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Different strategies in left ventricle unloading during venoarterial extracorporeal membrane oxygenation: A network meta-analysis 静脉体外膜氧合过程中左心室卸载的不同策略:网络荟萃分析
IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-04 DOI: 10.1016/j.ijcha.2024.101506
Han Zhang , Tianlong Wang , Jing Wang, Gang Liu, Shujie Yan, Yuan Teng, Jian Wang, Bingyang Ji

Background

Left ventricular (LV) overload is a frequent complication during VA-ECMO associated with poor outcomes. Many strategies of LV unloading have been documented but lack of evidence shows which is better. We conducted a network meta-analysis to compare different LV unloading strategies.

Methods

We searched databases for all published studies on LV unloading strategies during VA-ECMO. The pre-defined primary outcome was all-cause mortality.

Results

45 observational studies (34235 patients) were included. The Surface Under the Cumulative Ranking values (SUCRA) demonstrated that compared to no unloading strategy (15.4 %), IABP (73.8 %), pLVAD (60.8 %), atrial septostomy (51.2 %), catheter venting (48.8 %) were all associated with decreased all-cause mortality, in which IABP and pLVAD existed statistical significance. For secondary outcomes, no unloading group had the shortest VA-ECMO duration, ICU and hospital length of stay, and the lower risk of complications compared with unloading strategies. IABP was associated with reducing VA-ECMO duration, ICU and hospital length of stay, and the risk of complications (except for hemolysis as the second best) compared with other unloading strategies.

Conclusions

LV unloading strategies during VA-ECMO were associated with improved survival compared to no unloading, but the tendency to increase the risk of various complications deserves more consideration.

背景左心室(LV)负荷过重是 VA-ECMO 期间经常出现的并发症,与不良预后有关。目前已有多种左心室减压策略,但没有证据表明哪种策略更好。我们进行了一项网络荟萃分析,以比较不同的左心室减压策略。方法我们在数据库中搜索了所有已发表的关于VA-ECMO期间左心室减压策略的研究。结果共纳入45项观察性研究(34235例患者)。累积排名表面值(Surface Under the Cumulative Ranking values,SUCRA)显示,与无减压策略(15.4%)相比,IABP(73.8%)、pLVAD(60.8%)、心房间隔造口术(51.2%)和导管通气(48.8%)均与全因死亡率下降相关,其中IABP和pLVAD具有统计学意义。在次要结果方面,与减压策略相比,无减压组的VA-ECMO持续时间、重症监护室和住院时间最短,并发症风险较低。与其他卸载策略相比,IABP可缩短VA-ECMO持续时间、缩短ICU和住院时间、降低并发症风险(溶血风险次之)。
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引用次数: 0
Association of direct oral anticoagulants and warfarin with incidence of dementia in atrial fibrillation patients: A systematic review and meta-analysis 直接口服抗凝剂和华法林与心房颤动患者痴呆症发病率的关系:系统回顾和荟萃分析
IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-04 DOI: 10.1016/j.ijcha.2024.101401
Chenyang Zhang , JiaQi Zhang , Xuan Zhao , Dongyang Jiang , Xiaoqian Liu , Ying Liang

Objects

To evaluate the association of direct oral anticoagulants (DOACs) and warfarin with dementia incidence in atrial fibrillation (AF) patients.

Methods

Relevant studies were retrieved in databases including Embase, PubMed, Cochrane, Web of Knowledge, and ClinicalTrials.gov. Meta-analysis was then conducted using Stata 12.0 software.

