IJC Heart and Vasculature最新文献_第2页

The 3-level Wells score combined with D-dimer can accurately diagnose acute pulmonary embolism in hospitalized patients with acute exacerbation of COPD: A multicentre cohort study 3 级威尔斯评分结合 D-二聚体可准确诊断慢性阻塞性肺疾病急性加重住院患者的急性肺栓塞：一项多中心队列研究

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2024-11-15 DOI: 10.1016/j.ijcha.2024.101533

Xiaojing Jiao , Yixiao zhang , Tuguang Kuang , Juanni Gong , Yadong Yuan , Guohua Zhen , Jifeng Li , Suqiao Yang , Jianguo He , Yuanhua Yang

Background

Identification of acute pulmonary embolism (APE) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is challenging. Wells score and Revised Geneva score have been developed to diagnose APE. We aim to investigate the predictive accuracy of two clinical scoring systems combined with D-dimer for APE in patients with AECOPD.

Methods

A multicentre cross-sectional study was conducted in 13 China hospitals. A total of 731 patients were enrolled. Computed tomography pulmonary angiography (CTPA) was performed within 48 hours of admission. The performance of the clinical scoring systems was compared by calculating the area under the receiver operating characteristic curves (AUROC), sensitivities, and specificities.

Results

731 patients were included with an average age of 68.9 years, with a male proportion of 585 (80.0 %). 112 (15.3 %) were diagnosed with APE. The optimal D-dimer cut-off value for identifying APE in AECOPD was 690.12 ng/mL. Analysis for assessing the clinical probability of APE using the 3-level Wells and Revised Geneva scores showed the AUC were 0.74 and 0.60, sensitivity were 61.61 % and 77.68 %, and specificity were 85.46 % and 38.29 %, respectively. Analysis using the 3-level Wells and Revised Geneva scores combined with a D-dimer cut-off value of 690.12 ng/mL showed the AUC were 0.909 and 0.869, sensitivity were 73.21 % and 91.96 %, specificity were 92.08 %and 72.70 %. The performance of the 3-level Wells score with D-dimer was significantly better than the performance of the 3-level Revised Geneva score with D-dimer (P = 0.01).

Conclusions

The 3-level Wells score combined with a D-dimer cut-off value of 690.12 ng/mL performed better than other clinical scoring algorithms for assessing clinical probability of APE in patients with AECOPD.

背景在慢性阻塞性肺疾病（AECOPD）急性加重期患者中识别急性肺栓塞（APE）具有挑战性。目前已开发出威尔斯评分和修订版日内瓦评分来诊断急性肺栓塞。我们旨在研究两种临床评分系统结合 D-二聚体对 AECOPD 患者 APE 的预测准确性。共纳入 731 名患者。入院 48 小时内进行计算机断层扫描肺血管造影术（CTPA）。通过计算接收者操作特征曲线下面积（AUROC）、敏感性和特异性，比较了临床评分系统的性能。其中 112 人（15.3%）被诊断为 APE。确定 AECOPD 中 APE 的最佳 D-二聚体临界值为 690.12 纳克/毫升。使用 3 级威尔斯和修订版日内瓦评分评估 APE 临床可能性的分析表明，AUC 分别为 0.74 和 0.60，敏感性分别为 61.61 % 和 77.68 %，特异性分别为 85.46 % 和 38.29 %。使用 3 级威尔斯和修订版日内瓦评分结合 D-二聚体临界值 690.12 纳克/毫升进行的分析表明，AUC 分别为 0.909 和 0.869，灵敏度分别为 73.21 % 和 91.96 %，特异性分别为 92.08 % 和 72.70 %。在评估AECOPD患者APE的临床可能性时，3级Wells评分结合D-二聚体的表现明显优于3级Revised Geneva评分结合D-二聚体的表现（P = 0.01）。

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引用次数: 0

Efficacy of finerenone in reducing heart failure outcomes in patients with history of heart failure: A meta-analysis of randomized controlled trials 非格列酮能有效降低有心力衰竭病史患者的心力衰竭预后：随机对照试验荟萃分析

