Archives of Cardiovascular Diseases最新文献

{"title":"Index","authors":"","doi":"10.1016/S1875-2136(24)00303-6","DOIUrl":"10.1016/S1875-2136(24)00303-6","url":null,"abstract":"","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1875213624003036/pdfft?md5=2420df5ac8514b478f95ab8413d6d6ef&pid=1-s2.0-S1875213624003036-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142271154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The pre-Fontan cyanosis period: Key factor in post-Fontan exercise cardiac output in young patients","authors":"P. David ,&nbsp;A.S. Chaussade ,&nbsp;L. Iserin ,&nbsp;S. Malekzadeh-Milani ,&nbsp;F. Bajolle ,&nbsp;D. Bonnet ,&nbsp;D. Khraiche ,&nbsp;A. Legendre","doi":"10.1016/j.acvd.2024.07.008","DOIUrl":"10.1016/j.acvd.2024.07.008","url":null,"abstract":"<div><h3>Background</h3><p>Most patients with Fontan circulation struggle to increase cardiac output during exercise affecting aerobic capacity, response to training and quality of life. This poor cardiac performance affects their aerobic capacity, their response to training and their quality of life. We sought to identify the pre-Fontan and managerial factors that influence their exercise cardiac performance.</p></div><div><h3>Methods</h3><p>We retrospectively collected pre and post-Fontan anatomical, anamnestic and hemodynamic data in 57 consecutive young Fontan patients (median age 14.7 years) who underwent cardiopulmonary exercise test. We studied their exercise cardiac performance using a thoracic bioelectrical impedance device that allows measurement of the peak cardiac index (pCI).</p></div><div><h3>Results</h3><p>The median age at Fontan was 6.4<!--> <!-->±<!--> <!-->3 years. In multivariable models, pCI was negatively influenced by cyanosis duration (B<!--> <!-->=<!--> <!-->−0.240; <em>P</em> <!-->=<!--> <!-->0.0002). Peak indexed stroke volume (pSVi) was negatively influenced by Norwood procedure (B<!--> <!-->=<!--> <!-->-8.415; <em>P</em> <!-->=<!--> <!-->0.005) and cyanosis duration (B<!--> <!-->=<!--> <!-->−1.591; <em>P</em> <!-->=<!--> <!-->0.0002) and peak heart rate (pHR) by pre-Fontan peripheral oxygen saturation (B<!--> <!-->=<!--> <!-->0.602 <em>P</em> <!-->=<!--> <!-->0.009). Cyanosis duration<!--> <!-->≤<!--> <!-->6.9 years predicted a pSVi<!--> <!-->≥<!--> <!-->45 mL/m2 (AUC<!--> <!-->=<!--> <!-->0.747; <em>P</em> <!-->=<!--> <!-->0.001). Furthermore, pSVi and pHR were correlated with post-Fontan ventricular filling pressure (post-VFP) (respectively rp<!--> <!-->=<!--> <!-->−0.539, p<!--> <!-->=<!--> <!-->0.012 and rp<!--> <!-->=<!--> <!-->−0.552; <em>P</em> <!-->=<!--> <!-->0.010) and post-VFP was correlated with bidirectional cavopulmonary shunt duration (rs<!--> <!-->=<!--> <!-->0.498, <em>P</em> <!-->=<!--> <!-->0.023).</p></div><div><h3>Conclusion</h3><p>In young Fontan patients, the duration of cyanosis and low peripheral oxygen saturation prior to the Fontan procedure affect both components of cardiac exercise performance probably through increased ventricular filling pressure. Shortening the duration of cyanosis could help preserve cardiac performance in the long term.</p></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142271091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Which classification best predicts functional prognosis in children with congenital heart disease?","authors":"A. Gavotto ,&nbsp;P. Amedro ,&nbsp;I. Ouhab ,&nbsp;S. Guillaumont ,&nbsp;I. Liard ,&nbsp;H. Huguet ,&nbsp;M.C. Picot","doi":"10.1016/j.acvd.2024.07.010","DOIUrl":"10.1016/j.acvd.2024.07.010","url":null,"abstract":"<div><h3>Introduction</h3><p>Despite these advances in paediatric cardiology, the stratification of CHD severity using a simple and reproducible classification has not been established, as can be the NYHA functional class in adult heart failure. Various CHD classifications have been used in CHD, focusing on anatomical lesions, complexity of care, or physiological status, but their prognostic value has not been determined.