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New-generation single-layer PTFE-covered coronary stent for endovascular repair of iatrogenic arterial side-branch injury in non-coronary lesions for the RECOVER (REsults after percutaneous interventions with COVERed stents) Investigators. 新一代单层 PTFE 包覆冠状动脉支架用于非冠状动脉病变中先天性动脉侧支损伤的血管内修复,RECOVER(使用 COVERed 支架经皮介入治疗后的结果)研究者。
IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-18 DOI: 10.1016/j.carrev.2024.09.018
Lisa Strauß, Lorenzo Gibello, Felix Voll, Hector A Alvarez-Covarrubias, Tobias Lenz, Salvatore Cassese, Erion Xhepa, Michael Joner, Heribert Schunkert, Adnan Kastrati, Maria Antonella Ruffino, Sebastian Kufner

Background: The incidence of iatrogenic injuries in peripheral arteries is increasing due to the expanding opportunities of managing various cardiovascular diseases by means of percutaneous intervention. Thus, endovascular repair with implantation of covered stent (CS) after vascular injury is gaining importance as an alternative to open surgery. In cases of smaller side-branch injuries, stenting of the main vessel with subsequent exclusion and sealing of the side-branch is associated with unfavourable revascularization rates and unpredictable ischemic complications in the corresponding supply area.

Objective: This study reports the procedural and clinical outcomes of patients with iatrogenic vascular side-branch injuries treated with coronary-CS directly at the site of injury.

Methods: This is a retrospective, multicentre registry study, including 40 patients with acute iatrogenic injuries of arterial side-branches undergoing implantation of single-layer polytetrafluorethylene (PTFE)-CS at 3 different centres in Europe between June 2014 and June 2023. Endpoints were procedural success, death, target vessel reintervention (TVR), bleeding and the need for surgical conversion.

Results: A total of 40 patients underwent implantation of single-layer PTFE-CS in the lower (97.5 %) and the upper limbs (2.5 %). The most common mechanisms were injuries after punctures, caused by needle and/or sheath (80 %), balloon-dilations (7.5 %) and during/after non-cardiac surgery (7.5 %). Procedural success was achieved in all cases (100 %). The rate of in-hospital mortality was 7.5 %. The median duration of hospitalization after the CS procedure was 4 days [2; 5.3]. At a median follow-up of 202.5 days [97.3-711.8], 36 patients (90 %) were alive and main vessel patency was 100 %. There were no cases of TVRs, bleedings or surgical conversions. Access-site related complications occurred in 5 % of all cases.

Conclusions: In this study, the use of new-generation single-layer PTFE-covered coronary stents in non-coronary side-branch lesions after iatrogenic arterial injury shows a high technical success rate and favourable clinical efficacy and safety.

