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Clinical determinants and biomarkers associated with cardiac fibrosis after heart transplantation as assessed by magnetic resonance: Size matters 磁共振评估与心脏移植后心脏纤维化相关的临床决定因素和生物标志物:大小很重要
IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-08 DOI: 10.1016/j.ijcha.2024.101479
Anne Vorlat , Jeroen van Eijk , Sjoerd Wiersma , Leroy Smid , Sofie Depooter , Bernard Paelinck , Khadija Guerti , Bart Peeters , Nicole Sturkenboom , Emeline Van Craenenbroeck , Hein Heidbuchel , Caroline Van De Heyning

Background

Cardiac fibrosis is increasingly recognized as a marker of worse outcomes in long-term follow-up after heart transplantation (HTX). We investigated the clinical determinants and biomarkers of focal and interstitial cardiac fibrosis as assessed with cardiac magnetic resonance (CMR).

Methods

Consecutive HTX recipients underwent CMR with late gadolinium enhancement for focal myocardial fibrosis and T1 mapping for interstitial fibrosis. We calculated the correlations of these findings with clinical parameters, history, biomarkers of fibrosis (B-type natriuretic peptide (BNP), growth differentiation factor-15, galectin-3 and soluble ligand ST2) and echocardiography.

Results

Forty-eight HTX patients were included: median age 63 ± 13 years, 11 ± 6 years after heart transplantation. Only donor weight (p 0.044) and the rate of a > 30 % mismatch between donor and recipient weight (p 0.02) were significantly different in patients with vs. without late LGE. Extracellular volume (ECV) was correlated with the weight mismatch between donor and recipient (r = 0.32, p 0.04), resulting in a higher ECV for oversized donors. BNP was the only biomarker of the four studied that was correlated with interstitial fibrosis as assessed by ECV (r = 0.35, p 0.04). T1 relaxation time was correlated with treated acute cellular rejection grade ≥ 2 (ISHLT grading) (r = 0.34, p 0.02).

Conclusion

Both focal and interstitial fibrosis, as determined by CMR, after heart transplantation are correlated with donor and recipient weight mismatch. BNP was the only biomarker clinically relevant to interstitial cardiac fibrosis.

背景越来越多的人认为心脏纤维化是心脏移植(HTX)术后长期随访结果较差的标志。我们研究了心脏磁共振(CMR)评估局灶性和间质性心脏纤维化的临床决定因素和生物标志物。我们计算了这些结果与临床参数、病史、纤维化生物标志物(B 型利钠肽 (BNP)、生长分化因子-15、galectin-3 和可溶性配体 ST2)和超声心动图的相关性。结果纳入了 48 例 HTX 患者:中位年龄为 63 ± 13 岁,心脏移植后 11 ± 6 年。只有供体体重(P 0.044)和供体与受体体重不匹配率(30%)(P 0.02)在晚期 LGE 患者与非晚期 LGE 患者中存在显著差异。细胞外容积(ECV)与供体和受体的体重不匹配相关(r = 0.32,p 0.04),超大供体的ECV更高。BNP 是所研究的四种生物标志物中唯一与 ECV 评估的间质纤维化相关的生物标志物(r = 0.35,p 0.04)。T1弛豫时间与治疗后急性细胞排斥分级≥2(ISHLT 分级)相关(r = 0.34,p 0.02)。BNP是唯一与心脏间质纤维化临床相关的生物标志物。
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引用次数: 0
Investigating the impact of Tocilizumab, Sarilumab, and Anakinra on clinical outcomes in COVID-19: A systematic review and meta-analysis 研究COVID-19中托珠单抗、沙利单抗和阿纳金拉对临床疗效的影响:系统回顾和荟萃分析
IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-07 DOI: 10.1016/j.ijcha.2024.101483
Yousef Jafari Abarghan , Mohammad Heiat , Abolfazl Jahangiri , Mohammad Hossein Peypar , Mahdi Abdorrashidi , Amirmohammad Tohidinia , Mahmood Salesi , Shahrzad Tajik , Farnaz Farzaneh Dehkordi , Hamid Sedighian

