Pub Date : 2024-08-22DOI: 10.1016/j.carrev.2024.08.015
Ezequiel J Molina
{"title":"Improving outcomes with standardized care in high-risk patients supported with a percutaneous microaxial flow pump.","authors":"Ezequiel J Molina","doi":"10.1016/j.carrev.2024.08.015","DOIUrl":"https://doi.org/10.1016/j.carrev.2024.08.015","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142056904","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}
Pub Date : 2024-08-22DOI: 10.1016/j.carrev.2024.08.016
Gauravpal S Gill, Shikha Shailly, Teja Chakrala, Anirudh Palicherla, Pramod K Ponna, Venkata Mahesh Alla, Arun Kanmanthareddy
Background: Chronic kidney disease (CKD) and end stage renal disease (ESRD) are associated with increased risk of bleeding events, including hemorrhagic stroke, and periprocedural and gastrointestinal bleeding among patients with atrial fibrillation who are on anticoagulation. Safety of percutaneous left atrial appendage occlusion (LAAO) among this patient population has been uncertain with studies showing contradictory results.
Methods: PubMed and Google Scholar databases were queried for studies comparing outcomes among patients with and without significant CKD, and with and without ESRD who underwent LAAO device implantation. Data on outcomes from the selected studies were extracted and analyzed using random effects model. Heterogeneity was assessed using I2 test.
Results: Data from eleven studies with 61,724 patients with and without kidney disease were included in the final analyses. There was an increased risk of in-hospital mortality (OR 2.76, 95 % CI [1.15-6.64]; p = 0.02) and peri-procedural bleeding (1.51 [1.33-1.71]; p < 0.01) associated with kidney disease. There was no significant difference in risk of stroke (1.19 [0.70-2.03]; p = 0.53), pericardial effusion (1.22 [0.77-1.92]; p = 0.40), vascular complications (1.18 [0.92-1.52]; p = 0.20), or device related thrombus (1.13 [0.53-2.40]; p = 0.75).
Conclusions: This study shows an increased risk of complications among patients with kidney disease, who undergo LAAO device implantation. These findings suggest the need for studies with randomized control design specifically designed to compare outcomes with LAAO versus anticoagulation in the CKD and ESRD populations.
{"title":"Adverse outcomes with left atrial appendage occlusion device implantation in chronic and end stage kidney disease: A systemic review and meta-analysis.","authors":"Gauravpal S Gill, Shikha Shailly, Teja Chakrala, Anirudh Palicherla, Pramod K Ponna, Venkata Mahesh Alla, Arun Kanmanthareddy","doi":"10.1016/j.carrev.2024.08.016","DOIUrl":"https://doi.org/10.1016/j.carrev.2024.08.016","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease (CKD) and end stage renal disease (ESRD) are associated with increased risk of bleeding events, including hemorrhagic stroke, and periprocedural and gastrointestinal bleeding among patients with atrial fibrillation who are on anticoagulation. Safety of percutaneous left atrial appendage occlusion (LAAO) among this patient population has been uncertain with studies showing contradictory results.</p><p><strong>Methods: </strong>PubMed and Google Scholar databases were queried for studies comparing outcomes among patients with and without significant CKD, and with and without ESRD who underwent LAAO device implantation. Data on outcomes from the selected studies were extracted and analyzed using random effects model. Heterogeneity was assessed using I<sup>2</sup> test.</p><p><strong>Results: </strong>Data from eleven studies with 61,724 patients with and without kidney disease were included in the final analyses. There was an increased risk of in-hospital mortality (OR 2.76, 95 % CI [1.15-6.64]; p = 0.02) and peri-procedural bleeding (1.51 [1.33-1.71]; p < 0.01) associated with kidney disease. There was no significant difference in risk of stroke (1.19 [0.70-2.03]; p = 0.53), pericardial effusion (1.22 [0.77-1.92]; p = 0.40), vascular complications (1.18 [0.92-1.52]; p = 0.20), or device related thrombus (1.13 [0.53-2.40]; p = 0.75).</p><p><strong>Conclusions: </strong>This study shows an increased risk of complications among patients with kidney disease, who undergo LAAO device implantation. These findings suggest the need for studies with randomized control design specifically designed to compare outcomes with LAAO versus anticoagulation in the CKD and ESRD populations.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142082143","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}
Pub Date : 2024-08-22DOI: 10.1016/j.carrev.2024.08.013
Giulio Piedimonte, Enrico Cerrato, Cristina Rolfo, Ivan J Nunez Gil, Lorenzo Azzalini, Riccardo Mangione, Francesco Maiellaro, Alberto Boi, Donovan Riganelli, Andrea Sardone, Francesco Bruno, Fernando Scudiero, Giampiero Vizzari, Gabriele Carciotto, Dario Calderone, Marco Borgi, Francesco Paolo Cancro, Ivan Sanchez, Massimo Leoncini, Emanuele Sagazio, Francesco Colombo, Gabriele Rosso, Tania Chechi, Simone Zecchino, Marco Pavani, Alfonso Franzè, Greca Zanda, Manuel Bosco, Jose Maria De La Torre Hernandez, Antonio Micari, Gennaro Galasso, Francesco Versaci, Corrado Tamburino, Giuseppe Patti, Alessio La Manna, Francesco Tomassini, Ferdinando Varbella
Background: The optimal strategy during percutaneous coronary intervention (PCI) of aneurysmatic right coronary artery (ARCA) remains uncertain and has never been tested in the acute setting.
