissions between 2013 and 2021 in a tertiary department of cardiology. All patients with HF, defined according to the universal definition and classification of HF, were identified. The study included 8471 patients with a mean age of 65.1 (12.8) years, of whom 2823 (33.3%) were females. Most individuals had a prior diagnosis of HF (76.3%) and elevated N-terminal pro-B-type natriuretic peptide levels (99.0%) with a median of 1548 (629-3786) pg/ml. Mean ejection fraction (EF) was 36.2 (14.9)%. The median follow-up was 39.1 (18.1-70.5) months. The most frequent type of HF was HFrEF (n = 4947; 58.4%), followed by HFpEF (n = 1138; 28.2%) and HFmrEF (n = 2386; 13.4%). Urgent HF readmissions and all-cause deaths were highest in HFrEF (40.8% and 42.7%), followed by HFmrEF (25.4% and 31.5%) and HFpEF (15.2% and 23.8%, respectively). CONCLUSIONS: The highest rates of urgent HF readmissions and all-cause mortality were observed in patients with HFrEF, followed by HFmrEF and HFpEF. In all HF groups, the all-cause mortality rate was higher than the rates of urgent HF readmission.

Case Report: do heart transplant candidates benefit from mechanically supported revascularization?

Introduction: Recently published studies suggest that percutaneous coronary intervention (PCI) has no significant impact on outcomes in patients with heart failure and stable coronary artery disease. The use of percutaneous mechanical circulatory support is growing, but its value is still uncertain. If large areas of viable myocardium are ischemic, the benefit from revascularization should be evident. In such instances, we should strive for complete revascularization. The use of mechanical circulatory support in such cases is vital because it provides hemodynamic stability throughout the complex procedure. Case report: We present a case of a 53-year-old male heart transplant candidate with type 1 diabetes mellitus, initially considered unsuitable for revascularization and qualified for heart transplantation, transferred to our center due to acute decompensated heart failure. At this time, the patient had temporary contraindications for heart transplantation. As the patient was considered no-option, we have decided to reassess the possibility of revascularization. The heart team opted for a high-risk mechanically supported PCI with the aim of complete revascularization. A complex multivessel PCI was performed with optimal effect. The patient was weaned off dobutamine on the second day post-PCI. Four months post-discharge, he remains stable, is in NYHA II class, and has no chest pain. Control echocardiography showed improved ejection fraction. The patient is not a heart transplant candidate anymore. Conclusions: This case report shows that we must strive for revascularization in select heart failure cases. The outcome of this patient suggests that heart transplant candidates with potentially viable myocardium should be considered for revascularization, especially as the shortage of donors persists. In the most complex coronary anatomy and severe heart failure, mechanical support in the procedure might be essential.

Factors affecting short- and long-term survival of patients with acute coronary syndrome treated invasively using intravascular ultrasound and fractional flow reserve: Analysis of data from the Polish Registry of Acute Coronary Syndromes 2017-2020.

BACKGROUND: Intravascular ultrasound (IVUS) and fractional flow reserve (FFR) are invasive procedures increasingly used in treating acute coronary syndrome (ACS). AIMS: This study aimed to evaluate the frequency of IVUS and FFR use in patients with ACS in Poland and to assess the safety of these procedures as well as their impact on short- and long-term survival. METHODS AND RESULTS: This retrospective study included 103849 patients enrolled in the Polish Registry of Acute Coronary Syndromes in 2017-2020. IVUS was performed in 1727 patients, FFR in 1537 patients, and both procedures in 37 patients. The frequency of performing FFR in ACS patients increased over the years from 1.3% to 1.8% (P <0.0001) and IVUS from 1.7% to 2.3% (P <0.0001). In the FFR and/or IVUS group, a similar incidence of stroke, reinfarction, target vessel revascularization, and major bleeding was observed while in-hospital mortality was lower (0% for IVUS + FFR vs. 0.9% for FFR vs. 2.3% for IVUS vs. 3.7 for no procedure; P <0.0001). FFR and IVUS did not affect the 30-day and one-year prognosis. CONCLUSION: In recent years, the number of FFR and IVUS procedures performed in patients with ACS in Poland has increased. There was lower in-hospital mortality in the FFR and/or IVUS group in ACS patients, and no differences in the incidence of stroke, reinfarction, target vessel revascularization, and major bleeding were observed. Performing FFR and IVUS in ACS patients does not significantly affect 30-day or one-year mortality.

