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Stępień K, Nowak K, Kachnic N, Karcińska A, Del Carmen Yika A, Furczyński J, Platschek M, Skorupa M, Wyleciał Z, Zalewski J, Nessler J. Clinical characteristics and long-term outcomes of patients with heart failure with improved ejection fraction. First Polish experience from LECRA-HF registry. Adv Med Sci 2024; 69:132-138. [PMID: 38447613 DOI: 10.1016/j.advms.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/06/2023] [Accepted: 02/29/2024] [Indexed: 03/08/2024]
Abstract
PURPOSE Heart failure (HF) with improved ejection fraction (HFimpEF) is a new category of HF introduced in the newest European Society of Cardiology guidelines. However, clinical characteristics and long-term outcomes of HFimpEF patients remain insufficiently elucidated. We sought to characterize Polish HFimpEF patients and determine their long-term mortality. MATERIAL AND METHODS Of 1186 patients enrolled in the single-center Lesser Poland Cracovian Heart Failure (LECRA-HF) registry between 2009 and 2019 and hospitalized due to HF decompensation, 340 (28.7%) were those with HF with reduced ejection fraction (HFrEF). Based on follow-up echocardiography, 61 (17.9%) of them were classified as HFimpEF and the remaining as HFnon-impEF. RESULTS HFimpEF patients were more frequently females (P < 0.001), had higher baseline left ventricular ejection fraction (LVEF, P < 0.001), had less often a history of diabetes (P = 0.024), severe chronic kidney disease (P = 0.026) or prior myocardial infarction (P = 0.008) than HFnon-impEF patients. By multivariable analysis the HFimpEF diagnosis was independently predicted by baseline NYHA I/II (odds ratio [OR] 2.347, 95% confidence interval [95%CI] 1.020-5.405), non-ischemic etiology (OR 3.096, 95%CI 1.587-6.024), lack of diabetes mellitus (OR 2.016, 95%CI 1.059-3.846) and higher baseline LVEF (OR 1.084, 95%CI 1.042-1.126, per 1%). Within the median 49 (25-77) months all-cause mortality was lower in HFimpEF than in HFnon-impEF (10.8 vs 16.4%/year, P = 0.004). CONCLUSIONS Our findings indicate that every sixth Polish patient with HFrEF has a chance to improve LVEF during follow-up and to become a HFimpEF patient. Baseline characteristics of HFimpEF patients are different from HFnon-impEF. Simultaneously, the HFimpEF diagnosis is associated with higher long-term survival.
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Affiliation(s)
- Konrad Stępień
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, Kraków, Poland; Department of Thromboembolic Disorders, Jagiellonian University Medical College, Kraków, Poland; "Club 30", Polish Cardiac Society, Warsaw, Poland.
| | - Karol Nowak
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, Kraków, Poland; Department of Thromboembolic Disorders, Jagiellonian University Medical College, Kraków, Poland
| | - Natalia Kachnic
- Student Research Group at Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, Kraków, Poland
| | - Aleksandra Karcińska
- Student Research Group at Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, Kraków, Poland
| | - Alicia Del Carmen Yika
- Student Research Group at Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, Kraków, Poland
| | - Jakub Furczyński
- Student Research Group at Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, Kraków, Poland
| | - Michael Platschek
- Student Research Group at Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, Kraków, Poland
| | - Maria Skorupa
- Student Research Group at Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, Kraków, Poland
| | - Zuzanna Wyleciał
- Student Research Group at Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, Kraków, Poland
| | - Jarosław Zalewski
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, Kraków, Poland
| | - Jadwiga Nessler
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, Kraków, Poland
