Archives of Cardiovascular Diseases最新文献_第4页

Unique nature of sickle sell diastolic cardiomyopathy: A tailored echocardiographic definition to refine prognostic stratification in young adults

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Archives of Cardiovascular Diseases

Pub Date : 2025-01-01 DOI: 10.1016/j.acvd.2024.10.040

T. Simon , T. D’Humières , S. Laurent , G. De Luna , S. Iles , P. Bartolucci , G. Derumeaux

Introduction

Cardiovascular complications are the leading cause of mortality in sickle cell anemia (SCA) patients. While cardiac diastolic dysfunction (DD) is a well-documented mechanism contributing to heightened morbidity and mortality, the unique hemodynamic conditions inherent to SCA pose challenges to the application of standard diastolic evaluation methods.

Objective

To date, there remains an absence of a suitable echocardiographic definition for early DD in SCA, which could significantly improve risk stratification and management strategies.

Method

To delineate the uniqueness of diastolic function parameters in SCA and propose an adapted echocardiographic definition of early SCA diastolic cardiomyopathy, we leveraged data from the French multicentric cohort Etendard alongside a matched subgroup from the Copenhagen City Heart Study (CCHS) cohort as control. Our investigation focused on early left ventricular (LV) diastolic impairment parameters, including e’ lateral wave (e’lat), E/e’ ratio, and indexed left atrial volume (LAVi), integrating hemodynamic data and 12-year prognostic outcomes. We then identified a young subgroup within Etendard cohort among which age exerted no impact on diastolic function parameters, facilitating the formulation of an adapted definition for early DD.

Results

SCA patients from the Etendard cohort (n = 379) exhibited significantly and early impaired diastolic function parameters compared to the matched CCHS subgroup (n = 672). Among younger SCA patients (n = 252, age ≤ 38 years), e’lat emerged as the sole independent diastolic parameter associated with prognosis (P = 0.01), with an optimal cutoff of 11 cm/s selected for prognostic stratification and further definition as DD (Se = 89%, Sp = 50%, AUC = 0.66, 95% CI = [0.52; 0.81], P = 0.01). Strikingly, young SCA patients with DD exhibited a fourfold higher 12-year mortality rate (16% vs. 4%, P < 0.001) (Fig. 1). Additionally, e’lat correlated with 6-minute walk test, NT pro-BNP levels, diastolic blood pressure, and lactate dehydrogenase levels. A three-year follow-up revealed a decline in 6MWT distance among the DD group and a trend toward higher tricuspid regurgitation velocity (TRV).

Conclusion

In young SCA patients, diastolic function evaluation requires dedicated definition. Lateral e’ wave demonstrates associations with key indicators of cardiac impairment, hemolysis, and systemic vasculopathy, with a value below 11 cm/s dramatically increasing 12-year mortality.

{"title":"Unique nature of sickle sell diastolic cardiomyopathy: A tailored echocardiographic definition to refine prognostic stratification in young adults","authors":"T. Simon , T. D’Humières , S. Laurent , G. De Luna , S. Iles , P. Bartolucci , G. Derumeaux","doi":"10.1016/j.acvd.2024.10.040","DOIUrl":"10.1016/j.acvd.2024.10.040","url":null,"abstract":"<div><h3>Introduction</h3><div>Cardiovascular complications are the leading cause of mortality in sickle cell anemia (SCA) patients. While cardiac diastolic dysfunction (DD) is a well-documented mechanism contributing to heightened morbidity and mortality, the unique hemodynamic conditions inherent to SCA pose challenges to the application of standard diastolic evaluation methods.</div></div><div><h3>Objective</h3><div>To date, there remains an absence of a suitable echocardiographic definition for early DD in SCA, which could significantly improve risk stratification and management strategies.</div></div><div><h3>Method</h3><div>To delineate the uniqueness of diastolic function parameters in SCA and propose an adapted echocardiographic definition of early SCA diastolic cardiomyopathy, we leveraged data from the French multicentric cohort Etendard alongside a matched subgroup from the Copenhagen City Heart Study (CCHS) cohort as control. Our investigation focused on early left ventricular (LV) diastolic impairment parameters, including e’ lateral wave (e’lat), E/e’ ratio, and indexed left atrial volume (LAVi), integrating hemodynamic data and 12-year prognostic outcomes. We then identified a young subgroup within Etendard cohort among which age exerted no impact on diastolic function parameters, facilitating the formulation of an adapted definition for early DD.</div></div><div><h3>Results</h3><div>SCA patients from the Etendard cohort (<em>n</em>  =672). Among younger SCA patients (<em>n</em>    =0.01), with an optimal cutoff of 11cm/s selected for prognostic stratification and further definition as DD (Se=89%, Sp=50%, AUC=0.66, 95% CI=[0.52; 0.81], <em>P</em>  <0.001) (<span><span>Fig. 1</span></span>). Additionally, e’lat correlated with 6-minute walk test, NT pro-BNP levels, diastolic blood pressure, and lactate dehydrogenase levels. A three-year follow-up revealed a decline in 6MWT distance among the DD group and a trend toward higher tricuspid regurgitation velocity (TRV).</div></div><div><h3>Conclusion</h3><div>In young SCA patients, diastolic function evaluation requires dedicated definition. Lateral e’ wave demonstrates associations with key indicators of cardiac impairment, hemolysis, and systemic vasculopathy, with a value below 11cm/s dramatically increasing 12-year mortality.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Pages S42-S43"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143150458","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

Pulmonary hypertension in heart failure with preserved ejection fraction: Impact on mortality and hospitalization risk in PHHF registry

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Archives of Cardiovascular Diseases

Pub Date : 2025-01-01 DOI: 10.1016/j.acvd.2024.10.053

E. Berthelot , C. Fauvel , T. Damy , F. Bauer , J.-N. Trochu , F. Picard , N. Lamblin

Introduction

The 2022 ESC/ERS guidelines changed the definition of post-capillary pulmonary hypertension (pcPH) in heart failure (HF) by lowering the level of mean pulmonary arterial pressure (mPAP) and pulmonary vascular resistance (PVR). Yet, the echocardiographic profile of HF with preserved ejection fraction (PEF) patients according to their mPAP and RVP is not known.

