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Kaufmann D, Królak T, Dąbrowska-Kugacka A, Kapłon-Cieślicka A, Gawałko M, Budnik M, Uziębło-Życzkowska B, Krzesiński P, Starzyk K, Wożakowska-Kapłon B, Wójcik M, Błaszczyk R, Hiczkiewicz J, Budzianowski J, Mizia-Stec K, Wybraniec MT, Kosmalska K, Fijałkowski M, Szymańska A, Dłużniewski M, Haberka M, Kucio M, Michalski B, Kupczyńska K, Tomaszuk-Kazberuk A, Wilk-Śledziewska K, Wachnicka-Truty R, Koziński M, Burchardt P, Daniłowicz-Szymanowicz L. Can transesophageal echocardiography be safely omitted in patients scheduled for elective ablation of atrial arrhythmias? Data based on the LATTEE registry. Kardiol Pol 2024:VM/OJS/J/100081. [PMID: 38606739 DOI: 10.33963/v.phj.100081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 04/02/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND According to the present guidelines, transesophageal echocardiography (TEE) before scheduled catheter ablation (CA) for atrial arrhythmias (atrial fibrillation [AF] or atrial flutter [AFL]) is not deemed obligatory for optimally anticoagulated patients. However, daily clinical practice significantly differs from the recommendations. AIMS That study aimed to identify transthoracic echocardiographic parameters that could be useful in revealing patients without left atrial thrombus (LAT), thereby contributing to avoiding unnecessary TEE before scheduled CA. METHODS This is a sub-analysis of a multicenter, prospective, observational study - LATTEE registry. A total of 1346 patients referred for TEE before scheduled CA of AF/AFL were included. RESULTS LAT was present in 44 patients (3.3%) and absent in the remaining 1302, who were younger, more likely to have paroxysmal AF, and displayed sinus rhythm during TEE. Additionally, they exhibited a lower incidence heart failure, diabetes, systemic connective tissue disease, and chronic obstructive pulmonary disease. Furthermore, they had a lower CHA2DS2-VASc score and a higher prevalence of direct oral anticoagulants. Echocardiographic parameters, including left ventricular ejection fraction (LVEF) > 65%, left atrial diameter (LAD) < 40 mm, left atrial area (LAA) < 20 cm2, left atrial volume (LAV) < 113 ml, and left atrial volume index (LAVI) < 51 ml/m2, demonstrated 100% sensitivity and 100% negative predictive value for the LAT absence, and weremet by 417 patients. Additional echocardiographic indices: LVEF/LAD > 1.4, LVEF/LAVI > 1.6 and LVEF/LAA > 2.7 identified an additional 57 patients, bringing the total predicted LAT-free patients to 474 (35%). CONCLUSIONS Simple echocardiographic parameters could help identify individuals for whom TEE could be safely omitted before scheduled for elective CA due to atrial arrhythmias.
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Affiliation(s)
- Damian Kaufmann
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdańsk, Poland
| | - Tomasz Królak
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdańsk, Poland
| | - Alicja Dąbrowska-Kugacka
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdańsk, Poland
- "Club 30", Polish Cardiac Society, Warszawa, Poland
| | - Agnieszka Kapłon-Cieślicka
- "Club 30", Polish Cardiac Society, Warszawa, Poland
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Monika Gawałko
- "Club 30", Polish Cardiac Society, Warszawa, Poland
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
- Institute of Pharmacology, West German Heart and Vascular Centre, University Duisburg-Essen, Essen, Germany
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Monika Budnik
- "Club 30", Polish Cardiac Society, Warszawa, Poland
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Beata Uziębło-Życzkowska
- Department of Cardiology and Internal Diseases, Military Institute of Medicine - National Research Institute, Warszawa, Poland
| | - Paweł Krzesiński
- "Club 30", Polish Cardiac Society, Warszawa, Poland
- Department of Cardiology and Internal Diseases, Military Institute of Medicine - National Research Institute, Warszawa, Poland
| | - Katarzyna Starzyk
- 1st Clinic of Cardiology and Electrotherapy, Collegium Medicum, Jan Kochanowski University, Świętokrzyskie Cardiology Centre, Kielce, Poland
| | - Beata Wożakowska-Kapłon
- 1st Clinic of Cardiology and Electrotherapy, Collegium Medicum, Jan Kochanowski University, Świętokrzyskie Cardiology Centre, Kielce, Poland
| | - Maciej Wójcik
- Department of Cardiology, Medical University of Lublin, Lublin, Poland
| | - Robert Błaszczyk
- Department of Cardiology, Medical University of Lublin, Lublin, Poland
| | - Jarosław Hiczkiewicz
- Clinical Department of Cardiology, Nowa Sol Multidisciplinary Hospital, Nowa Sól, Poland
- Department of Interventional Cardiology and Cardiac Surgery, Collegium Medicum, University of Zielona Gora, Zielona Góra, Poland
| | - Jan Budzianowski
- Clinical Department of Cardiology, Nowa Sol Multidisciplinary Hospital, Nowa Sól, Poland
- Department of Interventional Cardiology and Cardiac Surgery, Collegium Medicum, University of Zielona Gora, Zielona Góra, Poland
| | - Katarzyna Mizia-Stec
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdańsk, Poland
- 1st Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
- European Reference Network on Heart Diseases - ERN GUARD-HEART
| | - Maciej T Wybraniec
- "Club 30", Polish Cardiac Society, Warszawa, Poland
- 1st Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
- European Reference Network on Heart Diseases - ERN GUARD-HEART
| | | | - Marcin Fijałkowski
- "Club 30", Polish Cardiac Society, Warszawa, Poland
- 1st Department of Cardiology, Medical University of Gdansk, Gdańsk, Poland
| | - Anna Szymańska
- "Club 30", Polish Cardiac Society, Warszawa, Poland
- Department of Heart Diseases, Postgraduate Medical School, Warszawa, Poland
| | | | - Maciej Haberka
- "Club 30", Polish Cardiac Society, Warszawa, Poland
- Department of Cardiology, School of Health Sciences, Medical University of Silesia, Katowice, Poland
| | - Michał Kucio
- Department of Cardiology, School of Health Sciences, Medical University of Silesia, Katowice, Poland
| | - Błażej Michalski
- "Club 30", Polish Cardiac Society, Warszawa, Poland
- Department of Cardiology, Medical University of Lodz, Łódź, Poland
| | - Karolina Kupczyńska
- "Club 30", Polish Cardiac Society, Warszawa, Poland
- Department of Cardiology, Medical University of Lodz, Łódź, Poland
| | - Anna Tomaszuk-Kazberuk
- "Club 30", Polish Cardiac Society, Warszawa, Poland
- Department of Cardiology, Lipidology and Internal Medicine with Intensive Cardiac Care Unit, Medical University of Bialystok, Białystok, Poland
| | - Katarzyna Wilk-Śledziewska
- "Club 30", Polish Cardiac Society, Warszawa, Poland
- Department of Cardiology, Lipidology and Internal Medicine with Intensive Cardiac Care Unit, Medical University of Bialystok, Białystok, Poland
| | - Renata Wachnicka-Truty
- Department of Cardiology and Internal Medicine, Medical University of Gdansk, Gdynia, Poland
| | - Marek Koziński
- "Club 30", Polish Cardiac Society, Warszawa, Poland
- Department of Cardiology and Internal Medicine, Medical University of Gdansk, Gdynia, Poland
| | - Paweł Burchardt
- "Club 30", Polish Cardiac Society, Warszawa, Poland
- Department of Hypertension, Angiology, and Internal Medicine, Poznan University of Medical Sciences, Poznań, Poland
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Roskal-Wałek J, Gołębiewska J, Mackiewicz J, Bociek A, Wałek P, Biskup M, Bołtuć-Dziugieł K, Starzyk K, Odrobina D, Wożakowska-Kapłon B, Jaroszyński A. The Impact of a Single Haemodialysis Session on the Retinal Thickness and Optic Nerve Morphology. Diagnostics (Basel) 2024; 14:331. [PMID: 38337847 PMCID: PMC10855457 DOI: 10.3390/diagnostics14030331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/23/2024] [Accepted: 01/31/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND The aim of the study was to assess the influence of a single haemodialysis (HD) session on the retinal and optic nerve morphology in end-stage kidney disease (ESKD) patients. METHODS It is a prospective study including only the right eye of 35 chronic kidney disease (CKD) patients subjected to HD. Each patient underwent a full eye examination 30 min before HD (8 a.m.) and 15 min after HD. Optical coherence tomography (OCT) was used to assess the peripapillary retinal nerve fibre layer (pRNFL) thickness, macular nerve fibre layer (mRNFL) thickness, ganglion cell layer with inner plexiform layer thickness (GCL+), GCL++ (mRNFL and GCL+) thickness, total retinal thickness (RT) and total macular volume (TMV). The correlation was tested between such systemic parameters changes as systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), body weight, plasma osmolarity and ocular perfusion pressure (OPP) and ultrafiltration volume with total RT and pRNFL thickness changes during HD. RESULTS In the results of a single HD session, we could observe a statistically significant increase in the total RT thickness (pre-HD 270.4 ± 19.94 μm, post-HD 272.14 ± 20.11 μm; p = 0.0014), TMV (pre-HD 7.48 ± 0.53 mm3, post-HD 7.52 ± 0.55 mm3; p = 0.0006), total pRNFL thickness (pre-HD 97.46 ± 15.71 μm, post-HD 100.23 ± 14.7 μm; p = 0.0039), total GCL+ thickness (pre-HD 70.11 ± 9.24 μm, post-HD 70.6 ± 9.7 μm; p = 0.0044), and GCL++ thickness (pre-HD 97.46 ± 12.56 μm, post-HD 97.9 ± 12.94 μm; p = 0.0081). We observed a significant correlation between the change in total RT and DBP change, as well as between body weight change and the change in total pRNFL thickness. There was also a correlation between total pRNFL thickness change and the presence of diabetes mellitus. CONCLUSION Even a single HD session affects the retinal and pRNFL thickness, which should be taken into account when interpreting the OCT results in patients subjected to HD. The impact of changes after a single HD session on selected parameters requires further assessment in subsequent studies, including long-term observation.
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Affiliation(s)
- Joanna Roskal-Wałek
- Ophthalmology Clinic, Voivodeship Regional Hospital, 25-736 Kielce, Poland
- Collegium Medicum, Jan Kochanowski University, 25-516 Kielce, Poland
| | - Joanna Gołębiewska
- Department of Ophthalmology, Military Institute of Aviation Medicine, 01-755 Warsaw, Poland
- Medical Faculty, Lazarski University, 02-662 Warsaw, Poland
| | - Jerzy Mackiewicz
- Department of Vitreoretinal Surgery, Medical University of Lublin, 20-079 Lublin, Poland
| | - Agnieszka Bociek
- Collegium Medicum, Jan Kochanowski University, 25-516 Kielce, Poland
| | - Paweł Wałek
- Collegium Medicum, Jan Kochanowski University, 25-516 Kielce, Poland
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, 25-736 Kielce, Poland
| | - Michał Biskup
- Ophthalmology Clinic, Voivodeship Regional Hospital, 25-736 Kielce, Poland
| | | | - Katarzyna Starzyk
- Collegium Medicum, Jan Kochanowski University, 25-516 Kielce, Poland
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, 25-736 Kielce, Poland
| | - Dominik Odrobina
- Collegium Medicum, Jan Kochanowski University, 25-516 Kielce, Poland
- Ophthalmology Clinic Boni Fratres Lodziensis, 93-357 Łódź, Poland
| | - Beata Wożakowska-Kapłon
- Collegium Medicum, Jan Kochanowski University, 25-516 Kielce, Poland
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, 25-736 Kielce, Poland
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Maciorowska M, Uziębło-Życzkowska B, Gorczyca-Głowacka I, Wożakowska-Kapłon B, Jelonek O, Wójcik M, Błaszczyk R, Kapłon-Cieślicka A, Gawałko M, Tokarek T, Rajtar-Salwa R, Bil J, Wojewódzki M, Szpotowicz A, Krzciuk M, Bednarski J, Bakuła-Ostalska E, Tomaszuk-Kazberuk A, Szyszkowska A, Wełnicki M, Mamcarz A, Krzesiński P. Oral anticoagulation therapy in atrial fibrillation patients at high risk of bleeding: Clinical characteristics and treatment strategies based on data from the Polish multicenter register of atrial fibrillation (POL-AF). Kardiol Pol 2024; 82:37-45. [PMID: 38230462 DOI: 10.33963/v.kp.98356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 11/29/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Despite its benefits, oral anticoagulant (OAC) therapy in patients with atrial fibrillation (AF) is associated with hemorrhagic complications. AIMS We aimed to evaluate clinical characteristics of AF patients at high risk of bleeding and the frequency of OAC use as well as identify factors that predict nonuse of OACs in these patients. METHODS Consecutive AF patients hospitalized for urgent or planned reasons in cardiac centers were prospectively included in the registry in 2019. Patients with HAS-BLED ≥3 (high HAS-BLED group) were assumed to have a high risk of bleeding. RESULTS Among 3598 patients enrolled in the study, 29.2% were at high risk of bleeding (44.7% female; median [Q1-Q3] age 72 [65-81], CHA2DS2-VASc score 5 [4-6], HAS-BLED 3 [3-4]). In this group, 14.5% of patients did not receive OACs, 68% received NOACs, and 17.5% VKAs. In multivariable analysis, the independent predictors of nonuse of oral OACs were as follows: creatinine level (odds ratio [OR], 1.441; 95% confidence interval [CI], 1.174-1.768; P <0.001), a history of gastrointestinal bleeding (OR, 2.918; 95% CI, 1.395-6.103; P = 0.004), malignant neoplasm (OR, 3.127; 95% CI, 1.332-7.343; P = 0.009), and a history of strokes or transient ischemic attacks (OR, 0.327; 95% CI, 0.166-0.642; P = 0.001). CONCLUSIONS OACs were used much less frequently in the group with a high HAS-BLED score than in the group with a low score. Independent predictors of nonuse of OACs were creatinine levels, a history of gastrointestinal bleeding, and malignant neoplasms. A history of stroke or transient ischemic attack increased the chances of receiving therapy.
