Cardiovascular Revascularization Medicine最新文献_第2页

Transcarotid versus transfemoral transcatheter aortic valve replacement: A systematic review and meta-analysis 经颈动脉与经股动脉经导管主动脉瓣置换术：系统回顾和荟萃分析。

IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiovascular Revascularization Medicine

Pub Date : 2024-11-01 DOI: 10.1016/j.carrev.2024.04.008

Cyrus Munguti , Paul M. Ndunda , Abdullah Abukar , Mohammed Abdel Jawad , Mohinder R. Vindhyal , Zaher Fanari

Background

In the 2021 Transcatheter Valve Therapy (TVT) registry, 8.9 % of patients underwent TAVR via access sites other than the femoral artery. Transthoracic approaches may be contraindicated in some patients and may be associated with poorer outcomes. Therefore other alternative access routes are increasingly being performed. We conducted a systematic review of the literature on transcarotid transcatheter aortic valve replacement (TC-TAVR) and meta-analysis comparing outcomes of TC-TAVR and other access routes.

Methods

We comprehensively searched for controlled randomized and non-randomized studies from 4 online databases. We presented data using risk ratios (95 % confidence intervals) and measured heterogeneity using Higgins' I².

Results

Sixteen observational studies on transcarotid TAVR were included in the analysis; 4 studies compared TC-TAVR vs TF-TAVR. The mean age and STS score for patients undergoing TC-TAVR were 80 years and 7.6 respectively. For TF-TAVR patients, mean age and STS score were 81.2 years and 6.5 respectively. There was no difference between patients undergoing TC-TAVR and TF-TAVR in the following 30-day outcomes: MACE [8.4 % vs 6.7 %; OR 1.32 (95 % CI 0.71–2.46 p = 0.38) I² = 0 %], mortality [5.6 % vs 4.0 %; OR 0.42 (95 % CI 0.60–3.37, P = 0.42) I² = 0 %] and stroke [0.7 % vs 2.3 %; OR 0.49 (95 % CI 0.09–2.56, P = 0.40) I² = 0 %]. There was no difference in 30-day major vascular complications [0.7 % vs 3 %; OR 0.55 (95 % CI 0.06–5.29, P = 0.61) I² = 39 %], major bleeding [0.7 % vs 3.8 %; OR 0.39 (95 % CI 0.09–1.67, P = 0.21) I² = 0 %], and moderate or severe aortic valve regurgitation [8.6 % vs 9.9 %; OR 0.89 (95 % CI 0.48–1.65, P = 0.72) I² = 0 %].

Conclusion

There are no significant differences in mortality, stroke MACE and major or life-threatening bleeding or vascular complications when TC-TAVR is compared to TF-TAVR approaches.

背景：在2021年经导管瓣膜治疗（TVT）登记中，8.9%的患者通过股动脉以外的入路接受了TAVR。经胸入路可能是某些患者的禁忌症，而且可能与较差的治疗效果有关。因此，越来越多的患者选择其他途径进行治疗。我们对经颈动脉经导管主动脉瓣置换术（TC-TAVR）的文献进行了系统性回顾，并对TC-TAVR和其他入路的疗效进行了荟萃分析：我们从 4 个在线数据库中全面检索了对照随机和非随机研究。我们使用风险比（95% 置信区间）来展示数据，并使用 Higgins'I2 来衡量异质性：16项关于经颈动脉TAVR的观察性研究被纳入分析；4项研究比较了TC-TAVR与TF-TAVR。接受TC-TAVR的患者的平均年龄和STS评分分别为80岁和7.6分。TF-TAVR患者的平均年龄和STS评分分别为81.2岁和6.5分。接受TC-TAVR和TF-TAVR的患者在以下30天结果方面没有差异：MACE [8.4 % vs 6.7 %; OR 1.32 (95 % CI 0.71-2.46 P = 0.38) I2 = 0 %]、死亡率[5.6 % vs 4.0 %; OR 0.42 (95 % CI 0.60-3.37, P = 0.42) I2 = 0 %]和中风[0.7 % vs 2.3 %; OR 0.49 (95 % CI 0.09-2.56, P = 0.40) I2 = 0 %]。30 天主要血管并发症[0.7 % vs 3 %; OR 0.55 (95 % CI 0.06-5.29, P = 0.61) I2 = 39 %]、大出血[0.7 % vs 3.8 %; OR 0.39 (95 % CI 0.09-1.67, P = 0.21) I2 = 0 %]、中度或重度主动脉瓣反流[8.6 % vs 9.9 %; OR 0.89 (95 % CI 0.48-1.65, P = 0.72) I2 = 0 %]：结论：TC-TAVR与TF-TAVR相比，在死亡率、中风MACE、大出血或危及生命的出血或血管并发症方面没有明显差异。

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引用次数: 0

Impact of coronary artery disease and revascularization on outcomes of transcatheter aortic valve replacement for severe aortic stenosis 冠状动脉疾病和血管重建对经导管主动脉瓣置换术治疗重度主动脉瓣狭窄疗效的影响。

IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiovascular Revascularization Medicine

Pub Date : 2024-11-01 DOI: 10.1016/j.carrev.2024.05.003

Yoshiyuki Yamashita , Serge Sicouri , Massimo Baudo , Aleksander Dokollari , Roberto Rodriguez , Eric M. Gnall , Paul M. Coady , Harish Jarrett , Sandra V. Abramson , Katie M. Hawthorne , Scott M. Goldman , William A. Gray , Basel Ramlawi

Background/purpose

To evaluate the impact of coronary artery disease (CAD), percutaneous coronary intervention (PCI), and coronary lesion complexity on outcomes of transcatheter aortic valve replacement (TAVR) for aortic stenosis.