Objective

To investigate the profile of HFPEF patients according to their mPAP and RVP.

Method

Stable HF patients with the need for right heart catheterization were enrolled from 2010 to 2018 and prospectively followed-up in this multicenter study. All patients had a right heart catheterization and an echocardiography within the 24 hours. PcPH was characterized by a pulmonary wedge pressure exceeding 20 mm Hg and mean mPAP greater than 20 mm Hg, from an isolated state when PVR was less than 2 Wood units (WU, IpcPH) to a combined form when PVR exceeded 2 WU (CpcPH).

Results

280 patients with HFpEF were included, with an average age of 71 years, 65% female, and 35% male. 31% of patients were hypertensive, and 39% were diabetic. Three groups were formed: patients without PH, patients with PH and resistances < 2 UW (IPC PH), and patients with PH and resistances > 2 UW (CPC PH). 13 patients (5%) did not have pulmonary hypertension, 72% had IPC PH, and 23% had CPC PH. Patients without PH had an all-cause mortality risk of 7.7% compared to 22% and 24% in the other two groups, respectively. Regarding death, there was no significant difference between the IPC PH and CPC PH groups. Regarding hospitalization, there was a 7.7% risk of hospitalization in the HFpEF group without PH versus 19% and 20% in the other two groups, respectively.

Conclusion

pEF patients with PH, CpcPH patients had worse right ventricular function despite similar remodeling when compared to IpcPH patients.

{"title":"Pulmonary hypertension in heart failure with preserved ejection fraction: Impact on mortality and hospitalization risk in PHHF registry","authors":"E. Berthelot , C. Fauvel , T. Damy , F. Bauer , J.-N. Trochu , F. Picard , N. Lamblin","doi":"10.1016/j.acvd.2024.10.053","DOIUrl":"10.1016/j.acvd.2024.10.053","url":null,"abstract":"<div><h3>Introduction</h3><div>The 2022 ESC/ERS guidelines changed the definition of post-capillary pulmonary hypertension (pcPH) in heart failure (HF) by lowering the level of mean pulmonary arterial pressure (mPAP) and pulmonary vascular resistance (PVR). Yet, the echocardiographic profile of HF with preserved ejection fraction (PEF) patients according to their mPAP and RVP is not known.</div></div><div><h3>Objective</h3><div>To investigate the profile of HFPEF patients according to their mPAP and RVP.</div></div><div><h3>Method</h3><div>Stable HF patients with the need for right heart catheterization were enrolled from 2010 to 2018 and prospectively followed-up in this multicenter study. All patients had a right heart catheterization and an echocardiography within the 24hours. PcPH was characterized by a pulmonary wedge pressure exceeding 20mm Hg and mean mPAP greater than 20mm Hg, from an isolated state when PVR was less than 2 Wood units (WU, IpcPH) to a combined form when PVR exceeded 2 WU (CpcPH).</div></div><div><h3>Results</h3><div>280 patients with HFpEF were included, with an average age of 71 years, 65% female, and 35% male. 31% of patients were hypertensive, and 39% were diabetic. Three groups were formed: patients without PH, patients with PH and resistances<2 UW (IPC PH), and patients with PH and resistances>2 UW (CPC PH). 13 patients (5%) did not have pulmonary hypertension, 72% had IPC PH, and 23% had CPC PH. Patients without PH had an all-cause mortality risk of 7.7% compared to 22% and 24% in the other two groups, respectively. Regarding death, there was no significant difference between the IPC PH and CPC PH groups. Regarding hospitalization, there was a 7.7% risk of hospitalization in the HFpEF group without PH versus 19% and 20% in the other two groups, respectively.</div></div><div><h3>Conclusion</h3><div>pEF patients with PH, CpcPH patients had worse right ventricular function despite similar remodeling when compared to IpcPH patients.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Pages S49-S50"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143150513","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

Real world data from a nationwide survey: Current approaches in post-acute coronary syndromes by cardiologists

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Archives of Cardiovascular Diseases

Pub Date : 2025-01-01 DOI: 10.1016/j.acvd.2024.10.076

P. Sabouret , F. Dievart , A. Sharareh , T. Garban , S. Cohen , O. Hoffman , D. Guedj-Meynier , J.C. Dib , L. Ouazana , M. Villaceque , B. Lequeux , E. Parrens , J.-L. Georges , F. Schiele , N. Lellouche , W. Amara

Introduction

New ESC guidelines and statement by EAS have recently been published based on recent advances in lipid lowering treatments. However, real world data are lacking regarding the implementation among the community of French cardiologists.

Objective

To determine the current approach and therapeutic strategies concerning lipid lowering treatments in post-acute coronary syndromes in France.

Method

This national survey was performed during October and November 2023 in France with an online questionnaire on the sites of 2 national French Societies of Cardiologists.

Four mailings were sent to cardiologists to invite them to answer to the questionnaire.

A total of 400 answers of cardiologists were collected during this 2 months period.

Results

For ASCVD patients, cardiologists agree with a LDL-C goal below 55 mg/dL in 69%, below 70 mg/dL in 16.5%, and 14.5% between 70 mg/dL and 100 mg/dL. An upfront strategy using fixed lipid lowering combinations was prescribed in less than 5% of patients, whereas high-intensity statins was prescribed in more than 90% of patients.

