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Early Effect of Transcatheter Mitral Valve Repair on Cardiac Sympathetic Nerve Activity 经导管二尖瓣修复术对心脏交感神经活动的早期影响
Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-05-01 DOI: 10.1016/j.shj.2022.100153
Hiroaki Yokoyama MD, Koki Shishido MD, Shingo Mizuno MD, Futoshi Yamanaka MD, Shigeru Saito MD

Background

Cardiac sympathetic nerve activity (SNA) is overactivated in heart failure patients and associated with clinical outcomes. The aim of this study is to investigate the early effect of MitraClip repair on cardiac SNA.

Methods

We evaluated the change of cardiac SNA by 123I- meta-iodobenzylguanidine (MIBG) scintigraphy in patients who underwent MitraClip repair from March 2019 to June 2020 in our hospital. Patients without acute procedural success were excluded, including patients who died or underwent mitral valve surgery before discharge. MIBG scintigraphy was performed at baseline and 1 ​month after MitraClip repair.

Results

We analyzed 48 patients (mean age 78.6 ± 10 years; 52.1% male; 37 secondary mitral regurgitation [SMR]/11 primary mitral regurgitation [PMR]). MR severity and New York Heart Association functional class significantly improved from baseline to 1 ​month after MitraClip repair (both p < 0.001). Overall, delay heart-mediastinum ratio (H/M) had no significant change, and washout rate (WR) showed a decreasing trend (delay H/M; pre 2.07 ± 0.46, post 2.05 ± 0.49, paired p = 0.348, WR; pre 36.1 ± 11.6%, post 33.6 ± 11.7%, paired p = 0.061). In PMR patients, WR was significantly decreased, however, delay H/M was not (delay H/M; pre 2.15 ± 0.50, post 2.10 ± 0.57, paired p = 0.019, WR; pre 34.6 ± 10.5%, post 26.7 ± 13.8%, paired p = 0.568). In contrast, in SMR patients, neither delay H/M nor WR were significantly changed (delay H/M; pre 2.05 ± 0.45, post 2.03 ± 0.47, paired p = 0.474, WR; pre 36.6 ± 11.9%, post 35.7 ± 10.4%, paired p = 0.523).

Conclusions

Our study demonstrates that MitraClip repair could significantly decrease cardiac SNA of WR in PMR patients during 1-month follow-up, however, in SMR patients, the significant change of MIBG parameters was not observed.

心脏交感神经活动(SNA)在心力衰竭患者中被过度激活,并与临床结果相关。本研究的目的是研究MitraClip修复对心脏SNA的早期影响。方法我们通过123I-间碘苄基胍(MIBG)闪烁扫描评估了2019年3月至2020年6月在我院接受MitraClib修复的患者的心脏SNA变化。没有急性手术成功的患者被排除在外,包括出院前死亡或接受二尖瓣手术的患者。MIBG闪烁扫描在基线和1​MitraClip修复后一个月。结果我们分析了48例患者(平均年龄78.6±10岁;52.1%为男性;37例为继发性二尖瓣反流[SMR]/11例为原发性二尖瓣返流[PMR])。MR严重程度和纽约心脏协会功能分级从基线显著改善到1​MitraClip修复后一个月(均p<0.001)。总体而言,延迟性心脏纵隔比(H/M)没有显著变化,冲洗率(WR)呈下降趋势(延迟性H/M;2.07±0.46前,2.05±0.49后,配对p=0.348,WR;36.1±11.6%前,33.6±11.7%后,配对p=0.061)。然而,在PMR患者中,WR显著降低,延迟H/M没有(延迟H/M;前2.15±0.50,后2.10±0.57,配对p=0.019,WR;前34.6±10.5%,后26.7±13.8%,配对p=0.068)。相反,在SMR患者中,延迟H/M和WR均无显著变化(延迟H/M;2.05±0.45前,2.03±0.47后,配对p=0.474,WR;36.6±11.9%,35.7±10.4%,配对p=0.523),未观察到MIBG参数的显著变化。
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引用次数: 0
Integrating Structural Heart Disease Trainees within the Dynamics of the Heart Team: The Case for Multimodality Training 将结构性心脏病受训者纳入心脏团队的动态:多模式培训的案例
Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-05-01 DOI: 10.1016/j.shj.2023.100167
Homam Ibrahim MD , Angela Lowenstern MD , Andrew M. Goldsweig MD, MS , Sunil V. Rao MD

Structural heart disease is a rapidly evolving field. However, training in structural heart disease is still widely variable and has not been standardized. Furthermore, integration of trainees within the heart team has not been fully defined. In this review, we discuss the components and function of the heart team, the challenges of current structural heart disease models, and possible solutions and suggestions for integrating trainees within the heart team.

