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Kurzyna P, Banaszkiewicz M, Florczyk M, Kępski J, Piłka M, Kędzierski P, Mańczak R, Szwed P, Kasperowicz K, Wrona K, Doroszewski G, Torbicki A, Kurzyna M, Szmit S, Darocha S. Safety and Outcomes of Inferior Vena Cava Filter Placement in Oncology Patients: A Single-Centre Experience. Cancers (Basel) 2024; 16:1562. [PMID: 38672644 PMCID: PMC11049443 DOI: 10.3390/cancers16081562] [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: 03/19/2024] [Revised: 04/15/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
The risk of venous thromboembolism (VTE) in the oncology population is significantly higher than in non-cancer patients. Inferior vena cava (IVC) filters may, therefore, be an important part of VTE treatment. In this study, we address the outcomes of placing IVC filters in the oncology population. This single-centre, observational, retrospective study included 62 patients with active malignancy and acute VTE who underwent an IVC filter implantation due to contraindications to anticoagulation during the period 2012-2023. The control group consisted of 117 trauma patients. In both groups, an urgent surgical procedure requiring temporary cessation of anticoagulation was the most noted reason for IVC filter placement-76% in the oncology group vs. 100% in the non-oncology group (p < 0.001). No complications were reported during the IVC filter implantation procedures. There was no recurrence of pulmonary embolism or deep venous thrombosis in the oncology group after filter implantation. The rate of successful filter explantation, median time to retrieval, and abnormal findings during retrieval were not significantly different between both subgroups (64.3% vs. 76.5%, p = 0.334; 77 days vs. 84 days, p = 0.764; 61.5% vs. 54.2%, p = 0.672; respectively). The study showed that IVC filter placement is a safe and effective method of preventing PE in cancer patients with contraindications to anticoagulation. The complication rate following IVC filter implantation in cancer patients is low and similar to that in non-oncology patients.
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Affiliation(s)
- Paweł Kurzyna
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, ERN-LUNG Member, 05-400 Otwock, Poland
| | - Marta Banaszkiewicz
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, ERN-LUNG Member, 05-400 Otwock, Poland
| | - Michał Florczyk
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, ERN-LUNG Member, 05-400 Otwock, Poland
| | - Jarosław Kępski
- Department of Cardio-Oncology, Chair of Haematology and Transfusion Medicine, Centre of Postgraduate Medical Education, 01-813 Warsaw, Poland
| | - Michał Piłka
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, ERN-LUNG Member, 05-400 Otwock, Poland
| | - Piotr Kędzierski
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, ERN-LUNG Member, 05-400 Otwock, Poland
| | - Rafał Mańczak
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, ERN-LUNG Member, 05-400 Otwock, Poland
| | - Piotr Szwed
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, ERN-LUNG Member, 05-400 Otwock, Poland
| | - Krzysztof Kasperowicz
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, ERN-LUNG Member, 05-400 Otwock, Poland
| | - Katarzyna Wrona
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, ERN-LUNG Member, 05-400 Otwock, Poland
| | - Grzegorz Doroszewski
- Centre of Postgraduate Medical Education, Pelvic Injury and Pathology Department, Konarskiego 13, 05-400 Otwock, Poland
| | - Adam Torbicki
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, ERN-LUNG Member, 05-400 Otwock, Poland
| | - Marcin Kurzyna
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, ERN-LUNG Member, 05-400 Otwock, Poland
| | - Sebastian Szmit
- Department of Cardio-Oncology, Chair of Haematology and Transfusion Medicine, Centre of Postgraduate Medical Education, 01-813 Warsaw, Poland
| | - Szymon Darocha
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, ERN-LUNG Member, 05-400 Otwock, Poland
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Zieliński D, Darocha S, Pietrasik A, Machowski M, Wróbel K, Kurzyna M, Pruszczyk P, Torbicki A, Biederman A. Chronic thromboembolic disease among patients undergoing surgical pulmonary embolectomy for acute pulmonary embolism. J Cardiovasc Surg (Torino) 2024:S0021-9509.24.12931-X. [PMID: 38635283 DOI: 10.23736/s0021-9509.24.12931-x] [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] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
BACKGROUND This study aimed to assess the prevalence of chronic thromboembolic lesions in the pulmonary arteries among patients undergoing pulmonary embolectomy for acute pulmonary embolism and their impact on treatment outcomes. METHODS We conducted a retrospective, single-center analysis of consecutive patients undergoing emergency pulmonary embolectomy for acute pulmonary embolism between 2013 and August 2021. According to European Society of Cardiology guidelines, the diagnosis was based on clinical presentation, imaging studies and laboratory tests. Surgery was selected as the optimal treatment modality within the Pulmonary Embolism Response Team. Based on the intraoperatively identified chronic lesions patients were divided into two groups: acute only and acute/chronic. The analysis comprised history, laboratory and imaging studies, early and long-term mortality, and postoperative complications. We determined predictive factors for chronic thromboembolic lesions and risk factors for death. RESULTS The analysis included 33 patients. Intraoperatively, 42% (14) of patients had chronic lesions. Predictive factors for these lesions are the duration of symptoms >1 week (OR=13.75), pulmonary artery dilatation >3.15 cm (OR=39.00) and right ventricle systolic pressure >52 mmHg (OR=29.33). No hospital deaths occurred in the acute only group and two in the acute/chronic group (0% vs. 14.3%; P=0.172). Risk factors for death are the duration of symptoms >3 weeks (HR=7.35) and postoperative use of extracorporeal membrane oxygenation (HR=7.04). CONCLUSIONS Acute thromboembolic disease overlapping chronic clots is relatively common among patients undergoing pulmonary artery embolectomy. A detailed evaluation of the patient's medical history and imaging studies can identify these patients, as they require special attention when making treatment decisions. Surgical treatment in a center of expertise in pulmonary endarterectomy seems reasonable.
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Affiliation(s)
- Dariusz Zieliński
- Department of Cardiac Surgery, Medicover Hospital, Warsaw, Poland -
- Faculty of Medicine, Lazarski University, Warsaw, Poland -
| | - Szymon Darocha
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, Otwock, Poland
- European Health Center, Otwock, Poland
| | | | - Michał Machowski
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Krzysztof Wróbel
- Department of Cardiac Surgery, Medicover Hospital, Warsaw, Poland
- Faculty of Medicine, Lazarski University, Warsaw, Poland
| | - Marcin Kurzyna
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, Otwock, Poland
- European Health Center, Otwock, Poland
| | - Piotr Pruszczyk
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Adam Torbicki
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, Otwock, Poland
- European Health Center, Otwock, Poland
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Torbicki A, Kurzyna M. MERIT reloaded-what has changed in CTEPH management since 2017? Lancet Respir Med 2024; 12:263-265. [PMID: 38548405 DOI: 10.1016/s2213-2600(24)00040-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 02/13/2024] [Indexed: 04/02/2024]
Affiliation(s)
- Adam Torbicki
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, Europejskie Centrum Zdrowia Otwock (ERN-LUNG), Otwock 05-400, Poland.
| | - Marcin Kurzyna
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, Europejskie Centrum Zdrowia Otwock (ERN-LUNG), Otwock 05-400, Poland
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Krigere A, Kalejs VR, Kaulins R, Rudzitis A, Bondare L, Sablinskis M, Lejnieks A, Kigitovica D, Kurzyna M, Skride A. The Initial Experience of Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension in Latvia. Medicina (Kaunas) 2024; 60:568. [PMID: 38674214 PMCID: PMC11052274 DOI: 10.3390/medicina60040568] [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: 01/14/2024] [Revised: 03/21/2024] [Accepted: 03/27/2024] [Indexed: 04/28/2024]
Abstract
Background: Treatment options for inoperable chronic thromboembolic pulmonary hypertension (CTEPH) or persistent pulmonary hypertension after pulmonary endarterectomy (PEA) include targeted medical therapy and balloon pulmonary angioplasty (BPA). BPA is an emerging treatment modality that has been reported to improve functional capacity, pulmonary hemodynamics, and right ventricular function. Reports from expert centers are promising, but more data are needed to make the results more generalizable. Materials and Methods: We conducted a prospective analysis of nine consecutive CTEPH patients who underwent balloon pulmonary angioplasty (BPA) sessions at Pauls Stradins Clinical University Hospital in Riga, Latvia between 1 April 2022 and 1 July 2023. We assessed World Health Organization (WHO) functional class, 6 min walk distance (6MWD), blood oxygen saturation (SpO2), brain natriuretic peptide (BNP) level at baseline and 3 months after the first BPA session. For two patients on whom repeated BPA sessions were performed, we additionally assessed cardiac output (CO), pulmonary vascular resistance (PVR), and mean pulmonary artery pressure (mPAP). Results: A total of 12 BPA procedures for nine patients were performed; repeated BPA sessions were performed for two patients. Our results show a reduction in BNP levels and improvement in WHO functional class, 6MWD, and SpO2 after the first BPA session. Improvement in 6MWD was statistically significant. Additionally, an improvement in pulmonary hemodynamic parameters was observed. Conclusions: Our data show that BPA is an effective interventional treatment modality, improving both the pulmonary hemodynamics and functional status. Moreover, BPA is safe and excellently tolerated.
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Affiliation(s)
- Anna Krigere
- Department of Rare Diseases, Pauls Stradins Clinical University Hospital, 1002 Riga, Latvia; (A.K.); (V.R.K.); (A.R.)
| | - Verners Roberts Kalejs
- Department of Rare Diseases, Pauls Stradins Clinical University Hospital, 1002 Riga, Latvia; (A.K.); (V.R.K.); (A.R.)
| | - Ricards Kaulins
- Department of Internal Diseases, Riga Stradins University, 1007 Riga, Latvia; (R.K.); (A.L.)
| | - Ainars Rudzitis
- Department of Rare Diseases, Pauls Stradins Clinical University Hospital, 1002 Riga, Latvia; (A.K.); (V.R.K.); (A.R.)
- Department of Internal Diseases, Riga Stradins University, 1007 Riga, Latvia; (R.K.); (A.L.)
| | - Liga Bondare
- Department of Rare Diseases, Pauls Stradins Clinical University Hospital, 1002 Riga, Latvia; (A.K.); (V.R.K.); (A.R.)
| | - Matiss Sablinskis
- Department of Rare Diseases, Pauls Stradins Clinical University Hospital, 1002 Riga, Latvia; (A.K.); (V.R.K.); (A.R.)
| | - Aivars Lejnieks
- Department of Internal Diseases, Riga Stradins University, 1007 Riga, Latvia; (R.K.); (A.L.)
- Department of Internal Diseases, Riga East Clinical University Hospital, 1038 Riga, Latvia
| | - Dana Kigitovica
- Department of Rare Diseases, Pauls Stradins Clinical University Hospital, 1002 Riga, Latvia; (A.K.); (V.R.K.); (A.R.)
- Department of Internal Diseases, Riga Stradins University, 1007 Riga, Latvia; (R.K.); (A.L.)
| | - Marcin Kurzyna
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, ERN-LUNG Member, 05-400 Otwock, Poland
| | - Andris Skride
- Department of Rare Diseases, Pauls Stradins Clinical University Hospital, 1002 Riga, Latvia; (A.K.); (V.R.K.); (A.R.)
- Department of Internal Diseases, Riga Stradins University, 1007 Riga, Latvia; (R.K.); (A.L.)
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Oknińska M, Zajda K, Zambrowska Z, Grzanka M, Paterek A, Mackiewicz U, Szczylik C, Kurzyna M, Piekiełko-Witkowska A, Torbicki A, Kieda C, Mączewski M. Role of Oxygen Starvation in Right Ventricular Decompensation and Failure in Pulmonary Arterial Hypertension. JACC Heart Fail 2024; 12:235-247. [PMID: 37140511 DOI: 10.1016/j.jchf.2023.03.010] [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: 09/04/2022] [Revised: 02/22/2023] [Accepted: 03/16/2023] [Indexed: 05/05/2023]
Abstract
Right ventricular (RV) function and eventually failure determine outcome in patients with pulmonary arterial hypertension (PAH). Initially, RV responds to an increased load caused by PAH with adaptive hypertrophy; however, eventually RV failure ensues. Unfortunately, it is unclear what causes the transition from compensated RV hypertrophy to decompensated RV failure. Moreover, at present, there are no therapies for RV failure; those for left ventricular (LV) failure are ineffective, and no therapies specifically targeting RV are available. Thus there is a clear need for understanding the biology of RV failure and differences in physiology and pathophysiology between RV and LV that can ultimately lead to development of such therapies. In this paper, we discuss RV adaptation and maladaptation in PAH, with a particular focus of oxygen delivery and hypoxia as the principal drivers of RV hypertrophy and failure, and attempt to pinpoint potential sites for therapy.
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Affiliation(s)
- Marta Oknińska
- Department of Clinical Physiology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Karolina Zajda
- Laboratory of Molecular Oncology and Innovative Therapies, Military Medical Institute, Warsaw, Poland
| | - Zuzanna Zambrowska
- Department of Clinical Physiology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Małgorzata Grzanka
- Department of Biochemistry and Molecular Biology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Aleksandra Paterek
- Department of Clinical Physiology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Urszula Mackiewicz
- Department of Clinical Physiology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Cezary Szczylik
- Department of Oncology at ECZ-Otwock, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Marcin Kurzyna
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology at ECZ-Otwock, ERN-LUNG Member, Centre of Postgraduate Medical Education, Warsaw, Poland
| | | | - Adam Torbicki
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology at ECZ-Otwock, ERN-LUNG Member, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Claudine Kieda
- Laboratory of Molecular Oncology and Innovative Therapies, Military Medical Institute, Warsaw, Poland; Centre for Molecular Biophysics, UPR, CNRS 4301, Orléans CEDEX 2, France; Department of Molecular and Translational Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Michał Mączewski
- Department of Clinical Physiology, Centre of Postgraduate Medical Education, Warsaw, Poland.
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Piłka M, Darocha S, Florczyk M, Mańczak R, Banaszkiewicz M, Kędzierski P, Zieliński D, Wróbel K, Torbicki A, Kurzyna M. The Utility of a Resting Electrocardiogram (ECG-PH Index) in Evaluating the Efficacy of Pulmonary Endarterectomy in Chronic Thromboembolic Pulmonary Hypertension. J Clin Med 2023; 12:7621. [PMID: 38137690 PMCID: PMC10743524 DOI: 10.3390/jcm12247621] [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: 10/30/2023] [Revised: 11/27/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND The ECG-PH index (PH-ECG score) has been proposed as a valuable ECG-derived method of evaluating the effectiveness of balloon pulmonary angioplasty (BPA) in chronic thromboembolic pulmonary hypertension (CTEPH). Pulmonary endarterectomy (PEA) is the main form of therapy for CTEPH with a proximal clot location. The objective of this study was to assess the clinical utility of a resting electrocardiogram (ECG-PH index) in assessing the effectiveness of PEA in CTEPH patients. METHODS The retrospective analysis included 73 patients who underwent PEA. Their ECG-PH index values were calculated using four ECG parameters: R-wave amplitude V1 + S-wave amplitude V5/V6 > 10.5 mm, QRS-wave axis > 110 degrees, R-wave amplitude V1 > S-wave amplitude V1, and SIQIII pattern. PH-ECG scores were assessed after a median time of 13 months (IQR: 8-31 months) had passed since the PEA procedures. RESULTS The current analysis documented that ECG-PH index = 0 is a good reflection of mPAP < 25mmHg (sensitivity 76.1%; specificity 66.7%; positive predictive value 79.5%; negative predictive value 62.1%) or mPAP ≤ 20 mmHg (sensitivity 69.6%; specificity 70.6%; positive predictive value 88.6%; negative predictive value 41.4%) after PEA. The values of the area under the ROC curve for ECG-PH index were 0.772 (95% CI: 0.676-0.867) and 0.743 (95% CI: 0.637-0.849) for the mPAP < 25 mmHg and mPAP ≤ 20 mmHg patient groups, respectively. CONCLUSION The ECG-PH index may be useful for monitoring the haemodynamic effect of PEA in CTEPH patients.
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Affiliation(s)
- Michał Piłka
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, European Health Center, ERN-LUNG Member, 05-400 Otwock, Poland; (S.D.); (M.F.); (R.M.); (M.B.); (P.K.); (A.T.); (M.K.)
| | - Szymon Darocha
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, European Health Center, ERN-LUNG Member, 05-400 Otwock, Poland; (S.D.); (M.F.); (R.M.); (M.B.); (P.K.); (A.T.); (M.K.)
| | - Michał Florczyk
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, European Health Center, ERN-LUNG Member, 05-400 Otwock, Poland; (S.D.); (M.F.); (R.M.); (M.B.); (P.K.); (A.T.); (M.K.)
| | - Rafał Mańczak
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, European Health Center, ERN-LUNG Member, 05-400 Otwock, Poland; (S.D.); (M.F.); (R.M.); (M.B.); (P.K.); (A.T.); (M.K.)
| | - Marta Banaszkiewicz
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, European Health Center, ERN-LUNG Member, 05-400 Otwock, Poland; (S.D.); (M.F.); (R.M.); (M.B.); (P.K.); (A.T.); (M.K.)
| | - Piotr Kędzierski
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, European Health Center, ERN-LUNG Member, 05-400 Otwock, Poland; (S.D.); (M.F.); (R.M.); (M.B.); (P.K.); (A.T.); (M.K.)
| | - Dariusz Zieliński
- Cardiac Surgery Department, Medicover Hospital, 02-972 Warsaw, Poland; (D.Z.); (K.W.)
- Faculty of Medicine, Lazarski University, 02-662 Warsaw, Poland
| | - Krzysztof Wróbel
- Cardiac Surgery Department, Medicover Hospital, 02-972 Warsaw, Poland; (D.Z.); (K.W.)
- Faculty of Medicine, Lazarski University, 02-662 Warsaw, Poland
| | - Adam Torbicki
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, European Health Center, ERN-LUNG Member, 05-400 Otwock, Poland; (S.D.); (M.F.); (R.M.); (M.B.); (P.K.); (A.T.); (M.K.)
| | - Marcin Kurzyna
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, European Health Center, ERN-LUNG Member, 05-400 Otwock, Poland; (S.D.); (M.F.); (R.M.); (M.B.); (P.K.); (A.T.); (M.K.)
