Heart and Vessels最新文献

To evaluate if integrating platelet reactivity (PR) evaluation in the original age, creatinine and ejection fraction (ACEF) score could improve the diagnostic accuracy of the model in patients with stable coronary artery disease (CAD). We enrolled patients treated with percutaneous coronary intervention between 2010 and 2011. High PR was included in the model (PR-ACEF). Co-primary end points were a composite of death/myocardial infarction (MI) and major adverse cardiovascular events (MACE). Overall, 471 patients were enrolled. Compared to the ACEF score, the PR-ACEF showed an improved diagnostic accuracy for death/MI (AUC 0.610 vs 0.670, p < 0.001) and MACE (AUC 0.572 vs 0.634, p < 0.001). These findings were confirmed using internal validation with bootstrap resampling. At 5 years, the PR-ACEF value > 1.75 was independently associated with death/MI [HR 3.51, 95% CI (1.97-6.23)] and MACE [HR 2.77, 95% CI (1.69-4.53)]. The PR-ACEF score was effective in improving the diagnostic performance of the ACEF score at the long-term follow-up.

To compare the long-term prognostic effect of complete percutaneous coronary intervention (PCI) on cardiovascular events in chronic total occlusion (CTO) patients with the multi-vessel disease (MVD) compared with medical therapy (MT). We enrolled 441 patients with CTO and MVD who underwent PCI. The study population was divided into the CTO-PCI (n = 231) and the CTO-MT (n = 210) groups. Active PCI for non-CTO lesions was permitted in both groups. The primary endpoint was defined as the composite of all-cause death or myocardial infarction (MI). The primary endpoint occurred more frequently in the CTO-MT group (13.5%) than in the CTO-PCI group (4.7%; P = 0.002). However, the target vessel revascularization (TVR), as a secondary endpoint, occurred more in the CTO-PCI group (16.3% vs. 5.5%, P = 0.001). After propensity score matching (PSM) analysis, the primary endpoint was higher in the CTO-MT group (12.6%) than in the PCI group (2.3%): all-cause death (8.4% vs. 2.3%, P = 0.042) and MI (4.3% vs. 0.0%, P = 0.023). Moreover, TVR of the CTO lesions occurred more frequently in the CTO-PCI group (18.1% vs. 6.8%, P = 0.009). Significant improvement in the left ventricular ejection fraction (LVEF) was observed in both groups. According to the results of the subgroup analysis, CTO-PCI may be more effective in patients with diabetes, preserved LVEF (> 50%), and well-developed collateral vessels (> grade II). In this study, complete revascularization in CTO with MVD reduced the incidence of all-cause death, MI, and a composite of both over a 5 year follow-up compared to medical treatment for CTO lesions.

Hypertrophic cardiomyopathy is characterized by significant left ventricular wall thickening, often leading to obstructive symptoms. Alcohol septal ablation (ASA) has emerged as an effective treatment for patients with hypertrophic obstructive cardiomyopathy (HOCM) who remain symptomatic despite maximal medical therapy. However, the detailed long-term effects of ASA in Japanese patients with HOCM remain unclear. Therefore, this study aimed to investigate the long-term effects of ASA for HOCM by evaluating changes in symptoms, pressure gradient, hemodynamics, prognosis, and predictive factors for cardiovascular events over time. In this retrospective study, we examined 239 highly symptomatic patients (age, 64 ± 13 years; median follow-up, 6.9 years) treated with ASA for drug-refractory HOCM between 1998 and 2021. Patients were assessed using transthoracic echocardiography, magnetic resonance imaging, and cardiac catheterization. Follow-up evaluations included clinical assessments, electrocardiography, and echocardiography. Data analysis included descriptive statistics, Kaplan-Meier analysis, and multivariate regression. ASA reduced the left ventricular outflow tract gradient from 90.5 ± 52.8 to 14.4 ± 17.1 mmHg (P < 0.01) and New York Heart Association (NYHA) class from 3 [2.5-3] to 1 [1-2] at 10 years after ASA (P < 0.01). The 30-day mortality rate following ASA was 1%. Overall, 31 patients (13%) died during the follow-up period. The survival rates at 1, 5, 10, and 15 years after ASA were 97.4%, 89.9%, 83.7%, and 77.6%, respectively. Multivariable analysis revealed NYHA functional class before ASA (odds ratio [OR], 3.09; 95% confidence interval [CI], 1.40-6.82; P = 0.005), beta-blocker use (OR, 0.25; 95% CI, 0.07-0.91; P = 0.036), and class Ia agent use (OR, 0.31; 95% CI, 0.13-0.75; P = 0.009) as independent predictors of all-cause mortality. This study demonstrated low periprocedural and long-term mortality rates following ASA in patients with HOCM, suggesting that ASA provides durable symptomatic relief and reduces left ventricular outflow tract obstruction in selected highly symptomatic patients with HOCM.

