Krivickas, Žilvinas

Background and Objectives: Transcatheter aortic valve replacement (TAVR) in large aortic annuli poses challenges due to limited valve-size options and increased complication risks. The aim is to evaluate the safety and performance of XL sizes (30.5 mm and 32 mm) of the Myval transcatheter heart valve (THV) for treating patients with severe aortic stenosis and large aortic annuli. Material and Methods: This retrospective observational study included consecutive patients undergoing TAVR with XL sizes of the Myval THV between December 2023 and December 2024 at a single centre. During this period, 146 TAVI procedures were performed, of which 15 patients (10.3%) with large aortic annuli (mean systolic annular area 786.5 ± 48.2 mm2) received XL valves and were included in the present analysis. Patients were followed up at discharge, 3–6 months, and 1 year. Patient evaluation included echocardiography and clinical assessments following the Valve Academic Research Consortium-3 criteria. Results: All patients were male, with a mean age of 79.1 ± 5.9 years. Technical success was achieved in 100% of cases. At discharge, none of the patients had moderate or greater paravalvular leakage (PVL); 11 patients had no PVL, while 1 had trace and 3 had mild PVL. The mean effective orifice area (EOA) improved from 0.75 ± 0.15 cm2 at baseline to 2.31 ± 0.21 cm2 at discharge (p < 0.0001). At the 12-month follow-up, the mean EOA was 2.4 ± 0.3 cm2, and no moderate or severe PVL or major adverse clinical outcomes were observed. One patient required a permanent pacemaker implantation due to an atrioventricular block. Conclusions: The XL sizes of Myval THV showed both safety and efficacy in patients with large aortic annuli, demonstrating acceptable hemodynamic performance and low complication rates. However, large-scale studies with longer follow-ups are needed to validate these findings in diverse populations.

Background/Introduction Galectin-3 (Gal-3) is a multifunctional protein implicated in diverse biological processes, including inflammation, fibrosis, and metabolic dysregulation, and it plays a significant role in cardiovascular disease, notably as atherosclerosis and acute coronary syndromes. Gal-3 enhances platelet aggregation and thrombosis via activation of Dectin-1 receptors, contributing to cardiovascular risk, particularly in high-risk patients. Purpose This study aimed to evaluate the effects of a Galectin-3 inhibitor (Gal-3I) on platelet aggregation in patients with acute coronary syndrome (ACS), stable angina, and metabolic risk factors, investigating the role of Gal-3 in modulating platelet hyperreactivity. Methods Platelet aggregation was conducted using a two-component assay with classical agonists (ADP and epinephrine) alone and in combination with Gal-3I, on venous and arterial blood samples from patient cohorts. The study included assessments across gender, age, and diabetes status. Statistical analyses adjusted for confounders were performed to evaluate aggregation responses. Mann-Whitney and KruskalWallis tests were used. Results ACS patients exhibited significantly (p<0.05) lower platelet aggregation in response to ADP (venous blood) when combined with Gal-3I compared to stable angina and high-risk groups (median (min-max), 51 (11- 94)%agr vs 60 (6-90)%agr vs 64 (0-91)%agr, respectively).. No significant gender differences were found, though a trend of declining platelet function with age was noted in females. Gal-3I normalized platelet aggregation levels between patients with diabetes and control subjects, supporting its role in reducing platelet hyperreactivity linked with metabolic disorders. Conclusion(s) Galectin-3 is a critical modulator of platelet function, particularly in acute cardiovascular events and metabolic disease contexts. Inhibition of Gal-3 attenuates platelet hyperactivity and may represent a promising therapeutic avenue for reducing thrombotic risk in ischemic heart disease. Further research is warranted to clarify underlying pathways and optimize therapeutic strategies.

