Background and Objectives: Prostate cancer is on the rise in the European Union, and radiofrequency ablation (RFA) is one of the minimally invasive treatment options used for its treatment. Therefore, the aim of this study was to investigate and analyze the effects of RFA on prostate tissues. Materials and Methods: A standard prostate RFA procedure was performed on 13 non-purebred dogs in three sessions: no cooling (NC), cooling with a 0.1% NaCl solution (C.01), and cooling using a 0.9% NaCl solution (C.09). Microtome-cut 2–3 µm sections of prostate samples were stained with hematoxylin and eosin and further examined. Results: A histopathologic evaluation identified four zones of exposure: direct, application, necrosis, and transitional, as the damage on tissues decreased going further from the ablation site. The areas and perimeters of these zones were calculated, and geometric shapes of ablative lesions were evaluated using the quotient formula. Areas and perimeters of prostate tissue lesions in the NC and C.09 sessions were of similar size, whereas those found in C.01 were statistically significantly smaller. Lesions observed in session C.01 were of the most regular geometric shape, while the most irregular ones were found in session C.09. The shapes of lesions closest to the ablation electrode were the most irregular, becoming more regular the further away from the electrode they were. Conclusions: Prostate RFA leads to tissue damage with distinct morphological zones. Notably, the prostate lesions were the smallest and the most regular in shape after RFA procedures using the 0.1% NaCl cooling solution. It can be argued that smaller ablation sites may result in smaller scars, thus allowing for faster tissue healing if the blood flow and innervation at the ablation site are not compromised.

This study aims to evaluate patients with limited state of changes in coronary arteries detected by coronary angiography, the dynamics of these changes over the two years, identify the relevant diagnostic criteria, and assess the efficacy of applied treatment by using speckle tracking echocardiography. Peak radial and circumferential strain and SR (systolic, early, and late diastolic strains) were measured based on the short-axis view; peak longitudinal strain and SR were measured from the apical side of four- two- and three-chamber views. Radial, longitudinal (GLS), circumferential global and regional strains were calculated as an average of measurements. All patients (n - 146) were assigned to normal (control) and CAD groups according to cardiac angiography results. 128 of them were evaluated repeatedly after two years. Depending on angiography findings, LAD (85.83%) stenosis predominate, when subsequently fewer instances of RCA (52.5%) or LCX (40.83%) were observed. Most (about 80%) of the patients had one or two-vessel disease and only 20% had systemic all three-vessel disease. Analysis of STE data in groups during a two-year study period showed statistically reliable differences associated with a particular coronary artery. In the control group: RCA-myocardial circumferential strain (p - 0.037); LAD-no changes; LCX-early (p - 0.013) and late diastolic longitudinal (p - 0.033) strains. Subsequently, in the CAD group: RCA-diastolic circumferential strain rate (p - 0.007); LAD-myocardial longitudinal strain (p - 0.006), systolic longitudinal (p - 0.038) and circumferential strain (p - 0.012) rates, early diastolic circumferential (p - 0.008) and late diastolic longitudinal (p - 0.037) strain rates; LCX-myocardial longitudinal (p - 0.049) strain. Between groups, we detected significant changes in such circumferential strain rates, respectively: RCA- systolic (p=0.037), early diastolic (p=0.019), and late diastolic (p=0.024) strain rates; LAD-no changes; LCX-early diastolic longitudinal strain (p - 0.004). The clinical condition of our patients over the two years has improved both in control and CAD groups, according to GLS. We hold the opinion that microvascular angina (MVA) may be responsible for such an improvement because the main diagnostic criteria and common treatment with ACE inhibitors, statins, beta-blockers, antithrombotic, and nitrates was typical and effective for MVA treatment.

Introduction. Aortic stenosis is the most common valvular disease among elderly patients and carries a poor prognosis if left untreated. Transcatheter aortic valve implantation (TAVI) has emerged as an effective alternative to surgical valve replacement, particularly in high- and intermediate-risk patients. The type of valve implanted may significantly influence postoperative outcomes. Aim of study. To assess the efficacy and safety of TAVI based on the type of prosthesis used: self-expanding (SEV) versus balloon-expandable (BEV). Materials and Methods. A prospective study was conducted on 114 patients over 70 years old with severe aortic stenosis who underwent TAVI: Abbott valve (n=44), Medtronic (n=40), Edwards (n=30). Valve performance and safety were evaluated according to Valve Academic Research Consortium-3 (VARC-3) criteria. Results. No significant differences were observed between groups regarding age, BMI, sex, or comorbidities. Edwards valves showed the highest post-TAVI mean pressure gradients (16.2 ± 6.7 mmHg), followed by Abbott (12.4 ± 6 mmHg) and Medtronic (10.1 ± 3.5 mmHg, pless than 0.001). Vmax was significantly higher in the Edwards group at all followups (pless than 0.01), indicating greater residual stenosis risk. Left ventricular function was similar across groups. Paravalvular regurgitation was more frequent with Edwards (pless than 0.001 vs. Abbott, p=0.008 vs. Medtronic). High-grade AV block and permanent pacemaker implantation were more frequent in the SEV group. Mortality and rehospitalization rates were similar between groups. Conclusions. TAVI proved to be an effective and safe treatment for severe aortic stenosis in elderly patients. The type of prosthesis influences hemodynamic performance and complication profile, highlighting the need for individualized valve selection based on patient characteristics.

