IJC Heart and Vasculature最新文献_第2页

The predictive value of the ARC-HBR criteria for in-hospital bleeding risk following percutaneous coronary intervention in patients with acute coronary syndrome ARC-HBR 标准对急性冠状动脉综合征患者经皮冠状动脉介入治疗后院内出血风险的预测价值

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2024-10-19 DOI: 10.1016/j.ijcha.2024.101527

Background

The Academic Research Consortium for High Bleeding Risk (ARC-HBR) criteria were proposed for predicting bleeding risk in patients undergoing percutaneous coronary intervention (PCI). However, there is a lack of research evaluating the risk of in-hospital bleeding following PCI for acute coronary syndrome (ACS) utilizing the ARC-HBR criteria.

Methods and results

This study involved 1013 ACS patients who underwent PCI and dual antiplatelet therapy. There were 63 cases of in-hospital bleeding events (6.22 %). According to the ARC-HBR criteria, patients classified as HBR had a significantly greater bleeding rate than non-HBR patients (15.81 % vs. 1.99 %, p < 0.001). As the CRUSADE score category increased, the risk of bleeding also increased. The area under the receiver operating characteristic curve (AUC) of the ARC-HBR criteria was significantly greater than that of the CRUSADE score for bleeding (0.751 vs. 0.696, p < 0.0001). Subgroup analysis revealed that the ARC-HBR criteria exhibited better predictive ability for ST-segment elevation myocardial infarction (STEMI, AUC 0.767 vs. 0.694, p = 0.020) but comparable predictive ability in patients with unstable angina (AUC 0.756 vs. 0.644, p = 0.213), non-ST-segment elevation myocardial infarction (AUC 0.713 vs. 0.683, p = 0.644), and non-ST-segment elevation ACS (AUC 0.739 vs. 0.687, p = 0.330).

Conclusion

Compared with the CRUSADE score, the ARC-HBR criteria demonstrate superior predictive ability for in-hospital bleeding events during PCI in ACS patients. Routine assessment of the ARC-HBR score might be helpful for identifying high-risk individuals in this specific population.

背景高出血风险学术研究联盟（ARC-HBR）标准被提出用于预测经皮冠状动脉介入治疗（PCI）患者的出血风险。然而，目前还缺乏利用 ARC-HBR 标准评估急性冠状动脉综合征（ACS）PCI 术后院内出血风险的研究。方法和结果本研究涉及 1013 例接受 PCI 和双联抗血小板治疗的 ACS 患者。共发生 63 例院内出血事件（6.22%）。根据 ARC-HBR 标准，HBR 患者的出血率明显高于非 HBR 患者（15.81 % vs. 1.99 %，p < 0.001）。随着 CRUSADE 评分类别的增加，出血风险也随之增加。在出血方面，ARC-HBR 标准的接收器操作特征曲线下面积（AUC）明显大于 CRUSADE 评分（0.751 vs. 0.696，p < 0.0001）。亚组分析显示，ARC-HBR 标准对 ST 段抬高型心肌梗死（STEMI，AUC 0.767 vs. 0.694，p = 0.020）具有更好的预测能力，但对不稳定型心绞痛（AUC 0.756 vs. 0.644，p = 0.结论与 CRUSADE 评分相比，ARC-HBR 标准对 ACS 患者 PCI 期间院内出血事件的预测能力更强。对 ARC-HBR 评分进行常规评估可能有助于识别这一特殊人群中的高危人群。

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引用次数: 0

Proposed framework regarding management of patients with breast cancer and anti-cancer treatment-related elevation in cardiac troponin 关于乳腺癌患者和抗癌治疗相关心肌肌钙蛋白升高的管理框架建议

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2024-10-17 DOI: 10.1016/j.ijcha.2024.101522

Cardiac biomarkers are a vital component within the first edition of the European Society of Cardiology guidelines in Cardio-Oncology. Specifically, they are mentioned in the definition of mild asymptomatic cancer therapy-related cardiac dysfunction, where left ventricular systolic function is ≥50 % with two outcomes; either a new decrease in global longitudinal strain >15 % from baseline and/or a new rise in cardiac biomarkers above the defined 99th percentile cut off values. Cardiac troponin is one such biomarker.

Many of the treatments for breast cancer have published data on cardiac dysfunction and/or cardiovascular toxicity, and such may lead to an elevation in cardiac troponin. However, there is conflicting and incomplete data regarding how to approach an elevated cardiac troponin during anti-cancer treatment, which has confounded patient care in the clinical trial setting.