Results

A total of 9 studies involving 447,644 AF patients were included. The results indicated that AF patients treated with DOACs had a lower incidence of dementia compared to those treated with warfarin (RR: 0.692, 95 % CI: 0.603–0.793, P = 0.000), This trend was observed in both age groups, <75 years old (RR: 0.770, 95 % CI: 0.639–0.929, P = 0.006) and ≥75 years old (RR: 0.858, 95 % CI: 0.756–0.973, P = 0.017), particularly in cases of Alzheimer's disease (RR: 0.798, 95 % CI: 0.684–0.932, P = 0.004) rather than vascular dementia (RR: 0.841, 95 % CI: 0.61–0.143, P = 0.269). Furthermore, patients taking rivaroxaban (RR: 0.680, 95 % CI: 0.624–0.741, P = 0.000) and apixaban (RR: 0.598, 95 % CI: 0.528–0.676, P = 0.000) instead of dabigatran (RR: 0.941, 95 % CI: 0.862–1.027, p = 0.17) exhibited a lower incidence of dementia than those took warfarin. Notably, AF patients taking rivaroxaban (RR: 0.75, 95 % CI: 0.67–0.84, P = 0.000) and apixaban (RR: 0.758, 95 % CI: 0.647–0.889, P = 0.001) had a lower incidence of dementia than those taking dabigatran, although the difference between trivaroxaban and apixaban was not statistically significant (RR:1.161, 95 % CI: 0.934–1.443, P = 0.018).

Conclusions

AF patients treated with DOACs, particularly rivaroxaban and apixaban, showed a lower incidence of dementia compared to those treated with warfarin, with a notable disparity observed when compared to dabigatran.

目的 评价直接口服抗凝药(DOACs)和华法林与房颤(AF)患者痴呆症发病率的关系。方法 在Embase、PubMed、Cochrane、Web of Knowledge和ClinicalTrials.gov等数据库中检索相关研究。结果共纳入 9 项研究,涉及 447644 名房颤患者。结果表明,与接受华法林治疗的房颤患者相比,接受 DOACs 治疗的房颤患者痴呆发生率较低(RR:0.692,95 % CI:0.603-0.793,P = 0.000),这一趋势在两个年龄组均可观察到,<75 岁(RR:0.770,95 % CI:0.639-0.929,P = 0.006)和≥75 岁(RR:0.858,95 % CI:0.756-0.973,P = 0.017),尤其是在阿尔茨海默病(RR:0.798,95 % CI:0.684-0.932,P = 0.004)而非血管性痴呆(RR:0.841,95 % CI:0.61-0.143,P = 0.269)病例中。此外,与服用华法林的患者相比,服用利伐沙班(RR:0.680,95 % CI:0.624-0.741,P = 0.000)和阿哌沙班(RR:0.598,95 % CI:0.528-0.676,P = 0.000)而非达比加群(RR:0.941,95 % CI:0.862-1.027,P = 0.17)的患者痴呆发生率更低。值得注意的是,服用利伐沙班(RR:0.75,95 % CI:0.67-0.84,P = 0.000)和阿哌沙班(RR:0.758,95 % CI:0.647-0.889,P = 0.001)的房颤患者的痴呆发生率低于服用达比加群者,但曲伐沙班和阿哌沙班之间的差异无统计学意义(RR:1.161,95 % CI:0.934-1.443,P = 0.018)。结论与接受华法林治疗的患者相比,接受 DOACs(尤其是利伐沙班和阿哌沙班)治疗的 AF 患者的痴呆发生率较低,与达比加群相比较,观察到明显的差异。
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引用次数: 0
Prognostic roles of neutrophil–lymphocyte, monocyte-lymphocyte and platelet-lymphocyte ratios for long-term all-cause mortality in heart failure 中性粒细胞-淋巴细胞、单核细胞-淋巴细胞和血小板-淋巴细胞比率对心力衰竭长期全因死亡率的预后作用
IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-31 DOI: 10.1016/j.ijcha.2024.101502
Caterina Delcea , Catalin Adrian Buzea , Dobromir Dobrev , Gheorghe Andrei Dan

Background

Heart failure (HF) and inflammation have a bidirectional relation leading to activation and adaptation of multiple cellular lines, including leucocyte subtypes and platelets. We aimed to assess and compare the predictive value of the neutrophil–lymphocyte (NLR), monocyte-lymphocyte (MLR) and platelet-lymphocyte (PLR) ratios for all-cause long-term mortality in HF.

Methods

This is an observational retrospective cohort study that included patients from the HI-HF cohort that survived the initial hospitalization. Vital status and survival time were assessed in June 2020.

