Adam Witkowski

Background: Visual angiographic assessment of left main (LM) bifurcation lesions is fraught with major limitations. Bifurcation‐dedicated quantitative coronary angiography (Bif‐QCA) assessment provides higher accuracy than standard QCA in bifurcation lesions. Fractal laws (e.g., Finet’s and Murray’s laws) can enhance the accuracy of reference diame...

Atherosclerosis is a systemic disease and involves not only the coronary vessels but also occurs in other vascular beds (e.g., cervical, cerebral, and peripheral vessels), increasing cardiovascular risk. One of the causes of atherosclerosis is lipid disorders. In addition, other diseases, such as diabetes, chronic kidney disease, or familial hyperc...

Background: Cardiogenic shock (CS) remains the leading cause of poor prognosis in patients with acute myocardial infarction (AMI), sustaining a high mortality rate of 40 to 50% within 30 days. Aims: In this unique analysis of two national all-comers, real-life registries including patients with AMI complicated by CS, for whom early revasculariza...

Background: Myocardial infarction (MI) remains the leading cause of death, especially in the elderly. Aims: To characterize management and factors related to event-free survival in patients with acute MI aged at least 90 years. Methods: We included all patients aged at least 90 years hospitalized for MI in Poland between 2014 and 2020 and foll...

Objectives: Antegrade wiring (AW) is the most common coronary chronic total occlusion (CTO) crossing strategy and usually relies upon stepwise guidewire escalation starting from the low tip-load polymer-jacketed wire (standard guidewire escalation). The authors aimed to investigate whether the upfront use of intermediate tip-load polymer-jacketed...

Mitral regurgitation (MR) is the second most common valvular disease. Symptomatic MR is associated with a poor prognosis. Cardiac surgery is recommended in the severe form of the disease. If the surgical risk is high or functional mitral regurgitation repair/replacement cannot be combined with aorto-coronary bypass graft surgery, a transcatheter ed...

Background The Hydra CE study revealed 1‐year favorable efficacy of TAVR, showing a large effective orifice area (EOA), low gradient, and acceptable complication rates. Aims We evaluated the 3‐year clinical and hemodynamic outcomes of Hydra self‐expanding transcatheter aortic valve (manufactured by Vascular Innovations Co Ltd, Nonthaburi, Thailand...

Background The-long term outcomes of patients with in-stent restenosis (ISR) presenting with chronic coronary syndrome (CCS) are not well studied. Purpose This study aims to investigate the outcomes of patients with drug-eluting stents (DES)-ISR presenting with CCS undergoing percutaneous coronary intervention (PCI) with drug-coated balloons (DCB)...

Cardiomyopathies (CMs) are a very broad group of diseases, including genetically determined and acquired, and their classification is based on phenotypic characteristics. There is always a need to search for the etiology (often also to try to identify the genetic cause), which may determine the appropriate choice of clinical management. The geograp...

The global prevalence of obesity has more than doubled over the past four decades, currently affecting more than a billion individuals. Beyond its recognition as a high-risk condition that is causally linked to many chronic illnesses, obesity has been declared a disease per se that results in impaired quality of life and reduced life expectancy. No...

Background: The rate of in-stent restenosis (ISR) is decreasing; however, it is still a challenge for contemporary invasive cardiologists. Therapeutic methods, including drug-eluting balloons (DEBs), intravascular lithotripsy, excimer laser coronary atherectomy, and imaging-guided percutaneous coronary intervention (PCI) with drug-eluting stents (D...

BACKGROUND Evidence suggests that drug-coated balloons may benefit in-stent restenosis (ISR) treatment. However, the efficacy of new-generation sirolimus-coated balloon (SCB) compared with the latest generation drug-eluting stents (DESs) has not been studied in this setting. METHODS All patients in the EASTBORNE (The All-Comers Sirolimus-Coated Ba...

Background: The literature review shows that female patients are more frequently underdiagnosed or suffer from delayed diagnosis. Recognition of sex-related differences is crucial for implementing strategies to improve cardiovascular outcomes. We aimed to assess sex-related disparities in the frequency of fractional flow reserve (FFR)-guided proced...