Objectives: To compare the in-hospital and long-term outcomes of immediate and staged PCI strategies for ARCA as culprit lesions during acute coronary syndrome (ACS).
Methods: Among 102.376 PCIs performed in 18 European centers, a total of 85 patients presenting with acute coronary syndrome undergoing ARCA PCI were finally included in the analysis. PCI strategy (stenting performed during the immediate vs staged procedure) and pharmacological approach adopted were collected. The primary outcome was procedural success (technical success without in-hospital MACE).
Results: The primary outcome occurred in 48.2 % of cases, with no significant differences observed between the immediate and staged PCI groups (50.9 % vs 43.3 %, p = 0.504). Patients in the staged-PCI group had a significantly higher rate of intravenous anticoagulant use (83.3 % vs 48.1 %, p = 0.002), BARC type 3 and 5 bleedings (12.9 % vs 1.9 %, p = 0.037), and longer in-hospital stay (7.40 ± 5.11 vs 9.5 ± 5.25 days, p = 0.049). After multivariate analysis, no independent predictors for procedural success were found in either group. Target lesion failure occurred in 24.1 % of cases without differences between groups at a median follow-up of three years.
Conclusions: Among patients undergoing ARCA PCI in the setting of ACS, immediate or staged PCI were associated with similar in-hospital and long-term outcomes. However, staged PCI was associated with a higher risk of major bleeding events and longer length of stay compared to immediate PCI strategy.
背景:动脉瘤右冠状动脉(ARCA)经皮冠状动脉介入治疗(PCI动脉瘤性右冠状动脉(ARCA)经皮冠状动脉介入治疗(PCI)的最佳策略仍不确定,且从未在急性病例中进行过测试:目的:比较急性冠状动脉综合征(ACS)期间作为罪魁祸首的ARCA立即和分阶段PCI策略的院内和长期疗效:在欧洲18个中心进行的102376例PCI手术中,共有85例急性冠状动脉综合征患者接受了ARCA PCI治疗,最终纳入分析。分析收集了患者的 PCI 策略(即刻手术与分阶段手术中的支架植入)和采用的药物治疗方法。主要结果是手术成功率(技术成功且无院内MACE):结果:48.2%的病例获得了主要结果,立即PCI组和分期PCI组之间没有观察到显著差异(50.9% vs 43.3%,P = 0.504)。分期 PCI 组患者的静脉抗凝剂使用率(83.3% vs 48.1%,p = 0.002)、BARC 3 型和 5 型出血率(12.9% vs 1.9%,p = 0.037)和住院时间(7.40 ± 5.11 vs 9.5 ± 5.25 天,p = 0.049)均明显更高。经过多变量分析,两组患者均未发现手术成功的独立预测因素。靶病变失败发生率为24.1%,中位随访三年,两组间无差异:结论:在接受ARCA PCI治疗的ACS患者中,立即或分期PCI与相似的院内和长期预后相关。然而,与立即PCI策略相比,分期PCI与更高的大出血风险和更长的住院时间相关。
{"title":"Percutaneous coronary interventions for aneurysmatic right coronary artery in acute coronary syndrome: RIGHTMARE registry outcomes.","authors":"Giulio Piedimonte, Enrico Cerrato, Cristina Rolfo, Ivan J Nunez Gil, Lorenzo Azzalini, Riccardo Mangione, Francesco Maiellaro, Alberto Boi, Donovan Riganelli, Andrea Sardone, Francesco Bruno, Fernando Scudiero, Giampiero Vizzari, Gabriele Carciotto, Dario Calderone, Marco Borgi, Francesco Paolo Cancro, Ivan Sanchez, Massimo Leoncini, Emanuele Sagazio, Francesco Colombo, Gabriele Rosso, Tania Chechi, Simone Zecchino, Marco Pavani, Alfonso Franzè, Greca Zanda, Manuel Bosco, Jose Maria De La Torre Hernandez, Antonio Micari, Gennaro Galasso, Francesco Versaci, Corrado Tamburino, Giuseppe Patti, Alessio La Manna, Francesco Tomassini, Ferdinando Varbella","doi":"10.1016/j.carrev.2024.08.013","DOIUrl":"https://doi.org/10.1016/j.carrev.2024.08.013","url":null,"abstract":"<p><strong>Background: </strong>The optimal strategy during percutaneous coronary intervention (PCI) of aneurysmatic right coronary artery (ARCA) remains uncertain and has never been tested in the acute setting.</p><p><strong>Objectives: </strong>To compare the in-hospital and long-term outcomes of immediate and staged PCI strategies for ARCA as culprit lesions during acute coronary syndrome (ACS).</p><p><strong>Methods: </strong>Among 102.376 PCIs performed in 18 European centers, a total of 85 patients presenting with acute coronary syndrome undergoing ARCA PCI were finally included in the analysis. PCI strategy (stenting performed during the immediate vs staged procedure) and pharmacological approach adopted were collected. The primary outcome was procedural success (technical success without in-hospital MACE).</p><p><strong>Results: </strong>The primary outcome occurred in 48.2 % of cases, with no significant differences observed between the immediate and staged PCI groups (50.9 % vs 43.3 %, p = 0.504). Patients in the staged-PCI group had a significantly higher rate of intravenous anticoagulant use (83.3 % vs 48.1 %, p = 0.002), BARC type 3 and 5 bleedings (12.9 % vs 1.9 %, p = 0.037), and longer in-hospital stay (7.40 ± 5.11 vs 9.5 ± 5.25 days, p = 0.049). After multivariate analysis, no independent predictors for procedural success were found in either group. Target lesion failure occurred in 24.1 % of cases without differences between groups at a median follow-up of three years.</p><p><strong>Conclusions: </strong>Among patients undergoing ARCA PCI in the setting of ACS, immediate or staged PCI were associated with similar in-hospital and long-term outcomes. However, staged PCI was associated with a higher risk of major bleeding events and longer length of stay compared to immediate PCI strategy.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142056843","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}