Results

We analyzed 1018 HF patients with a mean age of 72.32 ± 10.29 years and 53.54 % women. All-cause long-term mortality was 38.21 % after a median follow-up time of 68 [38 – 82] months. NLR (AUC 0.667, 95 %CI 0.637 – 0.697), MLR (AUC 0.670, 95 %CI 0.640 – 0.700) and PLR (AUC 0.606, 95 %CI 0.574 – 0.636) were predictors of all-cause mortality. In multivariable Cox proportional hazards analysis, NLR≥3.56 was the only hematological index independent predictor of fatality (HR 1.36, 95 %CI 1.05 – 1.76).

Conclusions

Of the three hematological indices, NLR was the only independent predictor of all-cause long-term mortality of HF patients. We suggest NLR≥3.56 as an auxiliary prognostic biomarker for the evaluation of HF patients.

背景心力衰竭(HF)和炎症有双向关系,导致多种细胞系(包括白细胞亚型和血小板)的活化和适应。我们的目的是评估和比较中性粒细胞-淋巴细胞(NLR)、单核细胞-淋巴细胞(MLR)和血小板-淋巴细胞(PLR)比率对心力衰竭患者全因长期死亡率的预测价值。结果我们分析了 1018 名高血压患者,平均年龄(72.32 ± 10.29)岁,女性占 53.54%。中位随访时间为 68 [38 - 82] 个月,全因长期死亡率为 38.21%。NLR(AUC 0.667,95 %CI 0.637 - 0.697)、MLR(AUC 0.670,95 %CI 0.640 - 0.700)和PLR(AUC 0.606,95 %CI 0.574 - 0.636)是预测全因死亡率的指标。在多变量 Cox 比例危险分析中,NLR≥3.56 是唯一独立预测死亡的血液指标(HR 1.36,95 %CI 1.05 - 1.76)。我们建议将 NLR≥3.56 作为评估心房颤动患者预后的辅助生物标志物。
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引用次数: 0
Causal relationship between serum uric acid and cardiovascular disease: A Mendelian randomization study 血清尿酸与心血管疾病之间的因果关系:孟德尔随机研究
IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-31 DOI: 10.1016/j.ijcha.2024.101503
Claudio Borghi, Federica Fogacci, Federica Piani
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引用次数: 0
Endoplasmic reticulum stress in abdominal aortic aneurysm 腹主动脉瘤中的内质网应力
IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-29 DOI: 10.1016/j.ijcha.2024.101500
Zhaohai Su , Weiling Lu , Jun Cao , Zheng Xie , Pei Zhao

Abdominal aortic aneurysms (AAAs) are characterized by permanent dilatation of the abdominal aorta, which is accompanied by inflammation, degradation of the extracellular matrix (ECM) and disruption of vascular smooth muscle cell (VSMC) homeostasis. Endoplasmic reticulum (ER) stress is involved in the regulation of inflammation, oxidative stress and VSMC apoptosis, all of which are critical factors in AAA development. Although several studies have revealed the occurrence of ER stress in AAA development, the specific biological functions of ER stress in AAA development remain largely unknown. Given that targeting ER stress is a promising strategy for treating AAAs, further investigation of the physiological and pathological roles of ER stress in AAA development is warranted.

腹主动脉瘤(AAA)的特征是腹主动脉永久性扩张,同时伴有炎症、细胞外基质(ECM)降解和血管平滑肌细胞(VSMC)平衡的破坏。内质网(ER)应激参与了炎症、氧化应激和血管平滑肌细胞凋亡的调控,所有这些都是 AAA 发生的关键因素。尽管多项研究揭示了ER应激在AAA发生发展过程中的存在,但ER应激在AAA发生发展过程中的具体生物学功能在很大程度上仍然未知。鉴于靶向 ER 应激是治疗 AAA 的一种有前景的策略,有必要进一步研究 ER 应激在 AAA 发生过程中的生理和病理作用。
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引用次数: 0
Association of epicardial adipose tissue density with postoperative atrial fibrillation after isolated aortic valve replacement 孤立主动脉瓣置换术后心外膜脂肪组织密度与心房颤动的关系
IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-27 DOI: 10.1016/j.ijcha.2024.101481
Rui Li , Jian Zhang , Lingling Ke , Xiaohui Zhang , Jiawei Wu , Jinsong Han

Backgrounds

It is well known that epicardial adipose tissue (EAT) is associated with the development of atrial fibrillation (AF). The aim of this study was to investigate whether EAT density (EAT-d) is associated with the development of new-onset atrial fibrillation (POAF) after aortic valve replacement (AVR).

