Therapeutic Advances in Cardiovascular Disease最新文献

Objective: The goal of this study was to compare the computed tomography angiography scans of the segmentation results from the Cvpilot, 3mensio, and Volume Viewer systems to explore the practicability of the Cvpilot system in the automatic segmentation and technical evaluation of the aortic root before transcatheter aortic valve replacement (TAVR).

Design: A total of 154 patients who underwent TAVR at our center from January 2022 to May 2023 were enrolled, and their computed tomography angiography images were analyzed using the Cvpilot, 3mensio, and Volume Viewer systems, respectively.

Setting: Not applicable.

Participants: Not applicable.

Main outcome measures: The reconstructed computed tomography angiography images were evaluated by experts, and the measurements of the aortic roots were analyzed statistically.

Results: Compared with the 3mensio system, 92.2% of patients (n = 142) evaluated with the Cvpilot system reached grade A, 5.2% of patients (n = 8) reached grade B, and 2.6% of patients (n = 4) reached grade C. Compared with the Volume Viewer system, 90.9% of patients (n = 140) evaluated with the Cvpilot system achieved grade A, 7.1% of patients (n = 11) achieved grade B, and 2.0% of patients (n = 3) achieved grade C. Furthermore, there was no significant difference among the measurement results of the Cvpilot, 3mensio, and Volume Viewer systems (all p > 0.05).

Conclusion: Overall, the Cvpilot system is effective and reliable. It can accurately complete the segmentation and the measurement of aortic root structures, thereby effectively improving the measurement quality before TAVR.

Trial registration: Not applicable.

Background: Extensive surgical resection of the thoracic aorta in patients with type A aortic dissection (TAAD) is thought to reduce the risk of late aortic wall degeneration and the need for repeat aortic operations.

Objectives: We evaluated the early and late outcomes after aortic root replacement and supracoronary ascending aortic replacement in patients with TAAD involving the aortic root.

Design: Retrospective, multicenter cohort study.

Methods: The outcomes after aortic root replacement and supracoronary ascending aortic replacement in patients with TAAD involving the aortic root, that is dissection flap located at least in one of the Valsava segments, were herein evaluated. In-hospital mortality, neurological complications, dialysis as well as 10-year repeat proximal aortic operation, and mortality were the outcomes of this study.

Results: Supracoronary ascending aortic replacement was performed in 198 patients and aortic root replacement in 215 patients. During a mean follow-up of 4.0 ± 4.0 years, 19 patients underwent 22 repeat procedures on the aortic root and/or aortic valve. No operative death occurred after these reinterventions. The risk of proximal aortic reoperation was significantly lower in patients who underwent aortic root replacement (5.5% vs 12.9%, adjusted subdistributional hazard ratio (SHR) 0.085, 95% CI 0.022-0.329). Aortic root replacement was associated with higher rates of in-hospital (14.4% vs 12.1%, adjusted odds ratio 2.192, 95% CI 1.000-4.807) and 10-year mortality (44.5% vs 30.4%, adjusted hazard ratio 2.216, 95% CI 1.338-3.671). Postoperative neurological complications and dialysis rates were comparable in the study groups.

Conclusion: Among patients with TAAD involving the aortic root, its replacement was associated with a significantly lower rate of repeat proximal aortic operation of any type compared to supracoronary aortic replacement. Still, aortic root replacement seems to be associated with an increased risk of mortality in these patients.

ClinicalTrials.gov: NCT04831073 (https://clinicaltrials.gov/study/NCT04831073).

Background: Hereditary transthyretin amyloidosis (hATTR) is caused by mutations in the transthyretin (TTR) gene, which lead to the aggregation of misfolded TTR protein and amyloid accumulation in the peripheral nerves, heart, and gastrointestinal tract. Recently, RNA therapeutics, including small interfering RNAs (siRNAs) and antisense oligonucleotides (ASOs), have been approved for treating patients with hATTR.

Objectives: To assess the neurological efficacy and safety of RNA therapeutics in hATTR patients.

Design: Systematic review and meta-analysis.

Data sources and methods: A systematic literature search was conducted on PubMed, Cochrane, and ClinicalTrials.gov from inception to August 14, 2024. Outcomes included changes from baseline in the Norfolk Quality of Life-Diabetic Neuropathy (Norfolk QOL-DN) score and the modified Neuropathy Impairment Score +7 (mNIS + 7), modified body mass index (mBMI), adverse effects, serious adverse events, and all-cause mortality.

