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An abstract of the study "Relation Between Infarct-Related Artery Stenosis and the Left Ventricle Remodeling. A Morphometric Study in Humans," by M. Prech and colleagues is presented.

Wstęp: Celem pracy było przedstawienie własnych doświadczeń w leczeniu pourazowych uszkodzeń aorty piersiowej wewnątrznaczyniowym wszczepieniem stentgraftu. Materiał i metody: Praca przedstawia 11 przypadków obrażeń aorty piersiowej spowodowanych wypadkami komunikacyjnymi, leczonych w tutejszej Klinice. Rozpoznania i doboru protezy dokonywano na podstawie tomografii komputerowej z wzmocnieniem kontrastowym. W badaniu stwierdzano różnego rodzaju uszkodzenia aorty oraz towarzyszące im obrażenia wielonarządowe. W 5 przypadkach stwierdzono pourazowy tętniak aorty piersiowej, w 4 -- pourazowe pęknięcie aorty z wynaczynieniem krwi do śródpiersia i jam opłucnowych, natomiast w 2 -- pourazowe rozwarstwienie aorty typu B. U 10 chorych zabiegi wykonywano standardowo, z dostępu poprzez tętnicę udową. W jednym przypadku z powodu trudności technicznych przeprowadzenia protezy przez tętnicę udową stentgraft wszczepiono poprzez czasowo doszytą do aorty brzusznej protezę PTF. U 9 chorych stentgraft wszczepiono tuż poniżej odejścia lewej tętnicy podobojczykowej. U dwóch chorych konieczne było usytuowanie stentgraftu poniżej tętnicy szyjnej wspólnej lewej i przykrycie ujścia lewej tętnicy podobojczykowej. Wyniki: We wszystkich przypadkach uzyskano dobry wynik leczenia, bez powikłań doraźnych i stabilizację krążenia w badaniach hemodynamicznych. U 2 chorych z przykrytym odejściem lewej tętnicy podobojczykowej nie stwierdzono objawów niedokrwienia OUN oraz kończyny górnej lewej. [ABSTRACT FROM AUTHOR]

Mycotic aneurysm of the thoracic aorta is a rare and life threatening condition. Two patients are presented (both male, aged 66 and 59 years) in whom coronary artery bypass surgery was complicated by the development of a mycotic aneurysm. Fever preceded the radiological and echocardiographic signs of the aneurysm by at least several months in both cases. Blood cultures were negative for one patient and the source of Corynebacterium sp infection in the other was not determined for several months. Both patients died before surgery could correct the aneurysm. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to assess the effect of surgical revascularization [coronary artery bypass grafting (CABG)] on systolic function and perfusion of the left ventricle using dobutamine echocardiography (DE) and Tc-99m-MIBI SPECT (SPECT). Methods: There were 32 patients mean age 52.2±7.2 years in whom DE and SPECT were performed before and 3–4 months after CABG using standard protocols. Wall motion score index (WMSI) and perfusion index (PI) were calculated. Results: Significant improvement of WMSI at rest (1.44±0.46 vs 1.33±0.41; P=0.03) as well as after maximal dose of dobutamine (1.49±0.42 vs 1.39±0.44; P=0.02) was observed after CABG as compared to preoperative examination. Similar relation was observed during SPECT study. Perfusion index diminished significantly after revascularization during rest acquisition (2.19±0.71 vs 1.93±0.70; P=0.0008) and after Dipirydamole administration (2.73±0.73 vs 2.20±0.69; P=0.0001) as compared to preoperative examination. We found correlation between PI and WMSI at rest before CABG (R=0.46; P=0.01), PI after Dipirydamole and WMSI after maximal dose of Dobutamine before CABG (R=0.37; P=0.04), PI and WMSI at rest after CABG (R=0.39; P=0.03), PI after Dipirydamole and WMSI after dobutamine after CABG (R=0.38; P=0.03). Conclusions: Surgical revascularization significantly improves both perfusion and contractility. Increased perfusion after CABG correlates with improvement of systolic function of the left ventricle. [Copyright &y& Elsevier]

