“People generally associate my name with the first ever heart transplant in Poland. But I know that if I hadn’t tried to do it, then four, maybe five years later someone else would have. What I am sure of, however, is that no one else in Poland would have started working on developing an artificial heart. Had I not fought to create this device, a few hundred people would not be alive today because we wouldn’t have had ventricular assist devices which saved their lives and wellbeing.”

– Zbigniew Religa,

famous Polish cardiac surgeon

B a c k g r o u n d: Heart failure (HF) is a life-threatening condition which aff ects up to 2% of contemporary populations. Generally, it is a chronic and progressive disease, however in many cases it can be prevented or treated. Nevertheless, effective control of this disease requires awareness of symptoms in the society.

A i m s: The aim of the study was to assess the level of HF knowledge in the Polish population.

M e t h o d s: The questionnaire concerning knowledge about HF prepared by the Competence Network HF under the patronage of the European Heart Failure Association of the ESC, was used. The survey included 534 contributors who formed three groups: medical students — in vast majority at fi rst half of the study course (MS) — 198 (37.1%), HF Awareness Day participants (HFDP) — 134 (25.1%) and other (OP) — 202 (37.8%).

R e s u l t s: Study groups diff ered in terms of gender, age and level of education. As predicted, MS achieved the highest score (22.5 [20.0–24.0]), compared to HFDP (20.0 [17.0–22.0], P <0.001) and OP (19.0 [16.0– 21.0], P <0.001). Knowledge on typical HF symptoms was alarmingly low in the analyzed groups — dyspnea (MS — 96.0%, HFDP — 78.4%, OP — 74.6%), ankle edema (MS — 79.8%, HFDP — 50.6%, OP — 32.2%), body weight gain (MS — 14.1%, HFDP — 17.2%, OP — 4.5%). By multivariate model medical education (β 3.372, 95% CI 2.738–4.005) and own illness or having relatives or friends with HF (β 0.654, 95% CI 0.066–1.242) independently aff ected the score of awareness questionnaire.

C on c l u s i o n s: The basic knowledge on HF in Poland is not sufficient. It is moderately better among MS. Further campaigns improving HF awareness are necessary.

We talk about the importance of psychoeducation for heart patients with Anna Mierzyńska and Karolina Jurczak of the Cardinal Stefan Wyszyński Institute of Cardiology in Anin.

Congestive heart failure (CHF) is the fi nal stage in several heart diseases. The diagnosis of CHF in older patients is a challenge. Preserved left ventricular systolic function is a characteristic type of CHF in seniors. The purpose of the study was to characterize elderly patients with CHF and to highlight specific features of the conditions in seniors. The most common etiology of HF in this group of patients is hypertension and coronary heart disease. In seniors atypical presentations of chronic heart failure is much more common than in younger patients. Malnutrition, limitations of exercise and sedentary lifestyles or comorbid diseases have an influence on asymptomatic, early stage of HF. Th ere are better outcomes of treatment in obese individuals. It is called the obesity paradox. Open communication with a patient and his/her family may improve their response to therapy. When heart failure becomes an incurable disease and aggressive treatment is ineffective, palliative care should be considered in end-of-life heart failure patients. The goal of treatment in the remaining moments of life last moments of life should be maximizing the patient’s comfort.

Mitral regurgitation is the second most common valvular disease. The etiology is either primary or functional-secondary to the left ventricle dysfunction in the course of coronary artery disease, arterial hypertension and diabetes. Along with the population aging and increasing number of comorbidities the number of patients with mitral regurgitation soars. In patients with heart failure the mitral regurgitation significantly decreases the quality of life and worsens the survival prognosis. Surgical correction is the treatment of choice in patients with mitral regurgitation. However, up to 50% of potential candidates are denied surgery for its prohibitive risk. The minimally invasive, percutaneus procedures are potential solution for those subjects. Currently the „edge to edge” technique with use of the MitraClip system is most commonly performed. This procedure is less efficient in MR reduction than open heart surgery. However, the number of periprocedural complications is smaller. It has been shown the MR correction with the MitraClip device improves the duration and quality of life. There are several ongoing preclinical studies on the percutaneusly implanted mitral valve prosthesis. First in men procedures have been performed. However the mitral valve anatomy is much more complex as compared to aortic. Therefore the breakthrough comparable to TAVI procedure will not occur in the very close future.

