Hellenic Journal of Cardiology最新文献

Background: The outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in patients with obstructive sleep apnea syndrome (OSAS) have received limited study.

Methods: We compared the procedural characteristics and outcomes of CTO PCIs in patients with and without OSAS in a multicenter registry.

Results: Of 7,403 patients who underwent 7,408 CTO PCIs between 2012 and 2024 at 47 centers, 942 (13%) had OSAS. Compared with patients without OSAS, patients with OSAS were older; more likely to be men; and had higher prevalence of diabetes, hypertension, dyslipidemia, cerebrovascular disease, previous heart failure, coronary artery bypass graft surgery, and previous PCI. They had higher J-CTO (2.73±1.20 vs. 2.30±1.25; p<0.001) and PROGRESS-CTO (1.35±1.01 vs. 1.16±0.96; p<0.001) scores, longer lesion length, and more complex angiographic characteristics. Compared with patients without OSAS, patients with OSAS had similar technical success (87.6% vs. 88.3%, p = 0.552) and procedural success (85.9% vs. 87.2%, p = 0.260). There were no differences in terms of in hospital MACEs and death. After a median follow-up of 71 days, the incidence of MACEs (3.9% vs 1.6%, p = 0.026) and death (2.6% vs 0.6%, p=0.003) was higher in patients with OSAS than in patients without OSAS. In the multivariable analysis, OSAS was independently associated with higher follow-up MACEs (hazard ratio 2.32, 95% confidence intervals 1.22-3.26, p=0.006).

Conclusions: OSAS is common in patients undergoing CTO PCI. Compared with patients without OSAS, patients with OSAS had more comorbidities and more complex CTOs, similar rates of periprocedural success and complications, and higher rates of follow-up MACEs.

Background: Cardiogenic shock (CS) in patients with left ventricular hypertrophy (LVH) due to hypertrophic cardiomyopathy (HCM) or hypertensive heart disease, is underreported in the literature. This study aimed to delineate the characteristics, management strategies and outcomes of patients experiencing CS with preexisting LVH and HCM.

Methods: FRENSHOCK is a prospective multicenter registry including 772 unselected CS patients from 49 centers. Baseline characteristics, management and 1-year outcomes were analyzed according to the occurrence on preexisting LVH.

Results: Within 772 CS patients included, CS occur on a preexisting LVH in 34 patients (4.4%, 1.4% with HCM). Clinical characteristics, medical history, and usual medications, as well as hemodynamic parameters upon inclusion, did not differ between patients with or without LVH. The LVEF in CS patients with LVH was 27.3 ± 14.5% indicating a non-obstructive cause of CS. In-hospital management according to LVH and non-LVH groups indicated no differences between the groups. The 1-month and 1-year mortality did not differ between CS patients with and without LVH (respectively 26.5% vs 26%, (adjusted HR [95% CI]: 0.87 [0.44-1.72]) and 55.9% vs 44.7%, (adjusted HR [95% CI]:0.88 [0.54-1.42]). Subgroup analyses comparing HCM (n =11) and hypertensive LVH (n=23) revealed similar clinical characteristics, in-hospital management, and one-year rehospitalization rates for these patients.

Conclusion: In a large and unselected CS population, the prevalence of LVH patients is low (4.4%) with less than half having HCM (1.4%). The presentation, management, and outcomes of CS are similar to the broader CS population in our series. However, HCM-CS represents a distinct clinical entity necessitating tailored management approaches.

Background: Atrial fibrillation (AF) is common in patients with mitral regurgitation (MR) undergoing transcatheter edge-to-edge repair (TEER) with MitraClip, but its impact on procedural hemodynamics and clinical outcomes remains inadequately characterized.

Methods: This retrospective single-centre study analysed 226 high-risk patients who underwent MitraClip implantation between 2010 and 2022. The primary endpoint was time to first heart failure hospitalization. Secondary endpoints included procedural hemodynamics and long-term mortality.

Results: AF was present in 46.9% of patients and was associated with distinct hemodynamic features, including significantly elevated right (11 vs 9 mmHg, P=0.008) and left atrial pressures (17 vs 15 mmHg, P=0.023). Despite similar procedural success rates, AF patients experienced markedly accelerated time to first HF hospitalization (median 48 vs 106 weeks, P=0.005). Tricuspid regurgitation at discharge emerged as the strongest predictor of early HF hospitalization (HR 1.393, 95% CI: 1.009-1.924, P=0.044). One-year mortality (16.0% vs 16.7%, P=0.899) and long-term survival remained comparable between groups.

Conclusions: AF in TEER patients is characterized by elevated atrial filling pressures and substantially accelerated time to HF hospitalization, with tricuspid regurgitation at discharge predicting early events. While these findings indicate the need for more intensive monitoring of AF patients during the first post-procedural year, comparable survival rates suggest that AF alone should not preclude TEER in otherwise suitable candidates.

