OBJECTIVE:The aim of this study was to investigate whether using radial access for coronary chronic total occlusion recanalization is effective and safe. METHOD:We enrolled 308 patients with chronic total coronary occlusion in our prospective study, between 2016 and 2019, in two cardiovascular centers. We included all transradial chronic total coronary occlusion percutan coronary interventions performed and all transfemoral cases were excluded from the study. A successful procedure was defined as recanalization of the target artery to <50% stenosis with successful stenting. We have investigated the procedural success rate, major adverse cardiac and cerebral events ratio, vascular complication rate, and the procedure related factors. RESULTS:During the 3-year period, we enrolled 272 cases with complex transradial chronic total occlusion percutan coronary intervention. The average age was 73 ± 9 years, and 74% were men. The procedural success was 83.4%, while the technical success was 64.7%. The 1-year rate of major adverse cardiac and cerebral events ratio was 15.6%. The rate vascular access complications was 2.57%. Procedural complications were observed in 4.78%. In 1.8% of cases, it was necessary to convert from transradial to transfemoral access during the procedure due to technical reasons. The rate of vascular access complications was 2.57%. The average contrast consumption was 178.1 ml (176-211), the average procedure time 52.3 min (51.3-66.2), the radiation 2140 mGy (2110-2998). CONCLUSION:Transradial access for chronic total occlusion recanalization is safe and effective and it is also associated with acceptable amount of access site complication rate. Orv Hetil. 2026; 167(1): 16-22.

Background: Transradial access has become a preferred strategy for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) because of lower access site complication rates and increasing feasibility for complex CTO techniques using large-bore slender or sheathless systems. However, long-term outcomes after successful transradial CTO recanalization and their predictors remain incompletely defined. We aimed to identify long-term clinical and procedural predictors of major adverse cerebrovascular and cardiac events (MACCEs) after successful transradial CTO PCI. Methods: We performed a prospective dual-center cohort study including 227 consecutive patients who underwent successful transradial CTO PCI at two high-volume catheterization laboratories with dedicated CTO programs. A total of 405 CTO PCI procedures were screened; all femoral access cases were excluded and only transradial cases were eligible. Baseline clinical characteristics, left ventricular ejection fraction (LVEF), lesion complexity including J-CTO score, coronary disease extent, and procedural variables were prospectively collected and/or verified from institutional databases. The primary endpoint was MACCEs, defined as a composite of all-cause death, non-fatal myocardial infarction, target vessel revascularization, and stroke/transient ischemic attack. Event rates were estimated using Kaplan-Meier methods. Predictors were explored using Cox proportional hazards regression with clinically relevant covariates and procedural characteristics entered into multivariable models. Results: Among 227 patients with successful transradial CTO recanalization and complete 5-year follow-up among survivors, cumulative MACCEs and all-cause mortality were 44.0% and 21.5%, respectively. In multivariable Cox analysis, prior myocardial infarction, right coronary artery target vessel, and a higher number of implanted stents were independently associated with increased MACCE risk, whereas previous PCI and preserved LVEF (≥40%) were associated with lower MACCE risk. For all-cause mortality, preserved LVEF was independently protective, while right coronary artery target vessel intervention was associated with increased mortality risk; severe chronic kidney disease showed a significant univariable association and remained a strong signal after multivariable adjustment. Conclusions: After successful transradial CTO PCI, long-term MACCEs appear to be driven primarily by baseline comorbidity and coronary disease burden. No deaths were related to access site bleeding, and vascular access was not associated with fatal complications. These findings contribute to personalized cardiovascular medicine by identifying readily available clinical, anatomical, and procedural factors that enable individualized long-term risk stratification following successful transradial CTO recanalization. Integrating these predictors into post-procedural assessment may support tailored secondary prevention, follow-up strategies, and patient management according to individual risk profiles.

