IJC Heart and Vasculature最新文献

{"title":"Heart failure medication use and follow-up patterns in renal transplant recipients with reduced ejection fraction: A single-center experience","authors":"Michael C. Hill ,&nbsp;Kaitlyn Legg ,&nbsp;Amer Ardati ,&nbsp;Vicki Groo","doi":"10.1016/j.ijcha.2024.101535","DOIUrl":"10.1016/j.ijcha.2024.101535","url":null,"abstract":"<div><h3>Background</h3><div>The role of medical therapy for heart failure with reduced ejection fraction (HFrEF) in subjects with end-stage renal disease receiving renal transplantation (RT) is understudied. Here, we describe post-RT HFrEF medical management practices at a single urban, academic tertiary care center.</div></div><div><h3>Methods</h3><div>RT recipients between January 1, 2015 and November 30, 2020 with history of ejection fraction (EF) &lt;40 % prior to RT were included. Medications, renal function, blood pressure, cardiology follow-up, and echocardiograms ≥90d post-RT were retrospectively collected for 2 years post-RT.</div></div><div><h3>Results and conclusions</h3><div>47/750 (6.3 %) of RT recipients had prior HFrEF diagnosis, of whom 26 experienced improvement in EF prior to RT. Pre-RT medical therapy included beta blocker (BB) in 43 (92 %) of subjects and renin-angiotensin-aldosterone inhibitors (RAASi) in 23 (49 %). By 24 months post-RT, BB were used in 34 (76 %) and RAASi were used in 12 (27 %) of subjects. Rates of post-RT cardiology follow-up (51 %) and echocardiogram (38 %) were lower than expected in this cohort. Of 29 subjects potentially eligible for RAASi based on preserved renal function and no hyperkalemia or hypotension episodes during follow-up, only 6 (21 %) received RAASi. Of 6 subjects with post-RT EF &lt;50 %, 4 were eligible but did not receive RAASi. Multidisciplinary collaboration between cardiology and transplant teams may help improve care for this high-risk patient population.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"55 ","pages":"Article 101535"},"PeriodicalIF":2.5,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142433411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dissecting causal relationships between immune cells, blood metabolites, and aortic dissection: A mediation Mendelian randomization study","authors":"Ao Li ,&nbsp;ZiAn Feng ,&nbsp;ShiHao Fu ,&nbsp;ZhenXiao Ma ,&nbsp;HaiYang Zhang ,&nbsp;ZhiWei Zhao","doi":"10.1016/j.ijcha.2024.101530","DOIUrl":"10.1016/j.ijcha.2024.101530","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;There exists a robust correlation between the infiltration of immune cells and the pathogenesis of aortic dissection (AD). Moreover, blood metabolites serve as immunomodulatory agents within the organism, influencing the immune system’s response and potentially playing a role in the development of AD. Nevertheless, the intricate genetic causal nexus between specific immune cells, blood metabolites, and AD remains partially elucidated.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;div&gt;This study aims to elucidate the causal relationships between specific immune cell types and the risk of developing AD, mediated by blood metabolites, using Mendelian Randomization (MR) methods.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We undertook a comprehensive investigation of 731 immune cell types through the analysis of published genome-wide association studies (GWAS). Our methodology hinged on the application of two-sample Mendelian randomization (MR) and mediator MR analyses, prioritizing blood metabolites as potential intermediary factors and AD as the principal outcome of interest. The primary statistical method employed was inverse variance-weighted estimation, complemented by a variety of sensitivity analyses to reinforce our conclusions. The entirety of our statistical analyses was executed on the R software platform.