Results: Our study included four RCTs with 842 patients (568 in the RNA therapeutics group and 274 in the placebo group). RNA therapeutics significantly improved Norfolk QoL-DN (mean difference (MD), -18.79; 95% CI, -22.32 to -15.25; p < 0.00001; I² = 28%) and mNIS + 7 scores (MD, -26.90; 95% CI, -31.67 to -22.13; p < 0.00001; I² = 61%), with significant preservation of mBMI (MD, 114.98; 95% CI, 90.64-139.32; p < 0.00001; I² = 59%) compared to placebo. There were no significant differences between the two groups regarding the risk of adverse effects (risk ratio (RR), 0.89; 95% CI, 0.69-1.15; p = 0.36; I² = 34%), serious adverse effects (RR, 0.70; 95% CI, 0.31-1.58; p = 0.39; I² = 20%), and all-cause mortality (RR, 0.70; 95% CI, 0.31 to 1.58; p = 0.39; I² = 20%).

Conclusion: RNA therapeutics are effective and well-tolerated in patients with hATTR, significantly improving quality of life and the progression of neurological impairment. siRNAs demonstrate better outcomes compared to ASOs.

Trial registration: PROSPERO (CRD42024568346).

Misplacement of pericardiocentesis catheter in central veins is a rare complication that can be managed with several methods. In this case, we report a percutaneous image-guided plug-assisted management of a misplaced pericardiocentesis catheter into the inferior vena cava through a transhepatic tract successfully occluded. This minimally invasive technique was not previously described in this setting and had a favorable long-term outcome.

Percutaneous coronary intervention (PCI) of calcified coronary arteries is associated with poor outcomes. Poorly modified calcified lesion hinders the stent delivery, disrupts drug-carrying polymer, impairs drug elution kinetics and results in under-expanded stent (UES). UES is the most common cause of acute stent thrombosis and in-stent restenosis after PCI of calcified lesions. Angiography has poor sensitivity for recognition and quantification of coronary calcium, thereby mandating the use of intravascular imaging. Intravascular imaging, like intravascular ultrasound and optical coherence tomography, has the potential to accurately identify and quantify the coronary calcium and to guide appropriate modification device before stent placement. Available options for the modification of calcified plaque include modified balloons (cutting balloon, scoring balloon and high-pressure balloon), atherectomy devices (rotational atherectomy and orbital atherectomy) and laser atherectomy. Coronary intravascular lithotripsy (IVL) is the newest addition to the tool box for calcified plaque modification. It produces the acoustic shockwaves, which interact with the coronary calcium to cause multiplanar fractures. These calcium fractures increase the vessel compliance and result in desirable minimum stent areas. Coronary IVL has established its safety and efficacy for calcified lesion in series of Disrupt CAD trials. Its advantages over atherectomy devices include ease of use on workhorse wire, ability to modify deep calcium, no debris embolization causing slow flow or no-flow and minimal thermal injury. It is showing promising results in modification of difficult calcified lesion subsets such as calcified nodule, calcified left main bifurcation lesions and chronic total occlusion. In this review, authors will summarize the mechanism of action for IVL, its role in contemporary practice, evidence available for its use, its advantages over atherectomy devices and its imaging insight in different calcified lesion scenarios.

Despite the significant increase in women in academic medicine over the last 50 years, women are still under-represented in leadership positions in academia. However, there is a lack of data on the diversity of editorial boards in Middle Eastern medical journals. So, we aim to portray the diversity of editorial boards of Iraqi medical journals by conducting a cross-sectional analysis of the editorial boards' members of all Iraqi medical journals. Gender, affiliation and specialty were extracted from the journals' websites and/or from the professional profiles of the editorial board members. Twenty-five journals and 446 editorial board members were analysed. More than half of editorial board members specialized in basic science, while 39.76% specialized in clinical specialties. Approximately, 20.18% of editorial board members (regardless their role) were women. Four percent of editor-in-chief were women. There were significant differences in editorial role according to gender (p < 0.0001), yet residency (p = 0.688) and specialty (p = 0.190) did not differ according to their gender. Most editorial board members were affiliated with Baghdad. So, we can conclude that there is a significant under-representation of women across all roles on the editorial board of medical journals especially in the leading positions. All stakeholders, publishers, authors and academics should commit to ensure the diversity of editorial boards.