Az elmúlt évtizedekben az Egészségügyi Tudományos Tanács (ETT) elsősorban a klinikai vizsgálatok testületi kutatásetikai véleményezését végezte, amely mellett ellátta az egészségügyi szolgáltatás nyújtásával kapcsolatban indított különböző bírósági, hatósági eljárásokban történő igazságügyi orvosszakértői testületi véleményalkotás feladatát is. 2023 óta feladatköre kibővült az orvosetikai eljárásokkal. A teljesen más jellegű eljárások különböző szempontok szerint felkért, illetve megválasztott tagokból álló testületek döntéseit, állásfoglalásait igénylik. A hivatásrenden belül szabad, közvetlen és titkos választásokon a kollegiális bizalom alapján választják meg az orvosetikai panaszok kivizsgálására hivatott bizottságok tagjait. A meritokrácia, a szakmai kiválóság alapján történő jelölések nyomán miniszteri felkérés alapján kerül be valaki az ETT kutatásetikai testületeibe, illetve az Egészségügy Területén Működő Igazságügyi Szakértői Testületbe (ISZT), amely egészségügyi szolgáltató ellen folyamatban lévő kártérítési eljárásban, illetve egészségügyi dolgozók ellen folyamatban lévő büntetőeljárásban adhat szakértői véleményt. Az orvosok ellen indított eljárások, panaszok vonatkozásában míg etikai eljárást bárki bármelyik orvos ellen kezdeményezhet, addig bíróságok, hatóságok kérhetik az ISZT testületi véleményét. Az ETT orvosetikai bizottságok az ETT Orvosetikai Kódexe szerint működnek; az ISZT a hatályos jogszabályok, szakmai irányelvek alapján alakítja ki szakértői véleményét. Orv Hetil. 2026; 167(22): 852–857.

Célkitűzés: Tudományos munkánk célja volt megvizsgálni a transradialis behatolás biztonságosságát és hatékonyságát krónikus teljes coronariaocclusio rekanalizációjában. Módszer: 2016 és 2019 között két cardiovascularis centrumban összesen 308 krónikus teljes coronariaocclusiós beteget vontunk be prospektív vizsgálatunkba. A transfemoralis behatolásból végzett eseteket kizártuk, így 272, transradialis behatolásból végzett krónikus teljes coronariaelzáródás miatt coronaria intervención átesett beteg adatait dolgoztuk fel. Procedurálisan sikeresnek tekintettük a beavatkozást, ha <50%-os reziduális szűkület maradt vissza a beavatkozás végén. Vizsgáltuk a beavatkozás sikerességét, a major cardialis és cerebralis események előfordulásának gyakoriságát, a vascularis komplikációk arányát, a procedurális faktorokat. Eredmények: A 3 éves vizsgálati periódusban 272, komplex krónikus teljes coronariaocclusiós eset percutan coronariaintervencióját végeztük el transradialis behatolásból. A betegek átlagéletkora 73 ± 9 év volt, és 74%-uk volt férfi. A procedurális siker 83,4%, míg a technikai siker aránya 64,7% volt. A major cardialis és cerebralis események 1 éves előfordulása 15,6%, a vascularis szövődmények előfordulása 2,57% volt. Procedurális komplikációt 4,78%-ban észleltünk. Az esetek 1,8%-ában volt szükség technikai okok miatt transradialisról transfemoralisra váltani a beavatkozás alatt. Az átlagos kontrasztanyag-felhasználás 178 ml (176–211), az átlagos procedurális idő 52,3 min (51,3–66,2) és a sugárdózis 2140,5 (2110–2998) mGy volt. Következtetés: Eredményeink alapján elmondható, hogy a transradialis behatolásból végzett krónikus teljes coronariaelzáródás percutan intervenciója biztonságos és sikeres beavatkozás, amely elfogadható arányú szövődményrátával társul. Orv Hetil. 2026; 167(1): 16–22.

