Cardiovascular diagnosis and therapy最新文献

{"title":"Superiority of coronary paclitaxel DCBs to limus DCBs in the late angiographic outcomes: the first meta-analysis showing the differences of coronary DCBs.","authors":"Kota Yamada, Tetsuya Ishikawa, Yohei Tamura, Isao Taguchi","doi":"10.21037/cdt-24-391","DOIUrl":"10.21037/cdt-24-391","url":null,"abstract":"","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"14 6","pages":"1025-1028"},"PeriodicalIF":2.1,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11707466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945370","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":"Automated volumetry of core and peel intrapulmonary vasculature on computed tomography angiography for non-invasive estimation of hemodynamics in patients with pulmonary hypertension (2022 updated hemodynamic definition).","authors":"Claudius Melzig, Oliver Weinheimer, Benjamin Egenlauf, Thuy D Do, Mark O Wielpütz, Ekkehard Grünig, Hans-Ulrich Kauczor, Claus Peter Heussel, Fabian Rengier","doi":"10.21037/cdt-24-293","DOIUrl":"10.21037/cdt-24-293","url":null,"abstract":"<p><strong>Background: </strong>Computed tomography pulmonary angiography (CTPA) is frequently performed in patients with pulmonary hypertension (PH) and may aid non-invasive estimation of pulmonary hemodynamics. We, therefore, investigated automated volumetry of intrapulmonary vasculature on CTPA, separated into core and peel fractions of the lung volume and its potential to differentially reflect pulmonary hemodynamics in patients with pre- and postcapillary PH.</p><p><strong>Methods: </strong>A retrospective case-control study of 72 consecutive patients with PH according to the 2022 joint guidelines of the European Society of Cardiology and the European Respiratory Society who underwent right heart catheterization (RHC) and CTPA within 7 days between August 2013 and February 2016 at Thoraxklinik at Heidelberg University Hospital (Heidelberg, Germany) was conducted. Vessel segmentation was performed using the in-house software YACTA. Vascular volumes in different core and peel fractions of the lung were corrected for body surface area. Spearman correlation coefficients with mean pulmonary arterial pressure (mPAP), pulmonary arterial wedge pressure (PAWP) and pulmonary vascular resistance (PVR) were calculated, and a linear regression analysis was done to account for potential confounders.</p><p><strong>Results: </strong>Median age of the study sample was 71.5 years [interquartile range (IQR), 60.0-77.0 years], 48 (66.67%) were female. Median mPAP was 35.5 mmHg (IQR, 27.0-47.2 mmHg). Postcapillary PH was present in 24/72 (33.3%) patients and precapillary PH in 48/72 (66.7%) patients. Moderate to strong correlations between core intrapulmonary vessel volumes and mPAP were observed in postcapillary PH patients with a maximum at 50% core lung volume (r=0.71, P<0.001). No significant influence of age or sex on this relationship was identified. Correlation with RHC measurements was weak or negligible in patients with precapillary PH.</p><p><strong>Conclusions: </strong>Automated volumetry of vessels in the core lung strongly correlated with mPAP in patients with postcapillary PH and has potential for non-invasive assessment of postcapillary PH in patients undergoing CTPA.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"14 6","pages":"1083-1095"},"PeriodicalIF":2.1,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11707475/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945158","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":"Three-dimensional speckle-tracking echocardiography-derived deformation analysis of the morphologic left ventricle in adults with corrected dextro-transposition of the great arteries-insights from the CSONGRAD Registry and MAGYAR-Path Study.","authors":"Árpád Kormányos, Nándor Gyenes, Zoltán Ruzsa, Alexandru Achim, Nóra Ambrus, Kálmán Havasi, Máté Vámos, Tamás Szili-Török, Csaba Lengyel, Attila Nemes","doi":"10.21037/cdt-24-266","DOIUrl":"10.21037/cdt-24-266","url":null,"abstract":"<p><strong>Background: </strong>Dextro-transposition of the great arteries (dTGA) stands out as a prevalent cyanotic congenital heart defect (CHD), characterized by an intricate reversal in the arrangement of the major arteries. In the past, several surgical procedures have been used to treat dTGA, including the atrial switch. Although the method is no longer used, survivors of the procedure still living among us. Recent advancements in cardiovascular imaging have led to the emergence of several novel echocardiographic techniques, notably three-dimensional (3D) and/or speckle-tracking echocardiography (STE). The present study aimed to employ 3DSTE to determine morphologic left ventricle (mLV) strain parameters in adults with dTGA who underwent Senning or Mustard procedure at infancy. Furthermore, it was also aimed to assess whether the type of correction procedure had any impact on mLV deformation parameters.