Heart and Vessels最新文献

Given the limited published data, we examined three-year outcomes in patients with and without diabetes mellitus (DM) in non-ST-segment elevation myocardial infarction (NSTEMI), according to left ventricular ejection fraction (LVEF). A total of 4594 patients were classified into DM (n = 1608) and non-DM (n = 2986) groups. They were further classified into heart failure with reduced EF (HFrEF, LVEF ≤ 40%), HF with mildly reduced EF (HFmrEF, LVEF 41-49%), and HF with preserved EF (HFpEF, LVEF ≥ 50%) subgroups. The primary outcome was all-cause mortality, and secondary outcomes included cardiac death (CD), non-CD (NCD), recurrent MI, any revascularization, and hospitalization for HF (HHF). In both DM and non-DM groups, in-hospital all-cause mortality rates were higher in the HFrEF subgroup than in the HFmrEF and HFpEF subgroups, but were similar between the HFmrEF and HFpEF subgroups. In the DM group, the three-year all-cause mortality (P < 0.001 for both), CD, NCD, recurrent MI, and HHF rates were higher in the HFrEF subgroup than in the HFmrEF and HFpEF subgroups. In the non-DM group, the three-year all-cause mortality (P = 0.001 and P < 0.001, respectively), CD, and HHF rates were higher in the HFrEF subgroup than in the HFmrEF and HFpEF subgroups. In both DM and non-DM groups, the three-year all-cause mortality and NCD rates were higher in the HFmrEF group than in the HFpEF group. Regardless of the presence of DM, the three-year outcomes were best in HFpEF, worst in HFrEF, and intermediate in HFmrEF patients.

Excimer laser coronary angioplasty (ELCA) plays an important role in modifying plaque composition, yet its impact on neointimal tissue (NIT) in in-stent restenosis lesions has remained unclear. While integrated backscatter intravascular ultrasound (IB-IVUS) can characterize plaque composition in de novo lesions, its ability to reflect tissue characteristics in NIT is limited due to the distinct structural and acoustic properties of neointimal tissue. This study aimed to investigate the effects of ELCA on NIT using IB-IVUS. We examined 49 in-stent lesions in 49 patients. IB-IVUS analysis focused on a 10 mm segment centered on the minimum lumen area (MLA), with data collected every 1 mm. Color maps were generated based on IB-IVUS backscatter values and included the following classifications: Red (typically calcification in de novo lesions), Yellow (dense fibrosis), Green (fibrosis), Blue (lipid pool), and Purple (lipid pool with attenuation). These classifications are based on tissue characteristics as defined in de novo settings and may differ in in-stent neointimal tissue. We compared Color-Ave (average color-coded area across 11 cross-sections, mm²) and %Color-Ave (relative to neointimal tissue area), before and after ELCA. IB-related values, including mean (Ave-IB) and variance (Variance-IB), were automatically obtained. Following ELCA, Purple-Ave and %Purple-Ave significantly decreased (from 0.95±1.28 mm² to 0.77±1.13 mm², and from 13.5±12.8% to 11.2±11.1%, both p=0.002). %Green-Ave increased significantly (from 53.6±14.1% to 55.5±12.7%, p=0.016), although Green-Ave remained unchanged. No significant changes were observed in Red-, Yellow-, and Blue-code areas. Similar trends were observed in MLA- and volume-based analyses. Ave-IB increased (p=0.028), while Variance-IB decreased (p=0.005). Changes in IB-related values were associated with their pre-ELCA levels. ELCA appears to ablate tissue with high IB-related values, leading to reduced tissue heterogeneity, even in NIT where tissue characterization by IB-IVUS is inherently limited.