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2024-11-15 DOI: 10.1016/j.ijcha.2024.101548

Vikash Jaiswal , Fakhar Latif , Sidra Naz , Pragathi Munnangi , Novonil Deb , Jishanth Mattupuram

引用次数: 0

Exploring risk Indicators of atrial fibrillation in severe Obesity: Left atrial cardiomyopathy and premature atrial contractions 探索严重肥胖症患者心房颤动的风险指标：左心房心肌病和心房早搏

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2024-11-14 DOI: 10.1016/j.ijcha.2024.101555

J.F. Chin , Y.S. Aga , S. Abou Kamar , S.M. Snelder , I. Kardys , R.A. de Boer , J.J. Brugts , B.M. van Dalen

Background

Although obesity is a major risk factor for atrial fibrillation (AF), its mechanisms and the diagnostic yield of AF screening in severe obesity is unclear. This study aims to enhance our comprehension of AF susceptibility in severe obesity by investigating associations between left atrial (LA) cardiomyopathy and premature atrial contractions (PACs) and to explore the diagnostic yield of AF screening.

Methods

This cross-sectional study included a total of 192 subjects aged 35–65 years with a BMI ≥ 35 kg/m², alongside 50 non-obese controls, both without known cardiac disease. Prolonged heart rhythm registration was done with either 24-hours (n = 147) or 7-day Holter monitoring (n = 75) or an implantable loop recorder (ILR) (n = 10). Furthermore, we performed conventional transthoracic echocardiography and strain analyses.

Results

In the obese cohort, LA enlargement was independently associated with PAC frequency. Each SD increment (10 ml/m²) of LA volume index corresponded with a 46 % increase in PACs. An increase of each SD (10 %) LA reservoir strain was associated with a decrease of 16 % in PAC frequency. There was no association found between LA cardiomyopathy and PACs in the control group. AF was not detected in any subject.

Conclusion

LA enlargement was independently associated with more frequent PACs in severe obesity, a well-known AF precursor. There was a noticeable trend suggesting a relation between impaired LA function and PACs. Considering our observed low diagnostic yield of AF screening within this population, further investigation is needed to determine whether incorporating LA cardiomyopathy as an additional risk measure could improve AF screening strategies for individuals with severe obesity.

背景虽然肥胖是心房颤动（AF）的一个主要风险因素，但其机制和重度肥胖者心房颤动筛查的诊断率尚不清楚。本研究旨在通过调查左心房（LA）心肌病与房性早搏（PACs）之间的关联，加深我们对重度肥胖者房颤易感性的理解，并探讨房颤筛查的诊断率。方法本横断面研究共纳入 192 名年龄在 35-65 岁之间、体重指数（BMI）≥ 35 kg/m2 的受试者，以及 50 名非肥胖对照者，两人均无已知的心脏病。通过 24 小时（147 人）或 7 天 Holter 监测（75 人）或植入式环路记录仪（ILR）（10 人）进行长时间心律登记。此外，我们还进行了常规经胸超声心动图检查和应变分析。LA 容积指数每增加一个 SD 值（10 ml/m2），PAC 就增加 46%。LA 储腔应变每增加一个标度（10%），PAC 频率就会减少 16%。在对照组中，LA 心肌病变与 PAC 之间没有关联。结论 LA增大与重度肥胖（众所周知的房颤前兆）患者更频繁的PACs有独立关联。有一种明显的趋势表明 LA 功能受损与 PACs 之间存在关系。考虑到我们在这一人群中观察到的房颤筛查诊断率较低，我们需要进一步调查，以确定将 LA 心肌病作为额外的风险指标是否能改善重度肥胖患者的房颤筛查策略。

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引用次数: 0

Different patterns of pre-excitation in a large Italian cohort of asymptomatic non-competitive athletes evaluated by telecardiology screening: Prevalence and ECG features 通过远程心电图筛查评估了一大批意大利无症状非竞技运动员的不同预激模式：发病率和心电图特征

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2024-11-12 DOI: 10.1016/j.ijcha.2024.101553

Martina Molinari , Sergio Setti , Natale Daniele Brunetti , Nicola Di Nunno , Maria Alberta Cattabiani , Giuseppe Molinari

Background

Telecardiology has proven to be a useful and cost-effective tool for ECG screening in several contexts, allowing the evaluation of large cohorts of subjects in a short time, even for non-competitive athletes (NCA).

