Heart and Vessels最新文献

This study aimed to clarify the contributions of dispersive electrode configuration, extracardiac impedance, and blood pool impedance to generator impedance (GI). Forty-five patients who underwent catheter ablation with Intellanav Stablepoint™ catheter were included. Four dispersive electrode positions were tested: the left hip, lower back, middle back, and upper back. For each dispersive electrode position, GI in the blood pool (BP-GI) and GI during contact with the myocardium of the left atrial anterior wall (Myo-GI) were measured at 46 kHz in standby mode. Body mass index (BMI) and hematocrit served as surrogates for extracardiac and blood pool impedance, respectively. The lowest BP-GI and Myo-GI were observed with the middle back dispersive electrode (BP-GI: 119 ± 13 Ω; Myo-GI: 123 ± 13 Ω), followed by the upper back (122 ± 13 Ω; 126 ± 13 Ω), lower back (126 ± 14 Ω; 129 ± 14 Ω), and the left hip dispersive electrode (153 ± 15 Ω; 156 ± 14 Ω). With the middle back dispersive electrode, BMI and hematocrit predicted BP-GI and Myo-GI with acceptable accuracy (adjusted R² = 0.78 and 0.55, respectively). The standardized beta coefficients of BMI and hematocrit were 0.38 and 0.70 for BP-GI and 0.37 and 0.54 for Myo-GI, respectively. The middle back dispersive electrode yielded the lowest GI. GI differences among the back positions were small. BMI and hematocrit accurately predicted GI under the optimal (middle back) dispersive electrode position, and the effect of hematocrit was greater than that of BMI.

Ultrasound-guided pacemaker puncture allows for visualization of vascular anatomy in real time, potentially reducing complications; however, detailed comparative studies with the traditional fluoroscopy-guided technique are lacking, particularly those incorporating objective imaging endpoints such as postoperative computed tomography (CT). In this study, we aimed to compare the procedural time and complications associated with fluoroscopy- and ultrasound-guided axillary and subclavian vein puncture techniques for pacemaker lead implantation. We conducted a retrospective analysis of 250 patients who underwent DDD pacemaker implantation for symptomatic bradycardia at Sakakibara Heart Institute between January 2021 and December 2023. The patients were categorized into two groups: fluoroscopy-guided (Group X, n = 147) and ultrasound-guided axillary or subclavian vein puncture (Group E, n = 103). The demographic data, number of punctures, and number of complications were analyzed. Among the 250 patients, postoperative chest CT scans were available for 75 to assess lead placement, focusing on intrathoracic lead insertion and distance from the lead to the outer edge of the clavicle. The mean age of the patients was 82 years, 46% were male, and the mean body mass index was 22 kg/m². The puncture time was significantly shorter in Group E than in Group X (5.6 ± 3.8 vs. 9.7 ± 10.3 min, p < 0.01). Patients in Group E had no puncture-related complications. Group X had more patients with the venous insertion point of the lead located within the thoracic cavity, as revealed by postoperative CT scans, than did Group E (8.0% vs. 0.6%, p < 0.01, respectively). Ultrasound-guided venous puncture reduced the puncture time, number of complications, and incidence of intrathoracic lead insertion. This technique may reduce lead stress and mitigate long-term lead-related complications.

