Kardiologia polska最新文献

{"title":"Recurrent ischemic stroke in atrial fibrillation patients despite NOAC therapy: Recent advances and their therapeutic implications.","authors":"Maurizio Paciaroni, Alessia Maruccia, Maura Pugliatti","doi":"10.33963/v.phj.112280","DOIUrl":"https://doi.org/10.33963/v.phj.112280","url":null,"abstract":"<p><p>Non-vitamin K oral anticoagulants (NOACs) are currently the preferred anticoagulant therapy for patients with non-valvular atrial fibrillation. Nevertheless, for patients receiving oral anticoagulants, clinical trials have reported a residual annual risk of recurrent ischemic events ranging from 0.7% to 2.3%, in both primary and secondary prevention settings. Furthermore, in the non-randomized RENO-EXTEND study, patients who had an ischemic stroke while on NOAC therapy, also had a recorded combined rate of thromboembolic and bleeding events of 16.7%, corresponding to an annual incidence of 13.4%. For those patients who experience an ischemic stroke while receiving NOAC therapy, reliable evidence on how to proceed with management is limited. This patient setting need to take into consideration the following strategies: 1) Exclude poor adherence to treatment; 2) Assess potential drug-drug interactions; 3) Ensure the prescription of the most appropriate NOAC dose; 4) Confirm the underlying mechanism of the recurrent ischemic event; 5) Continue the same NOAC after a cardioembolic event occurring during NOAC therapy, when appropriate; 6) Consider switching to a different NOAC so to improve adherence; 7) Evaluate, on a case-by-case basis and for the shortest feasible duration, the possible addition of an antiplatelet agent to NOAC therapy; 8) Consider left atrial appendage occlusion combined with indefinite NOAC therapy in selected patients with recurrent events despite anticoagulation; 9) Increment stricter risk factor controls. Moreover, results from randomized controlled trials investigating for more effective management strategies are needed to better treat patients in this setting.</p>","PeriodicalId":17784,"journal":{"name":"Kardiologia polska","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147775442","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":"Smoking and outcomes in MINOCA: Clarifying the smoker's paradox in a heterogeneous population.","authors":"Hersh Osman, Nazha Hamdani, Ibrahim El-Battrawy","doi":"10.33963/v.phj.112279","DOIUrl":"https://doi.org/10.33963/v.phj.112279","url":null,"abstract":"","PeriodicalId":17784,"journal":{"name":"Kardiologia polska","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147775527","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 ventricle assist device therapy in Poland: Growth, outcomes, and evolving paradigms in advanced heart failure care.","authors":"Michael J Bonios, Felix Schoenrath, Stavros G Drakos","doi":"10.33963/v.phj.112278","DOIUrl":"https://doi.org/10.33963/v.phj.112278","url":null,"abstract":"","PeriodicalId":17784,"journal":{"name":"Kardiologia polska","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147775450","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":"D-dimer testing in cardiovascular disease: Laboratory and clinical pitfalls.","authors":"Krystyna Sztefko, Małgorzata Konieczyńska, Jolanta Bugajska, Anetta Undas","doi":"10.33963/v.phj.112156","DOIUrl":"https://doi.org/10.33963/v.phj.112156","url":null,"abstract":"<p><p>D-dimer as a mixture of soluble cross-linked fibrin degradation products cleaved by plasmin is a well-established biomarker of in vivo blood coagulation activation with concomitant secondary fibrinolysis that is widely determined in a broad variety of clinical settings. D-dimer interpretation is hampered by the lack of the assay international standard and assay harmonization across laboratories, preanalytical variables affecting the results, multiple assays available with different units, and the impact of heterophilic nonspecific IgG or IgM antibodies, which cause falsely increased or decreased results. Different reactivity of monoclonal antibodies against D-dimer molecule results in a variability of results obtained with different assays within individual patients. Compelling clinical evidence supports a high negative predictive value of age-adjusted D-dimer concentration in ruling out venous thromboembolism, both pulmonary embolism and deep-vein thrombosis. Elevated D-dimer levels are observed in acute myocardial infarction or stroke, aortic aneurysm and acute dissection, atrial fibrillation, heart failure, following invasive procedures, infection. Elevated D-dimer can be found in chronic venous insufficiency, chronic inflammatory diseases, cancer, sepsis, autoimmune disorders, diabetes, advanced age, strenuous physical activity, and pregnancy. Though elevated D-dimer is associated with increased risk of first and recurrent venous thromboembolism, it is no per se indication for anticoagulant treatment and should lead to in-depth diagnostic evaluation to identify mechanisms underlying such abnormality. The current overview summarizes both laboratory and clinical knowledge on D-dimer measurement and interpretation with focus on acute and chronic cardiovascular diseases.