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AIMS: Catheter ablation (CA) of atrial fibrillation (AF) improves left ventricular ejection fraction (LVEF) in patients with heart failure with reduced ejection fraction (HFrEF). The impact of ST-segment depression before CA on LVEF recovery and clinical outcomes remains unknown. In the present study, we aimed to investigate the relationship between ST-segment depression during AF rhythm before CA and improvement in the LVEF and clinical outcomes in persistent atrial fibrillation (PerAF) patients with HFrEF. METHODS AND RESULTS: The present study included 122 PerAF patients (male; 98 patients, 80%, mean age: 69 [56, 76] years) from the Osaka Rosai Atrial Fibrillation ablation (ORAF) registry who had LVEF < 50% and underwent an initial ablation. The patients who underwent percutaneous coronary intervention or coronary artery bypass grafting within the past 1 month were not included in the enrolled patients. We assigned the patients based on the presence of ST-segment depression before CA during AF rhythm and evaluated improvement in the LVEF (LVEF ≥ 15%) 1 year after CA and the relationship between ST-segment depression and heart failure (HF) hospitalization/major adverse cardiovascular events (MACE), which are defined as a composite of HF hospitalization, cardiovascular death, hospitalization due to coronary artery disease, ventricular arrhythmia requiring hospitalization and stroke. The percentage of patients with improvement in the LVEF 1 year after CA was significantly lower in the patients with ST-segment depression than those without (58.6% vs. 79.7%, P = 0.012). Multiple regression analysis showed ST-segment depression was independently and significantly associated with improvement in the LVEF 1 year after CA (HR: 0.35; 95% CI: 0.129-0.928, P = 0.035). Kaplan-Meier analysis showed that the patients with ST-segment depression significantly had higher risk of HF hospitalization and MACE than those without (log rank P = 0.022 and log rank P = 0.002, respectively). Multivariable Cox proportional hazards analysis showed that ST-segment depression was independently and significantly associated with a higher risk of MACE (HR: 2.82; 95% CI: 1.210-6.584, P = 0.016). CONCLUSIONS: ST-segment depression before CA during AF rhythm was useful prognostic predictor of improvement in the LVEF and clinical outcomes including HF hospitalization and MACE in PerAF patients with HFrEF.
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BACKGROUND: Tachycardia-induced cardiomyopathy (TIC) is a reversible cardiomyopathy with ventricular dysfunction caused by tachyarrhythmias. Notably, atrial fibrillation (AF) is the most common causal arrhythmia leading to TIC. However, the risk factors for the development of TIC due to AF remain unclear. This study aimed to identify the associated factors of TIC due to AF. METHODS: Persistent AF patients with heart rate (HR) ≥100 beats per minute who underwent initial catheter ablation were enrolled in this study. TIC was diagnosed as left ventricular ejection fraction (LVEF) < 50% during AF rhythm, which was recovered after the restoration of sinus rhythm. Non-TIC was defined as LVEF ≥ 50% despite AF rhythm. The patient backgrounds were compared between the TIC group and the non-TIC group to reveal the contributing factors of TIC. RESULTS: The TIC group comprised 57 patients, while the non-TIC group consisted of 101 patients. The TIC group was younger than the non-TIC group (median 64 vs. 70, p = 0.006). Male sex was more frequent in the TIC group than the non-TIC group (82.5% vs. 58.4%, p = 0.003). HR was higher in the TIC group than in the non-TIC group (median 130 bpm vs. 111 bpm, p < 0.001). The number of smokers was significantly higher in the TIC group than in the non-TIC group (p < 0.001). Multivariable analysis demonstrated that higher HR (odds ratio [OR]: 1.74; 95% confidence interval [CI]: 1.37-2.21; p < 0.001) and current smokers (OR: 5.27; 95% CI: 1.60-17.4; p = 0.006) were the independent factors leading to TIC. CONCLUSION: Higher HR and current smokers were independent risk factors for the development of TIC due to AF.
