Heart failure (HF) is the only cardiovascular disease with an ever increasing incidence. HF, through reduced functional capacity, frequent exacerbations of disease, and repeated hospitalizations, results in poorer quality of life, decreased work productivity, and significantly increased costs of the public health system. The main challenge in the treatment of HF is the availability of reliable prognostic models that would allow patients and doctors to develop realistic expectations about the prognosis and to choose the appropriate therapy and monitoring method. At this moment, there is a lack of universal parameters or scales on the basis of which we could easily capture the moment of deterioration of HF patients’ condition. Hence, it is crucial to identify such factors which at the same time will be widely available, cheap, and easy to use. We can find many studies showing different predictors of unfavorable outcome in HF patients: thorough assessment with echocardiography imaging, exercise testing (e.g., 6-min walk test, cardiopulmonary exercise testing), and biomarkers (e.g., N-terminal pro-brain type natriuretic peptide, high-sensitivity troponin T, galectin-3, high-sensitivity C-reactive protein). Some of them are very promising, but more research is needed to create a specific panel on the basis of which we will be able to assess HF patients. At this moment despite identification of many markers of adverse outcomes, clinical decision-making in HF is still predominantly based on a few basic parameters, such as the presence of HF symptoms (NYHA class), left ventricular ejection fraction, and QRS complex duration and morphology.

Purpose: The aim of the study was to assess the relationship of dehydration, body mass index (BMI) and other indices with the occurrence of atrial fibrillation (AF) in heart failure (HF) patients.Methods: The study included 113 patients [median age 64 years; 57.52% male] hospitalized due to HF. Baseline demographics, body mass analysis, echocardiographic results, key cardiopulmonary exercise test (CPET) parameters, 6 min walk distance (6MWD) and Kansas City Cardiomyopathy Questionnaire (KCCQ) score were assessed.Results: Of all patients, 23 (20.35%) had AF, and 90 (79.65%) had sinus rhythm (SR). Patients with AF were older (med. 66 vs. 64 years; p = 0.039), with higher BMI (32.02 vs. 28.51 kg/m2; p = 0.017) and percentage of fat content (37.0 vs. 27.9%, p = 0.014). They were more dehydrated, with a lower percentage of total body water (TBW%) (45.7 vs. 50.0%; p = 0.022). Clinically, patients with AF had more often higher New York Heart Association (NYHA) class (III vs. II; p < 0.001), shorter 6MWD (median 292.35 vs. 378.4 m; p = 0.001) and a lower KCCQ overall summary score (52.60 vs. 73.96 points; p = 0.002). Patients with AF had significantly lower exercise capacity as measured by peak oxygen consumption (peak VO2) (0.92 vs. 1.26 mL/min, p = 0.016), peak VO2/kg (11 vs. 15 mL/kg/min; p < 0.001), and percentage of predicted VO2max (pp-peak VO2) (62.5 vs 70.0; p=0.010). We also found VE/VCO2 (med. 33.85 vs. 32.20; p = 0.049) to be higher and peak oxygen pulse (8.5 vs. 11 mL/beat; p = 0.038) to be lower in patients with AF than in patients without AF. In a multiple logistic regression model higher BMI (OR 1.23 per unit increase, p < 0.001) and higher left atrial volume index (LAVI) (OR 1.07 per unit increase, p = 0.03), lower tricuspid annular plane systolic excursion (TAPSE) (OR 0.74 per unit increase, p =0.03) and lower TBW% in body mass analysis (OR 0.90 per unit increase, p =0.03) were independently related to AF in patients with HF.Conclusion: Increased volume of left atrium and right ventricular systolic dysfunction are well-known predictors of AF occurrence in patients with HF, but hydration status and increased body mass also seem to be important factors of AF in HF patients.

Background. Care for patients with heart failure (HF) in Poland requires improvement. Objectives. The aim of this study was to define the journey of the HF patient, taking into account the specialization of the hospital ward and further, highly specialized outpatient care. Material and methods. Using the medical system CliniNET ® , we analyzed 214 consecutive patients hospitalized due to HF (International Statistical Classification of Diseases and Health Related Problems-ICD-10: I50) in the period from September 1 to December 31, 2015, and also the data from post-discharge outpatient care in a 3-month period. To fairly compare the management of care and outcomes of patients hospitalized in the internal medicine (IM) ward and in the cardiac ward, propensity score matching was performed. The multivariate regression analysis was performed to determine the independent predictors of the hospital ward selection and the risk of rehospitalization due to HF and/or death. Results. The majority of patients were hospitalized due to HF for the first time (72%) and in the cardiac ward (65%). For 55% of rehospitalized patients, the subsequent admission was within 3 months after initial discharge. The independent predictors of a higher risk of rehospitalization due to HF and/or death were ischemic heart disease, atrial fibrillation (AF), chronic kidney disease (CKD), mineralocorticoid antagonism (MRA) therapy, and hospitalization in the last year (for all, p < 0.05). Internal medicine ward patients differed from cardiac ward patients in: mode of admission (urgent 100% vs 83.5%; p < 0.001), length of hospitalization (median: 8 days vs 5 days; p = 0.001), death rate (24% vs 4.3%; p < 0.001), echocardiography (43% vs 98%; p < 0.001), and N-terminal prohormone B-type natriuretic peptide (NT-proBNP) measurements (43% vs 96%; p < 0.001). The burden of 5-9 accompanying diseases enhanced the choice of the cardiac ward (p < 0.05), while age and urgent mode of hospitalization decreased the chance of being referred to the cardiac ward (p < 0.01). Cardiac patients were more likely to receive β-blockers, diuretics, angiotensin receptor blockers (ARB), and MRA. Over 90% of cardiac ward patients were referred to cardiac ambulatory care after discharge from hospital, while among patients discharged from the IM ward, this rate was 60% (p < 0.001). Conclusions. There were significant differences among the 2 wards in relation to the course of hospitalization and post-discharge outpatient care.

