Cardiocore最新文献

We present a case about a 55 years old woman with aortic and mitral mechanical prosthesic valve. She had a stroke related to anticoagulation underdosing nine years ago. She has an inferior acute myocardial infarction (AMI) with ST elevation, with thrombotic coronary occlusions suggestive of multiple coronary embolism from non occlusive mitral valve thrombosis confirmed by echocardiography. We give undue emphasis to the importance of diagnostic coronary embolism suspicion in patients with prosthesis and coronary angiography without significant coronary lesions as well as the role the intracoronary imaging techniques (IVUS and OCT) play to complete the diagnosis.

Introduction

The role of collateral circulation (CC) in ischemic heart diseases remains controversial. There is a lack of evidence about the effect of CC on late presentation myocardial infarction (MI0) (>24 h). We hypothesized that coronary CC may be related to myocardial viability and left ventricular ejection fraction (LVEF) in late presenter MI patients and its connection with ECG and analytical parameters.

Methods

A total of 138 consecutive patients with a late presentation MI and a thrombotic occlusion (TIMI 0) in a major coronary artery were enrolled in this multicenter ambispective and blinded study. CC was classified according to Rentrop and Werner classifications in a blinded manner by 2 expert interventional cardiologists. Twelve patients were prospectively followed up and the wall motion score (WMS) was calculated using the 16 ventricular segments standard model in a blinded manner by 2 expert cardiologists at baseline and at 2-4 follow-up. ECG and analysis were requested before catheterization and during follow-up.

Results

Of all patients included, 67 patients (49%) was Rentrop 0-1 and 71 patients (51%) was Rentrop 2-3. The interobserver concordance for WMS calculation (r=0.99, p=0.001) was excellent.

The culprit vessel was successfully revascularized in 84/113 patients (74%) but it was not related neither to LVEF nor with WMS (p>0.05). Myocardial viability was confirmed in 65/116 patients (56%) and it was related to good CC (78 vs. 33.9%, p<0.001). Rentrop and Werner classifications were related to LVEF (r=0.29, p=0.004 and r=0.24, p=0.01) and with WMS (r=−0.73, p=0.01 and r=−0.72, p=0.01) at baseline and at follow-up (r=0.67, p=0.01 and r=−0.53, p=0.01) but also with some electrocardiographic parameters: number of leads showing: persistent ST elevation (r=−0.78, p=0.001 and r=−0.71, p=0.001), and Q and T waves (r=−0.79, p=0.001 and r=−0.7, p=0.01). Analytically, more eosinophils, lymphocytes and platelets and fever neutrophils are observed.

Conclusions

Good CC development in late presentation MI was related to myocardial viability and with LVEF.

Introduction and objectives

Heart failure is a highly prevalent disease with a high morbidity and mortality. Episodes of acute episodes of heart failure during its natural history leads to a deterioration in the quality of life of these patients, as well as a worsening of their prognosis and the increased health costs, given that these patients have a high frequency of hospital admissions. The development of multidisciplinary heart failure units provides an intensive treatment and follow-up of the decompensated patient that prevents them being admitted in many cases. However, there are no studies that have evaluated the efficacy and safety of outpatient management compared to conventional hospital treatment. For this reason, the aim of this work is to compare the treatment of decompensations due to heart failure in the hospital setting with that of their outpatient treatment.

Method

Patients with acute heart failure without severity criteria will be enrolled and then randomised to either hospital or outpatient management. This will be a non-inferiority study, in which the primary outcome of the analysis is the time until death of cardiovascular origin, or re-admission due to heart failure in the first month of follow-up. It is estimated that 54 patients per group will be needed. The secondary outcomes collected will be: time until the combined event of admissions due to heart failure or death of cardiovascular origin at 6 months follow-up, a change in the level of perceived dyspnoea, and a comparison of the costs of each strategy. The estimated time to complete the current project is 24 months.

Conclusions

The current study will determine the safety and efficacy of the outpatient treatment of patients with acute heart failure.

Introduction

Long lesions present special challenges for interventional cardiologists, including increased risk of restenosis and complications. We assessed the clinical outcome of real-world patients treated with ≥40 mm drug-eluting stents (DES).

Methods

Prospective observational study of consecutive patients with a very long coronary lesion (> 35 mm) treated by percutaneous coronary intervention with one implanted Xience Xpedition (Abbott Vascular) everolimus-eluting stent (EES) and Biomime (Palex Medical) sirolimus-eluting stent (SES) ≥40 mm. We collected major adverse cardiac events (MACE) including cardiac death, nonfatal myocardial infarction and target lesion revascularization (TLR).

Results

94 real-world patients with 113 lesions (80% male, 63.8 ± 10 years, 55% smoker, 77% hypertensive, 41.5% diabetic, 58% hyperlipidemic) were enrolled in the study. Clinical presentation was acute coronary syndrome in 80%. Bifurcation lesions account 44%, ostial 32%, calcified 87%, thrombotic 20.6% and 22.7% were CTO. Mean lesion length was 57.9 ± 19 mm, and mean stent length was 46 ± 2.5 mm, with overlapped stents in 59%. The total length (in mm) of stent per lesion was 64 ± 21 mm. 47 EES were implanted in 45 patients and 45 SES in 35 patients. At 14.8 ± 11 month follow-up, 4 (4.3%) patients had died from cardiac causes, 2 (2.1%) had a nonfatal myocardial infarction and 3 (3.2%) underwent TLR. One patient had a subacute stent thrombosis (2 overlapped SES stents = 1.1%). The cumulative rate of MACE was 9.6%.

Conclusions

Patients with complex very long coronary lesions in a real-world population treated with long DES (≥40 mm) are associated with excellent procedural results and good clinical outcomes at long term follow-up.

Introduction

The Minnesota Living with Heart Failure Questionnaire (MLHFQ) is a widely used scale to measure quality of life in patients with heart failure. The aim of the study was to analyse the usefulness of the MLHFQ in the follow-up of patients with chronic heart failure and establish the relationship with New York Heart Association (NYHA) functional class and ejection fraction.

Materials and methods

We reviewed 172 records, we presented general characteristics, assessed the internal validity and reliability and explored differences between the overall outcomes and by domain vs. ejection fraction and NYHA functional class.

Results

The median age of the patients was 63 (57; 72) years, with a predominance of males (67.4%). Fifty-one point one percent had an ejection fraction < 40%. The reliability coefficients in the 3 domains were > 0.6; the physical domain was the most affected; significant differences were found in ejection fraction in the «Others» domain. Regarding the NYHA admission, significant differences were observed in 3 domains, we found lower quality of life in patients with a higher NYHA score.

Conclusions

The MLHFQ proved to be reliable and valid in measuring the quality of life in patients with heart failure by demonstrating lower quality of life in patients who had worse functional class; comparing the quality of life of patients with preserved versus reduced ejection fraction, only differences were found in one domain.

Brugada syndrome is a life-threatening disease and atrial fibrillation can be its first clinical manifestation. The identification of these patients is really important because some antiarrhythmic drugs should be avoided as they increase the risk of sudden death. Sodium channel blocking test allows physicians to unmask concealed Brugada syndrome and it could be useful to assess young patients with atrial fibrillation and no structural heart disease. We explain the case of a man with “lone atrial fibrillation” who developed a type 1 Brugada pattern after being given flecainide at Emergency Department.