BACKGROUND:Transradial approach (TRA) is widely accepted as a method of choice for coronary procedures. Modern puncture site haemostasis involves application of mechanical compression devices (MCD), using the patent haemostasis method with or without active dressing facilitation to avoid haematoma formation and radial artery occlusion. The Radial Artery Puncture Haemostasis Evaluation (RAPHE) study sought to determine whether the standalone use of two novel dressings, the 100% chitosan sponge and potassium ferrate disc, was non-inferior to the current gold standard pneumatic balloon MCD. METHODS:Six hundred patients were randomized in a 1:1:1 ratio to the three arms of the trial after a TRA procedure. The primary objective of the study was to assess the non-inferiority of the device-oriented composite endpoint (DOCE), comprising radial artery occlusion or damage, as well as haematoma formation. Secondary outcomes encompassed haemostasis times affecting human resource management, as well as the number of utilized haemostasis devices and eventual bail-out requirements. RESULTS:Collected DOCE rates did not differ between the three groups, thus the chitosan and potassium ferrate dressings were non-inferior to the control MCD and each other. Secondary endpoints showed that both active dressings required fewer medical manipulations after application, thus alleviating staff, with potassium ferrate requiring marginally lower tourniquet times and the chitosan method requiring slightly more secondary devices and repeat tourniquets. CONCLUSIONS:Our trial showed that standalone application of either dressing is equal in primary outcomes to the control MCD and may require less medical management to achieve similar results. TRIAL REGISTRATION:ClinicalTrials.gov identifier: NCT04857385.

Every second person in Hungary dies because of cardiovascular disease. Cardiovascular (CV) disease and mortality are more common in patients who have already had a CV event. Thus, secondary prevention treatment is of paramount importance in improving morbidity and mortality indicators in Hungary. One of the essential elements of secondary CV prevention is antithrombotic therapy. In addition to conventional antiplatelet treatment, dual antithrombotic treatment (low dose rivaroxaban + aspirin) has emerged as a therapeutic option in the past decade based on the results of large, international, randomized studies. Among the Hungarian scientific societies dealing with atherosclerotic vascular diseases, the experts of the Hungarian Society of Angiology and Vascular Surgery, the Hungarian Society of Cardiology and the Hungarian Society of Stroke wished to summarize in this consensus document the place and significance of double antithrombotic treatment for specialists treating atherosclerotic vascular patients.

Cardiovascular dysfunction occurs in one-third of esophageal cancer patients, potentially impairing oncological treatment outcomes. Cardiac MRI (CMR) is a modern imaging modality evaluating both functional and tissue properties of the myocardium. Our study aimed to examine cachexia-related cardiovascular changes in surgery candidates with esophageal cancer. This prospective study analyzed pre-treatment CMR findings in esophageal cancer patients, comparing them to weight loss. Patients were grouped by >10% or ≤10% body weight loss. Associations between weight loss and cardiac parameters were assessed using Pearson correlation and linear regression in R with a significance level of 0.05. Among 41 patients, most were male (30/41), with a mean age of 63 ± 11.9 years. In Group 1 (n=21), the average weight loss was 18%, accompanied by higher T1 values (1003 ms [954–1,015] vs. 958 ms [900–968], p=0.006) and a trend toward lower stroke volume (70 ml [49–81] vs. 79 ml [70–92], p=0.12) compared to Group 2, where the average weight loss was 6%. The percentage of weight loss showed a weak negative correlation with left ventricular muscle mass (r=-0.343, p=0.028), while stroke volume had a strong positive correlation with left ventricular muscle mass (r=0.668, p<0.001). T1 values were weakly positively correlated with the percentage of weight loss (r=0.392, p=0.032). Linear regression revealed a significant positive association between weight loss and T1 values (β=3.31, p=0.011) and a significant negative association with left ventricular muscle mass (β=-0.13, p=0.028). Our findings indicate that weight loss >10% has a detrimental effect on cardiovascular function, reducing left ventricular muscle mass and increasing T1 values, which may indicate myocardial tissue damage in patients with eosophageal cancer. These changes could compromise oncological treatment outcomes and survival, emphasizing the importance of early diagnosis and comprehensive management.