Prognostic Value of Spot Urinary Creatinine Concentration and Its Relationship with Body Composition Parameters in HF Patients.

BACKGROUND: Low 24-h urinary excretion of creatinine in patients with heart failure (HF) is believed to reflect muscle wasting and is associated with a poor prognosis. Recently, spot urinary creatinine concentration (SUCR) has been suggested as a useful prognostic factor in selected HF cohorts. This more practical and cheaper approach has never been tested in an unselected HF population. Moreover, neither the relation between SUCR and body composition markers nor the association of SUCR with the markers of volume overload, which are known to worsen clinical outcome, has been studied so far. The aim of the study was to check the prognostic value of SUCR in HF patients after adjusting for body composition and indirect markers of volume overload. METHODS: In 911 HF patients, morning SUCR was determined and body composition scanning using dual X-ray absorptiometry (DEXA) was performed. Univariable and multivariable predictors of log SUCR were analyzed. All participants were divided into quartiles of SUCR. RESULTS: In univariable analysis, SUCR weakly correlated with fat-free mass (R = 0.09, p = 0.01). Stronger correlations were shown between SUCR and loop diuretic dose (R = 0.16, p < 0.0001), NTproBNP (R = -0.15, p < 0.0001) and serum sodium (R = 0.16, p < 0.0001). During 3 years of follow-up, 353 (38.7%) patients died. Patients with lower SUCR were more frequently female, and their functional status was worse. The lowest mortality was observed in the top quartile of SUCR. In the unadjusted Cox regression analysis, the relative risk of death in all three lower quartiles of SUCR was higher by roughly 80% compared to the top SUCR quartile. Apart from lower SUCR, the significant predictors of death were age and malnutrition but not body composition. After adjustment for loop diuretic dose and percent of recommended dose of mineralocorticoid receptor antagonists, the difference in mortality vanished completely. CONCLUSIONS: Lower SUCR levels in HF patients are associated with a worse outcome, but this effect is not correlated with fat-free mass. Fluid overload-driven effects may link lower SUCR with higher mortality in HF.

Anticoagulation for Atrial Fibrillation in Acute Coronary Syndrome Survivors Reduces Major Cardiovascular Events and Mortality.

The prevalence of atrial fibrillation (AF) in acute coronary syndrome (ACS) patients is increasing. Data on outcomes of anticoagulation in ACS patients with AF are lacking.The aim of our study was to investigate the prevalence of stroke, myocardial infarction, bleeding complications, and all-cause mortality in this population.PL-ACS and AMI-PL registries gather an all-comer population of ACS patients in Poland, exceeding half a million records. We have selected ACS survivors with concomitant AF on admission, divided them into subgroups with regard to the administered anticoagulation, and followed up with them for a 12-month period (n = 13,973). Subsequently, groups were propensity score matched for age, sex, ejection fraction, diabetes, heart failure, renal impairment, and type of ACS.The study population was divided with regard to the administration of anticoagulation. Anticoagulation was prescribed in 2,466 patients (17.6%). The (D)OAC+ patients were younger; however, comorbidities were more prevalent in this group. The 12-month follow-up showed that the (D)OAC+ patients had significantly lower rates of all-cause mortality, myocardial infarction, and ischemic stroke, with no significant increase in bleeding events. After matching, the study groups consisted of 2,194 patients each and showed no differences in baseline characteristics. The outcomes of the 12-month observation were similar to the findings before matching.This all-comer national registry analysis shows that the use of guideline-recommended therapy and anticoagulation in ACS survivors with AF is associated with a lower rate of all-cause mortality, recurrent myocardial infarction, and ischemic stroke.

Is the last before-death alert remote monitoring transmission in patients with heart failure life-threatening?

BACKGROUND: Remote monitoring (RM) of cardiac implantable electronic devices (CIED) allows for a regular analysis of the occurrence of arrhythmias and functioning of the devices. AIMS: To date, no study investigated the characteristics of the alert-triggered ultimate transmissions before death, which was the aim of the present analysis. METHODS: Patients monitored remotely in our center, whose baseline characteristics were obtained from the COMMIT-HF Registry (NCT02536443) were analyzed and divided according to the occurrence of alert transmissions during the RM. In patients who had an alert transmission, the last transmission was analyzed. All RM data were obtained from the software provided by four RM manufacturers. RESULTS: Of 1271 patients with CIEDs which transmitted at least one message to the RM center, 198 (15.6%) had no alert transmissions, while 1073 (84.4%) had at least one alert transmission. Respective mortality in patients with and without alerts during RM was 29.7% and 12.6%, respectively. In patients who had ever an alert, the last recorded transmission before death was scheduled in 166 patients and alert-triggered in 152 patients. The most frequent alert-triggered last transmissions were atrial fibrillation/flutter (39.4%) and ventricular tachyarrhythmias (26.8%). The median period from the last alert-triggered transmission to death was 10 days. CONCLUSION: This is the first analysis of the ultimate RM transmissions delivered by CIEDs before death. In approximately 85% of RM patients with CIEDs, at least one alert transmission occurred during the RM, and in patients who had ever an alert, almost half of the last transmissions before death were alert-triggered.