Methods/materials

This retrospective study included 1042 patients divided into two groups by the presence or absence of CAD (SYNTAX score 0, no history of revascularization). Propensity score matching was used to compare the two groups. The effect of PCI, SYNTAX score, and residual SYNTAX score was also analyzed.

Results

The median age of the cohort was 82 years, and 641 patients had CAD. After propensity score matching, 346 pairs were analyzed. During 5 years of follow-up (median: 25, range 0–72 months), the rate of coronary intervention was significantly higher in CAD patients (p = 0.018). However, all-cause mortality, composite of all-cause mortality, stroke, and coronary intervention, and overt bleeding defined by VARC-3 were comparable. After stratification, in patients with creatinine ≥1.5 mg/dl, CAD was associated with a worse composite outcome (p = 0.016). Neither PCI nor SYNTAX score was associated with all-cause mortality in CAD patients. Similarly, residual SYNTAX score showed no association with mortality in patients undergoing PCI (all p values >0.7). PCI did not reach a significant difference in overt bleeding in CAD patients (adjusted p = 0.06).

Conclusions

Despite a higher incidence of coronary interventions, major clinical outcomes were similar between patients with and without CAD after TAVR. In patients with chronic kidney disease, CAD may be associated with an adverse composite outcome. Neither PCI nor SYNTAX/residual SYNTAX score influenced all-cause mortality.

背景/目的：评估冠状动脉疾病（CAD）、经皮冠状动脉介入治疗（PCI）和冠状动脉病变复杂性对主动脉瓣狭窄经导管主动脉瓣置换术（TAVR）疗效的影响：这项回顾性研究纳入了 1042 名患者，按照是否存在 CAD（SYNTAX 评分 0，无血管再通史）分为两组。采用倾向评分匹配法对两组患者进行比较。同时还分析了PCI、SYNTAX评分和残余SYNTAX评分的影响：结果：组群的中位年龄为 82 岁，641 名患者患有 CAD。经过倾向评分匹配后，对 346 对患者进行了分析。在 5 年的随访期间（中位数：25，范围 0-72 个月），CAD 患者的冠状动脉介入率明显更高（p = 0.018）。然而，全因死亡率、全因死亡率、中风和冠状动脉介入治疗的复合死亡率以及 VARC-3 定义的明显出血率却相当。经过分层后，在肌酐≥1.5 mg/dl 的患者中，CAD 与较差的综合预后相关（p = 0.016）。PCI和SYNTAX评分均与CAD患者的全因死亡率无关。同样，残余 SYNTAX 评分与接受 PCI 患者的死亡率也没有关系（所有 p 值均大于 0.7）。PCI与CAD患者的明显出血没有明显差异（调整后P = 0.06）：结论：尽管冠状动脉介入治疗的发生率较高，但TAVR术后有CAD和无CAD患者的主要临床结果相似。在慢性肾脏病患者中，CAD可能与不良的综合结果有关。PCI和SYNTAX/剩余SYNTAX评分均不影响全因死亡率。

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引用次数: 0

Prevalence and progression of LV dysfunction and dyssynchrony in patients with new-onset LBBB post TAVR TAVR术后新发LBBB患者左心室功能障碍和不同步的发生率和进展。

IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiovascular Revascularization Medicine

Pub Date : 2024-11-01 DOI: 10.1016/j.carrev.2024.04.011

Andrei D. Margulescu , Dewi E. Thomas , Magid Awadalla , Parin Shah , Ayush Khurana , Omar Aldalati , Daniel R. Obaid , Alexander J. Chase , David Smith

Background

The impact of new-onset left bundle branch block (N-LBBB) developing after Transcatheter Aortic Valve Replacement (TAVR) on cardiac function and mechanical dyssynchrony is not well defined.

Methods

We retrospectively screened all patients who underwent TAVR in our centre between Oct 2018 and Sept 2021 (n = 409). We identified 38 patients with N-LBBB post-operatively (of which 28 were persistent and 10 were transient), and 17 patients with chronic pre-existent LBBB (C-LBBB). We excluded patients requiring pacing post TAVR. For all groups, we retrospectively analysed stored echocardiograms at 3 time points: before TAVR (T0), early after TAVR (T1, 1.2 ± 1.1 days), and late follow-up (T2, 1.5 ± 0.8 years), comparing LV mass and volumes, indices of LV function (LV ejection fraction, LVEF; global longitudinal strain, GLS), and mechanical dyssynchrony indices (systolic stretch index, severity of septal flash).