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Affiliation(s)
- Małgorzata Maciorowska
- Department of Cardiology and Internal Diseases, Military Institute of Medicine - National Research Institute, Warszawa, Poland.
| | - Beata Uziębło-Życzkowska
- Department of Cardiology and Internal Diseases, Military Institute of Medicine - National Research Institute, Warszawa, Poland
| | | | - Beata Wożakowska-Kapłon
- Collegium Medicum, The Jan Kochanowski University, Kielce, Poland
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, Kielce, Poland
| | - Olga Jelonek
- Collegium Medicum, The Jan Kochanowski University, Kielce, Poland
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, Kielce, Poland
| | - Maciej Wójcik
- Department of Cardiology, Medical University of Lublin, Lublin, Poland
| | - Robert Błaszczyk
- Department of Cardiology, Medical University of Lublin, Lublin, Poland
| | | | - Monika Gawałko
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
- Institute of Pharmacology, West German Heart and Vascular Centre, University Duisburg-Essen, Essen, Germany
| | - Tomasz Tokarek
- Center for Invasive Cardiology, Electrotherapy and Angiology, Nowy Sącz, Poland
- Center for Innovative Medical Education, Jagiellonian University Medical College, Kraków, Poland
| | - Renata Rajtar-Salwa
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | - Jacek Bil
- Centre of Postgraduate Medical Education, Department of Invasive Cardiology, Central Clinical Hospital of the Ministry of Interior and Administration, Warszawa, Poland
| | - Michał Wojewódzki
- Centre of Postgraduate Medical Education, Department of Invasive Cardiology, Central Clinical Hospital of the Ministry of Interior and Administration, Warszawa, Poland
| | - Anna Szpotowicz
- Department of Cardiology, Regional Hospital, Ostrowiec Świętokrzyski, Poland
| | - Małgorzata Krzciuk
- Department of Cardiology, Regional Hospital, Ostrowiec Świętokrzyski, Poland
| | - Janusz Bednarski
- Department of Cardiology, St John Paul II Western Hospital, Clinic of Cardiology, Grodzisk Mazowiecki, Poland
- Lazarski University, Warszawa, Poland
| | - Elwira Bakuła-Ostalska
- Department of Cardiology, St John Paul II Western Hospital, Clinic of Cardiology, Grodzisk Mazowiecki, Poland
| | | | - Anna Szyszkowska
- Department of Cardiology, Medical University of Bialystok, Białystok, Poland
| | - Marcin Wełnicki
- 3rd Department of Internal Diseases and Cardiology, Warsaw Medical University, Warszawa, Poland
| | - Artur Mamcarz
- 3rd Department of Internal Diseases and Cardiology, Warsaw Medical University, Warszawa, Poland
| | - Paweł Krzesiński
- Department of Cardiology and Internal Diseases, Military Institute of Medicine - National Research Institute, Warszawa, Poland
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Pieszko K, Hiczkiewicz J, Łojewska K, Uziębło-Życzkowska B, Krzesiński P, Gawałko M, Budnik M, Starzyk K, Wożakowska-Kapłon B, Daniłowicz-Szymanowicz L, Kaufmann D, Wójcik M, Błaszczyk R, Mizia-Stec K, Wybraniec M, Kosmalska K, Fijałkowski M, Szymańska A, Dłużniewski M, Kucio M, Haberka M, Kupczyńska K, Michalski B, Tomaszuk-Kazberuk A, Wilk-Śledziewska K, Wachnicka-Truty R, Koziński M, Kwieciński J, Wolny R, Kowalik E, Kolasa I, Jurek A, Budzianowski J, Burchardt P, Kapłon-Cieślicka A, Slomka PJ. Artificial intelligence in detecting left atrial appendage thrombus by transthoracic echocardiography and clinical features: the Left Atrial Thrombus on Transoesophageal Echocardiography (LATTEE) registry. Eur Heart J 2024; 45:32-41. [PMID: 37453044 PMCID: PMC10757867 DOI: 10.1093/eurheartj/ehad431] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 05/03/2023] [Accepted: 06/22/2023] [Indexed: 07/18/2023] Open
Abstract
AIMS Transoesophageal echocardiography (TOE) is often performed before catheter ablation or cardioversion to rule out the presence of left atrial appendage thrombus (LAT) in patients on chronic oral anticoagulation (OAC), despite associated discomfort. A machine learning model [LAT-artificial intelligence (AI)] was developed to predict the presence of LAT based on clinical and transthoracic echocardiography (TTE) features. METHODS AND RESULTS Data from a 13-site prospective registry of patients who underwent TOE before cardioversion or catheter ablation were used. LAT-AI was trained to predict LAT using data from 12 sites (n = 2827) and tested externally in patients on chronic OAC from two sites (n = 1284). Areas under the receiver operating characteristic curve (AUC) of LAT-AI were compared with that of left ventricular ejection fraction (LVEF) and CHA2DS2-VASc score. A decision threshold allowing for a 99% negative predictive value was defined in the development cohort. A protocol where TOE in patients on chronic OAC is performed depending on the LAT-AI score was validated in the external cohort. In the external testing cohort, LAT was found in 5.5% of patients. LAT-AI achieved an AUC of 0.85 [95% confidence interval (CI): 0.82-0.89], outperforming LVEF (0.81, 95% CI 0.76-0.86, P < .0001) and CHA2DS2-VASc score (0.69, 95% CI: 0.63-0.7, P < .0001) in the entire external cohort. Based on the proposed protocol, 40% of patients on chronic OAC from the external cohort would safely avoid TOE. CONCLUSION LAT-AI allows accurate prediction of LAT. A LAT-AI-based protocol could be used to guide the decision to perform TOE despite chronic OAC.
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Affiliation(s)
- Konrad Pieszko
- ‘Club 30’, Polish Cardiac Society, Poland
- Department of Interventional Cardiology and Cardiac Surgery, University of Zielona Gora, Collegium Medicum, Zielona Gora, Poland
- WSSP ZOZ Nowa Sol, Nowa Sol, Poland
| | - Jarosław Hiczkiewicz
- Department of Interventional Cardiology and Cardiac Surgery, University of Zielona Gora, Collegium Medicum, Zielona Gora, Poland
- WSSP ZOZ Nowa Sol, Nowa Sol, Poland
| | | | - Beata Uziębło-Życzkowska
- ‘Club 30’, Polish Cardiac Society, Poland
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
| | - Paweł Krzesiński
- ‘Club 30’, Polish Cardiac Society, Poland
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
| | - Monika Gawałko
- ‘Club 30’, Polish Cardiac Society, Poland
- First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
- Institute of Pharmacology, West German Heart and Vascular Centre, University Duisburg-Essen, Essen, Germany
| | - Monika Budnik
- ‘Club 30’, Polish Cardiac Society, Poland
- First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Starzyk
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, Kielce, Poland
| | - Beata Wożakowska-Kapłon
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, Kielce, Poland
| | | | - Damian Kaufmann
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Maciej Wójcik
- Department of Cardiology, Medical University of Lublin, Lublin, Poland
| | - Robert Błaszczyk
- Department of Cardiology, Medical University of Lublin, Lublin, Poland
| | - Katarzyna Mizia-Stec
- 1st Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Maciej Wybraniec
- 1st Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | | | | | - Anna Szymańska
- Department of Heart Diseases, Postgraduate Medical School, Warsaw, Poland
| | | | - Michał Kucio
- Department of Cardiology, School of Health Sciences, Medical University of Silesia, Katowice, Poland
| | - Maciej Haberka
- Department of Cardiology, School of Health Sciences, Medical University of Silesia, Katowice, Poland
| | | | - Błażej Michalski
- Department of Cardiology, Medical University of Lodz, Lodz, Poland
| | | | | | - Renata Wachnicka-Truty
- Department of Cardiology and Internal Medicine, Medical University of Gdansk, Gdynia, Poland
| | - Marek Koziński
- ‘Club 30’, Polish Cardiac Society, Poland
- Department of Cardiology and Internal Medicine, Medical University of Gdansk, Gdynia, Poland
| | - Jacek Kwieciński
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Rafał Wolny
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Ewa Kowalik
- Department of Congenital Heart Diseases, National Institute of Cardiology, Warsaw, Poland
| | - Iga Kolasa
- Department of Interventional Cardiology and Cardiac Surgery, University of Zielona Gora, Collegium Medicum, Zielona Gora, Poland
| | - Agnieszka Jurek
- ‘Club 30’, Polish Cardiac Society, Poland
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
| | - Jan Budzianowski
- ‘Club 30’, Polish Cardiac Society, Poland
- Department of Interventional Cardiology and Cardiac Surgery, University of Zielona Gora, Collegium Medicum, Zielona Gora, Poland
- WSSP ZOZ Nowa Sol, Nowa Sol, Poland
| | - Paweł Burchardt
- ‘Club 30’, Polish Cardiac Society, Poland
- Department of Biology and Lipid Disorders, Poznan University of Medical Sciences, Poznan, Poland
| | - Agnieszka Kapłon-Cieślicka
- ‘Club 30’, Polish Cardiac Society, Poland
- First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Piotr J Slomka
- Department of Medicine (Division of Artificial Intelligence in Medicine), Cedars-Sinai Medical Center, 8700 Beverly Blvd, Suite Metro 203, 90048, Los Angeles, CA, USA
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5
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Wałek P, Roskal-Wałek J, Dłubis P, Wożakowska-Kapłon B. Echocardiographic Evaluation of Atrial Remodelling for the Prognosis of Maintaining Sinus Rhythm after Electrical Cardioversion in Patients with Atrial Fibrillation. J Clin Med 2023; 12:5158. [PMID: 37568560 PMCID: PMC10419596 DOI: 10.3390/jcm12155158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/02/2023] [Accepted: 08/05/2023] [Indexed: 08/13/2023] Open
Abstract
Atrial fibrillation (AF) is the most common atrial tachyarrhythmia. One of the methods of AF treatment is direct current cardioversion (DCCV), but in the long-term follow-up we observe quite a high percentage of AF recurrences after this procedure. In order to assess the prognosis of DCCV effectiveness, we use clinical, biochemical and echocardiographic parameters. The objective of this review is to systematise the current knowledge on echocardiographic measurements in patients with persistent AF used to assess the progress of remodelling of the atrial wall, which affects the likelihood of maintaining sinus rhythm after DCCV. In this article, echocardiographic parameters for the evaluation of remodelling of the atrial wall are divided into groups referring to structural, mechanical, and electrical remodelling, as well as parameters for the evaluation of left ventricular filling pressure. The article aims to draw attention to the clinical value of echocardiographic measurements, which is the selection of patients who will maintain sinus rhythm after DCCV in the long-term follow-up, which will allow to avoid unnecessary risks associated with the procedure and enable the selection of the appropriate treatment strategy.
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Affiliation(s)
- Paweł Wałek
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland; (J.R.-W.); (P.D.); (B.W.-K.)
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, 25-736 Kielce, Poland
| | - Joanna Roskal-Wałek
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland; (J.R.-W.); (P.D.); (B.W.-K.)
- Ophthalmology Clinic, Voivodeship Regional Hospital, 25-736 Kielce, Poland
| | - Patryk Dłubis
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland; (J.R.-W.); (P.D.); (B.W.-K.)
| | - Beata Wożakowska-Kapłon
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland; (J.R.-W.); (P.D.); (B.W.-K.)
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, 25-736 Kielce, Poland
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6
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Roskal-Wałek J, Mackiewicz J, Wałek P, Sidło J, Biskup M, Wożakowska-Kapłon B, Odrobina D. Long-term mortality after retinal artery occlusion - a single centre study. Ann Agric Environ Med 2023; 30:252-258. [PMID: 37387374 DOI: 10.26444/aaem/167379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
INTRODUCTION AND OBJECTIVE Retinal artery occlusion (RAO) is an ophthalmic and systemic emergency requiring urgent diagnosis and treatment. Data regarding mortality in this group, especially in the European population, are modest. The aim of this study is to assess all-cause mortality in post-RAO patients. MATERIAL AND METHODS This is a retrospective, single-centre study involving 198 patients following RAO diagnosed in 2004-2020. The control group included 198 patients after cataract surgery matched for gender and age, with the date of cataract surgery corresponding to the date of the RAO. RESULTS The average follow-up of the study population was 6.32±2.15 years. Post-RAO patients had significantly higher risk of all-cause mortality (Log-rank test p = 0.001), also when stratified for ages below 75 years (Log-rank test p = 0.016) and those aged 75 and over (Log-rank test p = 0.001). In the group of patients without cardiovascular events before RAO/cataract surgery, post-RAO patients were also at higher risk of all-cause mortality (Log-rank test p = 0.011), but when stratified according to age, those observations were borderline significant (Log-rank test p = 0.083 for a group of patients aged less than 75 years, and p = 0.051 for patients aged 75 and over). Cox analysis showed that in the group of post-RAO patients, the main risk factors for all-cause mortality were age (HR 1.07, 95%CI 1.04-1.1; p < 0.001), ischemic heart disease (HR 1.72; 95%CI 1.08-2.72; p = 0.022), and permanent atrial fibrillation (HR 2.18, 95%CI 1.08-4.38; p = 0.029). CONCLUSIONS Regardless of age and previous cardiovascular events, post-RAO patients are at a higher risk of all-cause mortality than patients without a history of RAO.
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Affiliation(s)
- Joanna Roskal-Wałek
- Department of Ophthalmology, Regional Hospital, Kielce, Poland
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Jerzy Mackiewicz
- Department of Vitreoretinal Surgery, Medical University, Lublin, Poland
| | - Paweł Wałek
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, Kielce, Poland
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Jacek Sidło
- Department of Ophthalmology, Regional Hospital, Kielce, Poland
| | - Michał Biskup
- Department of Ophthalmology, Regional Hospital, Kielce, Poland
| | - Beata Wożakowska-Kapłon
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, Kielce, Poland
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Dominik Odrobina
- Ophthalmology Clinic Boni Fratres Lodziensis, Łódż, Poland
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
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7
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Bielecka B, Gorczyca-Głowacka I, Ciba-Stemplewska A, Wożakowska-Kapłon B. Anticoagulant Treatment in Patients with AF and Very High Thromboembolic Risk in the Era before and after the Introduction of NOAC: Observation at a Polish Reference Centre. Int J Environ Res Public Health 2023; 20:6145. [PMID: 37372735 PMCID: PMC10298142 DOI: 10.3390/ijerph20126145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/01/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023]
Abstract
Atrial fibrillation (AF) is associated with an increased risk of stroke. Therefore, patients with AF require appropriate management and anticoagulant therapy. To balance therapy risks and benefits, oral anticoagulants (OAC) treatment should be 'tailored' in patients at a high risk of stroke and bleeding. However, some studies have demonstrated that certain groups of patients do not receive anticoagulants despite the high risk of stroke or thromboembolism. The study aimed to analyse therapeutic methods of stroke prevention in very high-risk patients (CHA2DS2-VASc score of ≥5 in men and ≥6 in women), identify factors predisposing against the use of OACs and assess the administration of anticoagulants before the introduction of non-vitamin K antagonist OAC (NOAC) in 2004-2011 and beyond (years 2012-2019). The analysis covered 2441 patients with AF at a very high thromboembolic risk who were hospitalised in a reference cardiological centre from 2004 to 2019. Data concerning patients' sex, age, comorbidities, type of AF, renal and echocardiographic parameters, reasons for hospitalisation and applied treatment were collected from medical records. HAS-BLED, CHADS2, and CHA2DS2-VASc scores were calculated for all patients. The treatment with oral anticoagulants was compared in the entire population over 2004-2011 and 2012-2019. In this study, a fifth of patients were not treated with OAC. Most patients hospitalised in the years 2012-2019 were treated with OAC. The predictors of not using OAC turned out to be: age of >74 years, heart failure, cancer, paroxysmal AF, and acute coronary syndrome (ACS) or elective coronary angiography/percutaneous coronary intervention (PCI) as a reason for hospitalisation. The introduction of NOAC was associated with a decline in the use of VKA (from 62% to 19.1%) and APT (from 29.1% to 1.3%). This study outlines reasons to initiate OAC treatment in very high-risk patients in clinical practice.
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Affiliation(s)
- Bernadetta Bielecka
- 1st Clinic of Cardiology and Electrotherapy, Świętokrzyskie Cardiology Centre, 25-736 Kielce, Poland; (B.B.); (B.W.-K.)
| | | | - Agnieszka Ciba-Stemplewska
- Collegium Medicum, Jan Kochanowski University, 25-369 Kielce, Poland;
- Clinic of Internal Medicine, 25-736 Kielce, Poland
| | - Beata Wożakowska-Kapłon
- 1st Clinic of Cardiology and Electrotherapy, Świętokrzyskie Cardiology Centre, 25-736 Kielce, Poland; (B.B.); (B.W.-K.)
