首页 > 最新文献

Journal of interventional cardiology最新文献

英文 中文
Association between the Angle of the Left Subclavian Artery and Procedural Time for Percutaneous Coronary Intervention in Patients with Acute Coronary Syndrome 急性冠脉综合征患者经皮冠状动脉介入治疗时间与左锁骨下动脉角度的关系。
IF 1.6 3区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2022-11-17 DOI: 10.1155/2022/3249745
Masatsugu Miyagawa, Daisuke Fukamachi, Katsunori Fukumoto, Masaki Monden, Kurara Takahashi, Shohei Migita, Saki Mizobuchi, Yudai Tanaka, Akihito Ogaku, Yutaka Koyama, Hidesato Fujito, Riku Arai, Norio Takei, Keisuke Kojima, Korehito Iida, Nobuhiro Murata, Yasuo Okumura

Background. The effect of left subclavian artery tortuosity during percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS) remains unclear. Methods. Of 245 ACS patients (from November 2019 and May 2021), 79 who underwent PCI via a left radial approach (LRA) were included. We measured the angle of the left subclavian artery in the coronal view on CT imaging as an indicator of the tortuosity and investigated the association between that angle and the clinical variables and procedural time. Results. Patients with a left subclavian artery angle of a median of <70 degrees (severe tortuosity) were older (75.4 ± 11.7 vs. 62.9 ± 12.3 years, P < 0.001) and had a higher prevalence of female sex (42.1% vs. 14.6%, P = 0.007), hypertension (94.7% vs. 75.6%, P = 0.02), and subclavian artery calcification (73.7% vs. 34.2%, P < 0.001) than those with that ≥70 degrees. The left subclavian artery angle correlated negatively with the sheath cannulation to the first balloon time (ρ = −0.51, P < 0.001) and total procedural time (ρ = −0.32, P = 0.004). A multiple linear regression analysis revealed that the natural log transformation of the sheath insertion to first balloon time was associated with a subclavian artery angle of <70 degrees (β = 0.45, P < 0.001). Conclusion. Our study showed that lower left subclavian artery angles as a marker of the tortuosity via the LRA were strongly associated with a longer sheath insertion to balloon time and subsequent entire procedure time during the PCI.

背景:急性冠脉综合征(ACS)患者经皮冠状动脉介入治疗(PCI)时左锁骨下动脉扭曲的影响尚不清楚。方法:在245例ACS患者(2019年11月至2021年5月)中,包括79例经左桡骨入路(LRA)行PCI的患者。我们测量了CT冠状位上左锁骨下动脉的角度作为扭曲程度的指标,并研究了该角度与临床变量和手术时间的关系。结果:左锁骨下动脉夹角中位数为P < 0.001)、女性患病率(42.1%比14.6%,P=0.007)、高血压患病率(94.7%比75.6%,P=0.02)、锁骨下动脉钙化患病率(73.7%比34.2%,P < 0.001)均高于左锁骨下动脉夹角≥70度的患者。左锁骨下动脉角度与鞘套插管首次球囊时间(ρ = -0.51, P < 0.001)和总手术时间(ρ = -0.32, P=0.004)呈负相关。多元线性回归分析显示鞘插入到第一次气囊时间的自然对数变换与锁骨下动脉角度β = 0.45, P < 0.001)相关。结论:我们的研究表明,作为LRA扭曲的标志,左下锁骨下动脉角度与PCI术中较长的鞘插入到球囊时间和随后的整个手术时间密切相关。
{"title":"Association between the Angle of the Left Subclavian Artery and Procedural Time for Percutaneous Coronary Intervention in Patients with Acute Coronary Syndrome","authors":"Masatsugu Miyagawa,&nbsp;Daisuke Fukamachi,&nbsp;Katsunori Fukumoto,&nbsp;Masaki Monden,&nbsp;Kurara Takahashi,&nbsp;Shohei Migita,&nbsp;Saki Mizobuchi,&nbsp;Yudai Tanaka,&nbsp;Akihito Ogaku,&nbsp;Yutaka Koyama,&nbsp;Hidesato Fujito,&nbsp;Riku Arai,&nbsp;Norio Takei,&nbsp;Keisuke Kojima,&nbsp;Korehito Iida,&nbsp;Nobuhiro Murata,&nbsp;Yasuo Okumura","doi":"10.1155/2022/3249745","DOIUrl":"10.1155/2022/3249745","url":null,"abstract":"<div>\u0000 <p><i>Background</i>. The effect of left subclavian artery tortuosity during percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS) remains unclear. <i>Methods</i>. Of 245 ACS patients (from November 2019 and May 2021), 79 who underwent PCI via a left radial approach (LRA) were included. We measured the angle of the left subclavian artery in the coronal view on CT imaging as an indicator of the tortuosity and investigated the association between that angle and the clinical variables and procedural time. <i>Results</i>. Patients with a left subclavian artery angle of a median of &lt;70 degrees (severe tortuosity) were older (75.4 ± 11.7 vs. 62.9 ± 12.3 years, <i>P</i> &lt; 0.001) and had a higher prevalence of female sex (42.1% vs. 14.6%, <i>P</i> = 0.007), hypertension (94.7% vs. 75.6%, <i>P</i> = 0.02), and subclavian artery calcification (73.7% vs. 34.2%, <i>P</i> &lt; 0.001) than those with that ≥70 degrees. The left subclavian artery angle correlated negatively with the sheath cannulation to the first balloon time (<i>ρ</i> = −0.51, <i>P</i> &lt; 0.001) and total procedural time (<i>ρ</i> = −0.32, <i>P</i> = 0.004). A multiple linear regression analysis revealed that the natural log transformation of the sheath insertion to first balloon time was associated with a subclavian artery angle of &lt;70 degrees (<i>β</i> = 0.45, <i>P</i> &lt; 0.001). <i>Conclusion</i>. Our study showed that lower left subclavian artery angles as a marker of the tortuosity via the LRA were strongly associated with a longer sheath insertion to balloon time and subsequent entire procedure time during the PCI.</p>\u0000 </div>","PeriodicalId":16329,"journal":{"name":"Journal of interventional cardiology","volume":"2022 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2022-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9691329/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10349157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Selective Use of Pulmonary Vasodilators in Patients with Fontan Physiology 肺血管扩张剂在肺水肿患者中的选择性应用。
IF 1.6 3区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2022-11-10 DOI: 10.1155/2022/7602793
Thomas Glenn, Nicole Duster, Jerry Dwek, Jose Silva-Sepulveda, Howaida G. El-Said

Background. Fontan-associated liver disease is a well-known sequela following the Fontan procedure for patients living with single-ventricle heart disease. Pulmonary vasodilators, such as phosphodiesterase type 5 inhibitors, have emerged as a potential therapeutic option for lowering central venous pressures by reducing pulmonary vascular resistance. Method. We performed a single-center retrospective review of Fontan patients who were placed on pulmonary vasodilator therapy with prehemodynamic and posthemodynamic, MR elastography, and histologic assessments. Results. A total of 125 patients with Fontan circulation underwent surveillance with cardiac catheterization during the review period. Fifty-three (42%) patients who did not have increased end-diastolic pressures at the time of cardiac catheterization were started on phosphodiesterase type 5 inhibitor therapy. Nine patients (17%) underwent posttherapy follow-up catheterization. The mean Fontan pressure decreased from 15.4 ± 3.3 mmHg to 13.3 ± 2.5 mmHg (p = 0.026), after initiation of pulmonary vasodilatory therapy. There was no change in end-diastolic pressure, transpulmonary gradient, wedge pressure, pulmonary vascular resistance, cardiac index, or saturation. Eleven patients (21%) underwent pretherapy MR elastography testing with posttherapy follow-up MR elastography. We found no improvement in liver stiffness score following the application of pulmonary vasodilators. Three patients underwent pretherapy and posttherapy liver biopsies, with variable histological changes observed within the hepatic parenchyma. Conclusions. These data demonstrate indeterminate results for the selective use of pulmonary vasodilators but highlight the need for large prospective randomized control trials of pulmonary vasodilator therapies to fully assess the benefit of such therapies in Fontan-associated liver disease.

