Future cardiology最新文献

Bicuspid aortic valve (BAV) is one of the most common congenital valvular heart diseases occurring in 0.5-2% of the general population, in 2-6% of patients with severe aortic stenosis (AS) and up to 20% of octo/nonagenarians undergoing surgery. In this regard, Transcatheter aortic valve replacement (TAVR) has emerged as a therapeutic alternative. At the present time, there is not enough evidence to determine which is the best therapeutic approach for AS in BAV. We report a severe acute recoil following TAVR with a self-expanding prosthesis in heavily calcified BAV. In addition, we provide an updated review of the clinical significance of prosthesis underexpansion in the medium-term.

Aims: To objectively characterize the spatial-velocity dynamics of the QRS-loop in the vectorcardiogram (VCG) of patients with acute myocardial infarction (AMI).

Methods: VCG was constructed as a space curve directly with three quasi-orthogonal leads I, aVF and V2 recorded by conventional ECG of 25 healthy individuals and 50 AMI patients. Spatial velocity (SV) of the dynamic QRS loop, spatial distance (SD), and spatial magnitude (SM) were recorded, along with axis-specific component attributes of vector magnitude such as ΔX, ΔY, and ΔZ.

Results: Decreased SV (12-25%, p = 0.02) and SD (10-26%, p = 0.02) and altered spatial propagation patterns of ventricular vectors in AMI were recorded, with changes in specific axes based on infarct location. Significant vector changes were found in the Y-Axis in IWMI (p = 0.005) and X-Axis in cases of AWMI (p = 0.02), as compared to controls. There was no apparent alteration of SM in AMI.

Conclusion: Decreased SV and SD without any significant alteration of SM indicates close approximation and clustering of the tips of the ventricular vector in AMI. This may be due to dilation, thinning, and stress of the ventricular wall in early post infarction ventricular remodeling, along with relative ischemia due to associated tachycardia and higher myocardial oxygen demand.

Introduction: It remains unknown whether the concomitant coronary chronic total occlusion (CTO) would affect the outcomes of the Mitral valve Trans-catheter Edge to edge-to-edge repair (M-TEER) procedure.

Methodology: Study population was extracted from the Nationwide Inpatient Sample Data using the International Classification of Diseases and clinical modifications/procedure coding system codes for M-TEER and CTO. Primary outcomes were in-hospital all-cause mortality and net cardiac periprocedural complications. Propensity matching was used to extract a matched control (M-TEER-CTO and M-TEER-No CTO).

Results: A total of 48,835 cases of M-TEER were identified in the United States between January 2016 and December 2020, of whom 700 patients (1.5%) had the diagnosis of coronary total occlusion (CTO). The mean age of M-TEER patients was not significantly different between the two groups (76 vs. 75 years, p = 0.11); however, the CTO cohort had a higher percentage of males (66.72% vs. 53.41%, p = 0.002). M-TEER-CTO had higher odds of net all cardiac periprocedural complications (aOR 1.83,95% CI (1.17-2.84), p = 0.007) compared to the no-CTO group, however, there was no difference in in-hospital mortality (aOR 1.54, 95%CI (0.52-4.56), p = 0.43).

Conclusions: Patients undergoing M-TEER with CTO had a higher incidence of net all cardiac periprocedural complications but similar mortality compared to those with no CTO.

Introduction: Aortic valve replacement is the only effective treatment for symptomatic aortic valve disease. Transcatheter implantation has been introduced as alternative for surgery (SAVR), but its penetration varied widely. For high-risk octogenarian patients, the advantages of TAVI are clear. Patients between 75 and 79 years of age could be considered as "the gray zone."

Methods: We compared the outcome of SAVR with or without concomitant procedures between patients younger than 75 versus 75-79 years for their preoperative profile, operative parameters, and postoperative outcomes.

Results: Older patients had a higher risk score with more cardiovascular comorbidity and renal dysfunction. They required more concomitant CABG but less mitral valve repair. Cardiopulmonary bypass time was similar. In-hospital complication rates, need for blood transfusion, and length of stay in intensive care unit were higher in older patients. Thirty-day mortality was not significantly increased, Euroscore II overestimated mortality in both age groups. Age over 75 years was not an independent predictor for mortality. Need for emergent SAVR was only predictive in the older group. Long-term survival was acceptable. Age over 75 years was not the dominant predictor.

Conclusions: SAVR remains a valid option to treat symptomatic aortic valve disease in the age group of 75-79.

Objectives: Data about coronary bifurcations treated with ultrathin strut drug-eluting stents (DES) using T-and-protrusion (TAP) technique is limited.

Methods: In this study, a total of 84 consecutive patients, who underwent bifurcation percutaneous coronary intervention (PCI) with TAP technique using Orsiro® DES (Biotronik, Berlin, Germany), were included. All pre- and post-procedural data, as well as 1- and 2-year follow-up angiograms, were analyzed. Primary endpoints were procedural success and target lesion failure (TLF); secondary endpoints were all-cause mortality and major adverse cardiac and cerebrovascular events (MACCE) during follow-up.

Results: Procedural success was achieved in 100% of cases. TLF rate was higher in patients presented with acute coronary syndrome compared to the ones with chronic coronary syndrome (19% vs. 5% p = 0.09). All-cause mortality was 30% during follow-up, from which 26% was due to non-cardiovascular cause, and the MACCE rate was 46%.

Conclusions: Coronary bifurcations treated with ultrathin strut DES showed good short-term results and were associated with acceptable cardiovascular mortality. However, in these long-term patients, the rate of MACCE and non-cardiovascular death were rather high.

Background: Rotational atherectomy (RA) has been proven to treat coronary artery calcification (CAC) during percutaneous coronary intervention (PCI).

Purpose: This study evaluates the safety and efficacy of RA followed by cutting balloon angioplasty (ROTACUT) before stent placement in CAC.

Methods: A systematic review and meta-analysis of randomized controlled trials and observational studies was conducted. PubMed, Web of Science, Scopus, and Cochrane were searched through January 2024. We used Stata version 17 to pool dichotomous data using risk ratio (RR) and continuous data using mean difference (MD), with a 95% confidence interval (CI).

Results: Eight studies with 846 patients were included. There was no significant difference between ROTACUT and RA + bare balloons in major adverse cardiovascular events (MACE) (RR:0.60; 95%CI [0.31,1.16], p = 0.13), cardiac death (RR:1.32; 95%CI [0.42,4.14], p = 0.64), target vessel revascularization (TVR) (RR:1.89; 95%CI [0.40,8.84], p = 0.42), target lesion revascularization (TLR) (RR:0.83; 95%CI [0.39,1.79], p = 0.64), procedural duration (MD:0.78; 95%CI [-4.68,6.24], p = 0.78), stent thrombosis (RR:0.81; 95%CI [0.22,2.95], p = 0.75), and any procedure-related complications (RR:0.86; 95%CI [0.42,1.75], p = 0.68).

Conclusion: ROTACUT and RA + bare balloons demonstrated similar efficacy and safety profiles regarding MACE, cardiac death, TVR, TLR, procedural duration, stent thrombosis, and all safety outcomes.