American Journal of Cardiology最新文献_第8页

AngioWave Artificial Intelligence-Assisted Analysis of Septal Collaterals for Retrograde Chronic Total Occlusion Percutaneous Coronary Intervention 血管波人工智能辅助分析慢性逆行全闭塞经皮冠状动脉介入治疗中隔侧支。

IF 2.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-11-23 DOI: 10.1016/j.amjcard.2025.11.009

Dimitrios Strepkos MD, Sandeep Jalli DO, Michaella Alexandrou MD, Pedro E.P. Carvalho MD, Eleni Kladou MD, Nick Williford MD, Bavana V. Rangan BDS, MPH, Konstantinos Voudris MD, PhD, Yader Sandoval MD, Emmanouil S. Brilakis MD, PhD

Artificial intelligence (AI) can augment coronary angiography images to enhance interpretation. We compared two blinded operators' interpretation of chronic total occlusion (CTO) angiograms obtained for retrograde percutaneous coronary intervention (PCI) standard vs. AI-enhanced (AngioWave, Concord, MA) images and assessed the association with septal collateral crossing success. We reviewed 50 retrograde CTO PCI angiograms. The most common (83.7%) target vessel was the right coronary artery and target CTOs had high complexity with high rates of proximal cap ambiguity (55.3%), blunt or no stump (79.2%), moderate or severe calcification (50.0%) and high J-CTO scores (2.96 ± 0.93). Retrograde was the first crossing strategy in 44.0% of lesions and was successful in 80%. Operators assigned lower frequency of corkscrew bends (10.2% vs 20.6%, p=0.035) and septal collateral tortuosity (31.7% vs 51.5%, p=0.004) and higher frequency of CC2 collateral size (6.5% vs 0.0%, p=0.007) to AI-enhanced compared with standard angiograms. The aggregate predicted likelihood of crossing (85% vs 70%, p<0.001, Wilcoxon test: p<0.001) and ease of interpretation (9.00 vs 7.00, p<0.001) were higher in the AI-enhanced angiograms. There was no difference in predictive performance for crossing success in the two groups (AUCAI-enhanced = 0.74 and AUCstandard = 0.73, De Long test: p=0.856). AI-enhanced angiograms were assigned a median 10.7% higher predicted likelihood of success. Compared with standard angiograms, AI-enhanced angiograms allow easier interpretation of angiograms and have similar predictive performance for collateral crossing despite showing lower collateral complexity.

人工智能（AI）可以增强冠状动脉造影图像以增强解释。我们比较了两名盲法操作人员对逆行经皮冠状动脉介入治疗（PCI）标准和人工智能增强（AngioWave, Concord， MA）图像获得的慢性全闭塞（CTO）血管造影的解释，并评估了与间隔侧支穿越成功的关系。我们回顾了50张逆行CTO PCI血管造影。最常见的靶血管为右冠状动脉（83.7%），靶血管复杂性高，近端冠状动脉模糊率高（55.3%），钝或无残端（79.2%），中度或重度钙化（50.0%），J-CTO评分高（2.96±0.93）。逆行是44.0%病变的第一个交叉策略，80%的病变成功。与标准血管造影相比，操作者认为人工智能增强的螺旋状弯曲（10.2%对20.6%,p=0.035）和间隔侧支扭曲（31.7%对51.5%,p=0.004）的频率较低，CC2侧支大小的频率较高（6.5%对0.0%,p=0.007）。人工智能增强血管造影的总体预测交叉可能性（85% vs 70%, p<0.001， Wilcoxon检验：p<；0.001）和易解释性（9.00 vs 7.00, p<0.001）更高。两组对杂交成功的预测性能无差异（AUCAI-enhanced = 0.74, AUCstandard = 0.73， De Long检验：p=0.856）。人工智能增强血管造影的成功率中位数高出10.7%。与标准血管造影相比，人工智能增强血管造影可以更容易地解释血管造影，并且在侧枝交叉方面具有相似的预测性能，尽管侧枝复杂性较低。

