International journal of cardiology. Heart & vessels最新文献

Aim

Pulmonary vein thrombi (PVT) are believed to be rare. Some cases of PVT were reported in patients with lung cancer, thoracic surgery or catheter ablation. PVT are a possible cause of systemic embolism, but little is known about its complications. Since 2012, we have reported seven cases of PVT in patients without these predisposing factors.

The aim of the present study was to clarify whether PVT were rare or not in patients without these predisposing factors and how can we treat patients with PVT.

Methods

We performed 64-slice multidetector CT (64-MDCT) scans on 57 consecutive Japanese patients (28 men and 29 women; age = 73.8 ± 8.6 years old) with chest pain, but they didn't have lung cancer, thoracic surgery or catheter ablation, from September 2012 to March 2013.

Results

Coronary artery plaque was detected in 32 patients (56%). PVT were clearly demonstrated in 35 patients (61%), which indicated that PVT are not rare. Furthermore, 32 patients (91%) among 35 patients with PVT had no cerebral infarctions. In older people, PVT are not uncommon and have many clinico-pathologic correlations. Small or fine thrombi in the pulmonary vein should occlude a small artery of every organ and make effects on many diseases, which are not recognized by almost all medical doctors.

Conclusions

PVT are common observation in patients with chest pain and no clear predisposing factor. Further studies are required to assess if PVT can be considered as an etiology of chest pain and to determine its optimal management.

Background

People with schizophrenia are at significantly greater risk of cardiovascular disease-related mortality. We set out to determine if people with and without schizophrenia who undergo coronary artery catheterization differ with respect to coronary anatomy, coronary artery disease management, or outcome.

Methods and results

This study used provincial administrative data and a clinical registry that included all individuals who undergo coronary catheterization in Alberta, Canada. Individuals with schizophrenia were identified in hospital discharge data using ICD-9 codes. We identified 271 Albertans with a hospital discharge diagnosis of schizophrenia and a subsequent coronary catheterization and were matched with 1083 controls without schizophrenia that had undergone a coronary catheterization. Extent of coronary disease was assessed using 1) left ventricular ejection fraction; 2) the Duke Jeopardy Score (a valid measure of myocardium at risk for ischemic injury); and 3) a categorical assessment of coronary anatomy risk. People with schizophrenia were less likely to be categorized as high risk on the Duke coronary index (p < .005) and more likely to be categorized as having a normal coronary anatomy (p < .05). Significant differences in mortality were found among those with and without schizophrenia both before and after adjustment for clinical differences.

Conclusions

Our results suggest that people with schizophrenia have less severe coronary atherosclerosis, and are less likely to receive revascularization. Despite less severe coronary atherosclerosis, individuals with schizophrenia had a significantly higher mortality following catheterization. Interventions to increase therapeutic adherence and clinical follow up of patients with mental illness may improve health outcomes.

Background

It has been a decade since the complex fractionated atrial electrograms (CFAEs) were first established following the publication of Nademanee's standards. However, the status and focus of CFAE research are unclear, as is the efficacy of additional CFAE ablation in atrial fibrillation (AF). This literature review and meta-analysis were designed to determine the status of CFAE research and the efficacy and complications of CFAE ablation alone, pulmonary vein isolation (PVI) alone and PVI plus CFAE ablation in AF.

Methods

With the assistance from reference librarians and investigators trained in systematic review, we conducted a literature search of MEDLINE (via PubMed), Embase, the Cochrane Library, ScienceDirect, Wiley Blackwell and Web of Knowledge, using “complex fractionated atrial electrograms” for MeSH and keyword search.

Results

The literature on CFAEs increased from 2007, mainly focusing on mapping studies, with mechanism studies increasing significantly from 2012. Fifteen trials with 1525 patients were qualified for our meta-analysis. Success rates were as follows. Overall (P < 0.001): CFAE ablation alone, 23.5–26.2%; PVI, 64.7%; PVI plus CFAE ablation, 67.0%. Single ablation: PVI, 60.4%; PVI plus CFAEs, 68.8% (OR 1.53, 95% CI 1.07–2.20, P = 0.02). Re-ablation: PVI, 69.0%; PVI plus CFAEs, 77.2% (OR 1.54, 95% CI 1.06–2.24, P = 0.02). Paroxysmal AF: PVI, 76.7%; PVI plus CFAEs, 79.1% (OR 1.20, 95% CI 0.79–1.81, P = 0.39). Persistent or permanent AF: PVI, 47.9%; PVI plus CFAEs, 58.7% (OR = 1.59, 95% CI 1.13–2.24, P = 0.008). Complication rates: PVI, 2.6%; PVI plus CFAEs, 3.4% (OR 1.22, 95% CI 0.58–2.57, P = 0.61).

Conclusions

In the literature, CFAE mapping studies preceded mechanism studies. CFAE ablation alone is insufficient for the treatment of AF. Additional CFAE ablation after adequate PVI or PVI plus linear ablation improves the outcome of single ablation and re-ablation without increasing complications, especially in persistent or permanent AF. There are insufficient data to support a similar improvement in paroxysmal AF or inducible AF after PVI for paroxysmal AF.

Aim

We aimed in this study to assess the role of left atrial (LA), in addition to left ventricular (LV) indices, in predicting exercise capacity in patients with heart failure (HF).

