Revista espanola de cardiologia最新文献

英文中文

MIOS-MFO, un estudio observacional internacional multicéntrico del oclusor KONAR-MF de Lifetech en el tratamiento de defectos septales ventriculares perimembranosos MIOS-MFO， Lifetech公司的KONAR-MF闭塞剂在治疗隔膜周心室缺陷方面的多中心国际观察研究

IF 5.9 2区医学 Q2 Medicine

Revista espanola de cardiologia

Pub Date : 2025-05-05 DOI: 10.1016/j.recesp.2025.02.015

Raymond N. Haddad , Ali Houeijeh , Ender Odemis , Jean-Benoit Thambo , Turkay Saritas , Ibrahim Ece , Clement Karsenty , Kaan Yildiz , Mete Han Kizilkaya , Sébastien Hascoet , Hojat Mortezaeian , Harun Terin , Mohammed Kasem , Zakhia Saliba , Nazmi Narin

Introduction and objectives

The Lifetech KONAR-MF ventricular septal defect occluder (MFO) is increasingly used for transcatheter perimembranous ventricular septal defect (pmVSD) closure. We aim to collect real-world data on patient outcomes and MFO performance in pmVSD cases.

Methods

This was a nonrandomized, retrospective, multicenter, postmarketing clinical follow-up study of pmVSD patients implanted with the MFO device between 2018 and 2023. The primary endpoint was 6-month composite clinical success, defined as technical success (successful implantation and device retention at the end of the procedure), closure success (trivial or no residual shunt), absence of serious adverse events at 30 days, and no device removal or reintervention. Secondary endpoints consisted of technical success, procedural success (technical success and less than moderate residual shunt), closure success (clinically insignificant or absent residual shunt), and safety.

Results

Our cohort comprised 333 patients (51.4% male, 10.2% adults), with a median age of 4.6 [IQR, 2-10] years and a median weight of 17 [IQR, 11-32] kg. Baseline defect characteristics consisted of a left ventricular defect diameter of 8 [IQR, 7-10] mm, with 13.8% of patients having aortic valve regurgitation, 9.9% having an indirect Gerbode shunt, 10.5% having mild aortic valve prolapse, and 32.2% having subaortic rim deficiency. Closure via a retrograde approach was performed in 183 patients (55%). Technical success at procedure completion was 97.6%, and procedural success was 94.6%. Closure success at 6 months was 97.1%, while composite clinical success was 90.1%. Freedom from serious adverse events was 95.2% at 30 days. Freedom from device-related events was 96.8% at 6 months and 93.8% at 24 months. Risk factors for 6-month composite clinical failure were aortic valve prolapse (OR, 4.85; 95%CI, 2.07-11.39) and right ventricular defect diameter (OR, 1.41; 95%CI, 1.01-1.98).

Conclusions

Transcatheter closure of pmVSD with the MFO device demonstrated feasibility, effectiveness, and safety in real-world settings.

Lifetech的KONAR-MF室间隔缺损封堵器（MFO）越来越多地用于经导管膜周室间隔缺损（pmVSD）的封闭。我们的目标是收集关于pmVSD患者预后和MFO表现的真实数据。方法：对2018 - 2023年植入MFO装置的pmVSD患者进行非随机、回顾性、多中心、上市后临床随访研究。主要终点是6个月的综合临床成功，定义为技术成功（手术结束时成功植入和器械保留），闭合成功（轻微或无残留分流），30天无严重不良事件，无器械移除或再干预。次要终点包括技术成功、手术成功（技术成功和少于中度残留分流）、闭合成功（临床不显著或没有残留分流）和安全性。结果我们的队列包括333例患者（51.4%为男性，10.2%为成人），中位年龄为4.6 [IQR， 2-10]岁，中位体重为17 [IQR， 11-32] kg，基线缺陷特征包括左心室缺损直径为8 [IQR， 7-10] mm，其中13.8%的患者有主动脉瓣反流，9.9%有间接Gerbode分流，10.5%有轻度主动脉瓣脱垂，32.2%有主动脉下缘缺损。183例（55%）患者行逆行闭合。手术技术成功率97.6%，手术成功率94.6%。6个月闭合成功率为97.1%，临床综合成功率为90.1%。30天严重不良事件的发生率为95.2%。6个月和24个月时，与设备相关事件的自由度分别为96.8%和93.8%。6个月复合临床衰竭的危险因素为主动脉瓣脱垂（OR, 4.85; 95%CI, 2.07-11.39）和右室缺损直径（OR, 1.41; 95%CI, 1.01-1.98）。结论MFO装置在治疗pmVSD中具有可行性、有效性和安全性。