Background

Monoclonal antibodies (mAbs) are currently under investigation as a potential therapeutic option for COVID-19. Clinical trials are examining their efficacy in lowering mortality rates and the requirement for mechanical ventilation (MV). It is necessary to conduct a thorough examination of current randomized controlled trials (RCTs) in order to provide more definitive evidence on their effectiveness for COVID-19 patients. This meta-analysis aims to analyze RCT results on the impact of three mAbs (Anakinra, Sarilumab, Tocilizumab) on COVID-19 patient outcomes.

Method

The meta-analysis was conducted in accordance with the PRISMA guidelines. Eligible RCTs were conducted to evaluate the effectiveness of three mAbs in treating patients with COVID-19. These trials were identified by searching various databases up to April 1, 2024. In total, this meta-analysis incorporated 19 trials with a total of 8097 patients. Pooled relative risk and studies' heterogeneity were assessed by statistical analysis, which involved the use of fixed effects models and subgroup analysis.

Result

The administration of mAbs (Tocilizumab, Sarilumab, and Anakinra) showed various results in the management of COVID-19 patients. While the overall pooled data did not reveal a significant reduction in the need for MV, the study found that the use of mAbs was associated with a decreased risk of clinical worsening (pooled relative risk: 0.75, 95 % CI [0.59, 0.94], p = 0.01) and an increased probability of discharging COVID-19 patients by day 28 or 29 (pooled relative risk: 1.17, 95 % CI [1.10, 1.26]). Notably, the subgroup analysis revealed that Tocilizumab had a significant effect in reducing the risk of clinical worsening compared to Sarilumab. Additionally, the analysis of mortality outcomes indicated that the administration of mAbs had the potential to decrease the overall risk of mortality over time (pooled RR: 0.90, 95 % CI [0.83, 0.97], p = 0.01).

Conclusion

In summary, our meta-analysis suggests that mAbs, particularly Tocilizumab, may play a valuable role in managing COVID-19 by reducing the risk of clinical worsening, improving hospital discharge rates, and decreasing mortality.

背景目前正在研究将单克隆抗体(mAbs)作为 COVID-19 的潜在治疗方案。临床试验正在研究其在降低死亡率和机械通气(MV)需求方面的疗效。有必要对目前的随机对照试验(RCT)进行彻底检查,以便为它们对 COVID-19 患者的疗效提供更确切的证据。本荟萃分析旨在分析三种 mAbs(Anakinra、Sarilumab 和 Tocilizumab)对 COVID-19 患者预后影响的 RCT 结果。对符合条件的 RCT 进行了研究,以评估三种 mAbs 治疗 COVID-19 患者的有效性。这些试验是通过检索截至 2024 年 4 月 1 日的各种数据库确定的。本荟萃分析共纳入了19项试验,共计8097名患者。通过使用固定效应模型和亚组分析进行统计分析,评估了汇总的相对风险和研究的异质性。结果在COVID-19患者的治疗中,mAbs(托昔单抗、沙利单抗和安纳金拉)的用药效果各不相同。虽然总体汇总数据并未显示 MV 需求显著减少,但研究发现,使用 mAbs 与临床恶化风险降低(汇总相对风险:0.75,95 % CI [0.59,0.94],p = 0.01)和 COVID-19 患者在第 28 或 29 天出院的概率增加(汇总相对风险:1.17,95 % CI [1.10,1.26])有关。值得注意的是,亚组分析显示,与沙利单抗相比,托西珠单抗在降低临床恶化风险方面效果显著。总之,我们的荟萃分析表明,mAbs(尤其是 Tocilizumab)可通过降低临床恶化风险、提高出院率和降低死亡率,在管理 COVID-19 方面发挥重要作用。
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引用次数: 0
Safety of dofetilide in stable patients and investigating traits of susceptibility to torsade de pointes 多非利特在病情稳定患者中的安全性以及对心搏骤停易感性特征的研究
IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-06 DOI: 10.1016/j.ijcha.2024.101475
Maria Cecilia Tagle-Cornell , Chadi Ayoub , Christen Bird , Milagros Pereyra , Courtney Kenyon , Moaz Kamel , Shruti Iyengar , Hema Vemulapalli , Francesca Galasso , Marlene Girardo , Klanderman Molly , Komandoor Srivathsan

