Grzegorz Gielerak

Chronic total occlusion (CTO) is a common finding on coronary angiograms of patients diagnosed with coronary artery disease, with an incidence ranging from 15 to 25%. Despite its high incidence, this type of coronary lesion is rarely treated with percutaneous coronary intervention. The key to success appears to be appropriate qualification for revascularization. Asymptomatic patients should be assessed for inducible ischemia within the occluded vessel territory to detect patients with a high ischemic burden, defined as inducible ischemia involving > 10% of the myocardium. Single-photon emission computed tomography (SPECT) is a well-established method of myocardial perfusion assessment; however, it is not widely available, especially in less developed regions. The aim of the study was to evaluate CTO patients to identify clinical parameters that could predict the presence of relevant inducible ischemia measured by SPECT. The study included 50 patients with a single-vessel CTO and without any other significant coronary artery stenosis. Patients underwent clinical examination, laboratory tests, echocardiography, 6-minute walk test, cardiopulmonary exercise testing, exercise impedance cardiography, and SPECT. The only parameters associated with a high ischemic burden were CTO location (in the left anterior descending artery and circumflex artery) and one echocardiographic parameter: myocardial lateral wall longitudinal strain. Given the high incidence of CTO, there is an increasing need to define non-invasive markers that could predict the presence of a high ischemic burden and good clinical outcome after revascularization. Echocardiographic longitudinal strains are worth further research in terms of their utility in predicting inducible ischemia.

Choroby układu sercowo-naczyniowego stanowią istotne zagrożenie zdrowotne nawet dla żołnierzy zawodowych, którzy teoretycznie powinni cechować się lepszym stanem zdrowia dzięki rygorystycznym wymogom medycznym i trybowi życia. W rzeczywistości jednak wskaźniki nadwagi, nadciśnienia i zaburzeń lipidowych wśród personelu wojskowego państw NATO są alarmująco wysokie, co może negatywnie wpływać na zdolność bojową i gotowość operacyjną. Celem niniejszego artykułu jest ocena rozpowszechnienia klasycznych czynników ryzyka sercowo-naczyniowego wśród żołnierzy NATO oraz analiza ich potencjalnego wpływu na zdrowie i wydajność operacyjną. Przegląd literatury obejmował analizę badań oryginalnych opublikowanych w bazie PubMed w latach 2019–2024. Selekcji dokonano na podstawie kryteriów obejmujących wyłącznie badania dotyczące czynnych żołnierzy NATO, oceniające klasyczne czynniki ryzyka sercowo-naczyniowego, takie jak nadwaga, otyłość, nadciśnienie tętnicze, hiperlipidemia i palenie tytoniu. Dane poddano analizie porównawczej między różnymi armiami państw członkowskich Sojuszu. Wyniki przeglądu wskazują na wysoką częstość występowania czynników ryzyka sercowo-naczyniowego wśród żołnierzy NATO, z istotnymi różnicami między poszczególnymi krajami, oraz na konieczność wdrożenia nowoczesnych strategii profilaktycznych w celu minimalizacji ryzyka sercowo-naczyniowego w tej populacji.

