Future cardiology最新文献

Introduction: The aim of this article is to compare the long-term efficacy of Thoracic Endovascular Aortic Repair (TEVAR) versus Optimal Medical Therapy (OMT) in reducing mortality among adult patients with uncomplicated Stanford type B aortic dissection (uSTBAD).

Methods: An electronic search of PubMed, Cochrane Central and Google Scholar was conducted for studies comparing TEVAR with OMT for mortality in adult patients with uSTBAD. Relevant outcomes, including mortality, aortic rupture, re-intervention, retrograde type A dissection, myocardial infarction and stroke were analyzed and presented as risk ratios (RRs) along with their 95% confidence intervals (95% CI). A p-value of less than 0.05 was considered significant in all cases. All statistical analysis was conducted using Review Manager.

Results: A total of 12 studies were included (n = 25,605). Meta-analysis favored TEVAR over OMT for all-cause mortality (RR = 0.57, 95% CI: [0.43-0.76]; P < 0.01). However, there was no significant difference considering the morbidity, which included endovascular re-intervention (RR = 0.76, 95%CI: [0.46-1.28]; P = 0.30), aortic rupture (RR = 0.38; 95%CI: [0.14-1.05]; P = 0.06), retrograde type A dissection (RR = 1.00; 95%CI: [0.78-1.28]; P = 1.00), myocardial infarction (RR = 0.85; 95% CI: [0.51-1.42]; P = 0.53). However, a significant increase in risk of stroke in TEVAR group was observed (RR = 1.56; 95%CI: [1.30-1.89]; P < 0.01).

Conclusion: We report that while there were similar morbidity outcomes for uSTBAD treated with TEVAR and OMT, overall mortality was significantly improved with TEVAR. Further large-scale studies are needed to elucidate the differences in outcomes between the two treatment options.

Protocol registration: https://www.crd.york.ac.uk/prospero identifier is CRD42024566452.

Cardiogenic shock (CS) is a complex condition characterized by insufficient cardiac output, tissue hypoperfusion, and life-threatening organ failure. In this review, we describe the definition, pathophysiology, classification, and approach to management in CS. We highlight recent advances in understanding the phenotypic heterogeneity and classification of CS. Then, we describe the limited, evidence-based, therapeutic approaches demonstrating survival benefit, including emergent revascularization of the culprit vessel in acute myocardial infarction related CS, and the use of a microaxial flow pumps in those with ST-segment elevation myocardial infarctions and CS. We also detail the limited evidence for other interventions, including medical therapies and other mechanical circulatory support (MCS) devices. Importantly, we highlight the current gaps in evidence and key ongoing trials that might inform the management of clinicians caring for patients with CS.

The ongoing global shortage of donor hearts dictates the need for innovative solutions to enlarge the donor pool and to reduce mortality of patients on the waiting list. The extended-heart-transplantation-criteria premise is to match patients who fall outside traditional eligibility criteria with donor hearts that have high risk features. In our case, the donor experienced ventricular fibrillation episodes. Given the idiopathic arrhythmogenic substrate of the transplanted heart, we decided to protect the receiver with a subcutaneous implantable cardioverter defibrillator in the short-term post heart transplantation. It represents the first experience worldwide in this specific setting of sudden cardiac death.

Background: Patients with aortic stenosis have a high mortality risk treatable by transcatheter aortic valve replacement (TAVR). We conducted a network meta-analysis to compare the efficacy and safety of transcatheter aortic valves in aortic stenosis patients.

Methods: A systematic search of PubMed, Embase, and Cochrane was conducted. Randomized controlled trials (RCTs) that included adult patients with aortic stenosis undergoing TAVR, which compared clinical efficacy and safety between any of the transcatheter aortic valves, were included. Random effects meta-analysis was employed.

Results: A total of 4687 patients from 9 RCTs were included. Sapien XT had a significantly higher risk of stroke compared to Sapien 3 RR = 31.38 (95% CI: 1.12 to 876, p = 0.043), while other devices showed no significant differences. Evolut had a significantly increased risk of permanent pacemaker placement compared to Sapien 3 RR = 1.36 (95% CI: 1.07-1.74, p = 0.013). No significant differences were observed between valves for any of the other analyzed outcomes.

Conclusion: While most TAVR devices showed comparable safety profiles, Evolut was associated with increased pacemaker implantation risk. The higher stroke risk with Sapien XT should be interpreted with caution.

Protocol registration: This review was registered with PROSPERO (CRD42024563628).

The role of echocardiography is critical in the diagnostic evaluation and management of ischemic stroke, especially cryptogenic stroke, in which the cause is unknown. About 15-30% of ischemic strokes are caused by cardiogenic embolism, making cardiac imaging a critical component of evaluation. Guidelines from the American Heart Association and the American College of Cardiology highlight the importance of echocardiography and mobile cardiac telemetry or implantable loop recorders to identify possible sources of cardiac embolism and monitor for atrial fibrillation, thus guiding secondary prevention.Transthoracic echocardiography (TTE) is widely used as an initial tool to assess cardiac structure and function, detect intracardiac thrombi, and evaluate valvular abnormalities. Transesophageal echocardiography (TEE), as well as cardiac CT and MRI, offer enhanced visualization of certain cardiac structures, identifying embolic sources not readily visible on TTE, such as left atrial appendage thrombi and patent foramen ovale (PFO).The comprehensive diagnostic approach for cryptogenic stroke (CS) includes brain imaging (CT or MRI), neurovascular imaging, electrocardiography (ECG), and vascular ultrasound.Echocardiography plays a crucial role in assessing left atrial and ventricular thrombi, valvular disease, and aortic plaques. Additionally, advancements in echocardiography, such as real-time three-dimensional imaging, are emphasized for their potential to enhance stroke prevention and management strategies.

Anderson-Fabry disease (AFD) is a rare, X-linked, lysosomal storage disorder caused by the absence or deficiency of alpha-galactosidase A activity, leading to the progressive accumulation of sphingolipids in multiple organ systems, including the heart. Cardiac involvement accounts for > 50% of AFD-related mortality and is a primary determinant of disease prognosis. AFD cardiomyopathy is heterogenous with key features that include left ventricular hypertrophy, conduction disturbances, myocardial fibrosis and valvular disease. Early diagnosis and treatment are crucial to prevent progressive and irreversible myocardial damage. Electrocardiography and echocardiography are effective and inexpensive first-line modalities to detect abnormalities that suggest cardiac involvement in patients with AFD. However, cardiovascular magnetic resonance imaging (CMR) can provide a more comprehensive assessment of myocardial tissue characteristics and cardiac structure and function. Recent studies have strengthened the role of T1 mapping, myocardial strain and late gadolinium enhancement using CMR in the assessment of patients with AFD. Whilst CMR is less widely available than electrocardiography and echocardiography, it has the potential to improve the diagnosis, monitoring and prognostication of patients with AFD. In the future, advanced CMR techniques may further refine risk stratification, guide therapeutic decisions and facilitate earlier interventions that can ultimately improve patient outcomes.