BACKGROUND:Heart failure affects over 1.2 million Polish citizens. Although the current implantation rate of 3.3 left ventricular assist devices (LVADs) per million population remains below the European average, if the upward trend is maintained, Poland may soon reach the level of mid-range European countries (4-6 LVADs per million). AIMS:The national registry aimed to provide systematic oversight of the Polish LVAD population along with treatment outcomes. METHODS:A prospective multicenter observational registry of all consecutive LVAD patients undergoing LVAD implantation between January 1, 2022, and December 31, 2024. Data were compared to the Society of Thoracic Surgeons (STS) registry. RESULTS:From January 2022 to December 2024, 266 adult patients received LVAD in Poland. There has been a year-to-year increase in LVAD utilization of approximately 40%. The cohort consisted predominantly of men (96.1%) with a median age of 57.76 (49.80-64.53) years. In contrast, in the STS-Intermacs registry, women represented 21.9%. Ischemic cardiomyopathy was markedly more common (60.8%) in the POL-LVAD registry, contrary to non-ischemic cardiomyopathy in the STS registry (54.2%). Polish recipients presented with a significantly lower clinical acuity, with Intermacs profiles 1-3 accounting only for 55%-68% of implants, compared with nearly 90% in the STS cohort. Moreover, unlike the STS registry - in which destination therapy accounted for over 80% of implants - the Polish cohort was dominated by use of a bridge-to-transplantation strategy (72%). During a median follow-up of 471 days (interquartile range 283-729) 69 patients died and 26 underwent heart transplantation, which translates into an actual probability of survival of 81%, 71%, and 64% at 1, 2, and 3 years, respectively, and is comparable to the STS-Intermacs registry. Age was the main survival discriminator in the Polish cohort. CONCLUSIONS:This is the first report of the Polish National Mechanical Circulatory Support Registry. The POL-LVAD registry shows a dynamic growth of LVAD therapy in Poland, with survival outcomes comparable to the STS registry.

Introduction: Mechanical circulatory support (MCS) is a therapy increasingly used in patients with advanced heart failure. Left ventricular assist devices (LVAD) has the potential to improve patient's quality of life (QoL) significantly and may appreciably impact psychological functioning and social support among patients and their caregivers. Aim of the research: Assessment of the impact of depression and anxiety symptoms on the QoL and social support in therapy with mechanical circulatory support devices among patients and their caregivers. Material and methods: The analysis included 54 dyads of patients (median age: 61 years; men 96.30%) and their caregivers (median age: 59 years; men 3.70%). Data were collected 3 months after LVAD implantation. The study used the questionnaires SF-12, Berlin Social Support Scales, and the Hospital Anxiety and Depression Scale, and sociodemographic data. Results: Caregivers of patients with LVAD assessed the QoL as better than patients (PCS 55.94 vs. 41.87; MCS 48.98 vs. 45.58). Significant differences were found in perceived social-emotional support, need for support, and support seeking. Patients had a higher level of this support. Patients had higher levels of depression and anxiety symptoms than their caregivers. Among patients, depression and anxiety symptoms hurt the mental domain of QoL and the perceived protective buffering of emotional support. Among caregivers, higher intensity of anxiety was associated with a greater need for protective buffering support and a lower need for perceived instrumental support. Predictors of QoL for patients included time since LVAD implantation, depression, and type of device, while among caregivers - age, time since LVAD implantation, and professional activity. Conclusions: Psychological monitoring and the availability of support during care for the patient and caregiver are recommended.

IntroductionMechanical Cardiac Support and Left Ventricular Assist Devices (LVAD) have been demonstrated to prolong Heart Failure patients' survival and improve their quality of life. LVAD implantation has a considerable effect on patients' body image. Patients find it hard to accept the device as an extension of their body, especially the driveline. The study aimed to examine the relationships between anxiety and depressive symptoms, acceptance of illness, beliefs about pain control, and quality of life with body image among LVAD-implanted patients.MethodsThe cross-sectional study included 54 conveniently recruited patients who completed the Body Image Scale, SF-12, Acceptance of Illness Scale, Beliefs about Pain Control Questionnaire, NRS, HADS, and demographic and clinical data. Multiple regression analyses examined the associations between the research variable.ResultsThe mean Age of the participants was 59.64 (SD=9.63), and 96.3% were men. The mean scores were: Body Image Scale – 28.33 (SD=5,91); Acceptance of Illness Scale – 25.51 (SD=5.92); beliefs about pain control: internal factors – 15.85 (SD=4.96), the influence of physicians – 17.57 (SD=3.15), random events – 14.37(SD=3.32), NRS=2.80(SD=1.86), HADS anxiety – 5.33 (SD=4.12), HADS depression – 4.66 (SD=3.10), SF12MCS-45.49 (SD=6.48), SF-12PCS-41,33 (SD=6.48). The presence of anxiety and depressive symptoms and complications after LVAD significantly predicted low body image concerns.DiscussionHealthcare professionals should be aware of challenges regarding body image faced by LVAD-implanted patients and address related factors, especially anxiety and depression.

