American Journal of Cardiology最新文献

Relevant mitral regurgitation (MR) is associated with significant morbidity and mortality. Surgical mitral valve repair represents the treatment of choice for symptomatic severe degenerative MR (DMR) in patients with acceptable surgical risk. However, surgical failure and high perioperative risk may limit reintervention options, particularly in elderly patients with multiple comorbidities. In this context, transcatheter edge-to-edge mitral valve repair (M-TEER) may represent a viable alternative strategy, particularly in patient who underwent previous surgery. We report the case of a 79-year-old man with severe DMR due to P2 flail, who underwent minimally invasive surgical mitral valve repair with NeoChord implantation. The postoperative course was complicated by acute hemodynamic and respiratory deterioration requiring invasive mechanical ventilation, veno-arterial extracorporeal membrane oxygenation (VA-ECMO), and continuous renal replacement therapy (CRRT). Transoesophageal echocardiography revealed early NeoChord apical detachment, with persistence of prosthetic material attached to the posterior leaflet, recurrent severe MR and new-onset left ventricular dysfunction. Due to prohibitive surgical risk, the patient was deemed unsuitable for redo surgery and underwent urgent M-TEER with VA-ECMO support. Two MitraClip XTW G4 devices were successfully implanted achieving successful reduction of MR without significant increase in mitral gradient. Meticulous preprocedural echocardiographic assessment and advanced intraprocedural imaging guidance was essential to optimize procedural success. This complex case highlights that transcatheter M-TEER can represent a safe and effective bail-out strategy in patients with hemodynamically unstable severe DMR after surgical repair failure when redo surgery is contraindicated.

Background: Intravascular lithotripsy (IVL) has demonstrated efficacy in treating balloon-crossable calcified coronary lesions by inducing calcium fractures and improving coronary artery compliance (CACom). However, a direct comparison between IVL and non-compliant (NC) balloon angioplasty with respect to compliance modification has not yet been reported.

Methods: From the BENELUX-IVL prospective registry (NCT06577038), patients with calcified coronary artery lesions treated with IVL under intravascular ultrasound (IVUS) guidance were selected. CACom was calculated as the systo-diastolic change in luminal area (ΔA), measured using IVUS, divided by the corresponding change in aortic pressure (ΔP). CACom was assessed at three time points: (1) before NC balloon inflation (baseline), (2) after NC balloon inflation but prior to IVL (post-NC), and (3) after IVL pulse delivery (post-IVL). The NC balloon effect was defined as the difference between post-NC and baseline CACom; the IVL effect was defined as the difference between post-IVL and post-NC CACom.

Results: Twenty-four patients, for a total of 28 lesions, were pertinent for inclusion. CACom increased from 0.17 [0.12-0.23] mm²/mmHg at baseline to 0.32 [0.25-0.52] mm²/mmHg post-NC, and to 0.65 [0.44-0.84] mm²/mmHg post-IVL. The median NC effect was 0.14 [0.10-0.28] mm²/mmHg (p < 0.01), and the IVL effect was 0.23 [0.13-0.37] mm²/mmHg (p < 0.01). The IVL effect was significantly greater than the NC effect (p = 0.03).

Conclusions: sequential NC balloon angioplasty and IVL significantly improved coronary compliance, with IVL yielding a greater compliance gain, supporting its role in optimizing lesion preparation in calcified coronary arteries.

Background: Due to variable involvement of mitral valve(MV) anomalies in hypertrophic obstructive cardiomyopathy(HOCM), MV repair may be added to septal myectomy. This study reports on our experience with HOCM surgery, including the effect of MV surgery.

Methods: The HOCM population was divided per treatment in group 1=septal myectomy/ablation only, and group 2=septal myectomy + MV surgery. Clinical endpoints as survival and reoperation rate, and echocardiographic results were compared.

Results: The study comprised 47 patients(group 1=18 - group 2=29). Group 2 showed more MV anomalies(group 1:29% - group 2:79%, p=0.023) as increased leaflet length and annular calcification (group 1:0% - group 2:17.2%, p=0.062) and SAM-related MR(MR ≥ 2: group 1=17.7% - group 2=75.8%, p<0.001). MV surgery consisted of anterior leaflet patch augmentation(n=20), secondary chordae resection(n=15), Alfieri-repair(n=2) and MV replacement(n=6). Within median follow-up of 7.2y(IQR 1.2-13.4), 5-10 year survival was 87.2±8.6% and 79.3±10.9% for group 1, and 85.6±6.7% and 66.7±13.2% for group 2(p=0.333). Procedure-related reoperation was required in 6 patients. LVOTO relief was effective showing a comparable postoperative gradient reduction (group 1: 53.6±32.2 > 19.5±9.3 mmHg - group 2: 69.0±42.3 > 19.1±8.5 mmHg), which was maintained during FU(group 1: 11.2±3.8 mmHg - group 2: 12.2±6.3 mmHg).

