Heart and Vessels最新文献

The impact of inflammatory and nutritional indices in patients undergoing transcatheter aortic valve implantation (TAVI) remains controversial. Therefore, we aimed to analyze the prognostic impact of Geriatric Nutritional Risk Index (GNRI) and C-reactive protein (CRP) in these patients. We included 122 patients who underwent elective TAVI for aortic valve stenosis (AS) between April 2017 and May 2023. The primary outcome was all-cause mortality, and secondary outcomes were major adverse cerebral/cardiovascular events (MACCEs). Patients with a low GNRI, high CRP levels, and a combination of a low GNRI and high CRP levels exhibited significantly high all-cause mortality. The GNRI and CRP levels alone were significantly associated with late mortality in the univariate analysis; however, this trend was absent in the multivariate analysis. The combination of a low GNRI and high CRP levels was significantly associated with late mortality in the univariate and multivariate analyses. The GNRIs at 6 months showed no significant changes, and the low GNRI in patients before surgery persisted after TAVI. There was no association between low GNRI after TAVI and late mortality or MACCE. The combination of malnutrition (indicated by a low GNRI) and inflammation (indicated by high CRP levels) may be a risk factor for long-term mortality in patients undergoing TAVI for AS.

Background: The incidence and progression of atrial fibrillation (AF), the most common type of cardiac arrhythmia, correlate with atrial fibrosis. An increased epicardial adipose tissue (EAT) volume is associated with increased atrial fibrosis. Although the presence and severity of atrial fibrosis have been evaluated through various invasive and noninvasive methods, reports examining the association between EAT volume (EATV) and the left atrial (LA) stiffness index through echocardiography or LA compliance as determined by LA pressure are lacking. Therefore, we investigated the relationship between EAT and the LA stiffness index and directly measured LA pressure in patients undergoing AF ablation.

Methods: We retrospectively examined 165 patients who underwent catheter ablation for AF between December 2022 and March 2025. The EATV was measured using contrast-enhanced computed tomography. The LA stiffness index was calculated as the ratio of the early mitral inflow velocity to the early annular tissue velocity. LA pulse pressure was assessed as the difference between peak and nadir LA pressure.

Results: A weak correlation was observed between the LA-EATV index (LA-EATVI) and the LA stiffness index. No significant correlation was observed between the LA-EATVI and LA pulse pressure.

Conclusions: Our study showed a weak correlation between the LA-EATVI and the LA stiffness index, but not with LA pulse pressure in patients with AF. Changes in the LA owing to EAT may need to be evaluated quantitatively and qualitatively.

Red cell distribution width is a prognostic marker of adverse outcomes in adults with heart disease, including congenital heart disease. However, its significance has not been clarified in pediatric patients. We investigated the relationship between red cell distribution width and cardiovascular events in school-age children with congenital heart disease and uniform reference intervals. We performed a retrospective cohort study of pediatric patients with congenital heart disease between January 2018 and March 2023. Children aged 7-15 years were included, and the results of the first blood test during the study period were considered as baseline data. Cardiovascular events were defined as all-cause mortality, non-scheduled hospitalizations for cardiovascular reasons, heart failure, arrhythmias, thromboembolism, and unplanned intervention. In total, 101 children were included. The median red cell distribution width was 12.3% (interquartile range 11.9-12.8%). Cardiovascular events occurred in 15 patients (14.9%) during follow-up. The Kaplan-Meier analysis showed significantly worse cardiovascular event-free survival in the higher red cell distribution width group. Univariate Cox regression revealed that a higher red cell distribution width group (p < 0.001), Fontan circulation (p < 0.001), oxygen saturation (p < 0.001), aspartate aminotransferase (p < 0.001), alanine aminotransferase (p < 0.001), and gamma-glutamyl transpeptidase (p < 0.001) were associated with cardiovascular events. When adjusted for other variables respectively, only a higher red cell distribution width group and Fontan circulation remained independently significant. The red cell distribution width and Fontan circulation were independently associated with cardiovascular events in school-age children with congenital heart disease.

Coronary microvascular dysfunction (CMD) represent a crucial and often underdiagnosed cause of myocardial ischemia and dysfunction. It is closely linked to the prognosis of patients with coronary artery disease. Increased microvascular resistance (whether due to CMD or vascular rarefaction) is more frequent in the setting of coronary chronic total occlusions (CTO). Whether recanalization contributes to the recovery of microvascular function and whether measures of microvascular resistance can potentially be used as prognostic parameter to predict long-term success of CTO recanalization remains unknown. The aim of this study was to investigate CMD in patients with CTO and the effect of successful CTO recanalization. As well, we investigate whether CMD can be identified as a risk factor for restenosis after CTO recanalization. 119 patients underwent successful CTO recanalization at the University Medical Center in Mainz. After a follow-up period of 6 months, invasive control was carried out, in which 79 patients continued to have sufficient revascularization and 40 presented with restenosis. Angiography-based microvascular resistance (Angio-IMR) measurements were performed directly after successful CTO recanalization and at 6 months follow-up offline using a software package (QAngio XA 3D; Medis Medical Imaging Systems). 64% of the patients were male with an average age of 62 ±  9 years. The mean follow-up period was 191 ± 80 days. Median J-CTO Score was 1.8 ± 0.7. The CTO was localized at the RCA in 60%, at the LAD in 20% and at the LCX in 24% of the patients. All included patients had a good result after CTO recanalization confirmed by Quantitative flow ratio (QFR) of 0.94 ± 0.04 directly after PCI. Angio-IMR values immediately after CTO recanalization were pathological (> 25) in 78% of the patients and showed a significant decrease at 6 months follow-up (31.7 ± 7.1 vs. 28.6 ± 5.3¸ p = 0.0024). Post-procedural angio-IMR values did not predict restenosis at 6-month follow-up (31.7 ± 8 vs. 29.8 ± 7.5, p = 0.173). CMD can be detected in a majority of patients after successful CTO PCI. At 6 months follow-up we found significant improved angio-IMR values; CMD was not a predictor of restenosis.