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Torbicki A, Kurzyna M. The Diagnostic Approach to Pulmonary Hypertension. Semin Respir Crit Care Med 2023; 44:728-737. [PMID: 37487526 DOI: 10.1055/s-0043-1770116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
The clinical presentation of pulmonary hypertension (PH) is nonspecific, resulting in significant delays in its detection. In the majority of cases, PH is a marker of the severity of other cardiopulmonary diseases. Differential diagnosis aimed at the early identification of patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) who do require specific and complex therapies is as important as PH detection itself. Despite all efforts aimed at the noninvasive assessment of pulmonary arterial pressure, the formal confirmation of PH still requires catheterization of the right heart and pulmonary artery. The current document will give an overview of strategies aimed at the early diagnosis of PAH and CTEPH, while avoiding their overdiagnosis. It is not intended to be a replica of the recently published European Society of Cardiology (ESC) and European Respiratory Society (ERS) Guidelines on Diagnosis and Treatment of Pulmonary Hypertension, freely available at the Web sites of both societies. While promoting guidelines' recommendations, including those on new definitions of PH, we will try to bring them closer to everyday clinical practice, benefiting from our personal experience in managing patients with suspected PH.
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Affiliation(s)
- Adam Torbicki
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre for Postgraduate Medical Education at ECZ-Otwock, Otwock, Poland
| | - Marcin Kurzyna
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre for Postgraduate Medical Education at ECZ-Otwock, Otwock, Poland
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Mavromanoli AC, Jiménez D, Sanchez O, Sobkowicz B, Vanni S, Kurzyna M, Becattini C, Pruszczyk P, Wilkens H, Bova C, Tschöpe C, Sawicka-Śmiarowska E, Grifoni C, Kostrubiec M, Torbicki A, Meneveau N, Kresoja KP, Konstantinides SV. Major in-hospital bleeding in patients with pulmonary embolism treated with systemic thrombolysis. Thromb Res 2023; 231:29-31. [PMID: 37778058 DOI: 10.1016/j.thromres.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 09/06/2023] [Accepted: 09/18/2023] [Indexed: 10/03/2023]
Affiliation(s)
- Anna C Mavromanoli
- Center for Thrombosis and Haemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - David Jiménez
- Department of Respiratory Diseases, Ramon y Cajal Hospital, Universidad de Alcalá (IRYCIS), CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Olivier Sanchez
- University Paris Cité; Department of Pneumology and Critical Care Medicine, Hôpital Européen Georges Pompidou, APHP. Center Université Paris Cité; INSERM UMRS 1140 Innovative Therapies in Haemostasis; F-CRIN INNOVTE, Paris, France
| | - Bożena Sobkowicz
- Department of Cardiology, Medical University of Bialystok, Białystok, Poland
| | - Simone Vanni
- Emergency Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Marcin Kurzyna
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, European Health Center, Otwock, Poland
| | - Cecilia Becattini
- Department of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Piotr Pruszczyk
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Heinrike Wilkens
- Clinic for Internal Medicine V - Pneumology, Allergology and Critical Care Medicine, Saarland University Hospital, Homburg /Saar, Germany
| | - Carlo Bova
- Department of Internal Medicine, University Hospital of Cosenza, Cosenza, Italy
| | - Carsten Tschöpe
- Dept Cardiology, Angiology, and Intensive Medicine (CVK) at the German Heart Center of the Charite (DHZC), Charité Universitätsmedizin, Berlin, Germany; Berlin Institute of Health (BIH) for Regenerative Therapies (BCRT) at Charite; Charité Universitätsmedizin, Berlin, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Germany; Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | | | - Caterina Grifoni
- Emergency Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Maciej Kostrubiec
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Adam Torbicki
- Department of Pulmonary Circulation and Thromboembolic Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Nicolas Meneveau
- Department of Cardiology, University Hospital Jean Minjoz, Besançon, France; EA3920, University of Burgundy Franche-Comté, Besançon, France
| | - Karl-Patrik Kresoja
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Stavros V Konstantinides
- Center for Thrombosis and Haemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany; Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece.
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Sławek-Szmyt S, Stępniewski J, Kurzyna M, Kuliczkowski W, Jankiewicz S, Kopeć G, Darocha S, Mroczek E, Pietrasik A, Grygier M, Lesiak M, Araszkiewicz A. Catheter-directed mechanical aspiration thrombectomy in a real-world pulmonary embolism population: a multicenter registry. Eur Heart J Acute Cardiovasc Care 2023; 12:584-593. [PMID: 37319339 PMCID: PMC10519874 DOI: 10.1093/ehjacc/zuad066] [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: 03/27/2023] [Revised: 06/08/2023] [Accepted: 06/14/2023] [Indexed: 06/17/2023]
Abstract
AIMS High- (HR) and intermediate-high risk (IHR) pulmonary embolisms (PEs) are related to high early mortality and long-term sequelae. We aimed to describe clinical outcomes and adverse events in IHR and HR pulmonary embolism (PE) treated with catheter-directed mechanical thrombectomy (CDMT) in a real-world population. METHODS AND RESULTS This study is a multicenter, prospective registry enrolling 110 PE patients treated with CDMT between 2019 and 2022. The CDMT was performed using the 8F Indigo (Penumbra, Alameda, CA, USA) system bilaterally in pulmonary arteries (PAs). The primary safety endpoints included device or PE-related death during the 48-h after CDMT, procedure-related major bleeding, or other major adverse events. Secondary safety outcomes were all-cause mortality during hospitalization or the follow-up. The primary efficacy outcomes were the reduction of PA pressures and change in the right-to-left ventricular (RV/L) ratio assessed in the imaging 24-48 h after the CDMT.71.8% of patients had IHR PE and 28.2% HR PE. 11.8% of patients had a failure and 34.5% had contraindications to thrombolysis, and 2.7% had polytrauma. There was 0.9% intraprocedural death related to RV failure and 5.5% deaths within the first 48 h. CDMT was complicated by major bleeding in 1.8%, pulmonary artery injury in 1.8%, and ischaemic stroke in 0.9%. Immediate haemodynamic improvements included a 10.4 ± 7.8 mmHg (19.7%) drop in systolic PAP (P < 0.0001), a 6.1 ± 4.2 mmHg (18.8%) drop in mean PAP, and 0.48 ± 0.4 (36%) drop in RV/LV ratio (P < 0.0001). CONCLUSION These observational findings suggest that CDMT may improve hemodynamics with an acceptable safety profile in patients with IHR and HR PE.
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Affiliation(s)
- Sylwia Sławek-Szmyt
- Department of Cardiology, Poznan University of Medical Sciences, Długa 1/2 Street, 61-848 Poznan, Poland
| | - Jakub Stępniewski
- Pulmonary Circulation Centre, Department of Cardiac and Vascular Disease, Jagiellonian University Medical College, John Paul II Hospital in Krakow, Prądnicka 80 Street, 31-202 Krakow, Poland
- Department of Medical Education, Jagiellonian University Medical College, Medyczna 7 Street, 30-688 Krakow, Poland
| | - Marcin Kurzyna
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology European Health Centre Otwock, Medical Centre for Postgraduate Education, Borowa 14/18 Street, 05-400 Otwock, Poland
| | - Wiktor Kuliczkowski
- Department of Cardiology, Wroclaw Medical University, Borowska 213 Street, 50-556 Wroclaw, Poland
| | - Stanisław Jankiewicz
- Department of Cardiology, Poznan University of Medical Sciences, Długa 1/2 Street, 61-848 Poznan, Poland
| | - Grzegorz Kopeć
- Pulmonary Circulation Centre, Department of Cardiac and Vascular Disease, Jagiellonian University Medical College, John Paul II Hospital in Krakow, Prądnicka 80 Street, 31-202 Krakow, Poland
| | - Szymon Darocha
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology European Health Centre Otwock, Medical Centre for Postgraduate Education, Borowa 14/18 Street, 05-400 Otwock, Poland
| | - Ewa Mroczek
- Department of Cardiology, Wroclaw Medical University, Borowska 213 Street, 50-556 Wroclaw, Poland
| | - Arkadiusz Pietrasik
- Department and Faculty of Cardiology, Medical University of Warsaw, Banacha 1A Street, 02-097 Warsaw, Poland
| | - Marek Grygier
- Department of Cardiology, Poznan University of Medical Sciences, Długa 1/2 Street, 61-848 Poznan, Poland
| | - Maciej Lesiak
- Department of Cardiology, Poznan University of Medical Sciences, Długa 1/2 Street, 61-848 Poznan, Poland
| | - Aleksander Araszkiewicz
- Department of Cardiology, Poznan University of Medical Sciences, Długa 1/2 Street, 61-848 Poznan, Poland
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10
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Leszek P, Klotzka A, Bartuś S, Burchardt P, Czarnecka AM, Długosz-Danecka M, Gierlotka M, Koseła-Paterczyk H, Krawczyk-Ożóg A, Kubiatowski T, Kurzyna M, Maciejczyk A, Mitkowski P, Prejbisz A, Rutkowski P, Sierko E, Sterliński M, Szmit S, Szwiec M, Tajstra M, Tycińska A, Witkowski A, Wojakowski W, Cybulska-Stopa B. A practical approach to the 2022 ESC cardio-oncology guidelines: Comments by a team of experts - cardiologists and oncologists. Kardiol Pol 2023; 81:1047-1063. [PMID: 37660389 DOI: 10.33963/v.kp.96840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 08/04/2023] [Indexed: 09/05/2023]
Affiliation(s)
- Przemysław Leszek
- Department of Heart Failure and Transplantology, Department of Mechanical Circulatory Support and Transplant, National Institute of Cardiology, Warszawa, Poland.
| | - Aneta Klotzka
- 1st Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland
| | - Stanisław Bartuś
- 2nd Department of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Paweł Burchardt
- Department of Hypertension, Angiology, and Internal Medicine, Poznan University of Medical Sciences, Poznań, Poland
- Department of Cardiology, J Struś Hospital, Poznań, Poland
| | - Anna M Czarnecka
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warszawa, Poland
- Department of Experimental Pharmacology, Mossakowski Medical Research Center, Polish Academy of Sciences, Warszawa, Poland
| | - Monika Długosz-Danecka
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Kraków, Poland
| | - Marek Gierlotka
- Department of Cardiology, University Hospital, Institute of Medial Sciences, University of Opole, Opole, Poland
| | - Hanna Koseła-Paterczyk
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warszawa, Poland
| | - Agata Krawczyk-Ożóg
- 2nd Department of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Tomasz Kubiatowski
- University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
- Chemotherapy Department, Grochowski Hospital in Warsaw, Warszawa, Poland
| | - Marcin Kurzyna
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology Center of Postgraduate Medical Education in EHC Otwock, ERN-Lung Member, Otwock, Poland
| | - Adam Maciejczyk
- Department of Radiotherapy, Lower Silesian Center of Oncology, Katowice, Poland
- Department of Oncology, Wroclaw Medical University, Wrocław, Poland
| | - Przemysław Mitkowski
- 1st Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland
| | - Aleksander Prejbisz
- Department of Epidemiology, Cardiovascular Prevention and Health Promotion, National Institute of Cardiology, Warszawa, Poland
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warszawa, Poland
| | - Ewa Sierko
- Department of Radiotherapy I, Maria Sklodowska-Curie Bialystok Oncology Center, Białystok, Poland
- Department of Oncology, Medical University of Bialystok, Białystok, Poland
| | | | - Sebastian Szmit
- Department of Cardio-Oncology, Center of Postgraduate Medical Education, Institute of Hematology and Transfusion Medicine, Warszawa, Poland
- Clinic of Oncological Diagnostics and Cardio-Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Warszawa, Poland
| | - Marek Szwiec
- Department of Surgery and Oncology, University of Zielona Gora, Zielona Góra, Poland
- Clinical Department of Oncology, University Hospital of K. Marcinkowski in Zielona Gora, Zielona Góra, Poland
| | - Mateusz Tajstra
- 3rd Department of Cardiology, School of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Agnieszka Tycińska
- Department of Cardiology, Medical University of Bialystok, Białystok, Poland
| | - Adam Witkowski
- Departament of Interventional Cardiology & Angiology National Institute of Cardiology, Warszawa, Poland
| | - Wojciech Wojakowski
- Division of Cardiology and Structural Heart Diseases Medical University of Silesia, Katowice, Poland
| | - Bożena Cybulska-Stopa
- Department of Oncology, Lower Silesian Center of Oncology, Pulmonology and Hematology, Wrocław, Poland
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11
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Pietrasik A, Gąsecka A, Kurzyna P, Smyk JM, Wasilewski M, Wolański R, Wrona K, Darocha S, Zieliński D, Grabowski M, Torbicki A, Kurzyna M. Cancer-associated thrombosis: comparison of characteristics, treatment, and outcomes in oncologic and nononcologic patients followed by a pulmonary embolism response team. Pol Arch Intern Med 2023; 133:16421. [PMID: 36734981 DOI: 10.20452/pamw.16421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The risk of venous thromboembolism (VTE) in patients with cancer is currently 12 times higher than in the general population, and even 23 times higher when they receive chemotherapy. The main goal of the pulmonary embolism response team at the Center for the Management of Pulmonary Embolism (PERT‑CELZAT) is to improve prognosis through interdisciplinary care, with a particular focus on patients with contraindications to standard pharmacologic treatment, requiring individual decision‑making, including a wider use of interventional therapeutic methods. OBJECTIVES The objectives of the study were to report and compare the characteristics and outcomes of pulmonary embolism (PE) in patients with and without cancer treated by the PERT‑CELZAT. PATIENTS AND METHODS The analysis included 235 patients diagnosed with VTE who were consulted by local PERT between September 2017 and December 2021. The study group was divided into 2 cohorts: oncologic patients (OP) and nononcologic patients (NOP). There were 81 patients in the OP group (mean [SD] age, 66.2 [14.1] years) and 154 patients in the NOP group (mean age, 57.4 [17.4] years). RESULTS The OPs were older and more frequently diagnosed with incidental PE. In‑hospital mortality for all patients reached 6.4% (15/235), 3.7% in the OP and 7.8% in the NOP group (P = 0.27). In‑hospital events, such as major bleeding, minor bleeding, recurrent PE, and deep venous thrombosis occurred with similar frequency in both groups. Posthospital mortality up to 12 months after the PE diagnosis was 12.8% (10/78) in the OP and 4.2% (6/142) in the NOP group (P = 0.03). In a long‑term survival analysis, cancer was associated with increased risk of mortality (hazard ratio, 2.44 [95% CI, 1.51-3.95]; P <0.001) when adjusted for age. CONCLUSIONS The multidisciplinary therapeutic approach may provide the OPs with VTE an in‑hospital survival rate noninferior to that of the NOPs. The OPs died more often in the following months, because of their underlying neoplastic disease.
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Affiliation(s)
- Arkadiusz Pietrasik
- First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.
| | - Aleksandra Gąsecka
- First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Paweł Kurzyna
- First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Julia M Smyk
- First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Marcin Wasilewski
- First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Rafał Wolański
- First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Wrona
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre Otwock, Otwock, Poland
| | - Szymon Darocha
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre Otwock, Otwock, Poland
| | | | - Marcin Grabowski
- First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Adam Torbicki
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre Otwock, Otwock, Poland
| | - Marcin Kurzyna
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre Otwock, Otwock, Poland
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12
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Banaszkiewicz M, Kurzyna P, Kubikowska N, Mucha M, Rudnik A, Gąsecka A, Pietrasik A, Grabowski M, Jaguszewski MJ, Kasprzyk P, Kędzierski P, Ciećwierz D, Żuk G, Szwed P, Piłka M, Florczyk M, Kurzyna M, Darocha S. Emerging Role of Balloon Pulmonary Angioplasty in Chronic Thromboembolic Pulmonary Disease-Insights from the 2022 ESC Guidelines. J Clin Med 2023; 12:5336. [PMID: 37629379 PMCID: PMC10455782 DOI: 10.3390/jcm12165336] [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: 07/18/2023] [Revised: 08/08/2023] [Accepted: 08/12/2023] [Indexed: 08/27/2023] Open
Abstract
In this article, we discuss the topic of chronic thromboembolic pulmonary disease (CTEPD) and the growing role of balloon pulmonary angioplasty (BPA) in its treatment. We present the pathophysiology of CTEPD which arises from an incomplete resolution of thrombi in the pulmonary arteries and leads to stenosis and occlusion of the vessels. The article focuses mainly on the chronic thromboembolic pulmonary hypertension (CTEPH) subpopulation for which prognosis is very poor when left untreated. We describe a multimodal approach to treating CTEPH, including pulmonary endarterectomy (PEA), BPA, and pharmacological therapies. Additionally, the benefits of pharmacological pre-treatment before BPA and the technical aspects of the procedure itself are outlined. It is emphasized that BPA does not replace PEA but serves as a complementary treatment option for eligible patients. We summarized efficacy and treatment goals including an improvement in functional and biochemical parameters before and after BPA. Patients who received pre-treatment with riociguat prior to BPA exhibited a notable reduction in the occurrence of less severe complications. However, elderly patients are still perceived as an especially vulnerable group. It is shown that the prognosis of patients undergoing BPA is similar to PEA in the first years after the procedure but the long-term prognosis of BPA still remains unclear. The 2022 ESC/ERS guidelines highlight the significant role of BPA in the multimodal treatment of CTEPH, emphasizing its effectiveness and recommending its consideration as a therapeutic option for patients with CTEPD, both with and without pulmonary hypertension. This review summarizes the available evidence for BPA, patient selection, procedural details, and prognosis and discusses the potential future role of BPA in the management of CTEPH.
