Cardiovascular Revascularization Medicine最新文献

{"title":"Transcarotid versus transfemoral transcatheter aortic valve replacement: A systematic review and meta-analysis","authors":"Cyrus Munguti ,&nbsp;Paul M. Ndunda ,&nbsp;Abdullah Abukar ,&nbsp;Mohammed Abdel Jawad ,&nbsp;Mohinder R. Vindhyal ,&nbsp;Zaher Fanari","doi":"10.1016/j.carrev.2024.04.008","DOIUrl":"10.1016/j.carrev.2024.04.008","url":null,"abstract":"<div><h3>Background</h3><div>In the 2021 Transcatheter Valve Therapy (TVT) registry, 8.9 % of patients underwent TAVR via access sites other than the femoral artery. Transthoracic approaches may be contraindicated in some patients and may be associated with poorer outcomes. Therefore other alternative access routes are increasingly being performed. We conducted a systematic review of the literature on transcarotid transcatheter aortic valve replacement (TC-TAVR) and meta-analysis comparing outcomes of TC-TAVR and other access routes.</div></div><div><h3>Methods</h3><div>We comprehensively searched for controlled randomized and non-randomized studies from 4 online databases. We presented data using risk ratios (95 % confidence intervals) and measured heterogeneity using Higgins' I².</div></div><div><h3>Results</h3><div>Sixteen observational studies on transcarotid TAVR were included in the analysis; 4 studies compared TC-TAVR vs TF-TAVR. The mean age and STS score for patients undergoing TC-TAVR were 80 years and 7.6 respectively. For TF-TAVR patients, mean age and STS score were 81.2 years and 6.5 respectively. There was no difference between patients undergoing TC-TAVR and TF-TAVR in the following 30-day outcomes: MACE [8.4 % vs 6.7 %; OR 1.32 (95 % CI 0.71–2.46 <em>p</em> = 0.38) I² = 0 %], mortality [5.6 % vs 4.0 %; OR 0.42 (95 % CI 0.60–3.37, <em>P</em> = 0.42) I² = 0 %] and stroke [0.7 % vs 2.3 %; OR 0.49 (95 % CI 0.09–2.56, <em>P</em> = 0.40) I² = 0 %]. There was no difference in 30-day major vascular complications [0.7 % vs 3 %; OR 0.55 (95 % CI 0.06–5.29, <em>P</em> = 0.61) I² = 39 %], major bleeding [0.7 % vs 3.8 %; OR 0.39 (95 % CI 0.09–1.67, <em>P</em> = 0.21) I² = 0 %], and moderate or severe aortic valve regurgitation [8.6 % vs 9.9 %; OR 0.89 (95 % CI 0.48–1.65, <em>P</em> = 0.72) I² = 0 %].</div></div><div><h3>Conclusion</h3><div>There are no significant differences in mortality, stroke MACE and major or life-threatening bleeding or vascular complications when TC-TAVR is compared to TF-TAVR approaches.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"68 ","pages":"Pages 92-97"},"PeriodicalIF":1.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140870081","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 coronary artery disease and revascularization on outcomes of transcatheter aortic valve replacement for severe aortic stenosis","authors":"Yoshiyuki Yamashita ,&nbsp;Serge Sicouri ,&nbsp;Massimo Baudo ,&nbsp;Aleksander Dokollari ,&nbsp;Roberto Rodriguez ,&nbsp;Eric M. Gnall ,&nbsp;Paul M. Coady ,&nbsp;Harish Jarrett ,&nbsp;Sandra V. Abramson ,&nbsp;Katie M. Hawthorne ,&nbsp;Scott M. Goldman ,&nbsp;William A. Gray ,&nbsp;Basel Ramlawi","doi":"10.1016/j.carrev.2024.05.003","DOIUrl":"10.1016/j.carrev.2024.05.003","url":null,"abstract":"<div><h3>Background/purpose</h3><div><span>To evaluate the impact of coronary artery disease (CAD), percutaneous coronary intervention (PCI), and coronary lesion complexity on outcomes of </span>transcatheter aortic valve replacement<span> (TAVR) for aortic stenosis.</span></div></div><div><h3>Methods/materials</h3><div><span><span>This retrospective study included 1042 patients divided into two groups by the presence or absence of CAD (SYNTAX score 0, no history of revascularization). </span>Propensity score matching was used to compare the two groups. The effect of PCI, </span>SYNTAX score, and residual SYNTAX score was also analyzed.