IJC Heart and Vasculature最新文献

Background: Areas of conduction disorders play an important role in both initiation and perpetuation of AF and can be recognized by specific changes in unipolar potential morphology. For example, EGM fractionation may be caused by asynchronous activation of adjacent cardiomyocytes because of structural barriers such as fibrotic strands. However, it is unknown whether there are sex differences in unipolar potential morphology. Therefore, atrial potential morphologies during sinus rhythm (SR) were compared between male and female patients.

Methods: Based on propensity score matching, 62 male and female patients in whom high-resolution mapping of the right atrium (RA), left atrium (LA), and pulmonary vein area (PVA) including Bachmann's bundle (BB) was performed during coronary bypass grafting surgery and/or valvular heart surgery. Unipolar potentials were classified as single potentials (SPs), short double potentials (SDPs), long double potentials (LDP), fractionated potentials (FPs) and fraction duration (FD). The proportion of conduction block lines was also determined.

Results: Female patients had a higher proportion of SDPs, LDPs and FPs at the RA, and SDPs at BB. At the PVA, there were less SPs and more SDPs and FPs. In females, FDs were longer at the RA and PVA, and potential voltages of only SPs were lower at the RA (all P < 0.05). Females also had more CB at the RA and at PVA (P < 0.05).

Conclusion: In females, the proportion of single unipolar potentials indicative of smooth conduction, was lower compared to males, at the RA and PVA and to a lesser degree at BB. Females also had more CB at RA and PVA. Hence, these results may reflect sex-differences in the degree of electrical remodeling.

Background: Aortic stenosis (AS) is treated through transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR), with diabetes being prevalent among these patients. Inflammation participates in the pathogenesis of AS, and emerging evidence suggests that TAVI may exert anti-inflammatory effects. Given the established link between diabetes and inflammation, we sought to evaluate the impact of aortic valve replacement (AVR) on glycemic control.

Methods: Data from 10,129 consecutive patients undergoing either TAVI or SAVR between January 2010 and January 2022 were analyzed. Of these, 3,783 with diabetes had available pre- and post-procedural glycated hemoglobin (HbA1c) measurements. Analysis of 1,284 individuals with HbA1c ≥ 7 % was conducted. Propensity-score matching produced two well-matched cohorts of 266 TAVI and SAVR patients, enabling comparison of periprocedural HbA1c.

Results: In the total cohort (n = 1,284), HbA1c decreased from 8.15 ± 1.12 to 7.88 ± 1.38 (p < 0.001). After matching, the TAVI group showed a significant reduction from 8.31 ± 1.31 to 7.86 ± 1.56 (p < 0.001), while a modest decrease from 8.33 ± 1.33 to 8.15 ± 1.61 (p = 0.046) was observed in SAVR group. The TAVI group showed a trend toward a greater percentage change in HbA1c (p = 0.051). Clinically meaningful improvement in HbA1c (≥ 0.3 %) was similar between TAVI (53.1 %) and SAVR (45.6 %) patients (OR = 1.34, 95 % CI 0.93-1.95).

Conclusions: Management of AS through either intervention improved post-procedural glycemia in patients with uncontrolled diabetes. The extent of glycemic improvement was more pronounced with TAVI. Further investigations through controlled and prospective studies could provide more conclusive insights into this matter.

Background: The National Lung Screening Trial (NLST) has shown that screening with low dose CT in high-risk population was associated with reduction in lung cancer mortality. These patients are also at high risk of coronary artery disease, and we used deep learning model to automatically detect, quantify and perform risk categorisation of coronary artery calcification score (CACS) from non-ECG gated Chest CT scans.

Materials and methods: Automated calcium quantification was performed using a neural network based on Mask regions with convolutional neural networks (R-CNN) for multiorgan segmentation. Manual evaluation of calcium was carried out using proprietary software. This study used 80 patients to train the segmentation model and randomly selected 1442 patients were used for the validation of the algorithm. We compared the model generated results with Ground Truth.

Results: Automatic cardiac and aortic segmentation model worked well (Mean Dice score: 0.91). Cohen's kappa coefficient between the reference actual and the interclass computed predictive categories on the test set is 0.72 (95 % CI: 0.61-0.83). Our method correctly classifies the risk group in 78.8 % of the cases and classifies the subjects in the same group. F-score is measured as 0.78; 0.71; 0.81; 0.82; 0.92 in calcium score categories 0(CS:0), I (1-99), II (100-400), III (400-1000), IV (>1000), respectively. 79 % of the predictive scores lie in the same categories, 20 % of the predictive scores are one category up or down, and only 1.2 % patients were more than one category off. For the presence/absence of coronary artery calcifications, our deep learning model achieved a sensitivity of 90 % and a specificity of 94 %.

Conclusion: Fully automated model shows good correlation compared with reference standards. Automating the process could improve diagnostic ability, risk categorization, facilitate primary prevention intervention, improve morbidity and mortality, and decrease healthcare costs.

Atrial fibrillation (AF) is the most common tachyarrhythmia and seriously affects human health. Key targets of AF bioinformatics analysis can help to better understand the pathogenesis of AF and develop therapeutic targets. The left atrial appendage tissue of 20 patients with AF and 10 patients with sinus rhythm were collected for sequencing, and the expression data of the atrial tissue were obtained. Based on this, 2578 differentially expressed genes were obtained through differential analysis. Different express genes (DEGs) were functionally enriched on Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG), mainly focusing on neuroactive ligand-receptor interactions, neuronal cell body pathways, regulation of neurogenesis, and neuronal death, regulation of neuronal death, etc. Secondly, 14 significant module genes were obtained by analyzing the weighted gene co-expression network of DEGs. Next, LASSO and SVM analyzes were performed on the differential genes, and the results were in good agreement with the calibration curve of the nomogram model for predicting AF constructed by the weighted gene co-expression network key genes. The significant module genes obtained by the area under the ROC curve (AUC) analysis were analyzed. Through crossover, two key disease characteristic genes related to AF, HOXA2 and RND2, were screened out. RND2 was selected for further research, and qPCR verified the expression of RND2 in sinus rhythm patients and AF patients. Patients with sinus rhythm were significantly higher than those in AF patients. Our research indicates that RND2 is significantly associated with the onset of AF and can serve as a potential target for studying its pathogenesis.