Results

At baseline (T0), C-LBBB had worse cardiac function, and larger LV volumes and LV mass, compared with patients with N-LBBB. At T1, N-LBBB resulted in mild dyssynchrony and decreased LVEF and GLS. Dyssynchrony progressed at T2 in persistent N-LBBB but not C-LBBB. In both groups however, LVEF remained stable at T2, although individual response was variable. Patients with better LVEF at baseline demonstrated a higher proportion of developing LBBB-induced LV dysfunction at T2. Lack of improvement of LVEF immediately after TAVR predicted deteriorating LVEF at T2. In transient LBBB, cardiac function and most dyssynchrony indices returned to baseline.

Conclusions

N-LBBB after TAVR results in an immediate reduction of cardiac function, in spite of only mild dyssynchrony. When LBBB persists, patients with better cardiac function before TAVR are more likely to have LBBB-induced LV dysfunction after TAVR.

背景：经导管主动脉瓣置换术（TAVR）后新发左束支传导阻滞（N-LBBB）对心功能和机械不同步的影响尚未明确：我们回顾性地筛查了2018年10月至2021年9月期间在本中心接受TAVR的所有患者（n = 409）。我们确定了 38 例术后出现 N-LBBB 的患者（其中 28 例为持续性，10 例为短暂性），以及 17 例术后出现慢性前期 LBBB（C-LBBB）的患者。我们排除了 TAVR 术后需要起搏的患者。我们回顾性分析了所有组别在3个时间点储存的超声心动图：TAVR前（T0）、TAVR后早期（T1，1.2±1.1天）和随访后期（T2，1.5±0.8年），比较了左心室质量和容积、左心室功能指数（左心室射血分数，LVEF；整体纵向应变，GLS）和机械不同步指数（收缩期舒张指数、室间隔闪光严重程度）：结果：与N-LBBB患者相比，基线（T0）时C-LBBB患者的心功能更差，左心室容积和左心室质量更大。在T1，N-LBBB导致轻度不同步，LVEF和GLS下降。在T2期，持续性N-LBBB患者的不同步程度加深，而C-LBBB患者则没有。不过，两组患者的 LVEF 在 T2 阶段均保持稳定，但个体反应不一。基线时 LVEF 较好的患者在 T2 期出现 LBBB 引起的左心室功能障碍的比例较高。TAVR 术后 LVEF 没有立即改善，预示着 T2 时 LVEF 会恶化。在一过性LBBB中，心功能和大多数不同步指数恢复至基线：结论：TAVR术后的N-LBBB会导致心功能立即下降，尽管只有轻微的不同步。当LBBB持续存在时，TAVR前心功能较好的患者在TAVR后更有可能出现LBBB引起的左心室功能障碍。

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引用次数: 0

Markedly elevated high-sensitivity troponin and in-hospital mortality after cardiac surgery 心脏手术后高敏肌钙蛋白明显升高与院内死亡率。

IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiovascular Revascularization Medicine

Pub Date : 2024-11-01 DOI: 10.1016/j.carrev.2024.05.005

Pavan Reddy , Matteo Cellamare , Ilan Merdler , Cheng Zhang , Sukhdeep Bhogal , Amer I. Aladin , Itsik Ben-Dor , Lowell F. Satler , Toby Rogers , Ron Waksman

Background

High-sensitivity troponin (hsTnI) is correlated with cardiac mortality; however, studies on the relationship of markedly elevated hsTnI with in-hospital mortality after cardiac surgery are sparse. Therefore, we aimed to define this relationship in order to help guide in-hospital, acute management of post-surgical patients.

Methods

We retrospectively analyzed all cardiac surgeries completed at our institution between January 2020 and June 2022 in which a peak hsTnI was noted to be >35× upper limit of normal (ULN = 34 ng/L). The primary outcome was in-hospital death. Subgroup analysis was performed to assess differences between coronary artery bypass grafting (CABG) and other cardiac surgeries.

Results

A total of 1382 cases met inclusion criteria. The patients' mean age was 64.8 years and 68.2 % were male. Median peak hsTnI after surgery was 4202 ng/L (interquartile ratio: 2427–7654). Univariate analysis of troponin level with mortality found that for every 1000 ng/L increase in hsTnI, odds of in-hospital death increased by 3.8 % (odds ratio [OR]: 1.038; 95 % confidence interval [CI] 1.027–1.050; p < 0.0001). In a multivariate model, troponin (OR 1.02; 95 % CI 1.01–1.04; p = 0.004) maintained a significant association with in-hospital death. CABG was associated with a lower risk of in-hospital death for any given hsTnI level up to 60,000 ng/L compared to other cardiac surgeries.

Conclusion

Increasing hsTnI level is associated with increasing probability of in-hospital mortality and, therefore, serves as an additional, objective measure of risk to help guide in-hospital clinical management.