Aim of the study

To evaluate and detail the prevalence of the Wolff-Parkinson-White (WPW) syndrome in a large Italian cohort of young NCA.

Methods

In a 4-year period 216,424 consecutive NCA (118,851 males; 55%) underwent preparticipation ECG screening through a Telecardiology System. ECGs were recorded and sent by a network of ‘spoke’ centers located all over Italy; a ‘hub’ center, located in Genoa, received and reported back on ECGs, digitally stored and analyzed. Only asymptomatic NCA were included in the study.

Results

Out of 216,424 NCA 88 (mean age: 14 ± 8) presented a WPW pre-excitation at ECG analysis (55 males, 62.5 %); the prevalence of WPW pre-excitation in this population was 4.1 per 10,000 NCA. No significant sex-related differences were found. The highest incidence (29 WPW patterns) was observed in the 10–15 year group with an equal sex ratio (M/F:16/13).

Intermittent pre-excitation was found in 8 NCAs. The most frequent accessory pathway locations were right antero-septal (25.0%), mid-septal (21.6%) and postero-septal (13.6%).

Conclusions

In a large population of young NCA the prevalence of ECG pre-excitation at telemedicine remote screening was 4.1 per 10,000; intermittent pre-excitation was found in 9% of NCA with ECG pre-excitation.

背景电话心电图已被证明是在多种情况下进行心电图筛查的有效且经济的工具，可在短时间内对大量受试者进行评估，即使是非竞技运动员（NCA）也不例外。研究目的评估并详细说明沃尔夫-帕金森-怀特（WPW）综合征在意大利年轻 NCA 大样本中的患病率。方法在 4 年时间里，216,424 名连续的 NCA（118,851 名男性；55%）通过远程心电图系统接受了赛前心电图筛查。位于意大利各地的 "辐射 "中心网络记录并发送心电图；位于热那亚的 "枢纽 "中心接收并反馈心电图，进行数字存储和分析。结果在 216424 名 NCA 中，88 人（平均年龄：14 ± 8）在心电图分析时出现 WPW 预激（55 名男性，占 62.5%）；该人群中 WPW 预激的发生率为每 10,000 名 NCA 中 4.1 例。没有发现明显的性别差异。10-15岁年龄组的发病率最高（29种WPW模式），男女比例相同（男/女：16/13）。结论在一大群年轻的 NCA 中，远程医疗远程筛查中心电图预激的发生率为万分之 4.1；在 9% 的心电图预激 NCA 中发现了间歇性预激。

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引用次数: 0

Underrepresentation of women in cardiovascular disease clinical Trials—What’s in a Name? 心血管疾病临床试验中女性代表人数不足--名称有何意义？

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2024-11-08 DOI: 10.1016/j.ijcha.2024.101547

A.E. Spiering , A.M.L.N. van Ommen , J.E. Roeters van Lennep , Y. Appelman , K. Reue , N.C. Onland-Moret , H.M. den Ruijter

Background

Cardiovascular disease is the leading cause of death in women worldwide. Yet, women are often underrepresented in cardiovascular clinical trials. Trial characteristics may influence the participation of women. For instance, trials are often entitled with an acronym, which might be perceived as gendered. We aimed to investigate if the perceived gender of the acronym and other trial characteristics affect the representation of female patients in cardiovascular trials.