Background

Atrial fibrillation is the most prevalent cardiac arrhythmia, presenting symptomatic patients with diminished quality of life and worsening of heart failure. Dofetilide, a class 3 antiarrhythmic agent, is a proven and safe rhythm control medication. Initial risk of QT prolongation leading to torsade de pointes (TdP) necessitates a standard protocol mandating hospitalization for three days for initiation.

Objectives

To assess safety when adhering to initiation protocol and identify traits for susceptibility to TdP in elective dofetilide admissions.

Methods

We conducted a retrospective study involving patients admitted to Mayo Clinic sites across four states for elective inpatient initiation of dofetilide between 2003 and 2022. Patients’ charts underwent review, focusing on dofetilide-related TdP occurrences, baseline characteristics including QT intervals, laboratory values, comorbidities, and concomitant medications. Patients who experienced TdP were subjected to further evaluation to identify potential risk factors.

Results

Of 2036 patients identified, mean age 66.4 ± 11.4 years, and 67.2 % male, 16 experienced dofetilide-related TdP (incidence rate 0.79%). Notably, 81% (13/16) of TdP cases occurred in patients who deviated from the FDA/manufacturer algorithm protocol. The concomitant use of active intravenous diuretic therapy, digoxin, and QT-prolonging drugs emerged as identifiable risk factors. Additionally, females exhibited a higher incidence of TdP (1.5%) than males (0.44%) {odd ratio [OR] 3.46; P = 0.017}.

Conclusion

Overall incidence of TdP related to dofetilide initiation was low (0.79%). Adherence to protocol during elective hospital admissions appears extraordinarily safe. Patients who did not require concurrent use of intravenous diuretics, digoxin, or QT prolonging drugs exhibited lower risk of TdP.

背景心房颤动是最常见的心律失常,有症状的患者生活质量下降,心力衰竭恶化。多非利特是一种 3 类抗心律失常药物,是一种行之有效且安全的心律控制药物。方法我们进行了一项回顾性研究,涉及 2003 年至 2022 年期间梅奥诊所在四个州的医疗点收治的选择性住院多非利特起始治疗的患者。我们对患者的病历进行了审查,重点关注与多非利特相关的 TdP 发生率、基线特征(包括 QT 间期)、实验室值、合并症和伴随药物。对出现 TdP 的患者进行了进一步评估,以确定潜在的风险因素。结果 在 2036 名被确认的患者中,平均年龄为(66.4 ± 11.4)岁,男性占 67.2%,16 名患者出现了与多非利特相关的 TdP(发生率为 0.79%)。值得注意的是,81%(13/16)的 TdP 病例发生在偏离 FDA/制造商算法方案的患者身上。同时使用积极的静脉利尿剂治疗、地高辛和 QT 延长药物是可识别的风险因素。此外,女性的 TdP 发生率(1.5%)高于男性(0.44%){dod ratio [OR] 3.46; P = 0.017}。在择期入院期间遵守方案显得格外安全。无需同时使用静脉利尿剂、地高辛或 QT 延长药物的患者发生 TdP 的风险较低。
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引用次数: 0
Cardiovascular disease and covid-19: A systematic review 心血管疾病与 covid-19:系统回顾
IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-02 DOI: 10.1016/j.ijcha.2024.101482
B.A. Krishna , M. Metaxaki , N. Sithole , P. Landín , P. Martín , A. Salinas-Botrán

Background

Cardiovascular complications of COVID-19 are numerous and aspects of this phenomenon are not well known. The main objective of this manuscript is a systematic review of the acute and chronic cardiovascular complications secondary to COVID-19.