背景：高敏肌钙蛋白（hsTnI）与心脏病死亡率相关；然而，有关心脏手术后 hsTnI 明显升高与院内死亡率关系的研究却很少。因此，我们旨在明确这种关系，以帮助指导手术后患者的院内急性期管理：我们回顾性分析了本院 2020 年 1 月至 2022 年 6 月期间完成的所有心脏手术，其中发现 hsTnI 峰值大于正常值上限的 35 倍（ULN = 34 ng/L）。主要结果为院内死亡。为评估冠状动脉旁路移植术（CABG）与其他心脏手术之间的差异，进行了分组分析：共有 1382 例符合纳入标准。患者平均年龄为 64.8 岁，68.2% 为男性。术后 hsTnI 峰值中位数为 4202 ng/L（四分位数比：2427-7654）。对肌钙蛋白水平与死亡率的单变量分析发现，hsTnI每增加1000 ng/L，院内死亡几率增加3.8%（几率比 [OR]：1.038; 95 %置信区间 [CI] 1.027-1.050; p 结论：hsTnI 水平的升高与院内死亡几率的增加有关，因此可作为额外的客观风险测量指标，帮助指导院内临床管理。

{"title":"Markedly elevated high-sensitivity troponin and in-hospital mortality after cardiac surgery","authors":"Pavan Reddy , Matteo Cellamare , Ilan Merdler , Cheng Zhang , Sukhdeep Bhogal , Amer I. Aladin , Itsik Ben-Dor , Lowell F. Satler , Toby Rogers , Ron Waksman","doi":"10.1016/j.carrev.2024.05.005","DOIUrl":"10.1016/j.carrev.2024.05.005","url":null,"abstract":"<div><h3>Background</h3><div>High-sensitivity troponin (hsTnI) is correlated with cardiac mortality; however, studies on the relationship of markedly elevated hsTnI with in-hospital mortality after cardiac surgery are sparse. Therefore, we aimed to define this relationship in order to help guide in-hospital, acute management of post-surgical patients.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed all cardiac surgeries completed at our institution between January 2020 and June 2022 in which a peak hsTnI was noted to be >35× upper limit of normal (ULN = 34 ng/L). The primary outcome was in-hospital death. Subgroup analysis was performed to assess differences between coronary artery bypass grafting (CABG) and other cardiac surgeries.</div></div><div><h3>Results</h3><div><span>A total of 1382 cases met inclusion criteria. The patients' mean age was 64.8 years and 68.2 % were male. Median peak hsTnI after surgery was 4202 ng/L (interquartile ratio: 2427–7654). Univariate analysis<span> of troponin level with mortality found that for every 1000 ng/L increase in hsTnI, odds of in-hospital death increased by 3.8 % (odds ratio [OR]: 1.038; 95 % confidence interval [CI] 1.027–1.050; </span></span><em>p</em> < 0.0001). In a multivariate model, troponin <strong>(</strong>OR 1.02; 95 % CI 1.01–1.04; <em>p</em> = 0.004) maintained a significant association with in-hospital death. CABG was associated with a lower risk of in-hospital death for any given hsTnI level up to 60,000 ng/L compared to other cardiac surgeries.</div></div><div><h3>Conclusion</h3><div>Increasing hsTnI level is associated with increasing probability of in-hospital mortality and, therefore, serves as an additional, objective measure of risk to help guide in-hospital clinical management.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"68 ","pages":"Pages 57-61"},"PeriodicalIF":1.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140892075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Editorial: Tackling coronary calcified nodules: “Shocking our way to success?” 社论：应对冠状动脉钙化结节："冲击成功之路？

IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiovascular Revascularization Medicine

Pub Date : 2024-11-01 DOI: 10.1016/j.carrev.2024.06.009

Keisuke Yasumura, Annapoorna S. Kini, Samin K. Sharma

引用次数: 0

Comparison of interventional treatment options for coronary calcified nodules: A sub-analysis of the ROTA.shock trial 冠状动脉钙化结节介入治疗方案的比较：ROTA.shock试验的子分析

IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiovascular Revascularization Medicine

Pub Date : 2024-11-01 DOI: 10.1016/j.carrev.2024.05.030

Florian Blachutzik , Sophie Meier , Melissa Blachutzik , Sophia Schlattner , Tommaso Gori , Helen Ullrich-Daub , Luise Gaede , Stephan Achenbach , Helge Möllmann , Bogdan Chitic , Adem Aksoy , Georg Nickenig , Maren Weferling , Oliver Dörr , Niklas Boeder , Matthias Bayer , Christian Hamm , Holger Nef , ROTA.shock Investigators

Background

The optimal treatment for coronary calcified nodules (CNs) is still unclear. The aim of this study was to compare the modification of these lesions by coronary intravascular lithotripsy (IVL) and rotational atherectomy (RA) using optical coherence tomography (OCT).

Methods

ROTA.shock was a 1:1 randomized, prospective, double-arm multi-center non-inferiority trial that compared the use of IVL and RA with percutaneous coronary intervention (PCI) in severely calcified lesions. In 19 of the patients out of this study CNs were detected by OCT in the target lesion and were treated by either IVL or RA.

Results

The mean angle of CNs was significantly larger in final OCT scans than before RA (92 ± 17° vs. 68 ± 7°; p = 0.01) and IVL (89 ± 18° vs. 60 ± 10°; p = 0.03). The CNs were thinner upon final scans than in initial native scans (RA: 17.8 ± 7.8 mm vs. 38.6 ± 13.1 mm; p = 0.02; IVL: 16.5 ± 9.0 mm vs. 37.2 ± 14.3 mm; p = 0.02). Nodule volume did not differ significantly between native and final OCT scans (RA: 0.66 ± 0.12 mm³ vs. 0.61 ± 0.33 mm³; p = 0.68; IVL: 0.64 ± 0.19 mm³ vs. 0.68 ± 0.22 mm³; p = 0.74). Final stent eccentricity was high with 0.62 ± 0.10 after RA and 0.61 ± 0.09 after IVL.

