Cardiovascular Revascularization Medicine最新文献

{"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}

{"title":"Is there additional value in adding Impella to veno-arterial extracorporeal membrane oxygenation in patients with cardiogenic shock?","authors":"Ilan Merdler ,&nbsp;Brian C. Case ,&nbsp;Mohit Pahuja ,&nbsp;Fatima Hayat ,&nbsp;Imad Isaac ,&nbsp;Ritika Gadodia ,&nbsp;Kalyan R. Chitturi ,&nbsp;Pavan K. Reddy ,&nbsp;Matteo Cellamare ,&nbsp;Itsik Ben-Dor ,&nbsp;Ron Waksman","doi":"10.1016/j.carrev.2024.05.018","DOIUrl":"10.1016/j.carrev.2024.05.018","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"68 ","pages":"Pages 101-103"},"PeriodicalIF":1.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141038906","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: Does revascularization in TAVR patients make a difference?","authors":"Morton J. Kern,&nbsp;Arnold H. Seto","doi":"10.1016/j.carrev.2024.05.016","DOIUrl":"10.1016/j.carrev.2024.05.016","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"68 ","pages":"Pages 15-16"},"PeriodicalIF":1.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141038023","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":"Do we still need intra-procedural TTE during Transcatheter aortic valve replacement? A high volume, single center experience","authors":"Yoav Niv Granot,&nbsp;Giulia Passaniti,&nbsp;Francesca Romana Prandi,&nbsp;Samin K. Sharma,&nbsp;Annapoorna Kini,&nbsp;Stamatios Lerakis","doi":"10.1016/j.carrev.2024.05.011","DOIUrl":"10.1016/j.carrev.2024.05.011","url":null,"abstract":"<div><h3>Background</h3><div><span>Transcatheter aortic valve implantation<span> (TAVI) has undergone significant advances in recent years, with the development of improved pre-planning tools and devices. These advances have led to a reduction in the rate of paravalvular leak (PVL), a complication that is associated with poor outcomes even when mild. As some centers around the world are moving to solely fluoroscopy-focused implantation, we aimed to describe the clinical impact of intra-procedural </span></span>transthoracic echocardiography (TTE) during TAVI in a high volume hospital.</div></div><div><h3>Methods</h3><div>Observational study during a 3-month period. A limited TTE examination was performed immediately after deployment to assess the existence of PVL and grade its severity. Complete TTE was performed a day after the procedure. In case of ≥mild PVL after valve deployment, a decision was made according to the severity of the PVL, patient anatomy and extent of annular calcification to preform balloon post-dilation. If done, an additional limited TTE was performed to assess possible complication and the degree of PVL post dilatation.</div></div><div><h3>Results</h3><div>115 patient were included in the study. Intra-procedural TTE identified 16 patients (14 %) with at least mild PVL, three of them with moderate (3 %). Post balloon dilatation was performed in 10 patients (9 % of the cohort) with significant improvement in the degree of PVL.</div></div><div><h3>Conclusion</h3><div>Intra-procedural TTE immediately after TAVI deployment can accurately identify PVL, allowing operators to perform post balloon dilatation with improvement in early echocardiographic results. Our findings support the routine use of TTE during procedures, without relying solely on fluoroscopy.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"68 ","pages":"Pages 1-5"},"PeriodicalIF":1.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140946217","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":"Navigating the evolving landscape of HFpEF management: A detailed look at key ACC/AHA/ESC guideline updates","authors":"Niyati Grewal ,&nbsp;Jaspreet Singh Grewal ,&nbsp;Mohammed Aldhaeefi ,&nbsp;Prafulla P. Mehrotra ,&nbsp;Urooj Fatima","doi":"10.1016/j.carrev.2024.04.004","DOIUrl":"10.1016/j.carrev.2024.04.004","url":null,"abstract":"<div><div><span>Heart failure, a growing concern in the United States, significantly impacts both morbidity and mortality. Classified by ejection fraction, </span>heart failure with preserved ejection fraction<span> (HFpEF) now accounts for half of all cases and is steadily rising. Unlike its counterpart, heart failure with reduced ejection fraction (HFrEF), HFpEF lacks clear management guidelines. Recognizing this critical gap, we aim to review existing recommendations and formulate effective management strategies for HFpEF.</span></div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"68 ","pages":"Pages 79-85"},"PeriodicalIF":1.