Journal of Cardiovascular Medicine最新文献

Aims: Right heart failure (RHF) is associated with increased morbidity and mortality. We aimed to determine differences in baseline characteristics between survivors and nonsurvivors of index RHF admission, identify predictors of in-hospital mortality, and quantify the 30-day readmission rate.

Methods: We used the Nationwide Readmissions Database (NRD) from 2017 to 2020 to identify a cohort of patients with RHF, stratified by in-hospital mortality status during index admission. Baseline characteristics were compared using Pearson chi-square test and two-sample t-test for categorical and continuous variables, respectively. Multivariate analysis using logistic regression models was used to identify independent predictors of in-hospital mortality. Readmission rates within 30 days were determined by calculating the time to readmission for each patient.

Results: There were 12 305 (10.5%) deaths during index admission among 117 633 patients. Nonsurvivors were older (68.7 ± 14.6 years versus 66.5 ± 15.7 years) and more commonly had comorbidities such as major adverse cardiac and cerebrovascular events (MACCE), myocardial infarction, and coronavirus disease 2019 (COVID-19). The strongest predictors of in-hospital mortality (all P < 0.001) were COVID-19 [odds ratio (OR): 5.97 (5.34-6.68)], metastatic cancer [OR: 2.78 (2.52-3.06)], and myocardial infarction [OR: 1.80 (1.71-1.89)]. Over 4 years, 14.5% of index RHF admissions were readmitted within 30 days.

Conclusions: Our study offers insights into patients with RHF who may have a worse prognosis, highlighting the need for evidence-based management of acute and chronic RHF and consideration of advanced therapies. Interventions should be tailored to improve outcomes in RHF.

Aims: The aim of this study was to identify the demographic factors influencing the mode of emergency department (ED) admission among patients with ST-elevation myocardial infarction (STEMI), comparing those arriving by emergency medical services (EMS) versus walk-in patients, and to correlate them with outcomes.

Methods: This retrospective observational study utilized data provided by the regional emergency agency (AREU), analyzing ED admissions for STEMI across 120 hospitals in Lombardy between 1 January 2022 and 31 December 2022. The prevalence of EMS use and of walk-in patients was determined and the association between the mode of ED access and patient outcomes was assessed.

Results: We recorded 8235 STEMI cases, of which 58.4% presented at the ED via EMS. Younger and male patients were more likely to use self-transport. Age was positively correlated with EMS use, especially in cases with a red triage code. Patients accessing the ED independently were more likely to require secondary transport [odds ratio (OR) 3.80, 95% confidence interval (CI) 3.17-4.51; P < 0.001]. One hundred and twenty-eight deaths were recorded, of which 96 (75%) occurred in patients over 75 years of age. Women were more likely to die than men (OR 2.16, 95% CI 1.52-3.02; P < 0.001).

Conclusions: The number of patients not using EMS highlights the need for public education on the importance of EMS as a means of transport and as a platform for early treatment. Public health campaigns should focus on raising awareness of gender differences in the presentation of STEMI and address treatment disparities to improve outcomes for all patient groups.

Background: Severe tricuspid regurgitation is associated with elevated morbidity and mortality. In recent years, tricuspid transcatheter edge-to-edge repair (T-TEER) has emerged as a promising procedure for the treatment of this valvular disease. We conducted a systematic review and meta-analysis to compare the effectiveness of T-TEER with optimized medical therapy (OMT) versus OMT alone for the treatment of severe tricuspid regurgitation.

Methods: PubMed, Scopus, and Cochrane databases were searched for randomized controlled trials (RCTs) and observational studies comparing T-TEER plus OMT vs. OMT alone. Heterogeneity was assessed with I2 statistics, and a random-effects model was used for all the outcomes.

