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.

Fractional flow reserve (FFR) is an invasive standard, and resting full-cycle ratio (RFR), a non-hyperemic pressure ratio, is an alternative to FFR for evaluating the functional severity of coronary stenosis. However, the prognostic impact of coronary revascularization in vessels with discordant results of FFR and non-hyperemic pressure ratios remains unclear. This single-center study included 212 vessels in 191 patients with intermediate coronary stenosis and discordant results of FFR and RFR. FFR ≤ 0.80 and RFR ≤ 0.89 were considered physiologically positive. Vessels with discordant results of FFR and RFR were divided into two groups according to the revascularization strategies-the deferral and revascularization groups. The primary endpoint was target vessel failure (TVF), a composite of cardiac death and target vessel myocardial infarction and unplanned revascularization. Of the 212 vessels, 145 (68.4%) and 67 (31.6%) were categorized as the deferral and revascularization groups, respectively. The deferral group was more likely to be older and women than the revascularization group. FFR values were higher, and the rate of positive FFR was lower in the deferral group than in the revascularization group. During the median follow-up of 406 days, 12 of 212 (5.7%) developed TVF. The Kaplan-Meier analysis demonstrated that the TVF rate was significantly lower in the revascularization group than the counterpart (7.6% vs. 1.5% at 3 years, P = 0.046). In conclusion, coronary revascularization in vessels with discordant results of FFR and RFR was associated with lower TVF rates as compared with the deferral strategy.

Although nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used for musculoskeletal pain, their use in patients with heart failure (HF) is discouraged because of risks of fluid retention and worsening disease. Nevertheless, in older patients, NSAIDs are still prescribed by non-cardiologists. We conducted a single-center retrospective cohort study of patients aged ≥ 65 years who were hospitalized for acute decompensated HF at Yamaguchi Prefectural General Medical Center between January 2016 and January 2022. Patients were classified as NSAIDs-related HF if NSAIDs use for ≥ 1 week before admission was identified through pharmacist review. As part of comprehensive cardiac rehabilitation, all patients received self-management guidance on medications, including NSAIDs avoidance. Multivariate Cox proportional hazards models were applied to assess associations with clinical outcomes. Among 801 patients, 64 (8.0%) were classified as NSAIDs-related HF and 737 (92.0%) as NSAIDs-unrelated HF. NSAIDs-related HF cases more frequently represented first-time HF hospitalizations. For the primary endpoint of all-cause mortality or HF readmission, the NSAIDs-related group showed a trend toward improved outcomes, although the difference did not reach statistical significance (hazard ratio [HR] 0.569, 95% confidence interval [CI] 0.289-1.118; p = 0.102). In contrast, the incidence of the secondary endpoint, major adverse cardiac and cerebrovascular events (MACCE), was significantly lower in the NSAIDs-related group (HR 0.404, CI 0.178-0.917; p = 0.030). NSAIDs-related HF accounted for a modest proportion of new HF hospitalizations in older patients. After standard management and NSAIDs discontinuation, outcomes were comparable to those of other HF patients, with a trend toward fewer adverse events. These findings likely reflect differences in patient background and comprehensive rehabilitation rather than a direct protective effect of discontinuation.

While antipsychotic drugs are known to induce dysphagia, their impact on patients with acute heart failure (AHF) remains largely unexplored. This study investigates the critical association between antipsychotic use and both swallowing and physical function in AHF patients. A prospective cohort study was conducted on hospitalized patients with AHF. We rigorously examined the relationship between antipsychotic drug use during hospitalization and outcomes at discharge. Antipsychotic drug use was defined as the regular administration of oral medication. The primary outcome was dysphagia, evaluated using the Food Intake Level Scale (FILS), with secondary outcomes including physical function (Barthel Index) and dysphagia incidence. We employed sophisticated statistical analyses, including multiple regression, logistic regression, and Cox proportional hazards models, adjusting for an extensive range of potential confounders to ensure robust results. Among 325 eligible patients (mean age 81.5 years, 53.2% female), our findings reveal a striking association between antipsychotic use and impaired swallowing function; with 34 patients (10.5%) in the antipsychotic drug use group. Antipsychotic users (34/325, 10.5% of cohort) showed significantly higher odds of dysphagia at discharge (OR = 7.724; 95% CI, 2.585-23.081, p < 0.001) and increased dysphagia incidence during hospitalization (HR = 1.635, 95% CI, 1.002-2.669, p  = 0.049). Notably, antipsychotic use was not associated with Barthel Index at discharge (β = 0.015; p = 0.658), suggesting a specific effect on swallowing function. This study provides compelling evidence that antipsychotic use in AHF patients is associated with a markedly increased risk of dysphagia.