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140870080","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 and cancer therapy-related cardiovascular toxicity","authors":"Kalyan R. Chitturi ,&nbsp;Sukhdeep Bhogal ,&nbsp;Seyed Ebrahim Kassaian ,&nbsp;Ilan Merdler ,&nbsp;Waiel Abusnina ,&nbsp;Abhishek Chaturvedi ,&nbsp;Itsik Ben-Dor ,&nbsp;Ron Waksman ,&nbsp;Brian C. Case ,&nbsp;Ana Barac ,&nbsp;Hayder D. Hashim","doi":"10.1016/j.carrev.2024.05.001","DOIUrl":"10.1016/j.carrev.2024.05.001","url":null,"abstract":"<div><h3>Background</h3><div><span><span>Coronary microvascular dysfunction (CMD) has been implicated as a potential mechanism in the </span>pathophysiology of different clinical presentations, including </span>ischemia<span><span><span> and no obstructive coronary artery disease (INOCA), myocardial infarction and nonobstructive </span>coronary arteries<span> (MINOCA), stress cardiomyopathy<span>, heart failure, and myocarditis. There are limited data about the role of CMD in cancer therapy-related </span></span></span>cardiovascular toxicities.</span></div></div><div><h3>Case presentations</h3><div><span>Four women with a diagnosis of active cancer receiving treatment who developed subsequent MINOCA or INOCA presented for cardiac catheterization. Upon </span>coronary angiography showing no obstructive coronary arteries, coronary function testing was performed to evaluate for CMD.</div></div><div><h3>Methods</h3><div>Coronary physiology was assessed measuring non-hyperemic (resting full-cycle ratio [RFR]) and hyperemic (fractional flow reserve [FFR]) indices using a physiologic pressure wire. The wire also measured coronary flow reserve<span> (CFR), index of microcirculatory resistance (IMR), and RFR using thermodilution technology. CMD was confirmed if the CFR was &lt;2.5 and the IMR was &gt;25.</span></div></div><div><h3>Results</h3><div>Among 4 patients with diagnosis of active cancer presenting with chest pain, there was no evidence of obstructive coronary artery disease, leading to separate diagnoses of INOCA, MINOCA, stress cardiomyopathy, and myocarditis. We found CMD in 2 patients (1 with INOCA and 1 with immune checkpoint inhibitor-related myocarditis).</div></div><div><h3>Conclusions</h3><div>CMD may play a role in cardiovascular toxicities. Further coronary physiology studies are needed to understand the mechanisms of cancer therapy-related cardiovascular toxicity and CMD, as well as optimal preventive and treatment options.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"68 ","pages":"Pages 45-49"},"PeriodicalIF":1.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141049848","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: Procedural echo in TAVR: Mandatory, optional or redundant?","authors":"Haim D. Danenberg","doi":"10.1016/j.carrev.2024.05.039","DOIUrl":"10.1016/j.carrev.2024.05.039","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"68 ","pages":"Pages 6-7"},"PeriodicalIF":1.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141277767","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":"Examining patient demographics and major adverse cardiac events following noncardiac surgery: Applying a health equity lens","authors":"Demian Herrera-Quiroz ,&nbsp;Bradford B. Smith ,&nbsp;Christopher Dodoo ,&nbsp;Michael J. Brown ,&nbsp;Sharonne N. Hayes ,&nbsp;Adam J. Milam","doi":"10.1016/j.carrev.2024.06.004","DOIUrl":"10.1016/j.carrev.2024.06.004","url":null,"abstract":"<div><h3>Background</h3><div><span>Major adverse cardiac events (MACE) are a major contributor to </span>postoperative complications. This study employed a health equity lens to examine rates of postoperative MACE by race and ethnicity.</div></div><div><h3>Methods</h3><div>This single-center, retrospective observational cohort study followed patients with and without pre-existing coronary artery<span> stents from 2008 to 2018 who underwent non-cardiac surgery. MACE was the primary outcome (death, acute MI<span>, repeated coronary revascularization, in-stent thrombosis) and self-reported race and ethnicity was the primary predictor. A propensity score model of a 1:1 cohort of non-Hispanic White (NHW) patients and all other racial and ethnic minority populations (Hispanic and Black) was used to compare the rate of perioperative MACE in this cohort.</span></span></div></div><div><h3>Results</h3><div>During the study period, 79,686 cases were included in the analytic sample; 950 patients (1.2 %) had pre-existing coronary artery stents. &lt;1 % of patients experienced MACE within 30 days following non-cardiac surgery (0.8 %). After confounder adjustment and propensity score matching, there were no statistically significant differences in MACE among racial and ethnic minority patients compared to NHW patients (OR = 0.77; 95 % CI: 0.48, 1.25). In our sensitivity analyses, stratifying by sex, there were no differences in MACE by race and ethnicity.</div></div><div><h3>Conclusions</h3><div>The study found no statistically significant differences in MACE by race and ethnicity among patients who underwent non-cardiac surgery. Access to a high-volume, high-quality hospital such as the one studied may reduce the presence of healthcare disparities and may explain why our findings are not consistent with previous studies.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"68 ","pages":"Pages 62-70"},"PeriodicalIF":1.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141321812","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}