背景:Fontan相关性肝病是单心室心脏病患者Fontan手术后的一种众所周知的后遗症。肺血管扩张剂,如磷酸二酯酶5型抑制剂,已成为通过降低肺血管阻力来降低中心静脉压力的潜在治疗选择。方法:我们对接受肺血管扩张剂治疗的Fontan患者进行了单中心回顾性研究,并进行了血流动力学和血流动力学、MR弹性成像和组织学评估。结果:在回顾期间,共有125例Fontan循环患者接受了心导管插管监测。53例(42%)心导管插管时舒张末压未升高的患者开始接受磷酸二酯酶5型抑制剂治疗。9例(17%)患者接受治疗后随访置管。在开始肺血管扩张治疗后,平均丰坦压由15.4±3.3 mmHg降至13.3±2.5 mmHg (p=0.026)。舒张末压、跨肺梯度、楔压、肺血管阻力、心脏指数或饱和度均无变化。11名患者(21%)接受了治疗前磁共振弹性成像测试和治疗后随访磁共振弹性成像。我们发现应用肺血管扩张剂后肝脏僵硬评分没有改善。3例患者接受治疗前和治疗后肝活检,肝实质内观察到不同的组织学改变。结论:这些数据表明选择性使用肺血管扩张剂的结果不确定,但强调需要进行肺血管扩张剂治疗的大型前瞻性随机对照试验,以充分评估此类治疗在丰坦相关肝病中的益处。
{"title":"Selective Use of Pulmonary Vasodilators in Patients with Fontan Physiology","authors":"Thomas Glenn,&nbsp;Nicole Duster,&nbsp;Jerry Dwek,&nbsp;Jose Silva-Sepulveda,&nbsp;Howaida G. El-Said","doi":"10.1155/2022/7602793","DOIUrl":"10.1155/2022/7602793","url":null,"abstract":"<div>\u0000 <p><i>Background</i>. Fontan-associated liver disease is a well-known sequela following the Fontan procedure for patients living with single-ventricle heart disease. Pulmonary vasodilators, such as phosphodiesterase type 5 inhibitors, have emerged as a potential therapeutic option for lowering central venous pressures by reducing pulmonary vascular resistance. <i>Method</i>. We performed a single-center retrospective review of Fontan patients who were placed on pulmonary vasodilator therapy with prehemodynamic and posthemodynamic, MR elastography, and histologic assessments. <i>Results</i>. A total of 125 patients with Fontan circulation underwent surveillance with cardiac catheterization during the review period. Fifty-three (42%) patients who did not have increased end-diastolic pressures at the time of cardiac catheterization were started on phosphodiesterase type 5 inhibitor therapy. Nine patients (17%) underwent posttherapy follow-up catheterization. The mean Fontan pressure decreased from 15.4 ± 3.3 mmHg to 13.3 ± 2.5 mmHg (<i>p</i> = 0.026), after initiation of pulmonary vasodilatory therapy. There was no change in end-diastolic pressure, transpulmonary gradient, wedge pressure, pulmonary vascular resistance, cardiac index, or saturation. Eleven patients (21%) underwent pretherapy MR elastography testing with posttherapy follow-up MR elastography. We found no improvement in liver stiffness score following the application of pulmonary vasodilators. Three patients underwent pretherapy and posttherapy liver biopsies, with variable histological changes observed within the hepatic parenchyma. <i>Conclusions</i>. These data demonstrate indeterminate results for the selective use of pulmonary vasodilators but highlight the need for large prospective randomized control trials of pulmonary vasodilator therapies to fully assess the benefit of such therapies in Fontan-associated liver disease.</p>\u0000 </div>","PeriodicalId":16329,"journal":{"name":"Journal of interventional cardiology","volume":"2022 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2022-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9671729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40723076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Prophylactic Impella CP versus VA-ECMO in Patients Undergoing Complex High-Risk Indicated PCI 预防性Impella CP与VA-ECMO在复杂高危PCI患者中的应用
IF 1.6 3区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2022-11-07 DOI: 10.1155/2022/8167011
Deborah M.F. van den Buijs, Adriaan Wilgenhof, Paul Knaapen, Carlo Zivelonghi, Tom Meijers, Paul Vermeersch, Fatih Arslan, Niels Verouden, Alex Nap, Krischan Sjauw, Floris S. van den Brink

Objectives. To compare two different forms of mechanical circulatory support (MCS) in patients with complex high-risk indicated PCI (CHIP): the Impella CP system and veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Background. To prevent hemodynamic instability in CHIP, various MCS systems are available. However, comparable data on different forms of MCS are not at hand. Methods. In this multicenter observational study, we retrospectively evaluated all CHIP procedures with the support of an Impella CP or VA-ECMO, who were declined surgery by the heart team. Major adverse cardiac events (MACE), mortality at discharge, and 30-day mortality were evaluated. Results. A total of 41 patients were included, of which 27 patients were supported with Impella CP and 14 patients with VA-ECMO. Baseline characteristics were well-balanced in both groups. No significant difference in periprocedural hemodynamic instability was observed between both groups (3.7% vs. 14.3%; p = 0.22). The composite outcome of MACE showed no significant difference (30.7% vs. 21.4%; p = 0.59). Bleeding complications were higher in the Impella CP group, but showed no significant difference (22.2% vs. 7.1%; p = 0.22) and occurred more at the non-Impella access site. In-hospital mortality was 7.4% in the Impella CP group versus 14.3% in the VA-ECMO group and showed no significant difference (p = 0.48). 30-Day mortality showed no significant difference (7.4% vs. 21.4%; p = 0.09). Conclusions. In patients with CHIP, there were no significant differences in hemodynamic instability and overall MACE between VA-ECMO or Impella CP device as mechanical circulatory support. Based on this study, the choice of either VA-ECMO or Impella CP does not alter the outcome.

