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Background: Despite its benefits, oral anticoagulant (OAC) therapy in patients with atrial fibrillation (AF) is associated with hemorrhagic complications., Aims: We aimed to evaluate clinical characteristics of AF patients at high risk of bleeding and the frequency of OAC use as well as identify factors that predict nonuse of OACs in these patients., Methods: Consecutive AF patients hospitalized for urgent or planned reasons in cardiac centers were prospectively included in the registry in 2019. Patients with HAS-BLED ≥3 (high HAS-BLED group) were assumed to have a high risk of bleeding., Results: Among 3598 patients enrolled in the study, 29.2% were at high risk of bleeding (44.7% female; median [Q1-Q3] age 72 [65-81], CHA2DS2-VASc score 5 [4-6], HAS-BLED 3 [3-4]). In this group, 14.5% of patients did not receive OACs, 68% received NOACs, and 17.5% VKAs. In multivariable analysis, the independent predictors of nonuse of oral OACs were as follows: creatinine level (odds ratio [OR], 1.441; 95% confidence interval [CI], 1.174-1.768; P <0.001), a history of gastrointestinal bleeding (OR, 2.918; 95% CI, 1.395-6.103; P = 0.004), malignant neoplasm (OR, 3.127; 95% CI, 1.332-7.343; P = 0.009), and a history of strokes or transient ischemic attacks (OR, 0.327; 95% CI, 0.166-0.642; P = 0.001)., Conclusions: OACs were used much less frequently in the group with a high HAS-BLED score than in the group with a low score. Independent predictors of nonuse of OACs were creatinine levels, a history of gastrointestinal bleeding, and malignant neoplasms. A history of stroke or transient ischemic attack increased the chances of receiving therapy.

Background: The three-dimensional electroanatomic mapping (EAM) system allows performing catheter ablation (CA) without fluoroscopy in patients with premature ventricular contractions (PVCs). The right ventricle outflow tract (RVOT) location is favorable for performing zero-fluoroscopy CA. Non-RVOT zero-fluoroscopy CA is a challenging procedure. The study aimed to evaluate the efficacy and safety of zero-fluoroscopy CA using the EAM in patients with PVCs from RVOT and non-RVOT., Methods: Completely zero-fluoroscopy CA of PVCs guided by EAM was performed in 107 patients with PVCs. 54 patients underwent zero-fluoroscopy RVOT CA. The remaining 53 patients underwent zero-fluoroscopy non-RVOT CA. Demographic and clinical baseline characteristics, procedure parameters, and follow-up were obtained from medical records. Primary outcomes were the acute and the permanent success rate (12-month follow-up), complications, and procedure time., Results: There were no significant differences between groups regarding baseline characteristics. Acute procedural success was achieved in 52 patients (94,44%) in the RVOT zero-fluoroscopy CA group and in 45 patients (86,54%) in the non-RVOT zero-fluoroscopy CA group (ns). A long-term success rate was achieved in 50 patients (90,74%) in the RVOT zero-fluoroscopy CA group and in 44 patients (84,62%) in the non-RVOT zero-fluoroscopy CA group (ns). The median procedure time was 80.5 minutes in the RVOT group and 90 minutes in the non-RVOT group (ns). There were two complications in the non-RVOT group (ns)., Conclusions: There were no differences in procedure time efficacy and safety zero-fluoroscopy ablation between RVOT and non-RVOT locations. Non-fluoroscopy CA of PVCs is a feasible, safe, and efficient procedure.

The diagnosis of metabolic associated fatty liver disease (MAFLD) is significant for patients' prognosis, as the disease accelerates the development of cardiovascular complications and, on the other hand, cardiometabolic conditions are risk factors for the development of fatty liver diseases. This expert opinion presents principles of MAFLD diagnosis and standards of management to reduce cardiovascular risks in patients with MAFLD.