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Our analyses elucidated that three immune cell types exhibited a positive correlation with the incidence of AD, whereas two immune cell types were inversely associated with AD risk. Significantly, our mediation Mendelian randomization (MR) findings identified Benzoate as a pivotal mediator in the influence of CD19 on IgD − CD38br cells on AD, with a mediation proportion of 5.38 %. Additionally, N-acetylproline was determined to mediate the effect of CD24 on IgD- CD38- cells on AD, accounting for a mediation proportion of 13.70 %. Furthermore, Carnitine C5:1 was found to mediate the effect of CD28 on secreting T regulatory (Treg) cells on AD, with a mediation proportion of 17.80 %.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;These findings offer a nuanced understanding of the pathophysiological mechanisms underlying AD, thereby advancing the precision medicine paradigm in the clinical management of AD.&lt;/div&gt;&lt;div&gt;Abbreviations: AD: aortic dissection; AA: aortic aneurysm; GWAS: genome-wide association study; MR: Mendelian randomization; TSMR: two-step Mendelian randomization; Treg: secreting T regulatory cell; VSMC: vascular smooth muscle cell; MMP: matrix metalloproteinase; ROS: reactive oxygen species; IV: instrumental variable; SNP: single-nucleotide polymorphism; IVW: inverse variance weighted; LDSC: linkage disequilibrium score regression; OR: odds ratio; CI: confidence interval; LD: linkage disequilibrium; AC: absolute cell; MFI: median fluorescence intensity; MP: morphological parameter; RC: relative cell; CLSA: Canadian Longitudinal Study of Aging; Lp(a): Lipoprotein a; OxPL: oxidised ph","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"55 ","pages":"Article 101530"},"PeriodicalIF":2.5,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142433413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The myocardial function index (MFI): An integrated measure of cardiac function in AL-cardiomyopathy","authors":"Nadia Akhiyat ,&nbsp;Vidhu Anand ,&nbsp;Vinayak Kumar ,&nbsp;Alexander Ryu ,&nbsp;Raymond Gibbons ,&nbsp;Barry A. Borlaug ,&nbsp;Krishnaswamy Chandrasekaran ,&nbsp;Omar Abou Ezzeddine ,&nbsp;Nandan Anavekar","doi":"10.1016/j.ijcha.2024.101525","DOIUrl":"10.1016/j.ijcha.2024.101525","url":null,"abstract":"<div><h3>Background</h3><div>Amyloid light chain (AL) amyloidosis is a systemic disease that can cause restrictive cardiomyopathy (AL-CM). Current imaging techniques are not sensitive to detect myocardial dysfunction in AL-CM. We sought to evaluate role of a novel marker of myocardial dysfunction (myocardial function index, MFI) obtained using changes in left ventricular (LV) blood pool and myocardial volume in diastole and systole.</div></div><div><h3>Methods</h3><div>Consecutive patients diagnosed with AL-CM who had underwent cardiac MRI between 2001–2017 were identified and compared to healthy individuals. Two independent operators used cardiac MRI to perform epicardial and endocardial tracings in systole and diastole to obtain myocardial volume in diastole (MVd) and myocardial volume in systole (MVs). Changes in myocardial volumes during the cardiac cycle were measured to calculate the MFI by <span><math><mfrac><mrow><mfenced><mrow><mi>M</mi><mi>V</mi><mi>d</mi><mo>-</mo><mi>M</mi><mi>V</mi><mi>s</mi></mrow></mfenced><mo>+</mo><mi>S</mi><mi>t</mi><mi>r</mi><mi>o</mi><mi>k</mi><mi>e</mi><mspace></mspace><mi>v</mi><mi>o</mi><mi>l</mi><mi>u</mi><mi>m</mi><mi>e</mi></mrow><mrow><mi>MVd</mi><mo>+</mo><mi>L</mi><mi>V</mi><mspace></mspace><mi>e</mi><mi>n</mi><mi>d</mi><mspace></mspace><mi>d</mi><mi>i</mi><mi>a</mi><mi>s</mi><mi>t</mi><mi>o</mi><mi>l</mi><mi>i</mi><mi>c</mi><mspace></mspace><mi>v</mi><mi>o</mi><mi>l</mi><mi>u</mi><mi>m</mi><mi>e</mi></mrow></mfrac></math></span>. Multivariable analysis was performed to evaluate predictors of all-cause mortality and survival was evaluated using Kaplan Meier analysis.