Background: Aortic stenosis (AS) remains a prevalent and serious global health concern, exacerbated by an aging population worldwide. This valvular disease, when symptomatic and without appropriate intervention, severe AS can drastically reduce life expectancy. In our systematic review and meta-analysis, we aim to synthesize available evidence to guide clinical decision-making by comparing the performance of TAVR and SAVR, specifically in patients with severe AS and a small aortic annulus.

Methods: We searched PubMed, EMBASE, Cochrane, Web of Science, and Scopus from inception till May 2024. The risk ratio (RR) and mean difference (MD) with a 95 % confidence interval (CI) are provided as effect size estimates, with all analyses being conducted using RevMan 5.4.

Results: Eleven studies with 3,670 patients were included. TAVR significantly increased the risk of 2-year new permanent pacemaker implantation (PPI) (RR = 2.42; 95 % CI: [1.70-3.44], P < 0.0001) and major vascular complications (RR = 3.73; 95 % CI: [1.98-6.99], P < 0.0001) than SAVR. However, TAVR significantly decreased the risk of patient-prosthesis mismatch (PPM) (RR = 0.56; 95 % CI: [0.48-0.65], P < 0.00001) and new-onset atrial fibrillation (AF) (RR = 0.31; 95 % CI: [0.23-0.41], P < 0.00001). Also, SAVR reduced the risk of paravalvular leak (PVL) (RR = 3.35; 95 % CI: [1.79-6.27], P = 0.0002).

Conclusion: TAVR had a significantly reduced risk of PPM and new-onset AF but with increased PPI and vascular complications. Also, TAVR significantly improved EOA and iEOA. Furthermore, SAVR had less risk of PVL, and better LVEF improvement at predischarge. Therefore, TAVR and SAVR remain valid alternatives, and decisions should be based on anatomy of the annulus and aortic root,operative risk, and comorbidities.

Background: The optimal imaging modality for selecting the device size in patients with atrial fibrillation undergoing one-stop left atrial appendage occlusion (LAAO) with concomitant pulmonary vein isolation (PVi) remains undefined. We compared preprocedural 3-dimensional computed tomography (3D CT) with intra-procedural transesophageal echocardiography (TEE) and left atrial appendage (LAA) angiography in guiding one-stage PVi and LAAO.

Methods: We measured the LAA ostium diameter using an interactive 3D CT system with a central line-based approach and compared these measurements with those from intra-procedural TEE and angiography, and the actual device size. The optimal compression ratio was used to assess the attainment rates of the three imaging modalities.

Results: Twenty-two patients (median age: 68.5 years, 21.8 % female) underwent the one-stage procedure. The median LAA ostium diameter measured by 3D CT (24.3 mm, interquartile range [IQR] = 22.0-27.0 mm) was closer to the Watchman device size (27.0 mm, IQR = 24.0-31.0 mm, P = 0.127) compared to TEE (21.2 mm, IQR = 18.4-22.7 mm, P < 0.001) and angiography (22.5 mm, IQR = 17.9-25.1 mm, P < 0.001). 3D CT had a better attainment rate for the optimal compression ratio than TEE (10.8 %, IQR = 7.4-16.5 % vs. 22.7 %, IQR = 19.2-29.3 %, P < 0.001) and angiography (19.7 %, IQR = 15.1-24.1 %, P = 0.001). All patients underwent successful device implantation without peri-device leak or complications during the periprocedural period and follow-up.

Conclusions: In this pilot study, a preprocedural central line-based 3D CT planning system appeared to be more effective than intraoperative TEE and angiography in measuring the LAA ostium diameter to guide device size selection in patients with atrial fibrillation undergoing one-stop LAAO with concomitant PVi.

Introduction: Cardiac computerized tomographic angiography (CCTA) is perceived as a non-invasive tool for assessment of coronary vessel anatomy. Feature tracking echocardiography has recently emerged as a tool for assessment of regional and global left ventricular function. We aimed to explore the applicability of echocardiographic strain on CCTA cine clips and assess whether global and regional strain parameters are associated with the extent of coronary stenosis.

Methods: CCTA studies of 61 consecutive patients were reconstructed to yield cine images in classic echocardiographic long and short views. Siemens Velocity Vector Imaging (VVI) software was applied to generate strain and displacement results. Volumetric and mechanics parameters were compared among patients with no or non-significant coronary artery disease (CAD) and patients with significant CAD. Finally, a comparison of the degree of coronary stenosis to regional segmental strain was performed.

Results: Myocardial mechanics parameters could be generated in 60 cases. Ejection fraction (EF) and left ventricular end diastolic volume (LVEDV) were within the normal range in both groups. VVI values were lower in the CAD group (VVI LVEF 59 ± 6 vs. 50 ± 11, p = 0.0002). Global longitudinal and global circumferential strain both were significantly lower in this group. Regional segmental strain was lower in segments affected by coronary stenosis in comparison to unaffected segments.

Conclusion: While CT segmentation derived LVEF did not differ among groups, patients with significant coronary stenosis had reduced longitudinal and circumferential contraction. This suggests that application of VVI to CCTA cine clips tracking may help to differentiate significant and non-significant coronary stenosis, adding functional value to anatomic findings in CCTA.