- Collegium Medicum, Jan Kochanowski University, 25-369 Kielce, Poland;
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8
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Kasprzak JD, Gorczyca-Głowacka I, Sobczak-Kaleta M, Barylski M, Drożdż J, Filipiak KJ, Kapłon-Cieślicka A, Lelonek M, Mamcarz A, Ochijewicz D, Ryś-Czaporowska A, Starzyk K, Szymański FM, Wełnicki M, Wożakowska-Kapłon B. Pharmacotherapy of heart failure A.D. 2023. Expert opinion of Working Group on Cardiovascular Pharmacotherapy, Polish Cardiac Society. Kardiol Pol 2023:VM/OJS/J/95406. [PMID: 37179465 DOI: 10.33963/kp.a2023.0110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 05/02/2023] [Indexed: 05/15/2023]
Abstract
Heart failure (HF) remains one of the most common causes of hospitalization and mortality among Polish patients. The position of the Section of Cardiovascular Pharmacotherapy presents the currently applicable options for pharmacological treatment of HF based on the latest European and American guidelines from 2021-2022 in relation to Polish health care conditions. Treatment of HF varies depending on its clinical presentation (acute/chronic) or left ventricular ejection fraction. Initial treatment of symptomatic patients with features of volume overload is based on diuretics, especially loop drugs. Treatment aimed at reducing mortality and hospitalization should include: drugs blocking the renin-angiotensin-aldosterone system (preferably angiotensin receptor antagonist/neprilisin inhibitor, i.e. sacubitril/valsartan, selected beta-blockers (no class effect - options include bisoprolol, metoprolol succinate, or vasodilatory beta-blockers - carvedilol and nebivolol), mineralocorticoid receptor antagonist and sodium-glucose cotransporter type 2 inhibitor (flozin), constituting the 4 pillars of pharmacotherapy. Their effectiveness of the above-mentioned has been confirmed in numerous prospective, randomized trials. The current HF treatment strategy is based on the fastest possible implementation of all four mentioned classes of drugs due to their independent, additive action. It is also important to individualize therapy according to comorbidities, blood pressure, resting heart rate, or presence of arrhythmia. The manuscript emphasizes cardio- and nephroprotective role of flozins in HF therapy, regardless of ejection fraction. We propose practical guidelines for the use of medicines, the profile of adverse reactions, drug interactions, as well as pharmacoeconomic aspects. The principles of treatment with ivabradine, digoxin, vericiguat, iron supplementation or antiplatelet and anticoagulant therapy were also discussed, along with recent novel drugs including omecamtiv mecarbil, tolvaptan or coenzyme Q10 as well as progress in the prevention and treatment of hyperkalemia. Based on the latest recommendations, treatment regimens for different types of HF were discussed.
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Affiliation(s)
| | | | | | - Marcin Barylski
- Department of Internal Diseases and Cardiac Rehabilitation, Medical University of Lodz, Łódź, Poland
| | - Jarosław Drożdż
- 2nd Department of Cardiology, Medical University Lodz, Łódź, Poland
| | - Krzysztof J Filipiak
- Institute of Clinical Sciences, Maria Sklodowska-Curie Medical Academy, Warszawa, Poland
| | | | - Małgorzata Lelonek
- Nonivasive Cardiology Unit, Chair of Internal Medicine and Cardiology, Medical University of Lodz, Łódź, Poland
| | - Artur Mamcarz
- 3rd Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Dorota Ochijewicz
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warszawa, Polska
| | - Anna Ryś-Czaporowska
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warszawa, Polska
| | - Katarzyna Starzyk
- Collegium Medicum, Jan Kochanowski University in Kielce, Kielce, Poland
- 1st Department of Cardiology and Electrotherapy, Świętokrzyskie Cardiology Center, Kielce, Poland
| | - Filip M Szymański
- Department of Civilization Diseases, Faculty of Medicine, Collegium Medicum, Stefan Cardinal Wyszynski University in Warsaw, Warszawa, Polan
| | - Marcin Wełnicki
- 1st Department of Cardiology and Electrotherapy, Świętokrzyskie Cardiology Center, Kielce, Poland
| | - Beata Wożakowska-Kapłon
- Collegium Medicum, Jan Kochanowski University in Kielce, Kielce, Poland
- 1st Department of Cardiology and Electrotherapy, Świętokrzyskie Cardiology Center, Kielce, Poland
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9
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Tracz J, Gorczyca-Głowacka I, Rosołowska A, Wożakowska-Kapłon B. Long-Term Outcomes after Stroke in Patients with Atrial Fibrillation: A Single Center Study. Int J Environ Res Public Health 2023; 20:3491. [PMID: 36834183 PMCID: PMC9967874 DOI: 10.3390/ijerph20043491] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/11/2023] [Accepted: 02/13/2023] [Indexed: 06/18/2023]
Abstract
Atrial fibrillation (AF) is known to be a significant risk factor for poor prognosis after stroke. In this study, we compared differences in long-term outcomes after ischemic stroke among patients with AF and sinus rhythm (SR). We identified patients admitted to the reference Neurology Center between 1 January 2013 and 30 April 2015, inclusive, with acute ischemic stroke. Of the 1959 surviving patients, 892 were enrolled and followed for five years or until death. We analyzed the risk of stroke recurrence and death between patients with AF and SR at 1, 3, and 5 years after stroke. The rates of death and stroke recurrence were estimated using Kaplan-Meier analysis and multivariate Cox regression. During follow-up, 17.8% of patients died and 14.6% had recurrent stroke. The mortality in the AF group increased relative to the SR group with subsequent years. The risk of death was statistically higher in the AF than SR group at 1 year after stroke (13.5 vs. 7%, p = 0.004). After adjusting for age, stroke severity, and comorbidities, there was also no significant effect of AF on mortality in the first year after stroke (OR = 1.59, p = 0.247). There were no significant differences between the groups in stroke recurrence during follow-up. The results of our study showed that post-stroke patients with AF have a more severe prognosis, although AF itself does not have an independent negative effect on long-term outcomes after stroke. Long-term survival after stroke in patients with AF was strongly associated with age, stroke severity, and heart failure. The impact of other factors on prognosis after stroke in patients with AF should be considered.
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Affiliation(s)
- Justyna Tracz
- Clinic of Neurology, Swietokrzyskie Neurology Center, 25-736 Kielce, Poland
| | - Iwona Gorczyca-Głowacka
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, 25-736 Kielce, Poland
| | - Anita Rosołowska
- Clinic of Neurology, Swietokrzyskie Neurology Center, 25-736 Kielce, Poland
| | - Beata Wożakowska-Kapłon
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, 25-736 Kielce, Poland
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland
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10
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Gorczyca-Głowacka I, Wełnicki M, Mamcarz A, Filipiak KJ, Wożakowska-Kapłon B, Barylski M, Szymański FM, Kasprzak JD, Tomasiewcz K. Metabolic associated fatty liver disease and cardiovascular risk: The expert opinion of the Working Group on Cardiovascular Pharmacotherapy of the Polish Cardiac Society. Kardiol Pol 2023; 81:207-214. [PMID: 36866400 DOI: 10.33963/kp.a2023.0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 01/22/2023] [Indexed: 03/04/2023]
Abstract
The diagnosis of metabolic associated fatty liver disease (MAFLD) is significant for patients' prognosis, as the disease accelerates the development of cardiovascular complications and, on the other hand, cardiometabolic conditions are risk factors for the development of fatty liver diseases. This expert opinion presents principles of MAFLD diagnosis and standards of management to reduce cardiovascular risks in patients with MAFLD.
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Affiliation(s)
| | - Marcin Wełnicki
- 3rd Department of Internal Diseases and Cardiology, Warsaw Medical University, Warszawa, Poland
| | - Artur Mamcarz
- 3rd Department of Internal Diseases and Cardiology, Warsaw Medical University, Warszawa, Poland
| | - Krzysztof J Filipiak
- Institute of Clinical Sciences, Maria Sklodowska-Curie Medical Academy in Warsaw, Warszawa, Poland
| | - Beata Wożakowska-Kapłon
- Collegium Medicum, Jan Kochanowski University in Kielce, Kielce, Poland.,1st Department of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Center in Kielce, Kielce, Poland
| | - Marcin Barylski
- Department of Internal Diseases and Cardiological Physiotherapy, Medical University in Lodz, Łódź, Poland
| | - Filip M Szymański
- Department of Civilization Diseases, Collegium Medicum, Cardinal Stefan Wyszyński University in Warsaw, Warszawa, Poland
| | | | - Krzysztof Tomasiewcz
- Chair and Department of Infectious Diseases, the Medical University in Lublin, Lublin, Poland
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11
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Kaufmann D, Wabich E, Kapłon-Cieślicka A, Gawałko M, Budnik M, Uziębło-Życzkowska B, Krzesiński P, Starzyk K, Wożakowska-Kapłon B, Wójcik M, Błaszczyk R, Hiczkiewicz J, Budzianowski J, Mizia-Stec K, Wybraniec MT, Kosmalska K, Fijałkowski M, Szymańska A, Dłużniewski M, Haberka M, Kucio M, Michalski B, Kupczyńska K, Tomaszuk-Kazberuk A, Wilk-Śledziewska K, Wachnicka-Truty R, Koziński M, Burchardt P, Daniłowicz-Szymanowicz L. Echocardiographic predictors of thrombus in left atrial appendage—The role of novel transthoracic parameters. Front Cardiovasc Med 2022; 9:1059111. [DOI: 10.3389/fcvm.2022.1059111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 10/31/2022] [Indexed: 12/05/2022] Open
Abstract
IntroductionThe left atrium appendage thrombus (LAAT) formation is a complex process. A CHA2DS2-VASc scale is an established tool for determining the thromboembolic risk and initiation of anticoagulation treatment in patients with atrial fibrillation or flutter (AF/AFL). We aimed to identify whether any transthoracic echocardiography (TTE) parameters could have an additional impact on LAAT detection.MethodsThat is a sub-study of multicenter, prospective, observational study LATTEE (NCT03591627), which enrolled 3,109 consecutive patients with AF/AFL referred for transesophageal echocardiography (TEE) before cardioversion or ablation.ResultsLAAT was diagnosed in 8.0% of patients. The univariate logistic regression analysis [based on pre-specified in the receiver operating characteristic (ROC) analysis cut-off values with AUC ≥ 0.7] identified left ventricular ejection fraction (LVEF) ≤ 48% and novel TTE parameters i.e., the ratios of LVEF and left atrial diameter (LAD) ≤ 1.1 (AUC 0.75; OR 5.64; 95% CI 4.03–7.9; p < 0.001), LVEF to left atrial area (LAA) ≤ 1.7 (AUC 0.75; OR 5.64; 95% CI 4.02–7.9; p < 0.001), and LVEF to indexed left atrial volume (LAVI) ≤ 1.1 (AUC 0.75, OR 6.77; 95% CI 4.25–10.8; p < 0.001) as significant predictors of LAAT. In a multivariate logistic regression analysis, LVEF/LAVI and LVEF/LAA maintained statistical significance. Calculating the accuracy of the abovementioned ratios according to the CHA2DS2-VASc scale values revealed their highest predictive power for LAAT in a setting with low thromboembolic risk.ConclusionNovel TTE indices could help identify patients with increased probability of the LAAT, with particular applicability for patients at low thromboembolic risk.
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12
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Wałek P, Roskal-Wałek J, Dłubis P, Tracz J, Wożakowska-Kapłon B. Left Atrial Wall Motion Velocity Assessed during Atrial Fibrillation Predicts Sinus Rhythm Maintenance after Electrical Cardioversion in Patients with Persistent Atrial Fibrillation. Int J Environ Res Public Health 2022; 19:15508. [PMID: 36497585 PMCID: PMC9740887 DOI: 10.3390/ijerph192315508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/16/2022] [Accepted: 11/19/2022] [Indexed: 06/17/2023]
Abstract
Reduced left atrial wall motion velocity measured during AF (LAWMV) indicates left atrial remodeling. The aim of this study was to investigate whether LAWMV assessed with tissue Doppler imaging during atrial fibrillation (AF) predicts sinus rhythm (SR) maintenance after direct current cardioversion (DCCV) for persistent AF. The study included 126 patients who underwent DCCV and were followed for 12 months. At 12 months, maintained SR was reported in 55 patients (43.7%). We noted that LAWMV was higher in patients with maintained SR at 12 months than in those with recurrent AF (3.69 ± 0.84 vs. 2.86 ± 1.09; p < 0.001). In the multivariable regression model containing echocardiographic variables, LAWMV was an independent predictor of SR maintenance at 12 months (odds ratio [OR] 1.72, 95% confidence interval [CI] 1.1-2.69; p = 0.017). Similarly, LAWMW was an independent predictor of SR maintenance at 12 months (OR 1.81, 95% CI 1.19-2.77; p = 0.006) in the multivariate regression model containing both echocardiographic and clinical variables. LAWMV predicts SR maintenance after DCCV for persistent AF. Echocardiographic markers of left atrial mechanical remodeling are better at predicting SR maintenance than markers of structural remodeling.