Conclusion

In this contemporary national survey, we report an excellent agreement of lipid goals in secondary prevention by cardiologists. Despite the declared consensus concerning the low levels of LDL-C targets in ACS patients, lipid lowering strategies are suboptimal as mainly represented by the use of high intensity statins, whereas a combination of statins and ezetimibe is prescribed only for a minority of patients, especially as an early upfront strategy. The use of PCSK9i remains marginal and the interval between the ACS and initiation of these molecules remain high, advocating a better implementation of intensive and early strategies to reduce recurrent ischemic events.

{"title":"Real world data from a nationwide survey: Current approaches in post-acute coronary syndromes by cardiologists","authors":"P. Sabouret , F. Dievart , A. Sharareh , T. Garban , S. Cohen , O. Hoffman , D. Guedj-Meynier , J.C. Dib , L. Ouazana , M. Villaceque , B. Lequeux , E. Parrens , J.-L. Georges , F. Schiele , N. Lellouche , W. Amara","doi":"10.1016/j.acvd.2024.10.076","DOIUrl":"10.1016/j.acvd.2024.10.076","url":null,"abstract":"<div><h3>Introduction</h3><div>New ESC guidelines and statement by EAS have recently been published based on recent advances in lipid lowering treatments. However, real world data are lacking regarding the implementation among the community of French cardiologists.</div></div><div><h3>Objective</h3><div>To determine the current approach and therapeutic strategies concerning lipid lowering treatments in post-acute coronary syndromes in France.</div></div><div><h3>Method</h3><div>This national survey was performed during October and November 2023 in France with an online questionnaire on the sites of 2 national French Societies of Cardiologists.</div><div>Four mailings were sent to cardiologists to invite them to answer to the questionnaire.</div><div>A total of 400 answers of cardiologists were collected during this 2 months period.</div></div><div><h3>Results</h3><div>For ASCVD patients, cardiologists agree with a LDL-C goal below 55 mg/dL in 69%, below 70 mg/dL in 16.5%, and 14.5% between 70 mg/dL and 100 mg/dL. An upfront strategy using fixed lipid lowering combinations was prescribed in less than 5% of patients, whereas high-intensity statins was prescribed in more than 90% of patients.</div></div><div><h3>Conclusion</h3><div>In this contemporary national survey, we report an excellent agreement of lipid goals in secondary prevention by cardiologists. Despite the declared consensus concerning the low levels of LDL-C targets in ACS patients, lipid lowering strategies are suboptimal as mainly represented by the use of high intensity statins, whereas a combination of statins and ezetimibe is prescribed only for a minority of patients, especially as an early upfront strategy. The use of PCSK9i remains marginal and the interval between the ACS and initiation of these molecules remain high, advocating a better implementation of intensive and early strategies to reduce recurrent ischemic events.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Page S15"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143150787","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

Invasive versus conservative strategy after acute coronary syndrome in the elderly > 75 ans: Which strategy for which patient

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Archives of Cardiovascular Diseases

Pub Date : 2025-01-01 DOI: 10.1016/j.acvd.2024.10.072

A. Bouchlarhem , N. Ismaili , N. El Ouafi

Introduction

Elderly patients represent a special entity in the management of acute coronary syndrome (ACS), given the fragility of this population.

Objective

We analyzed the invasive versus conservative revascularization strategy in patients admitted for ACS over 75 years.

Method

We analyzed in the prospective analysis the invasive versus conservative revascularization strategy in patients admitted for ACS over 75 years to our CICU over a 3-year. The principal endpoint of our study is a composite of all-cause mortality, or readmissions for ACS or acute heart failure (AHF) during follow-up at 1-year.

Results

We included 414 patients who met the inclusion criteria: 173 (41.8%) in the invasive group and 241 (58.2%) in the conservative group, with 66.6% of patients admitted for STEMI. Men represented 63.8%. The invasive strategy group was younger (77.44 vs. 79.93 p < 0.001), with no difference for arterial hypertension (32.9% vs. 21.3%: p = 0.273) or diabetes (25.1% vs. 17.1%: p = 0.688), nor for admission time since onset of pain (11.88 vs. 17.93 p = 0.056), and higher ejection fraction (46.28 vs. 42.66 p = 0.002). For the primary endpoint, 50 (12.1%) were observed with 11 (6.4%) in the invasive group versus 38 (15.8%) in the conservative group (p = 0.003). In the multivariate Cox proportional regression analysis, the invasive strategy was independently associated with a reduction in the principal endpoint at 1-year in all ACS population (HR at 0.483, 95% CI (0.240; 0.975), p = 0.042), but in the subgroup analysis, this reduction is significant only for patients with STEMI (HR at 0.366, 95% CI (0.172; 0.778), p = 0.009) (Fig. 1A). However in patients with NSTEMI, the invasive strategy does not reduce the principal endpoint (HR at 0.370, 95% CI (0.820; 1,668), p = 0.168) (Fig. 1B).

Conclusion

If PCI remains effective in older STEMI patients, then for NSTEMI patients, further clinical trials will be required to fully assess its efficacy.

