Heart and Vessels最新文献

We aimed to examine the impact of coronary inflammation, coronary microvascular dysfunction (CMD), and coronary artery spasm (CAS) on cardiac remodeling and dysfunction in patients suspected of angina with non-obstructive coronary artery disease (ANOCA). This retrospective single-center study included consecutive patients who underwent coronary spasm provocation testing between July 2020 and January 2025 for suspected ANOCA without prior revascularization and coronary stenosis ≥ 75%. Those who underwent coronary angiography after September 2022 also underwent invasive coronary physiology studies to diagnose structural CMD. PCAT attenuation (PCATA), reflecting coronary inflammation, was measured from prior coronary CT angiography, while strain analyses were obtained from prior echocardiography. Regression models were established between echocardiographic parameters and each of PCATA, CMD, and CAS. 257 patients (mean age, 64.2 ± 12.2 years; male, 62.1%) were included in the analysis. Multivariable regression analyses including PCATA, CMD, and CAS demonstrated that higher PCATA was associated with higher left ventricular mass index (β = 0.25, p = 0.007), reduced left ventricular ejection fraction (β = -0.21, p = 0.01), and impaired right ventricular four-chamber strain (β = 0.21, p = 0.04). CMD was independently associated with higher left atrial volume index (β = 0.67, p = 0.002) and impaired left atrial contraction strain (β = 5.31, p = 0.009). CAS showed no correlation with these parameters. Our study demonstrated a significant association between PCATA and left ventricular remodeling and dysfunction independent of CMD. It also revealed a direct relationship between CMD and left atrial remodeling and dysfunction.

Advances in interventional cardiology have increased procedural complexity, raising concerns about radiation exposure-especially for women operators of reproductive age, who are subject to stricter dose limits. Standard dosimeters provide only delayed cumulative data, limiting timely risk assessment. Real-time personal dosimetry offers immediate feedback, but its clinical utility during catheter ablation (CA) remains underexplored. We retrospectively analyzed 82 CA procedures performed between January and May 2024. First operators wore real-time dosimeters positioned at the waist under lead aprons. Radiation exposure and procedural characteristics were recorded and analyzed. The median operator radiation dose per procedure was 2 [1, 3] µSv, while the median patient dose was 0.163 [0.082, 0.324] Gy. A procedure-related cardiac tamponade requiring pericardiocentesis resulted in the highest operator dose (50 µSv). Higher patient BMI (≥ 25 kg/m²) and longer fluoroscopy time were independently associated with increased operator exposure (OR: 1.238, P = 0.008; OR: 1.056, P = 0.022), though no linear correlation was observed between BMI and operator dose (r = 0.029, P = 0.797). Radiation exposure to operators during CA is generally low but may increase significantly in the event of complications or with higher-risk patient characteristics. Real-time dosimetry provides valuable immediate feedback and may be especially important for radiation-sensitive operators, supporting safer practice in the evolving field of interventional electrophysiology.

Transcatheter aortic valve implantation (TAVI) has become available for elderly patients with aortic stenosis (AS). However, no markers have been established to predict prognosis after TAVI. Cardiac damage caused by AS progresses sequentially in most cases through the left ventricle, left atrium, and right ventricle. However, cardiac damage does not always progress sequentially. This study examined whether the burden of cardiac damage assessed by echocardiography predicts prognosis in patients with severe AS who underwent TAVI. We assessed patient data from a multicenter TAVI registry involving seven hospitals in Japan. Among 1,850 patients with severe AS, patients with preserved LV ejection fraction were included. We performed echocardiography before TAVI in 1,285 patients. The primary endpoint was cardiovascular (CV) events including CV deaths and rehospitalizations for heart failure. During a median follow-up of 741 days, 76 CV events occurred. A multivariate Cox-proportional hazards analysis revealed that four echocardiographic parameters, including tricuspid regurgitation pressure gradient, E/e', left atrial volume index, and left ventricular mass index were associated with CV events. We created a scoring system using these four echocardiographic parameters. The echocardiography-directed aortic stenosis score (EDA score) was computed by assigning one point each for the presence of abnormal parameters. The receiver operating characteristic curve of EDA score for CV events showed an area under the curve value of 0.74, a cutoff value of 3 points, a sensitivity value of 75%, and a specificity value of 63%. Kaplan-Meier analysis showed that CV event rates were significantly higher in patients with high EDA scores compared with those having low scores. Hazard ratio was 14.3-fold for the 3-point group and 26.6-fold for the 4-point group when compared with the 0-point group of patients. EDA score may be a feasible indicator for risk stratification in patients with severe AS who underwent TAVI.