BACKGROUND:Dilated cardiomyopathy (DCM) is a highly heterogenous condition, resulting from both genetic and non-genetic mechanisms. However, little is known about the amount, pattern, and time course profile of fibrosis in DCM patients with different etiologies. AIMS:To evaluate the type, pattern, and course of fibrosis assessed with late gadolinium enhancement (LGE) and extracellular volume (ECV) on cardiovascular magnetic resonance (CMR) in patients with DCM of different etiologies. MATERIAL AND METHODS:We prospectively enrolled 102 DCM patients (87.3% male, mean age 45.2 [11.8] years). Patients were divided into 5 etiological sub-groups: toxic, inflammatory, tachyarrhythmic, genetic, and idiopathic. All patients underwent two CMR scans at baseline and after 12 months, assessing replacement fibrosis via LGE and interstitial fibrosis via ECV. RESULTS:The distribution of etiologies was as follows: toxic (26.5%), idiopathic (26.5%), genetic (23.5%), inflammatory (13.7%), and tachyarrhythmic (9.8%). At baseline, LGE was present in 45 (44.1%) patients and in 46 out of 92 (50%) patients at 12 months. Ten patients did not complete follow-up CMR (3 died, 1 underwent heart transplantation, and 6 received implantable cardiac devices). The predominant LGE pattern was linear mid-wall (57.8%), followed by transmural (17.8%), sub-endocardial (8.9%), patchy mid-wall (6.7%), right ventricular insertion points (4.4%), and mixed pattern (4.4%). No differences in LGE presence, pattern, and localization were observed among the etiology-based DCM sub-groups. Similarly, ECV values did not differ significantly between groups. The analysis between baseline and the 12-month parameters showed that only in genetic DCM did LGE mass and extent significantly increase (6.8 [2.1-10.9] vs. 7.4 [2.5-16.9] g; and 3.0 [0.9-5.9] vs. 3.3 [1.4-9.4]%; both P <0.05). CONCLUSIONS:In DCM, LGE presence, pattern, and localization did not differ across etiological subgroups. However, myocardial fibrosis progression, reflected by increased LGE mass and extent, occurred exclusively in patients with genetic DCM.

Clinical or subclinical malnutrition occurs in 30% to 70% of patients with advanced heart failure and increases the risk of postoperative adverse events. The main objective of this study was to assess the nutritional status of patients prior to left ventricular assist device (LVAD) implantation using different methods of malnutrition assessment and to evaluate the relationship between nutritional status and postoperative adverse events. A retrospective cohort study included 120 patients aged 26–74 years referred for LVAD surgery. Preoperative nutritional status (NRS-2002—Nutritional Risk Score 2002, NRI—Nutritional Risk Index, PNI—Prognostic Nutritional Index; TLC—total lymphocyte count) and postoperative adverse events were assessed. Moderate to severe malnutrition was found in 55.8%, 43.3%, 40.0%, and 20% of all patients, respectively, according to the PNI, NRI, TLC, and NRS-2002 scores. Patients with a TLC < 1200 cells/m3 had a higher risk of postoperative acute renal failure [hazard ratio (HR): 2.5; 95% confidence interval (95% CI): 1.01–6.3] and death during the observation period [HR = 2.1; 95% CI: 1.2–3.5]. Moderate to severe malnutrition was also associated with a significantly increased risk of in-hospital death [for the NRI score, HR = 4.9 (95% CI: 1.1–22.0); for the PNI score, HR = 5.0 (95% CI: 1.1–22.3)]. In conclusion, moderate to severe malnutrition prior to LVAD implantation has been identified as a risk factor for postoperative acute renal failure and mortality. Assessment of nutritional risk may improve patient selection and early initiation of nutritional support.

Purpose: The study's objective was to assess patient nutrition status before left ventricular assist device (LVAD) implantation using various methods of malnutrition assessment and, subsequently, to evaluate the relationship between nutritional status and postoperative adverse events.

