Objectives:Coronary artery disease remains the leading cause of death globally. Although early myocardial infarction management has improved, long-term secondary prevention remains challenging. This study evaluated the impact of comprehensive cardiac rehabilitation on long-term mortality among acute coronary syndrome survivors and examined factors influencing participation. Methods:Data were drawn from the National Myocardial Infarction Registry, including 158,599 patients who survived 30 days after myocardial infarction between 2014 and 2024. Date of data collection was JUL/31/2025. Propensity score matching generated 27,640 matched pairs. All-cause mortality was assessed over a median 4.3-year follow-up; Rosenbaum bounds evaluated sensitivity to hidden bias. Results:Comprehensive cardiac rehabilitation participation was low (17.4%), highest in ST-elevation myocardial infarction patients (24.6%), and lowest among non-ST-elevation myocardial infarction patients without percutaneous intervention (7.4%). Mortality was 37.4% in non-participants and 24.8% in participants. Adjusted analysis showed a 12.9% absolute mortality reduction and 34% relative risk reduction (number needed to treat = 8). Older age, non-ST-elevation myocardial infarction diagnosis, and conservative management predicted non-participation. Conclusions:Cardiac rehabilitation confers significant survival benefits after myocardial infarction, but remains underutilised, especially among high-risk groups. Active enrolment strategies and diverse rehabilitation modalities are needed to improve participation and outcomes.

The presence of higher body mass index (BMI) accompanied by better outcomes in patients with heart failure with reduced ejection fraction (HFrEF) is described as the obesity paradox. However, recent evidence has questioned the existence of this phenomenon by adjusting for better prognostic factors and using superior anthropometric measures of obesity. Nevertheless, data regarding the association between BMI and mortality in HFrEF patients with the use of contemporary guideline-directed medical therapy (GDMT), including SGLT2is, is scarce. To assess the association between BMI and mortality in patients with HFrEF treated with modern GDMT across a wide BMI spectrum. The data of 420 consecutive patients (male sex: 75

INTRODUCTION:Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare but potentially curable form of pulmonary hypertension. Pathology is characterized by persistent, organized thrombi causing mechanical vascular obstruction, often accompanied by a small-vessel vasculopathy. In 2023, balloon pulmonary angioplasty (BPA) was introduced in our institution as a new treatment option for managing CTEPH. OBJECTIVE:To present the initial clinical and hemodynamic outcomes of BPA interventions launched as part of the complete CTEPH program established at Gottsegen György National Cardiovascular Center. METHOD:In this retrospective study, we analyzed 38 inoperable patients diagnosed with CTEPH who underwent at least one BPA procedure between 2023 and 2024. Diagnosis was established according to the national guidelines. During BPA, balloon dilation was performed on stenosed or occluded segmental and subsegmental pulmonary arteries. The therapeutic efficacy was evaluated using echocardiographic, functional, laboratory, and hemodynamic parameters. RESULTS:The majority of CTEPH patients were categorized within WHO functional class II and III. A total of 119 BPA sessions were performed in 38 patients. At the time of data analysis, the majority of patients (81.5%) had not yet completed their full BPA treatment course. In patients treated with BPA, TAPSE/SPAP ratio improved significantly from 0.3 ± 0.03 to 0.4 ± 0.05 mm/mmHg (p<0.05). A trend towards improvement was also observed in the 6-minute walk distance and NT-proBNP levels (409 ± 28 vs. 418 ± 32 m, p = 0.07; 2984 ± 1083 vs. 1168 ± 279 pg/mL, p = 0.05, respectiveli). BPA treatment led to significant reductions in mean pulmonary artery pressure (40 ± 2.3 vs. 35 ± 2.1 mmHg, p<0.05), mean right atrial pressure (9.4 ± 1.0 vs. 6.2 ± 0.8 mmHg, p<0.05), and pulmonary vascular resistance (PVR [based on thermodilution]: 7.1 ± 0.8 vs. 5.5 ± 0.5 WU, p<0.05). No periprocedural mortality occurred, and major complications were observed in only 1.7% of sessions. CONCLUSION:BPA appears to be a safe and effective alternative therapy for CTEPH patients, providing notable hemodynamic improvement. The initial results of our program are promising for the future of CTEPH management in Hungary. Orv Hetil. 2026; 167(1): 23-29.