A hipertrófiás cardiomyopathia (HCM) egy genetikai eredetű szívizombetegség, amelyet fogamzóképes nők körében egyre gyakrabban diagnosztizálnak a fejlett szűrőprogramoknak és echokardiográfiás technológiáknak köszönhetően. Bár a várandósság körükben általában jól tolerálható, a várandósságban kialakuló hemodinamikai változások növelhetik a szövődmények kockázatát, amelyek kimenetelét a várandósság előtti állapot és a célzott várandósgondozás jelentősen befolyásol. A HCM-es várandós nők kockázatértékelése a módosított World Health Organisation osztályozása alapján történik, különös figyelemmel a csökkent bal kamrai ejekciós frakcióra, a súlyos obstrukcióra, a New York Heart Association szerinti III–IV. funkcionális állapotra és a ritmuszavarokra, amelyek magasabb szintű ellátást igényelnek. A várandósság alatti, megfelelő gyakoriságú orvosi kontroll és képalkotó vizsgálatok lehetővé teszik a lehetséges komplikációk időben történő felismerését, illetve megelőzését. Kiemelten fontos a fogamzás előtti multidiszciplináris értékelés, tanácsadás és a betegség kezelésének optimalizálása, valamint a várandósság alatti szoros monitorozás.

Background: The prevalence of cardiovascular disease increases exponentially with advancing age. However, biological age may differ from chronological age, and the mechanisms contributing to accelerated aging remain unclear.: We hypothesized that biological age and accelerated aging are independently associated with acute myocardial infarction (AMI) and may correlate with traditional cardiovascular risk factors. Methods: We analyzed biological age and aging patterns in patients with acute myocardial infarction using data from the prospective VMAJOR-MI-BIOAGE registry. Biological age was estimated via three artificial intelligence (AI)-based models (Visual Geometry Group [VGG], Residual Network [ResNet], and Prisoner), all validated for all-cause mortality prediction, using portrait photographs and laboratory data. Patients were classified as showing accelerated biological aging or not. Groups were compared by medical history, demographic and lifestyle factors, and clinical characteristics of myocardial infarction. A subgroup analysis focused on patients under 65 years. Use of automated AI tools was documented in the methodology per AHA and WAME guidelines. These contributed to age estimation only and did not participate in study design or data interpretation. Results: A total of 267 patients were enrolled; 38% were women. 49% were younger than 65 years. In the overall population (all p<0.05): Women gender aligned with accelerated aging (ResNet, VGG). Single individuals aged more slowly (ResNet). Retirees aged faster than those in managerial roles (Prisoner, ResNet). Physical inactivity was associated with faster aging (VGG). Participants sleeping <7 hours/day had older biological age (ResNet, Prisoner). Heart failure was associated with accelerated aging (Lab model). Among patients under 65 (all p<0.05): Those without prior cardiovascular disease aged more slowly (ResNet). Prior myocardial infarction and cancer were linked to higher biological age (Prisoner): Heart failure (based on lab-based estimates) and high stress levels (Lab model, VGG) were both associated with accelerated aging. Conclusions: Our findings suggest that biological age and age acceleration are relevant risk indicators in patients with acute myocardial infarction. AI-based biological age estimation may provide valuable insights beyond traditional risk factors in cardiovascular risk assessment. This research was supported by the Artificial Intelligence National Laboratory. Grant number: RRF-2.3.1-21-2022-00004