Pub Date : 2024-08-22DOI: 10.1016/j.carrev.2024.08.007
Enrico Poletti, Ignacio Amat-Santos, Enrico Criscione, Antonio Popolo Rubbio, Mario García-Gómez, Mateusz Orzalkiewicz, Manuel Pan, Antonio Sisinni, Mattia Squillace, Bruno García Del Blanco, Francesco Bruno, Vasileios Panoulas, Radoslaw Pracon, Ole De Backer, Maurizio Taramasso, Giuliano Costa, Marco Barbanti, Nicolas M Van Mieghem, Damiano Regazzoli, Antonio Mangieri, Andrea Scotti, Azeem Latib, Francesco Saia, Francesco Bedogni, Luca Testa
Background: The off-label utilization of transcatheter heart valve (THV) devices for the treatment of inoperable or high-surgical risk patients with pure native aortic valve regurgitation (NAVR) has demonstrated suboptimal outcomes, both with self- and balloon-expandable (BE) devices. The aim of this study is to compare the use of different BE scaffolds in treating pure NAVR.
Methods: Consecutive patients with pure severe NAVR who were deemed to be at high-risk and were treated with last-generation BE-THVs among seventeen Centers in Europe and US. Technical and device success rates were the primary objectives.
Results: Between February 2018 and July 2023, among 144 patients, 41 (28 %) received a MyVal device and 103 (72 %) were treated with a Sapien THV. Patients treated with a MyVal THV had an extra-large annulus more frequently compared to the Sapien group (49%vs.20 %, p < 0.001). Technical and device success rates were 90 % and 81 %, respectively, p > 0.1. The rate of THV migration/embolization (MyVal 4.9%vs. Sapien 11 %, p = 0.4) and second valve needed (4.9%vs.7.8 %, p = 0.7) were numerically lower in the MyVal group, whereas the rate of at least moderate paravalvular leak (15%vs.7.8 %, p = 0.2) and permanent pacemaker implantation (25%vs.18 %, p = 0.16) were numerically higher in the Myval group.
Conclusions: Off-label use of BE devices for pure NAVR represents a potential alternative in high-risk patients in the absence of dedicated devices. However, BE in NAVR is associated with suboptimal outcomes. The availability of larger THV sizes may introduce transcatheter aortic valve replacement as an effective treatment for patients traditionally deemed unsuitable.
Non-standard abbreviations and acronyms: AR = aortic regurgitation, BE = balloon-expandable, NAVR = native aortic valve regurgitation, PM = pacemaker, TAVR = transcatheter aortic valve replacement, THV = transcatheter heart valve, TVEM = transcatheter valve embolization and migration, VARC-3 = Valve Academic Research Consortium 3.
{"title":"Performance of balloon-expandable transcatheter bioprostheses in inoperable patients with pure aortic regurgitation of a native valve: The BE-PANTHEON international project.","authors":"Enrico Poletti, Ignacio Amat-Santos, Enrico Criscione, Antonio Popolo Rubbio, Mario García-Gómez, Mateusz Orzalkiewicz, Manuel Pan, Antonio Sisinni, Mattia Squillace, Bruno García Del Blanco, Francesco Bruno, Vasileios Panoulas, Radoslaw Pracon, Ole De Backer, Maurizio Taramasso, Giuliano Costa, Marco Barbanti, Nicolas M Van Mieghem, Damiano Regazzoli, Antonio Mangieri, Andrea Scotti, Azeem Latib, Francesco Saia, Francesco Bedogni, Luca Testa","doi":"10.1016/j.carrev.2024.08.007","DOIUrl":"https://doi.org/10.1016/j.carrev.2024.08.007","url":null,"abstract":"<p><strong>Background: </strong>The off-label utilization of transcatheter heart valve (THV) devices for the treatment of inoperable or high-surgical risk patients with pure native aortic valve regurgitation (NAVR) has demonstrated suboptimal outcomes, both with self- and balloon-expandable (BE) devices. The aim of this study is to compare the use of different BE scaffolds in treating pure NAVR.