Methods

A systematic review of the literature through Medline via PubMed was conducted (2020–2024).

Results

There is a plethora of effects of COVID-19 on the heart in the acute setting. Here we discuss pathophysiology, myocardial infarctions, heart failure, Takotsubo Cardiomyopathy, myocardial injury, myocarditis and arrhythmias that are caused by COVID-19. Additionally, these cardiovascular injuries can linger and may be an underlying cause of some Long COVID symptoms.

Conclusions

Cardiovascular complications of COVID-19 are numerous and life-threatening. Long COVID can affect cardiovascular health. Microclotting induced by SARS-CoV-2 infection could be a therapeutic target for some aspects of Long Covid.

背景COVID-19引起的心血管并发症很多,但人们对这一现象的各个方面了解不多。本手稿的主要目的是对 COVID-19 继发的急性和慢性心血管并发症进行系统综述。方法通过 Medline 和 PubMed 对文献进行了系统综述(2020-2024 年)。在此,我们将讨论 COVID-19 导致的病理生理学、心肌梗塞、心力衰竭、Takotsubo 心肌病、心肌损伤、心肌炎和心律失常。此外,这些心血管损伤可能会持续存在,并可能成为某些 Long COVID 症状的潜在原因。长COVID可影响心血管健康。SARS-CoV-2感染诱导的微凝血可能是长COVID某些方面的治疗目标。
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引用次数: 0
Predicting exercise intolerance in elderly individuals with heart failure using the 30-second chair stand test 利用 30 秒椅子站立测试预测心力衰竭老人的运动不耐受性
IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-01 DOI: 10.1016/j.ijcha.2024.101464
Marco Savino , Luigi Savino , Pasquale Mone , Concetta Schiano , Antonio De Luca , Gaetano Santulli
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引用次数: 0
Myocardial work and risk stratification in patients with severe aortic valve stenosis referred for transcatheter aortic valve replacement 转诊接受经导管主动脉瓣置换术的重度主动脉瓣狭窄患者的心肌功和风险分层
IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-01 DOI: 10.1016/j.ijcha.2024.101474
Ana Moya , Elayne Kelen de Oliveira , Leen Delrue , Monika Beles , Dimitri Buytaert , Marc Goethals , Sofie Verstreken , Riet Dierckx , Jozef Bartunek , Ward Heggermont , Eric Wyffels , Marc Vanderheyden

Background

Transcatheter aortic valve replacement(TAVR) has shown clear survival benefits in severe aortic valve stenosis(AS). However, patients unable to recover left ventricle function remain at risk with poor long-term survival. This single-center prospective study aims to analyze the supplementary benefits of myocardial work(MW) assessment for baseline risk stratification in patients with severe AS referred for TAVR.

Methods

A total of 110 patients with severe AS referred for TAVR were included in the study. Baseline ECG data, transthoracic echocardiographic(TTE) images and blood samples were obtained. The TTE examination was repeated one day and one month after valve replacement. The primary outcome of the study was a composite endpoint consisting of all-cause mortality and HF hospitalization.

Results

During a mean follow-up period of 521 ± 343 days, 29patients(26.4 %) reached the composite endpoint. Baseline troponins, NT-proBNP, sST2, GWI and GCW showed statistically significant differences between groups. Patients with a baseline GWI<2323 mmHg% (sensitivity 0.63 and specificity 0.76)had significantly worse outcome following TAVR. A basic predictive model included QRS-length, TAPSE, LAVI and E/e’. The addition of biomarkers did not yield any further advantages whereas incorporating the GWI cut-off value of 2323 mmHg% significantly enhanced the predictive value. Although there were no significant changes in LVEF and GLS, all patients exhibited a significant reduction in GWI and GCW immediately after TAVR.