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引用次数: 0

Progressive Conduction System Disease in Hydroxychloroquine Cardiotoxicity: A Call for Early Vigilance 羟基氯喹心脏毒性的进行性传导系统疾病：早期警惕的呼吁。

IF 2.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-11-21 DOI: 10.1016/j.amjcard.2025.10.029

Milica Vukićević MD , Mandeep R. Mehra MD, MSc , Robert F. Padera MD, PhD , Ameesh Isath MD

Hydroxychloroquine (HCQ) cardiotoxicity is increasingly recognized, yet progressive conduction system disease remains underappreciated and may represent a lethal phenotype. We report a 67-year-old female on chronic HCQ who developed progressive conduction abnormalities culminating in cardiogenic shock and sudden death despite initial stabilization with isolated atrial pacing. Autopsy revealed extensive sinoatrial and atrioventricular nodal lysosomal toxicity and fibrosis confirming irreversible conduction injury. This case highlights the lysosomal basis of HCQ toxicity and reframes conduction disease as a primary, irreversible manifestation. Vigilant ECG surveillance and early consideration of dual-chamber pacing may prevent catastrophic outcomes in patients on chronic HCQ therapy.

羟基氯喹（HCQ）的心脏毒性越来越被认识到，但进行性传导系统疾病仍未得到充分认识，可能代表一种致命的表型。我们报告了一位67岁的慢性HCQ女性患者，她发展为进行性传导异常，最终导致心源性休克和猝死，尽管最初通过孤立心房起搏稳定。尸检显示广泛的窦房和房室结溶酶体毒性和纤维化证实不可逆的传导损伤。本病例强调了HCQ毒性的溶酶体基础，并将传导疾病作为主要的、不可逆的表现。警惕的心电图监测和早期考虑双室起搏可以预防慢性HCQ治疗患者的灾难性后果。

引用次数: 0

Outcomes of Transcatheter Aortic Valve Replacement in Patients With Moderate Mixed Aortic Valve Disease 中度混合性主动脉瓣疾病患者经导管主动脉瓣置换术的疗效。

IF 2.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-11-19 DOI: 10.1016/j.amjcard.2025.10.026

Yu Tang MD , Xue-Chen Qiao MD , Meng-Yun Yan MD , Yue Yin MD , Wei-Ya Li MD , Ying Zhang MD , Tian-Yuan Xiong MD , Yi-Ming Li MD , Jun-Li Li MD , Lin Bai MD , Xin Wei MD , Yuan-Wei Xiang Ou MD , Zhong-Kai Zhu MD , Yi-Jun Yao MD , Qiao Li MD , Yi-Jian Li MD , Fei Chen MD , Jia-Fu Wei MD , Yong Peng MD , Yuan Feng MD , Mao Chen MD, PhD

The clinical impact of transcatheter aortic valve replacement (TAVR) in patients with moderate mixed aortic valve disease (MMAVD)—characterized by the coexistence of moderate aortic stenosis (AS) and aortic regurgitation (AR)—remains unclear, as current evidence primarily focuses on isolated severe AS. This study aimed to compare outcomes of TAVR between patients with MMAVD and those with isolated severe AS. Between January 2019 and June 2024, 848 patients who underwent TAVR at our center were identified for analysis, including 75 with MMAVD and 773 with isolated severe AS. To minimize confounding, 73 MMAVD patients were matched with 264 isolated AS patients using 1:4 propensity score matching for comparative analysis. The primary endpoint was all-cause mortality; secondary endpoints included heart failure rehospitalization, left ventricular (LV) reverse remodeling, and procedural complications. Continuous variables were compared using independent samples t-tests, categorical variables using chi-square or Fisher’s exact tests, and survival using Kaplan–Meier curves with log-rank tests. At baseline, MMAVD patients exhibited greater LV dilation (LV end-diastolic diameter [LVEDD]: 56.07±9.04 vs 50.68±7.70, p < 0.001) and hypertrophy (LV mass index [LVMI]: 163.68±50.17 vs 151.59±44.38, p = 0.026). Post-TAVR, MMAVD showed superior reverse remodeling (ΔLVEDD: −7.18±9.75 vs −2.52±7.64, p < 0.001), though LVEF recovery was comparable (ΔLVEF: 5.47±13.98 vs 6.88±15.20, p = 0.52). Survival rates were similar (log-rank p = 0.370), but MMAVD had higher 1-year heart failure rehospitalization (5.97% vs 0.96%, p = 0.032). In conclusion, TAVR with self-expandable valves yields comparable survival in MMAVD and isolated AS, with more pronounced reverse remodeling in MMAVD despite advanced baseline disease.