Abstract The “ECMO for Greater Poland” program takes full advantage of the extracorporeal membrane oxygenation (ECMO) perfusion therapy opportunities to promote the health of the 3.5 million inhabitants in the region. The main implementation areas are treatment of patients with hypothermia; severe reversible respiratory failure (RRF); critical states resulting in heart failure, that is, cardiac arrest, cardiogenic shock, or acute intoxication; and promotion of the donor after circulatory death (DCD) strategy in selected organ donor cases, after unsuccessful life-saving treatment, to achieve organ recovery. This organizational model is complex and expensive, so we used advanced high-fidelity medical simulation tests to prepare for real-life experience. Over the course of 4 months we performed scenarios including “ECMO for DCD,” “ECMO for extended cardiopulmonary resuscitation,” “ECMO for RRF,” and “ECMO in hypothermia.” Soon after these simulations, Maastricht category II DCD procedures were performed involving real patients and resulting in 2 successful double kidney transplantations for the first time in Poland. One month later we treated 2 hypothermia patients (7 adult patients with heart failure and 5 patients with reversible respiratory failure) with ECMO for the first time in the region. Fortunately, we have discovered an important new role of medical simulation. It can be used not only for skills testing but also as a tool to create non-existing procedures and unavailable algorithms. The result of these program activities will promote the care and treatment of patients in critical condition with ECMO therapy as well as increase the potential organ pool from DCDs in the Greater Poland region of Poland. Highlights The “ECMO for Greater Poland” program takes full advantage of the following ECMO perfusion therapy opportunities: • Treatment of patients with hypothermia. • Treatment of reversible severe respiratory failure. • Treatment of critical states resulting in heart failure. • Promotion of donor after circulatory death strategy with organ recovery on ECMO. [ABSTRACT FROM AUTHOR]

Aortic stenosis (AS) is a leading cause of surgical intervention in adults with acquired heart disease, driven by an aging population and advancements in diagnostic and treatment approaches. This study aimed to investigate levels of macroelements (Ca, K, Na, Mg, and P) in aortic valve tissues, serum, and epicardial fat in patients undergoing aortic valve replacement due to degenerative disease. Elemental composition was determined using inductively coupled plasma mass spectrometry. Analyses revealed a distinct accumulation of Ca and P in aortic valve tissues, not correlated to and exceeding that in epicardial adipose tissue, suggesting localized mineralization. Significant relationships between serum and aortic valve element concentrations were found, with serum K and Mg levels inversely correlated with Ca and P deposition and Ca/P ratio in the valve, highlighting their potential role as calcification inhibitors. Moreover, serum and valvular Na/K ratios were positively correlated. Furthermore, patient age was associated with increased Ca, Mg, Na, P levels, and Ca/P ratio in valve tissues, reinforcing age as a risk factor for valvular calcification. Creatinine and lipoprotein (a) levels correlated positively with valvular K content and Ca/P ratio, respectively, while high-density lipoprotein cholesterol concentration was positively associated with Ca, Mg, and P content in epicardial fat. Patients with increased transvalvular systolic pressure gradient revealed higher valvular Na content. Future longitudinal research should address mineralization across earlier disease stages, exploring additional trace elements and molecular contributors to advance understanding of calcification mechanisms, ultimately aiding in developing biomarkers or therapeutic strategies for postponing or preventing AS onset., Competing Interests: Declarations. Competing interests: The authors declare no competing interests. Ethics approval: The study was approved by the Local Bioethical Committee of the Poznan University of Medical Sciences, Poznan, Poland (approval number 518/23 issued on 29 June 2024)., (© 2025. The Author(s).)

Background/Objectives : Advanced calcific aortic stenosis, with or without coronary artery disease [CAD], may lead to severe systolic dysfunction. The aim of the study was to reveal clinical and laboratory parameters that may differentiate patients with severe aortic stenosis with and without systolic dysfunction. Methods : A retrospective, single-center study included all consecutive patients diagnosed with severe aortic stenosis with overt heart failure. Patients with hematological and neoplastic diseases were excluded. Demographic, clinical and laboratory data were analysed. Neutrophil-to-lymphocyte [NLR], monocyte-to-lymphocyte [MLR], and platelet-to-lymphocyte [PLR] ratios were calculated. The study group was divided based on left ventricular ejection fraction [LVEF]. Results : The final study population comprised 301 patients [133 males [44%]; median [Q1-3] age of 80 [75-83] years]. Co-morbidities included CAD [48.8%], arterial hypertension [75.4%], diabetes mellitus [n = 124, 41.2%], atrial fibrillation [39.2%], chronic kidney disease [60.8%]. Fifty-seven patients presented with LVEF ≤ 40% (heart failure with reduced ejection fraction (HFrEF)) and 244 with LVEF > 40%. In the multivariable analysis, N-terminal pro-B-type natriuretic peptide [NTproBNP] [ p < 0.001, OR 1.000, 95%CI 1.000-1.000], baseline MLR [ p < 0.020, OR 7.393, 95%CI 1.363-40.091] and female sex [ p < 0.001, OR 0.308, 95%CI 0.160-0.593] were revealed as significant predictors of HFrEF. Baseline MLR weakly correlated with EuroScore II [Spearman r = 0.141, p = 0.015] and NTproBNP [r = 0.142, p = 0.014]. Cut-off values were established as 0.36 for MLR and 3927 pg/mL for NTproBNP. After excluding 147 patients with CAD, there was still a statistically significant difference in MLR between the subgroups [ p = 0.024]. Conclusions : Increased values of MLR and NTproBNP together with female sex are predictive parameters for LVEF ≤ 40% in patients with severe aortic stenosis.

