Andreea Motoc, Jolien Kessels, Bram Roosens, Patrick Lacor, Nico Van de Veire, Johan De Sutter, Julien Magne, Steven Droogmans, Bernard Cosyns
{"title":"Impact of the initial clinical presentation on the outcome of patients with infective endocarditis.","authors":"Andreea Motoc, Jolien Kessels, Bram Roosens, Patrick Lacor, Nico Van de Veire, Johan De Sutter, Julien Magne, Steven Droogmans, Bernard Cosyns","doi":"10.5603/CJ.a2021.0075","DOIUrl":"https://doi.org/10.5603/CJ.a2021.0075","url":null,"abstract":"<p><strong>Background: </strong>Infective endocarditis (IE) is a life-threatening disease. Despite advancements in diagnostic methods, the initial clinical presentation of IE remains a valuable asset. Therefore, the impact of clinical presentation on outcomes and its association with microorganisms and IE localization were assessed herein.</p><p><strong>Methods: </strong>This retrospective study included 183 patients (age 68.9 ± 14.2 years old, 68.9% men) with definite IE at two tertiary care hospitals in Belgium. Demographic data, medical history, clinical presentation, blood cultures, imaging data and outcomes were recorded.</p><p><strong>Results: </strong>In-hospital mortality rate was 22.4%. Sixty (32.8%) patients developed embolism, 42 (23%) shock, and 103 (56.3%) underwent surgery during hospitalization. Shock at admission predicted embolism during hospitalization (odds ratio [OR] 2.631, 95% confidence interval [CI] 1.119-6.184, p = 0.027). A new cardiac murmur at admission predicted cardiac surgery (OR 1.949, 95% CI 1.007- -3.774, p = 0.048). Methicillin resistant Staphylococcus aureus predicted in-hospital mortality and shock (p = 0.005, OR 6.945, 95% CI 1.774-27.192 and p = 0.015, OR 4.691, 95% CI 1.348-16.322, respectively). Mitral valve and aortic valve IE predicted in-hospital death (p = 0.039, OR 2.258, 95% CI 1.043-4.888) and embolism (p = 0.017, OR 2.328, 95% CI 1.163-4.659), respectively.</p><p><strong>Conclusions: </strong>In this retrospective study, shock at admission independently predicted embolism during hospitalization in IE patients. Moreover, a new cardiac murmur at admission predicted the need for cardiac surgery. This emphasizes the importance of a comprehensive initial clinical evaluation in combination with imaging and microbiological data, in order to identify high-risk IE patients early.</p>","PeriodicalId":9492,"journal":{"name":"Cardiology journal","volume":"30 3","pages":"385-390"},"PeriodicalIF":2.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/45/88/cardj-30-3-385.PMC10287079.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9754916","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}
Cardiology journalPub Date : 2023-01-01Epub Date: 2021-10-21DOI: 10.5603/CJ.a2021.0128
Mohamed Ayoub, Peter Tajti, Miroslaw Ferenc, Ibrahim Akin, Michael Behnes, Franz-Josef Neumann, Kambis Mashayekhi
{"title":"Feasibility and outcome of the Rotapro system in treating severely calcified coronary lesions: The Rotapro study.","authors":"Mohamed Ayoub, Peter Tajti, Miroslaw Ferenc, Ibrahim Akin, Michael Behnes, Franz-Josef Neumann, Kambis Mashayekhi","doi":"10.5603/CJ.a2021.0128","DOIUrl":"10.5603/CJ.a2021.0128","url":null,"abstract":"Background The Rotapro study was conducted to evaluate the safety and feasibility of the new Rotapro rotational atherectomy system (RAS) for lesion preparation in calcified coronary artery stenosis. Methods Between 2015 and 2019 consecutive patients undergoing rotational atherectomy (RA) with the new Rotapro system and the conventional rotablator (Rotablator) were included from the Bad Krozingen Rotablation Registry. The primary endpoint was the incidence of in-hospital major adverse cardiovascular and cerebral event (MACCE) rate. Results Rotablation was performed in 3.6% of all patients (n = 597) treated by percutaneous coronary intervention. Procedural outcomes were compared according to the applied RAS (n = 246 Rotapro vs. n = 351 Rotablator). Overall technical success was achieved in 98.3% of patients. The primary endpoint of in-hospital MACCE was comparable between the Rotapro- and the Rotablator-group (3.7% vs. 5.7%, respectively, p = 0.254). The Rotapro group was associated with significant reductions of fluoroscopy time (30 vs. 38 min, p < 0.0001), procedural time (82.5 vs. 96 min, p = 0.0003), applied contrast volume (210 vs. 290 mL, p < 0.0001) and radiation dose (6129 vs. 9827 cGy*cm2, p < 0.0001) compared to the Rotablator group. Conclusions The present study demonstrates the safety and efficacy of the new Rotapro system. Inhospital MACCE rates were comparable between both RAS, whereas Rotapro was associated with less fluoroscopy time, radiation dose as well as contrast use.","PeriodicalId":9492,"journal":{"name":"Cardiology journal","volume":"30 4","pages":"526-533"},"PeriodicalIF":2.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/53/5d/cardj-30-4-526.PMC10508079.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10207537","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}
