Postepy W Kardiologii Interwencyjnej最新文献

Transradial access (TRA) has evolved from an alternative technique to the guideline-recommended default strategy for coronary angiography and percutaneous coronary intervention. This shift is driven by TRA's association with improved clinical outcomes, fewer complications, and enhanced patient comfort compared with transfemoral access (TFA). The evolution of transradial techniques, including distal radial access (DRA), reflects a broader move towards minimally invasive, patient-centered interventional cardiology. This narrative review synthesizes data from 50 peer-reviewed articles retrieved from PubMed, Scopus, and Web of Science, including randomized controlled trials, meta-analyses, observational studies, and expert consensus statements. Key topics examined include anatomical considerations, comparisons between left and right radial access, comparisons between TRA and TFA, the emerging role of DRA, special considerations in certain populations, procedural complications, and cost analysis. TRA represents a major advancement in interventional cardiology, enhancing safety, efficiency, and patient satisfaction. Its incorporation into routine practice improves outcomes and procedural ergonomics. Despite certain anatomical and technical challenges, robust evidence supports TRA as the default strategy for coronary interventions across most patient populations. Ongoing investigations and trials continue to define optimal procedural techniques and patient selection criteria. These data are expected to further standardize clinical practice and support more consistent, high-quality outcomes across centers.

Aortic stenosis (AS) remains the most prevalent valvular heart disease worldwide and is increasingly managed through transcatheter aortic valve implantation (TAVI). With the 2025 ESC/EACTS Guidelines lowering the age threshold for TAVI to 70 years, the focus has shifted from short-term survival to lifetime management, necessitating rigorous evaluation of device durability, coronary access, and biological valve degeneration. This review synthesizes the latest evidence-based strategies for TAVI, contrasting randomized trial data with long-term registry findings. We critically analyze the hemodynamic trade-offs between self-expandable valves and balloon-expandable valves, particularly in patients with small aortic annuli, where SEVs demonstrate superior indexed effective orifice areas and reduced rates of patient-prosthesis mismatch (SMALL-TAVI registry). We further examine the expansion of indications into complex anatomical subsets, including bicuspid aortic valves (BIVOLUTX, STABILITY) and pure aortic regurgitation, where dedicated anchoring mechanisms are required to mitigate the risk of valve migration. Procedural optimization is addressed through the "minimalist" TAVI pathway (BENCHMARK registry), which emphasizes conscious sedation and ultrasound-guided vascular access to reduce length of stay without compromising safety. Finally, we discuss emerging biomarkers (MMP-3, osteopontin) and the role of epicardial adipose tissue as novel predictors of structural valve deterioration, signaling a potential shift toward biological modulation of valvular disease.

Introduction: The management of high bleeding risk (HBR) patients with an acute coronary syndrome (ACS) who undergo percutaneous coronary intervention (PCI) is challenging because these patients combine a severe thrombotic burden with a significant risk of bleeding complications.

Aim: The aim of this study was to quantify the prevalence of HBR patients in a real-world ACS population, identify their in-hospital prognosis, and record their bleeding complications compared to non-HBR patients.

Material and methods: In this real-world registry, patients with an ACS who had undergone successful revascularization with PCI were classified into HBR and non-HBR based on the Academic Research Consortium for High Bleeding Risk (ARC-HBR) criteria and were monitored during their hospitalization.

Results: A total of 314 patients were enrolled: 103 HBR (32.8%) and 211 (67.2%) non-HBR. In-hospital all-cause mortality (17.4% vs. 2.84%, p < 0.001), cardiovascular mortality (12.6% vs. 2.84%, p < 0.001) and major bleeding events (15.5% vs. 1.89%, p < 0.001) were significantly higher in the HBR group. The trans-femoral access during PCI (OR = 3.524, 95% CI: 1.035-11.991, p = 0.044) and the baseline estimated glomerular filtration rate (eGFR) (OR = 0.966, 95% CI: 0.938-0.996, p = 0.027) were the only independent predictors of severe bleeding. More specifically, an e-GFR value ≤ 50 ml/min was calculated to predict in-hospital major bleeding complications in HBR patients with 87.5% sensitivity and 64.37% specificity.

Conclusions: In-hospital all-cause mortality, cardiovascular mortality, and major bleeding events were significantly higher in HBR patients with an ACS compared to non-HBR patients. HBR patients with baseline impaired renal function should be carefully monitored for severe bleeding complications.

Introduction: Non-invasive myocardial work assessment, using global left ventricular longitudinal strain (GLS), has emerged as a key tool for evaluating left ventricular (LV) function independent of loading conditions.

Aim: This study aims to evaluate the effects of concomitant mitral regurgitation (MR) on myocardial work parameters in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI).

Material and methods: A prospective registry study was conducted on 95 consecutive patients with severe AS, 28% of whom had moderate to severe MR. Echocardiographic data, including GLS and myocardial work parameters (global constructive work [GCW], global wasted work [GWW], and global work efficiency [GWE]), were collected prior to TAVI.

Results: While GLS values did not significantly differ between MR severity groups, GCW and GWE showed significant variation. The lowest GCW values were observed in patients with severe MR (1483.3 ±282.7 mm Hg%) and the highest in those with moderate MR (2114.9 ±534.6 mm Hg%) (p = 0.01). Similarly, lower GWE values were observed in patients with severe MR compared to the other groups (p = 0.02). No significant differences were found for GWW (p = 0.21).