Videoplethysmography is currently recognized as a promising noninvasive heart rate measurement method advantageous for ubiquitous monitoring of humans in natural living conditions. Although the method is considered for application in several areas including telemedicine, sports and assisted living, its dependence on lighting conditions and camera performance is still not investigated enough. In this paper we report on research of various image acquisition aspects including the lighting spectrum, frame rate and compression. In the experimental part, we recorded five video sequences in various lighting conditions (fluorescent artificial light, dim daylight, infrared light, incandescent light bulb) using a programmable frame rate camera and a pulse oximeter as the reference. For a video sequence-based heart rate measurement we implemented a pulse detection algorithm based on the power spectral density, estimated using Welch’s technique. The results showed that lighting conditions and selected video camera settings including compression and the sampling frequency influence the heart rate detection accuracy. The average heart rate error also varies from 0.35 beats per minute (bpm) for fluorescent light to 6.6 bpm for dim daylight.

O b j e c t i v e s: To evaluate the properties of natural sweetener solutions in whole organ preservation and assess their influence on the dimension, weight and shape of cardiac tissue samples in stated time intervals, up to a one-year period of observation.

B a c k g r o u n d: Tissue fixation is essential for biological sample examination. Many negative toxic effects of formaldehyde-based fixatives have forced us to seek alternatives for formaldehyde based solutions. It has been demonstrated that natural sweeteners can preserve small tissue samples well and that these solutions can be used in histopathological processes. However, their ability to preserve whole human organs are unknown.

M e t h o d s: A total of 30 swine hearts were investigated. Th ree study groups (n = 10 in each case) were formed and classifi ed on the type of fixative: (1) 10% formaldehyde phosphate-buffered solution (FPBS), (2) 10% alcohol-based honey solution (ABHS), (3) 10% water-based honey solution (WBHS). Samples were measured before fi xation and in the following time points: 24 hours, 72 hours, 168 hours, 3 months, 6 months and 12 months.

R e s u l t s: The WBHS failed to preserve heart samples and decomposition of tissues was observed one week after fixation. In half of the studied parameters, the ABHS had similar modifying tendencies as compared to FPBS. Th e overall condition of preserved tissue, weight, left ventricular wall thickness, right ventricular wall thickness and the diameter of the papillary muscle differed considerably.

C o n c l u s i o n s: The ABHS may be used as an alternative fi xative for macroscopic studies of cardiac tissue, whereas the WBHS is not suited for tissue preservation.

Background: Recoarctation (reCoA) of the aorta is a common complication after the Norwood procedure. Untreated, it can lead to failure of the systemic ventricle and death. The main goal of the study is to defi ne risk factors of reCoA after the Norwood procedure in hypoplastic left heart syndrome (HLHS).

Methods: We retrospectively analyzed the pre-, intra- and postoperative data of 96 successive patients who underwent the Norwood procedure between 2007 and 2011. In case of reCoA balloon angioplasty was performed. We analyzed and compared the data of the patients with reCoA and without reCoA using the StatSoft STATISTICA™ 10 soft ware.

Results: ReCoA was noted in 23 patients (33.3%). Th is complication was diagnosed 95.1 days (49–156 days) on the average aft er the Norwood procedure. Balloon angioplasty successfully allowed for decreasing the mean gradient across the site of the narrowing from the average 27.5 mmHg to the average 9.7 mmHg (p = 0.008) and enlarged the neo-isthmus by the average of 2 mm (p <0.05). Th e risks factors seemed to be the diameter of the ascending aorta OR = 7.82 (p = 0.001), atresia of the mitral valve OR = 7.00 (p = 0.003) and atresia of the aortic valve — OR = 6.22 (p = 0.002).

Conclusion: Balloon angioplasty seems to be an eff ective intervention in case of reCoA. A low diameter of the native ascending aorta (≤3mm) and the presence of atresia of the mitral and/or aortic valve should intensify the vigilance of a cardiologist in the search for signs of reCoA of the aorta.

I n t r o d u c t i o n: Hypoplastic left heart syndrome (HLHS) is a congenital heart anomaly that is diagnosed prenatally or postnatally. The prenatal diagnosis leads to limiting the rate of systemic complications in the preoperative period due to optimization of the early therapeutic management.

O b j e c t i v e: The objective of the study is to determine the effect of prenatal diagnostic management of HLHS on the condition of newborns and the frequency of antibiotherapy employment prior to the first stage of surgical treatment.

Me t h o d o l o g y: The study included 95 children with HLHS operated on in the years 2014–2016. The cohort was divided into two groups: newborns with a prenatally diagnosed heart defect (50 children — 52.6%) and neonates with the defect diagnosed after birth (45 children — 47.4%). The data of the patients were analyzed based on their medical records.

