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.

Evaluation of the Levels of Selected Cytokines and Their Possible Influence on the Development of Cardiovascular and Pulmonary Complications in Patients after COVID-19.

Background and Objectives: The aim of this study was to evaluate the levels of selected cytokines and their possible influence on the development of cardiovascular and pulmonary complications in patients hospitalized at the Silesian Centre for Heart Disease in Zabrze after having undergone COVID-19. Materials and methods: The study included 76 randomly selected patients from the SILCOVID-19 database. The median time from symptom onset to the study visit was 102 (86-118) days. The median age of the study group was 53 (44-60) years. Assays of a panel of 30 cytokines were carried out in the serum of patients on a Luminex100 platform using the Milliplex MAP kit from Merck KGaA Germany. Results: There were no statistically significant differences in most of the cytokines analyzed between patients with confirmed or excluded lung lesions or cardiac abnormalities. Additionally, no statistically significant differences in cytokine concentrations according to gender, age, comorbidity of diabetes, renal disease, hypertension, increased risk of thrombotic disease, or psychological disorders were demonstrated. There were high concentrations of cytokines such as platelet-derived growth actor-AA (PDGF-AA), monocyte chemoattractant protein-1 (MCP-1), monokine-induced gamma interferon (MIG), and vascular endothelial growth factor-A (VEGF-A). Conclusions: No direct impact of the dependencies between a panel of cytokines and the incidence of cardiovascular and pulmonary complications in patients hospitalized at the Silesian Centre for Heart Disease in Zabrze after having undergone COVID-19 was demonstrated. The demonstration of high levels of certain cytokines (PDGF-AA, VEGF, MIG, and IP10) that are of significance in the development of many lung diseases, as well as cytokines (MCP-1) that influence the aetiopathogenesis of cardiovascular diseases seems to be highly concerning in COVID-19 survivors. This group of patients should receive further monitoring of these cytokine levels and diagnostic imaging in order to detect more severe abnormalities as early as possible and administer appropriate therapy.

Long-term prognostic scores may underestimate the risk of death in patients with heart failure with reduced ejection fraction in whom red cell distribution width is elevated.

INTRODUCTION: Risk prediction in patients with heart failure with reduced ejection fraction (HFrEF) is one of the key challenges for clinicians. Novel biomarkers aggregating several important pathophysiological pathways may modify the diagnostic discrimination of validated scores. The red cell distribution width (RDW) is a cheap and easily available measure of anisocytosis, and was shown to have a strong independent prognostic power in short- and medium­term prognosis in HFrEF. OBJECTIVES: Our aim was to assess the prognostic power of RDW in optimally treated chronic HFrEF, and to investigate whether different RDW may impact the prognostic accuracy of validated long­term scores in HFrEF. PATIENTS AND METHODS: The study included 551 patients at a median (interquartile range [IQR]) age of 54 (47-59) years, of whom 86.6% were men. The patients represented the median New York Heart Association class III (IQR, II-III), and ischemic etiology occurred in 56.6% of the cases. In all patients, RDW as a coefficient of variation was calculated, along with Meta­Analysis Global Group in Chronic Heart Failure Score (MAGGIC­HF) and Seattle Heart Failure Survival Model (SHFSM). RESULTS: The patients were followed for 5 years and all­cause mortality was assessed. We recorded 166 (30.1%) and 225 (40.8%) deaths at 3 and 5 years, respectively. Scores based on MAGGIC­HF and SHFSM algorithms for the respective prediction of 3- and 5­year mortality were calculated for each patient and compared with the observed mortality. There was a significant underestimation of mortality in the patients with RDW above 15.4% (reference values, 11.5%-14.5%), while in those with lower RDW SHFSM overestimated the actual risk. The excess mortality in the higher RDW group was confirmed by the Hosmer-Lemeshow statistic. CONCLUSIONS: The RDW has a strong prognostic value in chronic HFrEF, independently of the risk assessed by the MAGGIC­HF or the SHFSM score.

Death without Previous Hospital Readmission in Patients with Heart Failure with Reduced Ejection Fraction-A New Endpoint from Old Clinical Trials.