经导管主动脉瓣置换术（TAVR）对中度混合性主动脉瓣疾病（MMAVD）患者的临床影响尚不清楚，因为目前的证据主要集中在孤立的严重AS。MMAVD的特征是中度主动脉瓣狭窄（AS）和主动脉瓣反流（AR）并存。本研究旨在比较MMAVD患者和孤立性严重AS患者的TAVR结果。在2019年1月至2024年6月期间，我们中心确定了848例接受TAVR的患者进行分析，其中75例患有MMAVD， 773例患有孤立的严重AS。为了尽量减少混淆，73例MMAVD患者与264例孤立AS患者采用1:4倾向评分匹配进行比较分析。主要终点是全因死亡率；次要终点包括心力衰竭再住院、左心室（LV）反向重构和手术并发症。使用独立样本t检验比较连续变量，使用卡方或Fisher精确检验比较分类变量，使用Kaplan-Meier曲线和log-rank检验比较生存率。在基线时，MMAVD患者表现出更大的左室扩张(左室舒张末期直径[LVEDD]: 56.07±9.04比50.68±7.70,p

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引用次数: 0

Right Ventricular Dysfunction in Acute Coronary Syndrome: Insights From Cardiac Magnetic Resonance Imaging 急性冠状动脉综合征右室功能障碍：心脏磁共振成像的见解。

IF 2.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-11-16 DOI: 10.1016/j.amjcard.2025.10.028

Mauricio Garcia-Cardenas MD , Pavel Martinez-Dominguez MD , Raul Miranda-Segura MD , Gilberto H. Acosta-Gutiérrez MD , Gabriela Meléndez-Ramírez MD, PhD , Aloha Meave MD , Nilda Espinola-Zavaleta MD, PhD

Acute coronary syndrome (ACS) significantly impacts global morbidity and mortality, traditionally emphasizing left ventricular (LV) dysfunction. However, the prognostic importance of right ventricular (RV) dysfunction remains underexplored. Cardiac magnetic resonance (CMR), the gold standard for RV assessment, enables precise evaluation of ventricular function and structure. We conducted a retrospective cohort study of 268 patients with ACS who underwent CMR between January 2020 and December 2022 at the National Institute of Cardiology Ignacio Chavez. RV dysfunction was defined as RV ejection fraction (RVEF) <50% by CMR. Multivariate logistic regression identified factors associated with RV dysfunction. RV dysfunction occurred in 170 patients (63.4%). Compared to those without RV dysfunction, patients with RV dysfunction were more likely to be male (84% vs 70%, p = 0.011) and smokers (66% vs 51%, p = 0.017). These patients exhibited reduced LV ejection fraction (39% vs 44%, p < 0.001), higher end-systolic and end-diastolic volumes, and reduced RV fractional area change (42% vs 45%, p = 0.004). BMI (OR 1.13, 95% CI 1.04-1.24, p = 0.008) and mitral regurgitation (OR 5.40, 95% CI 1.47–27, p = 0.020) were independently associated with RV dysfunction. Although mortality was higher among patients with RV dysfunction (3.5% vs 1%), it was not statistically significant (p = 0.4). In conclusion RV dysfunction is common in ACS and it is independently associated with increased BMI and mitral regurgitation. CMR evaluation of RV function in ACS patients may be considered to enhance clinical outcomes. Future research should explore targeted therapeutic interventions for RV dysfunction.

