American Journal of Cardiology最新文献_第10页

Artificial Intelligence-Driven Assessment of Coronary Computed Tomography Angiography for Intermediate Stenosis: Comparison With Quantitative Coronary Angiography and Fractional Flow Reserve 人工智能驱动的冠状动脉 CT 血管造影对中度狭窄的评估：与定量冠状动脉造影和分数血流储备的比较

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2024-12-11 DOI: 10.1016/j.amjcard.2024.12.011

Jung In Jo MD , Hyun Jung Koo MD , Joon Won Kang MD , Young Hak Kim MD , Dong Hyun Yang MD

We aimed to compare artificial intelligence (AI)-based coronary stenosis evaluation of coronary computed tomography angiography (CCTA) with its quantitative counterpart of invasive coronary angiography (ICA) and invasive fractional flow reserve (FFR). This single-center retrospective study included 195 symptomatic patients (mean age 61 ± 10 years, 149 men, 585 coronary arteries) with 215 intermediate coronary lesions, with quantitative coronary angiography (QCA) diameter stenosis ranging from 20% to 80%. An AI-driven research prototype (AI-CCTA) was used to quantify stenosis on CCTA images. The diagnostic accuracy of AI-CCTA was assessed on a per-vessel basis using ICA stenosis grading (with ≥50% stenosis) or invasive FFR (≤0.80) as reference standards. AI-driven diameter stenosis was correlated with the QCA results and expert manual measurements subsequently. The disease prevalence in the 585 coronary arteries, as determined by invasive angiography (≥50%), was 46.5%. AI-CCTA exhibited sensitivity, specificity, positive predictive value, negative predictive value, and area under the curve (AUC) of 71.7%, 89.8%, 85.9%, 78.5%, and 0.81, respectively. The diagnostic performance of AI-CCTA was moderate for the 215 intermediate lesions assessed using QCA and FFR, with an AUC of 0.63 for QCA and FFR. AI-CCTA demonstrated a moderate correlation with QCA (r = 0.42, p <0.001) for measuring the degree of stenosis, which was notably better than the results from manual quantification versus QCA (r = 0.26, p = 0.001). In conclusion, AI-driven CCTA analysis exhibited promising results. AI-CCTA demonstrated a moderate relation with QCA in intermediate coronary stenosis lesions; however, its results surpassed those of manual evaluations.

我们旨在比较基于人工智能（AI）的冠状动脉CT血管造影（CCTA）与有创冠状动脉造影（ICA）和有创分数血流储备（FFR）的定量评估。本单中心回顾性研究纳入195例有症状患者（平均年龄61±10岁，男性149例，冠状动脉585条），215例中度冠状动脉病变，定量冠状动脉造影（QCA）内径狭窄范围为20-80%。人工智能驱动的研究原型（AI-CCTA）用于量化CCTA图像上的狭窄。采用有创冠状动脉造影狭窄分级（狭窄≥50%）或有创FFR（≤0.80）作为参考标准，以每根血管为基础评估AI-CCTA的诊断准确性。人工智能驱动的内径狭窄与QCA结果和随后的专家人工测量相关。有创血管造影（≥50%）测定的585条冠状动脉的患病率为46.5%。AI-CCTA的敏感性为71.7%，特异性为89.8%，阳性预测值为85.9%，阴性预测值为78.5%，曲线下面积（AUC）为0.81。AI-CCTA对使用QCA和FFR评估的215个中间病变的诊断性能一般，QCA和FFR的AUC为0.63。AI-CCTA与QCA测量狭窄程度有中度相关性（r=0.42, p < 0.001），明显优于人工定量与QCA测量的结果（r=0.26, p=0.001）。总之，人工智能驱动的CCTA分析显示出有希望的结果。在中度冠状动脉狭窄病变中，AI-CCTA与QCA呈正相关；然而，其结果超过了人工评价的结果。

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引用次数: 0

Transient Low-Intensity Late Gadolinium Enhancement in Takotsubo Cardiomyopathy. 塔克次博心肌病的一过性低强度晚期钆增强

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2024-12-11 DOI: 10.1016/j.amjcard.2024.12.006

Haojie Wang

引用次数: 0

Gender- and Age-Based Differences in Nonsyndromic Arteriopathies in Younger Adults 年轻人中非综合征性动脉病变的性别和年龄差异

