JACC. Cardiovascular interventions最新文献

英文中文

Single-Leaflet Device Attachment After Mitral Transcatheter Edge-to-Edge Repair: Systematic Review and Meta-analysis. 二尖瓣经导管边对边修补术后的单叶器械附着：系统综述与 Meta 分析。

IF 11.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions

Pub Date : 2024-09-12 DOI: 10.1016/j.jcin.2024.08.008

Kirtipal Bhatia, Soumya Gupta, Kristen Carter, Marija Petrovic, Samantha V Shetty, Devika Aggarwal, Abel Casso Dominguez, Stamatios Lerakis, Edgar Argulian

引用次数: 0

Treatment of Aortic Regurgitation With a Novel Device 使用新型设备治疗主动脉瓣反流：J-Valve 早期可行性研究结果。

IF 11.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions

Pub Date : 2024-09-09 DOI: 10.1016/j.jcin.2024.06.028

Santiago Garcia MD, Tsuyoshi Kaneko MD, Michael Reardon MD, Sachin Goel MD, David J. Cohen MD, MSc, João L. Cavalcante MD, Michael L. Chuang MD, Rebecca T. Hahn MD, Azeem Latib MD, Ron Waksman MD, David G. Rizik MD, Peter Fail MD, Sameer A. Gafoor MD, Dean J. Kereiakes MD

引用次数: 0

Advancing Our Understanding of Post-TAVR Clinical Outcomes 增进我们对 TAVR 术后临床结果的了解

IF 11.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions

Pub Date : 2024-09-09 DOI: 10.1016/j.jcin.2024.07.040

Jonathon A. Leipsic MD, John K. Khoo MBBS

引用次数: 0

Volume-Adjusted Annular Sizing of Balloon-Expandable Transcatheter Heart Valves for Severe Bicuspid Aortic Valve Stenosis 用于治疗重度双尖瓣主动脉瓣狭窄的球囊扩张型经导管心脏瓣膜的体积调整瓣环尺寸

IF 11.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions

Pub Date : 2024-09-09 DOI: 10.1016/j.jcin.2024.06.023

So-Min Lim MD, Jung-Min Ahn MD, Do-Yoon Kang MD, Ha Hye Jo MD, Joong Min Lee MD, Young-Sun Park MD, Duk-Woo Park MD, Seung-Jung Park MD, PhD

引用次数: 0

The Feasibility of Cardiac Snare Retrieval of Embolized Cyanoacrylate Glue 栓塞氰基丙烯酸酯胶水的心脏卡环取出术的可行性

IF 11.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions

Pub Date : 2024-09-09 DOI: 10.1016/j.jcin.2024.07.026

Bryan P. Traynor MBBCh, BAO, Ahmad Alli MD, Melissa Y.Y. Moey MD, Loai Almazroa MD, Gianluigi Bisleri MD, Neil P. Fam MD, Sami Alnasser MD

引用次数: 0

Management of Pulmonary Congestion in Patients With Aortic Stenosis 主动脉瓣狭窄患者肺充血的处理方法

IF 11.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions

Pub Date : 2024-09-09 DOI: 10.1016/j.jcin.2024.07.027

Nicolas Girerd MD, PhD , Philippe Pibarot DVM, PhD

引用次数: 0

3-Year Outcomes of Balloon-Expandable Valves 球囊扩张瓣膜的 3 年疗效：20 毫米与更大的瓣膜（≥23 毫米）。

IF 11.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions

Pub Date : 2024-09-09 DOI: 10.1016/j.jcin.2024.06.001

Marvin H. Eng MD , Houman Khalili MD , John Vavalle MD , Karim M. Al-Azizi MD , Tom Waggoner DO , Jefferey A. Southard MD , Kenith Fang MD , Rebecca T. Hahn MD , James Lee MD , Dee Dee Wang MD , Mackram F. Eleid MD , William W. O’Neill MD , Amr E. Abbas MD

Background

A prior Society of Thoracic Surgeons/American College of Cardiology TVT (Transcatheter Valve Therapy) Registry–based analysis reported similar 1-year clinical outcomes with small (20-mm) vs large (≥23-mm) balloon-expandable valves (BEV).

Objectives

The aim of this study was to describe mid-term 3-year clinical outcomes for small vs large BEV and the relationship between discharge echocardiographic mean gradient (MG) and different definitions of prothesis-patient mismatch (PPM) with clinical outcomes.