We propose a novel framework to guide physicians in treatment-related elevation of cardiac troponin in the breast cancer population. Secondly, the additive role which the recommendation that cardiac troponin carries within mild asymptomatic definitions of CTRCD is the subject of great debate. We suggest a reflection on the role of biomarkers, specifically in reference to cardiac troponin.

心脏生物标志物是第一版欧洲心脏病学会心脏病肿瘤学指南的重要组成部分。具体来说，它们在轻度无症状癌症治疗相关心功能不全的定义中被提及，即左心室收缩功能≥50%，并伴有两种结果：总体纵向应变比基线下降15%和/或心脏生物标志物上升超过定义的第99百分位数临界值。心肌肌钙蛋白就是这样一种生物标志物。许多乳腺癌治疗方法都有关于心功能障碍和/或心血管毒性的公开数据，这可能会导致心肌肌钙蛋白升高。然而，在抗癌治疗期间如何处理心肌肌钙蛋白升高的问题上，存在着相互矛盾且不完整的数据，这给临床试验环境中的患者护理带来了困惑。其次，关于心肌肌钙蛋白在轻度无症状的 CTRCD 定义中的附加作用的建议引起了激烈的争论。我们建议对生物标志物的作用进行反思，特别是心肌肌钙蛋白。

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引用次数: 0

Importance of long non-coding RNAs in the pathogenesis, diagnosis, and treatment of myocardial infarction 长非编码 RNA 在心肌梗死的发病机制、诊断和治疗中的重要性

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2024-10-17 DOI: 10.1016/j.ijcha.2024.101529

Myocardial infarction (MI), a major global cause of mortality and morbidity, continues to pose a significant burden on public health. Despite advances in understanding its pathogenesis, there remains a need to elucidate the intricate molecular mechanisms underlying MI progression. Long non-coding RNAs (lncRNAs) have emerged as key regulators in diverse biological processes, yet their specific roles in MI pathophysiology remain elusive. Conducting a thorough review of literature using PubMed and Google Scholar databases, we investigated the involvement of lncRNAs in MI, focusing on their regulatory functions and downstream signaling pathways. Our analysis revealed extensive dysregulation of lncRNAs in MI, impacting various biological processes through diverse mechanisms. Notably, lncRNAs act as crucial modulators of gene expression and signaling cascades, functioning as decoys, regulators, and scaffolds. Furthermore, studies identified the multifaceted roles of lncRNAs in modulating inflammation, apoptosis, autophagy, necrosis, fibrosis, remodeling, and ischemia–reperfusion injury during MI progression. Recent research highlights the pivotal contribution of lncRNAs to MI pathogenesis, offering novel insights into potential therapeutic interventions. Moreover, the identification of circulating lncRNA signatures holds promise for the development of non-invasive diagnostic biomarkers. In summary, findings underscore the significance of lncRNAs in MI pathophysiology, emphasizing their potential as therapeutic targets and diagnostic tools for improved patient management and outcomes.

心肌梗死（MI）是导致全球死亡和发病的主要原因之一，继续给公共卫生带来沉重负担。尽管人们对心肌梗死发病机理的认识取得了进展，但仍然需要阐明心肌梗死进展背后错综复杂的分子机制。长非编码 RNA（lncRNA）已成为多种生物过程中的关键调控因子，但它们在 MI 病理生理学中的具体作用仍然难以捉摸。我们利用 PubMed 和 Google Scholar 数据库对文献进行了全面回顾，研究了 lncRNA 在 MI 中的参与情况，重点关注其调控功能和下游信号通路。我们的分析表明，lncRNAs 在 MI 中广泛失调，通过不同的机制影响着各种生物过程。值得注意的是，lncRNAs 是基因表达和信号级联的关键调节因子，具有诱饵、调节因子和支架的功能。此外，研究还发现了 lncRNA 在 MI 进展过程中调节炎症、细胞凋亡、自噬、坏死、纤维化、重塑和缺血再灌注损伤的多方面作用。最近的研究强调了 lncRNA 在心肌梗死发病机制中的关键作用，为潜在的治疗干预提供了新的见解。此外，循环 lncRNA 标志的鉴定为开发非侵入性诊断生物标志物带来了希望。总之，研究结果强调了 lncRNAs 在 MI 病理生理学中的重要性，强调了它们作为治疗靶点和诊断工具的潜力，以改善患者管理和预后。

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引用次数: 0

Heart failure medication use and follow-up patterns in renal transplant recipients with reduced ejection fraction: A single-center experience 射血分数降低的肾移植受者的心衰用药和随访模式：单中心经验

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2024-10-15 DOI: 10.1016/j.ijcha.2024.101535

Background

The role of medical therapy for heart failure with reduced ejection fraction (HFrEF) in subjects with end-stage renal disease receiving renal transplantation (RT) is understudied. Here, we describe post-RT HFrEF medical management practices at a single urban, academic tertiary care center.

