Postepy W Kardiologii Interwencyjnej最新文献

Veterinary interventional cardiology exemplifies the power of reverse translation in cardiovascular medicine. This review examines how procedures initially tested in animal models, refined in human medicine, and subsequently reintroduced to veterinary practice have completed the translational cycle. We analyze several key interventions - pacemaker implantation, patent ductus arteriosus occlusion, balloon valvuloplasty, radiofrequency ablation, septal defect closure, and mitral valve repair by V-Clamp (a veterinary version of the human MitraClip device) - demonstrating how each has evolved through bidirectional knowledge exchange between human and veterinary medicine. We show how spontaneous disease models in companion animals offer superior translational value compared to induced laboratory models. The development costs for cardiovascular devices ($30-94 million) and high failure rates (> 30%) in human trials create compelling economic incentives for integrating veterinary clinical trials as strategic de-risking investments. We provide comparative pathophysiology for key spontaneous disease models, including canine dilated cardiomyopathy and subaortic stenosis, demonstrating their direct relevance to human cardiovascular research through shared genetic, electrophysiological, and hemodynamic features. Current regulatory frameworks lack clear guidance for incorporating veterinary clinical data into human device submissions, creating uncertainty that impedes innovation. As interventional cardiology advances toward miniaturized, intelligent, and personalized therapies, the One Health approach offers a powerful framework for accelerating innovation while improving outcomes across species.

Introduction: Balloon aortic valvuloplasty (BAV) is typically performed in hybrid theaters or hospitals with cardiosurgery wards. Due to limited access to these facilities, BAV may also be conducted in standalone catheterization laboratories (ASC).

Aim: This study compared the safety and efficiency of BAV in ASC versus cardiac surgery-backed units (CSBU).

Material and methods: This multicenter (7 sites) retrospective registry included 514 symptomatic patients with severe aortic stenosis who underwent BAV. Of these, 376 procedures were performed in CSBU and 138 in ASC.

Results: Baseline characteristics were similar, except for a higher prevalence of CAD (ASC 63% vs. CSBU 45%, p = 0.001) and anemia (ASC 47.1% vs. CSBU 11.7%, p = 0.001) in the ASC group. No differences were observed between groups: in-hospital death (ASC 0.72% (n = 1) vs. CSBU 2.93% (n = 11) p = 0.14), tamponades (ASC 0.72% (n = 1) vs. CSBU 1.33% (n = 5) p = 0.57), significant bleeding which required transfusion (ASC 4.34% (n = 6) vs. CSBU 1.86% (n = 7) p = 0.57), pseudoaneurysm (ASC 1.44% (n = 2) vs. CSBU 0.52% (n = 2) p = 0.29) and implanting pacemakers (ASC 4.34% (n = 6) vs. CSBU 1.86% (n = 7) p = 0.57). Balloon dilatation with 18-24 mm diameter balloon catheters reduced the transvalvular gradient in both groups significantly (ASC: 49.6 ±8.2 mm Hg to 34.4 ±5.2 mm Hg, p = 0.01, and CSBU: 50.2 ±7.3 mm Hg to 36.5 ±4.3 mm Hg). There were no significant differences in transvalvular gradient after the procedure.

Conclusions: The safety and efficiency of BAV performed in standalone catheterization laboratories are comparable to those performed in cardiology wards with cardiac surgery backup.

Introduction: Radial or brachial access for endovascular treatment of peripheral arterial disease may reduce access site complications and avoid the need for post-procedure immobilization.

Aim: This study evaluated in-hospital, 30-day, and 12-month outcomes for iliac artery lesion treatment with these access types.

Material and methods: The study retrospectively included 109 patients, 67% males, aged 38-88 years, with chronic lower limb ischemia and atherosclerotic lesions in the iliac arteries. Endovascular treatment was performed via radial or brachial access in 22% and 78% of cases. Iliac artery occlusions, subocclusions, and significant stenoses were present in 11%, 24%, and 65% of patients. We collected data on demographics, comorbidities, procedural details, adverse events, and outcomes.

Results: During the hospital stay and 30-day follow-up, there were no deaths, amputations, or reinterventions. Technical success was achieved in 100% of cases, with no conversions to femoral access required. The overall complication rate related to the access site was 4.6%, with 3.6% of complications necessitating local surgical intervention. Notably, there was one minor ischemic stroke and one distal embolization during using right brachial access. All reported access site complications were associated with brachial access. The average time to discharge after the procedure was 1.2 days. At 12 months, the target lesion revascularization rate was 3.7%.

Conclusions: Radial or brachial access was a safe alternative to femoral access for endovascular procedures in the iliac arteries. Using left-side radial or brachial access enabled 100% technical success.

Introduction: High premature ventricular contraction (PVC) burden is known to cause atrial remodeling. P wave duration-to-amplitude ratio (PWDAR) is a new P wave index that includes both P wave duration and P wave voltage, which can be considered to effectively evaluate atrial cardiomyopathy. 3D speckle-tracking echocardiography is accepted as a valid and reliable technique for assessment of the left ventricle (LV) and left atrium (LA).

Aim: In the present study, we investigated whether patients with a high PVC burden exhibit subclinical left atrial electrical and mechanical dysfunction, assessed electrically using PWDAR and mechanically using 3D-speckle tracking echocardiography.

Material and methods: Seventy-five patients with PVC (PVC+) and 75 age- and gender-matched controls were enrolled in the study. Surface 12-lead standard electrocardiograms (ECGs) were recorded. Clinical characteristics and laboratory values of the patients were obtained. Conventional 2D echocardiographic and 3D-STE analyses were performed.