StreszczenieEuropejskie Towarzystwo Kardiologiczne w ostatnio opublikowanych w 2016 roku wytycznych dotyczących niewydolności serca (HF) wprowadziło do terapii pacjentów z niewydolnością serca i obniżoną frakcją wyrzutową (HFrEF) nową grupę leków -ARNI (angiotensin receptor-nephrilysin inhibitor) (klasa I zaleceń, poziom dowodów B). Jedynym przedstawicielem ARNI jest sakubitryl/walsartan. Na podstawie wyników badania PARADAGIM-HF sakubitryl/walsartan jest zalecany zamiast inhibitorów konwertazy angiotensyny (ACE) do dalszego obniżenia ryzyka zgonu i hospitalizacji z powodu HF u ambulatoryjnych chorych ze stabilną HFrEF, u których objawy HF (II-IV klasy wg New York Heart Association) utrzymują się mimo optymalnego leczenia inhibitorem ACE (lub antagonistą receptora dla angiotensyny II), beta-adrenolitykiem i antagonistą receptora mineralokortykoidowego. W pracy zaprezentowano opis pierwszych 2 pacjentów z HFrEF, u któ-rych zainicjowano terapię lekiem sakubitryl/walsartan. Słowa kluczowe: niewydolność serca z obniżoną frakcją wyrzutową, antagonista receptora dla angiotensyny II i inhibitor neprylizyny, ARNI Cardiologica 2017; 12, 4: 397-404 Wstęp W Polsce na niewydolność serca (HF, heart failure) choruje 600-700 tys. pacjentów [1]. Populacja chorych z HF systematycznie się powiększa. Należy pamiętać, że skuteczne leczenie HF oraz zapobieganie postępowi choroby jest możliwe. Warunkiem pozostaje między innymi optymalizacja leczenia zgodnie z wytycznymi, w tym sprawne wdrażanie nowych innowacyjnych leków, takich jak sakubitryl/ /walsartan. FoliaEuropejskie Towarzystwo Kardiologiczne (ESC, European Society of Cardiology) w 2016 roku opublikowało nowe wytyczne dotyczące HF [2]. W dokumencie tym po raz pierwszy do terapii niewydolności serca z obniżoną frakcją wyrzutową (HFrEF, heart failure reduced ejection fraction) wprowadzono nową grupę leków -ARNI. Jedynym przedstawicielem ARNI jest sakubitryl/walsartan. Molekuła ta zawiera dwie substancje, sakubitryl i walsartan. Aktywny metabolit proleku sakubitrylu, LBQ657, wykazuje działanie hamujące enzym neprylizynę, a walsartan jednoczasowo blokuje działania angiotensyny II. Neprylizyna jest enzymem proteolitycznym z grupy metaloproteaz, który rozkłada i unieczynnia peptydy wazoaktywne, między innymi peptydy natriuretyczne. Hamowanie neprylizyny przez LBQ657 powoduje zwiększenie dostępności peptydów natriuretycznych [3]. Korzystnymi tego klinicznymi efektami w HF są: zwiększenie diurezy, zwiększenie wydalania sodu z moczem, rozszerzenie naczyń krwionośnych, zwiększenie wskaźnika przesączania kłębuszkowego i przepływu krwi przez nerki, zahamowanie uwalniania reniny i aldosteronu,

