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Challenges in the treatment of patients with Brugada syndrome: The current role of ablation
No full textBrugada syndrome is an inherited ion channelopathy associated with an increased risk for ventricular arrhythmia and sudden death. Current management strategies to reduce arrhythmic risk are limited, with few pharmacological options, which may be ineffective or cause side-effects leading to suboptimal dosing or cessation of treatment. Hence, there is substantial interest in determining the long-term efficacy and safety profile of catheter ablation, as well as targeting triggers and electrophysiological substrates for ventricular arrhythmia. With the recent publication of small, randomized trials including the BRAVE study, the level of evidence is improving. However, the balance of risk verses benefit across the arrhythmic risk spectrum remains unclear, and procedural technical challenges remain, particularly given that most patients will require an epicardial approach for catheter ablation. This review outlines the current evidence in the published literature and highlights gaps in knowledge that should be prioritized in future studies
How does direct oral anticoagulant dosage affect long-term prognosis in patients with atrial fibrillation and heart failure? Results from the HEart failure ObsErvational Study (HEROES)
No full textBackground: Most patients with heart failure (HF) and atrial fibrillation (AF) require direct oral anticoagulants (DOACs) at appropriate doses.Aims: We analyzed the prevalence of non-recommended DOAC prescriptions and their influence on long-term prognosis.Material and methods: Patients with HF were included in the Heart failure ObsErvational Study, an observational, multicenter study. HF patients with AF treated with DOACs were included in the analysis.Results: Among the 459 patients, 46.8% were treated with apixaban, 34.9% were treated with rivaroxaban, and 18.3% with dabigatran. 71.7% of patients were treated with recommended doses of DOACs, 18.3% with doses lower than recommended and 10% with doses higher than recommended. The strongest factors associated with higher than recommended doses of prescribed DOACs were age ≥70.2 years (odds ratio [OR], 8.32; confidence interval [CI], 1.44–83.14; P = 0.03) and glomerular filtration rate <50 ml/min (OR, 34.16; CI, 6.18–324.93; P <0.001). The strongest factors associated with lower than recommended doses of DOACs were hemoglobin <12 g/dl (OR, 2.18; CI, 1.04–4.63; P = 0.039) and HF New York Heart Association class III/IV (OR, 2.82; CI, 1.2–7.23; P = 0.02). The risk of all-cause death was not significantly associated with receiving either higher or lower than recommended DOAC doses.Conclusions: In the present study, a significant percentage of patients with AF and HF received non-recommended doses of DOACs. Factors that predisposed to the prescription of non-recommended DOAC doses included those that increased the risk of bleeding and thromboembolic complications. All-cause death in patients with HF and AF was not influenced by non-recommended DOAC doses
Comparative analysis of direct routine left ventricular guidewire pacing and right ventricular pacing: A faster and safer approach to TAVR
No full textBackground: Traditional right ventricular (RV) pacing during transcatheter aortic valve replacement (TAVR) carries risks such as vascular complications and pericardial effusion. Alternative pacing strategies, such as routine left ventricular (LV) guidewire pacing, may offer improved outcomes by simplifying procedures and enhancing safety.Aims: This study aimed to evaluate the efficacy and safety of routine LV guidewire pacing compared to RV pacing in patients undergoing TAVR.Material and methods: A total of 635 patients undergoing TAVR were included, with 436 in the LV pacing group and 199 in the RV pacing group. Outcomes were assessed at 30 days, focusing on all-cause and cardiovascular mortality, composite safety outcomes, and procedure-related complications. Subgroup analyses examined the impact of different RV pacing lead types on outcomes.Results: LV pacing demonstrated lower all-cause