American Journal of Cardiology最新文献

Complications in percutaneous coronary intervention (PCI), particularly in chronic total occlusion (CTO) cases, pose notable challenges, with a mortality rate of approximately 0.4% during hospitalization, mainly due to issues like perforation and tamponade. While risk assessment tools can aid in evaluating periprocedural complication risk, prevention and preparedness take precedence. Guided by the "3 Ps" framework-prevention, preparedness, and planning-we navigate the complexities of managing complications in CTO PCI procedures. This emphasizes the importance of comprehensive patient discussions, adherence to appropriateness use criteria, and ensuring a well-trained team equipped with standardized equipment. Furthermore, it is crucial to extract valuable insights from encountered complications, turning potential setbacks into invaluable learning opportunities. This positive approach not only fosters individual growth but also contributes to the advancement of CTO PCI practices. Various complications specific to CTO PCI are addressed, including donor vessel injury, equipment loss/entrapment, radiation injury and coronary perforation.

Left ventricular (LV) thrombus formation remains a post-acute myocardial infarction (AMI) complication even in the modern era of early reperfusion. The optimal anticoagulation regimen in this clinical scenario is poorly defined. The present meta-analysis sought to investigate the efficacy and safety profile of direct oral anticoagulants (DOACs) compared with Vitamin K antagonists (VKAs) for the management of LV thrombus following AMI. A systematic literature review was conducted in electronic databases to identify studies reporting efficacy and safety outcome data regarding the use of DOACs versus VKAs for patients with LV thrombus after AMI. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated and random-effects meta-analyses were conducted to synthesize pooled ORs. Eight studies comprising a total of 605 patients were included. DOACs were associated with an almost 2-fold higher likelihood of thrombus resolution compared to VKAs (pooled OR 1.95 [1.25-3.04]; p =0.003, I² =0 %), and decreased the risk of systemic embolism by 70% (pooled OR 0.30 [0.12-0.75]; p =0.01, I² =0 %). The use of DOACs was associated with a 54% lower risk of bleeding compared to VKAs (pooled OR 0.46 [0.26-0.84]; p =0.01, I² =0 %). Overall, patients receiving DOACs had a 63% lower risk to reach the composite outcome of safety and efficacy compared with patients using VKAs (pooled OR 0.37 [0.23-0.60]; p <0.0001, I² =0 %). In conclusion, DOACs appear to have a more favorable efficacy and safety profile compared to VKAs for the management of LV thrombus related to AMI.

Although cardiopulmonary exercise testing (CPET) parameters have known prognostic value in adults after Fontan palliation, there are limited data correlating treadmill CPET with invasive exercise hemodynamics. Furthermore, the invasive hemodynamic underpinnings of exercise limitations have not been thoroughly investigated. This is retrospective analysis of 55 adults (≥18 years) after Fontan palliation who underwent treadmill CPET before invasive exercise hemodynamic testing by way of supine cycle protocol between November 2018 and April 2023. The median age was 32.2 (24.1 to 37.2) years. The peak heart rate (HR) was 139.7 ± 28.1 beats per minute and the peak oxygen consumption (VO₂) was 19.1 ± 5.7 ml/kg/min (47.4 ± 13.5% predicted). VO₂/HR was directly related to exercise stroke volume index (r = 0.50, p = 0.0002), whereas no association was seen with exercise arterio-mixed venous O₂ content difference (r = 0.14, p = 0.32). Peak HR was inversely related to exercise pulmonary artery (PA) pressures (r = -0 61, p <0.0001) and PA wedge pressures (PAWP) (r = -0.61, p <0.0001). Moreover, %predicted VO₂ was inversely related to exercise PA pressures (r = -0.50, p <0.0001) and PAWP (r = -0.55, p <0.0001). Peak VO₂ ≤19.1 ml/kg/min had a sensitivity of 81% and a specificity of 76% (area under the curve = 0.82) for predicting a ΔPAWP/ΔQs ratio >2 mm Hg/L/min and/or a ΔPA:ΔQp >3 mm Hg/L/min, whereas a predicted peak VO₂ ≤48% had a sensitivity of 74% and a specificity of 81% (area under the curve = 0.79) for the same parameters. In summary, lower peak HR and peak VO₂ were associated with higher exercise PAWP and PA pressure. Peak VO₂ ≤48% predicted provided the optimal cutoff for predicting increased indexed exercise PAWP or PA pressures; therefore, low peak VO₂ should alert clinicians of abnormal underlying hemodynamics.