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2024-12-11 DOI: 10.1016/j.amjcard.2024.12.009

George Bcharah BS , Christine E. Firth MD , Merna M. Abdou MD , Srekar N. Ravi MD , Ramzi Ibrahim MD , Girish Pathangey MD , Sant J. Kumar MD , Mahmoud Abdelnabi MBBCh, MSc , Yuxiang Wang MD , Mayowa A. Osundiji MBBS, PhD , Fadi E. Shamoun MD

Aneurysms are often associated with connective tissue disorders, but most occur sporadically and are nonsyndromic. Manifestations of these nonsyndromic arteriopathies across genders and age groups have not been discussed extensively in previous studies, especially in younger cohorts. We analyzed data from 84,496 patients in the Mayo Clinic Tapestry DNA Sequencing Study, excluding those with known vascular syndromes. Patients aged ≤60years were included and grouped by gender and into 5 age groups (18 to 60 years). The odds and prevalence of various arteriopathies and complications (i.e., revascularization, stroke, dissection, and death) were compared. Overall, 909 patients aged ≤60 years were included, with 68.0% women (mean age 47.49 years). Women were more likely to have carotid/cerebral aneurysms (55.2% vs 31.6%, p <0.0001), and men were more likely to have thoracic (50.9% vs 21.8%, p <0.0001) and abdominal aortic aneurysms (7.22% vs 2.59%, p <0.01). Men with splanchnic and carotid/cerebral aneurysms were more likely to dissect (58.14% vs 21.49% and 45.65% vs 30.79%, p <0.05, respectively). Women were more likely to have multisite aneurysms (16.34% vs 12.03%, p <0.05), with the most common being concurrent carotid/cerebral and splanchnic aneurysms. Both genders showed peak dissection rates at ages 36 to 45 years, although men experienced more complications in older age groups (56 to 60 years) and women in younger ones (46 to 55 years). In conclusion, men are more susceptible to large vessel aneurysms and complications later in life, whereas women more frequently experience medium-vessel aneurysms, complications earlier in life, and co-occurring multisite aneurysms. Potential unidentified genetic factors could be influencing these patterns.

动脉瘤通常与结缔组织疾病有关，但大多数是零星发生，无综合征性。这些非综合征性动脉病变在不同性别和年龄组的表现尚未在文献中得到广泛讨论，特别是在年轻人群中。我们分析了来自梅奥诊所Tapestry DNA测序研究的84,496名患者的数据，排除了已知血管综合征的患者。纳入≤60岁的患者，按性别分组，分为5个年龄组（18-60岁）。比较了各种动脉病变和并发症（即血运重建术、中风、夹层和死亡）的发生率和患病率。总体纳入909例≤60岁患者，其中68.0%为女性（平均年龄47.49岁）。女性更容易患颈动脉/脑动脉瘤(55.2% vs 31.6%, p

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引用次数: 0

Noninvasive Multimodality Imaging and Special Treatment Considerations for Pericarditis in Pregnancy 妊娠心包炎的无创多模态成像及特殊治疗。

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2024-12-10 DOI: 10.1016/j.amjcard.2024.12.007

Rehan Karmali DO, MS , Issam Motairek MD , Samia Mazumder MD , Felix Berglund MD , Lorenzo Braghieri MD , Astefanos Al-Dalakta MD , Katherine Singh MD , Brittany Weber MD , Allan Klein MD

Pericarditis in women who are pregnant or of childbearing age poses a challenge to clinicians. At present, there are no guidelines regarding the optimal approach for managing pericarditis in pregnancy regarding selecting the appropriate method of diagnostic imaging or tailoring the treatment regimen to gestational age. Pericarditis in pregnancy may manifest as an autoimmune or autoinflammatory phenotype but the predominant etiology is idiopathic. Transthoracic echocardiography and cardiac magnetic resonance are considered safe, but data are lacking on the use of gadolinium-based contrast agents. Shared decision-making is paramount to balance the risks and benefits of radiation and contrast exposure to the mother and fetus. The safety profile of treatment options differs at each time interval from preconception to the 3 trimesters and postpartum phase. A multidisciplinary approach using imaging guidance can improve outcomes in pregnant patients with pericarditis. Further studies are needed to ascertain the safety of interleukin-1 blocking agents in pregnancy.

