Population of Polish patients participating in the Heart Failure Pilot Survey (ESC-HF Pilot).

BACKGROUND: Heart failure (HF) is currently one of the main causes of cardiovascular mortality. In order to collect current epidemiological data on patients with HF, the Heart Failure Pilot Survey (ESC-HF Pilot) registry was initiated. AIM: Primary objective of the study was to compare clinical epidemiology of outpatients and inpatients with HF and investigate currently used diagnostic and therapeutic modalities in Poland and 11 other European countries. METHODS: The ESC-HF Pilot Survey study was a prospective multicentre observational registry conducted in 2009-2011 in 136 cardiology centres in 12 European countries selected to represent different health systems and care attitudes across Europe. All outpatients with HF and patients admitted due to acute decompensated HF were included into the registry during the enrolment period (1 day per week for 8 consecutive months). Researchers completed detailed medical data questionnaires for all HF patients recruited to the study. RESULTS: In all participating centres across Europe, 6108 patients were recruited, including 1159 patients from Poland (19% of the survey population). The majority of Polish participants were admitted due to acute HF (73%), while ambulatory chronic HF patients predominated in the remaining European centres (69%). Polish patients develop HF at a younger age compared to other European countries (proportion of patients above 65 years: 54 vs. 65%, respectively) and they are more severely ill (NYHA class III: 44 vs. 34%, respectively; NYHA class IV: 18 vs. 11%; mean BNP level 910 vs. 773 pg/mL). Angiographically documented coronary artery disease was the major aetiology of HF in Poland (39 vs. 33%) which explains a higher rate of invasive revascularisation procedures in the Polish population (13 vs. 7%). In Poland, therapy with implantable cardioverter- -defibrillators was used more frequently during the initial hospitalisation (7 vs. 4%), but the rate of cardiac resynchronisation therapy device implantation was smaller than in other European countries (4 vs. 7%). Drug therapy used in our country was comparable to the rest of Europe, except for more frequent use of aldosterone antagonists. Despite significant differences in the clinical characteristics seen between Polish and other European patients participating in the ESC-HF Pilot study, mortality at 3 months did not differ between Polish and other European centres (2.5 vs. 3%). CONCLUSIONS: The ESC-HF Pilot Survey findings indicate a very high standard of inpatient HF treatment but at the same time unsatisfactory current ambulatory HF therapy in Poland.

Electrocardiography and prognosis of patients with acute pulmonary embolism.

BACKGROUND: To assess the influence of electrocardiographic (ECG) pattern on prognosis and complications of patients hospitalized with acute pulmonary embolism (APE). METHODS: We performed a retrospective analysis of 292 patients who had confirmed APE. There were 183 females and 109 males, the age range was 17 to 89 years, and the mean age was 65.4 ± 15.5 years. RESULTS: In our study group, there were 33 deaths (mortality rate, 11.3%), and 73 (25%) patients developed complications during hospitalization. Based on European Society of Cardiology risk stratification, we classified 75 (25.7%) patients as high risk, 163 (55.8%) patients as intermediate risk, and 54 (18.5%) patients as low risk. A comparison between patients with complicated APE and those with no complications during hospitalization indicated that the following ECG parameters were more common in patients who had complications: atrial fibrillation, S1Q3T3 sign, negative T waves in leads V2-V4, ST segment depression in leads V4-V6, ST segment elevation in leads III, V1 and aVR, qR in lead V1, complete right bundle branch block (RBBB), greater number of leads with negative T waves, and greater sum of the amplitude of negative T waves. In multivariate analysis, the sum of negative T waves (OR 0.88; p = 0.22), number of leads with negative T waves (OR 1.46; p = 0.001), RBBB (OR 2.87; p = 0.02) and ST segment elevation in leads V1 (OR 3.99; p = 0.00017) and aVR (OR 2.49; p = 0.011) were independent predictors of complications during hospitalization. In turn, in multivariate analysis, only the sum of negative T waves (OR 0.81; p = 0.0098), number of leads with negative T waves [OR 1.68; p = 0.00068] and ST segment elevation in lead V1 (OR 4.47; p = 0.0003) were independent predictors of death during hospitalization. CONCLUSIONS: In our population of APE patients, the sum of negative T waves, the number of leads with negative T waves and the ST segment elevation in lead V1 were independent predictors of death during hospitalization. In turn, the sum of negative T waves, the number of leads with negative T waves, and RBBB and ST segment elevation in leads V1 and aVR were independent predictors of complications during hospitalization. We conclude that ECG analysis may be a useful noninvasive method for risk stratification of patients with APE.