</p><p><strong>Methods: </strong>Eleven dTGA patients, with a mean age of 28.8±8.5 years (6 males, 6 Senning- and 5 Mustard-operated patients) were enrolled. They were compared to 34 healthy controls matched for age and gender (age: 35.7±12.8 years, 21 males). All subjects underwent complete two-dimensional (2D) Doppler echocardiography with 3DSTE data acquisition as per recent guidelines.</p><p><strong>Results: </strong>Comparing all dTGA patients to the control group no mean segmental or global mLV strains showed significant differences, however out of the regional strains, midventricular mLV longitudinal strain was significantly better (higher) in dTGA compared to the healthy group (-16.8%±7.4% <i>vs.</i> -13.3%±2.5%, P<0.05). The Mustard-operated patients showed significantly worse (lower) global mLV circumferential strain compared to that of controls (-22.1%±12.4% <i>vs.</i> -28.9%±4.7%, P=0.05). Out of the regional strains the Mustard procedure group had a significantly worse (lower) apical mLV circumferential strain (-24.8%±11.9% <i>vs.</i> -35.6%±9.0%, P=0.05), better (higher) midventricular mLV longitudinal strain (-20.1%±9.2% <i>vs.</i> -13.3%±2.5%, P=0.04) and a worse (lower) apical mLV area strain (-36.3%±17.0% <i>vs.</i> -48.8%±9.7%, P=0.03).</p><p><strong>Conclusions: </strong>Significant mLV strain abnormalities are present in dTGA late after atrial switch procedures. These differences are more pronounced in the Mustard-operated group.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"14 6","pages":"1038-1047"},"PeriodicalIF":2.1,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11707480/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945374","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":"Predictive models of in-hospital deterioration of Society of Cardiovascular Angiography and Intervention shock stage in patients with acute myocardial infarction initially presenting with stable hemodynamic condition.","authors":"Takuto Mukaida, Yu Kataoka, Kota Murai, Kenichiro Sawada, Takamasa Iwai, Hideo Matama, Satoshi Honda, Masashi Fujino, Shuichi Yoneda, Kensuke Takagi, Kazuhiro Nakao, Fumiyuki Otsuka, Yoshio Tahara, Yasuhide Asaumi, Teruo Noguchi","doi":"10.21037/cdt-24-226","DOIUrl":"10.21037/cdt-24-226","url":null,"abstract":"<p><strong>Background: </strong>The Society of Cardiovascular Angiography and Intervention (SCAI) has defined 5 stages of cardiogenic shock (CS). In patients with acute myocardial infarction (AMI) who initially present in stable hemodynamic condition (SCAI CS stage: A or B), CS stages could deteriorate despite therapeutic management. However, deterioration of SCAI CS stages after AMI remains to be fully characterized. Therefore, the current study sought to investigate the frequency and clinical characteristics about deterioration of SCAI CS stages after AMI.</p><p><strong>Methods: </strong>We retrospectively analyzed 347 patients in a derivation cohort and 163 patients in a validation cohort who had AMI (SCAI shock stage upon arrival: A/B) and underwent percutaneous coronary intervention (PCI) at National Cerebral and Cardiovascular Center, Suita, Japan (enrolment period of study subjects: 2019.07.01-2022.09.30). Deterioration of CS (D-CS) was defined as SCAI shock stage C-E after PCI. Clinical characteristics and in-hospital mortality were compared according to D-CS status. Adjusted hazard ratios (HRs) for in-hospital mortality were calculated with multivariate Cox proportional hazards models that included variables with P<0.10 in univariate models. Uni- and multivariate logistic regression analyses were used to identify predictors of D-CS.</p><p><strong>Results: </strong>D-CS occurred in 17.3% (60/347) of the derivation cohort. Patients with D-CS had lower systolic blood pressure (BP) (P<0.001) and left ventricular ejection fraction (LVEF) (P<0.001) upon arrival with a higher proportion of initial Thrombolysis in Myocardial Infarction (TIMI) grade flow 0 or 1 (P=0.002). During hospitalization (13.9±9.4 days), D-CS was associated with higher in-hospital mortality [adjusted HR, 12.95; 95% confidence interval (CI): 1.46-114.97; P=0.02]. Initial systolic BP, LVEF, and TIMI grade flow 0 or 1 independently predicted D-CS. The D-CS risk score including these variables satisfactorily predicted D-CS [area under the curve (AUC), 0.749; 95% CI: 0.651-0.848] and in-hospital mortality (AUC, 0.961; 95% CI: 0.914-1.000) in the validation cohort.</p><p><strong>Conclusions: </strong>D-CS occurred in 17.3% of patients with AMI initially presenting in stable condition and increased the risk of in-hospital mortality. Our D-CS risk score (initial systolic BP, LVEF, and TIMI grade flow) could be helpful to predict D-CS.