Postepy W Kardiologii Interwencyjnej最新文献

Introduction: Transcatheter aortic valve replacement (TAVR) may lead to acute kidney injury (AKI), potentially associated with an unfavorable prognosis in the short and long term.

Aim: The goal of this analysis was to explore the predictive potential of pulmonary artery systolic pressure (PASP) for the evolution of AKI following TAVR in an effort to more reliably establish potential risk factors for this expanding population.

Material and methods: This single-center retrospective analysis included subjects (n = 90) with severe aortic stenosis (AS) undergoing TAVR. Subjects were categorized into two groups based on the evolution of TAVR-associated AKI. Logistic regression analysis was harnessed to determine predictors of TAVR-associated AKI.

Results: The overall incidence of TAVR-associated AKI was found to be 25.6%. Regarding the baseline PASP values, the TAVR-associated AKI(+) group demonstrated higher PASP values compared with those without AKI (55.4 ±14.0 vs. 37.1 ±16.3 mm Hg, p < 0.001). Multivariate logistic regression analysis suggested EuroSCORE (OR = 1.238, 95% CI: 1.093-1.401, p = 0.001), PASP (OR = 1.076, 95% CI: 1.017-1.139, p = 0.011), and hypertension (OR = 3.544, 95% CI: 1.438-5.738, p = 0.017) as independent AKI predictors. ROC curve analysis suggested a PASP value of > 39 mm Hg as an AKI predictor in the post-TAVI setting (with specificity and sensitivity of values of 70.7% and 82.6%, respectively).

Conclusions: PASP at baseline was found to be independently associated with TAVR-associated AKI evolution. In other words, a higher PASP value in the pre-TAVI setting might serve as a potential marker of AKI evolution following TAVI.

Introduction: The use of intravascular imaging during percutaneous coronary intervention (PCI) has been shown to have a significant positive impact on clinical outcomes. The two most frequently used techniques of intravascular imaging for guiding decision-making and optimizing PCI are intravascular ultrasound (IVUS) and optical coherence tomography (OCT).

Aim: To investigate the impact of iodinated contrast agent administration on creatinine clearance and renal function in patients undergoing OCT and IVUS procedures.

Material and methods: An observational retrospective study was conducted at a tertiary institution involving a total of 336 consecutive patients who underwent intracoronary imaging (OCT/IVUS) and PCI procedures with stent implantation. The study included patients in whom intracoronary imaging was used to guide the procedure as well as those in whom it was used to verify the results of stent implantation.

Results: A significant increase in creatinine (greater than 25% from the initial creatinine value) was recorded in 12 patients (3.6%), with 7 patients from the OCT group (4.7%) and 5 patients from the IVUS group (2.7%), p > 0.01. The difference in mean values regarding the imaging groups was statistically significant for the variable amount of contrast medium used (p < 0.01), where the median contrast volume in the OCT group was 320.0 ml and in the IVUS group it was 270.0 ml.

Conclusions: Through retrospective analysis, we can conclude that adequate patient selection for OCT guidance led to increased contrast consumption but did not result in worsening of renal function with adequate patient preparation and parenteral and oral hydration.

Introduction: Hypertension (HTN) poses a significant health threat in China, increasing the risk of cardiovascular disease. However, the impact of self-management interventions on patients with HTN in China has yet to be thoroughly explored.

Methods: This review examines the impact of self-management strategies on systolic blood pressure (SBP) and diastolic blood pressure (DBP). Data were collected from various sources, including PubMed, Cochrane Library, Web of Science, EBSCO, China National Knowledge Infrastructure, Chinese Biomedical Database, Chinese VIP Information, and WanFang Database. The study screening, quality assessment, data extraction, and meta-analysis were carried out according to Cochrane standards.

Results: This study included sixteen randomized controlled trials with a total of 8,652 participants. Compared to control groups, self-management interventions significantly reduced SBP (MD = -6.37, 95% CI [-9.13, -3.61]; I ² = 96%; p < 0.001) and DBP (MD = -4.01, 95% CI [-5.64, -2.37]; I ² = 93%; p < 0.001). In subgroup analyses based on duration, SBP and DBP improved with self-management interventions (p < 0.05), but no significant difference was found between groups (p > 0.05). Lower HTN levels were observed in the control groups within hospital and community settings (p < 0.05), but no effect was observed in rural areas (p > 0.05).

Conclusions: Self-management is an effective approach to reducing both SBP and DBP in hypertensive patients.