结构性心脏病是一个快速发展的领域。然而,结构性心脏病的训练仍然存在很大的变数,尚未标准化。此外,核心团队中受训人员的整合还没有完全确定。在这篇综述中,我们讨论了心脏团队的组成部分和功能,当前结构性心脏病模型的挑战,以及将受训人员整合到心脏团队中的可能解决方案和建议。
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引用次数: 0
The World of Structural Heart Disease Expands 结构性心脏病的世界在扩大
Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-05-01 DOI: 10.1016/j.shj.2023.100186
Anthony DeMaria MD
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引用次数: 0
Structural Valve Deterioration in Transcatheter Aortic Bioprostheses: Diagnosis, Pathogenesis, and Treatment 经导管主动脉生物假体的结构性瓣膜恶化:诊断、发病机制和治疗
Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-05-01 DOI: 10.1016/j.shj.2022.100155
Sankalp P. Patel DO , Santiago Garcia MD , Janarthanan Sathananthan MBChB, MPH , Gilbert H.L. Tang MD, MSc, MBA , Mazen S. Albaghdadi MD, MSc , Philippe Pibarot DVM, PhD , Robert J. Cubeddu MD

Transcatheter aortic valve replacement has emerged as the preferred treatment modality in most patients with severe aortic stenosis. With its global adoption and broader application in younger and healthier patients, the issue of transcatheter bioprosthetic valve degeneration and its impact on valve durability continues to earn clinical relevance. Differences in the pathophysiologic processes that separate native from transcatheter heart valve deterioration remain poorly understood. When compared to surgical aortic bioprostheses, the mechanisms of valve degeneration are similar in transcatheter heart valves, with meaningful differences most noticeably found between the individual constructs of their design. Recognizing the clinical and hemodynamic presentation of structural valve degeneration remains paramount. The recently revised consensus guidelines that incorporate the integration of advanced multimodality imaging with invasive hemodynamics represent a major step forward in our ability to accurately diagnose bioprosthetic valve degeneration, and to identify differences in durability patterns, and to establish treatment recommendations for the lifetime management of patients with aortic stenosis. Parallel efforts to unmask the biomolecular differences in atherosclerotic plaque burden, valve calcification, and thrombotic diathesis, including host immunocompetence, between the different available bioprostheses, will further advance the role of emerging valve tissue technologies to improve durability. As with surgical heart valves, the optimal treatment options for redo-transcatheter aortic valve replacement and surgical explant remain poorly understood. Ongoing translational research in bench testing coupled with prospectively designed core lab-adjudicated clinical trials are much needed. This report provides a contemporary overview of transcatheter structural valve degeneration, including evolving concepts in its pathogenesis, diagnosis, and treatment.

