Cardiovascular Revascularization Medicine最新文献

英文中文

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。

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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。

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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

Is there additional value in adding Impella to veno-arterial extracorporeal membrane oxygenation in patients with cardiogenic shock? 心源性休克患者在静脉-动脉体外膜氧合的基础上加用 Impella 是否有额外价值？

IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiovascular Revascularization Medicine

Pub Date : 2024-11-01 DOI: 10.1016/j.carrev.2024.05.018

Ilan Merdler , Brian C. Case , Mohit Pahuja , Fatima Hayat , Imad Isaac , Ritika Gadodia , Kalyan R. Chitturi , Pavan K. Reddy , Matteo Cellamare , Itsik Ben-Dor , Ron Waksman

引用次数: 0

Editorial: Does revascularization in TAVR patients make a difference? 社论：TAVR 患者的血管再通术有区别吗？

IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiovascular Revascularization Medicine

Pub Date : 2024-11-01 DOI: 10.1016/j.carrev.2024.05.016

Morton J. Kern, Arnold H. Seto

引用次数: 0

Do we still need intra-procedural TTE during Transcatheter aortic valve replacement? A high volume, single center experience 经导管主动脉瓣置换术中还需要术中 TTE 吗？大容量单中心经验。

IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiovascular Revascularization Medicine

Pub Date : 2024-11-01 DOI: 10.1016/j.carrev.2024.05.011

Yoav Niv Granot, Giulia Passaniti, Francesca Romana Prandi, Samin K. Sharma, Annapoorna Kini, Stamatios Lerakis

Background

Transcatheter aortic valve implantation (TAVI) has undergone significant advances in recent years, with the development of improved pre-planning tools and devices. These advances have led to a reduction in the rate of paravalvular leak (PVL), a complication that is associated with poor outcomes even when mild. As some centers around the world are moving to solely fluoroscopy-focused implantation, we aimed to describe the clinical impact of intra-procedural transthoracic echocardiography (TTE) during TAVI in a high volume hospital.

Methods

Observational study during a 3-month period. A limited TTE examination was performed immediately after deployment to assess the existence of PVL and grade its severity. Complete TTE was performed a day after the procedure. In case of ≥mild PVL after valve deployment, a decision was made according to the severity of the PVL, patient anatomy and extent of annular calcification to preform balloon post-dilation. If done, an additional limited TTE was performed to assess possible complication and the degree of PVL post dilatation.

Results

115 patient were included in the study. Intra-procedural TTE identified 16 patients (14 %) with at least mild PVL, three of them with moderate (3 %). Post balloon dilatation was performed in 10 patients (9 % of the cohort) with significant improvement in the degree of PVL.

Conclusion

Intra-procedural TTE immediately after TAVI deployment can accurately identify PVL, allowing operators to perform post balloon dilatation with improvement in early echocardiographic results. Our findings support the routine use of TTE during procedures, without relying solely on fluoroscopy.

背景：近年来，随着预规划工具和设备的改进，经导管主动脉瓣植入术（TAVI）取得了重大进展。这些进步降低了腔瓣旁漏（PVL）的发生率，这种并发症即使轻微也会导致不良预后。由于全球一些中心正在转向完全以透视为重点的植入术，我们旨在描述在一家高流量医院进行 TAVI 期间术中经胸超声心动图 (TTE) 的临床影响：方法：为期 3 个月的观察研究。手术后立即进行有限的 TTE 检查，以评估是否存在 PVL 及其严重程度。术后一天进行完整的 TTE 检查。如果瓣膜置入后出现≥轻度 PVL，则根据 PVL 的严重程度、患者的解剖结构和瓣环钙化程度决定是否进行球囊后扩张。如果进行了球囊后扩张，则再进行一次有限的 TTE，以评估可能出现的并发症和扩张后 PVL 的程度：研究共纳入 115 名患者。术中 TTE 发现 16 名患者（14%）至少有轻度 PVL，其中 3 人有中度 PVL（3%）。10 名患者（占总数的 9%）接受了球囊扩张术后治疗，PVL 程度明显改善：结论：TAVI 部署后立即进行术中 TTE 可以准确识别 PVL，使操作者可以进行球囊扩张后治疗，从而改善早期超声心动图结果。我们的研究结果支持在手术过程中常规使用 TTE，而不完全依赖透视。