</div></div><div><h3>Results</h3><div>Patients with AL-CM (n = 129, 61 ± 10 years, 32 % women) were older and more likely to be men compared to the normal cohort (n = 101, 39 ± 15 years, 61 % women). MFI was lower in patients with AL-CM (19 % [15; 23] vs 38 % [35; 41], p &lt; 0.001) and MFI &lt; 30 % discriminated between AL-CM with 92 % sensitivity and 100 % specificity (AUC 0.98, p &lt; 0.001). Higher MFI was independently associated with survival even after adjusting for conventional prognostic biomarkers of AL-CM (HR 0.02, 95 % CI 2.23 *104 – 0.24, p &lt; 0.05). Two independent operators demonstrated high intra and inter-rater correlation in measurements used to calculate MFI.</div></div><div><h3>Conclusion</h3><div>MFI is a novel metric for assessing LV function. It is abnormal in patients with AL-CM and may play a role in risk stratification.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"55 ","pages":"Article 101525"},"PeriodicalIF":2.5,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142433412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severity of diastolic dysfunction predicts myocardial infarction","authors":"Tanmay A. Gokhale,&nbsp;Mehak Dhande,&nbsp;Suresh Mulukutla,&nbsp;Oscar C. Marroquin,&nbsp;Floyd Thoma,&nbsp;Aditya Bhonsale,&nbsp;Krishna Kancharla,&nbsp;Andrew Voigt,&nbsp;Alaa A. Shalaby,&nbsp;N.A. Mark Estes III,&nbsp;Sandeep K. Jain,&nbsp;Samir Saba","doi":"10.1016/j.ijcha.2024.101532","DOIUrl":"10.1016/j.ijcha.2024.101532","url":null,"abstract":"<div><h3>Background</h3><div>Diastolic dysfunction (DD) is known to be a predictor of mortality. However, the impact of DD on the risk for myocardial infarction (MI) is not well defined. We sought to examine whether DD is an independent predictor of risk of MI in patients with a preserved ejection fraction.</div></div><div><h3>Methods</h3><div>This was an observational study of consecutive patients who underwent an echocardiogram that showed normal systolic function and had ≥ 3 months of follow-up. DD was graded using the contemporaneous guidelines at the time of the echocardiogram. Subsequent MI was determined by an inpatient encounter with a primary diagnosis of MI.</div></div><div><h3>Results</h3><div>129,476 patients were included (mean age 56 years; 58 % women). DD was present in 17.6 % of patients (13.6 % Grade I, 3.6 % Grade II, 0.4 % Grade III). Patients with DD were more likely to be older and have cardiovascular comorbidities. Survival free from MI was significantly lower as DD severity increased. Multivariate Cox proportional hazards modeling demonstrated that DD was an independent predictor of MI (hazard ratios [CI]: Grade I: 1.48 [1.33–1.66]; Grade II: 1.84 [1.57–2.16]; Grade III: 2.90 [1.98–4.25]).</div></div><div><h3>Conclusion</h3><div>Our data demonstrate that the risk of MI is significantly increased in the presence of DD, with higher risk at higher grades of DD. The increased risk associated with grade III DD is comparable to that from a prior history of percutaneous coronary intervention. These findings suggest that the severity of DD may be a useful tool in stratifying patients for risk of MI.