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Affiliation(s)
- Marta Banaszkiewicz
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, European Health Center, ERN-LUNG Member, 05-400 Otwock, Poland
| | - Paweł Kurzyna
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, European Health Center, ERN-LUNG Member, 05-400 Otwock, Poland
| | - Nina Kubikowska
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-091 Warszawa, Poland
| | - Magda Mucha
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-091 Warszawa, Poland
| | - Aleksander Rudnik
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-091 Warszawa, Poland
| | - Aleksandra Gąsecka
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-091 Warszawa, Poland
| | - Arkadiusz Pietrasik
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-091 Warszawa, Poland
| | - Marcin Grabowski
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-091 Warszawa, Poland
| | | | - Piotr Kasprzyk
- 1st Department of Cardiology, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Piotr Kędzierski
- 1st Department of Cardiology, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Dariusz Ciećwierz
- 1st Department of Cardiology, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Grzegorz Żuk
- 1st Department of Cardiology, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Piotr Szwed
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, European Health Center, ERN-LUNG Member, 05-400 Otwock, Poland
| | - Michał Piłka
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, European Health Center, ERN-LUNG Member, 05-400 Otwock, Poland
| | - Michał Florczyk
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, European Health Center, ERN-LUNG Member, 05-400 Otwock, Poland
| | - Marcin Kurzyna
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, European Health Center, ERN-LUNG Member, 05-400 Otwock, Poland
| | - Szymon Darocha
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, European Health Center, ERN-LUNG Member, 05-400 Otwock, Poland
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13
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Pietrasik A, Kurzyna P, Szwed P, Jasińska-Gniadzik K, Gąsecka A, Darocha S, Zieliński D, Szarpak Ł, Kochman J, Grabowski M, Opolski G, Torbicki A, Kurzyna M. Treatment of high- and intermediate-high-risk pulmonary embolism by the Pulmonary Embolism Response Team: Focus on catheter-directed therapies. Cardiol J 2023; 31:215-225. [PMID: 37519055 DOI: 10.5603/cj.a2023.0047] [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: 04/24/2023] [Accepted: 06/27/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND Multidisciplinary Pulmonary Embolism Response Teams (PERTs) were established to individualize the treatment of high-risk (HR) and intermediate-high-risk (IHR) pulmonary embolism (PE) patients, which pose a challenge in clinical practice. METHODS We retrospectively collected the data of all HR and IHR acute PE patients consulted by PERT CELZAT between September 2017 and October 2022. The patient population was divided into four different treatment methods: anticoagulation alone (AC), systemic thrombolysis (ST), surgical embolectomy (SE), and catheter-directed therapies (CDTx). Baseline clinical characteristics, risk stratification, PE severity parameters, and treatment outcomes were compared between the four groups. RESULTS Of the 110 patients with HR and IHR PE, 67 (61%) patients were treated with AC only, 11 (10%) with ST, 15 (14%) underwent SE, and 17 (15%) were treated with CTDx. The most common treatment option in the HR group was reperfusion therapy, used in 20/24 (83%) cases, including ST in 7 (29%) patients, SE in 5 (21%) patients, and CTDx in 8 (33%) patients. In contrast, IHR patients were treated with AC alone in 63/86 (73%) cases. The in-hospital mortality rate was 9/24 (37.5%) in the HR group and 4/86 (4.7%) in the IHR group. CONCLUSIONS The number of advanced procedures aimed at reperfusion was substantially higher in the HR group than in the IHR PE group. Despite the common use of advanced reperfusion techniques in the HR group, patient mortality remained high. There is a need further to optimize the treatment of patients with HR PE to improve outcomes.
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Affiliation(s)
- Arkadiusz Pietrasik
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Poland
| | - Paweł Kurzyna
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Poland.
| | - Piotr Szwed
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, European Health Center, Otwock, Poland
| | | | - Aleksandra Gąsecka
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Poland
| | - Szymona Darocha
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, European Health Center, Otwock, Poland
| | | | - Łukasz Szarpak
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine Houston, Houston, TX, United States
- Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy, Warsaw, Poland
| | - Janusz Kochman
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Poland
| | - Marcin Grabowski
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Poland
| | - Grzegorz Opolski
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Poland
| | - Adam Torbicki
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, European Health Center, Otwock, Poland
| | - Marcin Kurzyna
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, European Health Center, Otwock, Poland
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14
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Sławiński G, Zieleniewicz P, Faran A, Dąbrowska-Kugacka A, Kurzyna M, Kempa M, Daniłowicz-Szymanowicz L, Lewicka E. Case report: Transected Hickman catheter and its thrombotic occlusion in a patient with idiopathic pulmonary arterial hypertension-can a catheter replacement be avoided? Front Cardiovasc Med 2023; 10:1230417. [PMID: 37547245 PMCID: PMC10397384 DOI: 10.3389/fcvm.2023.1230417] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 07/05/2023] [Indexed: 08/08/2023] Open
Abstract
A 25-year-old female with idiopathic pulmonary arterial hypertension (PAH), who had a Hickman catheter implanted for continuous intravenous epoprostenol infusion, was admitted to the clinic after inadvertently cutting the catheter with nail scissors during a routine dressing change. Approximately 7 cm of the external segment of the Hickman catheter remained intact, with the distal end knotted by paramedics. A decision was made to repair the damaged Hickman catheter. However, it was discovered that its lumen was completely occluded by thrombosis. Therefore, catheter patency was mechanically restored using a 0.035-inch stiff guidewire in a sterile operating theatre setting, under fluoroscopy guidance. Successful aspiration and catheter flushing were achieved. Continuity of the Hickman catheter was then restored using a repair kit (Bard Access Systems) as per the manufacturer's instructions, with no visible leakage thereafter. Epoprostenol infusion through the Hickman catheter was resumed 24 h later, and the patient was discharged in good general condition two days afterward.
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Affiliation(s)
- Grzegorz Sławiński
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
- Club 30, Polish Cardiac Society, Warsaw, Poland
| | - Piotr Zieleniewicz
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Anna Faran
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Alicja Dąbrowska-Kugacka
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Marcin Kurzyna
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education in EHC Otwock, ERN-Lung Member, Otwock, Poland
| | - Maciej Kempa
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | | | - Ewa Lewicka
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
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15
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Lang IM, Andreassen AK, Andersen A, Bouvaist H, Coghlan G, Escribano-Subias P, Jansa P, Kopec G, Kurzyna M, Matsubara H, Meyer BC, Palazzini M, Post MC, Pruszczyk P, Räber L, Roik M, Rosenkranz S, Wiedenroth CB, Redlin-Werle C, Brenot P. Balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension: a clinical consensus statement of the ESC working group on pulmonary circulation and right ventricular function. Eur Heart J 2023:ehad413. [PMID: 37470202 PMCID: PMC10393078 DOI: 10.1093/eurheartj/ehad413] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 05/08/2023] [Accepted: 06/12/2023] [Indexed: 07/21/2023] Open
Abstract
The current treatment algorithm for chronic thromboembolic pulmonary hypertension (CTEPH) as depicted in the 2022 European Society of Cardiology (ESC)/European Respiratory Society (ERS) guidelines on the diagnosis and treatment of pulmonary hypertension (PH) includes a multimodal approach of combinations of pulmonary endarterectomy (PEA), balloon pulmonary angioplasty (BPA) and medical therapies to target major vessel pulmonary vascular lesions, and microvasculopathy. Today, BPA of >1700 patients has been reported in the literature from centers in Asia, the US, and also Europe; many more patients have been treated outside literature reports. As BPA becomes part of routine care of patients with CTEPH, benchmarks for safe and effective care delivery become increasingly important. In light of this development, the ESC Working Group on Pulmonary Circulation and Right Ventricular Function has decided to publish a document that helps standardize BPA to meet the need of uniformity in patient selection, procedural planning, technical approach, materials and devices, treatment goals, complications including their management, and patient follow-up, thus complementing the guidelines. Delphi methodology was utilized for statements that were not evidence based. First, an anatomical nomenclature and a description of vascular lesions are provided. Second, treatment goals and definitions of complete BPA are outlined. Third, definitions of complications are presented which may be the basis for a standardized reporting in studies involving BPA. The document is intended to serve as a companion to the official ESC/ERS guidelines.
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Affiliation(s)
- Irene M Lang
- Department of Internal Medicine II, Cardiology, and Comprehensive Center of Cardiovascular Medicine CCVM, Medical University of Vienna, Währinger Gürtel 18-20, Vienna A-1090, Austria
| | - Arne K Andreassen
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Pb 4950 Nydalen, 0424 Oslo, Norway
| | - Asger Andersen
- Aarhus University Hospital, Palle Juul Jensens Boulevard 99 8200 Aarhus N Denmark
| | - Helene Bouvaist
- Cardiology Department, Grenoble - Alpes University Hospital, 38043 Grenoble, France
| | - Gerry Coghlan
- Royal Free Hospital, London, Pond Street, Middlesex, London, NW3 2QG
| | | | - Pavel Jansa
- General University Hospital, U Nemocnice 2, 128 08 Prague 2, Czech Republic
| | - Grzegorz Kopec
- Pulmonary Circulation Centre Jagiellonian University Medical College, John Paul II Hospital in Krakow, Pradnicka Str. 80, 31-202 Krakow
| | - Marcin Kurzyna
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology Centre of Postgraduate Medical Education, EHC Otwock, Borowa 14/18, Otwock 05-400, Poland
| | - Hiromi Matsubara
- Department of Cardiology, National Hospital Organization Okayama Medical Center, 1711-1 Tamasu, Kita-ku, Okayama 701-1192, Japan
| | - Bernhard Christian Meyer
- Medizinische Hochschule Hannover - Institut für Diagnostische und Interventionelle Radiologie Carl-Neuberg-Str. 1, 30625 Hannover
| | - Massimiliano Palazzini
- Dipartimento DIMEC (Dipartimento di Scienze Mediche e Chirurgiche), Università di Bologna, 40126 Bologna, Italy
| | - Marco C Post
- Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Piotr Pruszczyk
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Zwirki I Wigury 61, 02-091 Warsaw, Poland
| | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern Freiburgstrasse 18 3010 Bern, Switzerland
| | - Marek Roik
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Zwirki I Wigury 61, 02-091 Warsaw, Poland
| | - Stephan Rosenkranz
- Dept. of Cardiology and Cologne Cardiovascular Research Center, Heart Center at the University Hospital Cologne, Kerpener Str. 62, 50937 Köln, Germany
| | - Christoph B Wiedenroth
- Department of Thoracic Surgery, Kerckhoff Heart and Thorax Centre, Benekestrasse 2-8, 61231 Bad Nauheim, Germany
| | - Carlo Redlin-Werle
- Department of Internal Medicine II, Cardiology, and Comprehensive Center of Cardiovascular Medicine CCVM, Medical University of Vienna, Währinger Gürtel 18-20, Vienna A-1090, Austria
| | - Philippe Brenot
- Interventional Radiology Department, Marie Lannelongue Hospital, Le Plessis Robinson 92350 France
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16
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Jonas K, Kurzyna M, Mroczek E, Chrzanowski Ł, Mularek-Kubzdela T, Skoczylas I, Błaszczak P, Grześk G, Mizia-Stec K, Kuśmierczyk B, Kamiński K, Lewicka E, Peregud-Pogorzelska M, Tomaszewski M, Jacheć W, Gąsior Z, Pawlak A, Ryczek R, Pruszczyk P, Doboszyńska A, Widejko-Pietkiewicz K, Zabłocka W, Waligóra M, Kopeć G. Impact of diabetes mellitus on disease severity and patient survival in idiopathic pulmonary arterial hypertension: data from the Polish multicentre registry (BNP-PL). Cardiovasc Diabetol 2023; 22:177. [PMID: 37443009 PMCID: PMC10347845 DOI: 10.1186/s12933-023-01885-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/11/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Recent studies revealed that alterations in glucose and lipid metabolism in idiopathic pulmonary arterial hypertension (IPAH) are associated with disease severity and poor survival. However, data regarding the impact of diabetes mellitus (DM) on the prognosis of patients with IPAH remain scarce. The aim of our study was to determine that impact using data from a national multicentre prospective pulmonary hypertension registry. METHODS We analysed data of adult patients with IPAH from the Database of Pulmonary Hypertension in the Polish population (BNP‑PL) between March 1, 2018 and August 31, 2020. Upon admission, clinical, echocardiographic, and haemodynamic data were collected at 21 Polish IPAH reference centres. The all-cause mortality was assessed during a 30-month follow-up period. To adjust for differences in age, body mass index (BMI), and comorbidities between patients with and without DM, a 2-group propensity score matching was performed using a 1:1 pairing algorithm. RESULTS A total of 532 patients with IPAH were included in the study and 25.6% were diagnosed with DM. Further matched analysis was performed in 136 patients with DM and 136 without DM. DM was associated with older age, higher BMI, more advanced exertional dyspnea, increased levels of N-terminal pro-brain natriuretic peptide, larger right atrial area, increased mean right atrial pressure, mean pulmonary artery pressure, pulmonary vascular resistance, and all-cause mortality compared with no DM. CONCLUSIONS Patients with IPAH and DM present with more advanced pulmonary vascular disease and worse survival than counterparts without DM independently of age, BMI, and cardiovascular comorbidities.
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Affiliation(s)
- Kamil Jonas
- Department of Cardiac and Vascular Diseases, John Paul II Hospital in Krakow, Krakow, 31-202, Poland
- Pulmonary Circulation Centre, Department of Cardiac and Vascular Diseases, Faculty of Medicine, Jagiellonian University Medical College, Krakow, 31-008, Poland
- Center for Innovative Medical Education, Department of Medical Education, Faculty of Medicine, Jagiellonian University Medical College, Krakow, 30-688, Poland
| | - Marcin Kurzyna
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, Fryderyk Chopin Hospital in European Health Centre Otwock, Otwock, Poland
| | - Ewa Mroczek
- Clinic of Heart Diseases, Institute of Heart Diseases, University Clinical Hospital, Wrocław, Poland
| | | | | | - Ilona Skoczylas
- 3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, 41-800, Poland
| | - Piotr Błaszczak
- Department of Cardiology, Cardinal Wyszynski Hospital, Lublin, 20-718, Poland
| | - Grzegorz Grześk
- Department of Cardiology and Clinical Pharmacology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Toruń, Poland
| | - Katarzyna Mizia-Stec
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia in Katowice, Katowice, 40-635, Poland
| | - Beata Kuśmierczyk
- Department of Congenital Heart Disease Institute of Cardiology, Warsaw, 04-628, Poland
| | - Karol Kamiński
- Department of Cardiology, Medical University of Bialystok, Bialystok, 15-276, Poland
- Department of Population Medicine and Civilization Diseases Prevention, Medical University of Bialystok, Bialystok, 15-269, Poland
| | - Ewa Lewicka
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, 80-211, Poland
| | | | - Michał Tomaszewski
- Department of Cardiology, Medical University of Lublin, Lublin, 20-090, Poland
| | - Wojciech Jacheć
- 2nd Department of Cardiology, School of Medicine with Dentistry Division in Zabrze, Medical University of Silesia in Katowice, Zabrze, 41-800, Poland
| | - Zbigniew Gąsior
- Department of Cardiology, School of Health Sciences, Medical University of Cardiology in Katowice, Katowice, 40-635, Poland
| | - Agnieszka Pawlak
- Department of Invasive Cardiology, Polish Academy of Sciences, Mossakowski Medical Research Centre, Central Clinical Hospital of the Ministry of Interior, Warsaw, 02-507, Poland
| | - Robert Ryczek
- Department of Cardiology and Internal Medicine, Military Institute of Medicine - National Research Institute, Warsaw, 04-141, Poland
| | - Piotr Pruszczyk
- Department of Internal Medicine and Cardiology with the Center for Diagnosis and Treatment of Venous Thromboembolism, Medical University of Warsaw, Warszawa, Poland
| | - Anna Doboszyńska
- Pulmonary Department, University of Warmia and Mazury, Olsztyn, 10-357, Poland
| | | | - Wiesława Zabłocka
- Department of Cardiology, Provincial Specialist Hospital in Szczecin, Szczecin, Poland
| | - Marcin Waligóra
- Department of Cardiac and Vascular Diseases, John Paul II Hospital in Krakow, Krakow, 31-202, Poland
- Pulmonary Circulation Centre, Department of Cardiac and Vascular Diseases, Faculty of Medicine, Jagiellonian University Medical College, Krakow, 31-008, Poland
- Center for Innovative Medical Education, Department of Medical Education, Faculty of Medicine, Jagiellonian University Medical College, Krakow, 30-688, Poland
| | - Grzegorz Kopeć
- Department of Cardiac and Vascular Diseases, John Paul II Hospital in Krakow, Krakow, 31-202, Poland.
- Pulmonary Circulation Centre, Department of Cardiac and Vascular Diseases, Faculty of Medicine, Jagiellonian University Medical College, Krakow, 31-008, Poland.
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17
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Wieteska-Miłek M, Kuśmierczyk-Droszcz B, Ryczek R, Szmit S, Florczyk M, Mańczak R, Betkier-Lipińska K, Hoffman P, Krzesiński P, Torbicki A, Kurzyna M. Outcomes of COVID-19 in patients vaccinated and unvaccinated against SARS-CoV-2 and suffering from pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension. Pol Arch Intern Med 2023; 133:16406. [PMID: 36602859 DOI: 10.20452/pamw.16406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) lead to progressive right heart failure. The mortality rates in PAH and CTEPH patients due to COVID‑19 are high, and vaccination against COVID‑19 is recommended in this group. OBJECTIVES We analyzed the incidence and outcomes of COVID‑19in the PAH/CTEPH patients for 2 years of the pandemic, as well as the predictors of worse outcomes of COVID‑19 in this group. PATIENTS AND METHODS PAH/CTEPH patient data for this observational, cohort study were obtained from 3 pulmonary hypertension centers between March 11, 2020 and March 11, 2022. RESULTS A total of 364 consecutive patients with PAH/CTEPH (248/122; 232 women [64%]; median [interquartile range] age, 61 years [18-92]) were included in the study. All the patients had advanced pulmonary hypertension at baseline. Eighty‑five patients (23%) suffered from COVID‑19. Seven of them (8%), all of whom were unvaccinated, died of COVID‑19. The unvaccinated patients suffered from COVID‑19 more often than the vaccinated ones (46% vs 9%; P <0.001). As many as 31% of the PAH/CTEPH patients with COVID‑19 needed hospitalization, in 8% of cases in the intensive care unit. Age equal to or above 65 years and severe pulmonary hypertension defined as a World Health Organization functional class 3 or 4 were associated with severe COVID‑19 in the PAH/CTEPH patients. CONCLUSIONS The vaccinated PAH/CTEPH patients suffered from COVID‑19 less frequently than the unvaccinated ones. The mortality rate and hospitalization due to COVID‑19 were higher in the PAH/CTEPH patients than in the general population. All efforts should be made to convince the PAH/CTEPH patients to vaccinate against COVID‑19.