{"title":"Invasive versus conservative strategy after acute coronary syndrome in the elderly > 75 ans: Which strategy for which patient","authors":"A. Bouchlarhem , N. Ismaili , N. El Ouafi","doi":"10.1016/j.acvd.2024.10.072","DOIUrl":"10.1016/j.acvd.2024.10.072","url":null,"abstract":"<div><h3>Introduction</h3><div>Elderly patients represent a special entity in the management of acute coronary syndrome (ACS), given the fragility of this population.</div></div><div><h3>Objective</h3><div>We analyzed the invasive versus conservative revascularization strategy in patients admitted for ACS over 75 years.</div></div><div><h3>Method</h3><div>We analyzed in the prospective analysis the invasive versus conservative revascularization strategy in patients admitted for ACS over 75 years to our CICU over a 3-year. The principal endpoint of our study is a composite of all-cause mortality, or readmissions for ACS or acute heart failure (AHF) during follow-up at 1-year.</div></div><div><h3>Results</h3><div>We included 414 patients who met the inclusion criteria: 173 (41.8%) in the invasive group and 241 (58.2%) in the conservative group, with 66.6% of patients admitted for STEMI. Men represented 63.8%. The invasive strategy group was younger (77.44 <em>vs.</em> 79.93 <em>p</em>  =0.273) or diabetes (25.1% <em>vs.</em> 17.1%: <em>p</em>  =0.056), and higher ejection fraction (46.28 <em>vs.</em> 42.66 <em>p</em>  =0.003). In the multivariate Cox proportional regression analysis, the invasive strategy was independently associated with a reduction in the principal endpoint at 1-year in all ACS population (HR at 0.483, 95% CI (0.240; 0.975), <em>p</em>  =0.009) (<span><span>Fig. 1</span></span>A). However in patients with NSTEMI, the invasive strategy does not reduce the principal endpoint (HR at 0.370, 95% CI (0.820; 1,668), <em>p</em>  <!-->0.168) (<span><span>Fig. 1</span></span>B).</div></div><div><h3>Conclusion</h3><div>If PCI remains effective in older STEMI patients, then for NSTEMI patients, further clinical trials will be required to fully assess its efficacy.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Pages S13-S14"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143150840","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

Femoral venous stasis index infor prediction of elevated right atrial pressure and mortality in pulmonary hypertension

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Archives of Cardiovascular Diseases

Pub Date : 2025-01-01 DOI: 10.1016/j.acvd.2024.10.097

J.-E. Trihan , M. De Géa , E.-M. Jutant , E. Larrieu-Ardilouze , C. Beaufort , M. Puyade , D. Montani , C. Thollot , C. Bouleti , D. Lanéelle , M. Croquette

Introduction

Elevated right atrial pressure (RAP) is associated with poor prognosis regarding 1-year mortality in pulmonary hypertension (PH) patients. Unfortunately, there is currently no reliable non-invasive technique for estimating RAP in PH patients. Recently, femoral venous stasis index (FVSI) has been described as highly correlated to RAP in PH patients.

Objective

Our goal was to confirm the diagnostic accuracy of FVSI for estimating RAP, and compare the prognostic value of FVSI, RAP and renal venous stasis index (RVSI) at 2 years in PH patients.

Method

In this prospective cross-sectional study, we included 101 patients with suspected or known PH undergoing right heart catheterization (RHC) for 18 months. Each included patient underwent DUS of the femoral and renal veins within 4 hours prior to the RHC, to blindly assess FVSI and RVSI. FVSI and RVSI (no unit) was calculated as the percentage of non anterograde flow time over an index cardiac cycle, during a short apnea ([Index cardiac cycle(ms) − Anterograde flow time (ms)/Index cardiac cycle(ms)]). For RAP analysis, we chose the cut-off values based on the 2022 ESC/ERS guidelines (RAP < 8 mmHg, 8–14 mmHg and > 14 mmHg).

Results

FVSI was highly correlated to RAP (rs = 0.77, p < 0.001). On multivariate analysis, only FVSI remained significantly associated with RAP (p < 0.001) compared to clinical and biological signs, echocardiography and RVSI. With a cutoff of 0.18, FVSI can exclude a RAP > 8 mmHg with an 87% sensitivity (area under ROC curve (AUROC) = 0.88) and, with a cutoff of 0.45, can confirm a RAP > 14 mmHg with a 93% specificity (AUROC = 0.93). During 2-year follow-up, the composite endpoint (hospitalization; increase in PH-treatment and all-cause death) occurred in 32 patients (31.7%). FVSI independently predicted PH morbidity/mortality (FVSI ≥ 0.45 versus FVSI < 0.18: HR = 5.41 [1.53–19.2], p = 0.009) (Figure 1). Inter-observer reproducibility between junior and senior operators was excellent (intraclass coefficient of 0.97 [IC95% 0.95–0.98]).

Conclusion

We propose FVSI as the first non-invasive tool for estimating RAP, according to the recommended cut-off values, in PH patients.

{"title":"Femoral venous stasis index infor prediction of elevated right atrial pressure and mortality in pulmonary hypertension","authors":"J.-E. Trihan , M. De Géa , E.-M. Jutant , E. Larrieu-Ardilouze , C. Beaufort , M. Puyade , D. Montani , C. Thollot , C. Bouleti , D. Lanéelle , M. Croquette","doi":"10.1016/j.acvd.2024.10.097","DOIUrl":"10.1016/j.acvd.2024.10.097","url":null,"abstract":"<div><h3>Introduction</h3><div>Elevated right atrial pressure (RAP) is associated with poor prognosis regarding 1-year mortality in pulmonary hypertension (PH) patients. Unfortunately, there is currently no reliable non-invasive technique for estimating RAP in PH patients. Recently, femoral venous stasis index (FVSI) has been described as highly correlated to RAP in PH patients.</div></div><div><h3>Objective</h3><div>Our goal was to confirm the diagnostic accuracy of FVSI for estimating RAP, and compare the prognostic value of FVSI, RAP and renal venous stasis index (RVSI) at 2 years in PH patients.</div></div><div><h3>Method</h3><div>In this prospective cross-sectional study, we included 101 patients with suspected or known PH undergoing right heart catheterization (RHC) for 18 months. Each included patient underwent DUS of the femoral and renal veins within 4hours prior to the RHC, to blindly assess FVSI and RVSI. FVSI and RVSI (no unit) was calculated as the percentage of non anterograde flow time over an index cardiac cycle, during a short apnea ([Index cardiac cycle(ms)−Anterograde flow time (ms)/Index cardiac cycle(ms)]). For RAP analysis, we chose the cut-off values based on the 2022 ESC/ERS guidelines (RAP<8mmHg, 8–14mmHg and>14mmHg).</div></div><div><h3>Results</h3><div>FVSI was highly correlated to RAP (rs=0.77, <em>p</em>  <0.001) compared to clinical and biological signs, echocardiography and RVSI. With a cutoff of 0.18, FVSI can exclude a RAP>8mmHg with an 87% sensitivity (area under ROC curve (AUROC)=0.88) and, with a cutoff of 0.45, can confirm a RAP>14mmHg with a 93% specificity (AUROC=0.93). During 2-year follow-up, the composite endpoint (hospitalization; increase in PH-treatment and all-cause death) occurred in 32 patients (31.7%). FVSI independently predicted PH morbidity/mortality (FVSI≥0.45 versus FVSI<0.18: HR=5.41 [1.53–19.2], <em>p</em>  <!-->0.009) (<span><span>Figure 1</span></span>). Inter-observer reproducibility between junior and senior operators was excellent (intraclass coefficient of 0.97 [IC95% 0.95–0.98]).</div></div><div><h3>Conclusion</h3><div>We propose FVSI as the first non-invasive tool for estimating RAP, according to the recommended cut-off values, in PH patients.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Pages S53-S54"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143151191","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