经导管主动脉瓣置换术已成为大多数严重主动脉狭窄患者的首选治疗方式。随着其在全球的采用和在更年轻、更健康的患者中的广泛应用,经导管生物瓣膜退化及其对瓣膜耐久性的影响继续具有临床意义。将天然心脏瓣膜恶化与经导管心脏瓣膜恶化区分开来的病理生理过程的差异仍知之甚少。与外科主动脉生物瓣膜相比,经导管心脏瓣膜的瓣膜退化机制相似,在其设计的单个结构之间发现了最显著的有意义的差异。认识结构性瓣膜变性的临床和血液动力学表现仍然至关重要。最近修订的共识指南将先进的多模态成像与有创血流动力学相结合,这标志着我们在准确诊断生物瓣膜退化、识别耐久性模式差异以及为主动脉瓣狭窄患者的终身管理制定治疗建议方面迈出了重要一步。同时努力揭示不同可用生物瓣膜在动脉粥样硬化斑块负荷、瓣膜钙化和血栓形成素质(包括宿主免疫能力)方面的生物分子差异,将进一步推进新兴瓣膜组织技术在提高耐用性方面的作用。与外科心脏瓣膜一样,对再次经导管主动脉瓣置换术和外科移植物的最佳治疗方案仍知之甚少。非常需要在台架测试中进行持续的转化研究,再加上前瞻性设计的核心实验室裁决的临床试验。本报告提供了经导管结构瓣膜变性的当代综述,包括其发病机制、诊断和治疗方面的概念演变。
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引用次数: 1
Computed Tomography-Guided Computational Modeling to Guide Treatment in Aortic Stenosis With Extremely Large Aortic Annulus 计算机断层扫描引导下的计算模型指导特大主动脉环狭窄的治疗
Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-05-01 DOI: 10.1016/j.shj.2023.100168
Abdul Rahman Ihdayhid MBBS, PhD , Breandan Yeats BS , Michael Vernon BEng , Janarthanan Sathananthan MD , John Webb MD , Jonathon Leipsic MD , Sharad Shetty MBBS , Vinod H. Thourani MD , Gerald Yong MBBS , Elena De-Juan-Pardo BEng, PhD , Lakshmi P. Dasi PhD
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引用次数: 0
Secondary Mitral Regurgitation: Cardiac Remodeling, Diagnosis, and Management 继发性二尖瓣返流:心脏重塑、诊断和处理
Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-05-01 DOI: 10.1016/j.shj.2022.100129
Alex L. Huang MBChB, PhD, Jacob P. Dal-Bianco MD, Robert A. Levine MD, Judy W. Hung MD

Secondary mitral regurgitation (MR) refers to MR resulting from left ventricular or left atrial remodeling. In ischemic or nonischemic cardiomyopathy, left ventricular dilation (regional or global) leads to papillary muscle displacement, tethering, and leaflet malcoaptation. In atrial functional MR, MR occurs in patients with left atrial dilation and altered mitral annular geometry due to atrial fibrillation. In addition to cardiac remodeling, leaflet remodeling is increasingly recognized. Mitral leaflet tissue actively adapts through leaflet growth to ensure adequate coaptation. Leaflets, however, can also undergo maladaptive thickening and fibrosis, leading to increased stiffness. The balance of cardiac and leaflet remodeling is a key determinant in the development of secondary MR. Clinical management starts with detection, severity grading, and identification of the underlying mechanism, which relies heavily on echocardiography. Treatment of secondary MR consists of guideline-directed medical therapy, surgical repair or replacement, and transcatheter edge-to-edge repair. Based on a better understanding of pathophysiology, novel percutaneous mitral repair and replacement devices have been developed and clinical trials are underway.

继发性二尖瓣反流(MR)是指由左心室或左心房重构引起的MR。在缺血性或非缺血性心肌病中,左心室扩张(局部或全局)会导致乳头肌移位、束缚和小叶接合不良。在心房功能性MR中,MR发生在左心房扩张和因心房颤动而改变二尖瓣环几何形状的患者中。除了心脏重塑外,小叶重塑也越来越受到重视。二尖瓣小叶组织通过小叶生长主动适应,以确保充分的接合。然而,小叶也会发生不适应的增厚和纤维化,导致硬度增加。心脏和小叶重塑的平衡是继发性MR发展的关键决定因素。临床管理从检测、严重程度分级和识别潜在机制开始,这在很大程度上依赖于超声心动图。继发性MR的治疗包括指南指导的药物治疗、手术修复或置换以及经导管边缘到边缘修复。基于对病理生理学的更好理解,已经开发出新型经皮二尖瓣修复和置换装置,临床试验正在进行中。
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引用次数: 1
Aims & Scope 目标和范围
Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-05-01 DOI: 10.1016/S2474-8706(23)00074-X
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引用次数: 0
Impact of Paravalvular Leak on Outcomes After Transcatheter Aortic Valve Implantation: Meta-Analysis of Kaplan-Meier-derived Individual Patient Data 经导管主动脉瓣置入术后瓣旁泄漏对结果的影响:kaplan - meier衍生个体患者数据的meta分析
Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-03-01 DOI: 10.1016/j.shj.2022.100118
Michel Pompeu Sá MD, MSc, MHBA, PhD , Xander Jacquemyn BSc , Jef Van den Eynde BSc , Panagiotis Tasoudis MD , Ozgun Erten MD , Serge Sicouri MD , Francisco Yuri Macedo MD, MSc , Tilak Pasala MD, MRCP , Ryan Kaple MD , Alexander Weymann MD, MHBA, PhD , Arjang Ruhparwar MD, PhD , Marie-Annick Clavel DVM, PhD , Philippe Pibarot DVM, PhD , Basel Ramlawi MD