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Stepien K, Nowak K, Kachnic N, Horosin G, Walczak P, Karcinska A, Schwarz T, Wojtas M, Zalewska M, Pastuszak M, Wegrzyn B, Nessler J, Zalewski J. Statin Use in Cancer Patients with Acute Myocardial Infarction and Its Impact on Long-Term Mortality. Pharmaceuticals (Basel) 2022; 15:ph15080919. [PMID: 35893743 PMCID: PMC9330549 DOI: 10.3390/ph15080919] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 02/04/2023] Open
Abstract
Statin use and its impact on long-term clinical outcomes in active cancer patients following acute myocardial infarction (MI) remains insufficiently elucidated. Of the 1011 consecutive acute MI patients treated invasively between 2012 and 2017, cancer was identified in 134 (13.3%) subjects. All patients were observed within a median follow-up of 69.2 (37.8−79.9) months. On discharge, statins were prescribed less frequently in MI patients with cancer as compared to the non-cancer MI population (79.9% vs. 91.4%, p < 0.001). The most common statin in both groups was atorvastatin. The long-term mortality was higher in MI patients not treated vs. those treated with statins, both in non-cancer (29.5%/year vs. 6.7%/year, p < 0.001) and cancer groups (53.9%/year vs. 24.9%/year, p < 0.05), respectively. Patient’s age (hazard ratio (HR) 1.04, 95% confidence interval (CI) 1.03−1.05, p < 0.001, per year), an active cancer (HR 2.42, 95% CI 1.89−3.11, p < 0.001), hemoglobin level (HR 1.14, 95% CI 1.09−1.20, p < 0.001, per 1 g/dL decrease), and no statin on discharge (HR 2.13, 95% CI 1.61−2.78, p < 0.001) independently increased long-term mortality. In MI patients, simultaneous diagnosis of an active cancer was associated with less frequently prescribed statins on discharge. Irrespective of cancer diagnosis, no statin use was found as an independent predictor of increased long-term mortality.
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Affiliation(s)
- Konrad Stepien
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, 31-202 Krakow, Poland; (K.N.); (N.K.); (G.H.); (P.W.); (A.K.); (J.N.); (J.Z.)
- Cardiocare, 31-159 Krakow, Poland; (T.S.); (M.W.)
- “Club 30”, Polish Cardiac Society, 00-193 Warsaw, Poland
- Correspondence: ; Tel.: +48-12-6142218
| | - Karol Nowak
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, 31-202 Krakow, Poland; (K.N.); (N.K.); (G.H.); (P.W.); (A.K.); (J.N.); (J.Z.)
- Cardiocare, 31-159 Krakow, Poland; (T.S.); (M.W.)
| | - Natalia Kachnic
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, 31-202 Krakow, Poland; (K.N.); (N.K.); (G.H.); (P.W.); (A.K.); (J.N.); (J.Z.)
| | - Grzegorz Horosin
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, 31-202 Krakow, Poland; (K.N.); (N.K.); (G.H.); (P.W.); (A.K.); (J.N.); (J.Z.)
| | - Piotr Walczak
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, 31-202 Krakow, Poland; (K.N.); (N.K.); (G.H.); (P.W.); (A.K.); (J.N.); (J.Z.)
| | - Aleksandra Karcinska
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, 31-202 Krakow, Poland; (K.N.); (N.K.); (G.H.); (P.W.); (A.K.); (J.N.); (J.Z.)
| | - Tomasz Schwarz
- Cardiocare, 31-159 Krakow, Poland; (T.S.); (M.W.)
- Department of Genetics, Animal Breeding and Ethology, University of Agriculture in Krakow, 31-059 Krakow, Poland
| | | | - Magdalena Zalewska
- Department of Emergency Medicine, Faculty of Health Sciences, Jagiellonian University Medical College, 31-126 Krakow, Poland;
| | | | - Bogdan Wegrzyn
- Department of Social Work, University of Applied Sciences in Tarnow, 33-100 Tarnow, Poland;
| | - Jadwiga Nessler
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, 31-202 Krakow, Poland; (K.N.); (N.K.); (G.H.); (P.W.); (A.K.); (J.N.); (J.Z.)
| | - Jarosław Zalewski
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, 31-202 Krakow, Poland; (K.N.); (N.K.); (G.H.); (P.W.); (A.K.); (J.N.); (J.Z.)
- Cardiocare, 31-159 Krakow, Poland; (T.S.); (M.W.)