Conclusion

RA or IVL are unable to reduce the volume of the calcified plaque. CN modulation seems to be mainly induced by the stent implantation and not by RA or IVL.

背景冠状动脉钙化结节（CNs）的最佳治疗方法尚不明确。这项研究的目的是比较冠状动脉血管内碎石术（IVL）和旋转动脉瘤切除术（RA）利用光学相干断层扫描（OCT）改变这些病变的效果。方法ROTA.shock是一项1:1随机、前瞻性、双臂多中心非劣效性试验，比较了在严重钙化病变中使用IVL和RA与经皮冠状动脉介入治疗（PCI）的效果。结果在最终的 OCT 扫描中，CN 的平均角度明显大于 RA（92 ± 17° vs. 68 ± 7°；p = 0.01）和 IVL（89 ± 18° vs. 60 ± 10°；p = 0.03）前。最终扫描时，CN 比初始原位扫描时更薄（RA：17.8 ± 7.8 mm vs. 38.6 ± 13.1 mm；p = 0.02；IVL：16.5 ± 9.0 mm vs. 37.2 ± 14.3 mm；p = 0.02）。结节体积在原始扫描和最终 OCT 扫描之间没有明显差异（RA：0.66 ± 0.12 mm3 vs. 0.61 ± 0.33 mm3；p = 0.68；IVL：0.64 ± 0.19 mm3 vs. 0.68 ± 0.22 mm3；p = 0.74）。最终支架偏心率较高，RA 后为 0.62 ± 0.10，IVL 后为 0.61 ± 0.09。CN调节似乎主要是由支架植入引起的，而不是由RA或IVL引起的。

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引用次数: 0

Geographical and socioeconomic disparities in post-transcatheter aortic valve replacement pacemaker placement 经导管主动脉瓣置换术后起搏器安置的地域和社会经济差异。

IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiovascular Revascularization Medicine

Pub Date : 2024-11-01 DOI: 10.1016/j.carrev.2024.04.010

Bilal Hussain , Sanchit Duhan , Ahmed Mahmood , Luay Al-Alawi , Mian Muhammad Salman Aslam , Christel Cuevas , Thomas Alexander , Mohammad M. Ansari , Fahad Waqar

Introduction

Pacemaker (PPM) implantation is indicated for conduction abnormalities which can develop post-transcatheter aortic valve replacement (TAVR). However, whether post-TAVR PPM risk is associated with the geographical location of the hospital and socioeconomic status of the patient is not well established. Our goal was to explore geographical and socioeconomic disparities in post-TAVR PPM implantation.

Methods

A retrospective cohort analysis was conducted using the National Inpatient Sample 2016–2020 with respective ICD-10 codes for TAVR and PPM implantation. A weighted multivariate logistic regression model was used to analyze prognostic outcomes.

Results

The number of patients hospitalized for undergoing TAVR was 296,740, out of which 28,265 patients had PPM implantation (prevalence 9.5 %). Patients' demographics including sex, ethnicity, household income, and insurance were not associated with risk of post-TAVR PPM except age (OR 1.01, CI 1.07–12.5, p < 0.001). Compared to rural hospitals, urban non-teaching hospitals were associated with a higher risk of post-TAVR PPM (OR 2.09, 1.3–3.43, p = 0.003). Compared to New England hospitals (ME, NH, VT, MA, RI, CT), middle Atlantic hospitals (NY, NJ, PA) were associated with highest post-TAVR PPM risk (OR 1.54, CI 1.2–1.98, p < 0.001), followed by Pacific (AK, WA, OR, CA, HI), mountain (ID, MT, WY, NV, UT, CO, AZ, NM) and east north central US.

Conclusion

Patients' demographics including sex, ethnicity, household income, and insurance were not associated with the risk of post-TAVR PPM except for age. Compared to New England hospitals, Middle Atlantic hospitals were associated with the highest post-TAVR PPM risk followed by Pacific, Mountain, and East North Central US. Prospective studies with data on TAVR wait times, expertise of the interventional staff, and post-TAVR management and discharge planning are required to further explore the observed regional distribution of TAVR outcomes.

导言：植入起搏器（PPM）适用于经导管主动脉瓣置换术（TAVR）后可能出现的传导异常。然而，经导管主动脉瓣置换术后出现传导异常的风险是否与医院的地理位置和患者的社会经济状况有关，目前尚无定论。我们的目标是探索 TAVR 术后 PPM 植入的地域和社会经济差异：我们使用 2016-2020 年全国住院患者样本进行了回顾性队列分析，并分别对 TAVR 和 PPM 植入术进行了 ICD-10 编码。采用加权多变量逻辑回归模型分析预后结果：接受 TAVR 的住院患者人数为 296,740 人，其中 28,265 人接受了 PPM 植入术（发病率为 9.5%）。除年龄外，患者的性别、种族、家庭收入和保险等人口统计学特征与TAVR术后PPM风险无关（OR 1.01，CI 1.07-12.5，P 结论：TAVR术后PPM风险与患者的性别、种族、家庭收入和保险等人口统计学特征无关：除年龄外，患者的人口统计学特征（包括性别、种族、家庭收入和保险）与 TAVR 术后 PPM 风险无关。与新英格兰地区的医院相比，中大西洋地区的医院TAVR术后PPM风险最高，其次是太平洋地区、山区和美国东北部地区。需要进行前瞻性研究，收集有关 TAVR 等待时间、介入人员的专业知识以及 TAVR 术后管理和出院计划的数据，以进一步探讨所观察到的 TAVR 结果的地区分布。