心包炎在妇女谁是怀孕或育龄提出了一个挑战，临床医生。目前，在选择合适的诊断成像方法或根据胎龄调整治疗方案方面，没有关于处理妊娠心包炎的最佳方法的指南。妊娠心包炎可能表现为自身免疫或自身炎症表型，但主要病因是特发性的。经胸超声心动图和心脏磁共振被认为是安全的，但缺乏使用钆基造影剂的数据。共同决策对于平衡辐射和对比暴露对母亲和胎儿的风险和益处至关重要。从孕前到妊娠三个月和产后阶段，治疗方案的安全性在每个时间间隔都是不同的。多学科方法使用影像学指导可以改善妊娠心包炎患者的预后。需要进一步的研究来确定白细胞介素-1阻断剂在妊娠期的安全性。

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引用次数: 0

Coronary Artery Dissection in Drug-Coated Balloon Angioplasty: Incidence, Predictors, and Clinical Outcomes 药物包被球囊血管成形术中的冠状动脉剥离：发病率、预测因素和临床结果。

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2024-12-10 DOI: 10.1016/j.amjcard.2024.12.008

Mauro Gitto MD , Pier Pasquale Leone MD, MSc , Francesco Gioia MD , Mauro Chiarito MD, PhD , Alessia Latini MD , Francesco Tartaglia MD , Ismail Dogu Kilic MD , Marco Luciano Rossi MD , Damiano Regazzoli MD , Gabriele Gasparini MD , Ottavia Cozzi MD , Alessandro Sticchi MD , Gianluigi Condorelli MD, PhD , Bernhard Reimers MD , Giulio Stefanini MD, PhD, MSc , Antonio Mangieri MD , Antonio Colombo MD

Coronary dissection is a potential occurrence after lesion preparation for percutaneous coronary intervention (PCI). Unlike stents, drug-coated balloons (DCBs) do not allow to cover dissections, thus demanding an assessment of their safety in this setting. This study aimed to evaluate the incidence, predictors, and clinical outcomes of dissections occurring with DCB-based PCI for de novo coronary artery disease. Consecutive patients with de novo coronary artery disease who underwent PCI with intention-to-treat DCB angioplasty, with or without stent implantation, were retrospectively enrolled between 2018 and 2022 at 2 Italian centers. The decision whether to leave a dissection untreated or to proceed with bail-out stenting was based on a combined angiographic evaluation of Thrombolysis In Myocardial Infarction flow, residual minimal lumen diameter, and persistent extraluminal contrast hang-up. The primary end point at 2-year follow-up was target lesion failure, a composite of cardiac death, target vessel myocardial infarction, and clinically driven target lesion revascularization. Among 522 DCB-treated lesions (466 patients), dissections were angiographically evident in 39.1% of cases, with 21.1% which underwent bail-out stenting and 78.9% left untreated. The incidence of bail-out stenting increased from type A to type E dissections (p for trend <0.001). Left anterior descending artery involvement (odds ratio 1.64, 95% confidence interval 1.12 to 2.39) was the strongest risk factors for dissection. Target lesion failure at 2 years occurred in 2.7% of lesions with untreated dissection compared with 4.2% of those with no dissection (log-rank p = 0.324). In conclusion, coronary dissections often complicate PCI with DCB angioplasty but do not correlate with increased risk of adverse events at midterm follow-up.

冠状动脉夹层是经皮冠状动脉介入治疗（PCI）病变准备后的潜在发生。与支架不同，药物包被气球（DCB）不允许覆盖解剖，因此需要对其安全性进行评估。本研究的目的是评估基于dbc的PCI治疗新发冠状动脉疾病（CAD）时发生夹层的发生率、预测因素和临床结果。2018年至2022年期间，在意大利的两个中心回顾性纳入了连续的新发CAD患者，这些患者接受了PCI治疗，有意向治疗DCB血管成形术，有或没有支架植入。是否对夹层不进行治疗或继续进行纾困支架置入的决定是基于对心肌梗死血流溶栓、剩余最小管腔直径和持续腔外造影剂悬挂的综合血管造影评估。2年随访时的主要终点是靶病变失败（TLF），即心源性死亡、靶血管心肌梗死和临床驱动的靶病变血运重建的综合结果。在466例522个dcb治疗的病变中，39.1%的病变血管造影显示明显夹层，其中21.1%接受了纾困支架置入术，78.9%未接受治疗。纾困支架的发生率从A型到E型夹层增加（p为趋势）