Assuntos
Fibrilação Atrial , Cardiomiopatias , Humanos , Fibrilação Atrial/etiologia , Masculino , Feminino , Fatores de Risco , Pessoa de Meia-Idade , Cardiomiopatias/etiologia , Idoso , Taquicardia/fisiopatologia , Taquicardia/complicações , Ablação por CateterRESUMO
Drug-eluting stents have significantly contributed to reducing mortality in patients with ST-segment elevation myocardial infarctions (STEMIs), but slow-flow/no-reflow phenomenon (SFNR) and in-stent restenosis are still clinical problems. In contrast, perfusion balloons (PBs) can compress thrombi and ruptured plaque for long inflation without ischemia and can be used as a delivery device for infusion of nitroprusside to distal risk area during ballooning. We conducted a Reduction of risk bY perfUsion balloon for ST-segment Elevated myocardial Infarction (RYUSEI) study to evaluate whether PBs before stenting are more effective than conventional stenting for STEMIs. We divided consecutive patients with STEMIs who underwent optical coherence tomography (OCT)-guided percutaneous coronary intervention into PB group who were treated with PBs (Ryusei; Kaneka Medix Corporation, Osaka, Japan) before stenting and the conventional percutaneous coronary intervention (CP) group. We compared clinical results including SFNR, OCT findings, and clinical events between the 2 groups. We finally analyzed 34 patients in PB group and 90 in CP group. After propensity score-matching, PB and CP groups consisted of 23 patients, respectively. In the propensity score-matched cohort, SFNR and maximum protrusion area detected by OCT were significantly lower (p = 0.047 and p = 0.019), and thrombolysis in myocardial infarction flow grade 3 was higher (p = 0.022) in the PB group than CP group. Kaplan-Meier analysis revealed a significantly better clinical outcome in PB group than CP group (p = 0.038). In conclusion, the RYUSEI study revealed a pre-stent lesion modification in addition to nitroprusside infusion using PB is useful to achieve better clinical courses in STEMI patients.
Assuntos
Infarto do Miocárdio com Supradesnível do Segmento ST , Tomografia de Coerência Óptica , Humanos , Feminino , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Idoso , Resultado do Tratamento , Stents Farmacológicos , Angioplastia Coronária com Balão/métodos , Angiografia Coronária , Intervenção Coronária Percutânea/métodos , Pontuação de Propensão , Seguimentos , Japão/epidemiologiaRESUMO
We report a case of a 44-year-old male who underwent an electrophysiological study for symptomatic supraventricular tachycardia (SVT) with wide QRS complex. The SVT was diagnosed as an antidromic atrioventricular reentrant tachycardia (AVRT) via antegrade conduction of left-sided accessory pathway (AP). However, the QRS morphology changed during the SVT, and then the SVT was terminated spontaneously. The mapping of AP was performed during sinus rhythm, and the radiofrequency application successfully eliminated the AP, which rendered tachycardias non-inducible. This was a rare case of antidromic AVRT during which the QRS morphology changed.
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BACKGROUND: Residual non-pulmonary vein (PV) foci are significantly associated with atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI). However, we previously reported among patients with non-PV foci induced only once, none experienced AF recurrence. Thus, we aimed to investigate the correlation between the residual induction number of non-PV foci and ablation outcome in paroxysmal AF patients. METHODS AND RESULTS: We investigated 55 paroxysmal AF patients with residual non-PV foci after PVI and ablation of non-PV-foci. Study patients were classified into the residual one-time induction of non-PV foci (residual OTI-nPVF) group (n = 23) and residual repeatedly induced non-PV foci (residual RI-nPVF) group (n = 32). Furthermore, the residual RI-nPVF group was divided into the low inducibility group (n = 10) and high inducibility group (n = 22) according to the presence or absence of non-PV foci provoked by two sets of drug induction tests (non-PV foci inducibility). In addition, the latter was divided into the ablation group (n = 14) or observation group (n = 8). The 2-year AF recurrence-free rate in the residual RI-nPVF group was significantly lower compared to the residual OTI-nPVF group (53% vs. 90%, p = 0.018). There was no significant difference of the 2-year AF recurrence-free rates in the inducibility of non-PV foci (p = 0.913) and the presence or absence of ablation (p = 0.812) in the residual RI-nPVF group. CONCLUSIONS: Among paroxysmal AF patients, the presence of residual RI-nPVF was associated with higher AF recurrence compared to residual OTI-nPVF. Furthermore, within residual RI-nPVF subgroup, non-PV foci inducibility or ablation of some residual RI-nPVF did not affect ablation outcome.