Methods

We searched ClinicalTrials.gov for randomized controlled trials in cardiovascular disease named with an acronym. Cardiovascular patients (n = 148) scored the perceived gender of the acronym of 148 identified trials. Prevalence ratios (PR) were calculated with Poisson regression to link trial characteristics to representation of female patients in the trials.

Results

In 62 % of trials, female patients were underrepresented relative to the disease population. There was no improvement over time in proportion of trials with adequate representation. A third of acronyms was classified as gendered. The perceived gender did not affect representation of female patients (PR 1.01; 95% CI 0.95 – 1.08; P = 0.68). A woman as first and/or last author (PR 1.22; 95% CI 1.07 – 1.38; P = 0.002) and recruitment in an outpatient setting (PR 1.15; 95% CI 1.02 – 1.29; P = 0.01) were associated with a higher prevalence of adequate representation of female patients.

Conclusions

Representation of female patients in cardiovascular trials does not depend on the perceived gender of the trial acronym but is improved in trials under female leadership in out-patient settings. Our findings may direct efforts towards increasing representation of female patients in cardiovascular trials.

背景心血管疾病是导致全球女性死亡的主要原因。然而，在心血管临床试验中，女性的参与人数往往不足。试验的特点可能会影响女性的参与。例如，试验的名称通常会有一个缩写，这可能会被认为是有性别区分的。我们的目的是调查缩写的性别感知和其他试验特征是否会影响女性患者在心血管试验中的代表性。方法我们在ClinicalTrials.gov中搜索了以缩写命名的心血管疾病随机对照试验。心血管病患者（n = 148）对 148 项已确定试验的首字母缩略词的感知性别进行了评分。通过泊松回归计算患病率比（PR），将试验特征与试验中女性患者的代表性联系起来。随着时间的推移，具有充分代表性的试验比例没有提高。三分之一的缩略词被归类为性别词。认为的性别并不影响女性患者的代表性（PR 1.01；95% CI 0.95 - 1.08；P = 0.68）。女性作为第一作者和/或最后作者（PR 1.22；95% CI 1.07 - 1.38；P = 0.002）以及在门诊环境中招募（PR 1.15；95% CI 1.02 - 1.29；P = 0.01）与女性患者的充分代表性较高相关。我们的研究结果可为提高女性患者在心血管试验中的代表性提供指导。

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引用次数: 0

Ten-year outcomes after transcatheter or surgical aortic valve replacement in low-risk patients: The OBSERVANT study 低风险患者经导管或手术主动脉瓣置换术后的十年预后：OBSERVANT 研究

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2024-11-01 DOI: 10.1016/j.ijcha.2024.101545

Fausto Biancari , Paola D’Errigo , Marco Barbanti , Gabriella Badoni , Corrado Tamburino , Gianluca Polvani , Giuliano Costa , Giovanni Baglio , Stefano Rosato

Background

The evidence of the long-term advantages of transcatheter aortic valve replacement (TAVR) over surgical aortic valve replacement (SAVR) for aortic stenosis (AS) remains scarce.

Methods

Patients with EuroSCORE II < 4 % who underwent TAVR or SAVR for AS from the prospective observational OBSERVANT study were included in this analysis. Ten-year survival was the primary outcome of this analysis. Secondary outcome was repeat procedure on the aortic valve prosthesis.

Results

Propensity score matching resulted in 355 matched pairs of patients who underwent TAVR or SAVR. The mean age of SAVR patients was 80.0 ± 5.1 years and that of TAVR patients 80.1 ± 6.4 years (p = 0.81) and the mean EuroSCORE II was 2.5 ± 0.8 % and 2.6 ± 0.8 % (p = 0.60), respectively. Thirty-day mortality was 2.8 % after SAVR and 2.5 % after TAVR (p = 0.82). At 10-year, survival was 37.0 % (95 %CI 32.2–42.5 %) after SAVR and 18.2 % (95 %CI 14.5–22.8 %) after TAVR (Log-rank test, p < 0.001; HR 1.70, 95 %CI 1.42–2.03). Difference in terms of survival between the propensity matched cohorts became significant 3 years after the procedures. Ten-year cumulative incidences of repeat aortic valve procedure were 2.6 % (95 %CI 1.4–5.0 %) after SAVR and 1.1 % (95 %CI 0.4–3.0 %) after TAVR (p = 0.153; SHR 0.43, 95 %CI 0.13–1.41).