Conclusion

Our findings provide evidence for the enhanced usefulness of MW analysis in the initial risk stratification of patients with severe AS referred for TAVR. Specifically, a baseline GWI<2323 mmHg% demonstrates an independent predictor associated with increased incidence of all-cause mortality and HF hospitalization following TAVR.

背景导管主动脉瓣置换术(TAVR)对严重主动脉瓣狭窄(AS)患者的生存有明显的益处。然而,无法恢复左心室功能的患者仍有长期生存不良的风险。这项单中心前瞻性研究旨在分析心肌功(MW)评估对转诊接受TAVR的重度主动脉瓣狭窄患者进行基线风险分层的辅助作用。获得基线心电图数据、经胸超声心动图(TTE)图像和血液样本。瓣膜置换术后一天和一个月重复进行 TTE 检查。研究的主要结果是由全因死亡率和心房颤动住院率组成的综合终点。结果在平均 521 ± 343 天的随访期间,29 名患者(26.4%)达到了综合终点。基线肌钙蛋白、NT-proBNP、sST2、GWI 和 GCW 在各组间存在显著的统计学差异。基线GWI<2323 mmHg%(敏感性0.63,特异性0.76)的患者在TAVR术后的预后明显较差。基本预测模型包括 QRS-长度、TAPSE、LAVI 和 E/e'。加入生物标志物并没有带来进一步的优势,而加入 2323 mmHg% 的 GWI 临界值则大大提高了预测价值。虽然 LVEF 和 GLS 没有明显变化,但所有患者在 TAVR 术后的 GWI 和 GCW 都有明显下降。具体而言,基线 GWI<2323 mmHg% 是与 TAVR 后全因死亡率和 HF 住院率增加相关的独立预测因子。
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引用次数: 0
Emerging role of sphingolipids and extracellular vesicles in development and therapeutics of cardiovascular diseases 鞘脂和细胞外囊泡在心血管疾病的发展和治疗中的新作用
IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-01 DOI: 10.1016/j.ijcha.2024.101469
Owais Mohmad Bhat , Rakeeb Ahmad Mir , Iqra Bashir Nehvi , Nissar Ahmad Wani , Abid Hamid Dar , M Afzal Zargar

Sphingolipids are eighteen carbon alcohol lipids synthesized from non-sphingolipid precursors in the endoplasmic reticulum (ER). The sphingolipids serve as precursors for a vast range of moieties found in our cells that play a critical role in various cellular processes, including cell division, senescence, migration, differentiation, apoptosis, pyroptosis, autophagy, nutrition intake, metabolism, and protein synthesis. In CVDs, different subclasses of sphingolipids and other derived molecules such as sphingomyelin (SM), ceramides (CERs), and sphingosine-1-phosphate (S1P) are directly related to diabetic cardiomyopathy, dilated cardiomyopathy, myocarditis, ischemic heart disease (IHD), hypertension, and atherogenesis. Several genome-wide association studies showed an association between genetic variations in sphingolipid pathway genes and the risk of CVDs. The sphingolipid pathway plays an important role in the biogenesis and secretion of exosomes. Small extracellular vesicles (sEVs)/ exosomes have recently been found as possible indicators for the onset of CVDs, linking various cellular signaling pathways that contribute to the disease progression. Important features of EVs like biocompatibility, and crossing of biological barriers can improve the pharmacokinetics of drugs and will be exploited to develop next-generation drug delivery systems. In this review, we have comprehensively discussed the role of sphingolipids, and sphingolipid metabolites in the development of CVDs. In addition, concise deliberations were laid to discuss the role of sEVs/exosomes in regulating the pathophysiological processes of CVDs and the exosomes as therapeutic targets.