Heart failure (HF) remains one of the most common causes of hospitalization and mortality among Polish patients. The position of the Section of Cardiovascular Pharmacotherapy presents the currently applicable options for pharmacological treatment of HF based on the latest European and American guidelines from 2021-2022 in relation to Polish healthcare conditions. Treatment of HF varies depending on its clinical presentation (acute/chronic) or left ventricular ejection fraction. Initial treatment of symptomatic patients with features of volume overload is based on diuretics, especially loop drugs. Treatment aimed at reducing mortality and hospitalization should include drugs blocking the renin-angiotensin-aldosterone system, preferably angiotensin receptor antagonist/neprilysin inhibitor, i.e. sacubitril/valsartan, selected beta-blockers (no class effect - options include bisoprolol, metoprolol succinate, or vasodilatory beta-blockers - carvedilol and nebivolol), mineralocorticoid receptor antagonist, and sodium-glucose cotransporter type 2 inhibitor (flozin), constituting the 4 pillars of pharmacotherapy. Their effectiveness has been confirmed in numerous prospective randomized trials. The current HF treatment strategy is based on the fastest possible implementation of all four mentioned classes of drugs due to their independent additive action. It is also important to individualize therapy according to comorbidities, blood pressure, resting heart rate, or the presence of arrhythmias. This article emphasizes the cardio- and nephroprotective role of flozins in HF therapy, regardless of ejection fraction value. We propose practical guidelines for the use of medicines, profile of adverse reactions, drug interactions, as well as pharmacoeconomic aspects. The principles of treatment with ivabradine, digoxin, vericiguat, iron supplementation, or antiplatelet and anticoagulant therapy are also discussed, along with recent novel drugs including omecamtiv mecarbil, tolvaptan, or coenzyme Q10 as well as progress in the prevention and treatment of hyperkalemia. Based on the latest recommendations, treatment regimens for different types of HF are discussed.

Respiratory diseases have been the fourth most common cause of death in Poland in recent years. Respiratory infection, especially pneumonia, can lead to exacerbation of chronic cardiovascular disease.Streptococcus pneumoniae is the most common bacterial pathogen causing community-acquired pneumonia. Pneumococci are also the most common pathogen complicating the course of infection with the influenza virus. Pneumonia, especially invasive pneumococcal disease, is associated with risk of death in the course of respiratory failure or sepsis and also with worsening of the prognosis for existing cardiovascular disease. Despite those facts, recommendations for pneumococcal vaccination are still not well established in cardiovascular guidelines. This expert opinion aims to summarize current knowledge on the importance of preventing invasive pneumococcal disease in cardiac patients.

Based on many randomized clinical trials, it can be concluded that dual antiplatelet therapy is one of the best-studied treatments in the field of cardiovascular medicine. For many years prasugrel and ticagrelor have been preferred inhibitors of the platelet P2Y12 receptor in patients with acute coronary syndromes. These drugs enable faster, stronger, and more consistent inhibition of platelets and lead to better clinical outcomes than clopidogrel. The following document is an expert group opinion summarizing the latest knowledge in the field of antiplatelet therapy in the prevention of cardiovascular events in patients with acute coronary syndromes, with a special focus on prasugrel.

Comprehensive cardiac rehabilitation (CR) is a mainstay of the secondary prevention of cardiovascular disease. In the European Society of Cardiology guidelines, comprehensive cardiovascular rehabilitation has the highest class of recommendation and level of evidence as an effective method for the treatment of patients with ST-segment elevation myocardial infarction, after myocardial revascularization, with chronic coronary syndrome, for CVD prevention in clinical practice, and in patients with heart failure (HF). This document presents an expert opinion of the Cardiac Rehabilitation and Exercise Physiology Section of the Polish Cardiac Society concerning the definition, goals, target population, organization of rehabilitation services, standard clinical indications and methods of implementation. Moreover, it describes psychosocial risk factors influencing the course of CR and secondary prevention of cardiovascular disease in patients undergoing CR. Comprehensive CR is as a process that should be implemented as soon as possible, continued without interruption, and consist of multiple stages. Moreover, it should be tailored to the individual clinical situation and should be accepted by the patient and their family, friends, and caregivers.

Nowadays, the intensive cardiac care unit (ICCU) provides care for patients with acute coronary syndrome, acute and exacerbated chronic heart failure, cardiogenic shock, sudden cardiac arrest, electrical storm, as well as with indications for urgent cardiac surgical treatment. Most of these patients require the use of 1, 2, or frequently even 3 drugs that act on the blood coagulation pathway. While antithrombotic drugs prevent thromboembolic events, they are associated with a higher risk of bleeding. In this population of patients, bleeding may often have a worse impact on prognosis than the primary disease. In this expert opinion of the Association of Intensive Cardiac Care, we presented practical guidelines on the management of bleeding in patients hospitalized at the ICCU, including bleeding risk reduction and treatment recommendations. Because of multiple comorbidities and diverse organs that may be the source of bleeding, we provided also recommendations from specialists in other fields of medicine. We hope that this document will facilitate the management of one of the most challenging populations at the ICCU.