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BACKGROUND: It has not been fully elucidated which patients with persistent atrial fibrillation (PerAF) should undergo substrate ablation plus pulmonary vein isolation (PVI). This study aimed to identify PerAF patients who required substrate ablation using intraprocedural assessment of the baseline rhythm and the origin of atrial fibrillation (AF) triggers. METHODSâANDâRESULTS: This was a post hoc subanalysis using extended data of the EARNEST-PVI trial, a prospective multicenter randomized trial comparing PVI-alone and PVI-plus (i.e., PVI with added catheter ablation) arms. We divided 492 patients into 4 groups according to baseline rhythm and the location of AF triggers before PVI: Group A (n=22), sinus rhythm with pulmonary vein (PV)-specific AF triggers (defined as reproducible AF initiation from PVs only); Group B (n=211), AF with PV-specific AF triggers; Group C (n=94), sinus rhythm with no PV-specific AF trigger; Group D (n=165), AF with no PV-specific AF trigger. Among the 4 groups, only in Group D (AF at baseline and no PV-specific AF triggers) was arrhythmia-free survival significantly lower in the PVI-alone than PVI-plus arm (P=0.032; hazard ratio 1.68; 95% confidence interval 1.04-2.70). CONCLUSIONS: Patients with sinus rhythm or PV-specific AF triggers did not receive any benefit from substrate ablation, whereas patients with AF and no PV-specific AF trigger benefited from substrate ablation.
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Fibrilação Atrial , Ablação por Cateter , Veias Pulmonares , Fibrilação Atrial/cirurgia , Fibrilação Atrial/fisiopatologia , Humanos , Ablação por Cateter/métodos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Veias Pulmonares/cirurgia , Veias Pulmonares/fisiopatologia , Estudos Prospectivos , Seleção de Pacientes , Resultado do Tratamento , Recidiva , Frequência CardíacaRESUMO
AIMS: Low-density lipoprotein cholesterol (LDL-C), anaemia and low platelets have been associated with worse clinical outcomes in heart failure patients. We investigated the relationship between the combination of these three components and clinical outcome in patients with heart failure with preserved ejection fraction (HFpEF). METHODS AND RESULTS: We examined the data of 1021 patients with HFpEF hospitalized with acute decompensated heart failure (HF) from the PURSUIT-HFpEF registry, a prospective, multicenter observational study. The enrolled patients were classified into four groups by an LEP (LDL-C, Erythrocyte, and Platelet) score of 0 to 3 points, with 1 point each for LDL-C, erythrocyte and platelet values less than the cut-off values as calculated by receiver operating characteristic curve analysis. The endpoint, a composite of all-cause death and HF readmission, was evaluated among the four groups. Median follow-up duration was 579 [300, 978] days. Risk of the composite endpoint significantly differed among the four groups (P < 0.001). Kaplan-Meier analysis showed that the groups with an LEP score of 2 had higher risk of the composite endpoint than those with an LEP score of 0 or 1 (P < 0.001, and P = 0.013, respectively), while those with an LEP score of 3 had higher risk than those with an LEP score of 0, 1 or 2 (P < 0.001, P < 0.001 and P = 0.020, respectively). Cox proportional hazards analysis showed that an LEP score of 3 was significantly associated with the composite endpoint (P = 0.030). Kaplan-Meier analysis showed that risk of the composite of all-cause death and HF readmission was significantly higher in low LDL values (less than the cut-off values as calculated by receiver operating characteristic curve analysis) patients with statin use than in those without statin use (log rank P = 0.002). CONCLUSIONS: LEP score, which comprehensively reflects extra-cardiac co-morbidities, is significantly associated with clinical outcomes in HFpEF patients.
