Cardiovascular Revascularization Medicine最新文献

{"title":"Association between frailty, use of advanced therapies, in-hospital outcomes, and 30-day readmission in elderly patients admitted with acute pulmonary embolism.","authors":"Mohammad Zghouzi, Ahmad Jabri, Sant Kumar, Anand Maligireddy, Roshan Bista, Timir K Paul, Mohamed Farhan Nasser, Hady Lichaa, Herbert D Aronow, Saraschandra Vallabhajosyula, Bryan Kelly, Gillian Grafton, Rana Awdish, Mir Babar Basir, Khaldoon Alaswad, Mohammad Alqarqaz, Gerald Koenig, Vikas Aggarwal","doi":"10.1016/j.carrev.2025.06.017","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.06.017","url":null,"abstract":"<p><strong>Background: </strong>Frailty increases vulnerability to morbidity and mortality among elderly individuals, particularly those with acute pulmonary embolism (PE). Elderly patients, especially frail ones, remain underrepresented in studies evaluating advanced PE therapies, creating uncertainty regarding therapy utilization and outcomes.</p><p><strong>Methods: </strong>Using the National Readmission Database (NRD), elderly patients (>75 years) admitted with acute PE between 2016 and 2020 were identified via ICD-10 codes. Patients were stratified based on the Hospital Frailty Risk Score (HFRS >5 defined frailty) and clinical presentation (high-risk vs. non-high-risk features). Advanced therapies analyzed included systemic thrombolysis (ST), catheter-directed thrombolysis (CDT), catheter-directed embolectomy (CDE), and surgical embolectomy (SE). Logistic regression adjusted for demographics and comorbidities compared in-hospital outcomes between frail and non-frail patients.</p><p><strong>Results: </strong>A total of 233,091 patients were included; 53.0 % without and 79.9 % with high-risk features were frail. Advanced therapy utilization did not differ significantly between frail and non-frail patients within high-risk PE. Frail patients experienced higher in-hospital mortality in both non-high-risk (7.2 % vs. 1.8 %, adjusted OR [aOR]: 2.3, 95 % confidence interval [CI]: 2.2-2.6, p < 0.001) and high-risk groups (36.2 % vs. 30.2 %, aOR: 1.2, 95 % CI: 1.0-1.3, p = 0.02). Frailty was associated with increased intracranial hemorrhage (aOR: 3.9, 95 % CI: 3.3-4.7, p < 0.001), gastrointestinal bleeding (aOR: 2.1, 95 % CI: 1.9-2.3, p < 0.001), and hematuria (aOR: 10.8, 95 % CI: 9.4-12.4, p < 0.001). Frail patients had higher 30-day readmissions compared to non-frail patients (aOR: 1.2, 95 % CI: 1.1-1.2, p < 0.001), longer lengths of stay (6.1 vs. 3.6 days, p < 0.001), and higher total charges ($61,100 vs. $36,370, p < 0.001).</p><p><strong>Conclusion: </strong>Frailty significantly increases mortality and adverse events in elderly patients hospitalized with acute PE, particularly in non-high-risk individuals. These findings highlight the necessity of frailty assessment to optimize management decisions and guide therapeutic strategies in this vulnerable population.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144545485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of same-day discharge after left atrial appendage closure with and without pre-discharge transthoracic echocardiography.","authors":"Prasana Ramesh, Uneza Khawaja, Chidubem Ezenna, Sudhi Reddy, Marshal Fox, Alexander Knee, Amin Daoulah, Hafiz Imran, Mohammad Kashef, Andrew M Goldsweig, Amir Lotfi","doi":"10.1016/j.carrev.2025.06.013","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.06.013","url":null,"abstract":"<p><strong>Background: </strong>Patients with nonvalvular atrial fibrillation with contraindication to anticoagulation undergo Left Atrial Appendage Closure. SCAI/HRS consensus recommends routine post-procedure TTE before same-day discharge. We studied whether there was a difference in outcomes with and without a TTE after device implantation by measuring 45-day hospitalization for any reason.</p><p><strong>Methods: </strong>We performed a retrospective observational study using the data from our institutional LAAC registry. We compared patients discharged on the same day after the procedure who underwent a TTE vs patients who were discharged without a TTE. The Primary outcome studied was 45-day readmission for any given reason from the day of discharge.