Hellenic Journal of Cardiology最新文献_第5页

INFLA-score: A new diagnostic paradigm to identify pericarditis INFLA 评分：鉴别心包炎的新诊断范式。

IF 2.7 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Hellenic Journal of Cardiology

Pub Date : 2025-07-01 DOI: 10.1016/j.hjc.2024.03.010

Alessandro Andreis , Andrea Solano , Marco Balducci , Cristina Picollo , Margherita Ghigliotti , Mario Giordano , Alessandra Agosti , Valentino Collini , Matteo Anselmino , Gaetano Maria De Ferrari , Mauro Rinaldi , Gianluca Alunni , Massimo Imazio

Background

Diagnosis of pericarditis may be challenging because not all patients meet the conventional criteria. An overlooked diagnosis implies a longer course of symptoms and an increased risk of recurrences. C-reactive protein (CRP), widely used as an inflammation marker, has some limitations. This study aimed to assess the usefulness and prognostic value of INFLA-score, a validated index assessing low-grade inflammation, in the definite diagnosis of pericarditis.

Methods

Patients with suspected pericarditis were included. The INFLA-score was computed based on white blood cells and platelet count, neutrophil-to-lymphocyte ratio, and CRP, ranging from −16 to +16. An INFLA-score > 0 was considered positive for the presence of pericardial inflammation. The primary end point was the association of INFLA-score with diagnosis of pericarditis according to conventional criteria. The recurrence of pericarditis at 6 months was the secondary end point.

Results

A total of 202 patients were included, aged 47 ± 17 years, and 57% were females. Among 72 (36%) patients with a diagnosis of pericarditis, an INFLA-score > 0 was observed in 86% (vs. 36%, p < 0.001), abnormal CRP in 42% (vs. 10%, p < 0.001), pericardial effusion in 44% (vs. 19%, p < 0.001), abnormal electrocardiogram in 56% (vs. 24%, p < 0.001), and rubs in 5% (vs. 0.1%, p = 0.072). INFLA-score > 0 had the strongest predictive value for the diagnosis of pericarditis (hazard ratio 8.48, 95% confidence interval [CI] 3.39–21.21), with 86% sensitivity and 64% specificity, as opposed to CRP (hazard ratio 1.72, non-significant 95% CI 0.69–4.29). Recurrent pericarditis at 6 months was more frequent in patients with a positive INFLA-score (37% vs. 8%, p < 0.001, rate ratio 4.15, 95% CI 2.81–6.12). In patients with normal CRP, INFLA-score–confirmed ongoing inflammation in 78% of the cases. Compared with the conventional criteria, the INFLA-score had the highest accuracy (area under the curve = 0.82). Different cutoffs were valuable to rule out (INFLA-score > 0, sensitivity 86%, and negative likelihood ratio 0.22) or rule in (INFLA-score ≥ 10, specificity 97%, and positive likelihood ratio 13) the diagnosis.

Conclusions

The INFLA-score is a useful diagnostic tool to assess the probability of pericarditis, with a strong prognostic value for further recurrences, outperforming CRP.

背景：心包炎的诊断可能具有挑战性，因为并非所有患者都符合常规标准。被忽视的诊断意味着症状持续时间更长，复发风险更高。C 反应蛋白（CRP）被广泛用作炎症标志物，但它也有一些局限性。本研究旨在评估 INFLA 评分（一种评估低级别炎症的有效指标）在明确诊断心包炎方面的实用性和预后价值：方法：纳入疑似心包炎患者。INFLA-评分根据白细胞和血小板计数、中性粒细胞与淋巴细胞比值、CRP计算得出，范围为-16至+16。主要终点是 INFLA 评分与常规标准心包炎诊断的相关性。结果：共纳入 202 名患者，年龄（47±17）岁，女性占 57%。在 72 例（36%）确诊为心包炎的患者中，86%（vs.36%, p0）的患者 INFLA 评分大于 0（HR 8.48，95%CI 3.39-21.21），与 CRP（HR 1.72，95%CI 3.39-21.20）相比，具有 86% 的敏感性和 64% 的特异性。INFLA-评分阳性（37% vs. 8%,P0,敏感性86%,阴性LR=0.22）或规则诊断（INFLA-评分≥10,特异性97%,阳性LR=13）的患者在6个月后复发心包炎的频率更高：INFLA-评分是评估心包炎可能性的有用诊断工具，对进一步复发有很强的预后价值，优于CRP。