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Affiliation(s)
- Paweł Wałek
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, 25-736 Kielce, Poland
| | - Joanna Roskal-Wałek
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland
- Ophthalmology Clinic, Voivodeship Regional Hospital, 25-736 Kielce, Poland
| | - Patryk Dłubis
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland
| | - Justyna Tracz
- Clinic of Neurology, Swietokrzyskie Neurology Center, 25-736 Kielce, Poland
| | - Beata Wożakowska-Kapłon
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, 25-736 Kielce, Poland
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13
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Uziȩbło-Życzkowska B, Kapłon-Cieślicka A, Gawałko M, Budnik M, Starzyk K, Wożakowska-Kapłon B, Daniłowicz-Szymanowicz L, Kaufmann D, Wójcik M, Błaszczyk R, Hiczkiewicz J, Łojewska K, Mizia-Stec K, Wybraniec M, Kosmalska K, Fijałkowski M, Szymańska A, Gos A, Haberka M, Kucio M, Michalski B, Kupczyńska K, Tomaszuk-Kazberuk A, Wilk-Śledziewska K, Wachnicka-Truty R, Koziński M, Burchardt P, Krzesiński P. Risk factors for left atrial thrombus in younger patients (aged < 65 years) with atrial fibrillation or atrial flutter: Data from the multicenter left atrial thrombus on transesophageal echocardiography (LATTEE) registry. Front Cardiovasc Med 2022; 9:973043. [PMID: 36312270 PMCID: PMC9611536 DOI: 10.3389/fcvm.2022.973043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 09/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background Methods Results Conclusions
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Affiliation(s)
- Beata Uziȩbło-Życzkowska
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland,*Correspondence: Beata Uziȩbło-Życzkowska
| | - Agnieszka Kapłon-Cieślicka
- “Club 30”, Polish Cardiac Society, Katowice, Poland,1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Monika Gawałko
- “Club 30”, Polish Cardiac Society, Katowice, Poland,1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland,West German Heart and Vascular Centre, Institute of Pharmacology, University Duisburg-Essen, Duisburg, Germany,Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
| | - Monika Budnik
- “Club 30”, Polish Cardiac Society, Katowice, Poland,1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | | | | | | | - Damian Kaufmann
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Maciej Wójcik
- “Club 30”, Polish Cardiac Society, Katowice, Poland,Department of Cardiology, Medical University of Lublin, Lublin, Poland
| | - Robert Błaszczyk
- Department of Cardiology, Medical University of Lublin, Lublin, Poland
| | - Jarosław Hiczkiewicz
- Collegium Medicum, University of Zielona Góra, Zielona Góra, Poland,Clinical Department of Cardiology, Nowa Sól Multidisciplinary Hospital, Nowa Sol, Poland
| | - Katarzyna Łojewska
- Clinical Department of Cardiology, Nowa Sól Multidisciplinary Hospital, Nowa Sol, Poland
| | - Katarzyna Mizia-Stec
- “Club 30”, Polish Cardiac Society, Katowice, Poland,Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland,Members of the European Reference Network on Heart Diseases–ERN GUARD-HEART, Amsterdam, Netherlands
| | - Maciej Wybraniec
- “Club 30”, Polish Cardiac Society, Katowice, Poland,Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland,Members of the European Reference Network on Heart Diseases–ERN GUARD-HEART, Amsterdam, Netherlands
| | | | - Marcin Fijałkowski
- 1st Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Anna Szymańska
- Department of Heart Diseases, Postgraduate Medical School, Warsaw, Poland
| | - Aleksandra Gos
- Department of Heart Diseases, Postgraduate Medical School, Warsaw, Poland
| | - Maciej Haberka
- “Club 30”, Polish Cardiac Society, Katowice, Poland,Department of Cardiology, School of Health Sciences, Medical University of Silesia, Katowice, Poland
| | - Michał Kucio
- Department of Cardiology, School of Health Sciences, Medical University of Silesia, Katowice, Poland
| | - Błazej Michalski
- “Club 30”, Polish Cardiac Society, Katowice, Poland,Department of Cardiology, Medical University of Lodz, Lodz, Poland
| | - Karolina Kupczyńska
- “Club 30”, Polish Cardiac Society, Katowice, Poland,Department of Cardiology, Medical University of Lodz, Lodz, Poland
| | | | | | - Renata Wachnicka-Truty
- Department of Cardiology and Internal Medicine, Medical University of Gdańsk, Gdynia, Poland
| | - Marek Koziński
- “Club 30”, Polish Cardiac Society, Katowice, Poland,Department of Cardiology and Internal Medicine, Medical University of Gdańsk, Gdynia, Poland
| | - Paweł Burchardt
- “Club 30”, Polish Cardiac Society, Katowice, Poland,Department of Hypertension, Angiology, and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Paweł Krzesiński
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland,“Club 30”, Polish Cardiac Society, Katowice, Poland
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14
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Ciba-Stemplewska A, Gorczyca-Głowacka I, Kapłon-Cieślicka A, Uziębło-Życzkowska B, Budnik M, Gawałko M, Krzesiński P, Jurek A, Scisło P, Filipiak KJ, Opolski G, Wożakowska-Kapłon B. Differences in the predictors of left atrial appendage thrombus between men and women treated with dabigatran or rivaroxaban. Pol Arch Intern Med 2022; 132. [PMID: 35916361 DOI: 10.20452/pamw.16301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Some patients with atrial fibrillation (AF) develop left atrial appendage thrombus (LAAT) despite receiving anticoagulant treatment. Different scores were proposed to evaluate thromboembolic risk in patients with AF. Risk stratification according to sex is common in clinical practice. OBJECTIVE We aimed to identify predictors of LAAT separately in men and women treated with dabigatran or rivaroxaban. PATIENTS AND METHODS This retrospective study included 1256 patients (479 women [38.1%]) with AF who underwent transesophageal echocardiography before electrical cardioversion or catheter ablation, between January 2013 and December 2019, and received dabigatran or rivaroxaban for at least 3 weeks. RESULTS Multivariable logistic regression analysis revealed nonparoxysmal AF to predict LAAT in women (odds ratio [OR], 9.70; P = 0.002). In men, the predictors were heart failure (OR, 4.14; P = 0.001), diabetes (OR, 2.64; P = 0.002), nonparoxysmal AF (OR, 5.61; P = 0.02), and estimated glomerular filtration rate below 60 ml/min/1.73 m2 (OR, 2.77; P = 0.01). In the receiver operating characteristic curve analysis, the CHA2DS2‑VASc-RAF score had the highest value for predicting LAAT in women (area under the curve [AUC] = 0.786). In men, CHA2DS2‑VASc-RAF, CHA2DS2, CHA2DS2‑VASc, and R2CHADS2 had sufficient predictive value (AUC = 0.786, 0.726, 0.734, and 0.780, respectively). CONCLUSIONS The predictors of LAAT differ between men and women treated with dabigatran or rivaroxaban. In women, the CHA2DS2‑VASc‑RAF score had the highest predictive value, while in men all the scores had equally sufficient predictive value.
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Affiliation(s)
- Agnieszka Ciba-Stemplewska
- Department of Internal Medicine, Integrated Provincial Hospital, Kielce, Poland,Jan Kochanowski University, Collegium Medicum, Kielce, Poland
| | - Iwona Gorczyca-Głowacka
- Jan Kochanowski University, Collegium Medicum, Kielce, Poland; 1st Department of Cardiology and Electrotherapy, Świętokrzyskie Cardiology Center, Kielce, Poland.
| | | | | | - Monika Budnik
- 1st Department and Division of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Monika Gawałko
- 1st Department and Division of Cardiology, Medical University of Warsaw, Warsaw, Poland,Institute of Pharmacology, West German Heart and Vascular Centre, University Duisburg-Essen, Duisburg, Germany
| | - Paweł Krzesiński
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
| | - Agnieszka Jurek
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
| | - Piotr Scisło
- 1st Department and Division of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Krzysztof J Filipiak
- 1st Department and Division of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Grzegorz Opolski
- 1st Department and Division of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Beata Wożakowska-Kapłon
- 1st Department of Cardiology and Electrotherapy, Świętokrzyskie Cardiology Center, Kielce, Poland
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15
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Szyszkowska A, Kuźma Ł, Wożakowska-Kapłon B, Gorczyca-Głowacka I, Jelonek O, Uziębło-Życzkowska B, Krzesiński P, Wójcik M, Błaszczyk R, Gawałko M, Kapłon-Cieślicka A, Tokarek T, Rajtar-Salwa R, Bil J, Wojewódzki M, Szpotowicz A, Krzciuk M, Bednarski J, Bakuła E, Wełnicki M, Mamcarz A, Tomaszuk-Kazberuk A. Do Patients with Atrial Fibrillation and a History of Ischemic Stroke Overuse Reduced Doses of NOACs?-Results of the Polish Atrial Fibrillation (POL-AF) Registry. Int J Environ Res Public Health 2022; 19:11939. [PMID: 36231257 PMCID: PMC9564626 DOI: 10.3390/ijerph191911939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/16/2022] [Accepted: 09/19/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The aim of our study was to assess if patients with AF (atrial fibrillation) and a history of ischemic stroke (IS) excessively receive reduced doses of NOACs (non-vitamin K antagonist oral anticoagulants). METHODS The Polish AF (POL-AF) registry is a prospective, observational, multicenter study, including patients with AF from 10 cardiology hospital centers. In this study we focused on patients with IS in their past. RESULTS Among 3999 patients enrolled in the POL-AF registry, 479 (12%) had a previous history of IS. Compared to patients without IS history, post-stroke subjects had a higher CHA2DS2-VASc score (median score 7 vs. 4, p < 0.05). Of these subjects, 439 (92%) had anticoagulation therapy, 83 (18.9%) were treated with a vitamin K antagonist (VKA), 135 (30.8%) with rivaroxaban, 112 (25.5%) with dabigatran, and 109 (24.8%) with apixaban. There were a significant number of patients after IS with reduced doses of NOACs (48.9% for rivaroxaban, 45.5% for dabigatran, and 36.7% for apixaban). In many cases, patients were prescribed reduced doses of NOACs without any indication for reduction (28.8% of rivaroxaban use, 56.9% of dabigatran use, and 60.0% of apixaban use-out of reduced dosage groups, p = 0.06). CONCLUSIONS A significant proportion of AF patients received reduced doses of NOAC after ischemic stroke in a sizeable number of cases, without indication for dose reduction.
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Affiliation(s)
- Anna Szyszkowska
- Department of Cardiology, Medical University of Bialystok, 15-276 Bialystok, Poland
| | - Łukasz Kuźma
- Department of Invasive Cardiology, Medical University of Bialystok, 15-276 Bialystok, Poland
| | - Beata Wożakowska-Kapłon
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, 25-736 Kielce, Poland
- Collegium Medicum, The Jan Kochanowski University, 25-369 Kielce, Poland
| | - Iwona Gorczyca-Głowacka
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, 25-736 Kielce, Poland
- Collegium Medicum, The Jan Kochanowski University, 25-369 Kielce, Poland
| | - Olga Jelonek
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, 25-736 Kielce, Poland
- Collegium Medicum, The Jan Kochanowski University, 25-369 Kielce, Poland
| | - Beata Uziębło-Życzkowska
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, 04-141 Warsaw, Poland
| | - Paweł Krzesiński
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, 04-141 Warsaw, Poland
| | - Maciej Wójcik
- Department of Cardiology, Medical University of Lublin, 20-059 Lublin, Poland
| | - Robert Błaszczyk
- Department of Cardiology, Medical University of Lublin, 20-059 Lublin, Poland
| | - Monika Gawałko
- 1st Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
- Department of Cardiology, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht, 6229 ER Maastricht, The Netherlands
- Institute of Pharmacology, West German Heart and Vascular Centre, University Duisburg-Essen, 45147 Essen, Germany
| | | | - Tomasz Tokarek
- Center for Invasive Cardiology, Electrotherapy and Angiology, 38-400 Nowy Sacz, Poland
| | - Renata Rajtar-Salwa
- Cardiology and Cardiovascular Interventions Clinical Department, The University Hospital, 30-688 Krakow, Poland
| | - Jacek Bil
- Department of Invasive Cardiology, Center of Postgraduate Medical Education, 02-776 Warsaw, Poland
| | - Michał Wojewódzki
- Department of Invasive Cardiology, Center of Postgraduate Medical Education, 02-776 Warsaw, Poland
| | - Anna Szpotowicz
- Department of Cardiology, Regional Hospital, 27-400 Ostrowiec Swietokrzyski, Poland
| | - Małgorzata Krzciuk
- Department of Cardiology, Regional Hospital, 27-400 Ostrowiec Swietokrzyski, Poland
| | - Janusz Bednarski
- Department of Cardiology, St. John Paul’s II Western Hospital, 05-825 Grodzisk Mazowiecki, Poland
| | - Elwira Bakuła
- Department of Cardiology, St. John Paul’s II Western Hospital, 05-825 Grodzisk Mazowiecki, Poland
| | - Marcin Wełnicki
- 3rd Department of Internal Diseases and Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Artur Mamcarz
- 3rd Department of Internal Diseases and Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland
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Bielecka B, Gorczyca-Głowacka I, Wożakowska-Kapłon B. Nine-Year Trends in Prevention of Thromboembolic Complications in Elderly Patients with Atrial Fibrillation Treated with NOACs. Int J Environ Res Public Health 2022; 19:ijerph191911938. [PMID: 36231248 PMCID: PMC9565553 DOI: 10.3390/ijerph191911938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/16/2022] [Accepted: 09/18/2022] [Indexed: 05/04/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common disease in elderly patients and thromboembolic complication prophylaxis significantly improves the prognosis in these patients. The study assessed the frequency of individual non-vitamin K antagonist oral anticoagulant (NOAC) use among patients ≥75 years and attempted to identify factors predisposing to their prescription. METHODS The data of patients with non-valvular AF hospitalized in the reference cardiology center between 2011 and 2019 were analyzed. RESULTS Out of 1443 analyzed patients, 329 (22.8%) received apixaban, 618 (42.8%) dabigatran, and 496 (34.4%) rivaroxaban. The entire population mean age was 82.3 ± 5 years, and 57.9% were females. Independent predictors of apixaban use were age, and bleeding history. Hospitalization for the implantation/reimplantation of a cardiac implantable electronic device (CIED) reduced the chance of apixaban use. Hypertension was a predictor of dabigatran prescription. The chance of using dabigatran decreased with age. Hypertension and bleeding history decreased the chance of rivaroxaban application. CONCLUSIONS In hospitalized AF patients ≥75 years, dabigatran was the most frequently used NOAC. Age, comorbidities and bleeding risk determined the selection of individual NOACs.
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Affiliation(s)
- Bernadetta Bielecka
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, 25-736 Kielce, Poland
| | - Iwona Gorczyca-Głowacka
- Collegium Medicum, Jan Kochanowski University, 25-369 Kielce, Poland
- Correspondence: ; Tel.: +48-604-407-956
| | - Beata Wożakowska-Kapłon
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, 25-736 Kielce, Poland
- Collegium Medicum, Jan Kochanowski University, 25-369 Kielce, Poland
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Uziębło-Życzkowska B, Kapłon-Cieślicka A, Kiliszek M, Gawałko M, Budnik M, Starzyk K, Wożakowska-Kapłon B, Daniłowicz-Szymanowicz L, Kaufmann D, Wójcik M, Błaszczyk R, Hiczkiewicz J, Łojewska K, Mizia-Stec K, Wybraniec MT, Kosmalska K, Fijałkowski M, Szymańska A, Gos A, Haberka M, Kucio M, Michalski B, Kupczyńska K, Tomaszuk-Kazberuk A, Wilk-Śledziewska K, Wachnicka-Truty R, Koziński M, Burchardt P, Krzesiński P. Increased Body Mass Index and Risk of Left Atrial Thrombus in Nonvalvular Atrial Fibrillation Patients-Data from the Left Atrial Thrombus on Transesophageal Echocardiography (LATTEE) Registry. Nutrients 2022; 14:nu14173652. [PMID: 36079909 PMCID: PMC9460640 DOI: 10.3390/nu14173652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/21/2022] [Accepted: 08/30/2022] [Indexed: 11/16/2022] Open
Abstract
An increased body mass index (BMI) is associated with a higher incidence of atrial fibrillation (AF) and a higher risk of thromboembolic complications in AF patients. The aim of this study was to investigate the effect of BMI on the risk of left atrial thrombi (LATs) in patients with nonvalvular AF/atrial flutter (AFl) (NV AF/AFl). Patients diagnosed with NVAF/AFl (between November 2018 and May 2020) were selected from the multicenter, prospective, observational Left Atrial Thrombus on Transesophageal Echocardiography (LATTEE) registry that included AF/AFl patients referred for cardioversion or ablation followed by transesophageal echocardiography. A total of 2816 AF/AFl patients (63.6% males; mean age 65.8 years; mean BMI 29.8 kg/m2) were included in the study. Two hundred and twenty-two of them (7.9%) had LATs. Compared with normal-weight patients, those with BMIs ≥ 25 kg/m2 more frequently presented clinical factors potentially provoking LATs, such as non-paroxysmal AF/AFl (p = 0.04), hypertension (p < 0.001), and diabetes (p < 0.001); had higher CHA2DS2 scores (p < 0.001); and had larger LA dimensions (LA diameter and LA area) (p < 0.001 for both parameters). On the other hand, they showed some features negatively related to thromboembolic risk; for example, they were younger (p < 0.001) and were more often male (p = 0.002). In addition, patients with abnormal BMIs were more likely to be smokers (p = 0.006) and to be treated with oral anticoagulants (p = 0.005). Despite these differences in the prevalence of thromboembolic risk factors, the incidence of LATs was not increased in patients with abnormal body weight (overweight and obese compared to normal-weight patients) in this large real-life cohort of AF/AFl patients. This is probably due to the balanced composition regarding the prevalence of positive and negative thromboembolic risk factors.
