The usefulness of echo-based hemodynamic parameters in cardiac resynchronization therapy with conduction system pacing for optimal device programing.

BACKGROUND: His bundle pacing (HBP) has proved to be a valuable alternative enabling the physiological activation of cardiac contraction in cardiac resynchronization therapy (CRT). At present, however, little is known about the optimal method of programming of the His bundle-paced CRT systems in terms of achieving the best cardiac output. AIM: The aim of this study was to evaluate the impact of cardiac resynchronization therapy with conduction system pacing (CRT+CSP) on echo-based hemodynamic parameters in the early post-operative measurements. METHODS: The study enrollment criteria included: permanent atrial fibrillation, heart failure and bundle branch block. All patients underwent implantation of CRT + HBP. During the post-operative phase, we aimed to optimize HOT-CRT settings in order to achieve the greatest cardiac output assessed by complex echocardiographic measurements. RESULTS: The study included 21 patients, mean age 71.2 (6.3) years, predominantly men (71.4%) with non-ischemic cardiomyopathy 62%. All patients had heart failure with NYHA functional class III and IV (81%). Mean left ventricular ejection fraction was 27.5 (9.7%). The mean duration of the QRS complex was 148.8 ms. The effects of resynchronization pacing: HBP alone, HBP with left ventricular pacing, HBP with biventricular pacing (BiV) and BiV without HBP ​​were analyzed consecutively. HBP combined with left ventricular pacing demonstrated the best hemodynamic response. CONCLUSION: His bundle pacing coupled with LV pacing proved to be the most advantageous pacing program setting with regard to cardiac output. Moreover, it performed better than biventricular pacing and significantly better than RV pacing.

HOT CRT-The Effective Combination of Conventional Cardiac Resynchronization and His Bundle Pacing.

Background and Objectives: Cardiac Resynchronization Therapy (CRT) has, besides its benefits, various limitations. For instance, atrial fibrillation (AF) has a huge impact on the therapy efficacy. It usually reduces the overall BiV pacing percentage and leads, inevitably, to lack of fusion beats. In many patients with heart failure that could benefit from resynchronization, the QRS morphology is often IVCD and atypical, or non-LBBB, which further diminishes the CRT response. In those cases, we established His pacing combined with LV pacing as a feasible option to reduce the impact of AF on the CRT response and regain partially physiological ventricular activation to improve the electromechanical sequence. Materials and Methods: We implanted two patients with AF, HF, EF < 35%, NYHA II-III and QRS > 150 ms with CRT-D systems modified to HOT-CRT and observed their clinical, ECG and echocardiographic improvements over a follow-up period of three months. Results: In both patients we observed improvements of the initial parameters. We were able to shorten the QRS duration to approx. 120 ms, improve NYHA functional class, increase the EF by approximately 12% and distinctly reduce mitral regurgitation. Conclusion: Since the conventional CRT reaches its limits within this specific patient group, we need to consider alternative pacing sites and the effective combination of them. Our results and respectively other studies that are also mentioned in the current guidelines, support the feasibility of HOT-CRT in the above mentioned patient group.

The arterial stiffness changes in hemodialysis patients with chronic kidney disease: The impact on mortality.

BACKGROUND: Patients with kidney disease suffer from high cardiovascular risk due to classic and disease-specific risk factors. Arterial stiffness is a novel cardiovascular risk factor whose role is yet to be established. High-resolution echo-tracking is a developing method for the assessment of local arterial stiffness. OBJECTIVES: To assess carotid stiffness in patients on long-term hemodialysis (HD) using high-resolution echo-tracking and to analyze the impact of arterial stiffness on mortality in the mid-term follow-up. MATERIAL AND METHODS: Fifty-eight HD patients (28 female (F), 30 male (M)) underwent clinical examination, laboratory tests and carotid stiffness assessment. Local arterial stiffness parameters such as beta stiffness index (ß), Young's modulus (Ep), arterial compliance (AC), and one-point pulse wave velocity (PWVß) were measured both before and after HD, allowing to calculate their change (Δ). The survival of patients was analyzed up to 48 months. The multivariate analysis of survival with the use of Cox proportional hazard stepwise regression was performed to determine the factors significantly correlated with the survival. RESULTS: After 48 months, 33 patients were alive (16 F, 17 M) and 25 patients (12 F, 13 M) died. The deceased group was significantly older (66.5 ±12.3 years compared to 56.6 ±17.8 years), had more pronounced coronary artery disease (percutaneous coronary intervention (PCI) 36% compared to 9%, p < 0.05, respectively). Deceased patients had significantly higher ΔAC than survivors. The results showed that age, history of PCI, left ventricular ejection fraction (LVEF), ΔAC, fasting glucose, serum total protein, sodium level after HD, and potassium level before HD were significantly associated with mortality. CONCLUSIONS: Echo-tracking-based arterial stiffness assessment in patients with chronic kidney disease (CKD) yields the clinical information regarding mid-term mortality risk. A paradoxical increase in AC is among independent risk factors for mid-term mortality in patients undergoing maintenance HD. The proper estimation of the correlations among vascular, hemodynamic and sympathetic-dependent changes in a given patient with kidney failure is complex.

