Beata Wożakowska-Kapłon

Background: Heart failure (HF) and atrial fibrillation (AF) often coexist, and this has a major impact on prognosis. Only a limited amount of data is available on the effect of integrated strategies to improve prognosis in patients with HF and AF. We aimed to evaluate the association between HF subtype, HF optimal medical therapy (OMT), adherence to the Atrial Fibrillation Better Care (ABC) pathway, and all-cause death. Methods: Hospitalized patients and outpatients were enrolled in the Heart failuRe ObsErvational Study, which is a prospective, multicenter cohort study, between April 2022 and January 2024. Our analysis included patients with both HF and AF, who were divided into three groups: ABC + OMT, noABC + OMT, and noABC + noOMT. Results: A total of 627 patients, of whom 51.7% had HF with reduced ejection fraction, were included in this study. Direct oral anticoagulants were prescribed to 70.8% of patients, and 71.6% of these received the recommended doses. The patients were divided into the following groups: 49.8% were assigned to the ABC + OMT group, 25.2% to the noABC + OMT group, and 25% to the noABC + noOMT group. All-cause death occurred in 19.5% of patients. OMT compliance was associated with lower risk of all-cause death (HR0.61, 95% CI 0.42–0.9, p = 0.01), whereas management compliant with the ABC pathway was not (HR0.74, 95% CI 0.51–1.09, p = 0.12). In the ABC + OMT group, the risk of all-cause death was lower than in the noABC + noOMT group (HR0.60, 95% CI 0.39–0.92, p = 0.02). Conclusions: Integrated treatment strategies were implemented in half of the population with HF and AF, and this was associated with better long-term prognosis compared with patients who did not receive a complex treatment strategy.

Background/Objectives: Urgent hospitalization due to acutely decompensated heart failure (ADHF) is an unfavorable event in the trajectory of this disease. Patient condition during decompensation frequently limits opportunities to implement and optimize guideline-directed medical therapy (GDMT). To define the tasks of post-hospital care, it is essential to gain knowledge regarding the extent of GDMT implementation on the day of discharge after ADHF episodes. The purpose of this analisis was to evaluate GDMT changes during hospitalization due to ADHF, with a particular emphasis on patients with reduced ejection fraction. Methods: The analysis was conducted in a group of 262 patients hospitalized due to ADHF and with known left ventricular ejection fraction (LVEF). The HEROES study was a prospective, multi-center, observational study. Results: The mean age in the study group (196 men and 66 women) was 67.6 ± 14.6 years, with a mean LVEF of 33.9 ± 14.8%. Six patients died during hospitalization. In the analysis for the whole group (regardless of ejection fraction [EF]), ARNI (angiotensin receptor-neprilysin inhibitor)/ACEI (angiotensin-converting enzyme inhibitor)/ARB (angiotensin receptor blocker) use increased from 63.3% of the subjects at admission to 81.3% at discharge, beta-blocker use increased from 70.6% to 92.6%, MRA (mineralocorticoid receptor antagonist) use increased from 43.1% to 75.8%, and SGLT2i (sodium-glucose co-transporter 2 inhibitor) use increased from 30.1% to 75.0%. ARNI/ACEI/ARB therapy was optimized in 48.4% of the subjects, with optimization rates of 37.9%, 40.2%, and 44.1% for beta-blockers, MRAs, and SGLT2is, respectively. However, only 38 (22.0%) patients reached the level of treatment corresponding to “SGLT2i and ARNI/ACEI/ARB and betablocker and MRA in doses ≥ 50%”. Conclusions: In patients hospitalized due to ADHF in the HEROES study, the use of GDMT at discharge was significantly higher than at admission. In patients with reduced ejection fraction, GDMTs from all drug classes were prescribed to over 80% of patients. However, an insufficient number of patients attained high doses of GDMT, which emphasizes the need for effective dose up-titration in outpatient settings.