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Affiliation(s)
- Beata Uziębło-Życzkowska
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, 01-755 Warsaw, Poland
- Correspondence: ; Tel.: +48-261-816376
| | - Agnieszka Kapłon-Cieślicka
- “Club 30”, Polish Cardiac Society, 40-001 Katowice, Poland
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Marek Kiliszek
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, 01-755 Warsaw, Poland
- “Club 30”, Polish Cardiac Society, 40-001 Katowice, Poland
| | - Monika Gawałko
- “Club 30”, Polish Cardiac Society, 40-001 Katowice, Poland
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland
- Institute of Pharmacology, West German Heart and Vascular Centre, University Duisburg-Essen, 4514 Essen, Germany
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, 6229 ER Maastricht, The Netherlands
| | - Monika Budnik
- “Club 30”, Polish Cardiac Society, 40-001 Katowice, Poland
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Katarzyna Starzyk
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland
| | | | | | - Damian Kaufmann
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Maciej Wójcik
- “Club 30”, Polish Cardiac Society, 40-001 Katowice, Poland
- Department of Cardiology, Medical University of Lublin, 20-059 Lublin, Poland
| | - Robert Błaszczyk
- Department of Cardiology, Medical University of Lublin, 20-059 Lublin, Poland
| | - Jarosław Hiczkiewicz
- Collegium Medicum, University of Zielona Góra, 65-417 Zielona Gora, Poland
- Clinical Department of Cardiology, Nowa Sól Multidisciplinary Hospital, 67-100 Nowa Sol, Poland
| | - Katarzyna Łojewska
- Clinical Department of Cardiology, Nowa Sól Multidisciplinary Hospital, 67-100 Nowa Sol, Poland
| | - Katarzyna Mizia-Stec
- “Club 30”, Polish Cardiac Society, 40-001 Katowice, Poland
- 1st Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, 40-635 Katowice, Poland
- Members of the European Reference Network on Heart Diseases—Ern Guard-Heart, 1105 AZ Amsterdam, The Netherlands
| | - Maciej T. Wybraniec
- “Club 30”, Polish Cardiac Society, 40-001 Katowice, Poland
- 1st Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, 40-635 Katowice, Poland
- Members of the European Reference Network on Heart Diseases—Ern Guard-Heart, 1105 AZ Amsterdam, The Netherlands
| | | | - Marcin Fijałkowski
- 1st Department of Cardiology, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Anna Szymańska
- Department of Heart Diseases, Postgraduate Medical School, 00-002 Warsaw, Poland
| | - Aleksandra Gos
- Department of Heart Diseases, Postgraduate Medical School, 00-002 Warsaw, Poland
| | - Maciej Haberka
- “Club 30”, Polish Cardiac Society, 40-001 Katowice, Poland
- Department of Cardiology, School of Health Sciences, Medical University of Silesia, 40-055 Katowice, Poland
| | - Michał Kucio
- Department of Cardiology, School of Health Sciences, Medical University of Silesia, 40-055 Katowice, Poland
| | - Błażej Michalski
- “Club 30”, Polish Cardiac Society, 40-001 Katowice, Poland
- Department of Cardiology, Medical University of Lodz, 90-419 Lodz, Poland
| | - Karolina Kupczyńska
- “Club 30”, Polish Cardiac Society, 40-001 Katowice, Poland
- Department of Cardiology, Medical University of Lodz, 90-419 Lodz, Poland
| | | | | | - Renata Wachnicka-Truty
- Department of Cardiology and Internal Medicine, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Marek Koziński
- “Club 30”, Polish Cardiac Society, 40-001 Katowice, Poland
- Department of Cardiology and Internal Medicine, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Paweł Burchardt
- “Club 30”, Polish Cardiac Society, 40-001 Katowice, Poland
- Department of Hypertension, Angiology, and Internal Medicine, Poznan University of Medical Sciences, 61-701 Poznan, Poland
| | - Paweł Krzesiński
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, 01-755 Warsaw, Poland
- “Club 30”, Polish Cardiac Society, 40-001 Katowice, Poland
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Putowska P, Starzyk K, Woronowicz-Chróściel A, Wożakowska-Kapłon B. Współwystępowanie zapalenia pęcherzyka żółciowego i zawału serca bez istotnych zwężeń w tętnicach wieńcowych u 65-letniej chorej. Folia Cardiologica 2022. [DOI: 10.5603/fc.2022.0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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19
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Roskal-Wałek J, Wałek P, Biskup M, Sidło J, Cieśla E, Odrobina D, Mackiewicz J, Wożakowska-Kapłon B. Retinal Artery Occlusion and Its Impact on the Incidence of Stroke, Myocardial Infarction, and All-Cause Mortality during 12-Year Follow-Up. J Clin Med 2022; 11:jcm11144076. [PMID: 35887842 PMCID: PMC9324734 DOI: 10.3390/jcm11144076] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 07/08/2022] [Accepted: 07/13/2022] [Indexed: 02/05/2023] Open
Abstract
The aim of the study was to evaluate the incidence of ischemic stroke, myocardial infarction, and all-cause mortality in patients with retinal artery occlusion (RAO). This single-center retrospective study included 139 patients diagnosed with RAO between 2009 and 2020. The control group included 139 age- and sex-matched patients without RAO who underwent cataract surgery. The year of the surgery corresponded to the year of RAO onset. During the 12-year follow-up, patients with RAO had a shorter time to death (49.95 vs. 15.74 months; p = 0.043), a higher all-cause mortality rate (log-rank p = 0.026, and a higher rate of the composite endpoint, including ischemic stroke, myocardial infarction, and all-cause mortality (log-rank p = 0.024), as compared with controls. Patients with RAO younger than 75 years showed a higher risk of cerebral ischemic stroke (log-rank p = 0.008), all-cause mortality (log-rank p = 0.023), and the composite endpoint (log-rank p = 0.001) than controls. However, these associations were not demonstrated for patients aged 75 years or older. Our study confirms that patients with RAO have a higher risk of all-cause mortality than those without RAO. Moreover, patients with RAO who are younger than 75 years are significantly more likely to experience ischemic stroke, death, or the composite endpoint after an occlusion event, as compared with individuals without RAO.
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Affiliation(s)
- Joanna Roskal-Wałek
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland; (J.R.-W.); (E.C.); (D.O.); (B.W.-K.)
- Ophthalmology Clinic, Voivodeship Regional Hospital, 25-736 Kielce, Poland; (M.B.); (J.S.)
| | - Paweł Wałek
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland; (J.R.-W.); (E.C.); (D.O.); (B.W.-K.)
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, 25-736 Kielce, Poland
- Correspondence: ; Tel.: +48-413-671-440; Fax: +48-413-671-510
| | - Michał Biskup
- Ophthalmology Clinic, Voivodeship Regional Hospital, 25-736 Kielce, Poland; (M.B.); (J.S.)
| | - Jacek Sidło
- Ophthalmology Clinic, Voivodeship Regional Hospital, 25-736 Kielce, Poland; (M.B.); (J.S.)
| | - Elżbieta Cieśla
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland; (J.R.-W.); (E.C.); (D.O.); (B.W.-K.)
| | - Dominik Odrobina
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland; (J.R.-W.); (E.C.); (D.O.); (B.W.-K.)
- Ophthalmology Clinic Boni Fratres Lodziensis, 93-357 Łódź, Poland
| | - Jerzy Mackiewicz
- Department of Vitreoretinal Surgery, Medical University of Lublin, 20-079 Lublin, Poland;
| | - Beata Wożakowska-Kapłon
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland; (J.R.-W.); (E.C.); (D.O.); (B.W.-K.)
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, 25-736 Kielce, Poland
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Rezaei A, Gregorczyk M, Ciba-Stemplewska A, Starzyk K, Korzeluch W, Spałek M, Wożakowska-Kapłon B. Left ventricular non-compaction cardiomyopathy: a rare cause of cardiovascular complaints. Folia Cardiologica 2022. [DOI: 10.5603/fc.2022.0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Barylski M, Legutko J, Lesiak M, Bartuś S, Mamcarz A, Wożakowska-Kapłon B, Grygier M, Wojakowski W, Witkowski A. An expert opinion of the Association of Cardiovascular Interventions and the Working Group on Cardiovascular Pharmacotherapy of the Polish Cardiac Society related to the place of prasugrel in the prevention of cardiovascular events in patients with acute coronary syndromes. Kardiol Pol 2022; 80:113-122. [PMID: 35076081 DOI: 10.33963/kp.a2022.0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 01/20/2022] [Indexed: 11/23/2022]
Abstract
Based on many randomized clinical trials, it can be concluded that dual antiplatelet therapy is one of the best-studied treatments in the field of cardiovascular medicine. For many years prasugrel and ticagrelor have been preferred inhibitors of the platelet P2Y12 receptor in patients with acute coronary syndromes. These drugs enable faster, stronger, and more consistent inhibition of platelets and lead to better clinical outcomes than clopidogrel. The following document is an expert group opinion summarizing the latest knowledge in the field of antiplatelet therapy in the prevention of cardiovascular events in patients with acute coronary syndromes, with a special focus on prasugrel.
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Affiliation(s)
- Marcin Barylski
- Department of Internal Medicine and Cardiac Rehabilitation, Medical University of Lodz, Łódź, Poland.
| | - Jacek Legutko
- Department of Interventional Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland
| | - Maciej Lesiak
- 1st Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland
| | - Stanisław Bartuś
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | - Artur Mamcarz
- 3rd Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Beata Wożakowska-Kapłon
- 1st Department of Cardiology and Electrotherapy, Voivodship Hospital Kielce, Poland.,Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Marek Grygier
- 1st Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Adam Witkowski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warszawa, Poland
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Gorczyca-Głowacka I, Kapłon-Cieślicka A, Wełnicki M, Szymański F, Barylski M, Mamcarz A, Filipiak KJ, Wożakowska-Kapłon B. Rules for the use of reduced doses of non-vitamin K antagonist oral anticoagulants in the prevention of thromboembolic complications in patients with atrial fibrillation. The opinion of the Working Group on Cardiovascular Pharmacotherapy of the Polish Cardiac Society. Kardiol Pol 2022; 80:1299-1306. [PMID: 36601886 DOI: 10.33963/kp.a2022.0286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 12/04/2022] [Indexed: 01/06/2023]
Affiliation(s)
| | | | - Marcin Wełnicki
- 3rd Department of Internal Diseases and Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Filip Szymański
- Collegium Medicum, Cardinal Stefan Wyszynski University in Warsaw, Warszawa, Poland
| | - Marcin Barylski
- Department of Internal Diseases and Cardiac Rehabilitation, Medical University of Lodz, Łódź, Poland
| | - Artur Mamcarz
- 3rd Department of Internal Diseases and Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Krzysztof J Filipiak
- Institute of Clinical Sciences, Maria Skłodowska-Curie Medical Academy in Warsaw, Warszawa, Poland
| | - Beata Wożakowska-Kapłon
- Collegium Medicum, Jan Kochanowski University in Kielce, Kielce, Poland.,1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Center in Kielce, Kielce, Poland
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Wełnicki M, Gorczyca-Głowacka I, Mamcarz A, Filipiak KJ, Wożakowska-Kapłon B, Barylski M, Szymański FM, Kasprzak JD, Grabowski M, Dzida G. The use of GLP-1 analogues in the treatment of diabetes in patients with cardiovascular diseases. The expert opinion of the Working Group of Cardiovascular Pharmacotherapy of the Polish Cardiac Society. Kardiol Pol 2022; 80:1286-1289. [PMID: 36601885 DOI: 10.33963/kp.a2022.0282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 12/04/2022] [Indexed: 01/06/2023]
Affiliation(s)
- Marcin Wełnicki
- 3rd Department of Internal Diseases and Cardiology, Medical University of Warsaw, Warszawa, Poland.
| | | | - Artur Mamcarz
- 3rd Department of Internal Diseases and Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Krzysztof J Filipiak
- Institute of Clinical Sciences, Maria Sklodowska-Curie Medical Academy, Warszawa, Poland
| | - Beata Wożakowska-Kapłon
- Collegium Medicum, Jan Kochanowski University in Kielce, Kielce, Poland.,1st Department of Cardiology and Electrotherapy, Świętokrzyskie Cardiology Center, Kielce, Poland
| | - Marcin Barylski
- Department of Internal Diseases and Cardiac Rehabilitation, Medical University of Lodz, Łódź, Poland
| | - Filip M Szymański
- Departament of Civilization Diseases, Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszyński University in Warsaw, Warszawa, Poland
| | - Jarosław D Kasprzak
- 1st Chair and Department of Cardiology, Medical University of Lodz, Łódź, Poland
| | - Marcin Grabowski
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Grzegorz Dzida
- Department of Internal Diseases, Medical University of Lublin, Lublin, Poland
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Major A, Gorczyca-Głowacka I, Wożakowska-Kapłon B, Wypchło Ł. 84-year-old man with dyspnea, tumor in the left atrium suspected and hiatal hernia of the diaphragm diagnosed. Folia Cardiologica 2021. [DOI: 10.5603/fc.a2021.0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Szpotowicz A, Gorczyca-Głowacka I, Uziębło-Życzkowska B, Maciorowska M, Wójcik M, Błaszczyk R, Kapłon-Cieślicka A, Gawałko M, Budnik M, Tokarek T, Rajtar-Salwa R, Bil J, Wojewódzki M, Bednarski J, Bakuła-Ostalska E, Tomaszuk-Kazberuk A, Szyszkowska A, Wełnicki M, Mamcarz A, Krzciuk M, Wożakowska-Kapłon B. Czy wynik CHA2DS2-VASc determinuje leczenie przeciwzakrzepowe u pacjentów z migotaniem przedsionków? Dane z POLish Atrial Fibrillation (POL-AF) Registry? Folia Cardiologica 2021. [DOI: 10.5603/fc.a2021.0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Roskal-Wałek J, Wałek P, Sidło J, Biskup J, Mackiewicz J, Wożakowska-Kapłon B. Relationship between atrial fibrillation and retinal artery occlusion: what we know now and how we can use it in clinical practice? Folia Cardiologica 2021. [DOI: 10.5603/fc.2021.0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Roskal-Wałek J, Wałek P, Biskup M, Odrobina D, Mackiewicz J, Głuszek S, Wożakowska-Kapłon B. Central and Branch Retinal Artery Occlusion-Do They Harbor the Same Risk of Further Ischemic Events? J Clin Med 2021; 10:jcm10143093. [PMID: 34300257 PMCID: PMC8307136 DOI: 10.3390/jcm10143093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/05/2021] [Accepted: 07/08/2021] [Indexed: 12/22/2022] Open
Abstract
Purpose: Retinal artery occlusion (RAO) is associated with an increased risk of cardiovascular events such as ischemic stroke and myocardial infarction, but whether different RAO subtypes such as central retinal artery occlusion (CRAO) or branch retinal artery occlusion (BRAO) carry similar risk of these events is unclear. Our aim was to determine whether the risk of cardiovascular events differs between CRAO and BRAO. Methods: This single-center, retrospective study included 131 patients hospitalized in our clinic in 2010–2020 with CRAO or BRAO confirmed by ophthalmic examination. Data on demographics, previous ischemic stroke and myocardial infarction, comorbidities, the results of echocardiographic and ultrasound carotid artery examinations and laboratory tests were assessed. Data on ischemic stroke, myocardial infarction, and all-cause mortality occurring after RAO were obtained from the Polish National Health Service, which collects data on all publicly funded hospitalizations. Using these data, Kaplan-Meier analyses and Cox proportional hazard regression were performed. Results: Ischemic stroke occurred in 9.9% of patients after RAO: 10.6% in the CRAO group and 8.1% in the BRAO group (p = 0.662). Myocardial infarction occurred in 2.3% of patients after RAO: 2.1% in the CRAO group and 2.7% in the BRAO group (p = 0.843). All-cause mortality occurred in 22.9% of patients after RAO: 25.5% in the CRAO group and 16.2% in the BRAO group (p = 0.253). The composite endpoint of ischemic stroke, myocardial infarction, and all-cause mortality after RAO occurred in 28.2% of patients: 30.9% in the CRAO group and 21.6% in the BRAO group (p = 0.338). There was no difference between CRAO and BRAO in median time to ischemic stroke (32 vs. 76.4 months; p = 0.352), all-cause mortality (35.9 vs. 36.3 months; p = 0.876) or composite endpoint (37.5 vs. 41.5 months; p = 0.912) after RAO. The Kaplan-Meier analysis showed no differences between CRAO and BRAO in ischemic stroke, myocardial infarction, all-cause mortality, or the composite endpoint; similar results were obtained in analyses of patients with and without cardiovascular events before RAO. Conclusions: The prognosis for ischemic stroke, myocardial infarction, and all-cause mortality is similar in patients with CRAO and BRAO. Ischemic strokes occur with a similar frequency before and after RAO. Myocardial infarctions are observed significantly more frequently before an episode of RAO than after. The results of our study indicate that both CRAO and BRAO require expanded diagnostics to assess the risk of recurrent cardiovascular events, especially ischemic strokes, to implement appropriate prophylaxis and reduce mortality.