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Plaquetas , LDL-Colesterol , Eritrócitos , Insuficiência Cardíaca , Volume Sistólico , Humanos , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/fisiopatologia , Masculino , Feminino , Volume Sistólico/fisiologia , Estudos Prospectivos , Idoso , Eritrócitos/metabolismo , Plaquetas/metabolismo , LDL-Colesterol/sangue , Sistema de Registros , Prognóstico , Seguimentos , Biomarcadores/sangue , Pessoa de Meia-Idade , Taxa de Sobrevida/tendênciasRESUMO
Pulmonary vein isolation (PVI) causes changes in P-wave parameters. However, the difference in changes in P-wave parameters including P-wave vector magnitude (Pvm) between radiofrequency catheter ablation (RFCA) and cryoballoon ablation (CBA) remains unknown. Paroxysmal atrial fibrillation (PAF) patients who underwent only PVI were enrolled. Pvm was calculated by the square root of the sum of the squared P-wave amplitude in leads II and V6 and one-half of the P-wave amplitude in V2. The patients were divided into 2 groups: RFCA and CBA. ΔPvm was calculated as ΔPvm (mV) = (Pvm at pre-PVI)-(Pvm at post-PVI). The following factors were evaluated: (1) differences in the ΔPvm between the 2 groups, (2) relation between late arrhythmia recurrence and ΔPvm in RFCA and CBA groups, and (3) the impact of relevant factors on ΔPvm. The study population included a total of 426 patients with PAF (RFCA, 167 patients; CBA, 259 patients). ΔPvm was significantly larger in CBA than in RFCA (p <0.001). Kaplan-Meier analysis showed late arrhythmia recurrence was significantly higher in patients with low ΔPvm (<0.019 mV) than high ΔPvm (≥0.019 mV) in RFCA (Log-rank p <0.001), and low ΔPvm (<0.033 mV) than high ΔPvm (≥0.033 mV) in CBA (Log-rank p <0.001). Multiple regression analysis showed that CBA and heart rate change were independently and significantly associated with ΔPvm (p <0.001 and p <0.001, respectively). In conclusion, ΔPvm was significantly larger in CBA than RFCA during procedure. Low ΔPvm had a higher risk of late arrhythmia recurrence in RFCA and CBA.
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Fibrilação Atrial , Ablação por Cateter , Criocirurgia , Eletrocardiografia , Veias Pulmonares , Humanos , Criocirurgia/métodos , Masculino , Fibrilação Atrial/cirurgia , Fibrilação Atrial/fisiopatologia , Feminino , Pessoa de Meia-Idade , Ablação por Cateter/métodos , Veias Pulmonares/cirurgia , Recidiva , Resultado do Tratamento , Estudos Retrospectivos , Idoso , Seguimentos , Período Pós-OperatórioRESUMO
BACKGROUND: The optimal duration of atrial fibrillation (AF) persistence for predicting poor outcomes after catheter ablation of long-standing AF (LsAF) and the best ablation strategy for these patients remain unclear. OBJECTIVE: We aimed to assess the impact of the duration of AF persistence on outcomes after catheter ablation of AF. METHODS: We analyzed the Efficacy of Pulmonary Vein Isolation Alone in Patients with Persistent Atrial Fibrillation (EARNEST-PVI) trial data comparing pulmonary vein isolation (PVI) alone (PVI-alone) with additional linear ablation or defragmentation (PVI-plus) in persistent AF (PerAF). Patients who received catheter ablation by contact force-sensing catheter were enrolled in the study. In patients with LsAF, the optimal cutoff duration of AF persistence was evaluated. With use of the threshold, patients with LsAF were divided into 2 groups and compared with PerAF <1 year for arrhythmia-free survival after a 3-month blanking period. RESULTS: The optimal cutoff duration was 2.4 years. Of 458 patients, arrhythmia-free survival rates for LsAF 1-2.4 years were comparable to those of PerAF (hazard ratio [HR], 1.01; 95% CI, 0.67-1.52). However, LsAF >2.4 years had a higher recurrence risk than PerAF (HR, 2.22; 95% CI, 1.42-3.47). In LsAF >2.4 years, the PVI-plus strategy showed advantages over the PVI-alone strategy (HR, 0.36; 95% CI, 0.14-0.89). However, the interaction effect between LsAF 1-2.4 years and LsAF >2.4 years did not reach statistical significance (P = .116). CONCLUSION: Whereas LsAF 1-2.4 years has similar outcomes to those of PerAF, LsAF >2.4 years was linked to higher arrhythmia recurrence risks. For LsAF >2.4 years, the PVI-plus strategy showed a potential to be superior to the PVI-alone strategy.