</p><p><strong>Methods: </strong>Consecutive patients with pure severe NAVR who were deemed to be at high-risk and were treated with last-generation BE-THVs among seventeen Centers in Europe and US. Technical and device success rates were the primary objectives.</p><p><strong>Results: </strong>Between February 2018 and July 2023, among 144 patients, 41 (28 %) received a MyVal device and 103 (72 %) were treated with a Sapien THV. Patients treated with a MyVal THV had an extra-large annulus more frequently compared to the Sapien group (49%vs.20 %, p < 0.001). Technical and device success rates were 90 % and 81 %, respectively, p > 0.1. The rate of THV migration/embolization (MyVal 4.9%vs. Sapien 11 %, p = 0.4) and second valve needed (4.9%vs.7.8 %, p = 0.7) were numerically lower in the MyVal group, whereas the rate of at least moderate paravalvular leak (15%vs.7.8 %, p = 0.2) and permanent pacemaker implantation (25%vs.18 %, p = 0.16) were numerically higher in the Myval group.</p><p><strong>Conclusions: </strong>Off-label use of BE devices for pure NAVR represents a potential alternative in high-risk patients in the absence of dedicated devices. However, BE in NAVR is associated with suboptimal outcomes. The availability of larger THV sizes may introduce transcatheter aortic valve replacement as an effective treatment for patients traditionally deemed unsuitable.</p><p><strong>Non-standard abbreviations and acronyms: </strong>AR = aortic regurgitation, BE = balloon-expandable, NAVR = native aortic valve regurgitation, PM = pacemaker, TAVR = transcatheter aortic valve replacement, THV = transcatheter heart valve, TVEM = transcatheter valve embolization and migration, VARC-3 = Valve Academic Research Consortium 3.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142093978","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}
Pub Date : 2024-08-22DOI: 10.1016/j.carrev.2024.08.006
Shreyash M Manegaonkar, Rishi Sukhija, Mohamed A Effat, Marepalli Rao, Rupak K Banerjee
Background: Evaluating the severity of aortic stenosis (AS) can be challenging, particularly in patients with low-gradient (LG, Δp < 40 mmHg) AS.
Objective: This study aims to improve the accuracy of assessing severity of AS using a novel functional index- Aortic Valve Coefficient (AVC). The AVC is defined as ratio of mean transvalvular pressure-drop (Δp) to the proximal dynamic pressure (1/2 × blood density × VLVOT2; VLVOT: left ventricular outflow tract peak velocity).
Hypothesis: AVC, developed from fundamental fluid dynamic principles, is a better index for accessing AS severity as it incorporates square of VLVOT and downstream pressure recovery.
Methods: This pilot prospective study enrolled 47 patients undergoing TAVR for AS. Using cardiac-catheterization-measured Δp and echocardiography-Doppler-derived VLVOT, AVC was evaluated. Pre- and post-TAVR pressure-velocity measurements were obtained, resulting in a dataset with 78 data points, including 32 data points specifically linked to LG AS. Linear regression analysis was performed to correlate AVC with Δp, VLVOT and aortic-valve-area. Welch 2-sample t-test was carried out to compare the means of AVC against aortic-valve-area.
Results: Moderate correlation (r = 0.85) was observed between AVC and aortic-valve-area indicating AVC could be a prospective index. However, correlation decreased (r = 0.75) in LG AS patients, indicating increased discordancy. Comparing AVC and aortic-valve-area in LG AS patients with left ventricular ejection fraction (LVEF) < 50 % and LVEF ≥50 %, t-test showed that AVC values are significantly different (p < 0.05) as compared to aortic-valve-area (p = 0.48).
Conclusion: AVC, a novel index, has the potential to improve assessment of AS severity and clinical decision making for treating patients with AS.
Condensed abstract: Complex hemodynamics, such as paradoxical "low-flow low-gradient (LG)" Aortic stenosis (AS) can be difficult to diagnose. Currently, mean transvalvular pressure-drop and flow-derived aortic-valve-area assess AS severity. Aortic valve coefficient (AVC) is a novel index which combines both pressure-drop and flow measurements to assess the severity of AS. A total of 47 patients (72 data points) were studied undergoing TAVR. In LG AS patients, t-test comparing left ventricular ejection fraction (LVEF) < 50 % and LVEF ≥50 % showed that AVC are significantly different (p < 0.05) as compared to aortic-valve-area (p = 0.48). Therefore, AVC could be a better index.