</p></div><div><h3>Objective</h3><p>We aimed to compare the accuracy of the main existing CHD classifications (Uzark, Stout and Bethesda classifications), in the prediction of functional status in children with CHD, as determined by cardiopulmonary fitness.</p></div><div><h3>Methods</h3><p>Longitudinal cohort study.</p></div><div><h3>Results</h3><p>The CHD population having had 2 CPET included 296 subjects (<em>n</em> <!-->=<!--> <!-->129 female). The time between the first (T1) and second CPET (T2) assessments was 4.1<!--> <!-->±<!--> <!-->1.6<!--> <!-->years. The performance of classifications according to VO₂max at T1 was better for Uzark classification. The VO₂max Z-score decreased significantly according to the severity group (groups 1 and 2<!--> <!-->&gt;<!--> <!-->group 3<!--> <!-->&gt;<!--> <!-->group 4) and group 4 had a significant VO₂max decrease of −6.68 [−10.69; −2.67] mL/kg/min compared to group 1. The prediction of classifications at T2 according to VO₂max was better for Uzark classification with AUC values of 0.62 [0.55–0.69], compared to 0.59 [0.51–0.66] for Stout and 0.55 [0.48–0.62] for Bethesda (<span><span>Fig. 1</span></span>).</p></div><div><h3>Conclusion</h3><p>Among the existing cardiovascular risk classifications for CHD, the Uzark classification appeared to be the most reliable for discriminating the severity of CHD according to exercise capacity and for predicting the VO₂max impairment than the other classifications tested. This longitudinal study also showed the continued decline in exercise capacity, whatever the CHD, and recalls the interest of regular monitoring to offer care adapted to these patients (such as rehabilitation programs) for primary prevention of the added cardiovascular risks of adulthood.</p></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142271092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A 3D analysis of ventricle position in patients with heterotaxy shows high frequency of ventricle malposition in D-Loop hearts","authors":"D. Madec ,&nbsp;S. Bernheim ,&nbsp;A. Desgrange ,&nbsp;N. Boddaert ,&nbsp;O. Raisky","doi":"10.1016/j.acvd.2024.07.014","DOIUrl":"10.1016/j.acvd.2024.07.014","url":null,"abstract":"<div><h3>Introduction</h3><p>Congenital heart defects in the context of heterotaxy are severe, with a complex anatomy. These defects are described using the binary concept of clinical loop (D-Loop or L-Loop), which implies that ventricle position is determined during heart looping. Recent work in the mouse has shown unexpected plasticity of ventricle position after heart looping. Based on a analysis of Nodal mutants with heterotaxy and right bronchus isomerism, 27% of D-Loop mutants at birth underwent leftward embryonic heart looping. These mice with a revertant loop, all display abnormal ventricle position.</p></div><div><h3>Objective</h3><p>Analysis of 3D ventricle position in human patients with heterotaxy and right bronchus isomerism, using the strategy developed in the mouse based on the 3D orientation of the interventricular septum.</p></div><div><h3>Methods</h3><p>Constitution of an heterotaxy cohort from the Necker database. Controls were selected as patients with transposition of the great arteries who had a systematic CT scan at 6 years. Three dimensions reconstructions of CT scans and quantitative analyses were performed using the Imaris software.</p></div><div><h3>Expected results</h3><p>Control patients had their right ventricle-left ventricle axis in the expected anteroposterior and left-right orientation. We collected 506 patients with heterotaxy syndrome, 186 of whom had CT scan. Forty patients had right bronchial isomerism. Among them, we found 29 (72%) patients who had an orientation of the interventricular septal axis similar to control, 7 (18%) patients with abnormal supero-inferior ventricles and 4 (10%) patients with abnormal left-right ventricles (<span><span>Fig. 1</span></span>). In total, 32% of patients in D-Loop have a malpositioned interventricular septum whereas 0 of patients in L-Loop.