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引用次数: 0

Patterns and Prognostic Impact of Postdischarge Ischemic, Bleeding, and Heart Failure Events After Myocardial Infarction 心肌梗死后出院后缺血、出血和心力衰竭事件的模式和预后影响。

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2024-12-09 DOI: 10.1016/j.amjcard.2024.12.004

Shogo Okita MD , Yuichi Saito MD , Hiroaki Yaginuma MD , Kazunari Asada MD , Hiroki Goto MD , Osamu Hashimoto MD , Takanori Sato MD , Hideki Kitahara MD , Yoshio Kobayashi MD

Although the in-hospital prognosis after acute myocardial infarction (AMI) has considerably improved to date, ischemic, bleeding, and heart failure (HF) events after discharge remain clinical challenges. However, the pattern of such events is not fully understood in contemporary clinical practice. This study aimed to evaluate the timing and prognostic impact of cardiovascular and bleeding events after AMI. This multicenter, retrospective registry included 2,059 patients with AMI who underwent percutaneous coronary intervention. Patients were grouped according to their first events after discharge, consisting of ischemic events (recurrent AMI or ischemic stroke), major bleeding, and HF hospitalization, whereas those without such events were classified as the no cardiovascular event group. All-cause mortality after discharge and the ischemic, bleeding, and HF events were evaluated. Ischemic events, major bleedings, and HF hospitalization as their first clinical outcome measures after discharge occurred in 99 (4.8%), 57 (2.8%), and 75 (3.6%) patients, respectively, during the median follow-up period of 538 days. Postdischarge mortality was highest in the major bleeding group, followed by the ischemic events, HF hospitalization, and no cardiovascular event groups. HF hospitalization occurred earlier than major bleeding and ischemic events after discharge. The mortality impact after the first events was greater in the major bleeding rather than ischemic events and HF hospitalization. In conclusion, patterns and prognostic impact of postdischarge outcomes differed significantly among ischemic, bleeding, and HF events, suggesting that timely and tailored follow-up may be needed after AMI.

虽然急性心肌梗死（AMI）后的住院预后到目前为止已经有了很大的改善，但出院后的缺血、出血和心力衰竭（HF）事件仍然是临床的挑战。然而，这些事件的模式在当代临床实践中尚未完全了解。本研究旨在评估AMI后心血管和出血事件的时间和预后影响。这项多中心、回顾性登记包括2059例经皮冠状动脉介入治疗的AMI患者。根据患者出院后的首次事件进行分组，包括缺血性事件（复发性AMI或缺血性卒中）、大出血和HF住院，无此类事件的患者分为无心血管事件组。评估出院后的全因死亡率、缺血性、出血和心衰事件。在538天的中位随访期间，以缺血性事件、大出血和心衰住院为出院后的第一临床指标的患者分别为99例（4.8%）、57例（2.8%）和75例（3.6%）。出院后死亡率最高的是大出血组，其次是缺血性事件组、心力衰竭住院组和无心血管事件组。HF住院时间早于出院后大出血和缺血性事件。第一次事件后，大出血事件对死亡率的影响大于缺血性事件和HF住院。综上所述，缺血、出血和心衰事件的模式和出院后预后影响有显著差异，提示AMI后可能需要及时和量身定制的随访。

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引用次数: 0

Type A Aortic Dissection After Thoracic Endovascular Aortic Repair for Type B B型TEVAR术后A型主动脉夹层。

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2024-12-09 DOI: 10.1016/j.amjcard.2024.12.005

Kyle A. McCullough MD , Katherine R. Hebeler MD , John B. Eisenga MD , Baron L. Hamman MD , Charles S. Roberts MD

Type A aortic dissection (TAAD) has been associated with thoracic endovascular aortic repair (TEVAR) for aortic conditions: dissection and aneurysm. Our purpose was to study a subset of patients who had an initial TEVAR for type B aortic dissection, followed by a TAAD, which was treated by open ascending aortic repair. Over a 6-year period, 171 consecutive patients underwent open ascending aortic repair for TAAD, of whom 21 (12%) had a previous cardiovascular procedure, 17 of which were endovascular. A total of 9 (5.2%) of 171 patients with TAAD had a previous TEVAR for a type B. The mean interval from TEVAR to open ascending aortic repair for TAAD was 4.6 years, with only 1 occurring within a month. Only 1 patient had abnormal aortic media by histology. In 5 of the 9 patients, the entry tear was in the proximal ascending aorta, remote from the endograft, which suggests that a TAAD late after TEVAR for type B represents a new spontaneous event.