Wprowadzenie i cel: Choroby układu sercowo-naczyniowego pozostają główną przyczyną zgonów na świecie, także w Polsce, gdzie stanowią 35% całkowitej śmiertelności. Wysoka częstość występowania czynników ryzyka, takich jak nadciśnienie tętnicze, hipercholesterolemia, otyłość i przewlekły stres, jest szczególnie widoczna w populacji żołnierzy. Kadra kierownicza wojska, z uwagi na charakter pracy, może być szczególnie narażona na te zagrożenia. Celem badania była ocena czynników ryzyka sercowo-naczyniowego wśród kierowniczej kadry wojska oraz określenie potencjalnych działań profilaktycznych zmniejszających ryzyko incydentów sercowo-naczyniowych.Materiał i metody: Przeprowadzono retrospektywną analizę danych z dokumentacji medycznej żołnierzy, obejmującą wyniki badań laboratoryjnych, pomiary ciśnienia tętniczego, BMI oraz kwestionariusz zdrowotny. Badana grupa liczyła 34 oficerów (100% mężczyzn) w wieku 40–58 lat (średnia 51 ± 4,2 roku).Wyniki: Nadciśnienie tętnicze stwierdzono u 54% badanych, z czego 23% miało II lub III stopień tego schorzenia. Nadwagę lub otyłość (BMI ≥25 kg/m²) stwierdzono u 83% uczestników. Hipercholesterolemię (>115 mg/dl LDL) rozpoznano u 65%, a 68% miało podwyższony poziom cholesterolu nie-HDL (>130 mg/dl). Wysokie lub bardzo wysokie 10-letnie ryzyko incydentu sercowo-naczyniowego (według SCORE2) występowało u 62% oficerów.Wnioski: Kadra kierownicza wojska charakteryzuje się wysokim rozpowszechnieniem czynników ryzyka sercowo-naczyniowego, w tym nadciśnienia tętniczego, otyłości i zaburzeń lipidowych. Wyniki wskazują na konieczność wdrożenia programów profilaktycznych, obejmujących edukację zdrowotną, strategie redukcji stresu oraz wsparcie w zakresie zmiany stylu życia, co może przyczynić się do poprawy zdrowia i zdolności operacyjnej sił zbrojnych.

Adverse effects associated with cancer treatment, including cancer therapy-related cardiovascular toxicity (CTR-CVT), affect patients’ quality of life and overall survival. Severe and potentially life-threatening cardiotoxicity associated with myocardial dysfunction is most likely to occur after treatment with anthracyclines, which are commonly used in cancer therapy. Cardiotoxicity is a significant complication for the patient and may also necessitate interruption of oncological treatment. The mechanism of anthracycline-induced cardiotoxicity is complex, multifactorial and not fully understood. Studies to date suggest a link between the formation of reactive oxygen species, oxidative damage and the subsequent induction of cardiac cell apoptosis. Knowledge of the mechanisms underlying anthracycline cardiotoxicity allows for safe implementation of the best possible oncological treatment in cancer patients by minimising the risk of CTR-CVT, as well as for planning preventive and monitoring interventions for the early detection and treatment of potential cardiovascular complications. Therefore, the search for effective methods to prevent anthracycline-induced cardiotoxicity and its clinical consequences, which have a negative impact on prognosis and quality of life, remains one of the major challenges faced by oncologists and cardiologists caring for cancer patients. This review discusses the main mechanisms underlying anthracycline cardiotoxicity and emphasises the need to identify an increased risk of anthracycline-induced cardiotoxicity in the context of optimising cardio-oncological management.

Background/Objectives: Acromegaly-induced prolonged exposure to growth hormone and insulin-like growth factor 1 may have significant cardiovascular effects. The purpose of this study was to assess the relationship between hemodynamic parameters measured via impedance cardiography (ICG) and parameters of systolic left ventricular function measured via echocardiography in patients with acromegaly. Methods: The observational cohort study included 33 patients with newly diagnosed acromegaly, with a mean age of 47 years and without significant comorbidities. Correlation analysis (Spearman’s rank correlation coefficient R) was performed on parameters obtained by ICG and left ventricular systolic function parameters obtained by echocardiography. ICG assessment included indices of (1) cardiac function as a pump: stroke volume index (SI), cardiac index (CI), Heather index (HI), velocity index (VI), and acceleration index (ACI); (2) afterload: systemic vascular resistance index (SVRI) and total arterial compliance index (TACI); and (3) thoracic fluid content (TFC). Echocardiographic examinations evaluated left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS). Results: A lower LVEF was associated with a lower SI (R = 0.38; p = 0.03) and a higher SVRI (R = −0.35; p = 0.046), whereas lower GLS was associated with lower SI (R = 0.43; p = 0.02), CI (R = 0.62; p < 0.001), VI (R = 0.59; p < 0.001), ACI (R = 0.38; p = 0.048), HI (R = 0.59; p < 0.001), and TACI (R = 0.50; p = 0.006) and a higher SVRI (R = −0.59; p < 0.001). No significant correlation was observed between either LVEF or GLS and TFC. Conclusions: In patients with acromegaly, poorer echocardiographic parameters of left ventricular systolic function are associated with impaired function of the heart as a pump and higher afterload as assessed via ICG.

