Acta Cardiologica Sinica最新文献

Background: The aim of this study was to investigate the consistency of diastolic hyperemia-free ratio (DFR) and instantaneous wave-free ratio (iFR) before and after lesions in the distal coronary artery.

Methods: The PRIME-DFRiFR Study was a single-center, prospective, observational study that evaluated DFR and iFR at points distal and proximal to lesions in distal coronary vessels after angiography and successful percutaneous coronary intervention (PCI). Target lesions with diameter stenosis of 50% to 70% were selected, and DFR and iFR were evaluated from the vessel distal point, the lesion distal point, the lesion proximal point, and the vessel proximal point, respectively.

Results: Thirty patients (23 males [76.7%]; age 70.6 ± 10.2 years) were enrolled between August 2022 and December 2023, with a total of 37 single intermediate coronary lesions, clinical manifestations of unstable angina, acute coronary syndrome, dilated cardiomyopathy, or syncope. The DFR and iFR values at the vessel distal point, lesion distal point, lesion proximal point, and vessel proximal point were 0.95 ± 0.06 and 0.94 ± 0.05, 0.96 ± 0.05 and 0.95 ± 0.05, 0.99 ± 0.03 and 0.99 ± 0.03, and 1.00 ± 0.01 and 1.00 ± 0.02, respectively. The Pearson correlation coefficients of the four point values were 0.894, 0.834, 0.667 and 0.632, respectively (p < 0.001).

Conclusions: The significant positive correlations indicate that DFR can show relevant pressure changes before and after lesions in a comparable manner to iFR. In this study, the biggest influencing factor for discordance between DFR and iFR was old myocardial infarction. Post-PCI results indicated that DFR wires appeared to maintain relatively good maneuverability with comparable accuracy to iFR wires.

Background: Obesity is a major risk factor for atrial fibrillation (AF). Individuals with obesity can be further classified into metabolically unhealthy obesity (MUO) or healthy obesity (MHO) groups based on the metabolic health subtype. The influence of these phenotypes and overweight status on AF ablation outcomes remains unclear.

Objective: This study aimed to examine the recurrence of paroxysmal AF (PAF) after ablation in patients across distinct obesity phenotypes.

Methods: From January 2019 to November 2023, 599 patients with drug-refractory PAF undergoing a first ablation were retrospectively analyzed. Based on the World Health Organization-defined body mass index thresholds for Asians regarding overweight (23-25 kg/m²) and obesity (> 25 kg/m²), the participants were categorized into normal-weight, metabolically healthy overweight (MHOW), metabolically unhealthy overweight (MUOW), MHO, or MUO groups. Metabolic health required the absence of hypertension, diabetes, and dyslipidemia. Pulmonary vein isolation was achieved using either a force-sensing catheter or cryoablation.

Results: The mean age of the patients was 60.7 ± 11.7 years, and 64.1% were men. Compared with the normal-weight patients, AF recurrence was higher in the MUOW (19.8%), MHO (18.0%), and MUO (14.9%) groups after an average follow-up of 534 days, with respective hazard ratios (HRs) of 3.240 (p = 0.003), 2.973 (p = 0.013), and 2.182 (p = 0.033) after adjusting for chronic kidney disease. MHOW (14.9%; HR 2.593, p = 0.053) showed a non-significant trend toward a higher risk. Complete pulmonary vein isolation was achieved in all patients.

Conclusions: Overweight and obesity, regardless of metabolic status, were associated with a significantly higher risk of AF recurrence after ablation compared to normal-weight, underscoring the importance of weight management in PAF.

[This corrects the article DOI: 10.6515/ACS.202505_41(3).20250224A.].

Background: Various factors associated with cardiopulmonary bypass (CPB) can produce an inflammatory response, resulting in morbidity and mortality. The aim of this study was to investigate how adenosine deaminase (ADA) activity changes after surgery in relation to the emergence of CPB-related complications.

