Heart and Vessels最新文献

Elevated arterial stiffness is associated with cardiovascular risk. Brachial-ankle pulse wave velocity (baPWV), a measure of arterial stiffness, is decreased by exercise stress, which is associated with good vascular endothelial function. Moreover, baPWV may predict outcomes following transcatheter aortic valve replacement (TAVR) and has been reported to change before and after TAVR. However, studies on baPWV changes in patients with TAVR undergoing exercise stress have not been conducted. This study aimed to assess the changes in baPWV before and after TAVR using a simple exercise stress method. We enrolled 40 patients (mean age, 84.6 ± 4.4 years; 45% males) with severe symptomatic aortic stenosis undergoing TAVR. baPWV was assessed at rest and immediately following the exercise protocol. Exercise stress was performed using a simple method wherein patients actively plantar flexed and dorsiflexed their legs in a resting supine position. Measurements were conducted at baseline and after TAVR. Resting baPWV significantly increased from 1673 ± 322 to 2073 ± 426 cm/s (p < 0.001), and exercise stress baPWV also significantly increased from 1662 ± 339 to 1972 ± 335 cm/s (p < 0.001) after TAVR. Compared with resting baPWV, post-exercise baPWV did not change before TAVR (from 1673 ± 322 to 1662 ± 339 cm/s, p = 0.68), but significantly decreased after TAVR (from 2073 ± 426 to 1972 ± 335 cm/s, p = 0.012). The arterial system demonstrated increased baPWV in response to the acute relief of the obstruction following TAVR. Exercise stress decreased baPWV following TAVR, suggesting that endothelial function was maintained, which was masked before TAVR.

Obesity is an independent risk factor for heart failure (HF) onset; however, weight loss is an independent poor prognostic factor in patients with HF. According to the obesity paradox, higher body weight is associated with better prognosis in these patients. This retrospective cohort study investigated the obesity paradox in super-elderly, understudied patients (aged ≥ 85 years) with HF and examined its impact on all-cause mortality. We included patients hospitalized for HF between April 2015 and March 2023. Participants were divided into four age groups: Groups A (< 65 years), B (65-74 years), C (75-84 years, elderly), and D (≥ 85 years, super-elderly). The primary endpoint was the 1-year all-cause mortality rate after discharge. The secondary endpoints included cardiac and non-cardiac death rates and all-cause mortality rates stratified by left ventricular ejection fraction (LVEF). Overall, 3,811 individuals (mean age: 74.3 years, 60.4% men) were included. A trend toward higher all-cause mortality rates associated with underweight (body mass index [BMI] < 18.5 kg/m²) was observed in all age groups. Patients with obesity (BMI ≥ 25.0 kg/m²) had significantly better survival than other patients. Underweight was associated with a higher cardiac death rate compared with the other weight categories (P = 0.014, 0.039, and 0.022 for groups B, C, and D, respectively). In the analysis stratified by LVEF, underweight was significantly associated with a higher cardiac death rate in patients with HF with preserved LVEF compared with the other weight categories (P < 0.001). The obesity paradox in the super-elderly population was confirmed. It is important to consider BMI in HF management and prognosis.

Previous studies have demonstrated favorable outcomes with percutaneous coronary intervention (PCI) using initial intravascular lithotripsy (IVL) for calcified lesions. However, IVL outcomes under intravascular ultrasound (IVUS) guidance remain unclear. The aim of this study was to evaluate the initial clinical outcomes of PCI for severe calcified lesions using IVUS. In this study, we evaluated initial clinical outcomes of IVUS-guided PCI with IVL for severe calcified lesions. Consecutive IVL cases performed at our hospital between April and October 2023 were retrospectively analyzed. Primary outcomes included cross-sectional area (CSA, mm²) and percent area stenosis (%AS) at the pre-IVL minimum lumen area (MLA) site as measured by IVUS. Pre-IVL, post-IVL, and post-stent results were compared. Secondary outcomes included angiographic success, procedural complications, and major adverse cardiovascular events (MACE) within 1 year. Thirty-one patients with 32 lesions were included. CSA values at the pre-IVL MLA site were 2.2 ± 0.9, 4.2 ± 1.5, and 7.5 ± 2.3 mm², and %AS values were 80.1 ± 7.2%, 62.9 ± 12.3%, and 35.5 ± 16.3% (p < 0.001). Angiographic success was achieved in all cases without complications. At 1 year, the cumulative MACE rate was 9.6%, comprising cardiac death (3.2%), myocardial infarction (3.2%), and target vessel revascularization (3.2%). IVUS-guided PCI with IVL for severe calcified lesions demonstrated high procedural success, no complications, and low 1-year MACE rates, highlighting the safety, effectiveness, and clinical relevance of IVUS guidance in real-world practice.

Right ventricular-pulmonary artery (RV-PA) coupling is an indicator of the degree to which the right ventricle can adapt to afterload. The ratio of tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP) (TAPSE/PASP ratio) has been proposed as a non-invasive measure of RV-PA coupling. RV-PA coupling is a key prognostic predictor of heart failure (HF); however, HF with mildly reduced left ventricular ejection fraction (HFmrEF) is difficult to predict. This study aimed to determine the prognostic significance of the TAPSE/PASP ratio in HFmrEF. This retrospective cohort study selected eligible patients from two previous cohorts of patients who were hospitalized for HF and discharged with HFmrEF diagnosed by echocardiography: one cohort from August 2015 to September 2019 and one from April 2020 and March 2023. The primary indicator was the TAPSE/PASP ratio, and the primary endpoint was a composite of all-cause mortality and HF rehospitalization. Patients were categorized into two groups based on the median TAPSE/PASP ratio, and the high and low TAPSE/PASP ratio groups were compared. Multivariate analysis was performed using the Cox proportional hazards model. This study included 391 patients (median age, 72 [60-80] years; 70% male). The median TAPSE/PASP ratio used as a cut-off was 0.54 mm/mmHg. The low TAPSE/PASP group was older (median age, 75 [67-82] vs. 68 [56-77] years, p < 0.001), had fewer men (65% vs. 76%, p = 0.019), and had higher B-type natriuretic peptide levels (267 [135-629] vs. 161 [54-394] pg/mL, p = 0.005) than the high TAPSE/PASP group. A significantly greater proportion of the low TAPSE/PASP group had atrial fibrillation (49% vs. 32%, p < 0.001) and renal dysfunction (estimated glomerular filtration rate, 46 [26-66] vs. 58 [32-76] mL/min/1.73 m², p = 0.003) compared with the high TAPSE/PASP group. The low TAPSE/PASP group showed significantly higher rates of all-cause mortality and HF rehospitalization than the high TAPSE/PASP group (log-rank p < 0.001). Multivariate analysis confirmed that a TAPSE/PASP ratio < 0.54 mm/mmHg was an independent predictor of the primary endpoint (hazard ratio, 2.242; 95% confidence interval, 1.492-3.370; p < 0.001). At the one-year post-discharge follow-up, patients in the low TAPSE/PASP group were more likely to have inadequate recovery of RV-PA coupling than those in the high TAPSE/PASP group. The TAPSE/PASP ratio is a useful non-invasive prognostic indicator in patients with HFmrEF. This ratio may contribute to early risk stratification and treatment decision-making.