Conclusion: Although septal myectomy remains the cornerstone in the treatment of HOCM, a significant MV contribution to the LVOTO is observed in many patients, often amenable to MV repair. LVOTO relief by septal myectomy with or without MV surgery is effective and durable, however at a potential risk of reoperation for recurrent MV dysfunction after MV repair.

Background: Approximately 1.5 million of the 44 million individuals of African descent in the United States are carriers of the p.V142I variant in transthyretin (TTR). This is the most common cause of variant amyloid cardiomyopathy (ATTR-CM) worldwide which leads to heart failure (HF) and premature death. Despite promising new treatments, ATTR-CM is often diagnosed at an advanced stage and conventional diagnostic tools lack specificity to detect early disease. Thus, the overall objectives of the Variant Imaging of Subclinical Transthyretin Amyloidosis (VISTA) study are to determine imaging and biomarker evidence of subclinical ATTR-CM that indicates amyloid progression in p.V142I TTR carriers.

Methods and results: In a multisite nested case-control study, contrast-enhanced cardiac resonance imaging (CMRI) and amyloid-specific blood biomarker measurements will be used to compare metrics associated with cardiac amyloid infiltration between a cohort of p.V142I TTR carriers without HF with age-, sex-, and race-matched non-carrier controls. A sub-sample of will undergo novel exercise CMRI to measure and compare cardiac systolic and diastolic reserve.

Conclusions: Completion of VISTA will establish evidence of subclinical variant ATTR-CM in p.V142I TTR carriers, will change how we think about ATTR-CM, and will justify future research in screening and treatment strategies for disease prevention.

Breast arterial calcification (BAC), detected on routine mammography, is the calcification of medial arteries. BAC has been suggested to be linked to cardiovascular disease (CVD) risk. A systematic search was done that identified studies examining BAC, CVD risk factors (diabetes, hypertension, dyslipidemia, smoking, obesity), cardiovascular outcomes [stroke, myocardial infarction (MI), heart failure (HF), cardiac mortality], and all-cause mortality. Additionally, an atherosclerotic CVD (ASCVD) composite outcomes including MI, stroke, and cardiac mortality was analyzed. A random-effects model was used to calculate risk ratios (RR) and odds ratio (OR) with 95% confidence intervals (CI). Heterogeneity was assessed with Q values and I2 statistics. 45 studies were included in the final meta-analysis, representing 68,584 women. BAC prevalence was 17.1%. Among cross-sectional studies, BAC was associated with diabetes (OR 1.97, 95%CI: 1.71-2.27, I2= 70.78%), hypertension (OR 1.82, 95% CI: 1.52-2.18, I2=88.3%), and hyperlipidemia (OR 1.24, 95% CI: 1.06-1.45, I2= 76.4%). BAC was negatively associated with smoking (OR 0.50, 95% CI: 0.41-0.61, I2=78.4%). BAC was associated with known CVD (OR 2.71 95% CI: 2.13-3.45, I2 = 76.7%). Among cohort studies, BAC was associated with incident stroke (RR 2.05, 95%CI: 1.58-2.65, I2=50.8%), HF (RR 2.14, 95%CI: 1.38-3.32, I2= 87.1%), cardiac death (RR: 2.94, 95%CI: 1.32-6.54, I2= 72.7%), ASCVD (RR 1.58 95% CI: 1.23-2.04 I2 =81.9%) and all-cause mortality (RR 2.04, 95%CI: 1.08-3.84, I2= 96.78%). Significant interstudy heterogeneity in this meta-analysis is a limitation on confidence in the pooled results. In conclusion, BAC observed on mammography may serve as a marker for increased CVD risk and mortality in women; however, future research is needed to standardize BAC assessment and confirm its clinical utility in CVD risk stratification.

Severe coronary artery calcification is associated with suboptimal stent expansion, higher complication rates and worse clinical outcomes after percutaneous coronary intervention. Several devices and techniques have been developed to facilitate the treatment of calcified coronary lesions. This manuscript outlines best practices and tips on the use of the super high pressure OPN non-compliant balloon (OPN®; SIS [Swiss Interventional Systems] Medical AG, Winterthur, Switzerland).