Background: The long-term outcomes for patients with in-stent restenosis (ISR) presenting with chronic coronary syndrome (CCS) are not well studied. Aims: We aimed to investigate the outcomes for patients with drug-eluting stents (DES)-ISR and CCS undergoing percutaneous coronary intervention (PCI) with drug-coated balloons (DCB) or thin strut-D...

Objective This study assesses the prevalence and characteristics of extracoronary vascular abnormalities (EVA) in patients with spontaneous coronary artery dissection (SCAD), a distinct form of acute coronary syndrome primarily affecting younger women. EVA include conditions like fibromuscular dysplasia (FMD) and aneurysms in non-coronary vessels....

Objective Pregnancy associated spontaneous coronary artery dissection (P-SCAD) remains poorly characterized cause of acute coronary syndrome during pregnancy and in postpartum period. The aim of the study was to assess clinical presentation, comorbidities and the outcomes of P-SCAD as compared with spontaneous coronary artery dissection not associa...

Objective Spontaneous coronary artery dissection (SCAD) is one of the causes of acute coronary syndrome of unknown etiology. Potential risk factors and comorbidities are female gender, fibromuscular dysplasia (FMD) and increased tortuosity. HTN is associated with increased coronary tortuosity and both have been shown to increase the risk of recurre...

Background Actual expansion of a transcatheter heart valve (THV) might differ from nominal, particularly during nonaortic valve-in-valve for a degenerated bioprosthetic surgical heart valve (SHV). This pilot study compared THV expansion measured using large-field-of-view intravascular ultrasound (IVUS) vs. multi-slice computed tomography (MSCT) and...

Introduction: Transfemoral access is a prevailing approach for transcatheter aortic valve implantation (TAVI) in contemporary practice, with a shift from surgical arteriotomy to a percutaneous arterial approach. Objectives: This study assessed long- and short‑term mortality, along with Valve Academic Research Consortium-2-defined complications i...

Lipoproteina(a) jest zbudowana z cząsteczki LDL oraz specyficznej apolipoproteiny(a). Stężenie Lp(a) we krwi jest w ok. 90% uwarunkowane genetycznie, a głównym czynnikiem genetycznym determinującym poziom Lp(a) jest wielkość izoformy apo(a), którą determinuje liczba powtórzeń domeny KIV2. Wielkość izoformy apo(a) jest odwrotnie proporcjonalna do st...

Lipoprotein(a) [Lp(a)] is made up of a low-density lipoprotein (LDL) particle and a specific apolipoprotein(a). The blood concentration of Lp(a) is approximately 90% genetically determined, and the main genetic factor determining Lp(a) levels is the size of the apo(a) isoform, which is determined by the number of KIV2 domain repeats. The size of th...

The prevalence of obstructive sleep apnea (OSA) in general population varies from 5 to 10%. OSA is the most common disease associated with resistant hypertension, diagnosed in 64% of patients. The potential pathophysiologic mechanisms of OSA in hypertensive patients is nocturnal rostral fluid shift, hyperaldosteronism and increased sympathetic acti...

Background. Actual expansion of a transcatheter heart valve (THV) might differ from nominal particularly during non-aortic valve-in-valve (VIV) for degenerated bioprosthetic surgical heart valve (SHV). Aims. To compare THV expansion measured using large-field-of-view intravascular ultrasound (IVUS) versus multi-slice computer tomography (MSCT) and...

Whereas coronary computed tomography angiography (CCTA) exceeds invasive angiography for predicting the procedural outcome of chronic total occlusion (CTO) percutaneous coronary intervention (PCI), CCTA-derived scores have never been validated in the hybrid CTO PCI population. In this single-center, retrospective, observational study, we included 1...

Introduction Although renal stenting is the standard revascularization method for atherosclerotic renal artery stenosis (RAS) (FMD-RAS), stenting in fibromuscular dysplasia (FMD) RAS is usually limited to periprocedural complications of angioplasty and primary arterial dissection. The main aim of the study was to retrospectively analyze the immedia...

Background Prediction of outcomes following transcatheter aortic valve implantation (TAVI) is challenging. While over the past decades multiple scores for risk stratification in TAVI patients have been proposed due to their limited accuracy none of them have been adopted clinically. Recently machine learning was leveraged for this purpose yet again...

