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ispartof: KARDIOLOGIA POLSKA vol:80 issue:4 pages:485-488 ispartof: location:Poland status: published

Cardiac conduction system pacing provides physiological ventricular activation by directly stimulating the conduction system. This review describes the two types of conduction system pacing: His bundle pacing (HBP) and left bundle area pacing (LBAP). The most significant advantage of HB pacing is that it can provide a regular, narrow QRS; however, the disadvantages are challenging implantation and a high risk of re-intervention due to lead dislodgement and the development of high pacing threshold. LBAP provides optimum physiological activation of the left ventricle by engaging the left bundle/fascicular fibers. LBAP is more physiological than traditional RV apical pacing and could be an attractive alternative to conventional cardiac resynchronization therapy (CRT). The advantages of LBAP are a relatively more straightforward implantation technique than HBP, better lead stability and pacing thresholds. HBP and LBAP are more physiological than right ventricular pacing and may be used instead of conventional pacemakers. Both HBP and LBBP are being investigated as alternatives to conventional CRT.

Abstract: Right ventricular function is one of the important predictors of survival in heart failure patients. In the past, there has been only limited knowledge regarding right-sided heart failure when compared to left-sided failure. However, there are more emerging data in recent years, and several studies have emphasized the unique features of the right ventricle regarding its anatomy, pathophysiology, clinical consequences, diagnostic modalities, and treatment options. Despite that, management of acute right ventricular failure is still challenging. This article summarizes an overview of acute right heart failure including pathophysiology, causes, clinical features, and diagnostic work-up with emphasis on the role of echocardiography.

ObjectivesThe nature of the relationship between baseline platelet count and clinical outcomes following percutaneous coronary intervention (PCI) is unclear. We undertook dose–response and pairwise meta-analyses to better describe the prognostic value of the initial platelet count and clinical endpoints in patients after PCI.MethodsA search of PubMed, Scopus and Web of Science (up to 9 October 2021) was performed to identify studies that evaluated the association between platelet count and clinical outcomes following PCI. The primary outcomes of interest were all-cause mortality, major adverse cardiovascular events (MACE) and major bleeding. We performed random-effects pairwise and one-stage dose–response meta-analyses by calculating HRs and 95% CIs.ResultsThe meta-analysis included 19 studies with 217 459 patients. We report a J-shaped relationship between baseline thrombocyte counts and all-cause death, MACE and major bleeding at follow-up. The risk of haemorrhagic events exceeded the risk of thrombotic events at low platelet counts (9/L), while a predominant ischaemic risk was observed at high platelet counts (>250×109/L). Pairwise meta-analyses revealed a robust link between initial platelet counts and the risk of postdischarge all-cause mortality, major bleeding (for thrombocytopenia: HR 1.39, 95% CI 1.30 to 1.49; HR 1.51, 95% CI 1.15 to 2.00, respectively) and future death from any cause and MACE (thrombocytosis: HR 1.60, 95% CI 1.29 to 1.98; HR 1.47, 95% CI 1.22 to 1.78, respectively).ConclusionLow platelet counts were associated with the predominant bleeding risk, while high platelet counts were only associated with the ischaemic events.PROSPERO registration numberCRD42021283270.

Mean platelet volume (MPV) is a hematological index that is routinely measured in clinical settings. Although many studies have been conducted to investigate the prognostic significance of MPV in acute coronary syndromes (ACS), the findings have been inconsistent. The goal of this study was to systematically review all current evidence on the association between admission MPV and clinical outcomes after ACS. PubMed, Scopus, Web of Science, and other databases were searched. The primary endpoints were major adverse cardiovascular events (MACE) and mortality. We applied a Knapp and Hartung adjustment, prediction interval calculations and permutation tests during pairwise meta-analyses. A one-stage dose–response meta-analysis was also conducted. The meta-analysis consisted of 41 studies with 33443 participants. Mean platelet volume, as a continuous variable, was associated with the risk of long-term mortality (hazard ratio 1.33, 95% CI 1.19–1.48). After conducting permutation tests and calculation of prediction intervals, this association remained significant. The results for MACE were nonsignificant. Linear models were the best fitted models during dose–response meta-analyses, trends for nonlinearity were significant for long-term endpoints. Admission MPV was associated with long-term mortality in ACS patients, with nonlinear associations between MPV levels and long-term clinical outcomes.

Venous thromboembolism (VTE) is one of the leading causes of post-operative morbidity and mortality. Over previous decades, heparin and warfarin were the predominant therapeutic options for post-operative thromboprophylaxis. However, their use is limited by drawbacks including a narrow therapeutic range, numerous food and drug interactions, and the need for regular monitoring for dose adjustments. Recently, direct oral anticoagulants (DOACs), such as dabigatran etexilate (a direct thrombin inhibitor) and apixaban, rivaroxaban and edoxaban (direct factor Xa inhibitors), have been developed to overcome these issues. DOACs have shown promising results in Phase III clinical trials for post-operative VTE prophylaxis. This review summarises the pharmacological profile of DOACs and highlights the use of DOACs in post-operative VTE prophylaxis based on the available clinical trial data.