Retinal artery occlusion (RAO) is an emergency condition causing acute retinal ischemia and is considered an equivalent of ischemic stroke. The occurrence of an episode of RAO is associated with significant impairment of visual functions and correlates with an increased risk of future vascular events. Although RAO requires immediate diagnosis and treatment, there are currently no clear guidelines specifying optimal management. This review discusses current and future therapeutic strategies following an episode of RAO, including secondary prevention.

Background: The aim of the study was to assess the influence of a single haemodialysis (HD) session on the retinal and optic nerve morphology in end-stage kidney disease (ESKD) patients. Methods: It is a prospective study including only the right eye of 35 chronic kidney disease (CKD) patients subjected to HD. Each patient underwent a full eye examination 30 min before HD (8 a.m.) and 15 min after HD. Optical coherence tomography (OCT) was used to assess the peripapillary retinal nerve fibre layer (pRNFL) thickness, macular nerve fibre layer (mRNFL) thickness, ganglion cell layer with inner plexiform layer thickness (GCL+), GCL++ (mRNFL and GCL+) thickness, total retinal thickness (RT) and total macular volume (TMV). The correlation was tested between such systemic parameters changes as systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), body weight, plasma osmolarity and ocular perfusion pressure (OPP) and ultrafiltration volume with total RT and pRNFL thickness changes during HD. Results: In the results of a single HD session, we could observe a statistically significant increase in the total RT thickness (pre-HD 270.4 ± 19.94 μm, post-HD 272.14 ± 20.11 μm; p = 0.0014), TMV (pre-HD 7.48 ± 0.53 mm³, post-HD 7.52 ± 0.55 mm³; p = 0.0006), total pRNFL thickness (pre-HD 97.46 ± 15.71 μm, post-HD 100.23 ± 14.7 μm; p = 0.0039), total GCL+ thickness (pre-HD 70.11 ± 9.24 μm, post-HD 70.6 ± 9.7 μm; p = 0.0044), and GCL++ thickness (pre-HD 97.46 ± 12.56 μm, post-HD 97.9 ± 12.94 μm; p = 0.0081). We observed a significant correlation between the change in total RT and DBP change, as well as between body weight change and the change in total pRNFL thickness. There was also a correlation between total pRNFL thickness change and the presence of diabetes mellitus. Conclusion: Even a single HD session affects the retinal and pRNFL thickness, which should be taken into account when interpreting the OCT results in patients subjected to HD. The impact of changes after a single HD session on selected parameters requires further assessment in subsequent studies, including long-term observation.

Atrial fibrillation (AF) is the most common atrial tachyarrhythmia. One of the methods of AF treatment is direct current cardioversion (DCCV), but in the long-term follow-up we observe quite a high percentage of AF recurrences after this procedure. In order to assess the prognosis of DCCV effectiveness, we use clinical, biochemical and echocardiographic parameters. The objective of this review is to systematise the current knowledge on echocardiographic measurements in patients with persistent AF used to assess the progress of remodelling of the atrial wall, which affects the likelihood of maintaining sinus rhythm after DCCV. In this article, echocardiographic parameters for the evaluation of remodelling of the atrial wall are divided into groups referring to structural, mechanical, and electrical remodelling, as well as parameters for the evaluation of left ventricular filling pressure. The article aims to draw attention to the clinical value of echocardiographic measurements, which is the selection of patients who will maintain sinus rhythm after DCCV in the long-term follow-up, which will allow to avoid unnecessary risks associated with the procedure and enable the selection of the appropriate treatment strategy.