Methods

We retrospectively studied 143 patients who underwent simple AVR at Department of Cardiovascular Surgery of the General Hospital of Northern Theater Command between June 2020 to August 2023. All patients received cardiac coronary artery computed tomography (CT) before surgery. EAT-d, EAT volume and EAT volume index (EATVI) were quantitatively measured and analysed using EAT analysis software (TIMESlicePro). POAF was detected by 7-day Holter monitoring.

Results

Of 143 patients undergoing AVR, 55 patients (38.46 %) developed POAF after surgery. Male patients and patients who had elder age or smoking history were more likely to develop POAF. On univariable analysis, patients developed POAF had significantly more EAT-d (−79.19(−83.91, −74.69) vs. −81.54(−87.16, −76.76); P = 0.043) and EATVI (4.14(3.32,5.03) vs. 3.90(2.70,4.51); P = 0.043) than patients without POAF. On multivariable analysis, EAT-d and age were independent risk factors for POAF (odds ratio (OR): 1.186, 95 % confidence interval (CI): 1.062–1.324, P = 0.002; OR: 1.119, 95 %CI: 1.055–1.187, P < 0.001). Furthermore, EAT-d was significantly associated with age. Furthermore, EAT-d was associated with cardiac structure changes, such as cardiac left ventricular end-diastolic, left ventricular end-systolic volumes and NT-proBNP before surgery.

Conclusion

EAT-d and age are independent predictors of POAF after simple AVR. EAT-d was related with age.

背景众所周知,心外膜脂肪组织(EAT)与心房颤动(AF)的发生有关。本研究旨在探讨 EAT 密度(EAT-d)是否与主动脉瓣置换术(AVR)后新发心房颤动(POAF)的发生有关。方法我们回顾性研究了 2020 年 6 月至 2023 年 8 月期间在北部战区司令部总医院心血管外科接受单纯 AVR 的 143 例患者。所有患者术前均接受了心脏冠状动脉计算机断层扫描(CT)。使用EAT分析软件(TIMESlicePro)对EAT-d、EAT体积和EAT体积指数(EATVI)进行定量测量和分析。结果 在接受 AVR 的 143 名患者中,55 名患者(38.46%)在术后出现 POAF。男性患者、年龄较大或有吸烟史的患者更容易出现 POAF。单变量分析显示,发生 POAF 的患者的 EAT-d (-79.19(-83.91, -74.69) vs. -81.54(-87.16, -76.76); P = 0.043) 和 EATVI (4.14(3.32,5.03) vs. 3.90(2.70,4.51); P = 0.043) 明显高于未发生 POAF 的患者。多变量分析显示,EAT-d 和年龄是 POAF 的独立危险因素(几率比(OR):1.186,95 % 置信区间(CI):1.062-1.324,P = 0.002;OR:1.119,95 %CI:1.055-1.187,P <0.001)。此外,EAT-d 与年龄明显相关。结论 EAT-d 和年龄是单纯 AVR 术后 POAF 的独立预测因素。EAT-d与年龄有关。
{"title":"Association of epicardial adipose tissue density with postoperative atrial fibrillation after isolated aortic valve replacement","authors":"Rui Li ,&nbsp;Jian Zhang ,&nbsp;Lingling Ke ,&nbsp;Xiaohui Zhang ,&nbsp;Jiawei Wu ,&nbsp;Jinsong Han","doi":"10.1016/j.ijcha.2024.101481","DOIUrl":"10.1016/j.ijcha.2024.101481","url":null,"abstract":"<div><h3>Backgrounds</h3><p>It is well known that epicardial adipose tissue (EAT) is associated with the development of atrial fibrillation (AF). The aim of this study was to investigate whether EAT density (EAT-d) is associated with the development of new-onset atrial fibrillation (POAF) after aortic valve replacement (AVR).</p></div><div><h3>Methods</h3><p>We retrospectively studied 143 patients who underwent simple AVR at Department of Cardiovascular Surgery of the General Hospital of Northern Theater Command between June 2020 to August 2023. All patients received cardiac coronary artery computed tomography (CT) before surgery. EAT-d, EAT volume and EAT volume index (EATVI) were quantitatively measured and analysed using EAT analysis software (TIMESlicePro). POAF was detected by 7-day Holter monitoring.</p></div><div><h3>Results</h3><p>Of 143 patients undergoing AVR, 55 patients (38.46 %) developed POAF after surgery. Male patients and patients who had elder age or smoking history were more likely to develop POAF. On univariable analysis, patients developed POAF had significantly more EAT-d (−79.19(−83.91, −74.69) vs. −81.54(−87.16, −76.76); P = 0.043) and EATVI (4.14(3.32,5.03) vs. 3.90(2.70,4.51); P = 0.043) than patients without POAF. On multivariable analysis, EAT-d and age were independent risk factors for POAF (odds ratio (OR): 1.186, 95 % confidence interval (CI): 1.062–1.324, P = 0.002; OR: 1.119, 95 %CI: 1.055–1.187, P &lt; 0.001). Furthermore, EAT-d was significantly associated with age. Furthermore, EAT-d was associated with cardiac structure changes, such as cardiac left ventricular end-diastolic, left ventricular end-systolic volumes and NT-proBNP before surgery.</p></div><div><h3>Conclusion</h3><p>EAT-d and age are independent predictors of POAF after simple AVR. EAT-d was related with age.</p></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"54 ","pages":"Article 101481"},"PeriodicalIF":2.5,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2352906724001477/pdfft?md5=f95b178af551fcb4ee9233fa5dd34677&pid=1-s2.0-S2352906724001477-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142083642","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
Cardiac remodeling and inflammation detected by magnetic resonance imaging in COVID-19 survivors 通过磁共振成像检测 COVID-19 幸存者的心脏重塑和炎症情况
IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-27 DOI: 10.1016/j.ijcha.2024.101499
Eduardo B. Schaustz , José Carlos P. Secco , Julia M. Barroso , Juliana R. Ferreira , Mariana B. Tortelly , Adriana L. Pimentel , Ana Cristina B.S. Figueiredo , Denilson C. Albuquerque , Allan R. Kluser Sales , Paulo H. Rosado de-Castro , Martha V.T. Pinheiro , Olga F. Souza , Emiliano Medei , Ronir R. Luiz , Andréa Silvestre-Sousa , Gabriel C. Camargo , Renata Moll-Bernardes