Introduction Impella (Abiomed, Danvers, MA, USA) is the smallest and the least invasive mechanical circulatory support device used in the setting of cardiogenic shock (CS) and high-risk percutaneous coronary interventions (HR-PCI). Data regarding the efficacy and safety of Impella in the real-life setting are urgently needed. Purpose The main goal...

Background: Impella is a percutaneous mechanical circulatory support device for treatment of cardiogenic shock (CS) and high-risk percutaneous coronary interventions (HR-PCIs). IMPELLA-PL is a national retrospective registry of Impella-treated CS and HR-PCI patients in 20 Polish interventional cardiological centers, conducted from January 2014 unt...

Cangrelor is the only intravenous P2Y12 receptor antagonist. It is an adenosine triphosphate analog that selectively, directly, and reversibly binds to the platelet P2Y12 receptors exerting its antiaggregatory effect. Cangrelor is characterized by linear, dose-dependent pharmacokinetics and rapid onset of action providing potent platelet inhibition...

Background: Coronary artery fistulas (CAFs) are usually congenital coronary artery anomalies of termination. Aims: The aim of the study was to assess the prevalence, anatomic characteristics, and clinical significance of CAFs detected by computed tomography (CT) in an adult population. Methods: Among 39 066 subjects 45817 CT examinations were...

Introduction Data regarding patients with a previous medical record of immunosuppression treatment who have undergone transcatheter aortic valve implantation (TAVI) are limited and extremely inconclusive. Available studies are mostly short term observations; thus there is a lack of evidence on efficacy and safety of TAVI in this specific group of p...

The 2022 European Society of Cardiology (ESC) guidelines [1] are a comprehensive document, prepared jointly by experts in cardiology and oncology. In the case of an oncological patient, it is necessary to individualize care in relation to the cardiological condition, the stage of the cancer and the type of potential anti-cancer therapy. Cardiac car...

Cardiovascular diseases account for 43% of deaths in Poland. The COVID-19 pandemic increased the number of cardiovascular deaths by as much as 16.7%. Lipid metabolism disorders are observed in about 20 million Poles. Lipid disorders are usually asymptomatic, they cause a significant increase in the risk of cardiovascular diseases. Up to 20% of pati...

Background We aimed to compare statin monotherapy and upfront combination therapy of statin and ezetimibe in patients with acute coronary syndromes (ACSs). Methods and Results The study included consecutive patients with ACS included in the PL‐ACS (Polish Registry of Acute Coronary Syndromes), which is a national, multicenter, ongoing, prospective...

Over 15 years of clinical experience and multiple large-scale observational studies followed by guidelines show good safety and efficacy of valve-in-valve transcatheter aortic valve implantation TAVI (ViV-TAVI), which reduces the need for re-do surgical aortic valve replacement (SAVR) in high-risk patients. The number of procedures in Poland, estim...

Objective Inflammatory activity is one of the potential mechanisms of spontaneous coronary artery dissection (SCAD). Recently, the pericoronary adipose tissue attenuation (PCAT) derived from CT angiography (CTA) has been established as a method for measuring vascular inflammation. We aimed to characterise the pancoronary and vessel-specific PCAT in...

Background: Current guidelines recommend coronary catheterization in patients with non-ST-segment elevation myocardial infarction (NSTEMI) within 24 hours of hospital admission. However, whether there is a stepwise relationship between the time to percutaneous coronary intervention (PCI) and long-term mortality in patients with NSTEMI treated inva...

Objective Percutaneous transluminal angioplasty (PTA) is the recommended revascularization strategy in patients with renal artery stenosis (RAS) caused by fibromuscular dysplasia (FMD), limiting stenting to complications management. However this recommendation is based on cases reports and small series. The main aim of the study was to retrospectiv...

Background and aims: Myocardial perfusion imaging (MPI) and anatomical imaging with coronary computed tomography angiography (CCTA) can play an important role in the preprocedural planning of a chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We aimed to establish the feasibility of a novel dynamic computed tomography perfus...

Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institute of Cardiology. Background Hypertrophic cardiomyopathy (HCM) is a congenital heart disease influencing patients' physical capacity and quality of life and increasing the risk of sudden cardiac death. For many years pa...