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引用次数: 0

In-hospital outcomes with extracorporeal membrane oxygenation alone versus combined with percutaneous left ventricular assist device 单独使用体外膜肺氧合与联合使用经皮左心室辅助装置的院内疗效对比。

IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiovascular Revascularization Medicine

Pub Date : 2024-11-01 DOI: 10.1016/j.carrev.2024.04.024

Fatima Lakhani , Bertrand Ebner , Crystal Lihong Yan , Sukhpreet Kaur , Rosario Colombo , Mrudula Munagala

Background

Veno-arterial extracorporeal membrane oxygenation (ECMO) is associated with increased afterload and hindered myocardial recovery. Adding a percutaneous left ventricular assist device (pLVAD) to ECMO is one strategy to unload the left ventricle. We evaluated in-hospital outcomes in cardiogenic shock patients treated with ECMO alone versus ECMO plus pLVAD.

Methods

We conducted a retrospective study using the National Inpatient Sample database from 2011 to 2019. Logistic regression analysis was performed to adjust for covariates.

Results

20,171 patients were included. 16,064 (79.6 %) patients received ECMO alone and 4107 (20.4 %) patients received ECMO plus pLVAD. The ECMO plus pLVAD group had higher rates of mortality, stroke, acute kidney injury, pericardial complications, and vascular complications. After adjusting for covariates, combined therapy was associated with higher rates of mortality (OR 1.2; 95 % CI [1.1–1.3]) and stroke (OR 1.3; 95 % CI [1.2–1.5]), however lower bleeding (OR 0.7; 95 % CI [0.68–0.81]) (p < 0.001 for all). After adjusting for covariates, a subgroup analysis of 5019 patients with acute coronary syndrome cardiogenic shock (ACS-CS) demonstrated higher rates of mortality (OR 1.3; 95 % CI [1.2–1.5]) and stroke (OR 1.7; 95 % CI [1.4–2.1]; p < 0.001 for all) with combined therapy, however similar rates of bleeding compared to ECMO alone (OR 0.95; 95 % CI [0.8–1.1]; p = 0.54).

Conclusions

In the overall group, ECMO plus pLVAD was associated with increased mortality and stroke, however decreased bleeding. In a sub-group of ACS-CS, ECMO plus pLVAD was associated with increased mortality and stroke, however similar rates of bleeding compared to ECMO alone.

背景：静脉-动脉体外膜氧合（ECMO）与后负荷增加和心肌恢复受阻有关。在 ECMO 的基础上增加经皮左心室辅助装置（pLVAD）是减轻左心室负荷的一种策略。我们评估了单纯 ECMO 与 ECMO 加 pLVAD 治疗心源性休克患者的院内预后：我们利用 2011 年至 2019 年的全国住院患者抽样数据库进行了一项回顾性研究。结果：共纳入 20171 名患者。16064名患者（79.6%）仅接受了ECMO治疗，4107名患者（20.4%）接受了ECMO加pLVAD治疗。ECMO 加 pLVAD 组的死亡率、中风、急性肾损伤、心包并发症和血管并发症发生率较高。调整协变量后，联合疗法与较高的死亡率（OR 1.2；95 % CI [1.1-1.3]）和中风率（OR 1.3；95 % CI [1.2-1.5]）相关，但出血率较低（OR 0.7；95 % CI [0.68-0.81]）（P 结论：ECMO 加 pLVAD 组的死亡率和中风率均高于 ECMO 加 pLVAD 组：在所有患者中，ECMO 加 pLVAD 会增加死亡率和中风发生率，但会减少出血量。在 ACS-CS 亚组中，ECMO 加 pLVAD 与死亡率和中风增加有关，但出血率与单用 ECMO 相似。