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Affiliation(s)
- Maria Wieteska-Miłek
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, European Health Center, Otwock, Center of Postgraduate Medical Education, Warsaw, Poland.
| | | | - Robert Ryczek
- Department of Cardiology, Military Institute of Medicine Legionowo Hospital, Legionowo, Poland
| | - Sebastian Szmit
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, European Health Center, Otwock, Center of Postgraduate Medical Education, Warsaw, Poland
| | - Michał Florczyk
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, European Health Center, Otwock, Center of Postgraduate Medical Education, Warsaw, Poland
| | - Rafał Mańczak
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, European Health Center, Otwock, Center of Postgraduate Medical Education, Warsaw, Poland
| | | | - Piotr Hoffman
- Department of Congenital Heart Disease, National Institute of Cardiology, Warsaw, Poland
| | - Paweł Krzesiński
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
| | - Adam Torbicki
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, European Health Center, Otwock, Center of Postgraduate Medical Education, Warsaw, Poland
| | - Marcin Kurzyna
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, European Health Center, Otwock, Center of Postgraduate Medical Education, Warsaw, Poland
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18
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Wieteska‐Miłek M, Kuśmierczyk‐Droszcz B, Betkier‐Lipińska K, Szmit S, Florczyk M, Zieliński P, Hoffman P, Krzesińki P, Kurzyna M. Long COVID syndrome after SARS-CoV-2 survival in patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension. Pulm Circ 2023; 13:e12244. [PMID: 37266140 PMCID: PMC10232226 DOI: 10.1002/pul2.12244] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/03/2023] [Accepted: 05/21/2023] [Indexed: 06/03/2023] Open
Abstract
Pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) patients have a more severe COVID-19 course than the general population. Many patients report different persistent symptoms after SARS-CoV-2 infection. The aim of our study is to analyze the prevalence of long COVID-19 symptoms and assess if COVID-19 affects pulmonary hypertension (PH) prognosis. PAH/CTEPH patients who survived COVID-19 for at least 3 months before visiting the PH centers were included in the study. The patients were assessed for symptoms in acute phase of SARS-CoV-2 infection and persisting in follow-up visit, WHO functional class, 6-min walk distance, NT-proBNP concentration. The COMPERA 2.0 model was used to calculate 1-year risk of death due to PH at baseline and at follow-up. Sixty-nine patients-54 (77.3%) with PAH and 15 (21.7%) with CTEPH, 68% women, with a median age of 47.5 years (IQR 37-68)-were enrolled in the study. About 17.1% of patients were hospitalized due to COVID-19 but none in an ICU. At follow-up (median: 155 days after onset of SARS-CoV-2 symptoms), 62% of patients reported at least 1 COVID-19-related symptom and 20% at least 5 symptoms. The most frequently reported symptoms were: fatigue (30%), joint pain (23%), muscle pain (17%), nasal congestion (17%), anosmia (13%), insomnia (13%), and dyspnea (12%). Seventy-two percent of PH patients had a low or intermediate-low risk of 1-year death due to PH at baseline, and 68% after COVID-19 at follow-up. Over 60% of PAH/CTEPH patients who survived COVID-19 suffered from long COVID-19 syndrome, but the calculated 1-year risk of death due to PH did not change significantly after surviving mild or moderate COVID-19.
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Affiliation(s)
- Maria Wieteska‐Miłek
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, European Health Centre OtwockCentre of Postgraduate Medical Education, Member of ERN LungWarsawPoland
| | | | - Katarzyna Betkier‐Lipińska
- Department of Cardiology and Internal DiseasesMilitary Institute of Medicine‐National Research InstituteWarsawPoland
| | - Sebastian Szmit
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, European Health Centre OtwockCentre of Postgraduate Medical Education, Member of ERN LungWarsawPoland
- Cardio‐Oncology Department, Centre of Postgraduate EducationInstitute of HematologyWarsawPoland
| | - Michał Florczyk
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, European Health Centre OtwockCentre of Postgraduate Medical Education, Member of ERN LungWarsawPoland
| | - Piotr Zieliński
- Department of Cardiology, Military Institute of Medicine‐National Research InstituteLegionowo HospitalLegionowoPoland
| | - Piotr Hoffman
- Department of Congenital Heart DiseaseNational Institute of CardiologyWarsawPoland
| | - Paweł Krzesińki
- Department of Cardiology and Internal DiseasesMilitary Institute of Medicine‐National Research InstituteWarsawPoland
| | - Marcin Kurzyna
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, European Health Centre OtwockCentre of Postgraduate Medical Education, Member of ERN LungWarsawPoland
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19
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Zieliński D, Zygier M, Dyk W, Wojdyga R, Wróbel K, Pirsztuk E, Szostakiewicz K, Szatkowski P, Darocha S, Kurzyna M, Ciurzyński M, Machowski M, Pruszczyk P, Torbicki A, Biederman A. Acute pulmonary embolism with coexisting right heart thrombi in transit-surgical treatment of 20 consecutive patients. Eur J Cardiothorac Surg 2023; 63:6994185. [PMID: 36661312 DOI: 10.1093/ejcts/ezad022] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 01/12/2023] [Accepted: 01/19/2023] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES The presence of right heart thrombi in transit in the setting of acute pulmonary embolism is associated with high mortality. The optimal management in such cases is inconclusive. We present the results of surgical treatment of 20 consecutive patients diagnosed with high or intermediate-high risk pulmonary embolism with coexisting right heart thrombi in transit. METHODS A retrospective analysis was performed of all consecutive patients undergoing surgical treatment in the Medicover Hospital between 2013 and 2021 for acute pulmonary embolism with coexisting thrombi in-transit in right heart cavities. The diagnosis was based on echocardiography, computed tomography pulmonary angiography, and laboratory tests. Eligibility criteria for surgical treatment were acute pulmonary embolism with right heart thrombi in transit, right ventricular overload on imaging studies, and significantly elevated levels of cardiac troponin and NTproBNP. All patients were operated on with extracorporeal circulation using deep hypothermia and total circulatory arrest. The primary end-point was hospital all-cause mortality; secondary end-points were perioperative complications and long-term mortality. RESULTS The analysis included 20 patients. There was no in-hospital death. Nearly one-third of patients required temporal hemofiltration for postoperative renal failure, but this did not involve the need for dialysis at discharge. No neurological complications occurred in any patient. The mean follow-up was 46 months (range 13-98). There was one death in the long-term follow-up, not related to pulmonary embolism. CONCLUSIONS Surgical treatment of patients with acute pulmonary embolism and coexisting right heart thrombi in transit can provide favourable results.
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Affiliation(s)
- Dariusz Zieliński
- Cardiac Surgery Department, Medicover Hospital, Warsaw, Poland.,Lazarski University, Faculty of Medicine, Warsaw, Poland
| | - Marcin Zygier
- Cardiac Surgery Department, Medicover Hospital, Warsaw, Poland.,Lazarski University, Faculty of Medicine, Warsaw, Poland
| | - Wojciech Dyk
- Cardiac Surgery Department, Medicover Hospital, Warsaw, Poland.,Lazarski University, Faculty of Medicine, Warsaw, Poland
| | - Ryszard Wojdyga
- Cardiac Surgery Department, Medicover Hospital, Warsaw, Poland.,Lazarski University, Faculty of Medicine, Warsaw, Poland
| | - Krzysztof Wróbel
- Cardiac Surgery Department, Medicover Hospital, Warsaw, Poland.,Lazarski University, Faculty of Medicine, Warsaw, Poland
| | - Ewelina Pirsztuk
- Department of Anaesthesiology and Intensive Care, Medicover Hospital, Warsaw, Poland
| | | | - Piotr Szatkowski
- Department of Anaesthesiology and Intensive Care, Medicover Hospital, Warsaw, Poland.,Department of Anaesthesiology, National Institute of Cardiology, Warsaw, Poland
| | - Szymon Darocha
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, Otwock, Poland
| | - Marcin Kurzyna
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, Otwock, Poland
| | - Michał Ciurzyński
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Michał Machowski
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Pruszczyk
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Adam Torbicki
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, Otwock, Poland
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20
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Kopeć G, Araszkiewicz A, Kurzyna M, Sławek-Szmyt S, Stępniewski J, Roik M, Darocha S, Gołębiowski M, Jaguszewski M, Jankiewicz S, Kałużna-Oleksy M, Kuliczkowski W, Lewicka E, Mularek-Kubzdela T, Pietrasik A, Protasiewicz M, Przybylski R, Pleskot P, Tycińska A, Zieliński D, Podolec P, Trzeciak P, Grygier M, Mroczek E, Pruszczyk P. Role of catheter-directed therapies in the treatment of acute pulmonary embolism. Expert opinion of the Polish PERT Initiative, Working Group on Pulmonary Circulation, Association of Cardiovascular Interventions, and Association of Intensive Cardiac Care of the Polish Cardiac Society. Kardiol Pol 2023; 81:423-440. [PMID: 36951599 DOI: 10.33963/kp.a2023.0075] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 03/23/2023] [Indexed: 05/03/2023]
Abstract
Thanks to advances in interventional cardiology technologies, catheter-directed treatment has become recently a viable therapeutic option in the treatment of patients with acute pulmonary embolism at high risk of early mortality. Current transcatheter techniques allow for local fibrinolysis or embolectomy with minimal risk of complications. Therefore, these procedures can be considered in high-risk patients as an alternative to surgical pulmonary embolectomy when systemic thrombolysis is contraindicated or ineffective. They are also considered in patients with intermediate-high-risk pulmonary embolism who do not improve or deteriorate clinically despite anticoagulation. The purpose of this article is to present the role of transcatheter techniques in the treatment of patients with acute pulmonary embolism. We describe current knowledge and expert opinions in this field. Interventional treatment is described in the broader context of patient care organization and therapeutic modalities. We present the organization and responsibilities of pulmonary embolism response team, role of pre-procedural imaging, periprocedural anticoagulation, patient selection, timing of intervention, and intensive care support. Currently available catheter-directed therapies are discussed in detail including standardized protocols and definitions of procedural success and failure. This expert opinion has been developed in collaboration with experts from various Polish scientific societies, which highlights the role of teamwork in caring for patients with acute pulmonary embolism.
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Affiliation(s)
- Grzegorz Kopeć
- Pulmonary Circulation Center, Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, Kraków, Poland
- John Paul II Hospital, Kraków, Poland
| | | | - Marcin Kurzyna
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education in Warsaw, European Health Center, Otwock, Poland
| | - Sylwia Sławek-Szmyt
- 1st Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland
| | - Jakub Stępniewski
- Center for Innovative Medical Education, Department of Medical Education, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
- Pulmonary Circulation Center, Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, Kraków, Poland
- John Paul II Hospital, Kraków, Poland
| | - Marek Roik
- Department of Internal Medicine and Cardiology with the Center for Diagnosis and Treatment of Venous Thromboembolism, Medical University of Warsaw, Warszawa, Poland
| | - Szymon Darocha
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education in Warsaw, European Health Center, Otwock, Poland
| | - Marek Gołębiowski
- 1st Department of Clinical Radiology, Medical University of Warsaw, Warszawa, Poland
| | - Miłosz Jaguszewski
- 1st Department of Cardiology, Medical University of Gdansk, Gdańsk, Poland
| | - Stanisław Jankiewicz
- 1st Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland
| | - Marta Kałużna-Oleksy
- 1st Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland
| | | | - Ewa Lewicka
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdańsk, Poland
| | | | - Arkadiusz Pietrasik
- 1st Chair at Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | | | - Roman Przybylski
- Department of Cardiac Transplantation and Mechanical Circulatory Support, Wroclaw Medical University, Wrocław, Poland
| | - Paweł Pleskot
- 1st Department of Clinical Radiology, Medical University of Warsaw, Warszawa, Poland
| | - Agnieszka Tycińska
- Department of Cardiology, Medical University of Bialystok, Białystok, Poland
| | - Dariusz Zieliński
- Cardiac Surgery Department, Medicover Hospital, Warszawa, Poland, Lazarski University, Faculty of Medicine, Warszawa, Poland
| | - Piotr Podolec
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, Kraków, Poland
- John Paul II Hospital, Kraków, Poland
| | - Przemysław Trzeciak
- 3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Marek Grygier
- 1st Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland
| | - Ewa Mroczek
- Department of Cardiology, University Clinical Hospital, Wrocław, Poland
| | - Piotr Pruszczyk
- Department of Internal Medicine and Cardiology with the Center for Diagnosis and Treatment of Venous Thromboembolism, Medical University of Warsaw, Warszawa, Poland
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21
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Szymańska UA, Kurzyna M, Kułak P, Kosior DA. In-hospital diagnostic strategies for acute pulmonary embolism — results of a single-center study based on the experience of a multi-profile clinical hospital. Acta Angiologica 2022. [DOI: 10.5603/aa.2022.0014] [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: 01/05/2023] Open
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22
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Mularek-Kubzdela T, Wojnarski J, Kamiński K, Ochman M, Kasprzak JD, Stącel T, Kurzyna M, Karolak W, Mroczek E, Kopeć G, Przybylski R, Skorzylas I, Żegleń S, Lewicka E, Urlik M, Grabka M, Furdal M, Florczyk M, Torbicki A. Lung transplantation in patients with pulmonary arterial hypertension: The opinion of the Polish Cardiac Society Working Group on Pulmonary Circulation. Kardiol Pol 2022; 80:1167-1179. [DOI: 10.33963/kp.a2022.0259] [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] [Received: 10/24/2022] [Accepted: 10/24/2022] [Indexed: 12/07/2022]
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23
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Rogula S, Pomirski B, Czyżak N, Eyileten C, Postuła M, Szarpak Ł, Filipiak KJ, Kurzyna M, Jaguszewski M, Mazurek T, Grabowski M, Gąsecka A. Biomarker-based approach to determine etiology and severity of pulmonary hypertension: Focus on microRNA. Front Cardiovasc Med 2022; 9:980718. [PMID: 36277769 PMCID: PMC9582157 DOI: 10.3389/fcvm.2022.980718] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/12/2022] [Indexed: 11/25/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is characterized by remodeling of the pulmonary arteries, and defined by elevated pulmonary arterial pressure, measured during right heart catheterization. There are three main challenges to the diagnostic and therapeutic process of patients with PAH. First, it is difficult to differentiate particular PAH etiology. Second, invasive diagnostic is required to precisely determine the severity of PAH, and thus to qualify patients for an appropriate treatment. Third, the results of treatment of PAH are unpredictable and remain unsatisfactory. MicroRNAs (miRNAs) are small non-coding RNAs that regulate post transcriptional gene-expression. Their role as a prognostic, and diagnostic biomarkers in many different diseases have been studied in recent years. MiRNAs are promising novel biomarkers in PAH due to their activity in various molecular pathways and processes underlying PAH. Lack of biomarkers to differentiate between particular PAH etiology and evaluate the severity of PAH, as well as paucity of therapeutic targets in PAH open a new field for the possibility to use miRNAs in these applications. In our article, we discuss the potential of miRNAs use as diagnostic tools, prognostic biomarkers and therapeutic targets in PAH.
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Affiliation(s)
- Sylwester Rogula
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland,*Correspondence: Sylwester Rogula,
| | - Bartosz Pomirski
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Norbert Czyżak
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Ceren Eyileten
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology, Medical University of Warsaw, Warsaw, Poland,Genomics Core Facility, Center of New Technologies (CeNT), University of Warsaw, Warsaw, Poland
| | - Marek Postuła
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology, Medical University of Warsaw, Warsaw, Poland
| | - Łukasz Szarpak
- Department of Outcomes Research, Maria Skłodowska-Curie Medical Academy in Warsaw, Warsaw, Poland
| | - Krzysztof J. Filipiak
- Institute of Clinical Sciences, Maria Skłodowska-Curie Medical Academy in Warsaw, Warsaw, Poland
| | - Marcin Kurzyna
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre Otwock, Otwock, Poland
| | - Miłosz Jaguszewski
- 1st Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Tomasz Mazurek
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Marcin Grabowski
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Aleksandra Gąsecka
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
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Mamzer A, Kasprzak JD, Waligora M, Kurzyna M, Mroczek E, Mularek-Kubzdela T, Pruszczyk P, Lewicka E, Karasek D, Kusmierczyk-Droszcz B, Mizia-Stec K, Ptaszynska-Kopczynska K, Skoczylas I, Blaszczak P, Kopec G. Impact of COVID-19 pandemics upon nationwide pulmonary hypertension cohort: 18-months analysis of BNP-PL national database. Eur Heart J 2022. [PMCID: PMC9619503 DOI: 10.1093/eurheartj/ehac544.1923] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Introduction Pulmonary hypertension (PH) patients may be vulnerable to SARS-CoV-2 infection, but large analytic studies on morbidity and mortality risks are limited. Aim Assessment of the incidence and course of COVID-19 among patients (pts) diagnosed with PH, treated under the NFZ program, registered in the national BNP-PL database with the assessment of the impact of the SARS-CoV-2 pandemic on the care of patients with pulmonary hypertension in Poland. Methods We analyzed the records of the complete population of Polish pts treated under the National Drug Program of PH (PAH and CTEPH), registered in the national database of BNP-PL, and updated on an ongoing basis by all PH centers. The frequency of SARS-CoV-2 infections, clinical severity of COVID-19 course and mortality were reviewed. Clinical characteristics of infected and deceased patients were compared to the remaining patients registered in the BNP-PL database. The rate of increase of new diagnoses ended with inclusion in the Drug Program between 01 March 2020 and 31 August 2021, compared to the pre-pandemic year 2019, and the change in the treatment profile were reviewed. Results The analysis included 1923 pts (PAH 1292, CTEPH 631). The incidence of SARS-CoV-2 infections was 7.4% (n=143) and similar to general population (7.6%), with a slight preponderance in PAH 8.1% (n=105) vs. CTEPH 6.0% (n=38) (p=0.099). 47 patients (33%) required hospitalization. Mortality rate was 24% (34/143) vs. 2.6% for general population – including 19/34 outside of hospital. Those who died due to COVID-19 were older (mean age 56±17.6 vs. 70.5±12.8 yrs; p<0.0001) and had more cardiovascular comorbidities (1.35 vs. 1.97; p=0.01). Systemic arterial hypertension was the strongest unique risk factor for mortality, present in 71% decedents vs. 45% of survivors, and the only independent risk factor in multivariate logistic regression analysis (OR 2.94, 95% CI 1.28–6.73). Moreover, there was a trend towards a higher incidence of diabetes and coronary artery disease in the group of non-survivors (Table 1). The number of new diagnoses of PH decreased during the pandemic compared to 2019 (new diagnoses rate in 2019 was 28.2/month vs. 19.2/month during COVID). A significant increase in total mortality was also observed in the PH group (11.1/month in 2019 vs. 13.7/month during COVID). Escalation of specific PH therapy also reduced (rate of specific therapy escalation in 2019 was 30.4/month vs. 20.5/month during COVID). Conclusions The COVID-19 pandemic has deeply affected the care of patients with pulmonary hypertension by reducing the number of new diagnoses, escalation of therapy, and increasing overall mortality in this population, and this impact continues into second year of pandemics. Pulmonary hypertension is associated with a more severe course and higher mortality in COVID-19. Funding Acknowledgement Type of funding sources: None.