R e s u l t s: The mean age of the children upon admission was 3.86 days in the group of patients with the prenatally diagnosed heart defect (PreHLHS) and 7.41 days in the group of newborns without the prenatal diagnosis (PostHLHS) (p = 0.001). In 60% of the PreHLHS group patients (30/50), at least one antibiotic was administered, while in the PostHLHS group, antibiotherapy was employed in 93.3% (42/45) cases (p = 0.001). Bacteriological tests demonstrated pathogen growth in 33 children (36% and 33.3%, respectively), what accounted for 34.7% of the entire cohort. On the average, the first antibiotic was introduced on the 6.55th day of life in the PreHLHS group and on the 2.73th day in the PostHLHS group (p = 0.005). Th e most profound differences in antibiotic employment involved aminoglycosides. The aforementioned type of antibiotic medications was administered to 6% of the children with the prenatal diagnosis and to 17.8% of the children diagnosed postnatally (p = 0.042).

C o n c l u s i o n s: Preoperative antibiotherapy in children with HLHS was employed more frequently than it would be indicated by microbiology tests results. Antibiotics were observed to be introduced more commonly and earlier in the newborns with the postnatally diagnosed congenital heart defect.

In this article a three-dimensional mathematical model of radiofrequency ablation during open-heart surgery is presented. It was developed to study temperature field distribution into myocardial tissue. This model uses an anatomically correct 3D model for the left atrium, obtained by magnetic resonance imaging (MRI) processing of a patient; takes into account thermoelectric characteristic differences depending on the area of electric current application; considers cooling by the air flow. An ex-vivo experiment on the pig’s heart was performed where the depth of myocardium tissue damage was measured for the model validation. It was shown that the deviation of the model data from the experiment is within the limits of instrumental measurement error. The developed model is proposed to be used for heart ablation procedures planning, or new equipment development.

Nitric oxide (NO) is known to be a neuromodulator with dual proconvulsive and anticonvul- sive action. Valeriana officinalis (VAL) was previously believed to be antiepileptic, but is today known as a sedative and sleep regulator. Seizures may be associated with abnormal electrocardio- graphic changes and cardiac dysfunction arising from epilepsy may be related with neuronal nitric oxide (nNO). This study was aimed to investigate the effects of the neuronal nitric oxide synthase (nNOS) inhibitor 7-Nitroindazole (7-NI) and VAL on seizure behaviours and electrocar- diographic parameters in the pentylentetrazole (PTZ)-kindled seizure model.

Wistar rats were randomised into saline control, PTZ-kindled, 7-NI, VAL and VAL+PTZ, 7-NI+PTZ and VAL+7-NI+PTZ groups. Latency, stage, frequency of seizures, blood pressure (BP), heart rate (HR) and corrected QT (QTc) values were evaluated.

Frequency and stage of seizures, BP and HR increased, while seizure latency decreased and QTc was prolonged in the PTZ-kindled group. 7-NI and VAL had no effects on BP and HR variables under normal conditions, but ameliorated the seizure stage and frequency of seizures. 7-NI treatment also resulted in a reduction of the increased BP and prolonged QTc values observed in PTZ-kindled rats.

Considering these results, QTc prolongation may be used as a predictor for recurrent seizures. 7-NI and VAL exhibited different effects on seizures and ECG variables. 7-NI shows potential as an anticonvulsant drug agent in epileptic patients with cardiac dysfunctions and those additional studies including in-vivo experiments are essential.

The study on cognitive workload is a field of research of high interest in the digital society.

The implementation of ‘Industry 4.0’ paradigm asks the smart operators in the digital factory

to accomplish more ‘cognitive-oriented’ than ‘physical-oriented’ tasks. The Authors propose

an analytical model in the information theory framework to estimate the cognitive workload

of operators. In the model, subjective and physiological measures are adopted to measure

the work load. The former refers to NASA-TLX test expressing subjective perceived work

load. The latter adopts Heart Rate Variability (HRV) of individuals as an objective indirect

measure of the work load. Subjective and physiological measures have been obtained by

experiments on a sample subjects. Subjects were asked to accomplish standardized tasks

with different cognitive loads according to the ‘n-back’ test procedure defined in literature.

Results obtained showed potentialities and limits of the analytical model proposed as well as

of the experimental subjective and physiological measures adopted. Research findings pave

the way for future developments.