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引用次数: 0

Ageism in medicine: procrustean logic in healthcare 医学中的年龄歧视：医疗保健中的Procrustean逻辑。

IF 2.7 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Hellenic Journal of Cardiology

Pub Date : 2025-07-01 DOI: 10.1016/j.hjc.2025.07.001

Charalambos Vlachopoulos , Demosthenes Panagiotakos

引用次数: 0

Comparing the predictive ability of GRACE 2.0 and GRACE 3.0 scores in a Greek cohort of patients hospitalized with acute coronary syndrome 比较希腊急性冠状动脉综合征住院患者队列中 GRACE 2.0 和 GRACE 3.0 评分的预测能力。

IF 2.7 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Hellenic Journal of Cardiology

Pub Date : 2025-07-01 DOI: 10.1016/j.hjc.2024.10.002

Christos Kofos , Andreas S. Papazoglou , Stavroula Rousopoulou , Paraskevi Douki , Andreas Takas , Athanasios Samaras , Panagiotis Stachteas , Athina Nasoufidou , Efstratios Karagiannidis , Barbara Fyntanidou , Nikolaos Fragakis , George Kassimis

引用次数: 0

Atrial fibrillation post CABG and the risk of arrhythmia recurrence: the AFRODITE study 心房颤动术后与心律失常复发风险：阿佛洛狄特研究。

IF 2.7 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Hellenic Journal of Cardiology

Pub Date : 2025-07-01 DOI: 10.1016/j.hjc.2024.03.003

Maria Nikolaou , Gregory Pattakos , Christos Hitas , Katerina Koniari , Antoniοs Pitsis , Dimitrios Iliopoulos , Αnastasia Xintarakou , Emmanouil P. Vardas , Stratis Pattakos , Stylianos Tzeis , Panagiotis Vardas

Background

New-onset postoperative atrial fibrillation (POAF) after coronary artery bypass surgery (CABG) occurs with an incidence of 20–40%. The clinical relevance of POAF remains a concern, and the need for further studies regarding the clinical management of POAF is necessary.

Aim

The AFRODITE study, a prospective multicenter cohort study, had as its primary endpoint the evaluation of AF recurrence in patients post CABG over a one-year period.

Methods

Two hundred twenty-eight patients aged >50 years who underwent isolated CABG were included in the study. Patients were stratified into two groups, POAF and non-POAF, and followed for 12 months for AF recurrence, hospitalizations, and death.

Results

Two hundred twenty-eight patients (mean age 67 years, 88.6% male) were included in the study. 28.5% of patients experienced at least one episode of POAF during index hospitalization (POAF group) and were compared with the non-POAF group (n = 163). Multivariate stepwise logistic regression analysis showed that the strongest prognostic parameter for POAF was the CHA₂DS_2-VASc score (odds ratio = 1.61, p < 0.001). POAF patients had a worse in-hospital outcome, but the incidence of long-term AF recurrence was not statistically different (3.6% vs. 4.8%, p = 0.9).

Conclusion

Interestingly, a one-year prospective follow-up of patients in the study did not reveal significant differences between POAF and non-POAF patients. A notable finding was that patients with a higher CHA₂DS_2-VASc score were more likely to develop POAF.

