Left bundle branch area pacing (LBBAP) is a developing alternative to right ventricular (RV) apical and His-bundle pacing [1]. Tri- cuspid regurgitation (TR) is recognized as a lead-related complication arising via leaflet impingement or damage at implantation, leaflet pinning, or fibrotic encapsulation, and it may also be aggravated by annular dilata- tion and chronic RVdysfunction.Importantly, chronic RV pacing with dyssynchronous activation can aggravate TR even without direct lead-leaflet interference. Reported TR worsening after pacemaker or cardiovert- er-defibrillat or implantation ranges from approximately 7% to 45% [2]. A recent study by Chod & oacute;r-Rozwadowska et al. [2] demon- strated that non-apical right ventricular lead positions were associated with more frequent progression to severe TR in patients under- going conventional pacing. Although their population and mechanisms differ from LB- BAP, their findings emphasize that pacing-lead geometry is an important determinant of tricuspid valve interaction. Available data specific to LBBAP remain limited, suggesting TR deterioration in approximately 11%-33% of cases [3]. LBBAP is typically performed on the right side of the interventricular septum (IVS), about 10-20 mm from the septal leaflet of the tricuspid valve (TV). A deeper lead posi- tion and a shorter distance from the tricuspid annulus (TA) may increase the risk of TV inter- action compared with right ventricular apical pacing. We hypothesized that the angle of lead implantation into the IVS may also affect this interaction. The aim of our study was to assess, using echocardiography, the impact of LBBAP lead position on tricuspid regurgitation (TR) progression.

Chronic thromboembolic pulmonary hypertension (CTEPH) is a progressive disease with poor outcome if left untreated. Identifying patients at risk of CTEPH already at acute pulmonary embolism (APE) would lead to earlier goal-directed management. Since echocardiography is frequently performed during APE we aimed to assess its predictive value for subsequent CTEPH. During follow up all symptomatic patients underwent diagnostic workup for CTEPH. Echocardiographic parameters recorded during the APE episode were analyzed for subsequent CTEPH. The study included 625 patients (345 F, age 60.36 ± 17.71), 25 subjects (4

Background:Patients with prior infective endocarditis are associated with an increased risk of recurrence. Aims:This study aimed to assess the clinical profile and treatment results of recurrent IE patients in Poland and compare them to European recurrent IE profile. Methods:A prospective multicenter observational cohort study of recurrent IE and first-episode IE patients from 160 medical centers in Poland registered between August 2022 and August 2024 was conducted. Polish recurrent IE cases were compared with those recorded in the ESC-EORP EURO-ENDO registry. Results:Of a total of 1758 IE patients, recurrent IE patients (n = 371) were younger than first-episode IE (n = 1387) patients [58.2 ± 16.6 vs. 62.6 ± 16.2, p < 0.001] and predominated in Poland [21.1 % vs. 8.6 %, p < 0.001]. Dental treatment predisposed to IE recurrence [12.8 % vs. 5.5 %, p < 0.001]. Prosthetic valve IE predominated among recurrent IE patients [33.1 % vs. 19.7 %, p < 0.001]. Fever > 38° was observed less often among recurrent IE cases [34.8 % vs. 54.1 %, p < 0.001]. Negative blood culture predominated among recurrent IE cases [43.3 % vs. 27.2 %, p < 0.001]. Polish recurrent IE patients were rarely operated than European counterparts [55.2 % vs. 64.8 %, p = 0.032]. The embolic surgery indications were less prominent in Poland [0.08 % vs. 20.2 %, p < 0.001]. Conclusions:The IE recurrence rate in Poland is greater. Dental treatment and valve prosthesis predispose to recurrence of IE. Fever > 38° is less often observed among recurrent IE. Surgical treatment is underutilized among Polish recurrent IE patients. Embolic and uncontrolled infection indications for surgery was underrated in Poland. The IE recurrence is not associated with increased in-hospital mortality.

