Postepy W Kardiologii Interwencyjnej最新文献

Introduction: The advanced lung cancer inflammation index (ALI) is an independent prognostic biomarker of inflammation and nutrition in various types of cancer, acute heart failure and acute coronary syndrome. The SYNTAX (Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery) score (SXscore) is an angiographic scoring tool used to determine the extent and severity of coronary artery disease.

Aim: To investigate the relationship between ALI and coronary artery lesion complexity assessed using the SXscore in patients with non-ST-segment elevation myocardial infarction (NSTEMI).

Material and methods: Between February and November 2020, a total of 284 patients with NSTEMI were included consecutively. ALI was calculated with the formula body mass index (BMI) × serum albumin concentration/neutrophil-to-lymphocyte ratio (NLR). SXscore was calculated using the online calculator and divided into two groups - low (< 32) and high (≥ 33) - and then analyzed.

Results: Patients with a high SXscore had lower ALI (22.4 ±7.3 vs. 58.5 ±44.3, p = 0.016). In the univariable analysis, age (p = 0.046), BMI (p = 0.021), C-reactive protein (p = 0.002), peak troponin I (p = 0.009), NLR (p = 0.025), serum albumin (p = 0.003) and ALI (p < 0.001) were significantly associated with a high SXscore. ALI emerged as an independent predictor of a high SXscore in multivariable analysis (95% CI: 0.931-0.984, p = 0.002).

Conclusions: The ALI may be useful as a simple tool for predicting high SXscore in patients with NSTEMI. To our knowledge, this is the first study to examine the relationship between ALI and severity of CAD.

Introduction: One of the predictable and preventable complications that may occur after transaortic valve implantation (TAVI) is the requirement for permanent pacemaker (PPM) implantation.

Aim: To evaluate the relationship between aortic knob calcification (AKC) assessed by preoperative chest X-ray and the requirement for post-procedure PPM implantation for patients who underwent TAVI.

Material and methods: This study was conducted with 110 patients who underwent TAVI with a Myval transcatheter heart valve in our center between June 2020 and December 2022. The patients' electrocardiograms were monitored after the procedure. The patients were evaluated in two groups according to whether they required PPM. The AKC grading was performed by examining the routine posterior-anterior chest radiographs of all patients participating in the study.

Results: A PPM was placed in 17 (15.4%) patients after TAVI. The remaining 93 patients formed the control group. AKC (p = 0.002) and membranous septum (p = 0.013) statistically significantly differed between the PPM and control groups; however, no significant difference was detected in relation to the other parameters. In the univariable (p = 0.004) and multivariable (p = 0.024) regression analyses performed to identify predictors of PPM requirement after TAVI, AKC was found to be both a dependent and independent predictor.

Conclusions: AKC can be used as a cost-effective and easily accessible parameter for predicting the post-procedure PPM requirement in patients who have undergone TAVI.

Introduction: There are few data on permanent pacemaker implantation (PPMI) in patients who have undergone transcatheter aortic valve implantation (TAVI) for bicuspid aortic valve (BAV) stenosis.

Aim: The purpose of this study was to evaluate the predictors and incidence of PPMI in bicuspid patients using a balloon-expandable (BE) TAVI device.

Material and methods: A total of 62 patients with bicuspid morphology who had undergone successful TAVI using a BE device without previous PPMI were included (retrospectively). Their baseline clinical, electrocardiographic (ECG), echocardiographic, and multislice computed tomography (MSCT) details were collected.

Results: The incidence of PPMI after TAVI in this BAV cohort was 12.9%. All eight patients with PPMs were found to have type 1 left-right (L-R) fusion morphology. In univariate analysis, the presence of right bundle branch block (RBBB) in preprocedural ECG (p < 0.0001), short membranous septum (MS) evaluated in MSCT (p < 0.0001), and increased annulus-left main coronary artery distance (p = 0.02) were statistically significant for PPMI. Among these parameters included in the model using multivariate Firth logistic regression analysis, the presence of preprocedural RBBB (p = 0.001) and shortness of the MS in MSCT (p = 0.004) were independent risk factors for predicting postprocedural PPMI in patients who underwent TAVI among those with BAV.

Conclusions: Preprocedural RBBB on ECG and shorter MS are independent risk factors for PPMI after TAVI in BAV patients and these parameters should be considered before the procedure to guide clinical decision making. Type 1 L-R patients may be considered at increased risk of PPMI.

Introduction: The use of atherectomy in peripheral vascular intervention remains controversial.

Aim: To review our experience with atherectomy as an adjunct to endovascular revascularization in a successive group of patients with chronic limb-threatening ischemia (CLTI).

Material and methods: Consecutive patients with CLTI treated in a high-volume vascular center between 12/01/2019 and 12/31/2021 were reviewed. Follow-up data were abstracted from office and hospital records. Endpoints were death, all amputation, major amputation and target lesion revascularization (TLR). Secondary endpoints were relief of ischemic rest pain and healing of wounds.

Results: During the study period 405 patients (447 limbs) underwent an endovascular procedure. Mean age was 77 ±11.7 years. Of the 447 limbs treated, 123 (27.5%) were Rutherford 4, 284 (63.5%) Rutherford 5 and 40 (8.9%) Rutherford 6. 1190 lesions (2.66 ±1.02 lesion per limb) underwent treatment, with 56.3% located in the femoral-popliteal distribution and 681 (57.2%) being total occlusion. During follow-up to 24 months, there were 76 deaths (18.8%) and 18 major amputations (4%). Surgical bypass was performed in 2% of cases. Estimated two-year amputation and major amputation-free survival probability was 88.4% and 94.5%, respectively. Estimated two-year TLR-free probability was 55%.

Conclusions: Atherectomy facilitated treatment of patients with CLTI. These patients were elderly, with limited life expectancy and had multiple lesions per extremity with a high percentage of long occlusions and tibial disease. While TLR-free probability at 2 years was 55%, the overall amputation rate was low. This approach resulted in excellent limb salvage in a high-risk patient group with limited life expectancy and advanced disease.

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.