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引用次数: 0

Navigating the evolving landscape of HFpEF management: A detailed look at key ACC/AHA/ESC guideline updates 驾驭不断变化的 HFpEF 管理：ACC/AHA/ESC 主要指南更新详解。

IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiovascular Revascularization Medicine

Pub Date : 2024-11-01 DOI: 10.1016/j.carrev.2024.04.004

Niyati Grewal , Jaspreet Singh Grewal , Mohammed Aldhaeefi , Prafulla P. Mehrotra , Urooj Fatima

Heart failure, a growing concern in the United States, significantly impacts both morbidity and mortality. Classified by ejection fraction, heart failure with preserved ejection fraction (HFpEF) now accounts for half of all cases and is steadily rising. Unlike its counterpart, heart failure with reduced ejection fraction (HFrEF), HFpEF lacks clear management guidelines. Recognizing this critical gap, we aim to review existing recommendations and formulate effective management strategies for HFpEF.

心力衰竭在美国日益受到关注，它对发病率和死亡率都有重大影响。按射血分数分类，射血分数保留型心力衰竭（HFpEF）目前占所有病例的一半，且呈稳步上升趋势。与射血分数降低型心力衰竭（HFrEF）不同，HFpEF 缺乏明确的管理指南。认识到这一关键差距，我们旨在回顾现有建议，并为 HFpEF 制定有效的管理策略。

引用次数: 0

Coronary microvascular dysfunction and cancer therapy-related cardiovascular toxicity 冠状微血管功能障碍与癌症治疗相关的心血管毒性

IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiovascular Revascularization Medicine

Pub Date : 2024-11-01 DOI: 10.1016/j.carrev.2024.05.001

Kalyan R. Chitturi , Sukhdeep Bhogal , Seyed Ebrahim Kassaian , Ilan Merdler , Waiel Abusnina , Abhishek Chaturvedi , Itsik Ben-Dor , Ron Waksman , Brian C. Case , Ana Barac , Hayder D. Hashim

Background

Coronary microvascular dysfunction (CMD) has been implicated as a potential mechanism in the pathophysiology of different clinical presentations, including ischemia and no obstructive coronary artery disease (INOCA), myocardial infarction and nonobstructive coronary arteries (MINOCA), stress cardiomyopathy, heart failure, and myocarditis. There are limited data about the role of CMD in cancer therapy-related cardiovascular toxicities.

Case presentations

Four women with a diagnosis of active cancer receiving treatment who developed subsequent MINOCA or INOCA presented for cardiac catheterization. Upon coronary angiography showing no obstructive coronary arteries, coronary function testing was performed to evaluate for CMD.

Methods

Coronary physiology was assessed measuring non-hyperemic (resting full-cycle ratio [RFR]) and hyperemic (fractional flow reserve [FFR]) indices using a physiologic pressure wire. The wire also measured coronary flow reserve (CFR), index of microcirculatory resistance (IMR), and RFR using thermodilution technology. CMD was confirmed if the CFR was <2.5 and the IMR was >25.

Results

Among 4 patients with diagnosis of active cancer presenting with chest pain, there was no evidence of obstructive coronary artery disease, leading to separate diagnoses of INOCA, MINOCA, stress cardiomyopathy, and myocarditis. We found CMD in 2 patients (1 with INOCA and 1 with immune checkpoint inhibitor-related myocarditis).

Conclusions

CMD may play a role in cardiovascular toxicities. Further coronary physiology studies are needed to understand the mechanisms of cancer therapy-related cardiovascular toxicity and CMD, as well as optimal preventive and treatment options.

