Acta cardiologica最新文献

Background: In 2012, the randomised trial IABP SHOCK II demonstrated that IABP did not reduce 30-day mortality in patients with acute myocardial infarction complicating cardiogenic shock (CS). However, SCAI proposed a new standardised classification of cardiogenic shock in 2019. It is reasonably hypothesised that the use of IABP may have different benefits for patients in different stages of CS.

Methods: AMI patients ≥18 years who had received treatment of implantation of IABP during emergency setting in Beijing Chaoyang Hospital between December 2010 and July 2021 were enrolled in this study. CS stages were classified at admission for all eligible cases. During the same period, AMI patients without implantation of IABP were matched with each stage of CS above using propensity score matching (PSM). Data were as follows: Stage B (n = 302), Stage C (n = 290), Stage D (n = 68), and Stage E (n = 32). In-hospital mortality was compared between using and without using IABP at each stage.

Results: In stage C, the in-hospital mortality was significantly lower in the IABP group (31/145, 21.4%) than in the group without IABP (47/145, 32.4%) (OR 0.567, 95% CI, p = .034). In-hospital mortality had no significant difference between use and no-use of IABP in stage B (16.6% vs 14.6%, p = .634), stage D (47.1% vs 38.2%, p = .462), and in stage E (81.3%vs 68.8%, p = .414).

Conclusions: For patients with acute myocardial infarction complicating cardiogenic shock, IABP has no effect on in-hospital mortality in SCAI stages B, D, and E. However, in SCAI stage C, IABP can reduce in-hospital mortality.

Background: Valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) is increasingly used for the treatment of surgical bioprosthetic valve degeneration (sBVD).

Methods: We investigated clinical outcomes and hemodynamic valve performance in all consecutive patients undergoing ViV-TAVI for sBVD in a single centre and assessed differences in patients who received a balloon-expandable (BEV) versus self-expandable valve (SEV) at 1, 6 and 12 months (m), and annually thereafter.

Results: Between 25 November 2011 and 4 September 2023, 86 patients (mean age 80.3 ± 6.6y; 53.5% female; median STS score 5.1% (3.7%;8.6%) underwent ViV-TAVI with BEV (n = 53) or SEV (n = 33). Overall, the cumulative incidences of all-cause and cardiovascular mortality at 12 m were 7.4% (3.4%;15.8%) and 3.6% (0.9%; 9.3%), respectively (comparison of SEV versus BEV within the first year: p = 0.253 and p = 0.168, and comparison for the entire follow-up (median 2.6 (0.9;4.6) years): p = 0.962 and p = 0.942). Aortic valve area (AVA) and peak and mean transprosthetic gradients (TPG) improved significantly from baseline to 1, 6 and 12 m follow-up (p < 0.001 for all). Peak and mean TPG were 10.5 (1.8;19.2) and 7.1 (1.6;12.7) mmHg lower in SEV as compared with BEV at 1 m (p = 0.019 and 0.012, respectively). Similarly, AVA of SEV was 0.23 (0.03;0.44) and 0.54 (0.28;0.81) cm² larger as compared with BEV at 1 and 6 m (p = 0.027 and p < 0.001, respectively). No significant differences in hemodynamic valve performance between BEV and SEV were observed during further follow-up.

Conclusion: ViV-TAVI is a safe and effective treatment for patients presenting sBVD. Improved hemodynamic valve performance with SEV over BEV observed during early follow-up did not translate into long-term lower mortality rates.

Uric acid to HDL ratio (UHR) is a new measure of inflammation that has been widely used to study cardiovascular disease relationships. The aim of this study was to investigate the relationship between uric acid to HDL ratio and hypertension. We found that UHR was positively associated with hypertension prevalence in a nationally representative sample of U.S. participants. In model 3 corrected for multiple confounders, the HR (95% CI) was 1.49 (1.30, 1.70), 2.11 (1.74, 2.54), and 2.97 (2.40, 3.68) for Q2, Q3, and Q4, respectively, compared with the reference value (Q1). There was a nonlinear relationship between the ratio of uric acid to HDL and blood pressure, with an inflection point value of approximately 17. The correlation between the ratio of uric acid to HDL and hypertension was more pronounced before the inflection point value, a finding that was consistent across subgroups except for coronary artery disease. Uric acid, HDL and UHR were predictive of the prevalence of hypertension to varying degrees, with Area Under the Curve (AUC) of 0.62, 0.53, and 0.59, respectively. Therefore, rational monitoring of the ratio of uric acid to HDL can help us in the early prevention of hypertension.