BACKGROUND: Most of the drugs approved and registered for use in heart failure (HF) therapy were examined in randomized clinical trials (RCTs) with the primary composite endpoint of death or hospital readmission. This study aimed to analyze the rates of the newly calculated event: death without prior hospital readmission, in HFrEF patients in large RCTs to show that the newly defined endpoint probably delivers additional data on the structure of the composite endpoint and helps to interpret the results of interventional studies. METHODS: This study included RCTs on therapeutic interventions in HF patients. A literature search was performed, and 31 trials in which death without hospital admission could be calculated were included in the analyses. The death without a prior hospital admission endpoint was calculated as the difference between the composite endpoint rate (death or hospital readmission) and the readmission rate. The differences in the new endpoint between the study groups were calculated. RESULT: The death rates without prior hospital admission were lower in the intervention groups in five trials. In the SENIORS study, significant differences were found in the primary (composite) and death without previous hospital admission endpoints. In the ACCLAIM, VEST, and GISSI-HF STATIN trials, death without previous hospital admission was the only endpoint with a significant difference between the study groups. Moreover, the new endpoint rates were higher in the intervention group in the latter two studies. CONCLUSIONS: The new endpoint describing patients who died without prior hospital admission might be useful in previous and future interventional studies to provide additional data on the structure of the composite endpoint. Some therapies might reduce death without previous hospital admission rates, which could be beneficial, even without a reduction in overall long-term mortality.

Post-COVID­19 complications in hospitalized and nonhospitalized patients: the Silesian database of COVID­19 complications (SILCOV­19).

INTRODUCTION: Due to the extent of the pandemic, high prevalence and severity of complications in the early post­recovery period are expected. OBJECTIVES: This study aimed to compare the scope of early post-COVID­19 complications in patients who had the disease and were or were not hospitalized. PATIENTS AND METHODS: This was a prospective, observational, registry­based cohort study conducted at a tertiary cardiovascular hospital in Silesia, Poland. Interdisciplinary diagnostics, including cardiovascular, pneumatological, respiratory, neurological, and psychiatric tests, was performed during the study visit. All patients completed the study. Two­hundred unselected, adult, white men and women with the symptoms of acute COVID­19 were included, of which 86 patients had the disease but did not require hospitalization. RESULTS: The median (interquartile range) time from symptom onset to the study visit was 107 (87-117) and 105 (79-127) days in nonhospitalized and hospitalized patients, respectively. Lung lesions on high­resolution computed tomography were found in 10 (8.8%) and 33 (39.3%) of nonhospitalized and hospitalized patients, respectively (P <0.01); no lesions were visualized on chest X­ray images. Elevated platelet distribution width was found in more than 70% of the patients in both groups. More than half of the patients had insomnia, regardless of the hospitalization status. CONCLUSIONS: The abnormal platelet parameters, functional and radiological findings in the lungs, and insomnia were the most frequent short­term COVID­19 complications in hospitalized and nonhospitalized patients. Considering the number of patients who have had COVID­19 worldwide, a high burden of the post-COVID­19 complications might be expected.

Managed Care after Acute Myocardial Infarction (MC-AMI) improves prognosis in AMI survivors with pre-existing heart failure: A propensity score matching analysis of Polish nationwide program of comprehensive post-MI care.

BACKGROUND: Despite improvement in acute myocardial infarction (AMI) treatment, post-discharge mortality remains high. The outcomes are supposed to be even worse in patients with post-MI heart failure (HF), as only a half of patients with newly diagnosed HF survive four years. AIMS: The study aimed to analyze whether managed care after acute myocardial infarction (MC-AMI) is associated with better survival in AMI survivors with a pre-existing diagnosis of HF. RESULTS: The study included 7228 patients with a pre-existing diagnosis of HF who survived the hospitalization for AMI in Poland between November 2017 and December 2020, of whom 2268 (31.4%) were referred for the MC-AMI program. The median follow-up was 1.5 (0.7-2.3) years. In the unmatched analysis, patients without MC-AMI had more than twice higher 12-month mortality (21.8% vs. 9.9%; P <0.01) than MC-AMI participants. The difference remained significant after propensity score matching (16,8% vs. 10.0%; P <0.01). In multivariable analysis, participation in MC-AMI was an independent factor of 12-month survival. MC-AMI participants had a lower stroke rate (1.5% vs. 3.0%; P <0.01) and fewer hospital admissions due to HF (22.9% vs. 27.6%; P <0.01). CONCLUSIONS: After propensity score matching, participation in MC-AMI was associated with lower rates of stroke, HF hospitalizations, and all-cause mortality in the 12-month follow-up and was an independent factor of 12-month survival in AMI survivors with pre-existing HF.

