Kardiologia polska最新文献

{"title":"Rehabilitation in patients with coexisting cardiovascular diseases and frailty syndrome. Expert opinion of the Section of Prevention and Epidemiology, Polish Cardiac Society.","authors":"Małgorzata Kupisz-Urbańska, Małgorzata Kurpesa, Anna Kawińska, Ewa Straburzyńska-Migaj, Wiktoria Niegowska, Piotr Bandosz, Agata Bielecka-Dąbrowa, Paweł Burchardt, Krzysztof Chlebus, Piotr Dobrowolski, Aleksander Prejbisz, Daniel Śliż, Karol Kamiński, Agnieszka Młynarska, Piotr Jankowski","doi":"10.33963/v.phj.114119","DOIUrl":"https://doi.org/10.33963/v.phj.114119","url":null,"abstract":"","PeriodicalId":17784,"journal":{"name":"Kardiologia polska","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148881030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alert burden and clinical relevance of remote monitoring in heart failure patients with cardiac implantable electronic devices: Single-center experience in the reimbursement era.","authors":"Klaudia Buczek, Marek Kiliszek, Paweł Krzesiński","doi":"10.33963/v.phj.114471","DOIUrl":"https://doi.org/10.33963/v.phj.114471","url":null,"abstract":"<p><strong>Background: </strong>Heart failure (HF) affects 1%-2% of adults in developed countries and is associated with significant healthcare burden. Remote monitoring (RM) of cardiac implantable electronic devices may improve outcomes in HF patients, but itincreases the clinical management demands on device follow-up clinics.</p><p><strong>Aims: </strong>The aim of our study was to assess the workload of a cardiac device follow-up clinic by analyzing RM alerts and associated clinical interventions.</p><p><strong>Methods: </strong>A retrospective single-center study of consecutive HF patients with implantable cardioverter defibrillator or cardiac resynchronization therapy-defibrillator was conducted to analyze unscheduled RM alerts, categorizing them as clinically significant or insignificant and assessing resulting medical interventions.</p><p><strong>Results: </strong>A cohort of 407 HF patients (median age 71 years, 15% female) with implantable cardioverter defibrillator or cardiac resynchronization therapy-defibrillator devices, predominantly implanted for primary prevention of sudden cardiac death and with predominantly ischemic etiology, was followed for a median of 18 months, with 10.6% mortality. A total of 19 788 alerts were generated (2.8 per patient-month), of which 1491 (7.5%) were clinically significant (0.21 per patient-month). The predominant clinically significant alert was a reduction in biventricular pacing below 85%. Clinically important arrhythmic alerts included 21 cases of first-detected atrial fibrillation, 107 episodes of sustained ventricular tachycardia and 37 episodes of ventricular fibrillation. The most frequent clinical intervention consisted of teleconsultation with pharmacotherapy modification.</p><p><strong>Conclusions: </strong>In this cohort, RM alerts identified clinically significant events, including newly detected atrial fibrillation and ventricular arrhythmias, and selected alerts were associated with subsequent clinical actions. The high alert burden and low proportion of actionable alerts underscore the need for optimized alert programming and structured monitoring workflows.</p>","PeriodicalId":17784,"journal":{"name":"Kardiologia polska","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Left atrial appendage closure versus medical therapy in atrial fibrillation: An updated meta-analysis of randomized trials on the trade-off between stroke prevention and bleeding.","authors":"Gianluca Di Pietro, Riccardo Improta, Emanuele Bruno, Carmine Musto, Achille Gaspardone, Massimo Mancone","doi":"10.33963/v.phj.114450","DOIUrl":"https://doi.org/10.33963/v.phj.114450","url":null,"abstract":"<p><strong>Background: </strong>Long-term oral anticoagulation remains the standard of care for patients with atrial fibrillation, despite the non-negligible risk of bleeding. Percutaneous left atrial appendage closure (LAAC) has emerged as an alternative strategy for preventing stroke with inconclusive modern data.</p><p><strong>Aims: </strong>Our aim was to evaluate the comparative efficacy and safety of LAAC vs. medical therapy in patients with atrial fibrillation.</p><p><strong>Methods: </strong>A systematic search of PubMED, Scopus and EMBASE was conducted up to April 2026 to identify randomized controlled trials comparing LAAC with medical therapy. The primary endpoint was overall stroke. The secondary endpoints were ischemic stroke, hemorrhagic stroke, systemic embolism, mortality, major bleeding and non-procedural bleeding. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model with restricted maximum likelihood estimation and Hartung-Knapp adjustment.</p><p><strong>Results: </strong>Six randomized controlled trials, encompassing 7004 patients globally (device group: 3681 patients; medical therapy group: 3323 patients), were included in the analysis. LAAC was associated with a similar risk of stroke to medical therapy (OR, 0.92; 95% CI, 0.65-1.3; P = 0.55) at a median 39 (interquartile range 36-47) months of follow-up. No significant differences were observed in ischemic stroke, hemorrhagic stroke, systemic embolism, all-cause mortality or cardiovascular mortality. Rates of major bleeding were comparable (OR, 1.13; 95% CI, 0.90-1.43; P = 0.23). However, medical therapy was associated with a significantly higher risk of non-procedural bleeding compared with LAAC (OR, 1.95; 95% CI, 1.67-2.27; P <0.001). These findings were consistent across subgroup analyses.</p><p><strong>Conclusions: </strong>LAAC provides thromboembolic protection comparable to medical therapy while reducing non-procedural bleeding. These findings support its role as an alternative strategy in selected patients at increased bleeding risk.</p>","PeriodicalId":17784,"journal":{"name":"Kardiologia polska","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148829839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can an electrophysiologist play a role in diagnosing skeletal myopathy? A case of fukutin-related protein (cardio)myopathy.","authors":"Agnieszka Zienciuk-Krajka, Michał Bohdan, Magdalena Chylińska, Szymon Budrejko, Kamil Suszczyński, Maciej Kempa, Aleksandra Gintowt-Chakour, Ludmiła Daniłowicz-Szymanowicz","doi":"10.33963/v.phj.114472","DOIUrl":"https://doi.org/10.33963/v.phj.114472","url":null,"abstract":"","PeriodicalId":17784,"journal":{"name":"Kardiologia polska","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148829806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative ionized calcium levels and risk of acute kidney injury after cardiac surgery.","authors":"Ji-Ho Lee, Hyo Jeong Kim, Jin Hyeog Lee, Seung Jun Kim, Sung Jin Moon, Jung Tak Park, Hee Byung Koh","doi":"10.33963/v.phj.113980","DOIUrl":"10.33963/v.phj.113980","url":null,"abstract":"<p><strong>Background: </strong>Postoperative acute kidney injury (AKI) is a significant complication following cardiac surgery, with limited preventive measures.</p><p><strong>Aims: </strong>Our aim was to evaluate the association between preoperative serum ionized calcium levels and postoperative AKI in patients undergoing cardiac surgery.</p><p><strong>Methods: </strong>This retrospective cohort study included adult patients (≥18 years) who underwent elective or non-elective cardiac surgery at two tertiary hospitals between 2006 and 2020. Patients with an estimated glomerular filtration rate ≥15 ml/min/1.73 m2 who were not receiving maintenance dialysis were eligible. Preoperative serum ionized calcium levels were categorized 2 / 25 into quartiles (Q1-Q4). The primary outcome was postoperative AKI within 48 hours, defined according to Kidney Disease: Improving Global Outcomes criteria. Multivariable logistic regression and mediation analyses were performed.</p><p><strong>Results: </strong>Among 9779 patients (median age, 64 years; 60.1% male; 42.6% coronary artery bypass grafting, 57.4% valvular surgery with or without coronary artery bypass grafting; 4.6% emergency surgery; 10.0% chronic kidney disease stages 3-4), mild AKI (Kidney Disease: Improving Global Outcomes stage 1) and moderate-to-severe AKI (Kidney Disease: Improving Global Outcomes stage 2-3) occurred in 3848 (39.3%) and 719 (7.4%) patients, respectively. Acute kidney injury requiring dialysis occurred in 197 (2.0%) patients, and in-hospital mortality was 2.5%. Compared with Q4 (highest calcium), the adjusted odds ratios (95% confidence intervals) for mild AKI were 1.58 (1.38-1.80), 1.21 (1.06-1.38), and 1.05 (0.92-1.20) for Q1, Q2, and Q3, respectively (P for trend < 0.001). For moderate-to-severe AKI, the corresponding adjusted odds ratios were 2.11 (1.65-2.69), 1.44 (1.12-1.87), and 1.16 (0.88-1.51) (P for trend < 0.001). The association was stronger in patients with congestive heart failure and those undergoing prolonged cardiopulmonary bypass (both P for interaction < 0.05). Mediation analyses suggested that intraoperative vasopressor use, cardiopulmonary bypass time, and red blood cell transfusion partially mediated the association between calcium levels and AKI outcomes. The lowest ionized calcium quartile was also independently associated with higher in-hospital mortality (Q1: adjusted odds ratio, 2.32; 95% confidence interval, 1.53-3.54).