INTRODUCTION:Urine albumin-to-creatinine ratio (UACR) has strategic importance in cardio-kidney-metabolic syndrome and leads to worse prognosis in heart failure. OBJECTIVE:To assess the role of UACR measurement in a consecutive, hospitalized patient cohort with heart failure with reduced ejection fraction (HFrEF) and to analyze the effect on guideline-directed medical therapy implementation and all-cause mortality. METHODS:The data of 186 patients, hospitalized for HFrEF between 01. 09. 2023 and 01. 09. 2024, were analyzed retrospectively, who had UACR measured in-hospital (admission parameters: male: 75%, age: 60 [51-70] years, diabetes: 36%, NT-proBNP: 5982 [2624-10567] pg/mL, eGFR: 59 [47-75] mL/min/1.73 m2, RASi: 63%, βB: 63%, MRA: 44%, SGLT2i: 18%, quadruple therapy [RASi + βB + MRA + SGLT2i]: 15%). Based on UACR values, 3 groups were created - A1: <3 mg/mmol, A2: 3-30 mg/mmol, A3: >30 mg/mmol - and pharmacotherapy at discharge was compared among them. All-cause mortality and its predictors were investigated. RESULTS:The distribution of UACR categories were: 53%, 38%, and 9% (A1, A2, A3). Patients with A2/A3 albuminuria were characterized by lower ratio of de novo HFrEF, higher comorbidity burden and NT-proBNP. Advanced albuminuria was associated with a lower application ratio of HFrEF pharmacotherapy (RASi: 98% vs. 94% vs. 59%, βB: 95% vs. 89% vs. 71%, MRA: 100% vs. 94% vs. 59%, SGLT2i: 84% vs. 68% vs. 41%, quadruple therapy: 80% vs. 61% vs. 41%). All-cause mortality rates of patients with higher albuminuria were worse (7% vs. 20% vs. 29%, p = 0.026). However, in the univariate analysis, UACR had a prognostic effect, while in the multivariate model, age, systolic blood pressure and the use of triple therapy (RASi + βB + MRA)/quadruple therapy remained the independent predictors of all-cause mortality. CONCLUSIONS:Our results highlight the importance of UACR in the identification of high-risk HFrEF patients. Guideline-directed medical therapy implementation was possible among them as well, underscoring the need of continuous therapy-optimization in wide spectrum of albuminuria. Orv Hetil. 2026; 167(10): 383-395.

Introduction:Echocardiography significantly underestimates left ventricular outflow tract (LVOT) area resulting in the underestimation of aortic valve area (AVA). Our aim was to identify predictors of measurement error between echocardiography and CT-based LVOT area and develop a model to predict CT-based AVA values (hybrid AVA: using CT-based LVOT) using only clinical and echocardiographic parameters. Methods and results:Consecutive severe AS patients between 1 January 2020 and 1 September 2024 were analysed to identify predictors of relative measurement inaccuracy using linear regression. We developed a model using only clinical and echocardiographic parameters to estimate CT-based hybrid AVA and validated it on consecutive patients between 2 September 2024 and 1 September 2025. Overall, 1367 patients were analysed (mean age 79.3 ± 6.3 years, 725 female). The mean difference between echocardiography- and CT-based LVOT area was -162 mm2 ± 98.2 mm2, resulting in an AVA mean difference of -0.29 ± 0.18 cm2, which led to reclassification of 31% of patients using a hybrid AVA cut-off of ≥1 cm2. Older age, female sex, increased LVOT diameter, aortic valve V max, and Doppler index were associated with reduced relative measurement error, whereas height, end-systolic, and end-diastolic volumes were associated with an increased relative measurement error. Our predicted AVA model had a strong correlation (r = 0.82; P < 0.001) with CT-based hybrid AVA values which was validated in 448 patients showing similar accuracy (r = 0.85; P < 0.001). Conclusion:Echocardiography significantly underestimates the LVOT area compared to CT, leading to the reclassification of nearly one-third of patients. Our provided model using clinical and echocardiography-based parameters may support CT-free estimation of hybrid AVA values.