Methods

RT recipients between January 1, 2015 and November 30, 2020 with history of ejection fraction (EF) <40 % prior to RT were included. Medications, renal function, blood pressure, cardiology follow-up, and echocardiograms ≥90d post-RT were retrospectively collected for 2 years post-RT.

Results and conclusions

47/750 (6.3 %) of RT recipients had prior HFrEF diagnosis, of whom 26 experienced improvement in EF prior to RT. Pre-RT medical therapy included beta blocker (BB) in 43 (92 %) of subjects and renin-angiotensin-aldosterone inhibitors (RAASi) in 23 (49 %). By 24 months post-RT, BB were used in 34 (76 %) and RAASi were used in 12 (27 %) of subjects. Rates of post-RT cardiology follow-up (51 %) and echocardiogram (38 %) were lower than expected in this cohort. Of 29 subjects potentially eligible for RAASi based on preserved renal function and no hyperkalemia or hypotension episodes during follow-up, only 6 (21 %) received RAASi. Of 6 subjects with post-RT EF <50 %, 4 were eligible but did not receive RAASi. Multidisciplinary collaboration between cardiology and transplant teams may help improve care for this high-risk patient population.

背景对接受肾移植（RT）的终末期肾病患者射血分数降低型心衰（HFrEF）的药物治疗作用研究不足。方法纳入 2015 年 1 月 1 日至 2020 年 11 月 30 日期间接受肾移植且接受肾移植前射血分数（EF）为 40% 的患者。结果和结论47/750（6.3%）例RT受术者之前已确诊为HFrEF，其中26例在RT前EF有所改善。43 名受试者（92%）在 RT 前接受了β受体阻滞剂（BB）治疗，23 名受试者（49%）接受了肾素-血管紧张素-醛固酮抑制剂（RAASi）治疗。手术后 24 个月内，34 名受试者（76%）使用了β受体阻滞剂，12 名受试者（27%）使用了 RAASi。在该队列中，RT 后心脏病学随访率（51%）和超声心动图检查率（38%）低于预期。在 29 名因肾功能保留且随访期间未出现高钾血症或低血压而有可能接受 RAASi 治疗的受试者中，只有 6 人（21%）接受了 RAASi 治疗。在6名RT后EF为50%的受试者中，有4人符合条件，但没有接受RAASi治疗。心脏科和移植团队之间的多学科合作可能有助于改善对这一高风险患者群体的护理。

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引用次数: 0

Dissecting causal relationships between immune cells, blood metabolites, and aortic dissection: A mediation Mendelian randomization study 剖析免疫细胞、血液代谢物与主动脉夹层之间的因果关系：调解孟德尔随机研究

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2024-10-15 DOI: 10.1016/j.ijcha.2024.101530

<div><h3>Background</h3><div>There exists a robust correlation between the infiltration of immune cells and the pathogenesis of aortic dissection (AD). Moreover, blood metabolites serve as immunomodulatory agents within the organism, influencing the immune system’s response and potentially playing a role in the development of AD. Nevertheless, the intricate genetic causal nexus between specific immune cells, blood metabolites, and AD remains partially elucidated.</div></div><div><h3>Objectives</h3><div>This study aims to elucidate the causal relationships between specific immune cell types and the risk of developing AD, mediated by blood metabolites, using Mendelian Randomization (MR) methods.</div></div><div><h3>Methods</h3><div>We undertook a comprehensive investigation of 731 immune cell types through the analysis of published genome-wide association studies (GWAS). Our methodology hinged on the application of two-sample Mendelian randomization (MR) and mediator MR analyses, prioritizing blood metabolites as potential intermediary factors and AD as the principal outcome of interest. The primary statistical method employed was inverse variance-weighted estimation, complemented by a variety of sensitivity analyses to reinforce our conclusions. The entirety of our statistical analyses was executed on the R software platform.</div></div><div><h3>Results</h3><div>Our analyses elucidated that three immune cell types exhibited a positive correlation with the incidence of AD, whereas two immune cell types were inversely associated with AD risk. Significantly, our mediation Mendelian randomization (MR) findings identified Benzoate as a pivotal mediator in the influence of CD19 on IgD − CD38br cells on AD, with a mediation proportion of 5.38 %. Additionally, N-acetylproline was determined to mediate the effect of CD24 on IgD- CD38- cells on AD, accounting for a mediation proportion of 13.70 %. Furthermore, Carnitine C5:1 was found to mediate the effect of CD28 on secreting T regulatory (Treg) cells on AD, with a mediation proportion of 17.80 %.</div></div><div><h3>Conclusions</h3><div>These findings offer a nuanced understanding of the pathophysiological mechanisms underlying AD, thereby advancing the precision medicine paradigm in the clinical management of AD.</div><div>Abbreviations: AD: aortic dissection; AA: aortic aneurysm; GWAS: genome-wide association study; MR: Mendelian randomization; TSMR: two-step Mendelian randomization; Treg: secreting T regulatory cell; VSMC: vascular smooth muscle cell; MMP: matrix metalloproteinase; ROS: reactive oxygen species; IV: instrumental variable; SNP: single-nucleotide polymorphism; IVW: inverse variance weighted; LDSC: linkage disequilibrium score regression; OR: odds ratio; CI: confidence interval; LD: linkage disequilibrium; AC: absolute cell; MFI: median fluorescence intensity; MP: morphological parameter; RC: relative cell; CLSA: Canadian Longitudinal Study of Aging; Lp(a): Lipoprotein a; OxPL: oxidised ph