</p>","PeriodicalId":17784,"journal":{"name":"Kardiologia polska","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147699284","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":"Clinical outcomes of left bundle branch area pacing in heart failure patients with typical or atypical left bundle branch block.","authors":"Yonghong Yang, Zijun Zhao, Yushi Luo, Tian Wu, Huazhong Miao, Wen Yang, Qijun Shan, Xiujuan Zhou, Zhixin Jiang","doi":"10.33963/v.phj.112157","DOIUrl":"https://doi.org/10.33963/v.phj.112157","url":null,"abstract":"<p><strong>Background: </strong>The impact of stricter definition of left bundle branch block (LBBB) on echocardiographic response of left bundle branch area pacing (LBBAP) and clinical outcomes remains unclear.</p><p><strong>Aims: </strong>This study aimed to compare the effects of LBBAP in heart failure (HF) patients with typical left bundle branch block (t-LBBB) versus atypical LBBB (a-LBBB).</p><p><strong>Methods: </strong>Ninety-seven patients with LBBB and left ventricular ejection fraction <50% who successfully underwent LBBAP were enrolled. Patients were categorized into t-LBBB group (n = 82) and a-LBBB group (n = 15) based on Strauss criteria. Baseline characteristics, pacing parameters and clinical outcomes were compared between the two groups.</p><p><strong>Results: </strong>In the t-LBBB group, the left ventricular end-diastolic dimension decreased from 63.9 (8.3) mm to 53.5 (8.2) mm (P <0.001) and the left ventricular ejection fraction improved from 33.3 (8.1)% to 51.1 (11.1)% (P <0.001). Compared with the a-LBBB group, the t-LBBB group has a higher proportion of responders (91.5% vs. 33.3%; P <0.001) and hyperresponders (59.8% vs. 13.3%; P<0.001). Besides, the t-LBBB group showed lower incidence of death from any cause (2.4% vs 20.0%; log-rank P = 0.005), HF hospitalizations (6.1% vs. 46.7%; log-rank P <0.001) and the primary composite endpoint (8.5% vs. 60.0%; log-rank P <0.001).</p><p><strong>Conclusions: </strong>Compared to HF patients with a-LBBB, LBBAP significantly reverses cardiac remodeling and improves clinical outcomes in those with t-LBBB.</p>","PeriodicalId":17784,"journal":{"name":"Kardiologia polska","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147699256","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":"Sudden cardiac arrest in an adolescent with Ebstein's anomaly: Multifactorial arrhythmogenic mechanisms.","authors":"Barbara Rabiega, Weronika Pelczar-Płachta, Agnieszka Kowalska-Tupko, Krzysztof Czyż, Bartłomiej Mroziński, Waldemar Bobkowski","doi":"10.33963/v.phj.112129","DOIUrl":"https://doi.org/10.33963/v.phj.112129","url":null,"abstract":"","PeriodicalId":17784,"journal":{"name":"Kardiologia polska","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147674757","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":"Real-world incidence and predictors of left atrial thrombus detected in transesophageal echocardiography before atrial fibrillation ablation procedures.","authors":"Elżbieta Ostrowska-Kaim, Karolina Golińska-Grzybała, Jolanta Rzucidło-Resil, Patrycja Mołek-Dziadosz, Maciej Stąpór, Barbara Szlósarczyk, Magdalena Mostowik, Andrzej Gackowski","doi":"10.33963/v.phj.112130","DOIUrl":"https://doi.org/10.33963/v.phj.112130","url":null,"abstract":"<p><strong>Background: </strong>Transesophageal echocardiography (TEE) is routinely performed before atrial fibrillation (AF) electrotherapy to exclude left atrial thrombus.</p><p><strong>Aims: </strong>The aim of this study is to assess the real-world prevalence of left atrial appendage thrombus (LAAT) and improve risk stratification to limit the number of unnecessary TEE studies.</p><p><strong>Methods: </strong>We retrospectively analysed 7357 TEE exams at high-volume hospital to assess LAAT prevalence. Subsequently, we prospectively studied 517 consecutive patients in whom TEE was routinely performed prior to elective AF ablation to assess LAAT and spontaneous echocardiographic contrast (SEC) prevalence.