The value of ECG parameters in estimating myocardial injury and establishing prognosis in patients with acute pulmonary embolism.

BACKGROUND: The electrocardiogram (ECG) is characterised by little sensitivity and specificity in the diagnostic evaluation of acute pulmonary embolism (APE). AIM: To assess the significance of ECG changes in predicting myocardial injury and prognosis in patients with APE. METHODS: The study group consisted of 225 patients (137 women and 88 men), mean age: 66.0 ± 15.2 years, in whom the diagnosis of APE was made, mostly based on computed tomography (n = 206, 92%). RESULTS: We observed 26 in-hospital deaths (mortality rate: 11.5%) and complications occurred in 58 (25.7%) patients. Elevated levels of troponin were observed in 103 (46%) patients. Logistic regression analysis showed that in-hospital mortality was associated with: coronary chest pain (0.06-0.53, OR 0.18), systolic blood pressure below 100 mm Hg (2.3-13.64, OR 5.61), heart rate above 100 bpm (1.17-15.11, OR 4.21), the S1Q3T3 sign (1.31-6.99, OR 3.02), QR in V(1) (1.60-12.32, OR 4.45), ST-segment depression in V(4)-V(6) (0.99-5.40, OR 2.31), ST-segment elevation in III (0.99-6.96, OR 2.64), ST-segment elevation in V(1) (1.74-9.49, OR 4.07); borderline (1.51-16.07, OR 4.93), moderate (1.42-17.74, OR 5.01) and severe troponin elevation (2.88-36.38, OR 10.24). In patients with cTnT(+), compared to patients with normal troponin levels, the following ECG changes were significantly more common: the S1Q3T3 sign (43 vs 21%, p = 0.003), negative T waves in V(2)-V(4) (57 vs 27%, p = 0.0001), ST-segment depression in V(4)-V(6) (40 vs 14%, p = 0.001), ST-segment elevation in III (22 vs 7%, p = 0.0006), V(1) and V(2) (43 vs 10%, p = 0.0001) and QR in V(1) (16 vs 5%, p = 0.007). CONCLUSIONS: ECG parameters are useful in predicting myocardial injury and assessing prognosis in patients with APE.

How often pulmonary embolism mimics acute coronary syndrome?