背景：冠状动脉搭桥术（CABG）术后新发心房颤动（POAF）的发生率为 20%-40%。目的：AFRODITE 研究是一项前瞻性多中心队列研究，其主要终点是评估 CABG 术后患者一年内房颤复发的情况：研究共纳入 228 名年龄大于 50 岁、接受过孤立的心血管手术的患者。将患者分为 POAF 和非 POAF 两组，随访 12 个月，以了解房颤复发、住院和死亡情况：研究共纳入 228 名患者（平均年龄 67 岁，88.6% 为男性）。28.5%的患者在指数住院期间至少发生过一次 POAF（POAF 组），并与非 POAF 组（163 人）进行了比较。多变量逐步逻辑回归分析表明，POAF 的最强预后参数是 CHA2DS2-Vasc 评分（赔率=1.61，p 结论：有趣的是，对研究中的患者进行为期一年的前瞻性随访并未发现 POAF 患者和非 POAF 患者之间存在显著差异。一个值得注意的发现是，CHA2DS2-Vasc评分较高的患者更有可能发展为POAF。

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引用次数: 0

Prognostic value of mitral valve regurgitation in patients with heart failure with mildly reduced ejection fraction 射血分数轻度降低型心力衰竭患者二尖瓣反流的预后价值

IF 2.7 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Hellenic Journal of Cardiology

Pub Date : 2025-07-01 DOI: 10.1016/j.hjc.2024.03.013

Noah Abel , Michael Behnes , Alexander Schmitt , Marielen Reinhardt , Felix Lau , Mohammad Abumayyaleh , Tina Sieburg , Kathrin Weidner , Mohamed Ayoub , Kambis Mashayekhi , Ibrahim Akin , Tobias Schupp

Background

Although mitral valve regurgitation (MR) is a common valvular heart disease in patients with heart failure (HF), there is a paucity of data on the characterization and outcomes of patients with HF with mildly reduced ejection fraction (HFmrEF) and concomitant MR.

Methods

From 2016 to 2022, consecutive patients hospitalized with HFmrEF (i.e., left ventricular ejection fraction from 41% to 49% and signs and/or symptoms of HF) were retrospectively included at one institution. Patients with MR were compared with patients without MR. Further risk stratification was performed according to MR severity and etiology (i.e., primary vs. secondary MR). The primary end point was all-cause mortality at 30 months (median follow-up), and the key secondary end point was hospitalization for worsening HF.

Results

Of 2181 patients hospitalized with HFmrEF, 59% presented with mild, 10% with moderate, and 2% with severe MR. MR was associated with increased all-cause mortality at 30 months (HR = 1.756; 95% CI 1.458–2.114; p = 0.001), with higher risk in more advanced stages. Furthermore, MR patients had higher risk of HF-related re-hospitalization at 30 months (HR = 1.560; 95% CI 1.172–2.076; p = 0.002). Even after multivariable adjustment, mild, moderate, and severe MR were still associated with all-cause mortality. Finally, the risk of all-cause mortality was lower in patients with secondary MR compared with patients with primary MR (HR = 0.592; 95% CI 0.366–0.956; p = 0.032).

Conclusion

MR is common in HFmrEF and independently associated with higher risk of all-cause mortality and HF hospitalization.

背景：尽管二尖瓣反流（MR）是心力衰竭（HF）患者常见的瓣膜性心脏病，但有关HFmrEF和合并MR患者的特征和预后的数据却很少：方法：从2016年至2022年，回顾性纳入了一家机构连续住院的HFmrEF（即左室射血分数41%-49%，且有HF体征和/或症状）患者。将患有 MR 的患者与未患有 MR 的患者进行比较，并根据 MR 的严重程度和病因（即原发性 MR 与继发性 MR）进一步进行风险分层。主要终点是随访30个月（中位数）时的全因死亡率，关键的次要终点是因心房颤动恶化而住院：在住院的 2,181 名 HFmrEF 患者中，59% 患有轻度 MR，10% 患有中度 MR，2% 患有重度 MR。MR 与 30 个月的全因死亡率增加有关（HR = 1.756；95% CI 1.458 - 2.114；P = 0.001），晚期患者的风险更高。此外，MR 患者在 30 个月时与心房颤动相关的再住院风险更高（HR = 1.560；95% CI 1.172 - 2.076；P = 0.002）。即使经过多变量调整，轻度、中度和重度 MR 仍与全因死亡率相关。最后，与原发性MR患者相比，继发性MR患者的全因死亡风险较低（HR = 0.592; 95% CI 0.366 - 0.956; p = 0.032）：结论：MR在HFmrEF中很常见，与较高的全因死亡率和HF住院风险独立相关。