Cardiology journalPub Date : 2023-01-01Epub Date: 2021-09-28DOI: 10.5603/CJ.a2021.0105
Yaling Liu, Sheng Kang, Xiaolin Li, Zhongwen Liu, Yang Gao, Xiaodong Wang
{"title":"Modified ticagrelor loading doses according to the vasodilator-stimulated phosphoprotein phosphorylation index improve the clinical outcome in ST-elevation myocardial infarction patients with high on-treatment platelet reactivity.","authors":"Yaling Liu, Sheng Kang, Xiaolin Li, Zhongwen Liu, Yang Gao, Xiaodong Wang","doi":"10.5603/CJ.a2021.0105","DOIUrl":"10.5603/CJ.a2021.0105","url":null,"abstract":"<p><strong>Background: </strong>Current guidelines recommend a standard ticagrelor loading dose (LD) in ST-segment elevation myocardial infarction (STEMI) patients. However, antiplatelet therapy in STEMI patients at high risk of thrombotic events is suboptimal. The study was conducted to validate whether vasodilatorstimulated phosphoprotein (VASP)-guided ticagrelor dosing individual therapy may result in more effective platelet inhibition and better clinical outcomes.</p><p><strong>Methods: </strong>This trial included 374 STEMI patients with a low platelet response after ticagrelor LD. The patients were randomized into a control group and a VASP-guided group, where the ticagrelor pretreatment was individually adjusted before and after percutaneous coronary intervention (PCI) to obtain a VASP index < 50%. Up to 2 additional boluses of ticagrelor (every additional dosing was 90 mg) were prescribed after the first LD, and the VASP index was assessed 2 hours after each administration until a VASP index < 50% was obtained or up to 3 dosages (360 mg). The primary endpoint was major adverse cardiovascular events (MACEs) at 30 days. The secondary endpoints were thrombolysis in myocardial infarction (TIMI) major and minor bleeding.</p><p><strong>Results: </strong>The characteristics were similar in the two groups. After the ticagrelor doses increased, the platelet reactivity index (PRI) decreased, and 98.4% of patients reached PRI < 50% in the VASP-guided group. The adenosine concentration increased, and the rate of MACE was significantly lower in the VASP-guided group (10 [5.3%] vs. 20 [10.8%], hazard ratio 2.38, 95% confidence interval 1.21-3.28, p = 0.007). There were no major hemorrhagic complications (0 vs. 0, p = 1.0). The rate of minor bleeding in the VASP-guided group was higher than that in the control group, but the difference was not significant (24 [12.8%] vs. 16 [8.6%], p = 0.068).</p><p><strong>Conclusions: </strong>The incremental ticagrelor dosing strategy decreases the rate of MACE after PCI without increasing major and minor bleeding.</p>","PeriodicalId":9492,"journal":{"name":"Cardiology journal","volume":" ","pages":"771-780"},"PeriodicalIF":2.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10635729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39464520","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}
Cardiology journalPub Date : 2023-01-01Epub Date: 2021-12-21DOI: 10.5603/CJ.a2021.0171
Seok Oh, Ji Sung Kim, Youngkeun Ahn, Joon Ho Ahn, Dae Young Hyun, Seung Hun Lee, Kyung Hoon Cho, Min Chul Kim, Doo Sun Sim, Young Joon Hong, Ju Han Kim, Myung Ho Jeong
