Heart, Lung and Circulation最新文献

Background: Ethanol infusion into the vein of Marshall (EIVOM) is proposed to improve atrial fibrillation (AF) ablation outcomes, though its efficacy is uncertain. This study reviews EIVOM's effect on AF catheter ablation.

Method: Systematic searches in PubMed, Embase, and Scopus identified studies comparing EIVOM with radiofrequency (RF) ablation. A random-effects model pooled mean differences with 95% confidence intervals (CIs), and heterogeneity was assessed with the I² statistic. R 4.2.3 was used for statistical analyses, including leave-one-out sensitivity analyses and Baujat plots to assess heterogeneity and study influence.

Results: We included 15 studies (four randomised controlled trials and 11 cohort studies) comprising 3,507 patients (mean age 64.07±9.57 years), of whom 73.25% were men and 1,536 were treated with EIVOM. This technique was associated with improved mitral isthmus (MI) block rates (relative risk [RR] 1.33; 95% CI 1.13-1.57; p<0.001) and reduced AF/atrial tachycardia (AT) recurrence (RR 0.65; 95% CI 0.52-0.80; p<0.001). No significant differences were found in MI reconnections (RR 0.65; 95% CI 0.31-1.34; p=0.240) while fluoroscopy (standardised mean difference [SMD] 0.25; 95% CI -0.86 to 1.37; p=0.656) and procedure times were longer in the EIVOM group (SMD 11.70 minutes; 95% CI -1.67 to 25.16; p=0.088). In the subgroup analyses, ethanol volumes >5 mL enhanced MI block and AF/AT recurrence.

Conclusion: EIVOM and RF are associated with a reduced MI block rates and recurrence of AF and AT when compared with RF only.

Background: Despite the proven efficacy of transcatheter aortic valve replacement (TAVR) in treating tricuspid aortic valve stenosis, the bicuspid aortic valve (BAV) population has been excluded from most of the landmark trials.

Aim: This study aimed to assess the outcomes of TAVR compared with those of surgical aortic valve replacement (SAVR) and examine the impact of BAV type, aortopathy, excess leaflet calcification, and raphe calcification on BAV TAVR outcomes.

Method: We searched PubMed/MEDLINE, Embase, and Cochrane Library for studies that assessed the outcomes of TAVR in the BAV population. We also included studies of patients with BAV undergoing TAVR and SAVR, and those assessing anatomical predictors of TAVR outcomes. Random-effects models were used to calculate the pooled risk ratios, mean differences, and hazard ratios.

Results: Patients with BAV who underwent TAVR showed significantly lower risks of major bleeding and acute kidney injury, and shorter hospital stays than those who underwent SAVR. However, BAV TAVR had a higher pacemaker implantation rate. Among the BAV types, Type 0 showed a higher risk of coronary obstruction, whereas Type 1 had a lower risk of pacemaker implantation following BAV TAVR. Additionally, BAV TAVR had a higher risk of long-term mortality in patients with aortopathy (ascending aortic diameter >4.5 cm) and excessive leaflet calcification.

Conclusions: Compared with SAVR, TAVR in BAV is associated with favourable in-hospital outcomes. Anatomical features, such as BAV type, aortopathy, excess leaflet calcification, and calcified raphe, significantly influence the outcomes of TAVR in the BAV population.

Background: Impaired recovery oxygen kinetics have been associated with greater prognostic risk in individuals with heart failure (HF). However, these parameters have not been routinely implemented into clinical practice when interpreting cardiopulmonary exercise tests (CPET). This study sought to identify a simple post-exercise oxygen kinetic parameter and assess prognostic outcomes in individuals with HF.

Method: Individuals with HF who underwent CPET were assessed. A novel parameter, oxygen consumption recovery ratio (V˙O₂RR), defined as the ratio of the V˙O₂ measured 10-40 seconds post-exercise (V˙O_2recovery) to V˙O_2peak, was used to assess V˙O₂ recovery. The ability of V˙O₂RR to predict major cardiac-related events (death, left ventricular assist device transplantation, or cardiac transplantation) within 24 months of CPET was examined.

Results: A total of 140 individuals with HF were included. When stratified by a V˙O₂RR ≥1.00, those with a higher V˙O₂RR demonstrated worse exercise capacity and ventilatory efficiency (V˙O_2peak: 18.4±6.0 vs 13.0±2.8 mL.min^-1.kg^-1; V˙_E/V˙CO₂ slope: 37.7±9.5 vs 41.7±8.0, respectively). A V˙O₂RR of ≥1.00 predicted poorer transplant-free survival in both univariate and multivariable logistic regression models (odds ratios were 14% and 8% per 0.01 increase in V˙O₂RR, respectively; both p<0.05).

Conclusions: The V˙O₂RR is an easily calculated parameter from a CPET that predicts outcomes in HF. Additionally, when combined with V˙O_2peak, the V˙O₂RR offers greater prognostic value in predicting outcomes in HF populations.