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Affiliation(s)
- A Mamzer
- Bieganski Hospital, 1st Department and Chair of Cardiology, Medical University of Lodz , Lodz , Poland
| | - J D Kasprzak
- Bieganski Hospital, 1st Department and Chair of Cardiology, Medical University of Lodz , Lodz , Poland
| | - M Waligora
- Jagiellonian University Medical College, Department of Cardiac and Vascular Diseases , Krakow , Poland
| | - M Kurzyna
- European Health Center, Cardiology Department , Otwock , Poland
| | - E Mroczek
- Wroclaw Medical University, Department of Cardiology , Wroclaw , Poland
| | - T Mularek-Kubzdela
- Poznan University of Medical Sciences, Cardiology Department , Poznan , Poland
| | - P Pruszczyk
- Medical University of Warsaw, Department of Internal Medicine and Cardiology , Warsaw , Poland
| | - E Lewicka
- Medical University of Gdansk, Department of Cardiology and Electrotherapy , Gdansk , Poland
| | - D Karasek
- Nicolaus Copernicus University, 2nd Department of Cardiology, Faculty of Health Sciences , Bydgoszcz , Poland
| | | | - K Mizia-Stec
- School of Medicine in Katowice, Medical University of Silesia, 1st Department of Cardiology , Katowice , Poland
| | | | - I Skoczylas
- The Medical University of Silesia, 3rd Department of Cardiology , Zabrze , Poland
| | - P Blaszczak
- Cardinal Wyszynski Hospital, Department of Cardiology , Lublin , Poland
| | - G Kopec
- Jagiellonian University Medical College, Department of Cardiac and Vascular Diseases , Krakow , Poland
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25
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Nowak MM, Niemczyk M, Florczyk M, Kurzyna M, Pączek L. Effect of Statins on All-Cause Mortality in Adults: A Systematic Review and Meta-Analysis of Propensity Score-Matched Studies. J Clin Med 2022; 11:jcm11195643. [PMID: 36233511 PMCID: PMC9572734 DOI: 10.3390/jcm11195643] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/15/2022] [Accepted: 09/20/2022] [Indexed: 11/25/2022] Open
Abstract
Statins are lipid-lowering medications used for the prevention of cardiovascular disease (CVD), but the pleiotropic effects of statins might be beneficial in other chronic diseases. This meta-analysis investigated the association between statin use and mortality in different chronic conditions. Eligible studies were real-world studies that compared all-cause mortality over at least 12 months between propensity score-matched statin users and non-users. Overall, 54 studies were included: 21 in CVD, 6 in chronic kidney disease, 6 in chronic inflammatory diseases, 3 in cancer, and 18 in other diseases. The risk of all-cause mortality was significantly reduced in statin users (hazard ratio: 0.72, 95% confidence interval: 0.66−0.76). The reduction in mortality risk was similar in CVD studies (0.73, 0.66−0.76) and non-CVD studies (0.70, 0.67−0.79). There were no significant differences in the risk reduction between cohorts with different diseases (p = 0.179). The greatest mortality reduction was seen in studies from Asia (0.61, 0.61−0.73) and the lowest in studies from North America (0.78, 0.73−0.83) and Australia (0.78, 0.62−0.97). There was a significant heterogeneity (I2 = 95%, tau2 = 0.029, p < 0.01). In conclusion, statin use was associated with a significantly reduced risk of all-cause mortality in real-world cohorts with CVD and non-CVD.
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Affiliation(s)
- Marcin M. Nowak
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology at the European Health Center, 05-400 Otwock, Poland
- Correspondence:
| | - Mariusz Niemczyk
- Department of Immunology, Transplant Medicine and Internal Diseases, Medical University of Warsaw, 02-006 Warsaw, Poland
| | - Michał Florczyk
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology at the European Health Center, 05-400 Otwock, Poland
| | - Marcin Kurzyna
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology at the European Health Center, 05-400 Otwock, Poland
| | - Leszek Pączek
- Department of Immunology, Transplant Medicine and Internal Diseases, Medical University of Warsaw, 02-006 Warsaw, Poland
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26
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Pietrasik A, Gasecka A, Kotulecki A, Karolak P, Araszkiewicz A, Darocha S, Grabowski M, Kurzyna M. Catheter-directed therapy to treat intermediate- and high-risk pulmonary embolism: Personal experience and review of the literature. Cardiol J 2022:VM/OJS/J/89624. [PMID: 35975795 DOI: 10.5603/cj.a2022.0075] [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: 04/14/2022] [Revised: 07/01/2022] [Accepted: 07/24/2022] [Indexed: 11/25/2022] Open
Abstract
Pulmonary embolism (PE) is the third leading cause of cardiovascular death in the western world. Prompt recognition, risk stratification, and individualized treatment are crucial to improve outcomes in patients with PE. Anticoagulation alone is a sufficient therapeutic option in low-risk patients, whereas primary reperfusion with systemic thrombolysis (ST) is usually chosen in high-risk patients. The choice of treatment in intermediate-risk patients is complex and depends on the clinical presentation. Catheter-directed therapy (CDTh) includes all therapies delivered via a catheter placed in the branches of the pulmonary arteries directly into the thrombus. Because ST bears a high risk of major bleeding and numerous patients have contraindications to ST, CDTh is an alternative to ST in intermediate- and high-risk PE patients. CDTh includes local thrombolysis using low-dose alteplase, ultrasound-assisted thrombolysis, and mechanical fragmentation and aspiration of the thrombi, as well as their combinations. In this review article, we have summarized devices and technical details for CDTh, discussed the efficacy and safety of CDTh in comparison to ST in previous clinical trials, and outlined future research directions regarding CDTh, both based on the literature and our personal experience from the local PE Response Team of the Center for the Management of Pulmonary Embolism (CELZAT) in Warsaw.
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Affiliation(s)
- Arkadiusz Pietrasik
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Poland.
| | - Aleksandra Gasecka
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Poland
| | | | - Paulina Karolak
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Poland
| | | | - Szymon Darocha
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Center Otwock, Poland
| | - Marcin Grabowski
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Poland
| | - Marcin Kurzyna
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Poland
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27
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Mamzer A, Waligora M, Kopec G, Ptaszynska-Kopczynska K, Kurzyna M, Darocha S, Florczyk M, Mroczek E, Mularek-Kubzdela T, Smukowska-Gorynia A, Wrotynski M, Chrzanowski L, Dzikowska-Diduch O, Perzanowska-Brzeszkiewicz K, Pruszczyk P, Skoczylas I, Lewicka E, Blaszczak P, Karasek D, Kusmierczyk-Droszcz B, Mizia-Stec K, Kaminski K, Jachec W, Peregud-Pogorzelska M, Doboszynska A, Gasior Z, Tomaszewski M, Pawlak A, Zablocka W, Ryczek R, Widejko-Pietkiewicz K, Kasprzak JD. Impact of the COVID-19 Pandemic on Pulmonary Hypertension Patients: Insights from the BNP-PL National Database. Int J Environ Res Public Health 2022; 19:ijerph19148423. [PMID: 35886278 PMCID: PMC9316841 DOI: 10.3390/ijerph19148423] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/04/2022] [Accepted: 07/07/2022] [Indexed: 02/05/2023]
Abstract
We aimed to evaluate the clinical course and impact of the SARS-CoV-2 pandemic on the rate of diagnosis and therapy in the complete Polish population of patients (pts) with pulmonary arterial hypertension (PAH-1134) and CTEPH (570 pts) treated within the National Health Fund program and reported in the national BNP-PL database. Updated records of 1704 BNP-PL pts collected between March and December 2020 were analyzed with regard to incidence, clinical course and mortality associated with COVID-19. Clinical characteristics of the infected pts and COVID-19 decedents were analyzed. The rates of new diagnoses and treatment intensification in this period were studied and collated to the proper intervals of the previous year. The incidence of COVID-19 was 3.8% (n = 65) (PAH, 4.1%; CTEPH, 3.2%). COVID-19-related mortality was 28% (18/65 pts). Those who died were substantially older and had a more advanced functional WHO class and more cardiovascular comorbidities (comorbidity score, 4.0 ± 2.1 vs. 2.7 ± 1.8; p = 0.01). During the pandemic, annualized new diagnoses of PH diminished by 25–30% as compared to 2019. A relevant increase in total mortality was also observed among the PH pts (9.7% vs. 5.9% pre-pandemic, p = 0.006), whereas escalation of specific PAH/CTEPH therapies occurred less frequently (14.7% vs. 21.6% pre-pandemic). The COVID-19 pandemic has affected the diagnosis and treatment of PH by decreasing the number of new diagnoses, escalating therapy and enhancing overall mortality. Pulmonary hypertension is a risk factor for worsened course of COVID-19 and elevated mortality.
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Affiliation(s)
- Aleksandra Mamzer
- 1st Department of Cardiology, Bieganski Hospital, Medical University of Lodz, ul. Kniaziewicza 1/5, 91-347 Lodz, Poland;
- Correspondence: (A.M.); (J.D.K.)
| | - Marcin Waligora
- Pulmonary Circulation Centre, Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital in Krakowul, Pradnicka 80, 31-202 Krakow, Poland; (M.W.); (G.K.)
| | - Grzegorz Kopec
- Pulmonary Circulation Centre, Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital in Krakowul, Pradnicka 80, 31-202 Krakow, Poland; (M.W.); (G.K.)
| | | | - Marcin Kurzyna
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, 05-400 Otwock, Poland; (M.K.); (S.D.); (M.F.)
| | - Szymon Darocha
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, 05-400 Otwock, Poland; (M.K.); (S.D.); (M.F.)
| | - Michal Florczyk
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, 05-400 Otwock, Poland; (M.K.); (S.D.); (M.F.)
| | - Ewa Mroczek
- Institute of Heart Diseases, University Clinical Hospital Mikulicz Radecki in Wroclaw, ul. Borowska 213, 50-558 Wroclaw, Poland;
| | - Tatiana Mularek-Kubzdela
- Department of Cardiology, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (T.M.-K.); (A.S.-G.); (M.W.)
| | - Anna Smukowska-Gorynia
- Department of Cardiology, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (T.M.-K.); (A.S.-G.); (M.W.)
| | - Michal Wrotynski
- Department of Cardiology, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (T.M.-K.); (A.S.-G.); (M.W.)
| | - Lukasz Chrzanowski
- 1st Department of Cardiology, Bieganski Hospital, Medical University of Lodz, ul. Kniaziewicza 1/5, 91-347 Lodz, Poland;
| | - Olga Dzikowska-Diduch
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, 02-005 Warsaw, Poland; (O.D.-D.); (K.P.-B.); (P.P.)
| | | | - Piotr Pruszczyk
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, 02-005 Warsaw, Poland; (O.D.-D.); (K.P.-B.); (P.P.)
| | - Ilona Skoczylas
- 3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 41-800 Katowice, Poland;
| | - Ewa Lewicka
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, 80-211 Gdansk, Poland;
| | - Piotr Blaszczak
- Department of Cardiology, Cardinal Wyszynski Hospital, 20-718 Lublin, Poland;
| | - Danuta Karasek
- 2nd Department of Cardiology, Faculty of Health Sciences, Collegium Medicum, Nicolaus Copernicus University, 85-168 Bydgoszcz, Poland;
| | | | - Katarzyna Mizia-Stec
- 1st Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, 41-800 Katowice, Poland;
| | - Karol Kaminski
- Department of Population Medicine and Civilization Diseases Prevention, Medical University of Bialystok, 15-269 Bialystok, Poland;
| | - Wojciech Jachec
- 2nd Department of Cardiology, School of Medicine with Dentistry Division in Zabrze, Medical University of Silesia in Katowice, 41-800 Zabrze, Poland;
| | | | - Anna Doboszynska
- Pulmonary Department, University of Warmia and Mazury, 10-357 Olsztyn, Poland;
| | - Zbigniew Gasior
- Department of Cardiology, School of Health Sciences, Medical University of Silesia in Katowice, 40-635 Katowice, Poland;
| | - Michal Tomaszewski
- Department of Cardiology, Medical University of Lublin, 20-090 Lublin, Poland;
| | - Agnieszka Pawlak
- Department of Invasive Cardiology, Polish Academy of Sciences, Mossakowski Medical Research Centre, Central Clinical Hospital of the Ministry of Interior, 02-507 Warsaw, Poland;
| | - Wieslawa Zablocka
- Department of Invasive Cardiology and Cardiology, Independent Public Provincial Complex Hospital in Szczecin, 71-455 Szczecin, Poland;
| | - Robert Ryczek
- Department of Cardiology and Internal Medicine, Military Institute of Medicine in Warsaw, 04-141 Warsaw, Poland;
| | | | - Jaroslaw D. Kasprzak
- 1st Department of Cardiology, Bieganski Hospital, Medical University of Lodz, ul. Kniaziewicza 1/5, 91-347 Lodz, Poland;
- Correspondence: (A.M.); (J.D.K.)
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Wieteska-Miłek M, Szmit S, Florczyk M, Witowicz A, Kurzyna M. Physical Activity in Pulmonary Arterial Hypertension during Pandemic COVID-19 and the Potential Impact of Mental Factors. Int J Environ Res Public Health 2022; 19:ijerph19148343. [PMID: 35886194 PMCID: PMC9323217 DOI: 10.3390/ijerph19148343] [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] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 07/01/2022] [Accepted: 07/06/2022] [Indexed: 02/01/2023]
Abstract
One of the non-pharmacological recommendations for stable patients with pulmonary arterial hypertension (PAH) is to increase physical activity. The study aimed to analyze the degree of physical activity of PAH patients and check if mental factors may have a potential negative impact during the COVID-19 pandemic. Forty patients with stable PAH were included in the study. Physical activity was assessed by pedometer (Omron HJ-321-E) for four weeks. At baseline, in addition to the 6 min walk test (6MWT) and functional assessment, patients completed the quality-of-life questionnaire SF-36, fear of COVID-19 scale, and hospital anxiety and depression scale (HADS). The mean age of the study group was 45.5 years, 80% were women, and 62.5% had idiopathic/heritable PAH. Low physical activity defined as <5000 steps/day had 19 (47.5%), and moderate/high physical activity (≥5000 steps/day) had 21 (52.5%) patients. Patients with low physical activity less frequently worked compared with the moderate−high-activity sub-group, 42% vs. 81%, p = 0.03, and had the shorter distance in 6-6MWT, p = 0.03. There was no significant correlation between steps/day and different mental factors. Almost half of the study group had low activity during the pandemic. Mental factors did not impact physical activity in PAH patients during the pandemic.
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Ciurzyński M, Kurzyna M, Kopeć G, Błaszczak P, Chrzanowski Ł, Kamiński K, Mizia-Stec K, Mularek-Kubzdela T, Biederman A, Zieliński D, Pruszczyk P, Torbicki A, Mroczek E. An expert opinion of the Polish Cardiac Society Working Group on Pulmonary Circulation on screening for chronic thromboembolic pulmonary hypertension patients after acute pulmonary embolism: Update. Kardiol Pol 2022; 80:723-732. [PMID: 35665906 DOI: 10.33963/kp.a2022.0141] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 06/06/2022] [Indexed: 11/23/2022]
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare complication of acute pulmonary embolism (APE). Both pharmacological and invasive treatments for CTEPH are available in Poland, and awareness of the disease among physicians is growing. It has been suggested that the COVID-19 pandemic may increase the incidence of CTEPH and facilitate disease detection during more advanced stages of the illness. Thus, the Polish Cardiac Society's Working Group on Pulmonary Circulation, in cooperation with independent experts in this field, launched the updated statement on the algorithm to guide a CTEPH diagnosis in patients with previous APE. CTEPH should be suspected in individuals after APE with dyspnea, despite at least 3 months of effective anticoagulation, particularly when specific risk factors are present. Echocardiography is the main screening tool for CTEPH. A diagnostic workup of patients with significant clinical suspicion of CTEPH and right ventricular overload evident on echocardiography should be performed in reference centers. Pulmonary scintigraphy is a safe and highly sensitive screening test for CTEPH. Computed tomography pulmonary angiography with precise detection of thromboembolic residues in the pulmonary circulation is important for the planning of a pulmonary thromboendarterectomy. Right heart catheterization definitively confirms the presence of pulmonary hypertension and direct pulmonary angiography allows for the identification of lesions suitable for thromboendarterectomy or balloon pulmonary angioplasty. In this document, we propose a diagnostic algorithm for patients with suspected CTEPH. With an individualized and sequential diagnostic strategy, each patient can be provided with suitable and tailored therapy provided by a dedicated CTEPH Heart Team.