Introduction. Severe aortic stenosis and ischemic coronary artery disease are frequently associated in elderly patients, adding complexity to interventional management. Diastolic dysfunction, a marker of myocardial impairment and elevated filling pressures, may influence prognosis after transcatheter aortic valve implantation (TAVI), particularly in the presence of concomitant coronary pathology. The aim of the study was to analyze the interaction between severe aortic valve stenosis, left ventricular diastolic dysfunction, and coronary ischemia in elderly patients with complex cardiovascular disease. Material and methods. This was a prospective analytical cohort study including 85 patients treated between 2019 and 2023, divided into two groups: Group I - TAVI without coronary intervention (n = 56), and Group II - TAVI associated with percutaneous coronary intervention (PCI) (n = 29), consisting of patients with significant coronary lesions. Echocardiography was performed according to the ESC/EACVI 2016 guideline standards, with detailed assessment of diastolic function. Results. The prevalence of left ventricular diastolic dysfunction of varying severity showed a statistically significant difference between groups (p = 0.04): Group I - 35 patients (62.5%) versus Group II - 24 patients (82.7%). The E-wave velocity was lower in Group II: 152.4 cm/sec (IQR = 43.0) compared to 173.0 cm/sec (IQR = 32.0), p = 0.01. The E/A ratio and the incidence of E/A ≥2 showed a borderline significant difference (p = 0.04). Median E/e′ was higher in Group II - 9.2 (IQR = 5.4) compared to 6.4 (IQR = 4.2), p = 0.003. E/Vp was 1.2 (IQR = 0.4) versus 0.8 (IQR = 0.5), p less than 0.001. Diastolic dysfunction was more frequent in Group II, with significantly different echocardiographic parameters, including decreased E-wave velocity, increased E/e′ and E/Vp ratios, and a higher incidence of E/A ≥2. Conclusions. Patients undergoing both PCI and TAVI more frequently exhibited left ventricular diastolic dysfunction. The echocardiographic parameters E, E/e′, and E/Vp showed statistically significant differences, suggesting an additive impact of coronary artery disease on diastolic function impairment in the setting of severe aortic stenosis.

Background/Objectives: Permanent pacemaker implantation (PPI) remains one of the most common complications following transcatheter aortic valve replacement (TAVR). Identifying patients at increased risk for post-procedural conduction disturbances is clinically important for procedural planning and patient management. The aim of this study was to develop and evaluate a machine learning-based model for predicting the risk of PPI after TAVR. Methods: This prospective study was conducted between 2019 and 2025, and included 179 patients with severe aortic stenosis who underwent TAVR. Patient eligibility was determined by a multidisciplinary Heart Team based on clinical, echocardiographic, and imaging criteria. The primary endpoint was PPI occurring during hospitalization or within 30 days after the procedure. Statistical analyses were performed using RStudio (v. 2024.09.1+394)and Python (v.3.12.3), including comparative tests for continuous and categorical variables, receiver operating characteristic analysis to assess model performance, and SHapley Additive exPlanations (SHAP) to evaluate feature importance and model interpretability. Results: A total of 179 patients undergoing TAVR were included in the analysis. PPI occurred in 17 patients (9.5%) within 30 days after the procedure. A machine learning model was developed to predict post-TAVR PPI. The model demonstrated good predictive performance, with an overall accuracy of 0.944 and a weighted F1-score of 0.947. The confusion matrix showed that the model correctly classified 155 patients without PPI and 14 patients with PPI, with only a small number of false predictions. Explainability analyses using SHAP and permutation feature importance revealed that anatomical and procedural variables had the greatest impact on model predictions. The most influential predictors included valve size, right coronary sinus diameter, prosthetic valve diameter, and mean aortic annulus diameter. In contrast, baseline clinical variables such as left ventricular ejection fraction, previous myocardial infarction, and mean transaortic gradient showed a comparatively lower contribution to the prediction of PPI after TAVR. Conclusions: This study demonstrates that machine learning models can effectively predict the risk of PPI after TAVR. Anatomical characteristics of the aortic root and prosthesis-related parameters were the main determinants of PPI, whereas baseline clinical variables had a lower impact. The use of explainable artificial intelligence methods, such as SHAP analysis, may improve risk stratification and support procedural planning in patients undergoing TAVR.

Fractional flow reserve (FFR) is regarded as the gold standard for assessing the functional significance of coronary artery lesions. However, its utilization in clinical practice remains limited. This study aims to determine whether FFR results can influence treatment decisions for coronary artery disease compared to visual assessments of angiographic images. We conducted a retrospective study involving 63 patients diagnosed with either chronic coronary syndrome (n = 39, 61.9%) or acute coronary syndrome (n = 24, 38.1%) who underwent an FFR assessment. Three experienced interventional cardiologists (>300 PCI procedures/year) reevaluated 105 ambiguous coronary lesions in these patients, blinded to the FFR results. The objective was to assess lesion significance and determine the treatment strategy based on a visual angiographic evaluation. The three operators reached concordant agreement (≥two operators) to perform PCI in 60 (57.1%) of the evaluated lesions based on the angiographic assessment. Of these, nine lesions (15%) were deemed functionally non-significant by FFR (FFR > 0.80). Conversely, they agreed to defer PCI in 45 (42.9%) lesions, but 4 lesions (8.9%) were found to be functionally significant (FFR ≤ 0.80) and required a re-evaluation for PCI. Visual-guided decision making by interventional cardiologists shows variability and does not always align with the functional significance of coronary lesions as determined by FFR. Incorporating FFR into routine decision making could enhance treatment accuracy and patient outcomes.