Heart and Vessels最新文献

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.

The efficacy of an early invasive strategy (EIS) in NSTEMI patients with renal dysfunction remains unclear. This study assesses the clinical impact of invasive time strategies in NSTEMI patients, stratified by renal function, using data from two major Korean acute myocardial infarction registries. We analyzed a decade-long dataset, combining 5 years each from the Korea Acute Myocardial Infarction-National Institute of Health (KAMIR-NIH) and Registry of Acute Myocardial Infarction for Regional Cardiocerebrovascular Centers (KAMIR-RCC). NSTEMI patients were classified into preserved renal function (PRF, eGFR ≥ 60 mL/min/1.73 m²) and decreased renal function (DRF, eGFR < 60 mL/min/1.73 m²). The comparison between early invasive strategy (EIS, ≤ 24 h) and delayed invasive strategy (DIS, > 24 h) for coronary angiography (CAG) referral was conducted. The baseline characteristics were adjusted using stabilized inverse probability of treatment weighting (IPTW). The primary endpoint was one-year all-cause mortality. Among 11,605 NSTEMI patients undergoing PCI, 75% had PRF and 25% had DRF. In patients with PRF, in-hospital mortality did not differ between EIS and DIS (0.7% vs. 0.4%, p = 0.196). However, in DRF patients, EIS was associated with higher in-hospital mortality compared to DIS (4.9% vs. 3.1%, p = 0.024). Similarly, in PRF patients, one-year mortality was comparable between EIS and DIS (HR 1.068, 95% CI 0.694-1.261, p = 0.664), whereas in DRF patients, EIS was associated with higher one-year mortality (HR 1.405, 95% CI 1.09-1.80, p = 0.007). Stratified by four eGFR groups, no significant differences were found between EIS and DIS in patients with PRF. However, mortality progressively increased with worsening renal function, with significant increases in patients with eGFR < 30 mL/min/1.73 m² (Adjusted HR: 1.545, p = 0.022) group. Interaction analysis revealed that the mortality risk associated with EIS increased significantly as renal function declined (p interaction < 0.001). In NSTEMI patients, the impact of EIS progressively diminished with worsening renal function, with significantly higher mortality observed in those with DRF, showing the harmful effects of EIS in this group.

The modified nutrition risk in critically ill (mNUTRIC) score was developed to quantify the risk of adverse events related to malnutrition in the intensive care unit setting. However, its prognostic value has not been examined in patients with acute heart failure (AHF). This study aimed to investigate the relationship between mNUTRIC score and all-cause mortality in AHF patients in the cardiac intensive care unit (CCU). We retrospectively examined 307 patients with AHF who were admitted to our CCU from April 2014 to March 2017. mNUTRIC score was calculated within 24 h of CCU admission. Patients were classified as either high nutritional risk (score ≥ 5) or low nutritional risk (score < 5). The primary endpoint was death from any cause. Median follow-up was 272 days (interquartile range 59-588). Kaplan-Meier survival analysis showed that overall survival was significantly worse in the high nutritional risk group (p < 0.001). In the multivariate analysis adjusted for chronic kidney disease, systolic blood pressure, hypoalbuminemia, anemia, and C-reactive protein concentration, mNUTRIC score ≥ 5 was an independent predictor of higher all-cause mortality (adjusted hazard ratio, 2.23; 95% confidence interval, 1.33-3.72; p = 0.003). mNUTRIC score ≥ 5 at admission to the CCU is associated with increased risk of mortality in AHF patients in the CCU.

In Japan, median waiting time of heart transplantation (HT) is estimated as more than 5 years. Internationally, they report relatively high incidence of right heart failure (RHF) during left ventricular assist device (LVAD) support. However, the analysis based on nationwide survey in Japan is still limited. Therefore, we aimed to clarify the predictor and incidence of RHF after LVAD implantation in contemporary cohort, and its impact on their survival outcomes. Adult patients who underwent LVAD implantation at our institution from 2007 to 2023 were retrospectively reviewed. Those eventually weaned off and those bridged from paracorporeal VAD were excluded, and finally 178 patients were enrolled. We evaluated the incidence of RHF, post-LVAD survival, and predictors of RHF or on-device mortality. Five-year on-device survival was 78.5%. The incidence of early RHF was 3.4% and its cumulative incidence at 5 year was 22.1%. While 91.5% of the cohort underwent LVAD as BTT, post-LVAD survival was not significantly worse with RHF (p = 0.107). Cox regression analyses demonstrated preoperative severe TR and dilated phase of hypertrophic cardiomyopathy or arrhythmogenic right ventricular cardiomyopathy were the independent predictors of RHF and on-device death (hazard ratio (HR) 8.59, 95% confidence interval (CI) 3.68-20.0, HR 2.62, 95% CI 1.08-6.34, respectively). The incidence of early RHF was 3.4% and its cumulative incidence at 5 year was 22.1%, which was relatively low. Although RHF was not significantly associated with worse 5-year survival after LVAD implantation, we would need a large, nation-wide study to further address this issue.

Type 2 diabetes mellitus (DM) is a risk factor for the development of heart failure (HF) and associated with a poor prognosis. However, the impact of DM on clinical outcomes in patients with left ventricular diastolic dysfunction (LVDD) and HF with preserved ejection fraction (EF), which is the phenotype of diabetic cardiomyopathy, remains uncertain. This study aimed to investigate the impact of DM on cardiac functional changes and prognosis in patients with pseudonormal LV diastolic filling pattern (LVDFP) and preserved EF. A total of 413 patients with pseudonormal LVDFP and preserved EF who underwent follow-up echocardiography were enrolled between 2011 and 2020. The primary outcome was major adverse cardiac events (MACE) including all-cause death, non-fatal myocardial infarction, cardiac hospitalization, or stroke. Among the study population, 125 patients (30.3%) had DM. During the follow-up period (median 3.8 years [interquartile range: 2.1 to 5.6 years]), the follow-up EF comparing baseline EF was more significantly decreased in DM patients (67.3 ± 6.3 to 64.8 ± 7.5; p = 0.001) compared with non-DM patients (67.8 ± 5.8 to 66.8 ± 6.9; p = 0.03). Furthermore, compared with the non-DM patients, the DM patients significantly increased the risk of MACE (26.2% vs. 54.7%; adjusted hazard ratio, 1.68; 95% confidence interval, 1.11-2.54; p = 0.015). In patients with pseudonormal LVDFP and preserved EF, the DM was associated with the risk of worse clinical outcomes compared with the non-DM.