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Affiliation(s)
- Michał Ciurzyński
- Department of Internal Medicine and Cardiology with the Center for Diagnosis and Treatment of Venous Thromboembolism, Medical University of Warsaw, Warszawa, Poland.
| | - Marcin Kurzyna
- Department of Pulmonary Circulation, Thromboembolism and Cardiology, Medical Center for Postgraduate Education in Warsaw, European Health Center, Otwock, Poland
| | - Grzegorz Kopeć
- Pulmonary Circulation Center, Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, Kraków, Poland.,Department of Cardiovascular Diseases with Cardiac Intensive Care Unit, John Paul II Hospital, Kraków, Poland
| | - Piotr Błaszczak
- Department of Cardiology and Intensive Cardiac Care, Stefan Cardinal Wyszynski Provincial Specialist Hospital, Lublin, Poland
| | | | - Karol Kamiński
- Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Bialystok, Białystok, Poland.,Department of Cardiology, University Hospital in Bialystok, Białystok, Poland
| | - Katarzyna Mizia-Stec
- 1st Department of Cardiology, Faculty of Medicine, Medical University of Silesia in Katowice, Katowice, Poland.,European Reference Network for Rare, Low Prevalence, or Complex Diseases of the Heart (ERN GUARD Heart)
| | | | | | | | - Piotr Pruszczyk
- Department of Internal Medicine and Cardiology with the Center for Diagnosis and Treatment of Venous Thromboembolism, Medical University of Warsaw, Warszawa, Poland
| | - Adam Torbicki
- Department of Pulmonary Circulation, Thromboembolism and Cardiology, Medical Center for Postgraduate Education in Warsaw, European Health Center, Otwock, Poland
| | - Ewa Mroczek
- Department of Cardiology, University Clinical Hospital, Institute of Heart Diseases, Wrocław, Poland
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Pietrasik A, Gąsecka A, Szarpak Ł, Pruc M, Kopiec T, Darocha S, Banaszkiewicz M, Niewada M, Grabowski M, Kurzyna M. Catheter-Based Therapies Decrease Mortality in Patients With Intermediate and High-Risk Pulmonary Embolism: Evidence From Meta-Analysis of 65,589 Patients. Front Cardiovasc Med 2022; 9:861307. [PMID: 35783825 PMCID: PMC9243366 DOI: 10.3389/fcvm.2022.861307] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 01/24/2022] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background Catheter-directed therapies (CDT) are an alternative to systemic thrombolysis (ST) in pulmonary embolism (PE) patients, but the mortality benefit of CDT is unclear. Objective We conducted a systematic review with meta-analysis to compare the efficacy and safety of CDT and ST in intermediate-high and high-risk PE. Methods We included (P) participants, adult PE patients; (I) intervention, CDT; (C) comparison, ST; (O) outcomes, mortality, complications, in-hospital treatment, and length of hospital stay; (S) study design, randomized controlled trials (RCTs), or cohort comparing CDT and ST. The primary endpoint was 30-day mortality. Secondary outcomes included treatment-related complications including bleeding, the use of hospital resources, and length of hospital stay. Results Eleven studies including 65,589 patients met the inclusion criteria. Thirty-day mortality was lower in the CDT group, compared to ST group [7.3 vs. 13.6%; odds ratio (OR) = 0.51, 95% confidence interval (CI) 0.38–0.69, p < 0.001]. The rates of myocardial injury, cardiac arrest, and stroke were lower in CDT group, compared to ST group (p < 0.001 for all). The rates of any major bleeding, intracranial hemorrhage, hemoptysis, and red blood cell transfusion were lower in patients treated with CDT, compared to ST (p ≤ 0.01 for all). Extracorporeal life support was used more often in patients treated with CDT, compared to ST (0.5 vs. 0.2%, OR = 2.52, 95% CI 1.88–3.39, p < 0.001). The use of hospital resources and length of hospital stay were comparable in both groups. Conclusion CDT might decrease mortality in patients with intermediate-high and high-risk PE and were associated with fewer complications, including major bleeding.
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Affiliation(s)
- Arkadiusz Pietrasik
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
- *Correspondence: Arkadiusz Pietrasik,
| | - Aleksandra Gąsecka
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Łukasz Szarpak
- Research Unit, Maria Sklodowska-Curie Białystok Oncology Center, Białystok, Poland
- Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy in Warsaw, Warsaw, Poland
| | - Michał Pruc
- Research Unit, Polish Society of Disaster Medicine, Warsaw, Poland
| | - Tomasz Kopiec
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Szymon Darocha
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre Otwock, Otwock, Poland
| | - Marta Banaszkiewicz
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre Otwock, Otwock, Poland
| | - Maciej Niewada
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland
| | - Marcin Grabowski
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Marcin Kurzyna
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre Otwock, Otwock, Poland
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Darocha S, Kurzyna P, Banaszkiewicz‐Cyganik M, Kędzierski P, Florczyk M, Pietrasik A, Zieliński D, Biederman A, Torbicki A, Kurzyna M. An unusual case of CTEPH treated by BPA in a patient with a single lung after cancer surgery. Pulm Circ 2022; 12:e12064. [PMID: 35795493 PMCID: PMC9248790 DOI: 10.1002/pul2.12064] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 02/25/2022] [Accepted: 03/11/2022] [Indexed: 12/02/2022] Open
Abstract
A 46‐year‐old man 1 year after left‐sided pneumonectomy for squamous cell lung cancer presented with severely limited exercise tolerance and dyspnea corresponding to World Health Organization functional class IV (WHO Class IV). After right heart catheterization (RHC), mean pulmonary artery pressure (mPAP) was 43 mmHg and pulmonary vascular resistance (PVR) was 10.2 Wood units (WU). Arteriography revealed organized clots located at the proximal level of the right pulmonary artery, leading to a diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH). The CTEPH team disqualified the patient from surgical treatment due to high perioperative risk and referred him for balloon pulmonary angioplasty (BPA) together with pulmonary hypertension‐specific pharmacotherapy (sildenafil). The patient underwent a cycle of nine BPA sessions and completed treatment without complications. Follow‐up showed sustained hemodynamic improvement in RHC (mPAP 23 mmHg, PVR 2.6 WU), improved physical capacity (WHO Class II), and relief of dyspnea symptoms.
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Affiliation(s)
- Szymon Darocha
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education Fryderyk Chopin Hospital in European Health Center Otwock 05‐400 Otwock Poland
| | - Paweł Kurzyna
- 1st Chair and Department of Cardiology Medical University of Warsaw 02‐097 Warsaw Poland
| | - Marta Banaszkiewicz‐Cyganik
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education Fryderyk Chopin Hospital in European Health Center Otwock 05‐400 Otwock Poland
| | - Piotr Kędzierski
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education Fryderyk Chopin Hospital in European Health Center Otwock 05‐400 Otwock Poland
| | - Michał Florczyk
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education Fryderyk Chopin Hospital in European Health Center Otwock 05‐400 Otwock Poland
| | - Arkadiusz Pietrasik
- 1st Chair and Department of Cardiology Medical University of Warsaw 02‐097 Warsaw Poland
| | - Dariusz Zieliński
- Department of Cardiac Surgery Medicover Hospital 02‐972 Warsaw Poland
| | - Andrzej Biederman
- Department of Cardiac Surgery Medicover Hospital 02‐972 Warsaw Poland
| | - Adam Torbicki
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education Fryderyk Chopin Hospital in European Health Center Otwock 05‐400 Otwock Poland
| | - Marcin Kurzyna
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education Fryderyk Chopin Hospital in European Health Center Otwock 05‐400 Otwock Poland
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Siniarski A, Gąsecka A, Starczyński M, Banaszkiewicz M, Darocha S, Torbicki A, Kurzyna M, Filipiak KJ, Nessler J, Gajos G. Prostacyclin analogues decrease platelet aggregation but have no effect on thrombin generation, fibrin clot structure, and fibrinolysis in pulmonary arterial hypertension: PAPAYA coagulation. Platelets 2022; 33:1065-1074. [DOI: 10.1080/09537104.2022.2042234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Aleksander Siniarski
- Department of Coronary Artery Disease and Heart Failure, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland
| | - Aleksandra Gąsecka
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Miłosz Starczyński
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Marta Banaszkiewicz
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre Otwock, Poland
| | - Szymon Darocha
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre Otwock, Poland
| | - Adam Torbicki
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre Otwock, Poland
| | - Marcin Kurzyna
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre Otwock, Poland
| | - Krzysztof J. Filipiak
- Department of Clinical Sciences, Maria Sklodowska-Curie Medical Academy, Warsaw, Poland
| | - Jadwiga Nessler
- Department of Coronary Artery Disease and Heart Failure, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland
| | - Grzegorz Gajos
- Department of Coronary Artery Disease and Heart Failure, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland
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Darocha S, Roik M, Kopeć G, Araszkiewicz A, Furdal M, Lewandowski M, Jacheć W, Grabka M, Banaszkiewicz M, Pietrasik A, Pietura R, Stępniewski J, Waligóra M, Magoń W, Jonas K, Łabyk A, Potępa M, Fudryna A, Jankiewicz S, Sławek-Szmyt S, Mularek-Kubzdela T, Lesiak M, Mroczek E, Orłowska J, Peregud-Pogorzelska M, Tomasik A, Mizia-Stec K, Przybylski R, Podolec P, Zieliński D, Biederman A, Torbicki A, Pruszczyk P, Kurzyna M. Balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension: a multicentre registry. EUROINTERVENTION 2022; 17:1104-1111. [PMID: 34219663 PMCID: PMC9725062 DOI: 10.4244/eij-d-21-00230] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Balloon pulmonary angioplasty (BPA) is a promising therapy for patients with chronic thromboembolic pulmonary hypertension (CTEPH) who are ineligible for pulmonary endarterectomy. AIMS The present study aimed to evaluate the safety and efficacy of BPA for CTEPH using the first multicentre registry of a single European country. METHODS Data were obtained from the Database of Pulmonary Hypertension in the Polish Population (NCT03959748), a prospective, multicentre registry of adult and paediatric pulmonary arterial hypertension (PAH) and CTEPH, for a total of 236 patients with confirmed CTEPH (124 women; mean age 67 years) who underwent 1,056 BPA procedures at eight institutions in Poland. RESULTS In 156 patients who underwent follow-up assessments after a median of 5.9 (IQR: 3.0-8.0) months after final BPA, the mean pulmonary arterial pressure decreased from 45.1±10.7 to 30.2±10.2 mmHg (p<0.001) and pulmonary vascular resistance from 642±341 to 324±183 dynes (p<0.001), and the six-minute walking test (6MWT) improved from 341±129 to 423±136 m (p<0.001). Pulmonary injury related to the BPA procedure occurred in 6.4% of all sessions. Eighteen patients (7.6%) died during follow-up, including 4 (1.7%) who died within 30 days after BPA. Overall survival was 92.4% (95% confidence interval [CI]: 87.6%-94.9%) three years after the initial BPA procedure. CONCLUSIONS This multicentre registry confirmed significant improvement of haemodynamic, functional, and biochemical parameters after BPA. Complication rates were low and overall survival comparable to the results of another registry. Therefore, BPA may be an important therapeutic option in patients with CTEPH in Poland.
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Affiliation(s)
- Szymon Darocha
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, European Health Centre Otwock, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Marek Roik
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Grzegorz Kopeć
- Pulmonary Circulation Centre, Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, Centre for Rare Cardiovascular Diseases, John Paul II Hospital, ul. Prądnicka 80, 31-202 Kraków, Poland
| | | | - Michał Furdal
- Department of Cardiology, Provincial Specialist Hospital Research and Development Center, Wrocław, Poland
| | | | - Wojciech Jacheć
- 2nd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Katowice, Poland
| | - Marek Grabka
- 1st Department of Cardiology, Silesian Medical University, Upper Silesian Medical Centre, Katowice, Poland
| | - Marta Banaszkiewicz
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, European Health Centre Otwock, Centre of Postgraduate Medical Education, Warsaw, Poland
| | | | - Radosław Pietura
- Department of Radiography, Medical University of Lublin, Lublin, Poland
| | - Jakub Stępniewski
- Pulmonary Circulation Centre, Department of Cardiac and Vascular Diseases, Faculty of Medicine, Jagiellonian University Medical College, Centre for Rare Cardiovascular Diseases, John Paul II Hospital in Krakow, Krakow, Poland,Department of Medical Education, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Marcin Waligóra
- Pulmonary Circulation Centre, Department of Cardiac and Vascular Diseases, Faculty of Medicine, Jagiellonian University Medical College, Centre for Rare Cardiovascular Diseases, John Paul II Hospital in Krakow, Krakow, Poland,Department of Medical Education, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Wojciech Magoń
- Pulmonary Circulation Centre, Department of Cardiac and Vascular Diseases, Faculty of Medicine, Jagiellonian University Medical College, Centre for Rare Cardiovascular Diseases, John Paul II Hospital in Krakow, Krakow, Poland
| | - Kamil Jonas
- Pulmonary Circulation Centre, Department of Cardiac and Vascular Diseases, Faculty of Medicine, Jagiellonian University Medical College, Centre for Rare Cardiovascular Diseases, John Paul II Hospital in Krakow, Krakow, Poland,Department of Medical Education, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Andrzej Łabyk
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Michał Potępa
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Aleksandra Fudryna
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Stanisław Jankiewicz
- 1st Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Sylwia Sławek-Szmyt
- 1st Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Maciej Lesiak
- 1st Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Ewa Mroczek
- Department of Cardiology, Provincial Specialist Hospital Research and Development Center, Wrocław, Poland
| | - Joanna Orłowska
- Department of Cardiology, Provincial Specialist Hospital Research and Development Center, Wrocław, Poland
| | | | - Andrzej Tomasik
- 2nd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Katowice, Poland
| | - Katarzyna Mizia-Stec
- 1st Department of Cardiology, Silesian Medical University, Upper Silesian Medical Centre, Katowice, Poland
| | - Roman Przybylski
- Clinic of Cardiac Transplantation and Mechanical Circulatory Support, Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Piotr Podolec
- Pulmonary Circulation Centre, Department of Cardiac and Vascular Diseases, Faculty of Medicine, Jagiellonian University Medical College, Centre for Rare Cardiovascular Diseases, John Paul II Hospital in Krakow, Krakow, Poland
| | | | | | - Adam Torbicki
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, European Health Centre Otwock, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Piotr Pruszczyk
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Marcin Kurzyna
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, European Health Centre Otwock, Centre of Postgraduate Medical Education, Warsaw, Poland
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Gościniak P, Larysz M, Sagan L, Larysz B, Syrenicz A, Kurzyna M. Effective Balloon Pulmonary Angioplasty in a Patient with Chronic Thromboembolic Complications after Ventriculoatrial Shunt for Hydrocephalus in von Hippel–Lindau Disease. Medicina (B Aires) 2022; 58:medicina58020185. [PMID: 35208509 PMCID: PMC8877788 DOI: 10.3390/medicina58020185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/22/2022] [Accepted: 01/24/2022] [Indexed: 11/18/2022] Open
Abstract
Von Hippel–Lindau (VHL) disease along with chronic thromboembolic pulmonary hypertension (CTEPH) is a unique and unusual severe complication of ventriculoatrial (VA) shunt implantation in the treatment of hydrocephalus. To the best of our knowledge, this can be the first reported case of an effective treatment with balloon pulmonary angioplasty in a patient with VHL after VA shunt placement. The patient underwent six balloon pulmonary angioplasty procedures. All invasive procedures resulted in haemodynamic and functional improvement.
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Affiliation(s)
- Piotr Gościniak
- Laboratory of Non-Invasive Cardiac Imaging, Independent Public Clinical Hospital Nr. 1, Pomeranian Medical University, 71-252 Szczecin, Poland
- Endocrinology and Internal Diseases Department, Independent Public Clinical Hospital Nr. 1, Pomeranian Medical University, 71-252 Szczecin, Poland;
- Correspondence: (P.G.); (M.K.)
| | - Michał Larysz
- Neurosurgery Department, Independent Public Clinical Hospital Nr. 1, Pomeranian Medical University, 71-252 Szczecin, Poland; (M.L.); (L.S.)
| | - Leszek Sagan
- Neurosurgery Department, Independent Public Clinical Hospital Nr. 1, Pomeranian Medical University, 71-252 Szczecin, Poland; (M.L.); (L.S.)
| | - Barbara Larysz
- Cardiology Department, Maria Curie Skłodowska Province Hospital, 71-527 Szczecin, Poland;
| | - Anhelli Syrenicz
- Endocrinology and Internal Diseases Department, Independent Public Clinical Hospital Nr. 1, Pomeranian Medical University, 71-252 Szczecin, Poland;
| | - Marcin Kurzyna
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, 05-400 Otwock, Poland
- Correspondence: (P.G.); (M.K.)
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Banaszkiewicz M, Gąsecka A, Darocha S, Florczyk M, Pietrasik A, Kędzierski P, Piłka M, Torbicki A, Kurzyna M. Circulating Blood-Based Biomarkers in Pulmonary Hypertension. J Clin Med 2022; 11:jcm11020383. [PMID: 35054082 PMCID: PMC8779219 DOI: 10.3390/jcm11020383] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/01/2022] [Accepted: 01/09/2022] [Indexed: 12/23/2022] Open
Abstract
Pulmonary hypertension (PH) is a serious hemodynamic condition, characterized by increased pulmonary vascular resistance (PVR), leading to right heart failure (HF) and death when not properly treated. The prognosis of PH depends on etiology, hemodynamic and biochemical parameters, as well as on response to specific treatment. Biomarkers appear to be useful noninvasive tools, providing information about the disease severity, treatment response, and prognosis. However, given the complexity of PH, it is impossible for a single biomarker to be adequate for the broad assessment of patients with different types of PH. The search for novel emerging biomarkers is still ongoing, resulting in a few potential biomarkers mirroring numerous pathophysiological courses. In this review, markers related to HF, myocardial remodeling, inflammation, hypoxia and tissue damage, and endothelial and pulmonary smooth muscle cell dysfunction are discussed in terms of diagnosis and prognosis. Extracellular vesicles and other markers with complex backgrounds are also reviewed. In conclusion, although many promising biomarkers have been identified and studied in recent years, there are still insufficient data on the application of multimarker strategies for monitoring and risk stratification in PH patients.
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Affiliation(s)
- Marta Banaszkiewicz
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre Otwock, 05-400 Warsaw, Poland; (S.D.); (M.F.); (P.K.); (M.P.); (A.T.); (M.K.)
- Correspondence:
| | - Aleksandra Gąsecka
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland; (A.G.); (A.P.)
| | - Szymon Darocha
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre Otwock, 05-400 Warsaw, Poland; (S.D.); (M.F.); (P.K.); (M.P.); (A.T.); (M.K.)
| | - Michał Florczyk
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre Otwock, 05-400 Warsaw, Poland; (S.D.); (M.F.); (P.K.); (M.P.); (A.T.); (M.K.)
| | - Arkadiusz Pietrasik
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland; (A.G.); (A.P.)
| | - Piotr Kędzierski
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre Otwock, 05-400 Warsaw, Poland; (S.D.); (M.F.); (P.K.); (M.P.); (A.T.); (M.K.)
| | - Michał Piłka
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre Otwock, 05-400 Warsaw, Poland; (S.D.); (M.F.); (P.K.); (M.P.); (A.T.); (M.K.)
| | - Adam Torbicki
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre Otwock, 05-400 Warsaw, Poland; (S.D.); (M.F.); (P.K.); (M.P.); (A.T.); (M.K.)
| | - Marcin Kurzyna
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre Otwock, 05-400 Warsaw, Poland; (S.D.); (M.F.); (P.K.); (M.P.); (A.T.); (M.K.)
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Abstract
In this article, we propose a new method of three-dimensional data plotting based on the use of mixed hue palettes, which makes it possible to distinguish simultaneously both huge and subtle changes in the value of the presented quantity at the same plot. This method called "braid plot" is based on the alternating use of multiple palettes of colors (a kind of interlacing), which greatly increases the sharpness of the graph and allows us to define areas of equal values more accurately than using traditional graphs with a single palette or contour plot. We present here an algorithm of preparing braid plot composed of any number of initial color sets. As a result of using this type of plot, it was possible to detect, e.g., weak perturbation effects or subtle oscillations of the spectral density function, which is very hard to observe using classical plots.