Results: We included two RCTs and four observational studies with a total of 1805 patients, of whom 849 (47%) underwent T-TEER plus OMT. We found a trend favoring T-TEER for all-cause mortality [risk ratio 0.87; 95% confidence interval (95% CI) 0.66-1.13; P  = 0.30] and cardiovascular death (risk ratio 0.77; 95% CI 0.36-1.65; P  = 0.50), although without statistically significant difference. Heart failure hospitalizations (risk ratio 0.72; 95% CI 0.61-0.85; P  = 0.0001) were significantly reduced in patients treated with T-TEER compared with OMT alone. Tricuspid regurgitation severity 2+ or less was also more frequently achieved in the T-TEER group (risk ratio 6.42; 95% CI 3.08-13.39; P  < 0.001). Functional status and quality of life were significantly improved, with higher KCCQ scores [(mean difference) +14.01], longer 6MWT distance (MD +29.35 m), and a greater proportion of patients in NYHA class I-II (risk ratio 1.39; 95% CI 1.27-1.51; P  < 0.00001).

Conclusion: In patients with severe symptomatic TR, T-TEER is associated with significant improvements in tricuspid regurgitation severity, reduction in heart failure hospitalizations, and enhanced quality of life and functional status, with no apparent effect on all-cause mortality and cardiovascular death.

Aims: Bicuspid aortic valve (BAV) is a common congenital heart disease. However, pivotal randomized trials of transcatheter aortic valve replacement (TAVR) have excluded this population. There remains a lack of consensus on the optimal choice between balloon-expandible valves (BEVs) and self-expanding valves (SEVs) in this setting. This study aimed to compare the efficacy and safety of BEVs vs. SEVs in patients with BAV stenosis.

Methods: A systematic search using four databases, including PubMed, Embase, Web of Science, and Cochrane CENTRAL, was conducted from inception to 26 November, 2024. Studies comparing the outcome of BEVs and SEVs in patients with BAV stenosis were included.

Results: Nineteen studies comprising 3794 participants were included in this meta-analysis. Procedural mortality did not differ significantly between BEVs and SEVs [odds ratio (OR), 1.06; 95% confidence interval (95% CI) 0.42-2.69, P = 0.91]. Similarly, no differences were observed in all-cause mortality at 1 year or 3 years. BEVs were associated with a lower risk of permanent pacemaker implantation (OR, 0.60; 95% CI 0.48-0.76, P < 0.01) and moderate to severe paravalvular leakage (OR, 0.44; 95% CI 0.23-0.85, P = 0.01) compared with SEVs. However, BEVs were associated with a higher risk of annular rupture (OR, 2.80; 95% CI 1.05-7.49, P = 0.04).

Conclusion: BEVs and SEVs demonstrate similar survival outcomes from the procedural period up to 3 years of follow-up. However, the risk profiles for specific complications differ between the valve types. Valve selection for TAVR in patients with BAV stenosis should be considered based on individual anatomical characteristics and the associated risk of specific complications.

Aim: Percutaneous pericardiocentesis represents the sole curative intervention for significant pericardial effusion, especially in cardiac tamponade. While the subxiphoid route is traditionally the most utilized, alternative approaches - such as the apical access - have also been adopted. To date, no studies have directly compared the performance, risk profile, and clinical implications of these techniques. This study aims to evaluate and compare the effectiveness, complication rates, and short- to medium-term outcomes of apical versus subxiphoid pericardiocentesis.

Materials and methods: We performed a retrospective analysis of pericardiocentesis procedures carried out at the Cardiac Intensive Care Unit of the IRCCS San Gerardo dei Tintori Foundation in Monza, Italy, between January 2011 and December 2024. Patients were categorized based on the access site: apical or subxiphoid.

Results: Among 199 procedures, 85 (42.7%) were performed via the subxiphoid route and 114 (57.3%) through apical access. Most interventions addressed acute tamponade or pretamponade states. Imaging guidance was employed in 89.6% of cases. Baseline demographics, comorbidities, and echocardiographic features were comparable between the two groups. The overall success rate was 98.5%, with no significant differences between approaches. Major complications were rare (0.5%), and minor complications occurred in 11.1% of cases, without notable variance between techniques. Patient outcomes - including overall survival, in-hospital survival, and pericardiocentesis-free survival - showed no statistically significant differences (median follow-up: 17.2 months; interquartile range: 3.8-69.2 months).

Conclusions: Apical access for percutaneous pericardiocentesis demonstrates similar efficacy and safety to the subxiphoid approach, representing a valid alternative in appropriate clinical contexts.