Patients with heart failure (HF) are at increased risk of hyperkalemia, and implementing appropriate potassium-lowering therapy is essential for optimizing outcomes. Sodium zirconium cyclosilicate (SZC) is a selective potassium binder that effectively reduces serum potassium levels; however, its impact on mortality and cardiovascular outcomes in HF remains unclear. This study compared the effects of SZC and calcium polystyrene sulfonate (CPS) on a composite of all-cause death and major adverse cardiovascular event (MACE)-related hospitalization, along with individual MACE components and continuation rates of HF medications. We conducted a retrospective cohort study using data from the JMDC hospital database, including adult patients with HF who initiated SZC or CPS between April 2020 and September 2023 and continued treatment for at least 30 days. Propensity score-based inverse probability of treatment weighting (IPTW) and multivariable Cox models were used to control for confounding. A total of 12,918 patients were included (11,139 CPS; 1779 SZC), with a median follow-up of 147 and 138 days, respectively. After IPTW adjustment, baseline characteristics were balanced, except for the prescription year. The primary composite outcome (all-cause death or MACE hospitalization) occurred in 148 patients in the SZC group and 839 in the CPS group (Hazard ratio [HR] 1.16, 95% confidence interval [CI] 0.94-1.43). In a post hoc analysis, the composite of all-cause death and HF hospitalization occurred in 143 vs. 793 patients (HR 1.21, 95% CI 0.98-1.50). SZC use was associated with a higher HR for HF hospitalization (103 vs. 524 events, HR 1.36, 95% CI 1.06-1.75) and a lower HR for stroke hospitalization (6 vs. 80 events, HR 0.33, 95% CI 0.12-0.91). Mineralocorticoid receptor antagonists (MRA) continuation was more frequent in the SZC group [70.1% vs. 59.0%, weighted odds ratio, 1.39 (95% CI 1.11-1.75)]. These findings suggest that although SZC may not improve survival or overall cardiovascular outcomes, it may help maintain essential HF therapies such as MRA.

Vascular endothelial function plays an important role in the pathophysiology of acute coronary syndrome (ACS). Plaque erosion (PE) and plaque rupture (PR) are the two major mechanisms of ACS; however, how the vascular endothelial function differs between these etiologies is not well understood. Flow-mediated dilation (FMD) is a method used to evaluate the endothelial function. We aimed to assess endothelial function using FMD in patients with PE and PR. ACS patients (N = 160) who underwent primary percutaneous coronary intervention (PCI) with optical frequency domain imaging (OFDI) and FMD assessment were retrospectively enrolled. Culprit plaques were categorized as PE or PR based on OFDI. Based on the median value of FMD (4.1%) in our data, patients were classified into high-FMD (> 4.1%) and low-FMD (≤ 4.1%) groups. Based on the plaque type and FMD values, the patients were divided into PR-HighFMD (N = 48), PR-LowFMD (N = 47), PE-HighFMD (N = 33), and PE-LowFMD (N = 32) groups, and then the clinical characteristics were compared. Major adverse cardiac events (MACE) were defined as cardiovascular death, nonfatal myocardial infarction, stroke, ischemia-driven revascularization, hospitalization for angina or heart failure. FMD was similarly impaired in the PE and PR groups (4.2% vs. 4.1%, P = 0.85). Most clinical characteristics did not differ between the groups. The PR-High_FMD group showed the highest MACE-free survival, followed by the PE-Low_FMD (HR = 2.62, CI = 0.58-11.7, P = 0.21), PE-High_FMD (HR = 3.18, CI = 0.76-13.3, P = 0.11), and PR-Low_FMD (HR = 5.44, CI = 1.55-19.1, P = 0.008) groups. FMD is likely to have a prognostic impact on patients with ACS, which might vary depending on the culprit lesion.

A convolutional neural network (CNN)-enhanced electrocardiogram (ECG) has been reported for detecting mitral regurgitation (MR). This tool may be particularly useful for identifying candidates for echocardiography in patients with chronic atrial fibrillation (AF) to detect atrial functional MR early. The data from a single-center, prospective cohort study (Shinken Database 2010-2017, n = 19,170) were combined with an ECG database. Initially, a CNN model was developed to detect MR (Grade ≥ 3) across the entire cohort using fivefold cross-validation. The model was refined using sublabels, including primary MR, MR with chronic AF and left atrial dilatation, and MR with left ventricular remodeling, to create an integrated neural network (INN) model. We then analyzed the relationship between MR diagnosed by the INN and the MR prevalence in chronic AF patients. In the CNN model, the AUCs of the ROC curve and PR curve in 0.836 (SD: 0.022) and 0.196 (SD: 0.036), which numerically increased to 0.848 (SD: 0.014) and 0.198 (SD: 0.031) in the INN model. The Grad-CAM analysis revealed that the CNN algorithm appears to highlight nonspecific ECG features, such as P-waves in the leads V1 to V2 (or f-wave in the lead V1) and R-wave amplitude or ST-T changes in precordial leads, which may explain the high false-positive rate in the model. When applying the model to CAF patients, although the sensitivity was around 0.9 at the threshold determined by the ROC curve, PPR and F1 score was relatively low. These metrics slightly improved when adjusting the threshold to that corresponding to a sensitivity of 0.8 and further improved by restricting the target population to those with BNP ≥ 100 pg/mL. The INN model improved MR detection performance compared to the initial CNN model, but the overall PPR remained suboptimal. High false-positive rates remained an issue, even in high-prevalence populations such as CAF patients or those with elevated BNP values.

