Postepy W Kardiologii Interwencyjnej最新文献

Introduction: In multivessel coronary disease, interventional therapy is recommended to improve symptoms and survival. Inflammatory activation is postulated as one of the coronary atherosclerosis progression risk factors and prognostic indicators of surgical intervention. Counts of plasma extracellular vesicles (EVs) derived from erythrocytes, leukocytes, and platelets are elevated in patients with inflammatory diseases, including atherosclerosis-based cardiovascular diseases.

Aim: We aimed to estimate the association between blood flow measurements in coronary artery bypass grafts and EV plasma count changes in patients undergoing surgical coronary revascularization.

Material and methods: Forty-four consecutive patients who underwent surgical off-pump revascularization (33 males, 75%) in the median (Q1-Q3) age of 65 (58-69) were included. The blood flow in the implanted coronary artery bypass grafts was measured intraoperatively. EV counts were measured at baseline (hospital admission) and on the 1^st and 3^rd postoperative days. The numbers of EVs from erythrocytes (CD235+), leukocytes (CD45+) and platelets (CD61+) were measured using flow cytometry with fluorescently labeled antibodies against specific antigens exposed on the EVs.

Results: The numbers of leukocyte-derived EVs were lower in patients who received a LIMA-LAD graft (p = 0.020). The total EV plasma count changes were found significant for RIMA-LAD grafting (p = 0.028) and LIMA-LAD (p = 0.015) in arterial and arterio-venous grafting, respectively.

Conclusions: Surgical revascularizations affect EV plasma count, including significantly lower postoperative values of leukocyte-derived EVs related to left descending artery grafting.

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.