</p></div><div><h3>Perspectives</h3><p>There is a high proportion of malpositioned ventricles in patients with D-Loop (32%), similar to what is observed in Nodal mouse mutants. This result supports conserved mechanisms in the mouse and human, including plasticity of ventricle position after heart looping.</p></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142271096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulmonary pressure in the first twelve-months of live: What should we expect?","authors":"A. Callegari,&nbsp;J. Grynblat,&nbsp;M. Mathilde,&nbsp;I. Szezepanski,&nbsp;S. Malekzadeh-Milani,&nbsp;D. Bonnet","doi":"10.1016/j.acvd.2024.07.003","DOIUrl":"10.1016/j.acvd.2024.07.003","url":null,"abstract":"<div><h3>Introduction</h3><p>Mean pulmonary artery pressure (mPAP)<!--> <!-->≥<!--> <!-->20<!--> <!-->mmHg defines pulmonary hypertension (PH).</p></div><div><h3>Objective</h3><p>Critically evaluate this cut-off in very young patients.</p></div><div><h3>Methods</h3><p>In total, 1129 consecutive patients had a reliable mPAP measurement between 1–12<!--> <!-->months of life. These invasive measurements and their clinical history were reviewed.</p></div><div><h3>Results</h3><p>Age was mean<!--> <!-->±<!--> <!-->SD 158<!--> <!-->±<!--> <!-->100<!--> <!-->days, weight 5.5<!--> <!-->±<!--> <!-->1.9<!--> <!-->kg. Patients with a palliated single ventricle anatomy 129/1129, peripheral PA-branch stenosis or MAPCAs 45/1129, PA-banding for open shunt 30/1129, or severe RVOTO 185/1129 were excluded. Of the remaining 726 patients 163/726 (22%) had mPAP<!--> <!-->&lt;<!--> <!-->20<!--> <!-->mmHg while 563 (78%) had PH with mPAP<!--> <!-->≥<!--> <!-->20<!--> <!-->mmHg.</p><p>Overall, PH at TTE was the reason for invasive mPAP measurement in 236 patients and only 16/236 patients (7%) had a mPAP<!--> <!-->&lt;<!--> <!-->20<!--> <!-->mmHg but 12/16 (75%) had a mPAP<!--> <!-->≥<!--> <!-->18<!--> <!-->mmHg. In the group with mPAP<!--> <!-->≥<!--> <!-->20<!--> <!-->mmHg PH persisted at 6-months in 109/236 (46%) (<span><span>Fig. 1</span></span>A) and in 68/236 (28%) at long-term follow-up (<span><span>Fig. 1</span></span>B). In the group with mPAP between 18 and 20<!--> <!-->mmHg PH persisted at 6-months in 9/12 (75%) and in 3/12 (25%) at long-term follow-up. None of the patients with mPAP<!--> <!-->&lt;<!--> <!-->18<!--> <!-->mmHg had PH at follow-up.</p><p>In patients with less than 3<!--> <!-->months of age, PH at TTE was the reason for invasive mPAP measurement in 73/306 (23%) and only 3/73 patients (4%) had a mPAP<!--> <!-->&lt;<!--> <!-->20<!--> <!-->mmHg, but 2/3 (75%) had a mPAP<!--> <!-->≥<!--> <!-->18<!--> <!-->mmHg. In the group with mPAP<!--> <!-->≥<!--> <!-->20<!--> <!-->mmHg PH persisted at 6-months in 34/70 (48%) (<span><span>Fig. 2</span></span>A) and in 34/70 (48%) at long-term follow-up (<span><span>Fig. 2</span></span>B). In the group with mPAP between 18 and 20<!--> <!-->mmHg PH persisted at 6-months in 2/2 (100%) and in 2/2 (100%) at long-term follow-up. None of those with mPAP<!--> <!-->&lt;<!--> <!-->18<!--> <!-->mmHg had PH at follow-up.</p></div><div><h3>Conclusion</h3><p>Pulmonary hypertension defined by mPAP<!--> <!-->≥<!--> <!-->20<!--> <!-->mmHg is very common in this cohort of young patients, especially in case of suspected PH at echo. A different cut-off defined as 18<!--> <!-->mmHg should be discussed in patients with less than 12-months.</p></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142271232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Infant mitral valve surgery: Comparison between valvuloplasty and replacement","authors":"S. Bernheim,&nbsp;M. Pontailler,&nbsp;A. Haydar,&nbsp;D. Bonnet,&nbsp;O. Raisky","doi":"10.1016/j.acvd.2024.07.005","DOIUrl":"10.1016/j.acvd.2024.07.005","url":null,"abstract":"<div><h3>Introduction</h3><p>Mitral valve replacement in infants is associated with high mortality and a significant rate of re-intervention. There is limited research examining the long-term consequences of valvuloplasty in this particular age group.