{"title":"In-hospital outcomes with extracorporeal membrane oxygenation alone versus combined with percutaneous left ventricular assist device","authors":"Fatima Lakhani , Bertrand Ebner , Crystal Lihong Yan , Sukhpreet Kaur , Rosario Colombo , Mrudula Munagala","doi":"10.1016/j.carrev.2024.04.024","DOIUrl":"10.1016/j.carrev.2024.04.024","url":null,"abstract":"<div><h3>Background</h3><div><span><span>Veno-arterial extracorporeal membrane oxygenation (ECMO) is associated with increased afterload and hindered myocardial recovery. Adding a percutaneous </span>left ventricular assist device<span> (pLVAD) to ECMO is one strategy to unload the left ventricle. We evaluated in-hospital outcomes in </span></span>cardiogenic shock patients treated with ECMO alone versus ECMO plus pLVAD.</div></div><div><h3>Methods</h3><div>We conducted a retrospective study using the National Inpatient Sample database from 2011 to 2019. Logistic regression analysis was performed to adjust for covariates.</div></div><div><h3>Results</h3><div><span>20,171 patients were included. 16,064 (79.6 %) patients received ECMO alone and 4107 (20.4 %) patients received ECMO plus pLVAD. The ECMO plus pLVAD group had higher rates of mortality, stroke, acute kidney injury<span>, pericardial complications, and vascular complications. After adjusting for covariates, combined therapy was associated with higher rates of mortality (OR 1.2; 95 % CI [1.1–1.3]) and stroke (OR 1.3; 95 % CI [1.2–1.5]), however lower bleeding (OR 0.7; 95 % CI [0.68–0.81]) (</span></span><em>p</em><span> < 0.001 for all). After adjusting for covariates, a subgroup analysis of 5019 patients with acute coronary syndrome cardiogenic shock (ACS-CS) demonstrated higher rates of mortality (OR 1.3; 95 % CI [1.2–1.5]) and stroke (OR 1.7; 95 % CI [1.4–2.1]; </span><em>p</em> < 0.001 for all) with combined therapy, however similar rates of bleeding compared to ECMO alone (OR 0.95; 95 % CI [0.8–1.1]; <em>p</em> = 0.54).</div></div><div><h3>Conclusions</h3><div>In the overall group, ECMO plus pLVAD was associated with increased mortality and stroke, however decreased bleeding. In a sub-group of ACS-CS, ECMO plus pLVAD was associated with increased mortality and stroke, however similar rates of bleeding compared to ECMO alone.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"68 ","pages":"Pages 50-54"},"PeriodicalIF":1.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140874902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The imprecision of measuring activated clotting time (ACT) from the guiding catheter during percutaneous coronary interventions 在经皮冠状动脉介入治疗过程中，从引导导管测量活化凝血时间 (ACT) 的不精确性。

IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiovascular Revascularization Medicine

Pub Date : 2024-11-01 DOI: 10.1016/j.carrev.2024.05.006

Aviv Y. Pollak , Ofer M. Kobo , Gilad Margolis, Majdi Saada, Erick Sanchez-Jimenez, Rami Abu Fanne, Yaniv Levi, Maguli Barel, Adeeb Abu-Akel, Ariel Roguin

Background

Finding the balance between the reduction in ischemic events and bleeding complications is crucial for the success of percutaneous coronary intervention (PCI). The activated clotting time (ACT) is used routinely worldwide to monitor and titrate anticoagulation therapy with unfractionated heparin (UFH) during the procedure.

Objectives

We aimed to test the accuracy of ACT measurements from the guiding catheter compared to the arterial access sheath.

Methods

Patients undergoing PCI with UFH therapy were prospectively enrolled. Blood samples were drawn from the coronary guide catheter and the arterial access sheath. ACT values were determined in the same ACT machine, and potential interactions with clinical variables were analyzed.

Results

The study included 331 patients with post PCI ACT measurements. The mean ACT value of the catheter samples was statistically higher than the arterial access sample [294 ± 77 s Vs. 250 ± 60 s, p < 0.001]. The mean difference between the guiding catheter and the arterial line sheath samples was 43 ± 27 s (P < 0.001). We found that in 101/331 [30 %] patients the ACT from the guiding catheter was above 250 s, while from the access sheath it was below 250 s. Notably, in 40/331 [12 %] the ACT from the guiding catheter was above 200 s, while from the access sheath it was below 200 s.

Conclusions

Large proportion of patient may be considered to have therapeutic ACT if measured from guide catheter during PCI, while the corresponding ACT from arterial sheath is subtherapeutic. This difference may have clinical and safety significance.

背景：在减少缺血事件和出血并发症之间找到平衡点对于经皮冠状动脉介入治疗（PCI）的成功至关重要。活化凝血时间（ACT）在全球范围内被常规用于监测和滴定手术过程中使用的非小份子肝素（UFH）抗凝治疗：我们旨在测试从引导导管测量凝血时间（ACT）的准确性，并与动脉通路鞘进行比较：方法：对接受 UFH 治疗的 PCI 患者进行前瞻性登记。从冠状动脉导引导管和动脉通路鞘管抽取血液样本。在同一台 ACT 仪器上测定 ACT 值，并分析与临床变量的潜在相互作用：该研究包括331名PCI后ACT测量患者。导管样本的平均 ACT 值在统计学上高于动脉通路样本[294 ± 77 s Vs. 250 ± 60 s, p 结论：导管样本的平均 ACT 值在统计学上高于动脉通路样本：如果在 PCI 过程中通过导引导管测量，很大一部分患者的 ACT 可被认为是治疗性的，而通过动脉鞘测量的相应 ACT 则是亚治疗性的。这种差异可能具有临床和安全意义。