Electrocardiographic (ECG) exercise stress test has been a major diagnostic test in cardiology for several decades. Ongoing technological advances that have led to a wide use of imaging techniques and development of new guidelines have called for a revised and updated approach to the technique and interpretation of the ECG exercise testing. The present document outlines an expert opinion of the Polish Cardiac Society Working Group on Cardiac Rehabilitation and Exercise Physiology regarding the performance and interpretation of ECG exercise testing in adults. We discussed technical requirements and necessary equipment for the exercise testing laboratory as well as healthcare personnel competencies necessary to supervise ECG exercise testing and fully interpret test findings. Broad indications for ECG exercise testing include diagnostic assessment of coronary artery disease (CAD), including pre-test probability of CAD, evaluation of functional disease severity and risk strati- fication in patients with established CAD, assessment of response to treatment, evaluation of exercise-related symptoms and exercise capacity, patient evaluation before exercise training/cardiac rehabilitation, and risk stratification prior to non-cardiac surgery. ECG exercise testing is safe if indications and contraindications are observed, testing is appropriately monitored, and indications for test termination are clearly established. The exercise protocol should be adjusted to the expected exercise capacity of a patient so as to limit the duration of exercise to 8-12 min. Clinical, haemodynamic, and ECG response to exercise is evaluated during the test. The test report should include information about the exercise protocol used, reason for test termination, perceived exertion, presence/severity of anginal symptoms, peak exercise capacity or tolerated workload in relation to the predicted exercise capacity, heart rate response, and the presence or absence of ST-T changes. The test report should conclude with a summary including clinical and ECG assessment.

Zespół metaboliczny (ZM) stanowi połączenie zaburzeń metabolicznych, będących czynnikami ryzyka chorób układu sercowo-naczyniowego. Powyższą patologię, zgodnie z ostatnimi danymi epidemiologicznymi, można obecnie rozpoznać u co czwartego dorosłego człowieka. Patogeneza zespołu metabolicznego stanowi nadal przedmiot intensywnych badań. Wazopresyna (AVP), znana z regulacji ciśnienia tętniczego, odgrywa także istotną role w zmianie aktywności glikogenolizy wątrobowej, jak również w wydzielaniu insuliny i glukagonu oraz w ośrodkowej regulacji przyjmowania pokarmu. W osoczu osób z ZM opisano wzrost stężenia kopeptyny (CPT; C-końcowego fragmentu prowazopresyny). Dlatego też, wydaje się, że lepsze zrozumienie roli układu wazopresynergicznego w patogenezie zespołu metabolicznego być może pozwoli na rozwój profilaktyki i nowych metod terapeutycznych.

Type 2 diabetes is responsible for approximately 90% of all diabetes worldwide and it is a global public health problem. This is a chronic, progressive, metabolic disease characterised by hyperglycaemia, which leads to microangiopathic and macroangiopathic complications. Subjects with type 2 diabetes have increased mortality and a reduced life expectancy compared with those without diabetes. Strong evidence supports the fact that identification of type 2 diabetes risk factors and early intervention influencing the modifiable ones can reduce incidence rate of diabetes and prevalence of its complications. There are many advantages of such interventions for patients (prolonged life expectancy, improvement of life quality) and for the whole society (reduction of the costs). Therefore the guidelines for the prevention of type 2 diabetes are needed. Experts of the Polish Cardiac Society Working Group on Cardiovascular Pharmacotherapy reviewed recently published clinical studies regarding the prevention of type 2 diabetes and prepared their recommendations. The guidelines are designed to assist clinicians and other healthcare workers to make evidence based management decisions. The strategies are grouped broadly into interventions that aim to change lifestyle through physical activity and diet, interventions based on drug administration (pharmacotherapy) and surgical interventions.

