BACKGROUND:Exercise capacity is frequently reduced in patients with hypertrophic cardiomyopathy (HCM), but structured training has historically been limited due to concerns about arrhythmias and sudden cardiac death. Recent data suggest that supervised, individualized exercise may be safe in selected patients; however, evidence for hybrid cardiac telerehabilitation (HCT) in non-obstructive HCM remains lacking. AIMS:To evaluate the efficacy and safety of a 12-week HCT program in patients with non-obstructive HCM and preserved left ventricular ejection fraction. METHODS:In this single-center randomized controlled trial, 60 patients were allocated (1:1) to HCT or usual care. The HCT program consisted of supervised center-based exercise sessions combined with remotely monitored home training. The primary endpoint was the change in peak oxygen uptake (pVO₂) after 3 months. Secondary endpoints included changes in 6-minute walk distance, perceived health status, and safety parameters. Follow-up continued for 12 months after program completion. RESULTS:Fifty-eight patients completed the 3-month assessment (HCT n = 28; control n = 30). HCT resulted in a significantly greater improvement in pVO₂ compared with usual care (between-group difference: +1.35 ml/kg/min; P <0.01). Additional significant improvements were observed in 6-minute walk test distance. Perceived health status improved in both groups, with a greater increase in the HCT group. No serious adverse events occurred, and adherence to the training program was high. CONCLUSIONS:HCT is feasible, safe, and effective in improving functional capacity and perceived health status in carefully selected patients with non-obstructive HCM. These findings support the use of structured, telemonitored exercise training in low-risk HCM populations, although larger multicenter trials are needed to confirm generalizability.

Transcatheter aortic valve implantation (TAVI) has become the guideline-supported treatment of choice for older or higher-risk patients with severe aortic stenosis. With expanding indications the community has faced substantial challenges in meeting the growing demand for TAVI procedures. This led to a transition towards simplification of the procedure and shortening of the hospital stay, defined together as the "fast-track", "minimalist" or "simplified" TAVI. Current data suggest that such approach can be adopted without compromising patients' safety if certain procedural standards are maintained. This document aims at providing a practical guide by highlighting best practices of simplified TAVI with particular focus on the specific features of Polish health care system.

BACKGROUND: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 the treatment of both 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 (HF) 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 between patients with and without atrial fibrillation. 54.5% of patients required a HF hospitalization and 65.0% a cardiovascular hospitalization. Mortality was comparable to other European registries, but rates of HF hospitalization were higher in the Polish population. CONCLUSIONS:The 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.

Rationale While antegrade wiring (AW) is the most common initial strategy for chronic total occlusion (CTO) percutaneous coronary intervention (PCI), difficult CTO lesions frequently require either antegrade dissection and re-entry (ADR) or a retrograde strategy. Comparative data between ADR and the retrograde approach remain limited. Design The Antegrade Dissection vs Retrograde re-ENtry And Load of Interventionalist Effort (ADRENALINE) is a prospective, multicenter randomized study with a superiority design. It is planned to enroll 121 patients with difficult coronary CTO (J-CTO score ≥2) referred for CTO-PCI in accordance with the hybrid algorithm. Subjects undergoing successful AW will be included in the observational arm. Patients with failed or unattempted AW will be randomized 1:1 to ADR or retrograde CTO crossing strategy (n = 74). All patients will undergo pre- and postprocedural laboratory testing (including cardiac troponin T and creatine kinase-MB), cardiac magnetic resonance (CMR) for late gadolinium enhancement, and health status assessment by the Seattle Angina Questionnaire and the Rose Dyspnea Scale. The co-primary endpoints are total procedure time and successful guidewire crossing. Additionally, the relationship between different recanalization strategies and stress among interventional cardiologists will be explored. Conclusion ADRENALINE is the first randomized study of ADR vs retrograde strategy for difficult CTO PCI, assessing procedural outcomes, CMR-detected myocardial infarction, and 3-month quality of life. Enrolment status The first patient was enrolled on July 29, 2025. As of June 14, 2026, 45 patients (26 randomized, 19 observational) of the planned 121 patients have been enrolled. Trials registration Clinicaltrials.gov: Identifier, NCT06878729.

