BackgroundSudden cardiac death (SCD) risk stratification is the most important preventive action in patients with hypertrophic cardiomyopathy (HCM). The identification of the ischemia biomarker high sensitive troponin I (hs-TnI) role for this arrhythmic disease may provide additional information for SCD risk stratification. The aim of the study was to compare echocardiographic parameters (prognostic for risk stratification of SCD in HCM) among two subgroups of HCM patients: with elevated hs-TnI versus non-elevated hs-TnI level.MethodsIn 51 HCM patients (mean age 39 ± 8 years, 31 males and 20 females) an echocardiographic examination, including the stimulating maneuvers to provoke maximized LVOT gradient, was performed. The hs-TnI was measured 24 h later.ResultsBy comparing two subgroups of patients, 26 members with hs-TnI positive versus 25 with hs-TnI negative, the study showed that the values of all three parameters were greater: provocable left ventricular outflow tract gradient (LVOTG) – 49.1 ± 45.9 vs 25.5 ± 24.8 mmHg, p = 0.019; left atrial diameter – 50.1 ± 9.6 vs 43.9 ± 9.8 mmHg, p = 0.041; maximal LV thickness – 22.1 ± 5.3 vs 19.9 ± 34 mm, p = 0.029.ConclusionThe increased value of all three echocardiographic parameters used as risk factors for SCD (ESC Guidelines) is related to the elevated level of hs-TnI in HCM. Due to the high LVOTG – great hs-TnI relationship, exercise stress, both diagnostic and even rehabilitation/training, should be monitored by biomarker control.

Background. Patients with degenerative aortic stenosis (AS) exhibit elevated prevalence of coronary artery disease (CAD) and internal carotid artery stenosis (ICAS). Our aim was to investigate prevalence of significant CAD and ICAS in relation to demographic and cardiovascular risk profile among patients with severe degenerative AS.Methods. We studied 145 consecutive patients (77 men and 68 women) aged 49-91 years (median, 76) with severe degenerative AS who underwent coronary angiography and carotid ultrasonography in our tertiary care center. The patients were divided into two groups according to the presence of either significant CAD (n=86) or ICAS (n=22).Results. The prevalence of significant CAD or ICAS was higher with increasing number of traditional risk factors (hypertension, hypercholesterolemia, diabetes, smoking habit) and decreasing renal function. We found interactions between age and gender in terms of CAD (p=0.01) and ICAS (p=0.06), which was confirmed by multivariate approach. With the reference to men with a below-median age, the prevalence of CAD or ICAS increased in men aged >76 years (89% vs. 55% and 28% vs. 14%, respectively), whereas the respective percentages were lower in older vs. younger women (48% vs. 54% and 7% vs. 17%).Conclusions. In severe degenerative AS gender modulates the association of age with coronary and carotid atherosclerosis with its lower prevalence in women aged >76 years compared to their younger counterparts. This may result from a hypothetical “survival bias”, i.e., an excessive risk of death in very elderly women with severe AS and coexisting relevant coronary or carotid atherosclerosis.

Background: Although triple antithrombotic therapy (TAT) is recommended in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI), guidelines allow an option of dual antithrombotic therapy (DAT). This study assesses the everyday practice of 10 cardiology departments in antithrombotic therapy in AF patients undergoing PCI and its agreement with current guidelines.Methods: This analysis included medical data of AF patients enrolled in the prospective, observational registry (The POLish Atrial Fibrillation-POL-AF) that underwent PCI [elective or due to acute coronary syndrome (ACS)].Results: Of the 3,999 consecutive subjects included, a final analysis was performed on 359 patients that underwent PCI: 148 with urgent PCI due to ACSand 211 patients with elective PCI. Eighty patients in the ACS-group and 120 patients in the elective-PCI group were treated with TAT, although guidelines also allowed DAT. Of 316 patients treated with oral anticoagulants as a part of combination therapy, 275 were on non-vitamin K antagonist oral anticoagulant (NOAC). Reduced doses of NOAC were used in 74 patients treated with rivaroxaban, 60 patients with dabigatran, and 54 patients with apixaban. The proportion of patients treated with reduced NOAC doses adequately to the guidelines was 29%, 100%, and 33% for rivaroxaban, dabigatran, and apixaban, respectively. Inappropriate low doses of NOACs were used in 71% of subjects on rivaroxaban and 67% on apixaban. Conclusions:In patients with AF undergoing PCI, NOACs are definitely preferred over vitamin-K antagonists (VKAs) in TAT/DAT, and an aggressive antithrombotic strategy with TAT is frequently chosen even if DAT is permissible by the guidelines. Label adherence of using reduced NOAC dose during

