Piotr Kasprzyk

Background/Objectives: Haemodynamic assessment during primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) is mostly restricted to continuous monitoring of arterial blood pressure. The volume-clamp method provides continuous non-invasive arterial pressure monitoring without the need for vascular access, together with simultaneous estimation of stroke volume, cardiac output and other haemodynamic variables, but its feasibility during primary PCI has not been evaluated. Methods: In this prospective observational study, 33 patients with STEMI undergoing primary PCI were monitored continuously (Acumen IQ, HemoSphere) at seven pre-specified timepoints: baseline, guidewire crossing of the culprit lesion, stent implantation, end of procedure, and after 1, 6 and 24 h. Patients with cardiogenic shock, ongoing cardiopulmonary resuscitation or symptom onset more than 24 h before admission were excluded. Cardiac index (CI), stroke volume index (SVI), systemic vascular resistance index (SVRI), pulse rate, dP/dt, mean arterial pressure (MAP) and the Hypotension Prediction Index (HPI) were analysed using linear mixed models with Holm correction within families of related tests. Results: Patients were aged 65.4 ± 12.7 years and 25 (76%) were men. The culprit vessel was the left anterior descending artery in 15 patients (45%), and ST-segment resolution exceeding 50% was achieved in 25 patients (76%). The overall time effect was significant for six of seven variables, all except pulse rate. At guidewire crossing, dP/dt rose by 183.7 mmHg/s (95% CI 87–276) in 25 of 29 patients (86%; corrected p = 0.008), with a concurrent rise in CI (corrected p = 0.042) and no change in pulse rate or MAP. At 24 h, CI, SVI and dP/dt were indistinguishable from baseline, whereas MAP (−13.7 mmHg) and SVRI (−427 dyn·s·cm⁻⁵·m²) were lower. SVI and MAP were unrelated (r = +0.057; p = 0.431) across 227 measurements, while SVI and pulse rate were inversely coupled (r = −0.434) in 28 of 33 patients. Increasing age was associated with lower CI and MAP and higher HPI values, but not with the change in arterial dP/dt at guidewire crossing. Patients with TIMI 0 flow had higher SVRI by 510 dyn·s·cm⁻⁵·m². Baseline pulse rate and its changes were different depending on the culprit vessel. Conclusions: Continuous non-invasive haemodynamic monitoring was feasible during primary PCI for STEMI. Given the small sample, the absence of a control group and the lack of validation against a reference method, the findings are exploratory and their clinical value remains to be established.

(1) Background: Lung cancer screening (LCS) consists of low-dose computed tomography (LDCT) results to reduce lung cancer-related mortality. The LCS program has a unique opportunity to impact CVD mortality by providing tools for CVD risk assessment and implementing preventative strategies. In this study, we estimated standardized CVD risk (SCORE) and assessed the prevalence of coronary artery calcium (CAC) in a Polish LCS cohort. (2) Methods: In this observational study, 494 LCS participants aged 50–79 years with a cigarette smoking history of at least 30 pack-years were included. Medical history, anthropometric measurements, blood pressure measurements, serum glucose, and cholesterol levels were assessed in one visit. CVD risk assessment using SCORE tables was performed. The results were compared to the general population (NATPOL 2011 study). On LDCT scans, CAC was classified using an Ordinal Score ranging from 0 to 12. (3) Results: The prevalence of classic cardiovascular risk factors was very high. Among study participants, 83.7% of men and 40.7% of women were classified with a very high CVD SCORE risk (>10%). CAC was reported in 190 (47%) participants. Calcification was categorized as severe (CAC ≥ 4) in 84 (21%) participants. (4) Conclusions: Due to the high cardiovascular risk, intensive preventive strategies are recommended for LCS participants.

In this article, we discuss the topic of chronic thromboembolic pulmonary disease (CTEPD) and the growing role of balloon pulmonary angioplasty (BPA) in its treatment. We present the pathophysiology of CTEPD which arises from an incomplete resolution of thrombi in the pulmonary arteries and leads to stenosis and occlusion of the vessels. The article focuses mainly on the chronic thromboembolic pulmonary hypertension (CTEPH) subpopulation for which prognosis is very poor when left untreated. We describe a multimodal approach to treating CTEPH, including pulmonary endarterectomy (PEA), BPA, and pharmacological therapies. Additionally, the benefits of pharmacological pre-treatment before BPA and the technical aspects of the procedure itself are outlined. It is emphasized that BPA does not replace PEA but serves as a complementary treatment option for eligible patients. We summarized efficacy and treatment goals including an improvement in functional and biochemical parameters before and after BPA. Patients who received pre-treatment with riociguat prior to BPA exhibited a notable reduction in the occurrence of less severe complications. However, elderly patients are still perceived as an especially vulnerable group. It is shown that the prognosis of patients undergoing BPA is similar to PEA in the first years after the procedure but the long-term prognosis of BPA still remains unclear. The 2022 ESC/ERS guidelines highlight the significant role of BPA in the multimodal treatment of CTEPH, emphasizing its effectiveness and recommending its consideration as a therapeutic option for patients with CTEPD, both with and without pulmonary hypertension. This review summarizes the available evidence for BPA, patient selection, procedural details, and prognosis and discusses the potential future role of BPA in the management of CTEPH.

Comorbidities and clinical outcomes of a lung cancer screening trial participants with chronic obstructive pulmonary disease in three-year follow-up. Background: To improve the effectiveness of lung cancer screening using low-dose computed tomography (LDCT), the presence of smoking-related comorb...