</p><p><strong>Results: </strong>In a Cohort of patients who were discharged on the same day, 350 did not undergo post-procedure TTE, and 60 underwent TTE. 33 patients were readmitted in the TTE group, and 4 patients were readmitted in the No TTE group. The RR for readmission without vs. with pre-discharge TTE was 1.41 (95 % CI 0.52-3.85, p = 0.25). No 45-day mortality occurred in either study group.</p><p><strong>Conclusion: </strong>For patients undergoing LAAC with same-day discharge, routine TTE before discharge did not significantly influence 45-day readmission rates. Given the absence of clinical benefit but the presence of TTE costs and resource use, a more selective approach to post-procedural imaging should be considered.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144561520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk stratification using the SCAI SHOCK classification in patients with acute pulmonary embolism.","authors":"Ahmad Jabri, Anand Maligireddy, Farhan Nasser, Sant Kumar, Srihari Naidu, Navin Kapur, Sripal Banglore, Jay Giri, Catalin Toma, Vikas Aggarwal, Herbert Aronow, Mir B Basir","doi":"10.1016/j.carrev.2025.06.018","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.06.018","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary embolism (PE) is a leading cause of cardiovascular mortality, with high-risk cases exhibiting significant heterogeneity in treatment and outcomes. Existing classification systems fail to differentiate PE patients requiring vasopressor support from those experiencing cardiac arrest. This study applies the Society for Cardiovascular Angiography and Interventions (SCAI) shock classification to stratify high-risk PE patients and assess mortality differences.</p><p><strong>Methods: </strong>Utilizing the Nationwide Inpatient Sample (NIS) database (2017-2020), we identified adult PE hospitalizations classified by SCAI shock stages: Stage A/B (hemodynamically stable or hypotensive without vasopressors), Stage C/D (requiring vasopressors and/or mechanical circulatory support [MCS]), and Stage E (out-of-hospital cardiac arrest [OHCA]). Outcomes included mortality, treatment modality, and complications. Multivariate logistic regression models were used to adjust for confounders.</p><p><strong>Results: </strong>Among 853,160 PE admissions, 5770 (0.68 %) were Stage C/D and 15,825 (1.86 %) were Stage E. Mortality increased with shock severity: 2.13 % (Stage A/B), 39.90 % (Stage C/D), and 65.95 % (Stage E) (p < 0.05). Mortality was lowest with surgical thrombectomy (17.24 % Stage C/D; 48.28 % Stage E) and highest with systemic thrombolysis (42.57 % Stage C/D; 70.62 % Stage E) (p < 0.05). Adjusted odds of mortality were 13.9 (95 % CI: 11.9-16.2, p < 0.05) for Stage C/D and 54.8 (95 % CI: 49.3-61.0, p < 0.05) for Stage E.</p><p><strong>Conclusion: </strong>Applying the SCAI shock classification to high-risk PE stratifies mortality risk more precisely. Patients with cardiac arrest exhibit significantly higher mortality than those requiring vasopressors alone. Future studies should explore refined risk stratification integrating hemodynamic parameters and biomarkers to optimize treatment selection.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144486630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expanding the differential for a bounding popliteal artery pulsation on physical exam.","authors":"Robert S Dieter, Robert S Dieter, Elizabeth G Dieter","doi":"10.1016/j.carrev.2025.05.025","DOIUrl":"10.1016/j.carrev.2025.05.025","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144334183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coronary microvascular dysfunction: Phenotype-specific targeted therapies.","authors":"Gianluca Mincione, Matteo Maurina, Alice Benedetti, Mauro Chiarito, Giulio G Stefanini, Pieter C Smits, Valeria Paradies","doi":"10.1016/j.carrev.2025.06.014","DOIUrl":"10.1016/j.carrev.2025.06.014","url":null,"abstract":"<p><p>Coronary microvascular dysfunction has always been a clinical entity that is often underdiagnosed and with limited therapeutic options. In this review, we aim to provide a comprehensive view of the pathology, correlating it with specific syndromic presentations to which it is often linked, and based on these, propose tailored diagnostic and therapeutic strategies.