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

Introduction and objectives: Despite advances in mechanical circulatory support, mortality rates in cardiogenic shock (CS) remain high. A reliable risk stratification system could serve as a valuable guide in the clinical management of patients with CS. This study aimed to develop and externally validate a risk prediction model for in-hospital mortality in CS patients using machine learning (ML) algorithms.

Methods: Data from 1247 patients with all-cause CS in the RESCUE registry (January 2014-December 2018) were analyzed. Key predictive variables were identified using 4 ML algorithms. A risk prediction model, the RESCUE score, was developed using logistic regression based on the selected variables. Internal validation was conducted within the RESCUE registry, and external validation was performed using an independent CS registry of 750 patients.

Results: The 4 ML models identified 7 predictors: age, vasoactive inotropic score, left ventricular ejection fraction, lactic acid level, in-hospital cardiac arrest at presentation, need for continuous renal replacement therapy, and mechanical ventilation. The RESCUE score demonstrated strong predictive performance, with an AUC of 0.86 (95%CI, 0.83-0.88) for in-hospital mortality. Ten-fold internal cross-validation yielded an AUC of 0.86 (95%CI, 0.77-0.95). External validation showed an AUC of 0.80 (95%CI, 0.76-0.84).

Conclusions: Our ML-based risk-scoring system, the RESCUE score, demonstrated excellent predictive performance for in-hospital mortality in all patients with CS, regardless of cause. The system could be a useful and reliable tool to estimate risk stratification of CS in everyday clinical practice.

Clinical trial registration: NCT02985008.

Introduction and objectives: In recent years, several cases of hereditary transthyretin amyloidosis (ATTRv) due to the p.Val142Ile variant have been described in patients without African ancestry. The aim of this study was to analyze the impact of ATTRv caused by p.Val142Ile in Spain, focusing on its phenotypic characteristics and its population frequency.

Methods: Patients diagnosed with ATTRv caused by p.Val142Ile, as well as carriers irrespective of their phenotype, were recruited from 16 centers in Spain. Baseline characteristics and events during follow-up were retrieved. Population frequency was assessed using data from the Spanish National DNA Bank (N=3569) and the Catalan Health Databank (N=790).

Results: The cohort included 164 participants: 75 probands (45.7%) and 89 relatives (54.3%). Among the probands, the mean age was 73.9±8.5 years, and 47 (62.7%) were male. Sixty-seven probands (89.3%) reported European ancestry, while only 6 (8%) reported African ancestry. Cardiac symptoms were the most frequent reason for ATTRv diagnosis (n=64; 85.3%). The median follow-up was 2.6 years [Interquartile range, 1.5-4.1]. Overall penetrance at ages 65, 75, and 85 years was 12.8%, 44.3%, and 94.2%, respectively. Tafamidis was initiated during follow-up in 38 patients: after 1 year of treatment, 14 patients (38.9%) met the combined endpoint (12 experienced disease progression and 2 died from cardiovascular causes). Population frequency was estimated to range between 0.0% and 0.12%, based on data from the Spanish and Catalan databases, respectively.

Conclusions: ATTRv caused by p.Val142Ile has a significant prevalence in Spain. Its phenotypic features are characterized by late onset, male predominance, and cardiac involvement.

Introduction and objectives: Balloon atrial septostomy (BAS) improves oxygenation in neonates with transposition of the great arteries (TGA) and restrictive foramen ovale. Currently, there is a global shortage of dedicated BAS catheters, while new unmarked catheters have recently become available at some European centers. This study aimed to characterize BAS outcomes using the currently available BAS catheters in Europe.

Methods: A 2-year multicenter observational registry was conducted, including all neonates undergoing BAS for TGA. We report preliminary results (September 2022-February 2024) focusing on BAS characteristics and outcomes.

Results: A total of 250 BAS procedures were performed in 29 centers. The median neonatal weight was 3.16 kg, and 88% of neonates had a prenatal diagnosis. Most procedures were performed often on the first day of life during working hours (72.8%), mainly in catheterization laboratories (59.2%). Guidance primarily involved ultrasound with or without fluoroscopy. A guidewire was used in 41.2% of procedures. A total of 290 catheters (286 Z-5 or Z-6) were used, achieving an overall BAS success rate of 96%. Complete procedural failure was associated with the use of the umbilical venous route (OR, 3.62; P = .001) and lower-volume catheters (OR, 7.01; P < .001). The occurrence of significant complications (8%; OR, 9.33; P < .001) was associated with complete procedural failure. For complex procedures, significant risk factors were the absence of fluoroscopy (OR, 3.32; P = .001), use of the umbilical venous route (OR, 2.28; P = .005), and lower-volume catheters (OR, 2.43; P = .03).

Conclusions: In the current era, BAS can be challenging, and significant complications and complete failures are not uncommon. The use of the umbilical venous route, low-volume BAS catheters, absence of fluoroscopy guidance, and the occurrence of complications negatively impact procedural outcomes.

Introduction and objectives: Patients undergoing percutaneous coronary intervention in vessels with moderate-to-severe tortuosity are at higher risk of adverse outcomes, but data are scarce in the era of newer-generation stents. We compared outcomes following percutaneous coronary intervention in vessels with moderate-to-severe tortuosity using a bioresorbable-polymer sirolimus-eluting stent (BP-SES) vs a durable-polymer everolimus-eluting stent (DP-EES).

Methods: A total of 2350 patients from the BIOFLOW II, IV, and V randomized trials were stratified into 2 groups based on target-vessel tortuosity: none-to-mild and moderate-to-severe. The primary endpoints included target lesion failure (TLF)-a composite of cardiac death, target-vessel myocardial infarction (TV-MI), or ischemia-driven target lesion revascularization (TLR)-and probable/definite stent thrombosis at 3 years.

Results: Patients with moderate-to-severe tortuosity (n=903) had more comorbidities than those with none-to-mild tortuosity (n=1447). Rates of TLF (P=.354), cardiac death (P=.690), TLR (P=.447), and stent thrombosis (P=.084) were similar between the 2 groups, whereas TV-MI occurred more frequently in the moderate-to-severe tortuosity group (P=.031). However, on multivariate analysis, moderate-to-severe tortuosity was not an independent predictor of TV-MI (adjusted HR, 1.06; 95% CI, 0.72-1.55; P=.772). Among patients with moderate-to-severe tortuosity, the use of BP-SES was associated with significantly lower rates of TLF compared with the durable-polymer everolimus-eluting stent (7.8% vs 13.4%; HR, 0.57; 95% CI, 0.37-0.87; P=.009), driven by reductions in TV-MI (5.0% vs 9.2%; HR, 0.54; 95% CI, 0.32-0.90; P=.018) and TLR (2.7% vs 6.1%; HR, 0.45; 95% CI, 0.23-0.90; P=.021).

Conclusions: This pooled analysis of the randomized BIOFLOW trials demonstrates that patients with none-to-mild and moderate-to-severe tortuosity have comparable long-term adverse event rates. However, the use of BP-SES in patients with moderate-to-severe tortuosity may help mitigate potential ischemic risks.

Clinical trial registration: Clinicaltrials.gov NCT01356888, NCT01939249, NCT02389946.