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"55 ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142420059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Edge-to-Edge mitral valve repair for preoperative bridging to heart transplantation","authors":"Moritz Messner ,&nbsp;Simon Staggl ,&nbsp;Maria Ungericht ,&nbsp;Marc-Michael Zaruba ,&nbsp;Christian Puelacher ,&nbsp;Lukas Stastny ,&nbsp;Jakob Hirsch ,&nbsp;Herwig Antretter ,&nbsp;Thomas Schuetz ,&nbsp;Nikolaos Bonaros ,&nbsp;Julia Dumfarth ,&nbsp;Christoph Brenner ,&nbsp;Axel Bauer ,&nbsp;Gerhard Poelzl","doi":"10.1016/j.ijcha.2024.101520","DOIUrl":"10.1016/j.ijcha.2024.101520","url":null,"abstract":"<div><div>Transcatheter edge-to-edge repair (TEER) is a less invasive alternative to mitral valve surgery. In patients with advanced heart failure (HF), TEER can improve pulmonary hypertension (PH) and decelerate the progression of HF. TEER could be considered as a possible bridging strategy before orthotopic heart transplantation (OHT) in suitable patients. We report our experience in patients with advanced HF and severe functional mitral regurgitation (FMR) who underwent TEER prior to OHT. In this retrospective single-center study, we evaluated the periprocedural characteristics and clinical and hemodynamic outcomes of 14 patients with advanced HF on guideline-directed medical therapy and severe FMR who underwent TEER prior to OHT. In 6 patients who were not eligible for transplantation because of PH, TEER was performed as bridge-to-candidacy (BTC) strategy, in 8 unstable patients on the waiting list as bridge-to-transplant (BTT) strategy.</div><div>Severity of FMR was reduced by 2 degrees from 4 (3–4) to 2 (1.25–2.25) (p &lt; 0.001), NYHA class from 3 (2–3) to 2 (1.75–2.13) (p = 0.003) and NT-proBNP from 4689 (2841–7932) ng/L to 2973 (1694–4812) ng/L (p = 0.008). Significant reduction in PH was observed in the BTC cohort (mean PAP from 50 (39–53) to 26 (23–33) (p = 0.027) and PCWP from to 34 (29–40) to 13.5 (11–21) mmHg (p = 0.027). 13 patients underwent successful OHT, 1 patient of the BTT cohort died of sepsis shortly after HTX listing. In conclusion patients with advanced HF and severe FMR who are considered for OHT, TEER appears suitable both as a BTC strategy in patients with PH and as a BTT strategy in unstable patients on the waiting list.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"55 ","pages":"Article 101520"},"PeriodicalIF":2.5,"publicationDate":"2024-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142433410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age-specific associations of invasive treatment with long-term mortality of patients with acute myocardial infarction: Results of a real-world cohort analysis","authors":"Michael Kraus ,&nbsp;Timo Schmitz ,&nbsp;Dennis Freuer ,&nbsp;Philip Raake ,&nbsp;Jakob Linseisen ,&nbsp;Christa Meisinger","doi":"10.1016/j.ijcha.2024.101524","DOIUrl":"10.1016/j.ijcha.2024.101524","url":null,"abstract":"<div><h3>Background</h3><div>To investigate the age-specific association between invasive treatment, that is percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) at acute myocardial infarction (AMI) and all-cause long-term mortality.</div></div><div><h3>Methods</h3><div>The analysis was based on 4964 hospitalized AMI patients (age 25–84 years) registered by the population-based Augsburg Myocardial Infarction Registry between 2010 and 2017. The median follow-up time was 4.7 years (IQR: 2.7; 6.8). All-cause mortality was obtained by regularly checking the vital status of all registered AMI patients in cooperation with the regional population registries. In multivariable adjusted Cox regression analyses the age-specific associations between invasive therapy (PCI or CABG versus no invasive therapy) and all-cause mortality were investigated.