We present a case of a 40-year-old woman, 4-months pregnant (in vitro fertilization), admitted to a hospital due to incessant supraventricular tachycardia with a rate of 187 beats/min. Attempts to stop the arrhythmia (3 × cardioversion, verapamil IV) were unsuccessful; after electrical cardioversion, tachycardia recurred after a few sinus beats. In the view of poor arrhythmia tolerance (hypotonia, dyspnea) and the risks associated with incessant tachycardia (placental hypoperfusion, development of tachyarrhythmic cardiomyopathy), it was decided to perform an electrophysiology study and ablation. The procedure was carried out with the use of a computer 3D mapping system (Ensite NavX), aiming to minimize standard fluoroscopy use. The electrophysiology study indicated the presence of focal right-atrial tachycardia. In this situation, geometry reconstruction and activation mapping of the right atrium was carried out, localizing the arrhythmogenic focus in the inferolateral portion of the tricuspid ring. After several radiofrequency (RF) applications, arrhythmia subsided and sinus rhythm was restored. Total fluoroscopy time in the procedure was only 90 seconds; the total radiation exposure was 12mGy. In addition, the abdomen of the pregnant woman was shielded with lead gowns from both sides, thus nearly completely eliminating the fetal radiation exposure. Unfortunately, after 4 weeks, the arrhythmia returned. A repeated ablation was carried out in an identical fashion as the index procedure, again with only minimal fluoroscopy time (62 s, 10mGy). The rest of pregnancy and labour were uneventful, without recurrence of tachycardia and a healthy baby was delivered. Therapeutic options and literature are reviewed and discussed.

RESEARCH LETTER Elevated troponin level in hypertrophic cardiomyopathy 445probably a common finding during normal everyday physical activity. In particular, we suspect that elevated hs -TnI levels (the high -sensitivity method being particularly useful) are quite common during the daily activities of patients with HCM (even on pharmacotherapy). However, this phenomenon may be underdiagnosed or completely unrecognized. Therefore, we decided to investigate the presence of and potential mechanism underlying the increased hs -TnI levels in relation to findings on Holter monitoring.Patients and methods Consecutive patients with HCM, treated and monitored at our clinic, were recruited to the study. Most patients received pharmacotherapy (TABLE 1) and underwent regular medical check -ups as part of ambulatory care.The exclusion criteria were as follows: ST--segment or non -ST -segment elevation myocardial infarction (recent or previous), significant coronary stenosis on coronary angiography, or renal failure. The final sample included 32 patients with HCM (mean [SD] age, 40 [11] years; 20 men and 12 women).According to the study protocol, echocardiography was performed first. Immediately after the echocardiography, a 24 -hour ECG test was started to assess possible tachycardia episodes as a potential trigger of hs -TnI release. Moreover, we searched for possible episodes of nonsustained ventricular tachycardia (NSVT, a risk factor for sudden cardiac death according to the European Society of Cardiology and American Heart Association / American College of Cardiology guidelines) as a potential result of ischemia detected by hs -TnI release. The hs -TnI level was assessed Introduction High -sensitive troponin I (hs -TnI), an ultraprecise biomarker for the detection of myocardial ischemia, has been investigated in patients with hypertrophic cardiomyopathy (HCM) in several studies. 1-4 However, troponin levels were measured only at a resting state and were not synchronized in time with ambulatory electrocardiography (ECG) monitoring (Holter monitoring). So far, no studies have used the following protocol: 24 -hour Holter monitoring first and then the measurement of hs -TnI (the biomarker level has a close temporal relationship with findings on Holter monitoring). This protocol seems to be reasonable because hs -TnI levels may be both associated with increased heart rate (potential cause of myocardial ischemia) and be a potential cause of life -threatening ventricular arrhythmias occurring during the previous 24 hours.As regards the dynamic stress test (under natural conditions and related to a single episode of rapidly increased heart rate) in adults with HCM, there have been only 2 reports of troponin measurement (without the use of high -sensitivity method): one taken after an episode of rapid supraventricular tachycardia in a natural everyday situation, 5 and the other after a physician--controlled exercise stress test. 6 The exercise stress test was performed in a small group of 7 patients, 5 of whom revealed elevated...