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Pieniak K, Gąsecka A, Pietrasik A, Scisło P, Darocha S, Banaszkiewicz M, Kurzyna M, Kapłon-Cieślicka A. Diagnostic challenges to determine the cause of pulmonary hypertension in a patient with heart failure with preserved ejection fraction and borderline pulmonary artery wedge pressure. Kardiol Pol 2021; 80:222-223. [PMID: 34870319 DOI: 10.33963/kp.a2021.0173] [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: 12/06/2021] [Accepted: 12/06/2021] [Indexed: 11/23/2022]
Affiliation(s)
- Katarzyna Pieniak
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Aleksandra Gąsecka
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Arkadiusz Pietrasik
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Piotr Scisło
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Szymon Darocha
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, European Health Center, Otwock, Poland
| | - Marta Banaszkiewicz
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, European Health Center, Otwock, Poland
| | - Marcin Kurzyna
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, European Health Center, Otwock, Poland
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Pietrasik A, Gąsecka A, Smyk JM, Darocha S, Zieliński D, Kurzyna M. Acute-on-chronic pulmonary embolism and concomitant paradoxical embolism: two diseases, one intervention. Pol Arch Intern Med 2021; 132. [PMID: 34851065 DOI: 10.20452/pamw.16155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
| | - Aleksandra Gąsecka
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.
| | - Julia M Smyk
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Szymon Darocha
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, European Health Center, Otwock, Poland
| | | | - Marcin Kurzyna
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, European Health Center, Otwock, Poland
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Wieteska-Miłek M, Szmit S, Florczyk M, Kuśmierczyk-Droszcz B, Ryczek R, Kurzyna M. COVID-19 Vaccination in Patients with Pulmonary Arterial Hypertension and Chronic Thromboembolic Pulmonary Hypertension: Safety Profile and Reasons for Opting against Vaccination. Vaccines (Basel) 2021; 9:vaccines9121395. [PMID: 34960141 PMCID: PMC8706780 DOI: 10.3390/vaccines9121395] [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] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/20/2021] [Accepted: 11/22/2021] [Indexed: 01/30/2023] Open
Abstract
The incidence of COVID-19 infection in patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) is similar to that in the general population, but the mortality rate is much higher. COVID-19 vaccination is strongly recommended for PAH/CTEPH patients. The aim of our cross-sectional study was to identify reasons why PAH/CTEPH patients refused vaccination against COVID-19. Moreover, we assessed the safety profile of approved COVID-19 vaccines in PAH/CTEPH patients. We examined 261 patients (164 PAH patients and 97CTEPH patients) with a median age of 60 (18–92) years, 62% of which were female. Sixty-one patients (23%) refused to be vaccinated. The main reason for unwillingness to be vaccinated was anxiety about adverse events (AEs, 61%). Age and fear of COVID-19 in the univariate analysis and age ≥60 years in the multivariate regression analysis were factors that impacted willingness to be vaccinated (OR = 2.5; p = 0.005). AEs were reported in 61% of vaccinated patients after the first dose and in 40.5% after the second dose (p = 0.01). The most common reported AEs were pain at the injection site (54.5%), fever (22%), fatigue (21%), myalgia (10.5%), and headache (10%). A lower percentage of AEs was reported in older patients (OR = 0.3; p = 0.001). The COVID-19 vaccines are safe for PAH/CTEPH patients. The results obtained in this study may encourage patients of these rare but severe cardio-pulmonary diseases to get vaccinated against COVID-19.
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Affiliation(s)
- Maria Wieteska-Miłek
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Center, 05-400 Otwock, Poland; (S.S.); (M.F.); (M.K.)
- Correspondence:
| | - Sebastian Szmit
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Center, 05-400 Otwock, Poland; (S.S.); (M.F.); (M.K.)
| | - Michał Florczyk
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Center, 05-400 Otwock, Poland; (S.S.); (M.F.); (M.K.)
| | | | - Robert Ryczek
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, 04-349 Warsaw, Poland;
| | - Marcin Kurzyna
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Center, 05-400 Otwock, Poland; (S.S.); (M.F.); (M.K.)
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Araszkiewicz A, Kurzyna M, Kopeć G, Sławek-Szmyt S, Wrona K, Stępniewski J, Jankiewicz S, Pietrasik A, Machowski M, Darocha S, Mularek-Kubzdela T, Torbicki A, Pruszczyk P, Roik M. Pulmonary Embolism Response Team - a multidisciplinary approach to pulmonary embolism treatment. Polish PERT Initiative Report. Kardiol Pol 2021; 79:1311-1319. [PMID: 34643260 DOI: 10.33963/kp.a2021.0130] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 10/08/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND A pulmonary embolism response team (PERT) is a multidisciplinary team established to improve clinical care for patients with pulmonary embolism (PE). However, data regarding detailed institutional experience and clinical outcomes from such teams are sparse. AIMS We aim to assess the frequency of activations, patients' characteristics, PE severity, applied treatments, and outcomes of PE patients treated by Polish PERTs. METHODS The survey registry was conducted between June 2018 and July 2020. All consecutive PERT activations of four institutionalized PERTs in Poland were analyzed. Patients' characteristics, therapies applied, and in-hospital outcomes were evaluated. RESULTS There were 680 unique PERT activations. The majority of activations originated from emergency departments (44.9%), and the remaining originated from internal medicine/cardiology units (31.1%), surgery/orthopedics (9.1 %), oncology (6.3%), intensive care units (6.0%), and others (2.5%). The origin of activation varied significantly between institutions (P <0.01). Most PERT cases were patients with intermediate-high risk PE (42.9%), whereas high-risk PE occurred in 10% of patients. Anticoagulation alone was delivered to 80.3% patients, and 23.3% patients received at least one advanced therapy: catheter directed therapies (11.3%), systemic thrombolysis (5.3%), surgical embolectomy (2.4%), vena cava filter placement (3.7%), and extracorporeal membrane oxygenation (0.6%). In-hospital mortality in the whole study group was 5.1%, with significant differences between institutions (P = 0.01). CONCLUSIONS The frequency of PE severity, type of delivered catheter-directed treatment, and in-hospital mortality varies between institutions without significant discrepancies in PERT activations. This variation between expert centers highlights the local differences in PERTs' organizational and operational forms.
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Affiliation(s)
| | - Marcin Kurzyna
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology European Health Centre Otwock, Medical Centre for Postgraduate Education, Otwock, Poland
| | - Grzegorz Kopeć
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland
| | - Sylwia Sławek-Szmyt
- 1st Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland.
| | - Katarzyna Wrona
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology European Health Centre Otwock, Medical Centre for Postgraduate Education, Otwock, Poland
| | - Jakub Stępniewski
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland
| | - Stanisław Jankiewicz
- 1st Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland
| | - Arkadiusz Pietrasik
- Department and Faculty of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Michał Machowski
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Szymon Darocha
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology European Health Centre Otwock, Medical Centre for Postgraduate Education, Otwock, Poland
| | | | - Adam Torbicki
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology European Health Centre Otwock, Medical Centre for Postgraduate Education, Otwock, Poland
| | - Piotr Pruszczyk
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Marek Roik
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warszawa, Poland
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Mamzer A, Kopec G, Kusmierczyk-Droszcz B, Skowron W, Mroczek E, Lewicka E, Kaminski K, Karasek D, Mularek-Kubzdela T, Mizia-Stec K, Kurzyna M, Gasior Z, Ciurzynski M, Plonska-Gosciniak E, Kasprzak JD. Atherosclerosis risk factors may be underestimated in patients with pulmonary hypertension associated with congenital heart disease – results of Polish snapshot registry. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2475] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Classic risk factors of atherosclerosis may contribute to cardiovascular (CV) risk in patients (pts) with pulmonary hypertension associated with congenital heart disease (PAH-CHD), but their prevalence is poorly studied.
Purpose
We evaluated a large cohort of Polish PAH-CHD patients (PAHpts) treated with specific therapies with regard to prevalence of classic risk factors for atherosclerosis.
Methods
A multicenter observational snapshot registry was conducted under the auspices of Polish Cardiac Society to study PAH pts, identified in centers treating >5 such pts in years 2008–2018. The analysis included 250 PAH-CHD pts, including non-corrected CHD – predominantly Eisenmenger Syndrome (Gr. 1, 224 pts, mean age 42±2 years, 63% females) and pts after heart disease correction (Gr. 2, 26 pts, mean age 42±6.5 years, 62% females). The incidence of classic CV risk factors was compared in both groups.
Results
The prevalence of risk factors was considerable considering young age of the cohort and statistically similar in both groups (Figure). Hypertension was present in 14% in Gr. 1 and 15% in Gr. 2. The incidence of diabetes was comparable in both groups (3% vs. 4%). Hyperlipidemia was nearly numerically twice as frequent in Gr. 1 (23% vs. 12%, p=0.18). Current smokers (1%) were only present in Gr. 1, while history of smoking was 4% in both groups. Symptomatic atherosclerosis of peripheral arteries was twice as frequent in Gr. 1 (8% vs. 4%, p=0,71). There was no difference regarding prior stroke (3,6% vs 4%, p=0,63). Chronic kidney disease and atrial fibrillation were one and a half more often in Gr. 1 (respectively, 12% vs. 8%, p=0,81; 12% vs. 8%, p=0.75). Mean heart rate was 72±2 bpm in Gr. 1 and 77±7 bpm in Gr. 2. Gastrointestinal bleeding was reported only in Gr. 1 (2.7%). SCORE calculated risks were low due to low age, but high risk was identified in 9.3% of Gr. 1 and 20% of Gr. 2 (p=0.096).
Conclusions
Based on our data from national survey, classic atherosclerosis CV risk factors are not uncommon in the population of relatively young patients with PAH-CHD, parallel to improved longevity. Selected pts from both groups present with elevated risk of death from atherosclerotic complications. This finding may influence the overall mortality risk in PAH-CHD population and reflects new challenges in management despite progress in specific therapies of pulmonary hypertension.
Funding Acknowledgement
Type of funding sources: None. Figure 1
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Affiliation(s)
- A Mamzer
- Bieganski Hospital, 1st Department and Chair of Cardiology, Medical University of Lodz, Lodz, Poland
| | - G Kopec
- Jagiellonian University Medical College, Department of Cardiac and Vascular Diseases, Krakow, Poland
| | - B Kusmierczyk-Droszcz
- Institute of Cardiology in Anin, Department of Congenital Heart Disease, Warsaw, Poland
| | - W Skowron
- Silesian Center for Heart Diseases (SCHD), 3rd Chair and Department of Cardiology, Zabrze, Poland
| | - E Mroczek
- Regional Specialist Hospital, Research and Development Center, Department of Cardiology, Wroclaw, Poland
| | - E Lewicka
- Medical University of Gdansk, Department of Cardiology and Electrotherapy, Gdansk, Poland
| | - K Kaminski
- Medical University of Bialystok, Department of Cardiology, Bialystok, Poland
| | - D Karasek
- Nicolaus Copernicus University, 2nd Department of Cardiology, Faculty of Health Sciences, Bydgoszcz, Poland
| | - T Mularek-Kubzdela
- Poznan University of Medical Sciences, Department of Cardiology, Poznan, Poland
| | - K Mizia-Stec
- School of Medicine in Katowice, Medical University of Silesia, 1st Department of Cardiology, Katowice, Poland
| | - M Kurzyna
- European Health Center, Department of Pulmonary Hypertension, Thromboembolic Diseases and Cardiology, Centre of Postgraduate, Otwock, Poland
| | - Z Gasior
- School of Medicine in Katowice, Medical University of Silesia, Department of Cardiology, Katowice, Poland
| | - M Ciurzynski
- Medical University of Warsaw, Department of Internal Medicine and Cardiology, Warsaw, Poland
| | | | - J D Kasprzak
- Bieganski Hospital, 1st Department and Chair of Cardiology, Medical University of Lodz, Lodz, Poland
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Mamzer A, Kasprzak JD, Waligora M, Kurzyna M, Mroczek E, Mularek-Kubzdela T, Pruszczyk P, Gasior M, Lewicka E, Karasek D, Kusmierczyk-Droszcz B, Mizia-Stec K, Ptaszynska-Kopczynska K, Jachec W, Kopec G. Impact of COVID-19 pandemics upon pulmonary hypertension patients: insights from BNP-PL national database. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1970] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
COVID-19 pandemic has caused not only an increase in overall and cardiovascular mortality, but also hindered access to health care, diagnosis and treatment of diseases other than coronavirus infection.
Aim
Assessment of the impact of the SARS-CoV-2 pandemic on the rate of diagnosis and therapy of pulmonary hypertension (PH) in Poland, along with an analysis of the incidence and course of COVID-19 among patients (pts) diagnosed with PH, treated under the National Health Fund program, registered in the national BNP-PL database.
Methods
The records of the complete population of Polish pts treated under the National Drug Program of PH (PAH and CTEPH), registered in the national database of BNP-PL, updated on an ongoing basis by all PH centers, were analyzed. The frequency of SARS-CoV-2 infections, the clinical severity of their course and the mortality were reviewed, taking into account the specific therapies used. The basic clinical characteristics of the group of sick and deceased patients were compared to the remaining patients registered in the BNP-PL database. The rate of increase of new diagnoses ended with inclusion in the Drug Program between March and December 2020, compared to the corresponding periods of the previous year, and the change in the treatment profile were compared.
Results
The analysis included 1704 pts (PAH 1134, CTEPH 570). The incidence of SARS-CoV-2 infections was 3.8% (n=65), including PAH 2.7% (n=46) and CTEPH 3,2% (n=18). 32 patients (49%) required hospitalization. Mortality rate was 28% (18/65) – including 7/18 outside of hospital. Those who died due to COVID-19 were older (mean age 68.4±15.8 vs. 50.8±18.8 yrs; p<0,001), had higher WHO class and more cardiovascular comorbidities (4±2,06 vs. 2,66±1,8; p=0,01) (Table 1). During the pandemic the number of new diagnoses of PH markedly decreased compared to the corresponding period in 2019 (total 150 vs. 203, PAH 90 vs. 123, CTEPH 60 vs. 80, respectively). A significant increase in total mortality was also observed in the PH group (9,72 vs. 5,85%). Moreover, escalation of specific PH therapy decreased significantly (14,7% vs. 21,6%). Incidence of COVID-19 study group was lower than estimated for general Polish adult population (3,8% vs. 6,5%).
Conclusions
COVID-19 pandemic deeply influenced the diagnostic and therapeutic process of pulmonary hypertension by reducing the number of new diagnoses, escalation therapy and increased overall mortality in this population. This may be due in part to the conversion of some PAH centers into hospitals treating patients infected with SARS-CoV-2, as well as to patients' fear of admitting to hospital despite clinical deterioration. Pulmonary hypertension is linked to markedly increased mortality in COVID-19, similarly for PAH and CTEPH. Intriguing finding of lower infection rate may be linked to protective lifestyle or specific therapies.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Mamzer
- Medical University of Lodz, 1st Department of Cardiology, Lodz, Poland
| | - J D Kasprzak
- Medical University of Lodz, 1st Department of Cardiology, Lodz, Poland
| | - M Waligora
- Jagiellonian University Medical College, Department of Cardiac and Vascular Diseases, Krakow, Poland
| | - M Kurzyna
- European Health Center, Department of Pulmonary Hypertension, Thromboembolic Diseases and Cardiology, Centre of Postgraduate, Otwock, Poland
| | - E Mroczek
- Regional Specialist Hospital, Research and Development Center, Department of Cardiology, Wroclaw, Poland
| | - T Mularek-Kubzdela
- Poznan University of Medical Sciences, Department of Cardiology, Poznan, Poland
| | - P Pruszczyk
- Medical University of Warsaw, Department of Internal Medicine and Cardiology, Warsaw, Poland
| | - M Gasior
- Silesian Center for Heart Diseases (SCHD), 3rd Chair and Department of Cardiology, Zabrze, Poland
| | - E Lewicka
- Medical University of Gdansk, Department of Cardiology and Electrotherapy, Gdansk, Poland
| | - D Karasek
- Nicolaus Copernicus University, 2nd Department of Cardiology, Faculty of Health Sciences, Collegium Medicum, Bydgoszcz, Poland
| | - B Kusmierczyk-Droszcz
- Institute of Cardiology in Anin, Department of Congenital Heart Disease, Warsaw, Poland
| | - K Mizia-Stec
- School of Medicine in Katowice, Medical University of Silesia, 1st Department of Cardiology, Katowice, Poland
| | | | - W Jachec
- The Medical University of Silesia, 2nd Department of Cardiology, Zabrze, Poland
| | - G Kopec
- Jagiellonian University Medical College, Department of Cardiac and Vascular Diseases, Krakow, Poland
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Staszczak B, Malinowski KP, Wańha W, Siudak Z, Jędrychowska M, Susuł M, Surowiec S, Darocha S, Surdacki A, Kurzyna M, Wojakowski W, Legutko J, Bartuś K, Bartuś S, Januszek R. Frequency and predictors of diagnostic coronary angiography and percutaneous coronary intervention related to stroke. Kardiol Pol 2021; 79:1099-1106. [PMID: 34472076 DOI: 10.33963/kp.a2021.0100] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 08/31/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Stroke related to percutaneous coronary interventions (PCIs) is an infrequent complication, which can be potentially life-threatening and can lead to serious disability. AIMS This study aimed to assess the relationship between the type of coronary procedure and incidence of stroke, as well as its predictors. METHODS This retrospective analysis was performed on prospectively collected data gathered in the Polish National Registry of Percutaneous Coronary Interventions (ORPKI) between January 2014 and December 2019 and included 1177 161 coronary procedures. Among them, 650 674 patients underwent isolated diagnostic coronary angiography (DCA), and 526 487 PCI. Stroke was diagnosed in 157 patients (0.013%), of which 100 (0.015%) happened during DCA and 57 (0.011%) during PCI. Multivariable logistic regression analysis was performed to separate predictors of stroke in patients undergoing coronary angiography and PCI. RESULTS The percentage of patients with periprocedural stroke was higher in the group treated with isolated DCA during the analyzed time. Among predictors of stroke in patients undergoing DCA, we confirmed prior stroke (P <0.001), contrast amount (P = 0.007), femoral access (P = 0.002), unfractionated heparin use (P = 0.01), direct transport to the catheterization laboratory (P = 0.04), older age (P <0.001) and multi-vessel disease (P <0.001). While for PCI ± DCA, these were prior stroke (P <0.001), thrombolysis (P = 0.003), treatment with bivalirudin (P <0.001), and acetylsalicylic acid loading during PCI (P = 0.003). CONCLUSIONS Based on the large national registry, PCI ± DCA is associated with fewer risk factors and a lower rate of periprocedural strokes than isolated DCA.