</div></div><div><h3>Results</h3><div>During follow-up 1224 patients (805 men and 419 women) died. In patients younger than 55 years 7.6 %, in the age group 55–64 years 7.1 %, in the age group 65–74 years 12.2 %, and in the age group 75–84 years 21.6 % did not undergo invasive therapy (PCI or CABG) during hospital stay. Invasive therapy using PCI or CABG significantly reduced mortality risk in all age-groups in comparison to AMI patients without invasive treatment. Even 75–84 years old benefited very impressively from invasive therapy regarding long-term all-cause mortality (PCI: HR 0.55; 95 % CI 0.44–0.70; CABG: HR 0.43; 95 % CI 0.30–0.62).</div></div><div><h3>Conclusions</h3><div>Invasive or surgical therapy procedures in the treatment of AMI patients are effective in all age groups. Therefore, also old AMI patients should receive guideline-compliant therapy to achieve a better outcome.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"55 ","pages":"Article 101524"},"PeriodicalIF":2.5,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142420055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility, safety and clinical impact of a less-invasive totally-endovascular (LITE) technique for transfemoral TAVI: A 1000 patients single-centre experience","authors":"Enrico Romagnoli ,&nbsp;Francesco Bianchini ,&nbsp;Cristina Aurigemma ,&nbsp;Andrea Zito ,&nbsp;Emiliano Bianchini ,&nbsp;Lazzaro Paraggio ,&nbsp;Mattia Lunardi ,&nbsp;Carolina Ierardi ,&nbsp;Marialisa Nesta ,&nbsp;Piergiorgio Bruno ,&nbsp;Francesco Burzotta ,&nbsp;Carlo Trani","doi":"10.1016/j.ijcha.2024.101523","DOIUrl":"10.1016/j.ijcha.2024.101523","url":null,"abstract":"<div><h3>Background</h3><div>Trans-femoral (TF) represents the main access for TAVI. Although there are various technical strategies to conduct TF-TAVI (pacing modality, secondary arterial access, primary access puncture etc.), the optimal technique is not recognized.</div></div><div><h3>Aims</h3><div>In the present study, we assessed the impact of systematic use of LITE-TAVI in terms of feasibility, safety, and main access complication management using VARC-3 outcomes definitions.</div></div><div><h3>Methods</h3><div>At our institution, a less-invasive totally-endovascular (LITE) technique for TF-TAVI has been developed since 2017. Key aspects are: precise TAVI access puncture using angiographic-guidewire ultrasound guidance; radial/ulnar approach as the default “secondary access”; non-invasive pacing (by guidewire stimulation or definitive pacemaker external programmer).</div></div><div><h3>Results</h3><div>1022 consecutive TF-TAVI patients (55 % women, mean age: 80 years, mean EuroSCORE II 6.1 %, mean STS-PROM 4.3 %, mean STS/ACC TVT TAVR mortality score 3.4 %) were approached using the LITE technique. Technical success was achieved in 993 (97.2 %) patients. Access-related major vascular complications occurred in 12 (1.2 %) and VARC-3 ≥ type 2 bleedings in 12 (1.2 %) patients. At 30-day, all-cause death occurred in 17 (1.7 %) patients. This figure resulted significantly lower than expected on the bases of the mortality predicted not only by EuroSCORE II (6.1 %, p &lt; 0.001) and STS-PROM score (4.3 %; p &lt; 0.001), but also by STS/ACC TVT TAVR mortality score (3.4 %; p = 0.01).</div></div><div><h3>Conclusions</h3><div>Systematic use of LITE-TAVI is feasible and is associated with an extremely low rate of access-related bleeding and vascular complications which may drive to outcome improvement.