Przetrwały otwór owalny (PFO-patent foramen ovale) to pozostałość po płodowym połączeniu między przedsionkami serca, umożliwiająca przepływ utlenowanej krwi między prawym, a lewym przedsionkiem serca. Uważa się, że obecność PFO u osoby dorosłej może promować częstsze występowanie m.in. udarów mózgów, TIA, zatorowości obwodowej czy zawału serca, w mechanizmie zatorowości skrzyżowanej (paradoksalnej). Przedstawiamy przypadek 32 letniego pacjenta, z wieloletnim wywiadem migren, ze stwierdzonym w echokardiografii przezklatkowej tętniakiem przegrody międzyprzedsionkowej, diagnozowanego w Klinice kardiologii po udarze mózgu, potwierdzonym zmianami w obrazowaniu NMR. W echokardiografii przezprzełykowej stwierdzono przegrodę międzyprzedsionkową w okolicy fossa ovalis zbudowaną z dwóch blaszek, a pomiędzy nimi kanał, z widocznym strumieniem przepływu z lewego do prawego przedsionka. Podczas wykonaniu próby Valsalvy blaszka tkankowa od strony lewego przedsionka uchylała się zwiększając szerokość kanału,a po zastosowaniu kontrastu zarejestrowano odwrócenie kierunku przepływu. Po zakończonej diagnostyce i wykluczeniu innych przyczyn udaru , pacjenta zakwalifikowano do zamknięcia PFO, ze względu na zwiększone ryzyko nawrotu niedokrwienia mózgu. Jeśli pacjent ma wskazania do przewlekłej OAC, zalecane jest raczej leczenie farmakologiczne. Zaś u pacjentów po przebytym udarze mózgu/TIA z potwierdzonymi zmianami w badaniach neuroradiologicznych (TK, MR), < 60r.ż., przy obecności PFO i co najmniej jednego czynnika podwyższonego ryzyka nawrotu wskazane jest zamknięcie PFO. U pacjentów po incydencie mózgowym oraz ze stwierdzonym kanałem PFO ale bez innych czynników ryzyka również taki zabieg należy rozważyć. Przetrwały otwór owalny (PFO-patent foramen ovale) to pozostałość po płodowym połączeniu między przedsionkami serca, umożliwiająca przepływ utlenowanej krwi między prawym, a lewym przedsionkiem serca. Uważa się, że obecność PFO u osoby dorosłej może promować częstsze występowanie m.in. udarów mózgów, TIA, zatorowości obwodowej czy zawału serca, w mechanizmie zatorowości skrzyżowanej (paradoksalnej). Przedstawiamy przypadek 32 letniego pacjenta, z wieloletnim wywiadem migren, ze stwierdzonym w echokardiografii przezklatkowej tętniakiem przegrody międzyprzedsionkowej, diagnozowanego w Klinice kardiologii po udarze mózgu, potwierdzonym zmianami w obrazowaniu NMR. W echokardiografii przezprzełykowej stwierdzono przegrodę międzyprzedsionkową w okolicy fossa ovalis zbudowaną z dwóch blaszek, a pomiędzy nimi kanał, z widocznym strumieniem przepływu z lewego do prawego przedsionka. Podczas wykonaniu próby Valsalvy blaszka tkankowa od strony lewego przedsionka uchylała się zwiększając szerokość kanału,a po zastosowaniu kontrastu zarejestrowano odwrócenie kierunku przepływu. Po zakończonej diagnostyce i wykluczeniu innych przyczyn udaru , pacjenta zakwalifikowano do zamknięcia PFO, ze względu na zwiększone ryzyko nawrotu niedokrwienia mózgu. Jeśli pacjent ma wskazania do przewlekłej OAC, zalecane jest raczej leczenie farmakologiczne. Zaś u pacjentów po przebytym udarze mózgu/TIA z potwierdzonymi zmianami w badaniach neuroradiologicznych (TK, MR), < 60r.ż., przy obecności PFO i co najmniej jednego czynnika podwyższonego ryzyka nawrotu wskazane jest zamknięcie PFO. U pacjentów po incydencie mózgowym oraz ze stwierdzonym kanałem PFO ale bez innych czynników ryzyka również taki zabieg należy rozważyć.

