Heart and Vessels最新文献

This Letter to the Editor responds to the recent study by Kanejima et al. on the association between health literacy (HL) and behavioral changes during phase I cardiac rehabilitation (CR). While acknowledging the study's valuable contribution, we contest the conclusion that low HL is an inherent barrier to behavioral change. Drawing on recent evidence, we highlight that HL is a modifiable factor that can be improved through targeted interventions, program designs, and the rehabilitation process itself. We present six key arguments: (1) digital health technologies and structured education can enhance HL and foster behavioral adaptation in low-HL populations; (2) non-literacy barriers such as logistical constraints often play a larger role; (3) comparable cardiovascular interventions have shown sustained benefits despite low baseline HL; (4) CR programs themselves can directly improve HL; (5) modern CR designs employ adaptive, individualized approaches effective across HL levels; and (6) nurse-led and home-based strategies can successfully overcome HL limitations. Collectively, these points suggest that low HL should be viewed as a dynamic and addressable factor rather than a fixed constraint. We urge future research to incorporate HL-enhancing interventions and longitudinal follow-up to better understand HL's evolving role in CR outcomes.

Atrial fibrillation (AF) is a common arrhythmia with increasing prevalence, especially in overweight and obese individuals. Pulmonary vein isolation (PVI) using high-power short-duration (HPSD) and very high-power short-duration (vHPSD) ablation has shown effectiveness, but data on the use of these techniques in obese and overweight patients remain limited. This study aimed to evaluate whether body mass index (BMI) influences procedural characteristics, safety, and clinical outcomes of PVI performed using HPSD and vHPSD ablation in patients with symptomatic AF. We retrospectively analyzed 367 patients (119 obese, 138 overweight, 110 normal weight) who underwent HPSD or vHPSD PVI at Ostalb-Klinikum Aalen between 2019 and 2023. Procedural parameters, complications, and 12-month AF recurrence were assessed across BMI groups. Groups were comparable except for age (normal: 68.2 ± 12, overweight: 68 ± 9.7, obese: 64 ± 10.7; p < 0.01), hypertension (54.6%, 70.3%, 73.1%; p < 0.01) and diabetes (12.7%, 11.6%, 22.7%; p = 0.03). Procedure times, fluoroscopy times, and acute PVI success rates (100%) were similar. Base impedance was significantly higher in overweight (122.8 ± 14.1) and obese (123.9 ± 17.6) than in normal weight patients (113.8 ± 21.7; p < 0.01). AF recurrence rates were similar (normal: 20%, overweight: 18.1%, obese: 20.1%; p = 0.9), with no significant BMI correlation (Spearman = - 0.02). Complications were rare (p = 0.54). HPSD and vHPSD ablation are safe and effective in overweight and obese AF patients, with comparable recurrence rates and outcomes to normal-weight patients. Higher base impedance did not impact recurrence or complications.

Given the limited published data, we examined three-year outcomes in patients with and without diabetes mellitus (DM) in non-ST-segment elevation myocardial infarction (NSTEMI), according to left ventricular ejection fraction (LVEF). A total of 4594 patients were classified into DM (n = 1608) and non-DM (n = 2986) groups. They were further classified into heart failure with reduced EF (HFrEF, LVEF ≤ 40%), HF with mildly reduced EF (HFmrEF, LVEF 41-49%), and HF with preserved EF (HFpEF, LVEF ≥ 50%) subgroups. The primary outcome was all-cause mortality, and secondary outcomes included cardiac death (CD), non-CD (NCD), recurrent MI, any revascularization, and hospitalization for HF (HHF). In both DM and non-DM groups, in-hospital all-cause mortality rates were higher in the HFrEF subgroup than in the HFmrEF and HFpEF subgroups, but were similar between the HFmrEF and HFpEF subgroups. In the DM group, the three-year all-cause mortality (P < 0.001 for both), CD, NCD, recurrent MI, and HHF rates were higher in the HFrEF subgroup than in the HFmrEF and HFpEF subgroups. In the non-DM group, the three-year all-cause mortality (P = 0.001 and P < 0.001, respectively), CD, and HHF rates were higher in the HFrEF subgroup than in the HFmrEF and HFpEF subgroups. In both DM and non-DM groups, the three-year all-cause mortality and NCD rates were higher in the HFmrEF group than in the HFpEF group. Regardless of the presence of DM, the three-year outcomes were best in HFpEF, worst in HFrEF, and intermediate in HFmrEF patients.