Methods

Using the TVT Registry with Centers for Medicare and Medicaid Services linkage, a propensity-matched analysis of patients receiving 20- vs ≥23-mm BEVs was performed. Spline curves and Kaplan-Meier plots with adjusted HRs determined the relationship between MG and 3-year mortality.

Results

In total, 316,091 patients were analyzed; after propensity matching, 8,100 pairs of each group were compared. The 20-mm BEV was associated with higher MGs compared with ≥23-mm BEVs (16.2 ± 7.2 mm Hg vs 11.8 ± 5.7 mm Hg; P < 0.0001). At 3 years, there was no difference in mortality between 20- and ≥23-mm BEVs (31.5% vs 32.5%, respectively; HR: 0.97; 95% CI: 0.90-1.05). Compared with an MG of 10 to 30 mm Hg, an MG <10 mm Hg (HR: 1.25; 95% CI:1.22-1.27) was associated with increased 3-year mortality. Measured severe PPM and predicted no PPM were associated with increased 3-year mortality (33.5% vs 32.9% vs 32.1%; P < 0.0001) and (33.5% vs 31.1% vs 30%; P < 0.0001), respectively. Low MG and severe measured PPM were associated with lower left ventricular ejection fraction (LVEF).

Conclusions

Patients with small-prosthesis BEVs (20 mm) had identical 3-year survival as those with larger (≥23-mm) BEV valves. Severe measured PPM and low MG (<10 mm Hg), but not predicted severe PPM, were associated with lower LVEF and increased mortality, suggesting that LVEF is the culprit for worse outcomes.

背景：之前胸外科医师协会/美国心脏病学会 TVT（经导管瓣膜治疗）注册中心的一项分析报告显示，小型（20 毫米）与大型（≥23 毫米）球囊扩张瓣膜（BEV）的 1 年临床疗效相似：本研究旨在描述小瓣膜与大瓣膜的 3 年中期临床疗效，以及出院超声心动图平均梯度（MG）和假体与患者不匹配（PPM）的不同定义与临床疗效之间的关系：利用与美国医疗保险和医疗补助服务中心（Centers for Medicare and Medicaid Services）链接的 TVT 注册表，对接受 20 毫米与≥23 毫米 BEV 的患者进行倾向匹配分析。结果显示，MG与3年死亡率之间的关系是通过Spline曲线和Kaplan-Meier图以及调整后的HRs确定的：共分析了 316,091 例患者；经过倾向匹配后，每组有 8,100 对患者进行了比较。与≥23毫米的BEV相比，20毫米的BEV与较高的MG有关（16.2 ± 7.2毫米汞柱 vs 11.8 ± 5.7毫米汞柱；P < 0.0001）。3 年后，20 mm 和 ≥23 mm BEV 之间的死亡率没有差异（分别为 31.5% vs 32.5%；HR：0.97；95% CI：0.90-1.05）。与 10 至 30 mm Hg 的 MG 相比，MG 更低：小人工瓣膜（20 毫米）患者与大人工瓣膜（≥23 毫米）患者的 3 年生存率相同。测量到的严重 PPM 和低 MG (

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引用次数: 0

Mechanical Circulatory Support–Assisted Percutaneous Rescue of Ventricularly Embolized Transcatheter Heart Valve 机械循环支持辅助经皮抢救脑室栓塞的经导管心脏瓣膜。

IF 11.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions

Pub Date : 2024-09-09 DOI: 10.1016/j.jcin.2024.07.012

Jonathan X. Fang MBBS, Pedro A. Villablanca MD, Brian P. O’Neill MD, Dee Dee Wang MD, Pedro Engel Gonzalez MD, Sammi Dali MD, Gennaro Giustino MD, James C. Lee MD, William W. O’Neill MD, Tiberio M. Frisoli MD

引用次数: 0

Real-World Implementation of a Genotype-Guided P2Y12 Inhibitor De-Escalation Strategy in Acute Coronary Syndrome Patients 在急性冠状动脉综合征患者中实际实施基因型指导的 P2Y12 抑制剂去梗策略。

