Heart and Vessels最新文献

Patients on double antiplatelet treatment who need early in-hospital coronary artery bypass grafting (CABG) are at high risk of major bleeding. In this study, we aimed to investigate the impact of ticagrelor preloading on CABG related bleeding in patients with ST-segment elevation myocardial infarction (STEMI) initially managed with primary percutaneous coronary intervention (pPCI). Patients with the diagnosis of STEMI who were managed with pPCI and underwent subsequent early (4-7 days following pPCI) or delayed (> 7 days following pPCI) on-pump CABG surgery were included. All study patients were preloaded with ticagrelor 180 mg prior to pPCI procedure. Patients' demographics, clinical variables, and short-term cardiovascular outcomes were recorded. This is a retrospective study which included 98 patients. Fifty-four (54%) patients underwent early and 44 (45%) patients underwent delayed CABG surgery. CABG-related bleeding occurred in 22 (22.4%) patients. There was no significant difference with respect to total ticagrelor dose and timing of the surgery between patients with or without CABG-related bleeding (p: 0.165 and p: 0.142). Multivariate analyses demonstrated that only preoperative hemoglobin level < 10.9 and use of mechanical cardiac support devices were independent predictors of CABG-related bleeding [OR: 3719, p: 0.009 and OR: 11,698, p: 0.004, respectively].There were three deaths within the 30 days of surgery, all occurring in patients with CABG-related bleeding. However, CABG-related bleeding was not associated with long-term cardiovascular events during the follow-up. Our results indicated that discontinuation of ticagrelor therapy 3 days prior to surgery is sufficient to avoid CABG-related bleeding. Moreover, early CABG following STEMI does not increase the risk of long-term cardiovascular events.

Continuous intravenous adenosine triphosphate (ATP) administration is the standard method for inducing maximal hyperemia in fractional flow reserve (FFR) measurements. Several cases have demonstrated fluctuations in the ratio of mean distal coronary pressure to mean arterial pressure (Pd/Pa) value during ATP infusion, which raised our suspicions of FFR value inaccuracy. This study aimed to investigate our hypothesis that Pd/Pa fluctuations may indicate inaccurate FFR measurements caused by insufficient hyperemia. We examined 57 consecutive patients with angiographically intermediate coronary lesions who underwent fractional flow reverse (FFR) measurements in our hospital between November 2016 and September 2018. Pd/Pa was measured after continuous ATP administration (150 μg/kg/min) via a peripheral forearm vein for 5 min (FFR_A); and we analyzed the FFR value variation in the final 20 s of the 5 min, defining 'Fluctuation' as variation range > 0.03. Then, 2 mg of nicorandil was administered into the coronary artery during continued ATP infusion, and the Pd/Pa was remeasured (FFR_A+N). Fluctuations were observed in 23 of 57 patients. The cases demonstrating discrepancies of > 0.05 between FFR_A and FFR_A+N were observed more frequently in the fluctuation group than in the non-fluctuation group (12/23 vs. 1/34; p < 0.0001). The discrepancy between FFR_A and FFR_A+N values was smaller in the non-fluctuation group (mean difference ± SD; -0.00026 ± 0.04636 vs. 0.02608 ± 0.1316). Pd/Pa fluctuation with continuous ATP administration could indicate inaccurate FFR measurements caused by incomplete hyperemia. Additional vasodilator administration may achieve further hyperemia when Pd/Pa fluctuations are observed.

The HeartMate Risk Score (HMRS), a simple clinical prediction rule based on the patients' age, albumin, creatinine, and the international normalized ratio of the prothrombin time (PT-INR), is correlated with mortality in the cohort of left ventricular assist device (LVAD) recipients. However, in an aging society, an LAVD is indicated for only a small proportion of patients with acute heart failure (AHF), and whether the HMRS has prognostic implications for unselected patients with AHF is unknown. This study aimed to assess the prognostic value of HMRS categories on admission in patients with AHF. We analyzed 339 hospitalized patients with AHF who had albumin, creatinine, and the PT-INR recorded on admission. The patients were categorized as follows: the High group (HMRS > 2.48, n = 131), Mid group (HMRS of 1.58-2.48, n = 97) group, and Low group (HMRS < 1.58, n = 111). The endpoints of this study were all-cause death and readmission for heart failure (HF). During a median follow-up of 247 days, 24 (18.3%) patients died in the High group, 7 (7.2%) died in the Mid group, and 8 (7.2%) died in the Low group. In a multivariable analysis adjusted for highly imbalanced baseline variables, a high HMRS was independently associated with survival, with a hazard ratio of 2.90 (95% confidence interval 1.42-5.96, P = 0.004). With regard to the composite endpoint of all-cause death and readmission for HF, the Mid group had a worse prognosis than the Low group, and the High group had the worst prognosis. A high HMRS on admission is associated with all-cause mortality and readmission for HF, and a mid-HMRS is associated with readmission for HF after AHF hospitalization. The HMRS may be a valid clinical tool to stratify the risk of adverse outcomes after hospitalization in unselected patients with AHF.