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引用次数: 0

Efficacy and safety of polymer-free biolimus-eluting stents versus durable polymer novolimus-eluting stents in a real-world clinical practice (FREEDOM-DES trial) 不含聚合物的 Biolimus 洗脱支架与耐用聚合物 Novolimus 洗脱支架在真实世界临床实践中的有效性和安全性（FREEDOM-DES 试验）。

IF 2.7 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Hellenic Journal of Cardiology

Pub Date : 2025-07-01 DOI: 10.1016/j.hjc.2024.09.005

Soohyung Park , Seung-Woon Rha , Byoung Geol Choi , Sang Ho Park , Jae-Bin Seo , Ju Yeol Baek , Jae Woong Choi , Yong Hoon Kim , Ji-Hun Ahn , Gi Chang Kim , Weon Kim , Soo-Han Kim , Markz RMP. Sinurat , Se Yeon Choi , Jin Ah Cha , Su Jin Hyun , Cheol Ung Choi , Chang Gyu Park

引用次数: 0

Sacubitril/valsartan reversal of left ventricular remodeling is associated with improved hemodynamics in resistant hypertension 沙库比特利/缬沙坦逆转左心室重构与改善耐药性高血压患者的血液动力学有关

IF 2.7 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Hellenic Journal of Cardiology

Pub Date : 2025-07-01 DOI: 10.1016/j.hjc.2024.03.012

Lixue Song , Hongrui Yang , Xiang Ning , Yanyan Ma , Aiying Xue , Yimeng Du , Qinghua Lu , Zhendong Liu , Xin Wang , Juan Wang

Background

Sacubitril/valsartan (S/V) has been shown to be an effective antihypertensive drug combination. However, its therapeutic effects on blood pressure (BP), hemodynamics, and left ventricular (LV) remodeling in resistant hypertension (RHTN) remain unclear.

Methods

Eighty-six patients completed this self-control study, during which olmesartan was administered within the first 8 weeks (phase 1), followed by S/V within the second 8 weeks (phase 2), with nifedipine and hydrochlorothiazide taken as background medications. Office BP, echocardiography, and hemodynamics assessment using impedance cardiography were performed at baseline and at the eighth and sixteenth weeks.

Results

The reduction in office BP was larger in phase 2 than in phase 1 (19.59/11.66 mmHg vs. 2.88/1.15 mmHg). Furthermore, the treatment in phase 2 provided greater reductions in systemic vascular resistance index (SVRI) and thoracic blood saturation ratio (TBR), with differences between the two phases of −226.59 (−1212.80 to 509.55) dyn·s/cm⁵/m² and −0.02 (−0.04 to 0.02). Switching from olmesartan to S/V also significantly reduced E/E′, LV mass index, LV end-diastolic volume index, and LV end-systolic volume index (all P < 0.05). Decreases in arterial stiffness, SVRI, and TBR were correlated with changes in indicators of LV remodeling (all P < 0.05). This correlation persisted even after adjusting for confounders including changes in BP.

Conclusions

Switching from olmesartan to S/V effectively lowered BP and reversed ventricular remodeling in RHTN. In addition, hemodynamic improvement was also observed. Changes in hemodynamics played an important role in reversing LV remodeling of S/V, and were independent of its antihypertensive effect.