Effectiveness of PCI for delayed STEMI patients: Insights from Moroccan cardiology intensive care units

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Archives of Cardiovascular Diseases

Pub Date : 2025-01-01 DOI: 10.1016/j.acvd.2024.10.077

A. Bouchlarhem , N. Ismaili , N. El Ouafi

Introduction

The benefits of myocardial revascularization in ST-segment elevation acute coronary syndrome (ACS) after 12 to 24 hours from symptom onset remain a topic of debate, especially in stable, asymptomatic patients.

Objective

We analyzed the benefit of late revascularization by PCI in patients admitted to Moroccan cardiac intensive care units (CICUs) with STEMI after 12 h of symptom onset.

Method

We carried out a retrospective study between 2017 and 2021 to assess the benefit of late revascularization by PCI in STEMI patients. The primary endpoint of our study is all-cause mortality at 1-year. The secondary endpoint was a composite of readmissions for acute coronary syndrome (ACS) or acute heart failure (AHF) during follow-up.

Results

We included a total of 406 patients who met the inclusion criteria, 262 patients in the invasive strategy group and 144 patients in the conservative strategy group. A total of 74.6% were men and 25.4% were women. For the primary outcome, death from all causes after at 2-years was observed in 46 (11.3%) of all patients, with 33 (23%) patients in the conservative strategy group, and 13 (5%) patients in the invasive strategy group, with a significant difference between the two groups (p < 0.001). Kaplein Meier survival analysis showed a significant difference in survival rate with a significant Lok-rank test (p < 0.001) (Fig. 1). For secondary outcomes, 19 (4.7%) patients were readmitted for ACS, and 14 (3.4%) patients for AHF, but with no significant difference for either in the two groups (p = 0.277, p = 0.205). Cardiogenic shock in the ICU was higher in the conservative strategy group, with a percentage of 19.4% versus 7.25% in the invasive strategy group, with a significant difference (p < 0.001). In multivariable analysis, 2-year all-cause mortality was independently associated with revascularization between 12 h and 48 h (HR at 0.372, 95% CI (0.182; 0.762), p = 0.007), EF < 35% at discharge (HR at 1.92, 95% CI (1.22; 2.54), p = 0.04) and cardiogenic shock in-CICU (HR at 2.69, 95% CI (1.82; 3.78), p = 0.005).

Conclusion

Although no evidence exists to date on the true benefit of late PCI revascularization in STEMI patients, this practice remains common, as demonstrated by the results of the majority of registries.

{"title":"Effectiveness of PCI for delayed STEMI patients: Insights from Moroccan cardiology intensive care units","authors":"A. Bouchlarhem , N. Ismaili , N. El Ouafi","doi":"10.1016/j.acvd.2024.10.077","DOIUrl":"10.1016/j.acvd.2024.10.077","url":null,"abstract":"<div><h3>Introduction</h3><div>The benefits of myocardial revascularization in ST-segment elevation acute coronary syndrome (ACS) after 12 to 24 hours from symptom onset remain a topic of debate, especially in stable, asymptomatic patients.</div></div><div><h3>Objective</h3><div>We analyzed the benefit of late revascularization by PCI in patients admitted to Moroccan cardiac intensive care units (CICUs) with STEMI after 12 h of symptom onset.</div></div><div><h3>Method</h3><div>We carried out a retrospective study between 2017 and 2021 to assess the benefit of late revascularization by PCI in STEMI patients. The primary endpoint of our study is all-cause mortality at 1-year. The secondary endpoint was a composite of readmissions for acute coronary syndrome (ACS) or acute heart failure (AHF) during follow-up.</div></div><div><h3>Results</h3><div>We included a total of 406 patients who met the inclusion criteria, 262 patients in the invasive strategy group and 144 patients in the conservative strategy group. A total of 74.6% were men and 25.4% were women. For the primary outcome, death from all causes after at 2-years was observed in 46 (11.3%) of all patients, with 33 (23%) patients in the conservative strategy group, and 13 (5%) patients in the invasive strategy group, with a significant difference between the two groups (<em>p</em>  <0.001) (<span><span>Fig. 1</span></span>). For secondary outcomes, 19 (4.7%) patients were readmitted for ACS, and 14 (3.4%) patients for AHF, but with no significant difference for either in the two groups (<em>p</em>  =0.205). Cardiogenic shock in the ICU was higher in the conservative strategy group, with a percentage of 19.4% versus 7.25% in the invasive strategy group, with a significant difference (<em>p</em>  =0.007), EF<35% at discharge (HR at 1.92, 95% CI (1.22; 2.54), <em>p</em>  =0.005).</div></div><div><h3>Conclusion</h3><div>Although no evidence exists to date on the true benefit of late PCI revascularization in STEMI patients, this practice remains common, as demonstrated by the results of the majority of registries.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Page S16"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143150106","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