背景免疫细胞的浸润与主动脉夹层（AD）的发病机制之间存在着密切的联系。此外，血液中的代谢物可作为机体内的免疫调节剂，影响免疫系统的反应，并可能在主动脉夹层的发病中发挥作用。本研究旨在利用孟德尔随机化（Mendelian Randomization，MR）方法，阐明血液代谢物介导的特定免疫细胞类型与AD发病风险之间的因果关系。方法我们通过分析已发表的全基因组关联研究（GWAS），对731种免疫细胞类型进行了全面调查。我们的方法主要是应用双样本孟德尔随机化（MR）和中介MR分析，将血液代谢物作为潜在的中介因素，将AD作为主要的研究结果。我们采用的主要统计方法是反方差加权估计法，并辅以各种敏感性分析来强化我们的结论。我们的所有统计分析都是在 R 软件平台上进行的。结果我们的分析表明，三种免疫细胞类型与 AD 发病率呈正相关，而两种免疫细胞类型与 AD 风险呈反相关。值得注意的是，我们的调解孟德尔随机化（MR）研究结果发现，苯甲酸盐是影响 IgD - CD38br 细胞的 CD19 对 AD 影响的关键调解因子，调解比例为 5.38%。此外，N-乙酰脯氨酸被确定为CD24对IgD- CD38-细胞对AD影响的中介因子，其中介比例为13.70%。此外，还发现肉碱 C5:1 能介导 CD28 对分泌 T 调节（Treg）细胞对 AD 的影响，介导比例为 17.80%。结论这些研究结果让人们对 AD 的病理生理机制有了细致入微的了解，从而推进了 AD 临床治疗中的精准医学范式：缩写：AD：主动脉夹层；AA：主动脉瘤；GWAS：全基因组关联研究；MR：孟德尔随机化；TSMR：两步孟德尔随机化；Treg：分泌型 T 调节细胞；VSMC：血管平滑肌细胞；MMP：基质金属蛋白酶；ROS：活性氧；IV：工具变量；SNP：单核苷酸多态性；IVW：反方差加权；LDSC：连锁不平衡得分回归；OR：几率比；CI：置信区间；LD：连锁不平衡；AC：绝对细胞；MFI：中位荧光强度；MP：形态参数；RC：相对细胞；CLSA：加拿大老龄化纵向研究；Lp（a）：Lp（a）：脂蛋白 a；OxPL：氧化磷脂；NMDAR：N-甲基-d-天冬氨酸谷氨酸受体；STROBE-MR：利用孟德尔随机化加强流行病学中观察性研究的报告。

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引用次数: 0

The myocardial function index (MFI): An integrated measure of cardiac function in AL-cardiomyopathy 心肌功能指数（MFI）：AL 型心肌病心功能的综合测量指标

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2024-10-15 DOI: 10.1016/j.ijcha.2024.101525

Background

Amyloid light chain (AL) amyloidosis is a systemic disease that can cause restrictive cardiomyopathy (AL-CM). Current imaging techniques are not sensitive to detect myocardial dysfunction in AL-CM. We sought to evaluate role of a novel marker of myocardial dysfunction (myocardial function index, MFI) obtained using changes in left ventricular (LV) blood pool and myocardial volume in diastole and systole.