Background: Upper ministernotomy for sutureless aortic prosthesis implantation provides an attractive opportunity compared to conventional access. Although in the last decade, the former has gained popularity, data comparing quality of life (QoL) following these procedures are scarce., Objectives: The purpose of this study was to assess the patient's QoL after aortic valve replacement (AVR) using a ministernotomy approach compared to a full sternotomy., Material and Methods: One hundred fifteen AVR patients were operated on using either minimally invasive access with sutureless valve implantation through an upper median ministernotomy (group I; n = 58) or through a full sternotomy (group II; n = 57) with either biological Edwards Perimount Magna™ (Edwards Lifescience, Irvine, USA) (n = 30) or mechanical On-X™ (Carbomedics, Austin, USA) (n = 27) aortic valve prostheses implantation by 1 experienced surgeon. At the end of the follow-up period, QoL was assessed using the EQ-5D-5L scale telephone survey., Results: In group I, there were significantly fewer problems with mobility, pain and usual activities than in group II (p < 0.05). Moreover, the visual analogue scale (VAS) and Health Index (HI) scores were more favorable for patients treated with ministernotomy. Additionally, group II participants provided comments beyond the survey questions, such as tiredness, dyspnea or pain. These kinds of remarks were not reported in group I. Ultimately, the EQ-5D-5L Index Score (IS) was consistent with the variables and more beneficial for group I subjects. Each group was compatible with the benefits for patients in group I., Conclusions: Cardiac surgical procedures for severe aortic stenosis through minimally invasive access are associated with improved QoL parameters.

Introduction: Transcatheter aortic valve implantation (TAVI) is an established treatment for aortic stenosis (AS) in patients at intermediate and high surgical risk. Circulating extracellular vesicles (EVs) are nanoparticles involved in cardiovascular diseases. We aimed to (i) determine the effect of TAVI on plasma concentrations of five EV subtypes and (ii) evaluate the predictive value of EVs for post-TAVI outcomes., Methods: Blood samples were collected 1 day before TAVI and at hospital discharge. Concentrations of EVs were evaluated using flow cytometry., Results: Concentration of leukocytes EVs decreased after TAVI, compared to the measurement before (p = 0.008). Among 123 patients discharged from the hospital, 19.5% experienced MACCE during the median of 10.3 months. Increased pre-TAVI concentration of phosphatidylserine-exposing EVs was an independent predictor of MACCE in multivariable analysis (OR 5.313, 95% CI 1.164-24.258, p = 0.031)., Conclusions: Patients with increased pre-TAVI concentration of procoagulant, PS-exposing EVs have over fivefold higher odds of adverse outcomes., (© 2024. The Author(s).)

Background: The survival benefit of surgical revascularization in multivessel coronary artery disease is well understood, though it can be modified by left ventricular dysfunction. Chronic exposure to air pollutants has gained more attention recently as a possible non-traditional morbidity and mortality cardiovascular risk factor. This study identified possible 5-year mortality risk factors related to postoperative left ventricular performance, including air pollutants., Patients: There were 283 patients (244 (86%) males) with a median age of 65 (60-70) years enrolled in the retrospective analysis. All patients were referred for off-pump coronary artery revascularization due to chronic coronary syndrome that presented as a multivessel coronary artery disease. They were divided into three groups depending on the postoperative course of left ventricular fraction (LVEF 50% or more (169 patients), LVEF between 41 and 49% (61 patients), and LVEF 40% or less (53 patients))., Results: The overall survival rate was 84% (237 patients) in a median follow-up time of 5.3 (4.8-6.1) years. The median (Q1-Q3) chronic air pollution exposures for the analyzed group were 19.3 (16.9-22.4) μg/m 3 for fine particles such as PM 2.5 , 25.8 (22.5-29.4) μg/m 3 for coarse particles such as PM 10 , and 12.2 (9.7-14.9) μg/m 3 for nitric dioxide (NO 2 ). The mortality in the first group (LVEF at least 50%) was 23 (13.6%), in the second group (LVEF 41-49%) was 9 (15%), and in the third group (LVEF 40% or less) was 14 (26%). The multivariable regression analysis for the five-year mortality risk in the first group revealed the predictive value of dyslipidemia (HR: 3.254, 95% CI: 1.008-10.511, p = 0.049). The multivariable regression analysis for five-year mortality risk in the second group revealed the predictive value of dyslipidemia (HR: 3.391, 95% CI: 1.001-11.874, p = 0.050) and PM 2.5 (HR: 1.327, 95% CI: 1.085-1.625, p = 0.006). In the third group (severely decreased LVEF), chronic PM 2.5 exposure was found to be significant (HR: 1.518, 95% CI: 1.50-2.195, p = 0.026) for 5-year mortality prediction., Conclusions: Traditional risk factors, such as dyslipidemia, are pivotal in the 5-year mortality risk following surgical revascularization. Chronic exposure to ambient air pollutants such as PM 2.5 may be an additional risk factor in patients with left ventricular dysfunction.

