IJC Heart and Vasculature最新文献

{"title":"The predictive value of the ARC-HBR criteria for in-hospital bleeding risk following percutaneous coronary intervention in patients with acute coronary syndrome","authors":"","doi":"10.1016/j.ijcha.2024.101527","DOIUrl":"10.1016/j.ijcha.2024.101527","url":null,"abstract":"<div><h3>Background</h3><div>The Academic Research Consortium for High Bleeding Risk (ARC-HBR) criteria were proposed for predicting bleeding risk in patients undergoing percutaneous coronary intervention (PCI). However, there is a lack of research evaluating the risk of in-hospital bleeding following PCI for acute coronary syndrome (ACS) utilizing the ARC-HBR criteria.</div></div><div><h3>Methods and results</h3><div>This study involved 1013 ACS patients who underwent PCI and dual antiplatelet therapy. There were 63 cases of in-hospital bleeding events (6.22 %). According to the ARC-HBR criteria, patients classified as HBR had a significantly greater bleeding rate than non-HBR patients (15.81 % vs. 1.99 %, p &lt; 0.001). As the CRUSADE score category increased, the risk of bleeding also increased. The area under the receiver operating characteristic curve (AUC) of the ARC-HBR criteria was significantly greater than that of the CRUSADE score for bleeding (0.751 vs. 0.696, p &lt; 0.0001). Subgroup analysis revealed that the ARC-HBR criteria exhibited better predictive ability for ST-segment elevation myocardial infarction (STEMI, AUC 0.767 vs. 0.694, p = 0.020) but comparable predictive ability in patients with unstable angina (AUC 0.756 vs. 0.644, p = 0.213), non-ST-segment elevation myocardial infarction (AUC 0.713 vs. 0.683, p = 0.644), and non-ST-segment elevation ACS (AUC 0.739 vs. 0.687, p = 0.330).</div></div><div><h3>Conclusion</h3><div>Compared with the CRUSADE score, the ARC-HBR criteria demonstrate superior predictive ability for in-hospital bleeding events during PCI in ACS patients. Routine assessment of the ARC-HBR score might be helpful for identifying high-risk individuals in this specific population.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142529502","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":"Proposed framework regarding management of patients with breast cancer and anti-cancer treatment-related elevation in cardiac troponin","authors":"","doi":"10.1016/j.ijcha.2024.101522","DOIUrl":"10.1016/j.ijcha.2024.101522","url":null,"abstract":"<div><div>Cardiac biomarkers are a vital component within the first edition of the European Society of Cardiology guidelines in Cardio-Oncology. Specifically, they are mentioned in the definition of mild asymptomatic cancer therapy-related cardiac dysfunction, where left ventricular systolic function is ≥50 % with two outcomes; either a new decrease in global longitudinal strain &gt;15 % from baseline and/or a new rise in cardiac biomarkers above the defined 99th percentile cut off values. Cardiac troponin is one such biomarker.</div><div>Many of the treatments for breast cancer have published data on cardiac dysfunction and/or cardiovascular toxicity, and such may lead to an elevation in cardiac troponin. However, there is conflicting and incomplete data regarding how to approach an elevated cardiac troponin during anti-cancer treatment, which has confounded patient care in the clinical trial setting.</div><div>We propose a novel framework to guide physicians in treatment-related elevation of cardiac troponin in the breast cancer population. Secondly, the additive role which the recommendation that cardiac troponin carries within mild asymptomatic definitions of CTRCD is the subject of great debate. We suggest a reflection on the role of biomarkers, specifically in reference to cardiac troponin.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142445409","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":"Importance of long non-coding RNAs in the pathogenesis, diagnosis, and treatment of myocardial infarction","authors":"","doi":"10.1016/j.ijcha.2024.101529","DOIUrl":"10.1016/j.ijcha.2024.101529","url":null,"abstract":"<div><div>Myocardial infarction (MI), a major global cause of mortality and morbidity, continues to pose a significant burden on public health. Despite advances in understanding its pathogenesis, there remains a need to elucidate the intricate molecular mechanisms underlying MI progression. Long non-coding RNAs (lncRNAs) have emerged as key regulators in diverse biological processes, yet their specific roles in MI pathophysiology remain elusive. Conducting a thorough review of literature using PubMed and Google Scholar databases, we investigated the involvement of lncRNAs in MI, focusing on their regulatory functions and downstream signaling pathways. Our analysis revealed extensive dysregulation of lncRNAs in MI, impacting various biological processes through diverse mechanisms. Notably, lncRNAs act as crucial modulators of gene expression and signaling cascades, functioning as decoys, regulators, and scaffolds. Furthermore, studies identified the multifaceted roles of lncRNAs in modulating inflammation, apoptosis, autophagy, necrosis, fibrosis, remodeling, and ischemia–reperfusion injury during MI progression. Recent research highlights the pivotal contribution of lncRNAs to MI pathogenesis, offering novel insights into potential therapeutic interventions. Moreover, the identification of circulating lncRNA signatures holds promise for the development of non-invasive diagnostic biomarkers. In summary, findings underscore the significance of lncRNAs in MI pathophysiology, emphasizing their potential as therapeutic targets and diagnostic tools for improved patient management and outcomes.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142445408","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":"Heart failure medication use and follow-up patterns in renal transplant recipients with reduced ejection fraction: A single-center experience","authors":"","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":null,"pages":null},"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":"","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":null,"pages":null},"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":"","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":null,"pages":null},"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":"","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":null,"pages":null},"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":"","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":null,"pages":null},"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":"","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":null,"pages":null},"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":"","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":null,"pages":null},"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}