Postepy W Kardiologii Interwencyjnej最新文献

Introduction: Pulmonary arterial hypertension (PAH) is a progressive condition characterized by elevated blood pressure in the pulmonary arteries, leading to significant morbidity and mortality. Treprostinil, a synthetic analogue of prostacyclin, has emerged as a potential treatment option.

Aim: The efficacy and safety of oral treprostinil in PAH patients remain subjects of ongoing research.

Methods: Comprehensive literature searches were performed across multiple databases for studies assessing the efficacy and/or safety of treprostinil in PAH patients. Quality assessment and statistical analysis were performed using the Cochrane Collaboration's tool and Comprehensive Meta-Analysis software, respectively.

Results: From 680 records identified, four studies met the inclusion criteria. These studies demonstrated that oral treprostinil significantly improved exercise capacity as measured by the 6-minute walk distance (6MWD), with a mean difference of 13.13 m in favor of treprostinil, despite high heterogeneity. The analysis also showed an increased risk of adverse events leading to discontinuation in the treprostinil group (OR = 4.39) but a protective effect against clinical worsening (OR = 0.554). No significant impact on mortality was observed.

Conclusions: Oral treprostinil offers a significant benefit in improving exercise capacity in PAH patients, with a potential role in delaying clinical worsening. However, the increased risk of adverse events necessitates careful patient management. These findings support the inclusion of oral treprostinil in the treatment strategy for PAH, underscoring the need for further research to optimize its use and understand its long-term impact on patient outcomes.Level of evidence: I.

Introduction: Atrial septal defects (ASD) are prevalent congenital heart anomalies found in the adult population. Percutaneous ASD closure has become a routine clinical practice. Elevation of postprocedural transient cardiac biomarkers and exacerbation of supraventricular arrhythmias have been reported in the subject literature.

Aim: To explore the relationship between cardiac troponin I (cTnI) elevation and supraventricular ectopy (SVE) following percutaneous closure of secundum atrial septal defect (ASD) in adult patients.

Material and methods: 600 consecutive patients who underwent successful transcatheter ASD secundum closure were analyzed. Serum levels of cTnI were measured before and within 72 h of device implantation. 24-hour Holter monitoring was performed before the procedure, at 1 month, and at 6 months of follow-up.

Results: SVE burden increased 1 month after the procedure (median 1021.00; min.-max. 11.00-29 862.00) compared to baseline values (median 146.00; min.-max. 0-1865.00; p < 0.01). 61.7% of patients demonstrated a cTnI rise exceeding 50% of the upper reference limit within 24 h of the procedure. A statistically significant positive correlation between SVE burden 1 month after the procedure and periprocedural cTnI increase (p < 0.05, r = 0.41) was observed, while cTnI levels significantly correlated with procedure and fluoroscopy time (p < 0.001), device size (p < 0.001) and maximal ASD diameter (p < 0.001).

Conclusions: A significant increase of cTnI is noted frequently after transcatheter ASD closure and seems to predict exacerbation in SVE burden on short-term follow up. The independent risk factors of cTnI rise are prolonged procedure duration and larger device sizes.

Introduction: The advanced lung cancer inflammation index (ALI) is an independent prognostic biomarker of inflammation and nutrition in various types of cancer, acute heart failure and acute coronary syndrome. The SYNTAX (Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery) score (SXscore) is an angiographic scoring tool used to determine the extent and severity of coronary artery disease.

Aim: To investigate the relationship between ALI and coronary artery lesion complexity assessed using the SXscore in patients with non-ST-segment elevation myocardial infarction (NSTEMI).

Material and methods: Between February and November 2020, a total of 284 patients with NSTEMI were included consecutively. ALI was calculated with the formula body mass index (BMI) × serum albumin concentration/neutrophil-to-lymphocyte ratio (NLR). SXscore was calculated using the online calculator and divided into two groups - low (< 32) and high (≥ 33) - and then analyzed.

Results: Patients with a high SXscore had lower ALI (22.4 ±7.3 vs. 58.5 ±44.3, p = 0.016). In the univariable analysis, age (p = 0.046), BMI (p = 0.021), C-reactive protein (p = 0.002), peak troponin I (p = 0.009), NLR (p = 0.025), serum albumin (p = 0.003) and ALI (p < 0.001) were significantly associated with a high SXscore. ALI emerged as an independent predictor of a high SXscore in multivariable analysis (95% CI: 0.931-0.984, p = 0.002).

Conclusions: The ALI may be useful as a simple tool for predicting high SXscore in patients with NSTEMI. To our knowledge, this is the first study to examine the relationship between ALI and severity of CAD.