目的:比较两种不同形式的机械循环支持(MCS)在复杂高危PCI (CHIP)患者中的应用:Impella CP系统和静脉-动脉体外膜氧合(VA-ECMO)。背景:为了防止CHIP的血流动力学不稳定,各种MCS系统都是可用的。然而,目前还没有关于不同形式MCS的可比数据。方法:在这项多中心观察性研究中,我们回顾性评估了所有由Impella CP或VA-ECMO支持的CHIP手术,这些手术被心脏团队拒绝手术。评估主要不良心脏事件(MACE)、出院死亡率和30天死亡率。结果:共纳入41例患者,其中Impella CP支持27例,VA-ECMO支持14例。两组的基线特征平衡良好。两组患者术中血流动力学不稳定性无显著差异(3.7% vs. 14.3%;P = 0.22)。MACE的综合结局无显著性差异(30.7% vs. 21.4%;P = 0.59)。Impella CP组出血并发症发生率较高,但差异无统计学意义(22.2% vs 7.1%;p = 0.22),且在非impella通路部位发生较多。Impella CP组的住院死亡率为7.4%,VA-ECMO组为14.3%,差异无统计学意义(p = 0.48)。30天死亡率无显著差异(7.4% vs. 21.4%;P = 0.09)。结论:在CHIP患者中,作为机械循环支持的VA-ECMO和Impella CP装置在血流动力学不稳定性和总体MACE方面无显著差异。根据本研究,选择VA-ECMO或Impella CP并不会改变结果。
{"title":"Prophylactic Impella CP versus VA-ECMO in Patients Undergoing Complex High-Risk Indicated PCI","authors":"Deborah M.F. van den Buijs,&nbsp;Adriaan Wilgenhof,&nbsp;Paul Knaapen,&nbsp;Carlo Zivelonghi,&nbsp;Tom Meijers,&nbsp;Paul Vermeersch,&nbsp;Fatih Arslan,&nbsp;Niels Verouden,&nbsp;Alex Nap,&nbsp;Krischan Sjauw,&nbsp;Floris S. van den Brink","doi":"10.1155/2022/8167011","DOIUrl":"10.1155/2022/8167011","url":null,"abstract":"<div>\u0000 <p><i>Objectives</i>. To compare two different forms of mechanical circulatory support (MCS) in patients with complex high-risk indicated PCI (CHIP): the Impella CP system and veno-arterial extracorporeal membrane oxygenation (VA-ECMO). <i>Background</i>. To prevent hemodynamic instability in CHIP, various MCS systems are available. However, comparable data on different forms of MCS are not at hand. <i>Methods</i>. In this multicenter observational study, we retrospectively evaluated all CHIP procedures with the support of an Impella CP or VA-ECMO, who were declined surgery by the heart team. Major adverse cardiac events (MACE), mortality at discharge, and 30-day mortality were evaluated. <i>Results</i>. A total of 41 patients were included, of which 27 patients were supported with Impella CP and 14 patients with VA-ECMO. Baseline characteristics were well-balanced in both groups. No significant difference in periprocedural hemodynamic instability was observed between both groups (3.7% vs. 14.3%; <i>p</i> = 0.22). The composite outcome of MACE showed no significant difference (30.7% vs. 21.4%; <i>p</i> = 0.59). Bleeding complications were higher in the Impella CP group, but showed no significant difference (22.2% vs. 7.1%; <i>p</i> = 0.22) and occurred more at the non-Impella access site. In-hospital mortality was 7.4% in the Impella CP group versus 14.3% in the VA-ECMO group and showed no significant difference (<i>p</i> = 0.48). 30-Day mortality showed no significant difference (7.4% vs. 21.4%; <i>p</i> = 0.09). <i>Conclusions</i>. In patients with CHIP, there were no significant differences in hemodynamic instability and overall MACE between VA-ECMO or Impella CP device as mechanical circulatory support. Based on this study, the choice of either VA-ECMO or Impella CP does not alter the outcome.</p>\u0000 </div>","PeriodicalId":16329,"journal":{"name":"Journal of interventional cardiology","volume":"2022 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2022-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9663242/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40723077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Mesenchymal Stem Cell-Derived Extracellular Vesicles Therapy for Pulmonary Hypertension: A Comprehensive Review of Preclinical Studies 间充质干细胞衍生的细胞外囊泡治疗肺动脉高压:临床前研究的综合综述。
IF 1.6 3区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2022-11-04 DOI: 10.1155/2022/5451947
Ji-Hong Xu, Jia-Ping Liang, Chu-Jun Zhu, Yu-Jun Lian

Pulmonary hypertension (PH) is a type of clinical pathophysiological syndrome characterized by a progressive increase in pulmonary vascular resistance and subsequent progressive failure of the right heart function, and is a common complication of many diseases. Mesenchymal stem cells (MSCs) autonomously home to sites damaged by disease, repair damaged tissues, and participate in the regulation of systemic inflammation and immune responses, which have good clinical application prospects. Extracellular vesicles (EVs), such as exosomes and microvesicles, participate in various biological activities by regulating intercellular communication. Exosomes secreted into the extracellular environment also affect the host immune system. MSC-derived extracellular vesicles (MSC-EVs), as a mediator in the paracrine processes of MSCs, carry biologically active substances such as proteins, lipids, mRNA, and micro-RNA. MSC-EVs therapies, safer than cell-based treatments, have been shown to be effective in modulating macrophages to support anti-inflammatory phenotypes, which are strongly related to histological and functional benefits in preclinical models of pulmonary hypertension. The main effects of active substances and their potential medical value have attracted wide attention from researchers. This article reviews the role and relevant mechanisms of MSC-EVs in the treatment of pulmonary hypertension in recent studies and provides a basis for their future clinical applications.

肺动脉高压(Pulmonary hypertension, PH)是一种以肺血管阻力进行性增高和右心功能进行性衰竭为特征的临床病理生理综合征,是许多疾病的常见并发症。间充质干细胞(Mesenchymal stem cells, MSCs)能够自主返回疾病损伤部位,修复受损组织,参与全身炎症和免疫反应的调节,具有良好的临床应用前景。细胞外囊泡(EVs),如外泌体和微囊泡,通过调节细胞间通讯参与多种生物活动。分泌到细胞外环境的外泌体也会影响宿主的免疫系统。间充质干细胞衍生的细胞外囊泡(msc - ev)作为间充质干细胞旁分泌过程的介质,携带生物活性物质,如蛋白质、脂质、mRNA和微rna。msc - ev治疗比基于细胞的治疗更安全,已被证明可有效调节巨噬细胞以支持抗炎表型,这与临床前肺动脉高压模型的组织学和功能益处密切相关。活性物质的主要作用及其潜在的医学价值引起了研究者的广泛关注。本文综述了近年来msc - ev在肺动脉高压治疗中的作用及相关机制,为其今后的临床应用提供基础。
{"title":"Mesenchymal Stem Cell-Derived Extracellular Vesicles Therapy for Pulmonary Hypertension: A Comprehensive Review of Preclinical Studies","authors":"Ji-Hong Xu,&nbsp;Jia-Ping Liang,&nbsp;Chu-Jun Zhu,&nbsp;Yu-Jun Lian","doi":"10.1155/2022/5451947","DOIUrl":"10.1155/2022/5451947","url":null,"abstract":"<div>\u0000 <p>Pulmonary hypertension (PH) is a type of clinical pathophysiological syndrome characterized by a progressive increase in pulmonary vascular resistance and subsequent progressive failure of the right heart function, and is a common complication of many diseases. Mesenchymal stem cells (MSCs) autonomously home to sites damaged by disease, repair damaged tissues, and participate in the regulation of systemic inflammation and immune responses, which have good clinical application prospects. Extracellular vesicles (EVs), such as exosomes and microvesicles, participate in various biological activities by regulating intercellular communication. Exosomes secreted into the extracellular environment also affect the host immune system. MSC-derived extracellular vesicles (MSC-EVs), as a mediator in the paracrine processes of MSCs, carry biologically active substances such as proteins, lipids, mRNA, and micro-RNA. MSC-EVs therapies, safer than cell-based treatments, have been shown to be effective in modulating macrophages to support anti-inflammatory phenotypes, which are strongly related to histological and functional benefits in preclinical models of pulmonary hypertension. The main effects of active substances and their potential medical value have attracted wide attention from researchers. This article reviews the role and relevant mechanisms of MSC-EVs in the treatment of pulmonary hypertension in recent studies and provides a basis for their future clinical applications.</p>\u0000 </div>","PeriodicalId":16329,"journal":{"name":"Journal of interventional cardiology","volume":"2022 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2022-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9652076/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40703303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Construction of a Clinical Predictive Model of Left Atrial and Left Atrial Appendage Thrombi in Patients with Nonvalvular Atrial Fibrillation 非瓣膜性心房颤动患者左心房及左心房附件血栓临床预测模型的建立。
IF 1.6 3区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2022-11-04 DOI: 10.1155/2022/7806027
Lei Yin, Changjian He, Huixin Zheng, Jianshuai Ma, Jinting Liu, Xiaohong Zhang, Ruiqin Xie