</div></div><div><h3>Results</h3><div>The median age of the cohort was 82 years, and 641 patients had CAD. After propensity score matching, 346 pairs were analyzed. During 5 years of follow-up (median: 25, range 0–72 months), the rate of coronary intervention was significantly higher in CAD patients (<em>p</em><span> = 0.018). However, all-cause mortality, composite of all-cause mortality, stroke, and coronary intervention, and overt bleeding defined by VARC-3 were comparable. After stratification, in patients with creatinine ≥1.5 mg/dl, CAD was associated with a worse composite outcome (</span><em>p</em> = 0.016). Neither PCI nor SYNTAX score was associated with all-cause mortality in CAD patients. Similarly, residual SYNTAX score showed no association with mortality in patients undergoing PCI (all <em>p</em> values &gt;0.7). PCI did not reach a significant difference in overt bleeding in CAD patients (adjusted <em>p</em> = 0.06).</div></div><div><h3>Conclusions</h3><div>Despite a higher incidence of coronary interventions, major clinical outcomes were similar between patients with and without CAD after TAVR. In patients with chronic kidney disease, CAD may be associated with an adverse composite outcome. Neither PCI nor SYNTAX/residual SYNTAX score influenced all-cause mortality.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"68 ","pages":"Pages 8-14"},"PeriodicalIF":1.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140892033","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":"Prevalence and progression of LV dysfunction and dyssynchrony in patients with new-onset LBBB post TAVR","authors":"Andrei D. Margulescu ,&nbsp;Dewi E. Thomas ,&nbsp;Magid Awadalla ,&nbsp;Parin Shah ,&nbsp;Ayush Khurana ,&nbsp;Omar Aldalati ,&nbsp;Daniel R. Obaid ,&nbsp;Alexander J. Chase ,&nbsp;David Smith","doi":"10.1016/j.carrev.2024.04.011","DOIUrl":"10.1016/j.carrev.2024.04.011","url":null,"abstract":"<div><h3>Background</h3><div><span>The impact of new-onset left bundle branch block (N-LBBB) developing after </span>Transcatheter Aortic Valve Replacement (TAVR) on cardiac function and mechanical dyssynchrony is not well defined.</div></div><div><h3>Methods</h3><div>We retrospectively screened all patients who underwent TAVR in our centre between Oct 2018 and Sept 2021 (<em>n</em><span> = 409). We identified 38 patients with N-LBBB post-operatively (of which 28 were persistent and 10 were transient), and 17 patients with chronic pre-existent LBBB (C-LBBB). We excluded patients requiring pacing post TAVR. For all groups, we retrospectively analysed stored echocardiograms<span> at 3 time points: before TAVR (T0), early after TAVR (T1, 1.2 ± 1.1 days), and late follow-up (T2, 1.5 ± 0.8 years), comparing LV mass and volumes, indices of LV function (LV ejection fraction, LVEF; global longitudinal strain, GLS), and mechanical dyssynchrony indices (systolic stretch index, severity of septal flash).</span></span></div></div><div><h3>Results</h3><div>At baseline (T0), C-LBBB had worse cardiac function, and larger LV volumes and LV mass, compared with patients with N-LBBB. At T1, N-LBBB resulted in mild dyssynchrony and decreased LVEF and GLS. Dyssynchrony progressed at T2 in persistent N-LBBB but not C-LBBB. In both groups however, LVEF remained stable at T2, although individual response was variable. Patients with better LVEF at baseline demonstrated a higher proportion of developing LBBB-induced LV dysfunction at T2. Lack of improvement of LVEF immediately after TAVR predicted deteriorating LVEF at T2. In transient LBBB, cardiac function and most dyssynchrony indices returned to baseline.</div></div><div><h3>Conclusions</h3><div>N-LBBB after TAVR results in an immediate reduction of cardiac function, in spite of only mild dyssynchrony. When LBBB persists, patients with better cardiac function before TAVR are more likely to have LBBB-induced LV dysfunction after TAVR.