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Affiliation(s)
- Joanna Roskal-Wałek
- Collegium Medicum, The Jan Kochanowski University, 25-317 Kielce, Poland; (P.W.); (D.O.); (S.G.); (B.W.-K.)
- Ophthalmology Clinic, Voivodeship Regional Hospital, 25-736 Kielce, Poland;
- Correspondence: ; Tel.: +48-413-671-440; Fax: +48-413-671-510
| | - Paweł Wałek
- Collegium Medicum, The Jan Kochanowski University, 25-317 Kielce, Poland; (P.W.); (D.O.); (S.G.); (B.W.-K.)
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, 25-736 Kielce, Poland
| | - Michał Biskup
- Ophthalmology Clinic, Voivodeship Regional Hospital, 25-736 Kielce, Poland;
| | - Dominik Odrobina
- Collegium Medicum, The Jan Kochanowski University, 25-317 Kielce, Poland; (P.W.); (D.O.); (S.G.); (B.W.-K.)
- Ophthalmology Clinic Boni Fratres Lodziensis, 93-357 Łódź, Poland
| | - Jerzy Mackiewicz
- Department of Vitreoretinal Surgery, Medical University of Lublin, 20-079 Lublin, Poland;
| | - Stanisław Głuszek
- Collegium Medicum, The Jan Kochanowski University, 25-317 Kielce, Poland; (P.W.); (D.O.); (S.G.); (B.W.-K.)
- Oncological, Endocrinological and General Surgery Clinic, Voivodeship Regional Hospital, 25-736 Kielce, Poland
| | - Beata Wożakowska-Kapłon
- Collegium Medicum, The Jan Kochanowski University, 25-317 Kielce, Poland; (P.W.); (D.O.); (S.G.); (B.W.-K.)
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, 25-736 Kielce, Poland
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Wałek P, Gorczyca I, Grabowska U, Spałek M, Wożakowska-Kapłon B. The prognostic value of soluble suppression of tumourigenicity 2 and galectin-3 for sinus rhythm maintenance after cardioversion due to persistent atrial fibrillation in patients with normal left ventricular systolic function. Europace 2021; 22:1470-1479. [PMID: 32754725 DOI: 10.1093/europace/euaa135] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 05/04/2020] [Indexed: 11/12/2022] Open
Abstract
AIMS Soluble suppression of tumourigenicity 2 (sST2) and galectin-3 are involved in cardiac fibrosis, inflammation, and remodelling. However, the place of sST2 and galectin-3 in predicting the outcomes of electrical cardioversion of atrial fibrillation (AF) is uncertain. We evaluated whether these biomarkers could predict sinus rhythm (SR) maintenance after cardioversion of persistent AF in patients with normal left ventricular systolic function. METHODS AND RESULTS The study included 80 patients with persistent AF, who underwent cardioversion from February 2016 to August 2018. The blood concentrations of sST-2 and galectin-3 were measured with ELISA and the ASPECT-PLUS assays. Clinical and electrocardiographic follow-up was performed at months 1, 6, and 12. Patients who maintained SR at 12 months had significantly lower concentrations of sST2, measured by ELISA and ASPECT-PLUS assays, than the remaining patients (16.9 ± 9.8 vs. 28 ± 22.9 ng/mL; P < 0.001; 28.7 ± 13.4 vs. 40 ± 25.1 ng/mL; P = 0.003); the concentration of galectin-3 did not differ between these patients. Multivariable logistic regression showed that log-transformed sST2 ELISA was a significant predictor of SR maintenance at 12 months [odds ratio 0.14; 95% confidence interval (CI) 0.03-0.58; P = 0.006]. On receiver-operating characteristic curve analysis, the areas under the curve for the concentration of sST2 was 0.752 (95% CI 0.634-0.870; P < 0.001). The concentrations of sST2 measured with the two assays were strongly correlated (rho = 0.8; CI 95% 0.7-0.87; P = 0.001). CONCLUSION Soluble suppression of tumourigenicity 2, but not galectin-3, can be used to predict SR maintenance after cardioversion of AF in patients with normal left ventricular systolic function. The measurements of sST2 concentrations with the rapid lateral flow and enzyme-linked immunoassays were consistent.
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Affiliation(s)
- Paweł Wałek
- 1st Clinic of Cardiology and Electrotherapy, Voivodship Hospital Kielce, Grunwaldzka 45, 25-736 Kielce, Poland
| | - Iwona Gorczyca
- 1st Clinic of Cardiology and Electrotherapy, Voivodship Hospital Kielce, Grunwaldzka 45, 25-736 Kielce, Poland
| | - Urszula Grabowska
- Medical Laboratory, Voivodship Hospital Kielce, Grunwaldzka 45, 25-736 Kielce, Poland
| | - Michał Spałek
- Department of Anatomy, Collegium Medicum, Jan Kochanowski University, 19 IX Wieków Kielc, 25-317 Kielce, Poland.,Department of Diagnostic Imaging, Holy Cross Center of Oncology, Stefana Artwińskiego 3, 25-734 Kielce, Poland
| | - Beata Wożakowska-Kapłon
- 1st Clinic of Cardiology and Electrotherapy, Voivodship Hospital Kielce, Grunwaldzka 45, 25-736 Kielce, Poland.,Collegium Medicum, Jan Kochanowski University, 19 IX Wieków Kielc Street, 25-317 Kielce, Poland
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Wożakowska-Kapłon B. Od Redaktora. Folia Cardiologica 2021. [DOI: 10.5603/fc.2021.0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Kukla D, Woźnica K, Bielecka B, Major A, Gorczyca I, Wożakowska-Kapłon B. Myocardial infarction complicated by left ventricle thrombus: vitamin K antagonists as first-line treatment? Folia Cardiologica 2021. [DOI: 10.5603/fc.2021.0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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31
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Bielecka B, Gorczyca I, Wożakowska-Kapłon B. Why do not all patients with atrial fibrillation at high risk of thromboembolism receive oral anticoagulation? Folia Cardiologica 2021. [DOI: 10.5603/fc.2021.0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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32
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Wałek P, Grabowska U, Cieśla E, Gorczyca I, Wożakowska-Kapłon B. Left atrial longitudinal strain in the contractile phase as a predictor of sinus rhythm maintenance after electrical cardioversion performed due to persistent atrial fibrillation. Kardiol Pol 2021; 79:458-460. [PMID: 33784038 DOI: 10.33963/kp.15913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Paweł Wałek
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland; 1st Department of Cardiology and Electrotherapy, Voivodship Hospital Kielce, Poland.
| | | | - Elżbieta Cieśla
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Iwona Gorczyca
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland,1st Department of Cardiology and Electrotherapy, Voivodship Hospital Kielce, Poland
| | - Beata Wożakowska-Kapłon
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland,1st Department of Cardiology and Electrotherapy, Voivodship Hospital Kielce, Poland
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Kiliszek M, Uziębło-Życzkowska B, Gorczyca I, Maciorowska M, Jelonek O, Wożakowska-Kapłon B, Wójcik M, Błaszczyk R, Gawałko M, Kapłon-Cieślicka A, Tokarek T, Rajtar-Salwa R, Bil J, Wojewódzki M, Szpotowicz A, Krzciuk M, Bednarski J, Bakuła-Ostalska E, Tomaszuk-Kazberuk A, Szyszkowska A, Wełnicki M, Mamcarz A, Krzesiński P. Symptomatic and Asymptomatic Patients in the Polish Atrial Fibrillation (POL-AF) Registry. J Clin Med 2021; 10:jcm10051091. [PMID: 33807883 PMCID: PMC7961425 DOI: 10.3390/jcm10051091] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/01/2021] [Accepted: 03/03/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Atrial fibrillation (AF) can cause severe symptoms, but it is frequently asymptomatic. We aimed to compare the clinical features of patients with asymptomatic and symptomatic AF. METHODS A prospective, observational, multicenter study was performed (the Polish Atrial Fibrillation (POL-AF) registry). Consecutive hospitalized AF patients over 18 years of age were enrolled at ten centers. The data were collected for two weeks during each month of 2019. RESULTS A total of 2785 patients were analyzed, of whom 1360 were asymptomatic (48.8%). Asymptomatic patients were more frequently observed to have coronary artery disease (57.5% vs. 49.1%, p < 0.0001), heart failure with preserved ejection fraction (39.8% vs. 26.5%, p < 0.0001), a previous thromboembolic event (18.2% vs. 13.1%, p = 0.0002), and paroxysmal AF (52.3% vs. 45.2%, p = 0.0002). In multivariate analysis, history of electrical cardioversion, paroxysmal AF, heart failure, coronary artery disease, previous thromboembolic event, and higher left ventricular ejection fraction were predictors of a lack of AF symptoms. First-diagnosed AF was a predictor of AF symptoms. CONCLUSIONS In comparison to symptomatic patients, more of those hospitalized with asymptomatic AF had been previously diagnosed with this arrhythmia and other cardiovascular diseases. However, they presented with better left ventricular function and were more frequently treated with cardiovascular medicines.
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Affiliation(s)
- Marek Kiliszek
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, 04-141 Warsaw, Poland; (B.U.-Ż.); (M.M.); (P.K.)
- Correspondence: ; Tel.: +48-261-817-909
| | - Beata Uziębło-Życzkowska
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, 04-141 Warsaw, Poland; (B.U.-Ż.); (M.M.); (P.K.)
| | - Iwona Gorczyca
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, Collegium Medicum, The Jan Kochanowski University, 25-369 Kielce, Poland; (I.G.); (O.J.); (B.W.-K.)
| | - Małgorzata Maciorowska
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, 04-141 Warsaw, Poland; (B.U.-Ż.); (M.M.); (P.K.)
| | - Olga Jelonek
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, Collegium Medicum, The Jan Kochanowski University, 25-369 Kielce, Poland; (I.G.); (O.J.); (B.W.-K.)
| | - Beata Wożakowska-Kapłon
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, Collegium Medicum, The Jan Kochanowski University, 25-369 Kielce, Poland; (I.G.); (O.J.); (B.W.-K.)
| | - Maciej Wójcik
- Department of Cardiology, Medical University of Lublin, 20-059 Lublin, Poland; (M.W.); (R.B.)
| | - Robert Błaszczyk
- Department of Cardiology, Medical University of Lublin, 20-059 Lublin, Poland; (M.W.); (R.B.)
| | - Monika Gawałko
- 1st Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland; (M.G.); (A.K.-C.)
| | | | - Tomasz Tokarek
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Krakow, Poland; (T.T.); (R.R.-S.)
- Department of Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, 30-688 Kraków, Poland
| | - Renata Rajtar-Salwa
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Krakow, Poland; (T.T.); (R.R.-S.)
| | - Jacek Bil
- Department of Invasive Cardiology, Centre of Postgraduate Medical Education, 02-507 Warsaw, Poland; (J.B.); (M.W.)
| | - Michał Wojewódzki
- Department of Invasive Cardiology, Centre of Postgraduate Medical Education, 02-507 Warsaw, Poland; (J.B.); (M.W.)
| | - Anna Szpotowicz
- Department of Cardiology, Regional Hospital, 27-400 Ostrowiec Świętokrzyski, Poland; (A.S.); (M.K.)
| | - Małgorzata Krzciuk
- Department of Cardiology, Regional Hospital, 27-400 Ostrowiec Świętokrzyski, Poland; (A.S.); (M.K.)
| | - Janusz Bednarski
- Department of Cardiology, St. John Paul II Western Hospital, 05-825 Grodzisk Mazowiecki, Poland; (J.B.); (E.B.-O.)
| | - Elwira Bakuła-Ostalska
- Department of Cardiology, St. John Paul II Western Hospital, 05-825 Grodzisk Mazowiecki, Poland; (J.B.); (E.B.-O.)
| | | | - Anna Szyszkowska
- Department of Cardiology, University Hospital of Bialystok, 15-276 Białystok, Poland;
| | - Marcin Wełnicki
- 3rd Department of Internal Diseases and Cardiology, Warsaw Medical University, 02-091 Warsaw, Poland; (M.W.); (A.M.)
| | - Artur Mamcarz
- 3rd Department of Internal Diseases and Cardiology, Warsaw Medical University, 02-091 Warsaw, Poland; (M.W.); (A.M.)
| | - Paweł Krzesiński
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, 04-141 Warsaw, Poland; (B.U.-Ż.); (M.M.); (P.K.)
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Gawałko M, Budnik M, Uziębło-Życzkowska B, Gorczyca I, Krzesiński P, Scisło P, Kochanowski J, Michalska A, Jelonek O, Starzyk K, Jurek A, Kiliszek M, Wożakowska-Kapłon B, Gielerak G, Filipiak KJ, Opolski G, Kapłon-Cieślicka A. Risk of left atrial appendage thrombus in older patients with atrial fibrillation. Arch Med Sci 2021; 19:1721-1730. [PMID: 38058707 PMCID: PMC10696955 DOI: 10.5114/aoms/126028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 08/04/2020] [Indexed: 12/08/2023] Open
Abstract
Introduction We aimed to compare the prevalence of left atrial appendage (LAA) thrombus and its predictors between old and young patients with atrial fibrillation (AF). Material and methods The study included 1970 patients aged ≥ 65 (n = 822 (41.7%)) and < 65 (n = 1148 (58.3%)) referred for AF cardioversion or ablation preceded by transoesophageal echocardiography (TEE). Results Oral anticoagulation (OAC) was prescribed in 799 (97.2%) patients aged ≥ 65 years and in 1054 (91.8%) of those aged < 65 years (p < 0.001). In patients treated with OAC, those aged ≥ 65 years less often received vitamin K antagonist (VKA) (267 (33.4%) vs. 416 (39.5%)) and more often non-VKA-OAC (NOAC) (532 (66.6%) vs. 638 (60.5%), p = 0.008, p = 0.008) compared to patients < 65 years. On TEE, LAA thrombus was more often observed in patients aged ≥ 65 years than those aged < 65 years (63 (7.7%) vs. 46 (4.0%), p < 0.001), with an absolute but not statistically significant difference between patients aged 65-74 and ≥ 75 years (47 (7.3%) vs. 16 (8.8%), p = 0.528). In patients aged ≥ 65 years, there was no difference in the prevalence of LAA thrombus between patients treated with VKA and NOAC, in contrast to patients aged < 65 years, in whom such a difference was observed (27 (6.5%) vs. 16 (2.5%), p = 0.002). In multivariate logistic regression, predictors of LAA thrombus in both age groups were older age, non-paroxysmal AF, and heart failure, whereas only in patients aged < 65 years - VKA use, and in those aged ≥ 65 years - lower glomerular filtration rate and platelet count. Conclusions Despite OAC use, older patients with AF remain at high risk of LAA thrombus formation. Older age, non-paroxysmal AF, and heart failure are predictors of LAA thrombus, irrespective of age.