Evaluation of the feasibility and efficacy of a coronary revascularization strategy by drug coated balloon

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Archives of Cardiovascular Diseases

Pub Date : 2025-01-01 DOI: 10.1016/j.acvd.2024.10.070

R. Bakdi , L. Meunier , C. Allix-Beguec

<div><h3>Introduction</h3><div>Percutaneous coronary revascularization (PCI) by drug eluting stenting (DES) still faces challenges such as complex revascularization procedures and stent (restenosis, thrombosis). The drug coated balloon (DCB) appears to be an attractive concept as no metallic material is left in the vascular wall. The SCRAP study found a satisfying efficacy profile with a 1-year MACE rate of 7.1% among patients who benefited from a stent-less coronary revascularization strategy (SLS). Uncertainties remain regarding the factors influencing the effectiveness and feasibility of this SLS.</div></div><div><h3>Objective</h3><div>We aimed to assess the prognostic role of LVEF in the occurrence of MACE at 3 years during a strategy of coronary revascularization by DCB. Secondary objectives were to evaluate the impact of clinical presentation and angiographic data on the occurrence of bailout stenting.</div></div><div><h3>Method</h3><div>983 unselected patients were prospectively and consecutively included between March 2019 and April 2020, and scheduled to benefit PCI at the La Rochelle Hospital Center. Patients without hemodynamic or rhythm instability were eligible for a SLS by DCB (<em>n</em>  =143). In the event of any iatrogenic coronary dissection, bailout stenting (BO-DES) was performed (<em>n</em>    =0.007). No statistically significant difference was observed if LVEF was impaired, particularly when<35% (42.3% if at least 1 stent was implanted <em>vs.</em> 36.8% if DCB-only; <em>p</em>            <!-->35%. Patients presenting with an ACS, a multi-vessel dis

{"title":"Evaluation of the feasibility and efficacy of a coronary revascularization strategy by drug coated balloon","authors":"R. Bakdi , L. Meunier , C. Allix-Beguec","doi":"10.1016/j.acvd.2024.10.070","DOIUrl":"10.1016/j.acvd.2024.10.070","url":null,"abstract":"<div><h3>Introduction</h3><div>Percutaneous coronary revascularization (PCI) by drug eluting stenting (DES) still faces challenges such as complex revascularization procedures and stent (restenosis, thrombosis). The drug coated balloon (DCB) appears to be an attractive concept as no metallic material is left in the vascular wall. The SCRAP study found a satisfying efficacy profile with a 1-year MACE rate of 7.1% among patients who benefited from a stent-less coronary revascularization strategy (SLS). Uncertainties remain regarding the factors influencing the effectiveness and feasibility of this SLS.</div></div><div><h3>Objective</h3><div>We aimed to assess the prognostic role of LVEF in the occurrence of MACE at 3 years during a strategy of coronary revascularization by DCB. Secondary objectives were to evaluate the impact of clinical presentation and angiographic data on the occurrence of bailout stenting.</div></div><div><h3>Method</h3><div>983 unselected patients were prospectively and consecutively included between March 2019 and April 2020, and scheduled to benefit PCI at the La Rochelle Hospital Center. Patients without hemodynamic or rhythm instability were eligible for a SLS by DCB (<em>n</em>  =143). In the event of any iatrogenic coronary dissection, bailout stenting (BO-DES) was performed (<em>n</em>    =0.007). No statistically significant difference was observed if LVEF was impaired, particularly when<35% (42.3% if at least 1 stent was implanted <em>vs.</em> 36.8% if DCB-only; <em>p</em>            <!-->35%. Patients presenting with an ACS, a multi-vessel dis","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Pages S12-S13"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143150109","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

Anatomical classification of patent foramen ovale before percutaneous closure

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Archives of Cardiovascular Diseases

Pub Date : 2025-01-01 DOI: 10.1016/j.acvd.2024.10.100

G. Chevrot, P. Guedeney, M. Dupuy, N. Bouziri, M. Zeitouni, W. Thomas, P. Devos, N. Procopi, N. Hammoudi, J. Silvain, G. Montalescot

Introduction

Anatomical characteristics of patent foramen ovale (PFO) vary a lot, potentially impacting the embolic risk, selection of the device and the final sealing results of the closure procedure.

Objective

To categorize the different PFO anatomies and evaluate the consequence on the type of device used and the incidence of residual shunt.

Method

In total, 624 consecutive patients who underwent PFO percutaneous closure with transoesophageal echocardiography (TEE) guidance in our center in France were retrospectively reviewed. Four types of PFO were identified, with two subcategories (Figure 1).

For each category, the number and types of implanted devices were collected, and the presence of residual shunt was evaluated 6 months after the procedure.

Results

Our population had a median age of 51 [41-59] years and included 43.8% women. The type II PFO was the most frequently encountered, with 42% of the patients (Table 1).

A total of 93 (14.9%) patients presented multiple types concomitantly (mostly type II and III). PFO occluders were the most implanted devices overall, particularly with type I and IIa, while ASD occluders were more frequently used with types IV and IIb. Cribriform/Uni devices were more frequently used with type IV. Large devices were predominantly used with type III and IV, but scarcely employed with type I and II. Within type II anatomies, large devices were more frequently used with type IIb. At 6 months ultrasound evaluation, large right-to-left residual shunt was significantly more frequent with type IV anatomy. No significant differences were observed regarding clinical outcomes during follow-up.