INTRODUCTION:Extracoronary vascular abnormalities (EVAs) have been found in patients with spontaneous coronary artery dissection (SCAD), suggesting that SCAD may reflect systemic vascular disease. OBJECTIVE:The aim of this study was to assess the prevalence and characteristics of EVAs in SCAD survivors. PATIENTS AND METHODS:A total of 109 consecutive patients with a history of SCAD underwent head‑to‑ pelvis computed tomography angiography for EVA screening. EVAs were defined as the presence of fibromuscular dysplasia (FMD), aneurysm, or cervical dissections. RESULTS:EVAs were identified in 47.7% of the cohort. The prevalence of FMD was 32.1%, aneurysms were observed in 23.2% of the patients, and dissections of cervical arteries in 5.5%, while 9.3% of the patients presented with both FMD and aneurysms. FMD predominantly affected the renal (20.3%) and cervical (15.6%) arteries, while aneurysms were most commonly detected in the renal and splenic arteries (7.3% each). Multisite FMD was present in 8.3% of the patients. Aneurysms in more than 1 vascular bed were found in 4.6% of the cases. Cervical FMD was associated with migraine headaches in 58.8% of the patients and was clinically silent in 41.2%. All aneurysms were silent, however, 3 patients (12%) with intracerebral aneurysms required intravascular treatment due to a risk of rupture. In FMD patients, higher prevalence of type 2a SCAD (65.7% vs 43.1%; P = 0.03) and pregnancy‑ associated SCAD (17.6% vs 4.2%; P = 0.03) was observed. The patients with type 2a SCAD had a 2.5‑ fold higher likelihood of having FMD (odds ratio, 2.53; 95% CI, 1.09-5.87; P = 0.03). CONCLUSIONS:This study showed a significant prevalence of EVAs in SCAD survivors, with silent aneurysms being more common than previously reported.

Pregnancy-associated spontaneous coronary artery dissection (P-SCAD) remains an incompletely characterized cause of acute coronary syndrome during pregnancy and postpartum period. We aimed to compare clinical presentation, comorbidities and outcomes of P-SCAD with non-pregnancy associated spontaneous coronary artery dissection (NP-SCAD). We studied 83 women with prior SCAD and at least one pregnancy (aged 44.8 ± 9.7y at SCAD event, 36

BACKGROUND:Transcatheter aortic valve replacement (TAVR) has become the standard treatment for most patients with severe aortic stenosis. However, data on long-term mortality and durability of transcatheter heart valves (THVs) is limited. The Hydra CE study previously reported good early- and medium-term clinical performance and safety for TAVR with Hydra self-expanding THV (Vascular Innovations Co Ltd, Nonthaburi, Thailand, a subsidiary of Sahajanand Medical Technologies Limited, India). AIMS:We herein report 5-year follow-up results from the long-term follow-up cohort of the Hydra CE study. METHODS:The Hydra CE was a prospective, multicenter, single-arm study that enrolled 157 patients. Of these, 54 patients from two participating centers (Lithuania and Poland) provided consent for extended follow-up (up to 5 years), forming the long-term follow-up cohort. These patients were monitored for up to 5 years to assess the durability and sustained performance of the device. The primary endpoint of this cohort was all-cause mortality, with patients monitored for both clinical and echocardiographic outcomes throughout the follow-up period. RESULTS:Among the 54 patients, the mean age was 81.0 ± 4.1 years. At 5-year follow-up, all-cause mortality was 24.3%, with cardiovascular deaths accounting for 6.0% of the patients. Effective orifice area increased from 0.68  ±  0.15 cm2 to 2.09  ±  0.57 cm2 (p < 0.001) and mean aortic valve gradient decreased from 53.4  ±  14.24 mmHg to 8.0 ±  3.14 mmHg at 5 years (p < 0.001). Improvement of at least one NYHA functional class from baseline to 5 years was observed in 65% of patients. New permanent pacemaker implantation rate at 5-year follow-up was 16.7%. There were no cases of valve endocarditis, thrombosis, or structural valve deterioration over 5 years. CONCLUSION:The 5-year results from the long-term follow-up cohort of the Hydra CE study established excellent valve durability and sustained hemodynamic performance. The study demonstrated favorable long-term safety and clinical performance of the Hydra THV, with acceptable survival rates at 5-year follow-up.