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Affiliation(s)
- Monika Gawałko
- 1 Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Monika Budnik
- 1 Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | | | - Iwona Gorczyca
- 1 Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, Kielce, Poland
| | - Paweł Krzesiński
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
| | - Piotr Scisło
- 1 Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Janusz Kochanowski
- 1 Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Anna Michalska
- Faculty of Medical and Health Sciences, Jan Kochanowski University, Kielce, Poland
| | - Olga Jelonek
- 1 Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, Kielce, Poland
| | - Katarzyna Starzyk
- 1 Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, Kielce, Poland
| | - Agnieszka Jurek
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
| | - Marek Kiliszek
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
| | - Beata Wożakowska-Kapłon
- 1 Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, Kielce, Poland
- Faculty of Medical and Health Sciences, Jan Kochanowski University, Kielce, Poland
| | - Grzegorz Gielerak
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
| | | | - Grzegorz Opolski
- 1 Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
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Wożakowska-Kapłon B. Od Redaktora. Folia Cardiologica 2021. [DOI: 10.5603/fc.2021.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Gorczyca I, Uziębło-Życzkowska B, Szpotowicz A, Chrapek M, Krzesiński P, Bielecka B, Woronowicz-Chróściel A, Wałek P, Krzciuk M, Wożakowska-Kapłon B. Elective cardioversion of atrial fibrillation is safe without transesophageal echocardiography in patients treated with non-vitamin K antagonist oral anticoagulants: Multicenter experience. Cardiol J 2021; 30:228-236. [PMID: 33634847 PMCID: PMC10129268 DOI: 10.5603/cj.a2021.0010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/30/2020] [Accepted: 01/17/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Current guidelines recommend electrical cardioversion (ECV) in patients with atrial fibrillation (AF) after at least 3 weeks of adequate non-vitamin K antagonist oral anticoagulant (NOAC) treatment without prior transesophageal echocardiography (TEE). However, in clinical practice in some centres, TEE is performed before ECV in patients with AF. The aim of the study was to evaluate prevalence of thromboembolic and hemorrhagic complications in patients with AF treated with NOACs and undergoing ECV without prior TEE. METHODS This observational, multicentre study included consecutive patients with AF treated with NOACs who were admitted for ECV without prior TEE. Thromboembolic events and major bleeding complications were investigated during a 30-day follow-up. RESULTS In the study group there were 611 patients, mean age was 66.3 ± 9.2 years, 40% were women. 52 (8.5%) patients had a low thromboembolic risk, 148 (24.2%) patients had an intermediate thromboembolic risk and 411 (67.2%) patients had a high thromboembolic risk. In the study group 253 (41.4%) patients were treated with rivaroxaban, 252 (41.2%) patients were treated with dabigatran and 106 (17.3%) patients were treated with apixaban. Reduced doses of NOACs were administered to 113 (18.9%) patients. In the entire study group, there were no thromboembolic events or major bleeding complications during the in-hospital stay and the 30-day follow-up. CONCLUSIONS In this "real-world" study of AF patients treated with NOACs, it was proved that ECV is safe without a preceding TEE, regardless of the risk of thromboembolic complications and of the type of NOAC used.
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Affiliation(s)
- Iwona Gorczyca
- 1 st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, Grunwaldzka 45, Kielce, Poland.,Collegium Medicum, The Jan Kochanowski University, Żeromskiego 8, Kielce, Poland
| | | | - Anna Szpotowicz
- Department of Cardiology, District Hospital, Ostrowiec Świętokrzyski, Poland
| | - Magdalena Chrapek
- Faculty of Natural Sciences, The Jan Kochanowski University, Kielce, Poland
| | - Paweł Krzesiński
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
| | - Bernadetta Bielecka
- 1 st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, Grunwaldzka 45, Kielce, Poland
| | | | - Paweł Wałek
- 1 st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, Grunwaldzka 45, Kielce, Poland
| | - Małgorzata Krzciuk
- Department of Cardiology, District Hospital, Ostrowiec Świętokrzyski, Poland
| | - Beata Wożakowska-Kapłon
- 1 st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, Grunwaldzka 45, Kielce, Poland.,Collegium Medicum, The Jan Kochanowski University, Żeromskiego 8, Kielce, Poland
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Bączek M, Zagańczyk-Bączek M, Szpringer M, Jaroszyński A, Wożakowska-Kapłon B. Students' perception of online learning during the COVID-19 pandemic: A survey study of Polish medical students. Medicine (Baltimore) 2021; 100:e24821. [PMID: 33607848 PMCID: PMC7899848 DOI: 10.1097/md.0000000000024821] [Citation(s) in RCA: 139] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 01/28/2021] [Indexed: 01/05/2023] Open
Abstract
The COVID-19 pandemic has disrupted teaching in a variety of institutions, especially in medical schools. Electronic learning (e-learning) became the core method of teaching the curriculum during the pandemic. After 8 weeks of only online learning, a survey was conducted to investigate perception of this type of learning among medical students.A survey was conducted by distributing an online questionnaire to Polish medical students. Data gathered from the survey were analyzed with routine statistical software.Eight hundred four students answered the questionnaire. According to respondents' answers, the main advantages of online learning were the ability to stay at home (69%), continuous access to online materials (69%), learning at your own pace (64%), and comfortable surroundings (54%). The majority of respondents chose lack of interactions with patients (70%) and technical problems with IT equipment (54%) as the main disadvantages. There was no statistical difference between face-to-face and online learning in terms of opinions on the ability of the learning method to increase knowledge (P = .46). E-learning was considered less effective than face-to-face learning in terms of increasing skills (P < .001) and social competences (P < .001). Students assessed that they were less active during online classes compared to traditional classes (P < .001). E-learning was rated as enjoyable by 73% of respondents.E-learning is a powerful tool for teaching medical students. However, successful implementation of online learning into the curriculum requires a well thought-out strategy and a more active approach.
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Uziębło-Życzkowska B, Krzesiński P, Maciorowska M, Gorczyca I, Jelonek O, Wójcik M, Błaszczyk R, Kapłon-Cieślicka A, Gawałko M, Tokarek T, Rajtar-Salwa R, Bil J, Wojewódzki M, Szpotowicz A, Krzciuk M, Bednarski J, Bakuła-Ostalska E, Tomaszuk-Kazberuk A, Szyszkowska A, Wełnicki M, Mamcarz A, Wożakowska-Kapłon B. Antithrombotic therapy in patients with atrial fibrillation undergoing percutaneous coronary intervention, including compliance with current guidelines-data from the POLish Atrial Fibrillation (POL-AF) Registry. Cardiovasc Diagn Ther 2021; 11:14-27. [PMID: 33708474 DOI: 10.21037/cdt-20-839] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Although triple antithrombotic therapy (TAT) is recommended in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI), guidelines allow an option of dual antithrombotic therapy (DAT). This study assesses the everyday practice of 10 cardiology departments in antithrombotic therapy in AF patients undergoing PCI and its agreement with current guidelines. Methods This analysis included medical data of AF patients enrolled in the prospective, observational registry (The POLish Atrial Fibrillation-POL-AF) that underwent PCI [elective or due to acute coronary syndrome (ACS)]. Results Of the 3,999 consecutive subjects included, a final analysis was performed on 359 patients that underwent PCI: 148 with urgent PCI due to ACSand 211 patients with elective PCI. Eighty patients in the ACS-group and 120 patients in the elective-PCI group were treated with TAT, although guidelines also allowed DAT. Of 316 patients treated with oral anticoagulants as a part of combination therapy, 275 were on non-vitamin K antagonist oral anticoagulant (NOAC). Reduced doses of NOAC were used in 74 patients treated with rivaroxaban, 60 patients with dabigatran, and 54 patients with apixaban. The proportion of patients treated with reduced NOAC doses adequately to the guidelines was 29%, 100%, and 33% for rivaroxaban, dabigatran, and apixaban, respectively. Inappropriate low doses of NOACs were used in 71% of subjects on rivaroxaban and 67% on apixaban. Conclusions In patients with AF undergoing PCI, NOACs are definitely preferred over vitamin-K antagonists (VKAs) in TAT/DAT, and an aggressive antithrombotic strategy with TAT is frequently chosen even if DAT is permissible by the guidelines. Label adherence of using reduced NOAC dose during combination therapy is not satisfactory for apixaban and rivaroxaban and probably results from too cautious an approach to the known indications for reduced therapy. The study is registered in the database Clinical Trials-NCT04419012.
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Affiliation(s)
| | - Paweł Krzesiński
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
| | - Małgorzata Maciorowska
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
| | - Iwona Gorczyca
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, Kielce, Poland.,Collegium Medicum, The Jan Kochanowski University, Kielce, Poland
| | - Olga Jelonek
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, Kielce, Poland.,Collegium Medicum, The Jan Kochanowski University, Kielce, Poland
| | - Maciej Wójcik
- Department of Cardiology, Medical University of Lublin, Lublin, Poland
| | - Robert Błaszczyk
- Department of Cardiology, Medical University of Lublin, Lublin, Poland
| | | | - Monika Gawałko
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Tomasz Tokarek
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Renata Rajtar-Salwa
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Jacek Bil
- Department of Invasive Cardiology, Centre of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland
| | - Michał Wojewódzki
- Department of Invasive Cardiology, Centre of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland
| | - Anna Szpotowicz
- Department of Cardiology, Regional Hospital, Ostrowiec Świętokrzyski, Poland
| | - Małgorzata Krzciuk
- Department of Cardiology, Regional Hospital, Ostrowiec Świętokrzyski, Poland
| | - Janusz Bednarski
- Department of Cardiology, St John Paul II Western Hospital, Grodzisk Mazowiecki, Poland
| | | | | | - Anna Szyszkowska
- Department of Cardiology, University Hospital of Bialystok, Białystok, Poland
| | - Marcin Wełnicki
- 3rd Department of Internal Diseases and Cardiology, Warsaw Medical University, Warsaw, Poland
| | - Artur Mamcarz
- 3rd Department of Internal Diseases and Cardiology, Warsaw Medical University, Warsaw, Poland
| | - Beata Wożakowska-Kapłon
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, Kielce, Poland.,Collegium Medicum, The Jan Kochanowski University, Kielce, Poland
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Wożakowska-Kapłon B. Od Redaktora. Folia Cardiologica 2020. [DOI: 10.5603/fc.2020.0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Kot AM, Jelonek O, Bączek M, Kośmider P, Szczygieł E, Bąkowski D, Wożakowska-Kapłon B. Jednostronne porażenie nerwu okoruchowego z towarzyszącym ostrym udarem niedokrwiennym po zabiegu koronarografii. Folia Cardiologica 2020. [DOI: 10.5603/fc.2020.0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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41
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Wożakowska-Kapłon B. Od Redaktora. Folia Cardiologica 2020. [DOI: 10.5603/fc.2020.0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Bączek M, Starzyk K, Kośmider P, Jelonek O, Gorczyca I, Kot A, Bartkowiak R, Wożakowska-Kapłon B. Epidemia COVID-19 opóźnia proces diagnostyczno-leczniczy chorych z ostrym zespołem wieńcowym. Folia Cardiologica 2020. [DOI: 10.5603/fc.2020.0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Wałek P, Ciesla E, Gorczyca I, Wożakowska-Kapłon B. Left atrial wall dyskinesia assessed during contractile phase as a predictor of atrial fibrillation recurrence after electrical cardioversion performed due to persistent atrial fibrillation. Medicine (Baltimore) 2020; 99:e23333. [PMID: 33285712 PMCID: PMC7717756 DOI: 10.1097/md.0000000000023333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Direct current cardioversion (DCCV) is one of the basic methods for restoring sinus rhythm (SR) in patients with atrial fibrillation (AF). Left atrial (LA) strain is one of the parameters used to assess the risk of AF recurrence following DCCV. Assessing the strain also allows for the detection of segmental disorders of LA wall contractility, including dispersion or dyskinesia. In the present study, we determined the predictive value of LA wall dyskinesia in assessing the risk of AF recurrence after DCCV. We performed a comprehensive echocardiography in 89 patients with persistent AF following successful DCCV. We assessed the strain and strain rate in the reservoir (r), conduit, and contractile (ct) phases by using speckle tracking echocardiography. Dyskinesia was diagnosed when the strain rate of any segment of the LA wall displayed positive values during contraction. After 12 months, 47.2% of patients maintained SR. Patients who maintained SR had a significantly lower LA strain (LAS)r assessed in the apical 4-chamber view (4c) (11.38 ± 4.63 vs 14.54 ± 5.11; P = .004) and 2-chamber view (2c) (11.05 ± 4.1 vs 14.93 ± 6.82%; P = .006), LASct4c (2.51 ± 2.3 vs 5.09 ± 3.29%; P < .001), LASct2c (3.6 ± 2.98 vs 5.67 ± 4.23%; P = .008), peak strain rate (pLASR) ct4c (0.36 ± 0.24 s vs 0.62 ± 0.4; P < .001) and pLASRct2c (0.49 ± 0.30 vs 0.79 ± 0.53 s; P = .01). LA dyskinesia was observed less frequently in the 4c view in patients who maintained SR (59.57 vs 17.5%; P < .001). Multivariable logistic regression showed that the LASct4c (odds ratio (OR) 0.78; 95%CI 0.63-0.97; P = .027) and LA dyskinesia observed in the 4c view (OR 3.53; 95%CI 1.16-10.76; P = .027) were significant independent predictors of AF recurrence at 12 months. We conclude that LA dyskinesia observed in the 4c view and LASct4c are independent risk factors for AF recurrence following DCCV.
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Affiliation(s)
- Paweł Wałek
- Collegium Medicum, Jan Kochanowski University, 19 IX Wieków Kielc Street, Kielce
- 1st Clinic of Cardiology and Electrotherapy, Voivodship Hospital Kielce, Grunwaldzka 45, 25-736 Kielce, Poland
| | - Elzbieta Ciesla
- Collegium Medicum, Jan Kochanowski University, 19 IX Wieków Kielc Street, Kielce
| | - Iwona Gorczyca
- Collegium Medicum, Jan Kochanowski University, 19 IX Wieków Kielc Street, Kielce
- 1st Clinic of Cardiology and Electrotherapy, Voivodship Hospital Kielce, Grunwaldzka 45, 25-736 Kielce, Poland
| | - Beata Wożakowska-Kapłon
- Collegium Medicum, Jan Kochanowski University, 19 IX Wieków Kielc Street, Kielce
- 1st Clinic of Cardiology and Electrotherapy, Voivodship Hospital Kielce, Grunwaldzka 45, 25-736 Kielce, Poland
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Ciba-Stemplewska A, Krzos D, Kal M, Pater E, Kleist M, Wożakowska-Kapłon B. Giant cell arteritis as the cause of chronic fever of unknown origin. Pol Arch Intern Med 2020; 130:995-996. [PMID: 32785208 DOI: 10.20452/pamw.15549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Gorczyca I, Jelonek O, Uziębło-Życzkowska B, Chrapek M, Maciorowska M, Wójcik M, Błaszczyk R, Kapłon-Cieślicka A, Gawałko M, Budnik M, Tokarek T, Rajtar-Salwa R, Bil J, Wojewódzki M, Szpotowicz A, Bednarski J, Bakuła-Ostalska E, Tomaszuk-Kazberuk A, Szyszkowska A, Wełnicki M, Mamcarz A, Wożakowska-Kapłon B. Trends in the Prescription of Non-Vitamin K Antagonist Oral Anticoagulants for Atrial Fibrillation: Results of the Polish Atrial Fibrillation (POL-AF) Registry. J Clin Med 2020; 9:jcm9113565. [PMID: 33167503 PMCID: PMC7694480 DOI: 10.3390/jcm9113565] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 10/30/2020] [Accepted: 11/03/2020] [Indexed: 12/25/2022] Open
Abstract
Background: Current guidelines do not suggest in which groups of patients with atrial fibrillation (AF) individual non-vitamin K antagonist oral anticoagulants (NOACs) should be used for the prevention of thromboembolic complications. The aim of this study was to evaluate the frequency of use of apixaban, dabigatran, and rivaroxaban, and attempt to identify factors predisposing their administration. Methods: The Polish Atrial Fibrillation (POL-AF) registry is a prospective, non-interventional study, including consecutive patients with AF hospitalized in ten Polish cardiology centers during the period ranging from January to December 2019. In this study, all patients were treated with NOACs. Results: Among the 2971 patients included in the analysis, 40.4% were treated with rivaroxaban, 32% with apixaban, and 27.6% with dabigatran. The mean age of the total population was 72 ± 11.5 years and 43% were female. A reduced dose of NOAC was used in 35% of patients treated with apixaban, 39.7% of patients treated with dabigatran, and 34.4% of patients treated with rivaroxaban. Independent predictors of the use of apixaban were previous bleeding (OR 2.37, CI 1.67–3.38), GFR < 60 mL/min (OR 1.38, CI 1.25–1.64), heart failure (OR 1.38, CI 1.14–1.67) and age (per 5 years) (OR 1.14, CI 1.09–1.19). GFR < 60 mL/min (OR 0.79, CI 0.66–0.95), female (OR 0.8, CI 0.67–0.96) and age (per 5 years) (OR 0.95, CI 0.91–0.99) diminished the chance of using dabigatran. Previous bleeding (OR 0.43, CI 0.28–0.64), vascular disease (OR 0.84, CI 0.70–0.99), and age (per 5 years) (OR 0.94, CI 0.90–0.97) diminished the chance of choosing rivaroxaban. Conclusions: In hospitalized patients with AF, the most frequently chosen NOAC was rivaroxaban. Apixaban was chosen more often in patients after bleeding, and in those who were advanced in years, with heart failure and impaired renal function. Impaired renal function and female gender were factors that diminished the chance of using dabigatran. Previous bleeding and vascular disease was the factor that diminished the chance of using rivaroxaban. Dabigatran and rivaroxaban have been used less frequently in elderly patients.