Conclusions

The results of this prospective observational, non-randomized study showed that 10-year survival of low-risk patients who underwent TAVR with early generation prosthesis devices was lower than SAVR.

背景经导管主动脉瓣置换术（TAVR）相对于手术主动脉瓣置换术（SAVR）治疗主动脉瓣狭窄（AS）的长期优势的证据仍然很少。方法本分析纳入了前瞻性观察性 OBSERVANT 研究中接受 TAVR 或 SAVR 治疗 AS 的 EuroSCORE II < 4 % 患者。十年生存率是本次分析的主要结果。次要结果是主动脉瓣假体的重复手术。结果通过倾向评分匹配，355 对患者进行了 TAVR 或 SAVR。SAVR患者的平均年龄为（80.0 ± 5.1）岁，TAVR患者的平均年龄为（80.1 ± 6.4）岁（P = 0.81），平均EuroSCORE II分别为（2.5 ± 0.8）%和（2.6 ± 0.8）%（P = 0.60）。SAVR术后30天死亡率为2.8%，TAVR术后为2.5%（p = 0.82）。SAVR术后10年生存率为37.0%（95 %CI 32.2-42.5%），TAVR术后10年生存率为18.2%（95 %CI 14.5-22.8%）（Log-rank检验，p < 0.001; HR 1.70, 95 %CI 1.42-2.03）。倾向匹配队列之间的生存率差异在术后 3 年变得显著。SAVR术后十年主动脉瓣重复手术累积发生率为2.6%（95 %CI 1.4-5.0%），TAVR术后为1.1%（95 %CI 0.4-3.0%）（p = 0.153；SHR 0.43，95 %CI 0.13-1.41）。

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引用次数: 0

Postoperative delirium in patients undergoing TAVI versus SAVR – A systematic review and meta-analysis TAVI 与 SAVR 患者的术后谵妄--系统回顾与荟萃分析

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2024-10-31 DOI: 10.1016/j.ijcha.2024.101544

Dimitrios Stavridis , Angelique Runkel , Anna Starvridou , Johannes Fischer , Luca Fazzini , Hristo Kirov , Max Wacker , Jens Wippermann , Torsten Doenst , Tulio Caldonazo

Background

Transcatheter Aortic Valve Implantation (TAVI) and Surgical Aortic Valve Replacement (SAVR) have different levels of invasiveness which can result in different levels of functional status after the procedure.

Methods

We performed a systematic review and meta-analysis to detect studies showing direct comparison between TAVI and SAVR regarding postoperative functional status. The primary endpoint was the incidence of postoperative delirium (POD) after TAVI or SAVR, assessed using the Confusion Assessment Method (CAM). Secondary endpoints included 30-day mortality, stroke, major bleeding, and hospital length of stay (LOS).

Results

We identified 1,161 manuscripts, of which 10 studies (12,015 patients) were analyzed. TAVI patients had a significantly lower incidence of POD (OR: 0.35, 95 % CI, 0.26–0.48, p < 0.01) compared to SAVR patients. No significant differences were found in secondary outcomes between the groups.

Conclusions

TAVI is associated with a lower incidence of postoperative delirium compared to SAVR without compromising length of stay or other major clinical outcomes. Further research is needed to understand the impact of postoperative delirium on short and long-term outcomes.