急性冠脉综合征（ACS）显著影响全球发病率和死亡率，传统上强调左心室功能障碍。然而，右心室功能障碍的预后重要性仍未得到充分探讨。心脏磁共振（CMR）是RV评估的金标准，能够精确评估心室功能和结构。我们对2020年1月至2022年12月期间在Ignacio Chavez国家心脏病研究所接受CMR治疗的268名ACS患者进行了回顾性队列研究。右心室功能障碍定义为右心室射血分数（RVEF）。

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引用次数: 0

Clinical Outcomes in Peripartum Cardiomyopathy Complicated by Cardiogenic Shock: A Retrospective Multicenter Cohort Study 围产期心肌病并发心源性休克的临床结局：一项回顾性多中心队列研究。

IF 2.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-11-16 DOI: 10.1016/j.amjcard.2025.11.004

Syed A. Hyder MD , Hamid Shirwany MD , Vibhu Parcha MD , J. Emerson Scheinuk MD , Ahmed Saleh MD , Moses Sghayyer MD , Gina C. Josey BS , Usman A. Hasnie MD , Salomon A. Roman Soto MD , Joanna M. Joly MD , Samuel K. McElwee MD , Marc G. Cribbs MD , Stephen Clarkson MD, MSPH

Peripartum cardiomyopathy (PPCM) is a rare but life-threatening condition that occurs in late pregnancy or early postpartum and leads to heart failure with reduced left ventricular ejection fraction (LVEF). A severe complication of PPCM is cardiogenic shock, and its incidence has increased in the recent years. We conducted a retrospective multicenter cohort analysis to evaluate the 180-day clinical outcomes of PPCM complicated by cardiogenic shock (PPCM-CS), with a focus on the role of mechanical circulatory support. We identified 733 patients diagnosed with PPCM-CS between January 2010 and January 2024 using TriNetX, a multi-institutional U.S. health record database. Subgroup analysis evaluated outcomes among patients with no mechanical circulatory support (MCS), those managed with intra-aortic balloon pump (IABP) or percutaneous left ventricular assist device (pLVAD), and those supported with extracorporeal membrane oxygenation (ECMO). At 180-day follow-up, all-cause mortality of overall cohort was 15.8%, with higher mortality observed in ECMO (24.1%) and IABP/pLVAD (18.7%) groups. Durable LVAD implantation occurred in 15.0% of the overall cohort, with higher prevalence in ECMO (17.7%) and IABP/pLVAD (29.0%) groups. Heart transplantation was performed in 12.9% of the overall cohort, with higher prevalence in ECMO (19.0%) and IABP/pLVAD (27.1%) patients. Data on outcomes in patients with PPCM complicated by cardiogenic shock remain limited. This study offers insight into the 180-day outcomes in this high-risk population and suggests that, although MCS is associated with higher mortality, it may serve as a viable bridge to advanced therapies.

背景：围产期心肌病（PPCM）是一种罕见但危及生命的疾病，发生在妊娠晚期或产后早期，可导致心力衰竭并降低左心室射血分数（LVEF）。心源性休克是PPCM的一个严重并发症，近年来其发病率有所上升。我们进行了一项回顾性多中心队列分析，以评估PPCM合并心源性休克（PPCM- cs）的180天临床结果，重点关注机械循环支持的作用。方法和结果：2010年1月至2024年1月，我们使用美国多机构健康记录数据库TriNetX确定了733例诊断为PPCM-CS的患者。亚组分析评估了无机械循环支持（MCS）、使用主动脉内球囊泵（IABP）或经皮左心室辅助装置（pLVAD）和体外膜氧合（ECMO）支持的患者的结局。随访180天，全因死亡率为15.8%，其中ECMO组（24.1%）和IABP/pLVAD组（18.7%）死亡率更高。持久LVAD植入发生率为15.0%，ECMO组（17.7%）和IABP/pLVAD组（29.0%）的发生率更高。12.9%的患者接受了心脏移植，其中ECMO患者（19.0%）和IABP/pLVAD患者（27.1%）的发生率更高。结论：PPCM合并心源性休克患者的预后数据仍然有限。这项研究为这一高危人群180天的预后提供了深入的见解，并表明，尽管MCS与较高的死亡率相关，但它可以作为通向先进治疗的可行桥梁。