IF 11.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions

Pub Date : 2024-09-09 DOI: 10.1016/j.jcin.2024.06.020

Jaouad Azzahhafi MD , Wout W.A. van den Broek MD , Dean R.P.P. Chan Pin Yin MD , Niels M.R. van der Sangen MD , Shabiga Sivanesan MD , Salahodin Bofarid MD , Joyce Peper MSc, PhD , Daniel M.F. Claassens MD, PhD , Paul W.A. Janssen MD, PhD , Ankie M. Harmsze PharmD, PhD , Ronald J. Walhout MD, PhD , Melvyn Tjon Joe Gin MD , Deborah M. Nicastia MD , Jorina Langerveld MD, PhD , Georgios J. Vlachojannis MD, PhD , Rutger J. van Bommel MD, PhD , Yolande Appelman MD, PhD , Ron H.N. van Schaik MSc, PhD , José P.S. Henriques MD, PhD , Wouter J. Kikkert MD, PhD , Jurriën M. ten Berg MD, PhD

Background

CYP2C19 genotype–guided de-escalation from ticagrelor or prasugrel to clopidogrel may optimize the balance between ischemic and bleeding risk in patients with acute coronary syndrome (ACS).

Objectives

This study sought to compare bleeding and ischemic event rates in genotyped patients vs standard care.

Methods

Since 2015, ACS patients in the multicenter FORCE-ACS (Future Optimal Research and Care Evaluation in Patients with Acute Coronary Syndrome) registry received standard dual antiplatelet therapy (DAPT). Since 2021, genotype-guided P2Y₁₂ inhibitor de-escalation was recommended at a single center, switching noncarriers of the loss-of-function allele CYP2C19∗3 or CYP2C19∗2 from ticagrelor or prasugrel to clopidogrel, whereas loss-of-function carriers remained on ticagrelor or prasugrel. The primary ischemic endpoint, a composite of cardiovascular mortality, myocardial infarction, or stroke, and the primary bleeding endpoint, Bleeding Academic Research Consortium 2, 3, or 5 bleeding, were compared between a genotyped cohort and a cohort treated with standard DAPT after 1 year.

Results

Among 5,321 enrolled ACS patients, 406 underwent genotyping compared with 4,915 nongenotyped ACS patients on standard DAPT. In the genotyped cohort, 65.3% (n = 265) were noncarriers, 88.7% (n = 235) of whom were switched to clopidogrel. The primary ischemic endpoint occurred in 5.2% (n = 21) of patients in the genotyped cohort compared to 6.9% (n = 337) in the standard care cohort (adjusted HR: 0.82; 95% CI: 0.53-1.28). The primary bleeding rate was significantly lower in the genotyped cohort compared to the standard care cohort (4.7% vs 9.8%; adjusted HR: 0.47; 95% CI: 0.30-0.76).

Conclusions

The implementation of a CYP2C19 genotype–guided P2Y₁₂ inhibitor de-escalation strategy in a real-world ACS population resulted in lower bleeding rates without an increase in ischemic events compared to a standard DAPT regimen.

背景：在CYP2C19基因型指导下，从替卡格雷或普拉格雷降至氯吡格雷可优化急性冠脉综合征（ACS）患者缺血和出血风险之间的平衡：本研究旨在比较基因分型患者与标准治疗的出血和缺血事件发生率：自2015年起，多中心FORCE-ACS（急性冠状动脉综合征患者未来最佳研究与护理评估）登记处的ACS患者接受标准双联抗血小板疗法（DAPT）。自2021年起，一个中心建议在基因型指导下进行P2Y12抑制剂降级，将非功能缺失等位基因CYP2C19∗3或CYP2C19∗2携带者从替卡格雷或普拉格雷换成氯吡格雷，而功能缺失携带者则继续使用替卡格雷或普拉格雷。对基因分型队列和接受标准 DAPT 治疗 1 年后的队列进行了主要缺血终点（心血管死亡率、心肌梗死或中风的复合终点）和主要出血终点（出血学术研究联盟 2、3 或 5 期出血）的比较：在5321名入选的ACS患者中，有406名接受了基因分型，而未接受基因分型的ACS患者中有4915名接受了标准DAPT治疗。在基因分型队列中，65.3%（n = 265）为非携带者，其中88.7%（n = 235）改用氯吡格雷。在基因分型队列中，5.2%（n = 21）的患者出现主要缺血终点，而在标准治疗队列中，这一比例为 6.9%（n = 337）（调整后 HR：0.82；95% CI：0.53-1.28）。基因分型队列的原发性出血率明显低于标准护理队列（4.7% vs 9.8%；调整后HR：0.47；95% CI：0.30-0.76）：结论：与标准DAPT方案相比，在真实世界的ACS人群中实施CYP2C19基因型指导的P2Y12抑制剂降级策略可降低出血率，同时不增加缺血事件。