Excimer laser coronary angioplasty (ELCA) plays an important role in modifying plaque composition, yet its impact on neointimal tissue (NIT) in in-stent restenosis lesions has remained unclear. While integrated backscatter intravascular ultrasound (IB-IVUS) can characterize plaque composition in de novo lesions, its ability to reflect tissue characteristics in NIT is limited due to the distinct structural and acoustic properties of neointimal tissue. This study aimed to investigate the effects of ELCA on NIT using IB-IVUS. We examined 49 in-stent lesions in 49 patients. IB-IVUS analysis focused on a 10 mm segment centered on the minimum lumen area (MLA), with data collected every 1 mm. Color maps were generated based on IB-IVUS backscatter values and included the following classifications: Red (typically calcification in de novo lesions), Yellow (dense fibrosis), Green (fibrosis), Blue (lipid pool), and Purple (lipid pool with attenuation). These classifications are based on tissue characteristics as defined in de novo settings and may differ in in-stent neointimal tissue. We compared Color-Ave (average color-coded area across 11 cross-sections, mm²) and %Color-Ave (relative to neointimal tissue area), before and after ELCA. IB-related values, including mean (Ave-IB) and variance (Variance-IB), were automatically obtained. Following ELCA, Purple-Ave and %Purple-Ave significantly decreased (from 0.95±1.28 mm² to 0.77±1.13 mm², and from 13.5±12.8% to 11.2±11.1%, both p=0.002). %Green-Ave increased significantly (from 53.6±14.1% to 55.5±12.7%, p=0.016), although Green-Ave remained unchanged. No significant changes were observed in Red-, Yellow-, and Blue-code areas. Similar trends were observed in MLA- and volume-based analyses. Ave-IB increased (p=0.028), while Variance-IB decreased (p=0.005). Changes in IB-related values were associated with their pre-ELCA levels. ELCA appears to ablate tissue with high IB-related values, leading to reduced tissue heterogeneity, even in NIT where tissue characterization by IB-IVUS is inherently limited.

Prolonged corrected QT interval (QTc) is known to be associated with adverse cardiovascular events in patients with heart failure. The delayed heart-to-mediastinum (H/M) ratio obtained from 123I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy is a marker of cardiac sympathetic nervous (CSN) activity and has been proposed as a prognostic marker of severe aortic stenosis (AS). However, the association between prolonged QTc and CSN overactivity in patients with AS remains unclear. This study retrospectively analyzed 83 patients with severe AS who underwent electrocardiography, echocardiography, and 123I-MIBG scintigraphy. Prolonged QTc was defined as QTc > 450 and > 470 ms in men and women, respectively. CSN overactivity was defined as delayed H/M ratio < 2.2 and washout rate (WR) > 34%. Prolonged QTc was detected in 14 patients, and these patients had higher left ventricular (LV) mass index and lower LV ejection fraction as compared to those with normal QTc. A significantly higher proportion of patients with prolonged QTc demonstrated CSN overactivity (p = 0.02). In addition, the prolonged QTc group had a lower delayed H/M ratio and higher WR. QTc was inversely correlated with the delayed H/M ratio in men (r =  - 0.53, p = 0.02) and women (r =  - 0.29, p = 0.02). QTc was positively correlated with WR in men (r = 0.55, p = 0.01) and women (r = 0.42, p = 0.001). Multivariate analysis identified age and prolonged QTc as significantly associated with CSN overactivity. Thus, prolonged QTc is associated with CSN overactivity, as assessed using 123I-MIBG scintigraphy in patients with severe AS.

