Revista española de cardiología (English ed.)最新文献

Introduction and objectives: Health-related quality of life in patients with heart failure (HF) is dynamic. This post hoc study aimed to examine the predictive value of serial Kansas City Cardiomyopathy Questionnaire (KCCQ) assessments for forecasting clinical outcomes in patients with HF with preserved ejection fraction (HFpEF) using a multistate Markov model in the PARAGON-HF study.

Methods: A total of 4707 patients were categorized into 5 health states based on KCCQ scores: excellent (75-100), good (50-74), fair (25-49), poor (0-24), and death. Endpoints included health state duration (sojourn time), transition probabilities, associations with mortality, and the impact of HF treatments on health state transitions and sojourn times.

Results: At baseline, 2384 patients were in the excellent state, 1687 in good, 568 in fair, and 68 in poor. Bidirectional transitions were observed, with the longest sojourn time in the excellent state (1.57 years; 95%CI, 1.51-1.63), compared with good (0.70 years; 95%CI, 0.68-0.72), fair (0.72 years; 95%CI, 0.69-0.74), and poor (0.80 years; 95%CI, 0.73-0.87) states. Annual mortality increased progressively with worsening health states: excellent (3.1%), good (4.3%), fair (9.4%), and poor (15.6%). Overall sojourn times did not differ between sacubitril/valsartan and valsartan. However, among patients in the poor health state, sacubitril/valsartan was associated with a higher likelihood of improvement to the fair state (93.1% vs 86.9%) and a lower risk of death (6.9% vs 13.1%).

Conclusions: Health states in HFpEF exhibit bidirectional changes with varying sojourn times. Mortality was higher in poorer health states, and sacubitril/valsartan was associated with more favorable outcomes in these patients.

Introduction and objectives: Stent implantation is an established treatment for aortic coarctation (CoA) in adults. In pediatric patients, however, ongoing somatic growth necessitates repeated stent redilations, and the optimal timing of these procedures remains undefined. This retrospective study aimed to identify an objective association between stent diameter and body growth parameters, thereby providing a basis for prognostic assessment and structured planning of redilation strategies.

Methods: In the derivation cohort, all stent implantations and redilations performed in 155 patients younger than 20 years with CoA at a tertiary center were analyzed (218 interventions; median age 10.1 years, IQR, 3.4-14.4). The findings were subsequently validated in an independent validation cohort from another tertiary center, comprising 198 patients (323 interventions; median age 7.5 years, IQR, 1.3-14.6).

Results: To assess the association between stent diameter and body growth parameters, correlation analyses were performed. Despite interindividual variability, a significant linear correlation between stent diameter and body height was identified (ꞇ: 0.737, P ≤ .001) and this finding was confirmed in the validation cohort. Based on this relationship, a formula, f(x) = 0.0831•x+1.86, where x represents body height, was derived to estimate the appropriate stent diameter. This formula yields minimum and maximum reference body heights for each stent diameter, which are reached at different ages depending on individual growth velocity. These results were subsequently translated into sex-specific reference tables.

Conclusions: The derived formula enables prediction of the required stent diameter and the anticipated number of subsequent catheter-based procedures, thereby supporting rapid estimation of intervention timing throughout somatic growth.

Introduction and objectives: Gatekeeper strategies using risk factor-weighted clinical likelihood (RF-CL), alone or combined with coronary artery calcium score-weighted clinical likelihood (CACS-CL), may reduce the number of normal scans, radiation exposure, and health care costs.

Methods: Three diagnostic algorithms based on RF-CL and CACS-CL were evaluated in 1792 patients (mean age 65± 11 years; 43% female) referred for rubidium-82 (⁸²Rb) positron emission tomography (PET). Algorithm 1 deferred testing if RF-CL ≤ 5%. Algorithm 2 reclassified patients with RF-CL >5%-15% using CACS-CL and deferred testing if either RF-CL or CACS-CL was ≤ 5%. Algorithm 3 deferred testing if CACS-CL ≤ 5%. Missed diagnoses, normal scans, radiation exposure, and costs were compared with the current reference standard (CACS+PET). Endpoints were defined as small ischemia (summed difference score [SDS] ≥ 2) and relevant ischemia (≥ 10% of the myocardium).

Results: Median RF-CL and CACS-CL were 11% [6-19] and 12% [3-28], respectively. Algorithm 1 reduced radiation exposure and costs by 22.0% while maintaining high gatekeeper performance (sensitivity/negative predictive value [NPV]: 92.7%/98.2%). Algorithm 2 deferred the largest proportion of patients (36.4%) but missed small ischemia in 2.0%. Algorithm 3 demonstrated the best overall gatekeeper performance, reducing radiation exposure by 28.7% and costs by 29.7% without compromising diagnostic accuracy (sensitivity/NPV: 93.2%/98.4% for small ischemia and 97.0%/99.7% for relevant ischemia).

Conclusions: Refining RF-CL in all patients and deferring testing when CACS-CL ≤ 5% provided the most effective gatekeeper strategy in patients with suspected chronic coronary syndromes.