BACKGROUND Quantitative flow ratio (QFR) is a non-invasive angiographic tool that provides functional assessment of coronary stenosis without the need for pressure wires or hyperemia. This prospective study aimed to evaluate the procedural and inpatient treatment outcomes of QFR-guided percutaneous coronary intervention (PCI) compared with that of angiography-guided PCI in patients with ST-elevation myocardial infarction (STEMI) undergoing staged revascularization of non-culprit lesions. MATERIAL AND METHODS This randomized prospective single-center study was conducted at the Hospital of the Lithuanian University of Health Sciences Kaunas Clinics (July 2020-June 2021). After successful culprit-lesion PCI for STEMI, 124 participants with residual angiographically significant non-culprit stenosis (50-75%) were randomized to QFR-guided (n=62) or angiography-guided PCI (n=62). Procedural characteristics, fluoroscopy time, contrast usage, stent number/length, and inpatient treatment outcomes were compared between groups using SPSS 28.0 software. RESULTS Compared with PCI guided by visual estimation alone, the QFR-guided PCI group showed significant reductions in fluoroscopy time (median 6.2 vs 8.0 min, P=0.009), contrast volume (median 100 vs 120 mL, P=0.038), number of stents implanted (median 1.5 vs 2.0, P=0.002), and stent length (median 28 vs 45 mm, P<0.001). No significant differences were found between the groups in terms of periprocedural complications or length of inpatient stay. CONCLUSIONS QFR-guided PCI of the non-culprit lesion resulted in shorter fluoroscopy time, lower contrast volume, and a smaller number and average length of implanted stents. These findings highlight the potential of QFR to enhance procedural efficiency and reduce unnecessary stenting in clinical practice without compromising patient outcomes.

Background. The Coronavirus disease 2019 (COVID-19) pandemic has changed the way patients seek medical attention and have medical services are provided. We sought to compare characteristics, clinical course, and outcomes of patients presenting with acute myocardial infarction (AMI) during the pandemic compared to before it. Methods. This is a multicenter, retrospective cohort study of consecutive COVID-19 negative patients with AMI in Lithuania from March 11,2020 to April 20,2020 compared to patients admitted with the same diagnosis during the same period in 2019. All patients under went angiography. Six month follow-up was obtained for all patients. Results. A total of 269 patients were included in this study, 107 (40.8%) of whom presented during the pandemic. Median pain-to-doot times were significantly longer (858 [quartile 1-360, quartile 3-2600] vs. 385.5 [200,745] mins, p<0.00001) and post-revascularization ejection fractions were significantly lower (35 [30,45] vs. 45 [40,50], p<0.0001) for patients presenting during vs. prior to the pandemic. While the in-hospital mortality rate did not differ, we observed a higher rate of six-month major adverse cardiovascular events (MACE) for patients whe presented during vs. prior to the pandemic (30.8% vs 13.6%, p=0,0006). Conclusion. In conclusion, 34% fewer patients with AMI presented to the hospital during the COVID 19 pandemic, and those who did waited longer to present and experienced more 6-month MACE compared to patients admitted before the pandemic.

Background. Coronary collateral circulation (CCC) plays a significant role in protecting the myocardium from ischemia during the events of myocardial infarctions. Elevated trimethylamine n-oxide (TVFO) levels induce NLRP3 inflammasome activation and subsequently trigger inflammatory and immune responses which has been shown to be atherogenic. However, only a few research studies of limited scale have reported the relationship between increased TMAO levels and impaired CCC development. We aimed to investigate the association between serum TMAO levels and CCC in Causaasian STEMI patients. Methods. This is a prospective study of 400 STEMI patients who underwent primary percutaneous coronary intervention (PCI) between September 2020 and September 2021. Inclusion criteria were patients with STEMI submitted to primary angioplasty within 120 min after ECG diagnosis. Angiographic collateral flow was evaluted using the Rentrop collateral score (RCS), RCS-o indicates no visible coronary collaterals; RCS-1, coronary collaterals without IRA filling; RCS-2, coronary collaterals with partial IRA filling and RCS-3, collaterals with complete IRA filing. Results. Overall, mean age was 68±14,8 years with 40.2% females. The left anterior descending (LAD) artery was the most common culprit vessel, accounting for 61,1% of cases, followed by the right coronary artery (32.0%) and the left circumflex artery (6.9%). 320 patients (80%) had RCS0-1, whilst 80 (20%) had RCS 2-3. Pateints with RCS 2-3 were with higher level of TMAO younger that those without (55.8 vs 65.2, p<0.05) and had a longer ischemic time (403.7 mins vs 235.8 mins, p<0.0001). Moreover, they were more likely to have the RCA as the culpit vessel, compared with the LAD or LCx (40.8% vs11.2% vs 13.5%, p<0.0001). The presence of well-developed collaterals had a higher on-admission TMAO levels than those with poorer formed collaterals (20.2 uM vs 6uM, p<0.01), and wasw associated with a with a greater LVEF (530.7% vs 44.5%, p<0.0001). At one month follow up, the presence of well-developed collaterals was not associated with lower cardiovascular events or mortality rates. Based on the receiver operating characteristic (ROC) curve, the optimal cut off value of serum level of TMAO as an indicator for screaning of well-developed collaterals was estimated to be 7,1 pM, which yielded a sensitivity of 69.3% and a specificity of 79.0%, with the area under the curve at 0.750 (95% CI, o.687-0,812). Conclusion. In STEMI patients, elevated levels of TMAO are associated with well developed collateral circulation.

