Marcin Protasiewicz

Background: Sepsis has heterogeneous etiologies. Although bacteria are the most common causative agents, viral and yeast forms of sepsis also occur. Procalcitonin (PCT) is widely used to monitor severe bacterial infections and may support the differential diagnosis of infection etiology. Methods: We evaluated the diagnostic value of PCT in viral sepsis using PCT levels at ICU admission and PCT kinetics during ICU treatment. Results: During the COVID-19 pandemic, 191 adult ICU patients with sepsis and a positive SARS-CoV-2 PCR test at hospital admission were included and classified into two groups according to the presence or absence of bacterial or yeast co-infection. PCT showed a distinct diagnostic pattern influenced by the presence of co-infection. PCT remained low in isolated viral sepsis, whereas elevated concentrations were associated with superimposed bacterial or yeast co-infection and worse clinical outcomes. Overall mortality was significantly lower in patients with isolated viral sepsis compared to those with co-infection (50 vs. 69%, p = 0.009). Conclusions: In viral sepsis, persistently low PCT concentrations argue against bacterial co-infection, whereas elevated or rising values should prompt increased diagnostic evaluation. Although PCT provides clinically relevant diagnostic information, it must be interpreted cautiously and in conjunction with clinical assessment and microbiological data. PCT should serve as an adjunctive, not a standalone, marker of infection etiology in sepsis.

Background: Left Ventricle Myocardial Work (LVMW) has shown utility in assessing patients with aortic stenosis (AS) in recent studies. In the present study, we evaluated the predictive value and optimal cut-off values of LVMW parameters measured prior to TAVI that may be associated with increased mortality in AS patients. Methods: A total of 116 consecutive patients who were qualified for TAVI between March 2021 and November 2022 were evaluated. Pre-procedural LVMW indices (GWI, GCW, GWW, and GWE) were assessed and long-term survival was analysed. Survival and influencing factors were evaluated using univariate and multivariate Cox proportional hazard models, with significant factors subsequently included in cut-off analysis. Results: The median survival time following the TAVI procedure was 1404 (1143–1549) days, with a maximum observation period of 1721 days. All-cause mortality during the follow-up period reached 29%. Multivariate analysis revealed that EF, GLS, GWI, GWE and GCW before TAVI were independent predictors of all-cause mortality. We identified 1975 mmHg, 1497 mmHg and 85% as optimal cut-off values for GCW, GWI and GWE, which allow for significant stratification of patients according to risk. Conclusions: In this analysis, baseline-assessed parameters such as GLS, GWI, GWE, and GCW emerged as independent predictors of all-cause mortality. The proposed cut-off values clearly separated patient groups with different survival outcomes.

Aortic stenosis (AS) increases left ventricular (LV) afterload and systolic pressure (LVSP). Left ventricular myocardial work (LVMW) enables early detection of LV dysfunction. Recent evidence suggests that ID may reduce LVMW parameters, raising the question of whether ID further impairs LV systolic performance in patients with AS undergoing transcatheter aortic valve implantation (TAVI). We evaluated 100 patients with severe AS scheduled for TAVI between March 2021 and November 2022. All underwent ID screening according to the classic and novel ID definitions and echocardiographic assessment of LVMW before TAVI and at the 1-year follow-up. Elimination of AS was observed within the 1-year follow-up in the whole population. Despite stable ejection fraction (EF) and global longitudinal strain (GLS), LVMW indices such as global work index (GWI) and global constructive work (GCW) significantly decreased from baseline in the entire population. However, when comparing ID and non-ID patients after the procedure, a statistically significant decrease in GWI and GCW was noted at the 1-year follow-up only in the TSAT > 20% group, not in the TSAT < 20% group. We also noted a significant correlation between TSAT status and echocardiographic as well as LVMW indices. When the classic ID definition was used, all LVMW parameters changed similarly in both groups during follow-up. TAVI significantly influenced the majority of LVMW indices in the overall study population. Using the standard ID definition, ID had no impact on differences in LVMW indices. However, when defined by TSAT < 20%, patients with ID showed no significant post-TAVI changes in LVMW indices.

Clinical improvement and survival benefit after transcatheter aortic valve replacement (TAVR) are difficult to predict. Despite the identification of multiple predictors of both endpoints, prognostic algorithms in patients undergoing TAVR are not well defined. Aim: To explore factors determining the lack of significant improvement in exercise capacity after TAVR, and investigate whether the predictive profile for poor functional response to TAVR (PFR) could also predict mortality. Methods and results: We enrolled 220 patients (78.0±6.4 yrs) with severe aortic stenosis who underwent TAVR. Pre- and post-procedural (3 months) data were collected, including clinical information, echocardiography with myocardial work assessment, and 6-minute walk test (6MWT). PFR was defined as an increase in 6MWT distance <40m. Only age and atrial fibrillation were independent predictors of both mortality and PFR. Mortality was associated with lower global work index (HR 0.99; p<0.001) and shorter 6MWT distance (HR 0.99; p=0.008). PFR was associated with higher global wasted work (OR 1.003; p=0.026) and less impaired 6MWT relative to predicted values (OR 0.19; p<0.001 for 6MWT <80% predicted). Unsupervised machine learning-based analysis (Partition Around Medoids algorithm) identified clusters associated with mortality but not with PFR. Conclusions: The predictive profiles for PFR and mortality after TAVR show only limited overlap, indicating that these two outcomes warrant distinct prognostic evaluations. The 6MWT may be useful in predicting the likelihood of both outcomes, with lower absolute values being associated with mortality, while higher percentage predicted values – with limited symptomatic benefit. Myocardial work analysis may further enhance prognostic assessment in this population. Abstract Figure:

Objectives: The aim of this study is to evaluate the safety and efficacy of repeat transcatheter aortic valve implantation (redo-TAVI) in the polish population. Methods: In this multicentre nationwide registry (ClinicalTrials.gov identifier, NCT03361046), we provide characteristics, periprocedural variables and long-term outcomes of high-risk patients who underwent redo-TAVI. Results: The mean age among 32 individuals who underwent redo-TAVI was 75 ± 13 years, and 62.5% were male. The mean time from index TAVI to redo-TAVI was 4.7 ± 3.5 years, with failed procedures (up to 1 year) occurring in 7 (21.9%) and failed transcatheter heart valve (THV, beyond 1 year) in the remaining majority of the 25 (78.1%) patients. Computed tomography-based native bicuspid aortic anatomy was found frequently in 37.5% of cases (58.3% in failed procedures and 41.7% in failed THV). The mean failed THV size was large (27.7 ± 3 mm) and predominantly presenting with pure regurgitation (59.4%). In more than two-thirds (68.7%), balloon-expandable or self-expandable THV was the most common strategy of redo-TAVI. None or mild regurgitation was found in 90.6%, and the mean transvalvular gradient was 13.1 ± 5.5 mmHg, with only three cases with >20 mmHg of the residual gradient (9.4%). Peri-procedural and 30-day complications were low, and cardiovascular and all-cause mortality at 1 year was 9.4 and 15.6%, respectively. There was a relatively high incidence of non-procedural stroke after redo-TAVI (n = 5, 15.6%), with all cases observed after 30 days. Conclusions: Initial data of redo-TAVI in Poland suggest that the procedure is safe and characterized by favourable efficacy and low rates of short-term adverse outcomes. A high frequency of baseline native bicuspid anatomy and late stroke occurrence after the redo-procedure warrants further investigation in larger cohorts.

Aims: Several factors, including device design, annulus size, and sizing strategies, influence transcatheter heart valve (THV) haemodynamic outcomes in patients with aortic stenosis (AS). This sub-study evaluates early (30-day) echocardiographic outcomes of the Myval, Sapien, and Evolut THV series, focusing on haemodynamic performance and valve durability. Methods and results: The LANDMARK trial is a prospective, randomised, multicentre, open-label, non-inferiority trial comparing 384 patients implanted with Myval THV series to 384 receiving Sapien and Evolut THV series. Haemodynamic assessments followed Valve Academic Research Consortium-3 recommendations. At 30-day, haemodynamic device success rates were 85.9%, 77.8, and 85.4% for Myval, Sapien, and Evolut THV series, respectively (PMyval-Sapien = 0.03 and PMyval-Evolut = 0.98). Significant improvements in peak aortic flow velocity, pressure gradients, effective orifice area (EOA), Doppler velocity index (DVI), and cardiac indices were observed across all groups, except for unchanged left ventricular ejection fraction. Moderate prosthesis-patient mismatch (PPM) was less frequent with Myval THV series(11.3%) vs. Sapien THV series(21.8%), but higher than Evolut THV series (5.3%) (PMyval-Sapien = 0.0024, PMyval-Evolut = 0.0396), while severe PPM showed no significant differences (4.2% vs. 6.3% vs. 1.8%; PMyval-Sapien = 0.394, PMyval-Evolut = 0.2438). Rates of ≥ moderate paravalvular leak (PVL) were lower in Myval (3.5%), and Sapien (1.7%) compared with Evolut THV series (8.3%) (PMyval-Sapien = 0.3769, PMyval-Evolut = 0.0336). Myval THV series required minimal oversizing compared with Evolut THV series (P < 0.0001). Conclusion: The Myval THV series demonstrates short-term haemodynamic performance comparable to Evolut THV series and superior to Sapien THV series. Including intermediate sizes minimizes oversizing, underscoring its potential as an alternative for TAVI patients. Long-term follow-up is necessary to confirm these findings. Clinical trial registration: ClinicalTrials.gov: NCT04275726, EudraCT number 2020-000,137-40

Introduction: Recently, a relationship between hyperparathyroidism and cardiovascular disorders has been highlighted. The current study aimed to find a possible relationship between parathyroid hormone (PTH) and valvular calcification performance. A secondary aim was to evaluate the potential association between PTH concentration and post-procedural outcomes after transcatheter aortic valve implantation (TAVI).Material and methods: Patients with severe symptomatic aortic stenosis were evaluated for the study eligibility. Demographics, clinical data, and blood samples were collected. Pre-procedurally, echocardiography and computed tomography (CT) were performed. Quantitative evaluation of calcific tissue was conducted over the three regions of interest: ascending aorta, aortic, and mitral valves using semiautomated software.Results: The final study group comprised 89 patients (50 females, median (Q1-3) age of 77 (72-82) years. Increased PTH concentration was associated with a higher peak aortic gradient (p=0.024), but not with mean aortic gradient nor mitral annular calcification occurrence. CT analysis revealed an association between increased PTH and mean calcific tissue attenuation in the mitral (p=0.004) and aortic valves (p<0.001) and ascending aorta (p<0.001), however lack of relationship with calcium volume in the regions of interest. Increased PTH did not differ between patients with and without paravalvular leak or new pacemaker implantation.Conclusions: Increased PTH concentration is associated with calcific tissue attenuation but not calcium volume, suggesting that PTH may influence the degree of calcium accumulation in degenerated regions. PTH could potentially serve as a biomarker of calcific loading in valvular heart disease. However, PTH concentration does not appear to be linked to the rate of complications following TAVI.