Postepy W Kardiologii Interwencyjnej最新文献

Introduction: Studies on anesthesia for cryoablation, one of the methods used in the treatment of atrial fibrillation (AF), and its effect on perioperative parameters are limited.

Aim: To compare the effects of conscious sedation with a combination of midazolam-fentanyl and unconscious sedation with propofol-midazolam on the success of the procedure.

Material and methods: 242 patients who underwent AF cryoablation for the first time were included. The ASA score and baseline SaO₂ before the procedure, and the minimum SaO₂, systolic and diastolic blood pressure change and the Richmond Agitation Sedation Scale (RASS) score during the procedure were obtained. Study data were divided into 2 groups - conscious sedation and unconscious sedation - and compared.

Results: Demographic, laboratory and echocardiographic findings did not differ significantly between the two groups (p > 0.05). When the hemodynamic parameters of the periprocedural AF ablation process and the effects of anesthesia were examined according to the anesthesia groups of the patients, minimum SaO₂ during the procedure was significantly higher in the group that underwent conscious sedation (93.6 ±2.21% vs. 92.4 ±1.96% and p < 0.01). RASS score, blood pressure changes were found to be significantly lower in the conscious sedation group (p < 0.01 for each). However, procedural time, fluoroscopy time, ASA score, non-invasive mechanical ventilation (NIMV) requirement, basal SaO₂, procedure success and frequency of AF recurrence were not significantly different between prolonged recovery groups (p > 0.05 for each).

Conclusions: In our study, it was found that the conscious sedation preference during AF cryoablation could be applied with similar success and recurrence compared to unconscious sedation with propofol and midazolam.

Introduction: Catheter ablation (CA) is the standard treatment for patients with symptomatic, idiopathic ventricular arrhythmias (VAs): premature ventricular contractions (PVCs) or sustained/non-sustained ventricular tachycardia. Three-dimensional electroanatomic mapping (3D EAM) systems enable accurate mapping of cardiac arrhythmias and precise catheter guidance, eliminating the need for radiation exposure. However, fluoroscopy may be required to pass through the arteries, valve, or catheter positioning near critical structures.

Aim: The study assessed the feasibility, efficacy, and safety of performing CA using a zero-fluoroscopy approach in patients with left-sided idiopathic VAs with the 3D EAM system.

Material and methods: Fifty-three consecutive patients with left-sided, idiopathic VAs undergoing elective CA were enrolled. Procedures were performed using the CARTO 3D EAM system with the intention of eliminating fluoroscopy usage whenever possible. The primary endpoints were the feasibility of performing the procedure without fluoroscopy and the acute and long-term (minimum 6-month follow-up) procedural efficacy. Demographic and clinical baseline characteristics, procedure parameters, and complications were included in the analysis.

Results: CA of left-sided VAs was performed without fluoroscopy in 44 out of 53 (83%) cases. Acute procedural success was achieved in 47 cases (88.7%). Long-term success was achieved in 45 cases (84.9%). Minor complications occurred in 3.7% of patients. No major complications were observed.

Conclusions: CA guided by 3D EAM without fluoroscopy is feasible and safe for left-sided VA.

Introduction: Epicardial adipose tissue (EAT) influences the development of cardiovascular diseases through the secretion of inflammatory cytokines. Transcatheter aortic valve implantation (TAVI) is one of the most commonly used methods for treating severe aortic stenosis in adults.

Aim: Given the role of inflammatory cytokines in the progression of aortic stenosis, we investigated the impact of EAT on the outcomes of patients undergoing TAVI.

Material and methods: The medical records of 334 patients who underwent TAVI for symptomatic severe aortic stenosis between March 2018 and December 2022 were evaluated after applying the exclusion criteria. Major adverse cardiac and cerebrovascular endpoints (MACCE) were defined according to the Valvular Academic Research Consortium criteria. The patients were divided into two groups: those with and without MACCE.

Results: Mean EAT volume was higher in patients with MACCE than those without MACCE (120.7 ±43.9 vs. 96.1 ±39.8, p < 0.001). Univariate Cox proportional-risk analysis revealed that creatinine and albumin levels, mean systolic pulmonary artery pressure, and EAT volume were significantly associated with MACCE. Multivariate Cox proportional-hazard analysis showed that EAT volume (hazard ratio (HR) = 1.012; 95% confidence interval (CI): 1.006-1.018; p < 0.001) and albumin level (HR = 0.925; 95% CI: 0.866-0.987; p = 0.018) were significantly independently associated with MACCE.

