Heart disease in the course of systemic sclerosis - an observational study.

Introduction: Cardiac involvement is one of the major mortality factors in systemic sclerosis (SSc). This observational study aimed to compare patients with and without heart involvement in the course of SSc. Material and methods: Electronic medical records of patients treated between January 2021 and August 2022 in the Department of Rheumatology were searched for the diagnosis of SSc (ICD-10 code M47). The clinical characteristics of patients with and without heart involvement in the course of SSc were compared. Results: Out of 36 patients with SSc, 7 patients were diagnosed with heart disease in the course of SSc. The major type of cardiac involvement was myocarditis (71%). The majority of patients with heart involvement had elevated troponin (86%) and NT-proBNP (71%) concentrations. The most common finding observed in echocardiography was diastolic failure (71%). The most frequent abnormality found in 24-hour Holter ECG was isolated supraventricular extrasystoles (100%). Risk factors for developing heart disease in the course of SSc were male gender (p = 0.018), diffuse type of SSc (p = 0.03), higher values of modified Rodnan skin score (p < 0.001), gastrointestinal tract involvement (p = 0.027) and myositis (p = 0.018). Conclusions: Optimal screening for heart disease is needed in this group of patients.

No effects of cardiac resynchronization therapy and right ventricular pacing on the right ventricle in patients with heart failure and atrial fibrillation.

BACKGROUND: The right ventricle (RV) function is crucial in heart failure with reduced ejection fraction (HFrEF), especially in patients with atrial fibrillation (AF). Aims. To assess the RV structure and function in patients with HFrEF, permanent atrial fibrillation (AF), cardiac resynchronization therapy (CRT) and RV pacing (RVp) with two- and three-dimensional echocardiography. Methods. Patients with ischemic HFrEF (NYHA II-III; LVEF ≤40%) were enrolled. The studied groups were: sinus rhythm (SR, control); AF and no implanted devices - AF/0; AF and CRT - AF/CRT; AF and RVp - AF/RVp. Two- and three-dimensional echocardiographic parameters of RV structure and function were analyzed in study groups. Results. The study included a group of 126 patients: n = 32 with SR, n = 28 with AF/0, n = 25 with AF/CRT and n = 41 with AF/RVp. Results were worse in AF groups than in SR: right ventricular ejection fraction, %, mean (SD): SR - 48.2 (7.5), AF/0 - 36.5 (6.5), AF/CRT - 38.3 (7.6), AF/RVp - 37.1 (7.7), p < .001. Other parameters lower in AF groups than in SR were: RV end-systolic volume, longitudinal strain of the free wall and tricuspid lateral annular systolic velocity. There were no differences between groups with AF and CRT and RV pacing in other analyzed parameters between AF groups and SR. Conclusions. In heart failure with reduced left ventricular ejection fraction and atrial fibrillation right ventricular pacing and cardiac resynchronization therapy were not associated with modified right ventricular function. Further prospective studies are needed to evaluate prognostic significance of these results.

Economical aspect of PET/CT-guided diagnosis of suspected infective endocarditis in a patient with implantable cardioverter-defibrillator.

We present a case report of potential reduction of hospitalization costs due to utilization of PET/CT in a diagnostic work-up of a patient with an implantable cardioverter-defibrillator and suspicion of infective endocarditis. The PET/CT scan would have shorten hospital stay, prevented clinical complications and reduced the cost of hospitalization by 45%.

[Clinical improvement after physical training in patient with severe postinfarction heart failure, who underwent prosthetic heart valve implantation and numerous coronary interventional procedures]. / Kliniczna poprawa po treningu fizycznym u pacjenta z ciezka pozawalowa niewydolnoscia serca, po wszczepieniu sztucznej zastawki aortalnej i licznych interwencjach wiencowych.

The case of patient with advanced congestive heart failure, NYHA III, of ischaemic and valvular aetiology and concomitant diseases is presented. Introduction of 6-month, controlled physical training resulted in improvement of health status, exercise performance, ventilation and left ventricular function. Quality of life got significantly better. This aspect of treatment should be considered in majority of patients with heart failure.

Quality of life improvement after radiofrequency catheter ablation of outflow tract ventricular arrhythmias in patients with structurally normal heart.