Objective: This multicenter study evaluated the diagnostic accuracy of coronary computed tomography angiography (CCTA) and computed tomography-derived fractional flow reserve (FFR_CT) in diagnosing coronary artery disease (CAD), focusing on the impact of coronary calcification, using invasive coronary angiography (ICA) as the reference.

Methods: The study analyzed 4172 patients from 3 centers who underwent CCTA and FFR_CT between August 2021 and August 2022. Exclusion criteria included the absence of ICA within 90 days after CCTA, left main disease, previous coronary revascularization, or unmeasurable Agatston score (AS).

Results: The study included 492 patients. In patients with less than mild calcification (AS < 100), the area under the receiver operating characteristic curve (AUC) for FFR_CT was superior to CCTA (0.87 [95% confidence interval (CI): 0.82-0.92] vs. 0.78 [95% CI: 0.73-0.84], P = 0.009). As the severity of calcification increased, both CCTA and FFR_CT showed reduced diagnostic efficacy, but FFR_CT maintained higher accuracy. In patients with greater than moderate calcification (AS ≥ 100), FFR_CT significantly outperformed CCTA (0.80 [95% CI: 0.74-0.85] vs. 0.62 [95% CI: 0.56-0.68], P < 0.001). Furthermore, integrating FFR_CT with CCTA and baseline factors using least absolute shrinkage and selection operator (LASSO) improved diagnostic performance in patients with greater than moderate calcification (AS≥100) than FFR_CT (0.85 [95% CI: 0.78-0.92] vs. 0.81 [95% CI: 0.72-0.90], P = 0.003).

Conclusion: FFR_CT offers superior diagnostic accuracy over CCTA, particularly in patients with moderate to severe calcification. Furthermore, the LASSO model enhances diagnostic performance in these cases, demonstrating potential for improving CAD diagnosis in patients with significant coronary calcification.

Aims: Despite advancements in medical and surgical therapies, infectious endocarditis (IE) remains life-threatening due to its complications. This study aimed to evaluate the clinical value and function of L1 cell adhesion molecule (L1CAM) in IE.

Methods: A prospective observational study included 94 IE patients (40 with embolic events [EEs], 54 without; 38 with adverse events, 56 without) and 25 healthy controls. Adverse events were defined as death or poorly controlled conditions requiring surgery. Plasma L1CAM levels were measured using enzyme-linked immunosorbent assays. Logistic regression and receiver operating characteristic (ROC) curves assessed L1CAM's predictive value for EEs and adverse events.

Results: L1CAM levels were higher in IE patients than in healthy controls (47.60 ± 10.86 vs. 94.80 ± 68.84 pg/mL, P = 0.008). Among IE patients, those with EEs or adverse events had significantly elevated L1CAM levels (EEs: 127.70 ± 78.20 vs. 70.45 ± 48.96 pg/mL; adverse events: 129.00 ± 79.79 vs. 71.59 ± 48.73 pg/mL, both P < 0.001). Multivariate analysis showed L1CAM as an independent predictor for EEs (OR = 1.02; 95% CI = 1.01-1.04; P = 0.001) and adverse events (OR = 1.01; 95% CI = 1.00-1.02; P = 0.003). AUCs were 0.7273 and 0.7119 for EEs and adverse events, respectively. L1CAM correlated positively with WBC (P = 0.028, r = 0.225) and CRP levels (P = 0.025, r = 0.231).

Conclusions: L1CAM may serve as a biomarker for embolism and adverse events in IE patients.

Objective: Transcatheter aortic valve replacement (TAVR) is a proven treatment for severe aortic stenosis. Transfemoral access is the most prevalent method, achieved either surgically or percutaneously. This study compared in-hospital outcomes and length of stay between surgical cut-down and fully percutaneous approaches.

Methods: This retrospective, propensity-matched study analyzed medical records of all patients who underwent transfemoral TAVR at our center from January 2019 to December 2023. Outcomes were assessed based on Valve Academic Research Consortium-2 (VARC-2) consensus criteria.

Results: A total of 251 TAVR patients (77 propensity score-matched pairs) were included (55% female) with a median (IQR) age of 80 (11) years. Surgical cut-down showed fewer vascular complications, bleeding, and transfusions. No death was reported in this group. Fewer mean hospitalization days were observed in the total cohort over the years (p < 0.001). This reduction was more pronounced after 2021 when the surgical approach was adopted. Mean hospitalization days were 6.40 ± 6.46 for percutaneous and 4.34 ± 1.61 for surgical groups (p < 0.001).

Conclusion: Surgical cut-down for TAVR femoral access yields superior outcomes and shorter hospital stays compared to fully percutaneous methods.