Cardiology Research最新文献

Background: The EVEREST trials established the MitraClip as a viable alternative to surgery in treating functional mitral valve regurgitation (FMVR). The MitraClip G4 offers a less invasive way of managing severe FMVR. We sought to compare in-patient mortality and cardiovascular complications in patients with heart failure with reduced ejection fraction (HFrEF) who developed severe FMVR requiring treatment with MitraClip G4 versus annuloplasty. Comparisons of outcomes to previous iterations of the MitraClip were included in the analysis.

Methods: Using the National Inpatient Sample, we included adult patients with FMVR and HFrEF between 2016 and 2020 who underwent percutaneous repair or annuloplasty. MitraClip G4 use was assumed for MitraClip performed in the third quarter of 2019 and afterward. To avoid overlap between the G4 and previous iterations, MitraClip data from 2019 were excluded. Mortality, stroke, and other complications were assessed. Survey-weighted logistic regression was used to adjust for selection bias in the treatment received based on age and comorbidities. The weighted analysis included 19,500 patients receiving either MitraClip G4 or annuloplasty.

Results: The MitraClip group was associated with a decreased risk of in-hospital mortality (odds ratio (OR): 0.38, confidence interval (CI): 0.18 - 0.77), ischemic stroke (OR: 0.29, CI: 0.13 - 0.61), and myocardial infarction (OR: 0.15, CI: 0.08 - 0.28). The MitraClip G4 cohort did not outperform earlier clip versions in reducing complications.

Conclusions: The MitraClip G4 was associated with lower in-hospital mortality and cardiovascular complications than annuloplasty but had outcomes similar to earlier clip versions. Additional studies comparing percutaneous therapies and surgical interventions are necessary to determine optimal treatment strategies for patients with FMVR.

Background: Previous studies have provided evidence of reduced recurrence of atrial fibrillation (AF), all-cause mortality, and heart failure (HF) hospitalizations after catheter ablation (CA) in both HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF). Aggregate data comparing the efficacy of AF ablation and clinical endpoints in HF with mildly reduced ejection fraction (HFmrEF) to HFrEF and HFpEF are lacking.

Methods: We conducted a systematic review and meta-analysis aimed at determining any differences in AF recurrence rate, all-cause mortality, and HF hospitalizations among patients with HFrEF, HFmrEF, and HFpEF who underwent AF ablation. A systematic search of PubMed/MEDLINE, Embase, and Cochrane Library databases was performed until October 31, 2023.

Results: A total of seven studies comprising 3,795 patients were retained: HFrEF 1,281 (33.8%), HFmrEF 870 (22.9%), and HFpEF 1,644 (43.3%). After median follow-up of 24 months, there was no significant difference in rate of AF recurrence between the three HF categories: HFrEF 40% (30-49%), HFmrEF 35% (28-43%); and HFpEF 35% (25-45%). Only two studies which included outcomes in the three HF categories were identified. Pooled hazard ratio (HR) of all-cause mortality and HF hospitalization combined after ablation or other rhythm control compared to other conservative management were: HFrEF 0.77 (0.63 - 0.94); HFmrEF 0.81 (0.55 - 1.20); and HFpEF 0.74 (0.55 - 1.00).

Conclusions: CA has similar efficacy in the long-term resolution of AF among patients with HFrEF, HFmrEF, and HFpEF. Further studies are needed to provide a robust analysis on the potential impact of CA on all-cause mortality.

The natural progression of bioprosthetic valve degeneration over time requires further interventions for those experiencing symptomatic prosthesis dysfunction. Transcatheter aortic valve replacement (TAVR) emerges as a promising therapeutic option to alleviate symptoms in such patients. The valve-in-valve (ViV) technique eliminates the necessity for repetitive open-heart surgical procedures, offering particular advantages for individuals with higher surgical risks. In this report, we describe the case of a 78-year-old female patient presenting with severe symptomatic aortic restenosis of a biological aortic valve implanted 5 years prior. Given the patient's high surgical risk, a transcatheter ViV implantation was chosen as the treatment approach. Utilizing a balloon-expandable valve, the intervention resulted in the successful implantation of a functional TAVR, resulting in symptom relief and enabling a fast discharge from the hospital.