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"68 ","pages":"Pages 23-29"},"PeriodicalIF":1.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140866743","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":"Markedly elevated high-sensitivity troponin and in-hospital mortality after cardiac surgery","authors":"Pavan Reddy ,&nbsp;Matteo Cellamare ,&nbsp;Ilan Merdler ,&nbsp;Cheng Zhang ,&nbsp;Sukhdeep Bhogal ,&nbsp;Amer I. Aladin ,&nbsp;Itsik Ben-Dor ,&nbsp;Lowell F. Satler ,&nbsp;Toby Rogers ,&nbsp;Ron Waksman","doi":"10.1016/j.carrev.2024.05.005","DOIUrl":"10.1016/j.carrev.2024.05.005","url":null,"abstract":"<div><h3>Background</h3><div>High-sensitivity troponin (hsTnI) is correlated with cardiac mortality; however, studies on the relationship of markedly elevated hsTnI with in-hospital mortality after cardiac surgery are sparse. Therefore, we aimed to define this relationship in order to help guide in-hospital, acute management of post-surgical patients.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed all cardiac surgeries completed at our institution between January 2020 and June 2022 in which a peak hsTnI was noted to be &gt;35× upper limit of normal (ULN = 34 ng/L). The primary outcome was in-hospital death. Subgroup analysis was performed to assess differences between coronary artery bypass grafting (CABG) and other cardiac surgeries.</div></div><div><h3>Results</h3><div><span>A total of 1382 cases met inclusion criteria. The patients' mean age was 64.8 years and 68.2 % were male. Median peak hsTnI after surgery was 4202 ng/L (interquartile ratio: 2427–7654). Univariate analysis<span> of troponin level with mortality found that for every 1000 ng/L increase in hsTnI, odds of in-hospital death increased by 3.8 % (odds ratio [OR]: 1.038; 95 % confidence interval [CI] 1.027–1.050; </span></span><em>p</em> &lt; 0.0001). In a multivariate model, troponin <strong>(</strong>OR 1.02; 95 % CI 1.01–1.04; <em>p</em> = 0.004) maintained a significant association with in-hospital death. CABG was associated with a lower risk of in-hospital death for any given hsTnI level up to 60,000 ng/L compared to other cardiac surgeries.</div></div><div><h3>Conclusion</h3><div>Increasing hsTnI level is associated with increasing probability of in-hospital mortality and, therefore, serves as an additional, objective measure of risk to help guide in-hospital clinical management.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"68 ","pages":"Pages 57-61"},"PeriodicalIF":1.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140892075","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":"Editorial: Tackling coronary calcified nodules: “Shocking our way to success?”","authors":"Keisuke Yasumura,&nbsp;Annapoorna S. Kini,&nbsp;Samin K. Sharma","doi":"10.1016/j.carrev.2024.06.009","DOIUrl":"10.1016/j.carrev.2024.06.009","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"68 ","pages":"Pages 43-44"},"PeriodicalIF":1.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141312002","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":"Comparison of interventional treatment options for coronary calcified nodules: A sub-analysis of the ROTA.shock trial","authors":"Florian Blachutzik ,&nbsp;Sophie Meier ,&nbsp;Melissa Blachutzik ,&nbsp;Sophia Schlattner ,&nbsp;Tommaso Gori ,&nbsp;Helen Ullrich-Daub ,&nbsp;Luise Gaede ,&nbsp;Stephan Achenbach ,&nbsp;Helge Möllmann ,&nbsp;Bogdan Chitic ,&nbsp;Adem Aksoy ,&nbsp;Georg Nickenig ,&nbsp;Maren Weferling ,&nbsp;Oliver Dörr ,&nbsp;Niklas Boeder ,&nbsp;Matthias Bayer ,&nbsp;Christian Hamm ,&nbsp;Holger Nef ,&nbsp;ROTA.shock Investigators","doi":"10.1016/j.carrev.2024.05.030","DOIUrl":"10.1016/j.carrev.2024.05.030","url":null,"abstract":"<div><h3>Background</h3><div>The optimal treatment for coronary calcified nodules (CNs) is still unclear. The aim of this study was to compare the modification of these lesions by coronary intravascular lithotripsy (IVL) and rotational atherectomy (RA) using optical coherence tomography (OCT).