Heart and Vessels最新文献

Cross-sectional area (eA) and volumetric elastic modulus (V_E) of the brachial artery estimated by an oscillometric device have been introduced to evaluate the degree of severity of atherosclerosis. However, there were concerns over the clinical efficacy of eA and V_E. In this study, we searched for a novel device-based index that effectively evaluates atherosclerosis, and compared its efficacy in detecting coronary artery disease (CAD) with conventional indexes comprising eA, V_E, carotid maximum intima-media thickness (IMT), cardio-ankle vascular index (CAVI), and flow-mediated dilation (FMD). The Health Chronos TM-2772 device approximates the arterial pressure-area relation to a logarithmic function. We hypothesized that the asymptotic pressure (P_a) of the logarithmic function that reflects the shift of the relation on the pressure axis may be effective in evaluating atherosclerosis. The diagnostic abilities of eA, V_E, P_a, IMT, CAVI, and FMD to detect CAD were analyzed in 60 patients who were classified into CAD (n = 30) and non-CAD (n = 30) groups based on coronary angiographic findings. In CAD group, P_a and FMD were significantly lower, and max-IMT was significantly higher than the respective indices in non-CAD group. eA, V_E, and CAVI showed no significant differences between the two groups. Receiver operating curve (ROC) analysis of the indices for diagnosing the presence of CAD indicated that only P_a [area under the ROC curve (AUC) = 0.706, p < 0.01] and max-IMT (AUC = 0.752, p < 0.01) had acceptable diagnostic ability. The optimal cutoff values were 15.3 mmHg for P_a (sensitivity 77%, specificity 67%) and 1.6 mm for max-IMT (sensitivity 71%, specificity 71%). In conclusion, P_a may be a sensitive and effective index for evaluating the severity of atherosclerosis. Verification of the efficacy and usefulness of P_a is warranted in further prospective multicenter studies and registries.

Beta-blockers are one of the four major pillars of guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF). The therapy has presented the best effects when up-titrated to evidence-based target doses. Despite their proven benefits, physicians have traditionally shown reluctance to up-titrate beta-blockers because of their negative inotropic and chronotropic effects. The effects of newly introduced sodium-glucose cotransporter 2 inhibitors (SGLT2I) in treating HFrEF might open more room for adequate beta-blockers up-titration. The goal of this study was to evaluate the up-titration practice, and impact of target doses of beta-blockers in patients with HFrEF receiving SGLT2I. This is a prospective cohort study involving patients with HFrEF receiving SGLT2I therapy. Baseline use and dosing to the evidence-based targets were examined. We compared the groups of patients receiving maximally titrated beta-blockers versus incompletely titrated. Primary outcome was composite of (1) rehospitalization or revisit to emergency unit due to the heart failure; (2) all-cause death and major adverse cardiac events (MACE). Secondary outcomes were heart rate at rest, left ventricular ejection fraction, NT-proBNP, and NYHA status at 6 and 12 months of follow-up. Study endpoints were documented via telephone interviews, regular outpatient follow-up, or by electronic hospital records. This study included a total of 458 patients with median follow-up time of 365 (186-502) days. A total of 122 (26.6%) patients had beta-blockers maximally up-titrated. The results show that adherence to maximal target doses of β-blocker therapy significantly reduces hazard of death or MACE comparing to not using maximal doses of β-blocker (factor 0.43). Hazard reduction was not statistically significant for composite of rehospitalization or revisit to emergency unit due to HF. Maximal doses of beta-blockers did not result in a significant decrease in resting heart rate. Our real-world data have highlighted the prevalence of incomplete titration of beta-blockers. Although it has been shown that evidence-based target dosing of beta-blockers reduces death and MACE, there is still room for improvement with up-titrating beta-blockers in eligible patients.