The influence of resistance training on muscle strength, irisin concentration, and metabolic parameters in type 1 diabetic patients.

INTRODUCTION: Resistance effort has a beneficial effect on muscle mass, body composition, bone density, and cardiac parameters. It is also a modulator of the inflammatory reaction. The aim of the study was to assess the impact of 3 months of resistance training on muscle strength, irisin levels, and metabolic parameters in patients with long-term type 1 diabetes. MATERIAL AND METHODS: Eleven type 1 male diabetic patients with low levels of physical activity were recruited, with mean age 38 ± 6 years, body mass index (BMI) 28.4 ± 2.6 kg/m², and diabetes duration 23 ± 7 years. All subjects participated in 60-minute resistance training sessions twice a week, for three months. At baseline and after 3 months in all patients, maximal muscle strength level, serum irisin concentration, metabolic control parameters, and anthropometric measures were assessed. RESULTS: After 3 months there was a statistically significant increase of maximal muscle strength in comparison to baseline. There was no significant change in serum irisin concentration, HbA1c, or other assessed parameters. CONCLUSION: A 3-month resistance training programme in patients with long-term type 1 diabetes and low level of physical activity significantly affects their maximum strength level. This indicates that people with diabetes are more adaptive to additional loads, which allows them to increase their load faster.

Everolimus-eluting stents versus sirolimus-eluting stents in patients with cardiac allograft vasculopathy.

INTRODUCTION: Cardiac allograft vasculopathy remains one of the most important factors leading to chronic cardiac allograft rejection. When revascularization is needed percutaneous coronary interventions are the method of choice. AIM: To compare the short- and long-term outcomes of cardiac allograft vasculopathy patients treated with everolimus- (EES) or sirolimus-eluting stents (SES). MATERIAL AND METHODS: Between December 2012 and December 2020, 319 patients after heart transplantation undergoing coronary angiography at our institution were analysed. Subsequently 39 patients underwent de novo angioplasty with second-generation EES. The primary study endpoint was angiographic restenosis as evaluated by quantitative coronary angiography. Secondary outcomes included binary restenosis, target lesion revascularization and cardiac death during the follow-up period (6 months). RESULTS: Twenty-four patients were treated with EES and 15 treated with SES. No significant differences were observed regarding the rate of risk factors of cardiovascular diseases and comorbidities. The patients treated with EES were younger (55.8 ±11.8 vs. 60.1 ±12.2) and less frequently male (79% vs. 93%). The majority of patients were diagnosed with single vessel disease with LAD involvement (62% and 86% in the EES group, and 47% and 56% in the SES group). In 6 months follow-up, late lumen loss was comparable in both groups, 0.19 ±0.15 vs. 0.14 ±0.15, and binary restenosis was 4% and 0% for EES and SES groups, respectively. CONCLUSIONS: Second generation drug-eluting stents eluting rapamycin analogues are associated with high direct efficacy of procedures and low incidence of restenosis in a 6-month follow-up.

Combined Aerobic and Resistance Training Performed under Conditions of Normobaric Hypoxia and Normoxia Has the Same Impact on Metabolic Control in Men with Type 1 Diabetes.

(1) Background: The aim was to assess whether combined aerobic and resistance training performed under hypoxic and normoxic conditions had an impact on diabetes control, VO2max (maximum oxygen consumption), and echocardiological and anthropometric parameters in men with long-term type 1 diabetes. (2) Methods: Sixteen male participants (mean age: 37 years, mean HbA1c (glycated hemoglobin): 7.0%) were randomly assigned to two groups: training in normoxic conditions or training in conditions of altitude hypoxia. All subjects participated in 60 min combined aerobic and resistance training sessions twice a week for 6 weeks. At baseline and in the 6th week, echocardiography, incremental exercise test, and anthropometric and diabetes control parameters were assessed. (3) Results: After 6 weeks, there was no significant change in HbA1c value in any group. We noted a more stable glycemia profile during training in the hypoxia group (p > 0.05). Patients in the hypoxia group required less carbohydrates during training than in the normoxia group. A comparable increase in VO2max was observed in both groups (p > 0.05). There were no significant differences in cardiological and anthropometric parameters. (4) Conclusions: Combined aerobic and resistance training improved VO2max after 6 weeks regardless of the conditions of the experiments. This exercise is safe in terms of glycemic control in patients with well-controlled diabetes.

