Hellenic Journal of Cardiology最新文献

Objectives: Uric acid (UA) concentration is associated with an increased risk of atrial fibrillation, but few studies have investigated this association after cardiac surgery. This study investigated the statistical association between postoperative atrial fibrillation (POAF) and preoperative UA concentration according to the type of cardiac surgery.

Methods: Consecutive patients undergoing cardiac surgery at a tertiary center from January to May 2019 were eligible. Patients were separated into two groups according to POAF occurrence. Subgroup analyses were performed in patients undergoing coronary artery bypass grafting (CABG) or valve surgery. Binary logistic regression models were used to assess independent factors of POAF. Principal component analyses (PCA) were performed to investigate whether CABG or valve surgeries were associated with different biological profiles for POAF.

Results: The study included 221 patients, of whom 76 presented at least one POAF episode. The UA concentration was higher in the POAF group compared with the POAF-free group (352 μmol/l [295-420] vs. 321 μmol/l [249-380], p=0.004). This association persisted in multivariable analysis (for 10 μmol, OR= 1.04 [1.34-8,7]; p=0.014) and in patients undergoing isolated CABG. In patients undergoing valve surgery, despite a high incidence of POAF, no association was found. PCA identified different blood biological profiles for POAF after CABG versus valve surgery.

Conclusions: The preoperative UA concentration was independently associated with the occurrence of POAF after CABG but not after valve surgery. PCA results suggests that different biological profiles contribute to POAF occurrence according to the type of cardiac surgery, thus suggesting different strategies for prevention/intervention.

Objective: This study aimed to explore the risk factors of microvascular obstruction (MVO) after percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI).

Methods: A retrospective analysis was performed on 165 patients with STEMI who successfully underwent emergency PCI and completed cardiac magnetic resonance (CMR) within 1 week after PCI. Total ischemia time (symptom onset to wire, S2W), first medical contact to wire (FMC2W), and door to wire (D2W) were compared with the recommended critical time nodes for STEMI treatment. Left ventricular function was evaluated by CMR cine, and myocardial infarction characteristics and MVO were evaluated by late-gadolinium enhancement (LGE). Binary logistic regression analysis was used to evaluate the effect of delay in treatment of STEMI on the occurrence of MVO after PCI.

Results: In this study, 89 (53.9%) patients with STEMI presented with MVO after emergency PCI. The FMC2W time and S2W time in the MVO (+) group were significantly longer than those in the MVO (-) group (P < 0.05). Compared with the MVO (-) group, the MVO (+) group had larger myocardial infarction size (IS) and lower left ventricular ejection fraction (LVEF) (P < 0.05). Patients with FMC2W time >120 min and S2W time >300 min had greater myocardial IS and MVO than the FMC2W ≤ 120 min and S2W time ≤300 min group, respectively. Logistic regression analysis showed that S2W time >300 min (P = 0.039, OR = 2.756, 95% CI = 1.053-7.213) was an independent predictor of MVO after PCI in patients with STEMI.

Conclusion: Shortening the total time of myocardial ischemia and increasing the proportion of early reperfusion therapy can prevent or reduce MVO after PCI.

Objective: Giant cell arteritis (GCA) is a chronic inflammatory condition associated with a significantly increased risk of various cardiovascular and thromboembolic events. Existing studies suggest an increased risk of cardiovascular disease in GCA, but results vary. This meta-analysis aims to quantify the association between GCA and the risk of various cardiovascular outcomes, providing a comprehensive evaluation of the cardiovascular burden in patients with GCA.

Methods: A comprehensive literature search was carried out using several databases. Studies were included based on predefined eligibility criteria. Using random effect models, Mantel-Haenszel odds ratios and associated 95% confidence intervals were produced to report the overall effect size. Funnel plots, Egger regression tests, and Begg-Mazumdar's rank correlation test were used to assess publication bias. The endpoint included any cardiovascular events, myocardial infarction (MI), coronary artery disease (CAD), aortic aneurysm/dissection, peripheral artery disease (PAD), stroke, and venous thromboembolism.

Results: The meta-analysis included 14 studies with a combined sample size of 609,954 patients, where the mean age was 73.8 years and 72.2% were female. Patients with GCA had significantly higher odds of experiencing any cardiovascular event (OR = 1.81, 95% CI = 1.55-2.15), acute myocardial infarction (OR = 1.63, 95% CI = 1.34-1.97), coronary artery disease (OR = 1.51, 95% CI = 1.09-2.08), aortic aneurysm/dissection (OR = 1.95, 95% CI = 1.55-2.46), peripheral artery disease (OR = 2.02, 95% CI = 1.69-2.41), stroke (OR = 1.52, 95% CI = 1.25-1.84), venous thromboembolism (OR = 1.92, 95% CI = 1.73-2.12), deep vein thrombosis (OR = 2.09, 95% CI = 1.50-2.91) and pulmonary embolism (OR = 2.45, 95% CI = 1.38-4.36). The heterogeneity of the outcomes ranged from low to high across different analyses. No publication bias was evident in the analysis.

Conclusion: The meta-analysis highlights the critical need for vigilant cardiovascular monitoring and proactive management strategies in GCA patients. Further research is needed to identify specific factors that contribute to cardiovascular complications in these patients.