Giant cell myocarditis is a rare, rapidly progressive, potentially lethal disease caused by a T-cell-mediated inflammation of the myocardium. Rapid, early diagnosis is complicated by the diverse clinical picture (acute coronary syndrome, heart failure, arrhythmia episodes). Our 52-year-old female patient has no significant medical history; she had an upper respiratory tract infection prior to admission. She presented to the ER with chest pain and dyspnea. ECG showed anterior ST-elevation. Urgent coronary angiography showed an intact coronary system. Initially, she was hemodynamically stable, and echocardiography showed a mildly reduced EF. During a short observation period, her condition rapidly progressed, she became hypotonic, and due to third-degree AV block and significant pausa, temporary PM implantation was performed. She was admitted to our clinic due to suspected progressive myocarditis. Her condition stabilized with dual circulatory support. Due to continuous PM requirement, performing cardiac MRI was not possible. Cardiac biopsy confirmed giant cell myocarditis. We started high-dose IV steroid therapy. As a result, left ventricular function improved and necroenzyme levels decreased. According to the latest literature recommendations, her steroid treatment was supplemented with mycophenolate mofetil and tacrolimus, which gradually improved the EF and AV conduction, eliminated the need for a pacemaker, we removed the iPM, and stopped the inotropes and vasopressors. Extensive bacteriological, viral serological and immunological tests did not confirm active infection or immunological abnormalities. Cardiac MRI showed good left and right ventricular ejection fractions and late non-ischemic contrast enhancement. She was discharged after 2 weeks of treatment in a stable clinical condition, with the use of complex immunosuppressive therapy. She receives regular follow-up in the heart transplantation department of our clinic. With immunosuppressive treatment, she is symptom-free, EF 60%, and has no arrhythmia or conduction disorders. Our patient's case draws attention to the fact that in case of suspected myocarditis, myocardial biopsy and rapid diagnosis can be life-saving. It is rare that with combined immunosuppressive therapy and regular follow-up over a period of 1 year, the patient remained symptom-free, had good cardiac function, and was able to avoid possible heart transplantation and implantation of a circulatory support device.

COVID-19 vaccines reduce hospitalization risk, but data on severe outcomes are limited. We analyzed the impact of COVID-19 vaccination on severe outcomes in hospitalized patients in Hungary during the pre-Omicron era, addressing a regional knowledge gap. This retrospective study included hospitalized patients with PCR-confirmed COVID-19 (March 2020 - December 2021) who were categorized as unvaccinated, primary immunized, or booster-vaccinated. Outcomes included oxygen therapy, ventilation types, ECMO, and death, with the most severe outcome as the primary outcome and individual outcomes as secondary measures. Polytomous logistic regression calculated relative risk ratios for the primary outcome and COVID-19 vaccination status, while logistic regression estimated odds ratios for individual outcomes. During the study, 7575 patients were hospitalized with PCR-confirmed COVID-19: 6420 (84.8 %) were unvaccinated, 1016 (13.4 %) received a primary vaccination series, and 139 (1.8 %) had received a booster dose. COVID-19 vaccination reduced the risk of both invasive ventilation and in-hospital death as the most severe outcome by 50 % within 12 months (relative risk ratio [RRR]: 0.52, 95 % CI: 0.30-0.89; 0.50, 95 % CI: 0.41-0.61). Booster doses within six months decreased the risk of in-hospital death to a similar extent (RRR 0.46, 95 % CI: 0.30-0.72). Primary and booster vaccination reduced the risk of progression to severe outcomes in hospitalized COVID-19 patients.

Magyarországon minden második ember szív-ér rendszeri betegség következtében hal meg. A kardiovaszkuláris (CV) betegségek és halálozás gyakrabban fordulnak elő CV eseményt már elszenvedett betegpopulációban. Így a szekunder prevenciós kezelésnek kiemelt jelentősége van a hazai morbiditási és halálozási mutatók javításában. A szekunder CV prevenció egyik lényeges eleme az antitrombotikus terápia. A hagyományosnak mondható vérlemezkegátló-kezelés mellett az elmúlt évtizedben nagy, nemzetközi, randomizált tanulmányok eredményének ismeretében terápiás lehetőségként jelent meg a kettős antitrombotikus kezelés (kis dózisú rivaroxaban + aszpirin). Az ateroszklerotikus érbetegségekkel foglalkozó hazai tudományos társaságok közül a Magyar Angiológiai és Érsebészeti Társaság, a Magyar Kardiológusok Társasága és a Magyar Stroke Társaság szakértői ebben a konszenzusdokumentumban össze kívánták foglalni az ateroszklerotikus érbetegeket kezelő szakemberek számára a kettős antitrombotikus kezelés helyét és jelentőségét.