</p></div><div><h3>Objective</h3><p>Evaluate patient outcomes with mitral disease (stenosis, regurgitation or both) who had mitral valvuloplasty or replacement in the first year of life.</p></div><div><h3>Methods</h3><p>Descriptive monocentric retrospective study including all children with mitral valve repair or replacement under 1<!--> <!-->year of age over a period of 22<!--> <!-->years (2001–2023). The outcomes assessed were: early mortality (at 30<!--> <!-->days), late mortality, need for re-intervention.</p></div><div><h3>Results</h3><p>Fifty-six patients were identified. Median age at surgery was 147<!--> <!-->days and median weight was 5.1<!--> <!-->kg. Thirty-nine patients underwent mitral valve repair and 17 mitral valve replacement. Mean duration of ICU stay was 7<!--> <!-->days. Overall median hospital stay was 11<!--> <!-->days. Mortality rate was 17.9% (7.1% before discharge). Overall survival was 96% at 30<!--> <!-->days, 86% at 1<!--> <!-->year 82% at 3<!--> <!-->years. Overall survival was significantly higher in patient with mitral valve repair compared to mitral valve replacement (<em>P</em> <!-->=<!--> <!-->0.039). The only mortality risk factor identified was replacement of the mitral valve compare to repair, HR: 9 (1.3–94.8; <em>P</em> <!-->=<!--> <!-->0.038). Twenty-three patients (41.1%) needed re-intervention. The re-intervention free survival rate after repair was 81% at 1<!--> <!-->year; 65% at 5<!--> <!-->years and 46% at 10<!--> <!-->years. The re-intervention free survival rate after replacement was 74% at 1<!--> <!-->year; 55% at 5 and 10<!--> <!-->years. A log-rank test showed no difference in re-intervention free survival between mitral valve repair or replacement.</p></div><div><h3>Conclusion</h3><p>Mitral valve surgery in infants carries particularly high risks and is associated with a high rate of re-interventions. While mitral valvuloplasty demonstrates superior outcomes in term of mortality, it frequently serves as a temporary measure, postponing the need for valve replacement.</p></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142271234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of 3D echocardiography-derived stroke volume ratio with VTI method: A correlation study","authors":"P. Pyra,&nbsp;C. Karsenty,&nbsp;K. Hadeed,&nbsp;Y. Dulac,&nbsp;A. Guitarte,&nbsp;P. Acar","doi":"10.1016/j.acvd.2024.07.044","DOIUrl":"10.1016/j.acvd.2024.07.044","url":null,"abstract":"<div><h3>Introduction</h3><p>Quantification of the pulmonary-to-systemic flow ratio (Qp:Qs) or stroke volume is important in assessing cardiac shunts or regurgitations. While the echocardiography velocity time integral (VTI) method is routinely used, 3D echocardiography offers another non-invasive alternative.</p></div><div><h3>Objective</h3><p>This study aims to correlate stroke volume ratios derived from 3D echocardiography with those obtained by conventional method.</p></div><div><h3>Methods</h3><p>We prospectively included patients with various cardiac conditions and without systemic valve stenosis or atrioventricular regurgitation who underwent conventional echocardiography with 3D acquisitions (4D auto RVQ and LVQ, GE Healthcare) for ratio assessment.</p></div><div><h3>Results</h3><p>Thirty-five patients with a mean age of 7.9<!--> <!-->years old (range: 1.1–16.9) were included, 16 patients with shunt and 19 normal patients. The correlation coefficient between stroke volume ratios obtained by 3D echocardiography and VTI method was 0.876 (<em>P</em> <!-->&lt;<!--> <!-->0.001). The 3D Qp:Qs was closer to 1 in structurally normal hearts [0.99<!--> <!-->±<!--> <!-->0.04] than with the VTI method [1.08<!--> <!-->±<!--> <!-->0.23].</p></div><div><h3>Conclusion</h3><p>3D echocardiography demonstrates good correlation with VTI method in assessing stroke volume ratios, supporting its utility for evaluating cardiac shunts in situations where VTI calculation is not feasible or reliable (like shunts with pulmonary stenosis). Further studies are warranted to validate its use, particularly in comparison with Qp:Qs ratios derived from cardiac magnetic resonance imaging (MRI) and to explore its broader clinical applications.