A型主动脉夹层（TAAD）与胸椎血管内主动脉修复（TEVAR）有关，包括主动脉夹层和动脉瘤。我们的目的是研究一组最初因B型主动脉夹层接受TEVAR，随后接受开放性升主动脉修复术治疗的TAAD患者。在6年的时间里，171例TAAD患者连续接受了开放性升主动脉修复术，其中21例（12%）有过心血管手术史，其中17例为血管内手术。171例TAAD患者中有9例（5.2%）既往有b型TEVAR。从TEVAR到TAAD的升主动脉切开修复的平均间隔为4.6年，只有1例发生在一个月内。仅有1例患者经组织学检查发现主动脉介质异常。在9例患者中，5例进入性撕裂位于升主动脉近端，远离移植物，这表明B型TEVAR术后晚期发生TAAD是一种新的自发事件。

引用次数: 0

Life-Threatening Ventricular Tachyarrhythmia in Isolated Cardiac Sarcoidosis Compared With Cardiac Sarcoidosis With Extracardiac Involvement 孤立性心脏结节病与累及心外的心脏结节病并发危及生命的室性心动过速比较。

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2024-12-09 DOI: 10.1016/j.amjcard.2024.12.002

Yoichi Takaya MD, PhD, Koji Nakagawa MD, PhD, Toru Miyoshi MD, PhD, Nobuhiro Nishii MD, PhD, Hiroshi Morita MD, PhD, Kazufumi Nakamura MD, PhD, Shinsuke Yuasa MD, PhD

Although isolated cardiac sarcoidosis (CS) is not uncommon, little is known about the risk of life-threatening ventricular tachyarrhythmia. We aimed to evaluate the incidence of ventricular tachyarrhythmia in patients with isolated CS. A total of 94 patients with CS were enrolled. Isolated CS was diagnosed by histologic or clinical confirmation in the heart alone. The end points were sudden cardiac death, ventricular fibrillation, sustained ventricular tachycardia, or implantable cardioverter-defibrillator therapy for ventricular fibrillation or sustained ventricular tachycardia. A total of 25 patients were diagnosed with isolated CS, and 69 were diagnosed with CS with extracardiac involvement. As the initial cardiac manifestation leading to the CS diagnosis, 10 patients (40%) with isolated CS had ventricular tachyarrhythmia. Over the median follow-up of 48 months after the CS diagnosis, sudden cardiac death occurred in 2 patients (8%) with isolated CS. Ventricular fibrillation or sustained ventricular tachycardia, including implantable cardioverter-defibrillator therapy, occurred in 15 patients (60%) with isolated CS and 13 (19%) with CS with extracardiac involvement. The rate of ventricular tachyarrhythmia was higher in patients with isolated CS than in those with CS with extracardiac involvement (log-rank, p <0.01). Cox proportional hazard analysis showed that isolated CS was independently associated with ventricular tachyarrhythmia. A total of 2 or more ventricular tachyarrhythmias more frequently occurred in patients with isolated CS (52% vs 13%, p <0.01). Electric storm more frequently occurred in patients with isolated CS (24% vs 6%, p = 0.01). In conclusion, patients with isolated CS have ventricular tachyarrhythmia at a higher rate than those with CS with extracardiac involvement.

虽然孤立性心脏结节病（CS）并不罕见，但对危及生命的室性心动过速的风险知之甚少。我们的目的是评估孤立性CS患者室性心动过速的发生率。94例CS患者入组。孤立性CS仅在心脏通过组织学或临床证实诊断。研究终点为心源性猝死、室性颤动、持续性室性心动过速或植入式心律转复除颤器（ICD）治疗室性颤动或持续性室性心动过速。25例患者被诊断为孤立性CS， 69例CS伴心外受累。作为导致CS诊断的最初心脏表现，10例（40%）孤立性CS患者有室性心动过速。在CS诊断后48个月的中位随访中，2例（8%）孤立性CS患者发生心源性猝死。包括ICD治疗在内的15例（60%）孤立性CS患者和13例（19%）累及心外的CS患者发生心室颤动或持续性室性心动过速。孤立性CS患者的室性心动过速率高于累及心外的CS患者（log-rank, p < 0.01）。Cox比例风险分析显示，孤立性CS与室性心动过速独立相关。孤立性CS患者更常发生两次或两次以上室性心动过速（52% vs 13%, p < 0.01）。孤立性CS患者更常发生电风暴（24% vs 6%, p = 0.01）。综上所述，孤立性CS患者发生室性心动过速的几率高于累及心外的CS患者。