背景:由于经皮介入治疗各种心血管疾病的机会越来越多,外周动脉先天性损伤的发生率也在不断上升。因此,在血管损伤后植入覆盖支架(CS)进行血管内修复,作为开刀手术的替代方法正变得越来越重要。在较小的侧支损伤病例中,先对主血管进行支架植入,然后再对侧支进行切除和封堵,这与不利的血管再通率和相应供血区域不可预测的缺血性并发症有关:本研究报告了先天性血管侧支损伤患者直接在损伤部位接受冠状动脉造影术治疗的过程和临床结果:这是一项回顾性、多中心登记研究,包括 40 名动脉侧支急性先天性损伤患者,他们于 2014 年 6 月至 2023 年 6 月期间在欧洲 3 个不同中心接受了单层聚四氟乙烯(PTFE)-CS 植入术。终点是手术成功率、死亡、靶血管再介入(TVR)、出血和手术转换需求:共有 40 名患者在下肢(97.5%)和上肢(2.5%)接受了单层 PTFE-CS 植入术。最常见的机制是穿刺损伤,由针头和/或鞘造成(80%)、球囊扩张(7.5%)和非心脏手术期间/之后(7.5%)。所有病例都取得了手术成功(100%)。院内死亡率为 7.5%。CS手术后的中位住院时间为4天[2; 5.3]。中位随访时间为202.5天[97.3-711.8天],36名患者(90%)存活,主血管通畅率为100%。没有发生 TVR、出血或手术转换。在所有病例中,5%的患者出现了与入路相关的并发症:在这项研究中,在先天性动脉损伤后的非冠状动脉侧支病变中使用新一代单层聚四氟乙烯覆盖冠状动脉支架显示出较高的技术成功率以及良好的临床疗效和安全性。
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引用次数: 0
Twenty-year trend of mortality from concomitant sepsis and acute myocardial infarction (Type 1 or Type 2) in the United States. 美国脓毒症和急性心肌梗死(1 型或 2 型)并发死亡率的二十年趋势。
IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-18 DOI: 10.1016/j.carrev.2024.10.003
Ashish Kumar, Rama Ellauzi, Nandan S Anavekar, Ankur Kalra
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引用次数: 0
The posterior mitral leaflet overhang: A rare yet possible complication of percutaneous mitral valve procedures. 二尖瓣后叶悬垂:经皮二尖瓣手术罕见但可能出现的并发症。
IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-15 DOI: 10.1016/j.carrev.2024.09.017
Francesca Napoli, Ciro Vella, Vittorio Romano, Luca Ferri, Marco B Ancona, Barbara Bellini, Filippo Russo, Eustachio Agricola, Antonio Esposito, Matteo Montorfano

The two surgical options for mitral valve regurgitation are replacement and repair, with annuloplasty being the cornerstone of correction. In cases of repair failure, especially in high surgical risk patients, transcatheter mitral valve-in-ring (MViR) procedures represent emerging and challenging options. Among the several complications linked to this treatment, this paper delves into the role that native mitral leaflets may play in precipitating acute bioprosthesis dysfunction in the MViR procedure. The literature extensively covers complications related to the anterior leaflet, including risks such as outflow tract obstruction and residual mitral insufficiency due to interaction between native and prosthetic leaflets. Conversely, complications involving the posterior leaflet are less understood and often overlooked. In this gap in the literature, we present a clinical case highlighting how a redundant native posterior mitral leaflet can unexpectedly lead to acute severe mitral insufficiency by interfering with prosthetic leaflets.

二尖瓣反流的两种手术方案是置换和修复,其中瓣环成形术是矫正的基础。在修复失败的情况下,尤其是手术风险较高的患者,经导管二尖瓣环内成形术(MViR)是新出现的具有挑战性的选择。在与这种治疗方法相关的几种并发症中,本文深入探讨了在 MViR 手术中,原生二尖瓣叶在引发急性生物假体功能障碍方面可能扮演的角色。文献广泛报道了与前叶有关的并发症,包括流出道梗阻和由于本体二尖瓣叶和人工二尖瓣叶相互作用导致的残余二尖瓣关闭不全等风险。相反,人们对涉及后叶的并发症了解较少,而且经常忽视。针对这一文献空白,我们介绍了一个临床病例,强调了多余的原生二尖瓣后叶如何通过干扰人工二尖瓣叶意外导致急性严重二尖瓣关闭不全。
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引用次数: 0
Imaging-guided PCI improves outcomes in patients with multivessel disease a meta-analysis of randomized and observational trials comparing treatment of ACS. 成像引导下的 PCI 可改善多血管疾病患者的预后,这是一项比较 ACS 治疗的随机和观察性试验的荟萃分析。
IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-25 DOI: 10.1016/j.carrev.2024.09.003
Jessica Saganowich, Jacob Powell, Timothy A Mixon, Jose Emilio Exaire, Hisao Otsuki, William Fearon, R Jay Widmer

Objective: This meta-analysis sought to investigate if IVUS-guided PCI (IVUS-PCI) can improve outcomes compared to standard PCI and CABG in patients with multivessel CAD.