INTRODUCTION: Patients with structurally normal hearts (SNH) suffering from ventricular tachycardia (VT) or frequent premature ventricular contractions (PVCs) are at low risk of sudden cardiac death. Any treatment ameliorates symptoms without a substantial influence on survival.The aim of this study was to prospectively evaluate the health-related quality of life (QoL) of patients with SNH undergoing elective radiofrequency ablation (RFA) of VT or PVCs. MATERIAL AND METHODS: Patients scheduled for RFA of VT or PVCs in SNH were enrolled. They underwent 24-h Holter ECG and QoL assessment (SF-36 questionnaire) at baseline and at 3-month follow-up. Results were compared within and between VT and PVCs groups. RESULTS: Among 44 enrolled patients:(i) 23 had VT; (ii) 21 had PVCs with a mean count of 18,711 +/- 10,378 beats/24h. Antiarrhythmic drugs (sotalol, propafenone) were more frequently used in the VT group than in the PVC group. All patients underwent successful RFA with no major complications with 2 cases of early reablation. At follow-up, a significant improvement 6 of 8 domains of SF-36 was observed in the VT and PVCs groups respectively with no significant difference in physical and mental component summary score between both groups. CONCLUSIONS: Favourable outcome of radiofrequency ablation in terms of quality of life and safety supports the idea of aggressive treatment of ventricular arrhythmia in patients with structurally normal hearts who are symptomatic and/or prone to cardiomyopathy. Comparable improvement of QoL in patients with PVCs and VT is an additional argument for performing ablation in symptomatic patients with frequent ventricular contractions.

Effect of combined spironolactone-ß-blocker ± enalapril treatment on occurrence of symptomatic atrial fibrillation episodes in patients with a history of paroxysmal atrial fibrillation (SPIR-AF study).

Angiotensin II and aldosterone are key factors responsible for the structural and neurohormonal remodeling of the atria and ventricles in patients with atrial fibrillation (AF). The aim of the present study was to evaluate the antiarrhythmic effects of spironolactone compared to angiotensin-converting enzyme inhibitors in patients with recurrent AF. A cohort of 164 consecutive patients (mean age 66 years, 87 men), with an average 4-year history of recurrent AF episodes, was enrolled in a prospective, randomized, 12-month trial with 4 treatment arms: group A, spironolactone, enalapril, and a ß blocker; group B, spironolactone and a ß blocker; group C, enalapril plus a ß blocker; and group D, a ß blocker alone. The primary end point of the trial was the presence of symptomatic AF episodes documented on the electrocardiogram. At 3-, 6-, 9-, and 12 months, a significant (p < 0.001) reduction had occurred in the incidence of AF episodes in both spironolactone-treated groups (group A, spironolactone, enalapril, and a ß blocker; and group B, spironolactone plus a ß blocker) compared to the incidence in patients treated with enalapril and a ß blocker (group C) or a ß blocker alone (group D). No significant difference was seen in AF recurrences between patients taking spironolactone and a ß blocker with (group A) and without (group B) enalapril. No significant differences were found in the systolic or diastolic blood pressure or heart rate among the groups before and after 1 year of follow-up. In conclusion, combined spironolactone plus ß-blocker treatment might be a simple and valuable option in preventing AF episodes in patients with normal left ventricular function and a history of refractory paroxysmal AF.

High monthly temperature as a possible risk factor of local vascular bleeding complications during percutaneous coronary interventions evaluated by ultrasonography - retrospective analysis.

BACKGROUND: Bleeding complications are a very important issue in the era of percutaneous coronary interventions (PCI). Effective antiplatelet therapy increases the rate of successful interventions but the risk of bleeding complications, among them local vascular complications, may be higher. Other factors may also be important in the development of local bleeding complications. AIM: To examine the relationship between air temperature and local haemorrhagic complications. METHODS: The retrospective analysis of ultrasonographic examinations performed during the last 5 years (2003-2007) in 10 548 consecutive patients undergoing cardiac catheterisation due to acute coronary syndromes or elective coronary angiography was performed. The relationship between mean monthly temperature, other factors and the rate of local bleeding complications was examined. RESULTS: Mean number of treated patients was 2708 +/- 377/year (2113-3089), of whom 1692 +/- 362/year had coronary angiography and 1345 +/- 281/year had PCI. Yearly rate of all femoral bleeding complications was 3.0 +/- 0.5%. There were more haematomas than pseudoaneurysms: 2.2 +/- 0.4 vs. 0.8 +/- 0.1%, p < 0.0001. Higher mean monthly air temperatures were positively correlated with the number of complications (r = 0.11, p < 0.05), both in males and females (r = 0.13, p < 0.05). A positive correlation between number of haematomas and air temperature values was detected in women. Yearly rate of all vascular complications, haematomas and pseudoaneurysms was higher in women than in men 4.3 +/- 0.9 vs. 2.3 +/- 0.3% (p < 0.0001), 3.0 +/- 0.7 vs. 1.7 +/- 0.3% (p < 0.0001) and 1.3 +/- 0.2 vs. 0.6 +/- 0.1% (p < 0.0005) respectively. In spite of more aggressive antiplatelet therapy, higher clopidogrel loading doses and abciximab use introduced during the analysed period, the rate of local vascular bleeding complications did not increase. CONCLUSIONS: High air temperature during the post-intervention period, besides female gender and advanced age, may be another risk factor for local bleeding complications. This risk remains low (3%), in spite of growing intensity of antiplatelet treatment.