鞘磷脂是由内质网(ER)中的非鞘磷脂前体合成的十八碳醇脂。鞘磷脂是细胞中各种分子的前体,在细胞分裂、衰老、迁移、分化、凋亡、热凋亡、自噬、营养摄入、新陈代谢和蛋白质合成等各种细胞过程中发挥着至关重要的作用。在心血管疾病中,不同亚类的鞘磷脂和其他衍生分子,如鞘磷脂(SM)、神经酰胺(CER)和鞘磷脂-1-磷酸(S1P)与糖尿病心肌病、扩张型心肌病、心肌炎、缺血性心脏病(IHD)、高血压和动脉粥样硬化直接相关。几项全基因组关联研究显示,鞘脂通路基因的遗传变异与心血管疾病风险之间存在关联。鞘脂通路在外泌体的生物生成和分泌过程中发挥着重要作用。最近发现,小细胞外囊泡(sEVs)/外泌体可能是心血管疾病发病的指标,它们与导致疾病进展的各种细胞信号通路相关联。EVs的重要特征,如生物相容性和穿越生物屏障,可以改善药物的药代动力学,并将被用于开发下一代药物输送系统。在这篇综述中,我们全面讨论了鞘脂和鞘脂代谢物在心血管疾病发展中的作用。此外,我们还简明扼要地讨论了鞘磷脂/外泌体在调节心血管疾病病理生理过程中的作用,以及外泌体作为治疗靶点的作用。
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引用次数: 0
Acute idiopathic pericarditis during a national lockdown to prevent transmission of SARS-COVID-19 为防止SARS-COVID-19传播而实行全国封锁期间的急性特发性心包炎
IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-01 DOI: 10.1016/j.ijcha.2024.101398

Background

Idiopathic acute pericarditis is often presumed to have a viral cause. We hypothesized that if acute viral infection was the cause, the incidence of acute ‘idiopathic’ pericarditis would decrease during a public health lockdown introduced to prevent the spread of SARS-COVID-19 in New Zealand when acute viral infections decreased by 75% to 99%.

Methods

Hospitalization for acute ‘idiopathic’ pericarditis during 5 months of the national public health lockdown were compared to 54 months before the COVID-19 pandemic from administrative data.

Results

The hospitalization rate for acute pericarditis was similar before (n = 1364, 24.8 cases/30 days) compared to during the public health lockdown (n = 132, 25.8 cases/30 days), +4% 95 % confidence interval −25 % to +30 % (P = 0.67).

Conclusion

These observations do not support the hypothesis that acute viral infection is the cause for most cases of acute idiopathic pericarditis.

背景特发性急性心包炎通常被认为是由病毒引起的。我们假设,如果急性病毒感染是病因,那么在新西兰为防止SARS-COVID-19传播而实行公共卫生封锁期间,急性 "特发性 "心包炎的发病率会下降,当时急性病毒感染下降了75%到99%。方法根据行政数据将全国公共卫生封锁5个月期间急性 "特发性 "心包炎的住院率与COVID-19大流行前54个月的住院率进行比较。结果与公共卫生封锁期间(n = 132,25.8 例/30 天)相比,封锁前(n = 1364,24.8 例/30 天)的急性心包炎住院率为 +4% 95% 置信区间为 -25% 至 +30% (P = 0.67)。
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引用次数: 0
Left ventricular thrombus recurrence after anticoagulation discontinuation 停止抗凝治疗后左心室血栓复发
IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-01 DOI: 10.1016/j.ijcha.2024.101480
Kamran Namjouyan , Aastha Mittal , Seth Krueger , Devon Chosky , Enrique Soltero , Idorenyin Udoeyo

Background

Evidence regarding the duration of anticoagulation (AC) therapy for left ventricular thrombus (LVT) is lacking. This study aims to evaluate the rate and risk factors for LVT recurrence in patients with Anterior ST-Segment elevation Myocardial Infarction (STEMI) complicated by LVT.