Background: Coronary artery disease (CAD) is traditionally revascularized by either percutaneous coronary intervention (PCI) or coronary artery bypass (CABG) with a historical benefit of CABG over PCI in multivessel CAD. Intravascular ultrasound-guided PCI (IVUS-PCI) may improve outcomes compared to angiography alone.

Methods: We undertook a systematic search using PubMed, MEDLINE, EMBASE, Web of Science, and Ovid from 2017 through 2022. We included randomized controlled trials and observational trials comparing PCI vs CABG for multivessel CAD evaluated by two independent reviewers. We extracted baseline data and major adverse cardiovascular events (MACE; death from any cause, MI, stroke, or repeat revascularization) at one year. Three trials were selected based on study arm criteria: FAME 3, BEST, and Syntax II.

Results: IVUS-PCI significantly reduced death from any cause (OR 0.45, CI 0.272-0.733, p = 0.001), repeat revascularization (OR 0.62, CI 0.41-0.95, p = 0.03), and showed a non-significant reduction in MACE (OR 0.74, CI 0.54-1.01, p = 0.054) when compared to CABG. IVUS-PCI significantly reduced MACE (OR 0.52, CI 0.38-0.72, p < 0.001) and showed a non-significant reduction in death (OR 0.66, CI 0.36-1.18, p = 0.16) and numerically reduced repeat revascularization (OR 0.66, CI95 0.431-1.02, p = 0.06) when compared to PCI without IVUS.

Conclusion: IVUS-PCI reduces cardiovascular outcomes in patients with multivessel disease compared to CABG and angiographically-guided PCI at one year. These results reinforce the importance of IVUS-PCI in complex CAD and provide evidence for improved PCI outcomes compared to CABG for multivessel CAD.

目的:本荟萃分析旨在研究与标准 PCI 和 CABG 相比,IVUS 引导 PCI(IVUS-PCI)能否改善多血管 CAD 患者的预后:本荟萃分析旨在研究与标准 PCI 和 CABG 相比,IVUS 引导 PCI(IVUS-PCI)能否改善多支血管 CAD 患者的预后:冠状动脉疾病(CAD)传统上通过经皮冠状动脉介入治疗(PCI)或冠状动脉搭桥术(CABG)进行血管再通,在多血管CAD患者中,CABG的疗效一直优于PCI。与单纯血管造影术相比,血管内超声引导下的 PCI(IVUS-PCI)可能会改善治疗效果:我们使用 PubMed、MEDLINE、EMBASE、Web of Science 和 Ovid 对 2017 年至 2022 年的研究进行了系统检索。我们纳入了随机对照试验和观察性试验,这些试验比较了 PCI 与 CABG 对多血管 CAD 的治疗效果,并由两名独立审稿人进行了评估。我们提取了基线数据和一年后的主要不良心血管事件(MACE;任何原因导致的死亡、心肌梗死、中风或重复血管再通)。根据研究臂标准选择了三项试验:结果:结果:与 CABG 相比,IVUS-PCI 能明显减少任何原因导致的死亡(OR 0.45,CI 0.272-0.733,p = 0.001)和重复血管再通(OR 0.62,CI 0.41-0.95,p = 0.03),并能明显减少 MACE(OR 0.74,CI 0.54-1.01,p = 0.054)。IVUS-PCI能明显降低MACE(OR 0.52,CI 0.38-0.72,P 结论:IVUS-PCI能降低心脏病患者的死亡率:与 CABG 和血管造影引导的 PCI 相比,IVUS-PCI 可降低多血管疾病患者一年后的心血管预后。这些结果加强了 IVUS-PCI 在复杂 CAD 中的重要性,并提供了与 CABG 相比,PCI 可改善多血管 CAD 患者预后的证据。
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引用次数: 0
Strategies to optimize initial P2Y12 inhibitor therapy in STEMI patients. 优化 STEMI 患者初始 P2Y12 抑制剂治疗的策略。
IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-25 DOI: 10.1016/j.carrev.2024.09.012
Alexandra C Millhuff, James C Blankenship

Introduction: Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor is the standard of care for patients who undergo percutaneous coronary intervention (PCI) for ST elevation myocardial infarction (STEMI). Though this regimen reduces rates of ischemic events in patients with STEMI, the optimal strategy for P2Y12 administration in STEMI patients is still evolving.