Prolonged corrected QT interval (QTc) is known to be associated with adverse cardiovascular events in patients with heart failure. The delayed heart-to-mediastinum (H/M) ratio obtained from 123I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy is a marker of cardiac sympathetic nervous (CSN) activity and has been proposed as a prognostic marker of severe aortic stenosis (AS). However, the association between prolonged QTc and CSN overactivity in patients with AS remains unclear. This study retrospectively analyzed 83 patients with severe AS who underwent electrocardiography, echocardiography, and 123I-MIBG scintigraphy. Prolonged QTc was defined as QTc > 450 and > 470 ms in men and women, respectively. CSN overactivity was defined as delayed H/M ratio < 2.2 and washout rate (WR) > 34%. Prolonged QTc was detected in 14 patients, and these patients had higher left ventricular (LV) mass index and lower LV ejection fraction as compared to those with normal QTc. A significantly higher proportion of patients with prolonged QTc demonstrated CSN overactivity (p = 0.02). In addition, the prolonged QTc group had a lower delayed H/M ratio and higher WR. QTc was inversely correlated with the delayed H/M ratio in men (r =  - 0.53, p = 0.02) and women (r =  - 0.29, p = 0.02). QTc was positively correlated with WR in men (r = 0.55, p = 0.01) and women (r = 0.42, p = 0.001). Multivariate analysis identified age and prolonged QTc as significantly associated with CSN overactivity. Thus, prolonged QTc is associated with CSN overactivity, as assessed using 123I-MIBG scintigraphy in patients with severe AS.

Transradial intervention (TRI) is increasingly used for EVT in these lesions, and the Misago bare nitinol stent (BNS) is compatible with this approach. However, clinical outcomes of the Misago stent via TRI have not yet been reported. Therefore, we evaluated the 3-year clinical outcomes of the Misago stent via TRI. We demonstrated the retrospective, single-center observational study included 348 aorto-iliac arteries in 255 patients treated between October 2019 and May 2023, with Rutherford classifications ranging from categories 1 to 6. The patients were divided into groups: those treated with other stent types via TFI (n = 231) and those treated with Misago stents (n = 117). Additionally, outcomes of patients treated with Misago stents via TRI (n = 72) were compared to those treated with Misago stents via TFI (n = 45). The primary endpoint was 3-year primary patency, and the secondary endpoints were clinically driven target lesion revascularization (CD-TLR), all-cause mortality, major amputation, cerebral infarction, and procedure-associated complications during hospitalization. The 3-year primary patency rate was not significantly different between the Misago stent and other stents (93.2% versus 91.8%, respectively; P = 0.78). Similarly, the 3-year primary patency rate of the Misago stent via TRI was comparable to that of the Misago stent via TFI (91.7% versus 95.6%, respectively; P = 0.44). The competing risks model with multivariate analysis showed that the Misago stent and TRI were not associated with 3-year TLR (hazard ratio [HR], 0.80; 95% confidence interval [CI],0.24-0.64; P = 0.71 and HR, 1.94; 95% CI,0.47-8.07; P = 0.36, respectively). Dialysis and TSAC II C-D were independent predictors of 3-year TLR (HR, 3.28; 95% CI, 1.50-7.18; P = 0.003 and HR, 2.70; 95% CI, 1.28-5.69; P = 0.009, respectively). The Misago stent via TRI for aorto-iliac arterial disease demonstrated acceptable 3-year clinical outcomes. Dialysis and TSAC II C-D were identified as predictors of 3-year TLR.

Pulmonary vein (PV) isolation by catheter ablation is a widely used curative therapy for atrial fibrillation (AF). However, in patients with persistent AF (PeAF), long-term outcomes are poor when PV isolation is performed alone. Although left atrial (LA) roof ablation is sometimes added to PV isolation, its effectiveness and predictors of success remain unclear. To identify predictors of arrhythmia recurrence in patients with PeAF undergoing LA roof ablation and PV isolation using a cryoballoon catheter. A retrospective assessment of LA roof ablation and PV isolation using a cryoballoon was performed in 65 consecutive patients with PeAF. The median age of the patients was 69 years [Q1:61, Q3:75]; 55% were female, and 49% had longstanding PeAF. The complete LA roof block success rate using a cryoballoon was 92.3%, with no esophagus-related complications. The 1-year post-ablation arrhythmia-free rate was 83.3%. Atrial arrhythmia recurrence was more common within the 3-month blanking period. The N-terminal prohormone of brain natriuretic peptide (NT-proBNP) reduction rate ≥60.7% and sinus rhythm at 1-month post-ablation, and no arrhythmia during the 3-month blanking period strongly predicted arrhythmia-free status at 1 year post-ablation. In patients with PeAF who underwent LA roof ablation and PV isolation using a cryoballoon, the arrhythmia-free rate was high. The NT-proBNP reduction rate at 1-month post-ablation may serve as a simple and potentially useful predictor of procedural success.