Telemedicine in Cardiology: Modern Technologies to Improve Cardiovascular Patients' Outcomes-A Narrative Review.

The registration of physical signals has long been an important part of cardiological diagnostics. Current technology makes it possible to send large amounts of data to remote locations. Solutions that enable diagnosis and treatment without direct contact with patients are of enormous value, especially during the COVID-19 outbreak, as the elderly require special protection. The most important examples of telemonitoring in cardiology include the use of implanted devices such as pacemakers and defibrillators, as well as wearable sensors and data processing units. The arrythmia detection and monitoring patients with heart failure are the best studied in the clinical setting, although in many instances we still lack clear evidence of benefits of remote approaches vs. standard care. Monitoring for ischemia is less well studied. It is clear however that the economic and organizational gains of telemonitoring for healthcare systems are substantial. Both patients and healthcare professionals have expressed an enormous demand for the further development of such technologies. In addition to these subjects, in this paper we also describe the safety concerns associated with transmitting and storing potentially sensitive personal data.

The clinical utility of direct His-bundle pacing in patients with heart failure and permanent atrial fibrillation.

In patients with significantly impaired left ventricle function permanent atrial fibrillation (AF) often coexists with symptoms of heart failure. Based on various studies, it is assumed that in patients with heart failure in functional class III and IV AF occurs in 40-50% of patients. AF adversely affects cardiac hemodynamics, and its harmfulness increases particularly in the failing heart. The lack of mechanical function of the left atrium, the usually fast ventricular rate and the irregular sequence of ventricular contraction constitute the spectrum of harmful effects of this arrhythmia. Therefore, the only way to address the underlying problem of AF, which is irregular ventricular rhythm, is to pace the ventricles and to slow or block the AV conduction. Classic, right ventricular pacing is contraindicated in this population as it promotes the abovementioned disorders by initiating additional dyssynchrony of left ventricular contraction with reduction of its contractility and aggravation of AF-related mitral regurgitation. The possibility of direct His bundle pacing (DHBP) significantly extended the clinical armamentarium of cardiac pacing. The restoration of the physiological electrical activation could significantly contribute to echocardiographic and clinical improvement. With time and the development of dedicated tools for direct His bundle pacing the success rate of implantations became more than 90% and the acceptable pacing thresholds under 2.0 V (1 ms) could be achieved in most patients. This contributed to the broader clinical application of DHBP in different patient' groups with various pacing indications. The authors of the paper discuss different electrocardiographic and clinical indications for DHBP.

The P wave dispersion-one pixel, one millisecond.

The electrophysiological activity of the heart is recorded and presented in form of electrocardiogram (ECG). In 1998 the concept of P wave dispersion as the risk factor for atrial fibrillation (AF) recurrence was introduced. It was calculated as the difference between the longest and the shortest P wave. The aim of our study is to prove that the P wave dispersion is an artifact of low accuracy in P wave measurement. The study included 186 patients (78M 108F) aged 59.7 ± 12.9 years, undergoing various electrophysiological procedures. The P wave was measured twice: first, at the paper speed of 50 mm/s, enhancement 8× (standard - imprecise) and the second time at 200 mm/s, 64-256× (precise). The imprecise measurement method resulted in different duration of all P wave parameters in comparison with precise measurement. The difference between Δ P max and Δ P min indicated a higher value for the latter parameter. It was indicated that the imprecise P wave dispersion value correlated most significantly with the maximal P wave duration, which was measured in a similar way. In contrast with the imprecise measurement method, the minimal and maximal durations of the P waves, being measured accurately, were almost identical. Using precise methodology, the P wave dispersion reaches negligible values and tends to zero. The measurements of the P wave have to be precise to assure the highest scientific and medical sincerity. The highest clinical value is related to the P wave duration.