Background. The purpose of this study was to investigate the risk factors of left atrial (LA) or left atrial appendage (LAA) thrombi in patients with nonvalvular atrial fibrillation (NVAF) and to establish and validate relevant predictive models. It might improve thromboembolic risk stratification in patients with NVAF. Methods. This study retrospectively included 1210 consecutive patients with NVAF undergoing transesophageal echocardiography (TEE), of whom 139 patients had thrombi in LA or in LAA. Through literature review and the ten events per variable (10EPV) principle, 13 variables were finally identified for inclusion in multivariate analysis. Models were constructed by multivariate logistic stepwise regression and least absolute shrinkage and selection operator (lasso) regression. Results. After logistic regression, five variables (AF type, age, B-type natriuretic peptide, E/e’ ratio, and left atrial diameter) were finally screened out as model 1. After Lasso regression, AF type, age, gender, B-type natriuretic peptide, E/e’ ratio, left atrial diameter, and left ventricular ejection fraction were finally screened as model 2. After comparing the two models, the simpler model 1 was finally selected. The area under the ROC curve (AUC) of the model 1 was 0.865 (95% CI: 0.838–0.892), the Hosmer–Lemeshow test = 0.898, and the AUC = 0.861 after internal validation. The clinical decision curve showed that the new clinical prediction model could achieve a net clinical benefit when the expected threshold was between 0 and 0.6. Conclusion. This study constructed a new clinical prediction model of LA or LAA thrombi, with a higher discriminative degree than the CHADS2 and CHA2DS2-VASc scoring systems (AUC: 0.865 vs. 0.643; AUC: 0.865 vs 0.652).

背景:本研究旨在探讨非瓣膜性心房颤动(NVAF)患者发生左房(LA)或左房附件(LAA)血栓的危险因素,建立并验证相关预测模型。它可能改善非瓣膜性房颤患者的血栓栓塞风险分层。方法:本研究回顾性纳入1210例连续接受经食管超声心动图(TEE)检查的非瓣膜性房颤患者,其中139例在LA或LAA有血栓。通过文献回顾和每变量十事件(10EPV)原则,最终确定13个变量纳入多变量分析。采用多元逻辑逐步回归、最小绝对收缩和选择算子(lasso)回归构建模型。结果:经logistic回归,最终筛选出房型、年龄、b型利钠肽、E/ E′比、左房内径5个变量作为模型1。经Lasso回归,最终筛选出AF型、年龄、性别、b型利钠肽、E/ E′比值、左房内径、左室射血分数作为模型2。经过两种模型的比较,最终选择了较为简单的模型1。模型1的ROC曲线下面积(AUC)为0.865 (95% CI: 0.838 ~ 0.892), Hosmer-Lemeshow检验= 0.898,内部验证的AUC = 0.861。临床决策曲线显示,当预期阈值在0 ~ 0.6之间时,新的临床预测模型可以实现临床净获益。结论:本研究构建了新的LA或LAA血栓临床预测模型,其鉴别度高于CHADS2和CHA2DS2-VASc评分系统(AUC: 0.865 vs 0.643;AUC: 0.865 vs 0.652)。
{"title":"Construction of a Clinical Predictive Model of Left Atrial and Left Atrial Appendage Thrombi in Patients with Nonvalvular Atrial Fibrillation","authors":"Lei Yin,&nbsp;Changjian He,&nbsp;Huixin Zheng,&nbsp;Jianshuai Ma,&nbsp;Jinting Liu,&nbsp;Xiaohong Zhang,&nbsp;Ruiqin Xie","doi":"10.1155/2022/7806027","DOIUrl":"10.1155/2022/7806027","url":null,"abstract":"<div>\u0000 <p><i>Background</i>. The purpose of this study was to investigate the risk factors of left atrial (LA) or left atrial appendage (LAA) thrombi in patients with nonvalvular atrial fibrillation (NVAF) and to establish and validate relevant predictive models. It might improve thromboembolic risk stratification in patients with NVAF. <i>Methods</i>. This study retrospectively included 1210 consecutive patients with NVAF undergoing transesophageal echocardiography (TEE), of whom 139 patients had thrombi in LA or in LAA. Through literature review and the ten events per variable (10EPV) principle, 13 variables were finally identified for inclusion in multivariate analysis. Models were constructed by multivariate logistic stepwise regression and least absolute shrinkage and selection operator (lasso) regression. <i>Results</i>. After logistic regression, five variables (AF type, age, B-type natriuretic peptide, <i>E</i>/<i>e</i>’ ratio, and left atrial diameter) were finally screened out as model 1. After Lasso regression, AF type, age, gender, B-type natriuretic peptide, E/e’ ratio, left atrial diameter, and left ventricular ejection fraction were finally screened as model 2. After comparing the two models, the simpler model 1 was finally selected. The area under the ROC curve (AUC) of the model 1 was 0.865 (95% CI: 0.838–0.892), the Hosmer–Lemeshow test = 0.898, and the AUC = 0.861 after internal validation. The clinical decision curve showed that the new clinical prediction model could achieve a net clinical benefit when the expected threshold was between 0 and 0.6. <i>Conclusion</i>. This study constructed a new clinical prediction model of LA or LAA thrombi, with a higher discriminative degree than the CHADS2 and CHA2DS2-VASc scoring systems (AUC: 0.865 vs. 0.643; AUC: 0.865 vs 0.652).</p>\u0000 </div>","PeriodicalId":16329,"journal":{"name":"Journal of interventional cardiology","volume":"2022 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2022-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9652078/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40703302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Four-Year Outcomes of Left Main Percutaneous Coronary Intervention with a Bioresorbable Scaffold in the Circumflex Ostium 旋口生物可吸收支架经皮左主干冠状动脉介入治疗的四年疗效。
IF 1.6 3区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2022-10-31 DOI: 10.1155/2022/7934868
Andrejs Erglis, Inga Narbute, Dace Sondore, Sanda Jegere, Indulis Kumsars, Andis Dombrovskis, Karlis Grikis, Ieva Briede, Kristine Dombrovska, Karlis Trusinskis, Alona Grave, Martins Erglis, Martins Kalejs, Peteris Stradins, Uldis Strazdins