Background The Hungarian Myocardial Infarction Registry is a mandatory registry that records the medical history, hospital care data, and long-term follow-up of every patient diagnosed with myocardial infarction in Hungary. The aim was to examine the age distribution, common risk factors and comorbidities among patients with acute myocardial infarction (AMI) recorded in the Registry between January 1, 2014 and December 31, 2024. Methods Generalised additive models were used to estimate the prevalence of risk factors and comorbidities, allowing smooth time trends and age-adjustment. UpSet plots were used to investigate frequent combinations. Results We analysed data from 135,865 patients (39.6% women) who received treatment for AMI (46.6% STEMI). The most prevalent comorbidity was hypertension. The prevalence of smoking, obesity and diabetes increased in both genders and both AMI types, with the odds ratios per 10 year ranging from 1.11 to 1.37 for diabetes (depending on gender and AMI type), from 1.43 to 2.08 for smoking and from 1.37 to 1.62 for obesity. In case of hyperlipidaemia, the increase was significant only among cases with STEMI. For hypertension, some changes were statistically significant, but were not clinically relevant. The prevalence of young (<40 years) patients changed significantly only among male patients with STEMI, where it decreased, while the prevalence of old (>80 years) patients decreased significantly in every group, except among male patients with NSTEMI. Conclusion We observed a significant increase in the prevalence of smoking, obesity and diabetes mellitus in different types of myocardial infarction in both sexes.

Aims:Atrial fibrillation is the most common sustained cardiac arrhythmia, associated with considerable morbidity and mortality. Early detection is essential for optimal management. While wearable smart devices have shown promise, smartphone applications using photoplethysmography have also emerged as potential screening tools, but their diagnostic accuracy has not been adequately validated. This study aimed to compare the diagnostic performance of two commercially available photoplethysmography-based smartphone applications. Methods and results:In this prospective multicentre study, consecutive patients from three cardiology centres underwent simultaneous recordings with the FibriCheck® and Preventicus Heartbeats® applications and a 12-lead electrocardiogram during hospital admission or outpatient evaluation. Electrocardiograms were independently interpreted by blinded cardiologists. Diagnostic accuracy, rate of inconclusive recordings, technical performance, features, and pricing were compared between the two applications. A total of 206 patients (median age 69.5 years, 64.1% male) with 216 electrocardiograms were analysed; atrial fibrillation was present in 43.1%. Successful photoplethysmography recordings were obtained in 97.7% of FibriCheck (mean attempts 1.2 ± 0.7) and 87.5% of Preventicus Heartbeats (1.6 ± 1.3) measurements. Sensitivity and specificity were 89.0% and 100.0% for FibriCheck, and 86.4% and 99.0% for Preventicus Heartbeats. Inconclusive reading rates (where the algorithm indicated a suspicion of mild arrhythmia) were 8.5% and 11.1%, respectively. Conclusion:Both smartphone applications demonstrated high and comparable diagnostic accuracy for atrial fibrillation detection in a real-world population. These tools represent a viable, non-invasive option for early rhythm screening and follow-up, potentially improving patient outcomes, although further refinement is needed to reduce inconclusive recordings.

Our case report describes the complex management of a 31-year-old female patient who developed severe aortic bioprosthesis stenosis. Her medical history includes a childhood Ross procedure, followed by repeat cardiac surgery at age 18 (implantation of aortic and pulmonary bioprostheses), and subsequent percutaneous pulmonary valve implantation (PPVI) at age 25. The patient presented with a rare anatomical variation: a single coronary artery system originating from the left ostium. Due to previous surgeries and extensive adhesions, surgical aortic valve replacement (SAVR) via repeat sternotomy was considered to carry a prohibitively high risk. During the planning of a Valve-in-Valve (ViV) TAVI, a rare and critically challenging anatomical situation was identified: following the initial Ross procedure and subsequent surgical bioprosthetic valve implantation, the left coronary ostium was located adjacent to the surgical bioprosthesis frame, but below the plane of the valve annulus. As percutaneous coronary protection was not considered safely feasible, myocardial blood supply was ensured via a minimally invasive MIDCAB procedure (LIMA–LAD bypass) performed through a left-sided thoracotomy. This was followed by a successful and uneventful TAVI on the same day. In cases where SAVR is contraindicated and the anatomy poses an extreme risk of coronary obstruction, TAVI performed in conjunction with minimally invasive surgical coronary protection can provide a safe and effective alternative.