Background

Concerns have been raised about cardiac inflammation in patients with long COVID-19, particularly those with myocardial injury during the acute phase of the disease. This study was conducted to examine myopericardial involvement, detected by cardiac magnetic resonance (CMR) imaging in patients hospitalized for COVID-19.

Methods

Adult patients hospitalized with COVID-19 who presented myocardial injury or increased D-dimers were enrolled in this prospective study. All patients were invited to undergo CMR imaging examination after discharge. During follow-up, patients with nonischemic myocardial or pericardial involvement detected on the first CMR imaging examination underwent second examinations. CMR imaging findings were compared with those of a control group of healthy patients with no comorbidity.

Results

Of 180 included patients, 53 underwent CMR imaging examination. The mean age was 58.4 ± 18.3 years, and 73.6 % were male. Myocardial and pericardial LGE was reported in 43.4 % and 35.8 % of patients, respectively. Nonischemic myocardial or pericardial involvement was reported in 26 (49.1 %) patients. The prevalence of pericardial LGE was associated inversely with the interval between hospital discharge and CMR. COVID-19 survivors had higher end-systolic volume indices (ESVis) and lower left-ventricular ejection fractions than did healthy controls. Seventeen patients underwent follow-up CMR imaging; the end-diastolic volume index, ESVi, and prevalence of pericardial LGE, but not that of nonischemic LGE, were reduced.

Conclusion

Among COVID-19 survivors with myocardial injury during the acute phase of the disease, the incidences of nonischemic myocardial and pericardial LGE and CMR imaging–detected signs of cardiac remodeling, partially reversed during follow-up, were high.