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引用次数: 0

Management of Fluid Overload in Patients With Severe Aortic Stenosis (EASE-TAVR) 重度主动脉瓣狭窄患者体液超负荷管理（EASE-TAVR）

IF 11.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions

Pub Date : 2024-09-09 DOI: 10.1016/j.jcin.2024.06.022

Kseniya Halavina MD , Matthias Koschutnik MD , Carolina Donà MD , Maximilian Autherith MD , Fabian Petric MD , Anna Röckel , Georg Spinka MD , Daryush Danesh MD , Jürgen Puchinger MD , Martin Wiesholzer MD , Katharina Mascherbauer MD , Gregor Heitzinger MD, PhD , Varius Dannenberg MD , Sophia Koschatko MD , Charlotte Jantsch MD , Max-Paul Winter MD, PhD , Georg Goliasch MD, PhD , Andreas A. Kammerlander MD, PhD , Philipp E. Bartko MD, PhD , Christian Hengstenberg MD , Christian Nitsche MD, PhD

Background

Fluid overload (FO) subjects patients with severe aortic stenosis (AS) to increased risk for heart failure and death after valve replacement and can be objectively quantified using bioimpedance spectroscopy (BIS).

Objectives

The authors hypothesized that in AS patients with concomitant FO, BIS-guided decongestion could improve prognosis and quality of life following transcatheter aortic valve replacement (TAVR).

Methods

This randomized, controlled trial enrolled 232 patients with severe AS scheduled for TAVR. FO was defined using a portable whole-body BIS device according to previously established cutoffs (≥1.0 L and/or ≥7%). Patients with FO (n = 111) were randomly assigned 1:1 to receive BIS-guided decongestion (n = 55) or decongestion by clinical judgment alone (n = 56) following TAVR. Patients without FO (n = 121) served as a control cohort. The primary endpoint was the composite of hospitalization for heart failure and/or all-cause death at 12 months. The secondary endpoint was the change from baseline to 12 months in the Kansas City Cardiomyopathy Questionnaire.

Results

The occurrence of the primary endpoint at 12 months was significantly lower in the BIS-guided vs the non–BIS-guided decongestion group (7/55 [12.7%, all deaths] vs 18/56 [32.1%, 9 hospitalizations for heart failure and 9 deaths]; HR: 0.36; 95% CI: 0.15-0.87; absolute risk reduction = −19.4%). Outcomes in the BIS-guided decongestion group were identical to the euvolemic control group (log-rank test, P = 0.7). BIS-guided decongestion was also associated with a higher increase in the Kansas City Cardiomyopathy Questionnaire score from baseline compared to non–BIS-guided decongestion (P = 0.001).

Conclusions

In patients with severe AS and concomitant FO, quantitatively guided decongestive treatment and associated intensified management post-TAVR was associated with improved outcomes and quality of life compared to decongestion by clinical judgment alone. (Management of Fluid Overload in Patients Scheduled for Transcatheter Aortic Valve Replacement [EASE-TAVR]; NCT04556123)

背景流体超负荷（FO）使严重主动脉瓣狭窄（AS）患者在瓣膜置换术后发生心力衰竭和死亡的风险增加，可使用生物阻抗光谱（BIS）进行客观量化。方法这项随机对照试验纳入了 232 例计划进行 TAVR 的严重 AS 患者。根据之前确定的临界值（≥1.0 L 和/或≥7%），使用便携式全身 BIS 设备对 FO 进行定义。FO患者（n = 111）按1:1的比例随机分配到TAVR后接受BIS引导下的减充血（n = 55）或仅靠临床判断的减充血（n = 56）。无 FO 的患者（n = 121）作为对照组。主要终点是12个月时因心衰住院和/或全因死亡的复合终点。结果BIS引导组与非BIS引导下解除充血组相比，12个月时主要终点的发生率显著降低（7/55 [12.7%，全部死亡] vs 18/56 [32.1%，9例心衰住院和9例死亡]；HR：0.36；95% CI：0.15-0.87；绝对风险降低=-19.4%）。BIS引导下解除充血组的结果与无充血对照组相同（对数秩检验，P = 0.7）。结论在重度 AS 并伴有 FO 的患者中，与仅通过临床判断进行减充血相比，TAVR 术后定量指导减充血治疗和相关强化管理可改善预后和生活质量。(计划接受经导管主动脉瓣置换术患者的体液超负荷管理[EASE-TAVR]；NCT04556123）

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