In end-stage heart failure, which is characterized by persistent or progressive ventricular dysfunction despite optimal medical therapy, a left ventricular assist device (LVAD) can be beneficial. Congestive heart failure provokes inflammatory and prothrombotic activation. The aim of this study was to evaluate the serum concentration of citrullinated histone 3 (CH3) representing neutrophil extracellular trap (NET) formation in patients referred for LVAD implantation. There were 10 patients with a median age of 61 (57-65) years enrolled in a prospective single-center analysis who underwent LVAD implantation. The CH3 plasma concentration was measured preoperatively and on the 1st and 7th postoperative days, followed by control measurements on the median (Q1-3) 88th (49-143) day. The preoperative CH3 concentration strongly correlated with brain natriuretic peptide (r = 0.879, p < 0.001). Significant differences in CH3 serum concentration were observed between pre- and postoperative measurements, including an increase on the first postoperative day ( p < 0.001), as well as a decrease on the seventh day ( p = 0.016) and in follow-up ( p < 0.001). CH3 concentration, as a marker of NET formation, decreases after LVAD implantation.

Background : Multiple risk factors for coronary artery disease have been identified without answering one of the leading questions related to the extent of the involvement of the epicardial arteries. Trace elements are involved in various stages of atherosclerotic lesion formation and may play a significant role in the advancement of coronary artery disease. Methods : A total of 157 (92 (59%) men and 65 (41%) women) patients with a median age of 71 (65-75) years presenting with chronic coronary syndrome were enrolled in the prospective single-center analysis. The coronary angiography results were compared with the concentration of trace elements in scalp hair. Results : Through Spearman analysis, a positive correlation between the number of diseased coronary arteries and hair trace element concentration was found for sodium (r = 0.198, p = 0.013), vanadium (r = 0.164, p = 0.040), chromium (r = 0.242, p = 0.002), and nickel (r = 0.176, p = 0.026). A negative relationship was noted between magnesium (r = -0.237, p = 0.003) and calcium (r = -0.217, p = 0.007) and the extent of epicardial lesions. Conclusions : Scalp hair trace element analysis indicates the possible modulatory role of trace elements in advancing coronary artery disease. Since a significant correlation with one- and two-vessel but not with three-vessel disease was noted, it might be considered an "all or nothing" phenomenon. A positive correlation between the number of diseased coronary arteries and sodium, vanadium, chromium, and nickel and an inverse correlation with magnesium and calcium were noted. The presented analysis is hypothesis-generating, and further studies are necessary to corroborate the results from a clinical perspective.