Objectives. The study aimed to investigate the long-term outcomes of a double stent scaffold strategy in patients with left main (LM) bifurcation lesions involving the ostium of the left circumflex artery (LCX), utilizing a drug-eluting stent (DES) in the LM extending into the left anterior descending artery (LAD) and a bioresorbable vascular scaffold (BVS) in the LCX ostium. Background. The high occurrence of in-stent restenosis of the LCX ostium is the major limitation of percutaneous coronary intervention (PCI) for LM lesions with a two-stent strategy. Methods. This was a single-center, prospective, single-arm study of 46 consecutively enrolled patients with a stable coronary artery disease and significant unprotected LM distal bifurcation disease. Patients underwent imaging-guided PCI using DES in the LM-LAD and BVS in the LCX using a T-stent or mini-crush technique. The primary outcome at four years was the composite of death, myocardial infarction, stroke, and target lesion revascularization (TLR). Results. At four years, the primary outcome was identified in 9 patients (19.6%). All events were TLRs except one myocardial infarction due to BVS thrombosis. Seven of the eight TLRs were a result of side branch BVS restenosis. Univariate predictors of the 4-year outcome were higher LDL cholesterol and BVS size ≤2.5 mm. On multivariate analysis, LCX lesion preparation with a cutting balloon and post-procedure use of intravascular ultrasound for optimization were found to be independent protective factors of MACE. Conclusions. In selected patients with LM distal bifurcation disease, an imaging-guided double stent scaffold strategy with DES in the LM and BVS in the LCX ostium was technically successful in all patients and was reasonably safe and effective for four years.

目的:本研究旨在探讨双支架支架策略在左主干(LM)分叉病变涉及左旋动脉(LCX)开口的患者中的长期效果,在LM中使用药物洗脱支架(DES)延伸到左前降支(LAD),在LCX开口使用生物可吸收血管支架(BVS)。背景:支架内LCX口再狭窄的高发生率是双支架策略下经皮冠状动脉介入治疗(PCI) LM病变的主要限制。方法:这是一项单中心、前瞻性、单臂研究,46例连续入组的稳定冠状动脉疾病和明显无保护的LM远分叉疾病患者。患者接受成像引导下的PCI,在LM-LAD中使用DES,在LCX中使用BVS,使用t支架或迷你挤压技术。四年时的主要结局是死亡、心肌梗死、卒中和靶病变血运重建术(TLR)的综合结果。结果:4年时,9例患者(19.6%)确定了主要结局。除一例因BVS血栓形成引起的心肌梗死外,所有事件均为tlr。8例tlr中有7例是侧支BVS再狭窄的结果。4年预后的单因素预测因子为较高的LDL胆固醇和BVS大小≤2.5 mm。多因素分析发现,LCX病变切割球囊准备和术后血管内超声优化是MACE的独立保护因素。结论:在选定的LM远端分叉疾病患者中,影像学引导下的双支架支架策略,即DES在LM, BVS在LCX口,在技术上所有患者都是成功的,并且在4年内是相当安全有效的。
{"title":"Four-Year Outcomes of Left Main Percutaneous Coronary Intervention with a Bioresorbable Scaffold in the Circumflex Ostium","authors":"Andrejs Erglis,&nbsp;Inga Narbute,&nbsp;Dace Sondore,&nbsp;Sanda Jegere,&nbsp;Indulis Kumsars,&nbsp;Andis Dombrovskis,&nbsp;Karlis Grikis,&nbsp;Ieva Briede,&nbsp;Kristine Dombrovska,&nbsp;Karlis Trusinskis,&nbsp;Alona Grave,&nbsp;Martins Erglis,&nbsp;Martins Kalejs,&nbsp;Peteris Stradins,&nbsp;Uldis Strazdins","doi":"10.1155/2022/7934868","DOIUrl":"10.1155/2022/7934868","url":null,"abstract":"<div>\u0000 <p><i>Objectives</i>. The study aimed to investigate the long-term outcomes of a double stent scaffold strategy in patients with left main (LM) bifurcation lesions involving the ostium of the left circumflex artery (LCX), utilizing a drug-eluting stent (DES) in the LM extending into the left anterior descending artery (LAD) and a bioresorbable vascular scaffold (BVS) in the LCX ostium. <i>Background</i>. The high occurrence of in-stent restenosis of the LCX ostium is the major limitation of percutaneous coronary intervention (PCI) for LM lesions with a two-stent strategy. <i>Methods</i>. This was a single-center, prospective, single-arm study of 46 consecutively enrolled patients with a stable coronary artery disease and significant unprotected LM distal bifurcation disease. Patients underwent imaging-guided PCI using DES in the LM-LAD and BVS in the LCX using a T-stent or mini-crush technique. The primary outcome at four years was the composite of death, myocardial infarction, stroke, and target lesion revascularization (TLR). <i>Results</i>. At four years, the primary outcome was identified in 9 patients (19.6%). All events were TLRs except one myocardial infarction due to BVS thrombosis. Seven of the eight TLRs were a result of side branch BVS restenosis. Univariate predictors of the 4-year outcome were higher LDL cholesterol and BVS size ≤2.5 mm. On multivariate analysis, LCX lesion preparation with a cutting balloon and post-procedure use of intravascular ultrasound for optimization were found to be independent protective factors of MACE. <i>Conclusions</i>. In selected patients with LM distal bifurcation disease, an imaging-guided double stent scaffold strategy with DES in the LM and BVS in the LCX ostium was technically successful in all patients and was reasonably safe and effective for four years.</p>\u0000 </div>","PeriodicalId":16329,"journal":{"name":"Journal of interventional cardiology","volume":"2022 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2022-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9640231/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40477366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Effect of TAVR Approach and Other Baseline Factors on the Incidence of Acute Kidney Injury: A Systematic Review and Meta-Analysis TAVR方法和其他基线因素对急性肾损伤发生率的影响:系统回顾和荟萃分析。
IF 1.6 3区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2022-10-27 DOI: 10.1155/2022/3380605
Hossam Alzu’bi, Anan Abu Rmilah, Ikram-UI Haq, Babikir Kheiri, Ahmad Al-abdouh, Bashar Hasan, Omar Elsekaily, Suhaib Jaber, Ibraheem Qaisi, Asil Yagmour, Hamada Dajani, Azza Ahmed,  Ahmed elhag, Kianoush Kashani, Abhishek Deshmukh

Background. Acute kidney injury (AKI) is a well-known complication following a transcatheter aortic valve replacement (TAVR) and is associated with higher morbidity and mortality. Objective. We aim to compare the risk of developing AKI after transfemoral (TF), transapical (TA), and transaortic (TAo) approaches following TAVR. Methods. We searched Medline and EMBASE databases from January 2009 to January 2021. We included studies that evaluated the risk of AKI based on different TAVR approaches. After extracting each study’s data, we calculated the risk ratio and 95% confidence intervals using RevMan software 5.4. Publication bias was assessed by the forest plot. Results. Thirty-six (36) studies, consisting of 70,406 patients undergoing TAVR were included. Thirty-five studies compared TF to TA, and only seven investigations compared TF to TAo. AKI was documented in 4,857 out of 50,395 (9.6%) patients that underwent TF TAVR compared to 3,155 out of 19,721 (16%) patients who underwent TA-TAVR, with a risk ratio of 0.49 (95% CI, 0.36–0.66; p < 0.00001). Likewise, 273 patients developed AKI out of the 1,840 patients (14.8%) that underwent TF-TAVR in contrast to 67 patients out of the 421 patients (15.9%) that underwent TAo-TAVR, with a risk ratio of 0.51 (95% CI, 0.27–0.98; p = 0.04). There was no significant risk when we compared TA to TAo approaches, with a risk ratio of 0.89 (95% CI, 0.29–2.75; p = 0.84). Conclusion. The risk of post-TAVR AKI is significantly lower in patients who underwent TF-TAVR than those who underwent TA-TAVR or TAo-TAVR.