{"title":"Different outcomes between iso-osmolar and low-osmolar contrast media in acute myocardial infarction with renal impairment.","authors":"Seok Oh, Ji Sung Kim, Youngkeun Ahn, Joon Ho Ahn, Dae Young Hyun, Seung Hun Lee, Kyung Hoon Cho, Min Chul Kim, Doo Sun Sim, Young Joon Hong, Ju Han Kim, Myung Ho Jeong","doi":"10.5603/CJ.a2021.0171","DOIUrl":"10.5603/CJ.a2021.0171","url":null,"abstract":"<p><strong>Background: </strong>The selection of appropriate contrast media (CM) remains an important issue in terms of renal preservation in patients with acute myocardial infarction (AMI) and renal impairment scheduled for percutaneous coronary intervention (PCI). We compared the clinical outcomes of patients with AMI and renal impairment, depending on the CM type (iso-osmolar CM [IOCM] vs. low-osmolar CM [LOCM]) that was used during PCI.</p><p><strong>Methods: </strong>From the Convergent Registry of Catholic and Chonnam University for Acute Myocardial Infarction, 3174 post-PCI patients with AMI and renal impairment were subdivided into two groups (IOCM [n = 2101] and LOCM [n = 1073]).</p><p><strong>Results: </strong>Regarding in-hospital clinical outcomes, the IOCM group had a higher peak creatinine (Cr) level and lower \"Cr differential\" than the LOCM group. A higher proportion of dialysis was noted in the IOCM group. In 30-day clinical outcomes, the IOCM group showed higher incidence of new-onset heart failure (HF) but lower incidence of revascularization than the LOCM group. The differences in in-hospital and 30-day clinical outcomes were attenuated after inverse probability of treatment weighting, except for new-onset HF. All other variables in 30-day clinical outcomes, including all-cause death, non-fatal myocardial infarction, cerebrovascular accidents, stent thrombosis, and any dialysis events, were similar between the two groups.</p><p><strong>Conclusions: </strong>IOCM use did not prevent future incidence of dialysis compared to LOCM use in AMI patients with renal impairment.</p>","PeriodicalId":9492,"journal":{"name":"Cardiology journal","volume":" ","pages":"790-798"},"PeriodicalIF":2.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10635715/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39832335","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}
Aleksander Nowak, Jakub Ratajczak, Michał Kasprzak, Adam Sukiennik, Tomasz Fabiszak, Wojciech Wojakowski, Andrzej Ochała, Wojciech Wańha, Wacław Kuczmik, Eliano Pio Navarese, Jacek Kubica
{"title":"Long-term outcome of rotational atherectomy according to burr-to-artery ratio and changes in coronary artery blood flow: Observational analysis.","authors":"Aleksander Nowak, Jakub Ratajczak, Michał Kasprzak, Adam Sukiennik, Tomasz Fabiszak, Wojciech Wojakowski, Andrzej Ochała, Wojciech Wańha, Wacław Kuczmik, Eliano Pio Navarese, Jacek Kubica","doi":"10.5603/CJ.a2021.0082","DOIUrl":"https://doi.org/10.5603/CJ.a2021.0082","url":null,"abstract":"<p><strong>Background: </strong>Rotational atherectomy (RA) has been proven to be efficient for the treatment of calcified and diffuse coronary artery lesions. However, the optimal burr-to-artery ratio (BtAR) remains unidentified as well as an influence of change in blood flow on long-term outcome. Aim of our study was to examine the association between long-term outcome, and both BtAR and change in coronary flow during RA.</p><p><strong>Methods: </strong>We conducted a retrospective study including patients who underwent RA. Two independent observers calculated BtAR, pre- and postprocedural corrected Thrombolysis in Myocardial Infarction (TIMI) frame count (cTFC) for artery treated with RA. The long-term outcome was defined as all-cause mortality.</p><p><strong>Results: </strong>Receiver operating characteristic curve analysis of BtAR determined threshold of 0.6106 for all-cause mortality detection with sensitivity 50.0%, specificity 90.8%, and area under the curve 0.730 (p < 0.001). Kaplan-Meier survival analysis showed that the all-cause mortality rate in the group with the BtAR > 0.6106 is significantly higher compared to the patients with lower BtAR (hazard ratio [HR] 3.76, 95% confidence interval [CI] 1.51-9.32; p < 0.001). Kaplan-Meier survival analysis revealed that the all-cause mortality rate in the group with impairment in coronary flow was significantly higher compared to group with cTFC difference ≤ 0 after RA (HR 3.28, 95% CI 1.56-9.31; p = 0.02).</p><p><strong>Conclusions: </strong>Burr-to-artery ratio > 0.6106 is associated with worse prognosis of patients treated with RA. Patients showing post-RA impairment in blood flow in the target artery have worse prognosis.</p>","PeriodicalId":9492,"journal":{"name":"Cardiology journal","volume":"30 3","pages":"361-368"},"PeriodicalIF":2.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a6/71/cardj-30-3-361.PMC10287084.