Introduction: Cardiac allograft vasculopathy (CAV) is the leading cause of late mortality after heart transplantation (HTx). It is a progressive and diffuse process involving both the epicardial coronary arteries and the microcirculation, caused by immunologic and non-immunologic factors resulting in localized inflammation. Microcirculatory and intravascular imaging assessments help characterize the physiological phenotype of patients and better predict their prognosis.

Aim: To conduct a comprehensive imaging and functional evaluation of the coronary arteries for early detection of vasculopathy in patients after heart transplantation.

Material and methods: This is a prospective, single-center study enrolling patients who underwent heart transplantation and their first coronary angiography (CA) within the first 2 years after HTx. In all patients, intravascular ultrasound was performed to detect thickening of the intima-media complex. Additionally, functional assessment of coronary arteries and microcirculation was done.

Results: Vessels from 10 patients (mean age: 56.6 ±11.6 years) within the first 2 years after transplantation were assessed with additional left anterior descending (LAD) evaluation. A plaque burden of > 30% in the segment of the most significant stenosis in the LAD was observed in 70% of vessels, and thickening of the intima-media complex > 0.5 mm was observed in 60% of cases. Fractional flow reserve (FFR) < 0.8 occurred in 1 patient. The mean index of microcirculatory resistance (IMR) was 17 ±10, and mean coronary flow reserve (CFR) was 4.33 ±1.1.

Conclusions: In heart transplantation patients, comprehensive angiographic, imaging, and physiological evaluation including microcirculation assessment may allow for early detection of allograft vasculopathy.

Introduction: Just as it is important to recommend lifestyle changes such as exercise, diet and smoking cessation to patients in the low-medium-risk group for protection from cardiovascular diseases, it is also important to identify patients in the high-risk group and reduce cardiovascular risk with lifestyle changes and, when necessary, pharmacological treatment.

Aim: This study evaluated the treatment and lifestyle change recommendations given by cardiologists to patients.

Material and methods: Our study was shared with cardiologists via e-mail from January 2024 to February 2024, and the surveys were answered online. Our questionnaire, consisting of 30 questions, covers topics related to cardiovascular protection, diet, nutritional habits, lifestyle, and diagnosis and treatment strategies of coronary artery disease, heart failure, arrhythmia, and dyslipidemia.

Results: Of the 104 participants included in the analysis, 37 (35.58%) were female, and 67 (64.42%) were male. The proportion of participants who recommended regular exercise to all of their patients was low at 25 (24.04%). It was determined that 60 (57.69%) participants were recommended to use aspirin in primary prevention in patients with moderate-severe cardiovascular risk. Achieving the target LDL value remains at a very low rate (2.88%).

Conclusions: The rate of recommending lifestyle changes, diet and exercise to patients in cardiology outpatient clinics is very low. SGLT2 inhibitors (SGLT2i) and angiotensin receptor-neprilysin inhibitors (ARNI) have become highly regarded drugs in heart failure patients. The rate of achieving the target low-density lipoprotein cholesterol value in patients admitted to the cardiology outpatient clinic remains very low.

Introduction: Studies on anesthesia for cryoablation, one of the methods used in the treatment of atrial fibrillation (AF), and its effect on perioperative parameters are limited.

Aim: To compare the effects of conscious sedation with a combination of midazolam-fentanyl and unconscious sedation with propofol-midazolam on the success of the procedure.

Material and methods: 242 patients who underwent AF cryoablation for the first time were included. The ASA score and baseline SaO₂ before the procedure, and the minimum SaO₂, systolic and diastolic blood pressure change and the Richmond Agitation Sedation Scale (RASS) score during the procedure were obtained. Study data were divided into 2 groups - conscious sedation and unconscious sedation - and compared.

Results: Demographic, laboratory and echocardiographic findings did not differ significantly between the two groups (p > 0.05). When the hemodynamic parameters of the periprocedural AF ablation process and the effects of anesthesia were examined according to the anesthesia groups of the patients, minimum SaO₂ during the procedure was significantly higher in the group that underwent conscious sedation (93.6 ±2.21% vs. 92.4 ±1.96% and p < 0.01). RASS score, blood pressure changes were found to be significantly lower in the conscious sedation group (p < 0.01 for each). However, procedural time, fluoroscopy time, ASA score, non-invasive mechanical ventilation (NIMV) requirement, basal SaO₂, procedure success and frequency of AF recurrence were not significantly different between prolonged recovery groups (p > 0.05 for each).

Conclusions: In our study, it was found that the conscious sedation preference during AF cryoablation could be applied with similar success and recurrence compared to unconscious sedation with propofol and midazolam.