Methods: The study included 78 patients, of whom 30 had complications. Blood samples were collected three times: on admission to the ward (preoperative), on the first postoperative day, and on the fifth postoperative day. The blood samples were analyzed for routine hematological and biochemical variables. In addition, serum ADA activity was evaluated, and normalized ADA [ADA_(Nor)] levels were calculated.

Results: On postoperative day 1, ADA and ADA_(Nor) levels differed between the groups. In multivariate analysis, left atrium diameter (p = 0.015), and ADA_(Nor) (p = 0.001) on postoperative day 1 were significant predictors of CPB-related complications. Receiver operating characteristic curve analysis showed that the area under curve for postoperative first day ADA_(Nor) was 0.767 (95% confidence interval 0.664-0.871). Using a cut-off value of 11.87, postoperative first day ADA_(Nor) predicted postoperative complication emergencies with 63.3% sensitivity and 77.1% specificity.

Conclusions: This study is the first to identify blood ADA_(Nor) activity as an independent risk factor for the development of postoperative CPB-related complications.

Background: Cardiovascular disease, particularly ST-segment elevation myocardial infarction (STEMI), continues to be a leading cause of death worldwide despite advances in treatment options. Contrast-induced nephropathy (CIN) increases the risk of morbidity and mortality after percutaneous coronary intervention (PCI) in STEMI patients. Blood pressure variability (BPV), defined as fluctuations in blood pressure (BP) over time, has been associated with cardiovascular events, stroke, target organ damage and renal dysfunction independently of BP levels. The relationship between BPV and CIN is unknown.

Methods: This prospective study investigated the relationship between invasively measured short-term BPV and CIN in haemodynamically stable STEMI patients undergoing PCI. In 220 patients, BP was monitored through the femoral sheath for six hours after PCI, and systolic and diastolic standard deviation (SD), average real variability (ARV) and delta parameters were calculated using universal formulae.

Results: The results indicated a significant association between short-term BPV, especially systolic BPV, and the development of CIN (p < 0.01). In particular, systolic SD [odds ratio (OR): 1.055, 95% confidence interval (CI) 1.003-1.110, p = 0.04] and systolic ARV (OR: 1.084, 95% CI 1.011-1.162, p = 0,02) emerged as independent predictors of CIN.

Conclusions: Our study demonstrated that intra-arterially measured short-term BPV was associated with the development of CIN in STEMI patients. Notably, systolic SD and systolic ARV were independent predictors of CIN, which may be of clinical importance for early diagnosis and prevention. These results suggest that BPV may be an indicator of CIN risk, and further large-scale randomised trials are warranted to clarify this relationship.

Aim: To evaluate the feasibility, safety, and effectiveness of the TAI QING^TM single-hub occluder for patent foramen ovale (PFO) in preclinical animal experiments.

Methods: Twelve Labrador retrievers were included to establish an animal model of PFO. Under fluoroscopic guidance, the TAI QING^TM single-hub occluder was implanted in the animals with PFO. Three animals were sacrificed at 1, 3, 9 and 12 months post-implantation, respectively, to evaluate the macroscopic anatomical structure and pathological conditions.

Results: The TAI QING^TM single-hub occluder was successfully implanted in all 12 Labrador retrievers (100%). No implant-related complications were detected during the operation and follow-up. The occluder remained stable in its implant location. At 1 month post-implantation, the surfaces of both discs was covered with a translucent layer. Over time, the surface of the occluder became covered with an opalescent membrane, and the tissue surrounding the occluder gradually thickened. Histological and electronic microscopy analysis revealed the presence of endothelial cells and collagen fiber deposition in the tissue with increasing implantation time. Furthermore, at 12 months post-implantation, successful re-puncture was performed.

Conclusions: The TAI QING^TM single-hub occluder was safe and effective in the animal model. The results support further investigations in large animal models and human clinical trials.