Background: The advanced glycation end products (AGEs), which can be assessed through skin autofluorescence (SAF), have been linked to chronic kidney disease (CKD), diabetes mellitus (DM), and aging. However, it is unknown how frailty and SAF levels are associated with cardiovascular disease (CVD).

Methods: We enrolled 1,000 consecutive CVD patients who participated in phase II cardiac rehabilitation (CR) and underwent assessment of SAF between November 2015 and September 2017 at Juntendo University Hospital. Of these, 48 patients were excluded as duplicate cases, and a deficiency in SAF data led to the exclusion of an additional 146 patients. The final analysis included 806 patients.

Results: Seventy percent of patients were male, and the mean age was 67.0 ± 12.9 years. In this study, the patients were divided into two groups (high SAF group and low SAF group) based on the median SAF level (2.9 a.u.), which is known as a cutoff value to increase the risk of CVD in previous studies. Compared with the low SAF group (n = 368, 45.7%), the high SAF group (n = 438; 54.3%) was older, and the Kihon Checklist (KCL) total score and prevalence of DM and CKD were significantly higher (all, P < 0.05). Multivariate regression analyses demonstrated that age was the only independent associated factor (P < 0.05) in the low SAF group. Conversely, in the high SAF group, creatinine, hemoglobin A1c (HbA1c) and the sub-total KCL score (1 - 20) were independently associated with SAF levels (all, P < 0.05).

Conclusions: Frailty assessed by KCL is one of the factors significantly correlated with the accumulation of AGEs as well as creatinine, HbA1c and brain natriuretic peptide (BNP) levels in the high SAF group of patients with CVD undergoing phase II CR, who have the higher risk of the onset of CVD and all-cause mortality.

Background: Heart failure (HF) and sepsis are significant causes of disease burden and mortality among the elderly population of the USA. HF causes fluid overload, which complicates the treatment approach when patients develop sepsis necessitating fluid resuscitation. While individual disease states have been studied extensively, the trends in mortality for concurrent sepsis and HF are not well known.

Methods: Mortality trends due to sepsis and HF in individuals aged 65 and older in the USA from 1999 to 2019 were analyzed using the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database. Differences in age-adjusted mortality rate (AAMR) and average annual percent change (AAPC) over the past two decades based on gender, race, region, and place of death were examined.

Results: Between 1999 and 2019, there were a total of 5,887,799 deaths related to HF, 2,584,523 deaths related to sepsis, and 250,115 deaths related to both HF and sepsis. There was also a decrease in AAMR for HF-related (AAPC -0.80%) and sepsis-related (AAPC -0.28) deaths but an increase in combined HF and sepsis-related AAMR (AAPC 1.06%). Men had consistently higher AAMRs compared to women and a greater increase in mortality (AAPC in men 1.53% vs. women 0.56%). African American patients had a higher AAMR than White patients throughout the study period, though the difference narrowed. African Americans saw a decrease in overall HF and sepsis-related AAMR from 48.90 to 40.56 (AAPC -0.83), whereas AAMR for the White population increased from 27.26 to 33.81 (AAPC 1.37). Regionally, the Northeast had the highest AAMR in 1999 (32.32) but decreased to the lowest AAMR by 2019 (30.77). Totally, 203,368 (81.31%) of all deaths related to HF and sepsis were in medical facilities, 18,430 (7.37%) were in home/hospice facilities, and 24,713 (9.88%) in nursing homes.

Conclusions: HF and sepsis-related mortality in the elderly population increased over the past two decades, with men and African Americans at disproportionately higher risk.