Transradial intervention (TRI) is increasingly used for EVT in these lesions, and the Misago bare nitinol stent (BNS) is compatible with this approach. However, clinical outcomes of the Misago stent via TRI have not yet been reported. Therefore, we evaluated the 3-year clinical outcomes of the Misago stent via TRI. We demonstrated the retrospective, single-center observational study included 348 aorto-iliac arteries in 255 patients treated between October 2019 and May 2023, with Rutherford classifications ranging from categories 1 to 6. The patients were divided into groups: those treated with other stent types via TFI (n = 231) and those treated with Misago stents (n = 117). Additionally, outcomes of patients treated with Misago stents via TRI (n = 72) were compared to those treated with Misago stents via TFI (n = 45). The primary endpoint was 3-year primary patency, and the secondary endpoints were clinically driven target lesion revascularization (CD-TLR), all-cause mortality, major amputation, cerebral infarction, and procedure-associated complications during hospitalization. The 3-year primary patency rate was not significantly different between the Misago stent and other stents (93.2% versus 91.8%, respectively; P = 0.78). Similarly, the 3-year primary patency rate of the Misago stent via TRI was comparable to that of the Misago stent via TFI (91.7% versus 95.6%, respectively; P = 0.44). The competing risks model with multivariate analysis showed that the Misago stent and TRI were not associated with 3-year TLR (hazard ratio [HR], 0.80; 95% confidence interval [CI],0.24-0.64; P = 0.71 and HR, 1.94; 95% CI,0.47-8.07; P = 0.36, respectively). Dialysis and TSAC II C-D were independent predictors of 3-year TLR (HR, 3.28; 95% CI, 1.50-7.18; P = 0.003 and HR, 2.70; 95% CI, 1.28-5.69; P = 0.009, respectively). The Misago stent via TRI for aorto-iliac arterial disease demonstrated acceptable 3-year clinical outcomes. Dialysis and TSAC II C-D were identified as predictors of 3-year TLR.

Pulmonary vein (PV) isolation by catheter ablation is a widely used curative therapy for atrial fibrillation (AF). However, in patients with persistent AF (PeAF), long-term outcomes are poor when PV isolation is performed alone. Although left atrial (LA) roof ablation is sometimes added to PV isolation, its effectiveness and predictors of success remain unclear. To identify predictors of arrhythmia recurrence in patients with PeAF undergoing LA roof ablation and PV isolation using a cryoballoon catheter. A retrospective assessment of LA roof ablation and PV isolation using a cryoballoon was performed in 65 consecutive patients with PeAF. The median age of the patients was 69 years [Q1:61, Q3:75]; 55% were female, and 49% had longstanding PeAF. The complete LA roof block success rate using a cryoballoon was 92.3%, with no esophagus-related complications. The 1-year post-ablation arrhythmia-free rate was 83.3%. Atrial arrhythmia recurrence was more common within the 3-month blanking period. The N-terminal prohormone of brain natriuretic peptide (NT-proBNP) reduction rate ≥60.7% and sinus rhythm at 1-month post-ablation, and no arrhythmia during the 3-month blanking period strongly predicted arrhythmia-free status at 1 year post-ablation. In patients with PeAF who underwent LA roof ablation and PV isolation using a cryoballoon, the arrhythmia-free rate was high. The NT-proBNP reduction rate at 1-month post-ablation may serve as a simple and potentially useful predictor of procedural success.

Although cerebral macrocirculation is routinely assessed postoperatively in infants in the pediatric intensive care unit, monitoring cerebral microcirculation is not yet a standard practice. Our objective was to investigate the correlation between parameters of cerebral macro- and microcirculation in children following cardiac surgery and compare them with patients after neurosurgical and abdominal procedures. We conducted a prospective observational study in infants who underwent congenital cardiac surgery, visceral surgery, and neurosurgical procedures to measure parameters of cerebral macro- and microcirculation. Doppler ultrasound of anterior cerebral artery was performed, along with measurements of microcirculatory parameters using O2C device. 89 infants were included in the study. Group 1 (n = 35) comprised children after corrective cardiac surgery, group 2 (n = 22), after aortopulmonary shunt procedures, group 3 (n = 11), after Glenn operations, and group 4 (n = 21), after abdominal or neurosurgical procedures. The systolic peak flow was significantly lower in groups 2 and 3 compared to groups 1 and 4, 52.3 and 56.7 versus 59.6 and 68.8 cm/s, p = 0.01, respectively. Pulsatility index was higher in patients of group 2 compared to groups 1, 3 and 4, 2.5 vs. 1.3, 1.4, and 1.5 (p < 0.001), respectively. The cerebral blood flow in the staged palliation groups (2 and 3) was lower compared to groups 1 and 4, 203 and 236 vs. 250 and 262 AU, p = 0.045. Children undergoing staged palliation may show variations in cerebral macro- and microcirculation. Both approaches described in our study provide complementary information and can accordingly be utilized in the postoperative intensive care period. Future studies should focus on establishing reference values for macro- and microcirculation parameters across various patient populations.