The COMBO^® stent is a unique stent on which the CD34 antibody is mounted to capture CD34 + endothelial progenitor cells (EPCs) and from which sirolimus is eluted to suppress neointimal hyperplasia. The COMBO^® stent aims to induce early re-endothelialization and vascular healing and to prevent restenosis. In the clinical setting, however, the effects of the COMBO^® stent have not been validated in terms of EPC biology. In this study, we assessed the kinetics of circulating EPCs, not only quantitatively by flow cytometric analysis but also qualitatively by an EPC colony-forming assay, in 25 patients undergoing COMBO^® stent implantation. Among all patients, flow cytometric analysis indicated that the number of circulating CD34 + /KDR + EPCs did not change after COMBO^® stent implantation compared with baseline (before stent implantation). The EPC colony-forming assay demonstrated that the number of small-type EPC colonies increased on day 2 (3 [2, 9] to 6 [4, 9]/dish, P = 0.026) and that of large-type EPC colonies more prominently increased on day 2 (1 [0, 4] to 5 [1, 10]/dish, P < 0.001) and day 7 (to 2 [1, 7], P = 0.006) after COMBO^® stent implantation. Based on the results of optical coherence tomography at 3 months after stent implantation, the patients were divided into two groups: well (uncovered strut ratio < 10%, n = 14) and poor (uncovered strut ratio ≥ 10%, n = 10) stent coverage. Compared with baseline values, the number of large-type EPC colonies increased on day 2 (2.9 ± 0.8 to 7.3 ± 2.0, P = 0.026) and tended to increase on day 7 (6.8 ± 2.0/dish, P = 0.062) after COMBO^® stent implantation in the well coverage group, while it did not change in the poor coverage group. Thus, the COMBO^® stent might induce mature EPCs in the circulation, which might be associated with subsequent healing processes in vessel sites with stent-induced injury.

Transcatheter aortic valve implantation (TAVI) is a proven treatment for severe aortic stenosis (AS); however, the effects of TAVI on central blood pressure (CBP) and clinical outcomes remain unclear. We assessed CBP indices before and after TAVI and their prognostic value. Seventy-six patients with severe AS who underwent TAVI were retrospectively evaluated, and CBP was estimated noninvasively 1 day before and after TAVI. The following indices were measured: augmentation index corrected for heart rate (HR) (AIx@HR75), peak pressure of the forward wave (Pf) and backward wave (Pb), time to peak pressure of the forward wave corrected for HR (Tfc) and the backward wave corrected for HR (Tbc), and ejection duration (ED). The primary endpoint was the composite outcome of all-cause mortality and hospitalized heart failure. The median follow-up period was 1135 (844-1404) days. Tfc, Tbc, ED, Pb, and AIx@HR75 decreased despite no significant changes in Pf after TAVI. The univariable Cox proportional hazards model showed that ED 1 day after TAVI was associated with composite outcomes (hazard ratio: 1.02; 95% confidence interval [CI]: 1.01-1.04; P = 0.002). When the patients were divided into two groups by the cutoff value determining composite outcomes by receiver operating characteristic curve analysis, a long ED 1 day after TAVI was significantly associated with composite outcomes by Kaplan-Meier curve analysis (log-rank test, P < 0.001). The multivariable Cox proportional hazards model showed that a long ED 1 day after TAVI was associated with composite outcomes (adjusted hazard ratio: 12.12; 95% CI 2.41-60.81; P = 0.002). In conclusion, a long ED 1 day after TAVI was associated with adverse clinical outcomes.

