Postepy W Kardiologii Interwencyjnej最新文献

Introduction: As transcatheter aortic valve implantation (TAVI) indications expand, understanding the valve degeneration process and potential influencing biomarkers becomes increasingly important.

Aim: To investigate temporal changes in biomarker levels and their potential association with ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) and ¹⁸F-sodium fluoride (¹⁸F-NaF) uptake, assessed using positron emission tomography/computed tomography (PET/CT) studies as markers for native aortic annulus calcifications and early-stage TAVI valve degeneration.

Material and methods: A total of 71 TAVI patients underwent blood sampling and transthoracic echocardiography at baseline (pre-TAVI) and 6, 12, 18, and 24 months after the procedure. PET/CT using ¹⁸F-NaF and ¹⁸F-FDG was performed at 6 and 24 months. Serum levels of matrix metalloproteinase-3 (MMP-3), matrix metalloproteinase-9 (MMP-9), and osteopontin (OPN) were measured. In addition, plasma levels of osteoprotegerin (OPG), lipoprotein a (Lp(a)), and oxidized LDL (ox-LDL) were assessed.

Results: Finally, 31 patients (median age: 84.0 years) completed the study. Valve function improved after TAVI and remained stable during follow-up. Over 24 months, OPN levels decreased (p = 0.010), while MMP-3 and MMP-9 levels increased (p = 0.046 and p = 0.041). MMP-3 and MMP-9 showed multiple positive correlations across time points. OPN, ox-LDL, and OPG demonstrated significant negative correlations with follow-up effective orifice area index and effective orifice area (EOA). No significant correlations were found between biomarkers and PET/CT uptake.

Conclusions: Significant biomarker changes over 24 months and negative correlations with EOA suggest potential roles in aortic valve function. However, no correlations between biomarkers and PET/CT results were observed.

Introduction: Cardiac risk factors and diseases exacerbate anxiety and may cause exercise sensitivity by increasing awareness of physical conditions. However, the extent to which exercise sensitivity influences the level of physical activity and kinesiophobia in CVD patients is unclear.

Aim: The current study aimed to determine exercise sensitivity and its associated kinesiophobia and physical activity levels in patients with chronic coronary syndrome (CCS).

Material and methods: This cross-sectional study involved 43 patients diagnosed with CCS and 45 age- and gender-matched healthy individuals. Exercise sensitivity (questionnaire created by researchers), physical activity levels (short form Physical Activity Questionnaire, IPAQ), and kinesiophobia (Tampa Kinesiophobia Scale Heart, TSK-H) were evaluated.

Results: The exercise sensitivity score (ESS, 37.40 ±7.38 and 33.65 ±5.83, p = 0.010) was higher in the CSS group. During exercise, feeling pain, depletion of energy fatigue, chest pain, chest tightness, dizziness, palpitations, dyspnoea, and fainting frightened the patients (p < 0.05). The TSK-H score was higher, and the difference was significant in CCS patients compared the healthy controls (p = 0.007). Tye physical activity level was lower in patients than in healthy controls (p < 0.001), and 58.1% of CCS patients were inactive. ESS was significantly associated with IPAQ score (r = -0.360; p = 0.018) and TKS-H score (r = 0.529; p < 0.001) in CCS patients. According to linear regression analyses, exercise sensitivity explains 25% of kinesiophobia and physical activity.

Conclusions: Patients with CCS exhibit fear and sensitivity towards exercise, and these fears contribute to high levels of kinesiophobia and low physical activity levels. Future studies should be designed based on exercise sensitivity to increase participation in exercise-based programs.

Introduction: Radial access reduces vascular complications compared to femoral access. Various factors may influence the patient's pain during coronary intervention.

Aim: To assess what clinical and periprocedural factors affect discomfort and pain intensity during angiography via the radial artery without use of spasmolytics.

Material and methods: A group of 238 patients (M/F 142/96, mean age: 67 ±10 years) who underwent coronary angiography and interventions through the radial artery approach was studied. Every patient had ultrasound assessment of the radial artery. Pain was assessed according to the numerical pain rating scale, where mild pain is 1-3, moderate pain is 4-7, and severe pain is above 7.

Results: We included 238 patients. Most of the participants had a low pain level (n = 133 (55.88%)), while a smaller number had moderate and severe pain level (n = 88 (36.97%) and n = 17 (7.14%), respectively). We analyzed 38 characteristics of the patients in terms of the possible influence on the pain level during angiography.

Conclusions: In our study we analyzed possible factors which may contribute to the severe pain sensation during percutaneous coronary intervention. We found that masculine gender, greater weight and height as well as diabetes mellitus and myocardial infarction diagnosis on admission correlated with lower pain level. Conversely, greater maximal and minimal diameters of the radial artery correlated with stronger pain level.

Introduction: Pericoronary fat thickness (PFT) is a well-established marker crucial for evaluating the extent and severity of coronary artery disease (CAD). While its role in CAD is widely acknowledged, a considerable gap exists in understanding the prognostic implications of PFT after percutaneous coronary intervention (PCI), specifically for coronary chronic total occlusions (CTO).

Aim: This study investigated the relationship between PFT and prognostic outcomes in patients undergoing PCI for CTO.

Material and methods: A retrospective study analyzed data from 415 patients who had undergone coronary computed tomography angiography (CCTA) and coronary angiography (CAG). PFT measurements were taken, and patients were categorized into normal, PCI (non-CTO), and CTO-PCI groups. Prognostic implications within the CTO-PCI group were evaluated based on survival status.

Results: PFT measurements varied significantly among groups. The CTO-PCI group had a 13.9% mortality rate over a median follow-up of 16.6 ±10.3 months. Higher average PFT values were found in the non-survival group (p = 0.013). ROC curve analysis identified an average PFT cut-off value of 13.6 mm (AUC = 0.682, p = 0.011). Cox regression analysis linked mortality with LVEF (HR = 0.938, p = 0.001), albumin (HR = 0.189, p = 0.006), and average PFT (HR = 1.252, p = 0.040). Elevated average PFT was associated with higher mortality (p = 0.001).

Conclusions: PFT is a significant inflammatory marker and a promising prognostic indicator following PCI for CTO. Integrating PFT into risk prediction models may enhance prognostic accuracy and aid in timely clinical interventions.

Introduction: The effect of using intravascular ultrasound (IVUS) during percutaneous coronary intervention (PCI) on short-term mortality is not well established.

Aim: To evaluate any association between the use of IVUS vs. no IVUS during PCI and mortality in a large inpatient database.

Material and methods: We used the National Inpatient Sample (NIS) database for available ICD-10 codes from 2016-2020 for IVUS and PCIs.

Results: A total of 10,059,56 PCIs were performed. In 206,910, IVUS-guided PCI was performed vs. 9,852,359 without IVUS. Mortality did not differ between the two groups, with 2.52% mortality in the IVUS arm vs. 2.59% in no IVUS cohort, p = 0.4. The mean age of patients with IVUS use was 65.5 vs. 70.1 years without IVUS, p < 0.001. Total in-hospital cost in the IVUS group was double that without IVUS ($141,920 vs. $71,568, p < 0.001). Furthermore, IVUS utilization was significantly higher in patients with private health insurance (28.3% vs. 17.2%, p < 0.001).

Conclusions: In-patient all-cause mortality using IVUS during PCI was similar to that in patients without IVUS utilization, but the cost was doubled, with higher utilization in privately insured patients.