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"14 6","pages":"1148-1160"},"PeriodicalIF":2.1,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11707481/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945360","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 best devices for superficial femoral artery, with \"limited\" cases and vessel preparations.","authors":"Norihito Nakamura, Manabu Shiozaki, Sho Torii","doi":"10.21037/cdt-24-418","DOIUrl":"10.21037/cdt-24-418","url":null,"abstract":"","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"14 6","pages":"1003-1006"},"PeriodicalIF":2.1,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11707471/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945371","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":"A computer vision model for the identification and scoring of calcium in aortic valve stenosis: a single-center experience.","authors":"Tibor Poruban, Dominik Pella, Ingrid Schusterova, Marta Jakubova, Karolina Angela Sieradzka Uchnar, Marianna Barbierik Vachalcova","doi":"10.21037/cdt-24-179","DOIUrl":"10.21037/cdt-24-179","url":null,"abstract":"<p><strong>Background: </strong>Echocardiography is widely used to assess aortic stenosis (AS) but can yield inconsistent results, leading to uncertainty about AS severity and the need for further diagnostics. This retrospective study aimed to evaluate a novel echocardiography-based marker, the signal intensity coefficient (SIC), for its potential in accurately identifying and quantifying calcium in AS, enhancing noninvasive diagnostic methods.</p><p><strong>Methods: </strong>Between May 2022 and October 2023, 112 cases of AS that were previously considered severe by echocardiography were retrospectively evaluated, as well as a group of 50 cases of mild or moderate AS, both at the Eastern Slovak Institute of Cardiovascular Diseases in Kosice, Slovakia. Utilizing ImageJ software, we quantified the SIC based on ultrasonic signal intensity distribution at the aortic valve's interface. Pixel intensity histograms were generated to measure the SIC, and it was compared with echocardiographic variables. To account for variations in brightness due to differing acquisition settings in echocardiography images (where the highest intensity corresponds to calcium), adaptive image binarization has been implemented. Subsequently, the region of interest (ROI) containing calcium was interactively selected and extracted. This process enables the calculation of a calcium pixel count, representing the spatial quantity of calcium. This study employed multivariate logistic regression using backward elimination and stepwise techniques. Receiver operating characteristic (ROC) curves were utilized to assess the model's performance in predicting AS severity and to determine the optimal cut-off point.</p><p><strong>Results: </strong>The SIC emerged as a significant predictor of AS severity, with an odds ratio (OR) of 0.021 [95% confidence interval (CI): 0.004-0.295, P=0.008]. Incorporating SIC into a model alongside standard echocardiographic parameters notably enhanced the C-statistic/ROC area from 0.7023 to 0.8083 (P=0.01).</p><p><strong>Conclusions: </strong>The SIC, serving as an additional echocardiography-based marker, shows promise in enhancing AS severity detection.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"14 6","pages":"1029-1037"},"PeriodicalIF":2.1,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11707472/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945148","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":"Assessing the impact of evolocumab on thin-cap fibroatheroma and endothelial function in patients with very high-risk atherosclerotic cardiovascular disease: a study protocol for a randomized controlled trial.","authors":"Bingyu Gao, Nan Nan, Mingduo Zhang, Jinfan Tian, Yanlong Ren, Yuguo Xue, Min Zhang, Xiantao Song, Changjiang Ge","doi":"10.21037/cdt-24-336","DOIUrl":"10.21037/cdt-24-336","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of very high-risk atherosclerotic cardiovascular disease (ASCVD) is significant in China, with suboptimal rates of low-density lipoprotein cholesterol (LDL-C) compliance exacerbating plaque instability and causing a higher incidence of major adverse cardiac events (MACEs). Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) are effective in reducing LDL-C levels, increase the stability of vulnerable plaque, and influence the progression of atherosclerosis through multiple mechanisms as demonstrated in animal studies. However, there is currently a lack of <i>in vivo</i> evidence regarding the efficacy and safety of high-intensity statin therapy combined with PCSK9i in the secondary prevention of ASCVD in the Chinese population. This study aims to demonstrate the efficacy of high-intensity statins combined with PCSK9i on vulnerable plaques in very high-risk ASCVD patients through intravascular imaging and non-invasive endothelial function test.