Acta cardiologica最新文献

Cor Triatriatum Dexter (CTD) is a rare congenital heart malformation, with an estimated incidence of 0.025%, characterised by a membrane dividing the right atrium (RA) into two chambers. A variant, incomplete CTD (CTDi), occurs when the right membrane extends partially into the interatrial septum without fully dividing the RA. CTDi can be associated with interatrial septal defects, found in 5% of patients with atrial septal defects or a patent foramen ovale (PFO). The study reports three adult patients (46-53 years old) with CTDi and a PFO, all presenting cryptogenic stroke and referred for PFO closure. Two cases underwent percutaneous closure with guidance from fluoroscopy and 2D/3D transesophageal echocardiography (TEE), and the last one utilised intracardiac echocardiography (ICE) for device placement. In patients referred for PFO closure, CTDi is common and can complicate visualisation, prolong procedure times, and reduce success rates. Difficulties in device deployment and the risk of residual shunt or embolisation have been reported. The authors highlight that using oversizing techniques, traction manoeuvres during device deployment, and preoperative planning with advanced imaging (such as ICE or 3D TEE) are crucial for successful percutaneous closure in cases with CTDi and PFO.

Background: This study aimed to evaluate the association between peak tricuspid regurgitation velocity (TRV) and 1-year heart failure (HF) readmission in hospitalised patients with HF with preserved ejection fraction (HFpEF) because the impact of peak TRV on the short-term prognosis of these patients has been unclear.

Methods: From January 2020 to December 2021, 513 hospitalised HFpEF patients age ≥ 60 years with 1-year follow-up were included in this study. Peak TRV was classified as normal (≤ 2.8 m/s) and high (> 2.8 m/s) value according to pulmonary hypertension probability.

Results: Approximately 68.23% of HFpEF patients had a high peak TRV value. In the final adjusted Cox regression model, peak TRV was still independently associated with HF readmission (HR: 1.74, 95% CI: 1.19-2.55, p = 0.004). Furthermore, patients with high peak TRV were also associated with an increased risk of HF readmission (HR: 2.30, 95% CI: 1.31-4.04, p = 0.004), compared to those with normal peak TRV. After inverse probability of weighting, the risk of HF readmission in patients with high peak TRV was 2.53 (95% CI: 1.35-4.75, p = 0.004) compared to those with normal peak TRV. Additionally, Subgroup analysis revealed very elderly patients, male, and patients with hypertension had a significantly worse prognosis.

Conclusion: Peak TRV is independently associated with HF readmission in hospitalised HFpEF patients. High peak TRV has a higher risk of HF readmission in patients age ≥ 80 years, male and patients with hypertension, indicating that special attention should be paid to these patients.

Background: Patients with chronic kidney disease (CKD) undergoing maintenance haemodialysis (MHD) develop several abnormalities of left ventricular (LV) structure and function. Speckle-tracking echocardiography permits compressive assessment of LV myocardial deformation. Previous studies involving CKD patients have shown a significant reduction in LV global longitudinal strain (GLS) with strong prognostic implications. However, the other components of LV deformation have not been fully elucidated.

Methods: A total of 90 CKD patients undergoing MHD (mean age 41.3 ± 12.5 years, 80% men) were compared with 45 apparently healthy age- and gender-matched controls.

Results: The CKD patients had a high prevalence (77.8% patients) of LV hypertrophy. They also had a significantly elevated ratio of early diastolic mitral inflow velocity to annular velocity (12.1 ± 4.6 vs. 7.1 ± 1.5, p < .001) indicating a high prevalence of LV diastolic dysfunction. LV ejection fraction (LVEF) was the same between the two groups, but the CKD patients had significantly impaired LVGLS (-17.8 ± 3.9 vs. -20.8 ± 2.6, p < .001), global circumferential strain (-14.0 ± 3.5 vs. -16.1 ± 3.4, p = .001), LV apical rotation (6.6 ± 4.7° vs. 8.8 ± 4.0°, p = .008) and LV twist (12.8 ± 6.1° vs. 15.0 ± 6.0°, p = .037). There was no difference in the global radial strain between the two groups.

Conclusions: The present study shows that CKD patients on MHD have significantly impaired LV longitudinal and circumferential mechanics despite preserved LVEF. The prognostic implications of reduced LVGLS have already been demonstrated previously. Future studies are needed to assess the prognostic implications of abnormal LV circumferential mechanics as well as their reversibility following renal transplant.