</p></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142271252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anatomic variability of tricuspid leaflets and right ventricle in Ebstein's anomaly: Anatomic and morphogenetic considerations","authors":"C. Huet,&nbsp;J. Karila-Cohen,&nbsp;B. Bessières,&nbsp;D. Bonnet,&nbsp;L. Houyel","doi":"10.1016/j.acvd.2024.07.039","DOIUrl":"10.1016/j.acvd.2024.07.039","url":null,"abstract":"<div><h3>Introduction</h3><p>Ebstein's anomaly of the tricuspid valve (TV) is a congenital cardiac malformation of the tricuspid valve (TV) and right ventricle (RV) characterized by downward displacement of the functional annulus usually involving septal and inferior leaflets. Ebstein's anatomical spectrum is highly variable. This anatomical study aimed to unravel the morphogenetic mechanisms underlying this variability.</p></div><div><h3>Methods</h3><p>Forty-two hearts exhibiting Ebstein anomaly from the Reference Center for Complex Congenital Heart Defects (CHD) collection were macroscopically analysed: 28 isolated and 14 associated with another CHD. Tricuspid leaflets, right ventricle (RV), and associated lesions were analysed. Measurements were related to fetal heart reference values according to gestational age. Specimens were classified depending on the distal insertion of the anterior leaflet: linear, hyphenated or focal.</p></div><div><h3>Results</h3><p>Among isolated Ebstein hearts, distal insertion of the anterior leaflet was linear in 36%, hyphenated in 29% and focal in 36%. Linear insertion was always associated with anterior TV orifice and absent inferior leaflet, with absent septal leaflet in 80%. Atrialisation (thin, paper-like, inferior RV wall) was found in 90% of the linear forms and 37.5% of the hyphenated forms, which were associated with various degrees of inferior and septal leaflets non-delaminationanomalies. In focal forms, only the septal leaflet was involved, and there was no atrialisation. Ventricular septal defect was found in 3 specimens, Uhl-like RV anterior wall in 2, including 1 with left ventricle non compaction. Associated Ebstein anomalies were predominantly found in pulmonary atresia with intact ventricular septum; there was no atrialisation and septal leaflet only was involved.</p></div><div><h3>Conclusion</h3><p>Ebstein anomaly corresponds to an arrest in TV development, early in linear forms, late in focal forms, intermediate in hyphenated forms. Atrialisation was always associated with absent inferior leaflet, underlining developmental interaction between endocardial cushions and myocardium at the RV inferior wall.</p></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142271253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"His bundle pacing versus left bundle branch area pacing in patients undergoing atrioventricular node ablation: A prospective and comparative study","authors":"","doi":"10.1016/j.acvd.2024.05.118","DOIUrl":"10.1016/j.acvd.2024.05.118","url":null,"abstract":"<div><h3>Background</h3><div>Pacemaker implantation combined with atrioventricular node ablation (AVNA) is a well-established strategy for uncontrolled atrial arrhythmias. Limited data are available regarding His bundle pacing (HBP) and left bundle branch area pacing (LBBAP) in this setting.</div></div><div><h3>Aim</h3><div>To compare the outcomes of HBP and LBBAP in patients undergoing pacemaker implantation combined with AVN in routine clinical practice.</div></div><div><h3>Methods</h3><div>We prospectively included all patients who underwent AVNA after successful conduction system pacing (CSP) in two hospitals between September 2017 and May 2023. The primary outcome was the 1-year composite of first episode of heart failure hospitalization, symptomatic atrioventricular node reconduction requiring a second AVNA procedure, lead revision or death from any cause.