Background: This study investigated the impact of complete revascularization (CR) and incomplete revascularization (IR) on long-term survival in patients undergoing isolated coronary artery bypass grafting (CABG) using multiple arterial graft (MAGs) or a single artery with saphenous vein grafts (SAGs)., Methods: Between January 2006 and December 2020, 12,625 patients underwent CABG and were divided into 4 groups: MAG CR (n = 1066), MAG IR (n = 286), SAG CR (n = 8360), and SAG IR (n = 2913). Inverse probability of treatment weighting based on the generalized propensity score was used to minimize imbalance between the groups., Results: In the weighted cohort, median follow-up time was 8.35 years (interquartile range, 5.01-11.6 years). MAG CR was associated with similar long-term survival compared with MAG IR (hazard ratio [HR], 0.79; 95% CI, 0.60-1.03; P = .084). SAG CR was associated with improved long-term survival compared with SAG IR (HR, 0.67; 95% CI, 0.52-0.84; P = .01). MAG CR was associated with better long-term survival compared with SAG CR (HR, 0.45; 95% CI, 0.35-0.57; P < .001). Moreover, MAG IR was protective compared with SAG IR (HR, 0.62; 95% CI, 0.45-0.85; P = .033). Additional analysis was performed comparing perfect CR vs imperfect CR vs IR in MAG and SAG patients, separately. In the weighted sample of MAG, there were no differences in the long-term survival between perfect CR, imperfect CR, and IR. However, in the weighted sample of the SAG cohort, SAG perfect CR was associated with improved survival compared with SAG imperfect CR (HR, 0.81; 95% CI, 0.0.72-0.92; P = .001). Whereas, SAG perfect and imperfect CR were both associated with improved survival compared with SAG IR (HR, 0.51; 95% CI, 0.0.35-0.87; P = .006 and HR, 0.72; 95% CI, 0.64-0.82; P < .001), respectively., Conclusions: MAG CR is associated with better survival compared with SAG CR. If IR is inevitable, patients with MAG IR had better long-term survival compared with patients receiving SAG IR. Moreover, similar long-term survival is observed whether perfect CR, imperfect CR, or IR is achieved in the MAG population but not in SAG patients., Competing Interests: Disclosures Sleiman Sebastian Aboul-Hassan reports a relationship with Getinge that includes: speaking and lecture fees and travel reimbursement. Michel Pompeu Sa reports a relationship with The Society of Thoracic Surgeons that includes: funding grants. Mario Gaudino reports a relationship with National Institutes of Health that includes: funding grants. The other authors have no conflicts of interest to disclose., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

(1) Background: Left ventricular assist devices (LVADs) represent mechanical support in end-stage congestive heart failure and are characterized by satisfactory long-term results. Uric acid (UA) represents one of the early heart failure markers whose usefulness was postulated in clinical practice. (2) Methods: Twenty-nine male patients with a median age of 58 (51-62) years were referred for LVAD implantation due to end-stage congestive heart failure in the mean (SD) New York Heart Association (NYHA) status class 3.3 (0.6). Preoperative and postoperative right ventricular (RV) characteristics were compared with serum uric acid concentration within 12 (8-15) months following the implantation. (3) Results: Significant correlations between postoperative uric acid concentration and right ventricular dimension (r = 0.604, p = 0.005), tricuspid annulus plane systolic excursion (TAPSE) (r = -0.496, p = 0.022), left ventricular ejection fraction (r = -0.463, p = 0.046), and N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) (r = 0.505, p = 0.041) were noted. (4) Conclusions: The analysis shows the association between the postoperative RV diameter and TAPSE results in LVAD patients and uric acid concentration. Serum uric acid can be regarded as a possible right ventricular dysfunction marker in LVAD patients.

Background : There is mounting evidence that diabetic-related cardiac metabolism abnormalities with oxidative stress and inflammatory mechanism activation align with the functional impairments that result in atherosclerotic lesion formation. Among the possible non-traditional coronary lesion risk factors, environmental exposure may be significant, especially in diabetic patients. Methods : A total of 140 diabetic patients (115 (82%) males and 25 (18%) females) with a mean age of 65 (60-71) underwent surgical revascularization due to multivessel coronary disease. The possible all-cause mortality risk factors, including demographical and clinical factors followed by chronic air pollution exposure, were identified. Results : All patients were operated on using the off-pump technique and followed for 5.6 (5-6.1) years. The multivariable model for 5-year mortality prediction presented the nitrogen dioxide chronic exposure (HR: 3.99, 95% CI: 1.16-13.71, p = 0.028) and completeness of revascularization (HR: 0.19, 95% CI: 0.04-0.86, p = 0.031) as significant all-cause mortality risk factors. Conclusions : Ambient air pollutants such as an excessive chronic nitrogen dioxide concentration (>15 µg/m 3 ) may increase 5-year all-cause mortality in diabetic patients following surgical revascularization.

Coronary artery disease is among the leading current epidemiological challenges. The genetic, clinical, and lifestyle-related risk factors are well documented. The reason for specific epicardial artery locations remains unsolved. The coronary artery topography and blood flow characteristics may induce local inflammatory activation. The atherosclerotic plaque formation is believed to represent inflammatory response involving enzymatic processes co-factored by trace elements. The possible relation between trace elements and coronary artery disease location was the subject of the study. There were 175 patients (107 (61) men and 68 (39) females) in a median (Q1-3) age of 71 years (65-76) admitted for coronary angiography due to chronic coronary syndrome. The angiographic results focused on the percentage of lumen stenosis in certain arteries and were compared with the results for hair scalp trace elements. The correlation between left main coronary artery atherosclerotic plaques and nickel (Ni), zinc (Zn), and antimony (Sb) hair scalp concentration was noted. The analysis revealed a positive relation between left descending artery disease and chromium (Cr), sodium (Na), arsenic (As), and molybdenum (Mo) and a negative correlation with strontium (Sr). The atherosclerotic lesion in the circumflex artery revealed correlations in our analysis with sodium (Na), potassium (K), chromium (Cr), nickel (Ni), arsenic (As), and negative with strontium (Sr) (r) hair scalp concentrations. The negative correlations between right coronary artery disease and magnesium (Mg) and strontium (Sr) concentrations were noted. The possible explanation of different epicardial artery involvement and severity by atherosclerotic processes may lay in their topography and blood rheological characteristics that induce different inflammatory reactions co0factored by specific trace elements. The trace element concentration in the hair scalp may correlate with a particular coronary atherosclerotic involvement, including the severity of lumen reduction. This may indicate the missing link between the pathophysiological processes of atherosclerosis development and its location in coronary arteries., (© 2024. The Author(s).)