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引用次数: 0

Early and Long-Term Outcomes of Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention to the Left Main Coronary Artery 经皮冠状动脉介入治疗急性冠状动脉综合征患者的早期和长期预后。

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2024-12-07 DOI: 10.1016/j.amjcard.2024.12.001

Mohammad Abdelghani MD, PhD , Salma Taha MD , Osama Shoeib MD , Kevin Hamzaraj MD , Amr Y. Emam MBBCh, MSc , Khaled M. Elmaghraby MD , Mohamed Elsoudi MBBCh, MSc , Mahmoud Abdelshafy MD , Robbert J. de Winter MD, PhD , Ahmed Elguindy MD , Rayyan Hemetsberger MD , Ahmed Hassan MD

Patients who undergo percutaneous coronary intervention (PCI) to the left main (LM) coronary artery in the setting of acute coronary syndrome (ACS) were not adequately studied in the era of modern PCI. We investigated early and long-term outcomes of these patients, especially those with a true LM bifurcation stenosis. The Left Main Intervention in Acute Coronary Syndrome (LIMACS) is a multicenter registry that enrolled patients who underwent PCI to unprotected LM disease in the setting of ACS using a drug-eluting stent. The study included 360 patients (age 65 ± 12 years, men 74%, ST-elevation myocardial infarction 65%). During index hospitalization, 25% of patients developed cardiogenic shock and 15% died. Cardiogenic shock (adjusted odds ratio [adjOR] 26, 95% confidence interval [CI] 7 to 93) and final Thrombolysis in Myocardial Infarction (TIMI) grade <3 flow (adjOR 7, 95% CI 1.6 to 31) were associated with in-hospital mortality. The 3-year mortality (37%) correlated with left ventricular ejection fraction ≤40% (adjHR 2.4 [1.4 to 4.2]), Killip class II to IV at presentation (adjHR 1.7 [1.02 to 2.8]), LM culprit (adjHR 1.7 [1.04 to 2.8]), true LM bifurcation stenosis (adjHR 1.8[1.1 to 2.9]), final TIMI grade <3 flow (adjHR 3.2 [1.7 to 5.8]), and radial access (adjHR 0.58 [0.38 to 0.99]). In patients with true LM bifurcation stenosis (n = 127), 2-stent strategy was adopted in 60% and was associated with lower 3-year mortality or repeat revascularization than 1-stent strategy (48% vs 69%, p = 0.012). In conclusion, patients who undergo PCI to the LM in the setting of an ACS sustain high adverse event rates. Hemodynamic status, LM culprit lesion, femoral access, and failure to restore normal flow are major determinants of adverse outcomes. In patients with LM true bifurcation lesions, outcomes are impaired, especially with 1-stent strategy.

急性冠脉综合征（ACS）患者经皮冠状动脉介入治疗（PCI）左主干（LM）在现代PCI时代没有得到充分的研究。我们调查了这些患者的早期和长期预后，特别是那些真正的LM分叉狭窄的患者。左主干介入治疗急性冠脉综合征（LIMACS）是一项多中心登记，纳入了在ACS背景下使用药物洗脱支架接受PCI治疗的无保护LM疾病患者。研究纳入360例患者(年龄65±12岁；男性,74%;STEMI, 65%)。在指数住院期间，25%的患者发生心源性休克，15%的患者死亡。心源性休克（adjOR[95% CI]: 26[7-93]）和最终TIMI评分

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引用次数: 0

Clinical Course and Outcomes of Acute Heart Failure With Moderate-to-Severe Mitral or Tricuspid Regurgitation 急性心力衰竭合并中重度二尖瓣或三尖瓣反流的临床过程和结果：心力衰竭合并房室瓣反流的去充血。