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Affiliation(s)
- Iwona Gorczyca
- Collegium Medicum, The Jan Kochanowski University, 25-369 Kielce, Poland; (I.G.); (O.J.); (B.W.-K.)
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, 25-736 Kielce, Poland
| | - Olga Jelonek
- Collegium Medicum, The Jan Kochanowski University, 25-369 Kielce, Poland; (I.G.); (O.J.); (B.W.-K.)
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, 25-736 Kielce, Poland
| | - Beata Uziębło-Życzkowska
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, 04-141 Warsaw, Poland;
- Correspondence: ; Tel.: +48-261-816-376
| | - Magdalena Chrapek
- Faculty of Natural Sciences, The Jan Kochanowski University, 25-369 Kielce, Poland;
| | - Małgorzata Maciorowska
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, 04-141 Warsaw, Poland;
| | - Maciej Wójcik
- Department of Cardiology, Medical University of Lublin, 20-059 Lublin, Poland; (M.W.); (R.B.)
| | - Robert Błaszczyk
- Department of Cardiology, Medical University of Lublin, 20-059 Lublin, Poland; (M.W.); (R.B.)
| | - Agnieszka Kapłon-Cieślicka
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland; (A.K.-C.); (M.G.); (M.B.)
| | - Monika Gawałko
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland; (A.K.-C.); (M.G.); (M.B.)
| | - Monika Budnik
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland; (A.K.-C.); (M.G.); (M.B.)
| | - Tomasz Tokarek
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Krakow, Poland; (T.T.); (R.R.-S.)
| | - Renata Rajtar-Salwa
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Krakow, Poland; (T.T.); (R.R.-S.)
| | - Jacek Bil
- Department of Invasive Cardiology, Centre of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, 02-507 Warsaw, Poland; (J.B.); (M.W.)
| | - Michał Wojewódzki
- Department of Invasive Cardiology, Centre of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, 02-507 Warsaw, Poland; (J.B.); (M.W.)
| | - Anna Szpotowicz
- Department of Cardiology, Regional Hospital, 27-400 Ostrowiec Swiętokrzyski, Poland;
| | - Janusz Bednarski
- Department of Cardiology, St John Paul II Western Hospital, 05-825 Grodzisk Mazowiecki, Poland; (J.B.); (E.B.-O.)
| | - Elwira Bakuła-Ostalska
- Department of Cardiology, St John Paul II Western Hospital, 05-825 Grodzisk Mazowiecki, Poland; (J.B.); (E.B.-O.)
| | - Anna Tomaszuk-Kazberuk
- Department of Cardiology, Medical University, 15-276 Bialystok, Poland; (A.T.-K.); (A.S.)
| | - Anna Szyszkowska
- Department of Cardiology, Medical University, 15-276 Bialystok, Poland; (A.T.-K.); (A.S.)
| | - Marcin Wełnicki
- 3rd Department of Internal Diseases and Cardiology, Warsaw Medical University, 02-091 Warsaw, Poland; (M.W.); (A.M.)
| | - Artur Mamcarz
- 3rd Department of Internal Diseases and Cardiology, Warsaw Medical University, 02-091 Warsaw, Poland; (M.W.); (A.M.)
| | - Beata Wożakowska-Kapłon
- Collegium Medicum, The Jan Kochanowski University, 25-369 Kielce, Poland; (I.G.); (O.J.); (B.W.-K.)
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, 25-736 Kielce, Poland
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Ciba-Stemplewska A, Krzos D, Wożakowska-Kapłon B. Choroba Fabry’ego — długa droga do prawidłowego rozpoznania u 43-letniego chorego „Dr Google” nie zawsze taki zły... Folia Cardiologica 2020. [DOI: 10.5603/fc.2020.0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Uziębło-Życzkowska B, Kiliszek M, Gorczyca I, Woronowicz-Chróściel A, Bielecka B, Wałek P, Jelonek O, Wożakowska-Kapłon B, Krzesiński P. Factors determining elective cardioversion preceded with transesophageal echocardiography: two cardiology centres’ experiences. Pol Arch Intern Med 2020; 130:837-843. [DOI: 10.20452/pamw.15546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Uziębło-Życzkowska B, Krzesiński P, Jurek A, Budnik M, Gorczyca I, Kapłon-Cieślicka A, Kiliszek M, Wójcik A, Gawałko M, Jelonek O, Michalska A, Starzyk K, Scisło P, Kochanowski J, Filipiak KJ, Wożakowska-Kapłon B, Opolski G, Gielerak G. Prevalence and risk factors of left atrial thrombus in patients with atrial fibrillation and lower class (IIa) recommendation to anticoagulants. Cardiovasc Diagn Ther 2020; 10:717-724. [PMID: 32968628 DOI: 10.21037/cdt-20-151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Oral anticoagulation therapy (OAT) prevents ischaemic incidents in patients with atrial fibrillation (AF). CHA2DS2-VASc risk score of ≥2 points in men and ≥3 in women is a class I indication for OAT. OAT should also be considered as a prevention of thromboembolism in AF men with a CHA2DS2-VASc score of 1 point and women with 2 points, but the class of recommendation is lower (IIa). This study aims to assess the occurrence of left atrial appendage thrombus (LAAT) and risk factors of its formation in patients with lower class recommendation to oral antiocoagulation treatment. Methods The study group consisted of 1,858 patients: 555 patients with class IIa indication to OAT (IIa group) and 1,303 patients with class I indication as a control group (I group). Patients were admitted to three cardiology departments. All subjects underwent transoesophageal echocardiography. Results The incidence of LAAT was comparable in both IIa and I group: LAAT was confirmed in 30 (5.4%) subjects of IIa group and in 77 (5.9%) of I group. The prevalence of LAAT in IIa group was higher on treatment with VKAs (in comparison to NOACs) (8.4% vs. 3.4%, P=0.010), and lower in case of paroxysmal AF (in comparison to non-paroxysmal AF) (2.4% vs. 9.8%, P=0.0002). Multivariate logistic regression revealed the following variables as the independent predictors of LAAT in IIa group: treatment with VKAs (OR 2.99, 95% CI: 1.33-6.69; P=0.007), paroxysmal AF (OR 0.26, 95% CI: 0.11-0.62; P=0.002) and eGFR <60 mL/min/1.73 m2 (OR 3.19, 95% CI: 1.42-7.16; P=0.005). Conclusions The prevalence of LAAT in AF patients with lower class (IIa) recommendation to anticoagulants was comparable to higher (I). Treatment with VKAs, along with non-paroxysmal type of AF and eGFR <60 mL/min/1.72 m2 were identified as the strongest predictors of LAAT in IIa group.
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Affiliation(s)
| | - Paweł Krzesiński
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
| | - Agnieszka Jurek
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
| | - Monika Budnik
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Iwona Gorczyca
- Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, Kielce, Poland
| | | | - Marek Kiliszek
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
| | - Agnieszka Wójcik
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
| | - Monika Gawałko
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Olga Jelonek
- Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, Kielce, Poland
| | - Anna Michalska
- Faculty of Medical and Health Sciences, The Jan Kochanowski University, Kielce, Poland
| | - Katarzyna Starzyk
- Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, Kielce, Poland
| | - Piotr Scisło
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Janusz Kochanowski
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Krzysztof J Filipiak
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Beata Wożakowska-Kapłon
- Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, Kielce, Poland.,Faculty of Medical and Health Sciences, The Jan Kochanowski University, Kielce, Poland
| | - Grzegorz Opolski
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Grzegorz Gielerak
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
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Gorczyca I, Jelonek O, Michalska A, Chrapek M, Wałek P, Wożakowska-Kapłon B. Stroke prevention and guideline adherent antithrombotic treatment in elderly patients with atrial fibrillation: A real-world experience. Medicine (Baltimore) 2020; 99:e21209. [PMID: 32702889 PMCID: PMC7373526 DOI: 10.1097/md.0000000000021209] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Patients aged ≥75 years with the diagnosis of atrial fibrillation (AF) are at a higher risk of stroke and, according to recent recommendations, should receive oral anticoagulant (OAC) therapy. This study aimed to assess the recommended prophylactic antithrombotic therapy among patients with AF aged ≥ 75 years and its compliance with current guidelines. We also aimed to identify predisposing factors associated with the administration of non-vitamin K antagonist oral anticoagulants (NOACs) in elderly patients with AF.This was a retrospective, single-center observational study. Patients with AF aged ≥75 years hospitalized at a reference cardiology center from 2014 to 2017 were included in the analysis.Among the 1236 eligible patients (43.4% male; mean age, 82 years), OACs were recommended in 90.1% of cases. Of these, 59.8% of patients used NOACs and 40.2% used vitamin K antagonists. Additionally, 3.3% of patients received antiplatelet (AP) therapy and 2.5% were administered low molecular weight heparin. Only 4.5% of patients did not receive any anticoagulant treatment. The majority (89.9%) of patients received relevant prophylactic antithrombotic therapy according to current guidelines; only 1.4% were overtreated and 8.7% were undertreated. The significant predictors of NOAC therapy among patients treated with anticoagulants were non-permanent AF (odds ratio [OR] = 1.68, 95% confidence interval [CI] = 1.30-2.18, P = .0001), age-by 5 years (OR = 1.33, 95% CI = 1.16-1.52, P = .0001), and glomerular filtration rate-by 5 units (OR = 1.06, 95% CI = 1.02-1.10, P = .0066).A high percentage of AF patients aged ≥75 years receive OACs, mainly NOACs. Most patients are treated according to the current guidelines; under treatment is primarily observed in patients receiving AP therapy. Non-permanent AF, age, and preservation of renal function are significant predictors of NOAC use.
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Affiliation(s)
- Iwona Gorczyca
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre
- Collegium Medicum, The Jan Kochanowski University
| | - Olga Jelonek
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre
| | | | - Magdalena Chrapek
- Faculty of Mathematics and Natural Sciences, The Jan Kochanowski University, Kielce, Poland
| | - Paweł Wałek
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre
| | - Beata Wożakowska-Kapłon
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre
- Collegium Medicum, The Jan Kochanowski University
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50
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Michalska A, Gorczyca I, Chrapek M, Kapłon-Cieślicka A, Uziębło-Życzkowska B, Starzyk K, Jelonek O, Budnik M, Gawałko M, Krzesiński P, Jurek A, Scisło P, Kochanowski J, Kiliszek M, Gielerak G, Filipiak KJ, Opolski G, Wożakowska-Kapłon B. Does the CHA2DS2-VASc scale sufficiently predict the risk of left atrial appendage thrombus in patients with diagnosed atrial fibrillation treated with non-vitamin K oral anticoagulants? Medicine (Baltimore) 2020; 99:e20570. [PMID: 32569181 PMCID: PMC7310852 DOI: 10.1097/md.0000000000020570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The CHA2DS2-VASc scale does not include potential risk factors for left atrial appendage thrombus (LAAT) formation such as a form of atrial fibrillation (AF) and impaired kidney function. The real risk of thromboembolic complications in AF patients is still unclear as well as an optimal anticoagulant treatment in males with a CHA2DS2-VASc score of 1 and females with a CHA2DS2-VASc score of 2.The aim of this study was to compare the predictive value of the CHA2DS2-VASc scale and other scales to estimate the risk of LAAT formation in AF patients treated with non-vitamin K oral anticoagulants (NOACs) and to assess the prevalence of thrombi in patients at intermediate risk of stroke.The observational study included consecutive patients with a diagnosis of non-valvular AF treated with NOACs, admitted to 3 high-reference institutions between 2013 and 2018. All individuals underwent transoesophageal echocardiography before cardioversion or ablation.Out of 1163 enrolled AF patients (62.1% male, mean age 62 years) the LAAT had been detected in 50 individuals (4.3%). Among patients with LAAT, 1 patient (2.0%) was classified as a low-risk category, 9 (18.0%) were at intermediate-risk, and 40 (80.0%) were at high risk of thromboembolic complications according to CHA2DS2-VASc scale. All patients were treated with NOACs: 51.0% rivaroxaban, 47.1% dabigatran, and 1.9% apixaban.Patients at intermediate stroke-risk with detected LAAT had higher R2CHADS2 score (2.1 ± 1.2 vs 1.2 ± 0.8, P = .007), higher CHA2DS2-VASc-RAF score (6.4 ± 4.4 vs 3.7 ± 2.6, P = .027) and more often had an estimated glomerular filtration rate below 56 mL/min/1.73 m (44.4% vs 13.2%, P = .026) compared to patients without LAAT. The receiver operating characteristics revealed that the CHA2DS2-VASc-RAF scale had better predictive ability to distinguish between patients with and without LAAT in the study group than CHA2DS2-VASc (P = .0006), CHADS2 (P = .0006) and R2CHADS2 scale (P = .0140).The CHA2DS2-VASc scale should be supplemented with an assessment of renal function and form of AF to improve stroke risk estimation. The application of additional scales to estimate the risk of LAAT might be especially useful among males with a CHA2DS2-VASc score of 1 and females with a CHA2DS2-VASc score of 2.
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Affiliation(s)
| | - Iwona Gorczyca
- Collegium Medicum, the Jan Kochanowski University
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre
| | | | | | | | - Katarzyna Starzyk
- Collegium Medicum, the Jan Kochanowski University
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre
| | - Olga Jelonek
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre
| | - Monika Budnik
- 1st Chair and Department of Cardiology, Medical University of Warsaw
| | - Monika Gawałko
- 1st Chair and Department of Cardiology, Medical University of Warsaw
| | - Paweł Krzesiński
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
| | - Agnieszka Jurek
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
| | - Piotr Scisło
- 1st Chair and Department of Cardiology, Medical University of Warsaw
| | | | - Marek Kiliszek
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
| | - Grzegorz Gielerak
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
| | | | - Grzegorz Opolski
- 1st Chair and Department of Cardiology, Medical University of Warsaw
| | - Beata Wożakowska-Kapłon
- Collegium Medicum, the Jan Kochanowski University
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre
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