背景冠状动脉微血管功能障碍（CMD）被认为是不同临床表现的潜在病理生理学机制，包括缺血和无阻塞性冠状动脉疾病（INOCA）、心肌梗死和无阻塞性冠状动脉（MINOCA）、应激性心肌病、心力衰竭和心肌炎。有关 CMD 在癌症治疗相关心血管毒性中的作用的数据有限。病例介绍四名确诊为活动性癌症的女性患者在接受治疗后出现 MINOCA 或 INOCA，并前来接受心导管检查。冠状动脉造影显示无阻塞性冠状动脉后，进行了冠状动脉功能测试以评估是否存在 CMD。方法使用生理压力导线测量非充血（静息全周期比值 [RFR]）和充血（分数血流储备 [FFR]）指数，评估冠状动脉生理功能。生理压力线还利用热稀释技术测量冠状动脉血流储备（CFR）、微循环阻力指数（IMR）和RFR。结果在确诊为活动性癌症并伴有胸痛的 4 位患者中，没有证据表明存在阻塞性冠状动脉疾病，因此分别诊断为 INOCA、MINOCA、应激性心肌病和心肌炎。我们在 2 名患者（1 人患有 INOCA，1 人患有与免疫检查点抑制剂相关的心肌炎）中发现了 CMD。需要进一步开展冠状动脉生理学研究，以了解癌症治疗相关心血管毒性和 CMD 的机制以及最佳预防和治疗方案。

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引用次数: 0

Editorial: Procedural echo in TAVR: Mandatory, optional or redundant? 社论：TAVR 中的程序回声：必须、可选还是多余？

IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiovascular Revascularization Medicine

Pub Date : 2024-11-01 DOI: 10.1016/j.carrev.2024.05.039

Haim D. Danenberg

引用次数: 0

Examining patient demographics and major adverse cardiac events following noncardiac surgery: Applying a health equity lens 研究非心脏手术后患者的人口统计学特征和主要心脏不良事件：应用健康公平视角。

IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiovascular Revascularization Medicine

Pub Date : 2024-11-01 DOI: 10.1016/j.carrev.2024.06.004

Demian Herrera-Quiroz , Bradford B. Smith , Christopher Dodoo , Michael J. Brown , Sharonne N. Hayes , Adam J. Milam

Background

Major adverse cardiac events (MACE) are a major contributor to postoperative complications. This study employed a health equity lens to examine rates of postoperative MACE by race and ethnicity.

Methods

This single-center, retrospective observational cohort study followed patients with and without pre-existing coronary artery stents from 2008 to 2018 who underwent non-cardiac surgery. MACE was the primary outcome (death, acute MI, repeated coronary revascularization, in-stent thrombosis) and self-reported race and ethnicity was the primary predictor. A propensity score model of a 1:1 cohort of non-Hispanic White (NHW) patients and all other racial and ethnic minority populations (Hispanic and Black) was used to compare the rate of perioperative MACE in this cohort.

Results

During the study period, 79,686 cases were included in the analytic sample; 950 patients (1.2 %) had pre-existing coronary artery stents. <1 % of patients experienced MACE within 30 days following non-cardiac surgery (0.8 %). After confounder adjustment and propensity score matching, there were no statistically significant differences in MACE among racial and ethnic minority patients compared to NHW patients (OR = 0.77; 95 % CI: 0.48, 1.25). In our sensitivity analyses, stratifying by sex, there were no differences in MACE by race and ethnicity.

Conclusions

The study found no statistically significant differences in MACE by race and ethnicity among patients who underwent non-cardiac surgery. Access to a high-volume, high-quality hospital such as the one studied may reduce the presence of healthcare disparities and may explain why our findings are not consistent with previous studies.

背景：重大心脏不良事件（MACE）是导致术后并发症的主要因素。本研究采用健康公平视角，按种族和民族划分，研究术后 MACE 的发生率：这项单中心、回顾性观察队列研究跟踪了 2008 年至 2018 年期间接受非心脏手术的已植入或未植入冠状动脉支架的患者。MACE是主要结局（死亡、急性心肌梗死、重复冠状动脉血运重建、支架内血栓形成），自我报告的种族和民族是主要预测因素。采用非西班牙裔白人（NHW）患者与所有其他少数种族和族裔人群（西班牙裔和黑人）1:1队列的倾向得分模型来比较该队列中围手术期MACE的发生率：在研究期间，有79686个病例被纳入分析样本；950名患者（1.2%）在手术前已植入冠状动脉支架。结论研究发现，在接受非心脏手术的患者中，不同种族和族裔的MACE差异无统计学意义。入住像本研究中这样的高容量、高质量医院可能会减少医疗差异的存在，这也可以解释为什么我们的研究结果与之前的研究结果不一致。

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