{"title":"The imprecision of measuring activated clotting time (ACT) from the guiding catheter during percutaneous coronary interventions","authors":"Aviv Y. Pollak , Ofer M. Kobo , Gilad Margolis, Majdi Saada, Erick Sanchez-Jimenez, Rami Abu Fanne, Yaniv Levi, Maguli Barel, Adeeb Abu-Akel, Ariel Roguin","doi":"10.1016/j.carrev.2024.05.006","DOIUrl":"10.1016/j.carrev.2024.05.006","url":null,"abstract":"<div><h3>Background</h3><div><span><span>Finding the balance between the reduction in ischemic events and bleeding complications is crucial for the success of </span>percutaneous coronary intervention<span> (PCI). The activated clotting time (ACT) is used routinely worldwide to monitor and titrate </span></span>anticoagulation therapy with unfractionated heparin (UFH) during the procedure.</div></div><div><h3>Objectives</h3><div>We aimed to test the accuracy of ACT measurements from the guiding catheter compared to the arterial access sheath.</div></div><div><h3>Methods</h3><div>Patients undergoing PCI with UFH therapy were prospectively enrolled. Blood samples were drawn from the coronary guide catheter and the arterial access sheath. ACT values were determined in the same ACT machine, and potential interactions with clinical variables were analyzed.</div></div><div><h3>Results</h3><div>The study included 331 patients with post PCI ACT measurements. The mean ACT value of the catheter samples was statistically higher than the arterial access sample [294 ± 77 s Vs. 250 ± 60 s, <em>p</em><span> < 0.001]. The mean difference between the guiding catheter and the arterial line sheath samples was 43 ± 27 s (</span><em>P</em> < 0.001). We found that in 101/331 [30 %] patients the ACT from the guiding catheter was above 250 s, while from the access sheath it was below 250 s. Notably, in 40/331 [12 %] the ACT from the guiding catheter was above 200 s, while from the access sheath it was below 200 s.</div></div><div><h3>Conclusions</h3><div>Large proportion of patient may be considered to have therapeutic ACT if measured from guide catheter during PCI, while the corresponding ACT from arterial sheath is subtherapeutic. This difference may have clinical and safety significance.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"68 ","pages":"Pages 98-100"},"PeriodicalIF":1.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140898272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Prevalence of rheumatic heart disease diagnosed according to the echocardiographic criteria of the World Heart Federation in Africa: A systematic review and meta-analysis 根据世界心脏联盟超声心动图标准诊断的风湿性心脏病在非洲的患病率：系统回顾和荟萃分析。

IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiovascular Revascularization Medicine

Pub Date : 2024-11-01 DOI: 10.1016/j.carrev.2024.05.025

Humberto Morais , Hilaryano da Silva Ferreira

Rheumatic heart disease (RHD) is a chronic complication arising from acute rheumatic fever (ARF), an autoimmune response triggered by group A streptococcal infection. It primarily affects children and young adults in developing countries. RHD continues to show substantial global heterogeneity. Socioeconomic factors lead the virtual disappearance of RHD in industrialized countries with the introduction of penicillin. By contrast, RHD is still endemic in Africa, Asia, South America, and developing communities of Australasia. We provide an estimate of the current prevalence of latent RHD in Africa using the echocardiographic diagnostic criteria of the World Heart Federation (WHF). Systematic review and meta-analysis of 21 studies reporting the prevalence of RHD, encompassing 40.639 patients. Estimated prevalence of RHD was 25.5 cases per 1000 population (P ≤0.02; 95 % CI, 18.1–32.9 per 1000): definite RHD 13.1 cases per 1000 population (95 % CI, 7.7–18.5 per 1000): and borderline 12,4 cases per 1000 population (95 % CI, 7.7–17.0 per 1000). The prevalence of definite RHD was a significantly higher in adults (M = 28.2, SD = 6.1) compared to children (M = 10.3, SD = 9.2), t(17) = 2.6, p = .0179. Prevalence of definite RHD in schools was 7,92 cases per 1000 population (95 % CI, 4,49–11,35 per 1000) and in community was 26,17 cases per 1000 population (95 % CI, 12,27–40,06 per 1000). This meta-analysis may have produced a better estimate of the prevalence of RHD in Africa using only studies performed according to the 2012 WHF, and clearly showed the high prevalence of RHD in the community and in adults.

风湿性心脏病（RHD）是急性风湿热（ARF）引起的一种慢性并发症，是由A组链球菌感染引发的一种自身免疫反应。它主要影响发展中国家的儿童和年轻成年人。风湿性心脏病在全球范围内仍有很大的异质性。由于社会经济因素，随着青霉素的引入，RHD在工业化国家几乎绝迹。相比之下，在非洲、亚洲、南美洲和澳大拉西亚的发展中社区，RHD仍然流行。我们采用世界心脏联盟（WHF）的超声心动图诊断标准，对目前非洲潜伏性 RHD 的发病率进行了估计。对 21 项报告 RHD 患病率的研究进行了系统回顾和荟萃分析，这些研究涉及 40639 名患者。RHD的估计患病率为每千人25.5例（P≤0.02；95 % CI，每千人18.1-32.9例）：明确RHD为每千人13.1例（95 % CI，每千人7.7-18.5例）：边缘RHD为每千人12.4例（95 % CI，每千人7.7-17.0例）。与儿童（M = 10.3，SD = 9.2）相比，成人（M = 28.2，SD = 6.1）的确诊 RHD 患病率明显更高，t(17) = 2.6，p = .0179。学校中确诊的 RHD 患病率为 7.92 例/1000 人（95 % CI，4.49-11.35 例/1000 人），社区中确诊的 RHD 患病率为 26.17 例/1000 人（95 % CI，12.27-40.06 例/1000 人）。这项荟萃分析仅使用了根据2012年WHF进行的研究，可能对非洲的RHD患病率做出了更好的估计，并清楚地显示了RHD在社区和成人中的高患病率。

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引用次数: 0