Vascular calcification represents a significant clinical challenge, leading to cardiovascular disease, though its underlying mechanisms remain incompletely understood. Recent studies indicate that Toll-like receptor 9 (TLR9), a key element of innate immunity, plays a pathogenic role in vascular inflammation and atherogenesis. Therefore, we hypothesized that TLR9 signaling promotes vascular chondrogenesis and calcification. We compared apolipoprotein E-deficient (ApoE^-/-) mice and Tlr9^-/- ApoE^-/- mice after 24 -weeks high-cholesterol diet feeding. There were no differences between the groups in body weight gain, blood pressure, or plasma glucose levels, although total cholesterol levels were significantly lower in the Tlr9^-/- ApoE^-/- mice. The genetic deletion of TLR9 attenuated vascular calcification as determined by von Kossa staining (5.83 ± 1.14% vs. 3.04 ± 0.68%; P < 0.05), alkaline phosphatase (ALP-1) activity (P < 0.05), and chondroid matrix deposition as determined by Alcian blue staining (P < 0.05) in aortic arch compared with control mice. Immunohistostaining revealed that TLR9 deletion also decreased bone morphogenetic protein (BMP)-2 expression in aortic plaques (P < 0.05). In vitro experiments revealed that TLR9 activation by ODN1826, a TLR9 agonist, stimulated BMP-2 expression in murine peritoneal macrophages, but not in Tlr9-deficient macrophages. Although TLR9 agonists had no direct effect on vascular smooth muscle cells (VSMCs), the culture supernatants of macrophages stimulated with TLR9 agonist increased BMP-2 expression in VSMCs. TLR9 signaling promotes vascular chondrogenesis and calcification in ApoE^-/- mice. Our analyses suggest that TLR9 pathway contributes to bone morphogenic activation of macrophages and VSMCs at least partially, participating in the development of vascular calcification.

To examine the impact of preoperative weight fluctuations on postoperative outcomes in patients underwent elective cardiovascular surgery. This retrospective study included 157 consecutive patients who underwent elective cardiovascular surgery between April 2018 and March 2023. We assessed weight changes during a median surgical waiting period of 42 days. The primary outcome was the postoperative length of hospital stay. Patients were stratified into two groups-weight loss and weight maintenance-based on a 1-standard deviation (SD) reduction in weight variability. Multiple regression analysis was performed with adjustments for confounding factors. The mean weight change was + 1.9%, and the threshold for definition of the 'weight loss' and 'weight maintenance' groups was set at 1 SD (- 1.5%). The weight loss group (n = 22, 14%), with a weight loss that exceeded 1.5%, had significantly length of hospital stay been prolonged by a median of 5.0 days compared to the weight maintenance group (n = 135, 86%) (21.0 [17.0, 28.0] vs 26.0 [19.3, 42]; p = 0.03). In a multivariate analysis, weight change of - 1.5% (p < 0.01), eGFR (p = 0.04), and intubation days (p < 0.01) were significantly associated. Unintentional preoperative weight loss exceeding 1.5% was associated with a longer hospital stay. The identification of unintentional preoperative weight loss could aid clinicians in preoperative guidance and risk stratification.