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The incremental diagnostic value of microvascular resistance reserve in the assessment of coronary microvascular dysfunction.","authors":"Kalyan R Chitturi, Sant Kumar, Beni Rai Verma, Waiel Abusnina, Matteo Cellamare, Ilan Merdler, Sevket Tolga Ozturk, Vijoli Cermak, Vaishnavi Sawant, Itsik Ben-Dor, Ron Waksman, Hayder D Hashim, Brian C Case","doi":"10.1016/j.carrev.2025.06.009","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.06.009","url":null,"abstract":"<p><strong>Background: </strong>Patients with coronary microvascular dysfunction (CMD) are at increased risk of major adverse cardiovascular events. The index of microcirculatory resistance (IMR) is more specific than coronary flow reserve (CFR) for CMD diagnosis, but the microvascular resistance reserve (MRR) shows potential due to its hemodynamic adjustments. Our study evaluated the diagnostic utility of IMR, MRR, and their combination in CMD diagnosis for patients experiencing angina and non-obstructive coronary arteries (ANOCA).</p><p><strong>Methods: </strong>This observational study analyzed data from the Coronary Microvascular Disease Registry (CMDR) of ANOCA patients at two tertiary care centers from 2021 to 2024. Demographics, lab results, and microvascular testing outcomes using bolus thermodilution were evaluated. Participants were grouped by MRR and IMR levels to evaluate CMD prevalence.</p><p><strong>Results: </strong>Between December 3, 2021, and July 31, 2024, 279 patients with ANOCA underwent invasive microvascular function assessment. Most were female (67.4 %), with an average age of 61.6 ± 11.0 years. CMD prevalence varied by group: 100 % in low MRR/high IMR, 92.3 % in high MRR/high IMR, 13.9 % in low MRR/low IMR, and 2.8 % in high MRR/low IMR (P < 0.001). IMR showed high diagnostic accuracy (81.6 % sensitivity, 99.5 % specificity), while MRR had 79 % sensitivity and 69.5 % specificity. Combining high IMR and low MRR improved specificity to 100 % but reduced sensitivity (65.8 %). ROC analysis showed AUCs of 0.80 (MRR), 0.97 (IMR), and 0.98 (IMR + MRR).</p><p><strong>Conclusions: </strong>The combination of IMR and MRR enhanced diagnostic specificity for CMD in patients with ANOCA, highlighting their complementary value. Future studies should focus on larger cohorts to validate these findings.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence-driven techniques for interventional cardiology: A current appraisal.","authors":"Debabrata Dash, Umanshi Dash, Batool Abu-Dakka","doi":"10.1016/j.carrev.2025.06.016","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.06.016","url":null,"abstract":"<p><p>The ability to simulate the process of human intelligence with computer systems is known as artificial intelligence (AI). This review aims to elucidate the impact of AI on clinical practice in interventional cardiology (IC) with particular attention to its most recent developments. In recent years, there have been exceptional breakthroughs in computational tools, particularly in the development of AI. The main objectives are to achieve the integration of various cardiac imaging modalities, establish online decision support systems and platforms based on augmented and/or virtual realities, and finally to create automatic medical systems, facilitating access to electronic health data about patients. In summary, AI applications in IC can be categorized into two primary domains: virtual and physical. As a result, numerous studies have offered information on the use of AI for automated interpretation and analysis of data from different cardiac modalities, including electrocardiogram, echocardiography, angiography, cardiac magnetic resonance imaging, and computed tomography as well as data collected during robotic-assisted percutaneous coronary intervention (PCI) procedures.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144486629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coronary microvascular dysfunction: Focus on pathophysiological mechanisms and recent diagnostic techniques.","authors":"Gianluca Mincione, Matteo Maurina, Alice Benedetti, Mauro Chiarito, Giulio G Stefanini, Pieter C Smits, Valeria Paradies","doi":"10.1016/j.carrev.2025.06.015","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.06.015","url":null,"abstract":"<p><p>In interventional cardiology, our efforts have traditionally centered on treating lesions in the epicardial coronary arteries, which can be visualized on coronary angiography. However, a significant proportion of patients experience similar symptoms to those with epicardial coronary artery lesions, yet without any angiographically visible coronary artery disease. These cases fall under the spectrum of coronary microvascular dysfunction. In this review, we will explore the disease's pathophysiology and focus on new frontiers in terms of diagnostic approaches and therapeutic strategies according to different endotypes.