JACC. Cardiovascular interventions最新文献

英文中文

Major Bleeding Risk Assessment With Atrial Fibrillation Post-TAVR tavr术后心房颤动的大出血风险评估

IF 11.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions

Pub Date : 2026-02-09 DOI: 10.1016/j.jcin.2025.11.028

George D. Dangas MD, PhD , Martin Unverdorben MD, PhD , Christian Hengstenberg MD , Roxana Mehran MD , Raúl Moreno MD, PhD , Luis Nombela-Franco MD , Tetsuya Kimura MS , Diego López-Otero MD, PhD , Peter Nordbeck MD , Yusuke Watanabe MD, PhD , Hyo-Soo Kim MD, PhD , Johny Nicolas MD , Johanna van Zyl PhD , Cathy Chen MD , Stéphane Noble MD , Nicolas M. Van Mieghem MD, PhD

Background

Estimating the probability of major bleeding (MB) in patients with atrial fibrillation (AF) after transcatheter aortic valve replacement (TAVR) is important for decision-making regarding anticoagulation strategy.

Objectives

The aim of this study was to identify independent predictors of MB to create a risk assessment score in patients with AF after successful TAVR.

Methods

In this ENVISAGE-TAVI AF (EdoxabaN Versus standard of care and their effectS on clinical outcomes in pAtients havinG undergonE Transcatheter Aortic Valve Implantation-in Atrial Fibrillation; NCT02943785) on-treatment analysis, a stepwise Cox regression model identified MB predictors from baseline patient characteristics. A simple point-based additive score was constructed using the variable β estimates from the selected model. Patients were stratified into low-, moderate-, and high-risk groups according to their risk assessment scores; the likelihood of MB was compared between groups.

Results

Among 1,377 patients, 139 (10.1%) experienced MB (mean ± SD on-treatment follow-up: 1.3 ± 0.8 years). The independent predictors of MB formed the HARHP (low Hemoglobin, excessive Alcohol use, severe Renal impairment, history of Hypercholesterolemia, and Percutaneous coronary intervention performed within 30 days of TAVR) score, with each parameter given a weight of 1 or 2. The likelihood of MB for high-risk patients (score ≥ 4) was 6.5 times higher than for low-risk patients (score = 0 or 1) (HR: 6.54; 95% CI: 3.61-11.85; P < 0.0001) and 2.9 times higher than moderate-risk patients (score = 2 or 3) (HR: 2.86; 95% CI: 1.62-5.04; P = 0.0003). The C statistic for the HARHP score was 0.63 at 1-year follow-up and 0.62 at 2-year follow-up.

Conclusions

Five independent predictors of long-term MB were identified in patients with AF requiring oral anticoagulant agents after TAVR and formed the HARHP score to assess MB risk. Use of the HARHP score may improve patient outcomes.

评估心房颤动（AF）患者经导管主动脉瓣置换术（TAVR）后大出血（MB）的概率对抗凝策略的决策具有重要意义。目的：本研究的目的是确定独立的MB预测因素，以建立AF患者在TAVR成功后的风险评估评分。方法在这项envisagtavi AF（依多沙班与标准护理及其对经导管主动脉瓣置入术心房颤动患者临床结局的影响；NCT02943785）治疗分析中，逐步Cox回归模型从基线患者特征中确定了MB预测因子。使用所选模型的变量β估计构建了一个简单的基于点的加性评分。根据患者的风险评估得分将患者分为低、中、高风险组；比较两组间发生MB的可能性。结果1377例患者中，139例（10.1%）发生MB（治疗期平均±SD: 1.3±0.8年）。MB的独立预测因子形成了HARHP评分（低血红蛋白、过量饮酒、严重肾功能损害、高胆固醇血症史和TAVR后30天内进行的经皮冠状动脉介入治疗），每个参数的权重为1或2。高危患者（评分≥4）发生MB的可能性是低危患者（评分= 0或1）的6.5倍（HR: 6.54; 95% CI: 3.61-11.85; P < 0.0001），是中危患者（评分= 2或3）的2.9倍（HR: 2.86; 95% CI: 1.62-5.04; P = 0.0003）。随访1年HARHP评分的C统计值为0.63，随访2年为0.62。结论在TAVR后需要口服抗凝药物的AF患者中，确定了5个独立的长期MB预测因素，并形成了HARHP评分来评估MB风险。使用HARHP评分可以改善患者的预后。