We introduce a technique for treating chronic limb-threatening ischemia with superficial femoral artery flush occlusion, facilitating intravascular treatment when conventional anterograde puncture is challenging. This retrospective study reviewed 37 patients who underwent vascular sheath fenestration assisted anterograde puncture to complete endovascular treatment for chronic limb-threatening ischemia from December 2022 to December 2023. All patients had superficial femoral artery flush occlusion, meeting chronic limb-threatening ischemia diagnostic criteria. Evaluations included intraoperative radiation dose, technical success rate, patency rate, limb retention rate, and postoperative complications from surgery to a 12-month follow-up. The mean age of the patients was 70 ± 10 years, with an age range of 46 to 90 years. A significant proportion of the cases presented with severe chronic limb-threatening ischemia, with 78.4% classified as Rutherford ≥ 5, 51.3% as WiFi ≥ 3, and 97.3% as Global Limb Anatomic Staging System III. In all surgical procedures, a plain old balloon angioplasty was utilized for anterograde dilation. Subsequently, based on angiographic findings, treatment involved either drug-coated balloon dilation combined with stent implantation or drug-coated balloon dilation alone. Successful revascularization was achieved in all cases, resulting in marked clinical and hemodynamic improvements, as evidenced by the mean ankle-brachial index increasing from 0.49 preoperatively to 0.86 postoperatively. The 12-month follow-up outcomes were as follows: limb salvage rate of 94.6%, primary patency rate of 83.8%, assisted primary patency rate of 91.9%, and secondary patency rate of 94.6%. The incidence of postoperative complications was 8.1%. The average duration of hospital stay was 8.43 ± 2.72 days. The vascular sheath fenestration assisted anterograde puncture technique demonstrates favorable surgical outcomes and merits consideration as a viable treatment option for chronic limb-threatening ischemia patients with superficial femoral artery occlusion.

Because heart failure (HF) with preserved ejection fraction (HFpEF) is mainly a disease of elderly, there are a few reports focusing young patients. This study aims to elucidate characteristics of comparatively young HFpEF patients. We divided HFpEF patients in PURSUIT-HFpEF registry into younger HFpEF group (age ≤ 65 years) and older HFpEF group and compared the all-cause mortality and HF readmission (HFR) between the two groups and identified discharge factors correlated with HFR among younger HFpEF patients. The younger HFpEF group comprised 51 patients (4.1%). In this group, body mass index and smoking were significantly higher, while hypertension was significantly lower compared to older HFpEF group. Kaplan-Meier analysis indicated no significant difference in HFR between the groups, although all-cause mortality was significantly lower in younger HFpEF group (p < 0.001). Multivariable Cox proportional hazards analysis indicated that angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB) were inversely correlated with HFR, whereas mineralocorticoid receptor antagonists (MRA) were positively correlated with HFR in younger HFpEF patients (p = 0.004 and p = 0.007, respectively). In conclusion, younger HFpEF is rare (approximately 4%), with obesity and smoking being significant modifiable factors. HFR was similar between younger and older HFpEF patients. Administration of ACEI/ARB and unnecessity of MRA at discharge may be associated with reducing HFR in younger HFpEF patients.