</div></div><div><h3>Methods</h3><div>ROTA.shock was a 1:1 randomized, prospective, double-arm multi-center non-inferiority trial that compared the use of IVL and RA with percutaneous coronary intervention (PCI) in severely calcified lesions. In 19 of the patients out of this study CNs were detected by OCT in the target lesion and were treated by either IVL or RA.</div></div><div><h3>Results</h3><div>The mean angle of CNs was significantly larger in final OCT scans than before RA (92 ± 17° vs. 68 ± 7°; <em>p</em> = 0.01) and IVL (89 ± 18° vs. 60 ± 10°; <em>p</em> = 0.03). The CNs were thinner upon final scans than in initial native scans (RA: 17.8 ± 7.8 mm vs. 38.6 ± 13.1 mm; <em>p</em> = 0.02; IVL: 16.5 ± 9.0 mm vs. 37.2 ± 14.3 mm; p = 0.02). Nodule volume did not differ significantly between native and final OCT scans (RA: 0.66 ± 0.12 mm³ vs. 0.61 ± 0.33 mm³; <em>p</em> = 0.68; IVL: 0.64 ± 0.19 mm³ vs. 0.68 ± 0.22 mm³; <em>p</em> = 0.74). Final stent eccentricity was high with 0.62 ± 0.10 after RA and 0.61 ± 0.09 after IVL.</div></div><div><h3>Conclusion</h3><div>RA or IVL are unable to reduce the volume of the calcified plaque. CN modulation seems to be mainly induced by the stent implantation and not by RA or IVL.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"68 ","pages":"Pages 37-42"},"PeriodicalIF":1.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141142530","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":"Geographical and socioeconomic disparities in post-transcatheter aortic valve replacement pacemaker placement","authors":"Bilal Hussain ,&nbsp;Sanchit Duhan ,&nbsp;Ahmed Mahmood ,&nbsp;Luay Al-Alawi ,&nbsp;Mian Muhammad Salman Aslam ,&nbsp;Christel Cuevas ,&nbsp;Thomas Alexander ,&nbsp;Mohammad M. Ansari ,&nbsp;Fahad Waqar","doi":"10.1016/j.carrev.2024.04.010","DOIUrl":"10.1016/j.carrev.2024.04.010","url":null,"abstract":"<div><h3>Introduction</h3><div>Pacemaker (PPM) implantation is indicated for conduction abnormalities which can develop post-transcatheter aortic valve replacement (TAVR). However, whether post-TAVR PPM<span> risk is associated with the geographical location of the hospital and socioeconomic status of the patient is not well established. Our goal was to explore geographical and socioeconomic disparities in post-TAVR PPM implantation.</span></div></div><div><h3>Methods</h3><div><span>A retrospective cohort analysis was conducted using the National Inpatient Sample 2016–2020 with respective ICD-10 codes for TAVR and PPM implantation. A weighted multivariate </span>logistic regression model was used to analyze prognostic outcomes.</div></div><div><h3>Results</h3><div>The number of patients hospitalized for undergoing TAVR was 296,740, out of which 28,265 patients had PPM implantation (prevalence 9.5 %). Patients' demographics including sex, ethnicity, household income, and insurance were not associated with risk of post-TAVR PPM except age (OR 1.01, CI 1.07–12.5, p &lt; 0.001). Compared to rural hospitals, urban non-teaching hospitals were associated with a higher risk of post-TAVR PPM (OR 2.09, 1.3–3.43, p = 0.003). Compared to New England hospitals (ME, NH, VT, MA, RI, CT), middle Atlantic hospitals (NY, NJ, PA) were associated with highest post-TAVR PPM risk (OR 1.54, CI 1.2–1.98, p &lt; 0.001), followed by Pacific (AK, WA, OR, CA, HI), mountain (ID, MT, WY, NV, UT, CO, AZ, NM) and east north central US.