The study presents a case of a 72-year-old patient who developed heparin-induced thrombocytopenia during hospitalization for non-ST elevation myocardial infarction. The coexistence of both conditions poses a significant problem regarding treatment in such patients. The authors discuss the management used and current standards of care in the course of this disease. The study presents a case of a 72-year-old patient who developed heparin-induced thrombocytopenia during hospitalization for non-ST elevation myocardial infarction. The coexistence of both conditions poses a significant problem regarding treatment in such patients. The authors discuss the management used and current standards of care in the course of this disease.

Introduction and objective: Retinal artery occlusion (RAO) is an ophthalmic and systemic emergency requiring urgent diagnosis and treatment. Data regarding mortality in this group, especially in the European population, are modest. The aim of this study is to assess all-cause mortality in...

Atrial fibrillation (AF) is associated with an increased risk of stroke. Therefore, patients with AF require appropriate management and anticoagulant therapy. To balance therapy risks and benefits, oral anticoagulants (OAC) treatment should be ‘tailored’ in patients at a high risk of stroke and bleeding. However, some studies have demonstrated that certain groups of patients do not receive anticoagulants despite the high risk of stroke or thromboembolism. The study aimed to analyse therapeutic methods of stroke prevention in very high-risk patients (CHA₂DS₂-VASc score of ≥5 in men and ≥6 in women), identify factors predisposing against the use of OACs and assess the administration of anticoagulants before the introduction of non-vitamin K antagonist OAC (NOAC) in 2004–2011 and beyond (years 2012–2019). The analysis covered 2441 patients with AF at a very high thromboembolic risk who were hospitalised in a reference cardiological centre from 2004 to 2019. Data concerning patients’ sex, age, comorbidities, type of AF, renal and echocardiographic parameters, reasons for hospitalisation and applied treatment were collected from medical records. HAS-BLED, CHADS₂, and CHA₂DS₂-VASc scores were calculated for all patients. The treatment with oral anticoagulants was compared in the entire population over 2004–2011 and 2012–2019. In this study, a fifth of patients were not treated with OAC. Most patients hospitalised in the years 2012–2019 were treated with OAC. The predictors of not using OAC turned out to be: age of >74 years, heart failure, cancer, paroxysmal AF, and acute coronary syndrome (ACS) or elective coronary angiography/percutaneous coronary intervention (PCI) as a reason for hospitalisation. The introduction of NOAC was associated with a decline in the use of VKA (from 62% to 19.1%) and APT (from 29.1% to 1.3%). This study outlines reasons to initiate OAC treatment in very high-risk patients in clinical practice.

Atrial fibrillation (AF) is known to be a significant risk factor for poor prognosis after stroke. In this study, we compared differences in long-term outcomes after ischemic stroke among patients with AF and sinus rhythm (SR). We identified patients admitted to the reference Neurology Center between 1 January 2013 and 30 April 2015, inclusive, with acute ischemic stroke. Of the 1959 surviving patients, 892 were enrolled and followed for five years or until death. We analyzed the risk of stroke recurrence and death between patients with AF and SR at 1, 3, and 5 years after stroke. The rates of death and stroke recurrence were estimated using Kaplan–Meier analysis and multivariate Cox regression. During follow-up, 17.8% of patients died and 14.6% had recurrent stroke. The mortality in the AF group increased relative to the SR group with subsequent years. The risk of death was statistically higher in the AF than SR group at 1 year after stroke (13.5 vs. 7%, p = 0.004). After adjusting for age, stroke severity, and comorbidities, there was also no significant effect of AF on mortality in the first year after stroke (OR = 1.59, p = 0.247). There were no significant differences between the groups in stroke recurrence during follow-up. The results of our study showed that post-stroke patients with AF have a more severe prognosis, although AF itself does not have an independent negative effect on long-term outcomes after stroke. Long-term survival after stroke in patients with AF was strongly associated with age, stroke severity, and heart failure. The impact of other factors on prognosis after stroke in patients with AF should be considered.