萨库比特利/缬沙坦（S/V）已被证明是一种有效的降压药物组合。然而，它对抵抗性高血压（RHTN）患者的血压（BP）、血液动力学和左心室（LV）重塑的治疗效果仍不明确。86名患者完成了这项自我控制研究，在研究的前8周（第一阶段）服用了奥美沙坦酯，随后在后8周（第二阶段）服用了S/V，并将硝苯地平和氢氯噻嗪作为背景药物。在基线、第 8 周和第 16 周时，使用阻抗心动图进行诊室血压、超声心动图和血液动力学评估。与第一阶段相比，第二阶段的诊室血压降低幅度更大（19.59/11.66 mmHg 对 2.88/1.15 mmHg）。此外，第 2 阶段治疗对全身血管阻力指数（SVRI）和胸廓血液饱和度比值（TBR）的降低幅度更大，两个阶段的差异分别为-226.59（-1212.80 至 509.55）dyn-s/cm/m 和-0.02（-0.04 至 0.02）。从奥美沙坦转为 S/V 还能显著降低 E/E′、左心室质量指数、左心室舒张末期容积指数和左心室收缩末期容积指数（均 < 0.05）。动脉僵化、SVRI 和 TBR 的降低与 LV 重塑指标的变化相关（均<0.05）。即使在调整了包括血压变化在内的混杂因素后，这种相关性仍然存在。将奥美沙坦换成 S/V，可有效降低血压并逆转 RHTN 的心室重构。此外，还观察到血液动力学的改善。血液动力学的变化在S/V逆转左心室重构的过程中发挥了重要作用，而且与S/V的降压作用无关。

{"title":"Sacubitril/valsartan reversal of left ventricular remodeling is associated with improved hemodynamics in resistant hypertension","authors":"Lixue Song , Hongrui Yang , Xiang Ning , Yanyan Ma , Aiying Xue , Yimeng Du , Qinghua Lu , Zhendong Liu , Xin Wang , Juan Wang","doi":"10.1016/j.hjc.2024.03.012","DOIUrl":"10.1016/j.hjc.2024.03.012","url":null,"abstract":"<div><h3>Background</h3><div>Sacubitril/valsartan (S/V) has been shown to be an effective antihypertensive drug combination. However, its therapeutic effects on blood pressure (BP), hemodynamics, and left ventricular (LV) remodeling in resistant hypertension (RHTN) remain unclear.</div></div><div><h3>Methods</h3><div>Eighty-six patients completed this self-control study, during which olmesartan was administered within the first 8 weeks (phase 1), followed by S/V within the second 8 weeks (phase 2), with nifedipine and hydrochlorothiazide taken as background medications. Office BP, echocardiography, and hemodynamics assessment using impedance cardiography were performed at baseline and at the eighth and sixteenth weeks.</div></div><div><h3>Results</h3><div>The reduction in office BP was larger in phase 2 than in phase 1 (19.59/11.66 mmHg vs. 2.88/1.15 mmHg). Furthermore, the treatment in phase 2 provided greater reductions in systemic vascular resistance index (SVRI) and thoracic blood saturation ratio (TBR), with differences between the two phases of −226.59 (−1212.80 to 509.55) dyn·s/cm<sup>5</sup>/m<sup>2</sup> and −0.02 (−0.04 to 0.02). Switching from olmesartan to S/V also significantly reduced E/E′, LV mass index, LV end-diastolic volume index, and LV end-systolic volume index (all <em>P</em> < 0.05). Decreases in arterial stiffness, SVRI, and TBR were correlated with changes in indicators of LV remodeling (all <em>P</em> < 0.05). This correlation persisted even after adjusting for confounders including changes in BP.</div></div><div><h3>Conclusions</h3><div>Switching from olmesartan to S/V effectively lowered BP and reversed ventricular remodeling in RHTN. In addition, hemodynamic improvement was also observed. Changes in hemodynamics played an important role in reversing LV remodeling of S/V, and were independent of its antihypertensive effect.</div></div>","PeriodicalId":55062,"journal":{"name":"Hellenic Journal of Cardiology","volume":"84 ","pages":"Pages 51-60"},"PeriodicalIF":2.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140583947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Massive right coronary aneurysm-left ventricle fistula 大块右冠状动脉瘤-左心室瘘。

