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Heart failure in the course of peripartum cardiomyopathy followed by ECMO and Impella implantation and heart transplantation
No full textInfluence of renal function and dose of non-vitamin K antagonist oral anticoagulants on left atrial thrombus risk in patients with atrial fibrillation. Results from the multicenter LATTEE study
No full textBackground: Renal dysfunction increases thromboembolic risk but is not consistently included in standard risk scores.
Aims: To compare the prevalence of left atrial thrombus (LAT) in atrial fibrillation (AF)/atrial flutter (AFl) patients based on renal function and oral anticoagulant (OAC) regimens.
Material and methods: Consecutive AF/AFl patients undergoing transesophageal echocardiography before cardioversion or ablation were included.
Results: Among 2790 patients with creatinine clearance (CrCl) data, 89% had CrCl ≥50 ml/min, 9.6% had CrCl 30–49 ml/min, and 1.5% had CrCl <30 ml/min. LAT prevalence was 6.7%, 16%, and 19%, respectively (P = 0.008). CrCl <50 ml/min was an independent predictor of LAT (odds ratio [OR], 1.81; 95% confidence interval [CI], 1.25–2.64). Of 2028 patients treated with non-vitamin K antagonist OACs (NOACs), 17% received reduced doses, with 56% of these reductions deemed inappropriate. LAT prevalence was higher with reduced NOAC doses (12%) compared to standard doses (4.6%, P <0.001). Patients with no indication for dose reduction but receiving reduced doses had a higher LAT risk (12% vs. 4.2%; P <0.001). Among those with an indication for reduced doses, LAT prevalence was similar (11%) regardless of dose appropriateness. There were no significant differences in LAT prevalence among different NOACs. Inappropriate NOAC dosing increased LAT risk (OR, 1.74; 95% CI, 1.11–2.73). Inappropriate dose reductions, especially with apixaban and rivaroxaban, was the main issue in inappropriate NOAC prescribing, likely influenced by age, bleeding risk, anemia, low CrCl, and antiplatelet use.
Conclusions: AF patients with CrCl <50 ml/min face a doubled LAT risk despite OAC therapy. Inappropriate NOAC dosing, particularly with apixaban and rivaroxaban, leads to double LAT risk
In-hospital and 1-year outcomes of mitral transcatheter edge-to-edge repair in Poland derived from an all-comers administrative database
No full textBackground: Transcatheter mitral edge-to-edge repair (TEER) is an effective and safe therapeutic option for patients with severe mitral regurgitation (MR) and may be used in treatment of both the primary and secondary MR. Aims: To provide insights into patients’ characteristics, in-hospital procedural outcomes and 1-year follow-up for 1204 patients with severe MR treated with TEER in Poland. Methods: A comprehensive, all-comers, administrative database that covers the whole population of Poland was searched for all reimbursed TEER procedures performed since 2019. Electronic health records provided details regarding baseline study group characteristics as well as the in-hospital and 1-year outcomes. Results: The in-hospital mortality was 3.2% with no difference between sexes. Blood transfusion was required in 7.8% of patients, more frequently in women (11.1% vs. 6.1%; P = 0.004). Patients with atrial fibrillation had a higher rate of in-hospital heart failure in New York Heart Association functional class II–IV vs. I (66.8% vs. 42.5%; P <0.001). Mean follow-up was 336.7 days, the mortality rate was 13.9% and was comparable between males and females and patients with and without atrial fibrillation. 54.5% of patients required a heart failure hospitalization and 65.0% a cardiovascular hospitalization. Mortality was comparable to other European registries, rates of heart failure hospitalization were higher in the Polish population. Conclusions: Polish TEER registry provides real-world data on transcatheter edge-to-edge repair procedures, demonstrating outcomes comparable to other European registries despite a higher-risk patient population
Survival of patients with cardiac implantable electronic device infections after transvenous lead extraction
No full textBackground: Cardiac implantable electronic device (CIED) infections, particularly CIED-associated infective endocarditis (CIED-associated IE), are associated with a high 1-year mortality rate of 14% to 35%, reduced quality of life, and increased burden on the healthcare system.
Aims: In this prospective, single-center, high-volume referral study, we aimed to analyze and compare 3 groups of patients who underwent transvenous lead extraction (TLE): patients with CIED-associated IE, patients with pocket infection (PI), and both.
Methods: This study included all consecutive patients with CIEDs who underwent TLE due to device-related infection at a tertiary referral hospital between 2011 and 2023. Patients were divided into 3 groups (CIED-associated IE, PI and both indications) based on the modified Duke criteria.
Results: A total of 253 consecutive patients underwent TLE. Of these, 135 (53%) were treated for PI, 90 (36%) for CIED-associated IE and 28 (11%) for both indications. Almost all procedures (97%) were completed without complications.
Patients with CIED-associated IE had significantly higher mortality than patients in the CIED-associated IE + PI group and patients in the PI group had the lowest. One-year, two-year, and five-year overall survival rates in the CIED-associated IE group were 61%, 49%, and 32%, respectively, compared with 77%, 73%, and 56% in the CIED-associated IE + PI group and with 90%, 86%, 67% in the PI group (P <0.001).
Conclusions: Patients with CIED-associated IE had almost a 4-fold higher 1-year mortality compared to those with PI. Patients with CIED-associated IE and PI had about twice higher one-year mortality compared to those with PI
Update on the epidemiology, healthcare utilization, and economic burden of heart failure in Poland (2015–2025)
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