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引用次数: 0

Afinando en la valoración del exceso de trabeculación del ventrículo izquierdo 改进左心室过度凝块的评估

IF 5.9 2区医学 Q2 Medicine

Revista espanola de cardiologia

Pub Date : 2025-05-05 DOI: 10.1016/j.recesp.2025.04.005

Álvaro Montes Muñiz , Alberto Cecconi , Luis Jesús Jiménez-Borreguero

引用次数: 0

Reserva fraccional de flujo u OCT para guiar el tratamiento de estenosis coronarias complejas y no complejas angiográficamente intermedias 用于指导血管造影中复杂和非复杂冠状动脉狭窄治疗的部分流量储备或近距离观察

IF 5.9 2区医学 Q2 Medicine

Revista espanola de cardiologia

Pub Date : 2025-05-05 DOI: 10.1016/j.recesp.2025.02.016

Andrea Zito , Francesco Burzotta , Cristina Aurigemma , Enrico Romagnoli , Francesco Bianchini , Emiliano Bianchini , Lazzaro Paraggio , Mattia Lunardi , Carolina Ierardi , Filippo Crea , Antonio Maria Leone , Carlo Trani

Introduction and objectives

The management of patients with coronary artery disease can benefit from devices that improve functional or anatomical evaluation. This study aimed to compare the efficacy of optical coherence tomography (OCT) and fractional flow reserve (FFR) guidance for managing vessels with angiographically intermediate coronary lesions according to angiographic lesion complexity.

Methods

The FORZA trial (NCT01824030) was a randomized trial comparing the use of OCT or FFR for revascularization decisions and percutaneous coronary intervention optimization in patients with angiographically intermediate coronary lesions. Complex lesions were defined as long (length > 38 mm), severely calcified, or bifurcation lesions. The primary outcome was major adverse cardiac events (MACE), defined as a composite of all-cause death, myocardial infarction, or target vessel revascularization.

Results

A total of 420 vessels (200 OCT-guided and 220 FFR-guided) were enrolled, including 212 vessels with complex lesions. At the 5-year follow-up, the MACE rate was 20.8% in vessels with complex lesions and 13.9% in vessels with noncomplex lesions (HR, 1.52; 95%CI, 0.95-2.44; P = .078). Compared with FFR, OCT was associated with a lower risk of MACE in vessels with complex lesions (HR, 0.53; 95%CI, 0.28-0.98; P = .044), but with a higher risk of MACE in vessels with noncomplex lesions (HR, 2.23; 95%CI, 1.04-4.81; P = .040; P_interaction = .004).

Conclusions

In vessels with angiographically intermediate coronary lesions, angiographic lesion complexity may modulate the long-term efficacy of the guidance modality, with a potential benefit of OCT in complex lesions and FFR in noncomplex lesions.

介绍和目的冠状动脉疾病患者的治疗可以从改善功能或解剖评价的器械中获益。本研究旨在比较光学相干断层扫描（OCT）和分数血流储备（FFR）指导根据血管造影病变复杂性对冠脉造影中期病变血管的治疗效果。方法FORZA试验（NCT01824030）是一项随机试验，比较使用OCT或FFR进行血管重建决策和经皮冠状动脉介入治疗对血管造影中期冠状动脉病变患者的影响。复杂病变被定义为长（长度>； 38mm），严重钙化或分叉病变。主要终点是主要心脏不良事件（MACE），定义为全因死亡、心肌梗死或靶血管重建术的综合结果。结果共纳入420条血管（oct引导200条，ffr引导220条），其中病变复杂的血管212条。在5年随访中，复杂病变血管的MACE率为20.8%，非复杂病变血管的MACE率为13.9% （HR, 1.52; 95%CI, 0.95-2.44; P = 0.078）。与FFR相比，OCT与复杂病变血管发生MACE的风险较低（HR, 0.53; 95%CI, 0.28-0.98; P = 0.044），但与非复杂病变血管发生MACE的风险较高（HR, 2.23; 95%CI, 1.04-4.81; P = 0.040； P相互作用= 0.004）。结论在冠状动脉造影中度病变的血管中，血管造影病变复杂性可能调节引导方式的长期疗效，在复杂病变中OCT和非复杂病变中FFR具有潜在的优势。