We present a 49-year-old female suffering from primary biliary cholangitis (PBC), with a history of a congenital heart disease (CHD), who was evaluated before liver transplantation (LTx) due to liver cirrhosis.The score on the MELD (Model for End-stage Liver Disease) scale was 9 and on Child-Pugh scale was B7.On physical examination a loud systolic murmur over the heart at Erb's point was found (5/6 on Levin's scale).Symptoms of overt heart failure and arrhytmias were

INTRODUCTION:The aim of this study was to analyze echocardiographic parameters of the right and left ventricular function in patients with genetically confirmed myotonic dystrophy (DM). CLINICAL RATIONALE FOR THE STUDY:Cardiac complications remain a major cause of morbidity and mortality in DM; however, up until now, data on the right ventricular function is scarce. MATERIAL AND METHODS:We analyzed echocardiograms of 83 consecutive DM patients referred to our center for comprehensive clinical neurological and cardiac assessment and compared them to echocardiograms in 46 controls. Patients with diagnosed coronary artery disease or with significant valvular lesions were not included. RESULTS:The study group consisted of 83 DM patients (41 females; aged 15-69 years), including 42 with DM type 1 (DM1) (13 females; aged 15-64 years) and 41 with DM type 2 (DM2) (28 females; aged 18-69 years). 44% of DM2 and 4.8% of DM1 patients suffered from hypertension, 4.9% and 12% had type 2 diabetes. TAPSE and RV S' medians were lower in DM than in controls (p < 0.001 and p = 0.01, respectively), with lower values in DM1 than in DM2 (p = 0.009 and p = 0.02). TAPSE < 17mm was observed only in DM patients (8.4%, p = 0.049). RV S' < 9.5 cm/s was found only in DM1, not in DM2. Right ventricular systolic dysfunction defined as TAPSE < 17 mm or RV S' < 9.5 cm/s was observed in 12.1% DM patients (19% DM1 vs. 4.9% DM2, p = 0.09) and 2.2% of controls (p = 0.1). Left ventricular systolic dysfunction defined by LVEF < 50% was found in 3.6% of DM patients and was threefold less frequent than right ventricular systolic dysfunction (p = 0.04). Diastolic dysfunction was found in 24.1% DM patients (21% DM1 and 27% DM2, p = 0.75), and in 6.6% controls (p = 0.02), more frequently in older patients with hypertension. Systolic parameters of both ventricles were similar in patients with and without comorbidities. The echocardiographic findings did not correlate with the disease duration or neurological status. CONCLUSIONS:Right ventricular systolic function is impaired in DM patients, especially in DM1, irrespectively of neurological impairment, disease duration, and presence of comorbidities. In our study, left ventricular systolic dysfunction was rare and less prevalent than right; however, future studies with larger cohorts of patients are needed. Our findings underline the need for close cardiac follow-up with detailed echocardiographic assessment of both ventricles in DM.