Background Quantifying the fibrotic and calcific composition of the aortic valve at CT angiography (CTA) can be useful for assessing disease severity and outcomes of patients with aortic stenosis (AS); however, it has not yet been validated against quantitative histologic findings. Purpose To compare quantification of aortic valve fibrotic and calcific tissue composition at CTA versus histologic examination. Materials and Methods This prospective study included patients who underwent CTA before either surgical aortic valve replacement for AS or orthotopic heart transplant (controls) at two centers between January 2022 and April 2023. At CTA, fibrotic and calcific tissue composition were quantified using automated Gaussian mixture modeling applied to the density of aortic valve tissue components, calculated as [(volume/total tissue volume) × 100]. For histologic evaluation, explanted valve cusps were stained with Movat pentachrome as well as hematoxylin and eosin. For each cusp, three 5-µm slices were obtained. Fibrotic and calcific tissue composition were quantified using a validated artificial intelligence tool and averaged across the aortic valve. Correlations were assessed using the Spearman rank correlation coefficient. Intermodality and interobserver variability were measured using the intraclass correlation coefficient (ICC) and Bland-Altman plots. Results Twenty-nine participants (mean age, 63 years ± 10 [SD]; 23 male) were evaluated: 19 with severe AS, five with moderate AS, and five controls. Fibrocalcific tissue composition strongly correlated with histologic findings ( r = 0.92; P < .001). The agreement between CTA and histologic findings for fibrocalcific tissue quantification was excellent (ICC, 0.94; P = .001), with underestimation of fibrotic composition at CTA (bias, -4.9%; 95% limits of agreement [LoA]: -18.5%, 8.7%). Finally, there was excellent interobserver repeatability for fibrotic (ICC, 0.99) and calcific (ICC, 0.99) aortic valve tissue volume measurements, with no evidence of a difference in measurements between readers (bias, -0.04 cm 3 [95% LoA: -0.27 cm 3 , 0.19 cm 3 ] and 0.02 cm 3 [95% LoA: -0.14 cm 3 , 0.19 cm 3 ], respectively). Conclusion In a direct comparison, standardized quantitative aortic valve tissue characterization at CTA showed excellent concordance with histologic findings and demonstrated interobserver reproducibility. Clinical trial registration no. NCT06136689 Published under a CC BY 4.0 license. Supplemental material is available for this article. See also the editorial by Almeida in this issue.

Background and Objectives: The progression of global warming results in an increased exposure to extreme heat, leading to exaggeration of preexisting diseases and premature deaths. The aim of the study was to present possible risk factors for all-cause long-term mortality in patients who underwent surgical revascularization, including an assessment of the influence of ambient temperature exposure. Materials and Methods: Retrospective analysis included 153 (123 (80%) males and 30 (20%) females) patients who underwent off-pump revascularization and were followed for a median time of 2533 (1035-3250) days. The demographical, clinical data and ambient temperature exposure were taken into analysis for prediction of all-cause mortality. Individual exposure was calculated based on the place of habitation. Results: In the multivariate logistic regression model with backward stepwise elimination method, risk factors such as dyslipidaemia ( p = 0.001), kidney disease ( p = 0.005), age ( p = 0.006), and body mass index ( p = 0.007) were found to be significant for late mortality prediction. In addition to traditional factors, environmental characteristics, including tropical nights ( p = 0.043), were revealed to be significant. Conclusions: High night-time ambient temperatures known as tropical nights may be regarded as additional long-term mortality risk factor after surgical revascularization.