Conclusion

Based on specific anatomical characteristics, four types of PFO may be identified, presenting with increasing procedural complexity, and requesting specific closure devices.

{"title":"Anatomical classification of patent foramen ovale before percutaneous closure","authors":"G. Chevrot, P. Guedeney, M. Dupuy, N. Bouziri, M. Zeitouni, W. Thomas, P. Devos, N. Procopi, N. Hammoudi, J. Silvain, G. Montalescot","doi":"10.1016/j.acvd.2024.10.100","DOIUrl":"10.1016/j.acvd.2024.10.100","url":null,"abstract":"<div><h3>Introduction</h3><div>Anatomical characteristics of patent foramen ovale (PFO) vary a lot, potentially impacting the embolic risk, selection of the device and the final sealing results of the closure procedure.</div></div><div><h3>Objective</h3><div>To categorize the different PFO anatomies and evaluate the consequence on the type of device used and the incidence of residual shunt.</div></div><div><h3>Method</h3><div>In total, 624 consecutive patients who underwent PFO percutaneous closure with transoesophageal echocardiography (TEE) guidance in our center in France were retrospectively reviewed. Four types of PFO were identified, with two subcategories (<span><span>Figure 1</span></span>).</div><div>For each category, the number and types of implanted devices were collected, and the presence of residual shunt was evaluated 6 months after the procedure.</div></div><div><h3>Results</h3><div>Our population had a median age of 51 [41-59] years and included 43.8% women. The type II PFO was the most frequently encountered, with 42% of the patients (<span><span>Table 1</span></span>).</div><div>A total of 93 (14.9%) patients presented multiple types concomitantly (mostly type II and III). PFO occluders were the most implanted devices overall, particularly with type I and IIa, while ASD occluders were more frequently used with types IV and IIb. Cribriform/Uni devices were more frequently used with type IV. Large devices were predominantly used with type III and IV, but scarcely employed with type I and II. Within type II anatomies, large devices were more frequently used with type IIb. At 6 months ultrasound evaluation, large right-to-left residual shunt was significantly more frequent with type IV anatomy. No significant differences were observed regarding clinical outcomes during follow-up.</div></div><div><h3>Conclusion</h3><div>Based on specific anatomical characteristics, four types of PFO may be identified, presenting with increasing procedural complexity, and requesting specific closure devices.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Pages S55-S56"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143151190","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

Predicting one-year mortality after discharge using Acute Heart Failure Score (AHFS)

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Archives of Cardiovascular Diseases

Pub Date : 2025-01-01 DOI: 10.1016/j.acvd.2024.10.055

M. Magaldi , N. Erika , N. Molinari , D.L. Nicola , A.-M. Dupuy , F. Leclercq , J.-L. Pasquie , C. Roubille , G. Mercier , J.-P. Cristol , F. Roubille

Introduction

Acute heart failure (AHF) represents a leading cause of unscheduled hospital stays, frequent rehospitalisations, and mortality worldwide.

Objective

The aim of our study was to develop a bedside prognostic tool, a multivariable predictive risk score, that is useful in daily practice, thus providing an early prognostic evaluation at admission and an accurate risk stratification after discharge in patients with AHF.

Method

This study is a subanalysis of the STADE HF study, which is a single-centre, prospective, randomised controlled trial enrolling 123 patients admitted to hospital for AHF. Here, 117 patients were included in the analysis, due to data exhaustivity. Regression analysis was performed to determine predictive variables for one-year mortality and/or rehospitalisation after discharge.

Results

During the first year after discharge, 23 patients died. After modellisation, the variables considered to be of prognostic relevance in terms of mortality were (1) non-ischaemic aetiology of HF, (2) elevated creatinine levels at admission, (3) moderate/severe mitral regurgitation, and⁴ prior HF hospitalisation. We designed a linear model based on these four independent predictive variables, and it showed a good ability to score and predict patient mortality with an AUC of 0.84 (95%CI: 0.76–0.92), thus denoting a high discriminative ability. A risk score equation was developed. During the first year after discharge, we observed as well that 41 patients died or were rehospitalised; hence, while searching for a model that could predict worsening health conditions (i.e., death and/or rehospitalisation), only two predictive variables were identified: non-ischaemic HF aetiology and previous HF hospitalisation (also included in the one-year mortality model). This second modellisation showed a more discrete discriminative ability with an AUC of 0.67 (95% C.I. 0.59–0.77).

Conclusion

The proposed risk score and model, based on readily available predictive variables, are promising and useful tools to assess, respectively, the one-year mortality risk and the one-year mortality and/or rehospitalisations in patients hospitalised for AHF and to assist clinicians in the management of patients with HF aiming at improving their prognosis.