Atrial fibrillation (AF) is a common arrhythmia in critically ill patients. The objective of this narrative review is to evaluate the characteristics of patients who develop new-onset atrial fibrillation (NOAF) because of sepsis, current management of NOAF in sepsis patients, special consideration in different populations that developed NOAF, health economic and quality of life of patients. We conducted a literature search on PubMed to find research related to NOAF, sepsis and critical illness. Nineteen studies were analyzed for risk factors and outcomes. The incidence rate ranges from 0.53% to 43.9% among these studies. There were numerous risk factors that had been reported from these articles. The most reported risk factors included advanced age, male sex, White race, and cardiovascular comorbidities. The management of septic patients is significantly challenging because of the unfavorable cardiovascular consequences and thromboembolic hazards associated with NOAF. There are comprehensive guidelines available for managing AF, but the effectiveness and safety of therapies in patients with sepsis are still uncertain. Various approaches for managing newly diagnosed AF have been explored. Sinus rhythm can be restored through either pharmacological or non-pharmacological intervention or combination of both. In addition, thromboembolism is a complication that can occur in patients with AF and can have a negative impact on the prognosis of sepsis patients. The use of anticoagulation to prevent stroke after NOAF in sepsis patients is still controversial. Extensive prospective investigations are required to have a deeper understanding of the necessity for anticoagulation following NOAF in sepsis. Beside the treatment of NOAF, early detection of NOAF in sepsis plays a critical role. The prompt initiation of rhythm control medication following a clinical diagnosis of AF can enhance cardiovascular outcomes and reduce mortality in patients with AF and cardiovascular risk factors. Additionally, NOAF in the intensive care unit can prolong hospital stays, increasing hospitalization costs and burdening the hospital. Therefore, preventing and managing NOAF effectively not only benefit the patients but also the hospital in financial aspect. Lastly, to address the existing gaps in knowledge, future research should focus on developing machine learning models that can accurately anticipate risks, establish long-term follow-up protocols, and create complete monitoring systems. The focus is on early intervention and personalized approaches to improve outcomes and quality of life.

Background: This study evaluated the safety and efficacy of BioMime sirolimus-eluting stent (SES) system, with an ultra-low strut thickness (65 µm), in real-world all-comers population with coronary artery stenosis (CAD).

Methods: This was a post-marketing, multicenter, single-arm, observational clinical registry among patients undergoing intervention for CAD. Patients were clinically followed up at 1, 9, 12, and 24 months after the index percutaneous coronary intervention. Four major indications, namely long stents of > 30 mm, stents with diameters of 4 and 4.5 mm, bifurcation subgroup, and chronic total occlusion (CTO) were evaluated as pre-specified subsets.

Results: A total of 771 patients (1,079 treated lesions) from 23 sites were included in this study. The mean length and diameter of the implanted stents were 25.57 ± 9.35 mm and 3.00 ± 0.44 mm, respectively. The mean minimum lumen diameter before and after the procedure was 1.00 ± 1.69 mm and 2.96 ± 1.35 mm, respectively. The cumulative rates of major adverse cardiovascular events (MACEs) and stent thrombosis (ST) at 1, 9, 12, and 24 months were 1.05%, 3.13%, 4.04%, 5.64% and 0%, 0.13%, 0.28%, 0.28%, respectively. In a subset with > 30 mm long stents, the cumulative rate of MACEs was 0.4%, 4.6%, 5.12%, and 7.01% at 1, 9, 12, and 24 months, respectively. The corresponding rates of ST were 0%, 0.42%, 0.43%, and 0.44%, indicating constant rate of ST after 9 months. In a subset of 4 and 4.5 mm diameter stents, the cumulative rate of MACEs was high (0%, 6.25%, 6.25%, and 10.41%) at 1, 9, 12, and 24 months, respectively. However, there was no case of ST until 24 months. In patients with bifurcation lesions, the cumulative rates of MACEs and ST were 2.46%, 6.32%, 11.53%, 16.21% and 0%, 1.27%, 1.28%, 1.35% at 1, 9, 12, and 24 months follow-up. In patients with chronic total occlusion, the cumulative rates of MACEs and ST were 0.79%, 5.04%, 6.83%, 7.07% and 0%, 0.84%, 0.85%, 0.88% at 1, 9, 12, and 24 months, respectively, indicating constant rate of ST after 9 months.