Patient with sick sinus syndrome and implanted dual-chamber pacemaker with reduced P-wave duration following low interatrial septal pacing: Case report.

INTRODUCTION: A dual-chamber pacemaker (DDD/R) for a sinus node disease is sometimes referred to as a physiological pacemaker as it maintains atrioventricular synchrony, however several clinical trials have proved its inferiority to a nonphysiological single-chamber ventricular back-up pacing. PATIENT CONCERNS: A subject of the study is a 74-year-old woman with a sick sinus syndrome (SSS) and a previously implanted physiological DDD/R pacemaker. The SSS was diagnosed because of patient's very slow sinus rhythm of about 36 bpm, and due to several episodes of dizziness. After the DDD/R implantation the percentage of atrial pacing approached 100%, with almost none ventricular pacing. DIAGNOSES: Sick sinus syndrome, complete Bachmann's bundle block, atrial fibrillation, atrial flutter. INTERVENTIONS: The patient was previously implanted with a physiological DDD/R pacemaker. Several years after the implantation, the atrial fibrillation was diagnosed and the pulmonary vein isolation was then performed by cryoablation. During the follow-up after pulmonary vein isolation, the improvement of mitral filling parameters was assessed using echocardiography. Shortly thereafter the patient developed the persistent paroxysm of a typical atrial flutter which was successfully terminated using a radiofrequency ablation. No recurrence thereof has been observed ever since (24 months). OUTCOMES: The atrial electrode of the pacing system was implanted within the low interatrial septal region that resulted in a reduced P-wave duration compared to native sinus rhythm P-waves. The said morphology was deformed because of the complete Bachmann bundle block. That approach, despite a nonphysiological direction of an atrial activation, yielded relatively short P-waves (paced P-wave: 179 ms vs intrinsic sinus P-wave: 237 ms). It also contributed to a significantly shorter PR interval (paced PR: 204 ms vs sinus rhythm PR: 254 ms). CONCLUSIONS: The authors took into consideration different aspects of alternative right atrial pacing sites. This report has shown that in some patients with a sinus node disease, low interatrial septal pacing can reduce the P-wave duration but does not prevent from the development of atrial arrhythmias.

Can the in-hospital mortality rate in patients with ST-elevation myocardial infarctions be lowered any further?

BACKGROUND: A myocardial infarction is a specific clinical condition characterized by a relatively high acute mortality rate. Earlier reperfusion results in a smaller infarct size and a lower mortality rate. OBJECTIVES: To assess the in-hospital mortality in patients with ST-elevation myocardial infarction (STEMI) regarding patients' characteristics, and the mechanisms behind the deterioration in hemodynamic and clinical status, in order to assess the possibility of preventing this type of death. MATERIAL AND METHODS: A group of 106 patients aged 64.5 ±11.3 years was divided into 2 groups: patients who died while hospitalized (group I; n = 5) and patients who survived while hospitalized for STEMI (group II; n = 101). Primary coronary intervention was performed in all individuals, with direct stent implantation in all but 1 patient. In all patients the standard medication was started or continued, depending on the patient's status. The demographic and selected clinical and biochemical parameters were compared between the study groups. RESULTS: The patients in group I were significantly older than the survivors (76.2 ±12.7 compared to 64.0 ±11.0 years; p < 0.05). The group with fatal myocardial infarction had a lower left ventricular ejection fraction (LVEF) (31.7 ±12.8% compared to 60.4 ±11.0%; p < 0.05) and a higher maximal serum troponin level (973.6 ±1121.8 ng/mL compared to 453.2 ±924.2 ng/mL; p < 0.05). Interestingly, among the patients who died, the pain-to-balloon time was significantly shorter than in the myocardial infarction survivors (84 ±48 min compared to 342 ±504 min; p < 0.05). CONCLUSIONS: The development of the medical care system has made invasive procedures available, improving outcomes in patients with acute myocardial infarction. This form of treatment is likely optimized to such an extent that any changes in the time before intervention will not substantially improve mortality rates.

The Role of Sleep Disturbance, Depression and Anxiety in Frail Patients with AF-Gender Differences.