The areas with electrically fractionated potentials (AEFP) during sinus rhythm are related to non-pulmonary vein triggers and may serve as substrates of atrial fibrillation (AF) maintenance. However, the histological properties of these compounds remain unclear. Therefore, we aimed to evaluate the late gadolinium enhancement (LGE) properties of AEFP in patients with AF. We enrolled 15 patients with AF who had undergone LGE magnetic resonance imaging before catheter ablation. AEFP in the left atrium was detected using the HD-Grid and NavX systems after pulmonary vein isolation. We compared LGE properties between AEFP and the surrounding non-fractionated areas (non-AEFP). LGE heterogeneity and density were evaluated through entropy (LGE entropy) and the volume ratio of the enhancement voxel (LGE volume ratio), respectively. Thirty-three AEFP were detected in the left atrium. LGE entropy and LGE volume ratio were significantly higher in AEFP than in non-AEFP [LGE entropy: 6.2 (6.1-6.4) vs. 5.9 (5.8-6.0), p ≤ 0.0001; LGE volume ratio: 23.0% (17.2-29.0%) vs. 10.4% (3.4-20.2%), p ≤ 0.0001]. The atrial voltages did not differ [2.4 (1.3-3.7) vs. 2.5 (1.9-3.1) mV, p = 0.96]. AF recurrence was more significantly found in patients with more than three AEFP than in those without it (log-rank test: p = 0.009). AEFP is likely to be distributed in heterogeneous and moderate LGE areas, regardless of the atrial voltage.

Access site bleeding is a complication which may occur during Impella support (Abiomed, Danvers, MA, USA), possibly due to unstable fixation of the device in the groin. Using a large-bore sheath for Impella insertion may reduce this complication. However, the efficacy and safety of this strategy are still unknown. The main aim of this study was to assess whether employing a large-bore sheath during Impella insertion mitigates access site bleeding without increasing limb ischemia. All consecutive patients who received either the Impella 2.5 or CP for cardiogenic shock from September 2019 to February 2023 were included in this study. We compared patients who underwent Impella insertion using the conventional peel-away introducer and the attached sheath (repositioning sheath) and patients in whom the Impella was inserted using a 16 Fr sheath. All patients received antegrade perfusion with a 4Fr sheath to prevent limb ischemia at the Impella site. The primary outcome was access site major bleeding: 36 patients were treated with a 16 Fr sheath and 39 were treated with a conventional sheath. The use of a 16 Fr sheath was associated with a significant reduction in major bleeding (33.0% vs. 64.0%, p = 0.01) in comparison to the conventional sheath. After adjusting for covariates, the risk of major bleeding at the access site in the 16 Fr sheath group was significantly lower than that in the conventional sheath group (adjusted odds ratio, 0.294; 95% confidence interval 0.087-0.991; p = 0.048). The insertion of Impella through a 16 Fr sheath significantly reduced the risk of major bleeding at the access site in comparison to the conventional sheath.

The Global Leadership Initiative on Malnutrition (GLIM) suggested a two-step framework for the assessment of malnutrition based on screening and diagnosis. Malnutrition, as defined by the GLIM criteria, and the risk of malnutrition determined through nutritional screening are associated with adverse outcomes in patients with heart failure (HF). This study investigated the prognostic impact of malnutrition, as defined by the GLIM criteria, compared with the risk of malnutrition determined by the Mini Nutritional Assessment-Short Form (MNA-SF) screening tool among patients hospitalized for acute HF. A total of 446 patients with acute HF who underwent nutritional screening using the MNA-SF and were diagnosed with malnutrition based on the GLIM criteria were include in this study. The primary outcome was the incidence of all-cause death or HF-related readmission after discharge. Patients diagnosed with malnutrition based on both indices had a higher incidence of adverse events within one year post-discharge than patients diagnosed without malnutrition. However, a landmark analysis of years one to three post-discharge found that the incidence of the primary outcome was comparable between patients diagnosed with malnutrition and those that here not. Furthermore, although malnutrition as defined by the GLIM criteria was found to be an independent predictor of the 1 year incidence of all-cause death or rehospitalization for HF even after adjusting for other prognostic indicators (hazard ratio, 1.593; 95% confidence interval, 1.056-2.403; P = 0.026), the risk of malnutrition based on the MNA-SF was not. In conclusion, a diagnosis of malnutrition based on the GLIM criteria provides better prognostic stratification in the first year post-discharge in patients with acute HF as compared with nutritional screening based only on the MNA-SF.

