Journal of Invasive Cardiology最新文献

Objectives: Patients with coarctation of aorta (COA) have arterial stiffening and left ventricular (LV) diastolic dysfunction similar to patients with heart failure with preserved ejection fraction (HFpEF) and obese subjects. However, the relationship between obesity, cardiac hemodynamics, and HF in adults with COA is unknown. The purpose of this study was to compare cardiac hemodynamics and prevalence of HFpEF between COA patients with vs without obesity, and to assess the relationship between obesity and HFpEF in this population.

Methods: Adults with COA who underwent right heart catheterization were divided into an obese group (body mass index, BMI > 30 kg/m2) or a non-obese group (BMI ≤ 30 kg/m2). We also selected a control group of subjects without structural heart disease and with normal invasive hemodynamics at rest (n = 36). HFpEF was defined as having clinical symptoms of HF (exertional dyspnea or fatigue), LV ejection fraction of at least 50%, and pulmonary artery wedge pressure (PAWP) greater than 15 mm Hg at rest.

Results: Of 99 COA patients, 29 (29%) had obesity. The obese COA group had higher right atrial pressure and PAWP, and worse pulmonary and systemic vascular function compared with the non-obese COA group and the control group. The overall prevalence of HFpEF in adults with COA was 32%, and the prevalence was higher in COA patients with obesity (55%) compared with those without obesity (23%). Obesity was associated with HFpEF after adjustment for demographic indices, comorbidities, and vascular function.

Conclusions: The abnormal hemodynamics and higher prevalence of HFpEF in COA patients with obesity underscores the need for intervention to address obesity in this population.

Objectives: Although coronary artery disease (CAD) and heart failure (HF) are separate entities, HF is a common complication of CAD, and both CAD and HF are known causes of wall motion abnormalities (WMA) of transthoracic echocardiography (TTE). Specifically, global hypokinesis on TTE could logically be due to multivessel CAD or non-ischemic cardiomyopathy. The purpose of this study was to investigate the relationship between CAD, HF, and WMA on TTE.

Methods: A single-center retrospective chart review was conducted of adults who had a resting TTE and cardiac catheterization within 30 days. We analysed the association between global hypokinesis, triple-vessel CAD, and HF diagnosis.

Results: Across 754 included patients, there was a positive association between global hypokinesis on TTE and HF diagnosis (P < .001). There was no association between global hypokinesis on TTE and triple-vessel CAD (P = .341), possibly an inverse correlation. The sensitivity of regional (R) WMAs on TTE for diagnosing CAD was generally lower in patients without heart failure (44%), while specificity was higher in these same patients (89%).

Conclusions: There was a positive association between global hypokinesis and HF, and a possible inverse correlation between global hypokinesis and triple-vessel CAD. This could be explained by heart failure diagnosis and other diagnoses having a stronger effect on global hypokinesis than any potential effect from triple-vessel CAD. These sensitivity and specificity results for RWMA on CAD, stratified by HF diagnosis and/or global hypokinesis, can be used to inform clinical decision-making in an acute coronary syndrome case with borderline electrocardiography and/or troponin findings.

Objectives: For percutaneous closure of the patent ductus arteriosus (PDA) with a mushroom-shaped occluder, the establishment of a guidewire rail with the antegrade venous approach may be difficult in some cases. The retrograde technique can be used instead; however, the use of a snare system may bring extra costs and risks. The aim of the study was to report on a new method that fulfills the retrograde technique without the use of a snare system in transcatheter closure of PDA.

Methods: From May 2019 to January 2023, we attempted transcatheter closure using the kissing-catheter technique after failure of the conventional antegrade venous approach on 22 consecutive patients with PDA. This technique involves docking the distal ends of the antegrade catheter and retrograde catheter in the main pulmonary artery, and sending an exchange guidewire from one catheter, through the docking junction, and externalized from the proximal end of the other. Then an artery-PDA-vein guidewire loop was established for the delivery of the occluder. The results and operation time of this method were analyzed.

Results: Successful establishment of the guidewire rail was achieved in all patients. The average time from attempting to dock the 2 catheters to successfully passing the guidewire was 26 ± 15 seconds. There were no complications during or after the procedures.

Conclusions: The snare-free kissing-catheter technique is an efficient and reliable method for transcatheter closure of PDA in cases where the antegrade approach is difficult.

Objectives: Calcific peripheral artery disease (PAD) is a common finding in patients scheduled for transcatheter aortic valve implantation (TAVI) and often requires iliofemoral axis preparation. However, evidence about the use of intravascular lithotripsy (IVL) in this setting is scarce. The aim of this study was to describe in-hospital and mid-term outcomes of IVL-assisted transfemoral (TF)-TAVI in patients with severe calcific PAD.

Methods: The study included 13 patients with severe calcified PAD who were initially scheduled for balloon angioplasty (PTA)-assisted TF-TAVI but were eventually treated with peripheral IVL between October 2020 and February 2024. Accurate analysis of preoperative computed tomography scans revealed difficult TF access routes (severe calcified PAD with minimal lumen diameter ≤ 4.5 mm, circumferential calcification along iliofemoral axis, and marked vessels tortuosity).

Results: In all cases, IVL was performed after PTA failure and allowed successful valve delivery. One patient had procedural bleeding (BARC-3a). The valve was successfully delivered without complications in 12 patients (92.3%), and no major adverse events were reported at the longest follow-up (median 18.5 months).

Conclusions: IVL-assisted TF-TAVI may represent a feasible and safe option for patients presenting with severe aortic stenosis and severe calcified PAD. However, standardization of the access site severity as well as indications for a planned up-front IVL-assisted strategy are missing and require dedicated studies.