背景人们对COVID-19长期患者的心脏炎症,尤其是疾病急性期的心肌损伤表示担忧。本研究旨在通过心脏磁共振(CMR)成像检查 COVID-19 住院患者的心肌受累情况。所有患者出院后均被邀请接受 CMR 成像检查。在随访期间,首次 CMR 成像检查发现非缺血性心肌或心包受累的患者接受了第二次检查。将 CMR 成像检查结果与无合并症的健康患者对照组的结果进行了比较。平均年龄为 58.4 ± 18.3 岁,73.6% 为男性。43.4%和35.8%的患者出现心肌和心包LGE。非缺血性心肌或心包受累的患者有 26 例(49.1%)。心包LGE的发生率与出院和CMR之间的间隔时间成反比。与健康对照组相比,COVID-19 存活者的收缩末期容积指数 (ESVis) 较高,左心室射血分数较低。17名患者接受了随访CMR成像;舒张末期容积指数、ESVi和心包LGE的发生率降低了,但非缺血性LGE的发生率没有降低。结论 COVID-19幸存者在疾病急性期出现心肌损伤,非缺血性心肌和心包LGE以及CMR成像检测到的心脏重塑迹象的发生率很高,但在随访期间发生了部分逆转。
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引用次数: 0
A fearsome evolution of presumed cardiac sarcoidosis: The sarcoid-lymphoma syndrome 假定性心脏肉样瘤病的可怕演变:肉样瘤-淋巴瘤综合征
IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-26 DOI: 10.1016/j.ijcha.2024.101496
Paola Sormani , Enrico Ammirati , Cristina Giannattasio , Andrea Garascia , Patrizia Pedrotti
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引用次数: 0
Guidance Directed Care of Spontaneous Coronary Artery Dissection: A Healthcare System-Based Experience 自发性冠状动脉夹层的指导性护理:基于医疗系统的经验
IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-26 DOI: 10.1016/j.ijcha.2024.101498
Eleanor Christenson , Deeksha Acharya , Kathryn Berlacher, Agnes Koczo

Introduction

Data on treatment of spontaneous coronary artery dissection (SCAD) has evolved with guidance from national societies beginning around 2018. Given emerging guidance and relatively uncommon presentation of SCAD, we hypothesized that a specialized SCAD clinic would improve guidance-based care.

Methods

We utilized a system-wide electronic medical record search to identify individuals with SCAD diagnosis from 2018 to 2023. All diagnostic angiograms were reviewed to verify diagnosis. We analyzed frequency of guidance-based care since 2018 system-wide. We also compared guidance-based care for individuals with index visits to the SCAD outpatient clinic as compared to non-SCAD clinic providers from initiation of specialty clinic in 2021.

Results

Differences were observed in pregnancy and contraception discussions (88 % vs 0 %, p < 0.001) among pre-menopausal individuals in SCAD clinic compared to non-SCAD clinics. Safety of hormone replacement therapy (HRT) in menopausal women was addressed more by SCAD clinic providers (85 % vs 7 %, p < 0.001). There was more fibromuscular dysplasia (FMD) screening in SCAD clinic (100 % vs 30 %, p < 0.001). Among individuals with migraines, there was more discussion of triggering medications (triptans) in SCAD clinic (80 % vs 14 %, p = 0.008). In individuals prescribed statins not by primary prevention guidelines and without atherosclerosis, there was a trend toward more discussion of statin use in SCAD clinic follow up vs non-SCAD clinic providers (63 % vs 17 %, p = 0.06).

Conclusions

Individuals with follow up in SCAD clinic compared to non-SCAD clinics were more likely to have future pregnancy and contraception counseling, discussion of HRT safety, and FMD screening following index outpatient visit. Future quality improvement initiatives will target these aspects of guidance-based care among non-SCAD clinic providers with integration into cardiology fellow training.