Background: The main cause of hospitalization in patients with heart failure is hypervolemia. Therefore, the primary treatment strategy involves diuretic therapy using intravenous loop diuretics to achieve decongestion and euvolemia. Some patients with acutely decompensated heart failure (ADHF) do not respond well to diuretic treatment, which may be due to diuretic resistance (DR). Such cases require high doses of diuretic medications and combination therapy with diuretics of different mechanisms of action. Although certain predisposing factors for diuretic resistance have been identified (such as hypotension, type 2 diabetes, impaired renal function, and hyponatremia), further research is needed to identify other pathophysiological markers of DR. Objective: This study aims to identify admission markers that can predict a high requirement for intravenous diuretics in hospitalized patients with decompensated heart failure. Methods: This study included 102 adult patients hospitalized for ADHF. At admission, patients underwent clinical assessment, laboratory parameter evaluation (including the N-terminal prohormone of brain natriuretic peptide [NT-proBNP] levels), and hemodynamic assessment using impedance cardiography (ICG). Hemodynamic profiles were based on the use of parameters such as heart rate (HR), blood pressure (BP), and thoracic fluid content (TFC) as markers of volume status. The analysis included 97 patients with documented doses of intravenous diuretic use. Patients were stratified into two groups based on median diuretic consumption (equivalent to 540 mg of intravenous furosemide): the high-loop diuretic utilization (LDU) group (n = 49) and the low-LDU group (n = 48). Results: Compared to low-LDU patients, high-LDU patients had greater thoracic fluid content at admission, both quantitatively (37.4 ± 8.1 vs. 34.1 ± 6.9 kOhm-1; p = 0.024) and qualitatively (TFC ≥ 35 kOhm-1: 59.2% vs. 33.3%; p = 0.011). Anemia was more common in the high-LDU group (67.4% vs. 43.8%; p = 0.019), as was elevated NT-proBNP (≥median of 3952 pg/mL: 60.4% vs. 37.5%; p = 0.024). High LDU was associated with a significantly longer hospitalization duration (12.9 ± 6.4 vs. 7.0 ± 2.6 days; p < 0.001). Logistic regression analysis identified anemia, elevated NT-proBNP, and high TFC as predictors of high LDU (HR: 2.65, 2.54, and 2.90, respectively). In a multifactorial model, only high TFC remained an independent predictor (HR: 2.60, 95% CI 1.04–6.49; p = 0.038). Conclusions: TFC was the sole independent admission marker of a high requirement for intravenous diuretics in patients hospitalized for decompensated heart failure. An objective assessment of volume status by impedance cardiography may support intensive personalized decongestion therapy.

Introduction and objective: The SARS-CoV-2 virus has triggered a global pandemic, particularly affecting individuals with comorbidities and those on renal replacement therapy. Vaccination has become a critical strategy, although evidence indicates suboptimal immunity in these groups compared to the general population. Material and methods: The study assessed the post-vaccination response in 121 patients undergoing renal replacement therapy and 104 control individuals. IgG antibody levels against glycoprotein S were measured twice: the first sample was collected 4–8 months after two vaccine doses, and the second sample 6–8 months after third dose. Results: In both groups, antibody titres significantly increased after the third vaccine dose, with no notable difference between the control and study groups after two vaccine doses (p < 0.001). The findings revealed no statistically significant difference in antibody levels between the two groups. Furthermore, there was no significant difference in infection frequency after three vaccine doses (p = 0.072). Patients who contracted COVID-19 after the third vaccination had lower antibody levels during the first blood draw, suggesting a potential impact on immunity. Among dialysis patients, a correlation was found between IgG antibody titres (in the first blood draw) and a longer time interval between the first and second vaccine doses (p = 0.021). The regression analysis indicated that a 1-unit increase in antibody level resulted in a 0.1% reduction in the risk of infection. Conclusions: The results imply that achieving immunity comparable to the general population is possible among patients undergoing renal replacement therapy more than half a year after receiving three vaccine doses. The study also introduces the hypothesis of a delayed antibody response.