B a c k g r o u n d: A novel paradigm of diastolic heart failure with preserved ejection fraction (HFpEF) proposed the induction of coronary microvascular dysfunction by HFpEF comorbidities via a systemic pro-infl ammatory state and associated oxidative stress. Th e consequent nitric oxide deficiency would increase diastolic tension and favor fi brosis of adjacent myocardium, which implies not only left ventricular (LV), but all-chamber myocardial stiff ening. Our aim was to assess relations between low-grade chronic systemic infl ammation and left atrial (LA) pressure-volume relations in real-world HFpEF patients.

Me t h o d s: We retrospectively analyzed medical records of 60 clinically stable HpEFF patients in sinus rhythm with assayed high-sensitive C-reactive protein (CRP) during the index hospitalization. Subjects with CRP >10 mg/L or coexistent diseases, including coronary artery disease, were excluded. LV and LA diameters and mitral E/E’ ratio (an index of LA pressure) were extracted from routine echocardiographic 46 Cyrus M. Sani, Elahn P.L. Pogue, et al. records. A surrogate measure of LA stiff ness was computed as the averaged mitral E/e’ ratio divided by LA diameter.

R e s u l t s: With ascending CRP tertiles, we observed trends for elevated mitral E/e’ ratio (p <0.001), increased relative LV wall thickness (p = 0.01) and higher NYHA functional class (p = 0.02). Th e LA stiffness estimate and log-transformed CRP levels (log-CRP) were interrelated (r = 0.38, p = 0.003). On multivariate analysis, the LA stiff ness index was independently associated with log-CRP (β ± SEM: 0.21 ± 0.07, p = 0.007) and age (β ± SEM: 0.16 ± 0.07, p = 0.03), which was maintained upon adjustment for LV mass index and relative LV wall thickness.

C o n c l u s i o n s: Low-grade chronic infl ammation may contribute to LA stiff ening additively to age and regardless of the magnitude of associated LV hypertrophy and concentricity. LA stiff ening can exacerbate symptoms of congestion in HFpEF jointly with LV remodeling.

T h e a i m: The aim of the study is to present the initial experience with continuous flow left ventricle assist device (CF-LVAD) in pediatric patients with BSA below 1.5 m2.

M a t e ri a l a n d M e t h o d s: Between 2016 and 2017, CF-LVAD (the Heartware System) have been implanted in three pediatric patients in the Department of Pediatric Cardiac Surgery, Jagiellonian University, Krakow, Poland. The indications for initiating CF-LVAD were end-stage congestive heart failure due to dilated cardiomyopathy in all children.

R e s u l t s: Implanted patients have had BSA of 1.09, 1.42, 1.2 m2, and 37, 34, 34 kg of body weight and the age 12, 11, 12 years, respectively. The time of support was 550 days in two patients and 127 in another one, and is ongoing. The main complication has been driveline infection.

C o n c l u s i o n: The outcomes from our single-center experience using the HeartWare CF-LVAD have been excellent with a low incidence of complication and no necessity to reoperation in our patients. Children could be successfully and safely discharged home.

Myxomatous mitral valve disease (MMVD) is a cardiac condition commonly found in older dogs. The disease process can lead to heart failure (HF). In HF, an increase of reactive oxygen species (ROS) and abnormal mitochondrial activity, as well as apoptosis, have been reported. Humanin (HN) is a polypeptide that has a cardioprotective effect against apoptosis and oxidative stress. The purposes of this study were (1) to investigate the potential role of plasma HN as a cardiac biomarker to predict disease progression of MMVD, and (2) to compare plasma HN concentrations with plasma NT-pro BNP concentrations. Thirty-one dogs were included in the study. The dogs were separated into four groups: Group 1 was healthy dogs (n = 8), Group 2 was MMVD class B (n = 8), Group 3 was MMVD class C (n = 8), and Group 4 was MMVD class D (n = 7). All dogs were given a physical examination, thoracic radiography, echocardiography, and samples of their blood were collected for hematology and blood chemistry analysis. Levels of plasma HN and plasma NT-proBNP were also investigated. The results showed that plasma HN levels were lower in the dogs with MMVD and that lower plasma HN levels were associated with greater severity of MMVD-induced HF. It was possible to observe changes in plasma HN levels at a less severe disease stage than plasma NT-proBNP in dogs with MMVD. These findings sug- gest that a decreased plasma HN level can be used as a biomarker to identify dogs with MMVD -induced HF.