Background. The Coronavirus disease 2019 (COVID-19) pandemic has changed the way patients seek medical attention and have medical services are provided. We sought to compare characteristics, clinical course, and outcomes of patients presenting with acute myocardial infarction (AMI) during the pandemic compared to before it. Methods. This is a multicenter, retrospective cohort study of consecutive COVID-19 negative patients with AMI in Lithuania from March 11,2020 to April 20,2020 compared to patients admitted with the same diagnosis during the same period in 2019. All patients under went angiography. Six month follow-up was obtained for all patients. Results. A total of 269 patients were included in this study, 107 (40.8%) of whom presented during the pandemic. Median pain-to-doot times were significantly longer (858 [quartile 1-360, quartile 3-2600] vs. 385.5 [200,745] mins, p<0.00001) and post-revascularization ejection fractions were significantly lower (35 [30,45] vs. 45 [40,50], p<0.0001) for patients presenting during vs. prior to the pandemic. While the in-hospital mortality rate did not differ, we observed a higher rate of six-month major adverse cardiovascular events (MACE) for patients whe presented during vs. prior to the pandemic (30.8% vs 13.6%, p=0,0006). Conclusion. In conclusion, 34% fewer patients with AMI presented to the hospital during the COVID 19 pandemic, and those who did waited longer to present and experienced more 6-month MACE compared to patients admitted before the pandemic.

Background. Coronary collateral circulation (CCC) plays a significant role in protecting the myocardium from ischemia during the events of myocardial infarctions. Elevated trimethylamine n-oxide (TVFO) levels induce NLRP3 inflammasome activation and subsequently trigger inflammatory and immune responses which has been shown to be atherogenic. However, only a few research studies of limited scale have reported the relationship between increased TMAO levels and impaired CCC development. We aimed to investigate the association between serum TMAO levels and CCC in Causaasian STEMI patients. Methods. This is a prospective study of 400 STEMI patients who underwent primary percutaneous coronary intervention (PCI) between September 2020 and September 2021. Inclusion criteria were patients with STEMI submitted to primary angioplasty within 120 min after ECG diagnosis. Angiographic collateral flow was evaluted using the Rentrop collateral score (RCS), RCS-o indicates no visible coronary collaterals; RCS-1, coronary collaterals without IRA filling; RCS-2, coronary collaterals with partial IRA filling and RCS-3, collaterals with complete IRA filing. Results. Overall, mean age was 68±14,8 years with 40.2% females. The left anterior descending (LAD) artery was the most common culprit vessel, accounting for 61,1% of cases, followed by the right coronary artery (32.0%) and the left circumflex artery (6.9%). 320 patients (80%) had RCS0-1, whilst 80 (20%) had RCS 2-3. Pateints with RCS 2-3 were with higher level of TMAO younger that those without (55.8 vs 65.2, p<0.05) and had a longer ischemic time (403.7 mins vs 235.8 mins, p<0.0001). Moreover, they were more likely to have the RCA as the culpit vessel, compared with the LAD or LCx (40.8% vs11.2% vs 13.5%, p<0.0001). The presence of well-developed collaterals had a higher on-admission TMAO levels than those with poorer formed collaterals (20.2 uM vs 6uM, p<0.01), and wasw associated with a with a greater LVEF (530.7% vs 44.5%, p<0.0001). At one month follow up, the presence of well-developed collaterals was not associated with lower cardiovascular events or mortality rates. Based on the receiver operating characteristic (ROC) curve, the optimal cut off value of serum level of TMAO as an indicator for screaning of well-developed collaterals was estimated to be 7,1 pM, which yielded a sensitivity of 69.3% and a specificity of 79.0%, with the area under the curve at 0.750 (95% CI, o.687-0,812). Conclusion. In STEMI patients, elevated levels of TMAO are associated with well developed collateral circulation.