Conclusions: The findings suggest that while GLS remains relatively consistent across different MR severity groups, GCW and GWE tend to decrease in patients with severe MR. This observation may indicate that GCW is a more responsive marker of myocardial function in the presence of concomitant MR.

Introduction: The onset of heart failure (HF) often signifies disease progression and unfavorable prognoses in cases of acute ST-segment elevation myocardial infarction (STEMI).

Aim: To explore the potential value of circulating cardiomyocyte-specific cell-free DNA (CS cfDNA) levels as an indicator for predicting risk of HF after acute STEMI.

Material and methods: Overall, 146 STEMI patients were included and classified into two groups according to CS cfDNA levels at admission: Group N1: ≤ 164 copies/ml, Group N2: > 164 copies/ml. A follow-up period of approximately 355 days was completed.

Results: The prevalence of HF in Group N2 was significantly higher than that in Group N1 (77.4% vs. 18.3%, p < 0.001). ROC curve analysis revealed an AUC of 0.838 (95% CI: 0.688-0.899) for CS cfDNA in predicting onset of HF after STEMI. This AUC value was notably elevated in comparison to that of conventional biomarkers, namely NT-proBNP (AUC = 0.726) and soluble suppression of tumorigenicity-2 (sST2) (AUC = 0.635). Cox proportional hazards regression model analysis further confirmed that level of CS cfDNA at the time of admission was an independent predictor of HF following STEMI, with a hazard ratio (HR) of 2.804 and a 95% CI of 1.086-7.243, achieving statistical significance at p = 0.035.Conclusions: There was a significant positive association between CS cfDNA levels and cardiac injury biomarkers (such as cTnI and sST2). CS cfDNA levels may represent a promising and important biomarker for predicting the occurrence of HF after STEMI, providing novel strategies for clinical management and prognostic evaluation of patients.

Introduction: Atherosclerosis is a systemic disease, but the relationship between plaque characteristics in the coronary and carotid arteries remains unclear.

Aim: This study aimed to compare the morphological and compositional characteristics of atherosclerotic plaques in coronary and carotid arteries using multidetector computed tomography angiography (MDCTA) in the same patient group.

Material and methods: Eighty-eight patients who underwent both coronary and carotid MDCTA were analyzed. Plaque volume, composition (soft, mixed, calcified), and plaque burden were quantitatively measured in both vascular beds.

Results: Plaque burden (63.7% vs. 36.9%) and the proportion of soft plaque (23.5% vs. 7.2%) were significantly higher in the coronary arteries compared to the carotid arteries (p < 0.001 for both). Conversely, the total plaque volume and the proportion of calcified plaque were higher in the carotid arteries. While a strong positive correlation was found between the calcified plaque volumes in both vascular beds (r = 0.651, p < 0.001), importantly, no significant relationship was observed between the soft plaque volumes, which are associated with acute events (r = -0.037, p = 0.735).

Conclusions: Atherosclerosis exhibits different characteristics in the coronary and carotid arteries. While the accumulation of stable, calcified plaque reflects a systemic process, the formation of high-risk soft plaques appears to be more influenced by local factors. Therefore, although non-invasive assessment of the carotid arteries provides valuable information about the overall calcified atherosclerotic burden, it may be insufficient for predicting the presence of soft plaques in the coronary arteries and the associated risk of acute events.

Introduction: Intravascular lithotripsy (IVL) has a strong safety and efficacy profile for managing calcified coronary lesions during percutaneous coronary intervention (PCI). Nevertheless, evidence on its application in left main (LM) disease remains scarce.

Aim: This study aimed to evaluate procedural success, efficacy, safety, and two-year clinical outcomes of IVL in LM PCI.

Material and methods: The analysis included 53 patients who underwent LM PCI using the Shockwave C2 and C2+ IVL systems beginning in April 2020. Outcomes were compared with those of 148 patients who underwent non-LM PCI during the same period.

Results: The two groups were similar in age. Non-ST elevation myocardial infarction (NSTEMI) (43.4% vs. 23.6%; p = 0.006) and heart failure history were more common in the LM cohort (47.2% vs. 29.1%; p = 0.017). Larger IVL balloon diameters were chosen in LM lesions, with less use of 3.0 mm balloons (24.5% vs. 44.6%; p = 0.016) and more use of 4.0 mm balloons (15.1% vs. 2.0%; p < 0.001). Intravascular imaging (IVUS/OCT) was performed in nearly every LM case (94.3% vs. 40.5%; p < 0.001). IVL success rates were high in both groups (100% vs. 96.6%; p = 0.400), as were overall procedural success rates. No cases of coronary artery perforation or slow-flow/no-reflow phenomena were recorded. During long-term follow-up, there were no differences between the LM and non-LM cohorts in all-cause mortality (14.8% vs. 6.3%; p = 0.087) or major adverse cardiovascular events (MACE) incidence (6.7% vs. 9.0%; p = 0.582).

Conclusions: In LM PCI, IVL demonstrates a favorable safety and efficacy profile, achieving high technical success rates and long-term outcomes, including MACE rates comparable to those observed in non-LM PCI.