Results: The PWDAR was significantly higher in the PVC+ group than in the control group (p < 0.001); and the LAS-r, LAS-active, and LV-GLS were significantly depressed in the PVC+ group (p < 0.001, p < 0.001, p = 0.015, respectively). The multivariate regression models demonstrated that PWDAR (p < 0.001), LAS-r (p < 0.001), LAS-active (p = 0.008), and LV-GLS (p = 0.021) were independent factors predicting PVC-induced atrial cardiomyopathy (PVC-ACMP).

Conclusions: Our results revealed subclinical left atrial electrical and mechanical dysfunction in patients with a high PVC burden. PWDAR and left atrial strain parameters can predict PVC-ACMP.

Introduction: Anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV) is a systemic autoimmune disease that may cause subclinical cardiac involvement, increasing morbidity and mortality.

Aim: This study aimed to evaluate subclinical myocardial dysfunction, including both left ventricular (LV) and right ventricular (RV) function, as well as LV dyssynchrony, in patients with ANCA-associated vasculitis (AAV) using speckle-tracking echocardiography (STE).

Material and methods: The study included 39 consecutive patients with AAV (mean age: 52.9 ±12.8 years, 19 male sex) and 44 healthy controls (mean age: 50.2 ±8.7 years, 28 male sex). All participants underwent standard transthoracic echocardiography. LV and RV strain parameters including global longitudinal strain (GLS), as well as LV dyssynchrony assessed by peak systolic dispersion (PSD), were evaluated using STE.

Results: LV GLS was significantly reduced in patients with AAV compared to healthy controls (-16.6 ±2.2% vs. -19.6 ±2.0%, p < 0.001), despite similar ejection fraction (EF). LV PSD was significantly higher in the AAV group (54.9 ±14.8 ms vs. 43.9 ±11.8 ms, p < 0.001), suggesting increased LV dyssynchrony. RV strain parameters were also impaired, with lower RV GLS (-19.2 ±2.7% vs. -20.6 ±2.8%, p = 0.024) and RV free wall strain (-21.6 ±3.7% vs. -23.9 ±3.5%, p = 0.004). Multivariable regression analysis showed that the presence of AAV was independently associated with both LV GLS and LV PSD.

Conclusions: STE revealed subclinical impairments in both LV and RV function in patients with AAV, despite normal EF and no overt clinical symptoms, which emphasizes the value of cardiac monitoring to explore cardiac involvement.

Introduction: Endovascular therapy (EVT) strategies have been developed, and complex lesions can often be revascularized using antegrade wiring. However, there are situations in which the distal artery approach is required. Anterolateral popliteal artery (PA) puncture has many advantages, such as ease of puncture and ability to be performed in the supine position. However, there is hesitancy to use sheaths larger than 4.0 Fr because of the risk of bleeding complications due to the long distance from the skin to the PA.

Aim: To evaluate the safety of sheath insertion via anterolateral popliteal artery puncture.

Material and methods: We retrospectively reviewed the devices and outcomes of 14 patients who underwent EVT with a wide sheath inserted during anterolateral PA puncture at our institution and introduced a hemostatic method.

Results: A total of 179 EVTs were performed at our institution, 14 of which involved anterolateral PA puncture. 4.0-6.0 Fr sheaths were used, and the PA was ballooned for 10 min during sheath removal. The dorsal PA was compressed with hemostatic compression cotton, and the anterior puncture site was compressed with Stepty (NICHIBAN, Tokyo, Japan) and fixed together with an adhesive elastic bandage. There were no complications, such as hematoma formation or compartment syndrome, in all 14 patients.

Conclusions: The safety of insertion of a wide-diameter sheath in anterolateral PA puncture has been recognized and is expected to expand the range of treatment strategies for EVT using the anterolateral PA approach.

Introduction: A persistent patent foramen ovale (PFO) is a congenital heart defect that predisposes to crossed embolism resulting in stroke. The defect can be accompanied by endothelial dysfunction. One marker reflecting endothelial dysfunction is serotonin, the concentration of which can be increased by passing through the PFO, thus bypassing degradation in the lungs.

Aim: To study the potential association between endothelial dysfunction and the occurrence of cryptogenic stroke in patients with PFO, compared with patients without PFO and without a history of cryptogenic stroke.

Material and methods: Seventy-nine patients were recruited, including 51 (64.65%) women and 28 (35.44%) men, who underwent PFO closure surgery within the Clinical Department of Cardiovascular Diseases of the John Paul II Specialized Hospital of Krakow, Poland, for a history of cryptogenic stroke between 2009 and 2021. The mean age was 48.34 ±13.13 years. The control group consisted of 79 patients (male and female) without a stroke history. Patients underwent the following examinations: subject and physical examination, transthoracic and transesophageal echocardiography, and laboratory tests including serotonin levels collected before the PFO closure procedure.

Results: There was a statistically significant difference between serotonin levels in the study group and the control group (1645.55 ±801.26 vs. 856.98 ±781.63; p < 0.001). There was no correlation between serotonin concentration and channel length and width (r = 0.082; p = 0.471; r = 0.085; p = 0.455).

Conclusions: Serotonin levels appear to be significantly higher in patients with PFO after cryptogenic stroke compared with patients without PFO and stroke history. The length and width of the PFO canal may not correlate with serotonin levels.