Anatolian Journal of Cardiology最新文献

Background: Transcatheter closure approaches of ventricular septal defects (VSDs) include anterograde through the right ventricle using an arteriovenous loop and retrograde transarterial approach. This systematic review assesses the outcomes and complications associated with transcatheter closure of VSD through a retrograde approach.

Methods: PubMed was searched for articles in English on retrograde closure of VSD from 2006 to 2024. The pooled estimates of success and complication rates were done by the random effects model.

Results: A total of 11 publications comprising 482 patients with variable types of VSD were included in this analysis. The pooled estimate of success was 89.3% (95% CI: 0.84-0.93). The most common complication is residual shunt pooled estimated is 7.1% (95% CI: 0.02-0.20). Others included valvular lesions pooled estimate is 6.4% (95% CI: 0.02-0.14), arrhythmias pooled estimate is 5.5% (95% CI: 0.02-0.12), conduction abnormalities pooled estimate rate is 5.3% (95% CI: 0.01-0.13), and death pooled estimated rate is 2.8% (95% CI: 0.08-0.07).

Conclusion: This analysis suggests that transcatheter retrograde closure of VSD is safe and effective with promising results. The limitations of this study are difficulties in analyzing the types of devices and VSDs individually. Clear inclusion and exclusion criteria including the patient's age, weight, VSD type, and other features must be considered before proceeding with this approach.

Background: Myval is a balloon-expandable valve (BEV) used in transcatheter aortic valve implantation (TAVI) with distinguished features. Data comparing Myval with contemporary transcatheter heart valves (THVs) is limited. The authors performed a meta-analysis of studies comparing Myval with contemporary THVs (Sapien series and Evolut series).

Methods: The authors searched PubMed, EMBASE, and Cochrane databases. The primary composite endpoint of early safety (freedom from death and major complications) and other outcomes were extracted as defined by the Valve Academic Research Consortium 3 (VARC 3). The authors computed risk ratios (RRs) with 95% CIs using a Mantel-Haenszel method with a random-effects model with Review Manager (Cochrane Collaboration).

Results: Six studies with 2084 patients were included. Myval had better early safety at 30 days as per VARC 3 (RR 1.12; 95% CI: 1.02-1.22; P = .01) and lower need for permanent pacemaker implantation (PPI) (RR 0.62; 95% CI: 0.45-0.86; P = .004). Other outcomes were comparable in both groups. Vis-à-vis Evolut, Myval had better 30-day device success and lower rates of moderate or severe paravalvular leak (PVL) in addition to better early safety and lower need for PPI. Subgroup analyses of Myval with Sapien showed non-inferiority of Myval.

Conclusion: Myval showed better safety and lower need for PPI and may become a promising alternative for concurrent THVs.

Background: Nurse-led cardiac rehabilitation (NLCR) is a patient-centered approach for managing cardiovascular disease (CVD) risk factors, but its physiological effects are unclear. This study evaluates NLCR's impact on key physiological parameters, including systolic and diastolic blood pressure (SBP, DBP), body mass index (BMI), body weight, and waist circumference (WC).

Methods: PubMed, Scopus, Embase, Cochrane Library, Web of Science, Google Scholar, ClinicalTrials.gov, and International Clinical Trials Registry Platform were searched from inception to May 30, 2025, to identify randomized controlled trials (RCTs) comparing NLCR to usual care in adult patients with CVDs (e.g., coronary heart disease, acute coronary syndrome, myocardial infarction, chronic heart failure, and atrial fibrillation). Standardized mean differences (SMDs) were pooled using random-effects models, and heterogeneity, subgroup, and sensitivity analyses were performed.

Results: Eleven RCTs (15 records, N = 1146 participants) were included, with mean ages of ~59 years in both intervention (133 male, 415 female) and control groups (126 male, 407 female). Nurse-led cardiac rehabilitation significantly reduced SBP (SMD = -0.20; 95% CI: 0.34 to -0.05) and DBP (SMD = -0.20; 95% CI: -0.37 to -0.03) compared to usual care, with low heterogeneity across studies. A significant reduction in body weight was also observed (SMD = -0.27; 95% CI: -0.46 to -0.07), while changes in BMI and WC did not reach statistical significance. A 12-week follow-up optimized blood pressure improvements, while longer durations better influenced anthropometric outcomes.

Conclusion: Nurse-led cardiac rehabilitation improves hemodynamics and modestly reduces weight in cardiac patients, supporting its inclusion in standard rehab protocols. Optimizing program duration may enhance outcomes. Future research should assess NLCR's components and long-term benefits. #W.Z. and Q.W. contributed equally in this study.

Background: Left atrial ejection force (LAEF) represents the force exerted by the left atrium (LA) to push blood into the left ventricle (LV) at the end of diastole. It is calculated as LAEF = 1/3 × mitral orifice area × (peak A velocity)2.

Methods: The primary endpoint was to assess changes in LAEF after 6 months of sodium-glucose co-transporter-2 inhibitor (SGLT-2 inhibitor) therapy in patients with heart failure with preserved ejection fraction (HFpEF). Secondary endpoints include changes in diastolic function, LV global longitudinal strain (LV-GLS), and LA strain parameters.

Results: In this single-center, prospective, randomized open-label study, 100 HFpEF patients were divided into 2 groups (n = 50 each). The study group received Dapagliflozin 10 mg daily along with guideline-directed medical therapy (GDMT) for 6 months, while the control group received only GDMT. The study group showed a significant reduction in LAEF (143.74 ± 10.33 to 134.4 ± 8.82; P < .001), LV-GLS improvement (-15.9 ± 4.13 to -17.1 ± 3.53; P < .001), and enhanced LA strain parameters (LA reservoir strain: 28.74 ± 9.31% to 36.39 ± 12.3%; LA contractile strain: -12.8 ± 5.41 to -17.89 ± 6.85; LA conduit strain: -15.97 ± 5.49 to -22.5 ± 8.25; all P < .001). Additionally, left ventricular mass index (199.9 ± 21.17 to 186.24 ± 16.77; P < .001) and left atrial volume index (36.17-32.21 mL/m2; P < .001) significantly decreased.

Conclusion: Dapagliflozin significantly reduces LAEF while improving LA strain and LV-GLS, reinforcing its role in LA and LV reverse remodeling in patients with HFpEF.