mortality (5.1 vs. 11.4%) and cardiovascular mortality (4.6 vs. 9.4%) at 30 days compared to RV pacing. However, adjusted analyses showed no significant differences (aHR, 1.69; 95% CI, 0.88–3.26; P = 0.112). Composite safety outcomes (pericardial, vascular complications, and bleeding) significantly favored LV pacing (aHR, 2.43; 95% CI, 1.44–4.12; P <0.001), with fewer pericardial complications (aHR, 7.15; 95% CI, 2.52–20.28; P <0.001) and inguinal hematomas (aHR, 2.01; 95% CI, 1.02–3.97; P = 0.042). Subgroup analysis showed that balloon-tipped RV leads produced outcomes comparable to LV pacing, while conventional RV leads were associated with higher mortality risks (aHR, 2.86; 95% CI, 1.41–5.78; P = 0.003).Conclusions: Routine LV pacing offers significant advantages over RV pacing, including reduced complication rates, shorter procedure times, and greater efficiency. These findings support its potential as a safer and more effective standard pacing strategy in TAVR, pending further validation through randomized trials
Differentiation of non-ST-segment elevation myocardial infarction from unstable angina using coronary computed tomography angiography: the role of imaging features and pericoronary adipose tissue radiomics
No full textBackground: To ascertain the diagnostic value of radiomic features of pericoronary adipose tissue (PCAT) and other coronary computed tomography angiography (CCTA) parameters for differentiating non-ST-segment-elevation myocardial infarction (NSTEMI) from unstable angina (UA).
Methods: This study included NSTEMI and UA patients (n = 102 each). The radiomic features of PCAT were selected according to the intraclass correlation coefficient, Pearson’s coefficient, the t test, and least absolute shrinkage and selection operator. Six classifiers—random forest, support vector machine, naive Bayes, K-nearest neighbors, extreme gradient boosting, and light gradient boosting machine (LightGBM)—were used to build radiomics models, and the best were selected. Four CCTA parameter models, encapsulating plaque parameters (model 1), plaque parameters + fatty attenuation index (FAI) (model 2), plaque parameters + CT fractional flow reserve (CT-FFR) (model 3), and plaque parameters + CT-FFR + FAI (model 4), were constructed. Finally, we established a fusion model (nomogram) with all CCTA parameters and radiomics model scores. All models were compared regarding their performance.
Results: The LightGBM radiomics model achieved the highest AUC. Among CCTA parameter models, only model 4 achieved a predictive performance similar to that of the radiomics model in the training and test cohorts (AUC = 0.904 vs. 0.898 and 0.860 vs. 0.877). The combined model (nomogram) showed greater predictive efficacy (AUC = 0.963, 0.910) than model 4 or the radiomics model.
Conclusion: The PCAT-based radiomics model accurately distinguishes between NSTEMI and UA, with similar diagnostic performance as the model that combined all the significant CCTA parameters. The nomogram integrating CCTA parameters and the radiomic score has good clinical application prospects
Long-term safety and efficacy of self-apposing Stentys drug-eluting stent in left main stem percutaneous coronary intervention: final results of multicentre LM-STENTYS registry
No full textBackground: Stentys drug-eluting stent (Stentys DES) was proposed to possess potential benefits over balloon-expandable platforms in large bifurcations, mainly distal left main stem (LMS). Several registries demonstrated favourable one-year clinical results of percutaneous coronary intervention (PCI) using Stentys DES for LMS disease. However, long-term follow- up data have been lacking hitherto.
Methods: The study enrolled 175 consecutive patients who underwent PCI with Stentys DES for unprotected LMS and categorized them into acute- and chronic coronary syndrome (ACS/CCS). The primary endpoint was major adverse cardiac and cerebral events (MACCE) composed of cardiac death, myocardial infarction (MI), target lesion revascularization (TLR), and stroke assessed at five years. The secondary endpoints were stent thrombosis (ST), restenosis and target vessel revascularization (TVR).