</p><p><strong>Conclusions: </strong>Lower preoperative serum ionized calcium levels were independently associated with higher risk of postoperative AKI following cardiac surgery. These findings suggest that ionized hypocalcemia may serve as a hemodynamic risk factor for AKI in this population.</p>","PeriodicalId":17784,"journal":{"name":"Kardiologia polska","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148673731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Right hemidiaphragmatic twitching: Atypical manifestation of ratchet syndrome associated with late atrial lead dislodgement.","authors":"Michał Szotek, Rafał Król, Agnieszka Czunko, Paweł T Matusik","doi":"10.33963/v.phj.114449","DOIUrl":"https://doi.org/10.33963/v.phj.114449","url":null,"abstract":"","PeriodicalId":17784,"journal":{"name":"Kardiologia polska","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148818725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Structured educational program for healthcare professionals improves outcomes of atrial fibrillation management: A Polish subgroup analysis of the European Society of Cardiology STEEER-AF cluster-randomized trial.","authors":"Wiktor K Gmiński, Paweł Balsam, Jarosław Blicharz, Piotr Buchta, Tomasz Czerski, Robert Gajda, Adam Gorlo, Monika Lica-Gorzyńska, Marcin Kostkiewicz, Wojciech Kucejko, Piotr Pączek, Grzegorz Skonieczny, Andrzej Skrzyński, Grzegorz Sobieszek, Stanisław Tubek, Hanna Wilk-Manowiec, Karina V Bunting, Samir Mehta, Isabelle van Gelder, Giuseppe Boriani, Serge Boveda, Eduard Guasch, Lluis Mont, Kim Rajappan, Phillipp Sommer, Dipak Kotecha, Maciej Sterliński, STEEER-AF Investigators","doi":"10.33963/v.phj.114470","DOIUrl":"10.33963/v.phj.114470","url":null,"abstract":"<p><strong>Background: </strong>The STEEER-AF trial evaluated the effect of a structured educational program on adherence to European Society of Cardiology guidelines for atrial fibrillation.</p><p><strong>Aims: </strong>We aimed to report the prespecified subgroup analysis of centers in Poland to evaluate regional guideline adherence and the impact of the educational intervention.</p><p><strong>Methods: </strong>Twelve Polish centers recruiting 300 patients with atrial fibrillation were randomized 1:1 to an educational intervention for healthcare professionals or standard practice. Co-primary outcomes were patient-level adherence to class I and III European Society of Cardiology recommendations for stroke prevention and rhythm control at 6-9 months.</p><p><strong>Results: </strong>Complete case analysis included 262 patients. Baseline oral anticoagulant prescription was 96.3%. At follow-up, adherence to stroke prevention guidelines was 76.6% in the intervention group and 70.9% in the control group (adjusted risk ratio, 1.12; 95% confidence interval, 0.99-1.27). For rhythm control, guideline adherence reached 53.1% in the intervention group compared with 26.9% in the control group (adjusted risk ratio 1.75; 95% confidence interval, 1.16-2.64). Educational engagement was robust, with learners spending a median of 11.5 hours on the platform.</p><p><strong>Conclusions: </strong>Following structured professional education, absolute adherence to rhythm control recommendations was substantially higher in the Polish cohort. A near-optimal baseline oral anticoagulant prescription rate limited the capacity for measurable improvement in stroke prevention. These findings are hypothesis-generating and highlight the need for targeted education aligned with local healthcare infrastructure.</p>","PeriodicalId":17784,"journal":{"name":"Kardiologia polska","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148818754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recent advances and knowledge gaps in anticoagulation strategy with durable left ventricular assist devices.","authors":"Katrina F Etts, Ashwin A Pillai, John Marchuk-Welsby, Abhishek Jaiswal","doi":"10.33963/v.phj.113979","DOIUrl":"10.33963/v.phj.113979","url":null,"abstract":"<p><p>Driven by technological advancements, donor shortages, and an aging population, utilization of left ventricular assist devices (LVAD), both as a bridge to transplant and as destination therapy, has risen in recent years for symptomatic patients with end-stage heart failure. With wide blood flow pathways, friction-free movement, and intrinsic pulsatility that reduce shear stress and promote more favorable intrapump blood flow, the incidence of adverse events such as device failure and thromboembolism has been significantly reduced in patients receiving the