Methods

Consecutive patients diagnosed with AL-CM who had underwent cardiac MRI between 2001–2017 were identified and compared to healthy individuals. Two independent operators used cardiac MRI to perform epicardial and endocardial tracings in systole and diastole to obtain myocardial volume in diastole (MVd) and myocardial volume in systole (MVs). Changes in myocardial volumes during the cardiac cycle were measured to calculate the MFI by

\frac{(M V d - M V s) + S t r o k e v o l u m e}{MVd + L V e n d d i a s t o l i c v o l u m e}

. Multivariable analysis was performed to evaluate predictors of all-cause mortality and survival was evaluated using Kaplan Meier analysis.

Results

Patients with AL-CM (n = 129, 61 ± 10 years, 32 % women) were older and more likely to be men compared to the normal cohort (n = 101, 39 ± 15 years, 61 % women). MFI was lower in patients with AL-CM (19 % [15; 23] vs 38 % [35; 41], p < 0.001) and MFI < 30 % discriminated between AL-CM with 92 % sensitivity and 100 % specificity (AUC 0.98, p < 0.001). Higher MFI was independently associated with survival even after adjusting for conventional prognostic biomarkers of AL-CM (HR 0.02, 95 % CI 2.23 *104 – 0.24, p < 0.05). Two independent operators demonstrated high intra and inter-rater correlation in measurements used to calculate MFI.

Conclusion

MFI is a novel metric for assessing LV function. It is abnormal in patients with AL-CM and may play a role in risk stratification.

背景淀粉样轻链（AL）淀粉样变性是一种可导致局限性心肌病（AL-CM）的全身性疾病。目前的成像技术对检测 AL-CM 的心肌功能障碍并不敏感。我们试图评估一种新型心肌功能障碍标记物（心肌功能指数，MFI）的作用，该标记物是利用舒张期和收缩期左心室（LV）血池和心肌容积的变化获得的。两名独立操作者使用心脏核磁共振成像进行收缩期和舒张期心外膜和心内膜描记，以获得舒张期心肌容积（MVd）和收缩期心肌容积（MVs）。测量心动周期中心肌容积的变化，通过 MVd-MVs+StrokevolumeMVd+LVenddiastolicvolume 计算 MFI。结果与正常队列（n = 101，39 ± 15 岁，61 % 为女性）相比，AL-CM 患者（n = 129，61 ± 10 岁，32 % 为女性）年龄更大，更可能是男性。AL-CM 患者的 MFI 较低（19 % [15; 23] vs 38 % [35; 41]，p < 0.001），MFI < 30 % 可区分 AL-CM，灵敏度为 92 %，特异性为 100 %（AUC 0.98，p < 0.001）。即使在调整了 AL-CM 的常规预后生物标志物后，较高的 MFI 仍与存活率独立相关（HR 0.02，95 % CI 2.23 *104 - 0.24，p < 0.05）。结论MFI是评估左心室功能的一种新指标。MFI是评估左心室功能的新指标，在AL-CM患者中存在异常，可能在风险分层中发挥作用。

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引用次数: 0

Severity of diastolic dysfunction predicts myocardial infarction 舒张功能障碍的严重程度可预测心肌梗死的发生

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2024-10-13 DOI: 10.1016/j.ijcha.2024.101532

Background

Diastolic dysfunction (DD) is known to be a predictor of mortality. However, the impact of DD on the risk for myocardial infarction (MI) is not well defined. We sought to examine whether DD is an independent predictor of risk of MI in patients with a preserved ejection fraction.

Methods

This was an observational study of consecutive patients who underwent an echocardiogram that showed normal systolic function and had ≥ 3 months of follow-up. DD was graded using the contemporaneous guidelines at the time of the echocardiogram. Subsequent MI was determined by an inpatient encounter with a primary diagnosis of MI.

Results

129,476 patients were included (mean age 56 years; 58 % women). DD was present in 17.6 % of patients (13.6 % Grade I, 3.6 % Grade II, 0.4 % Grade III). Patients with DD were more likely to be older and have cardiovascular comorbidities. Survival free from MI was significantly lower as DD severity increased. Multivariate Cox proportional hazards modeling demonstrated that DD was an independent predictor of MI (hazard ratios [CI]: Grade I: 1.48 [1.33–1.66]; Grade II: 1.84 [1.57–2.16]; Grade III: 2.90 [1.98–4.25]).

Conclusion

Our data demonstrate that the risk of MI is significantly increased in the presence of DD, with higher risk at higher grades of DD. The increased risk associated with grade III DD is comparable to that from a prior history of percutaneous coronary intervention. These findings suggest that the severity of DD may be a useful tool in stratifying patients for risk of MI.

