Journal of Cardiovascular Medicine最新文献

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.

Aims: The PRIORITY (PRedictIng long-term Outcomes afteR Isolated coronary artery bypass surgerY) project was designed to identify preoperative risk factors for 10-year all-cause mortality and major adverse cardiac and cerebrovascular events (MACCE) after isolated coronary artery bypass grafting (CABG).

Methods: PRIORITY is an observational cohort study merging two prospective multicenter studies conducted in 2002-2004 and 2007-2008 on isolated CABG. Follow-up information was obtained through administrative databases and was truncated 10 years after the intervention. The primary endpoint was long-term all-cause mortality and the secondary endpoint was a composite of MACCE.

Results: The study cohort included 10 989 patients with complete 10-year follow-up. Mortality up to 10 years was associated with almost all variables defined by EuroSCORE and the risk factors with higher impact were left ventricular ejection fraction (LVEF) <30% [hazard ratio (HR) 2.29, 95% confidence interval (CI) 1.95-2.69], diabetes (HR 3.17, 95% CI 2.31-4.34), and cirrhosis (HR 3.90, 95% CI 2.09-7.28). Also, 10-year MACCE was affected by preoperative comorbidities defined by EuroSCORE, with different weights compared with 30-day prediction scores. The risk factors with the worst effect on long-term MACCE were LVEF <30% (HR 1.61, 95% CI 1.39-1.86), dialysis (HR 2.52, 95% CI 1.87-3.40), and cirrhosis (HR 1.93, 95% CI 1.09-3.41). Both scores demonstrated good performance in terms of discrimination and calibration.

Conclusion: The PRIORITY study confirms the importance of long-term follow-up for patients who undergo CABG and has led to the design of online risk calculators for predicting all-cause mortality and MACCE up to 10 years to support the clinical management of patients.

Background: Left ventricular global longitudinal strain (LV-GLS) is associated with increased risk of adverse outcomes in nonischemic dilated cardiomyopathy (NIDCM). However, it can be altered by LV afterload. The global myocardial work index (GMWI) accounts for LV afterload and could improve risk discrimination when compared with LV-GLS. We sought to determine whether GMWI outperformed LV-GLS for risk stratification in patients with NIDCM.

Methods and results: We determined the association between GMWI and a combined endpoint of death or heart failure (HF) admission. We included 524 patients with NIDCM (median age 67 years, LVEF 35%), with a median GMWI of 968 mmHg%. Patients with lower GMWI had more frequent history of HF admission, higher E/e' ratio, and worse right ventricular function. During a median follow-up of 3.4 years, 171 had the endpoint. There was a significant and nonlinear relationship between GMWI and the endpoint, with a progressive increase in risk until values below 1000 mmHg% were reached, where the risk of the endpoint plateaued. GMWI was strongly collinear with LV-GLS, and both parameters demonstrated similar performance after adjustment, suggesting that GMWI adds little value in this population if LV-GLS has already been accounted for.

Conclusion: In patients with NIDCM, lower GMWI is associated with previous HF admission, worse echocardiographic parameters and higher risk of subsequent HF admissions and death, but it does not seem to improve discrimination when compared with LV-GLS.

Background: The potential clinical benefit of complex high-risk indicated percutaneous coronary intervention (CHIP-PCI) remains uncertain. Temporary mechanical circulatory support with a microaxial flow pump allows the performance of protected PCI, potentially reducing peri-procedural myocardial injury and enabling a more complete myocardial revascularization. Whether this reflects an improvement in left ventricular (LV) function after PCI remains uncertain.

Methods: We conducted a systematic literature search in PubMed/MEDLINE, Scopus and CENTRAL and performed a one-group meta-analysis using pre- and post-PCI LV ejection fraction (LVEF) data from randomized and observational studies evaluating microaxial flow pump use in CHIP-PCI. The primary outcome was the mean difference (MD) in LVEF between follow-up and baseline.