BACKGROUND:Limited information exists on the impact of bicuspid aortic valve (BAV) type on paravalvular leak (PVL) occurrence following transcatheter aortic valve implantation (TAVI). AIMS:This study aimed to assess whether BAV type and aortic root morphology can predict the development and severity of PVL post-TAVI. METHODS:We retrospectively analyzed 145 patients with BAV stenosis who underwent TAVI at our center from January 2015 to December 2023. BAVs were classified based on the presence of raphes: 2-sinus BAV, fused BAV (right-left, right-noncoronary, left-noncoronary), and two raphes. RESULTS:The mean age was 77.4 (7.7) years, with 47.6% being men. Right-left (R-L) cusp fusion was associated with an increased incidence of greater than mild PVL (P = 0.02). Patients with more than mild PVL exhibited higher calcium score (4873 [3554-6514] vs. 3750 [2264-5900]; P = 0.03) and larger dimensions in the ascending aorta (39.8 [4.9] mm vs. 37.9 [5.2] mm; P = 0.045), sinotubular junction (STJ) long axis (33.7 [5.2] mm vs. 31.7 [4.2] mm; P = 0.02), and sinus of Valsalva (34.4 [4.6] mm vs. 32.6 [4.1] mm; P = 0.03) compared to those with ≤ mild PVL. Multivariable analysis showed independent predictors of more than mild PVL as the use of self-expanding prosthesis (P <0.001), STJ dimension (P <0.001), atrial fibrillation prior to TAVI (P = 0.003), and R-L cusp fusion (P = 0.02). CONCLUSIONS:The incidence of more than mild PVL varied with BAV subtypes and aortic root morphology. Independent factors increasing PVL risk included R-L cusp fusion, self-expanding prosthesis use, extended STJ short axis, and pre-existing atrial fibrillation.

Renal denervation is an innovative method of treating hypertension (HT), used in clinical practicefor about a decade. The pathophysiological basis of this method derives from the role of efferentand afferent fibers of the sympathetic nervous system, entering and leaving the kidneys, in thedevelopment of HT, especially treatment-resistant HT. Initial clinical trials have suggested the highefficacy of denervation in the treatment of patients with resistant HT. However, the results of theSymplicity HTN-3 trial, which introduced a sham procedure as a control, undermined these hopes,although this trial was criticized for its methodology. Recent research, using latest-generation cathetersand more stringent protocols, confirms a significant reduction in blood pressure in patientsafter this procedure. Renal denervation should be considered in patients with HT (after excludingall hormonal causes and ischemic etiology) that is resistant to pharmacological treatment. Pseudoresistance, e.g., caused by so-called white-coat HT, should be ruled out. Every patient should complete24 hours ambulatory blood pressure monitoring. Lack of cooperation between the patientand the physician, irregular use of antihypertensive medications, and non-compliance with othertherapeutic recommendations should also be excluded. However, the condition for the successof renal denervation is the precise determination of patient eligibility and the performance of theprocedure in specialized centers with appropriate experience.

INTRODUCTION:A hybrid strategy involving left atrial appendage closure (LAAC) followed by long‑term anticoagulation may be considered in patients experiencing thromboembolic events or LAA thrombus despite anticoagulant treatment (anticoagulation failure). OBJECTIVES:We aimed to report the adoption rate and outcomes of the hybrid strategy in patients treated with LAAC for thromboembolic indications at 5 centers in Poland. PATIENTS AND METHODS:High‑volume Polish centers reported outcomes of LAAC after anticoagulation failure between the years 2014 and 2024. The hybrid strategy was compared with other pharmacotherapy regimens (nonhybrid strategy) with respect to thromboembolic events, device‑related thrombus (DRT), and major bleeding occurrence. RESULTS:Out of 1625 patients undergoing LAAC procedures across 5 centers, 141 (8.7%) had a history of anticoagulation failure. The hybrid strategy was applied in 64 individuals (45%), and its rate increased from 0% in 2014 to 80% in 2024. As compared with the nonhybrid group, the patients treated with the hybrid strategy more often received newer‑generation occluders (98.4% vs 68.8%; P <0.001), had lower rates of prior bleeding (12.5% vs 35.1%; P = 0.003) and lower HAS‑BLED scores (median [interquartile range], 3 [2-3] vs 3 [2-4] points; P = 0.008), and more often had a history of LAA thrombus (23.4% vs 10.4%; P = 0.04) and left ventricular ejection fraction below 40% (18.8% vs 6.5%; P = 0.04). During a median 1.3‑year follow‑up, the hybrid strategy showed greater thromboembolic risk reduction relative to the CHA2DS2‑VASc-predicted rate (91% vs 60%; annualized event rates of 1.1% vs 5.5%), and greater major bleeding risk reduction relative to the HAS‑BLED-predicted rate (100% vs 73%; annualized rates of 0% vs 1.7%), with similar DRT rates (6.9% vs 6.8%; P >0.99). CONCLUSIONS:In patients with anticoagulant treatment failure, the hybrid strategy (LAAC + long‑term anticoagulation) is increasingly adopted and was associated with greater thromboembolic risk reduction, as compared with the standard nonhybrid strategy, without compromising the bleeding profile.