</p><p><strong>Results: </strong>LAAT was detected in only 1.5% (108/7357) of all TEE studies performed for various indications. In elective AF ablation patients, LAAT or dense SEC was found in only 1.6% of cases (8/511). Predictors of LAAT/SEC were: persistent AF over one year (odds ratio [OR], 0.20; 95% confidence interval [CI], 0.05-0.7; P = 0.012), at least moderate valvular heart disease or post-valve repair/replacement status (OR, 0.46; 95% CI, 0.22-0.98; P = 0.044). Conversely, the identified protective factors included: CHA2DS2-VA score <4 points (OR, 2.1; 95% CI, 1.01-4.32; P = 0.046), left atrial volume index <51.5 ml/m2 (OR, 2.9; 95% CI, 1.37-6.14; P = 0.005), N-terminal pro-B-type natriuretic peptide <956.5 pg/ml (OR, 4.2; 95% CI, 1.98-9.12; P <0.001), and left ventricular ejection fraction >40% (OR, 9.5; 95% CI, 4.29-20.86; P <0.001). A point score and nomogram were developed to predict the odds of absence of LAAT/SEC.</p><p><strong>Conclusions: </strong>Among the patients referred to AF ablation, easily accessible clinical data may improve selection of patients who truly require TEE to exclude LAAT prior to the procedure. Further studies are needed to independently validate the proposed risk assessment model.</p>","PeriodicalId":17784,"journal":{"name":"Kardiologia polska","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147674665","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":"Minimally invasive Wheat procedure via right axillary approach with 3d-endoscopic support: First Polish experience.","authors":"Andrzej Klapkowski, Nikodem Ulatowski, Maciej Duda, Igor Tomczyk, Aleksandra Stańska, Wojciech Karolak","doi":"10.33963/v.phj.111779","DOIUrl":"10.33963/v.phj.111779","url":null,"abstract":"","PeriodicalId":17784,"journal":{"name":"Kardiologia polska","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147513362","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":"Obesity, anti-obesity medications, and atrial fibrillation: Recent advances.","authors":"Konstantinos C Siaravas, Dimitrios G Sfairopoulos, Christos E Ballas, Christos S Katsouras, Panagiotis G Korantzopoulos","doi":"10.33963/v.phj.111856","DOIUrl":"https://doi.org/10.33963/v.phj.111856","url":null,"abstract":"<p><p>Obesity and atrial fibrillation (AF) are closely connected conditions that share many metabolic, hemodynamic, and inflammatory pathways. An increasing body mass index is linked to incident AF, AF progression, and higher recurrence rates after cardioversion or catheter ablation. Notably, obesity contributes to atrial structural and electrical remodeling through various mechanisms, including systemic inflammation, oxidative stress, epicardial adipose tissue buildup, metabolic dysregulation, and changes in calcium handling and connexin expression. These alterations create a proarrhythmic substrate that promotes AF initiation and maintenance. Sustained weight loss has been strongly associated with reverse atrial remodeling, improved hemodynamics, decreased AF burden, and lower recurrence rates. In this evolving treatment landscape, anti-obesity pharmacotherapy, particularly glucagon-like peptide-1 (GLP-1) receptor agonists, has emerged as a promising supplementary strategy. Beyond weight reduction and blood sugar control, these medications have pleiotropic cardiovascular effects, such as anti-inflammatory and antioxidant actions, hemodynamic improvements, decreases in epicardial adipose tissue, and reductions in atrial fibrosis. Several observational studies and meta-analyses suggest that GLP-1 receptor agonists lower the risk of new-onset AF and AF recurrence after cardioversion or ablation. However, most available data come from studies where AF was a secondary endpoint, involving diverse populations and relatively short follow-up periods. While anti-obesity drugs - especially GLP-1 receptor agonists - show significant potential to influence AF risk and progression, conclusive evidence requires well-powered randomized controlled trials with AF as the primary endpoint, standardized arrhythmia monitoring, and long-term follow-up.</p>","PeriodicalId":17784,"journal":{"name":"Kardiologia polska","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147530270","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":"How to link recurrent nosebleeds and ischemic stroke: All you need is multimodal and multidisciplinary approach to detect and treat arteriovenous malformations.","authors":"Sonia Nartowicz, Zofia Stanisz, Magdalena Janus, Katarzyna Stanisławska, Agnieszka Katarzyńska-Szymańska, Tomasz Korobacz, Julia Dzierla, Weiyi Xia, Grzegorz Adamiak, Aleksandra Ciepłucha","doi":"10.33963/v.phj.111840","DOIUrl":"https://doi.org/10.33963/v.phj.111840","url":null,"abstract":"","PeriodicalId":17784,"journal":{"name":"Kardiologia polska","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147513294","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}