</div></div><div><h3>Conclusion</h3><div>Patients' demographics including sex, ethnicity, household income, and insurance were not associated with the risk of post-TAVR PPM except for age. Compared to New England hospitals, Middle Atlantic hospitals were associated with the highest post-TAVR PPM risk followed by Pacific, Mountain, and East North Central US. Prospective studies with data on TAVR wait times, expertise of the interventional staff, and post-TAVR management and discharge planning are required to further explore the observed regional distribution of TAVR outcomes.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"68 ","pages":"Pages 86-91"},"PeriodicalIF":1.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140852972","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":"In-hospital outcomes with extracorporeal membrane oxygenation alone versus combined with percutaneous left ventricular assist device","authors":"Fatima Lakhani ,&nbsp;Bertrand Ebner ,&nbsp;Crystal Lihong Yan ,&nbsp;Sukhpreet Kaur ,&nbsp;Rosario Colombo ,&nbsp;Mrudula Munagala","doi":"10.1016/j.carrev.2024.04.024","DOIUrl":"10.1016/j.carrev.2024.04.024","url":null,"abstract":"<div><h3>Background</h3><div><span><span>Veno-arterial extracorporeal membrane oxygenation (ECMO) is associated with increased afterload and hindered myocardial recovery. Adding a percutaneous </span>left ventricular assist device<span> (pLVAD) to ECMO is one strategy to unload the left ventricle. We evaluated in-hospital outcomes in </span></span>cardiogenic shock patients treated with ECMO alone versus ECMO plus pLVAD.</div></div><div><h3>Methods</h3><div>We conducted a retrospective study using the National Inpatient Sample database from 2011 to 2019. Logistic regression analysis was performed to adjust for covariates.</div></div><div><h3>Results</h3><div><span>20,171 patients were included. 16,064 (79.6 %) patients received ECMO alone and 4107 (20.4 %) patients received ECMO plus pLVAD. The ECMO plus pLVAD group had higher rates of mortality, stroke, acute kidney injury<span>, pericardial complications, and vascular complications. After adjusting for covariates, combined therapy was associated with higher rates of mortality (OR 1.2; 95 % CI [1.1–1.3]) and stroke (OR 1.3; 95 % CI [1.2–1.5]), however lower bleeding (OR 0.7; 95 % CI [0.68–0.81]) (</span></span><em>p</em><span> &lt; 0.001 for all). After adjusting for covariates, a subgroup analysis of 5019 patients with acute coronary syndrome cardiogenic shock (ACS-CS) demonstrated higher rates of mortality (OR 1.3; 95 % CI [1.2–1.5]) and stroke (OR 1.7; 95 % CI [1.4–2.1]; </span><em>p</em> &lt; 0.001 for all) with combined therapy, however similar rates of bleeding compared to ECMO alone (OR 0.95; 95 % CI [0.8–1.1]; <em>p</em> = 0.54).</div></div><div><h3>Conclusions</h3><div>In the overall group, ECMO plus pLVAD was associated with increased mortality and stroke, however decreased bleeding. In a sub-group of ACS-CS, ECMO plus pLVAD was associated with increased mortality and stroke, however similar rates of bleeding compared to ECMO alone.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"68 ","pages":"Pages 50-54"},"PeriodicalIF":1.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140874902","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 imprecision of measuring activated clotting time (ACT) from the guiding catheter during percutaneous coronary interventions","authors":"Aviv Y. Pollak ,&nbsp;Ofer M. Kobo ,&nbsp;Gilad Margolis,&nbsp;Majdi Saada,&nbsp;Erick Sanchez-Jimenez,&nbsp;Rami Abu Fanne,&nbsp;Yaniv Levi,&nbsp;Maguli Barel,&nbsp;Adeeb Abu-Akel,&nbsp;Ariel Roguin","doi":"10.1016/j.carrev.2024.05.006","DOIUrl":"10.1016/j.carrev.2024.05.006","url":null,"abstract":"<div><h3>Background</h3><div><span><span>Finding the balance between the reduction in ischemic events and bleeding complications is crucial for the success of </span>percutaneous coronary intervention<span> (PCI). The activated clotting time (ACT) is used routinely worldwide to monitor and titrate </span></span>anticoagulation therapy with unfractionated heparin (UFH) during the procedure.