Cardiovascular (CV) prevention in young adults is pivotal due to escalating morbidity and mortality rates in this demographic. Assessing CV awareness and its socio-behavioural correlates is essential for developing effective prevention strategies. This study assessed CV awareness and lifestyle behaviours among Polish 18-year-olds, hypothesising that significant gender-specific disparities exist at the threshold of adulthood. A nationwide, representative survey was conducted over 10,000 students in final-year grades from 250 Polish secondary schools. Sampling employed a stratified cluster method. Data were weighted to ensure national representativeness. Awareness of CV risk factors and lifestyle behaviours (diet, physical activity, sleep, and substance use) were evaluated. Of 10,095 participants (6,076 females, 4,019 males), overweight and obesity were recorded at 17.0% and 4.1% in males, and 8.4% and 2.1% in females, respectively (p < 0.001). Only 14.6% of women and 14.3% of men knew their current blood pressure values (p = 0.48). Weekday screen time averaged 5.9 ± 2.7 hours, rising to 6.7 ± 2.8 hours on weekends, with significant gender differences on weekends (p = 0.009). Sleep duration was concerning, with 52.6% of women and 40.5% of men sleeping under seven hours on weekdays (p < 0.001), though 95% slept sufficiently on weekends. Awareness of sleep-related diabetes and obesity risks was minimal. Men had higher alcohol consumption, with 20.5% consuming 100g or more weekly, compared to 12.6% of women (p < 0.001). Smoking was prevalent, with 22.8% of women and 23.7% of men smoking daily. Exercise adherence varied, with only 61.0% of women and 76.7% of men meeting guidelines in summer, declining in winter (p < 0.001). Men generally consumed unhealthy foods more often. While most recognized common myocardial infarction risk factors, under 65% identified high cholesterol as a risk, with women generally performing better in awareness. Polish 18-year-olds exhibit distinct, gender-specific cardiovascular risk profiles. While females possess superior theoretical knowledge, they are more prone to physical inactivity and poor sleep hygiene. In contrast, males are primarily burdened by adverse dietary habits and substance use. These findings indicate that public health interventions should be gender-tailored: prioritising physical activity for young women and focusing on dietary improvements and addiction prevention for young men to effectively mitigate future cardiovascular risk.

BACKGROUND:Studies on mitral transcatheter edge-to-edge repair for atrial functional mitral regurgitation (AFMR) and ventricular functional mitral regurgitation (VFMR) are limited. METHODS:We report 1-year outcomes of mitral transcatheter edge-to-edge repair for AFMR and VFMR using the PASCAL transcatheter valve repair system in the MiCLASP multicenter European postmarket clinical follow-up study (REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04430075). RESULTS:Analysis included 295 patients with functional mitral regurgitation (75.5±9.93 years old, 59.3% male) from the first 600 enrolled in the MiCLASP study, with AFMR in 17.6% (52) and VFMR in 82.4% (243). Patients with AFMR were older (79.7±6.67 versus 74.6±10.30 years), majority female (75.0% versus 33.3%), and had higher rates of hypertension (98.1% versus 82.3%) and atrial fibrillation (82.7% versus 60.1%) than patients with VFMR (all P<0.05). Patients with VFMR had higher NT-proBNP (N-terminal pro-B-type natriuretic peptide) levels (3350.0 [1720.0-6564.0] versus 1562.0 [790.0-2286.0]; P<0.001) and more severe mitral regurgitation (≥3+) at baseline (71.9% versus 46.2%; P<0.001). Procedural success was high (AFMR, 96.2%; VFMR, 97.1%; P=0.661), and patients with AFMR had shorter procedure duration (73.5 versus 85.5 minutes; P=0.044). One-year Kaplan-Meier estimate of freedom from all-cause mortality or heart failure hospitalizations was 79.3% in AFMR and 70.9% in VFMR (P=0.267). Both AFMR and VFMR groups demonstrated significant mitral regurgitation reduction (mitral regurgitation ≤1+, 93.1% and 81.3%), low mean transmitral gradients (3.5 and 3.1 mm Hg), significant proportional reductions in left ventricular end-diastolic volume (-12.9% and -16.4%) and left atrial volume (-9.6% and -10.9%), high proportions at New York Heart Association class I/II (76.5% and 64.6%), and significant increases in Kansas City Cardiomyopathy Questionnaire Overall Summary score (+18.0 and +11.6 points), respectively (all P<0.05 from baseline). CONCLUSIONS:One-year MiCLASP results support the safety of mitral transcatheter edge-to-edge repair with the PASCAL system in both AFMR and VFMR, with comparable echocardiographic, functional, and quality-of-life changes, despite baseline differences in clinical presentation.