The authors examined the issues of care for patients who survived myocardial infarction. A postal questionnaire was sent to 1,000 randomly selected, working-age patients who survived myocardial infarction, which included questions related to institutional rehabilitation, outpatient care, and occupational rehabilitation following acute hospital treatment. 32.4% of the selected patients returned the questionnaire. The response rate, based on literature data, can be considered reasonable. The average follow-up time was 509±104 days. At the end of acute care, 39 patients (12.1%) from 36 hospitals were transferred to a rehabilitation institution. No patients were assigned to a rehabilitation institution from half of the institutions providing acute care. During the follow-up period, 15 patients (4.6%) were treated for another infarction, and there were no deaths. In connection with outpatient check-ups, 91 (28.1%) patients visited a doctor once, while 224 (69.1%) patients did so several times. 90.7% of the patients indicated a cardiologist, 44.1% a family doctor and 11.7% an internal medicine specialist as their treating doctor. At the time of the infarction, 269 patients (83%) were working, and 199 employees (61.4%) were employed in manual work. At the time of filling out the questionnaire, 151 patients (46.6%) worked full-time, and 14 (4.3%) worked part-time. 95 (29.3%) patients received benefits (old-age or disability pension, etc.), of whom 73 were disability pensioners. In addition to the benefits, 32 patients worked part-time or full-time. The data of the present study confirm that the rate of medical rehabilitation of patients with myocardial infarction is inadequate. The authors emphasise that outpatient rehabilitation and care after myocardial infarction should be organised and monitored. The rate of occupational rehabilitation is lower than expected, with adverse effects on both the individual and society.

Abstract Introduction Ten patients underwent off-pump transapical mitral valve repair with chordal implantation for the treatment of primary mitral valve regurgitation (MR) between 01.2023 and 03.2024 in our tertiary referral center. Purpose Our aim was to examine the safety, feasibility and effectivity of the surgical method. Methods We fulfilled the retrospective analysis of the patients’ preoperative, operative and postoperative data. Results Median age was 75.5 years [IQR: 74; 80], Euroscore II 2.8 [IQR: 2; 3], and STS Score 3.8 [IQR: 2; 4]. Three patients were in NYHA II, four patients in NYHA III and three patients in NYHA IV functional stage. The patients had severe co-morbidities as congestive heart failure (n=9), pulmonary hypertension (n=10), chronic renal failure (n=4), more than mild coronary artery disease (n=4), peripheral arterial disease (n=4), previous pulmonary embolism (n=4), atrial fibrillation (n=3), chronic obstructive pulmonary disease (n=2), previous stroke (n=1). All the patients had posterior mitral leaflet prolapse ± chordal rupture, causing severe mitral regurgitation. Six patients had isolated P2 disease and four had more complex pathology. Median MR PISA radius was 14 mm [12-15.8], 3-dimension vena contracta area 0.56 cm2 [IQR: 0.56-0.57], effective regurgitant orifice 0.61 cm2 [IQR: 0.5-0.84], regurgitant volume 83 ml [IQR: 65-111], leaflet-to-annulus index 1.23 [IQR: 1.2-1.3] and coaptation index 5 mm [IQR: 4.5-5]. All the surgeries were successful, with median 90 minutes [IQR: 75; 100] surgery time, 2-5 chordal implantations. The intra-operative echocardiography showed trace or mild MR in seven cases, and mild-to-moderate MR in three cases. There was no operative/early postoperative mortality, or early valvular/chordal failure. One case of postoperative bleeding occurred with successful surgical revision. There was one case of 30-days-mortality in a critically ill patient with severe heart failure. Mild left-sided pleural effusions and postoperative atrial arrhythmias were detected in five and three patients, respectively. Median ICU stay was 27 hours [IQR: 23.5; 27.8], and postoperative in-hospital stay was 8 days [IQR: 7; 9]. Predischarge transthoracic echocardiography showed trace-to-mild MR in eight patients, and mild-to-moderate MR in two patients, while three months postoperatively we detected four cases of mild, four cases of mild-moderate or moderate and one case of moderate-to-severe MR. In comparison to the baseline values, five patients were in NYHA I, two in NYHA II and two in NYHA III functional stage three months after surgery. Conclusion In summary, transapical beating heart mitral valve chordal repair seems a relatively safe and effective option for high-risk patients, however, we emphasize the significance of judicious preoperative risk and echocardiographic eligibility assessment and the need for further studies to examine the durability and long-time efficacy of the method.