IF 2.7 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Hellenic Journal of Cardiology

Pub Date : 2025-07-01 DOI: 10.1016/j.hjc.2025.03.006

Xiangfeng Gong , Chunyan Jiang , Chaoyi Qin , Xiaoqin Chen , Zhenghua Xiao

引用次数: 0

Treatment of radial artery occlusion after transradial coronary catheterization: a review of the literature and proposed treatment algorithm 经桡动脉冠状动脉导管置管后桡动脉闭塞的治疗：文献综述及建议的治疗方法。

IF 2.7 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Hellenic Journal of Cardiology

Pub Date : 2025-07-01 DOI: 10.1016/j.hjc.2025.01.008

Matthaios Didagelos , Dimitrios Afendoulis , Areti Pagiantza , Dimitrios Moysidis , Andreas Papazoglou , Charalambos Kakderis , Stylianos Daios , Vasileios Anastasiou , Konstantinos C. Theodoropoulos , Antonios Kouparanis , Athanasios Kartalis , Vasileios Kamperidis , George Kassimis , Antonios Ziakas

The transradial artery has been established as the default access site for most coronary catheterization procedures with fewer access-related and bleeding complications, rapid hemostasis, early ambulation of the patient, and reduction in all-cause mortality compared with transfemoral access. However, radial artery occlusion (RAO) remains the most frequent complication of coronary catheterization procedures performed via transradial artery access. The purpose of our review was to conduct detailed literature research and summarize all the available treatment strategies for RAO, given the lack of a standardized treatment protocol in the literature. Pharmacological treatment with low-molecular-weight heparin (LMWH) or other anticoagulants, invasive strategies, and pharmaco-invasive methods available in the literature were included in our review. Data were derived from case series, case reports, clinical trials, and observational studies. Eight studies regarding pharmacological treatment with LMWH or any other anticoagulant and seven studies of invasive treatment were included in our review. There were only two randomized studies: one with LMWH (tinzaparin) and one with apixaban. Furthermore, taking into consideration data derived from the above-mentioned studies, a treatment algorithm for RAO was proposed. RAO remains the most frequent complication of coronary procedures with transradial access. Application of preventive strategies and comprehensive knowledge of the risk factors remain the key factors for the reduction of the incidence of this clinical entity. Therapeutic options include anticoagulation regimens and interventional techniques through the distal radial artery. Large, randomized, multicenter studies should be conducted to evaluate the efficacy of the available treatment methods and define a standardized treatment protocol for RAO.

经桡动脉通路（TRA）已被确立为大多数冠状动脉导管手术的默认通路，与经股通道相比，其通路相关并发症和出血并发症较少，止血迅速，患者早期走动，全因死亡率降低。然而，桡动脉闭塞（RAO）仍然是TRA冠状动脉导管置入手术中最常见的并发症。鉴于文献中缺乏标准化的治疗方案，本综述的目的是进行详细的文献研究，总结所有可用的RAO治疗策略。我们回顾了文献中可用的低分子肝素（LMWH）或其他抗凝药物治疗、侵入性策略和药物侵入性方法。数据来源于病例系列、病例报告、临床试验和观察性研究。我们的综述包括8项关于低分子肝素或其他抗凝药物治疗的研究和7项关于侵入性治疗的研究。只有两项随机研究，一项使用低分子肝素（丁沙巴林），另一项使用阿哌沙班。在此基础上，结合上述研究数据，提出了一种RAO的处理算法。RAO仍然是冠状动脉手术中最常见的并发症。预防策略的应用和对危险因素的良好认识仍然是减少这种临床实体发生率的关键因素。治疗方案包括抗凝治疗方案和桡动脉远端介入技术。应该进行大型、随机、多中心的研究，以评估现有治疗方法的疗效，并确定RAO的标准化治疗方案。

