Journal of Cardiovascular Medicine最新文献

Background: Transcatheter edge-to-edge tricuspid valve repair (T-TEER) has emerged as a well tolerated and efficacious treatment modality among patients with tricuspid valve regurgitation. Right ventricular dysfunction (RVD) has been observed in up to 22% of patients undergoing T-TEER. Currently, the determinants of RVD recovery are not sufficiently understood.

Methods: All patients in four German tertiary cardiac centers scheduled for T-TEER were included for analysis. Patients were divided according to concomitant RVD at the time of T-TEER. RVD was defined as impairment of either tricuspid plane systolic excursion (TAPSE) or right ventricular fractional area change (RV-FAC). The primary endpoint of the study was recovery from RVD during follow-up 3 months after T-TEER. Predictors of RVD recovery were identified via univariable and multivariable logistic regression analyses.

Results: A total of 105 patients were included. Concomitant RVD was present in 43.8% of the patients (46/105). Recovery from RVD was observed in 47.8% (22/46) of patients, particularly in patients with mild RVD at baseline according to the TAPSE. A sufficient reduction in tricuspid valve regurgitation to mild severity likewise constituted a predictor of RVD recovery and emerged as a surrogate parameter of reduced right ventricular volume overload.

Conclusion: Recovery from RVD was most likely in patients who presented with mild RVD and a sufficient reduction in tricuspid valve regurgitation to mild severity according to T-TEER. Early identification and interventional treatment of today's patients with high-grade tricuspid valve regurgitation and RVD represent key factors in providing relief for this particular cohort of patients.

Background: Coronary microvascular dysfunction (CMD) is common in ST-segment elevation myocardial infarction (STEMI) patients despite timely primary percutaneous coronary intervention (PPCI). Angiography-derived microcirculatory resistance (AMR), a novel noninvasive CMD index, offers potential for risk stratification, but its prognostic value in STEMI over mid- and long-term follow-up remains unclear.

Methods: This retrospective study enrolled 278 STEMI patients between May 2023 and May 2024, excluding those with prior coronary artery bypass grafting, severe left main disease, or poor angiographic quality. The primary endpoint was major adverse cardiovascular events (MACE), including cardiac death, nonfatal myocardial infarction, and stroke.

Results: During a mean follow-up of 14.30 ± 6.45 months, 44 patients (15.8%) experienced MACE. AMR ≥300 was strongly associated with higher MACE rates and demonstrated superior predictive value compared with corrected TIMI frame count (area under the receiver operating characteristic curve, 0.705, P < 0.001). Restricted cubic spline analysis revealed a nonlinear relationship between AMR and MACE, with a significant increase in risk at AMR ≥300 (nonlinear P = 0.0142). Multivariable Cox regression identified AMR ≥300, age, white blood cell count, and left ventricular ejection fraction (LVEF) as independent predictors of MACE. Incorporating AMR into traditional risk models significantly improved the predictive performance of the MACE (C-index: 0.659 vs. 0.824, P < 0.001).

Conclusions: AMR ≥300 is an independent predictor of MACE in STEMI patients post-PPCI. Incorporating AMR into risk models improves predictive accuracy, supporting its use in clinical practice.

Aim: The distinctive feature of the analgesia induced by morphine is the profound pain relieving combined with the lack of loss of consciousness. We evaluated the impact of the use of morphine as the first anesthetic drug during the thermal atrial fibrillation (AF) ablation procedure.

Methods: One hundred and nine patients undergoing radiofrequency (RF) or cryoballoon (Cryo) pulmonary vein (PV) isolation using sedation by means of morphine were enrolled (Group 1) and compared with the last consecutive 109 patients treated with thermal ablation using a conscious sedation protocol with midazolam as the first drug used (Group 2). Pain was assessed by means of a numerical rating scale.

Results: No statistically significant differences were observed between the two study groups. All PVs were isolated. No patients required general anesthesia or deep sedation. In Group 1, ablation was carried out under morphine alone in 78 patients with a mean morphine dose/patient of 8.5 ± 2.3 mg. Midazolam was used in 31 (28%, 21 RF, 10 Cryo) patients, and Fentanyl in 2 RF patients. In Group 2, ablation was carried out without any anesthetic drug in 35 (32%) patients. Midazolam was required in 74 (68%) patients with a mean dose/patient of 3.3 ± 1.5 mg. Fentanyl was required in five (5%) patients. There was no difference in the overall pain experience between the two study groups (4.7 ± 1.6 vs. 4.8 ± 1.5, P = 0.58).

Conclusions: Thermal catheter ablation for AF can be performed under conscious sedation using only morphine in most patients without impacting the patient's pain experience.

Background: Pulmonary vein isolation (PVI) is still the cornerstone for the catheter ablation of paroxysmal atrial fibrillation (AF). A combined radiofrequency (RF) approach using very high-power short-duration (vHPSD) posteriorly and ablation index guided high-power short-duration (HPSD) anteriorly has been recently shown to provide excellent profiles of effectiveness, safety and efficiency. The present study sought to compare with a propensity score match analysis vHPSD/HPSD ablation to cryoballoon (CB) ablation in patients with paroxysmal AF.

Methods: All patients having undergone PVI as the index procedure for paroxysmal AF were consecutively included. A 1 : 1 propensity score matching was carried out including age, gender, arterial hypertension, diabetes, left atrial diameter, and left ventricular ejection fraction in the logistic regression model.

Results: Ninety-six patients who had undergone RF were matched and compared with 96 patients who had undergone CB ablation. The mean age was 61.8 ± 9.8 years (142 males, 74%). Over a mean follow-up of 22.6 ± 5.9 months, freedom from atrial tachyarrhythmias was achieved in 75% of patients (72/96) in the CB group and in 84.4% of patients (81/96) in the RF group (P = 0.1). One cerebrovascular event (1.0%) treated with mechanical thrombectomy and four phrenic nerve palsies (4.2%), which recovered within 1 year, occurred in the CB group. Procedure times were similar (88.6 ± 14.0 vs. 92.1 ± 12.1 min, P = 0.1), but the fluoroscopy time was shorter in the vHPSD/HPSD group (10.8 ± 2.5 vs. 4.9 ± 1.8 min, P < 0.01).

Conclusions: The optimized workflow in a setting of a hybrid RF approach of vHPSD/HPSD made point-by-point PVI as fast, safe and effective as CB ablation.