背景众所周知，舒张功能障碍（DD）是预测死亡率的一个因素。然而，舒张功能障碍对心肌梗死（MI）风险的影响尚不明确。我们试图研究 DD 是否是射血分数保留患者心肌梗死风险的独立预测因素。方法这是一项观察性研究，研究对象是接受超声心动图检查并显示收缩功能正常且随访时间≥ 3 个月的连续患者。根据超声心动图检查时的同期指南对 DD 进行分级。随后发生的心肌梗死由主要诊断为心肌梗死的住院患者决定。结果共纳入 129476 名患者（平均年龄 56 岁；58% 为女性）。17.6%的患者存在DD（13.6%为I级，3.6%为II级，0.4%为III级）。DD患者更有可能年龄较大并患有心血管并发症。随着DD严重程度的增加，无心肌梗死的生存率明显降低。多变量考克斯比例危险模型显示，DD是心肌梗死的独立预测因子（危险比[CI]：结论我们的数据表明，DD 会显著增加心肌梗死的风险，DD 等级越高，风险越大。与 III 级 DD 相关的风险增加与既往接受过经皮冠状动脉介入治疗的风险增加相当。这些发现表明，DD 的严重程度可能是对患者进行 MI 风险分层的有用工具。

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引用次数: 0

Edge-to-Edge mitral valve repair for preoperative bridging to heart transplantation 二尖瓣边缘到边缘修复术，为心脏移植搭桥

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2024-10-13 DOI: 10.1016/j.ijcha.2024.101520

Transcatheter edge-to-edge repair (TEER) is a less invasive alternative to mitral valve surgery. In patients with advanced heart failure (HF), TEER can improve pulmonary hypertension (PH) and decelerate the progression of HF. TEER could be considered as a possible bridging strategy before orthotopic heart transplantation (OHT) in suitable patients. We report our experience in patients with advanced HF and severe functional mitral regurgitation (FMR) who underwent TEER prior to OHT. In this retrospective single-center study, we evaluated the periprocedural characteristics and clinical and hemodynamic outcomes of 14 patients with advanced HF on guideline-directed medical therapy and severe FMR who underwent TEER prior to OHT. In 6 patients who were not eligible for transplantation because of PH, TEER was performed as bridge-to-candidacy (BTC) strategy, in 8 unstable patients on the waiting list as bridge-to-transplant (BTT) strategy.

Severity of FMR was reduced by 2 degrees from 4 (3–4) to 2 (1.25–2.25) (p < 0.001), NYHA class from 3 (2–3) to 2 (1.75–2.13) (p = 0.003) and NT-proBNP from 4689 (2841–7932) ng/L to 2973 (1694–4812) ng/L (p = 0.008). Significant reduction in PH was observed in the BTC cohort (mean PAP from 50 (39–53) to 26 (23–33) (p = 0.027) and PCWP from to 34 (29–40) to 13.5 (11–21) mmHg (p = 0.027). 13 patients underwent successful OHT, 1 patient of the BTT cohort died of sepsis shortly after HTX listing. In conclusion patients with advanced HF and severe FMR who are considered for OHT, TEER appears suitable both as a BTC strategy in patients with PH and as a BTT strategy in unstable patients on the waiting list.

经导管边缘到边缘修补术（TEER）是二尖瓣手术的一种微创替代方法。对于晚期心力衰竭（HF）患者，TEER 可以改善肺动脉高压（PH）并减缓 HF 的进展。对于合适的患者，TEER 可被视为正位心脏移植（OHT）前的一种可能的桥接策略。我们报告了晚期 HF 和严重功能性二尖瓣反流（FMR）患者在 OHT 前接受 TEER 的经验。在这项回顾性单中心研究中，我们评估了 14 名接受指导性药物治疗的晚期 HF 和重度 FMR 患者在 OHT 前接受 TEER 的围手术期特征、临床和血流动力学结果。在6例因PH而不符合移植条件的患者中，TEER被作为 "通向候选者的桥梁"（BTC）策略实施，在8例处于候选名单中的不稳定患者中，TEER被作为 "通向移植的桥梁"（BTT）策略实施。FMR 的严重程度降低了 2 度，从 4（3-4）降至 2（1.25-2.25）（p < 0.001），NYHA 分级从 3（2-3）降至 2（1.75-2.13）（p = 0.003），NT-proBNP 从 4689（2841-7932）纳克/升降至 2973（1694-4812）纳克/升（p = 0.008）。在 BTC 队列中观察到 PH 显著降低（平均 PAP 从 50（39-53）降至 26（23-33）（p = 0.027），PCWP 从 34（29-40）降至 13.5（11-21）mmHg（p = 0.027）。13 名患者成功接受了 OHT，1 名 BTT 队列患者在 HTX 上市后不久死于败血症。总之，对于考虑进行 OHT 的晚期 HF 和严重 FMR 患者，TEER 似乎既适合作为 PH 患者的 BTC 策略，也适合作为等待名单中不稳定患者的 BTT 策略。