Conclusions: The BioMime SES demonstrated good safety and efficacy outcomes at 24-month follow-up, with low rates of MACEs and ST in patients with CAD in the real-world setting.

Continuous electrocardiographic (ECG) monitoring remains crucial during surgery in infants and children. Although generally uncommon in pediatric-aged patients, ECG changes may occasionally be indicative of a variety of myocardial pathologies including anomalous origin of coronary arteries, ventricular hypertrophy, myocarditis, hypothermia, drug effects, electrolyte abnormalities, acid-base disturbances or conduction system disorders such as Wolff-Parkinson-White and Brugada syndrome. Distinguishing between pathologic and non-pathologic conditions impacting the ECG must be considered so that appropriate interventions are provided to prevent perioperative morbidity and mortality. We report a case of a 2-year-old child who exhibited ST segment depression and increased R wave amplitude during general anesthesia. Although the anesthetic care was uneventful and the patient was otherwise asymptomatic, immediate postoperative workup including echocardiogram revealed previously undiagnosed hypertrophic cardiomyopathy. The occurrence of intraoperative ST-T wave changes in this patient underscores the need for a high index of suspicion for underlying cardiac pathology, even in the absence of overt clinical manifestations. This case highlights the importance of intraoperative ECG monitoring in pediatric patients, explores the causes of ST-T wave changes, reviews similar cases in the literature, and proposes a pathway for perioperative evaluation.

Background: Syncope is a common medical condition. The reflex or neurally mediated syncope (NMS) is the most frequent type. The tilt table test (TTT) helps distinguish syncope from other common causes of complete loss of consciousness, such as epilepsy, define syncope subtypes and guide management. This study aimed to assess the TTT yield in patients with suspected NMS and to compare the nitroglycerin (NTG) and isoproterenol (Isuprel) provocative protocols.

Methods: This study was a retrospective analysis of the data of 426 consecutive patients who underwent TTT at the Heart Center at King Faisal Specialist Hospital and Research Center (KFSH&RC), Riyadh, Saudi Arabia, between January 1, 2006, and March 31, 2017.

Results: The age at referral for TTT ranged from 7 to 84 years (mean 38.4 ± 15.75 years), and 212 (49.8%) were males. The main clinical manifestations were recurrent syncope in 259 patients (60.8%), a single syncopal episode in 60 (14.1%), and pre-syncope or dizzy spells without loss of consciousness in 171(25.1%). The test was positive in 295 patients (69.2%), with type 1 (mixed response) seen in 151 patients (51.19%), type 2a (cardioinhibitory without pause) in 16 (5.4%), type 2b (cardioinhibitory with pause) in 10 patients (3.39%), and type 3 (vasodepressor) in 118 patients (40%). A false positive test was seen in 11 patients (2.6%) and a false negative in 27 patients (6.3%). The overall test sensitivity was 91%, specificity was 89%, positive predictive value (PPV) was 96%, and negative predictive value (NPV) was 79%.

Conclusions: The TTT is beneficial in diagnosing syncope in males and females and patients of young and old ages. A provocative test utilizing NTG provides a shorter, more straightforward test with the same diagnostic accuracy as the isoproterenol test. Lifestyle modification is effective and remains the primary intervention in managing patients with NMS.

An 83-year-old man underwent dual-chamber pacemaker placement for complete atrioventricular block at another hospital. The active-fixation ventricular lead was positioned on the free wall of the anterior right ventricle. Ventricular pacing failure occurred on the day after pacemaker implantation, and fluoroscopy revealed right ventricular (RV) lead perforation. The patient was transferred to our hospital, and chest computed tomography revealed a severe pneumothorax and moderate pneumopericardium. These symptoms were relieved after chest tube drainage, and the patient's hemodynamics stabilized. The RV lead was percutaneously removed using simple traction under fluoroscopic guidance with cardiac surgical backup and was uneventfully refixed to the RV septum. Although there have been several reports of pneumopericardium caused by atrial lead perforation, there are very few cases related to RV lead. Pneumopericardium complicated by pneumothorax due to RV lead perforation can be relieved using chest tube drainage without the need for pericardiocentesis.