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

Introduction and objectives: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) improve outcomes in heart failure (HF), but their role in patients undergoing transcatheter aortic valve implantation (TAVI) remains unclear. A recent randomized trial (DapaTAVI) showed reduced HF hospitalizations with SGLT2i post-TAVI, but effects on mortality and broader outcomes are unknown.

Methods: Using the TriNetX Research Network, we conducted a multicenter retrospective cohort study of adults with HF who underwent TAVI between 2015 and 2025. Patients prescribed SGLT2i within 30 days of TAVI were 1:1 propensity score-matched to nonusers. The primary outcome was all-cause mortality; secondary outcomes included hospitalizations, myocardial infarction, stroke, arrhythmias, and renal events.

Results: Among 58 193 TAVI recipients, 3022 SGLT2i users were matched to 3022 nonusers. SGLT2i use was associated with significantly lower mortality at 3 months (3.5% vs 4.9%; HR, 0.71), 6 months (5.0% vs 8.1%; HR, 0.61), 12 months (7.3% vs 10.5%; HR, 0.71), and 5 years (10.7% vs 20.6%; HR, 0.59; all P <.01). SGLT2i users also had fewer hospital or emergency room visits and a lower 5-year incidence of myocardial infarction (12.0% vs 14.4%; OR, 0.81, P=.007). Stroke incidence was lower at 6 months (4.8% vs 6.1%; P=.041) but was not sustained long term. Renal and arrhythmic outcomes were similar between groups.

Conclusions: SGLT2i use in patients with HF undergoing TAVI was associated with reduced mortality and fewer adverse cardiovascular events. These findings support the integration of SGLT2i into post-TAVI management strategies.

Introduction and objectives: Evaluation of diastolic function (DF) increases the prognostic value of exercise echocardiography. A protocol including both systolic and diastolic evaluation could predict different types of events.

Methods: Systolic and DF were evaluated during exercise echocardiography in 2519 patients: left ventricular systolic function at peak-exercise (step 1), and E/e'/systolic pulmonary pressure postexercise (step 2). Abnormal systolic function was defined as ischemia or fixed wall motion abnormalities; abnormal DF was defined as postexercise E/e'> 15. The endpoint was to analyze the predictive value of systolic and DF for cardiac failure/cardiovascular death (CF/CVD), and for ischemic events.

Results: Systolic abnormalities were found in 806 patients (32%) and diastolic abnormalities in 451 (18%). Patients with CF/CVD more frequently had abnormal postexercise DF than those with ischemic events (48% vs 27%; P <.001), whereas the percentage of systolic abnormalities was higher in the latter group (78% vs 40%; P <.001). During follow-up, there were 477 events. Independent overall predictors included Δ wall motion score index (Δ WMSI) (HR, 8.08; 95%CI, 6.15-10.60; P <.001), and postexercise E/e' (HR, 1.02; 95%CI, 1.01-1.04; P=.004). Predictors of CF/CVD also included postexercise DF (E/e': sHR, 1.04; 95%CI, 1.00-1.07; P=.035) but not systolic function. Conversely, predictors of ischemic events included systolic function (Δ WMSI: sHR=12.81; 95%CI, 8.8- 18.71; P <.001) but not DF.

Conclusions: Two-step exercise echocardiography assessing systolic and diastolic function predicts different types of events. Exercise echocardiography based only on systolic function might not capture the full spectrum of abnormalities.

Introduction and objectives: Implantation of drug-eluting stents (DES) is currently the standard of care in chronic total occlusion percutaneous coronary intervention (CTO-PCI). However, drug-coated balloons (DCB) have emerged as a promising alternative, providing antiproliferative drug delivery while avoiding permanent scaffolding. This meta-analysis compared the effectiveness of DCB and hybrid strategies vs DES in CTO-PCI.

Methods: Studies comparing DCB with and without hybrid strategies and DES in CTO-PCI were identified through PUBMED/MEDLINE and Web of Science up to February 2025. The primary outcome was target lesion revascularization. Secondary outcomes included major adverse cardiac events, cardiovascular mortality, target vessel revascularization, and target vessel myocardial infarction.

Results: Six observational studies, including 2221 patients, met the inclusion criteria. After a median follow-up of 2.8 years, target lesion revascularization occurred in 9.9% of DCB-treated patients and 9.7% of DES-treated patients (HR, 0.81; 95%CI, 0.57-1.13; P=.22). Subgroup analysis showed no significant differences between de-novo and in-stent CTOs. The rates of secondary outcomes were comparable between the DCB and DES groups. On meta-regression analysis, advanced lesion preparation (with cutting balloons, intravascular lithotripsy, or rotational atherectomy) was associated with lower rates of target lesion revascularization (P=.02).

Conclusions: This meta-analysis comparing DCB and DES in CTO-PCI found no significant differences in target lesion revascularization or other clinical outcomes, supporting the potential role of DCB strategies in selected CTO-PCI cases. These findings support the potential role of stentless revascularization and provide a rationale for further randomized trials to validate DCB-based strategies in complex CTO anatomies. Registered at PROSPERO ID: CRD42025642790.

Hyperkalemia is an electrolyte disorder characterized by elevated serum potassium levels, which can be dangerous and lead to severe cardiac complications. This condition is particularly common in patients with comorbidities such as diabetes mellitus, chronic kidney disease, heart failure, and hypertension, among others. Additionally, hyperkalemia frequently develops in patients treated concurrently with certain medications, especially renin-angiotensin-aldosterone system inhibitors, which are commonly used to manage cardiac and nephrological conditions, significantly increasing the risk of hospitalizations and mortality in these patients. This review aims to identify key challenges in the management of hyperkalemia, including improving early detection, optimizing access to appropriate therapies, ensuring continuous monitoring, and establishing effective strategies to manage complications. Furthermore, it is essential to raise awareness of its significance and promote a multidisciplinary approach to enhance health outcomes and the quality of life of patients with hyperkalemia.

Introduction and objectives: Left atrial appendage closure (LAAC) has emerged as a viable stroke prevention strategy in selected patients with nonvalvular atrial fibrillation. The objective of the study was to analyze temporal trends and outcomes of LAAC in a nationwide study.

Methods: This population-based study analyzed the incidence, epidemiological and clinical characteristics, and outcomes of all patients discharged with a diagnosis of percutaneous LAAC from hospitals included in the Spanish National Health System over a 7-year period (from January 2016 to December 2022).

Results: A total of 3786 patients undergoing percutaneous LAAC were identified. The rate of procedures significantly increased over the study period (annual growth of 23%; IRR, 1.23; 95%CI, 1.17-1.28; P <.001), both in men and in women. The in-hospital mortality rate was 1%, and the incidences of in-hospital concomitant adverse events (AE) and 30-day readmission were 14.0% and 3.5%, respectively. The most frequent AE was the need for blood transfusion (11.5%), followed by vascular complications (2.2%) and acute renal failure (1.9%). The HAS-BLED score was a predictor of in-hospital mortality (OR, 2.55; 95%CI, 1.73-3.74, P <.001) and AE (OR, 1.82, 95%CI, 1.58-2.10; P <.001). Periprocedural AE was less frequent in elective procedures (24.5% vs 11.2%; P <.001) and in high-volume (> 120 procedures) centers (OR, 0.76; 95%CI, 0.63-0.93; P=.008).

Conclusions: The rate of percutaneous LAAC procedures significantly increased over recent years, with a low in-hospital mortality rate. High volume centers and elective LAAC procedures were significantly associated with a lower risk of AE.