背景:急性肾损伤(AKI)是经导管主动脉瓣置换术(TAVR)后常见的并发症,具有较高的发病率和死亡率。目的:比较TAVR术后经股(TF)、经根尖(TA)和经主动脉(TAo)入路发生AKI的风险。方法:检索2009年1月至2021年1月的Medline和EMBASE数据库。我们纳入了基于不同TAVR方法评估AKI风险的研究。提取各研究资料后,使用RevMan软件5.4计算风险比和95%置信区间。用森林图评估发表偏倚。结果:共纳入36项研究,共70406例TAVR患者。35项研究比较了TF和TA,只有7项研究比较了TF和TAo。50,395例接受TF TAVR的患者中有4,857例(9.6%)记录了AKI,而19,721例接受TA-TAVR的患者中有3,155例(16%)记录了AKI,风险比为0.49 (95% CI, 0.36-0.66;P < 0.00001)。同样,接受TF-TAVR的1,840例患者中有273例(14.8%)发生AKI,而接受TAo-TAVR的421例患者中有67例(15.9%)发生AKI,风险比为0.51 (95% CI, 0.27-0.98;p = 0.04)。当我们将TA方法与TAo方法进行比较时,没有显著风险,风险比为0.89 (95% CI, 0.29-2.75;p = 0.84)。结论:tavr后AKI的风险在TF-TAVR患者中明显低于TA-TAVR或TAo-TAVR患者。
{"title":"Effect of TAVR Approach and Other Baseline Factors on the Incidence of Acute Kidney Injury: A Systematic Review and Meta-Analysis","authors":"Hossam Alzu’bi,&nbsp;Anan Abu Rmilah,&nbsp;Ikram-UI Haq,&nbsp;Babikir Kheiri,&nbsp;Ahmad Al-abdouh,&nbsp;Bashar Hasan,&nbsp;Omar Elsekaily,&nbsp;Suhaib Jaber,&nbsp;Ibraheem Qaisi,&nbsp;Asil Yagmour,&nbsp;Hamada Dajani,&nbsp;Azza Ahmed,&nbsp; Ahmed elhag,&nbsp;Kianoush Kashani,&nbsp;Abhishek Deshmukh","doi":"10.1155/2022/3380605","DOIUrl":"10.1155/2022/3380605","url":null,"abstract":"<div>\u0000 <p><i>Background</i>. Acute kidney injury (AKI) is a well-known complication following a transcatheter aortic valve replacement (TAVR) and is associated with higher morbidity and mortality. <i>Objective</i>. We aim to compare the risk of developing AKI after transfemoral (TF), transapical (TA), and transaortic (TAo) approaches following TAVR. <i>Methods</i>. We searched Medline and EMBASE databases from January 2009 to January 2021. We included studies that evaluated the risk of AKI based on different TAVR approaches. After extracting each study’s data, we calculated the risk ratio and 95% confidence intervals using RevMan software 5.4. Publication bias was assessed by the forest plot. <i>Results</i>. Thirty-six (36) studies, consisting of 70,406 patients undergoing TAVR were included. Thirty-five studies compared TF to TA, and only seven investigations compared TF to TAo. AKI was documented in 4,857 out of 50,395 (9.6%) patients that underwent TF TAVR compared to 3,155 out of 19,721 (16%) patients who underwent TA-TAVR, with a risk ratio of 0.49 (95% CI, 0.36–0.66; p &lt; 0.00001). Likewise, 273 patients developed AKI out of the 1,840 patients (14.8%) that underwent TF-TAVR in contrast to 67 patients out of the 421 patients (15.9%) that underwent TAo-TAVR, with a risk ratio of 0.51 (95% CI, 0.27–0.98; <i>p</i> = 0.04). There was no significant risk when we compared TA to TAo approaches, with a risk ratio of 0.89 (95% CI, 0.29–2.75; <i>p</i> = 0.84). <i>Conclusion</i>. The risk of post-TAVR AKI is significantly lower in patients who underwent TF-TAVR than those who underwent TA-TAVR or TAo-TAVR.</p>\u0000 </div>","PeriodicalId":16329,"journal":{"name":"Journal of interventional cardiology","volume":"2022 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2022-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9633203/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40474810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Antithrombotic Therapy Duration after Patent Foramen Ovale Closure for Stroke Prevention: Impact on Long-Term Outcome 预防脑卒中卵圆孔未闭后抗血栓治疗持续时间:对长期预后的影响。
IF 1.6 3区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2022-10-27 DOI: 10.1155/2022/6559447
Joelle Kefer, Karlien Carbonez, Sophie Pierard, François-Pierre Mouthuy, Andre Peeters, Cedric Hermans, Catherine Lambert, Christophe DeMeester, Thierry Sluysmans, Agnes Pasquet

Background. The optimal duration of antithrombotic therapy (ATT) after patent foramen ovale (PFO) closure remains under debate. This study sought to compare the clinical outcome of patients receiving antithrombotic agents for a short (6 months) versus extended (>6 months) period after the procedure. Methods. This was a retrospective cohort study using a propensity score matching analysis on 259 consecutive patients (131 males, 43 ± 10 years) undergoing PFO closure due to cryptogenic stroke, with complete follow-up (median duration of 10 [4–13] years). The outcome was compared between patients receiving short-term (Group short, N = 88) versus extended ATT (Group long, N = 171). Results. The PFO closure device was successfully implanted in all cases, with 3% of minor complications. After propensity score matching, there were no differences between Groups short and long in the rate of stroke (0.3 vs. 0.4% patient-year, p = 1.00), bleeding (2 vs. 2% patient-year, p = 0.17), and device thrombosis (0.3 vs. 0.1% patient-year; p = 0.60). Univariate analysis showed that short-term ATT was not associated with an increased risk of recurrent stroke (HR: 1.271 [95% CI: 0.247–6.551], p = 0.775) or prosthesis thrombus (HR: 0.50 [95% CI: 0.070–3.548], p = 0.72). Kaplan–Meier analysis revealed similar overall survival in Group short and long (100 vs. 99 ± 1%, respectively; p = 0.25). Conclusions. Short-term (6 months) ATT after PFO closure did not impair the clinical outcome, with a preserved low rate of recurrent stroke (0.3% patient-year) and device thrombosis (0.2% patient-year) at 10-year follow-up.