{"title":"Edge-to-Edge mitral valve repair for preoperative bridging to heart transplantation","authors":"","doi":"10.1016/j.ijcha.2024.101520","DOIUrl":"10.1016/j.ijcha.2024.101520","url":null,"abstract":"<div><div>Transcatheter edge-to-edge repair (TEER) is a less invasive alternative to mitral valve surgery. In patients with advanced heart failure (HF), TEER can improve pulmonary hypertension (PH) and decelerate the progression of HF. TEER could be considered as a possible bridging strategy before orthotopic heart transplantation (OHT) in suitable patients. We report our experience in patients with advanced HF and severe functional mitral regurgitation (FMR) who underwent TEER prior to OHT. In this retrospective single-center study, we evaluated the periprocedural characteristics and clinical and hemodynamic outcomes of 14 patients with advanced HF on guideline-directed medical therapy and severe FMR who underwent TEER prior to OHT. In 6 patients who were not eligible for transplantation because of PH, TEER was performed as bridge-to-candidacy (BTC) strategy, in 8 unstable patients on the waiting list as bridge-to-transplant (BTT) strategy.</div><div>Severity of FMR was reduced by 2 degrees from 4 (3–4) to 2 (1.25–2.25) (p < 0.001), NYHA class from 3 (2–3) to 2 (1.75–2.13) (p = 0.003) and NT-proBNP from 4689 (2841–7932) ng/L to 2973 (1694–4812) ng/L (p = 0.008). Significant reduction in PH was observed in the BTC cohort (mean PAP from 50 (39–53) to 26 (23–33) (p = 0.027) and PCWP from to 34 (29–40) to 13.5 (11–21) mmHg (p = 0.027). 13 patients underwent successful OHT, 1 patient of the BTT cohort died of sepsis shortly after HTX listing. In conclusion patients with advanced HF and severe FMR who are considered for OHT, TEER appears suitable both as a BTC strategy in patients with PH and as a BTT strategy in unstable patients on the waiting list.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142433410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Age-specific associations of invasive treatment with long-term mortality of patients with acute myocardial infarction: Results of a real-world cohort analysis 有创治疗与急性心肌梗死患者长期死亡率的特定年龄关联：真实世界队列分析结果

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2024-10-10 DOI: 10.1016/j.ijcha.2024.101524

Background

To investigate the age-specific association between invasive treatment, that is percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) at acute myocardial infarction (AMI) and all-cause long-term mortality.

Methods

The analysis was based on 4964 hospitalized AMI patients (age 25–84 years) registered by the population-based Augsburg Myocardial Infarction Registry between 2010 and 2017. The median follow-up time was 4.7 years (IQR: 2.7; 6.8). All-cause mortality was obtained by regularly checking the vital status of all registered AMI patients in cooperation with the regional population registries. In multivariable adjusted Cox regression analyses the age-specific associations between invasive therapy (PCI or CABG versus no invasive therapy) and all-cause mortality were investigated.

Results

During follow-up 1224 patients (805 men and 419 women) died. In patients younger than 55 years 7.6 %, in the age group 55–64 years 7.1 %, in the age group 65–74 years 12.2 %, and in the age group 75–84 years 21.6 % did not undergo invasive therapy (PCI or CABG) during hospital stay. Invasive therapy using PCI or CABG significantly reduced mortality risk in all age-groups in comparison to AMI patients without invasive treatment. Even 75–84 years old benefited very impressively from invasive therapy regarding long-term all-cause mortality (PCI: HR 0.55; 95 % CI 0.44–0.70; CABG: HR 0.43; 95 % CI 0.30–0.62).

Conclusions

Invasive or surgical therapy procedures in the treatment of AMI patients are effective in all age groups. Therefore, also old AMI patients should receive guideline-compliant therapy to achieve a better outcome.

