Cardiology and cardiovascular medicine最新文献

Objectives: To compare the fractional flow reserve (FFR) and diastolic hyperemia-free ratio (DFR) measurements in a population with intermediate coronary artery stenosis and improve the diagnosis.

Background: Visual assessment of coronary artery stenosis severity, particularly in intermediate lesions, is prone to errors in decision-making. FFR provides a reliable assessment of functional severity in these cases but requires hyperemia induction by adenosine, which has side effects and increased cost. DFR is a novel hyperemia-independent index, which could be used as an alternative to adenosine-based hyperemia induction.

Methods and results: Between September 2019 to March 2020, 25 patients with 38 intermediate coronary stenotic lesions were included in the study. All patients underwent assessment of whole cycle Pd/Pa (ratio of distal coronary pressure to proximal aortic pressure), DFR and FFR. Mean whole cycle Pd/Pa, DFR and FFR were 0.93±0.06, 0.88±0.09, and 0.85±0.08, respectively. A significant positive correlation between DFR and FFR [r = 0.74; p<0.001] was observed. Receiver operating characteristic analysis showed an area under the curve of 0.90. DFR-only strategy with a treatment cut-off of ≤0.89 showed a diagnostic agreement with the FFR-only strategy in 74% of lesions, with a sensitivity of 54%, specificity of 82%, a positive predictive value of 60%, and a negative predictive value of 79%.

Conclusions: Real-time DFR measurements show a clinically reliable correlation with FFR. Hence, using DFR is likely to avoid adenosine administration as well as reduce the cost and procedural time. Further studies with a larger sample size would be ideal to evaluate specific cut-off values and endpoints.

Background: Hypertrophic cardiomyopathy (HCM) is defined by the presence of left ventricular hypertrophy (LVH) in the absence of other potentially causative cardiac, systemic, syndromic, or metabolic diseases [1]. It is the most common genetic abnormality of the myocardium, with an anaesthetized prevalence ranging from 1:500 to as high as 1:200 [2-4]. It is the primary cause of sudden cardiac death (SCD) among teenagers and athletes.

Patient: A 56-year-old man presented with chest tightness and palpitations which had been occurring post-activity for the previous 6 months. The patient was advised to be admitted. He underwent echocardiography, cardiac magnetic resonance (CMR), coronary angiography (CAG) examination, and left ventriculography. He was diagnosed with hypertrophic obstructive cardiomyopathy (HOCM) with systolic anterior motion (SAM) phenomenon.

Results: Echocardiography results showed that the interventricular septal thickness was 14-16 mm and that there were 2 degrees of SAM of the mitral valve. This resulted in severe stenosis of the left ventricular outflow tract (LVOT) and moderate to severe mitral insufficiency. Left ventriculography confirmed mitral regurgitation (MR) associated with HOCM with SAM phenomenon. Under the protection of a permanent pacemaker, the patient was treated with alcohol septal ablation (ASA). After discharge, the symptoms of chest tightness and palpitation did not recur.

Conclusion: Beneficial effects were observed when patients with HOCM and SAM were treated with ASA under the condition of a permanent pacemaker.

Background: Our objective was to review the latest evidence on resuscitation care for maternal cardiac arrest (MCA) and gain expert consensus on best practices to inform an evidence-based curriculum.

Methods: We convened a multidisciplinary panel of stakeholders in MCA to develop an evidence-based simulation training, Obstetric Life Support™ (OBLS). To inform the learning objectives, we used a novel three-step process to achieve consensus on best practices for maternal resuscitation. First, we reaffirmed the evidence process on an existing MCA guideline using the Appraisal of Guidelines for Research and Evaluation (AGREE II). Next, via systematic review, we evaluated the latest evidence on MCA and identified emerging topics since the publication of the MCA guideline. Finally, we applied a modified Research and Development (RAND) technique to gain consensus on emerging topics to include as additional just-in-time best practices.

Results: The AGREE II survey results demonstrated unanimous consensus on reaffirmation of the 2015 American Heart Association (AHA) MCA guideline for inclusion into the OBLS curriculum. A systematic review with deduplication resulted in 11,871 articles for review. After categorizing and synthesizing the relevant literature, we presented twelve additional best practices to the expert panel using a modified RAND technique. Upon completion, the 2015 AHA statement and nine additional just-in-time best practices were affirmed to inform the OBLS curriculum.

Conclusions: A novel three-step process including reaffirmation of evidence process, systematic review, and a modified RAND technique resulted in unanimous consensus from experts in MCA resuscitation on existing and new just-in-time best practices to inform the learning objectives for an evidence-based curriculum.

Aortic stenosis (AS) is the most common valvular heart disease in Europe and North America requiring a surgical or interventional treatment. Due to demographic changes with an aging population the burden of valvular heart diseases and especially the importance of aortic stenosis (AS) will be growing in future. As the onset of symptoms is associated with a decrease in life expectancy appropriate and early diagnosis are of utmost importance. However, insights of clinical practice underline diagnostic challenges which may lead to a delayed initiation of treatment with an adverse effect on the prognosis. The aim of this review is to display different diagnostic approaches that may be helpful in detecting patients with aortic valve stenosis. This review will focus on both non-invasive and invasive diagnostic approaches that can be implemented in clinical routine. Further-more, we will especially highlight recommendations of the 2021 European guidelines for the management of valvular heart disease.

Methods: For this review a selective literature research on the databases PubMed and Google Scholar was conducted. Original articles, reviews and meta-analyses were included when meeting our search criteria. Following terms were used in different combinations: Aortic valve stenosis; Aortic stenosis; diagnosis of aortic stenosis; ESC Guidelines for the management of valvular heart disease.