Purpose: The purpose of this review is to summarize current evidence on optimal use of ticagrelor and prasugrel in the acute phase of STEMI.

Summary: Due to high platelet activity in the acute setting of STEMI and PCI, adequate and rapid platelet inhibition is important. Strategies of increased ticagrelor/prasugrel loading dose or earlier administration in STEMI have not been successful in closing this platelet inhibition gap. Potential strategies for improving ticagrelor/prasugrel use early in STEMI include bridging with intravenous antiplatelet agents or crushed or chewed administration.

Conclusion: Oral ticagrelor/prasugrel given before or immediately after STEMI PCI is usually sufficient to prevent thrombotic complications. When faster platelet inhibition is desired, or oral administration is compromised by inability to swallow tablets, crushing/chewing ticagrelor/prasugrel tablets is an alternative to intravenous P2Y12 inhibitor therapy.

简介:使用阿司匹林和 P2Y12 抑制剂的双联抗血小板疗法(DAPT)是 STEMI 患者接受经皮冠状动脉介入治疗(PCI)的标准疗法。摘要:由于 STEMI 和 PCI 急性期血小板活性较高,因此充分、快速地抑制血小板非常重要。在 STEMI 中增加替卡格雷/普拉格雷的负荷剂量或提前给药的策略并未成功缩小血小板抑制的差距。改善 STEMI 早期使用替卡格雷/普拉格雷的潜在策略包括与静脉注射抗血小板药物或压碎或咀嚼给药进行桥接:结论:在 STEMI PCI 之前或之后立即口服替卡格雷/普拉格雷通常足以预防血栓并发症。如果希望更快地抑制血小板,或因无法吞咽药片而影响口服给药,则可将替卡格雷/普拉格雷药片压碎/嚼碎,作为静脉注射 P2Y12 抑制剂疗法的替代方案。
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引用次数: 0
Intracardiac vs. transesophageal echocardiography guided transcatheter closure of patent foramen ovale and atrial septal defects. 心内超声心动图与经食道超声心动图引导的经导管卵圆孔和房间隔缺损闭合术。
IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-24 DOI: 10.1016/j.carrev.2024.09.016
Islam Shatla, Kevin Kennedy, John Thomas Saxon, Adnan K Chhatriwalla, Anthony Magalski, Kyle Lehenbauer, Islam Abdelkarim, Kenneth Christopher Huber, Chetan P Huded

Transcatheter closure of atrial septal defects (ASD) and patent foramen ovale (PFO) can be performed with transesophageal echocardiography (TEE) or intracardiac echocardiography (ICE) guidance, but data comparing both modalities in contemporary practice is lacking. Using ICD-10 codes, patients who underwent transcatheter ASD/PFO closure between 2016 and 2020 using ICE or TEE in the Nationwide Readmissions Database (NRD) were identified. Propensity-score matching was performed to compare in-hospital adverse events, length of stay (LOS), cost, and 30-day non-elective readmissions. A total of 964 patients underwent ASD/PFO closure with ICE (38.3 %, n = 369) or TEE (61.7 %, n = 595) between 2016 and 2020. Propensity score matching yielded 327 patients in each group, which were well balanced. Median (IQR) age was 59.0 (46.0, 72.0) years and 54.7 % were female. No difference was observed in the rate of in-hospital major adverse events between groups. ICE guidance was associated with a lower median cost (ICE $20,140.1 (14,622.3, 25,027.0) vs TEE $20,740.4 (14,137.5, 33,045.3), p < 0.04). In conclusion, ICE guided ASD/PFO closure was associated with lower hospitalization cost without increasing in-hospital adverse events when compared with TEE guidance.