</p><p><strong>Methods: </strong>This randomized, open-label, prospective clinical study involves 240 patients with very high-risk ASCVD who meet the criteria outlined in the 2023 Chinese lipid management guidelines. Patients recruitment will be processed in Beijing Anzhen Hospital from January 2021 to December 2024. Patients with thin-cap fibroatheroma (TCFA) detected by optical coherence tomography (OCT) are randomly assigned in a 1:1 ratio to the evolocumab group (evolocumab 140 mg every 2 weeks plus atorvastatin 40 mg nightly) or the standard treatment group (atorvastatin 40 mg nightly). The primary endpoint is the absolute change of the minimum fibrous cap thickness (FCT) at a median follow-up of 1 year. The secondary endpoints are other OCT metrics, assessment of MACE rates, alterations in serum lipid profiles and markers of inflammation, endothelial function, and adverse drug reactions. Logistic regression, analysis of covariance (ANCOVA), Kaplan-Meier curve survival analysis, and Cox regression will be used to investigate the relationship between variables and endpoints.</p><p><strong>Discussion: </strong>The purpose of this study is to evaluate the efficacy of high-intensity statin therapy combined to PCSK9i for the secondary prevention of coronary artery disease in Chinese patients with very high-risk ASCVD. The results will provide evidence to optimize the management of this high-risk population.</p><p><strong>Trial registration: </strong>This study was registered on chictr.org.cn (ChiCTR2000032570).</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"14 6","pages":"1236-1246"},"PeriodicalIF":2.1,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11707485/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945151","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":"Energy loss and adults with congenital heart disease: a novel marker of cardiac workload beyond right ventricular size.","authors":"Yumi Shiina, Keiichi Itatani, Kei Inai, Koichiro Niwa","doi":"10.21037/cdt-24-296","DOIUrl":"10.21037/cdt-24-296","url":null,"abstract":"<p><p>Right ventricular (RV) dysfunction after biventricular repair is critical in most adults with congenital heart disease (ACHD). Conventional 2D magnetic resonance imaging (MRI) measurement is considered as a 'gold standard' for RV evaluation; however, addition information on ACHD after biventricular repair is sometimes required. The reasons why adjunctive information is required is as follows: (I) to evaluate the severity of cardiac burden in symptomatic patients with normal RV size and ejection fraction (EF), (II) to determine the optimal timing of invasive treatments in asymptomatic ones, and (III) to detect proactively a potential cardiac burden leading to ventricular deterioration, from a fluid dynamics perspective. Energy loss (EL) using 4D flow MRI is a novel non-invasive flow visualisation method, and EL using 4D flow MRI can be a potential marker of cardiac burden. EL is the energy dissipated by blood viscosity, and evaluates the cardiac workload related to the prognosis of heart failure. The advantages are as follows: EL can detect cardiac overload which integrates both afterload and preload. EL is an independent parameter of current heart failure or cardiac remodeling state, such as chamber size or ventricular wall motion. This parameter is based on intuitive and clear physiological concepts, suitable for <i>in vivo</i> flow measurements using inner velocity profiles without a pressure-volume loop. The possible clinical applications of EL are as follows: (I) to follow the temporal changes in each patient and (II) to calculate the percentage of cardiac burden by combining pressure data from catheterisation. Although EL appears to be an ideal marker of haemodynamics from a fluid dynamics perspective, EL measurement using 4D flow MRI has some limitations. Flow dynamics software is still being developed, both technically and methodologically, and its clinical impact on long-term outcomes remains unknown. Therefore, further studies are warranted.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"14 6","pages":"1202-1209"},"PeriodicalIF":2.1,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11707469/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945196","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":"Impact of cardiovascular magnetic resonance in single ventricle physiology: a narrative review.","authors":"Inga Voges, Dominik Daniel Gabbert, Daniela Panakova, Sylvia Krupickova","doi":"10.21037/cdt-24-409","DOIUrl":"10.21037/cdt-24-409","url":null,"abstract":"<p><strong>Background and objective: </strong>Cardiovascular magnetic resonance (CMR) is a routine cross-sectional imaging modality in adults with congenital heart disease. Developing CMR techniques and the knowledge that CMR is well suited to assess long-term complications and to provide prognostic information for single ventricle (SV) patients makes CMR the ideal assessment tool for this patient cohort. Nevertheless, many of the techniques have not yet been incorporated into day-to-day practice. The aim of this review is to provide a comprehensive overview of CMR applications in SV patients together with recent scientific findings.