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Stepien K, Nowak K, Szlosarczyk B, Nessler J, Zalewski J. Clinical Characteristics and Long-Term Outcomes of MINOCA Accompanied by Active Cancer: A Retrospective Insight Into a Cardio-Oncology Center Registry. Front Cardiovasc Med 2022; 9:785246. [PMID: 35669480 PMCID: PMC9163819 DOI: 10.3389/fcvm.2022.785246] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 04/19/2022] [Indexed: 12/21/2022] Open
Abstract
Background Clinical characteristics and long-term outcomes of patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) and cancer are insufficiently elucidated. Objectives We sought to characterize these patients hospitalized in a tertiary cardio-oncology center and to find the potential determinants affecting their long-term mortality. Methods MINOCA was diagnosed in 72 of the 1,011 patients with consecutive myocardial infarction who underwent coronary angiography. Mortality rates and their determinants were analyzed within a median follow-up of 69.2 (37.8-79.9) months. Results Active cancer was identified in 21 (29.2%) of patients with MINOCA and in 113 (12.0%) patients with myocardial infarction and obstructive coronary artery disease (MI-CAD) (p < 0.001). MINOCA patients with cancer were characterized by a higher incidence of anemia (47.6 vs. 21.6%, p = 0.03) and more frequently Takotsubo syndrome (19.1 vs. 2.0%, p = 0.01) than in non-cancer MINOCA. The troponin T/hemoglobin ratio was higher in both cancer MINOCA and MI-CAD groups when compared with their respective non-cancer patients (both p < 0.05). The age and sex-standardized mortality rates were significantly higher in cancer MINOCA (26.7%/year) when compared with non-cancer MINOCA (2.3%/year, p = 0.002) and in cancer MI-CAD (25.0%/year) vs. non-cancer MI-CAD (3.7%/year, p < 0.001). Active cancer (HR 3.12, 95% CI 2.41-4.04) was independently associated with higher long-term mortality, while higher hemoglobin levels (HR 0.93, 95% CI 0.88-0.99, per g/dl) and a MINOCA diagnosis (HR 0.69, 95% CI 0.47-0.97) improved long-term survival. Conclusion Patients with MINOCA were comorbid with cancer more frequently than MI-CAD. In turn, an active malignancy was associated with an unfavorable long-term survival both in MI-CAD population and in patients with MINOCA.
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Affiliation(s)
- Konrad Stepien
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, Kraków, Poland.,John Paul II Hospital, Kraków, Poland.,Club 30, Polish Cardiac Society, Kraków, Poland
| | - Karol Nowak
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, Kraków, Poland.,John Paul II Hospital, Kraków, Poland
| | - Barbara Szlosarczyk
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, Kraków, Poland.,John Paul II Hospital, Kraków, Poland
| | - Jadwiga Nessler
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, Kraków, Poland.,John Paul II Hospital, Kraków, Poland
| | - Jaroslaw Zalewski
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, Kraków, Poland.,John Paul II Hospital, Kraków, Poland
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Versaci F, Conte M, Van't Veer M, Lalancette S, Oldroyd K, Calcagno S, Biondi Zoccai G. A novel algorithm for the computation of the diastolic pressure ratio in the invasive assessment of the functional significance of coronary artery disease. Panminerva Med 2021; 63:206-213. [PMID: 34154320 DOI: 10.23736/s0031-0808.20.04202-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Invasive functional assessment is a mainstay in the management of patients with coronary artery disease (CAD), but there is uncertainty on the comparative accuracy of diagnostic indices of functional significance. We aimed to validate the diagnostic performance of a novel non-hyperemic diastolic pressure ratio (dPR). METHODS We performed a retrospective analysis including two separate registries (VERIFY 2, Latina, Italy) of patients in whom functional indices were measured for lesions with angiographically moderate severity. On top of fractional flow reserve, distal coronary pressure (Pd)/aortic pressure (Pa) ratio, instantaneous wave-free ratio (iFR) and diastolic pressure ratio (dPR) were computed using a novel dedicated algorithm over 4 consecutive beats. Agreement/discrepancy between indexes was appraised Bland-Altman analysis, area under the receiver operating characteristic curve (AUC), and unsupervised machine learning. RESULTS A total of 525 lesions from 479 patients were included. The novel dPR was highly correlated with iFR (R2=0.99, P<0.001), with a mean difference of -0.004±0.014. The diagnostic performance of dPR (best cutoff value: ≤0.89) against iFR was as follows: accuracy =96%; sensitivity =94%; specificity =97%; positive-predictive value =94%; and negative-predictive value =96%. Additionally, AUC to predict iFR≤0.89 was 0.99, which was significantly higher than that of Pd/Pa (0.97, P<0.001). In the iFR range of 0.85-0.93 ("grey zone"), the diagnostic performance was well maintained (accuracy =91%; sensitivity =87%; specificity =93%; and AUC=0.96). Results were supported also by unsupervised learning analysis. CONCLUSIONS This multicenter registry suggests this novel dPR algorithm provides results that are numerically equivalent to iFR. Pending further studies, physicians may consider using this novel dPR algorithm to gauge the functional significance of a coronary lesion.