背景:卵圆孔未闭(PFO)闭合后抗血栓治疗(ATT)的最佳持续时间仍存在争议。本研究旨在比较术后短时间(6个月)和长时间(>6个月)接受抗血栓药物治疗的患者的临床结果。方法:这是一项回顾性队列研究,使用倾向评分匹配分析259例连续患者(男性131例,43±10岁),因隐源性卒中而进行PFO关闭,并进行完整随访(中位持续时间为10[4-13]年)。比较短期(短组,N = 88)和延长ATT(长组,N = 171)患者的结果。结果:所有病例均成功植入PFO闭合器,轻微并发症发生率为3%。倾向评分匹配后,短组和长组在卒中发生率(0.3 vs. 0.4%患者-年,p=1.00)、出血发生率(2 vs. 2%患者-年,p=0.17)和器械血栓发生率(0.3 vs. 0.1%患者-年;p = 0.60)。单因素分析显示,短期ATT与卒中复发风险增加(HR: 1.271 [95% CI: 0.247-6.551], p=0.775)或假体血栓(HR: 0.50 [95% CI: 0.070-3.548], p=0.72)无关。Kaplan-Meier分析显示,短组和长组的总生存率相似(分别为100 vs 99±1%);p = 0.25)。结论:PFO关闭后的短期(6个月)ATT没有影响临床结果,在10年随访中,卒中复发率(0.3%患者-年)和器械血栓形成率(0.2%患者-年)保持较低。
{"title":"Antithrombotic Therapy Duration after Patent Foramen Ovale Closure for Stroke Prevention: Impact on Long-Term Outcome","authors":"Joelle Kefer,&nbsp;Karlien Carbonez,&nbsp;Sophie Pierard,&nbsp;François-Pierre Mouthuy,&nbsp;Andre Peeters,&nbsp;Cedric Hermans,&nbsp;Catherine Lambert,&nbsp;Christophe DeMeester,&nbsp;Thierry Sluysmans,&nbsp;Agnes Pasquet","doi":"10.1155/2022/6559447","DOIUrl":"10.1155/2022/6559447","url":null,"abstract":"<div>\u0000 <p><i>Background</i>. The optimal duration of antithrombotic therapy (ATT) after patent foramen ovale (PFO) closure remains under debate. This study sought to compare the clinical outcome of patients receiving antithrombotic agents for a short (6 months) versus extended (&gt;6 months) period after the procedure. <i>Methods</i>. This was a retrospective cohort study using a propensity score matching analysis on 259 consecutive patients (131 males, 43 ± 10 years) undergoing PFO closure due to cryptogenic stroke, with complete follow-up (median duration of 10 [4–13] years). The outcome was compared between patients receiving short-term (Group short, <i>N</i> = 88) versus extended ATT (Group long, <i>N</i> = 171). <i>Results</i>. The PFO closure device was successfully implanted in all cases, with 3% of minor complications. After propensity score matching, there were no differences between Groups short and long in the rate of stroke (0.3 vs. 0.4% patient-year, <i>p</i> = 1.00), bleeding (2 vs. 2% patient-year, <i>p</i> = 0.17), and device thrombosis (0.3 vs. 0.1% patient-year; <i>p</i> = 0.60). Univariate analysis showed that short-term ATT was not associated with an increased risk of recurrent stroke (HR: 1.271 [95% CI: 0.247–6.551], <i>p</i> = 0.775) or prosthesis thrombus (HR: 0.50 [95% CI: 0.070–3.548], <i>p</i> = 0.72). Kaplan–Meier analysis revealed similar overall survival in Group short and long (100 vs. 99 ± 1%, respectively; <i>p</i> = 0.25). <i>Conclusions</i>. Short-term (6 months) ATT after PFO closure did not impair the clinical outcome, with a preserved low rate of recurrent stroke (0.3% patient-year) and device thrombosis (0.2% patient-year) at 10-year follow-up.</p>\u0000 </div>","PeriodicalId":16329,"journal":{"name":"Journal of interventional cardiology","volume":"2022 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2022-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9633204/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40474809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Balloon-Expandable TAVR Bioprostheses: Area or Perimeter Sizing? A Prospective Pilot Study 气球可膨胀TAVR生物假体:面积还是周长尺寸?前瞻性试点研究。
IF 1.6 3区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2022-10-18 DOI: 10.1155/2022/3139476
Jonathan Halim, Peter den Heijer, Jeroen Vos, Bas E. Schölzel, Martijn Meuwissen, Ben van den Branden, Andreas Baumbach, Alexander J. J. Ijsselmuiden

Objective. In TAVR, area sizing is used for balloon-expandable (BE) valves, whereas self-expanding valves are sized to annulus perimeter. For BE valves, this seems illogical: these frames force a circular shape even on an ellipsoid annulus. This can potentially lead to relative undersizing when area sizing is being applied. We developed a perimeter-based sizing algorithm to evaluate the safety and feasibility of perimeter sizing for the Myval BE valve. Methods. In this prospective single-center study, 60 patients with severe aortic stenosis treated with the Myval BE valve were included. Perimeter sizing was used with limited oversizing of 3.7% ± 1.3% compared to the annulus perimeter. After TAVR, clinical outcomes were evaluated at 30 days and 1 year. An echocardiographic follow-up took place at 30 days. Results. At 30 days, the need for PPI and stroke occurred in 2% and 3% of the patients, respectively. Moreover, cardiac death and moderate-severe PVL were absent. At 1-year, cardiac death and stroke were observed in 3% and 8% of the patients, respectively. In 33.3% of the patients, a larger valve size was implanted compared to the valve size calculated by area sizing. Conclusions. Perimeter sizing with the Myval BE valve leads to substantial use of larger valve sizes and favorable clinical outcomes, with low PPI and the absence of significant PVL. A randomized controlled trial is being planned to prove the superiority of this alternative sizing method.