背景:评估主动脉瓣狭窄(AS)的严重程度具有挑战性,尤其是在低梯度(LG,Δp)患者中:本研究旨在使用一种新型功能性指标--主动脉瓣系数(AVC)来提高评估主动脉瓣狭窄严重程度的准确性。AVC 的定义是平均跨瓣压降(Δp)与近端动态压力(1/2 × 血液密度 × VLVOT2;VLVOT:左室流出道峰值速度)之比:假设:根据流体动力学基本原理开发的AVC是评估强直性脊柱炎严重程度的更好指标,因为它包含了VLVOT的平方和下游压力恢复:这项试验性前瞻性研究招募了 47 名因 AS 而接受 TAVR 的患者。方法:这项试验性前瞻性研究共纳入了 47 名因 AS 而接受 TAVR 的患者,使用心脏导管测量的 Δp 和超声心动图-多普勒衍生的 VLVOT 对 AVC 进行了评估。TAVR前和TAVR后的压力-速度测量结果产生了一个包含78个数据点的数据集,其中包括32个与LG AS特别相关的数据点。进行了线性回归分析,将 AVC 与 Δp、VLVOT 和主动脉瓣面积相关联。对 AVC 与主动脉瓣面积的平均值进行了韦尔奇 2 样本 t 检验:结果:AVC 与主动脉瓣面积之间存在适度的相关性(r = 0.85),表明 AVC 可以作为一种前瞻性指标。然而,LG AS 患者的相关性降低(r = 0.75),表明不一致性增加。比较左心室射血分数(LVEF)的 LG AS 患者的 AVC 和主动脉瓣面积 结论:AVC作为一项新指标,有可能改善对AS严重程度的评估和治疗AS患者的临床决策。主动脉瓣狭窄(AS)很难诊断。目前,平均跨瓣压降和血流衍生的主动脉瓣面积可评估主动脉瓣狭窄的严重程度。主动脉瓣系数(AVC)是一种新型指数,它结合了压降和血流测量来评估主动脉瓣狭窄的严重程度。共对 47 名接受 TAVR 的患者(72 个数据点)进行了研究。在LG AS患者中,比较左心室射血分数(LVEF)的t检验结果为:LVEF(左心室射血分数)高于AVC(左心室射血分数)。
{"title":"A novel functional index, aortic-valve-coefficient, for assessing aortic-stenosis in patients undergoing TAVR: A prospective-pilot study.","authors":"Shreyash M Manegaonkar, Rishi Sukhija, Mohamed A Effat, Marepalli Rao, Rupak K Banerjee","doi":"10.1016/j.carrev.2024.08.006","DOIUrl":"https://doi.org/10.1016/j.carrev.2024.08.006","url":null,"abstract":"<p><strong>Background: </strong>Evaluating the severity of aortic stenosis (AS) can be challenging, particularly in patients with low-gradient (LG, Δp < 40 mmHg) AS.</p><p><strong>Objective: </strong>This study aims to improve the accuracy of assessing severity of AS using a novel functional index- Aortic Valve Coefficient (AVC). The AVC is defined as ratio of mean transvalvular pressure-drop (Δp) to the proximal dynamic pressure (1/2 × blood density × V<sub>LVOT</sub><sup>2</sup>; V<sub>LVOT</sub>: left ventricular outflow tract peak velocity).</p><p><strong>Hypothesis: </strong>AVC, developed from fundamental fluid dynamic principles, is a better index for accessing AS severity as it incorporates square of V<sub>LVOT</sub> and downstream pressure recovery.</p><p><strong>Methods: </strong>This pilot prospective study enrolled 47 patients undergoing TAVR for AS. Using cardiac-catheterization-measured Δp and echocardiography-Doppler-derived V<sub>LVOT</sub>, AVC was evaluated. Pre- and post-TAVR pressure-velocity measurements were obtained, resulting in a dataset with 78 data points, including 32 data points specifically linked to LG AS. Linear regression analysis was performed to correlate AVC with Δp, V<sub>LVOT</sub> and aortic-valve-area. Welch 2-sample t-test was carried out to compare the means of AVC against aortic-valve-area.</p><p><strong>Results: </strong>Moderate correlation (r = 0.85) was observed between AVC and aortic-valve-area indicating AVC could be a prospective index. However, correlation decreased (r = 0.75) in LG AS patients, indicating increased discordancy. Comparing AVC and aortic-valve-area in LG AS patients with left ventricular ejection fraction (LVEF) < 50 % and LVEF ≥50 %, t-test showed that AVC values are significantly different (p < 0.05) as compared to aortic-valve-area (p = 0.48).</p><p><strong>Conclusion: </strong>AVC, a novel index, has the potential to improve assessment of AS severity and clinical decision making for treating patients with AS.</p><p><strong>Condensed abstract: </strong>Complex hemodynamics, such as paradoxical \"low-flow low-gradient (LG)\" Aortic stenosis (AS) can be difficult to diagnose. Currently, mean transvalvular pressure-drop and flow-derived aortic-valve-area assess AS severity. Aortic valve coefficient (AVC) is a novel index which combines both pressure-drop and flow measurements to assess the severity of AS. A total of 47 patients (72 data points) were studied undergoing TAVR. In LG AS patients, t-test comparing left ventricular ejection fraction (LVEF) < 50 % and LVEF ≥50 % showed that AVC are significantly different (p < 0.05) as compared to aortic-valve-area (p = 0.48). Therefore, AVC could be a better index.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142113444","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}
Pub Date : 2024-08-22DOI: 10.1016/j.carrev.2024.08.012
Placido Maria Mazzone, Davide Capodanno
{"title":"C-reactive protein and TAVR: Impact of inflammation on patient outcomes.","authors":"Placido Maria Mazzone, Davide Capodanno","doi":"10.1016/j.carrev.2024.08.012","DOIUrl":"https://doi.org/10.1016/j.carrev.2024.08.012","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142082144","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}
Pub Date : 2024-08-22DOI: 10.1016/j.carrev.2024.08.014
David Gittess, R David Anderson
{"title":"Editorial response to \"Outcomes in transcatheter aortic valve replacement (TAVR) patients requiring red blood cell transfusion: A nationwide perspective\".","authors":"David Gittess, R David Anderson","doi":"10.1016/j.carrev.2024.08.014","DOIUrl":"https://doi.org/10.1016/j.carrev.2024.08.014","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142082145","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}
Pub Date : 2024-08-20DOI: 10.1016/j.carrev.2024.08.008
Keshav Patel, Melissa Duckett, Mladen I Vidovich, Khalil Ibrahim
Introduction: Intra-arterial (IA) vasodilators are recommended during transradial access (TRA) to prevent radial artery spasm (RAS). The American Heart Association (AHA) recommends either IA verapamil, diltiazem, nicardipine, or nitroglycerin to prevent RAS. To our knowledge, the efficacy of RAS prevention and patient tolerability of verapamil and nicardipine has not been directly compared in a randomized fashion.