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引用次数: 0

Left bundle branch area pacing versus conventional pacing in patients with advanced atrioventricular conduction abnormalities: a prospective cohort study 晚期房室传导异常患者的左束支区起搏与传统起搏：一项前瞻性队列研究。

IF 2.7 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Hellenic Journal of Cardiology

Pub Date : 2025-07-01 DOI: 10.1016/j.hjc.2024.03.005

Georgios Leventopoulos , Panagiotis Patrinos , Angeliki Papageorgiou , Spyridon Katechis , Angelos Perperis , Christoforos Travlos , Panagiota Spyropoulou , Nikolaos Koutsogiannis , Athanasios Moulias , Periklis Davlouros

Background

Left bundle branch area pacing (LBBAP) is an emerging pacing method that may prevent the deleterious effects of right ventricular pacing. The aim of this study is to compare the effects of LBBAP with right ventricular septal pacing (RVSP) in patients with advanced atrioventricular conduction abnormalities and preserved left ventricular ejection fraction.

Methods

The effect of pacing was evaluated by echocardiographic indices of dyssynchrony, including global myocardial work efficiency (GWE) and peak systolic dispersion (PSD). The primary endpoint was GWE postprocedural, at 3, 6, and 12 months after the procedure.

Results

Twenty patients received LBBAP and 18 RVSP. Complete follow-up was accomplished in 37 patients (97.4%) due to the death of a patient (RVSP arm) from nonrelated cause. GWE was significantly increased in the group of LBBAP compared to RVSP at all time points (90.8% in LBBAP versus 85.8% in RVSP group at 12 months, p = 0.01). PSD was numerically lower in the LBBAP arm at all time points, yet not statistically significant (56.4 msec in LBBP versus 65.1 msec in RVSP arm at 12 months, p = 0.178). The implantation time was increased (median 93 min in LBBAP versus 45 min in RVSP group, p < 0.01), along with fluoroscopy time and dose area product (DAP), in the arm of LBBAP. There were no severe perioperative acute complications in either group.

Conclusions

LBBAP is an emerging and safe technique for patients with a pacing indication. Despite the longer procedural and fluoroscopy time, as well as higher DAP, LBBAP seems to offer better left ventricular synchrony compared to RVSP, according to GWE measurements.

背景：左束支区起搏（LBBAP）是一种新兴的起搏方法，可避免右室起搏的有害影响。本研究旨在比较左束支区起搏与右室间隔起搏（RVSP）对晚期房室传导异常和左室射血分数保留患者的影响：方法：起搏的效果通过超声心动图不同步指数进行评估，包括心肌整体工作效率（GWE）和收缩峰值弥散（PSD）。主要终点是术后3个月、6个月和12个月的GWE：20名患者接受了LBBAP，18名患者接受了RVSP。由于一名患者（RVSP 组）非相关原因死亡，37 名患者（97.4%）完成了完全随访。在所有时间点上，LBBAP 组的 GWE 都明显高于 RVSP 组（12 个月时，LBBAP 组为 90.8%，RVSP 组为 85.8%，P=0.01）。在所有时间点上，LBBAP 组的 PSD 均较低，但无统计学意义（12 个月时，LBBAP 组为 56.4 毫秒，RVSP 组为 65.1 毫秒，P=0.178）。植入时间有所增加（LBBAP 组中位 93 分钟，RVSP 组中位 45 分钟，P=0.178）：对于有起搏指征的患者来说，LBBAP 是一种新兴且安全的技术。尽管手术和透视时间较长，DAP也较高，但根据GWE测量结果，LBBAP与RVSP相比，似乎能提供更好的左心室同步性。

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引用次数: 0