BACKGROUND: The clinical picture of acute pulmonary embolism (APE) is often uncharacteristic and may mimic acute coronary syndrome (ACS) or lung diseases, leading to misdiagnosis. In 50% of patients, APE is accompanied by chest pain and in 30-50% of the patients markers of myocardial injury are elevated. AIM: To perform a retrospective assessment of how often clinical manifestations and investigations (ECG findings and elevated markers of myocardial injury) in patients with APE may be suggestive of ACS. METHODS: We included 292 consecutive patients (109 men and 183 women) from 17 to 89 years of age (mean age 65.4 ± 15.5 years) with APE diagnosed according the ESC guidelines. RESULTS: Among the 292 patients included in the study 33 patients died during hospitalisation (mortality rate 11.3%) and 73 (25.0%) patients developed complications. A total of 75 (25.7%) patients were classified as high risk according to the ESC risk stratification, 163 (55.8%) as intermediate risk and 54 (18.5%) as low risk. Chest pain on and/or before admission was reported by 128 (43.8%) patients, including 73 (57.0%) patients with chest pain of coronary origin, 52 (40.6%) patients with chest pain of pleural origin and 3 patients with pain of undeterminable origin based on the available documentation. A total of 56 (19.2%) patients had a history of ischaemic heart disease and 5 (1.7%) had a history of myocardial infarction. A total of 8 (2.7%) patients were admitted with the initial diagnosis of ACS. The high-risk group consisted of 15 (20.6%) patients with a typical retrosternal chest pain and 60 (27.3%) patients without the typical anginal pain. Elevated troponin was observed in 103 (35.3%) patients. The ECG changes suggestive of myocardial ischaemia (inverted T waves, ST-segment depression or elevation) were observed in 208 (71.2%) patients. The following findings were significantly more common in high-risk versus non-high-risk patients: ST-segment depression in V4-V6 (42.6% vs 23.9%, p = 0.02), ST-segment elevation in V1 (46.7% vs 20.0%, p = 0.0002) and aVR (70.7% vs 40.1%, p = 0.0007). CONCLUSIONS: One third of patients with APE may present with all the manifestations (pain, elevated troponin and ECG changes) suggestive of ACS. The ECG changes suggestive of myocardial ischaemia are observed in 70% of the patients with ST-segment depression in V4-V6 and ST-segment elevation in V1 and aVR being significantly more common in high-risk vs non-high-risk patients.

[Thrombosis within the area of muscle bridge as a cause of myocardial infarction]. / Zakrzep w obszarze mostka miesniowego jako przyczyna zawalu serca.

Muscle bridge with concomitant sclerotic lesions may cause myocardial infarction (MI). We present a case of 70 year-old woman, who suffered from MI due to sclerotic lesion located within the anterior descending artery, right above the muscle bridge. Implanting two drug eluting stents resulted in restoration of proper flow through the vessel, widening the sclerotic lesion and the area of muscle bridge.

[Changes in electrocardiographic and angiographic images in the course of myocardial infarction]. / Dynamika zmian obrazu elektrokardiograficznego i angiograficznego w przebiegu zawalu serca.

Different types of disorders, varying in time, concerning atrio-ventricular (AV) conductivity may occur during myocardial infarction (MI). Similarly, angiography may reveal the dynamics within lesions of thrombosis in arteries. A case of 58 year-old man, who suffered from temporal AV block of all degrees, and what is more, a block in anterior fascicle or the whole left bundle branch in the bundle of His is presented. Only the second coronary arteriography revealed a thrombosis in coronary artery. Successful angioplasty resulted in relief of symptoms and conductivity disorders. Clinical course of MI was discussed on the basis of the described case.

Subclavian artery stenosis as a cause of acute coronary syndrome in a patient after coronary artery bypass grafting.

We described a case of a 74-year-old man who suffered from acute coronary syndrome 7 years after coronary artery bypass grafting. The patient underwent angioplasty of the obtuse marginal branch of the left coronary artery from venous graft access, which did not result in relief of ailments. Only angioplasty of the narrowed subclavian artery caused an improvement in the patient's condition. The clinical significance of narrowing within the subclavian artery in patients after the procedure of implanting the left subclavian artery into the coronary artery system was discussed.

[Big myxoma of the left atrium suggesting pulmonary embolism]. / Duzy sluzak lewego przedsionka o przebiegu sugerujacym poczatkowo zatorowosc plucna.

Cardiac myxomas are rare. They usually appear as a sporadic isolated mass in the left atrium of women with no other pathology. Our patient had symptoms which may suggest pulmonary embolism (PE)-TTE, D-dimers, ECG, laboratory findings seemed to confirm acute PE. Physical examination was unremarkable. Signs of pulmonary hypertension and shortened acceleration time also suggested PE. However, angio-CT excluded it. The patient was transfered to surgical department. During the operation the big myxoma filling the whole space of the left atrium and blocking the entrance to the left ventricle was found and easily removed. Kardiol Pol 2010; 68, 6: 695-696.

