European Heart Journal: Acute Cardiovascular Care最新文献

Aims: Catheter-based therapies for pulmonary embolism (PE), including endovascular mechanical thrombectomy (MT) and catheter-directed thrombolysis (CDT), are increasingly being used in clinical practice. However, real-world comparative data between these two modalities are scarce. We aimed to evaluate and compare the outcomes of MT and CDT in patients with PE.

Methods and results: This retrospective cohort study utilized the 2021 National Readmission Database (NRD) to identify adults with a primary diagnosis of PE who underwent either MT or CDT. The primary outcome was in-hospital mortality, while secondary outcomes included major bleeding, cardiac arrest, vascular complications, and post-discharge readmissions. Propensity-score matching was applied, followed by logistic and Cox-proportional hazard regression analyses. Subgroup analyses were conducted based on hospital procedural volume. After propensity-score matching, 7376 patients who underwent MT and 7355 who underwent CDT were included. MT was associated with higher odds of in-hospital mortality (4.4% vs. 3.4%; OR: 1.31, 95% CI: 1.01-1.68; P = 0.04) and major bleeding (6.3% vs. 3.6%; OR: 1.79, 95% CI: 1.39-2.32; P < 0.001) compared with CDT. No significant differences were observed in post-discharge mortality, although all-cause readmissions were higher in the MT group. Higher hospital procedural volumes were associated with lower in-hospital mortality and lower major bleeding rates in both MT and CDT.

Conclusion: Endovascular CDT was associated with lower in-hospital mortality and major bleeding compared to MT in PE. As hospital procedural volume increased, both these outcomes improved, while difference in outcomes between MT and CDT reduced.

Aims: Congestion is a major cause of hospitalisation in patients with heart failure (HF), and the persistence of congestive signs at discharge is a robust predictor of early readmission. Currently, there is increasing interest in the comprehensive assessment of subclinical congestion, as it can increase residual risk in individuals who appear to be euvolemic. Our aim was to investigate the prevalence and prognostic impact of subclinical venous congestion assessed by ultrasound.

Methods and results: This is a two-centre, prospective observational study. Patients admitted for HF between June 2021 and March 2023 were selected. Clinical [physical examination (PE)] and subclinical venous congestion [Venous Excess Ultrasound score (VExUS)] were assessed. The prognostic impact was assessed through a composite endpoint of death from any cause, HF readmissions, or unscheduled visits requiring intravenous diuretic administration at 6-month follow-up. 120 patients were included (62% male, mean age 75 ± 15 years). Congestion parameters decreased during hospitalisation but tended to worsen at the first outpatient visit. At discharge, 24% showed subclinical venous congestion. This group had a significantly higher incidence of adverse outcomes, comparable to those with overt clinical congestion. Subclinical congestion was an independent predictor of the composite endpoint (HR 2.84; 95% CI: 1.01-8.01, P value = 0.048) after adjustment for age, chronic kidney disease, NYHA class at admission, and NT-proBNP level at discharge.

Conclusion: Clinical and subclinical congestion decreased during hospitalisation but worsened shortly after discharge. A quarter of patients had residual venous congestion, which was associated with a worse prognosis at 6 months.

Background: E-wave propagation index (EPI) could be a simple echocardiographic parameter to identify patients at increased risk of left ventricular (LV) thrombus following ST-elevation myocardial infarction (STEMI). We aimed to investigate the association between EPI and LV thrombus as assessed by cardiac magnetic resonance imaging (MRI).

Methods: We included 665 STEMI patients treated with percutaneous coronary intervention from the MARINA-STEMI study. EPI was measured using transthoracic echocardiography at 3 (IQR 2-4) days post-STEMI and calculated as the ratio of the E-wave velocity-time integral to the LV end-diastolic length, measured in the apical four-chamber view. LV thrombus was evaluated with cardiac MRI at 4 (IQR 3-5) days post-STEMI.

Results: A total of 665 STEMI patients (17% female) with a median age of 58 [IQR 52-66] years were included. Patients with LV thrombus (n=32, 5%) had a significantly lower EPI than those without (0.92 versus 1.29, p<0.001). EPI independently predicted LV thrombus with an adjusted odds ratio of 0.84 (95% CI 0.74-0.95; p=0.007). The area under the curve for EPI in detecting LV thrombus was 0.73 (95% CI 0.64-0.82, p<0.001). EPI of 0.95 emerged as best cut-off to identify patients at high risk of LV thrombus formation (15.9% thrombus rate in patients with EPI<0.95 as compared to 2.5% in patients with EPI≥0.95).

Conclusion: EPI emerged as significant and independent predictor of LV thrombus formation in STEMI patients. These findings highlight the usefulness of EPI as simple echocardiographic parameter to optimize LV thrombus screening in routine STEMI care.