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引用次数: 0

Prognostic Significance of Echocardiographic Transaortic Flow Rate in Aortic Valve Stenosis: A Systematic Review and Meta-Analysis 超声心动图经主动脉血流率对主动脉瓣狭窄的预后意义：系统回顾和荟萃分析。

IF 2.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-11-16 DOI: 10.1016/j.amjcard.2025.10.027

Hoda Mombeini MD , Mohammad Reza Hatamnejad MD, MPH , Fatemeh Chichagi MD , Mahta Arbabi MD , Parnian Jamshidi MD, MPH , Setayesh Sotoudehnia MD , Maryam Sahafi bandary MD , Moein Piroozkhah MD

Echocardiographic evaluation of Aortic valve stenosis (AS) severity relies on aortic valve area and peak jet velocity. In pursuit of improving accuracy, the transaortic flow rate (FR), defined as the ratio of stroke volume to systolic ejection time, has been introduced. However, its prognostic value in AS patients remains a matter of controversy. This study aims to systematically review the predictive value of FR in AS patients and provide quantitative pooled analysis results where applicable. A systematic search was conducted for observational studies on AS patients published up to July 31, 2025. Studies were included if they assessed the clinical prognostic utility of FR with at least 3 months of follow-up. Pooled estimates and 95% CI for FR's hazard ratio (HR) in each binary outcome were calculated using a random effects model. Twenty-one studies with 10,895 patients underwent descriptive analysis, and 19 eligible studies were included in the meta-analysis. For predicting all-cause mortality, the pooled HR for low FR measured at rest (cut-off value 200–210 mL/s) was 1.31 (95% CI: 1.03–1.60, I²: 66%, p < 0.05). For FR measured during stress echocardiography (cut-off value 250 mL/s), the pooled HR was higher at 1.58 (95% CI: 1.20–1.96, I²: 0%, p < 0.05). However, data in stress echocardiography have been drawn from a smaller number of studies compared to rest FR assessment, and validation in larger studies is warranted. Additionally, every 100 mL/s increase in FR, either at rest or stress, significantly reduced all-cause mortality. In Conclusion, FR is a prognostic marker for all-cause mortality and adverse composite outcomes in AS patients, indicating its potential for risk stratification. Incorporating FR into clinical assessments could help personalize follow-up and monitoring strategies.

Systematic Review Registration: PROSPERO (registration number: CRD42023404048).

超声心动图评价主动脉瓣狭窄（AS）严重程度依赖于主动脉瓣面积和峰值射流速度。为了提高准确性，引入了经主动脉血流率（FR），定义为卒中容积与收缩期射血时间之比。然而，其在AS患者中的预后价值仍存在争议。本研究旨在系统回顾FR在AS患者中的预测价值，并在适用的情况下提供定量汇总分析结果。系统检索了截至2025年7月31日发表的关于AS患者的观察性研究。如果研究评估FR的临床预后效用，随访至少三个月，则纳入研究。使用随机效应模型计算每个二元结局FR风险比（HR）的汇总估计值和95% CI。21项研究10,895例患者进行了描述性分析，19项符合条件的研究纳入了meta分析。对于预测全因死亡率，静息时低FR的合并HR（临界值200-210 mL/s）为1.31 (95% CI: 1.03-1.60, I2: 66%, p2: 0%, p

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引用次数: 0

Fractional Flow Reserve Versus Intravascular Imaging to Guide Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis 血流储备分数与血管内成像指导经皮冠状动脉介入治疗：系统回顾和荟萃分析。

IF 2.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-11-15 DOI: 10.1016/j.amjcard.2025.11.002

Akshat Banga MBBS, MD , Sidharth Misra MBBS , Ashish Yadav MD , Sawai Singh Rathore MD , Yash Vardhan Trivedi MBBS , Soban Ahmad MD , Nmair Alziadin MD , Ankit Agrawal MD , Sarju Ganatra MD , Sourbha Dani MD, MSc , Andrew M. Goldsweig MD, MS