</div></div><div><h3>Results</h3><div>A total of 164 patients underwent AVNA following successful CSP (68 HBP and 96 LBBAP). Mean pacemaker implantation and AVNA procedure times were shorter in the LBBAP group than the HBP group (46<!--> <!-->±<!--> <!-->18 vs 59<!--> <!-->±<!--> <!-->23<!--> <!-->min; <em>P<!--> </em>&lt;<!--> <!-->0.001 and 31<!--> <!-->±<!--> <!-->12 v<em>s</em> 43<!--> <!-->±<!--> <!-->22<!--> <!-->min, respectively; <em>P<!--> </em>&lt;<!--> <!-->0.001). Complete atrioventricular block was more frequently obtained in the LBBAP group (88/96 patients [92%] vs 54/68 patients [79%]; <em>P</em> <!-->=<!--> <!-->0.04). One-year freedom from the composite outcome was more frequent in the LBBAP group (89.7% vs 72.9%; hazard ratio 0.32, 95% confidence interval 0.14<!--> <!-->−<!--> <!-->0.72; <em>P</em> <!-->=<!--> <!-->0.01). The strategy was similarly effective in both groups with a significant improvement in NYHA class and left ventricular ejection fraction. A secondary pacing threshold elevation &gt;1<!--> <!-->V occurred only in the HBP group (11%).</div></div><div><h3>Conclusion</h3><div>In this prospective, comparative study, LBBAP provided better 1-year outcomes than HBP.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141565225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accurate detection of atrioventricular septal defect (AVSD) in fetal ultrasound using artificial intelligence","authors":"B. Stos ,&nbsp;M. Lévy ,&nbsp;E. Héry ,&nbsp;I. Durand ,&nbsp;E. Askinazi ,&nbsp;V. Thorey ,&nbsp;M. De Boisredon ,&nbsp;C. Gardella","doi":"10.1016/j.acvd.2024.07.004","DOIUrl":"10.1016/j.acvd.2024.07.004","url":null,"abstract":"<div><h3>Introduction</h3><p>A deep neural network could accurately detect AVSD in 2nd trimester fetal heart ultrasound video clips.</p></div><div><h3>Objective</h3><p>AVSDs are often undetected before birth, with an impact on morbidity and mortality. In addition, detecting AVSD may allow diagnosing genetic disorders (such as Down syndrome), which are frequently associated.</p><p>Here, we aim at evaluating whether a deep neural network (DNN) could identify AVSD in 2nd trimester (2T) fetal ultrasound video clips.</p></div><div><h3>Methods</h3><p>Patients with single pregnancy who had an echocardiography performed at one center (18–25<!--> <!-->weeks GA) were included retrospectively starting from Jan 1, 2021. Based on clinical records, we included consecutive cases of partial or complete AVSD, and consecutive negative cases referred due to family history. This inclusion criterion was used for negative cases to be more representative of the general population, in a center with a high prevalence of CHD since it only receives patients referred for echocardiography.</p><p>Cases were reviewed by one of two fetal echocardiography experts to confirm that the presence or absence of AVSD was documented in at least one video clip. Patients with no such video clip were excluded.</p><p>The DNN takes as input all the recorded video clips of a given examination and outputs the absence or presence of AVSD, or an “inconclusive” output if its confidence is low. The DNN was trained to detect AVSD, as seen on the four-chamber view, on patients not included in the evaluation.</p></div><div><h3>Results</h3><p>We included 26 cases with AVSD and 129 cases without. The DNN achieved an AUC of 97.1%, a sensitivity of 86.4% (95% CI: 66.7–95.3) and a specificity of 95.2% (95% CI: 90.0–97.8), after excluding inconclusive diagnosis. The DNN predicted a conclusive diagnosis in 95.5% of cases (<span><span>Fig. 1</span></span>).</p></div><div><h3>Conclusion</h3><p>A DNN could accurately identify AVSD in 2T fetal echocardiography. These results establish the groundwork for efficient and accurate AI-assisted fetal ultrasound heart screening.</p></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142271233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}