Objective: Intrarenal vein flow (IRVF) abnormalities can predict cardiovascular events including heart failure. This study aimed to evaluate the utility of short IRVF scans during routine comprehensive transthoracic echocardiography (TTE) examinations in a standard TTE laboratory.

Methods: We screened consecutive patients who underwent elective TTE at our Ultrasound Imaging Laboratory between March 2018 and July 2019 and prospectively enrolled those who completed a 5 min IRVF scan during the 30 min TTE procedure.

Results: Among the 2101 screened patients, 1326 were included in the study cohort (age: 73 ± 13 years, 756 men). IRVF abnormalities were detected in 13 (1.0%) patients. Twenty-one cardiac events were observed (1.6%, 21/1326): one myocardial infarction and 20 heart failures. Cumulative survival probability plots were generated using the Kaplan-Meier method within 6 months after the TTE index day and assessed using the log-rank test. The plots revealed significantly worse prognoses in patients with elevated right arterial pressure (RAP) and abnormal IRVF, when compared to normal RAP or normal IEVF (p < 0.0001 and p < 0.0001, respectively). In a receiver operating curve analysis to predict the occurrence of cardiovascular events, E/e' had moderate predictive potential (area under the curve: 0.795, p < 0.0001), and the combination of E/e' and IRVF abnormality had better predictive potential than did E/e' alone (p = 0.043).

Conclusion: Although rarely observed on TTE, IRVF abnormalities improve the ability of E/e' to detect cardiac events, especially heart failure. Further large-scale prospective studies are required to confirm our findings.

We appreciate the comments from Arshad et al. regarding our study on long-term outcomes of alcohol septal ablation (ASA) for hypertrophic obstructive cardiomyopathy (HOCM) in Japan. Addressing concerns about sex-related differences, our analyses revealed no significant differences between men and women in overall mortality (log-rank P = 0.759) or major cardiovascular events (heart failure admission, P = 0.521; pacemaker/implantable cardioverter-defibrillator implantation, P = 0.234; sustained ventricular tachycardia/ventricular fibrillation, P = 0.615; new-onset atrial fibrillation, P = 0.894). The 12% reintervention rate is consistent with reported rates from high-volume centers over 10 years (10-15%), suggesting appropriate patient selection. Primary risk factors for reintervention were thicker interventricular septum and residual mitral regurgitation, as previously reported. Sustained efficacy of ASA is supported by 75% of patients maintaining NYHA class I at 10-year follow-up. These findings, while acknowledging potential differences between Japanese and Western populations, reinforce the long-term safety and effectiveness of ASA for HOCM in Japan.

Transcatheter aortic valve replacement (TAVR) offers a solution, especially for high-risk aortic stenosis (AS) patients. However, patient outcomes post-TAVR show variability, highlighting the need for reliable prognostic indicators. Brachial-ankle pulse wave velocity (baPWV), a measure of arterial stiffness, may predict outcomes post-TAVR. This study aims to explore baPWV's prognostic value in relation to all-cause mortality post-TAVR. This study prospectively enrolled 212 severe AS patients undergoing TAVR between September 2015 and December 2021, focusing on pre- and post-TAVR baPWV measurements to explore associations with all-cause mortality. Of the 212 patients (119 females, 93 males, mean age 85 years), post-TAVR baPWV increased significantly from 1589 ± 376 to 2010 ± 521 cm/s (p < 0.001). Aortic valve (AV) peak velocity and mean pressure gradient decreased, while AV area increased, indicating procedural success. Despite this, 88% of patients experienced an increase in baPWV, with higher pre-procedure AV peak velocity and mean pressure gradient identified as predictors of increased baPWV post-TAVR. Over 23 months, 29 patients (14%) reached the primary endpoint of all-cause mortality. Notably, changes in baPWV, rather than baseline values, were significantly associated with event-free survival (HR: 0.64 per 1SD increase, p = 0.009). The study highlights the prognostic value of baPWV changes post-TAVR in predicting patient outcomes. Elevated baPWV post-TAVR may reflect a beneficial adaptation to altered hemodynamics, suggesting the need for individualized patient evaluation and the integration of baPWV measurements into clinical practice for improved post-TAVR management.