Conclusions: The EAT volume and 1-year outcomes may be related in patients undergoing TAVI for severe aortic stenosis.

Introduction: Pulmonary hypertension (PH) is characterized by increased pulmonary artery pressure (PAP) and pulmonary vascular resistance (PVR) due to loss of arterial elasticity and vascular obstruction. The dicrotic notch index (DNI) represents reflected wave characteristics and vascular elasticity, potentially serving as an important marker in PH assessment.

Aim: This study evaluates the relationship between DNI and PVR, PAPs, and other hemodynamic and clinical parameters in PH patients.

Material and methods: A retrospective analysis was conducted on 76 patients diagnosed with pulmonary arterial hypertension (PAH), chronic thromboembolic pulmonary hypertension (CTEPH), or normal PAPs who underwent right heart catheterization (RHC). PAP waveforms were analyzed to determine DNI. Correlations between DNI and hemodynamic, clinical, and echocardiographic parameters were assessed using Pearson's correlation coefficient. Logistic regression and ROC analysis were performed to evaluate the DNI's predictive value.

Results: DNI showed significant positive correlations with systolic PAP (sPAP) (r = 0.972, p < 0.001), diastolic PAP (dPAP) (r = 0.876, p < 0.001), mean PAP (mPAP) (r = 0.987, p < 0.001), right atrial (RA) pressure (r = 0.741, p = 0.018), and PVR (r = 0.814, p < 0.001). Significant negative correlations were observed with cardiac index (CI) (r = -0.573, p = 0.012) and pSO₂ (r = -0.516, p = 0.043). Univariable logistic regression identified DNI as a significant predictor of PH (OR = 1.100, 95% CI: 1.048-1.155, p < 0.001). ROC analysis showed an AUC of 0.922 for DNI, indicating excellent predictive value.

Conclusions: DNI is correlated with key hemodynamic parameters such as PVR and mPAP, underscoring its potential as a crucial marker in the assessment of PAH and CTEPH patients. Additionally, DNI exhibited significant correlations with echocardiographic measurements and clinical indicators, suggesting its utility in evaluating pulmonary arterial stiffness and resistance. Further research is needed to validate these findings in larger cohorts and to establish standardized protocols for DNI measurement in clinical practice.

Introduction: Stenting of the right ventricular outflow tract (RVOT) is a reasonable palliation in symptomatic infants with tetralogy of Fallot (ToF) and variants. However, this procedure needs reintervention until corrective surgery.

Aim: To compare RVOT stenting followed with or without propranolol medication until complete repair of ToF and variants.

Material and methods: Twenty-five cyanotic infants under 6 months of age with ToF and variants underwent RVOT stenting between March 2017 and May 2024 including the first 11 followed without propranolol medication and the next 14 followed with propranolol medication.

Results: Median age at initial RVOT stent implantation was 92 days and similar in both groups. At the time of this writing, total correction of ToF has been performed in 23 patients including 11 followed without propranolol medication and 12 followed with propranolol medication. Median age at the time of surgery was 258 days and similar in both groups. The rate of reintervention before complete repair was 8/25 (32%) during follow-up for recurrence of cyanosis, including 6/11 (54%) patients followed without propranolol medication and 2/14 (14%) in patients with propranolol medication (p = 0.041). The remaining 2 patients followed with propranolol medication required reintervention 150 and 170 days after initial intervention.

Conclusions: Long-term treatment with propranolol given after RVOT stenting in ToF and variants, particularly under 3 months of age, may reduce the need for further interventions prior to complete repair.

Introduction: Morbidity related to cardiovascular disease (CVD) is a leading epidemiological problem. Carotid intima-media thickness (CIMT) can be regarded as a surrogate marker for cardiovascular disease. Lipid-lowering agents such as statins have proven to reduce future risk and promote regression of atherosclerotic plaques.

Aim: To relate long-term high-dose statin therapy to CIMT in a retrospective analysis of patients presenting with preserved ejection fraction heart failure (HFpEF).