Background/Introduction Heart failure (HF) and atrial fibrillation (AF) are two conditions that are likely to dominate the next years of cardiovascular (CV) care. These diseases frequently coexist and they can beget one another due to similar risk factors and similar pathophysiology. Purpose The aim of the study was to assess the relationship of dehydration, body mass index (BMI) and other indices with the occurrence of AF in HF patients. Methods The study included 113 patients [median age 64 years; 57.52% male] hospitalized due to HF. Baseline demographics, body mass analysis, echocardiographic results, key cardiopulmonary exercise test (CPET) parameters, six minute walk distance (6MWD) and Kansas City Cardiomyopathy Questionnaire (KCCQ) score were assessed. Results Of all patients, 23 (20.35%) had AF, and 90 (79.65%) had sinus rhythm (SR). Patients with AF were older (med. 66 vs 64 years; p=0.039), with higher BMI (32.02 vs. 28.51 kg/m2; p=0.017) and percentage of fat content (37.0 vs. 27.9%, p=0.014). They were more dehydrated, with a lower percentage of total body water (TBW%) (45.7 vs 50.0%; p=0.022). Clinically, patients with AF had more often higher New York Heart Association (NYHA) class (III vs II; p&lt;0.001), shorter 6MWD (median 292.35 vs 378.4 m; p=0.001) and a lower KCCQ overall summary score (52.60 vs 73.96 points; p=0.002). Patients with AF had significantly lower exercise capacity as measured by peak oxygen consumption (peak VO2) (0.92 vs 1.26 mL/min, p=0.016), peak VO2/kg (11 vs. 15 mL/kg/min; p&lt;0.001), and percentage of predicted VO2max (pp-peak VO2) (62.5 vs 70.0; p=0.010). We also found VE/VCO2 (med.33.85 vs 32.20; p=0.049) to be higher and peak oxygen pulse (8.5 vs 11 mL/beat; p=0.038) to be lower in patients with AF than in patients without AF. In a multiple logistic regression model higher BMI (OR 1.23 per unit increase, p&lt;0.001) and higher left atrial volume index (LAVI) (OR 1.07 per unit increase, p=0.03), lower tricuspid annular plane systolic excursion (TAPSE) (OR 0.74 per unit increase, p=0.03) and lower TBW% in body mass analysis (OR 0.90 per unit increase, p=0.03) were independently related to AF in patients with HF. Conclusions Increased volume of left atrium and right ventricular systolic dysfunction are well-known predictors of AF occurrence in patients with HF, but hydration status and increased body mass also seem to be important factors of AF in HF patients. Funding Acknowledgement Type of funding sources: None. Figure 1

Background Heart failure (HF) is the only cardiovascular disease with an ever-increasing incidence. Aims The aim of this study was to assess the predictors of adverse clinical events (CE) and the creation and evaluation of the prognostic value of a novel personalized scoring system in patients with HF. Methods The study included 113 HF patients (median age 64 years (IQR 58–69); 57.52% male). The new novel prognostic score named GLVC (G, global longitudinal peak strain (GLPS); L, left ventricular diastolic diameter (LVDD); V, oxygen pulse (VO2/HR); and C, high sensitivity C-reactive protein (hs-CRP)) was created. The Kaplan–Meier method and log-rank test were used to compare the CE. Results Results from final analyses showed that low GLPS (< 13.9%, OR = 2.66, 95% CI = 1.01–4.30, p = 0.002), high LVDD (> 56 mm, OR = 2.37, 95% CI = 1.01–5.55, p = 0.045), low oxygen pulse (< 10, OR = 2.8, 95% CI = 1.17–6.70, p = 0.019), and high hs-CRP (> 2.38 µg/ml, OR = 2.93, 95% CI = 1.31–6.54, p = 0.007) were independent prognostic factors for adverse CE in HF population. All the patients were stratified into a low-risk or high-risk group according to a novel “GLVC” scoring system. The Kaplan–Meier analyses demonstrated that patients in the high-risk group were more predisposed to having higher adverse clinical events compared to patients in the low-risk group. Conclusions A novel and comprehensive personalized “GLVC” scoring system is an easily available and effective tool for predicting the adverse outcomes in HF. Graphical abstract

StreszczenieW pracy przedstawiono przypadek kliniczny 67-letniego mężczyzny z gwałtownie postępującym kłębuszkowym zapaleniem nerek w przebiegu zespołu Goodpasteure'a, u którego wystąpił ostry zespół wieńcowy (ACS). Początkowe objawy pod postacią białkomoczu, krwinkomoczu i krwioplucia nasuwały rozpoznanie, które ostatecznie zostało potwierdzone w powtarzanych badaniach przeciwciał anty-GBM oraz w biopsji nerki, gdzie uwidoczniono obraz pozawłośniczkowego kłębuszkowego zapalenia nerek (postać z przeciwciałami IgG przeciw błonie podstawnej). W momencie rozpoznania chory prezentował także objawy niewydolności nerek, z oligurią, wymagał hemodializoterapii. Mężczyznę skutecznie leczono zabiegami wymiany osocza, steroidami i pulsami cyklofosfamidu. Niespodziewanie u pacjenta wystąpiły powikłania kardiologiczne pod postacią ostrego incydentu wieńcowego i epizodów migotania przedsionków. Ze względu na ryzyko zatorowe chory wymagał leczenia przeciwkrzepliwego, jednak przy tak wysokim ryzyku krwawienia, jakie występuje w zespole Goodpasteure'a, nie włączono tej terapii. Przedstawiony przypadek kliniczny pokazuje, że u każdego pacjenta z migotaniem przedsionków należy brać pod uwagę indywidualizację postępowania i szacowanie stosunku ryzyko-korzyści z rozważeniem nowych metod leczenia zmniejszających ryzyko zatorowe i minimalizujących powikłania krwotoczne.Słowa kluczowe: zespół płucno-nerkowy, gwałtownie postępujące kłębuszkowe zapalenie nerek, zespół Goodpasture'a, migotanie przedsionków, incydenty wieńcowe Cardiologica 2016; 11, 5: 433-439 Folia