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Affiliation(s)
- Francesco Versaci
- Department of Cardiology, Santa Maria Goretti Hospital, Latina, Italy
| | - Micaela Conte
- Department of Cardiology, Clinic Saint Jean, Brussels, Belgium
| | | | | | - Keith Oldroyd
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Simone Calcagno
- Department of Cardiology, Santa Maria Goretti Hospital, Latina, Italy
| | - Giuseppe Biondi Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy - .,Mediterranea Cardiocentro, Naples, Italy
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Versaci F, Frati G, Biondi-Zoccai G. Managing NSTEMI in older patients. Lancet 2021; 397:370. [PMID: 33516333 DOI: 10.1016/s0140-6736(20)32385-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 11/02/2020] [Indexed: 02/08/2023]
Affiliation(s)
- Francesco Versaci
- Unità Operativa Complessa di Unità di Terapia Intensiva Coronarica, Emodinamica e Cardiologia, Ospedale S Maria Goretti, Latina, Italy
| | - Giacomo Frati
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina 04100, Italy; IRCCS NEUROMED, Pozzilli, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina 04100, Italy; Mediterranea Cardiocentro, Napoli, Italy.
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Clinical Conundrum: Three Management Strategies for Three-Vessel Coronary Artery Disease? J Cardiovasc Pharmacol 2020; 76:489-491. [PMID: 32826412 DOI: 10.1097/fjc.0000000000000900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Stepien K, Furczynska P, Zalewska M, Nowak K, Wlodarczyk A, Owsianka I, Skorek P, Zalewski J, Nessler J. Dementia screening in elderly high-risk patients following heart failure decompensation may predict unfavorable long-term clinical outcomes. Minerva Cardiol Angiol 2020; 69:251-260. [PMID: 32643895 DOI: 10.23736/s2724-5683.20.05157-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Recently heart failure (HF) has been found to be a new dementia risk factor; nevertheless, their relations in patients following HF decompensation remain unknown. We sought to investigate whether a screening diagnosis for dementia (SDD) in this high-risk population may predict unfavorable long-term clinical outcomes. METHODS One hundred forty-two patients following HF decompensation requiring hospitalization were enrolled. Within a median time of 55 months all patients were screened for dementia with ALFI-MMSE scale whereas their compliance was assessed with the Morisky Medication Adherence Scale. Any incidents of myocardial infarction, coronary revascularization, stroke or transient ischemic attack (TIA), revascularization, HF hospitalization and bleedings during follow-up were collected. RESULTS SDD was established in 37 patients (26%) based on the result of an ALFI-MMSE score of <17 points. By multivariate analysis the lower results of the ALFI-MMSE score were associated with a history of stroke/TIA (β=-0.29, P<0.001), peripheral arterial disease (PAD) (β=-0.20, P=0.011) and lower glomerular filtration rate (β=0.24, P=0.009). During the follow-up, patients with SDD were more often rehospitalized following HF decompensation (48.7% vs. 28.6%, P=0.042) than patients without SDD, despite a similar level of compliance (P=0.25). Irrespective of stroke/TIA history, SDD independently increased the risk of rehospitalization due to HF decompensation (HR 2.22, 95% CI: 1.23-4.01, P=0.007). CONCLUSIONS In patients following decompensated HF, a history of stroke/TIA, PAD and impaired renal function independently influenced SDD. In this high-risk population, SDD was not related with patients' compliance but irrespective of the stroke/TIA history it was associated with the increased risk of HF rehospitalization.
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Affiliation(s)
- Konrad Stepien
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland -
| | - Patrycja Furczynska
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Magdalena Zalewska
- Department of Emergency Medicine, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Karol Nowak
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Aleksandra Wlodarczyk
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Izabella Owsianka
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Pawel Skorek
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Jaroslaw Zalewski
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Jadwiga Nessler
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
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