Methods: We conducted a prospective, single-blinded randomized clinical trial comparing the discomfort experienced by patients receiving either 400 μg of IA nicardipine (n = 26) or 5 mg of IA verapamil (n = 29). Patient discomfort and/or pain was assessed using the Visual Analogue Scale (VAS) both before and after IA administration of nicardipine or verapamil.
Results: There was a statistically significant difference in mean change in VAS scores between the 2 groups, with an average increase in VAS score of 0.88 in the nicardipine group and 4.81 in the verapamil group (p < 0.0001). The overall rate of RAS was low in our study (5.5 %) with no significant difference in RAS incidence between the 2 groups (p = 0.465). The nicardipine group had 2 RAS cases (7.7 %), with 1 requiring a change in strategy (3.8 %). The verapamil group had 1 RAS case (3.4 %) that did not require a change in strategy.
Conclusion: In this trial, we showed that nicardipine causes significantly less discomfort and pain compared to verapamil during IA administration for TRA cardiac catheterization.
导言:建议在经桡动脉入路(TRA)时使用动脉内(IA)血管扩张剂,以防止桡动脉痉挛(RAS)。美国心脏协会(AHA)建议使用维拉帕米、地尔硫卓、尼卡地平或硝酸甘油来预防 RAS。据我们所知,维拉帕米和尼卡地平对 RAS 的预防效果和患者耐受性还没有进行过直接的随机比较:我们进行了一项前瞻性、单盲随机临床试验,比较了接受 400 μg 体内注射尼卡地平(26 人)或 5 mg 体内注射维拉帕米(29 人)的患者的不适感。在服用尼卡地平或维拉帕米前后,均使用视觉模拟量表(VAS)对患者的不适和/或疼痛进行评估:结果:两组 VAS 评分的平均变化差异有统计学意义,尼卡地平组 VAS 评分平均增加 0.88 分,维拉帕米组则平均增加 4.81 分(p 结论:尼卡地平和维拉帕米的疗效均优于尼卡地平:本试验表明,与维拉帕米相比,尼卡地平在 TRA 心导管植入术中引起的不适和疼痛明显更少。
{"title":"Intra-arterial nicardipine versus verapamil during transradial access coronary catheterization.","authors":"Keshav Patel, Melissa Duckett, Mladen I Vidovich, Khalil Ibrahim","doi":"10.1016/j.carrev.2024.08.008","DOIUrl":"https://doi.org/10.1016/j.carrev.2024.08.008","url":null,"abstract":"<p><strong>Introduction: </strong>Intra-arterial (IA) vasodilators are recommended during transradial access (TRA) to prevent radial artery spasm (RAS). The American Heart Association (AHA) recommends either IA verapamil, diltiazem, nicardipine, or nitroglycerin to prevent RAS. To our knowledge, the efficacy of RAS prevention and patient tolerability of verapamil and nicardipine has not been directly compared in a randomized fashion.</p><p><strong>Methods: </strong>We conducted a prospective, single-blinded randomized clinical trial comparing the discomfort experienced by patients receiving either 400 μg of IA nicardipine (n = 26) or 5 mg of IA verapamil (n = 29). Patient discomfort and/or pain was assessed using the Visual Analogue Scale (VAS) both before and after IA administration of nicardipine or verapamil.</p><p><strong>Results: </strong>There was a statistically significant difference in mean change in VAS scores between the 2 groups, with an average increase in VAS score of 0.88 in the nicardipine group and 4.81 in the verapamil group (p < 0.0001). The overall rate of RAS was low in our study (5.5 %) with no significant difference in RAS incidence between the 2 groups (p = 0.465). The nicardipine group had 2 RAS cases (7.7 %), with 1 requiring a change in strategy (3.8 %). The verapamil group had 1 RAS case (3.4 %) that did not require a change in strategy.</p><p><strong>Conclusion: </strong>In this trial, we showed that nicardipine causes significantly less discomfort and pain compared to verapamil during IA administration for TRA cardiac catheterization.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142082146","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}
Pub Date : 2024-08-17DOI: 10.1016/j.carrev.2024.08.002
Ahmad Jabri, Mohammed Ayyad, Maram Albandak, Ahmad Al-Abdouh, Luai Madanat, Basma Badrawy Khalefa, Laith Alhuneafat, Asem Ayyad, Alejandro Lemor, Mohammed Mhanna, Zaid Al Jebaje, Raef Fadel, Pedro Engel Gonzalez, Brian O'Neill, Rodrigo Bagur, Ivan D Hanson, Amr E Abbas, Tiberio Frisoli, James Lee, Dee Dee Wang, Vikas Aggarwal, Khaldoon Alaswad, William W O'Neill, Herbert D Aronow, Mohammad AlQarqaz, Pedro Villablanca
Background: While transcatheter aortic valve replacement (TAVR) has broadened treatment options for critically ill patients, outcomes among those with concomitant cardiogenic shock (CS) are not well-explored.