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引用次数: 0

PCI After TAVR TAVR术后PCI

IF 11.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions

Pub Date : 2026-02-09 DOI: 10.1016/j.jcin.2025.11.031

Chen Mao PhD, Qing-Mei Huang MD

引用次数: 0

Ostial vs Ampulla Techniques to Measure Virtual Valve-to-Coronary Distance in TAVR Coronary Obstruction Risk 口腹技术测量TAVR冠状动脉阻塞风险中瓣膜到冠状动脉的虚拟距离。

IF 11.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions

Pub Date : 2026-02-09 DOI: 10.1016/j.jcin.2025.10.064

Rim N. Halaby MD , Christopher G. Bruce MD , Jaffar M. Khan PhD, MD , Toby Rogers PhD, MD , Adam B. Greenbaum MD , Vasilis C. Babaliaros MD , Robert J. Lederman MD

引用次数: 0

Genotype-Guided Antiplatelet Therapy 基因型引导抗血小板治疗

IF 11.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions

Pub Date : 2026-02-09 DOI: 10.1016/j.jcin.2025.12.005

Young-Hoon Jeong MD, PhD , Hendrianus Hendrianus MD , Diana A. Gorog MD

引用次数: 0

Parenteral Antiplatelets 注射用药物的抗血小板

IF 11.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions

Pub Date : 2026-02-09 DOI: 10.1016/j.jcin.2025.12.013

Zuzana Motovska MD, PhD , Deepak L. Bhatt MD, MPH, MBA

引用次数: 0

Long-Term Clinical and Hemodynamic Outcomes of Transcatheter Mitral Valve Replacement 经导管二尖瓣置换术的长期临床和血流动力学结果

IF 11.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions

Pub Date : 2026-01-26 DOI: 10.1016/j.jcin.2025.09.052

Nicolas Groshenry MD , Gaspard Suc MD, PhD , Jules Mesnier MD , Clemence Delhomme MD , Audrey Cailliau MD , Eric Brochet MD , Gregory Ducrocq MD, PhD , Reza Farnoud PhD , Linda Bleuze RN , Dominique Himbert MD , Skerdi Haviari MD , Bernard Iung MD, PhD , Marina Urena MD, PhD

Background

Long-term outcomes of transcatheter mitral valve replacement (TMVR) with balloon-expandable aortic prostheses remain uncertain.

Objectives

The aim of this study was to evaluate long-term clinical and hemodynamic outcomes after TMVR.

Methods

All patients undergoing TMVR at the authors’ center were included. Balloon-expandable transcatheter heart valves were implanted in all cases, usually using a trans-septal approach. The primary outcome was a composite of death or mitral reintervention (surgical or transcatheter replacement or transplantation). Secondary outcomes included mortality, hemodynamic changes, recurrent mitral regurgitation, structural valve deterioration (SVD), and TMVR failure.

Results

A total of 200 patients underwent TMVR: 60.5% (121 of 200) valve-in-valve, 22.5% (45 of 200) valve-in-ring, and 17% (34 of 200) valve–in–mitral annular calcification. The median age was 70 years (Q1-Q3: 52-80 years), and 67% were women (134 of 200). Median follow-up was 3.2 years (Q1-Q3: 1.2-6.8 years). Freedom from death or reintervention at 1, 5, and 8 years was 82% (95% CI: 77%-88%), 48% (95% CI: 40%-56%), and 20% (95% CI: 11%-29%), respectively, with worse outcomes in valve-in-ring and valve–in–mitral annular calcification compared with valve-in-valve (P < 0.01). Mean gradient increased slightly over time (+0.25 ± 0.07 mm Hg/y; P < 0.01), with a modest decrease in effective orifice area (−0.04 cm²/y; P < 0.01). Significant recurrent mitral regurgitation occurred in 5.5% of patients (11 of 200). Seven percent (14 of 200) developed severe SVD after 5.3 (Q1-Q3: 3.5-7.4 years), and 10% (20 of 200) developed TMVR failure after 4.4 (Q1-Q3: 1.8-6.7 years).