Although cerebral macrocirculation is routinely assessed postoperatively in infants in the pediatric intensive care unit, monitoring cerebral microcirculation is not yet a standard practice. Our objective was to investigate the correlation between parameters of cerebral macro- and microcirculation in children following cardiac surgery and compare them with patients after neurosurgical and abdominal procedures. We conducted a prospective observational study in infants who underwent congenital cardiac surgery, visceral surgery, and neurosurgical procedures to measure parameters of cerebral macro- and microcirculation. Doppler ultrasound of anterior cerebral artery was performed, along with measurements of microcirculatory parameters using O2C device. 89 infants were included in the study. Group 1 (n = 35) comprised children after corrective cardiac surgery, group 2 (n = 22), after aortopulmonary shunt procedures, group 3 (n = 11), after Glenn operations, and group 4 (n = 21), after abdominal or neurosurgical procedures. The systolic peak flow was significantly lower in groups 2 and 3 compared to groups 1 and 4, 52.3 and 56.7 versus 59.6 and 68.8 cm/s, p = 0.01, respectively. Pulsatility index was higher in patients of group 2 compared to groups 1, 3 and 4, 2.5 vs. 1.3, 1.4, and 1.5 (p < 0.001), respectively. The cerebral blood flow in the staged palliation groups (2 and 3) was lower compared to groups 1 and 4, 203 and 236 vs. 250 and 262 AU, p = 0.045. Children undergoing staged palliation may show variations in cerebral macro- and microcirculation. Both approaches described in our study provide complementary information and can accordingly be utilized in the postoperative intensive care period. Future studies should focus on establishing reference values for macro- and microcirculation parameters across various patient populations.

Abdominal visceral adipose tissue (AVAT) is associated with the incidence of cardiovascular events (CVEs). We retrospectively evaluated the association between AVAT and the incidence of CVEs in 602 patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI). Patients were divided into four groups according to the quartiles of AVAT areas using computed tomography. The incidence of CVEs (cardiovascular death, ACS recurrence and stroke) during the follow-up period (median 49.5 months) was evaluated. Cox analysis adjusting for cardiovascular risk factors revealed that the AVAT quartile classification exhibited a significant association with the incidence of CVEs. The risk in quartile 3 (moderate AVAT areas, ≥ 106.0 to < 142.6 cm²) was significantly lower than in quartiles 1 (low AVAT areas, < 71.0cm²; P < 0.01; hazard ratio [HR], 5.06), 2 (mild AVAT areas, ≥ 71.0 to < 106.0 cm²; P < 0.01; HR, 4.25) and 4 (severe AVAT areas, ≥ 142.6 cm²; P < 0.01; HR, 4.52). Polynomial analyses revealed that quadratic model was the most appropriate to illustrate the relationship between AVAT area and the hazard ratios for CVEs (corrected Akaike's information criterion, 49.2; R², 0.47). The AVAT area and the incidence of CVEs exhibited a U-shaped relationship in patients with ACS undergoing PCI independent of conventional cardiovascular risk factors. The risk of CVEs was the lowest in patients with moderate AVAT areas. Evaluating AVAT may provide additional information for the assessment of long-term prognosis in patients with ACS.

