Acta cardiologica最新文献

Background: Implantable cardioverter-defibrillators (ICDs) are lifesaving devices that prevent sudden cardiac death in patients at risk of life-threatening arrhythmias. However, if ICDs are not deactivated in the terminal phase of life, they may deliver shocks that can pose a problem during end-of-life care. While guidelines recommend initiating discussions on ICD deactivation early, in practice these conversations often take place too late or not at all.

Methods: A scoping review aimed at three key groups (patients, relatives, and healthcare professionals) was performed based on a search of PubMed and Embase conducted on June 9, 2024, focusing on studies examining attitudes towards ICD deactivation. Studies were selected based on their relevance to the perspectives of patients, relatives, and healthcare professionals.

Results: 32 articles were included: 16 focused on patients, 10 on professionals, 3 on relatives, and 3 on combinations of study groups. Findings revealed significant knowledge gaps. Many patients and relatives were unaware that ICD deactivation was an option. Healthcare professionals felt they lacked confidence in initiating discussions, citing time constraints and discomfort. A preference for shared decision-making was identified, although preferences varied. There was no consensus on the optimal timing for these discussions. All groups reported ethical and legal concerns about ICD deactivation.

Conclusion: This review emphasises the need for individualised ICD deactivation discussions. Enhancing communication, education, and training for healthcare professionals is essential. Timely, ongoing conversations about ICD deactivation should be integrated into routine care, ensuring decisions align with patient values, especially in the final stages of life.

Background: Ischaemic cerebrovascular events (CVEs) are a major complication of transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis.

Purpose: We aimed to determine the incidence and risk factors for CVE at 30 days and 1 year after TAVI in a large, real-world patient cohort and evaluate the association of these events with all-cause mortality at 1 year.

Methods: All consecutive patients undergoing TAVI at a single centre between April 2008 and February 2024 were included in the analysis. CVE were defined as a composite of stroke and transient ischaemic attack.

Results: One thousand and three patients (mean age 81.8 ± 7.0 years, 52.6% male, median EuroSCORE II 6% [Q1 = 3.51%; Q3 = 10.9%]) underwent TAVI with a self-expandable valve (SEV) (n = 275; 27.4%) or balloon-expandable valve (BEV) (n = 728; 72.6%). The cumulative incidence of CVE was 3.6% (95% confidence interval (95% CI) = [2.6%; 4.9%], n = 36) at 30 days (77.8% within 48 h) and 6.2% (95% CI = [4.8%; 7.8%], n = 62) at 1 year. Risk factors associated with a lower risk of CVE at 30 days included BEV vs. SEV (OR 0.32 [0.16-0.63], p = 0.0009) and larger baseline aortic valve area (AVA) (OR_{Unit = 0.1 cm2} 0.74 [0.61-0.91], p = 0.0035), while the risk was higher in the case of new-onset atrial fibrillation (AF) (OR 3.19 [1.18-8.59], p = 0.0218), diabetes (OR 2.00 [1.01-3.97], p = 0.0484), and conversion to sternotomy (OR 16.57 [4.62-59.48], p < 0.0001). Analysis at 1-year follow-up identified the same associations. Finally, the occurrence of CVE significantly increased 1-year all-cause mortality (OR 2.44 [1.32-4.50], p = 0.0045).

Conclusions: CVE after TAVI were associated with double the odds of 1-year all-cause mortality. Risk factors associated with CVE include the use of a SEV, new-onset AF, diabetes, conversion to sternotomy, and a smaller AVA.

Background: Conduction system pacing (CSP) is an increasingly used approach for physiological ventricular pacing. We conducted a nationwide survey aimed to evaluate the adoption of CSP in the Italian clinical practice.

Methods: An online survey consisting of 20 questions, distributed to Italian centres performing cardiac pacing, was conducted from October to November 2024.

Results: A total of 136 centres took part in the survey (37% of all arrhythmia centres operating in Italy), 119 of which (86%) declared to perform CSP implants. The lack of trained operators was the main perceived barrier to CSP adoption, reported by 58% of the centres that did not perform CSP implants. Forty-seven percent of the centres had started performing CSP implants within the last 2 years. Sixty-three percent of the operators declared to be independent in CSP implant procedures, however, 45% of them still had little experience, having performed ≤10 procedures. The median rate of pacemakers (PMs) with CSP on the total PMs implanted per year was 10%. Left bundle branch area pacing (LBBAP) was the pacing strategy used in 98% of CSP implants. The main indication for CSP implantation was atrioventricular block (46%), followed by cardiac resynchronisation therapy (17%), ablate and pace (15%), and upgrading (14%).

Conclusions: CSP appears to be widely used in the Italian clinical practice, although most centres have only begun adopting it in the past few years, and many operators are still not very experienced. LBBAP is the CSP strategy most commonly chosen by the Italian operators.

Objective: To explore the susceptibility to aortic dissection in an SSc mouse model and identify potentially related markers.

Methods: Thirty-six female BALB/C mice were divided into experimental, control, and intervention groups (12 each). SSc was induced in the experimental and intervention groups using bleomycin, while the control group received phosphate-buffered saline. The intervention group additionally received MMP inhibitor SD1776. All groups were then subjected to angiotensin II injections to induce aortic dissection. Histopathological changes in the aortic wall and MMP expression levels were analysed using immunohistochemistry and western blotting.

Results: Mice with induced SSc showed more severe non-inflammatory degenerative changes in the aortic media, indicating increased susceptibility to aortic dissection. The experimental group exhibited higher MMP expression (MMP9, MMP2) compared to the intervention and control groups(p < 0.05). However, there was no significant difference in IL6 expression among the groups(p > 0.05). TIMP-1 expression was significantly higher in both the SSc and intervention groups compared to the control group(p < 0.05), suggesting a compensatory response to increased MMP activity.

Conclusions: Mice with SSc were more prone to aortic dissection, potentially due to enhanced MMP activity in the aortic wall, underlining the importance of MMPs in the pathogenesis of aortic dissection in connective tissue diseases and indicating a pathway for future therapeutic interventions by targeting MMPs to mitigate the risk of aortic dissection in patients with SSc.