背景导管主动脉瓣植入术（TAVI）和外科主动脉瓣置换术（SAVR）的创伤程度不同，会导致术后功能状态的不同。主要终点是 TAVI 或 SAVR 术后谵妄（POD）的发生率，采用意识模糊评估法（CAM）进行评估。次要终点包括30天死亡率、中风、大出血和住院时间（LOS）。结果我们共鉴定了1,161篇手稿，对其中10项研究（12,015名患者）进行了分析。与 SAVR 患者相比，TAVI 患者的 POD 发生率明显较低（OR：0.35，95 % CI，0.26-0.48，p < 0.01）。结论与SAVR相比，TAVI术后谵妄发生率较低，且不影响住院时间或其他主要临床结果。要了解术后谵妄对短期和长期预后的影响，还需要进一步的研究。

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引用次数: 0

Role of Lipoprotein (A) in aortic valve stenosis: Novel disease mechanisms and emerging pharmacotherapeutic approaches 脂蛋白 (A) 在主动脉瓣狭窄中的作用：新的疾病机制和新的药物治疗方法

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2024-10-30 DOI: 10.1016/j.ijcha.2024.101543

Mohammad Ishrak Khan , Raisa Subaita Zahir , Abel Casso Dominguez , Francisco José Romeo

Lipoprotein(a) (Lp(a)) has garnered increasing attention as a significant contributor to the pathogenesis of aortic stenosis (AS), prompting a focused investigation into innovative pharmacological strategies to target this lipoprotein and its associated risks. Despite its recognized role in AS progression, Lp(a) often remains overlooked in clinical assessments, mirroring the broader challenges observed in holistic disease management. This review delves into the mechanistic intricacies of Lp(a) involvement in AS pathophysiology and its potential as a therapeutic target. Drawing parallels with the imperative for healthcare providers to proactively engage with patients regarding treatment regimens, this review underscores the essential role of cardiologists and physicians in recognizing and addressing Lp(a) as a modifiable risk factor in AS management. Furthermore, it explores promising avenues of novel drug approaches, including emerging pharmacotherapies and targeted interventions, aimed at modulating Lp(a) levels and attenuating AS progression. By navigating the complexities of Lp(a) modulation and its implications for AS management, this review aims to bridge critical gaps in understanding and clinical practice, ultimately optimizing treatment strategies and improving patient outcomes in the realm of AS therapeutics.

脂蛋白（a）（Lp(a)）作为主动脉瓣狭窄（AS）发病机制的一个重要因素，已引起越来越多的关注，促使人们集中研究针对这种脂蛋白及其相关风险的创新药理策略。尽管脂蛋白（a）在主动脉瓣狭窄进展中的作用已得到公认，但在临床评估中仍经常被忽视，这反映了在整体疾病管理中观察到的更广泛的挑战。本综述深入探讨了脂蛋白（a）参与强直性脊柱炎病理生理学的复杂机制及其作为治疗靶点的潜力。本综述与医疗保健提供者必须积极主动地与患者就治疗方案进行沟通相类似，强调了心脏病专家和医生在认识和处理 Lp(a) 这一强直性脊柱炎管理中可改变的风险因素方面的重要作用。此外，它还探讨了新型药物治疗方法的前景，包括新兴药物疗法和靶向干预，旨在调节脂蛋白（a）水平并减轻强直性脊柱炎的进展。通过了解 Lp(a) 调节的复杂性及其对强直性脊柱炎治疗的影响，本综述旨在弥合认识和临床实践中的关键差距，最终在强直性脊柱炎治疗领域优化治疗策略并改善患者预后。

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引用次数: 0

Age-dependent hypertrophy and fibrosis dynamics in hypertrophic cardiomyopathy: Insights from longitudinal CMR studies 肥厚型心肌病随年龄变化的肥大和纤维化动态：纵向 CMR 研究的启示

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2024-10-30 DOI: 10.1016/j.ijcha.2024.101546

Sebastian M. Haberkorn , Mukaram Rana , Vitali Koch , Simon Martin , Thomas Vogl , David M. Leistner , Marco M. Ochs

Background

This study aims to evaluate the progression of morphological and functional alterations over time in patients with hypertrophic cardiomyopathy (HCM) using Cardiac Magnetic Resonance (CMR).