引用次数: 0

Clinical Use and Effectiveness of Colchicine for Secondary Prevention Following Acute Myocardial Infarction 秋水仙碱在急性心肌梗死二级预防中的临床应用及疗效。

IF 2.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-11-13 DOI: 10.1016/j.amjcard.2025.11.001

Paul Marano MD, Susan Cheng MD, MS, MSc, Tzu Yu Huang MPH, Jesse Navarrette MPA, Patrick Botting DHsc, MSHS, Joseph E. Ebinger MD, MS

Randomized controlled trials investigating colchicine for secondary prevention of cardiovascular events following acute myocardial infarction (AMI) have yielded conflicting results, and the real-world use and effectiveness of colchicine in this context remains unknown. As such, we sought to evaluate the use of colchicine following AMI in clinical practice and the associated outcomes. We performed a retrospective analysis of patients diagnosed with AMI and longitudinally followed in a large academic health system between 2018 and 2024 to describe the clinical use of colchicine for secondary prevention following AMI, as well as patient-level demographic and clinical characteristics associated with colchicine use. Next, using both multivariable logistic regression models with and without propensity matching, we examined the association between colchicine prescription following AMI and composite cardiovascular outcomes (comprised of recurrent AMI, any revascularization, stroke, and death). Kaplan-Meier Event-free Survival Analysis and Cox Proportional Hazards Models were performed. Of 1,796, 126 (7.0%) were prescribed colchicine after AMI. There was no association between use of colchicine and the composite cardiovascular events in either standard multivariable adjusted (Odds Ratio 1.00, 95% CI 0.66–1.50, p = 0.99) or propensity matched models (0.98, 0.57–1.66, p = 0.93). There was no difference in event-free survival between patients who were prescribed colchicine and those who were not. In summary, we report the first real-world data on the use and effectiveness of colchicine for prevention of cardiovascular events after AMI. Colchicine was infrequently prescribed for this indication and was not associated with lower rates of subsequent cardiovascular events.

调查秋水仙碱对急性心肌梗死（AMI）后心血管事件二级预防的随机对照试验得出了相互矛盾的结果，秋水仙碱在这种情况下的实际使用和有效性仍然未知。因此，我们试图评估急性心肌梗死后秋水仙碱在临床实践中的应用及其相关结果。我们对2018-2024年间诊断为AMI的患者进行了回顾性分析，并在一个大型学术卫生系统中进行了纵向随访，以描述秋水仙碱在AMI后二级预防的临床使用情况，以及与秋水仙碱使用相关的患者水平的人口统计学和临床特征。接下来，使用有倾向匹配和没有倾向匹配的多变量logistic回归模型，我们检查了AMI后秋水仙碱处方与复合心血管结局（包括复发性AMI、任何血运重建、中风和死亡）之间的关系。Kaplan-Meier无事件生存分析和Cox比例风险模型。1796例患者中，126例（7.0%）AMI后服用秋水仙碱。在标准多变量调整模型（优势比1.00,95% CI 0.66-1.50， P=0.99）或倾向匹配模型（0.98,0.57-1.66，P=0.93）中，秋水仙碱的使用与复合心血管事件均无关联。服用秋水仙碱的患者和未服用秋水仙碱的患者在无事件生存率方面没有差异。总之，我们报告了秋水仙碱用于预防AMI后心血管事件的使用和有效性的第一个真实数据。秋水仙碱很少用于这一适应症，并且与较低的后续心血管事件发生率无关。

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引用次数: 0

Refining Risk Stratification in Ventricular Arrhythmias: The Expanding Role of Cardiac MRI 改进室性心律失常的风险分层：心脏MRI的扩展作用。

IF 2.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-10-30 DOI: 10.1016/j.amjcard.2025.10.020