Patients hospitalized for heart failure (HF) experience impairments in functional status, primarily affecting basic activities of daily living (ADL). We investigated the independent effect of functional status for ADL on patient-centered outcomes (i.e., home discharge) and conventional clinical outcomes in HF. We analyzed 2936 consecutive hospitalized patients with HF from a prospective multicenter registry. The functional status of ADL was assessed before discharge by using the Barthel index (BI). Patients were categorized into the lower BI group (≤85; the lowest tertile) and higher BI group (>85). We evaluated the risk-adjusted association between BI and non-home discharge, as well as the two-year all-cause mortality. Exploratory subgroups included patients categorized by age, sex, HF hospitalization, left ventricular ejection fraction, body mass index, and estimated glomerular filtration rate (eGFR). Of the participants (age: 79 [69-85] years; 41.1% women), 86.3% were discharged home. A lower BI was independently associated with non-home discharge (OR: 5.12, 95% CI 3.86-6.80) and higher all-cause mortality rates (HR: 1.96, 95% CI 1.58-2.45). Two-year cardiac and non-cardiac mortality rates were higher in the lower BI group; however, the proportion of cardiac causes in two-year deaths did not differ between the lower and higher BI groups (48.8% vs. 49.5%, P = 0.891). Subgroup analyses consistently demonstrated an association between two-year mortality and lower BI; however, this association was stronger among patients with a higher eGFR (P-value for interaction = 0.004). A lower BI was independently associated with non-home discharge and higher mortality rates because of cardiac- and non-cardiac-related causes in hospitalized patients with HF.

Purpose: To evaluate the impact of intravascular ultrasound (IVUS)-evaluated tissue morphology on recurrence following drug-coated balloon (DCB) angioplasty for the treatment of femoropopliteal in-stent restenosis (FP-ISR).

Methods: This study was a single-center, retrospective, observational study. Study subjects were 65 FP-ISR lesions (mean lesion length: 165 ± 88 mm, occlusive restenosis: 25%) in 53 patients (age: 76 ± 8, diabetes mellitus: 66%) who underwent DCB angioplasty and whose IVUS data of tissue morphology were available. The morphology of ISR was determined by dominant tissue and classified into two group with and without fibrous tissue. Fibrous tissue was defined as the absence of calcification, equal to or more advanced than the echo luminance of the outer membrane, but without acoustic shadow. The outcome measure was recurrence-ISR, and cox proportional hazards models were used to explore factors associated with recurrence-ISR.

Results: During mean follow-up period of 16 ± 12 months, recurrence-ISR was found in 32% (n = 21). The tissue morphology of FP-ISR before DCB angioplasty was distributed with 68% (n = 44) in fibrous tissue group and with 33% (n = 21) in non-fibrous tissue group. Factors associated with recurrence-ISR were drug-eluting stent (DES)-ISR (hazard ratio [HR]: 4.329; 95% confidence interval [CI]: 1.572-11.918, P = 0.005) and non-fibrous tissue (HR: 4.595; 95% CI: 1.484-14.228, P = 0.008).

Conclusion: The current study revealed IVUS-evaluated tissue morphology and DES-ISR lesions were significantly associated with recurrence FP-ISR after DCB angioplasty.

Right heart failure (HF) is a poor prognostic factor in patients with HF. The right atrial (RA) function has attracted less attention than the right ventricular (RV) function. The association of RA reservoir strain evaluated by 2D speckle-tracking echocardiography (2DSTE) with clinical outcomes in patients with HF remains unclear. We prospectively enrolled patients with HF admitted to our hospital. We measured the RA, RV, left atrial (LA), and left ventricular (LV) strain using 2DSTE before discharge. The RA reservoir strain (RASr) was measured in the global right atrium. The primary endpoints were cardiac death and worsening of HF requiring rehospitalization or intravenous diuretics. Among 226 patients with HF, 72 primary endpoints were recorded during a median follow-up period of 1081 days. Kaplan-Meier analysis showed a higher cardiac event rate in the low RASr group than in the high RASr group (P = 0.0089). Multivariate Cox hazard analysis showed that RASr was independently associated with cardiac events after adjusting for confounding factors [hazard ratio (HR) 0.71; 95% confidence interval (CI) 0.51-0.96; P = 0.0347]. Decreased RASr could be a feasible marker of cardiac events in patients with HF.