Introduction: Percutaneous coronary intervention (PCI) with drug-eluting stents (DES) is a cornerstone of the management of ischemic heart disease. However, in-stent restenosis (ISR) remains a significant clinical challenge, occurring in approximately 5–10% of patients undergoing PCI. This study is designed to compare the efficacy and safety of the primary therapeutic approaches for DES-ISR, specifically drug-coated balloons (DCBs)—paclitaxel-coated balloons (PCBs) and sirolimus-coated balloons (SCBs)—with a new-generation everolimus-eluting stent (EES), contributing to the evolving field of personalized medicine. Methods and Analysis: This prospective, multicentre, randomised, non-inferiority trial aims to enroll 150 patients with DES-ISR, who will be randomised into one of the following: SCB, PCB, or EES. The primary endpoint comparing DCB and EES is late lumen loss (LLL) at 6 months, as measured by quantitative coronary angiography (QCA). Secondary endpoints comparing the three arms include a device-oriented composite endpoint, intraluminal gain, optical coherence tomography (OCT) measured LLL, and correlations between LLL and quantitative flow ratio (QFR). The primary endpoint will be analysed using a non-inferiority design, with a margin set at 0.25 mm, for which the sample size was calculated. Statistical analysis of the primary endpoint will be conducted on an intention-to-treat basis with a one-tailed Mann–Whitney U test with a significance level of 95. Secondary endpoints will be analysed via superiority testing using ANOVA, the Kruskal–Wallis test, logistic regression, or Fisher’s exact test, as appropriate. Ethics and Dissemination: The study protocol has been approved by the Medical Devices Department of the Hungarian National Institute of Pharmacy and Nutrition, ensuring compliance with ethical standards as outlined in the Declaration of Helsinki. All investigators declare no conflicts of interest related to this study. The trial is registered in ClinicalTrials.gov under the ID: NCT04862052.

Introduction: The use of machine learning is exploding in all areas of healthcare, including the diagnosis and treatment of heart failure. Supervised machine learning can help predict the onset of heart failure, establish the diagnosis, and even predict decompensations. Conversely, unsupervised machine learning is chiefly used for phenotyping of the heart failure population. Several studies have identified distinctive groups of heart failure patients, but the widespread clinical implementation is still lacking. Aims: Our study aims to identify groups with similar characteristics among patients cared for HFrEF at the City Major Heart and Vascular Clinic of Semmelweis University using unsupervised machine learning and to describe the characteristic features of the resulting groups. We then examine the differences in outcome between the resulting groups. Methods: data from outpatients with reduced left ventricular ejection fraction heart failure were collected in a prospective registry. A total of 27 parameters included anamnestic data, laboratory tests, echocardiographic parameters and EQ5D quality of life questionnaire scores. The composite of hospitalization for heart failure and all-cause mortality was considered as the endpoint of the study. Spectral clustering was used to divide the population into three groups. The groups were plotted spatially using principal component analysis. Finally, we compared the groups in terms of parameters and endpoint occurrence. Results: Three characteristic groups were identified in the analysis of 259 patients. The first group consisted of 89 patients with ischemic etiology, more complaining, renal failure, and requiring duck diuretic therapy. The second group of 99 patients consisted of predominantly younger patients with atrial fibrillation, non-ischemic cardiomyopathy, dilated left ventricle, and a lower ejection fraction, almost exclusively on ARNI therapy. The third group of 71 patients included patients with the best ejection fraction, frequently taking ACE inhibitors and MRAs, and not requiring loop diuretics. Group 1 had significantly worse prognosis than group 2 (p=0.013) with a trend to worse prognosis compared to group 3. Conclusion: Our study identified three groups of patients with different characteristics based on a prospectively managed HFrEF registry. After validation on a larger patient cohort, our data may provide a basis for developing targeted treatment strategies.