Acta cardiologica最新文献

Objectives: Edge-to-edge mitral valve repair with MitraClip leads to a differed flow pattern and a decreased flow velocity at the left ventricle apex. This combination may lead to initiation of thrombus formation, especially in patients with severely reduced ejection fraction. The prevalence and mechanism of left ventricular thrombus formation after MitraClip implantation is still unknown.

Methods: We describe a case of a 74 year old women with a non-ischaemic cardiomyopathy and chronic heart failure with a severely reduced ejection fraction who was treated with a MitraClip for a severe secondary mitral valve insufficiency. One and a half year later she suffered from an ischaemic stroke due to a large thrombus at the ventricular side of the posterior mitral leaflet. Oral anticoagulation was started with complete resolution of the thrombus. We performed a literature review.

Results: There are just a few case reports of this complication and two single centre observational retrospective studies on the prevalence of thrombus formation after MitraClip. They reported a divergent prevalence of 4.4% and 21%. Multiple hypotheses have been described such as the correction of the regurgitating blood that might be leading to more stasis of blood in the left ventricle. Another hypothesis states that the 2 divergent jets after the MitraClip can lead to an increase of shear stress, which might initiate thrombus formation.

Conclusion: Thrombus formation in the left ventricle after MitraClip implantation in patients with severely reduced ejection fraction is a rare complication. This case reports shows that it may occur even more than one year after the intervention. Permanent vigilance is warranted, especially in patients who are not chronically treated with oral anticoagulation.

Introduction: Determining the normal diameter of the abdominal aorta in different populations and its relationship with other demographic factors is crucial for diagnosing and managing abdominal aortic diseases. This study aimed to assess the size of the abdominal aorta in a healthy Iranian population.

Methods: This cross-sectional study included healthy individuals. Various variables including age, sex, height, and weight were measured as part of this study. We performed an echocardiographic evaluation to assess the aortic sections.

Results: The study encompassed 167 participants, predominantly women (67.7%). Notable differences in sizes of the ascending aorta, aortic arch, sinus of Valsalva, and abdominal aorta were observed across the four age groups. Men exhibited greater sizes in multiple aortic sections within the 45-64 age group. Correlation and regression analyses demonstrated significant positive relationships between abdominal aorta size and various aortic dimensions, with a one-millimeter increase in ascending or descending aorta diameter corresponding to a 0.23 and 0.35 mm increase, respectively, in abdominal aorta diameter. The relationship between abdominal aorta size and demographic factors such as gender, age, weight, BSA, and SBP was explored, revealing age as a significant predictor.

Conclusions: We observed significant differences in the sizes of distinct aortic sections across different age groups, underscoring the importance of considering age-related changes when evaluating aortic characteristics. These findings contribute to our understanding of the structural changes that occur in the aorta over time. Echocardiographic screening of the abdominal aorta would enable echocardiologists to diagnose the aneurysmal aorta.

Objective: Atrial high-rate episodes (AHRE) are atrial tachyarrhythmia episodes detected by implanted cardiac devices, characterised by an atrial rate exceeding 180-190 beats per minute. Recent studies have linked AHRE to the development of atrial fibrillation (AF) and increased stroke risk, especially when episodes last longer than 5-6 min. This study aimed to evaluate the relationship between predictive factors and the occurrence of AHRE in heart failure with reduced ejection fraction (HFrEF) patients with cardiac implantable electronic devices (CIEDs).

Methods: This single-centre, retrospective study included a cohort of 155 consecutive HFrEF patients with CIEDs, but without a diagnosis of AF, enrolled between January 2023 and December 2023. Patients were stratified based on the presence of AHRE detected during device interrogation.

Results: The average age of the patients was 54 ± 14 years, and 83.2% of the study population were male. Patients with AHRE had a reduced left ventricular ejection fraction (LVEF) (p = 0.026) and an increased left atrial diameter (p < 0.001) compared to the group without AHRE. Patients with AHRE had elevated levels of creatinine, uric acid, and TSH compared to those without AHRE (p = 0.006, p = 0.021, p = 0.009, respectively). In the univariable logistic regression analysis, LVEF (HR = 0.690, 95% CI = 0.610-0.913, p = 0.013), left atrial diameter (HR = 8.215, 95% CI = 1.557-43.34, p < 0.001), creatinine (HR = 7.369, 95% CI = 1.749-31.05, p = 0.006), uric acid (HR = 1.073, 95% CI = 1.062-1.196, p = 0.020), total cholesterol (HR = 0.989, 95% CI = 0.979-0.999, p = 0.031), and C-reactive protein levels (HR = 1.146, 95% CI = 1.002-1.131, p = 0.047) were identified as independent predictors of AHRE. In multivariable logistic regression analysis, left ventricular ejection fraction (HR = 0.890, 95% CI = 0.795-0.998, p = 0.046), left atrial diameter (HR = 8.215, 95% CI = 1.557-43.34, p < 0.001), and uric acid concentration (HR = 1.650, 95% CI = 1.063-2.561, p = 0.025) were identified as predictors of atrial high-rate events.

Conclusion: LVEF, left atrial diameter, and uric acid level were found to be independent predictors of AHRE in patients with HFrEF. Identifying AHRE is crucial for risk stratification and guiding therapeutic decisions to improve patient outcome.