[Can angiography system with large-area flat digital panel induce higher irradiation in a patient during coronary angiography]. / Czy angiografy z plaskim panelem cyfrowym o dutej powierzchni powoduja wieksze napromieniowanie chorego poddanego koronarografii.

BACKGROUND: Nowadays, angiography systems with flat digital panel are used in cardiology and invasive radiology as the detector of irradiation. The so called universal systems with a magnified panel are becoming more common. In this study we tried to find out whether in practice the increased surface area of detectors may increase the absorption dose in a patient. MATERIAL AND METHODS: The study included 486 patients who underwent coronary angiography carried out by the same physicians. In 268 subjects the procedure was performed in cathlab A equipped with a cardiac angiography system, whereas in 218 subjects in cathlab B using universal angiography system. In the study the absorbed dose of irradiation by the patient was determined and its ratio to body mass, body mass index (BMI) and body surface area (BSA) was evaluated. RESULTS: The mean dose absorbed by the person under study did not differ between both catheterization laboratories. Similarly, there were no differences in the ratio of the absorbed dose and BMI. But the comparison of the ratio of the absorbed dose and the body mass showed significantly higher values in cathlab A, where. higher values of the ratio of the absorbed dose and BSA were also found (p < 0.01). CONCLUSIONS: In the present study it was found that the use of universal angiography systems with a larger surface area of the detecting panel is not connected with the increase in the irradiation dose absorbed by the patent during coronary angiography as compared with classical cardiac angiography systems.

[Left ventricular thrombus--variability of causes and clinical presentation--four case reports]. / Skrzeplina w swietle lewej komory. Róznorodnosc przyczyn i przebiegu klinicznego na podstawie czterech przypadków.

Thrombi occurring in heart chambers, particularly in the left ventricle, are very often due to diseases leading to heart dilation. Thrombi could dissolve spontaneously or as a result of pharmacological treatment. They could also be mobilizes and produce emboli. The risk of emboli vary significantly from low to extremely high due to different morphology and mobility of thrombi. The most effective treatment of thrombi is to cure the underlying disease. Additionally antithrombotic agents or surgical treatment may be applied. In this article 4 cases with different clinical course treated only with drugs are presented.

[Repeat angioplasty of the left anterior descending coronary artery due to restenosis. How many times could we do it?]. / Wielokrotna angioplastyka tetnicy zstepujacej przedniej. Ile razy nalezy poszerzac tetnice z powodu restenozy?

Coronary angioplasty is widely accepted method of myocardium revascularisation. Repeat restenosis is often an indication for surgical treatment. Unfortunately, some patients are not treated surgically for various reasons. This leads to major therapeutic problems. We present a case of a 79-year-old female with repeat angioplasty done 6 times to the left anterior descending artery due to acute coronary syndromes in a 4-year period. The patient did not agree to recommended surgical treatment. We observed gradually deteriorating left ventricular function. The patient finally agreed to surgery, but left ventricle injury added to other clinical problems resulted in disqualification from operation.

[Recent myocardial infarction, cardiogenic shock and unsuccessful coronary angioplasty--the pattern of cooperation between a centre without on-site surgical back-up and a distantly located clinical cardiosurgery centre]. / Ostry zawal miesnia serca, wstrzas kardiogenny i nieskuteczna angioplastyka wiencowa--modelowy przyklad wspólpracy osrodka inwazyjnego bez zaplecza sali operacyjnej z odleglym osrodkiem kardiochirurgicznym.

The case of a 66-year-old male with acute myocardial infarction (AMI) complicated by cardiogenic shock is presented. Because of failed primary PCI, after stabilisation of ischaemia and haemodynamics by medication and IABP he was transferred to a distantly located cardiosurgery unit. This patient underwent successful emergency CABG on the second day after infarction. The problem of transporting a patient with AMI and cardiogenic shock to a distant site and the problem of emergency CABG in such high-risk patients is discussed.