Is neural network better than logistic regression in death prediction in patients after ST-segment elevation myocardial infarction?

BACKGROUND: There is a need to develop patient classification methods and adjust post-discharge care to improve survival after ST-segment elevation myocardial infarction (STEMI). AIMS: The study aimed to determine whether a neural network (NN) is better than logistic regression (LR) in mortality prediction in STEMI patients. METHODS: The study included patients from the Polish Registry of Acute Coronary Syndromes (PL-ACS). Patients with the first anterior STEMI treated with the primary percutaneous coronary intervention (pPCI) of the left anterior descending (LAD) artery between 2009 and 2015 and discharged alive were included in the study. Patients were randomly divided into three groups: learning (60%), validation (20%), and test group (20%). Two models (LR and NN) were developed to predict 6-month all-cause mortality. The predictive values of LR and NN were evaluated with the Area Under the Receiver Operating Characteristics Curve (AUROC), and the comparison of AUROC for learning and test groups was performed. Validation of both methods was performed in the same group. RESULTS: Out of 175 895 patients with acute coronary syndrome, 17 793 were included in the study. The 6-month all-cause mortality was 5.9%. Both NN and LR had good predictive values. Better results were obtained in the NN approach regarding the statistical quality of the models - AUROC 0.8422 vs. 0.8137 for LR (P <0.0001). AUROCs in the test groups were 0.8103 and 0.7939, respectively (P = 0.037). CONCLUSIONS: The neural network may have a better predictive value for mortality than logistic regression in patients after the first STEMI.

Prevalence, management and outcomes of cardiac tamponade complicating 66,812 invasive cardiac procedures: single-center clinical registry.

INTRODUCTION: There are numerous studies concerning iatrogenic cardiac tamponade. Those studies are predominantly focused on one cardiac procedure and the follow-up is not always presented. AIM: To estimate the rate of cardiac tamponade following 66,812 percutaneous invasive cardiac interventions depending on the procedure. For each group the baseline characteristics and hospital management, as well as in-hospital, 30-day and 1-year mortality, were evaluated. MATERIAL AND METHODS: The study was a single-center retrospective analysis performed in a tertiary clinical hospital, which encompasses two cardiology departments, assessing a large sample of patients who underwent percutaneous invasive cardiac procedures complicated with cardiac tamponade between January 2006 and December 2018. For this purpose, medical records and hospital databases were analyzed. Long-term follow-up was obtained in cooperation with the Silesian Cardiovascular Base. RESULTS: The rate of iatrogenic cardiac tamponade during the 13-year period was 0.176%. The incidence among selected invasive cardiac procedures ranged between 0.09% and 1.42%. The majority of cases (104/118) were treated by pericardiocentesis, 16 had pericardiotomy and 4 patients had both therapies. Inotropes were used in 25-45%, blood transfusion in 45% of patients. The highest in-hospital mortality was observed in patients with cardiac tamponade after transcatheter aortic valve implantation. The highest 30-day and 1-year mortality rates were seen in the group with temporary electrode pacing. CONCLUSIONS: The low incidence of cardiac tamponade with the high number of patients requiring intensive care supply and high in-hospital mortality tend to confirm that cardiac tamponade is a rare but life-threatening complication.

Baseline characteristics, management and long-term outcomes of different etiologies of cardiac tamponade evaluated in a cohort of 340 patients.

INTRODUCTION: Studies on the etiology of cardiac tamponade (CT) are scarce or lacking follow-up, and usually include small or highly selected groups of patients. AIM: To evaluate the various etiologies and outcomes of CT in a cohort of patients treated in a tertiary care hospital encompassing cardiology, cardiac surgery and intensive care units. MATERIAL AND METHODS: We retrospectively analyzed all adult patients hospitalized in the Silesian Centre for Heart Diseases in Zabrze (Poland) between January 2008 and December 2018, who required therapeutic pericardiocentesis or pericardiotomy due to CT. All various etiologies of CT were presented and assigned to the main etiology groups. For each group basic characteristics, in-hospital management, in-hospital and up to 2-year mortality were analyzed. RESULT: Among 340 patients with CT, 56% were men. The leading etiology groups included patients after invasive cardiac procedures, patients following postpericardiotomy (PCT) syndrome and the patients with neoplasm. Patients with end stage renal failure, PCT and iatrogenic CTs were the most disease burdened groups. The highest need for advanced therapy and in-hospital mortality were observed for the acute myocardial infarction group, in contrast to PCT. CONCLUSIONS: Within our cohort of patients, the invasive cardiac procedures overtake neoplastic causation of cardiac tamponade. The worst in-hospital prognosis was noted for CT following acute myocardial infarction and both iatrogenic invasive cardiac and cardiac surgery procedures. The highest long-term mortality was recorded for patients with end stage renal failure and the neoplastic group.