latest LVAD, the HeartMate 3 (HM3; Abbott Laboratories, Abbott Park, IL, US). However, hemocompatibility related complications, especially bleeding, remain common and a major cause of morbidity and hospitalization. This has prompted interest in less aggressive antithrombotic strategies for LVAD patients. Recent evidence has demonstrated that aspirin can be safely omitted in most HM3 recipients, substantially reducing bleeding without increasing thromboembolic events. Moreover, the direct oral anticoagulant apixaban has emerged as a promising alternative to warfarin in selected LVAD patients, with the potential to reduce bleeding risk without compromising protection against thrombotic complications. However, randomized phase III evidence remains limited, and important knowledge gaps persist in this population. This review summarizes contemporary antithrombotic strategies in HM3 recipients, evaluates emerging evidence supporting apixaban and aspirin withdrawal, and highlights remaining knowledge gaps. We also outline future directions, including ongoing randomized clinical trials, novel anticoagulants targeting factors XI and XII, and artificial intelligence-based approaches to individualized anticoagulation. As the field continues to evolve, personalized antithrombotic strategies have the potential to optimize hemocompatibility while improving clinical outcomes and quality of life in patients receiving durable LVAD.</p>","PeriodicalId":17784,"journal":{"name":"Kardiologia polska","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148669154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Silent thrombosis of a mechanical tricuspid valve prosthesis in a patient with Ebstein's anomaly.","authors":"Aneta Klotzka, Adrian Forszpaniak, Angelika Kuczmarska, Julia Terlikowska, Aleksandra Ciepłucha, Maciej Lesiak","doi":"10.33963/v.phj.114455","DOIUrl":"https://doi.org/10.33963/v.phj.114455","url":null,"abstract":"<p><p>[N/A].</p>","PeriodicalId":17784,"journal":{"name":"Kardiologia polska","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148818736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CAD-RADS 2.0-guided diagnostic pathways in chronic coronary syndromes: a real-world Polish registry of over 10 000 patients.","authors":"Jadwiga Fijałkowska, Katarzyna Sienkiewicz, Dorota Gałąska, Julia Niemierko, Joanna Pieńkowska, Marlena Rygusik, Łukasz Lewicki, Radosław Targoński, Marcin Gruchała, Edyta Szurowska, Marcin Fijałkowski","doi":"10.33963/v.phj.114453","DOIUrl":"https://doi.org/10.33963/v.phj.114453","url":null,"abstract":"<p><strong>Background: </strong>Coronary computed tomography angiography (CCTA) reported with Coronary Artery Disease Reporting and Data System (CAD-RADS) 2.0 is increasingly used in chronic coronary syndromes, but real-world adherence to the recommended downstream pathways is poorly characterized.</p><p><strong>Aims: </strong>To describe the population referred for CCTA in a Polish tertiary center, the distribution of CAD-RADS 2.0 categories by sex and age, and adherence to guideline-recommended downstream pathways.</p><p><strong>Methods: </strong>We retrospectively analyzed 10 005 consecutive patients who underwent CCTA between July 1, 2022 and December 31, 2024. Downstream procedures were identified in the National Health Fund registry. A pre-specified multivariable logistic regression model (CAD-RADS category, age, sex) described referral for invasive coronary angiography (ICA); discrimination was quantified as the area under the receiver-operating-characteristic curve (AUC).</p><p><strong>Results: </strong>Women constituted 57.8% of the cohort and were older than men (mean 66.4 vs. 64.1 years; P < 0.001). The distribution of categories differed by sex (P < 0.001). Among patients with CAD-RADS 0-2, 18.5% underwent at least one additional test. Among patients with CAD-RADS 3, 41.8% proceeded directly to ICA without prior functional testing and 17.7% followed a functional-testing-first pathway. Among patients with CAD-RADS 4-5, 26.0% did not undergo ICA and 17.8% had no further testing. CAD-RADS category dominated referral for ICA (full model AUC 0.886; 95% confidence interval, 0.877-0.894; CAD-RADS alone 0.883; age and sex alone 0.677).</p><p><strong>Conclusions: </strong>Divergence between observed and guideline-recommended pathways was evident across all CAD-RADS categories, indicating a need for structured implementation of CAD-RADS-guided care pathways.</p>","PeriodicalId":17784,"journal":{"name":"Kardiologia polska","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148813360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}