Celina Wojciechowska

Background: Multimorbidity significantly affects prognosis in patients after transvenous lead extraction (TLE). The CHA₂DS₂-VASc and CHA₂DS₂-VA scores, widely used for stroke risk stratification in atrial fibrillation, include clinical factors that are also associated with long-term mortality. Purpose: To evaluate the usefulness of the CHA₂DS₂-VASc and CHA₂DS₂-VA scores in predicting short- and long-term mortality in patients following non-laser TLE. Methods: This retrospective study included 3822 patients who underwent non-laser TLE between March 2006 and April 2023 at high-volume centres. The median follow-up was 1848 days (Q1-Q3: 815– 3146 days). Patients were stratified into two groups according to CHA₂DS₂-VASc score (< 3 vs. ≥ 3). 30-day, 1-year, and 3-year, and overall follow-up mortality were assessed. Cox proportional hazards models were used to identify independent predictors of death during short and long follow-up. Results: Patients with CHA₂DS₂-VASc ≥ 3 had significantly higher mortality at 30 days 1 year, 3 years, and during overall follow-up compared with those scoring < 3. A cut-off ≥ 3 showed 80.6% sensitivity and 62.3% specificity for predicting 3-year mortality. Mortality increased progressively with higher CHA₂DS₂-VASc scores (Spearman’s r = 0.983, p< 0.001). The multivariate Cox regression demonstrated that number of points on CHA₂DS₂-VASc and CHA₂DS₂-VA scores were independent predictors long-term mortality, alongside Charlson comorbidity index, atrial fibrillation, infective TLE indications, and renal dysfunction. Each 1-point increase in the CHA₂DS₂VA score was associated with an 11.7% increase in the risk of death. In sex-specific analysis, the risk increased by 33.0% per point in females (HR 1.330; p< 0.001) and by 20.6% in males (HR 1.206; p< 0.001). Conclusion: CHA₂DS_2-VASc and CHA₂DS_2-VA score may be a useful tool for predicting the risk of death during long-term observation of patients after TLE. Incorporation of this score into clinical decision-making may improve risk stratification and support individualized management of patients undergoing TLE.

Background: Glycated hemoglobin (HbA1c) is a parameter commonly used in clinical practice to assess glycemic control in patients with diagnosed diabetes. Hyperglycemia is a strong risk factor for developing cardiovascular (CV) disease. Although there is some evidence that this parameter could also help assess CV health in patients without known carbohydrate metabolism disorders, this is not entirely clear. The purpose of this study was to investigate the relationship between HbA1c and selected echocardiographic parameters in patients without diabetes. Methods: This study was a retrospective analysis of data from 59 patients (females: 72.88%) with a mean age of 54.82 ± 17.34 years without any features of acute illness or exacerbation of chronic diseases hospitalized in the Department of Internal Medicine, Angiology and Physical Medicine of the Medical University of Silesia in Katowice (Poland) in the period between June 2022 and May 2024. Only individuals with HbA1c levels and who have undergone transthoracic echocardiography were included in the analysis. Spearman’s rank correlation test was used for statistical analysis, and a multivariate analysis model was then constructed (adjusted for age, sex, body mass index, low-density lipoprotein cholesterol, systolic blood pressure, hypertension, and smoking). Results: In univariate analysis, HbA1c was found to be significantly correlated with selected parameters relating to left ventricular dimensions and mass, left atrial dimensions, right ventricular systolic function, mitral inflow profile parameters, and tissue Doppler echocardiography. Multivariate analysis did not confirm a significant association between HbA1c and the assessed echocardiographic parameters. Conclusions: Although HbA1c significantly correlates with some echocardiographic parameters, the observed relationships are entirely explained by confounding variables.

Background: The COVID-19 outbreak began in December 2019 in China and quickly spread to other countries. Although most infected individuals experienced mild or moderate symptoms, 17% of patients were reported to have severe cases. Analysis of the available literature confirms the link between severe forms of COVID-19 and cyto-kine storm syndrome. Methods: A total of 57 patients participated in the study, divid-ed into a non-COVID group (24 people) and a COVID group (33 people). Each patient completed a questionnaire designed by the authors, followed by anthropometric measurements and venous blood sampling to determine cytokines, and pro- and an-ti-inflammatory chemokines using the Bio-Plex 200 system. Results: Showed statisti-cally significant higher values of IL-6, IL-13, TNF-α and the chemokines IP-10, MCP-1 (MCAF), MIP-1α, MIP-1β in the COVID-19 group. Conclusions: The results of our study support for the occurrence of elevated levels of IL-6, IL-13, TNF-α and selected chemokines in COVID-19 patients, which are associated with a worse course and prognosis of COVID-19. An in-depth understanding of the pathophysiology and im-mune dysfunction accompanying cyto-kine storm is crucial for identifying patients at increased risk, as well as for developing effective therapies and vaccines.