Background

Paravalvular leak (PVL) after transcatheter aortic valve implantation (TAVI) is frequent and the impact of mild PVL on outcomes remains uncertain. Our study aimed to evaluate the impact of PVL on TAVI outcomes.

Methods

To analyze late outcomes of patients after TAVI according to the presence and severity of PVL, PubMed/MEDLINE, EMBASE and Google Scholar were searched for studies that reported rates of all-cause mortality/survival and/or rehospitalization and/or cardiovascular mortality accompanied by at least one Kaplan-Meier curve for any of these outcomes. We adopted a 2-stage approach to reconstruct individual patient data based on the published Kaplan-Meier graphs.

Results

Thirty-eight studies with Kaplan-Meier curves met our eligibility criteria including over 25,000 patients. Patients with any degree of PVL after TAVI had a significantly higher risk of overall mortality (hazard ratio (HR), 1.52; 95% confidence interval (CI), 1.43-1.61; p < 0.001), rehospitalization (HR, 1.81; 95% CI, 1.54-2.12; p < 0.001), and cardiovascular mortality (HR, 1.52; 95% CI, 1.33-1.75; p < 0.001) over time. These findings remained consistent when we stratified the results for the methods of assessment of PVL (i.e., echocardiography vs. angiography) and PVL severity. Both moderate/severe PVL and mild PVL were associated with increased risk of overall mortality (p < 0.001), rehospitalization (p < 0.001), and cardiovascular mortality (p < 0.001) during follow-up.

Conclusions

Patients with PVL, even if mild, experience higher risk of all-cause mortality, rehospitalization, and cardiovascular mortality following TAVI. These findings provide support to the implementation of procedural strategies to prevent any degree of PVL at the time of TAVI.

背景经导管主动脉瓣植入术(TAVI)后的瓣旁漏(PVL)很常见,轻度PVL对结果的影响尚不确定。我们的研究旨在评估PVL对TAVI结果的影响。方法根据PVL的存在和严重程度分析TAVI后患者的晚期结果,检索PubMed/MEDLINE、EMBASE和Google Scholar的研究,这些研究报告了所有原因的死亡率/存活率和/或再住院率和/或者心血管死亡率,并伴有至少一条Kaplan-Meier曲线。我们采用了一种基于已发表的Kaplan-Meier图的两阶段方法来重建个体患者数据。结果38项Kaplan-Meier曲线研究符合我们的资格标准,包括25000多名患者。TAVI后任何程度PVL的患者总体死亡率的风险都显著较高(危险比(HR),1.52;95%置信区间为1.43-1.61;p<;0.001)、再住院(HR,1.81;95%CI,1.54-2.12;p<0.001)和心血管死亡率(HR,1.52;95%CI;1.33-1.75;p<0.001.)。当我们对PVL评估方法(即超声心动图与血管造影术)和PVL严重程度的结果进行分层时,这些发现保持一致。在随访期间,中度/重度PVL和轻度PVL均与总死亡率(p<0.001)、再次住院(p<001)和心血管死亡率(p>0.001)的风险增加有关。结论PVL患者,即使病情较轻,TAVI后发生全因死亡率、再次住院和心血管死亡率的风险也较高。这些发现为TAVI时预防任何程度PVL的程序策略的实施提供了支持。
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引用次数: 10
Strategies for Transcatheter Aortic Valve Replacement in Patients With a Right Aortic Arch 右主动脉弓患者经导管主动脉瓣置换术的策略
Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-03-01 DOI: 10.1016/j.shj.2022.100099
Hanjay Wang MD , Olabisi Akanbi MD , John W. MacArthur MD , Rahul P. Sharma MBBS
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引用次数: 0
Clinical Predictors of Mortality and Heart Failure Hospitalization in Patients With Severe Tricuspid Regurgitation 严重三尖瓣反流患者死亡率和心力衰竭住院的临床预测因素
Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-03-01 DOI: 10.1016/j.shj.2022.100130
Kris Kumar DO, MSc , Timothy Byrne DO , Timothy F. Simpson MD, PharmD , Ashraf Samhan BS , Raj Shah MD , Jorge Rodriguez MD , Loren Wagner MS , Scott M. Chadderdon MD , Howard K. Song MD, PhD , Harsh Golwala MD , Firas E. Zahr MD