Long-term clinical outcomes after placement of an implantable cardioverter-defibrillator: does the etiology of heart failure matter?

BACKGROUND: European and American guidelines for the placement of implantable cardioverter­defibrillator (ICD) and cardiac resynchronization therapy defibrillator (CRT­D) in patients with heart failure (HF) remain unchanged despite controversy and ongoing debate on the etiology of HF. However, there are limited data on the long­term follow­up in patients who received primary defibrillator therapy with regard to ischemic cardiomyopathy (ICM) and nonischemic cardiomyopathy (NICM). The prognostic significance of the etiology of HF is not well established. AIMS: The aim of the study was to assess the predictive value of the cause of HF. METHODS: A total of 1073 patients with the first implantation of ICD/CRT­D between January 2009 and December 2013 from the COMMIT­HF (Contemporary Modalities In Treatment of Heart Failure) registry were selected for the study. Patients were divided into 2 groups depending on the etiology of HF: ischemic (n = 705; 65.7%) and nonischemic (n = 368; 34.3%). The primary endpoint was long­term all­cause mortality. RESULTS: The median follow­up was 60.5 months. The primary endpoint occurred more often in the ICM as compared with the NICM group (35.7% vs 26.6%; P = 0.008). A higher out­of­hospital mortality in patients with ICM tended to be statistically significant (15.5% vs 10.6; P = 0.05). The multivariate analysis revealed that, among others, an ischemic etiology of HF was an independent factor of long­term mortality (hazard ratio, 1.43; 95% CI, 1.30-1.81; P = 0.003). Other independent predictors for mortality are: age older than 65 years, impaired left ventricular ejection fraction, chronic kidney disease, atrial fibrillation, diabetes mellitus. CONCLUSIONS: In the real­world population, significantly worse survival of patients with ICM in comparison with those with NICM is observed, and an ischemic etiology of HF is a strong independent predictor of mortality among individuals following the placement of ICD/ CRT­D.

Female gender and the clinical and periprocedural profile and clinical outcomes of transcatheter aortic valve implantation: experiences of a tertiary Polish centre.

INTRODUCTION: Despite the establishment of multiple factors influencing short- and mid-term outcomes in patients treated with transcatheter aortic valve implantation (TAVI), the real-world data on the association between gender and outcomes after TAVI remain conflicting. AIM: To evaluate the association of female gender with the clinical and periprocedural characteristics along with in-hospital, short- and medium-term outcomes of patients treated with TAVI in comparison with male patients. MATERIAL AND METHODS: Data from the prospective, single-centre registry of consecutive patients with severe AS referred for TAVI from 26 November 2008 to 31 December 2018 were analysed retrospectively. The study population comprised 275 patients who were divided by gender. The primary endpoint of the study was all-cause mortality at 1 year. RESULTS: Women constituted 132 (48.0%) of the overall population. Women were significantly older, but had a significantly higher left ventricular ejection fraction (LVEF) and had less frequently undergone coronary artery bypass grafting (CABG) before TAVI. The implantation success rate was comparable between genders, but women less frequently required implantation of a pacemaker after TAVI, although they more frequently required blood transfusion due to severe bleeding. The primary endpoint occurred in 13.6% of women and 7.7% of men (p = 0.12). CONCLUSIONS: Despite advanced age and prevalence of cardiovascular risk factors, the overall short- and medium-term mortality in patients treated with TAVI in our analysis of the real-world population remains relatively low. Although women seemed to have a slightly better clinical baseline profile, their in-hospital, 30-day, 6-month and 12-month outcomes did not differ significantly from the male patients.

Everolimus-Eluting Second-Generation Stents for Treatment of De Novo Lesions in Patients with Cardiac Allograft Vasculopathy.