Despite advances in the treatment of cardiogenic shock (CS), the 30-day mortality rate remains high. While some biomarkers predict outcomes in CS, none have been identified for prognostic prediction in IMPELLA patients. Patients with IMPELLA support due to CS were prospectively enrolled in the Japanese Registry for Percutaneous Ventricular Assist Devices. Patients enrolled between February 2020 and December 2022 were included in the study cohort. We investigated the effects of albumin levels before IMPELLA insertion. The primary endpoint was all-cause mortality within 30 days following IMPELLA initiation. A total of 3,683 patients diagnosed with CS (median age, 69 years; 77.3% male) were included in our analysis. Acute coronary syndromes were present in 1,920 (52.1%) of the patients, whereas out-of-hospital cardiac arrest had occurred in 856 of the patients (23.2%). Before IMPELLA insertion, 1,727 (46.9%) of the patients received venoarterial extracorporeal membrane oxygenation. ROC curve showed that a cut-off albumin level of 3.5 g/dL predicted the 30-day survival rate with a sensitivity of 0.613 and a specificity of 0.507. Patients with albumin levels of ≥ 3.5 g/dL had a significantly higher 30-day survival rate (67% vs. 57%; hazard ratio = 0.736; 95% confidence interval: 0.6785-0.7894; p < 0.01). Lower baseline serum albumin levels were associated with worse outcomes in patients with CS receiving IMPELLA support.

Angioplasty using ultra-high-pressure (UHP) balloons may successfully treat stenotic lesions refractory to high-pressure dilation. The use of UHP balloons in patients with congenital heart disease is mostly for dilation of the pulmonary artery, and there have been few reports on the effectiveness and safety of balloons for other sites. We retrospectively evaluated the efficacy and safety of the ultra-high-pressure balloon angioplasty (UHP-BA) for stenotic lesions in patients with congenital heart disease between January 2020 and December 2022 at Okayama University Hospital. A total of 78 UHP-BAs were performed in 44 patients, with a median age of 6.6 years and a median weight of 17.6 kg. The balloon types used in the UHP-BAs were Yoroi^® and Conquest^®. UHP-BA performed 39 procedures for the pulmonary artery (PA), 24 for fenestration, 8 for SVC, 4 for shunt, and three for others. The lesion-specific acute procedural success rates for PA, Fontan fenestration, SVC, and shunt were 77%, 75%, 88%, and 75%, respectively. A complication of UHP-BA occurred in 3.8% (3/78). Two of the three patients had pulmonary hemorrhage, and the remaining patients had pulmonary artery embolization due to the migration of a thrombus. There were no fatal complications. Balloon dilation with UHP balloons was safe and effective not only for pulmonary artery stenotic lesions but also for SVC, Fontan fenestration, shunt, and other dilation sites in patients with congenital heart disease.

Wearable technology, such as photoplethysmography (PPG), enables easily accessible individual health data with the potential for improved risk assessment. We hypothesized that the overnight stiffness index (OSI), derived from nocturnal finger PPG, could be used to assess cardiovascular risk and vascular ageing. Subjects with confirmed or suspected hypertension (n = 79, 56 males) underwent simultaneous ambulatory blood pressure monitoring (ABPM) and overnight sleep polygraphy with a continuous PPG registration. Overnight PPG-based pulse propagation time was used to calculate OSI. Associations between OSI and markers of cardiovascular risk, blood pressure, and indices of arterial stiffness, as indicators of vascular ageing, were assessed. Subjects were stratified into low and high OSI (according to median, 10.9 m/s). SCORE2/SCORE2-OP and Framingham risk scores were calculated. The high OSI group had higher SCORE2/SCORE2-OP (9.5 [5.5;12.5] vs 5.0 [4.0;6.5]), and OSI correlated with SCORE2/SCORE2-OP and Framingham risk score (r_s = 0.40 and r_s = 0.41; both P < 0.01). Indices of arterial stiffness were increased in the high OSI group including ABPM awake and asleep pulse pressures (59 ± 14 vs 50 ± 9 mmHg, P < 0.01, and 54 ± 14 vs 45 ± 7 mmHg, P < 0.001), and ambulatory arterial stiffness index (0.47 ± 0.12 vs 0.37 ± 0.11, P < 0.001), respectively. OSI correlated with 24-h and asleep pulse pressure also after adjusting for confounders. OSI was related to systolic ABPM (awake r = 0.42, asleep r = 0.55; both P < 0.001) and diastolic ABPM (asleep r = 0.36, P < 0.01). OSI, a novel PPG-based measure of nocturnal arterial stiffness, correlates with established cardiovascular risk scores and with blood pressure-derived indices of vascular ageing. This simple method may facilitate cardiovascular risk assessment using readily available medical and wearable consumer devices.