经导管关闭房间隔缺损(ASD)和卵圆孔未闭(PFO)可在经食道超声心动图(TEE)或心内超声心动图(ICE)的引导下进行,但目前还缺乏比较这两种模式在当代实践中的数据。利用ICD-10编码,在全国再入院数据库(NRD)中找到了2016年至2020年间使用ICE或TEE接受经导管ASD/PFO闭合术的患者。进行倾向分数匹配以比较院内不良事件、住院时间(LOS)、费用和 30 天非选择性再入院情况。2016年至2020年间,共有964名患者接受了ICE(38.3%,n = 369)或TEE(61.7%,n = 595)的ASD/PFO闭合术。倾向评分匹配结果显示,每组有 327 名患者,均衡性良好。中位(IQR)年龄为 59.0(46.0,72.0)岁,54.7% 为女性。两组患者的院内主要不良事件发生率无差异。ICE 指导的中位成本较低(ICE 20,140.1 美元 (14,622.3, 25,027.0) vs TEE 20,740.4 美元 (14,137.5, 33,045.3), p
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引用次数: 0
Racial and ethnic disparities in clinical outcomes among patients with takotsubo syndrome; A nation-wide analysis. 拓扑综合征患者临床疗效的种族和民族差异;一项全国性分析。
IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-24 DOI: 10.1016/j.carrev.2024.09.013
Jamal Christopher Perry, Oluwasegun Matthew Akinti, Chukwuka Eneh, Henry Osarumme Aiwuyo, Charles Poluyi, Ukenenye Emmanuel, Esther Doudu, Henry Alberto Becerra, Mustafa Bilal Ozbay, Kibwey Roderick Peterkin, Rosy Thachil, Abdullah Khan

Background: Takotsubo syndrome (TTS), a stress-induced transient left ventricular dysfunction, remains poorly understood, with an estimated incidence of 1-2 % among acute coronary syndrome cases. This study investigates racial and ethnic disparities in hospital outcomes and clinical characteristics of TTS.

Methods: We conducted a retrospective cohort study using the National Inpatient Sample data from 2016 to 2020, identifying TTS cases through validated ICD-10 codes. Statistical analysis was performed using Stata 18, with logistic regression models adjusting for confounders to identify disparities in outcomes.

Results: The study included 32,785 TTS hospitalizations; the majority were White (80.5 %), followed by Black (6.7 %) and Hispanic (5.8 %) patients. Minority groups, mainly Black and Hispanic patients, were younger (average age 63) and predominantly from lower-income brackets, while Asians had the highest income bracket. Length of stay (5.1 days) and Total cost ($22,707.60) were highest among Native Americans. Notable findings include Black patients showing the highest rate of stroke (4.8 %, OR 2.1, 95 % CI 1.2 to 3.4, p = 0.003). The rate of cardiogenic shock was highest among Asians (11 %, OR 2, 95 % CI 1.5 to 2.5, p < 0.001). Mortality rates were elevated in Black (2 %, OR 1.5, 95 % CI 1.3 to 1.7 p < 0.001) and Asian populations (1.8 %, OR 1.97, 95 % CI 1.5 to 2.5, p < 0.001).

Conclusion: Significant racial and ethnic disparities exist in TTS outcomes, with minority groups having more in-hospital outcomes. These findings highlight the urgent need for targeted interventions and further research to reduce healthcare inequities in TTS management.