Regular physical activity has a beneficial impact on the cardiovascular system. However, the intense and prolonged exertion typical of professional athletes and amateur marathon runners can lead to adaptive changes in the heart. These changes encompass both structural and functional modifications, which may have positive or negative effects on cardiac function and contribute to the development of so-called “athlete’s heart.” Prolonged exercise induces adaptations at the molecular and cellular levels, including altered gene expression and remodeling of myocardial proteins. It may also cause transient elevations in biomarkers such as N-terminal pro-brain natriuretic peptide (NT-proBNP) and high-sensitivity troponin. Some athletes experience cardiac arrhythmias, including atrial fibrillation. Morphological changes, such as myocardial hypertrophy or chamber dilation, can be assessed using echocardiography. Studies have reported potentially benign valvular abnormalities, as well as cases of myocardial fibrosis and arrhythmias. Early diagnosis of cardiac conditions in marathon runners is essential for effective prevention and health monitoring. This article reviews the current data on cardiac changes in endurance athletes, based on the literature from the past decade.

Sodium-glucose co-transporter-2 (SGLT-2) inhibitors have become integral in treating both diabetes mellitus and heart failure, independent of left ventricular ejection fraction. Their pleiotropic effect influences multiple mechanisms, enhancing the function of various systems within the body. They exhibit nephroprotective and cardioprotective effects by improving cell metabolism, endothelial function, and slowing the fibrosis of the cardiac muscle, and they also have a beneficial impact on other organs. At the cellular level, they protect against the harmful effects of free radicals both by lowering glucose levels and by supporting the function of the antioxidant system. Moreover, SGLT-2 inhibitors can modify the metabolism of adipocytes by affecting the production of cytokines such as adiponectin—which increases insulin sensitivity, leading to weight loss and improved glycemic control.

Background: The coronavirus–caused disease (COVID-19), first identified in China in December 2019, has spread worldwide becoming a global pandemic. Although people infected with the SARS-CoV-2 virus presented mainly respiratory and gastrointestinal symptoms, an increase in cardiovascular incidents was observed in several scientific studies. SARS-CoV-2 virus has been shown to disrupt the normal immune response leading to a dysregulation of immune system function and massive production of inflammatory cytokines commonly known as “cytokine storm”. Methods: 57 patients eventually participated in the study, assigned to non–COVID (24 patients) and COVID (33 patients) groups. After signing consent to participate in the study, each patient was given a self–administered questionnaire to fill out prior to specimen collection, anthropometric measurements were taken and venous blood was collected for the following determinations: pro- and anti–inflammatory cytokines using a Bio–Plex 200 system, oxidative stress markers and basic hematological blood parameters. Results: showed statistically significant higher values of IL–1Ra and IL–1β in the COVID-19 group. Of the oxidative stress markers, only MDA levels were higher in the COVID-19 group. Conclusions: the results of our study provide evidence and support the occurrence of elevated levels of IL–1Ra, IL–1β and MDA in the COVID-19 group of patients, which are associated with a worse course and prognosis of COVID-19. A better understanding of the pathophysiology and dysregulation of the immune system associated with the cytokine storm is essential to select patients at risk and develop effective drugs and vaccines.

Background/Objectives: Cardiac resynchronization therapy (CRT) is one of the interventional methods of heart failure (HF) treatment, with the criteria for CRT device implantation based on the value of the left ventricular ejection fraction, New York Heart Association functional class, QRS complex duration, and electrocardiographic morphology. Pulmonary hypertension is an important factor influencing the prognosis of patients with HF, but its influence on CRT is not fully understood. Aim: The main aim of the study was to determine the prognostic value of baseline right heart catheterization-derived parameters on the response to CRT. Methods: It was a single-centre study with retrospective analysis of data of 39 non-ischemic HF patients. Clinical, biochemical, echocardiographic, electrocardiographic, and hemodynamic data were obtained before the CRT device implantation, and after 6 months of follow-up, non-invasive re-assessment was performed. Various criteria for the response to CRT were assessed along with the correlation between the baseline parameters. Results: After follow-up, a significant difference was found in the reduction in symptoms associated with HF, an increase achieved in the six-minute walk test distance, and a reduction in N-terminal pro-brain natriuretic peptide concentration as well as improvement of LV function assessed in echocardiographic examination. Among all parameters assessed, the baseline higher value of the transpulmonary gradient and pulmonary vascular resistance most often had a significant negative impact on meeting the criteria of response to CRT. Conclusions: The results of the analyses show that the initial assessment of pulmonary hemodynamics may be crucial in predicting the response to CRT in patients with non-ischemic cardiomyopathy.