Background: Valve-in-valve transcatheter transfemoral mitral valve implantation (ViV-TMVI) is an emerging treatment alternative to reoperation in high surgical risk patients with a failed mitral bioprostheses. Aim: To describe characteristics and evaluate 30-day outcomes of ViV-TMVI in the Polish population. Methods: Nationwide registry was in...

Background: Mitral regurgitation (MR) is frequently observed in patients with myocardial infarction (MI). However, the incidence of severe MR in contemporary population is unknown. Aims: The study evaluates the prevalence and prognostic impact of severe MR in contemporary population of patients with ST-segment elevation myocardial infarction (ST...

Background: The two most common organisms found in infective endocarditis following transcatheter aortic valve implantation (TAVI-IE) are enterococci (EC-IE) and staphylococci (SC-IE). We aimed to compare clinical characteristics and outcomes of patients with EC-IE and SC-IE. Methods: TAVI-IE patients from 2007 to 2021 were included in this anal...

BACKGROUND: Patients after acute myocardial infarction (AMI) are at very high cardiovascular (CV) risk. Therefore, appropriate management of dyslipidemia with adequate lipid-lowering therapy is crucial for preventing subsequent CV events in these patients. AIMS: Our analysis aimed to assess the treatment of dyslipidemia and the attainment of low-d...

Introduction: One of the crucial aspects of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) is the valve prosthesis selection. Aim: To assess the consistency of the aortic valve sizing in SAVR and TAVR by comparing the sizes of aortic prostheses selected based on the intraprocedural annulus measurements...

Aims: Prediction of adverse events in mid-term follow-up after transcatheter aortic valve implantation (TAVI) is challenging. We sought to develop and validate a machine learning model for prediction of 1-year all-cause mortality in patients who underwent TAVI and were discharged following the index procedure. Methods and results: The model was...

Background: Transcatheter left atrial appendage closure (LAAC) is performed in patients unsuitable for long-term anticoagulation, predominantly due to prior bleeding events. The study aimed to investigate the incidence and predictors of clinically significant bleeding (CSB) post-LAAC. Methods: Consecutive patients after LAAC with an Amplatzer or...

Background: Recurrent ST-segment elevation myocardial infarction (rSTEMI) can be attributed to the same (target-vessel, TV-rSTEMI) or different culprit vessel (non-target, nonTV-rSTEMI) compared with the first infarction. We hypothesized that long-term mortality after rSTEMI depends on the infarct-related artery (the same or different compared wit...

Background Spontaneous coronary artery dissection (SCAD) is a non-atherosclerotic cause of myocardial infarction of unclear aethiology. Histopathological analyses have identified increased coronary inflammation in patients with SCAD [1]. Recently the peri-coronary adipose tissue attenuation (PCAT) derived from standard computed tomography angiograp...

Background: Increase in pulmonary artery diameter (PAD) in multi-detector computed tomography (MDCT) may indicate pulmonary hypertension. We assessed the prognostic value of MDCT-derived measurements of pulmonary artery diameter (PAD) on outcomes after successful transcatheter aortic valve replacement (TAVR). Methods: Consecutive patients treate...

Resumo Desde a primeira descrição da tetralogia de Fallot (ToF) em 1671 por Niels Stensen e em 1888 por Étienne-Louis Arthur Fallot, vários trabalhos relataram essa anomalia juntamente com suas variantes e anomalias cardiovasculares concomitantes. A artéria subclávia direita aberrante (ASDA) é a anomalia do arco aórtico mais comum. Diferentemente d...

Objectives Patients with bicuspid aortic valve (BAV) stenosis were excluded from the pivotal trials of transcatheter aortic valve implantation (TAVI). We compared the in-hospital and long-term outcomes between patients undergoing TAVI for bicuspid and tricuspid aortic valve (TAV) stenosis.Methods We performed a retrospective registry-based analysis...

Hypertrophic cardiomyopathy (HCM) is the most common congenital disease increasing the risk of sudden cardiac death. For many years, HCM patients were excluded from exercise training. However, there are data showing that patients with HCM undergoing supervised exercise training could improve physical performance without serious adverse events. A pr...