Tajstra M

Effect of Therapeutic Ionizing Radiation on Implantable Electronic Devices: Systematic Review and Practical Guidance

Cardiac implantable electronic devices (CIEDs) have been in use for over 50 years and their therapeutic value is undisputable. With the rapidly aging population, it is estimated that the number of CIEDs will grow dramatically over the next 2 decades. Given these predictions, the topic of management of concomitant conditions associated with older age becomes more relevant than ever. In particular, the number of patients with an implanted CIED diagnosed with cancer is expected to rise by about 70%, from 14 million in 2012 to 22 million within the next 2 decades. Treatment of most of these tumors and tumor metastases requires radiation therapy. However, the necessary high doses of radiation can potentially interact with the function, longevity, and integrity of the CIEDs and/or cause harm to the patient. The impact of an absence of clear therapeutic guidelines for oncology patients with CIEDs who should undergo radiation therapy is vast; and due to the fear of possible complications related to device failure, many of these patients may not be treated adequately to their needs, which can strongly affect their prognosis.

Aspirin 'resistance': impact on no-reflow, platelet and inflammatory biomarkers in diabetics after ST-segment elevation myocardial infarction.

Background: The no-reflow (NR) phenomenon exists despite percutaneous coronary intervention (PCI), and is especially prevalent in diabetics. The causes(s) of NR are not fully elucidated, but may be associated with impaired residual platelet and inflammatory reactivity during dual-antiplatelet therapy. Objective: To assess the relationship between dual-antiplatelet therapy, NR and conventional biomarkers suggestive of platelet and inflammatory response in diabetics following ST-segment elevation myocardial infarction (STEMI) treated with PCI. Methods: Sixty diabetics with (n = 27) and without NR (n = 33) were prospectively enrolled. All patients were treated with clopidogrel and aspirin. Platelet and inflammatory biomarkers were assessed serially in the peripheral blood and right atrium before and after PCI and then at 24 h, 7 days and 30 days. Results: Arachidonic acid (AA)-induced platelet aggregation and the serum thromboxane B2 level before and after PCI (in the peripheral and right atrium blood) were significantly higher in the NR patients than in those with no NR. AA-induced aggregation >100 (AUC*min) before PCI predicted NR in diabetic patients with 96.2% sensitivity and 38.5% specificity (AUC 0.66; 95% CI 0.52-0.71; p = 0.029). There were no other correlations between NR and platelet reactivity (collagen, adenosine diphosphate, thrombin receptor agonist peptide-induced aggregation, vasodilator-stimulated phosphoprotein platelet reactivity index, soluble P-selectin, soluble CD40 ligand, platelet-derived growth factor AB and the level of platelet-monocyte aggregates) or between NR and inflammatory indices (i.e. high-sensitivity C-reactive protein, interleukin 6 and interleukin 10). Conclusion: An inadequate response to aspirin, but not to clopidogrel, may be associated with the occurrence of the NR phenomenon in diabetics with STEMI who have been treated with primary PCI.

Renal function on admission affects both treatment strategy and long-term outcomes of patients with myocardial infarction (from the Polish Registry of Acute Coronary Syndromes)

BACKGROUNDnImpairment of renal function (IRF) is an independent risk factor of myocardial infarction (MI).nnnAIMnThe aim of study was to determine if the presence of IRF affects the choice of treatment strategy in patients with MI, and if long-term mortality rates are influenced by the use of an invasive strategy in patients with MI according to the grade of IRF.nnnMETHODSnData from the PL-ACS Registry of 22,431 patients hospitalised for MI during 2007-2008 with an available estimated glomerular filtration rate (eGFR) with 2009 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula were included. Patients were stratified based on eGFR: ≥ 90 (normal); 60-89 (mild IRF); 30-59 (moderate IRF); 15-29 (severe IRF); and < 15 mL/min/1.73 m² (end-stage IRF).nnnRESULTSnAfter adjustment, each increase in IRF grade reduced the likelihood of percutaneous coronary intervention by 19% (odds ratio [OR] 0.81; 95% confidence interval [CI] 0.78-0.85; p < 0.001). A higher IRF grade was independently associated with mortality (OR 2.01; 95% CI 1.86-2.18; p < 0.001) and major bleeding (OR 1.42; 95% CI 1.22-1.66; p < 0.001) during hospitalisation, and mortality at 12 (hazard ratio [HR] 1.55; 95% CI 1.49-1.62; p < 0.001) and 36 months (HR 1.50; 95% CI 1.45-1.55; p < 0.001). Invasive treatment was independently associated with improved 12-month prognosis in non-ST-segment elevation MI (NSTEMI) patients with mild-to-severe IRF and in ST-elevation MI (STEMI) patients at all IRF grades.nnnCONCLUSIONSnInvasive procedures were less frequent with worsening renal dysfunction. Invasive treatment was associ-ated with improved 12-month prognosis in STEMI patients regardless of renal function and in NSTEMI patients with eGFR ≥ 15 mL/min/1.73 m².

2017 Monitoring and Teletransmission of Medical-Data in Heart Failure. First Report

Number of analyses taken collectively have provided evidence that RPM using non-invasive approach reduce relative risk of all-cause mortality by 15 - 40%, and the risk of HF-related hospitalizations by 14 - 36%. Improvement of hospitalization was greater in stable as compared to newly decompensated patients and approached 30%, reduction of mortality was more pronounced in patients newly (< 28 days) discharged from the hospital due to acute episode of HF and was estimated at 38%. These techniques were also cost-effective. Optimal RPM techniques in HF are still not established. The large diversity of HF phenotypes likely differing with respect to their pathophysiology precludes one common solution to prevent HF decompensation and hospitalizations. Rather, various individually tailored techniques should be searched for. The implantable cardiac device companies have their own databases and follow-up systems. Users of the platform are assigned to support levels corresponding with their duties and knowledge. We determined a model of cooperation between the medical personnel in the monitoring and care of patients. The users have their own lists of cases to manage. The incidents or follow-up transmissions are the cases to manage. The frst-line/primary support level analyzes the data and determines a course of action.