Results: Clinical follow-up at five years was completed for 124 out of 175 patients (70.9%), encompassing 85 with ACS and 39 with CCS. At five years, MACCE occurred in 55 out of 124 patients (44.4%). Although, there was a higher rate of MACCE (53% vs 28.2%, p = 0.018), MI (27.1% vs 2.6%, p = 0.016) and TLR (20% vs 2.6%, p = 0.036) in ACS vs. CCS patients, the rates of cardiac deaths were similar (27.1% vs. 25.6%, p = 0.77, respectively).
Conclusions: Herein, favourable long-term outcome of LMS PCI with Stentys DES in the CCS setting are shown. In the ACS setting, worse one-year outcome persisted at five years and was partially related to high rate of acute/subacute ST that might be optimized by immediate loading with potent antiplatelet drugs
Short- and long-term outcomes of Impella-protected, high-risk, elective PCI in patients with multivessel coronary disease and low ejection fraction — Polish Impella Registry
No full textBackground: The Impella percutaneous mechanical circulatory support device provides improved support in treating patients with high-risk percutaneous coronary interventions (HR-PCI) or in cardiogenic shock. IMPELLA-PL is a multicenter registry developed to share clinical data and experiences using Impella technology in Poland. The retrospective analysis conducted in this study aims to fill the knowledge gap of Impella performance in patients with multivessel coronary artery disease (CAD) and depressed left ventricular ejection fraction (EF) (≤ 30%) treated with HR-PCI.
Methods: Retrospective data were analyzed from patients presenting with multivessel coronary disease and low EF treated with Impella CP collected from 20 Polish interventional cardiology centers registered with IMPELLA-PL to assess the safety and efficacy in short- and long-term clinical outcomes.
Results: A total of 115 patients with low EF received Impella CP support during HR-PCI. The success rate of Impella supported HR-PCI was high (99.1%) with an average hospital stay of 15.6 ± 10.7 days. The right femoral artery was the most common access (55.7%) followed by the left femoral artery (37.4%). The in-hospital mortality rate was 6.1%, and the all-cause mortality rate at one year was 13.9%.
Conclusions: High-risk PCI with Impella CP periprocedural support was safe and effective in patients with low EF (≤ 30%). The all-cause mortality rate (6.1% and 13.9%, respectively, for in-hospital and at 12-months) was comparable with other Impella registries
Cavernous transformation of the portal vein in blood pool scintigraphy
No full textA patient suspected of having two hepatic hemangiomas was referred to the department of nuclear medicine for verification of the diagnosis. A blood pool scintigraphy confirmed the presence of one of the hemangiomas. In addition, it revealed a region of increased activity, that corresponded with the cavernous transformation of the portal vein (CTPV), a rare consequence of portal vein thrombosis, diagnosed in the previous imaging studies. Due to the increased blood pool, this focal lesion imitated the image of a hemangioma. This publication aims to emphasize the importance of a carefully conducted patient interview and evaluation of other imaging studies to avoid misdiagnosis
Lublin Comorbidity of Adiposity Study (LUCAS 1.0 BMI) — quantifying the success of a region-wide overweight and obesity treatment program: a retrospective real‑world data analysis
No full textIntroduction: Obesity has emerged as a global health epidemic, which carries significant implications for both individual health and healthcare systems worldwide. Numerous reports have shown the health advantages associated with a 5–10% reduction of one’s initial body weight, but it remains unclear whether the data from clinical trials translate to real-world clinical practice. In our retrospective analysis, we evaluated the effectiveness of a multifactorial obesity treatment, including pharmacotherapy, in Polish conditions. The objective was to assess the efficacy of this multimodal treatment in achieving a 5–10% weight reduction over 3–6 months.
Material and methods: The patient cohort included 1114 adults: 243 (22%) men and 871 (78%) women, aged 16–80 years, diagnosed with obesity and overweight in a team-based obesity treatment program with one-day-stay admissions. Each patient underwent a tailored multifactorial obesity treatment regimen, which incorporated dietary adjustments, physical activity, psychological support, and pharmacotherapy.