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Affiliation(s)
- Bartłomiej Staszczak
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | | | - Wojciech Wańha
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Zbigniew Siudak
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Magdalena Jędrychowska
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | - Michał Susuł
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | - Sławomir Surowiec
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | - Szymon Darocha
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, European Health Center, Otwock, Poland
| | - Andrzej Surdacki
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland.,Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Marcin Kurzyna
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, European Health Center, Otwock, Poland
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Jacek Legutko
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland
| | - Krzysztof Bartuś
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland
| | - Stanisław Bartuś
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland.,Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Rafał Januszek
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland. .,Department of Clinical Rehabilitation, University of Physical Education, Kraków, Poland.
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Stącel T, Latos M, Urlik M, Nęcki M, Antończyk R, Hrapkowicz T, Kurzyna M, Ochman M. Interventional and Surgical Treatments for Pulmonary Arterial Hypertension. J Clin Med 2021; 10:jcm10153326. [PMID: 34362109 PMCID: PMC8348951 DOI: 10.3390/jcm10153326] [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: 07/05/2021] [Revised: 07/20/2021] [Accepted: 07/27/2021] [Indexed: 12/13/2022] Open
Abstract
Despite significant advancements in pharmacological treatment, interventional and surgical options are still viable treatments for patients with pulmonary arterial hypertension (PAH), particularly idiopathic PAH. Herein, we review the interventional and surgical treatments for PAH. Atrial septostomy and the Potts shunt can be useful bridging tools for lung transplantation (Ltx), which remains the final surgical treatment among patients who are refractory to any other kind of therapy. Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) remains the ultimate bridging therapy for patients with severe PAH. More importantly, VA-ECMO plays a crucial role during Ltx and provides necessary left ventricular conditioning during the initial postoperative period. Pulmonary denervation may potentially be a new way to ensure better transplant-free survival among patients with the aforementioned disease. However, high-quality randomized controlled trials are needed. As established, obtaining the Eisenmenger physiology among patients with severe pulmonary hypertension by creating artificial defects is associated with improved survival. However, right-to-left shunting may be harmful after Ltx. Closure of the artificially created defects may carry some risk associated with cardiac surgery, especially among patients with Potts shunts. In conclusion, PAH requires an interdisciplinary approach using pharmacological, interventional, and surgical modalities.
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Affiliation(s)
- Tomasz Stącel
- Silesian Centre for Heart Diseases in Zabrze, Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia, 40-055 Katowice, Poland; (M.L.); (M.U.); (M.N.); (R.A.); (T.H.)
- Correspondence: (T.S.); (M.O.); Tel.: +48-691-045-785 (T.S.); +48-60-923-4437 (M.O.)
| | - Magdalena Latos
- Silesian Centre for Heart Diseases in Zabrze, Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia, 40-055 Katowice, Poland; (M.L.); (M.U.); (M.N.); (R.A.); (T.H.)
| | - Maciej Urlik
- Silesian Centre for Heart Diseases in Zabrze, Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia, 40-055 Katowice, Poland; (M.L.); (M.U.); (M.N.); (R.A.); (T.H.)
| | - Mirosław Nęcki
- Silesian Centre for Heart Diseases in Zabrze, Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia, 40-055 Katowice, Poland; (M.L.); (M.U.); (M.N.); (R.A.); (T.H.)
| | - Remigiusz Antończyk
- Silesian Centre for Heart Diseases in Zabrze, Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia, 40-055 Katowice, Poland; (M.L.); (M.U.); (M.N.); (R.A.); (T.H.)
| | - Tomasz Hrapkowicz
- Silesian Centre for Heart Diseases in Zabrze, Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia, 40-055 Katowice, Poland; (M.L.); (M.U.); (M.N.); (R.A.); (T.H.)
| | - Marcin Kurzyna
- European Health Centre Otwock, Centre of Postgraduate Medical Education, Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, 05-400 Otwock, Poland;
| | - Marek Ochman
- Silesian Centre for Heart Diseases in Zabrze, Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia, 40-055 Katowice, Poland; (M.L.); (M.U.); (M.N.); (R.A.); (T.H.)
- Correspondence: (T.S.); (M.O.); Tel.: +48-691-045-785 (T.S.); +48-60-923-4437 (M.O.)
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45
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Kwapiński T, Kurzyna M. Topological Atomic Chains on 2D Hybrid Structure. Materials (Basel) 2021; 14:ma14123289. [PMID: 34198678 PMCID: PMC8232186 DOI: 10.3390/ma14123289] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/01/2021] [Accepted: 06/10/2021] [Indexed: 11/16/2022]
Abstract
Mid-gap 1D topological states and their electronic properties on different 2D hybrid structures are investigated using the tight binding Hamiltonian and the Green's function technique. There are considered straight armchair-edge and zig-zag Su-Schrieffer-Heeger (SSH) chains coupled with real 2D electrodes which density of states (DOS) are characterized by the van Hove singularities. In this work, it is shown that such 2D substrates substantially influence topological states end evoke strong asymmetry in their on-site energetic structures, as well as essential modifications of the spectral density function (local DOS) along the chain. In the presence of the surface singularities the SSH topological state is split, or it is strongly localized and becomes dispersionless (tends to the atomic limit). Additionally, in the vicinity of the surface DOS edges this state is asymmetrical and consists of a wide bulk part together with a sharp localized peak in its local DOS structure. Different zig-zag and armachair-edge configurations of the chain show the spatial asymmetry in the chain local DOS; thus, topological edge states at both chain ends can appear for different energies. These new effects cannot be observed for ideal wide band limit electrodes but they concern 1D topological states coupled with real 2D hybrid structures.
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Pietrasik A, Gąsecka A, Chojecka D, Pytlos J, Rymuza B, Główczyńska R, Banaszkiewicz M, Darocha S, Kurzyna M. Iatrogenic pulmonary embolism with cyanoacrylate - to remove, or to leave? Kardiol Pol 2021; 79:706-707. [PMID: 33885273 DOI: 10.33963/kp.15959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Indexed: 11/23/2022]
Affiliation(s)
- Arkadiusz Pietrasik
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Aleksandra Gąsecka
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Dominika Chojecka
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Jakub Pytlos
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Bartosz Rymuza
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Renata Główczyńska
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Marta Banaszkiewicz
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Center, Otwock, Poland
| | - Szymon Darocha
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Center, Otwock, Poland
| | - Marcin Kurzyna
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Center, Otwock, Poland
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Klimkiewicz M, Sławiński G, Faran A, Dąbrowska-Kugacka A, Romanowicz G, Kurzyna M, Lewicka E. Ciężkie przewlekłe zakrzepowo-zatorowe nadciśnienie płucne po splenektomii z powodu sferocytozy wrodzonej — potrzeba długoterminowego nadzoru i ścisłej współpracy hematologów i kardiologów. Folia Cardiologica 2021. [DOI: 10.5603/fc.2021.0015] [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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48
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Pietrasik A, Gąsecka A, Pieniak K, Karpiński G, Kochman J, Darocha S, Kurzyna M. Iatrogenic embolism caused by fractured vascular port: successful endovascular treatment. Kardiol Pol 2021; 79:877-878. [PMID: 33926174 DOI: 10.33963/kp.15991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Indexed: 11/23/2022]
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49
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Kopeć G, Dzikowska-Diduch O, Mroczek E, Mularek-Kubzdela T, Chrzanowski Ł, Skoczylas I, Tomaszewski M, Peregud-Pogorzelska M, Karasek D, Lewicka E, Jacheć W, Gąsior Z, Błaszczak P, Ptaszyńska-Kopczyńska K, Mizia-Stec K, Biederman A, Zieliński D, Przybylski R, Kędzierski P, Waligóra M, Roik M, Grabka M, Orłowska J, Araszkiewicz A, Banaszkiewicz M, Sławek-Szmyt S, Darocha S, Magoń W, Dąbrowska-Kugacka A, Stępniewski J, Jonas K, Kamiński K, Kasprzak JD, Podolec P, Pruszczyk P, Torbicki A, Kurzyna M. Characteristics and outcomes of patients with chronic thromboembolic pulmonary hypertension in the era of modern therapeutic approaches: data from the Polish multicenter registry (BNP-PL). Ther Adv Chronic Dis 2021; 12:20406223211002961. [PMID: 33854746 PMCID: PMC8010818 DOI: 10.1177/20406223211002961] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 02/11/2021] [Accepted: 02/24/2021] [Indexed: 12/13/2022] Open
Abstract
Background: Significant achievements in the treatment of chronic thromboembolic pulmonary hypertension (CTEPH) have provided effective therapeutic options for most patients. However, the true impact of the changed landscape of CTEPH therapies on patients’ management and outcomes is poorly known. We aimed to characterize the incidence, clinical characteristics, and outcomes of CTEPH patients in the modern era of CTEPH therapies. Methods: We analyzed the data of CTEPH adults enrolled in the prospective multicenter registry. Results: We enrolled 516 patients aged 63.8 ± 15.4 years. The incidence rate of CTEPH was 3.96 per million adults per year. The group was burdened with several comorbidities. New oral anticoagulants (n = 301; 58.3%) were preferred over vitamin K antagonists (n = 159; 30.8%). Pulmonary endarterectomy (PEA) was performed in 120 (23.3%) patients and balloon pulmonary angioplasty (BPA) in 258 (50%) patients. PEA was pretreated with targeted pharmacotherapy in 19 (15.8%) patients, and BPA in 124 (48.1%) patients. Persistent CTEPH was present in 46% of PEA patients and in 65% of patients after completion of BPA. Persistent CTEPH after PEA was treated with targeted pharmacotherapy in 72% and with BPA in 27.7% of patients. At a mean time period of 14.3 ± 5.8 months, 26 patients had died. The use of PEA or BPA was associated with better survival than the use of solely medical treatment. Conclusions: The modern population of CTEPH patients comprises mostly elderly people significantly burdened with comorbid conditions. This calls for treatment decisions that are tailored individually for every patient. The combination of two or three methods is currently a frequent approach in the treatment of CTEPH. Clinical Trial Registration: clinicaltrials.gov/ct2/show/NCT03959748
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Affiliation(s)
- Grzegorz Kopeć
- Pulmonary Circulation Centre, Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, ul. Pradnicka 80, Krakow 31-202, Poland
| | - Olga Dzikowska-Diduch
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Ewa Mroczek
- Department of Cardiology, Provincial Specialist Hospital Research and Development Center, Wrocław, Poland
| | | | - Łukasz Chrzanowski
- I Department and Chair of Cardiology, Medical University of Lodz, Łódź, Poland
| | - Ilona Skoczylas
- 3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | | | | | - Danuta Karasek
- 2nd Department of Cardiology, Faculty of Health Sciences, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Ewa Lewicka
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Wojciech Jacheć
- 2nd Department of Cardiology, School of Medicine with Dentistry Division in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Zbigniew Gąsior
- Department of Cardiology, School of Health Sciences, Medical University of Silesia, Katowice, Poland
| | - Piotr Błaszczak
- Department of Cardiology, Cardinal Wyszynski Hospital, Lublin, Poland
| | | | - Katarzyna Mizia-Stec
- 1st Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | | | | | - Roman Przybylski
- Department of Heart Diseases, Wroclaw Medical University, Clinic of Cardiac Transplantation and Mechanical Circulatory Support, Wrocław, Poland
| | - Piotr Kędzierski
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, Otwock, Poland
| | - Marcin Waligóra
- Pulmonary Circulation Centre Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland, Department of Medical Education, Center for Innovative Medical Education, Jagiellonian University Medical College, Krakow, Poland
| | - Marek Roik
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Marek Grabka
- 1st Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Joanna Orłowska
- Department of Cardiology, Provincial Specialist Hospital Research and Development Center, Wrocław, Poland
| | | | - Marta Banaszkiewicz
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, Otwock, Poland
| | - Sylwia Sławek-Szmyt
- Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland
| | - Szymon Darocha
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, Otwock, Poland
| | - Wojciech Magoń
- Pulmonary Circulation Centre, Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | | | - Jakub Stępniewski
- Pulmonary Circulation Centre Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland, Department of Medical Education, Center for Innovative Medical Education, Jagiellonian University Medical College, Krakow, Poland
| | - Kamil Jonas
- Pulmonary Circulation Centre Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland, Department of Medical Education, Center for Innovative Medical Education, Jagiellonian University Medical College, Krakow, Poland
| | - Karol Kamiński
- Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Białystok, Białystok, Poland
| | - Jarosław D Kasprzak
- I Department and Chair of Cardiology, Medical University of Lodz, Łódź, Poland
| | - Piotr Podolec
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland
| | - Piotr Pruszczyk
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Adam Torbicki
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, Otwock, Poland
| | - Marcin Kurzyna
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, Otwock, Poland
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50
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Darocha S, Araszkiewicz A, Kurzyna M, Banaszkiewicz M, Jankiewicz S, Dobosiewicz A, Sławek-Szmyt S, Janus M, Grymuza M, Pietrasik A, Mularek-Kubzdela T, Kędzierski P, Pietura R, Zieliński D, Biederman A, Lesiak M, Torbicki A. Balloon Pulmonary Angioplasty in Technically Operable and Technically Inoperable Chronic Thromboembolic Pulmonary Hypertension. J Clin Med 2021; 10:jcm10051038. [PMID: 33802475 PMCID: PMC7959461 DOI: 10.3390/jcm10051038] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/04/2021] [Accepted: 02/24/2021] [Indexed: 11/16/2022] Open
Abstract
Background: In this study, we aimed to assess the efficacy and safety of balloon pulmonary angioplasty (BPA) in patients with technically inoperable distal-type chronic thromboembolic pulmonary hypertension (d-CTEPH) and technically operable proximal-type disease (p-CTEPH) by analyzing the results of BPA treatment in two collaborating CTEPH referral centers. Methods and results: We assessed hemodynamic results, functional efficacy, complication and survival rate after BPA treatment in 70 CTEPH patients (median age 64 years; (interquartile range (IQR): 52–73 years)), of whom 16 (median age 73 years; (QR 62–82 years)) were in the p-CTEPH subgroup. Altogether, 377 BPA procedures were performed, resulting in significant (p < 0.001) improvement in mean pulmonary artery pressure (mPAP 48.6 ± 10 vs. 31.3 ± 8.6 mmHg), pulmonary vascular resistance (694 ± 296 vs. 333 ± 162 dynes*s*cm−5), six-minute walk test (365 ± 142 vs. 433 ± 120 metres) and N-terminal pro B-type natriuretic peptide (1307 (510–3294) vs. 206 (83–531) pg/mL). The rate of improvement did not differ between the sub-groups. Lung injury episodes and severe hemoptysis were similarly infrequent in d-CTEPH and p-CTEPH (6.4% vs. 5%; p = 0.55 and 1.0% vs. 2.5; p = 0.24, respectively). There was no significant difference between the sub-groups regarding survival (p = 0.53 by log-rank test). Conclusion: BPA may be beneficial in patients with p-CTEPH who cannot undergo pulmonary endarterectomy (PEA). Larger long-term studies are needed to better define the efficacy, safety, and optimal BPA procedural standards in this population.
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Affiliation(s)
- Szymon Darocha
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre Otwock, 05-400 Otwock, Poland; (S.D.); (M.B.); (A.D.); (P.K.); (A.T.)
| | - Aleksander Araszkiewicz
- Department of Cardiology, Poznan University of Medical Sciences, 61-848 Poznan, Poland; (A.A.); (S.J.); (S.S.-S.); (M.J.); (M.G.); (T.M.-K.); (M.L.)
| | - Marcin Kurzyna
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre Otwock, 05-400 Otwock, Poland; (S.D.); (M.B.); (A.D.); (P.K.); (A.T.)
- Correspondence: ; Tel.: +48-22-7103052; Fax: +48-22-7103169
| | - Marta Banaszkiewicz
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre Otwock, 05-400 Otwock, Poland; (S.D.); (M.B.); (A.D.); (P.K.); (A.T.)
| | - Stanisław Jankiewicz
- Department of Cardiology, Poznan University of Medical Sciences, 61-848 Poznan, Poland; (A.A.); (S.J.); (S.S.-S.); (M.J.); (M.G.); (T.M.-K.); (M.L.)
| | - Anna Dobosiewicz
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre Otwock, 05-400 Otwock, Poland; (S.D.); (M.B.); (A.D.); (P.K.); (A.T.)
| | - Sylwia Sławek-Szmyt
- Department of Cardiology, Poznan University of Medical Sciences, 61-848 Poznan, Poland; (A.A.); (S.J.); (S.S.-S.); (M.J.); (M.G.); (T.M.-K.); (M.L.)
| | - Magdalena Janus
- Department of Cardiology, Poznan University of Medical Sciences, 61-848 Poznan, Poland; (A.A.); (S.J.); (S.S.-S.); (M.J.); (M.G.); (T.M.-K.); (M.L.)
| | - Maciej Grymuza
- Department of Cardiology, Poznan University of Medical Sciences, 61-848 Poznan, Poland; (A.A.); (S.J.); (S.S.-S.); (M.J.); (M.G.); (T.M.-K.); (M.L.)
| | - Arkadiusz Pietrasik
- 1st Department and Faculty of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Tatiana Mularek-Kubzdela
- Department of Cardiology, Poznan University of Medical Sciences, 61-848 Poznan, Poland; (A.A.); (S.J.); (S.S.-S.); (M.J.); (M.G.); (T.M.-K.); (M.L.)
| | - Piotr Kędzierski
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre Otwock, 05-400 Otwock, Poland; (S.D.); (M.B.); (A.D.); (P.K.); (A.T.)
| | - Radosław Pietura
- Department of Radiography, Medical University of Lublin, 00-635 Lublin, Poland;
| | - Dariusz Zieliński
- Department of Cardiac Surgery, Medicover Hospital, 02-972 Warsaw, Poland; (D.Z.); (A.B.)
| | - Andrzej Biederman
- Department of Cardiac Surgery, Medicover Hospital, 02-972 Warsaw, Poland; (D.Z.); (A.B.)
| | - Maciej Lesiak
- Department of Cardiology, Poznan University of Medical Sciences, 61-848 Poznan, Poland; (A.A.); (S.J.); (S.S.-S.); (M.J.); (M.G.); (T.M.-K.); (M.L.)
| | - Adam Torbicki
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre Otwock, 05-400 Otwock, Poland; (S.D.); (M.B.); (A.D.); (P.K.); (A.T.)
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