导言:自发性冠状动脉夹层(SCAD)的治疗数据随着各国学会从 2018 年左右开始提供指导而不断发展。鉴于新出现的指导意见和 SCAD 相对不常见的表现形式,我们假设 SCAD 专科门诊将改善基于指导意见的治疗。我们审查了所有诊断性血管造影,以核实诊断。我们分析了自 2018 年以来全系统基于指导的护理频率。我们还比较了自 2021 年专科门诊启动以来,与非 SCAD 诊所提供者相比,SCAD 门诊索引就诊者的指导性护理情况。结果观察到,与非 SCAD 诊所相比,SCAD 诊所绝经前患者的妊娠和避孕讨论存在差异(88 % vs 0 %,p <0.001)。更年期妇女激素替代疗法(HRT)的安全性在 SCAD 诊所提供者中得到了更多的讨论(85% 对 7%,p < 0.001)。在 SCAD 诊所,纤维肌发育不良(FMD)筛查率更高(100% 对 30%,p < 0.001)。在偏头痛患者中,SCAD 诊所对诱发药物(曲普坦)的讨论更多(80% 对 14%,p = 0.008)。结论与非 SCAD 诊所的患者相比,在 SCAD 诊所接受随访的患者更有可能在门诊就诊后获得未来妊娠和避孕咨询、获得有关 HRT 安全性的讨论以及进行 FMD 筛查。未来的质量改进计划将针对非 SCAD 诊所的医疗服务提供者在这些方面的指导性护理,并将其纳入心脏病学研究员的培训中。
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引用次数: 0
Multicenter, propensity-weighted comparison of stented, rapid-deployment and new-generation aortic valves 多中心、倾向加权比较支架、快速置入和新一代主动脉瓣
IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-22 DOI: 10.1016/j.ijcha.2024.101487
Augusto D’Onofrio , Giorgia Cibin , Chiara Tessari , Giulia Lorenzoni , Giampaolo Luzi , Erica Manzan , Dario Gregori , Gino Gerosa , the INTU-ITA And RES-ITA Investigators

Background

Conventional stented, rapid deployment and new-generation stented valves are now available for surgical aortic valve replacement (SAVR). New-generation devices feature advanced tissue treatment for theoretical prolonged durability and a new stent design able to expand in case of future transcatheter Valve-in-Valve. Aim of this retrospective, multicenter, propensity-weighted study was to compare early clinical and hemodynamic outcomes of these three different bioprostheses.

Methods

We analyzed data of 2589 patients from two national multicenter registries and one Institutional database. Study devices were Magna Ease, Intuity/Intuity Elite and Inspiris Resilia (Edwards Lifesciences, Irvine, CA, USA) and were implanted in 296 (11.4 %), 1688 (65.2 %) and 605 (23.4 %) patients, respectively. A propensity score weighting approach was employed.

Results

In isolated SAVR, aortic cross clamp (ACC) time was shorter for Intuity (Magna Ease: 87, Intuity: 55, Inspiris: 70 min; Magna Ease vs. Intuity: p < 0.001; Inspiris vs. Intuity: p < 0.001). Overall mortality was 2 %, 1.7 % and 0.5 % in Magna Ease, Intuity and Inspiris groups, respectively (Magna Ease vs. Intuity: p = 0.476; Inspiris vs. Intuity: p = 0.395); permanent pace-maker implantation rate was lower for Inspiris (Magna Ease: 6 %, Intuity: 6 %, Inspiris: 2 %; Magna Ease vs. Intuity: p = 0.679; Inspiris vs. Intuity: p < 0.001). Median mean gradients were 13, 10 and 10 mmHg for Magna Ease, Intuity and Inspiris, respectively (Magna Ease vs. Intuity: p < 0.001; Inspiris vs. Intuity: p = 0.13).

Conclusions

All study devices provide excellent early clinical and hemodynamic outcomes. Inspiris shows low rates of permanent pace-maker implantation and its transaortic gradients are similar to rapid-deployment valves and lower than Magna Ease.