The effect of percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) on left ventricular dyssynchrony was unclear. Patients with one CTO vessel were included. Tissue Doppler imaging (TDI) was used to assess the left ventricular dyssynchrony index (DI) in twelve segments before and after successful CTO PCI. Multiple regression was used to identify independent correlates of DI reduction. Ninety one patients were included with the mean age of 62.04 years. 88(96.70%) had left ventricular DI more than 33. It decreased from 69.58 ± 28.35 to 43.38 ± 17.34 (P < 0.001) after successful CTO PCI. PCI of infarct-relative CTO was associated with less percentage of DI reduction (Coefficient [Coef.], 11.13; 95% confidence interval [CI], 2.33-19.93; P = 0.01). Higher initial DI was associated with more percentage of DI reduction (Coef., - 0.38; 95% CI - 0.52 to - 0.23; P < 0.001). Percentage of DI reduction was associated with ejection fraction (EF) improvement (Coef., - 1.45; 95% CI - 2.58 to - 0.33; P = 0.01). CTO PCI led to significant reduction in DI and improvement of EF, particularly in patients without myocardial infraction and severe dyssynchrony. CTO patients with evident left ventricular dyssynchrony or without a history of myocardial infarction may benefit from a more proactive revascularization strategy. The association between dyssynchrony reduction and long-term benefits of CTO PCI warrants further investigation.

Ejection fraction is commonly used to assess Duchenne muscular dystrophy-associated cardiomyopathy (DMDAC), but it may remain normal (wrongly) despite significant myocardial dysfunction in patients. Therefore, better indicators of myocardial dysfunction are needed for longitudinal (with time) assessment and treatment of DMDAC patients. This study evaluates non-invasive LV PV loop-derived elastance, contractility and efficiency in relation to EF for patients developing DMDAC. The current retrospective study includes thirty DMDAC patients who underwent two serial CMR imaging from 2014 to 2023. The patients were divided into EF < 55% and EF ≥ 55%. Brachial pressures from cuff sphygmomanometer and CMR short axis steady-state free-precession images for the LV were acquired, and a non-invasive PV loop algorithm based on temporal elastance was used to derive mean elastance, contractility, and efficiency. While mean elastance and contractility showed moderate correlations (r = 0.56, p < 0.01, and r = 0.65, p < 0.001 respectively), efficiency exhibited a strong correlation with EF (r = 0.97, p < 0.01). Importantly, mean elastance, efficiency, and contractility were significantly lower in the EF < 55% group compared to EF ≥ 55% (p < 0.001). Therefore, these indices could serve as viable diagnostic endpoints for longitudinal evaluation of DMDAC.

The optimal procedural protocol for coronary stent deployment remains undetermined. Post-dilation with a high-pressure balloon is often performed to optimize the stent expansion. However, high-pressure dilation also carries the potential risk of coronary artery injury. A previous in vitro study reported that multiple-times balloon inflation at the same pressure resulted in better stent expansion compared to one-time balloon inflation. In our facility, we frequently perform the repeated 3-time-balloon-inflation method, wherein the stent delivery balloon was inflated 3 times at nominal pressure to deploy the stent, to improve stent expansion without high-pressure balloon inflation. Although this method seems effective in avoiding excessive high-pressure dilation, its clinical data are insufficient. In this study, we investigated the clinical outcomes of the repeated 3-time-balloon-inflation method. This retrospective study included 370 patients with 467 stented coronary lesions. These subjects were divided into two groups: one with standard balloon inflation and the other with repeated 3-time balloon inflation, and treatment outcomes were compared. The repeated 3-time-balloon-inflation group had 254 lesions, and the standard-balloon-inflation group had 213 lesions. Stent edge dissection occurred in 6 lesions (2.8%) in the standard-balloon-inflation group, whereas did not occur in the repeated 3-time-balloon-inflation group. A statistically significant difference remained even after propensity score matching (p = 0.040). The final minimum stent area and long-term clinical outcomes were not significantly different between the two groups. The repeated 3-time-balloon-inflation method may reduce stent edge dissection while demonstrating comparable minimal stent area and long-term outcomes to the standard-balloon-inflation method.