背景:高突波综合征(TTS)是一种应激诱发的一过性左心室功能障碍,人们对其了解甚少,估计其在急性冠状动脉综合征病例中的发病率为 1-2%。本研究调查了 TTS 住院结果和临床特征的种族和民族差异:我们使用 2016 年至 2020 年的全国住院患者抽样数据进行了一项回顾性队列研究,通过有效的 ICD-10 编码识别 TTS 病例。统计分析使用Stata 18进行,逻辑回归模型调整了混杂因素,以确定结果的差异:该研究包括 32,785 例 TTS 住院病例;其中大多数是白人(80.5%),其次是黑人(6.7%)和西班牙裔(5.8%)患者。少数族裔群体(主要是黑人和西班牙裔患者)更年轻(平均年龄 63 岁),主要来自低收入阶层,而亚洲人的收入阶层最高。美国原住民的住院时间(5.1 天)和总费用(22,707.60 美元)最高。值得注意的发现包括黑人患者的中风率最高(4.8%,OR 2.1,95 % CI 1.2 至 3.4,p = 0.003)。亚裔患者的心源性休克发生率最高(11%,OR 2,95 % CI 1.5 至 2.5,P 结论:亚裔患者的心源性休克发生率最高:在 TTS 的预后方面存在明显的种族和民族差异,少数群体的院内预后更高。这些发现突出表明,迫切需要有针对性的干预措施和进一步研究,以减少 TTS 管理中的医疗不公平现象。
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引用次数: 0
Diagnostic performance of angiography-derived fractional flow reserve compared to pressure wire-derived fractional flow reserve: Rationale and design of MPFFR pivotal trial. 血管造影得出的分数血流储备与压力导线得出的分数血流储备的诊断性能比较:MPFFR 关键性试验的原理和设计。
IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-24 DOI: 10.1016/j.carrev.2024.09.015
Hyun-Wook Chu, Chang-Hwan Yoon, Donghoon Han, Won-Woo Seo, Sang-Don Park, Joon Hyung Doh, Chang-Wook Nam, Eun-Seok Shin, Bon-Kwon Koo, In-Ho Chae, Tae-Jin Youn

Background: Cardiovascular disease remains the leading cause of death and the use of percutaneous coronary intervention (PCI) is steadily increasing. Current guidelines advocate the use of the fractional flow reserve (FFR) to assess coronary stenosis and treatment strategies; however, invasive FFR has some limitations. Angiography-derived FFR is a potential alternative for calculating FFR from two-dimensional (2D) angiographic images, thereby reducing invasiveness and complications. A novel artificial intelligence (AI)-based angiography-derived FFR, named "MPFFR," offers automated operator-independent hemodynamic calculations; this phase 3 trial aims to validate its diagnostic performance against 2D-quantitative coronary angiography (QCA).

Methods and analysis: This pivotal MPFFR trial is a prospective, multicenter, single-blind study. This trial involves patients with coronary artery disease (CAD) from eight cardiovascular centers. Invasive FFR will be performed according to standard guidelines and defined as the reference standard. Angiography-derived FFR will be computed using a proprietary method and 2D-QCA will be performed using validated software. The primary endpoint is the area under the curve for identifying physiologically significant coronary stenosis (FFR ≤0.80), with secondary endpoints including diagnostic accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and correlations between angiography-derived and invasive FFR. This study is designed to demonstrate the superiority of angiography-derived FFR over 2D-QCA and is powered to achieve this with a sample size of 240 patients. Medipixel Inc. supports the trial and is not involved in the data analysis or management.