This study evaluates possible differences in prognosis in acute coronary syndrome (ACS) based on gender of the patient, analyzing data from the National Myocardial Infarction Register in Hungary. The data include 76,153 ACS patients followed over five years. The study evaluates all-cause mortality, risk factors, and treatment outcomes. All cause mortality was assessed at 30 days, 1 year, and 5 years. The data set analyzed is the result of mandatory reporting of data on patients presenting with ACS to hospitals in Hungary, in effect from January 2014 on forward. Data on 155,000 encounters involving over 130,000 patients were collected by September 2022. The current study comprises a retrospective analysis of all cases reported to the registry from its date of inception (January 1st, 2014) to 2019. The primary outcome measured was all-cause mortality. The analyzed patient cohort had a median age of 67.4 years, 60% of patients entered were males. Key patient characteristics included a 34% prevalence of diabetes and an 18% history of previous ACS, 44% of the patients presented with ST elevation myocardial infarction (STEMI) during their initial admission, and 77% were admitted directly to hospitals with percutaneous coronary intervention (PCI) capability. There was a 12.1% short-term (30 day), a 21.5% mid-term (one year), and a 37% long-term (five year) all-cause-mortality rate across the cohort. Both short- term and long-term mortality rates were influenced significantly by age, diabetes, and whether the patient’s ACS presentation was caused by a STEMI versus a non ST elevation myocardial infarction (NSTEMI). Women presented with a less favourable cardiovascular risk profile, characterized by higher rates of diabetes, hypertension, and older age. Men had a higher incidence of prior cardiac interventions, they notably received more timely treatment compared to women, and they were more likely to undergo PCI. Further, women experienced higher rates of complications during treatment and they were less likely to receive guideline consistent drug therapy at discharge. Our results demonstrate gender-related disparities in key parameters relating to presentation, triaging, and treatment modality chosen in patients presenting with ACS. Physiological gender related patient differences alone cannot explain these disparities. We believe that unconscious bias and knowledge deficits regarding the more diverse and atypical presentation patterns of female ACS patients likely affect decision makers at all levels (patients themselves, physicians, and allied health professionals). Such unconscious bias and knowledge deficits should be the target of educational campaigns directed at the public and at health care professionals.

Introduction: The 2023 European Society of Cardiology Cardiomyopathy Guidelines emphasize the crucial role of a multiparametric approach in diagnosing. During the diagnostic workup of hypertrophic cardiomyopathy, besides echocardiography and cardiac magnetic resonance, ECG plays an important role. Based on literature data, only 4-18% of patients with hypertrophic cardiomyopathy have normal ECG, however, ECG deviations are often non-specific. Objective: To evaluate the ECG characteristics in a hypertrophic cardiomyopathy patient cohort followed-up at the Heart Failure Outpatient Clinic of Gottsegen National Cardiovascular Center. Method: We retrospectively analyzed the data and the first ECGs registered of patients with hypertrophic cardiomyopathy, diagnosed by cardiac magnetic resonance and/or genetic testing, followed-up between 01. 11. 2023 and 30. 09. 2024 at our Heart Failure Outpatient Clinic. Results: Data from 72 patients were evaluated, male: 58%, age: 49 (34-62) years, left ventricular ejection fraction: 63 (47-72)%, NYHA functional class: 2 (1-2), ICD/CRT-D: 47%. Based on the left ventricular outflow tract obstruction of >= 30 mmHg, 31% of the patients belonged to hypertrophic obstructive cardiomyopathy subgroup. Based on the ECGs analyzed, atrial fibrillation occurred in 6%. Interatrial conduction disturbances affected 29% of the patients. Atrioventricular and intraventricular conduction disturbances occurred in 50% (AV block: 20% [grade I: 18%, grade II: 2%, grade III: 0%], right bundle branch block: 14%, left bundle branch block: 16%, left anterior hemiblock: 13%, left posterior hemiblock: 3%, non-specific intraventricular conduction disturbance: 8%). The sensitivity of the Cornell, Sokolow-Lyon, and Peguero-Lo Presti high voltage criteria were low (23-14-25%). Pathological Q wave occurred in 42% of the patients, QRS fragmentation in 43% and corrected QT interval prolongation in 44%. T wave inversion was present in 94%, significant ST elevation in 21%, ST depression in 48%, while only 3% of patients had negative ECG. The only difference between hypertrophic obstructive cardiomyopathy and non-obstructive hypertrophic cardiomyopathy patients was the fulfillment of the Cornell criterion (45% vs. 15%, p = 0.044). Conclusions: A multimodal approach is essential in the diagnosis of hypertrophic cardiomyopathy. Based on our results, hypertrophic cardiomyopathy is often associated with heterogeneous ECG abnormalities. However, the early recognition of the ECG variations may help in the further diagnostic steps, contributing to the initiation of disease-modifying treatment.