To analyze the clinical characteristics of cardiovascular disease in systemic lupus erythematosus (SLE) patients and identify risk factors for predicting the occurrence of cardiovascular disease in SLE patients. Clinical data of 110 SLE patients were randomly selected from the Tongde Hospital of Zhejiang Province clinical medical record database, including 50 patients with cardiovascular disease and 60 patients without. Clinical data, blood biochemistry indicators, antibody detection results, and complement levels were collected. The receiver operating characteristic (ROC) curve was used to analyze the efficacy of these differential indicators in predicting the occurrence of cardiovascular disease in SLE patients. Univariate logistic regression analysis and multivariate logistic regression analysis showed that anti-ribosomal P protein, RNP/sm, IgG, IgM, serum creatinine, uric acid, and lipoprotein a were independent risk factors for cardiovascular disease in SLE patients (P < 0.05). The area under the curve (AUC) for predicting cardiovascular disease in SLE patients using IgG was 0.67, with low sensitivity of 44% and high specificity of 88.48%. The AUC for predicting cardiovascular disease in SLE patients using IgM was 0.67, with sensitivity of 76% and specificity of 55.17%. The AUC for predicting cardiovascular disease in SLE patients using serum creatinine was 0.73, with sensitivity of 68% and specificity of 78.33%. The AUC for predicting cardiovascular disease in SLE patients using uric acid was 0.69, with sensitivity of 52% and specificity of 81.67%. The AUC for predicting cardiovascular disease in SLE patients using lipoprotein a was 0.96, with high sensitivity of 96% and specificity of 91.67%. Levels of anti-ribosomal P protein, RNP/sm, IgG, IgM, serum creatinine, uric acid, and lipoprotein A are significantly altered in SLE patients with cardiovascular disease. These indicators can be used to predict the risk of cardiovascular disease in SLE patients.

This study aims to compare 1-year outcomes after transcatheter aortic valve replacement (TAVR) between patients with moderate-severe MR and severe MR preoperatively using the Japan Transcatheter Valve Therapy (J-TVT) registry. Patients undergoing TAVR for aortic stenosis between August 2013 and December 2019 with preoperative mitral regurgitation of moderate-severe (group MR3) or severe (group MR4) were included. Patients with a history of valve surgery and dialysis patients were excluded. A total of 2017 patients were included, and 1-year follow-up data were obtained from the registry (follow-up rate 98.5%). Propensity-score matching between MR3 and MR4 groups was performed. All-cause mortality and the composite outcome of death and/or heart failure events were compared. Crude data showed that 1-year survival was significantly higher in the MR 3 (89.8%) than MR 4 (84.7%) groups, and freedom from 1-year mortality and heart failure events was also higher in the MR 3 (87.1%) than MR 4 (80.5%) groups (p = 0.0001). After propensity-score matching, 452 cases (226 cases each in MR 3 group and MR 4 group) were extracted. Cox regression model showed no statistical difference in the 1-year survival rate between MR 3 group (84.5%) and MR 4 group (85.5%) (p = 0.84), nor in freedom from 1-year death and/or heart failure events between MR 3 group (80.2%) and MR 4 group (81.6%) (p = 0.72). The 1-year survival rate and freedom from death and/or heart failure events were found to be similar between patients undergoing TAVR with MR grade 3 and MR grade 4.

The relationship between post-ablation excessive supraventricular ectopic activity (ESVEA), a new marker for new-onset atrial fibrillation (AF), and late AF recurrence is uncertain. We enrolled 469 patients with AF who underwent initial radiofrequency catheter ablation and 24-h Holter monitoring the day after. Early AF recurrence (n = 57; 12%) and ESVEA (n = 242; 52%) were noted. During a median follow-up of 25 months, 152 (32%) patients experienced late AF recurrence. Patients with early AF recurrence or ESVEA were significantly more likely to experience late recurrence (p = 0.02). Even without AF, ESVEA was associated with late recurrence following AF ablation.

Acute myocardial infarction-associated cardiogenic shock (AMICS) remains a condition with high mortality. Some patients require mechanical circulatory support (MCS) as their condition deteriorates. Sex-specific differences in risk factors and outcomes of cardiovascular disease have previously been described but are inconclusive regarding the use of MCS in AMICS. We aimed to investigate these with a focus on long-term outcomes. Health claim data from AOK - Die Gesundheitskasse (local health care funds) for patients hospitalized with AMICS between January 1, 2014, and December 31, 2015, was descriptively analyzed. Then, a Cox proportional hazards model was used to adjust for confounders. We analyzed 10,023 patients, of which 477 (4.8%) were treated with veno-arterial extra-corporeal membrane oxygenation (V-A ECMO). In-hospital mortality was high, but similar between treatments (V-A ECMO 59.1%, no V-A ECMO 56.6%). Women had a higher median age (78.9 years, IQR 13.8 vs. 71.8 years, IQR 17.9; p < 0.001), a different cardiovascular risk profile and in the conservatively treated patients underwent revascularization less often (69.2% vs. 77.1%; p < 0.001) than men did. In a multivariate analysis, female sex was not associated with lower survival (HR 1.03, CI 0.98-1.09; p = 0.233). V-A ECMO, however, was associated with lower survival in both sexes. We observed a low overall survival in follow-up after three years (no V-A ECMO: men 28.9% vs. women 21.7%, V-A ECMO: men 18.2% vs. women 17.0%). In conclusion, women with AMICS presented with a different risk profile, especially a higher age, and underwent guideline-recommended therapies such as revascularization less often than men. Female sex, however, was not associated with lower survival in a multivariate analysis. In-hospital mortality was high, regardless of treatment, and V-A ECMO was associated with lower survival in follow-up.