BackgroundThe long-term success of organ transplantation (Tx) depends on the transplant recipient's ability to self-manage symptoms, treatment, lifestyle changes, and psychosocial consequences. Health behavior (HB) determinants include personality traits such as optimism, self-efficacy, and health locus of control.PurposeAssessing the relationship between personal resources and expectations and health behaviors of organ transplant recipients.Material and methodsThe study was conducted between 01/04/2018 and 30/10/2019 at 3 transplant centers in Poland. The study group consisted of 243 Tx recipients of kidney, heart, liver, and lung. The Health Behavior Inventory, Multidimensional Health Locus of Control Scale (MHLC), General Self-Efficacy Scale, Dispositional Optimism Scale, and Hospital Anxiety and Depression Scale were used to collect data.FindingsThe study group had medium levels of dispositional optimism (mean 15) and high levels of self-efficacy (mean 30.18). The MHLC scale was dominated by a belief in the influence of others and an internal locus of control over one's health. The respondents presented a high level of HB (mean 92.09). A positive relationship was found between personal resources (self-efficacy and optimism), MHLC and HB. The presence of depression and anxiety negatively affected personal resources and internal locus of health control and HB in terms of a positive mental attitude. Type of Tx differentiated internal locus of health control and HB. Predictors of HB were dispositional optimism, self-efficacy, influence of others with health locus of control, symptoms of depression, age and time since transplantation-explaining between 6.1% and 14.5% of health behavior categories.ConclusionsTo improve health practices among organ recipients, strengthening their personal resources is recommended. It is necessary to form an internal locus of control for adherence to positive HB.

Background. Heart transplantation is the treatment of choice for selected patients with end-stage heart failure. Persistent donor organ shortage causes a growing demand for mechanical circulatory support not only as a bridge to transplantation but mainly as a destination therapy (DT). Methods. The aim of the study was to analyze the indications, comorbidities, and complications during the follow-up of all patients undergoing left ventricular assist device (LVAD) implantation with at least 12 months of follow-up time in one of the most experienced clinics in Poland between 2015 and 2023. Results. There were 125 individuals with LVAD implantation, from which 90 had full 12 months of follow-up (85 males - 94%, 5 females - 6%), with a median age of 58 (50.25-63.75) years. The median body mass index was 27.12 (25.27-29.68). The etiology of heart failure was ischemic (n = 44, 49%), dilated cardiomyopathy (n = 44, 49%), and others. Preoperative echocardiography revealed a mean LV ejection fraction of 13.8% and a median LV dimension of 7.55 (6.92-8.2) cm. In 61 patients (68%), imaging confirmed pulmonary hypertension. Thirty-four patients (38%) had diabetes and 16 (18%) were active smokers. Median follow-up was 30 (17.25-42) months, with the longest period being about 82 months. 40 (44%) patients had kidney failure before LVAD implantation, and in 43 cases (48%), we observed relevant, transient deterioration of kidney function. Almost all patients (n = 82, 91%) suffered from anemia (Hb <13 g/dL in males and <12 g/dL in females) in different periods after LVAD implantation due to perioperative bleeding, gastrointestinal bleeding or unknown causes. The lowest Hb level was observed in the first week after LVAD implantation in 53 cases (58%). Median red cell concentrate transfusion demand before the discharge after surgery was 6 (2-8, 5) units. Conclusions. Appropriate selection of candidates and timing of LVAD implantation are critical for improved outcomes of DT. Anemia and kidney failure are the most frequent follow-up complications. Improved results and increased applicability and durability of LVADs have established this treatment option as an excellent alternative for patients with end-stage heart failure.

BackgroundDonor organ shortages cause increasing demand for mechanical circulatory support in patients with end-stage heart failure not only as a bridge to heart transplantation but mainly as a destination therapy. Improved results and increased applicability and durability of left ventricular assist devices (LVADs) have established this treatment option as an alternative to heart transplantation in selected patients. One of the most common complications after LVAD implantation is driveline infections (DLIs).MethodsThis study aimed to expand the understanding of DLI epidemiology and potential changes in implantation techniques regarding optimizing DLI prevention and treatment among all patients undergoing LVAD (Medtronic's Heartware HVAD and HeartMate 3 Abbott LVAD system) implantation with at least 12 months of follow-up time between 2015 and 2022.ResultsThere were 120 individuals with LVAD implantation, of whom 90 had 12 months of follow-up (85 men [94%], 5 women [6%]) with a median age of 58 years (50.25-63.75). The median body mass index was 27.12 kg/m2 (25.27-29.68). Of the 90 patients, 43 had ischemic heart failure (48%), 43 had dilated cardiomyopathy (48%), and the remaining 3 had other etiologies (3%), such as postinflammatory, and the remaining 1 had congenital heart defect (1%). Preoperative echocardiography revealed a mean left ventricle ejection fraction of 13.8% and a median left ventricle dimension of 7.55 cm (6.92-8.2). Imaging confirmed pulmonary hypertension in 61 patients (68%). Thirty-four of the 90 patients had diabetes (38%), and 16 were active smokers (18%). Median follow-up was 30 months (17.25-42), with the longest period being 82 months. More than half of the patients (n = 52; 57%) experienced a DLI. The median time to the first episode of DLI was 13 months (6-25). The most common pathogen revealed in wound swab culture was methicillin-sensitive Staphylococcus aureus (n = 23; 44%), Pseudomonas aeruginosa (n = 9; 17%), Proteus mirabilis (n = 4; 7%), and others. We observed that deeper driveline implantation below the left rectus muscle and just above the posterior rectus sheath resulted in fewer DLIs and longer free-from-DLI follow-up time. There was no statistically significant difference in DLI frequency between patients with or without diabetes mellitus.ConclusionsAppropriate selection of candidates and timing of LVAD implantation are critical for improved outcomes of destination therapy. DLI is the most common complication after LVAD implantation. Optimal surgical techniques and early implementation of targeted antibiotics are crucial. Significant challenges remain in optimizing DLI prevention and treatment.