Material and methods: There were 77 (47 female and 30 male) consecutive patients with a median age of 69 (62-75) years admitted to the Hypertension and Internal Medicine Department presenting with preserved ejection fraction heart failure symptoms in NYHA class 2.0 (0.5) for clinical evaluation in 2024. Laboratory tests, echocardiography, carotid ultrasound, and cine angiography were performed. The possible relation between CIMT and patients' characteristics was evaluated.

Results: The multivariable model indicated possible relations between CIMT above 0.8 mm and obesity (BMI > 30 kg/m²) (OR = 11.86, 95% CI: 2.5-54.02, p = 0.001), and high-statin therapy (OR = 0.18, 95% CI: 0.04-0.08, p = 0.024). The receiver operator curve (ROC) was characterized by an area under the curve (AUC) of 0.794 with an F-measure of 0.417, yielding a sensitivity of 35.7% and specificity of 91.8%.

Conclusions: The results from the retrospective single-measurement analysis on long-term statin therapy may indicate the relation between CIMT and rosuvastatin (at least 20 mg/day) or atorvastatin (at least 40 mg/day) administration. Long-term statin therapy is associated with a reduced likelihood of having CIMT above 0.8 mm, although the presented results are statin-type and dosage-dependent.

Introduction: Infective endocarditis (IE) is the infection of the cardiac endothelium and heart valves. The incidence of IE has recently increased due to the widespread use of cardiac device therapies and prosthetic heart valves. Despite modern medical and surgical treatment methods, morbidity and mortality are still high, and it leads to serious complications. Evaluation of predictive factors leading to septic embolism, which is one of the most important complications in terms of mortality and morbidity, is important for improving outcomes in infective endocarditis.

Aim: In this study, we aimed to determine the predictive parameters of in-hospital mortality and septic embolism in patients with IE.

Material and methods: This was a retrospective cohort study. The patients were divided into two groups: group 1 (septic embolism or mortality +, 21 patients) and group 2 (septic embolism or mortality -, 43 patients). ROC analysis was performed to determine the cut-off value of the predictive parameters. Univariable and multivariable regression analysis was performed to identify parameters significantly associated with in-hospital mortality/septic embolism in infective endocarditis.

Results: A total of 64 patients diagnosed with IE were included in the study. In the multivariable regression analysis, the parameters vegetation size (OR = 1.227; 95% CI: 1.019-1.477, p = 0.031), aortic valve vegetation (OR = 0.088; 95% CI: 0.009-0.820, p = 0.033), mitral valve vegetation (OR = 0.082; 95% CI: 0.009-0.760, p = 0.028), albumin (OR = 0.185; 95% CI: 0.039-0.889, p = 0.035) and D-dimer (OR = 1.004; 95% CI: 1.000-1.009, p = 0.045) were found to be independent predictors for septic embolism and mortality in IE patients.

Conclusions: Vegetation size, high D-dimer and low serum albumin levels are predictors of in-hospital mortality and septic embolism in patients with IE.

Introduction: Coronary artery disease (CAD) is common worldwide and is a significant cause of morbidity and mortality. CAD is a chronic and inflammatory disease mainly caused by atherosclerosis. SYNTAX and Gensini scoring systems are used to evaluate CAD extent and severity. Uric acid to high-density lipoprotein (HDL) ratio (UHR) increases in inflammatory conditions.

Aim: To investigate the relationship between UHR and the extent and severity of CAD and its correlation with SYNTAX and Gensini scoring systems.

Material and methods: 894 patients who underwent angiography were included in the study. 612 participants with critical coronary stenosis were designated as the patient group, and 282 participants without stenosis were designated as the control group. Characteristic features and laboratory parameters of the groups were compared. The relationship between the SYNTAX and Gensini scores of the patient group and UHR was analyzed.

Results: Baseline characteristics and laboratory parameters were similar in both groups, except for uric acid and UHR levels. Both uric acid levels (7.58 ±2.55 mg/dl vs. 5.71 ±1.46 mg/dl, p < 0.01) and UHR (0.2016 ±0.094 vs. 0.1461 ±0.05, p < 0.01) were significantly higher in the patient group. UHR levels were found to be correlated significantly with both scoring systems. In the ROC curve analysis the UHR cut-off value of 0.1567 was able to predict CAD moderately (AUC = 0.669 (0.634-0.704), sensitivity 61.1%, specificity 38.7%).

Conclusions: UHR is an easy-to-use parameter that can be used before invasive evaluation to predict the presence, severity, and extent of CAD.