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

Introduction and objectives: Suboptimal outcomes with the ACURATE neo2 valve have been attributed to valve frame underexpansion, reported in approximately 20% of cases according to 3 recently proposed angiographic criteria. We aimed to validate these criteria in an independent registry with a 2-year follow-up.

Methods: This registry included 696 patients with severe aortic stenosis treated with the ACURATE neo2 valve at 7 experienced centers. Underexpansion was defined as the presence of at least 1 of the 3 criteria; the boundary box method was also applied to assess postparallelism. The primary endpoint was a composite of all-cause mortality, stroke, or heart failure hospitalization at 2 years.

Results: The mean age was 81± 5.8 years. Based on the 3-criteria method, underexpansion was identified in 154 patients (22%). There were no significant differences in the primary endpoint between the 2 groups. The cumulative incidence of the composite outcome was 13.7% vs 11.0% at 1 year and 21.0% vs 17.4% at 2 years for the underexpanded and expanded groups, respectively (P=.535). Similarly, no differences were observed with the boundary box method. On multivariable analysis, underexpansion was not independently associated with the primary endpoint (HR, 1.15; 95%CI, 0.73-1.80, P=.537). The only variables significantly associated with major adverse events at 2-years were atrial fibrillation, diabetes mellitus, and reduced glomerular filtration rate.

Conclusions: The presence of at least 1 angiographic underexpansion criterion after ACURATE neo2 implantation did not predict adverse outcomes at follow-up.

Introduction and objectives: Transcatheter patent ductus arteriosus (PDA) closure is safe in<2-kg infants and in≥6-kg patients, but major safety concerns remain when applied to the intermediate weight range. We aimed to assess outcomes of transcatheter PDA closure in 2- to 6-kg infants.

Methods: An international, multicenter, retrospective cohort study was conducted in 31 tertiary hospitals in 17 countries between 2000 and 2023, investigating all infants who underwent attempted transcatheter PDA closure with a procedural weight of 2-to-6kg.

Results: Attempted transcatheter PDA closure was performed in 1231 infants (median [Q1-Q3] weight, 4747 [3700-5300] g; median age, 132 [83-194] days; ex-preterm, n=581 [56.8%]) with a 95.0% success rate. A composite outcome of procedural failure or major adverse events was observed in 173 (14%) patients, including device embolization in 64 (3.7%), device-induced left pulmonary artery stenosis in 47 (2.7%), and procedural death in 2 (0.2%). Logistic regression model analysis identified a 2- to 3.9-kg procedural weight, increased pulmonary artery pressure, and window-type or tubular ductal morphologies as independent predictors of the composite outcome. Based on propensity score matching analysis, 2- to 3.9-kg infants had a risk ratio of 2.19 (95%CI, 1.25-3.83) for experiencing the composite outcome, compared with 4- to 5.9-kg infants.

Conclusions: Transcatheter PDA closure in 2- to 6-kg infants was feasible in most patients. Procedural failure or major adverse events occurred in 14% and several independent risk factors were identified, including the 2- to 3.9-kg weight range identified as a higher-risk subgroup. These findings may improve risk stratification and the decision-making process.

Introduction and objectives: Arterial stiffness is associated with left ventricular diastolic dysfunction (DD), which can lead to heart failure with preserved ejection fraction. However, longitudinal data on their relationship in the general population are limited. This study aimed to evaluate the association between arterial stiffness, assessed by brachial-ankle pulse wave velocity (baPWV), and the prevalence and progression of DD, as well as long-term outcomes in a large, community-based cohort.

Methods: This retrospective cohort study enrolled 16 476 adults (≥ 18 years) who underwent health screening, including echocardiography and baPWV measurements, between 2010 and 2019. Participants were categorized into normal (< 1400cm/s), borderline (1400-1799cm/s), and elevated (≥ 1800cm/s) baPWV groups. Multivariable regression was conducted to analyze the association between baPWV, DD progression, and all-cause mortality during long-term follow-up.

Results: At baseline, the prevalence of definite DD was significantly higher in the borderline baPWV group (PR, 1.73; 95%CI, 1.23-2.23) and the elevated baPWV group (PR, 3.25; 95%CI, 2.16-4.33) compared with the normal group. Participants with borderline or elevated baPWV had a faster increase in left ventricular filling pressure (E/e') over a mean follow-up of 4 years. Elevated baPWV was independently associated with an increased risk of incident DD (HR, 2.61; 95%CI, 1.73-3.95) and higher all-cause mortality during follow-up (HR, 3.91; 95%CI, 1.68-9.10), even after adjustment for traditional cardiovascular risk factors.

Conclusions: Borderline and elevated baPWV were significantly associated with a higher prevalence and faster DD progression, as well as an increased mortality risk in the general population, suggesting that baPWV is an important factor in DD pathophysiology and a useful noninvasive tool for cardiovascular risk stratification.