背景为了研究急性心肌梗死（AMI）时经皮冠状动脉介入治疗（PCI）或冠状动脉旁路移植术（CABG）等侵入性治疗与全因长期死亡率之间的年龄特异性关联，奥格斯堡心肌梗死登记处在 2010 年至 2017 年间登记了 4964 名住院的急性心肌梗死患者（年龄在 25-84 岁之间）。中位随访时间为 4.7 年（IQR：2.7；6.8）。通过与地区人口登记处合作，定期检查所有登记的急性心肌梗死患者的生命体征，从而获得全因死亡率。在多变量调整 Cox 回归分析中，研究了有创治疗（PCI 或 CABG 与无创治疗）与全因死亡率之间的年龄特异性关联。在住院期间未接受侵入性治疗（PCI 或 CABG）的患者中，55 岁以下占 7.6%，55-64 岁占 7.1%，65-74 岁占 12.2%，75-84 岁占 21.6%。与未接受侵入性治疗的急性心肌梗死患者相比，使用 PCI 或 CABG 进行侵入性治疗可显著降低所有年龄组患者的死亡风险。在长期全因死亡率方面，即使是 75-84 岁的患者也从侵入性治疗中获益匪浅（PCI：HR 0.55；95 % CI 0.44-0.70；CABG：HR 0.43；95 % CI 0.30-0.62）。因此，老年急性心肌梗死患者也应接受符合指南的治疗，以获得更好的疗效。

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引用次数: 0

Feasibility, safety and clinical impact of a less-invasive totally-endovascular (LITE) technique for transfemoral TAVI: A 1000 patients single-centre experience 经股动脉 TAVI 的微创全血管内 (LITE) 技术的可行性、安全性和临床影响：1000例患者的单中心经验

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2024-10-09 DOI: 10.1016/j.ijcha.2024.101523

Background

Trans-femoral (TF) represents the main access for TAVI. Although there are various technical strategies to conduct TF-TAVI (pacing modality, secondary arterial access, primary access puncture etc.), the optimal technique is not recognized.

Aims

In the present study, we assessed the impact of systematic use of LITE-TAVI in terms of feasibility, safety, and main access complication management using VARC-3 outcomes definitions.

Methods

At our institution, a less-invasive totally-endovascular (LITE) technique for TF-TAVI has been developed since 2017. Key aspects are: precise TAVI access puncture using angiographic-guidewire ultrasound guidance; radial/ulnar approach as the default “secondary access”; non-invasive pacing (by guidewire stimulation or definitive pacemaker external programmer).

Results

1022 consecutive TF-TAVI patients (55 % women, mean age: 80 years, mean EuroSCORE II 6.1 %, mean STS-PROM 4.3 %, mean STS/ACC TVT TAVR mortality score 3.4 %) were approached using the LITE technique. Technical success was achieved in 993 (97.2 %) patients. Access-related major vascular complications occurred in 12 (1.2 %) and VARC-3 ≥ type 2 bleedings in 12 (1.2 %) patients. At 30-day, all-cause death occurred in 17 (1.7 %) patients. This figure resulted significantly lower than expected on the bases of the mortality predicted not only by EuroSCORE II (6.1 %, p < 0.001) and STS-PROM score (4.3 %; p < 0.001), but also by STS/ACC TVT TAVR mortality score (3.4 %; p = 0.01).

Conclusions

Systematic use of LITE-TAVI is feasible and is associated with an extremely low rate of access-related bleeding and vascular complications which may drive to outcome improvement.

背景经股动脉（TF）是 TAVI 的主要入路。尽管开展 TF-TAVI 有多种技术策略（起搏方式、二级动脉通路、主通路穿刺等），但最佳技术尚未得到认可。Aims在本研究中，我们使用 VARC-3 结果定义，评估了系统使用 LITE-TAVI 在可行性、安全性和主通路并发症管理方面的影响。Methods自 2017 年以来，我院已开发出用于 TF-TAVI 的微创全血管内（LITE）技术。主要内容包括：使用血管造影-导丝超声引导进行精确的 TAVI 入路穿刺；将桡侧/尺侧入路作为默认的 "辅助入路"；无创起搏（通过导丝刺激或明确的起搏器外部编程器）。结果 1022 名连续的 TF-TAVI 患者（55% 为女性，平均年龄 80 岁，平均 EuroSCORE II 6.1%，平均 STS-PROM 4.3%，平均 STS/ACC TVT TAVR 死亡率评分 3.4%）接受了 LITE 技术。993例（97.2%）患者获得了技术成功。12例（1.2%）患者发生了与介入相关的主要血管并发症，12例（1.2%）患者发生了VARC-3≥2型出血。在 30 天内，有 17 名患者（1.7%）因各种原因死亡。结论系统性使用 LITE-TAVI 是可行的，而且与入路相关的出血和血管并发症发生率极低，这可能会改善治疗效果。

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引用次数: 0