The aim of the study was to assess the link between anxiety and depression and frailty syndrome (FS) in patients with atrial fibrillation (AF) with regard to gender differences. MATERIAL AND METHODS: The study was conducted on 158 patients with AF (mean age 70.4 ± 7.6). The study used the hospital anxiety and depression scale (HADS-M), the Athens insomnia scale (AIS) and the Edmonton frailty scale to assess and compare anxiety, depression, and sleep disturbance between frail and non-frail patients with AF. RESULTS: FS was diagnosed in 53.2% of patients. A comparative analysis showed a statistically significantly higher severity level of anxiety (12.0 ± 2.6 vs. 8.4 ± 2.5, p < 0.001) and depression (12.5 ± 2.5 vs. 7.2 ± 3.3, p < 0.001) in frail patients compared to non-frail patients. The analysis of the level of anxiety, depression and FS did not show any significant differences between the studied women and men. However, statistically, significant differences were observed when FS occurred, regardless of gender. Anxiety disorders were observed in 75.5% of patients with FS and in 16.7% without frailty, whereas depressive disorders were observed in 73.6% of frail patients and in 4.2% without frailty. In an analysis of the impact of cumulative variables on the level of frailty, the risk of FS in patients with anxiety/depression and sleep disturbance is almost 500 times higher compared to patients without anxiety/depression and sleep disturbance. The risk of frailty in patients with sleep disturbance only is thirteen times higher than in the reference group, i.e., in patients without depression/anxiety and sleep disturbances. CONCLUSIONS: Patients with AF and FS show deeper anxiety, depression and sleep disturbances. Gender does not influence the risk of frailty in AF patients. Frailty in patients with AF is associated with a higher risk of depression, sleep disturbances and anxiety.

Quality of Life and Frailty Syndrome in Patients with Atrial Fibrillation.

INTRODUCTION: Atrial fibrillation (AF) and frailty syndrome (FS) are a part of the aging process. Both are still of great importance in the assessment of quality of life (QoL). There is definitely a lack of research clarifying the association between FS and QoL in AF patients. OBJECTIVE: The aim of this study was to evaluate the influence of FS on QoL in AF patients. MATERIALS AND METHODS: The retrospective and observational study included 158 inpatients with mean age 69.8±7.1 years, treated for AF in the cardiac department from 1 April 2019 to 31 June 2019. The following instruments were used: the Arrhythmia-Specific Questionnaire in Tachycardia and Arrhythmia (ASTA) and the Edmonton Frail Scale (EFS). RESULTS: The mean level of frailty in the study group was 8.5±5.0. In 25.9% of patients, the level of frailty was mild, in 10.1% moderate, and in 17.1% severe. Patients were divided into two groups based on their frailty status. In comparative analysis of the QoL, there were significant differences between the groups: the frail group had more intense symptoms of arrhythmia than the non-frail group (14.9±4.1 vs 11.9±4.9; p<0.001). In the analysis of the total score impact of arrhythmia on QoL, the frail group had a significantly higher score than the non-frail group (23.5±5.2 vs 14.5±5.5), which confirmed the stronger negative impact of arrhythmia on QoL. In the regression coefficient analysis, the independent predictor of symptom severity and QoL was FS. However, we observed a negative impact of diabetes, which increased the impact of arrhythmia on QoL, and physical activity, which improved QoL and decreased the impact of symptoms on everyday life. CONCLUSION: Patients in the frail group have worse QoL and higher impact of arrhythmia on QoL in comparison to patients in the non-frail group. Frailty is an independent predictor of higher intensity of symptoms of arrhythmia and worse QoL. Diabetes and physical activity are predictors of QoL for patients with AF.

Large animals as models of atrial fibrillation.

In clinical practice, atrial fibrillation (AF) is the most common cardiac arrhythmia in humans and it may lead to numerous complications, including central nervous system embolism. The electrical activity of the heart in AF is rapid and chaotic, while the atrioventricular conduction leads to irregular ventricular contraction. Consequently, the stroke volume is reduced, which may lead to symptoms of heart failure. Heart failure is one of the causes of AF as well. Numerous in vivo and in vitro models are used to study the pathophysiology of AF. Animal models play a key role in understanding the mechanisms of arrhythmias as well as in developing treatment regimens. The models of AF include large animals (goats, sheep, pigs, dogs) as well as small laboratory animals. This study reviews the large animal models of AF, which enhance our understanding of numerous mechanisms responsible for the development of AF, but we must be aware that the pathomechanism of AF in humans is complex and is affected by numerous factors, including environmental and congenital ones.

Patient-Reported Compliance in older age patients with chronic heart failure.

