Postepy W Kardiologii Interwencyjnej最新文献

Introduction: Electrocardiographic (ECG) markers such as the Tpeak-Tend interval (Tpe), QRS interval, and fragmented QRS (fQRS) are increasingly recognized as predictors of clinical outcomes in heart failure patients with reduced ejection fraction (HFrEF). However, the association of these ECG markers with invasive hemodynamic parameters remains underexplored.

Aim: The primary objective of this study is to assess the prognostic value of ECG parameters in patients with HFrEF. The secondary aim is to investigate the relationship between ECG markers (Tpe, QRS interval, and fQRS) and invasive hemodynamic parameters in these patients.

Material and methods: A total of 325 patients with HFrEF who underwent right heart catheterization between January 2007 and January 2017 were included in this cross-sectional study. The primary end-points were defined as all-cause mortality and composite end-point (CEP) (recently undergone heart transplant surgery, mechanical circulatory support, and all-cause mortality).

Results: During a median follow-up of 28.1 months, all-cause mortality was observed in 138 patients. Patients with CEP (n = 156) had longer QRS, Tpe intervals, and a greater number of fQRS complexes (p < 0.05). Prolonged QRS and Tpe intervals showed significant correlations with elevated pulmonary artery pressures and reduced cardiac output (p < 0.05). Every one ms increase in Tpe and QRS intervals was associated with a 3% and 5% increase in CEP, respectively. Tpe and QRS intervals were found to be independent predictors of CEP and all-cause mortality in patients with HFrEF.

Conclusions: Tpe and QRS intervals provide valuable information regarding the hemodynamic status and prognosis in patients with HFrEF. These simple ECG parameters may serve as noninvasive tools for risk stratification and aid in clinical decision-making in this high-risk population.

Introduction: Excimer laser coronary angioplasty (ELCA) employs catheters of various sizes. Although the crossability and irradiation time are better with the use of smaller-diameter catheters, the available irradiation area is greater when larger-diameter catheters are used.

Aim: To investigate the effects of laser catheter size on myocardial function and salvage in patients with ST-elevation myocardial infarction (STEMI), as assessed using nuclear scintigraphy data.

Material and methods: A total of 123 consecutive patients with STEMI who underwent primary percutaneous coronary intervention (PCI; median age, 67 [69-72] years; males, n = 102 [82.9%]) were retrospectively enrolled. The patients were divided into a 0.9-mm catheter diameter group (n = 47) and a 1.4-/1.7-mm catheter diameter group (n = 76). Clinical and periprocedural outcomes, along with myocardial function assessed by nuclear scintigraphy, were compared.

Results: There were no significant differences in patient characteristics, PCI procedures, or in-hospital outcomes between the two groups. The occurrence of slow coronary flow and final Thrombolysis in Myocardial Infarction (TIMI) flow grade were similar between the two groups. Nuclear scintigraphy showed improvements in systolic function and myocardial salvage in both groups, with greater changes observed in the 0.9 mm group, although baseline differences in myocardial risk may have influenced these results.

Conclusions: The 0.9-mm catheter may achieve myocardial salvage outcomes comparable to larger catheter sizes in STEMI patients undergoing ELCA, though further study is warranted.

Introduction: Out-of-hospital cardiac arrests (OHCAs) require rapid emergency medical service (EMS) responses to improve patient outcomes. This study examines non-patient factors affecting EMS response times and OHCA outcomes, particularly return of spontaneous circulation (ROSC), with a focus on factors such as location, time of day, and season.

Aim: To evaluate the influence of operational and situational factors on EMS response times and their association with ROSC rates.

Material and methods: A retrospective analysis was performed using EMS records from the Lublin Voivodeship, Poland, covering 2014 to 2017. A total of 4,361 OHCA cases were selected from an initial 5,111 identified cases through ICD-10 and ICD-9 codes, utilizing call-out cards and medical rescue activity cards. Statistical analyses, including χ² tests and correlation coefficients, assessed the impact of socio-demographic and operational factors on ROSC outcomes.

Results: Shorter EMS response times were significantly associated with higher ROSC rates, with a mean response time of 7.92 min for ROSC cases (SD = 4.86) versus 8.29 min for non-ROSC cases (SD = 4.19; p = 0.0430). High-priority cases (K-1) had better ROSC outcomes (16.97%) compared to lower-priority cases (K-2: 12.30%; p < 0.05). Time of day and season did not significantly impact response effectiveness.

Conclusions: Rapid EMS response and effective prioritization improve ROSC rates in OHCA incidents. The findings highlight the need to optimize EMS protocols and training, with targeted strategies that consider operational factors to enhance survival rates across varied populations.