Although surface electrocardiography (ECG) provides important information about the localization of atrial flutter (Afl), in cases where the p wave is unclear, it may not provide enough information about the ablation strategy and the procedure time may be prolonged. This study aimed to investigate the potential utility of crista terminalis double split signals in the differentiation of right- versus left-sided Afl in patients undergoing ablation therapy. In this retrospective study, symptomatic patients with Afl diagnosed by surface ECG and in whom no thrombus was detected by transesophageal echocardiography were enrolled. The decapolar catheter was placed into the crista terminalis and coronary sinus. The two most distant split signals were recorded as 'maximum interdeflection time' (MIT) in crista terminalis. The right or left atrium was mapped with 3-D system. 3-D mapping identified 112 patients with right Afl and 32 patients with left Afl. The right atrium was found to be significantly increased in patients with right Afl, whereas the left atrial diameter (LAD) was found to be significantly increased in patients with left Afl. The number of patients with coronary sinus activation sequence from proximal to distal, coronary sinus proximal to distal interval time and MIT were significantly increased in patients with right Afl. When patients with MIT > 80 ms and coronary sinus activation sequence from proximal to distal were taken together, it was found that the distinction between right and left atrial flutter was perfectly distinguished. In conclusion, MIT may serve as a valuable adjunctive parameter for distinguishing right- from left-sided Afl prior to 3-D mapping.

The international guidelines recommend a target low-density lipoprotein cholesterol (LDL-c) level of < 55 mg/dL in very-high-risk patients with dyslipidemia, which were defined as those with history of acute coronary syndrome (ACS), chronic coronary syndrome with multivessel disease, diabetes mellitus, chronic kidney disease, familiar hypercholesterolemia, recurrent coronary artery disease, or polyvascular disease. In addition, an early reduction in LDL-c levels is recommended especially for ACS. Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have been reported to be very effective for an early reduction in the LDL-c level, but some patients showed non-early reduction. We investigated the factors correlating with non-early lowering LDL-c levels using PSCK9 inhibitors in very-high-risk patients. We enrolled consecutive patients with dyslipidemia who received evolocumab due to very-high-risk. We divided them into the early achievement of the target LDL-c level (EAC) group whose LDL-c level decreased to < 55 mg/dL 1 month later and the non-EAC group. We investigated the various factors possibly correlated with non-EAC. The non-EAC group comprised 25 patients (35.2%). A univariable analysis revealed that a body mass index (BMI) > 23.9 kg/m², history of ACS, LDL-c > 144 mg/dL, and high-intensity statins were related to the non-EAC group. A multivariable analysis showed that a history of ACS was negatively and LDL cholesterol level > 144 mg/dL positively correlated with non-EAC. In conclusion, we induced PSCK9 inhibitors more aggressively in ACS, and we should pay attention to the patients with higher baseline LDL-c levels during the follow-up.

The association between high-density lipoprotein cholesterol (HDL-C) levels and prognosis in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) remains unclear. This study aimed to investigate the relationship between HDL-C levels and all-cause mortality in this population. This multicenter prospective cohort study included 17,180 ACS patients who underwent PCI from the Multicenter Prospective Cohort Study on Acute Coronary Syndrome (MPCS-ACS). HDL-C levels were categorized into four groups: < 30, 30-60, 60-90 (reference), and ≥ 90 mg/dL. The primary endpoint was all-cause mortality. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), with multivariable adjustments. During a median follow-up of 49 months, 1200 all-cause mortality events occurred. U-shaped associations were observed between HDL-C levels and risks of all-cause mortality. After multivariable adjustment, compared to patients with HDL-C levels of 60-90 mg/dL, ACS patients with HDL-C < 30 mg/dL or ≥ 90 mg/dL had a significantly increased risk of all-cause mortality, with HRs [95% CI] of 3.52 (2.66-4.64) and 2.71 (2.10-3.50), respectively. Both extremely low and high HDL-C levels were associated with increased risk of all-cause mortality in ACS patients undergoing PCI. Maintaining HDL-C levels within the 60-90 mg/dL range may be associated with better long-term outcomes.

Coronary microcirculatory dysfunction (CMD) is a known predictor of adverse outcomes after percutaneous coronary intervention (PCI). However, the prognostic significance of CMD in patients with severely calcified lesions treated with rotational atherectomy (RA) remains unclear. We retrospectively studied consecutive chronic coronary syndrome patients who underwent PCI with RA followed by second-generation drug-eluting stent (DES) implantation. CMD was evaluated by angiography-derived index of microcirculatory resistance (IMR_angio), calculated from the quantitative flow ratio (QFR) obtained immediately after PCI without hyperemia. The primary outcome was the occurrence of major adverse cardiovascular events (MACE) within 2 years, including cardiovascular death, spontaneous myocardial infarction, and target vessel revascularization. Among the 128 enrolled patients, 22 (17.2%) experienced MACE. Post-IMR_angio was significantly higher in patients who experienced MACE than in those who did not (39.3 ± 12.5 vs. 30.4 ± 9.8, p < 0.001). Increased post-IMR_angio was independently associated with MACE (hazard ratio, 1.05; 95% confidence interval [CI]: 1.02-1.09, p = 0.004). Receiver operating characteristic curve analysis identified optimal cutoff values of 40.6 for post-IMR_angio to predict MACE (area under the curve 0.72, 95% CI: 0.58-0.86). Including high post-IMR_angio (> 40U), along with clinical risk factors and QFR findings, significantly improved the discriminatory and reclassification ability to identify the risk of MACE after RA. IMR_angio measured immediately after the PCI with RA followed by second-generation DES implantation is a valuable tool for risk stratification in patients with severely calcified lesions.