Haojie Wang MD, PhD

引用次数: 0

Outcomes of Acurate Neo 2 Sapien 3 and Evolut Pro/Pro+ in Transcatheter Aortic Valve Replacement 经导管主动脉瓣置换术中准确的neo2 Sapien 3和Evolut Pro/Pro+的结果：准确的neo2 vs Sapien 3和Evolut Pro/Pro。

IF 2.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-10-30 DOI: 10.1016/j.amjcard.2025.10.014

Gal Bental , Sharon Daniel , Tamir Bental , David Belkin , Guy Witberg , Leor Perl , Amos Levi , Hana Vaknin Assa , Yeela Talmor , Keren Skalsky , Alon Shechter , Mordechai Vaturi , Yaron Shapira , Katia Orvin , Ashraf Hamdan , Ran Kornowski , Pablo Codner

Transcatheter aortic valve replacement (TAVR) is an established treatment for patients with severe symptomatic aortic stenosis (AS). Comparative data on the efficacy and safety of newer transcatheter heart valve (THV) devices is still evolving. We aim to compare clinical and hemodynamic outcomes of the Symetis ACURATE Neo-2® versus the Medtronic Evolut Pro/Pro^+® and the Edwards Sapien-3® THVs, from a large cohort of patients undergoing TAVR. In this all-comer, single center trial, patients with severe symptomatic AS undergoing TAVR and treated with either ACURATE Neo-2 (N = 240), Evolut Pro/Pro+ (N = 324) or Sapien-3 (N = 485) THVs were included. Baseline clinical, demographic and follow-up data were collected. Patients (N = 1049) (female 48.6%) mean age 80.1 ± 7.7 years. ACURATE Neo-2 patients were predominantly female (81%) in comparison to Evolut Pro/Pro+ (59%) and Sapien-3 (26%). Need for post-TAVR permanent pacemaker implantation (PPI) was lower in the ACURATE Neo-2 group in comparison to the Evolut Pro/Pro+ and similar to the Sapien-3 group. Rates of ≥ moderate paravalvular leak (PVL) were similar between ACURATE Neo-2 and Evolut Pro/Pro+, but higher in comparison to Sapien-3. In sight of our center's clinical approach to choosing various THV’s according to patient characteristics, The ACURATE Neo-2 constitutes a reliable and suitable tool for the treatment of patients with severe symptomatic AS undergoing TAVR. Even in the wake of the ACURATE Neo-2′s withdrawal, our study offers valuable contributions to ongoing discourse in the field of TAVR, emphasizing the necessity for continuous research and innovation to improve patient care and device efficacy.

经导管主动脉瓣置换术（TAVR）是治疗严重症状性主动脉瓣狭窄（AS）的常用方法。新型经导管心脏瓣膜（THV）装置的有效性和安全性的比较数据仍在不断发展。我们的目标是比较Symetis precision Neo-2®与Medtronic Evolut Pro/Pro+®和Edwards Sapien-3®thv的临床和血流动力学结果，这些thv来自一大批接受TAVR的患者。在这项全方面的单中心试验中，纳入了接受TAVR治疗的严重症状性AS患者，并接受了acute Neo-2 （N=240）、Evolut Pro/Pro+ (N=324)或Sapien-3 (N=485) thv治疗。收集基线临床、人口统计学和随访数据。患者1049例（女性48.6%），平均年龄80.1±7.7岁。与Evolut Pro/Pro+(59%)和Sapien-3（26%）相比，准确的Neo-2患者主要是女性（81%）。与Evolut Pro/Pro+相比，precision Neo-2组tavr后永久起搏器植入（PPI）的需求较低，与Sapien-3组相似。≥中度瓣旁漏（PVL）的发生率在precision Neo-2和Evolut Pro/Pro+之间相似，但高于Sapien-3。鉴于我们中心根据患者特点选择各种THV的临床方法，The accurate Neo-2是治疗严重症状性AS患者进行TAVR的可靠和合适的工具。即使在accurate Neo-2停药之后，我们的研究也为TAVR领域的持续讨论提供了有价值的贡献，强调了持续研究和创新以改善患者护理和设备功效的必要性。

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引用次数: 0