BACKGROUND Cardiac allograft vasculopathy is a major cause of cardiac allograft rejection. Percutaneous coronary intervention has become the main form of treatment of significant focal lesions. Despite the significance of the problem, data remain scarce. With a large population of transplant recipients undergoing coronary angiography at our center, we decided to analyze the implications of the use of everolimus-eluting second-generation stents by performing 6-month clinical and angiographic follow-up. MATERIAL AND METHODS From December 2012 and August 2019, 319 patients after heart transplantation undergoing coronary angiography at our institution were analyzed. Subsequently, 22 patients underwent de novo angioplasty with second-generation everolimus-eluting stents. The primary study endpoint was angiographic restenosis as evaluated by quantitative coronary angiography. Secondary outcomes included binary restenosis, target lesion revascularization, and cardiac death during the follow-up period (6 months). RESULTS Patient comorbidities included hypertension (77.3%), type 2 diabetes mellitus (68.2%), dyslipidemia (68.2%), and obesity (31.8%). Primary success was obtained in all of the treated lesions. The analysis of quantitative coronary angiography after 6-month follow-up revealed low late lumen loss (0.22±0.40). Significant restenosis was observed in 1 of the cases. There were no deaths in the 6-month observation period. CONCLUSIONS In the analyzed population, invasive strategy with second-generation everolimus-eluting stents for de novo lesions in cardiac allograft vasculopathy resulted in a low rate of binary restenosis, low late lumen loss, and no deaths during the 6-month follow-up.

Characteristics and Outcomes in Patients With Electrical Storm.

Electrical storm (ES) is a life-threatening condition with diverse clinical presentation, caused by recurrent malignant ventricular arrhythmia--≥3 episodes of ventricular tachycardia (VT) or ventricular fibrillation within 24hours and is associated with high mortality. The aim of this study was analysis of clinical profile, treatment, and prognosis of patients with ES admitted to a high-volume cardiovascular center. We present results of a single-center, retrospective, ongoing observational registry enrolling consecutive patients presenting with ES admitted between 2006 and 2017. Clinical history, results of diagnostic investigations, and treatment were collected for all patients. Follow-up data were collected from hospital documentation, outpatient clinic, remote monitoring systems, and from data gathered from national health services. Registry enrolled 101 consecutive patients admitted with ES. Two-thirds of patients had ischemic cardiomyopathy. Mean left ventricle ejection fraction was 26%. In 56.4% of the patients coronary angiogram was performed and in 20.8% cases percutaneous coronary intervention was needed. 18.8% of the patients underwent VT ablation. 12-month mortality from first ES in our population was 21.8%. NYHA class III and IV, raised N-terminal fragment of prohormone B-type Natriuretic Peptide and creatinine levels, and lower hemoglobin levels were independent predictors of death. In conclusion, most patients admitted with ES have ischemic cardiomyopathy. Over 1/3 of the population had significant narrowing of at least one coronary artery with ES masking ischemia and underwent percutaneous coronary intervention. Nearly 1/5 of the patients were treated with VT ablation. 12-month mortality was high and exceeded 1/4 of patients with ES.

Mortality risk factors in patients with advanced heart failure and diabetes mellitus.

BACKGROUND: An accurate assessment of prognosis is an important element of the management of patients with advanced heart failure (HF) and diabetes mellitus (DM), due to the particularly unfavourable effect of concomitance of both diseases on their course and treatment efficacy.   Aims: The aim of the study was to determine the prognostic factors affecting survival in patients with HF and DM. METHODS: A retrospective analysis of clinical and laboratory data of 367 consecutive patients with advanced HF (New York Heart Association class III-IV) and DM, hospitalised in a referral centre for interventional cardiology between 2009 and 2013, was performed. Patients with haematological disorders, treated with steroids or with incomplete clinical data were excluded from the analysis. The endpoint of the study was death from all causes. RESULTS: The average patient age was 63.3 ± 10.8 years, 75.7 % of the patients were male. During a mean follow-up of 4.4 ± 1.3 years, the overall mortality rate was 53.7 %. In a multivariate analysis, independent risk factors of death included atrial fibrillation [Hazard Ratio (HR) 1.5730 (95 % Confidence Interval (CI) 1.1417 - 2.1671)); p <0.01], red blood cell distribution width (RDW) [HR 1.0492 (95 % CI 1.0247 - 1.0743); p <0.0001] and platelet-to-lymphocyte ratio (PLR) [HR 1.0045 (95 % CI 1.0032 - 1.0057); p <0.0001]. CONCLUSIONS: Our study showed that permanent atrial fibrillation and two haematological parameters, RDW and PLR, are associated with an increased risk of death in advanced HF patients with concomitant DM in the long-term follow-up.