[Left atrial myxoma in a patient with heart failure after myocardial infarction - a case report]. / Sluzak lewego przedsionka u mezczyzny z pozawalowa niewydolnoscia serca - opis przypadku.

A case of a 54-year-old male patient with left atrial myxoma, coronary heart disease, heart failure and multiple cardiovascular risk factors is described. The patient did not present typical symptoms of myxoma. Diagnosis and treatment of cardiac myxoma as well as the importance of echocardiographic examination in every patient with decompensated chronic heart failure are discussed.

[Thrombus visualisation during radiofrequency catheter ablation. A case report]. / Obrazowanie skrzeplin w trakcie ablacji przeznaczyniowej. Opisy przypadków.

We report two patients in whom thrombus formation during radiofrequency catheter ablation was detected by echocardiography. Resolution of thrombus after intravenous use of heparin was observed in both patients. Transesophageal and intracardiac echocardiography may be useful in management of this complication.

[Pharmacological versus invasive treatment in patients with atrial fibrillation]. / Prospektywna ocena chorych z migotaniem przedsionków leczonych za pomoca ablacji przeznaczyniowej i farmakoterapii.

Aim of this prospective study was to assess quality of life (QoL), left ventricular (LV) function and exercise performance in two groups of patients (pts) with atrial fibrillation (Af) treated with: radiofrequency catheter ablation (RFA) and antiarrhythmic drugs (AA). Between 1996 and 2000 - 74 patients, 28 women, with drug refractory Af were enrolled by clinical indications for two modes of therapy: RFA and AA. RFA group consisted of 38 pts, 63.7 +/- 11.5 years old: 28 pts with RF AV Node ablation and pacemaker implantation (PI) and 10 pts with AV Node modification or right atrial isthmus RF ablation due to Af conversion to atrial flutter (Aflu) during medical therapy. AA group consisted of 36 pts, aged 59.7 +/- 13.8 years. Patients from RFA group suffered significantly more serious diseases than pts from AA group. No significant (sign.) differences between two groups were found in age, gender, arrhythmia history and number of AA taken. Pts were analyzed before entry, after 3 and 12 months of follow-up (3 mo. FU, 12 mo. FU) with following indices: LV function (Echo: EF & FS), exercise performance (treadmill test), QoL questionnaires, number of hospital admissions connected to arrhythmia or procedures (RFA & PI), number of AA drugs taken in RFA group. RFA group: Two deaths occurred due to end stage respiratory insufficiency (COPD), one pt required reposition of pacemaker lead. AA group: 3 pts required RFA due to uncontrolled Af/Aflu (AV Node ablation with PI - 1 pt, right atrial isthmus ablation - 2 pts). Analysis of two patients groups: LV function: Sign. improvement (EF & FS) in both groups in 12 mo. FU; Exercise performance: no sign. changes in 3 and 12 mo. FU. QoL: Arrhythmia scale: 3 mo. FU sign. reduction in both groups; 12 mo. FU reduction in RFA group only; Anxiety scale: 3 and 12 mo. FU sign. reduction of anxiety level in RFA group; Exercise and activity scales: 3 and 12 mo. FU sign. improvement in RFA group. During 3 and 12 mo. FU sign. less pts from RFA group required hospital admission versus pts from AA group. Sign. reduction in AA was noted in RFA group. Patients with symptomatic Af treated with RFA benefit from this kind of therapy more than patients treated with AA. Quality of life improvement visible in short term observation in patients from RFA group is still present after one year observation. Improvement in LV function is observed after one year in both groups of pts with Af.