Background/Objectives : Cardiac resynchronization therapy (CRT) is one of the interventional methods of heart failure (HF) treating, with the criteria for CRT device implantation based on the value of left ventricular ejection fraction, New York Heart Association (NYHA) functional class, QRS duration and electrocardiographic morphology. Pulmonary hypertension is an important factor influencing the prognosis of patients with heart failure, but its influence on CRT is not fully understood. Aim: The main aim of the study was to determine the prognostic value of baseline right heart catheterization ( RHC) derived parameters on the response to CRT . Methods : It was a single centre study with retrospective analysis of data of 39 non-ischemic HF patients. Clinical, biochemical, echocardiographic, electrocardiographic and hemodynamic data were obtained before the CRT device implantation, and a fter 6 months of follow-up non-invasive re-assessment was performed. Various criteria for the response to CRT were assessed along with the correlation between the baseline parameters. Results : After follow-up a significant difference was found in the reduction of symptoms associated with heart failure, an increase in the distance achieved in the six-minute walk test distance (6MWT) and a reduction of N-terminal pro-brain natriuretic peptide (NT-proBNP) concentration as well as improvement of left ventricular function assessed in echocardiographic examination. Among all parameters assessed, the baseline higher value of transpulmonary gradient (TPG) and pulmonary vascular resistance (PVR) most often had a significant negative impact on meeting the criteria o f response to CRT. Conclusions : The results of the analyses show that the initial assessment of pulmonary hemodynamics may be crucial in predicting the response to CRT in patients with non-ischemic cardiomyopathy.

Background: CHA2DS2VASc scale is commonly used to risk stratification of stroke in atrial fibrillation patients. With the exception of female gender, the remaining components of the scale are also risk factors for long-term prognosis. Aim: Assessment of the usefulness of the CHA2DS2VASc scale for predicting the short and long term risk of death in the population of transvenous lead extraction (TLE) patients. Methods: Retrospective analysis of data of 3822 consecutive patients underwent TLE followed by to 6239 days: median (Q1-Q3) 1846 (852 – 3146). Results: The strong corelation between number of CHA2DS2VASc scale points and mortality was detected both in 30-days, 1-year, 3-year and all time of follow-up (Spearman r for all follow-up = 0.983, p<0.001). In all TLE population multivariable Cox regression shown that number of points of CHA2DS2VASc scale is independent predictor of death [HR=1.181; 95%CI (1.104-1.264), p<0.001], alongside Carlson index, atrial fibrillation, infective TLE indications and renal dysfunction. A scale value higher by 1 point is associated with an increase in the risk of death by 18.1%. In female group the risk increased by 37.5% [HR=1.375; 95%CI(1.193-1.584), p<0.001)] and in male group the risk increased by 22.00% [HR=1.220; 95%CI 1.110-1.342), p<0.001)]. Conclusion: The commonly known stroke risk CHA2DS2VASc scale may be a useful tool for predicting the risk of death both in short and long-term observation in the group of patients after transvenous lead extraction.Table 1

Heart failure (HF) remains a major medical and social problem. The NT-pro-brain natriuretic peptide (NT-proBNP) and its active form, brain-type natriuretic peptide (BNP), in a simple blood test are the gold-standard biomarkers for HF diagnosis. However, even good biomarkers such as natriuretic peptides fail to predict all the risks associated with HF due to the diversity of the mechanisms involved. The pathophysiology of HF is determined by numerous factors, including oxidative stress, inflammation, neuroendocrine activation, pathological angiogenesis, changes in apoptotic pathways, fibrosis and vascular remodeling. High readmission and mortality rates prompt a search for new markers for the diagnosis, prognosis and treatment of HF. Oxidative-stress-mediated inflammation plays a crucial role in the development of subsequent changes in the failing heart and provides a new insight into this complex mechanism. Oxidative stress and inflammatory biomarkers appear to be a promising diagnostic and prognostic tool in patients with HF. This systematic review provides an overview of the current knowledge about oxidative stress and inflammation parameters as markers of HF.