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2024-12-04 DOI: 10.1016/j.amjcard.2024.11.034

Sarah C. Ashley MD , Muhammad Shahzeb Khan MD MSc , Stephen J. Greene MD

Moderate-to-severe mitral regurgitation (MR) and tricuspid regurgitation (TR) are common in patients hospitalized with heart failure (HF) and have been associated with poor quality of life and increased mortality. The impact of these valve lesions on in-hospital decongestion and postdischarge outcomes is less clear. This study analyzed 617 patients hospitalized for acute HF in the Diuretic Optimization Strategies in Acute Heart Failure (DOSE-AHF), Renal Optimization Strategies Evaluation in Acute Heart Failure (ROSE-AHF), and Cardiorenal Rescue Study in Acute Decompensated Heart Failure (CARESS-HF) trials. We assessed biomarkers, physical examination findings, and symptom scores in 288 patients without moderate-to-severe regurgitation, 221 patients with moderate-to-severe MR, and 242 patients with moderate-to-severe TR to evaluate decongestion efficacy and outcomes. For patients with moderate-to-severe MR, there was no difference in weight loss, net fluid loss, or change in creatinine compared with those without moderate-to-severe regurgitation (all p >0.05 at 72 hours). For patients with moderate-to-severe TR, there was more weight loss (−4.77 vs −2.83 pounds at 24 hours, p = 0.029; −9.32 vs −6.99 pounds at 72 hours, p = 0.007), net fluid loss (−4,988 vs −4,581 ml, p = 0.008), and improvement in creatinine (−0.09 mg/100 ml vs +0.06 mg/100 ml at 72 hours, p = 0.002) than those without moderate-to-severe regurgitation. In those with and without moderate-to-severe regurgitation, there was no difference in the change in patient-reported dyspnea or global well-being (all p >0.05 at 72 or 96 hours). For postdischarge outcomes, compared with patients without moderate-to-severe regurgitation, moderate-to-severe MR was associated with a nonsignificant trend toward increased death, rehospitalization, or unscheduled clinic or emergency department visit 60 days after hospital discharge (48.4% vs 38.2% of patients, p = 0.098). This association was not clearly apparent in patients with moderate-to-severe TR (43.8% vs 38.2%, p = 0.407). In conclusion, patients with moderate-to-severe MR experienced similar in-hospital decongestion compared with those without significant regurgitation but had a trend toward worse postdischarge outcomes. Patients with moderate-to-severe TR experienced significantly more decongestion but this was not associated with incremental improvement in dyspnea, global well-being, or clinical outcomes.

中度至重度二尖瓣反流（MR）和三尖瓣反流（TR）在心力衰竭住院患者中很常见，并与生活质量差和死亡率增加有关。这些瓣膜病变对院内消血和出院后预后的影响尚不清楚。本研究在DOSE-AHF、ROSE-AHF和CARESS-HF试验中分析了617例因急性HF住院的患者。我们评估了288例无中重度反流患者、221例中重度MR患者和242例中重度TR患者的生物标志物、体格检查结果和症状评分，以评估去充血疗效和结果。对于中度至重度MR患者，与没有中度至重度反流的患者相比，体重减轻、净流失量或肌酐变化没有差异（72小时均p < 0.05）。对于中重度TR患者，体重减轻更多(24小时-4.77磅vs -2.83磅，p = 0.029；与没有中度至重度反流的患者相比，72小时时-9.32磅vs -6.99磅，p = 0.007)，净液体损失（-4988mL vs -4581mL, p = 0.008）和肌酐改善（72小时时-0.09 mg/dl vs +0.06 mg/dl, p = 0.002）。在有和没有中度至重度反流的患者中，患者报告的呼吸困难或整体幸福感的变化没有差异(所有：对于出院后的结果，与没有中重度反流的患者相比，中重度MR与出院后60天死亡、再住院或未安排的门诊或急诊就诊增加的无显著趋势相关(48.4% vs 38.2%的患者； = 0.098页)。这种关联在中重度TR患者中并不明显（43.8% vs 38.2%, p = 0.407）。总之，与没有明显反流的患者相比，中度至重度MR患者在医院内经历了相似的缓解充血，但出院后的结果有更差的趋势。中度至重度TR患者的充血明显减少，但这与呼吸困难、总体幸福感或临床结果的渐进式改善无关。

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