背景:心血管疾病仍然是导致死亡的主要原因,而经皮冠状动脉介入治疗(PCI)的使用正在稳步增加。目前的指南提倡使用分数血流储备(FFR)来评估冠状动脉狭窄情况和治疗策略;然而,有创 FFR 有一些局限性。血管造影衍生 FFR 是一种从二维(2D)血管造影图像计算 FFR 的潜在替代方法,从而减少了侵入性和并发症。基于人工智能(AI)的新型血管造影衍生 FFR 被命名为 "MPFFR",可提供独立于操作者的自动血流动力学计算;该三期试验旨在验证其与二维定量冠状动脉造影(QCA)相比的诊断性能:这项关键的 MPFFR 试验是一项前瞻性、多中心、单盲研究。这项试验涉及八个心血管中心的冠状动脉疾病(CAD)患者。有创 FFR 将根据标准指南进行,并被定义为参考标准。血管造影得出的 FFR 将使用专有方法计算,2D-QCA 将使用经过验证的软件执行。主要终点是识别有生理意义的冠状动脉狭窄(FFR ≤0.80)的曲线下面积,次要终点包括诊断准确性、敏感性、特异性、阳性预测值、阴性预测值以及血管造影衍生和有创 FFR 之间的相关性。该研究旨在证明血管造影得出的 FFR 优于二维-QCA,其样本量为 240 例患者。Medipixel 公司为该试验提供支持,但不参与数据分析或管理。
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引用次数: 0
Clinical impact of sex differences and procedural setting in transcatheter aortic valve implantation. 经导管主动脉瓣植入术中性别差异和手术环境对临床的影响。
IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-24 DOI: 10.1016/j.carrev.2024.09.014
Lis Victória Ravani, Henrique Barbosa Ribeiro, Pedro Calomeni, Fábio Sandoli de Brito, Fernando Bernardi, Pedro Lemos, Fausto Feres, Dimytri Alexandre Siqueira, Ricardo Costa, Rogério Sarmento-Leite, Fernanda Mangione, José Armando Mangione, Luiz Eduardo Koenig São Thiago, Valter Correia de Lima, Adriano Dias Dourado Oliveira, Marcos Antônio Marino, Carlos José Francisco Cardoso, Paulo Ricardo Avancini Caramori, Rogério Tadeu Tumelero, Antenor Lages Fortes Portela, Maurício Lopes Prudente, Leônidas Alvarenga Henriques, Fabio Solano de Freitas Souza, Cristiano Guedes Bezerra, Guy Fernandes de Almeida Prado Junior, Leandro Zacarias Figueiredo de Freitas, Ederlon Ferreira Nogueira, George César Ximenes Meirelle, Renato Bastos Pope, Ênio Eduardo Guérios, Pedro Beraldo de Andrade, Luciano de Moura Santos, Mauricio Felippi de Sá Marchi, Vinicius Borges Cardozo Esteves, Alexandre Abizaid

Background: Transcatheter aortic valve implantation (TAVI) is a well-established treatment for symptomatic patients with aortic stenosis. Yet, the impact of sex differences and public vs. private procedural setting on TAVI outcomes remain uncertain.

Methods: The RIBAC-NT (Brazilian Registry for Evaluation of Transcatheter Aortic Valve Replacement Outcomes) dataset included 3194 TAVI patients from 2009 to 2021. This retrospective analysis explored disparities in baseline characteristics, procedural and in-hospital outcomes stratifying patients by sex and procedural setting. Temporal trends were also investigated.

Results: We included 1551 (49 %) female and 1643 (51 %) male patients. Women were older (83 [78-87] vs. 81 [75-85] years; p < 0.01) but had a lower prevalence of diabetes mellitus (30.2 % vs. 36.3 %, p < 0.01) and coronary artery disease (39.0 % vs. 52.2 %, p < 0.01). However, women had a 3-fold higher higher risk of life-threatening bleeding (6.1 % vs. 2.4 %, p < 0.01). Women presented higher procedural and in-hospital mortality rates (4.4 % vs. 2.5 % and 7.7 % vs. 4.5 %, all p < 0.01, respectively). Although public hospitals presented ~2-fold higher procedural mortality rate compared with private settings (5.0 % vs. 2.7 %, p < 0.01), after multivariable analysis procedural setting was not independently associated with in-hospital mortality.

Conclusions: Women had higher procedural and in-hospital mortality rates after TAVI as compared with men, while facing higher life-threatening bleeding and adverse events rates. Although public hospitals exhibited higher mortality rates than private centers, procedural setting was not independently associated with in-hospital mortality.