This article is available in open access under Creative Common Attribution-Non-Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0) license, allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially. Cardiology Journal 2023, Vol. 30, No. 4, 668–670 DOI: 10.5603/CJ.a2023.0044 Copyright © 2023 Via Medica ISSN 1897–5593 eISSN 1898–018X RESEARCH LETTER COVID-19

OBJECTIVE:Both the right ventricular (RV) contractile function and pulmonary arterial (PA) pressure influence clinical outcomes in patients supported with left ventricular assist devices (LVADs), but the impact of RV-PA coupling is unknown. This study aimed to determine the prognostic impact of RV-PA coupling in patients with implanted LVADs. METHODS:Patients with implanted third-generation LVADs were retrospectively enrolled. The RV-PA coupling was assessed preoperatively by the ratio of RV free wall strain (RVFWS) derived from speckle-tracking echocardiography and noninvasively measured peak RV systolic pressure (RVSP). The primary end point was a composite of all-cause mortality or right heart failure (RHF) hospitalization. Secondary end points consisted of all-cause mortality at a 12-month follow-up and RHF hospitalization. RESULTS:A total of 103 patients were screened, and 72 with good RV myocardial imaging were included. The median age was 57 years; 67 patients (93.1%) were men, and 41 (56,9%) had dilated cardiomyopathy. A receiver-operating characteristic analysis (AUC 0.703, 51.5% sensitivity, 94.9% specificity) was used to identify the optimal cutoff point (0.28%/mmHg) for the RVFWS/TAPSE threshold. Nineteen subjects (26.4%) had advanced RV-PA uncoupling. Event rates were estimated using the Kaplan-Meier method showing a strong association with an increased risk for the primary end point of death or RHF hospitalization (89.47% vs. 30.19%, p < 0.001). A similar observation applied to all-cause mortality (47.37% vs. 13.21%, p = 0.003) and RHF hospitalization (80.43% vs. 20%, p < 0.001). CONCLUSIONS:An advanced RV dysfunction assessed by RV-PA coupling may serve as a predictor of adverse outcomes in patients with implanted LVADs.