Background

There is an incomplete understanding of the predictors of morbidity and mortality in patients with severe tricuspid regurgitation (TR). This study sought to identify key risk factors for all-cause mortality and heart failure (HF) hospitalization among patients with severe TR.

Methods

Patients with severe TR were identified from 2 centers, Oregon Health & Science University and Abrazo Health, from January 01, 2016 to December 31, 2018. Patients with any concomitant severe valvular diseases or prior valvular intervention were excluded. Multivariable regression was utilized to identify demographic, clinical, and echocardiographic variables independently associated with all-cause mortality or HF hospitalization.

Results

435 patients with severe TR were followed for a median of 2.8 years. The mean age of the population was 66.9 ± 18.5 years and 58% were female. All-cause mortality was identified in 20.5% of the population. Of the cohort, 35.4% of patients were hospitalized for HF. Isolated tricuspid valve intervention was performed in 2.5% of patients. Independent predictors of all-cause mortality included history of solid tumor (odds ratio [OR] 6.6, 95% confidence interval [CI] 2.1-19.1, p = 0.001), history of peripheral artery disease (OR 3.5, 95% CI 1.2-9.4, p = 0.013), and elevated international normalized ratio in the absence of anticoagulation (OR 1.9, 95% CI 1.2-3.2, p = 0.008). Predictors of HF hospitalization included history of diabetes mellitus (OR 2.2, 95% CI 1.1-4.0, p = 0.014) and history of reduced left ventricular ejection fraction (OR 5.7, 95% CI 2.9-11.7, p < 0.0001).

Conclusions

Severe untreated TR is associated with high mortality and frequent HF hospitalizations. Understanding predictors of these outcomes is important to identify patients who may benefit from early tricuspid valve intervention to help improve outcomes in this patient population.

背景对严重三尖瓣反流(TR)患者发病率和死亡率的预测因素了解不完全。本研究旨在确定严重TR患者全因死亡率和心力衰竭(HF)住院的关键危险因素;科学大学和Abrazo Health,2016年1月1日至2018年12月31日。排除伴有严重瓣膜病或既往进行过瓣膜介入治疗的患者。多变量回归用于确定与全因死亡率或HF住院独立相关的人口统计学、临床和超声心动图变量。结果435例严重TR患者的随访时间中位数为2.8年。人群的平均年龄为66.9±18.5岁,58%为女性。全因死亡率为20.5%。在队列中,35.4%的患者因HF住院。2.5%的患者进行了独立的三尖瓣介入治疗。全因死亡率的独立预测因素包括实体瘤病史(比值比[OR]6.6,95%置信区间[CI]2.1-19.1,p=0.001)、外周动脉疾病史(OR 3.5,95%CI 1.2-9.4,p=0.013),HF住院的预测因素包括糖尿病史(OR 2.2,95%CI 1.1-4.0,p=0.014)和左心室射血分数降低史(OR 5.7,95%CI 2.9-11.7,p<;0.0001)HF住院治疗。了解这些结果的预测因素对于确定可能受益于早期三尖瓣干预的患者以帮助改善该患者群体的结果非常重要。
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引用次数: 1
期刊
Structural Heart
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