Abstract Introduction The role of mitral valve prolapse (MVP) as an arrhythmic substrate rather than an isolated structural defect is under investigation. There is a possible link between the MVP, its morphology, and arrhythmic MVP (aMVP). Purpose To obtain data on the morphology and clinical significance of MVP in the Polish population. Methods 417 patients with MVP (mean age 45.5 years-yrs.; females: 249/59.7%) were enrolled into the prospective observational registry MITPROL AR-PL of the Polish Cardiac Society. Data was obtained from 23 Polish tertiary medical centers; the recruitment lasted 12 months. The analysis included demographics, clinical symptoms, 12-lead ECG, 24-hour Holter ECG, transthoracic, and transesophageal echocardiography. The MVP morphology was analyzed and defined as Barlow’s disease (BD), Forme Fruste (FF), and Fibroelastic deficiency (FED), according to standardized criteria. Groups were dichotomized into aMVP and non-arrhythmic MVP (non-aMVP) following the 2022 European Heart Rhythm Association consensus [1]. Patients who fulfilled the arrhythmic criteria but had proarrhythmic comorbidities comprised the MVP A+C (arrhythmia + comorbidities) group. Analysis was performed for the total population and age-divided subgroups: pediatric (0-18 yrs.), young adults (19-45 yrs.), middle-aged (46-59 yrs.), elderly (60+ yrs.). Results MVP population in the age subgroups: pediatric 86 (20%), young adults 120 (29%), 67 (16%) middle-aged, 144 (35%) elderly. BD was present in 140 (34%), FF in 242 (58%), and FED in 35 (8%). Bileaflet prolapse occurred in 228 (55%), anterior leaflet prolapse in 65 (16%), and posterior leaflet prolapse in 124 (29%). The frequency of the MVP morphology in the consecutive age subgroups was akin. The aMVP group consisted of 62 (15%), non-AMVP 336 (80%), and MVP A+C of 19 (5%) patients. Distribution of aMVP in the age subgroups: pediatric- 11%, young adults- 42%, middle-aged- 23%, elderly- 24%, 76% of aMVP patients were < 60 yrs. The aMVP corresponded mainly to the following MVP morphology: BD– 29 (47%) vs. 103(31%) in non-AMVP (p=0.01). Bileaflet prolapse was the most frequent for aMVP (46/74%) vs. non-aMVP (175/52%) (p=0.001), respectively anterior leaflet prolapse 4 (7%) vs. 57 (17%) (p=0.03), posterior leaflet prolapse 12 (19%) vs. 104 (31%) (p=0.06). Moderate to severe MR was observed in 35 (56%) aMVP vs. 196 (58%) non-aMVP (p=0.8), MAD in 48 (77%) aMVP vs. 193 (57%) non-aMVP (p=0.003), Pickelhaube sign in 28 (45%) aMVP vs. 98 (29%) non-AMVP cases (p=0.01). MAD diameter was higher in the aMVP (8.6 ± 2.7 mm) vs. the non-aMVP (7.2 ± 2.5 mm) group (p=0.001). The age of MVP A+C group was higher, with 84% of patients >60 yrs. vs. 24% >60 yrs. in the aMVP (p<0.0001). MVP morphology in the MVP A+C was: BD 8 (42%), FF 10 (53%), and FED 1 (5%). Conclusion The MVP is a primary and heterogenous disease, and aMVP variant is rare. The aMVP population differs significantly from non-AMVP and MVP A+C populations. Mitprol AR-PL Methodology Mitprol AR-PL Population

Post-pulmonary embolism syndrome (PPES) is an emerging phenomenon and a major complication of acute pulmonary embolism (APE). The pathogenesis of PPES is complex and multifactorial, and involves clinical, laboratory, and echocardiographic findings. A major component of PPES is persistent dyspnea, along with other symptoms such as fatigue, chest pain, lightheadedness, and/or syncope, persisting for more than 3-months after APE. Despite extensive research on PPES, there is a limited understanding of its course and management in the elderly population. The Vulnerable Elders Survey (VES-13), a tool used to identify health impairment risks, is specifically employed for patients aged≥ 60 years. This study aimed to identify elderly survivors of APE who are at a higher risk of developing PPES, thereby guiding more targeted interventions. This study included 241 patients aged ≥60 years who were diagnosed with APE. All patients with APE were diagnosed and managed according to the European Society of Cardiology (ESC) guidelines, presented with dyspnea at admission, and were followed up for at least 3-months after discharge. Clinical evaluation, biochemical tests, the VES-13 score, and transthoracic echocardiography (TTE) were evaluated at baseline. After 3-months period, the routine evaluation of persistent dyspnea was assessed during the follow-up visit in the outpatient clinic. The primary endpoint was dyspnea 3-months after the acute episode. A total of 179 patients were included. Persistent dyspnea was observed in 42 subjects (23,4