Two professions against two killer diseases: the rationale, organization, and initial experience of a cardio-oncology service.

BACKGROUND: Cardiovascular diseases are the most common factor affecting prognosis in cancer survivors. Cardio­oncology (CO) services have been developed to solve this issue. The outcomes regarding patient demographics and clinical findings are limited and the available data include CO services evaluating patients undergoing only chemotherapy as opposed to those also undergoing radiation therapy. AIMS: We aimed to show initial experiences of the CO service implemented in a tertiary oncology center. METHODS: The CO service was designed to include 2 major domains, general CO and electrotherapy consultations. This observational study included patients referred to the CO service with the following data: baseline demographics, cancer type, reasons for referral, cardiac evaluation, and initial clinical outcomes. RESULTS: All patients with cancer referred to our CO service between March 2016 and December 2019 were included in the study. A total of 2762 patients (77% women) at the mean (SD) age of 62 (12) years were referred (63% on an out­patient basis) for general consultations. The most frequent diagnosis was breast cancer (66%). A total of 18% of patients were referred to the CO service due to cardiovascular complications related to cancer treatment. The CO-cardiac implantable electronic device (CIED) team evaluated 652 patients (515 patients with CIEDs who were qualified for radiotherapy, 48 patients with CIEDs who were assessed with magnetic resonance imaging, and 89 patients with CIEDs who underwent cancer surgery). In the total of 5872 radiotherapy sessions, there were 2 harmful interactions; no other complications during magnetic resonance imaging and surgery were recorded. CONCLUSIONS: The CO­service established within the cancer center seems to be safe and feasible.

Radiation therapy in patients with cardiac implantable electronic devices.

BACKGROUND: The number of patients with cardiac implantable electronic devices (CIEDs) treated with radiation therapy (RT) as an oncological treatment is expected to increase. AIMS: The aim of the study was to assess whether cancer treatment with radiation therapy is associated with any device dysfunctions and device­related threats in patients with CIEDs. METHODS: The risk of all patients with CIEDs undergoing RT was assessed according to guidelines. Device interrogations were performed before the first and after the last RT session. In patients at high risk and/or with an implantable cardioverter­defibrillator or cardiac resynchronization therapy with defibrillator (CRT­D), all sessions were supervised by a cardiologist, and device interrogations were performed before and after every single RT session. Device parameters and events were monitored during thewhole treatment. RESULTS: The study included 157 patients with CIEDs who had palliative (n = 71) or radical (n = 86) RT. Pacemakers were implanted in 113 patients, implantable cardioverter­defibrillators in 36, and CRT­D in 8. During the 2396 RT sessions (median [interquartile range], 5 [5-28] per patient) with cumulative dose up to 78 Gy per patient for the whole RT treatment and maximum energy beam up to 20 MV, 2 events potentially related to radiation were recorded. CONCLUSIONS: Radiation therapy in patients with CIEDs is not associated with substantial risk to the patients assuming the patients' management follows current guidelines.

Patients with cardiac implantable electronic devices undergoing radiotherapy in Poland. Expert opinion of the Heart Rhythm Section of the Polish Cardiac Society and the Polish Society of Radiation Oncology.

Older age and high morbidity of the society contribute to a growing number of patients with cardiac implantable electronic devices (CIEDs) requiring effective cancer treatment, including radiotherapy (RT). The effect of RT on a CIED may vary depending on the type and physical parameters of radiation, location of the treated lesion, indications for electrotherapy, and the type of CIED. In the most dramatic scenarios, it may cause an irreversible damage to the CIED, with serious clinical consequences. The lack of precise guidelines may limit the access to RT for many patients with CIEDs who would otherwise benefit from the therapy or may lead to a therapy without taking the necessary precautions, which may worsen the prognosis. Therefore, clear and unequivocal recommendations for assessing patient eligibility for RT are aimed at ensuring that adequate precautions are taken as well as at providing patients with concomitant cardiovascular and oncologic diseases with access to safe and effective RT.