Background: Recent studies have changed the perception of rhythm control in the treatment of atrial fibrillation (AF). Functional mitral regurgitation (fMR) can be both a cause and a consequence of AF and may influence rhythm restoration procedures. Materials and methods: A retrospective analysis included 182 consecutive patients with AF on optimal medical therapy (OMT) undergoing electrical cardioversion (CVE). Based on transthoracic echocardiography, the study group was divided into 20 (11%) patients without mitral regurgitation (MR) and 132 (82%) with fMR 77 (58%) with atrial fMR (afMR; left ventricle ejection fraction (LVEF) ≥ 50%, left atrial (LA) dilatation) and 55 (42%) and with ventricular fMR (vfMR; LVEF < 50%). Patients with severe and organic MR were excluded from the study. Results: vfMR patients had a greater incidence of kidney failure (p = 0.01) and coronary heart disease (p = 0.02); more frequent use of diuretics during hospitalization (p < 0.01); greater LA diameter and area (p < 0.01; p < 0.01) than afMR patients. CVE efficiency was high in all four groups (84–95%). The presence and type of fMR did not affect the efficacy of CVE (p = 0.2; p = 0.9) and did not require the use of more energy (p = 0.4; p = 0.8). The independent predictor of successful CVE was the amount of white blood cells (OR 0.74, p < 0.05). Conclusions: Efficacy of CVE is high among AF patients on OMT regardless of the incidence and type of fMR. Subclinical inflammation should be excluded before elective CVE because it may decrease its efficacy.

We sought to compare the safety and efficiency of Tiger-2 in the right radial and Judkins catheter in the left radial access. We retrospectively collected data of 487 patients, involving 172 patients after coronary angiography with Judkins on the left radial artery and 315 patients with Tiger-2 on the right radial artery access. There were no differences in baseline characteristics, except for hypertension ratio and mean age. There was a difference in pulse absence on the radial artery. The volume of contrast used was higher in the Judkins group. Both groups differed in the amount of drugs administered (NTG and heparin). Fluorescence times were comparable between groups. Radiation dosage and AK was significantly greater in the Tiger-2 group. The Tiger-2 catheters were significantly more often changed to another type of catheter (100 changes) than the Judkins (12 changes). However, there was no statistical difference in access site change. Judkins with left radial access seems to be a safer option because of the lower radiation exposure and less incidence of complications than Tiger-2 with right radial access, however, it requires a higher volume of contrast.

Introduction A persistent patent foramen ovale (PFO) is a congenital heart defect that predisposes to crossed embolism resulting in stroke. The defect can be accompanied by endothelial dysfunction. One marker reflecting endothelial dysfunction is serotonin, the concentration of which can be...

Background: Patent foramen ovale (PFO) is associated with cryptogenic stroke, but mechanisms beyond paradoxical embolism remain unclear. Inflammation, fibrosis-related remodeling, and nitrosative stress may contribute to vascular vulnerability in these patients. The aim of this study was to evaluate inflammatory, fibrotic, and nitrosative biomarker profiles in patients with PFO and prior cryptogenic stroke and to determine whether these patients exhibit coupled inflammatory fibrotic nitrosative activation. Methods: This prospective, observational, single-center study included 92 patients aged <55 years with PFO and prior cryptogenic stroke and 56 age-matched controls without PFO and cerebrovascular events. Circulating interleukin-18 (IL-18), galectin-3, and 3-nitrotyrosine (3-NT) levels were measured using ELISA assays. Correlation and linear regression analyses were performed. Results: Compared with controls, patients with PFO had higher galectin-3 (11.87 vs. 10.36 ng/mL; p = 0.015), IL-18 (268.0 vs. 121.0 pg/mL; p < 0.001), and 3-NT (48.5 vs. 41.8 ng/mL; p = 0.046). Significant correlations were observed between IL-18 and galectin-3 (r = 0.565), IL-18 and 3-NT (r = 0.425), and galectin-3 and 3-NT (r = 0.292) (all p ≤ 0.002). Conclusions: Patients with PFO and prior cryptogenic stroke exhibit a distinct biomarker profile consistent with coupled inflammatory–fibrotic–nitrosative activation, suggesting a potential non-mechanical component of stroke susceptibility.

Background/Objectives: Embolic Stroke of Undetermined Source (ESUS) refers to non-lacunar ischemic stroke without an identified cause and is presumed to be related to a cardioembolic mechanism. A potential etiological factor is atrial fibrosis leading to left atrial (LA) dysfunction, also known as atrial cardiomyopathy. This study aimed to compare advanced transthoracic echocardiographic parameters of LA function in patients with ESUS and age- and sex-matched controls. Methods: In this prospective matched observational case–control study, fifty patients with ESUS and 50 age- and sex-matched controls were analyzed. All participants underwent comprehensive transthoracic echocardiography (TTE). LA parameters included four-dimensional volumetry, LA strain (LAS), and LA stiffness index calculated as the ratio of E/eʹ to reservoir strain. All ESUS patients additionally underwent transesophageal echocardiography (TEE) to assess the presence of patent foramen ovale (PFO). Results: Compared with controls, ESUS patients had significantly reduced LAS in the reservoir phase (LAS-r 37.3% vs. 42.3%; p < 0.01) and conduit phase (LAS-cd 22.9% vs. 28.4%; p < 0.01), as well as a higher LA stiffness index (0.171 vs. 0.149; p < 0.01). No significant differences were found in LA size or volume. In subgroup analysis, ESUS patients with and without PFO did not differ, while both subgroups showed significant impairment compared with controls. Conclusions: ESUS is associated with impaired LA functional properties despite preserved LA size. LAS may provide complementary information on subclinical LA functional abnormalities in patients with ESUS; however, its clinical and prognostic significance requires validation in prospective studies.