Transcatheter aortic valve replacement (TAVR) is an established treatment for patients with severe symptomatic aortic stenosis but expanding indications have increased strain on hospital resources. Several studies assessed same-day discharge (SDD) after TAVR during the COVID-19 pandemic and showed it to be safe in well-selected, low-risk patients. However, more studies are warranted, with no studies in an Australian population and minimal data on self-expanding valves. Patients undergoing consecutive, transfemoral TAVR procedures at two large-volume centres in Sydney, Australia between 2021 and 2023 were prospectively recruited to the CONDUCT-TAVI study cohort. A locally derived clinical pathway ('The North Shore Pathway') was retrospectively applied to identify which patients would have been suitable for SDD. In-hospital and 30-day outcomes were compared between SDD patients and the remaining, ineligible patients (standard discharge cohort). Of 182 patients, 20 (11.0%) met SDD criteria. The total cohort received both self-expanding (67.3%) and balloon-expandable valves (32.7%). The SDD cohort had a higher proportion of females (55.0% vs. 21.5%, p = 0.04) but was otherwise comparable in baseline and procedural characteristics. No significant differences were found in hospital or 30-day outcomes. One SDD patient was readmitted with complete heart block requiring pacemaker implantation (day 20), and two patients had non-cardiovascular readmissions. No other adverse outcomes occurred in the SDD cohort. The present study suggests SDD after TAVR is feasible in both balloon-expandable and self-expanding cohorts. The study also supports prospective validation of the North Shore Day Stay pathway as a tool to safely identify low-risk patients that are suitable for SDD after TAVR.

Objective: Implantable loop recorders (ILRs) are useful in determining syncope etiology. We observed a higher diagnostic rate in patients receiving early implantation. We hypothesized that shorter implantation times were associated with higher diagnostic rates and investigated how the syncope-to-ILR interval affected diagnosis.

Methods: Medical data of patients at our hospital with syncope of unknown etiology who received ILRs between January 2017 and July 2023 were analyzed in relation to the date of syncope, first visit, and ILR use. Patients were classified into event and non-event groups according to whether ILRs revealed the syncope etiology.

Results: We examined the medical records of 113 patients (median age, 72.6 ± 13.1 years). Syncope etiologies were identified in 34 (30%) patients. We identified 37 (16-58) syncope-to-ILR days. The event group had significantly shorter syncope-to-ILR days (event group, 28 days; non-event group, 44 days, p = 0.001) and syncope-to-first visit days (1.5 vs. 13 days, respectively; p = 0.00). To improve diagnostic rates, a receiver operating characteristic curve indicated cut-off values for syncope-to-ILR days and syncope-to-first visit days of 17 and 12 days (area under the curve, 0.69 and 0.74), respectively. Patients accompanied by family or friends underwent ILR placement significantly earlier than unaccompanied patients.

Conclusion: The number of syncope-to-ILR days significantly affected syncope diagnosis, indicating that early hospital attendance following syncope is critical. Public awareness campaigns and the presence of family or friends may be useful.

Owing to the aging population, patients are increasingly undergoing endovascular therapy (EVT) for chronic limb-threatening ischemia (CLTI). CLTI onset causes patients to become increasingly frail and less able to perform daily activities, preventing their discharge home. However, the association of discharge destination with clinical backgrounds and outcomes in these patients has not been fully evaluated. In this study, data from 606 patients with CLTI who underwent EVT between March 2021 and December 2023 and survived to discharge were obtained from a multicenter registry (mean age, 74.5 years; 61.4% men). Non-home discharge was defined as transfer to another hospital or nursing home. Logistic regression analysis was used to identify independent predictors of non-home discharge. Mortality rates within two years of discharge were compared between the home and non-home discharge groups. Of the 606 patients, 108 underwent non-home discharge. Multivariate analysis identified mild frailty (odds ratio [OR] 2.32, 95% confidence interval [CI] 1.34-4.02, p = 0.003), advanced frailty (OR 3.50, 95% CI 1.95-6.28, p < 0.001), a Hemoglobin level < 11 g/dL (OR 1.87, 95% CI 1.15-3.02, p = 0.011), and a Wound, Ischemia, and Foot Infection grade 4 (OR 7.27, 95% CI 2.16-24.46, p = 0.001) as significant predictors of non-home discharge. During the two-year follow-up period, 161 patients died. Cumulative all-cause mortality was significantly higher in the non-home discharge group than in the home discharge group (58.6% vs. 33.7%; log-rank p < 0.001). The findings of this study reveal that non-home discharge occurred in one-sixth of patients with CLTI undergoing EVT, and was linked to a more severe clinical status and worse prognosis than home discharge.