METHODS AND RESULTS: 475 patients (including 222 women), mean age 69.7±7.7, with HF, hospitalized at University Hospital between January and December 2018 were included in the study. The patients were selected by a physician specializing in cardiology. A cardiac nurse assessed the non-pharmacological level of compliance using the Revised Heart Failure Compliance Questionnaire (RHFCQ). The socio-clinical data were obtained from medical records. The majority of the study group were patients in NYHA II (62.4%) and NYHA III (28.3%), the mean duration of the disease was 6.2±4.9 years, and the mean ejection fraction of the left ventricle (EF) was 48.6±12.6. The average level of compliance in the study group measured on a scale from 0 to 4 points was: median = 2.7, IQR [2.32; 3.25]. Only 6.9% of the respondents adhere to recommendations totally (all dimensions of RHFCQ). In univariate analysis, predictors negatively affecting compliance were: female gender (rho = -0.325), age below 65 years (rho = -0.014)), loneliness (rho = -0.559), number of hospitalizations (rho = -0.242), higher stage of NYHA (rho = -1.612), co-morbidities (rho = -0.729), re-hospitalizations (rho = -0.729), beta-blockers treatment (rho = -1.612) and diuretics treatment (rho = -0.276). Factors positively affecting compliance were: EF≥45% (rho = 0.020) and treatment with ACEI/ARB (rho = 0.34), whereas compliance was negatively affected by-EF<45% (ß = 0.009). Independent predictors influencing the level of compliance were: loneliness (ß = -1.816), number of hospitalizations (ß = -0.117), NYHA III and IV and number of co-morbidities (ß = -0.676). CONCLUSIONS: Patients with HF do not adhere to therapeutic recommendations. The lowest compliance levels were found for exercise and daily weighing, and the highest for follow-up appointment-keeping and medication. Loneliness and age are the strongest predictors which influence the level of compliance.

The impact of health education on treatment outcomes in heart failure patients.

BACKGROUND: In 2016 heart failure (HF) affected between 600,000 and 700,000 people in Poland being one of the most common causes of hospitalization and death. Health education is an elements of patient treatment aimed at improving the level of self-care and adherence to the treatment recommendations. OBJECTIVES: To perform a systematic review and meta-analysis of the available literature in order to determine the role of health education in HF treatment and its impact on outcomes in patients with chronic HF. MATERIAL AND METHODS: A search was performed in the MEDLINE, PubMed and Scopus databases from January 2010 to January 2019 for the impact of health education on treatment outcomes in HF patients. RESULTS: A total of 16 studies from 12 countries on 5 continents were analyzed. The meta-analysis focused on the impact of education on outcomes in 944 study group patients. We found that the overall impact of education on outcomes was positive (+1 standard deviation (SD); 95% confidence interval (95% CI) >0). After education was provided, the target patients improved in terms of self-care (mean change (MC) = 13.49; p = 0.003; I² = 99.47%). Self-care also improved in the controls, but the improvement was less marked (MC = 9.56; p = 0.001; I² = 98.33%). No impact of education on quality of life (QoL) was confirmed (95% CI = 0). CONCLUSIONS: The greatest benefit of education is seen in terms of adherence to pharmaceutical treatment and self-care, while QoL was not associated with education.

The true nature of P wave dispersion.

BACKGROUND: The electrophysiological activity of the heart is recorded and presented in form of electrocardiography (ECG). In 1998, the concept of P wave dispersion as the risk factor for atrial fibrillation (AF) recurrence was introduced. It was calculated as the difference between the longest and the shortest P wave. OBJECTIVES: To prove that the P wave dispersion is an artifact of low accuracy in P wave measurement. MATERIAL AND METHODS: The study included 104 patients (48 women, 56 men), aged 63 ±14 years, undergoing various electrophysiological procedures. The P wave was measured twice - firstly at the paper speed of 50 mm/s, enhancement ×8 (standard - imprecise), and secondly at 200 mm/s, ×64-256 (precise). RESULTS: The imprecise measurement method resulted in different duration of all P wave parameters in comparison with precise measurement. The longest P wave duration (Pmax) measured imprecisely was 105.1 ±22.1, the Pmax measured precisely was 134.0 ±21.3 (p < 0.001). The P dispersion measured imprecisely was 44.1 ±16.8 and the P dispersion measured precisely was 2.8 ±3.4 (p < 0.0001). The correlation between imprecise Pmax and imprecise Pmin was r = 0.664 (p < 0.05). The correlation between imprecise Pmax and imprecise P wave dispersion was r = 0.612 (p < 0.05). The correlation between precise Pmax and Pmin was almost 1.0 (r = 0.987, p < 0.05). CONCLUSIONS: The P wave dispersion does not exist. The measurements of the P wave have to be precise to assure the highest scientific and medical sincerity. The highest clinical value is related to the P wave duration.