Bevezetés: Az Európai Kardiológus Társaság 2023-ban publikált, Cardiomyopathia Irányelve a cardiomyopathiák diagnosztikájában a multiparametrikus megközelítés fontosságát hangsúlyozza. A hypertrophiás cardiomyopathia kivizsgálásában az echokardiográfia, a szív mágnesesrezonancia-vizsgálata mellett az EKG is fontos szerepet játszik. Szakirodalmi adatok alapján a hypertrophiás cardiomyopathiában szenvedő betegek mindössze 4–18%-a rendelkezik eltérés nélküli EKG-val, ám a megfigyelt EKG-eltérések gyakorta aspecifikusak. Célkitűzés: Tercier kardiológiai centrumunk, a Gottsegen György Országos Kardiovaszkuláris Intézet Szívelégtelenség Ambulanciáján gondozott, hypertrophiás cardiomyopathiában szenvedő betegpopuláció EKG-jellemzőinek értékelése. Módszer: Intézetünk Szívelégtelenség Ambulanciáján 2023. 11. 01. és 2024. 09. 30. között gondozásba vett, a szív mágnesesrezonancia-vizsgálatával és/vagy genetikai vizsgálattal igazolt hypertrophiás cardiomyopathiában szenvedő betegek adatait, első ambuláns EKG-paramétereit elemeztük retrospektív módon. Eredmények: A vizsgált betegek (n = 72 fő) 58%-a volt férfi, mediánéletkoruk 49 (34–62) év, bal kamrai ejekciós frakciójuk 63 (47–72)%, NYHA funkcionális osztályuk 2 (1–2) volt, ICD-t/CRT-D-t 47%-uk viselt. A balkamrakiáramlási-pályaobstrukciójának ≥30 Hgmm értéke alapján a betegek 31%-a tartozott a hypertrophiás obstruktív cardiomyopathia csoportba. Az elemzett EKG-kon a betegek 6%-a pitvarfibrillált, az interatrialis vezetési zavarok a 29%-ukat érintették. Atrioventricularis és intraventricularis vezetési zavarok a betegek 50%-ában jelentkeztek (AV blokk: 20% [PQ-szakasz-megnyúlás: 18%, II. fokú AV blokk: 2%, III. fokú AV blokk: 0%], jobb-Tawara-szárblokk: 14%, bal-Tawara-szár-blokk: 16%, bal anterior hemiblokk: 13%, bal posterior hemiblokk: 3%, aspecifikus intraventricularis vezetési zavar: 8%). A Cornell, a Sokolow–Lyon-, illetve a Peguero–Lo Presti „high voltage” kritériumok szenzitivitása alacsonynak bizonyult (23–14–25%). Patológiás Q-hullám 42%-ban, QRS-fragmentáció 43%-ban, korrigált QT-idő-megnyúlás 44%-ban fordult elő. Repolarizációs eltérések, mint a T-hullám-inverzió, a csoport 94%-ában, szignifikáns ST-eleváció a 21%-ában és ST-depresszió a 48%-ában volt megfigyelhető, mindössze a páciensek 3%-a rendelkezett negatív EKG-val. A hypertrophiás obstruktív cardiomyopathia és a nonobstruktív hypertrophiás cardiomyopathia alcsoportok között egyedül a Cornell-kritérium gyakoriságában adódott különbség (45% vs. 15%, p = 0,044). Következtetés: A hypertrophiás cardiomyopathia diagnosztikájában elengedhetetlen a multimodális szemlélet. Eredményeink alapján hypertrophiás cardiomyopathiában gyakorta azonosíthatók heterogén EKG-eltérések, ám a gyanújelek időbeli felismerése a további diagnosztikus lépéseket segítheti, hozzájárulva a célzott kezelés megkezdéséhez, a prognózis javításához. Orv Hetil. 2025; 166(25): 970–981.