背景传统支架、快速部署和新一代支架瓣膜现已可用于外科主动脉瓣置换术(SAVR)。新一代设备采用先进的组织处理技术,理论上可延长耐用性,而且新型支架设计可在未来经导管瓣中瓣的情况下进行扩张。这项回顾性、多中心、倾向加权研究的目的是比较这三种不同生物前体的早期临床和血流动力学结果。方法我们分析了来自两个国家多中心登记处和一个机构数据库的 2589 名患者的数据。研究设备为 Magna Ease、Intuity/Intuity Elite 和 Inspiris Resilia(Edwards Lifesciences,Irvine,CA,USA),分别植入 296 例(11.4%)、1688 例(65.2%)和 605 例(23.4%)患者体内。结果在孤立SAVR中,Intuity的主动脉交叉钳夹(ACC)时间更短(Magna Ease:87分钟,Intuity:55分钟,Inspiris:70分钟;Magna Ease vs. Intuity:p < 0.001;Inspiris vs. Intuity:p < 0.001)。Magna Ease 组、Intuity 组和 Inspiris 组的总死亡率分别为 2%、1.7% 和 0.5%(Magna Ease vs. Intuity:p = 0.476;Inspiris vs. Intuity:p = 0.395);Inspiris的永久起搏器植入率较低(Magna Ease:6%,Intuity:6%,Inspiris:2%;Magna Ease vs. Intuity:p = 0.679;Inspiris vs. Intuity:p <0.001)。Magna Ease、Intuity 和 Inspiris 的中位平均梯度分别为 13、10 和 10 mmHg(Magna Ease vs. Intuity:p = 0.001;Inspiris vs. Intuity:p = 0.13)。Inspiris显示出较低的永久起搏器植入率,其经主动脉梯度与快速部署瓣膜相似,低于Magna Ease。
{"title":"Multicenter, propensity-weighted comparison of stented, rapid-deployment and new-generation aortic valves","authors":"Augusto D’Onofrio ,&nbsp;Giorgia Cibin ,&nbsp;Chiara Tessari ,&nbsp;Giulia Lorenzoni ,&nbsp;Giampaolo Luzi ,&nbsp;Erica Manzan ,&nbsp;Dario Gregori ,&nbsp;Gino Gerosa ,&nbsp;the INTU-ITA And RES-ITA Investigators","doi":"10.1016/j.ijcha.2024.101487","DOIUrl":"10.1016/j.ijcha.2024.101487","url":null,"abstract":"<div><h3>Background</h3><p>Conventional stented, rapid deployment and new-generation stented valves are now available for surgical aortic valve replacement (SAVR). New-generation devices feature advanced tissue treatment for theoretical prolonged durability and a new stent design able to expand in case of future transcatheter Valve-in-Valve. Aim of this retrospective, multicenter, propensity-weighted study was to compare early clinical and hemodynamic outcomes of these three different bioprostheses.</p></div><div><h3>Methods</h3><p>We analyzed data of 2589 patients from two national multicenter registries and one Institutional database. Study devices were Magna Ease, Intuity/Intuity Elite and Inspiris Resilia (Edwards Lifesciences, Irvine, CA, USA) and were implanted in 296 (11.4 %), 1688 (65.2 %) and 605 (23.4 %) patients, respectively. A propensity score weighting approach was employed.</p></div><div><h3>Results</h3><p>In isolated SAVR, aortic cross clamp (ACC) time was shorter for Intuity (Magna Ease: 87, Intuity: 55, Inspiris: 70 min; Magna Ease vs. Intuity: p &lt; 0.001; Inspiris vs. Intuity: p &lt; 0.001). Overall mortality was 2 %, 1.7 % and 0.5 % in Magna Ease, Intuity and Inspiris groups, respectively (Magna Ease vs. Intuity: p = 0.476; Inspiris vs. Intuity: p = 0.395); permanent pace-maker implantation rate was lower for Inspiris (Magna Ease: 6 %, Intuity: 6 %, Inspiris: 2 %; Magna Ease vs. Intuity: p = 0.679; Inspiris vs. Intuity: p &lt; 0.001). Median mean gradients were 13, 10 and 10 mmHg for Magna Ease, Intuity and Inspiris, respectively (Magna Ease vs. Intuity: p &lt; 0.001; Inspiris vs. Intuity: p = 0.13).</p></div><div><h3>Conclusions</h3><p>All study devices provide excellent early clinical and hemodynamic outcomes. Inspiris shows low rates of permanent pace-maker implantation and its transaortic gradients are similar to rapid-deployment valves and lower than Magna Ease.</p></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"54 ","pages":"Article 101487"},"PeriodicalIF":2.5,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2352906724001532/pdfft?md5=aaf57a7591a1bc8db585e9a4529dba64&pid=1-s2.0-S2352906724001532-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142040818","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}
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IJC Heart and Vasculature
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