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引用次数: 0

Atrioseptostomía con balón para la transposición de las grandes arterias en Europa: características y resultados actuales 欧洲大动脉移位球状心房切除术：特点和实际结果

IF 5.9 2区医学 Q2 Medicine

Revista espanola de cardiologia

Pub Date : 2025-04-26 DOI: 10.1016/j.recesp.2024.12.014

Hugues Lucron , Sophie-Guiti Malekzadeh-Milani , Thomas Perouse de Montclos , Alban-Elouen Baruteau , Alberto Mendoza Soto , Gianfranco Butera , Ina Michel-Behnke , Caroline Ovaert , Carles Bautista-Rodriguez , James Bentham , Zakaria Jalal , Pedro Betrian Blasco , Hélène Bouvaist , Marie Vincenti , José Diego Ferreira Matins , Jean-Marc Jellimann , Alessia Callegari , Laurent Bonnemains , Ronan Bonnefoy , Biagio Castaldi , Damien Bonnet

Introduction and objectives

Balloon atrial septostomy (BAS) improves oxygenation in neonates with transposition of the great arteries (TGA) and restrictive foramen ovale. Currently, there is a global shortage of dedicated BAS catheters, while new unmarked catheters have recently become available at some European centers. This study aimed to characterize BAS outcomes using the currently available BAS catheters in Europe.

Methods

A 2-year multicenter observational registry was conducted, including all neonates undergoing BAS for TGA. We report preliminary results (September 2022-February 2024) focusing on BAS characteristics and outcomes.

Results

A total of 250 BAS procedures were performed in 29 centers. The median neonatal weight was 3.16 kg, and 88% of neonates had a prenatal diagnosis. Most procedures were performed often on the first day of life during working hours (72.8%), mainly in catheterization laboratories (59.2%). Guidance primarily involved ultrasound with or without fluoroscopy. A guidewire was used in 41.2% of procedures. A total of 290 catheters (286 Z-5 or Z-6) were used, achieving an overall BAS success rate of 96%. Complete procedural failure was associated with the use of the umbilical venous route (OR, 3.62; P = .001) and lower-volume catheters (OR, 7.01; P < .001). The occurrence of significant complications (8%; OR, 9.33; P < .001) was associated with complete procedural failure. For complex procedures, significant risk factors were the absence of fluoroscopy (OR, 3.32; P = .001), use of the umbilical venous route (OR, 2.28; P = .005), and lower-volume catheters (OR, 2.43; P = .03).

Conclusions

In the current era, BAS can be challenging, and significant complications and complete failures are not uncommon. The use of the umbilical venous route, low-volume BAS catheters, absence of fluoroscopy guidance, and the occurrence of complications negatively impact procedural outcomes.

简介与目的球囊房间隔造口术（BAS）改善新生儿大动脉转位（TGA）和限制性卵圆孔的氧合。目前，全球缺乏专用的BAS导管，而新的无标记导管最近在一些欧洲中心可用。本研究旨在描述目前在欧洲使用BAS导管的BAS结果。方法采用2年多中心观察登记法，纳入所有因TGA而接受BAS治疗的新生儿。我们报告了初步结果（2022年9月至2024年2月），重点关注BAS的特征和结果。结果29个中心共实施了250例BAS手术。新生儿体重中位数为3.16 kg， 88%的新生儿有产前诊断。大多数手术通常在出生第一天的工作时间进行（72.8%），主要在导管室进行（59.2%）。指导主要包括超声检查和透视检查。41.2%的手术使用导丝。共使用290根导管（286根Z-5或Z-6），总体BAS成功率为96%。完全手术失败与使用脐静脉路径相关(OR, 3.62；P = .001)和小容量导管(OR, 7.01；P & lt;措施)。严重并发症的发生(8%；或者,9.33;P & lt;.001)与完全手术失败相关。对于复杂的手术，重要的危险因素是没有透视检查(OR, 3.32；P = .001)，使用脐静脉途径(OR, 2.28；P = 0.005)，低容量导管(OR, 2.43；p = .03)。结论在当今时代，BAS具有挑战性，严重并发症和完全失败并不罕见。使用脐静脉路径、小容量BAS导管、缺乏透视指导以及并发症的发生对手术结果产生负面影响。