Methods

This study included 88 consecutive patients (60 ± 10 years) with stable HF. LV end-diastolic and end-systolic dimensions, ejection fraction (EF), mitral and tricuspid annulus peak systolic excursion (MAPSE and TAPSE), myocardial velocities (s′, e′ and a′), LA dimensions, LA volume and LA emptying fraction were measured. A 6-min walking test (6-MWT) distance was performed on the same day of the echocardiographic examination.

Results

Patients with limited exercise performance (≤ 300 m) were older (p = 0.01), had higher NYHA functional class (p = 0.004), higher LV mass index (p = 0.003), larger LA (p = 0.002), lower LV EF (p = 0.009), larger LV end-systolic dimension (p = 0.007), higher E/A ratio (p = 0.03), reduced septal MAPSE (p < 0.001), larger LA end-systolic volume (p = 0.03), larger LA end-diastolic volume (p = 0.005) and lower LA emptying fraction (p < 0.001) compared with good performance patients. In multivariate analysis, only the LA emptying fraction [0.944 (0.898–0.993), p = 0.025] independently predicted poor exercise performance. An LA emptying fraction < 60% was 68% sensitive and 73% specific (AUC 0.73, p < 0.001) in predicting poor exercise performance.

Conclusion

In heart failure patients, the impaired LA emptying function is the best predictor of poor exercise capacity. This finding highlights the need for routine LA size and function monitoring for better optimization of medical therapy in HF.

Background

This study aimed to evaluate the relationship between tricuspid annular dilatation (TAD) and tricuspid regurgitation (TR), and the prognostic value of TAD using three-dimensional transesophageal echocardiography (3D TEE).

Methods

Tricuspid annular area (TAA) was measured in 116 patients using 3D TEE. Patients were classified into three groups (mild TR: n = 77, moderate TR: n = 26, severe TR: n = 13). Moreover, patients were classified into two groups based on rehospitalization for heart failure (HF); HF (+) group (n = 18) and HF (−) group (n = 98).

Results

TAA in the severe TR group was significantly larger than that in the mild and moderate TR groups (18.4 ± 3.8 cm² vs. 11.7 ± 3.2 cm², 12.3 ± 3.4 cm², p < 0.05). TAA in the HF (+) group was significantly larger than that in the HF (−) group (16.8 ± 4.3 cm² vs. 11.8 ± 3.3 cm², p < 0.001). In receiver operating characteristics curve assessing the ability of TAA to predict hospitalization for HF, the area under the curve was 0.84. TAA ≥ 15 cm² best predicted hospitalization for HF with 77.8% sensitivity and 84.6% specificity. The incidence of hospitalization for HF during 3 years was significantly higher in the TAD (+) group (TAA ≥ 15 cm²) than the TAD (−) group (48.3% vs 4.6%, p < 0.001).

Conclusions

The results of this study suggested a possible association between TAD and the TR severity. TAD estimated using 3D TEE may predict hospitalization for prospective HF.

Background

Atrial fibrillation (AF) is common in patients with aortic stenosis (AS) although the exact mechanism is unclear. The purpose of this study was to investigate echocardiographic characteristics among patients with severe AS and AF and to identify factors associated with the development of new-onset AF after aortic valve replacement (AVR).

Methods

125 patients with severe AS and ejection fraction > 40% scheduled for AVR were evaluated preoperatively and 3, 6, 9 and 12 months postoperatively with electrocardiography (ECG) and echocardiography, and Holter-ECG analysis was performed after 3 and 12 months. The primary endpoint was new-onset AF defined as an episode of AF exceeding 30 s, on the ECG or Holter-ECG and/or patients hospitalized due to AF.

Results

AF was present in 19 patients prior to AVR, compared to patients in sinus rhythm AF patients had increased NT-proBNP, increased left atrial (LA) volume (61 ± 21 vs. 47 ± 17 ml/m², p = 0.002), reduced global longitudinal left ventricular strain (− 13.1 ± 3.7 vs. − 16.0 ± 3.5, p = 0.002) and presented more often with a restrictive filling pattern (37% vs. 10%, p = 0.002). During follow-up 23 patients developed new-onset AF; predictors were LA volume, restrictive filling pattern, NT-proBNP, E/e′ and systolic blood pressure. After correcting for age and LA volume index, a restrictive filling pattern and systolic blood pressure remained associated with new-onset AF.

Conclusions

The presence of preoperative AF and development of new-onset AF after AVR is associated with restrictive filling pattern and LA dilatation in patients with severe AS.

Background

It has been suggested that there is an increase in aortic regurgitation (AR) in the short and medium term after percutaneous closure of patent foramen ovale (PFO). The aim of this study is to determine the long-term effect of percutaneous closure of PFO on the prevalence of AR.

Methods

Patients with cryptogenic stroke or transient ischemic attack who had undergone percutaneous closure of PFO more than five years before the study were invited to an echocardiographic examination.

Results

Out of 83 invited patients, 64 accepted the invitation and were examined with echocardiography. Mild AR was found in one patient (2%), but this was already evident in the patient's echocardiographic result before PFO closure. Trace AR was detected in 11 patients (17%). No case of moderate or severe AR was detected. Patients with AR were more often hypertensive (six out of 12 patients with AR, compared to nine of the 52 without AR, p = 0.025), and the indexed sinus of Valsalva was larger in patients with AR (18.6 mm/m², SD 1.6, as compared to 17.3 mm/m², SD 1.6, p = 0.02).

Conclusion

In this long-term study with a minimum follow-up of 5.6 years and a mean of 7.1 years, we found negligible levels of AR. Where present, AR was associated with hypertension and mild dilatation of the aortic root, but there was no indication that device closure per se increased the risk of developing AR.