Background: According to epidemiological studies, dyslipidaemia is the commonest risk factor of atherosclerosis in the Polish population. It is estimated that 18 million adult Poles are affected by dyslipidaemia., Aim: The purpose of this study was to evaluate the quality of the statin therapy in high-risk Polish outpatients., Methods: The 3ST-POL study involved 49,950 Polish outpatients. The enrolled patients met the following inclusion criteria: age between 40 and 85 years and a history of a minimum three months of statin therapy. A full lipid profile was screened in each patient; 72% of all subjects were high-risk patients., Results: Among the patients in the 3ST-POL study, women represented 53%, and the mean age was 59.5 ± 10.8 years. Patients were treated by: general practitioners (GPs) 78.95%; diabetologists 5.02%; and cardiologists 16.03%. The most frequently used statins were atorvastatin and simvastatin. The most common dose was 20 mg/24 h. In the high-risk population, the lowest recommended total cholesterol (TC) concentration was achieved in 3.7% of treated subjects, whereas 5.6% of patients attained LDL < 80 mg/dL (2.0 mmol/L). 9.5% of patients did not exceed the upper limit of normal values for TC (155-175 mg/dL; 4.0-4.5 mmol/L) and 12.6% of patients reached LDL between 80-100 mg/dL (2.0-2.5 mmol/L). Subjects under the cardiologists' and diabetologists' care more often reached the recommended TC concentration (TC < 175 mg/dL; TC < 4.5 mmol/dL) and the difference was statistically important., Conclusions: This partial efficacy in dyslipidaemia control is not satisfactory.

The ventricular septum defect (VSD) is one of the congenital heart diseases that in developed countries can be rarely found in adults. We present a case of young athlete, member of the Polish Olympic Team, diagnosed with VSD during medical check-up. The congenital heart disease did not prevent the athlete from participating in sport on world-class level.

Background: One of the most important aims of modern sports cardiology is prevention of sudden cardiac death among athletes. Adequate pre-participation screening is a crucial part of prevention, however, current ACC, AHA or ESC guidelines are not uniform in this context. There is recently ongoing discussion on implementation of 12-lead ECG to the screening protocol., Aim: To assess the prevalence of alterations of resting 12-lead ECG in a population of top-level professional athletes - members of the Polish Olympic Team - using recently accepted criteria., Methods: During the period of intensive training before the Summer Olympic Games in Beijing (2008), a 12-lead, resting ECG was performed in 73 members (20 women and 53 men) of the Polish Olympic Team. Commonly accepted criteria were used to assess the ECG, and alterations were divided into two groups according to recent publications: group I - 'benign', common - thought to be consistent with the athlete's heart syndrome (i.e.: sinus bradycardia, 1st degree atrioventricular block, early repolarisation, right bundle branch hemiblock, isolated signs of left ventricular hypertrophy); and group II - 'suspected', uncommon - which may occur due to organic heart disease (i.e. complete bundle branch block, ventricular arrhythmia, inverse T wave or pathological QRS axis deviation)., Results: Completely normal ECG was present in 11% of those examined, common (group I) findings were observed in 65% and 'suspected' (group II) in 23%. The most commonly occurring 'benign' findings were bradycardia incomplete, right bundle branch block and isolated left ventricular hypertrophy, found in 75, 71 and 41%, respectively. From 'suspected' (group II) the most frequent was left posterior fascicular hemiblock, present in 10% of those examined; other findings were complete right bundle branch block, left atrial hypertrophy, inverse T waves and left anterior fascicular hemiblock in single cases., Conclusions: 1. Most of the observed alterations in resting ECG of professional athletes belong to the 'common' group and result from adaptation to exercise. 2. Frequent occurrence of left posterior fascicular hemiblock, which is thought to be 'potentially malignant', requires further investigation.

The purpose of the study was to describe the clinical picture in patients with ischemic heart disease (IHD) and verifying severity of ventricular arrhythmias. The study included 856 patients with IHD aged 23-88 years (mean = 55.3), including 659 men and 197 women. Holter monitoring was performed in all patients. Ventricular arrhythmias were graded according to Lown. The patients were divided into five groups: group 1-349 patients with Lown's grade 1 and 2; group 2-95 patients with grade 3; group 3-152 patients with grade 4a and 4b; group 4-11 patients with grade 5; group 5-507 patients (selected from groups 2, 3 and 4) with Lown's grade 3 and 4 or 5. Arterial hypertension was found in 17.1%, myocardial infraction in 66%, and syncope in 12.3% of the patients. The patients with complex ventricular arrhythmias versus Lown's grade 1 and 2 show significant differences especially in respect to: the frequency of previous anterior myocardial infraction, the incidence of pain at rest, loss consciousness, the frequency of ventricular tachycardia and fibrillation, anginal pain and exercise-related arrhythmias. The patients with Lown's ventricular arrhythmia grade 3-5 do not differ significantly in their clinical manifestations of IHD from the patients with ventricular arrhythmias grade from 3 to 5. The development of silent myocardial ischemia during exercise stress testing is typical also for the patients with complex ventricular arrhythmias. A decreased contractility index, ejection fraction and dyskinesis are significantly more frequent in the patients with complex ventricular arrhythmias.