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The AltaValve system for transcatheter mitral valve replacement: A narrative review of early safety and efficacy data.","authors":"Michail Penteris","doi":"10.1016/j.carrev.2025.06.008","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.06.008","url":null,"abstract":"<p><p>Mitral regurgitation (MR) is a prevalent and progressive condition associated with poor outcomes in high-risk patients who are often ineligible for surgery or transcatheter repair. The AltaValve system (4C Medical Technologies, Maple Grove, MN), a novel transcatheter mitral valve replacement (TMVR) device, employs a unique supra-annular, atrial-only fixation mechanism designed to minimize left ventricular outflow tract (LVOT) obstruction and paravalvular leak. This narrative review summarizes current clinical evidence on AltaValve, including case reports, single-center, and multicenter experiences, as well as findings from the recent AltaValve Early Feasibility Study. Across diverse patient populations, such as those with functional, primary, and atrial MR, the device has demonstrated high technical success, favorable safety, and significant reduction in MR severity. Transseptal delivery has emerged as a less invasive and safer approach compared to transapical access, further expanding the device's applicability. Short-term follow-up reveals consistent improvement in hemodynamics, functional capacity, and quality of life measures, with low procedural complication rates. No cases of valve embolization, significant thrombosis, or structural degeneration have been reported yet. While early outcomes are promising, the data are limited to small, non-randomized cohorts, and long-term durability remains to be established. The AltaValve system represents a significant step forward in TMVR, particularly for patients with anatomically complex or inoperable MR. Ongoing pivotal trials will be essential to confirm its role within the transcatheter valve therapy landscape.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144318385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Meta-analysis of transcatheter edge-to-edge repair vs surgery for secondary mitral regurgitation.","authors":"Sahib Singh, Muhammad Asim Shabbir, Nidhish Tiwari, Kevin Bliden, Udaya S Tantry, Paul A Gurbel, Mohammed Y Kanjwal, Scott W Lundgren","doi":"10.1016/j.carrev.2025.06.012","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.06.012","url":null,"abstract":"<p><strong>Background: </strong>Transcatheter edge-to-edge repair (TEER) in patients with secondary mitral regurgitation (MR) has shown variable outcomes in clinical studies when compared with mitral valve surgery. We conducted a meta-analysis to reconcile the data.</p><p><strong>Methods: </strong>Online databases were searched for studies assessing TEER vs surgery for secondary MR. The outcomes of interest were length of hospital stay, all deaths, heart failure (HF) rehospitalization, mitral valve reintervention, implantation of left ventricular assist device (LVAD), stroke and recurrence of grade 3 or 4 MR. Pooled odds ratios (OR) and standardized mean difference (SMD), with 95 % confidence intervals (CI) were calculated.</p><p><strong>Results: </strong>Eight studies (1 randomized and 7 observational) with a total of 1436 patients (TEER n = 826, surgery n = 610) were included. Length of hospital stay was shorter in the TEER group (SMD -2.50, 95 % CI -4.65 to -0.35, p = 0.02). No significant differences were found between the two groups with respect to all deaths (p = 0.80), HF rehospitalization, mitral valve reintervention, implantation of LVAD and stroke. Recurrence of grade 3 or 4 MR was higher in the TEER group (OR 5.33, 95 % CI 2.57 to 11.03, p < 0.00001).</p><p><strong>Conclusions: </strong>In patients with secondary MR, TEER and surgery have comparable outcomes such as mortality, except for the lower recurrence of grade 3 or 4 MR in the surgical group. Thus, TEER may be the first approach in such patients, except in low surgical risk cases who need other concomitant cardiac surgeries.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144318384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}