Conclusions

TMVR with balloon-expandable aortic prostheses provides favorable long-term outcomes and acceptable durability, with low rates of severe SVD and valve failure.

背景：经导管二尖瓣置换术（TMVR）与球囊扩张主动脉假体的长期预后仍不确定。目的本研究的目的是评估TMVR后的长期临床和血流动力学结果。方法纳入所有在作者中心接受TMVR的患者。所有病例均采用球囊扩张经导管心脏瓣膜植入，通常采用经隔膜入路。主要结局是死亡或二尖瓣再干预（手术或经导管置换术或移植）。次要结局包括死亡率、血流动力学改变、复发性二尖瓣反流、结构性瓣膜恶化（SVD）和TMVR衰竭。结果200例患者行TMVR: 60.5%（200例中121例）瓣内化，22.5%（200例中45例）瓣内环钙化，17%（200例中34例）瓣内环钙化。中位年龄为70岁（Q1-Q3: 52-80岁），其中67%为女性（200人中有134人）。中位随访时间为3.2年（Q1-Q3: 1.2-6.8年）。1年、5年和8年无死亡或再干预的分别为82% （95% CI: 77%-88%）、48% （95% CI: 40%-56%）和20% (95% CI: 11%-29%)，与瓣内瓣相比，瓣内环和二尖瓣内环钙化的结果更差（P < 0.01）。随着时间的推移，平均梯度略有增加（+0.25±0.07 mm Hg/y; P < 0.01），有效孔口面积略有减少（- 0.04 cm2/y; P < 0.01）。5.5%（11 / 200）的患者出现明显的二尖瓣返流。7%（200人中有14人）在5.3年（Q1-Q3: 3.5-7.4年）后出现严重SVD， 10%（200人中有20人）在4.4年（Q1-Q3: 1.8-6.7年）后出现TMVR失败。结论stmvr联合球囊扩张主动脉假体具有良好的远期疗效和可接受的耐久性，严重SVD和瓣膜衰竭发生率低。

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引用次数: 0

The Predictive Value of Right Ventricle to Pulmonary Artery Coupling in Valvular Heart Disease 右心室-肺动脉耦合对瓣膜性心脏病的预测价值：三瓣一征。

IF 11.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions

Pub Date : 2026-01-26 DOI: 10.1016/j.jcin.2025.11.016

Alessandro Sticchi MD , Lukas Stolz MD

引用次数: 0

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IF 11.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions

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引用次数: 0

Drug-Coated Balloon Angioplasty vs Drug-Eluting Stent Implantation Following Rotational Atherectomy for Heavily Calcified Coronary Lesions 药物包被球囊血管成形术与药物洗脱支架植入术后旋转动脉粥样硬化严重钙化病变

IF 11.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions

Pub Date : 2026-01-26 DOI: 10.1016/j.jcin.2025.09.040

Hisanori Yui MD, PhD , Yoshifumi Kashima MD , Takuro Sugie MD , Yutaka Tadano MD , Umihiko Kaneko MD , Takuya Shimizu MD, PhD , Daitaro Kanno MD , Koichiro Kuwahara MD, PhD , Tsutomu Fujita MD , Shoichi Kuramitsu MD, PhD

引用次数: 0

Redo Transcatheter Aortic Valve Replacement in Bicuspid Valves 双尖瓣重做经导管主动脉瓣置换术

IF 11.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions

Pub Date : 2026-01-26 DOI: 10.1016/j.jcin.2025.06.046

Nikolaos Pyrpyris MD , Kyriakos Dimitriadis MD, PhD , Eirini Beneki MD, MSc , Konstantina Aggeli MD, PhD , Konstantinos Tsioufis MD, PhD

引用次数: 0

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