During cryoballon pulmonary vein isolation (PVI) complete occlusion of the pulmonary vein ostia during the freeze cycles is mandatory. Typically, PV occlusion is assessed by contrast injection under fluoroscopy. Using an update for the Cryo Console it is possible to directly visualize occlusion pressure as an indicator of complete PV occlusion during cryoballoon procedures. In this study, we compared PV pressure monitoring during cryoballoon PVI to a conventional approach regarding procedural outcomes. We retrospectively analysed the procedural data of 50 patients (25 patients with pressure-guided PVI and 25 patients with contrast-guided PVI) treated with cryoballoon PVI in our centre. Complete PV occlusion in the pressure-guided group was defined as an abrupt change in the pressure waveform with a loss of the a-wave after advancing the cryoballoon to the PV ostium. We observed comparable results regarding procedural time, left atrial dwell time or fluoroscopy time when comparing the pressure guided to our conventional approach. Moreover, there were no differences regarding acute procedural effectivity or freeze cycle characteristics. As expected, a significant reduction of contrast use was achieved in the pressure measurement group (10.4 vs. 25.5 ml, p < 0.0001). Monitoring complete PV occlusion by visualizing the occlusion pressure is feasible. Acute procedural outcome was comparable to our standard approach using contrast injection to verify complete PV occlusion. Most importantly, a significant reduction in contrast use could be achieved which has to be confirmed in larger patient cohorts.

An extracorporeal membrane oxygenation (ECMO) system consisting of a heparin-coated membrane oxygenator with polymethylpentene hollow fiber membranes and a heparin-coated hydrodynamically levitated centrifugal pump was developed. The effect of heparin anticoagulation on the antithrombogenicity of the ECMO system under veno-arterial bypass was evaluated in an animal model. Veno-arterial bypass with the ECMO system was induced in goats. Ten goats were evaluated which were divided into heparin anticoagulation-free (HPF; n = 5) and heparin anticoagulation (HP; n = 5) groups. Evaluation of the ECMO system focused on thrombus formation and changes in blood test data. Veno-arterial bypass with the ECMO system was maintained for 2 weeks in both groups. The extent of thrombus formation in the oxygenators was suppressed in the HP group. The centrifugal pumps were free of major thrombus formation in both groups. From baseline to postoperative day (POD) 1, both groups showed significant decreases in platelet counts, with a significant reduction in von Willebrand factor (vWF) activity levels in the HPF group. Between PODs 1 and 14, POD differences were observed in platelet counts without group or interaction differences. The levels of vWF activity showed significant group differences, with the HPF group demonstrating lower values than the HP group, but no significant POD or interaction differences. Veno-arterial bypass with the ECMO system was sustained for 2 weeks regardless of heparin anticoagulation. Heparin anticoagulation suppressed the extent of thrombus formation in the oxygenators. The centrifugal pumps were free of major thrombus formation regardless of heparin anticoagulation.

The HELT-E₂S₂ score, replacing diabetes mellitus and heart failure and adding extreme elderly (≥ 85 years), type of atrial fibrillation (AF), and low body mass index (BMI), has been proposed as a new measure for stratifying the risk of stroke in Japanese patients with AF. However, the association of the HELT-E₂S₂ score with left atrial appendage (LAA) dysfunction in patients with ischemic stroke remains unclear. We performed transthoracic and transesophageal echocardiography and evaluated the HELT-E₂S₂ scores in 593 patients with acute ischemic stroke and 296 patients without acute ischemic stroke as the control group. LAA dysfunction, defined as the presence of an LAA thrombus and/or severe spontaneous echo contrast, was identified in 182 patients. In a receiver operating characteristic curve analysis, the area under the curve of the HELT-E₂S₂ score for predicting LAA dysfunction was significantly higher than those of the CHADS₂ score (0.74 vs. 0.67, P < 0.001) and the CHA₂DS₂-VA score (0.74 vs. 0.67, P < 0.001). Multivariate logistic regression analysis showed that the HELT-E₂S₂ score was an independent predictor of LAA dysfunction after adjusting for conventional risk factors. The HELT-E₂S₂ score is a promising marker for predicting LAA dysfunction in patients with ischemic stroke.