Methods: We conducted a comprehensive search of major databases for studies comparing outcomes following TAVR in patients with and without CS since inception up to October 31, 2023. Our meta-analysis included five non-randomized observational. Dichotomous outcomes were assessed using the Mantel-Haenszel method (risk ratio, 95 % CI), and continuous outcomes were evaluated using mean difference and 95 % CI with the inverse variance method. Statistical heterogeneity was determined using the inconsistency test (I2).
Results: Among 26,283 patients across five studies, 30-day mortality was higher in the CS group (7267 patients; 27.6 %) compared to those without CS (OR 3.41, 95 % CI [2.01, 5.76], p < 0.01), as well as 30-day major vascular complications (OR 1.72, 95 % CI [1.54, 1.92], p < 0.01). At 1-year follow-up, there was no statistically significant difference in mortality rates between the compared groups (OR 2.68, 95 % CI [0.53, 13.46], p = 0.12). No significant between-group differences were observed in the likelihood of 30-day aortic valve reintervention (OR 3.20, 95 % CI [0.63, 16.22], p = 0.09) or post-TAVR aortic insufficiency (OR 0.91, 95 % CI [0.33, 2.51], p = 0.73). Furthermore, 30-day stroke, pacemaker implantation, and in-hospital major bleeding were comparable between both cohorts.
Conclusion: Among patients undergoing TAVR, short-term mortality is higher but one-year outcomes are similar when comparing those with, to those without, CS. Future studies should examine whether TAVR outcomes are improved when the procedure is delayed to optimize CS and when delay is not possible, whether particular management strategies lead to more favorable periprocedural outcomes.
{"title":"Outcomes following TAVR in patients with cardiogenic shock: A systematic review and meta-analysis.","authors":"Ahmad Jabri, Mohammed Ayyad, Maram Albandak, Ahmad Al-Abdouh, Luai Madanat, Basma Badrawy Khalefa, Laith Alhuneafat, Asem Ayyad, Alejandro Lemor, Mohammed Mhanna, Zaid Al Jebaje, Raef Fadel, Pedro Engel Gonzalez, Brian O'Neill, Rodrigo Bagur, Ivan D Hanson, Amr E Abbas, Tiberio Frisoli, James Lee, Dee Dee Wang, Vikas Aggarwal, Khaldoon Alaswad, William W O'Neill, Herbert D Aronow, Mohammad AlQarqaz, Pedro Villablanca","doi":"10.1016/j.carrev.2024.08.002","DOIUrl":"https://doi.org/10.1016/j.carrev.2024.08.002","url":null,"abstract":"<p><strong>Background: </strong>While transcatheter aortic valve replacement (TAVR) has broadened treatment options for critically ill patients, outcomes among those with concomitant cardiogenic shock (CS) are not well-explored.</p><p><strong>Methods: </strong>We conducted a comprehensive search of major databases for studies comparing outcomes following TAVR in patients with and without CS since inception up to October 31, 2023. Our meta-analysis included five non-randomized observational. Dichotomous outcomes were assessed using the Mantel-Haenszel method (risk ratio, 95 % CI), and continuous outcomes were evaluated using mean difference and 95 % CI with the inverse variance method. Statistical heterogeneity was determined using the inconsistency test (I<sup>2</sup>).</p><p><strong>Results: </strong>Among 26,283 patients across five studies, 30-day mortality was higher in the CS group (7267 patients; 27.6 %) compared to those without CS (OR 3.41, 95 % CI [2.01, 5.76], p < 0.01), as well as 30-day major vascular complications (OR 1.72, 95 % CI [1.54, 1.92], p < 0.01). At 1-year follow-up, there was no statistically significant difference in mortality rates between the compared groups (OR 2.68, 95 % CI [0.53, 13.46], p = 0.12). No significant between-group differences were observed in the likelihood of 30-day aortic valve reintervention (OR 3.20, 95 % CI [0.63, 16.22], p = 0.09) or post-TAVR aortic insufficiency (OR 0.91, 95 % CI [0.33, 2.51], p = 0.73). Furthermore, 30-day stroke, pacemaker implantation, and in-hospital major bleeding were comparable between both cohorts.</p><p><strong>Conclusion: </strong>Among patients undergoing TAVR, short-term mortality is higher but one-year outcomes are similar when comparing those with, to those without, CS. Future studies should examine whether TAVR outcomes are improved when the procedure is delayed to optimize CS and when delay is not possible, whether particular management strategies lead to more favorable periprocedural outcomes.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142113458","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}
Background: The impact of palliative care consultation on the management and outcomes of patients hospitalized with out-of-hospital cardiac arrest (OHCA) remains poorly understood. This study examined associations between palliative care consultation and in-hospital outcomes of patients hospitalized with OHCA, stratified by survival status.
Method: This cross-sectional study used data from the National Inpatient Sample (2016-2021). Adult patients hospitalized with OHCA who received cardiopulmonary resuscitation were included. Multivariable analyses assessed associations between palliative care consultation and outcomes in non-terminal and terminal OHCA hospitalizations, adjusting for demographics, hospital characteristics, and comorbidities.