Introduction: Global warming is claimed to be an important cardiovascular disease risk factor. The air pollution and ambient temperatures are believed to have a significant influence on increased morbidity and premature deaths., Aim: To point out possible causative factors for coronary angiography progression in patients presenting with chronic coronary syndrome., Material and Methods: There were 66 patients (41 [62%] men and 25 [38%] women) with a median age of 71.5 (62-76) years, who underwent repeated coronary angiographies due to chronic coronary syndrome within a median time interval of 145 (96-296) days. In 18 (27%) patients coronary artery lesion progression was observed despite optimal pharmacotherapy. The demographical, clinical, and personalised epidemiological factors including air pollution particles and ambient temperature exposure were taken into account in the analysis., Results: In the multivariate logistic regression model with backward stepwise elimination method, tropical nights ( p = 0.047) and mean daily temperatures ( p = 0.043) were revealed as predictors of coronary lesion progression > 30%. The analysis of seasonal temperature changes showed significant differences related to minimal winter temperatures between both groups ( p = 0.018)., Conclusions: Coronary artery lesion progression can be related to either high values of daily temperatures or to low ambient temperature. The dichotomous characteristics of temperature exposure to atherosclerosis progression suggest a detrimental role of environmental extremities on human health., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2024 Termedia Sp. z o. o.)

Introduction: Left main (LM) coronary disease is believed to represent a complex, advanced, and potentially life-threatening atherosclerotic syndrome that can be treated by either percutaneous or surgical interventions. Despite its satisfactory results, the declined number of off-pump coronary artery bypass grafting (OPCAB) is observed., Aim: To compare 10-year survival and point out possible mortality risk factors in patients referred for left main and multivessel OPCAB surgery followed by transit time bypass measurements., Material and Methods: There were 159 patients (128 (81%) men and 31 (19%) women) in a median age of 66 (60-70) years enrolled in retrospective analysis who were referred to surgical intervention due to left main (51, 32%) and multivessel (108, 68%) disease. The regression analysis for long-term mortality risk and the Kaplan-Meyer survival curve were analyzed., Results: Multivariable analysis pointed female sex (HR = 1.08, 95% CI: 1.03-1.14, p = 0.001) and diabetes mellitus (HR = 6.33, 95% CI: 1.86-21.52, p = 0.003) as possible risk factors for 10-year mortality risk. There was no significant difference in Kaplan-Meyer 10-year mortality comparison between left main and multivessel disease patients treated by off-pump surgical revascularization (HR = 0.93, 95% CI: 0.40-2.13, p = 0.86)., Conclusions: Off-pump surgery in the left main disease, compared to multivessel disease, represents a safe surgical technique with satisfactory long-term results. The female sex and diabetes mellitus were found as possible risk factors for 10-year mortality risk in multivariable analysis., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2024 Termedia Sp. z o. o.)

Objectives: Transcatheter aortic valve implantation (TAVI) remains the preferred strategy for high-risk or elderly individuals with aortic valve (AV) stenosis who are not considered to be optimal surgical candidates. Recent evidence suggests that low-risk patients may benefit from TAVI as well. The current study evaluates midterm survival in low-risk patients undergoing elective surgical AV replacement (SAVR) versus TAVI., Methods: The Aortic Valve Replacement in Elective Patients From the Aortic Valve Multicenter Registry (AVALON) compared isolated elective transfemoral TAVI or SAVR with sternotomy or minimally invasive approach in low-risk individuals performed between 2015 and 2019. Propensity score matching was conducted to determine SAVR controls for TAVI group in a 1-to-3 ratio with 0.2 caliper., Results: A total of 2393 patients undergoing elective surgery (1765 SAVR and 629 TAVI) with median European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) score 1.81 (interquartile range [IQR], 1.36 to 2.53]) were initially included. Median follow-up was 2.72 years (IQR, 1.32-4.08; max 6.0). Propensity score matching returned 329 TAVI cases and 593 SAVR controls. Thirty-day mortality was 11 out of 329 (3.32%) in TAVI and 18 out of 593 (3.03%) in SAVR (risk ratio, 1.10; 95% CI, 0.52-2.37; P = .801) groups, respectively. At 2 years, survival curves began to diverge in favor of SAVR, which was associated with 30% lower mortality (hazard ratio, 0.70; 95% CI, 0.496-0.997; P = .048)., Conclusions: Our data did not demonstrate a survival difference between TAVI and SAVR during the first 2 postprocedure years. After that time, SAVR is associated with improved survival. Extended observations from randomized trials in low-risk patients undergoing elective surgery are warranted to confirm these findings and draw definitive conclusions., (Copyright © 2022 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Thoracic aortic aneurysms are often an accidental finding and result from a degenerative process. Medical therapy includes pharmacological control of arterial hypertension and smoking cessation, that slows the growth of aneurysms. An association between the dilatation of the ascending and abdominal aorta has been already reported. The aim of the study was to identify possible demographic and clinical factors that may implicate further imaging diagnostics in patients with ascending aorta dilatation., Methods: There were 181 (93 (53%) males and 88 (47%) females) patients with a median age of 54 (41-62) years who underwent cardiac magnetic resonance due to non-vascular diseases, were enrolled into retrospective analysis., Results: Multivariable analysis revealed ascending aorta dilatation (odds ratios (OR) = 7.45, 95% confidence interval (CI): 1.98-28.0, p = 0.003) and co-existence of coronary artery disease (OR = 8.68, 95% CI: 2.15-35.1, p = 0.002) as significant predictors for thoracic descending aorta dilatation. In patients with abdominal aorta dilatation, the multivariable analysis showed a predictive value of ascending aortic dilatation (OR = 14.8, 95% CI: 2.36-92.8, p = 0.004) and age (OR = 1.04, 95% CI: 1.00-1.08, p = 0.027). In addition, cut-off values were established for age groups determining the risk of thoracic aorta dilatation over 49 years and abdominal aorta dilatation over 54 years., Conclusions: The results of our analysis showed predictive factors, including ascending aorta dilatation and co-existence of coronary artery disease, particularly over 49 years of age for thoracic, while ascending aorta dilatation and age, particularly over 54 years, for abdominal aorta dilatation. These features may be considered to increase clinical vigilance in patients with aortic diameter abnormalities., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2024 The Author(s). Published by IMR Press.)