Methods

A retrospective analysis was conducted on patients with HCM who underwent serial CMR at 1.5 Tesla. Left ventricular (LV) mass was measured during diastole, including papillary muscles and trabeculae assessment. Appearance of Late Gadolinium Enhancement (LGE) was volumetrically quantified using a 5-standard-deviation (SD) threshold.

Results

Thirty-two patients, with a mean age of 44 ± 16 years (range: 11–70 years), were evaluated after an average follow-up period of 5.2 ± 2.4 years (range: 0.8–9.1 years). Significant increases were observed in LV mass (from 194 ± 56 g to 217 ± 60 g; p = 0.0001), septal wall thickness (from 18 ± 4 mm to 19 ± 4 mm; p = 0.01), LGE mass (from 6 ± 17 g to 8 ± 18 g; p = 0.006), and left atrial volume (from 109 ± 41 ml to 129 ± 40 ml; p = 0.0001). Both left and right ventricular ejection fractions (LVEF and RVEF) significantly decreased over time (LVEF: from 70 ± 9 % to 66 ± 9 %; p = 0.04 and RVEF: from 70 ± 7 % to 67 ± 9 %; p = 0.02). Multivariate regression analysis revealed that HCM mass gain was independently associated with age (B = -0.43; p = 0.02) and LGE mass (B = -0.46; p = 0.02). The median LV mass gain rate in adults was 1.7 g per year/BSA (IQR, 0.6–2.7) compared to 6.0 g per year/BSA (IQR, 0.5–11.6) in adolescents (mean age: 16 years; range: 11–20 years). A positive correlation was found between LV mass and LGE mass (B = 0.55; p = 0.001), while an inverse relationship was observed between LV mass gain and LGE mass gain rates (−0.37; p = 0.03).

Conclusion

The range of morphological changes in HCM seems to reflect an age-related equilibrium between hypertrophy and fibrosis. The extent of changes in LV mass, fibrosis, and functional decline in HCM may help identify patients at risk, emphasizing the importance of ongoing follow-up studies.

背景本研究旨在利用心脏磁共振（CMR）评估肥厚型心肌病（HCM）患者的形态和功能改变随时间推移的进展情况。测量舒张期左心室（LV）质量，包括乳头肌和小梁评估。结果 32 名患者的平均年龄为 44 ± 16 岁（范围：11-70 岁），平均随访时间为 5.2 ± 2.4 年（范围：0.8-9.1 年）。观察到左心室质量（从 194 ± 56 g 增加到 217 ± 60 g；p = 0.0001）、室间隔壁厚度（从 18 ± 4 mm 增加到 19 ± 4 mm；p = 0.01）、LGE 质量（从 6 ± 17 g 增加到 8 ± 18 g；p = 0.006）和左心房容积（从 109 ± 41 ml 增加到 129 ± 40 ml；p = 0.0001）显著增加。随着时间的推移，左心室和右心室射血分数（LVEF 和 RVEF）均显著下降（LVEF：从 70 ± 9% 降至 66 ± 9%；p = 0.04；RVEF：从 70 ± 7% 降至 67 ± 9%；p = 0.02）。多变量回归分析显示，HCM 质量增加与年龄（B = -0.43；P = 0.02）和 LGE 质量（B = -0.46；P = 0.02）独立相关。成人左心室质量增加率的中位数为每年 1.7 克/BSA（IQR，0.6-2.7），而青少年（平均年龄：16 岁；范围：11-20 岁）则为每年 6.0 克/BSA（IQR，0.5-11.6）。LV 质量与 LGE 质量之间呈正相关（B = 0.55；P = 0.001），而 LV 质量增加率与 LGE 质量增加率之间呈反比关系（-0.37；P = 0.03）。HCM 中左心室质量、纤维化和功能衰退的变化程度可能有助于识别高危患者，强调了持续随访研究的重要性。