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9704758","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":"Impella-assisted intracoronary lithotripsy of heavily calcified left main lesion in a patient with severely impaired ejection fraction and the last remaining patent vessel.","authors":"Marta M Bujak, Paweł Gąsior, Wojciech Wojakowski","doi":"10.5603/CJ.2023.0040","DOIUrl":"https://doi.org/10.5603/CJ.2023.0040","url":null,"abstract":"A 56-year-old man with the last remaining patent vessel, heavily calcified significant left main (LM) stenosis (Fig. 1A) and chronic total occlu - sion of both right coronary artery and circumflex branch was referred to our institution for revas - cularization of the LM lesion. Patient was turned down from surgery due to severely impaired left ventricular ejection fraction (LVEF) of 12% and multiple comorbidities. Due to high surgical risk (EuroScore II of 23.05%), the decision to proceed with Impella-assisted revascularization was made. Calcified LM lesion was predilated with multiple non-compliant balloons (NCBs) (up to 4.0 mm) (Fig. 1B), however the full balloon expansion was","PeriodicalId":9492,"journal":{"name":"Cardiology journal","volume":"30 3","pages":"493-494"},"PeriodicalIF":2.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/78/8c/cardj-30-3-493.PMC10287076.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9711525","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":"Clinical features of ST-segment elevation myocardial infarction in young Chinese patients.","authors":"Yunjuan Sun, Jialiang Xu, Zhisong He, Xujie Cheng, Tingbo Jiang","doi":"10.5603/CJ.a2021.0059","DOIUrl":"10.5603/CJ.a2021.0059","url":null,"abstract":"<p><strong>Background: </strong>To investigate the clinical characteristics, angiographic findings and clinical outcomes (in-hospital) of young adults with acute myocardium infarction in a Chinese population.</p><p><strong>Methods: </strong>This was an observational study. Five hundred and forty-nine patients who suffered with ST-segment elevation myocardial infarction (STEMI) firstly between January 2013 and December 2015 were enrolled consecutively. All patients were divided into two groups: \"young group\" patients were ≤ 50 years old; and \"non-young group\" patients were > 50 years old. Clinical features were compared, angiographic findings and clinical outcomes were observed between the two groups.</p><p><strong>Results: </strong>There were 131 and 418 patients included in the young group and the non-young group, respectively. Twenty-eight patients suffered deaths during the hospital stay and only one death occurred in the young group. Compared with non-young group, the young group was associated with male, smoke, fewer chronic diseases, Killip class I on admission, lower level of N-terminal pro B-type natriuretic peptide (NT-proBNP), higher level of triglyceride and lower level of high-density lipoprotein cholesterol (HDL-C), single-vessel lesion and intracoronary thrombus (p < 0.005). The average length of hospital stay of non-young group was 1.5 days longer than the young group. Compared with the non-young group, the young group inclined not to use or use only one stent (p = 0.026). Multivariable logistic regression analysis showed that older age, shorter hospital stay, advanced Killip class III/IV, increased white blood cell and NT-proBNP were independent risk factors for survival in acute STEMI patients during hospitalization (p < 0.005).</p><p><strong>Conclusions: </strong>Compared with non-young group, the young group was associated with male, smoke, higher level of triglyceride and lower level of HDL-C. The condition of patients in young group were relatively mild and the risk of death during hospitalization was lower than the other group.</p>","PeriodicalId":9492,"journal":{"name":"Cardiology journal","volume":"30 4","pages":"627-635"},"PeriodicalIF":2.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/94/a7/cardj-30-4-627.PMC10508084.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10201885","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}
Cardiology journalPub Date : 2023-01-01Epub Date: 2023-07-04DOI: 10.5603/CJ.a2023.0043
Jacek Kubica, Piotr Adamski, Robert Gajda, Mariusz Gąsior, Marek Gierlotka, Robert Gil, Miłosz Jaguszewski, Aldona Kubica, Wiktor Kuliczkowski, Krzysztof Kurek, Jerzy Robert Ładny, Piotr Michalski, Eliano Pio Navarese, Piotr Niezgoda, Małgorzata Ostrowska, Agnieszka Tycińska