Applications for graphene and its derivatives in medical devices: Current knowledge and future applications.

Graphene is a novel carbon-based material with unique crystal nanostructure and extraordinary physical and chemical properties. Several biomedical applications of graphene and graphene-derived materials have been proposed. Its antimicrobial properties might be useful in all areas of medicine where antiseptics are required. On the other hand, the safe limits of graphene concentration for human cells have not been clearly established yet. The possibility to attach various chemically active groups to the basic lattice structure allows researchers to build graphene-based sensors for detecting biochemical molecules (and ultimately - selected cells). Sensors for physical signals, such as cardiac electrical activity, have also been proposed. The unique nanostructure of the material and the resulting physical properties (mechanical strength, elasticity and large surface area) make it a very promising material for scaffolds used in tissue regeneration. Several studies have investigated the potential advantages of a graphene coating for endovascular implants, such as stents or valves. Most of them indicate an advantage of graphene coating over other currently available solutions in terms of better hemocompatibility and facilitating endothelialization. Many of the results published so far are from in vitro studies. Promising as they might be, more data, preferably from experiments on more sophisticated animal models, must be obtained before any valid conclusions as to potential uses of graphene in medicine can be drawn.

Transvenous extraction of 3-year-old Seldinger guide wire lost in venous system and causing superior vena cava syndrome - rare complication of implantable cardioverter-defibrillator implantation.

A CASE REPORT: A 65-year-old male patient underwent left-sided placement of implantable cardioverter-defibrillator. At three years after implantation he emerged complaining on left upper limb and left-sided neck edema. Left brachicephalic vein thrombosis due to device leads was recognized. The attending cardiologist referred the patient to university radiology department for venous angioplasty but the patient was admitted to cardiology department. Coronary angiography was performed due to suspicion of ischemic heart disease. However, it showed the presence of foreign body in cardiovascular system - completely intravascular round-tipped guide wire used in Seldinger technique for insertion of the endocardial lead abandoned in left subclavian vein and reaching to superior vena cava. Patient was transferred to third-degree reference lead extraction center. The procedure was performed under general anesthesia in hybrid operating room. Via femoral vein access we introduced Needle's Eye Snare and grasped the guide wire. Then, using polytetrafluoroethylene sheath the tissue adhesions were dissected and the complete guide wire was retrieved.

Psychometric evaluation of the Polish version of the Arrhythmia­Specific Questionnaire in Tachycardia and Arrhythmia: a new tool for symptom and health­related quality of life assessment.

BACKGROUND: Atrial fibrillation (AF) is the most common arrhythmia resulting in hospitalization. The assessment of symptoms and health­related quality of life (HRQoL) can provide valuable information before, during, and after health care interventions for AF. AIMS: We aimed to perform a translation and cultural adaptation of the Arrhythmia­Specific Questionnaire in Tachycardia and Arrhythmia (ASTA), and to evaluate the reliability and validity of its Polish version. METHODS: The standard forward­backward translation procedure to translate the ASTA questionnaire into Polish was used. A total of 244 patients with AF at a mean (SD) age of 70.7 (10.7) years completed the questionnaire and were included in the study. Reliability was tested using internal consistency (Cronbach α) and validity with an item­total correlation, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA). RESULTS: The ASTA symptom scale had satisfactory psychometric properties (α = 0.718), and the corrected item­total correlation was sufficient for most items (0.361-0.506), except for cold sweats (0.156). The ASTA HRQoL scale showed good psychometric properties (α = 0.855). Initial CFA analyses showed that the 1- and 2­factor models had similar properties, with strong factor loadings and satisfactory goodness­of­fit values according to the comparative fit index (0.947 for the 1­factor model vs 0.988 for the 2­factor model). A comparison of the 1­and 2­factor models showed that the close fit for the root­mean­square error of approximation was better for the 2­factor model (0.387 vs 0.193). A 2­factor EFA model was produced, and for factor 1 (physical scale), the varimax low ranged between 0.470 and 0.804, and for factor 2 (the mental scale), it ranged between 0.597 and 0.873. CONCLUSIONS: The psychometric properties of the Polish version of the ASTA questionnaire were overall found to be satisfactory.