</div></div><div><h3>Objectives</h3><div>We aimed to test the accuracy of ACT measurements from the guiding catheter compared to the arterial access sheath.</div></div><div><h3>Methods</h3><div>Patients undergoing PCI with UFH therapy were prospectively enrolled. Blood samples were drawn from the coronary guide catheter and the arterial access sheath. ACT values were determined in the same ACT machine, and potential interactions with clinical variables were analyzed.</div></div><div><h3>Results</h3><div>The study included 331 patients with post PCI ACT measurements. The mean ACT value of the catheter samples was statistically higher than the arterial access sample [294 ± 77 s Vs. 250 ± 60 s, <em>p</em><span> &lt; 0.001]. The mean difference between the guiding catheter and the arterial line sheath samples was 43 ± 27 s (</span><em>P</em> &lt; 0.001). We found that in 101/331 [30 %] patients the ACT from the guiding catheter was above 250 s, while from the access sheath it was below 250 s. Notably, in 40/331 [12 %] the ACT from the guiding catheter was above 200 s, while from the access sheath it was below 200 s.</div></div><div><h3>Conclusions</h3><div>Large proportion of patient may be considered to have therapeutic ACT if measured from guide catheter during PCI, while the corresponding ACT from arterial sheath is subtherapeutic. This difference may have clinical and safety significance.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"68 ","pages":"Pages 98-100"},"PeriodicalIF":1.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140898272","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":"Prevalence of rheumatic heart disease diagnosed according to the echocardiographic criteria of the World Heart Federation in Africa: A systematic review and meta-analysis","authors":"Humberto Morais ,&nbsp;Hilaryano da Silva Ferreira","doi":"10.1016/j.carrev.2024.05.025","DOIUrl":"10.1016/j.carrev.2024.05.025","url":null,"abstract":"<div><div>Rheumatic heart disease (RHD) is a chronic complication arising from acute rheumatic fever (ARF), an autoimmune response triggered by group A streptococcal infection. It primarily affects children and young adults in developing countries. RHD continues to show substantial global heterogeneity. Socioeconomic factors lead the virtual disappearance of RHD in industrialized countries with the introduction of penicillin. By contrast, RHD is still endemic in Africa, Asia, South America, and developing communities of Australasia. We provide an estimate of the current prevalence of latent RHD in Africa using the echocardiographic diagnostic criteria of the World Heart Federation (WHF). Systematic review and meta-analysis of 21 studies reporting the prevalence of RHD, encompassing 40.639 patients. Estimated prevalence of RHD was 25.5 cases per 1000 population (<em>P</em> ≤0.02; 95 % CI, 18.1–32.9 per 1000): definite RHD 13.1 cases per 1000 population (95 % CI, 7.7–18.5 per 1000): and borderline 12,4 cases per 1000 population (95 % CI, 7.7–17.0 per 1000). The prevalence of definite RHD was a significantly higher in adults (M = 28.2, SD = 6.1) compared to children (M = 10.3, SD = 9.2), <em>t</em>(17) = 2.6, <em>p</em> = .0179. Prevalence of definite RHD in schools was 7,92 cases per 1000 population (95 % CI, 4,49–11,35 per 1000) and in community was 26,17 cases per 1000 population (95 % CI, 12,27–40,06 per 1000). This meta-analysis may have produced a better estimate of the prevalence of RHD in Africa using only studies performed according to the 2012 WHF, and clearly showed the high prevalence of RHD in the community and in adults.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"68 ","pages":"Pages 73-78"},"PeriodicalIF":1.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141082592","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}