Results: Weight reduction was observed in 868 (78%) patients. Of these, 635 (57%) achieved a 5% weight reduction, and 379 (34%) achieved a 10% reduction. No significant gender differences were found in weight reduction. Unlike clinical trials, weight reduction was similar between those receiving only behavioral treatment and those also on medication. The profile of a good responder in real-world conditions included high adherence to recommendations and follow-up visits, and absence of type 2 diabetes.
Conclusions: Our study demonstrates that obesity can be effectively managed through individualized multimodal treatment. Nonetheless, this process demands sustained effort and necessitates individualized therapy overseen by a multidisciplinary therapeutic team
Hemorrhages into the central nervous system in pediatric patients with hemophilia in Polish centers between 1999 and 2024
No full textIntroduction: Intracranial hemorrhage (ICH) is quite an uncommon complication of hemophilia in children but still poses a life-threatening condition. The aim of our study was to present an analysis of risk factors, clinical presentation, and results of treatment of ICH in a group of Polish pediatric patients suffering from hemophilia A and B.
Material and methods: Our report is based on a questionnaire and describes the cases of ICH that were diagnosed and treated in seven centers of pediatric hematology in Poland between 1999 and 2024.
Results: We present an analysis of both the data concerning the underlying condition (type and severity of hemophilia, presence of inhibitor) and the data summarizing a bleeding episode (age at the onset of bleeding, trigger factors, symptoms, treatment, and outcome).
Discussion: The data concerning our group of patients are quite consistent with analyses from other centers that have been published previously. Physicians should be familiar with triggering factors and symptoms of ICH in hemophilia patients, which can be non-specific. A concentrate of the appropriate clotting factor should be administered to the patient as soon as possible after head injury, as early implementation of treatment improves the outcome. The need for good primary prophylaxis in all children with hemophilia after intensive treatment for intracranial bleeding should be highlighted.
Conclusions: We consider the treatment outcomes for children with hemophilia and bleeding into the central nervous system to be good. Nevertheless, the clinical presentation of this complication may not always be obvious, and management usually requires a multidisciplinary, experienced team
Harnessing the synergy of contact brachytherapy and immune checkpoint inhibitors in advanced melanoma: first reported case series
No full textBackground: Melanoma is an aggressive malignancy with high metastatic potential, often requiring systemic treatment with immune checkpoint inhibitors (CHI) in advanced stages. While CHI has significantly improved outcomes, its combination with local radiotherapy — particularly brachytherapy (BT) — may further enhance therapeutic efficacy by promoting immunogenic tumor cell death. BT enables precise delivery of high radiation doses, providing rapid symptom relief and potentially triggering local and systemic immune responses. This case series presents the first known clinical experience with noninvasive contact high-dose-rate brachytherapy (HDR-BT) combined with CHI in patients with metastatic melanoma treated in a palliative setting.
Materials and methods: We retrospectively analyzed four patients with stage IV melanoma and symptomatic subcutaneous metastases, all receiving ongoing CHI (nivolumab or pembrolizumab). Each underwent a single HDR-BT session (5–7 Gy) using a Freiburg Flap applicator. The primary goal was symptom relief. Treatment response was assessed clinically and radiologically, focusing on local control, response of non-irradiated lesions, progression-free survival (PFS), and overall survival (OS).
Results: All patients experienced rapid clinical improvement and significant regression of the irradiated lesion, with minimal (Grade 0–1) acute skin toxicity. In two cases, complete remission of treated sites was achieved. One patient demonstrated long-term remission in both subcutaneous and visceral metastases. Median PFS was 3.4 months (range: 1.5–15.0), and OS ranged from 8.5 to 22 months.
Conclusions: Single-fraction contact HDR-BT in combination with CHI appears to be a safe and effective palliative strategy for metastatic melanoma, offering fast local control, minimal toxicity, and potential systemic immune benefits.