Objective: Transcatheter mitral valve interventions (TMVI) have been proven to reduce symptom burden and improve outcomes in patients with severe mitral regurgitation (MR). However, the impact of right ventricular function (RVF) on exercise capacity in MR patients is less well understood.

Methods: Cardiopulmonary exercise testing (CPET) is the most comprehensive approach to assess maximum exercise capacity. Submaximal exercise capacity (SEC), assessed by constant work rate exercise time testing (CWRET), is presumed to be relevant in daily life activities and gives a more differentiated physiological insight into the nature of exercise intolerance. Thus, 28 MR patients underwent CPET and CWRET (at 75% of the maximum work rate in the initial incremental exercise test) prior to TMVI and 3 months post-procedurally.

Results: Patients' mean age was 75.0 ± 8.7 years and 32.1% were female. One patient presented with an MR reduction of less than two grades. RVF was at least moderately impaired in 25% of the patients. SEC of these patients was lower but did not significantly differ (416.4s ± 359.6 vs. 296.1 ± 216.5s; p=) from patients without RVF-deterioration. At follow-up, the SEC improved significantly (from 337.4 ± 262.2s to 517.4 ± 393.5s; p = 0.006). Maximum oxygen uptake (peakVO₂) showed a positive trend, but no statistically significant difference (10.3 ± 3.1 ml/min/kg vs. 11.3 ± 3.4 ml/min/kg; p = 0.06). RVF improved in 35.7% of the patients and these patients showed a significantly higher SEC increase (471.7 ± 153.9s vs. 82.7 ± 47.0s, p = 0.003).

Conclusion: SEC is significantly increased in MR patients undergoing TMVI, reflecting an improvement, especially regarding daily life activities. This may be related to TMVIś beneficial effect on right ventricular remodeling.

Objective: Transcatheter Aortic Valve Implantation (TAVI) has emerged as a pivotal therapeutic modality for aortic stenosis, predominantly in the elderly population. Despite its clinical success, the incidence and implications of vascular complications during TAVI remain a subject of critical concern.

Methods: A retrospective analysis was conducted on 140 patients who experienced vascular complications during TAVI procedures from a total cohort of 1343 cases. Patient demographics, clinical profiles, and procedural characteristics were scrupulously examined. Vascular complications, both intraoperative and postoperative, were identified through various diagnostic modalities. Statistical analyses were employed to discern associations and significance levels. Comparative assessments with international literature were performed to gain broader insights.

Results: The study unveiled an overall incidence of vascular complications at approximately 10.44%. Coronary Artery Disease (CAD)-p-value (0.013), choice of valve type-p-value (0.016), and access point-p-value (0.027) demonstrated significant correlations with these complications. Complication incidences in TAVI procedures included pseudoaneurysms (4.76%), arteriovenous fistulas (1.49%), hematomas (0.37%), dissections (2.24%), arterial perforations (0.15%), stenosis/occlusion (0.37%), and closure device failures (1.94%). Over 70% of complications at the valve entry point result from dissections and closure device failures, while the pigtail entry point is predominantly linked to over 70% of pseudoaneurysms. Extended hospitalization (7.84 ± SD 3.14) was observed for patients experiencing vascular complications, underlining the importance of vigilant postprocedural care.

Conclusion: This study provides comprehensive insights into vascular complications during TAVI procedures, shedding light on their incidence, risk factors, clinical presentations, diagnostic methodologies, and management strategies.

Objective: Treating iron deficiency (ID) with ferric carboxymaltose (FCM) in patients with heart failure with reduced ejection fraction (HFrEF) enhances morbidity, quality of life (QoL), and exercise capacity.

Methods: In the presented single-center, prospective follow-up study, symptomatic patients with HFrEF with ID and CIEDs scheduled for IV FCM were followed up for 12-months. Arrhythmic activity was evaluated from CIEDs and non-invasive markers from Holter recordings before and after FCM. Ventricular tachycardia/ventricular fibrillation (VT/VF) episodes, non-sustained VT (nsVT), late potentials (LPs), microvolt T-wave alternans (MTWA), heart rate variability, turbulence (HRT) QTc, and premature ventricular contractions (PVCs, number, and Lown and Wolf classification) were assessed. Left ventricular EF (LVEF), global longitudinal strain (LV GLS), QoL (KCCQ, EQ-5D-5L), 6-min walking distance (6-MWD), peak oxygen consumption, and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) levels were also recorded.

Results: Ninety-six patients in optimal medical treatment participated (median age 71.9 [12.3] years, 83% male). After FCM treatment, the VT/VF (P = 0.043) and nsVT (P < 0.001) frequency decreased significantly. The Lown and Wolf classification improved (P = 0.002) and predicted VT/VF episodes better than other markers (AUC 0.737, P = 0.001). MTWA, LPs, and HRT improved statistically significantly after FCM. Hospitalization rates and NT-proBNP levels decreased, whereas LVEF, LV GLS, 6-MWD, QoL, and peak VO2 improved statistically significantly (P < 0.001).

Conclusion: Our study provides real-world evidence that IV FCM led to statistically significant reduction in ventricular arrhythmic episodes, as well as an improvement in non-invasive arrhythmic markers.