Results: Nine studies involving 2370 patients were included, with a weighted follow-up period of 154.6  days. Overall, 67.4% of patients had chronic coronary syndrome as the clinical presentation, with a mean SYNTAX score of 32.8 and a mean baseline LVEF of 29.5%. CHIP-PCI assisted by a microaxial flow pump was associated with a significant improvement in LVEF during follow-up (MD, +6.70%; 95% confidence interval, 4.49 to 8.91, P = 0.0001).

Conclusions: Microaxial flow pump-supported CHIP-PCI was associated with significant LVEF increase at follow-up, suggesting its potential beneficial role in LV functional recovery after myocardial revascularization in CHIP patients.

Aims: Lipoprotein(a) [Lp(a)] is a recognized risk factor for atherosclerotic cardiovascular disease. However, its potential association with the risk of recurrent atrial fibrillation (AF) after ablation remains unexplored. This study aimed to investigate whether Lp(a) serum levels are linked to the risk of recurrent AF following pulsed field ablation (PFA).

Methods: A retrospective cohort analysis was conducted on patients who underwent PFA at the Cardiology Clinic of the Ferrara University Hospital from October 2023 to January 2025. Lp(a) percentile groups were established, with the first 50th percentile serving as the reference. Cox proportional hazards modeling was used to assess the relationship between Lp(a) percentile and recurrent AF after PFA.

Results: The study included 133 patients (mean age 59.6 years, 29.3% women). Over a median follow-up of 7.8 months after the blanking period (range: 6.4-9.3 months), 29 patients (21.8%) experienced confirmed recurrent AF. A continuous increase in the hazard of recurrent AF was observed with rising Lp(a) levels. Specifically, individuals in the 51st-70th, 71st-90th, and 91st-100th Lp(a) percentiles had adjusted hazard ratios of 1.13 [95% confidence interval (CI): 1.04-1.22, P < 0.001], 1.21 (95% CI: 1.11-1.31, P < 0.001), and 1.26 (95% CI: 1.13-1.39, P < 0.001), respectively.

Conclusions: Elevated Lp(a) levels are associated with an increased risk of recurrent AF after PFA, suggesting that Lp(a)-lowering therapies may be beneficial for these patients.

Aims: Contrast-induced nephropathy (CIN) remains a significant complication following coronary angiography (CAG) and percutaneous coronary intervention (PCI), particularly among patients with diabetes mellitus. Sodium-glucose cotransporter-2 inhibitors (SGLT-2i) have demonstrated renoprotective effects in chronic kidney disease; however, their role in preventing CIN remains unclear.

Methods: In this retrospective, single-center study, 206 patients with diabetes mellitus and acute coronary syndrome (ACS) undergoing CAG or PCI were included. Patients were divided into two groups based on SGLT-2i usage. Lasso penalized regression analysis was performed to identify significant predictors of CIN, followed by multivariate logistic regression analysis to adjust for potential confounders. The predictive performance of the model was assessed using a receiver-operating characteristic curve.

Results: The study included 94 SGLT-2i users and 112 nonusers. CIN occurred less frequently among SGLT-2i users (9.6 vs. 16.1%). Lasso regression identified female sex, SGLT-2i usage, contrast amount, baseline glomerular filtration rate (GFR), and left ventricular ejection fraction (LVEF) as significant predictors of CIN. Multivariate analysis demonstrated that SGLT-2i usage was independently associated with a reduced risk of CIN (odds ratio: 0.24, P = 0.012), while female sex, lower LVEF, worse baseline GFR, and higher contrast volume were associated with increased CIN risk. The final model exhibited excellent discriminative ability (area under the curve: 0.85).

Conclusion: SGLT-2i usage was independently associated with a decreased risk of CIN among diabetic patients with ACS undergoing coronary interventional procedures. Female sex, reduced LVEF, impaired renal function, and greater contrast volume emerged as independent predictors of increased CIN risk.