{"title":"Predicting one-year mortality after discharge using Acute Heart Failure Score (AHFS)","authors":"M. Magaldi , N. Erika , N. Molinari , D.L. Nicola , A.-M. Dupuy , F. Leclercq , J.-L. Pasquie , C. Roubille , G. Mercier , J.-P. Cristol , F. Roubille","doi":"10.1016/j.acvd.2024.10.055","DOIUrl":"10.1016/j.acvd.2024.10.055","url":null,"abstract":"<div><h3>Introduction</h3><div>Acute heart failure (AHF) represents a leading cause of unscheduled hospital stays, frequent rehospitalisations, and mortality worldwide.</div></div><div><h3>Objective</h3><div>The aim of our study was to develop a bedside prognostic tool, a multivariable predictive risk score, that is useful in daily practice, thus providing an early prognostic evaluation at admission and an accurate risk stratification after discharge in patients with AHF.</div></div><div><h3>Method</h3><div>This study is a subanalysis of the STADE HF study, which is a single-centre, prospective, randomised controlled trial enrolling 123 patients admitted to hospital for AHF. Here, 117 patients were included in the analysis, due to data exhaustivity. Regression analysis was performed to determine predictive variables for one-year mortality and/or rehospitalisation after discharge.</div></div><div><h3>Results</h3><div>During the first year after discharge, 23 patients died. After modellisation, the variables considered to be of prognostic relevance in terms of mortality were (1) non-ischaemic aetiology of HF, (2) elevated creatinine levels at admission, (3) moderate/severe mitral regurgitation, and<sup>4</sup> prior HF hospitalisation. We designed a linear model based on these four independent predictive variables, and it showed a good ability to score and predict patient mortality with an AUC of 0.84 (95%CI: 0.76–0.92), thus denoting a high discriminative ability. A risk score equation was developed. During the first year after discharge, we observed as well that 41 patients died or were rehospitalised; hence, while searching for a model that could predict worsening health conditions (i.e., death and/or rehospitalisation), only two predictive variables were identified: non-ischaemic HF aetiology and previous HF hospitalisation (also included in the one-year mortality model). This second modellisation showed a more discrete discriminative ability with an AUC of 0.67 (95% C.I. 0.59–0.77).</div></div><div><h3>Conclusion</h3><div>The proposed risk score and model, based on readily available predictive variables, are promising and useful tools to assess, respectively, the one-year mortality risk and the one-year mortality and/or rehospitalisations in patients hospitalised for AHF and to assist clinicians in the management of patients with HF aiming at improving their prognosis.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Pages S50-S51"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143151195","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

Incidence and prognosis of myocardial infarction with non-obstructive coronary arteries (MINOCA)

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Archives of Cardiovascular Diseases

Pub Date : 2025-01-01 DOI: 10.1016/j.acvd.2024.10.089

I. Chamtouri , W. Jomaa , A. Turki , K. Ben Hamda

Introduction

Myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA) is a heterogeneous entity often overlooked in contemporary medicine. Myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA) is a heterogeneous entity often overlooked in contemporary medicine.

Objective

To assess incidence and characteristics of MINOCA in a large cohort of patients admitted for myocardial infarction.

Method

A total of 1734 consecutive patients were retrospectively enrolled in the STEMI registry of the cardiology B department of Fattouma Bourguiba university. MINOCA was defined as a non-obstructive coronary artery disease and a lack of previous coronary revascularization. Clinical profile and prognosis of all patients were assessed.

Results

The proportion of MINOCA patients among all myocardial infarction was 2.7%. The MINOCA patients were younger (age 47 ± 14.9 vs. 60.7 ± 12.4 years), more often males (87.2% vs. 78.7%) with significantly lower rates of diabetes mellitus (19.1% vs. 36.4%, p = 0.015), hypertension (10.6% vs. 30.6%, p = 0.003), kidney disease (2.1% vs. 7.8%, p = 0.032), peripheral artery disease (2.8% vs. 8.3%, p = 0.015) and previous MI (2.1% vs. 11.1%, p = 0.028) comparing to patients with obstructive coronary artery disease (CAD). History of smoking was more common in the MINOCA group. Typical chest pain at presentation was higher in MINOCA patients (98.6% vs. 93,4%, p = 0.046). MINOCA patients presented more frequently anterior ST- segment elevation. All-cause in-hospital and 5 years follow-up mortality rate was lower in the MINOCA patients (1.5% vs. 9.6%, p < 0.001; 7.6 vs. 13.8%, p = 0.036 respectively).

Conclusion

MINOCA represents a challenging group of heterogeneous patients whose clinical characteristics contrast with classical cardiovascular risk factors. A search for etiology and eventual treatment provides a rich avenue for improving prognosis in patients with MINOCA.

{"title":"Incidence and prognosis of myocardial infarction with non-obstructive coronary arteries (MINOCA)","authors":"I. Chamtouri , W. Jomaa , A. Turki , K. Ben Hamda","doi":"10.1016/j.acvd.2024.10.089","DOIUrl":"10.1016/j.acvd.2024.10.089","url":null,"abstract":"<div><h3>Introduction</h3><div>Myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA) is a heterogeneous entity often overlooked in contemporary medicine. Myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA) is a heterogeneous entity often overlooked in contemporary medicine.</div></div><div><h3>Objective</h3><div>To assess incidence and characteristics of MINOCA in a large cohort of patients admitted for myocardial infarction.</div></div><div><h3>Method</h3><div>A total of 1734 consecutive patients were retrospectively enrolled in the STEMI registry of the cardiology B department of Fattouma Bourguiba university. MINOCA was defined as a non-obstructive coronary artery disease and a lack of previous coronary revascularization. Clinical profile and prognosis of all patients were assessed.</div></div><div><h3>Results</h3><div>The proportion of MINOCA patients among all myocardial infarction was 2.7%. The MINOCA patients were younger (age 47±14.9 <em>vs.</em> 60.7±12.4 years), more often males (87.2% <em>vs.</em> 78.7%) with significantly lower rates of diabetes mellitus (19.1% <em>vs.</em> 36.4%, <em>p</em>  =0.003), kidney disease (2.1% <em>vs.</em> 7.8%, <em>p</em>  =0.015) and previous MI (2.1% <em>vs.</em> 11.1%, <em>p</em>  =0.046). MINOCA patients presented more frequently anterior ST- segment elevation. All-cause in-hospital and 5 years follow-up mortality rate was lower in the MINOCA patients (1.5% <em>vs.</em> 9.6%, <em>p</em>  =0.036 respectively).</div></div><div><h3>Conclusion</h3><div>MINOCA represents a challenging group of heterogeneous patients whose clinical characteristics contrast with classical cardiovascular risk factors. A search for etiology and eventual treatment provides a rich avenue for improving prognosis in patients with MINOCA.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Page S22"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143149743","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