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引用次数: 0

Asociación entre la metilación del ADN en loci relacionados con el tabaco y mortalidad en pacientes con enfermedad arterial periférica 烟草相关位点的DNA甲基化与周围动脉疾病患者死亡率之间的关联

IF 5.9 2区医学 Q2 Medicine

Revista espanola de cardiologia

Pub Date : 2025-04-25 DOI: 10.1016/j.recesp.2025.02.024

Lidia Marcos-García , Albert Clarà , Sonia Pérez-Cabezón , Manuel Miralles-Hernández , Roberto Elosua , Alina Velescu

引用次数: 0

Identificación de nuevos biomarcadores en enfermedades de la aorta torácica ascendente mediante metabolómica basada en espectrometría de masas de alta resolución no dirigida 利用非定向高分辨率质谱代谢组学识别胸椎上升主动脉疾病的新生物标志物

IF 5.9 2区医学 Q2 Medicine

Revista espanola de cardiologia

Pub Date : 2025-04-25 DOI: 10.1016/j.recesp.2025.02.022

Miguel Morales-García , María Belén García-Ortega , José Pérez del Palacio , Eduardo Moreno-Escobar , Diego Segura-Rodríguez , Rocío García-Orta

引用次数: 0

¿Español o castellano? 西班牙语或西班牙语吗？

IF 5.9 2区医学 Q2 Medicine

Revista espanola de cardiologia

Pub Date : 2025-04-23 DOI: 10.1016/j.recesp.2025.04.003

引用次数: 0

Impacto de la prescripción temprana de inhibidores de SGLT2 en los resultados de la insuficiencia cardiaca aguda descompensada: evidencia del mundo real 早期开SGLT2抑制剂对急性缺损性心力衰竭结果的影响：真实世界的证据

IF 5.9 2区医学 Q2 Medicine

Revista espanola de cardiologia

Pub Date : 2025-04-17 DOI: 10.1016/j.recesp.2025.02.009

Luis E. Echeverría , Lyda Z. Rojas , Angie Yarlady Serrano-García , Daniel R. Botero , María Cantillo-Reines , Adriana M. Jurado , Karen Andrea García-Rueda , Ángela Torres-Bustamante , Diana Ivonne Cañón-Gómez , Carolina Idrovo-Turbay , Robinson Sánchez-García , Jaime Alberto Rodríguez , Sergio A. Gómez-Ochoa

Introduction and objectives

Although sodium-glucose cotransporter 2 inhibitors (SGLT2i) have shown benefits in acute decompensated heart failure (ADHF), the extrapolability of clinical trial results to general populations remains limited. This study evaluated the impact of early in-hospital SGLT2i prescription on ADHF outcomes in a real-world setting.

Methods

Prospective cohort study. Adults with ADHF from a third-level cardiovascular center were included. The primary analysis compared early SGLT2i (prescribed within 48 hours of admission) versus late SGLT2i (prescribed after 48 hours). A secondary analysis included patients not receiving in-hospital SGLT2i. The primary outcome was in-hospital mortality. Secondary outcomes included the length of hospital stay, 30-day improvement in the Minnesota Living with Heart Failure Questionnaire score, 30-day rehospitalization due to heart failure, and 30-day all-cause mortality.

Results

Of 2016 patients, early SGLT2i (≤ 48 h) was initiated in 1275 (63.2%) patients, late SGLT2i in 346 (17.2%), and 395 (19.6%) did not receive in-hospital SGLT2i. After multivariate adjustment, early versus late SGLT2i use was associated with decreased in-hospital mortality (RR, 0.37; 95%CI, 0.17-0.77) and reduced hospital stay (mean difference −5.70 days; 95%CI, −7.05 to −4.34). Similarly, early versus late or no in-hospital SGLT2i use was associated with decreased in-hospital mortality (RR, 0.25; 95%CI, 0.14-0.44), reduced hospital stay (mean difference −2.99 days; 95%CI, −4.05 to −1.92), and lower 30-day combined mortality/heart failure rehospitalization (RR, 0.72; 95%CI, 0.53-0.98).

