Catheterization and Cardiovascular Interventions最新文献

Transcatheter aortic valve implantation (TAVI) has become an established treatment for severe aortic stenosis. However, the need for unplanned conversion to cardiac surgery (CS) during TAVI remains an infrequent but critical event. It is unclear whether this risk is higher in patients undergoing urgent procedures. We conducted a systematic review and meta-analysis to compare the incidence of unplanned conversion to CS between patients undergoing urgent versus elective TAVI. A systematic search of PubMed, SCOPUS, and Cochrane databases was performed to identify eligible studies. The primary outcome was the rate of unplanned conversion to CS. Secondary outcomes included mortality, device success, vascular complications, device embolization, acute kidney injury (AKI), stroke, permanent pacemaker implantation (PPI), moderate-or-severe paravalvular regurgitation (PVL), need for second valve implantation, bleeding, and duration of hospitalization. Seven studies comprising 71,909 patients were analyzed; 5108 underwent urgent TAVI and 66,801 underwent elective TAVI. No significant difference in conversion to CS was observed between the groups (RR: 0.89; 95% CI: 0.65−1.22). Device success rates were similar (RR: 0.99; 95% CI: 0.97–1.00). Urgent TAVI was associated with prolonged hospitalization (mean difference: 7.75 days; 95% CI: 4.06–11.45) and increased AKI risk (RR: 2.20; 95% CI: 1.53–3.16). Vascular complications, device embolization, stroke, PPI, PVL, second valve implantation, and major bleeding rates were comparable between the groups. Urgent TAVI is not associated with an increased risk of unplanned conversion to surgery. The observed higher AKI rates and longer hospital stay suggest that patient-related factors beyond procedural urgency may contribute to adverse outcomes.

Background

Assessing coronary artery disease in severe aortic stenosis (AS) presents unique challenges. Fractional flow reserve (FFR) may yield unreliable results due to altered coronary hemodynamics, leading to discordance with non-hyperemic indices. Women with AS develop distinct myocardial remodeling patterns that may predispose to coronary microvascular dysfunction. We investigated whether sex influences the diagnostic performance and agreement of invasive physiological indices in severe AS.

Methods

This prospective single-center study enrolled 221 patients with severe AS and intermediate coronary stenoses. We performed comprehensive physiological assessment of 416 vessels using FFR, instantaneous wave-free ratio (iFR), and quantitative flow ratio (QFR). Discordance in the detecting significant ischemia was defined using standard thresholds (FFR ≤ 0.80, iFR ≤ 0.89, QFR ≤ 0.80). Multivariable logistic regression identified predictors of discordance.

Results

Among 130 women and 91 men with similar angiographic disease severity, women demonstrated systematically weaker correlations between all physiological indices. FFR/iFR concordance was significantly lower in women (90.2% vs. 96.1%; p = 0.021). Discordance was predominantly FFR-negative/iFR-positive (9.8% in women vs. 3.9% in men). Female sex independently predicted FFR/iFR discordance (OR 2.70; 95% CI: 1.03–7.04; p = 0.043), along with smoking status and percent diameter stenosis. No FFR-positive/iFR-negative cases occurred.

Conclusions

Female sex is an independent predictor of FFR/iFR discordance in severe AS, manifesting exclusively as the FFR-negative/iFR-positive pattern. This finding suggests sex-specific differences in coronary microvascular function that may influence revascularization decisions. Recognition of these differences might be important for optimal management of coronary disease in severe AS.

Background

Myocardial infarction with nonobstructive coronary arteries (MINOCA) is a heterogeneous syndrome presenting as acute infarction despite < 50% epicardial stenosis. Recognition remains low, and optimal management is unclear.

Aims

This study aims to analyze the clinical profile of MINOCA patients compared to those with myocardial infarction with obstructive lesions, and evaluate MINOCA patients.

Methods

A total of 1421 consecutive patients with acute MI admitted to our hospital between January 2016 and March 2019 were retrospectively screened. Patients were classified into two groups: MINOCA, comprising patients with no significant lesions on angiography, and MI-CAD, consisting of patients with lesions of the coronary artery. A total of 130 patients with MINOCA and 210 patients with MI-CAD were enrolled. Demographics, laboratory parameters, imaging findings, etiologies, in-hospital outcomes, and discharge therapies were analyzed.

Results

The prevalence of MINOCA was 9.7%. Patients with MINOCA were more frequently women (especially premenopausal women) and had a younger age (54.65 ± 18.4 to 63.2 ± 12.3, p < 0.001). The prevalence of traditional CAD risk factors was lower in MINOCA patients. Patients with MINOCA were more likely to have a history of upper-respiratory-tract infections (URIs) and use of antidepressant drugs compared to MI-CAD at admission. In-hospital mortality and event rates were comparable to those with MI-CAD. However, antiplatelets, statins, renin−angiotensin system blockers, and β-blockers were less frequently prescribed to patients with MINOCA at discharge.

Conclusions

Patients with MINOCA constitute a population that differs from the classical MI profile. Compared with MI-CAD, MINOCA is accompanied by fewer traditional risk factors for CAD.

Background

Atrial septal defect (ASD) is a common congenital heart anomaly causing a significant hemodynamic burden if untreated. Transcatheter closure is a minimally invasive standard treatment, but prospective data on short-term cardiac remodeling are limited.

Aims

To evaluate short-term echocardiographic changes in cardiac structure and function following transcatheter ASD closure in adults.

Methods

This prospective observational cohort study included 112 patients aged 15–68 years who underwent transcatheter ASD closure. Comprehensive echocardiography was performed pre-procedure and at 1 and 6 months postprocedure. Parameters assessed included right and left ventricular dimensions, atrial volumes, right ventricular systolic pressure (RVSP), pulmonary artery pressure (PAP), tricuspid regurgitation (TR) severity, and right ventricular ejection fraction (RVEF).

Results

Significant reductions in right atrial volume index (RAVI) by 4.5 ± 5.19 mL/m², right ventricular internal diameter, RVSP by 6.8 ± 9.44 mmHg, PAP decreased by 6.46  ±  8.50 mmHg, and TR severity were observed at 6 months (all p < 0.05). Left ventricular dimensions and ejection fraction remained stable, indicating preserved left-heart function. RVEF improved in 31% of patients by 6 months. Cardiac rhythm remained unchanged. Notably, reverse remodeling magnitude and timing were independent of baseline ASD size.

Conclusion

Transcatheter ASD closure results in early and sustained right-heart reverse remodeling and pulmonary pressure reduction, without adverse effects on left ventricular function or cardiac rhythm. These consistent benefits, regardless of defect size, support the safety and efficacy of this minimally invasive intervention.