Abstract Background Endothelial cell (EC) homeostasis is characterized by a quiescent and low-metabolic state. Obesity leads to EC dysfunction and CVD. We demonstrated that bariatric surgery improved obesity-induced EC dysfunction and increased fasting and post-prandial plasma levels of bile acids (BAs)(in particular, cholic acid (CA), chenodeoxycholic acid (CDCA) and deoxycholic acid (DCA)). BAs are emerging as metabolic signaling molecules in several tissues, but their effect on ECs has not been clearly established yet. Purpose We investigate the effect of BA on the maintenance of EC quiescence. Methods Human Aortic Endothelial Cells (HAECs) were treated for 24h with vehicle (0.1% DMSO), CA, CDCA and DCA (50uM each) in 2%FBS EGM-2 media. Percentage of apoptotic cells was assessed with AnnexinV/PI. Seahorse Mitostress test, Mitoplate and glucose uptake with 0.5µCi/ml of 14C-2-deoxy-D-glucose were used to evaluate changes of HAEC metabolism. Immunostaining for Ki67, Crystal Violet staining and scratch assay were performed to assess HAEC proliferation and migration. NO production and endothelial NO synthase (eNOS) activity were measured via DAF-2 probe and Western Blot, respectively. By qPCR genes involved in Notch pathway were evaluated. Mesoscale vascular injury panel, scratch assay, Ki67 immunostaining and glucose uptake were also performed in HAECs pre-treated with 50uM of BAs and stimulated with 0.5ng/mL TNF-α for 24h. Results HAECs treated with BAs increased NO production compared to vehicle and a reduction in both basal and maximal mitochondrial respiration and extracellular acidification rate was shown by Seahorse Mitostress test. Mitoplate assay displayed an overall reduction in the metabolic rate of HAECs treated with CA and DCA and a peculiar metabolic pattern in cells treated with CDCA. Reduction in glucose uptake was also observed after BA treatment, suggesting that BAs are able to decrease EC metabolism. Immunostaining for Ki67 and Crystal Violet highlighted that BAs reduced cell proliferation. The scratch assay also displayed a reduction in EC migration after BA treatment. BAs also reduced EC apoptosis, as significant differences in the percentage of AnnexinV/PI positive cells was observed in BA-treated cells compared to vehicle. qPCR showed increased expression of genes involved in Notch pathway promoting quiescence after BA treatment. Glucose uptake, scratch assay and Ki67 immunostaining performed in TNF-α stimulated HAECs suggested a BA-dependent endothelial protection in conditions of EC pro-inflammatory activation. We did not observed a reduction in pro-inflammatory biomarkers released in the supernatant of HAECs pre-treated with BA and stimulated with TNF-α. Conclusions Our results suggest that BAs may be involved in the maintenance of EC quiescence by regulating EC metabolism and gene expression profile. These findings highlight a potential role of BAs as endothelial-protective molecules.

Abstract Funding Acknowledgements Type of funding sources: None. Objective Malnutrition in patients undergoing left ventricular assist device (LVAD) implantation has negative consequences, such as infection and limited functional capacity. The effects of nutritional status of patients with LVAD on their clinical outcomes were investigated. Methods 116 records of patients with LVAD implantation were retrospectively analysed. For nutritional evaluation, nutrition risk score NRI score was calculated to divide the patients into two groups with and without malnutrition risk. Demographic and clinical data before LVAD, early postoperative adverse events after LVAD, prognostic data, and laboratory findings were analysed. Results 116 patients (6 females, 110 man) had a mean age of 60.5±9,46 years; Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) scores were determined as 1 (n=11), 2 (n=36), 3 (n=65), and 4 (n=4). Forty four patients (44%) (19 mild, 6 moderate, 19 severe) had MR. The MR was higher in patients with preoperative INTERMACS score 1, low level of haemoglobin and albumin The incidence of adverse events was found to be significantly higher in patients with higher preoperative grade NRI (death during the pooperative period, bleeding). Conclusion In the early postoperative period, a MR of 44% was detected in patients who underwent LVAD. Total 72.2 % patients had any adverse events. We found that the presence of MR was effective in predicting postoperative adverse events according to NRI score before LVAD treatment.

Background. Donor organ shortage caused a growing interest in mechanical circulatory support not only as a bridge to transplant but also as a destination therapy. Improved results and increased applicability and durability of left ventricular assist devices (LVADs) have established this treatment option as an alternative for patients with end-stage heart failure. Methods. The aim of the study was to compare the early results, major complications, and the follow up of all patients undergoing HeartMate3 (HM3) LVAD and HeartWare Ventricular Assist Device (HVAD) system implantation in one of the most experienced Clinic in Poland between 2015 and 2020. Results. There were 78 individuals (72 male, 92%; 6 female, 8%), with median age 57 years (range, 50-62 years). Until 2020 we implanted 47 (60%) HVADs and 31 (40%) HM3 LVADs. Patient characteristics were comparable between both groups apart from median left ventricle diameter (8.2 cm [range, 7.4-8.4 cm] in HM3 group vs 7.2 cm [range, 6.7-7.9 cm] in HVAD group; P < .01) The overall survival was 53.2% in the HVAD group and 77.4% in the HM3 group (P =.03). Mean survival time was higher in HM3 group (2.97 years [range, 2.43-3.5 years] vs 2.51 years [range, 1.94-3.08 years]; P < .05). Mean complication-free survival time was also higher in the HM3 group (2.16 years [range, 1.55-2.76] vs 1.61 [range, 1.16-2.06 years]; P < .05), with overall complication-free rate of 54.8% for HM3 vs 29.8% for HVAD (P = .27). Median hospitalization time was comparable (31 days [range, 25-39 days] in the HM3 group vs 32 days [range, 24-38 days] in the HVAD group; P = .49). Conclusions. Patients supported with the HM3 had significantly fewer major complications than HVAD. Moreover, the HVAD was associated with higher mortality.