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引用次数: 0

Hemodynamic and clinical outcomes with balloon-expandable valves versus self-expanding valves in patients with small aortic annulus undergoing transcatheter aortic valve replacement: A meta-analysis of randomized controlled trials and propensity score matched studies 接受经导管主动脉瓣置换术的主动脉瓣环较小患者使用球囊扩张瓣和自扩张瓣的血流动力学和临床结果：随机对照试验和倾向评分匹配研究的荟萃分析

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2024-10-28 DOI: 10.1016/j.ijcha.2024.101542

Mushood Ahmed , Areeba Ahsan , Shehroze Tabassum , Irra Tariq , Eeshal Zulfiqar , Mahnoor Farooq Raja , Asma Mahmood , Raheel Ahmed , Farhan Shahid , Syed Khurram M. Gardezi , Mahboob Alam , Rodrigo Bagur , Mamas A. Mamas

Transcatheter aortic valve replacement (TAVR) is considered more effective than surgical aortic valve implantation for patients with a small aortic annulus (SAA), however, the comparative efficacy of different transcatheter heart valves (THVs) remains uncertain. A literature search was performed across databases from their inception until June 2024 to identify eligible randomized controlled trials (RCTs) and propensity-score matched (PSM) studies. Clinical outcomes were evaluated using a random-effects model to pool risk ratios (RRs) with 95 % confidence intervals (CIs). The analysis included 10 studies with 2,960 patients. BEVs were associated with a significantly smaller indexed effective orifice area (MD: −0.18, 95 % CI: −0.27 to −0.10), and a higher transvalvular mean pressure gradient (MD: 5.07, 95 % CI 3.43 to 6.71) than SEVs. The risk for prosthesis-patient mismatch (PPM) (RR = 1.89, 95 % CI: 1.42 to 2.51) and severe PPM (RR = 2.80, 95 % CI: 1.96 to 4.0) was significantly higher for patients receiving BEVs than those receiving SEVs. Although nonsignificant differences were observed between BEVs and SEVs regarding 30-day and 1-year all-cause mortality, 30-day stroke rates, vascular complication, paravalvular leak, and permanent pacemaker implantation (p > 0.05), patients receiving BEVs were associated with a significantly increased risk of 1-year cardiovascular mortality (RR = 1.61, 95 % CI: 1.05 to 2.47) compared to those receiving SEVs. In patients with SAA, BEVs demonstrated worse hemodynamic performance as determined by the higher risk of moderate and severe PPM compared to SEVs. Moreover, the use of BEVs was associated with a higher risk of 1-year cardiovascular mortality.

对于主动脉瓣环较小的患者，经导管主动脉瓣置换术（TAVR）被认为比手术主动脉瓣植入术更有效，但不同经导管心脏瓣膜（THV）的疗效比较仍不确定。为了确定符合条件的随机对照试验（RCT）和倾向分数匹配（PSM）研究，我们对从开始到2024年6月的所有数据库进行了文献检索。采用随机效应模型对临床结果进行评估，以得出风险比 (RR) 和 95% 置信区间 (CI)。分析包括 10 项研究，共 2,960 名患者。与 SEV 相比，BEV 的指数化有效孔面积明显更小（MD：-0.18，95 % CI：-0.27 至 -0.10），跨瓣平均压力梯度更高（MD：5.07，95 % CI 3.43 至 6.71）。接受 BEV 的患者发生假体与患者不匹配（PPM）（RR = 1.89，95 % CI：1.42 至 2.51）和严重 PPM（RR = 2.80，95 % CI：1.96 至 4.0）的风险明显高于接受 SEV 的患者。虽然在 30 天和 1 年全因死亡率、30 天卒中率、血管并发症、腔旁漏和永久起搏器植入方面，BEV 和 SEV 之间无显著差异（P > 0.05），但与接受 SEV 的患者相比，接受 BEV 的患者 1 年心血管死亡风险显著增加（RR = 1.61，95 % CI：1.05 至 2.47）。在 SAA 患者中，与 SEV 相比，BEV 的血液动力学性能更差，表现为中度和重度 PPM 风险更高。此外，使用 BEV 与较高的 1 年心血管死亡风险相关。

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