Introduction: One of the predictable and preventable complications that may occur after transaortic valve implantation (TAVI) is the requirement for permanent pacemaker (PPM) implantation.

Aim: To evaluate the relationship between aortic knob calcification (AKC) assessed by preoperative chest X-ray and the requirement for post-procedure PPM implantation for patients who underwent TAVI.

Material and methods: This study was conducted with 110 patients who underwent TAVI with a Myval transcatheter heart valve in our center between June 2020 and December 2022. The patients' electrocardiograms were monitored after the procedure. The patients were evaluated in two groups according to whether they required PPM. The AKC grading was performed by examining the routine posterior-anterior chest radiographs of all patients participating in the study.

Results: A PPM was placed in 17 (15.4%) patients after TAVI. The remaining 93 patients formed the control group. AKC (p = 0.002) and membranous septum (p = 0.013) statistically significantly differed between the PPM and control groups; however, no significant difference was detected in relation to the other parameters. In the univariable (p = 0.004) and multivariable (p = 0.024) regression analyses performed to identify predictors of PPM requirement after TAVI, AKC was found to be both a dependent and independent predictor.

Conclusions: AKC can be used as a cost-effective and easily accessible parameter for predicting the post-procedure PPM requirement in patients who have undergone TAVI.

Introduction: There are few data on permanent pacemaker implantation (PPMI) in patients who have undergone transcatheter aortic valve implantation (TAVI) for bicuspid aortic valve (BAV) stenosis.

Aim: The purpose of this study was to evaluate the predictors and incidence of PPMI in bicuspid patients using a balloon-expandable (BE) TAVI device.

Material and methods: A total of 62 patients with bicuspid morphology who had undergone successful TAVI using a BE device without previous PPMI were included (retrospectively). Their baseline clinical, electrocardiographic (ECG), echocardiographic, and multislice computed tomography (MSCT) details were collected.

Results: The incidence of PPMI after TAVI in this BAV cohort was 12.9%. All eight patients with PPMs were found to have type 1 left-right (L-R) fusion morphology. In univariate analysis, the presence of right bundle branch block (RBBB) in preprocedural ECG (p < 0.0001), short membranous septum (MS) evaluated in MSCT (p < 0.0001), and increased annulus-left main coronary artery distance (p = 0.02) were statistically significant for PPMI. Among these parameters included in the model using multivariate Firth logistic regression analysis, the presence of preprocedural RBBB (p = 0.001) and shortness of the MS in MSCT (p = 0.004) were independent risk factors for predicting postprocedural PPMI in patients who underwent TAVI among those with BAV.

Conclusions: Preprocedural RBBB on ECG and shorter MS are independent risk factors for PPMI after TAVI in BAV patients and these parameters should be considered before the procedure to guide clinical decision making. Type 1 L-R patients may be considered at increased risk of PPMI.

Introduction: The use of atherectomy in peripheral vascular intervention remains controversial.

Aim: To review our experience with atherectomy as an adjunct to endovascular revascularization in a successive group of patients with chronic limb-threatening ischemia (CLTI).

Material and methods: Consecutive patients with CLTI treated in a high-volume vascular center between 12/01/2019 and 12/31/2021 were reviewed. Follow-up data were abstracted from office and hospital records. Endpoints were death, all amputation, major amputation and target lesion revascularization (TLR). Secondary endpoints were relief of ischemic rest pain and healing of wounds.

Results: During the study period 405 patients (447 limbs) underwent an endovascular procedure. Mean age was 77 ±11.7 years. Of the 447 limbs treated, 123 (27.5%) were Rutherford 4, 284 (63.5%) Rutherford 5 and 40 (8.9%) Rutherford 6. 1190 lesions (2.66 ±1.02 lesion per limb) underwent treatment, with 56.3% located in the femoral-popliteal distribution and 681 (57.2%) being total occlusion. During follow-up to 24 months, there were 76 deaths (18.8%) and 18 major amputations (4%). Surgical bypass was performed in 2% of cases. Estimated two-year amputation and major amputation-free survival probability was 88.4% and 94.5%, respectively. Estimated two-year TLR-free probability was 55%.

Conclusions: Atherectomy facilitated treatment of patients with CLTI. These patients were elderly, with limited life expectancy and had multiple lesions per extremity with a high percentage of long occlusions and tibial disease. While TLR-free probability at 2 years was 55%, the overall amputation rate was low. This approach resulted in excellent limb salvage in a high-risk patient group with limited life expectancy and advanced disease.