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"55 ","pages":"Article 101523"},"PeriodicalIF":2.5,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142420056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac power output associated with hospitalization and mortality in coronary artery disease patients at stage B heart failure","authors":"Ming-Jer Hsieh ,&nbsp;Jih-Kai Yeh ,&nbsp;Yu-Chang Huang ,&nbsp;Ming-Yun Ho ,&nbsp;Dong-Yi Chen ,&nbsp;Cheng-Hung Lee ,&nbsp;Chao-Yung Wang ,&nbsp;Shang-Hung Chang ,&nbsp;Chun-Chi Chen ,&nbsp;I-Chang Hsieh","doi":"10.1016/j.ijcha.2024.101521","DOIUrl":"10.1016/j.ijcha.2024.101521","url":null,"abstract":"<div><h3>Background</h3><div>Cardiac power output (CPO) predicts outcomes in advanced heart failure (HF) and cardiogenic shock, but its role in early HF stages is unclear. This study assessed the prognostic value of CPO in coronary artery disease patients with asymptomatic left ventricular systolic dysfunction (ALVSD) at stage B HF.</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis of coronary artery disease patients who underwent coronary and pulmonary artery catheterization between 2006 and 2016. Stage B HF with ALVSD was defined as left ventricular ejection fraction &lt; 50 %, without HF symptoms, signs, or prior HF hospitalization. CPO was derived from invasive hemodynamic parameters. Endpoints included HF hospitalization, cardiovascular mortality, and all-cause mortality over a 5-year follow-up.</div></div><div><h3>Results</h3><div>A total of 783 coronary artery disease patients with ALVSD at stage B HF were enrolled. Incidence rates (per 1000 person-years) were 13.9 for HF hospitalization, 14.5 for cardiovascular mortality, and 23.7 for all-cause mortality.Multivariate analysis adjusting for covariates demonstrated that CPO was independent associated with all endpoints. Patients with a low CPO (&lt;0.97 Watts) were at significantly higher risk for HF hospitalization (adjusted hazard ratio [HR]: 4.04; 95 % CI: 1.53 – 10.6; p = 0.005), cardiovascular mortality (adjusted HR: 2.73; 95 % CI: 1.19 – 6.27; p = 0.018), and all-cause mortality (adjusted HR: 1.86; 95 % CI: 1.05 – 3.30; p = 0.035) compared to those with higher CPO, regardless of subgroup classification.</div></div><div><h3>Conclusion</h3><div>Resting CPO in patients with ALVSD is significantly associated with adverse events, including HF hospitalization and mortality, highlighting its value in early-stage HF management.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"55 ","pages":"Article 101521"},"PeriodicalIF":2.5,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142420057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of overweight and obesity on radiation dose and outcome in patients undergoing pulmonary vein isolation by cryoballoon and pulsed field ablation","authors":"Christiane Jungen ,&nbsp;Manuel Rattka ,&nbsp;Jan Bohnen ,&nbsp;Evangelos Mavrakis ,&nbsp;Dimitra Vlachopoulou ,&nbsp;Sebastian Dorna ,&nbsp;Isabel Rudolph ,&nbsp;Christina Kohn ,&nbsp;Dobromir Dobrev ,&nbsp;Tienush Rassaf ,&nbsp;Shibu Mathew","doi":"10.1016/j.ijcha.2024.101516","DOIUrl":"10.1016/j.ijcha.2024.101516","url":null,"abstract":"<div><h3>Background</h3><div>Pulmonary vein isolation (PVI) using pulsed field ablation (PFA) or cryoballoon ablation (CBA) are commonly used single-shot techniques for the treatment of patients with atrial fibrillation (AF). The number of overweight (BMI 25–30 kg/m²) and obese (BMI&gt;30 kg/m²) patients undergoing PVI is increasing, but data on this patient population is limited.</div></div><div><h3>Methods</h3><div>Consecutive AF patients with a BMI ≥25 kg/m² undergoing PFA- or CBA-PVI were included in this retrospective analysis. Baseline characteristics, procedural parameters and 1-year AF-freedom were retrospectively analyzed and compared for both ablation modalities.