Introduction and objective: The experience of the war in Ukraine shows that success in the field of medical protection of the population can only be ensured by a complete service, tailored to the nature of operational activities, using solutions that allow the use of the latest organizational...

Background: Dyspnoea is one of the most common symptoms in the emergency department, and identification of its cause may require complex diagnostic tests. In everyday practice, some concerns arise when the reported dyspnoea is not fully compatible with objective measures in additional tests. This study was performed to evaluate which objective diagnostic markers differentiate patients admitted to hospital due to acute heart failure with and without resting dyspnoea, with a special emphasis on haemodynamic parameters measured by impedance cardiography. Methods: This study enrolled patients over 18 years of age who were hospitalised due to acute heart failure. The admission evaluation included haemodynamic profiling by ICG, with special emphasis on parameters characterising afterload (systemic vascular resistance index), cardiac function (cardiac index; stroke index), and congestion (thoracic fluid content). Results: The study population consisted of 102 patients, mostly men (76.5%), with a mean age of 71.4 ± 12.5 years and a left ventricle ejection fraction of 37.3 ± 14.1%. Patients with dyspnoea at rest (n = 41), in comparison with those without this symptom (n = 61), presented with poorer clinical states: more frequent orthopnoea (p = 0.002), tachypnoea (p = 0.001), palpitations (p = 0.004), and peripheral hypoperfusion (p = 0.0005), higher concentration of high-sensitivity troponin T (p = 0.021), and higher thoracic fluid content (p = 0.003). No significant differences were noted for haemoglobin, creatinine, N-terminal pro-brain natriuretic peptide, heart rate, blood pressure, chest X-ray, left ventricular ejection fraction, cardiac index, stroke index, or systemic vascular resistance index. Conclusions: Thoracic fluid content assessed by impedance cardiography was found to be a good diagnostic marker for differentiating patients admitted to hospital due to acute heart failure with and without resting dyspnoea, and was superior to chest X-rays, N-terminal pro-brain natriuretic peptide, and left ventricle ejection fraction.

Background: Cushing’s disease (CD) is associated with a specific form of metabolic syndrome that includes visceral obesity, which may affect cardiovascular hemodynamics by stimulating hypercortisolism-related metabolic activity. The purpose of this study was to evaluate the relationship between obesity and the hemodynamic profile of patients with CD. Methods: This prospective clinical study involved a hemodynamic status assessment of 54 patients newly diagnosed with CD with no significant comorbidities (mean age of 41 years). The assessments included impedance cardiography (ICG) to assess such parameters as stroke index (SI), cardiac index (CI), velocity index (VI), acceleration index (ACI), Heather index (HI), systemic vascular resistance index (SVRI), and total arterial compliance index (TACI) as well as applanation tonometry to assess such parameters as central pulse pressure (CPP) and augmentation index (AI). These assessments were complemented by echocardiography to assess cardiac structure and function. Results: Compared with CD patients without obesity, individuals with CD and obesity (defined as a body mass index ≥ 30 kg/m²) exhibited significantly lower values of ICG parameters characterizing the pumping function of the heart (VI: 37.0 ± 9.5 vs. 47.2 ± 14.3 × 1*1000⁻¹*s⁻¹, p = 0.006; ACI: 58.7 ± 23.5 vs. 76.0 ± 23.5 × 1/100/s², p = 0.005; HI: 11.1 ± 3.5 vs. 14.6 ± 5.5 × Ohm/s², p = 0.01), whereas echocardiography in obese patients showed larger heart chamber sizes and a higher left ventricular mass index. No significant intergroup differences in blood pressure, heart rate, LVEF, GLS, TACI, CPP, or AI were noted. Conclusions: Hemodynamic changes associated with obesity already occur at an early stage of CD and manifest via significantly lower values of the ICG parameters illustrating the heart’s function as a pump, despite the normal function of the left ventricle in echocardiography.