Background: An imbalance between pro- and anti-inflammatory mechanisms is indicated in the pathophysiology of atherosclerotic plaque. The coronary artery and carotid disease, despite sharing similar risk factors, are developed separately. The aim of this study was to analyze possible mechanisms between trace element hair-scalp concentrations and whole blood counts that favor atherosclerotic plaque progression in certain locations., Methods: There were 65 (36 (55%) males and 29 (45%) females) patients with a median age of 68 (61-73) years enrolled in a prospective, preliminary, multicenter analysis. The study group was composed of 13 patients with stable coronary artery disease (CAD group) referred for surgical revascularization due to multivessel coronary disease, 34 patients with carotid artery disease (carotid group) admitted for vascular procedure, and 18 patients in a control group (control group)., Results: There was a significant difference between the CAD and carotid groups regarding lymphocyte ( p = 0.004) counts. The biochemical comparison between the coronary and carotid groups revealed significant differences regarding chromium (Cr) ( p = 0.002), copper (Cu) ( p < 0.001), and zinc (Zn) ( p < 0.001) concentrations. Spearman Rank Order Correlations between lymphocyte counts and trace elements in the analyzed groups were performed, revealing a strong correlation with zinc (R = 0.733, p < 0.001) in the control group (non-CAD, non-carotid)., Conclusion: Significant differences in hair-scalp concentrations related to atherosclerosis location were observed in our analysis. The interplay between zinc concentration and lymphocyte count may play a pivotal role in cardiovascular disease development.

Background: The objective of this multicenter study aimed to investigate the impact of sex on long-term survival among patients with multivessel coronary artery disease undergoing coronary artery bypass grafting (CABG) using multiple arterial grafting (MAG) or a single artery with saphenous vein grafts., Materials and Methods: Data were obtained from the Polish National Registry of Cardiac Surgery Procedures database. This study included 81 136 patients who underwent CABG for multivessel disease between January 2012 and December 2020 (22.9 were women and 77.1% were men). MAG was performed in 8.3 and 11.7% of female and male patients, respectively. A 1:1 propensity score (PS)-matching was performed. Long-term mortality was compared between matched groups of men and women. Subgroup analyses of patients aged <70 and ≥70 years, with an ejection fraction (EF) >40% and ≤40%, and with and without diabetes, obesity, peripheral artery disease (PAD), or chronic lung disease (CLD) were performed separately in women and men., Results: MAG was associated with lower long-term mortality than saphenous vein grafts in 1528 PS-matched female pairs [hazard ratio (HR): 0.74; 95% CI: 0.59-0.92; P =0.007) and 7283 PS-matched male pairs (HR: 0.80; 95% CI: 0.72-0.88; P <0.001). Subgroup analyses confirmed the results among female patients aged <70 years, with diabetes and EF >40%, and without PAD or CLD, and of male patients aged <70 and ≥70 years; with EF >40%; with or without diabetes, obesity, or PAD; and without CLD., Conclusions: In patients undergoing CABG, MAG was associated with significantly improved survival in both sexes. The long-term benefits of MAG observed across subgroups of men and women support the consideration of a multiarterial revascularization strategy for a broader spectrum of patients., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)