Background: Young doctors have made up a substantial part of healthcare forces during the Coronavirus Disease 2019 (COVID-19) pandemic. The aim of this study was to determine the rate and level of psychological distress among young doctors during the COVID-19 outbreak. Methods: This cross-sectional cohort study, dedicated to doctors, at or below the age of 40, was conducted in 62 countries as an online survey between September – November 2020. Survey questions covered the following areas: 1. demographics 2. work environment 3.the ‘Hospital Anxiety and Depression Scale (HADS)’ and the ‘Perceived Stress Scale 10 (PSS-10)’. The primary outcome was the rate and level of anxiety/depression and stress among surveyed population defined according to adopted cut off values (HADS>13, PSS-10>14). Secondary outcomes included risk factors for increased HADS and PSS-10 scores.Results: Among 1186 respondents, median aged 32 [29–36], 675 (44.5%) females, 96% reported a high level of anxiety/depression and 97% reported a high level of stress. Factors associated with significantly higher scores for anxiety/depression were increased work hours [OR 1.61 95%CI (1.12–2.34);p=0.01] and loss of pay [OR 5.53, 95% CI (1.57–19.47);p=0.008], while reduced work hours [OR 0.68 95% CI (0.48 - 0.98);p=0.03], increased salaries [OR 0.54 95% CI (0.35–0.85);p=0.003) and good training [OR 0.99 95%CI (0.99– 1.00);p=0.002] were associated with lower scores. Higher scores for stress were associated with higher professional experience [OR 1.08 95% CI (1.02–1.14);p=0.008], reduced salaries [OR 1.74 95% CI (1.01–2.92);p=0.04] and living with a partner [OR 1.53 95% CI (1.08–2.17);p=0.01]. Conclusions: A high rate of young doctors working clinically during the COVID-19 pandemic reported a persistently high level of psychological distress more than six months after the initial outbreak. Improvements in work organization, including reduced work hours and financial security are essential to prevent further psychological suffering among young doctors worldwide.

Background: No previous study has investigated the association between gamma glutamyltransferase (GGT) and vitamin D in patients with stable coronary artery disease (CAD). We investigated the cross-sectional associations between vitamin D status as assessed by serum 25(OH)D and GGT. Methods: 169 patients were enrolled. Study population was divided into three groups: 1: 25(OH)D &lt, 10 ng/mL (n = 59), 2: 25(OH)D 10&ndash, 20 ng/mL (n = 82), and 3: 25(OH)D &gt, 20 ng/mL (n = 28). Based on a cut-off GGT value identified in ROC analysis, we also divided the study population to compare the following groups: GGT &le, 19 (n = 66) and GGT &gt, 19 (n = 103). Results: GGT activity was the highest in vitamin D severely deficient patients and the lowest in vitamin D insufficient patients. GGT was inversely correlated with 25(OH)D concentrations (R = &minus, 0.23, p = 0.002). The receiver operating characteristics curve identified the discrimination threshold of GGT of &gt, 19 U/L in predicting vitamin D deficiency. Higher leukocyte and neutrophil counts and lower 25(OH)D concentration were found in patients with GGT &gt, 19 U/L. Conclusions: We identified an interaction between declining 25(OH)D levels and rising GGT levels with increasing age, which resulted in an unfavorable 25(OH)D-to-GGT ratio in stable CAD patients. These results suggest that these changes might further contribute to a high cardiovascular risk in the elderly.

Introduction: Hypertension is one of the most prevalent modifiable risk factor for the development of heart failure (HF). Chronic heart failure (CHF) is the most common cause of readmission for patients in worldwide. Despite this recent attention to HF readmission, we know relatively little about its actual causes despite the fact that patients are in many ways best positioned to identify the underlying factors that contribute to their readmission. Objective: To systematically investigate the patients' perspectives about the reasons for their hospital readmission related to hypertension after discharged of stabalized HF patients and to study how to improve our heart failure care system to reduce the number of readmission in cost effective way. Method and Materials: Patients were recruited for this study was admitted to national institute of cardiovascular diseases, through emergency department. Patients discharged with a primary discharge diagnosis for HF who were then readmitted for any cause in the subsequent 6 month were eligible for the study. We recruited patients over the period of 3 month form June 2019 till August 2019. Eligible patients were approached, consented, and interviewed within the next 24 hours while they were still in hospital. Result: For the readmission, median length of stay was 6 days. Total 500 patient included, out of which 375 (75%) were male and most important cause of heart failure is ischaemic cardiomyopathy 400 (80%). No death recorded. Common reasons for readmission are lack of counselling 200(40%), under dose 75(15%), non-compliance 60(12%), volume over load 50(10%), hypertension 50(10%), secondary infection 35(7%). Conclusion: We concluded that hypertension is not largely associated with heart failure hospitalization in our study. But patient compliance of medication, appropriate fluid intake, self-care and life style modification are the important elements in hospital readmission of heart failure.

Cardiovascular disease (CVD) is one of the most global threatened diseases; particularly coronary artery disease (CAD) is a major deadly attack around the world. Diabetes mellitus (DM) is associated with a 2 to 4-fold increased mortality risk from heart disease. Diabetes related microvascular complication is seemed to be a hazardous factor for cardiovascular system and likely to cause coronary arteries disease, hypertension, peripheral arteries, and carotid vessels, especially seen in the type 2 DM populations. The severity of cardiovascular complications are related to prolong hyperglycemia and the control of dysglycemia. Thus, effective glycemic control is one of the imperative aspects of the management for the prevention of CVD in diabetes. In addition, different kinds of antidiabetes agents have different mechanism of actions that has impacted to cardiovascular outcome.

Cardiovascular disease is the number one killer of death around the world. Most of the cardiovascular diseases are caused by sedentary life style, bad eating habit, tobacco smoking, high alcohol intake, dyslipidemia and genetic factors .Recently the idea of human microbiome science has emerged in diseases pathogenesis