背景:经导管主动脉瓣植入术(TAVI)是治疗有症状的主动脉瓣狭窄患者的一种行之有效的方法。然而,性别差异和公共与私人手术环境对 TAVI 结果的影响仍不确定:RIBAC-NT(巴西经导管主动脉瓣置换术结果评估登记)数据集包括2009年至2021年的3194名TAVI患者。这项回顾性分析探讨了基线特征、手术和住院结果的差异,并按性别和手术环境对患者进行了分层。同时还研究了时间趋势:我们纳入了 1551 例(49%)女性患者和 1643 例(51%)男性患者。女性年龄更大(83 [78-87] 岁 vs. 81 [75-85]岁;P 结论:女性的手术和住院率更高:与男性相比,女性在 TAVI 术后的手术死亡率和院内死亡率较高,同时危及生命的出血率和不良事件发生率也较高。虽然公立医院的死亡率高于私立医院,但手术环境与院内死亡率并无独立关联。
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引用次数: 0
ANOCA updated: From pathophysiology to modern clinical practice. ANOCA 已更新:从病理生理学到现代临床实践。
IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-21 DOI: 10.1016/j.carrev.2024.09.010
Kyriakos Dimitriadis, Nikolaos Pyrpyris, Athanasios Sakalidis, Eirini Dri, Panagiotis Iliakis, Panagiotis Tsioufis, Fotis Tatakis, Eirini Beneki, Christos Fragkoulis, Konstantinos Aznaouridis, Konstantinos Tsioufis

Lately, a large number of stable ischemic patients, with no obstructed coronary arteries are being diagnosed. Despite this condition, which is being described as angina with no obstructive coronary arteries (ANOCA), was thought to be benign, recent evidence report that it is associated with increased risk for adverse cardiovascular outcomes. ANOCA is more frequent in women and, pathophysiologically, it is predominantly related with microvascular dysfunction, while other factors, such as endothelial dysfunction, inflammation and autonomic nervous system seem to also play a major role to its development, while other studies implicate ANOCA and microvascular dysfunction in the pathogenesis of heart failure with preserved ejection fraction. For establishing an ANOCA diagnosis, measurement including coronary flow reserve (CFR), microvascular resistance (IMR) and hyperemic microvascular resistance (HMR) are mostly used in clinical practice. In addition, new modalities, such as optical coherence tomography (OCT) are being tested and show promising results for future diagnostic use. Regarding management, pharmacotherapy consists of a wide selection of drugs, according to the respected pathophysiology of the disease (vasospastic angina or microvascular dysfunction), while research for new treatment options including interventional techniques, is currently ongoing. This review, therefore, aims to provide a comprehensive analysis of all aspects related to ANOCA, from pathophysiology to clinical managements, as well as clinical implications and suggestions for future research efforts, which will help advance our understanding of the syndrome and establish more, evidence-based, therapies.

最近,大量冠状动脉无阻塞的稳定型缺血性患者被确诊。尽管这种被称为无冠状动脉阻塞性心绞痛(ANOCA)的病症被认为是良性的,但最近有证据表明,它与不良心血管后果风险的增加有关。无冠状动脉阻塞性心绞痛在女性中更为常见,从病理生理学角度看,它主要与微血管功能障碍有关,而其他因素,如内皮功能障碍、炎症和自主神经系统似乎也对其发展起着重要作用,而其他研究则认为无冠状动脉阻塞性心绞痛和微血管功能障碍与射血分数保留型心力衰竭的发病机制有关。在临床实践中,为确定 ANOCA 的诊断,大多采用包括冠状动脉血流储备(CFR)、微血管阻力(IMR)和充盈微血管阻力(HMR)在内的测量方法。此外,光学相干断层扫描(OCT)等新模式正在接受测试,并显示出未来诊断使用的良好前景。在治疗方面,药物疗法包括根据疾病的病理生理学(血管痉挛性心绞痛或微血管功能障碍)选择多种药物,而包括介入技术在内的新治疗方案的研究目前正在进行中。因此,本综述旨在全面分析与 ANOCA 相关的各个方面,从病理生理学到临床管理,以及对未来研究工作的临床影响和建议,这将有助于增进我们对该综合征的了解,并建立更多循证疗法。
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Cardiovascular Revascularization Medicine
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