Methods

This was a retrospective analysis of patients with Anterior STEMI complicated by LVT and reduced ejection fraction (<35 %) from 2010 to 2020. Patients with atrial fibrillation and hypercoagulable state were excluded. Recurrence of LVT was defined as a new LVT on transthoracic echocardiography (TTE) after interval resolution and AC discontinuation. Demographics, comorbidities, guideline directed medical therapy, TTE, and angiographic characteristics were assessed and compared in patients with and without LVT recurrence.

Results

87 patients met the inclusion criteria. Nine (10.3 %) had LVT recurrence of which three (33.3 %) had cardioembolic events. More patients with recurrence had ventricular aneurysm/scarring (33 % vs 10.3 %) and multi-vessel disease (22.2 % vs 9 %).

Conclusion

This study reveals that a portion of patients with Anterior STEMI complicated by LVT are at a higher risk of recurrence after initial resolution and AC discontinuation. Larger prospective trials are needed to re-address the appropriate duration of anticoagulation.

背景有关左心室血栓(LVT)抗凝治疗(AC)持续时间的证据尚缺。本研究旨在评估前ST段抬高型心肌梗死(STEMI)并发左心室血栓患者的左心室血栓复发率和风险因素。方法这是对2010年至2020年间前STEMI并发左心室血栓和射血分数降低(<35 %)患者的回顾性分析。排除了心房颤动和高凝状态患者。经胸超声心动图(TTE)显示,间歇期缓解和停用 AC 后出现新的 LVT,即为 LVT 复发。对 LVT 复发和未复发患者的人口统计学、合并症、指南指导的药物治疗、TTE 和血管造影特征进行了评估和比较。9例(10.3%)左心室支架复发,其中3例(33.3%)发生了心肌栓塞事件。更多复发患者患有心室动脉瘤/瘢痕(33 % vs 10.3 %)和多血管疾病(22.2 % vs 9 %)。需要进行更大规模的前瞻性试验,以重新确定适当的抗凝时间。
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引用次数: 0
Change in pulse pressure and cardiovascular outcomes after percutaneous coronary intervention: The CLIDAS study 经皮冠状动脉介入治疗后的脉压变化和心血管预后:CLIDAS 研究
IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-01 DOI: 10.1016/j.ijcha.2024.101430

Background

Limited data exist on the prognostic value of changes in pulse pressure (PP, the difference between systolic and diastolic blood pressure) during hospitalization for patients with coronary artery disease who have undergone percutaneous coronary intervention (PCI).

Methods

In the Clinical Deep Data Accumulation System (CLIDAS), we studied 8,708 patients who underwent PCI. We aimed to examine the association between discharge PP and cardiovascular outcomes. PP was measured before PCI and at discharge. Patients were divided into five groups (quintiles) based on the change in PPQ1 (−18.0 ± 9.9 mmHg), Q2 (−3.8 ± 2.6), Q3 (reference; 3.7 ± 2.0), Q4 (11.3 ± 2.6), and Q5 (27.5 ± 11.2). We then analyzed the relationship between PP change and outcomes.

Results

The mean patient age was 70 ± 11 years, with 6,851 (78 %) men and 3,786 (43 %) having acute coronary syndrome. U-shaped relationships were observed for the incidence rates of major adverse cardiac or cerebrovascular events (MACCE, a composite endpoint of cardiovascular death, myocardial infarction, and stroke), revascularization, and hospitalization for heart failure (HF). After adjusting for confounding factors, higher PP at discharge was associated with an increased risk of MACCE (adjusted hazard ratio 1.41; 95 %CI, 1.06–1.87 in Q5 [73.9 ± 9.3 mmHg]). Evaluating PP change revealed a U-shaped association with MACCE (1.50; 1.11–2.02 in Q1 and 1.47; 0.98–2.20 in Q5). Additionally, Q5 had a higher risk for hospitalization for HF (1.37; 1.00–1.88).

Conclusions

Our findings demonstrate a U-shaped association between changes in PP and cardiovascular outcomes. This data suggests the significance of blood pressure control during hospitalization for patients who have undergone PCI.