Coronary embolism (CE) is an uncommon cause of acute myocardial infarction (AMI), representing around 3% of cases. Left atrial strain (LAS) has emerged as a promising tool for assessing atrial function, however its prognosis role in CE remains unsettled. We retrospectively analyzed 100 consecutive patients with CE that was diagnosed based on criteria encompassing clinical, angiographic and diagnostic imaging findings. We evaluated in-hospital and long-term outcomes. Among the 100 patients, 28 experienced adverse in-hospital events. In the univariate analysis, lower estimated glomerular filtration rate, peak troponin I, lower LAS reservoir, atrial fibrillation (AF), right ventricular dysfunction (RVD), mitral regurgitation and reduced left ventricular ejection fraction were associated with in-hospital events. Multivariate analysis confirmed reduced LAS reservoir (OR 0.88, 95%CI 0.81-0.95; p = 0.03), AF (OR 15, 95%CI 1.4-168; p = 0.02), and RVD (OR 18, 95% CI 1.2-275; p = 0.04) as independent predictors of adverse in-hospital outcomes. After a median follow-up of 26 months, 21 patients (23%) experienced adverse long-term events. In the univariate analysis chronic kidney disease, STEMI presentation, RVD and lower LAS reservoir were associated with worse long-term outcomes. In multivariate analysis, reduced LAS reservoir (HR 0.9 (95%CI 0.84-0.98; p = 0.02)) remained a significant predictor of long-term adverse outcomes. On the log-rank test using the discriminatory cutoff value of LASr < 17.5%, LASr was associated with higher risk of long-term outcomes (p < 0.001). Reduced LAS is associated with worse in-hospital and long-term outcomes in patients with CE. These findings highlight the potential role of LAS as a valuable prognostic tool in CE.

The impact of mid-range (mr) ejection fraction (EF) on long-term clinical outcomes has been reported in patients with heart failure but remains unclear in patients with ST-segment elevation myocardial infarction (STEMI). The purpose of this study was to compare the long-term clinical outcomes among STEMI patients with preserved EF (pEF), mrEF, and reduced EF (rEF), and to evaluate the significance of mrEF as a prognostic factor for patients with STEMI. We included 705 patients with STEMI and divided them into rEF group (n = 155), mrEF group (n = 155), and pEF group (n = 395) according to the pre-discharge EF. The primary endpoint was the major adverse cardiovascular events (MACE), which were defined as the composite of all-cause death, re-admission for heart failure, and non-fatal myocardial infarction (MI). The median follow-up duration was 906 days (Q1:349.5-Q3:1479). The Kaplan-Meier curves showed that MACE and re-admission for heart failure were more frequently observed in the rEF group, followed by the mrEF group, and least in the pEF group (p < 0.001). The multivariate Cox hazard analysis revealed that mrEF as well as rEF were significantly associated with MACE after controlling for confounding factors [rEF: hazard ratio (HR) 2.333, 95% confidence interval (CI) 1.350-4.034, p = 0.002, mrEF:HR1.852, 95%CI 1.139-3.010, p = 0.013]. Mid-range EF as well as rEF was significantly associated with MACE and re-admission for heart failure in patients with STEMI. Our results suggest that mrEF is an important prognostic factor in patients with STEMI.

Purpose: To evaluate the peri-procedural and 6-month outcomes of the Jetstream rotational atherectomy system in treating severely calcified femoropopliteal lesions in a Japanese population under postmarketing surveillance (PMS).

Materials and methods: This prospective observational PMS included 154 patients (161 procedures) treated at 20 Japanese centers between September 2022 and March 2023. Eligible lesions were ≥ 70% stenosed and severely calcified. Procedural success was defined as no bailout stenting or bypass. Lesion success required ≤ 30% residual stenosis, no Grade C or higher dissection, no perforation requiring treatment, and no significant flow reduction. Six-month follow-up included duplex ultrasound, Ankle-Brachial Index, and Rutherford category assessment.

Results: Patients had a mean age of 74.3 years; 74.7% had diabetes while 44.8% were currently on dialysis. Most lesions were in the superficial femoral artery with a mean length of 80.0 mm. Lesions were severely calcified (99.4%), and 33.3% of patients had chronic limb threatening ischemia at baseline. Procedural and lesion success rates were 98.8% and 96.6%, respectively. Distal embolization occurred in 5.8% of procedures. At 6 months, primary patency was 87.5%, freedom from TLR was 98.8%, and 87.1% of patients showed hemodynamic improvement without reintervention. All-cause mortality was 7.8% at 6-months post procedure.

Conclusion: The Jetstream atherectomy system demonstrated high procedural and lesion success with acceptable complication rates in complex, calcified femoropopliteal lesions. These findings support its use in combination with drug-coated balloons in real-world Japanese clinical practice.

Level of evidence: Level 3a, Nonrandomized postmarket surveillance.