Background/Objectives: Randomized studies of patients with unprotected left main coronary artery (ULMCA) disease involve highly selected populations. Therefore, we sought to investigate the 60-month event-free survival of consecutive patients undergoing ULMCA percutaneous coronary intervention (PCI) and determine the best risk score system and independent predictors of event-free survival. Methods: All patients who underwent ULMCA PCI at our center between 1 January 2007 and 31 December 2014 were included. The primary endpoint was the time to cardiac death, target lesion myocardial infarction, or target lesion revascularization (whichever came first) with a follow-up of 60 months. Results: A total of 513 patients (mean age 68 ± 12 years, 64% male, 157 elective, 356 acute) underwent ULMCA PCI. The 60-month incidence of events was 16.8% and 38.0% in elective and acute patients, respectively. There were significantly more events in the acute group during the first 6.5 months. Of the risk scores, the ACEF (AUC = 0.786) and SYNTAX II (AUC = 0.716) scores had the best predictive power in elective and acute patients, respectively. The SYNTAX score proved to be the least predictive in both groups (AUC = 0.638 and 0.614 in the elective and acute groups, respectively). Left ventricular function (hazard ratio (HR) for +10% 0.53 [95% CI, 0.38-0.75] and 0.81 [95% CI, 0.71-0.92] in elective and acute patients, respectively) and, in acute patients, access site (femoral vs. radial HR 1.76 [95% CI, 1.11-2.80]), hyperlipidemia (HR 0.58 [95% CI, 0.39-0.86]), and renal function (HR for +10 mL/min/1.73 m2 higher GFR: 0.87 [95% CI, 0.78-0.97]) were independent predictors of event-free survival. Conclusions: Acute ULMCA PCI patients have worse prognosis than elective patients, having more events during the first 6.5 months. Besides anatomical complexity, clinical and procedural parameters determine the prognosis.

A súlyos, tünetes tricuspidalis regurgitatio progresszív, rossz prognózisú betegség, amelynek kezelésére lehetőségeink korlátozottak. Megoldást jelenthet palliatív jelleggel a bicavalis heterotop billentyűimplantáció (TricValve), amelynek során sztentelt bioprotéziseket ültetünk be vena cava superior és inferior pozíciókba az eredeti tricuspidalis billentyű érintése nélkül. Az intézetünkben végzett, tudomásunk szerint első hazai beavatkozás tapasztalatait szeretnénk bemutatni. A 74 éves, súlyos szekunder tricuspidalis regurgitatio és következményes jobbszívfél-elégtelenség miatt többször hospitalizált nőbeteget jelentős dózisú diuretikus kezelés ellenére is jelentkező újabb dekompenzációs epizód miatt vettük fel osztályunkra NYHA IV-es funkcionális stádium és jelentős folyadékretenció mellett. Echokardiográfián jó systolés funkciójú bal kamra és volumenterhelt jobb kamra volt látható, valamint a tricuspidalis billentyű inkomplett koaptációja következtében szekunder, súlyos fokú regurgitatio. A tricuspidalis billentyű cseréjének indikációja fennállt; a Heart Team a szívsebészeti műtétet igen nagy kockázatúnak tartotta, és a billentyűanatómia nem felelt meg a korrekcióját célzó percutan beavatkozásoknak, de alkalmasnak bizonyult TricValve-implantációra. A lehetőségek szerinti kompenzált állapotban bicavalis billentyűrendszert implantáltunk, szövődményt nem észleltünk. A rehabilitációt követően a beteg NYHA II-es funkcionális állapotba került, diuretikumdózisa jelentősen csökkenthető volt, és a beavatkozást követő első évben nem igényelt újabb hospitalizációt cardialis dekompenzáció miatt. Előrehaladott, gyógyszeresen nem kezelhető jobbszívfél-elégtelenséget okozó súlyos tricuspidalis regurgitatio esetén, amennyiben sebészi és a billentyűt célzó percutan beavatkozás nem jön szóba, megoldást nyújthat a TricValve-implantáció. Ennek köszönhetően csökken a vénás rendszerbe a visszaáramlás, ezáltal a szisztémás pangás és a beteg tünetei is mérséklődnek. Jelen ismereteink szerint az eljárás megfelelő tüneti kezelést nyújthat, arról azonban még nem állnak rendelkezésre adatok, hogy a beavatkozás befolyásolja-e a túlélést. Orv Hetil. 2025; 166(32): 1271–1277.