Introduction: COVID-19 pandemic has changed the way patients seek medical attention and the manner medical service is provided. Purpose: To examine the changes in patient characteristics, clinical course and rates of rehospitalization due to decompensated heart failure for patients admitted with acute myocardial infarction (AMI) during the COVID-19 pandemic compared to the corresponding period in the previous year. Methods: This is a region-wide, multicenter, retrospective cohort study of consecutive COVID-19 negative patients with AMI from March 11, 2020 to April 20, 2020 compared to patients admitted with the same diagnosis during the same period in the previous year. Six-month follow-up was obtained for all patients included in the study. Results: A total of 269 AMI patients were evaluated in this study. Pain-to-door times (858 [360, 2600] vs. 385.5 [200, 745] min, p < 0.0001) and troponin I levels (7.8 [2.6, 37.2] vs. 4.5 [1.1, 25.4] µg/l, p = 0.013) were significantly higher for AMI patients presenting during the pandemic. Similarly, NSTEMI patients had a significantly prolonged pain-to-door time during the pandemic than prior to it (2021 [960, 5746] vs 558 [369, 882.5] min, p < 0.0001) and there is evidence to suggest a trend toward longer door-to-wire times, as well (302.5 [179, 600] vs 200.5 [98, 434.5] min, p = 0.0948). furthermore, STEMI patients waited significantly longer before presenting to the hospital during the pandemic (582 [180, 1212] vs 262 [120, 525] min, p = 0.0003). However, door-to-wire times were similar (75 [53.5, 106.5] vs 71 [43, 119] min, p = 0.2257). Additionally, Post-revascularization ejection fraction was significantly lower for AMI patients during the pandemic (35 [30, 45] vs. 45 [40, 50] %, p < 0.0001). During follow-up we observed a significantly higher rate of re-hospitalization due to decompensated heart failure in patients admitted with NSTEMI and STEMI during the pandem[...].

The Coronavirus disease 2019 (COVID-19) pandemic has changed the way patients seek medical attention and how medical services are provided. We sought to compare characteristics, clinical course, and outcomes of patients presenting with acute myocardial infarction (AMI) during the pandemic compared to before it. This is a multicenter, retrospective cohort study of consecutive COVID-19 negative patients with AMI in Lithuania from March 11, 2020 to April 20, 2020 compared to patients admitted with the same diagnosis during the same period in 2019. All patients underwent angiography. Six-month follow-up was obtained for all patients. A total of 269 patients were included in this study, 107 (40.8%) of whom presented during the pandemic. Median pain-to-door times were significantly longer (858 [quartile 1=360, quartile 3 = 2600] vs. 385.5 [200, 745] mins, p<0.0001) and post-revascularization ejection fractions were significantly lower (35 [30, 45] vs. 45 [40, 50], p<0.0001) for patients presenting during vs. prior to the pandemic. While the in-hospital mortality rate did not differ, we observed a higher rate of six-month major adverse cardiovascular events (MACE) for patients who presented during vs. prior to the pandemic (30.8% vs 13.6%, p = 0.0006). In conclusion, 34% fewer patients with AMI presented to the hospital during the COVID-19 pandemic, and those who did waited longer to present and experienced more 6-month MACE compared to patients admitted before the pandemic.

Introduction Exercise is planned, structured, repetitive and intentional movement intended to improve or maintain physical fitness [1]. Physical exercise causes the heart to pump blood into the circulation more efficiently as a result of more forceful and efficient myocardial contractions, increased perfusion of tissues and organs with blood, and increased oxygen delivery [2]. The present knowledge of blood pressure behaviour during and instantly after physical activity is relatively scarce [3-5]. It is within the scope of knowledge, that athlete’s heart rate at rest and sub-maximal workloads may be considered low when compared to the general population [6-8]. Clinical studies have revealed that in athletes heart rates return to basal level faster than sedentary individuals. It is well known that sinus bradycardia in athletes is due to the heart adapting to the physical stresses that it is put under by the athlete’s physical activity [9]. Aim Assess the dynamic variation occurring in blood pressure and heart rate in athletes versus healthy sedentary individuals for a given amount of exercise. Methods A total of 180 Lithuanian males aged between 21-25 years volunteered to participate in the study. Male athletes (N.=90) were included in the study based on the criteria of at least 2 years of regular aerobic training and they were compared with untrained healthy sedentary individuals (N.=90). Exercise performance test was Harvard step test. The individual who is taking the test steps up and down on a platform in a cycle of two seconds. The platform is at a height of about 50 cm. The rate of 30 steps per minute must be sustained for five minutes or until exhaustion. Statistical analyses were performed using the SPSS 20.0 software. The value of P<0.05 was considered as statistically significant. Results The mean systolic blood pressure in untrained healthy sedentary individuals before exercise was statistically [...].