Background: Cardiogenic shock (CS) remains the leading cause of poor prognosis in patients with acute myocardial infarction (AMI), sustaining a high mortality rate of 40 to 50% within 30 days. Aims: In this unique analysis of two national all-comers, real-life registries including patients with AMI complicated by CS, for whom early revascularization was planned, we aimed to compare the effect of percutaneous coronary revascularization (PCI) and coronary artery bypass grafting (CABG) on 30-day and 1-year all-cause mortality. Material and methods: The study included consecutive patients with AMI complicated by CS included in the Polish Registry of Acute Coronary Syndromes (PL-ACS) and the Polish National Registry of Cardiac Surgical Procedures (KROK), treated with PCI and CABG, respectively. A layered analysis and Kaplan-Meier curves were used in the propensity score matched (PSM) groups. Results: Between 2006 and 2022, a total of 1970 patients with AMI complicated by CS, with known coronaryanatomywere included in PL-ACS and KROK registries. 1376 (69.8%) had PCI and 594 (30.2%) had CABG. Following a 1:1 PSM, a total of 822 patients were finally included in the analysis. The mortality rates were 48.2% in the PCI group compared with 38.6% in the CABG group at 30 days (P <0.001) and 53.5% compared with 41.1%, respectively, at 1 year (P <0.001). Conclusions: Among patients with AMI affected by CS, those qualified to be treated with CABG had a higher survival rate at 30 days and one year as compared to those treated with PCI.

BACKGROUND:Transcatheter aortic valve implantation (TAVI) has become a cornerstone in the treatment of severe aortic stenosis, with expanding indications for lower-risk patients. However, real-world data, especially regarding post-discharge outcomes, from multicenter registries are scarce but needed. AIMS:To evaluate the in-hospital and mid-term outcomes of patients undergoing TAVI in all Polish centers between 2019 and 2023. MATERIAL AND METHODS:Clinical data were extracted from the Polish E-Health database of the National Health Fund. Procedures were identified using specific procedural codes. Long-term outcomes were established based on National Health Fund data, with outcome occurrence derived from the primary/secondary diagnoses for admissions during the one-year duration of follow-up, with a censoring date of December 31, 2023. RESULTS:Between 2019 and 2023, 11 351 TAVIs were performed in Poland. The in-hospital mortality rate was 2.9%. Of the total group, 7860 underwent the procedure between 2019 and 2022, providing a one-year follow-up to the censoring date. In those patients, the overall all-cause 1-year mortality was 12.7%, with higher rates among patients with atrial fibrillation, heart failure, and among men. Myocardial infarction occurred in 1.2%, stroke in 2.3%, and 23.3% patients required hospitalization for heart failure. The 12-month rate of cardiac implantable electronic device implantation was 11.8%. CONCLUSIONS:This study provides the first real-world TAVI outcomes in Polish patients based on the national, multicenter registry, showing an in-hospital mortality of 2.9% and a 12-month all-cause mortality of 12.7%. The 1-year outcomes of patients treated with TAVI in Poland are comparable to international registries.

Atherosclerosis is a systemic disease which involves not only the coronary vessels but also occurs in other vascular beds (e.g., cervical, cerebral, and peripheral vessels), increasing cardiovascular risk. One of the causes of atherosclerosis is lipid disorders. In addition, other diseases, such as diabetes, chronic kidney disease, or familial hypercholesterolemia, accelerate the development of multi-bed (multilevel) atherosclerosis. Such patients are often treated by physicians of various specialties, and in our country there is no integrated system for managing these patients and their further treatment. This frequently results in the inability to achieve the therapeutic goals for low-density lipoprotein cholesterol set by the guidelines despite the availability of modern therapy for the treatment of lipid disorders in our country. The presented expert position paper postulates modification of the treatment of patients with multi-bed atherosclerosis by strengthening cooperation between physicians of many specialties (cardiologists, diabetologists, nephrologists, vascular surgeons, pediatricians, etc.) to improve the effectiveness of treatment and better educate the medical community and the treated patients.