</p><p><strong>Methods: </strong>Articles from 2009 to August 2024 retrieved from PubMed on CMR in SV patients were included. Case reports and non-English literature were excluded.</p><p><strong>Key content and findings: </strong>CMR is essential for serial follow-up of SV patients and CMR-derived standard markers can improve patient management and prognosis assessment. Advanced CMR techniques likely will enhance our understanding of Fontan hemodynamics and are promising tools for a comprehensive patient evaluation and care.</p><p><strong>Conclusions: </strong>There is increasing research that shows the advantages of CMR in Fontan patients. However, further research about the prognostic role of CMR in older Fontan patients and how new methods such as modeling and deep learning pipelines can be clinically implemented is warranted.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"14 6","pages":"1161-1175"},"PeriodicalIF":2.1,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11707479/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945303","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":"Twins with at least one with CHD and their immunisation status in direct comparison-are both twins complying with the German immunisation recommendations?","authors":"Julia Remmele, Paul C Helm, Jia Li, Renate Oberhoffer-Fritz, Ulrike M M Bauer, Peter Ewert","doi":"10.21037/cdt-24-302","DOIUrl":"10.21037/cdt-24-302","url":null,"abstract":"<p><strong>Background: </strong>Patients with congenital heart defects (CHDs) are at higher risk for infectious diseases. This may partly be due to frequent hospital stays and the associated exposure to pathogens. This study aims to provide a comprehensive overview of immunisation coverage among twins in which at least one twin has CHD. Confounding factors from shared environments and genetic components can be controlled through co-twin control analysis, thus minimising confounding effects.</p><p><strong>Methods: </strong>In the framework of the cross-sectional twin study \"Same Same, but different?\" twins, with at least one of them having CHD aged 3 to 99 years, were recruited nationwide in Germany between August 2019 and December 2022. Their primary immunisation status based on the German Standing Committee on Vaccination (STIKO) and immunisation against respiratory diseases, including influenza, respiratory syncytial virus (RSV), pneumococci, and coronavirus disease 2019 (COVID-19), were assessed and compared between the twins.</p><p><strong>Results: </strong>In total, 64 twins (128 individuals) were included for direct twin comparison. Overall, 56.3% of the twins reached complete primary immunisation status, negatively influenced by hospitalisation duration [odds ratio (OR): 0.98; 95% confidence interval (CI): 0.96-0.99; P=0.01]. Compared to their healthy twin, twins with CHD received their rotavirus vaccine significantly later (P=0.04). Only 3.1% of the twins with CHD received the pneumococcal vaccine recommended for high-risk patients. A higher number of catheter interventions can lead to a higher number of patients receiving the pneumococcal vaccine (OR: 1.79; 95% CI: 1.16-2.76; P=0.009). The direct twin comparison showed a significant difference between the twins in vaccination against influenza (P=0.007), although it is recommended for CHD patients and their household contacts-including their twin. A higher number of surgeries (OR: 1.51; 95% CI: 1.12-2.05; P=0.007) and catheter interventions (OR: 1.49; 95% CI: 1.00-2.21; P=0.049) increase the probability of influenza vaccination in CHD patients.</p><p><strong>Conclusions: </strong>In the direct twin comparison, twins are similarly vaccinated except for RSV and influenza. Immunisation against influenza in twins should be improved. With new upcoming RSV vaccines, existing recommendations must be reconsidered and adapted. Another disturbing fact is that only 30% of infants are vaccinated against pertussis and pneumococcus within the primary recommended timeframe, even though they are exposed at high risk during infancy. Further education of parents, patients, and medical staff might lead to higher vaccination coverage, especially in pneumococcal vaccines recommended for high-risk patients. We must provide sufficient information on the importance of vaccinations and their side effects for parents' and patients' decision-making.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"14 6","pages":"1108-1121"},"PeriodicalIF":2.1,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11707476/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945375","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}