背景有关接受经皮冠状动脉介入治疗(PCI)的冠心病患者住院期间脉压(PP,收缩压与舒张压之差)变化的预后价值的数据有限。我们的目的是研究出院 PP 与心血管预后之间的关系。PCI前和出院时均测量了PP。根据 PPQ1(-18.0 ± 9.9 mmHg)、Q2(-3.8 ± 2.6)、Q3(参考值;3.7 ± 2.0)、Q4(11.3 ± 2.6)和 Q5(27.5 ± 11.2)的变化将患者分为五组(五分位数)。结果患者平均年龄为 70 ± 11 岁,其中 6851 人(78%)为男性,3786 人(43%)患有急性冠状动脉综合征。重大心脏或脑血管不良事件(MACCE,心血管死亡、心肌梗死和中风的复合终点)、血管重建和心力衰竭(HF)住院的发生率呈 U 型关系。在对混杂因素进行调整后,出院时 PP 值越高,发生 MACCE 的风险越高(调整后危险比为 1.41;95%CI,1.06-1.87,Q5 [73.9 ± 9.3 mmHg])。对 PP 变化的评估显示,其与 MACCE 呈 U 型关系(第一季度为 1.50;1.11-2.02;第五季度为 1.47;0.98-2.20)。结论我们的研究结果表明,PP 的变化与心血管预后呈 U 型关系。这些数据表明,PCI 患者住院期间的血压控制非常重要。
{"title":"Change in pulse pressure and cardiovascular outcomes after percutaneous coronary intervention: The CLIDAS study","authors":"","doi":"10.1016/j.ijcha.2024.101430","DOIUrl":"10.1016/j.ijcha.2024.101430","url":null,"abstract":"<div><h3>Background</h3><p>Limited data exist on the prognostic value of changes in pulse pressure (PP, the difference between systolic and diastolic blood pressure) during hospitalization for patients with coronary artery disease who have undergone percutaneous coronary intervention (PCI).</p></div><div><h3>Methods</h3><p>In the Clinical Deep Data Accumulation System (CLIDAS), we studied 8,708 patients who underwent PCI. We aimed to examine the association between discharge PP and cardiovascular outcomes. PP was measured before PCI and at discharge. Patients were divided into five groups (quintiles) based on the change in PPQ1 (−18.0 ± 9.9 mmHg), Q2 (−3.8 ± 2.6), Q3 (reference; 3.7 ± 2.0), Q4 (11.3 ± 2.6), and Q5 (27.5 ± 11.2). We then analyzed the relationship between PP change and outcomes.</p></div><div><h3>Results</h3><p>The mean patient age was 70 ± 11 years, with 6,851 (78 %) men and 3,786 (43 %) having acute coronary syndrome. U-shaped relationships were observed for the incidence rates of major adverse cardiac or cerebrovascular events (MACCE, a composite endpoint of cardiovascular death, myocardial infarction, and stroke), revascularization, and hospitalization for heart failure (HF). After adjusting for confounding factors, higher PP at discharge was associated with an increased risk of MACCE (adjusted hazard ratio 1.41; 95 %CI, 1.06–1.87 in Q5 [73.9 ± 9.3 mmHg]). Evaluating PP change revealed a U-shaped association with MACCE (1.50; 1.11–2.02 in Q1 and 1.47; 0.98–2.20 in Q5). Additionally, Q5 had a higher risk for hospitalization for HF (1.37; 1.00–1.88).</p></div><div><h3>Conclusions</h3><p>Our findings demonstrate a U-shaped association between changes in PP and cardiovascular outcomes. This data suggests the significance of blood pressure control during hospitalization for patients who have undergone PCI.</p></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"53 ","pages":"Article 101430"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2352906724000964/pdfft?md5=1667682f580d9fdcd253ae5c8312fe85&pid=1-s2.0-S2352906724000964-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141136571","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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