Results: Among 488,700 OHCA hospitalizations, palliative care consultation was associated with lower odds of invasive procedures in non-terminal hospitalizations, including percutaneous coronary intervention (PCI) (aOR 0.30, 95 % CI 0.25-0.36), mechanical circulatory support (aOR 0.54, 95 % CI 0.44-0.68), permanent pacemaker (aOR 0.27, 95 % CI 0.20-0.37), implantable cardioverter defibrillator insertion (aOR 0.22, 95 % CI 0.16-0.31), and cardioversion (aOR 0.62, 95 % CI 0.55-0.70). In terminal hospitalizations, palliative care was associated with lower odds of PCI (aOR 0.78, 95 % CI 0.70-0.87) and cardioversion (aOR 0.91, 95 % CI 0.85-0.97), but higher odds of therapeutic hypothermia (aOR 3.12, 95 % CI 2.72-3.59), gastrostomy (aOR 1.22, 95 % CI 1.05-1.41), and renal replacement therapy (aOR 1.19, 95 % CI 1.12-1.26). Palliative care was associated with higher DNR utilization in both subgroups and lower hospital costs in non-terminal hospitalizations but higher costs in terminal hospitalizations.
Conclusion: Palliative care consultation in OHCA is associated with differences in invasive procedures, DNR utilization, and hospital costs, varying by survival status.
背景:姑息关怀咨询对院外心脏骤停(OHCA)住院患者的管理和预后的影响仍鲜为人知。本研究探讨了姑息治疗咨询与OHCA住院患者的院内预后之间的关系,并根据生存状况进行了分层:这项横断面研究使用了全国住院病人抽样调查(2016-2021 年)的数据。研究纳入了接受心肺复苏的 OHCA 住院成人患者。多变量分析评估了姑息治疗咨询与非终末期和终末期 OHCA 住院治疗结果之间的关联,并对人口统计学、医院特征和合并症进行了调整:在 488,700 例 OHCA 住院患者中,姑息关怀咨询与非终末期住院患者较低的侵入性程序几率相关,包括经皮冠状动脉介入治疗(PCI)(aOR 0.30,95 % CI 0.25-0.36)、机械循环支持(aOR 0.54,95 % CI 0.44-0.68)、永久起搏器(aOR 0.27,95 % CI 0.20-0.37)、植入式心律转复除颤器(aOR 0.22,95 % CI 0.16-0.31)和心脏复律(aOR 0.62,95 % CI 0.55-0.70)。在末期住院治疗中,姑息治疗与较低的 PCI(aOR 0.78,95 % CI 0.70-0.87)和心脏电复律(aOR 0.91,95 % CI 0.85-0.97)几率相关,但与较高的治疗性低温(aOR 3.12,95 % CI 2.72-3.59)、胃造瘘(aOR 1.22,95 % CI 1.05-1.41)和肾脏替代治疗(aOR 1.19,95 % CI 1.12-1.26)几率相关。姑息治疗与两个亚组中较高的DNR使用率和较低的非终末期住院费用相关,但与较高的终末期住院费用相关:结论:在 OHCA 患者中,姑息治疗咨询与侵入性手术、DNR 使用率和住院费用的差异有关,这些差异因存活状况而异。
{"title":"Palliative care consultation in patients hospitalized with out-of-hospital cardiac arrest: Impact on invasive procedures, do-not-resuscitate orders, and healthcare costs.","authors":"Abdilahi Mohamoud, Nadhem Abdallah, Abdirahman Wardhere, Mahmoud Ismayl","doi":"10.1016/j.carrev.2024.08.003","DOIUrl":"https://doi.org/10.1016/j.carrev.2024.08.003","url":null,"abstract":"<p><strong>Background: </strong>The impact of palliative care consultation on the management and outcomes of patients hospitalized with out-of-hospital cardiac arrest (OHCA) remains poorly understood. This study examined associations between palliative care consultation and in-hospital outcomes of patients hospitalized with OHCA, stratified by survival status.</p><p><strong>Method: </strong>This cross-sectional study used data from the National Inpatient Sample (2016-2021). Adult patients hospitalized with OHCA who received cardiopulmonary resuscitation were included. Multivariable analyses assessed associations between palliative care consultation and outcomes in non-terminal and terminal OHCA hospitalizations, adjusting for demographics, hospital characteristics, and comorbidities.</p><p><strong>Results: </strong>Among 488,700 OHCA hospitalizations, palliative care consultation was associated with lower odds of invasive procedures in non-terminal hospitalizations, including percutaneous coronary intervention (PCI) (aOR 0.30, 95 % CI 0.25-0.36), mechanical circulatory support (aOR 0.54, 95 % CI 0.44-0.68), permanent pacemaker (aOR 0.27, 95 % CI 0.20-0.37), implantable cardioverter defibrillator insertion (aOR 0.22, 95 % CI 0.16-0.31), and cardioversion (aOR 0.62, 95 % CI 0.55-0.70). In terminal hospitalizations, palliative care was associated with lower odds of PCI (aOR 0.78, 95 % CI 0.70-0.87) and cardioversion (aOR 0.91, 95 % CI 0.85-0.97), but higher odds of therapeutic hypothermia (aOR 3.12, 95 % CI 2.72-3.59), gastrostomy (aOR 1.22, 95 % CI 1.05-1.41), and renal replacement therapy (aOR 1.19, 95 % CI 1.12-1.26). Palliative care was associated with higher DNR utilization in both subgroups and lower hospital costs in non-terminal hospitalizations but higher costs in terminal hospitalizations.</p><p><strong>Conclusion: </strong>Palliative care consultation in OHCA is associated with differences in invasive procedures, DNR utilization, and hospital costs, varying by survival status.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142037294","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}