Background/Objectives: In heart failure (HF) with reduced ejection fraction (HFrEF), the early diagnosis and proper treatment of comorbidities (CMs) are of fundamental relevance. Our aim was to assess the prevalence of CMs among real-world patients requiring hospitalisation for HFrEF and to investigate the effect of CMs on the implementation of guideline-directed medical therapy (GDMT) and on all-cause mortality (ACM). Methods: The data of a consecutive HFrEF patient cohort hospitalised for HF between 2021 and 2024 were analysed retrospectively. Sixteen CMs (6 CV and 10 non-CV) were considered. Patients were divided into three categories: 0-3 vs. 4-6 vs. >= 7 CMs. GDMT at discharge and ACM were compared among CM categories. The predictors of 1-year ACM were also evaluated. Results: From the 388 patients (male: 76%, age: 61 [50-70] years; NT-proBNP: 5286 [2570-9923] pg/mL; >= 2 cardiovascular-kidney-metabolic disease overlap: 46%), a large proportion received GDMT (RASi: 91%; beta B: 85%; MRA: 95%; SGLT2i: 59%; triple therapy [TT: RASi+beta B+MRA]: 82%; quadruple therapy [QT: TT + SGLT2i]: 54%) at discharge. Multimorbidity was accompanied with a (p < 0.05) lower application ratio of RASi (96% vs. 92% vs. 85%; 0-3 vs. 4-6 vs. >= 7 CMs) and beta B therapy (94% vs. 85% vs. 78%), while MRA (99% vs. 94% vs. 94%) and SGTL2i use (61% vs. 59% vs. 57%) did not differ (p > 0.05). Patients with multimorbidity were less likely to be treated with TT (93% vs. 82% vs. 73%, p = 0.001), while no difference was detected in the implementation of QT (56% vs. 54% vs. 50%, p = 0.685). The 1-year ACM of patients with an increased burden of CMs was higher (9% vs. 13% vs. 25%, p = 0.003). The risk of 1-year ACM was favourably affected by the use of TT/QT and less severe left ventricular systolic dysfunction, while having >= 5 CMs had an unfavourable impact on prognosis. Conclusions: According to our real-world analysis, HFrEF patients with an increased burden of CMs can expect a less favourable outcome. However, modern GDMT can even be applied in this patient population, resulting in a significantly improved prognosis. Thus, clinicians should insist on the early, conscious implementation of a prognosis-modifying drug regime in multimorbid HF patients as well.

Aorto-ostial lesions represent a distinct subgroup among coronary lesions. Due to their developmental characteristics, they are particularly prone to in-stent restenosis, the risk of which can be significantly reduced through flawless and precise coronary intervention. Owing to the anatomical features of the aorto-ostial segment and the pathological characteristics of its lesions, interventions in this area pose greater technical challenges for the operator. Unique solutions (e.g., optimal stent apposition) are required, and specific problems (e.g., unstable guide catheter positioning) often arise. These considerations are essential for avoiding iatrogenic complications. Some of the methods and device manipulations used in aorto-ostial interventions differ from those commonly employed in standard, non-aorto-ostial cases, making them more demanding. In planning the intervention, intravascular imaging is of particular importance, as it provides critical information for selecting the appropriate plaque modification tools (e.g., cutting balloon, rotational atherectomy). In this article, we review the specific characteristics of ostial lesions, the considerations for intervention, and their clinical implications.