Conclusions

Early in-hospital SGLT2i prescription was associated with improved cardiovascular outcomes in ADHF in a real-world setting.

虽然钠-葡萄糖共转运蛋白2抑制剂（SGLT2i）已显示出对急性失代偿性心力衰竭（ADHF）的益处，但临床试验结果对一般人群的可推广性仍然有限。本研究评估了在现实世界中早期住院SGLT2i处方对ADHF结果的影响。方法前瞻性队列研究。纳入了来自三级心血管中心的ADHF成人患者。初步分析比较了早期SGLT2i（入院48小时内开药）和晚期SGLT2i（48小时后开药）。二次分析纳入了未在医院接受SGLT2i治疗的患者。主要终点是住院死亡率。次要结局包括住院时间、明尼苏达州心力衰竭患者问卷评分30天改善、心力衰竭30天再住院以及30天全因死亡率。结果2016年患者中，早期SGLT2i（≤48 h）患者1275例（63.2%），晚期SGLT2i患者346例（17.2%），395例（19.6%）未接受住院SGLT2i治疗。多因素调整后，早期与晚期使用SGLT2i与住院死亡率降低（RR, 0.37; 95%CI, 0.17-0.77）和住院时间缩短（平均差为- 5.70天；95%CI, - 7.05 - - 4.34）相关。同样，早期与晚期或不住院使用SGLT2i与住院死亡率降低（RR, 0.25; 95%CI, 0.14-0.44）、住院时间缩短（平均差为- 2.99天；95%CI, - 4.05至- 1.92）以及30天合并死亡率/心力衰竭再住院率降低（RR, 0.72; 95%CI, 0.53-0.98）相关。结论：在现实世界中，早期住院SGLT2i处方与ADHF患者心血管结局的改善相关。

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引用次数: 0

Entre la fibrilación auricular y la ablación: un hallazgo inesperado 在耳部纤颤和消融之间：意外发现

IF 5.9 2区医学 Q2 Medicine

Revista espanola de cardiologia

Pub Date : 2025-04-17 DOI: 10.1016/j.recesp.2025.02.020

Ismael Arco Adamuz, Torcuato Garrido-Arroquia Jurado, Rocío García Orta

引用次数: 0

Implante percutáneo de válvula aórtica en válvulas aórticas bicúspides: presente y futuro 双尖主动脉瓣皮下主动脉瓣膜植入：现在和将来

IF 5.9 2区医学 Q2 Medicine

Revista espanola de cardiologia

Pub Date : 2025-04-17 DOI: 10.1016/j.recesp.2025.02.013

Alberto Alperi , Raquel del Valle , Isaac Pascual , Paula Antuna , Marcel Almendárez , Rut Álvarez , Daniel Hernández-Vaquero , Pablo Avanzas

The prevalence of bicuspid aortic valves (BAV) in patients undergoing transcatheter aortic valve implantation (TAVI) is expected to gradually increase over the coming years. However, in the absence of dedicated randomized trials, TAVI outcomes in BAV patients have failed to match those obtained in trileaflet anatomies. This discrepancy is mainly due to varying degrees of valve morphology and calcification, aortic angulation, concomitant aortopathy, and the difficulties of achieving optimal preprocedural anatomic sizing and device selection in the BAV setting. In this review, we aim to outline the current state of knowledge in the BAV and TAVI field, evaluate the main challenges faced by TAVI operators when dealing with these anatomies, summarize novel approaches for sizing and preprocedural evaluation, and provide a glimpse into the future of this interesting and evolving field.

在接受经导管主动脉瓣植入术（TAVI）的患者中，双尖瓣主动脉瓣（BAV）的患病率预计将在未来几年逐渐增加。然而，由于缺乏专门的随机试验，BAV患者的TAVI结果未能与三胞胎解剖结果相匹配。这种差异主要是由于不同程度的瓣膜形态和钙化，主动脉成角，伴随主动脉病变，以及在BAV设置中实现最佳手术前解剖尺寸和设备选择的困难。在这篇综述中，我们旨在概述BAV和TAVI领域的知识现状，评估TAVI操作员在处理这些解剖时面临的主要挑战，总结尺寸和手术前评估的新方法，并展望这一有趣且不断发展的领域的未来。

引用次数: 0

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