</div></div><div><h3>Results</h3><div>Of 115 patients (66 % men, 64 years [IQR: 58–71 years], 57 % overweight and 43 % obese) PFA- was performed in 68 % and CBA-PVI in 32 %. Contrast-dye volume (PFA: 80 ml [IQR: 60 − 117 ml] vs. CBA: 130 ml [IQR: 95 − 200 ml], <em>P</em>=0.001) and radiation exposure (PFA: 2196 cGy·cm² [IQR: 1398 − 2973 cGy·cm²] vs. CBA: 3239 cGy·cm² [IQR: 1288 − 5062 cGy·cm²], <em>P</em>=0.009) was lower in patients undergoing PFA-PVI. Logistic regression analysis identified obesity (OR: 5.58, 95 % CI: 1.63–19.06; <em>P</em>=0.006) and CBA-PVI (OR: 12.93, 95 % CI: 3.51–47.68; <em>P</em><strong>&lt;</strong>0.001) to be associated with increased radiation exposure. Both techniques were comparably safe (PFA: 4 % vs. CBA: 0 %; <em>P</em>=0.3). The median follow-up time was 145 days [IQR: 103 − 294 days]. AF-freedom after 1-year was similar in overweight (82 %) and obese patients (67 %) (HR: 0.61; 95 % CI: 0.29–1.28; <em>P</em>=0.19) as well as in PFA- and CBA-PVI patients (76 % vs. 76 %, HR: 1.37; 95 % CI: 0.63–2.99; <em>P</em>=0.42).</div></div><div><h3>Conclusion</h3><div>Overweight and obese patients undergoing PFA-PVI had lower contrast-dye volume compared to CBA-PVI. Obesity was associated with increased radiation exposure. Both techniques were comparably safe. The 1-year AF-freedom was similar in overweight and obese patients.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"55 ","pages":"Article 101516"},"PeriodicalIF":2.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142420058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is there an obesity paradox in cardiovascular outcomes for patients undergoing Transcatheter Edge-to-Edge Repair? A pilot meta-analysis","authors":"Aman Goyal ,&nbsp;Surabhi Maheshwari ,&nbsp;Muhammad Daoud Tariq ,&nbsp;Eeshal Zulfiqar ,&nbsp;Abdul Moiz Khan ,&nbsp;Humza Saeed ,&nbsp;Mohamed Daoud ,&nbsp;Gauranga Mahalwar","doi":"10.1016/j.ijcha.2024.101519","DOIUrl":"10.1016/j.ijcha.2024.101519","url":null,"abstract":"<div><h3>Background</h3><div>The impact of body mass index (BMI) on Transcatheter Edge-to-Edge Repair (TEER) outcomes remains uncertain, with studies showing conflicting results. Some suggest an ’obesity paradox’ exists, favoring better outcomes for obese patients and worse outcomes for underweight patients, while others report no significant impact of BMI.</div></div><div><h3>Methodology</h3><div>We systematically searched major databases for studies on baseline BMI and post-procedural outcomes in TEER patients. Patients were grouped by BMI: underweight (&lt;18.5 kg/m²), normal (18.5–24.9 kg/m²), overweight (25–29.9 kg/m²), and obese (≥30 kg/m²). Data were pooled using a random-effects model, with risk ratios (RRs) and their 95 % confidence intervals (CIs) as effect measures. Statistical significance was set at p &lt; 0.05.</div></div><div><h3>Results</h3><div>Our study, analyzing five observational studies with 7580 obese and 74,717 non-obese patients, found no significant difference in in-hospital mortality between the groups (RR: 0.85; p = 0.427). Subgroup analysis indicated a higher mortality risk for underweight patients compared to overweight (RR: 1.48; p = 0.006) and obese patients (RR: 1.40; p = 0.036), though the difference between underweight and normal-weight patients was not significant (RR: 1.18; p = 0.216). The risks of myocardial infarction (RR: 1.10; p = 0.592) and stroke (RR: 0.43; p = 0.166) were also similar between obese and non-obese patients.</div></div><div><h3>Conclusions</h3><div>In conclusion, our analysis found no significant difference in in-hospital mortality, myocardial infarction or stroke risk between obese and non-obese patients undergoing TEER. However, underweight patients may have a higher risk of in-hospital mortality compared to overweight and obese individuals, highlighting the potential impact of BMI on outcomes in TEER patients.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"55 ","pages":"Article 101519"},"PeriodicalIF":2.5,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142357562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}