目的:在TAVR中,面积尺寸用于球囊膨胀(BE)瓣膜,而自膨胀瓣膜的尺寸为环周。对于BE阀来说,这似乎不合逻辑:这些框架即使在椭球环上也会形成圆形。这可能会在应用区域大小调整时导致尺寸相对不足。我们开发了一种基于周长的施胶算法来评估Myval BE阀周长施胶的安全性和可行性。方法:在这项前瞻性单中心研究中,纳入了60例使用Myval BE瓣膜治疗的严重主动脉瓣狭窄患者。采用周长施胶,与环空周长相比,有限的超施胶量为3.7%±1.3%。TAVR后,分别于30天和1年评估临床结果。超声心动图随访30天。结果:在30天,需要使用PPI和卒中的患者分别为2%和3%。此外,心源性死亡和中重度PVL未见。1年后,分别有3%和8%的患者出现心源性死亡和中风。在33.3%的患者中,植入的瓣膜尺寸比通过面积大小计算的瓣膜尺寸大。结论:Myval BE瓣膜的周长缩小导致大量使用更大瓣膜尺寸和良好的临床结果,PPI低,无明显的PVL。正在计划进行一项随机对照试验,以证明这种可选择的分级方法的优越性。
{"title":"Balloon-Expandable TAVR Bioprostheses: Area or Perimeter Sizing? A Prospective Pilot Study","authors":"Jonathan Halim,&nbsp;Peter den Heijer,&nbsp;Jeroen Vos,&nbsp;Bas E. Schölzel,&nbsp;Martijn Meuwissen,&nbsp;Ben van den Branden,&nbsp;Andreas Baumbach,&nbsp;Alexander J. J. Ijsselmuiden","doi":"10.1155/2022/3139476","DOIUrl":"10.1155/2022/3139476","url":null,"abstract":"<div>\u0000 <p><i>Objective</i>. In TAVR, area sizing is used for balloon-expandable (BE) valves, whereas self-expanding valves are sized to annulus perimeter. For BE valves, this seems illogical: these frames force a circular shape even on an ellipsoid annulus. This can potentially lead to relative undersizing when area sizing is being applied. We developed a perimeter-based sizing algorithm to evaluate the safety and feasibility of perimeter sizing for the Myval BE valve. <i>Methods</i>. In this prospective single-center study, 60 patients with severe aortic stenosis treated with the Myval BE valve were included. Perimeter sizing was used with limited oversizing of 3.7% ± 1.3% compared to the annulus perimeter. After TAVR, clinical outcomes were evaluated at 30 days and 1 year. An echocardiographic follow-up took place at 30 days. <i>Results</i>. At 30 days, the need for PPI and stroke occurred in 2% and 3% of the patients, respectively. Moreover, cardiac death and moderate-severe PVL were absent. At 1-year, cardiac death and stroke were observed in 3% and 8% of the patients, respectively. In 33.3% of the patients, a larger valve size was implanted compared to the valve size calculated by area sizing. <i>Conclusions</i>. Perimeter sizing with the Myval BE valve leads to substantial use of larger valve sizes and favorable clinical outcomes, with low PPI and the absence of significant PVL. A randomized controlled trial is being planned to prove the superiority of this alternative sizing method.</p>\u0000 </div>","PeriodicalId":16329,"journal":{"name":"Journal of interventional cardiology","volume":"2022 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2022-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9596236/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40448764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Uric Acid to High-Density Lipoprotein Cholesterol Ratio is a Novel Marker to Predict Functionally Significant Coronary Artery Stenosis 尿酸与高密度脂蛋白胆固醇比值是预测冠状动脉功能性显著狭窄的新指标。
IF 1.6 3区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2022-10-13 DOI: 10.1155/2022/9057832
Fanqi Li, Donghui Zhao, Qiuyu Li, Xiaolong Lin, Haoxuan Sun, Qian Fan

Background. Intermediate coronary stenosis (ICS) is defined as a visually estimated percentage of diameter stenosis ranging between 40% and 70% by conventional coronary angiography (CAG). Whether to perform percutaneous coronary intervention (PCI) for these lesions is a challenge in clinical practice. The fractional flow reserve (FFR) can guide treatment by determining the functional significance of ICS. Studies have shown that some clinical indicators can be used to predict FFR. However, there is little research on this in the Chinese population. Methods. We retrospectively analyzed 690 patients who underwent FFR measurements to determine the functional significance of a single ICS. Patients were divided into 2 groups: FFR ≤0.8 (n = 280) and FFR >0.8 (n = 410). We compared the clinical factors between the two groups and performed multivariate logistic regression analyses to explore the risk factors. In addition, receiver-operating characteristic (ROC) curves were constructed for FFR ≤0.8 diagnoses. Results. The mean UHR (uric acid to high-density lipoprotein cholesterol ratio) level was significantly higher in the FFR ≤0.8 group (p < 0.001). UHR corrects negatively with FFR (r = −0.44, p < 0.001). High-level UHR was an independent risk factor for the FFR ≤0.8 (OR = 7.17, 95% CI 4.17–12.34). The area under the curve (AUC) of the UHR diagnostic capacity for the FFR ≤0.8 is 0.77, with 77.3% sensitivity and 68.2% specificity. Conclusion. UHR levels were significantly increased in patients with hemodynamically significant coronary lesions. UHR is a novel predictor of functionally significant lesions in patients with a single-vessel disease of ICS.

背景:中度冠状动脉狭窄(ICS)被定义为通过常规冠状动脉造影(CAG)视觉估计的直径狭窄百分比,范围在40%至70%之间。是否对这些病变进行经皮冠状动脉介入治疗(PCI)是临床实践中的一个挑战。分数血流储备(FFR)可以通过确定ICS的功能意义来指导治疗。研究表明,一些临床指标可用于预测FFR。然而,在中国人口中,这方面的研究很少。方法:我们回顾性分析了690例接受FFR测量的患者,以确定单个ICS的功能意义。患者分为FFR≤0.8组(n = 280)和FFR >0.8组(n = 410)。我们比较两组的临床因素,并进行多因素logistic回归分析,探讨两组的危险因素。此外,对于FFR≤0.8的诊断,构建受试者工作特征(ROC)曲线。结果:FFR≤0.8组尿酸与高密度脂蛋白胆固醇之比(UHR)水平显著升高(p < 0.001)。UHR与FFR呈负相关(r = -0.44, p < 0.001)。高水平UHR是FFR≤0.8的独立危险因素(OR = 7.17, 95% CI 4.17-12.34)。FFR≤0.8时UHR诊断能力的曲线下面积(AUC)为0.77,敏感性77.3%,特异性68.2%。结论:有血流动力学意义的冠状动脉病变患者UHR水平显著升高。UHR是一种新的预测单血管病变患者功能显著病变的指标。
{"title":"Uric Acid to High-Density Lipoprotein Cholesterol Ratio is a Novel Marker to Predict Functionally Significant Coronary Artery Stenosis","authors":"Fanqi Li,&nbsp;Donghui Zhao,&nbsp;Qiuyu Li,&nbsp;Xiaolong Lin,&nbsp;Haoxuan Sun,&nbsp;Qian Fan","doi":"10.1155/2022/9057832","DOIUrl":"10.1155/2022/9057832","url":null,"abstract":"<div>\u0000 <p><i>Background</i>. Intermediate coronary stenosis (ICS) is defined as a visually estimated percentage of diameter stenosis ranging between 40% and 70% by conventional coronary angiography (CAG). Whether to perform percutaneous coronary intervention (PCI) for these lesions is a challenge in clinical practice. The fractional flow reserve (FFR) can guide treatment by determining the functional significance of ICS. Studies have shown that some clinical indicators can be used to predict FFR. However, there is little research on this in the Chinese population. <i>Methods</i>. We retrospectively analyzed 690 patients who underwent FFR measurements to determine the functional significance of a single ICS. Patients were divided into 2 groups: FFR ≤0.8 (<i>n</i> = 280) and FFR &gt;0.8 (<i>n</i> = 410). We compared the clinical factors between the two groups and performed multivariate logistic regression analyses to explore the risk factors. In addition, receiver-operating characteristic (ROC) curves were constructed for FFR ≤0.8 diagnoses. <i>Results</i>. The mean UHR (uric acid to high-density lipoprotein cholesterol ratio) level was significantly higher in the FFR ≤0.8 group (<i>p</i> &lt; 0.001). UHR corrects negatively with FFR (<i>r</i> = −0.44, <i>p</i> &lt; 0.001). High-level UHR was an independent risk factor for the FFR ≤0.8 (OR = 7.17, 95% CI 4.17–12.34). The area under the curve (AUC) of the UHR diagnostic capacity for the FFR ≤0.8 is 0.77, with 77.3% sensitivity and 68.2% specificity. <i>Conclusion</i>. UHR levels were significantly increased in patients with hemodynamically significant coronary lesions. UHR is a novel predictor of functionally significant lesions in patients with a single-vessel disease of ICS.</p>\u0000 </div>","PeriodicalId":16329,"journal":{"name":"Journal of interventional cardiology","volume":"2022 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2022-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9584719/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40656309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Journal of interventional cardiology
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1