Background: The prevalence of portopulmonary hypertension (PoPH) is relatively low; however, its presence significantly worsens patients’ prognosis. When diagnosed, PoPH can be effectively treated, and specific therapies can lead to a substantial reduction in pulmonary circulation pressure, facilitating the safe performance of liver transplantation. Echocardiography is recommended as a first-line method for the non-invasive diagnosis of pulmonary hypertension and serves as a valuable screening tool for patients being evaluated for liver transplantation (LT). The objective of this study was to thoroughly assess the occurrence of echocardiographic signs indicative of pulmonary hypertension and hepatopulmonary syndrome (HPS) in candidates for LT. We assumed that our analysis also made it possible to assess how frequently these candidates require further invasive diagnostics for pulmonary hypertension at specialized centers and how often they may need targeted treatment for pulmonary arterioles as a bridge to transplantation, which could improve patient outcomes. Additionally, this study included a comprehensive review of the current literature. Methods: All LT candidates underwent standardized transthoracic echocardiography and contrast evaluation to identify intrapulmonary vascular shunts. Results: A total of 152 liver transplantation candidates (67 women, mean age 50.6 years) were included in the analysis. The estimated echocardiographic probability of pulmonary hypertension was classified as high in only one patient. However, 63 patients exhibited the visualization of microbubbles in the left heart chambers after an average of six cardiac cycles (ranging from three to nine cycles) following their appearance in the right heart. Conclusions: Our analysis shows that the features of PoPH and a high probability of PH were very rare in the LT candidates, and echocardiographic signs suggestive of hepatopulmonary syndrome were more prevalent. Liver transplant candidates need screening for PoPH and HPS, as both PoPH and HPS significantly worsen their prognosis, but specific PH treatment as a bridge to transplantation improves PoPH patients’ survival.

Background: Cardiovascular diseases are the leading cause of morbidity and mortality in patients with end-stage renal disease. Aims: This study aimed to assess the prognostic value of high-sensitivity cardiac troponin T (hs-cTnT) in identifying patients with obstructive coronary artery disease (CAD) among patients on hemodialysis listed for kidney transplantation. Methods: The study prospectively enrolled consecutive adult hemodialysis patients listed for kidney transplantation. They underwent laboratory tests and a standardized set of imaging and functional tests, including coronary angiography, according to patient characteristics. Results: The study included 100 consecutive patients (72 men)at a median age of 56.5 years. Ultimately, 48% of the patients were diagnosed with obstructive CAD. Age and plasma hs-cTnT levels predicted the diagnosis of obstructive CAD (OR, 1.13; 95% CI, 1.08-1.20; P <0.001 and OR, 1.03l 95% CI, 1.01-1.05; P = 0.001, respectively). The calculated cut-off value for age was 53 years, which showed sensitivity of 87.5% and specificity of 76.9% for obstructive CAD diagnosis. The calculated value for hs-cTnT was 0.067 ng/ml, which showed sensitivity of 61.4% and specificity of 82.2% for the detection of obstructive CAD. In patients aged >52 years, 79.2% were diagnosed with obstructive CAD. However, in the group of patients <= 52 years and with hs-cTnT >0.069 ng/ml, the incidence of obstructive CAD was significantly higher than in the group with hs-cTnT level <= 0.069 ng/ml. Conclusions: Baseline hs-cTnT level is a useful prognostic biomarker in the diagnosis of obstructive CAD in hemodialysis patients listed for kidney transplantation.

A 75-years-old woman with acute dyspnea was diagnosed for suspected acute pulmonary embolism (APE).Initially, she was stable with blood pressure of 135/80mmHg, tachycardia of 105bpm and oxygen blood saturation of 84%.Computed tomography pulmonary angiography (CTPA) showed a bilateral central pulmonary embolism and an enlarged right ventricle (RV).After this examination, a sudden drop in systolic blood pressure to 80mmHg was reported.She was classified as a high-risk APE and referred immediately to a tertiary cardiology care unit.On admission to our department, the patient was in good general condition without peripheral hypoperfusion.Her left hand was colder without a palpable pulse, however without signs of acute ischemia.A difference of 60mmHg in systolic blood pressure between upper extremities

We present a 68-year-old man who was admitted with signs of exacerbation of heart failure in the course of atrial fibrillation (AF) with an undefined onset with heart rate up to 170 bpm.Metoprolol and digoxin were ineffective in slowing HR, so landiolol was used and the patient

A 57-year-old woman with a hypertrophic cardiomyopathy (HCM) and end stage renal disease treated with hemodialysis was admitted with symptoms of decompensated heart failure in New York Heart Association class III. The serum levels of N-terminal pro-B-type natriuretic pep - tide and troponin were elevated (> 35000 pg/mL and 0.161 ng/mL). The electrocardiogram (ECG) revealed sinus rhythm, first degree atrioventricu - lar block (PQ 215 ms) and increased QRS voltages (Sokolow-Lyon criteria of left ventricular [LV