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Fibrilação Atrial , Ablação por Cateter , Veias Pulmonares , Recidiva , Humanos , Fibrilação Atrial/cirurgia , Fibrilação Atrial/fisiopatologia , Ablação por Cateter/métodos , Masculino , Feminino , Pessoa de Meia-Idade , Veias Pulmonares/cirurgia , Fatores de Tempo , Resultado do Tratamento , Idoso , Fatores de Risco , SeguimentosRESUMO
Heart failure (HF) readmission post-transcatheter aortic valve implantation (TAVI) is common; however, its anatomical predictors remain unclear. This study identified a small systolic left ventricular inflow-outflow (LVIO) angle, evaluated using computed tomography, as a potential anatomical predictor associated with HF readmission post-TAVI. Patients with a small systolic LVIO angle may require close follow-up post-TAVI.
Assuntos
Estenose da Valva Aórtica , Valva Aórtica , Insuficiência Cardíaca , Readmissão do Paciente , Substituição da Valva Aórtica Transcateter , Função Ventricular Esquerda , Humanos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/terapia , Masculino , Feminino , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/diagnóstico por imagem , Resultado do Tratamento , Idoso , Valva Aórtica/fisiopatologia , Valva Aórtica/cirurgia , Valva Aórtica/diagnóstico por imagem , Fatores de Risco , Estudos Retrospectivos , Valor Preditivo dos Testes , Fatores de Tempo , Hemodinâmica , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologiaRESUMO
BACKGROUND: Little has been reported on the predictors of 30-day survival after emergent percutaneous coronary intervention (PCI) following life-threatening ventricular tachyarrhythmias associated with acute myocardial infarction (AMI). METHODS: We analyzed 55 consecutive patients who underwent an emergent PCI after ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) complicating AMI between September 2014 and March 2023 in our hospital. These patients were categorized into two groups: survival group (S group) who survived >30 days after the emergent PCI and death group (D group) who died by 30 days after the emergent PCI. We compared the patient characteristics, coronary angiographic findings, and PCI procedures between the two groups. RESULTS: S group consisted of 40 patients. In the univariate analysis, absence of diabetes mellitus, presence of immediate cardiopulmonary resuscitation (CPR), low arterial lactate, and single-vessel coronary artery disease (CAD) were associated with 30-day survival after the emergent PCI (P = 0.048, P < 0.001, P = 0.009, and P = 0.003, respectively). In the multivariate analysis, presence of immediate CPR and single-vessel CAD were independently associated with 30-day survival after the emergent PCI (P = 0.023 and P = 0.032, respectively). CONCLUSIONS: Immediate CPR and single-vessel CAD were significant predictors of 30-day survival after the emergent PCI following VF or pulseless VT complicating AMI. Absence of diabetes mellitus and low arterial lactate were associated with 30-day survival in the univariate analysis.
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Doença da Artéria Coronariana , Diabetes Mellitus , Infarto do Miocárdio , Intervenção Coronária Percutânea , Taquicardia Ventricular , Humanos , Intervenção Coronária Percutânea/efeitos adversos , Fibrilação Ventricular/diagnóstico , Fibrilação Ventricular/terapia , Fibrilação Ventricular/complicações , Infarto do Miocárdio/complicações , Infarto do Miocárdio/cirurgia , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/terapia , Doença da Artéria Coronariana/complicações , Arritmias Cardíacas/complicações , Lactatos , Resultado do TratamentoAssuntos
Estenose da Valva Aórtica , Próteses Valvulares Cardíacas , Substituição da Valva Aórtica Transcateter , Humanos , Valva Aórtica/cirurgia , Substituição da Valva Aórtica Transcateter/métodos , Próteses Valvulares Cardíacas/efeitos adversos , Resultado do Tratamento , Estenose da Valva Aórtica/cirurgia , Desenho de PróteseRESUMO
The impact of the P-wave morphology on clinical outcomes postcatheter ablation (post-CA) and recurrent arrhythmia characteristics or electrophysiologic findings in patients with paroxysmal atrial fibrillation (PAF) remains unclear. Patients with PAF who underwent cryoballoon ablation were enrolled. In 12-lead electrocardiography recorded within 1 month before CA, the P-wave duration (Pd) and P-wave vector magnitude (Pvm) (square root of the sum of the squared P-wave amplitude in leads II, V6, and one-half of the P-wave amplitude in V2) were measured and divided into 2 groups: patients with high and low Pd/Pvm based on a statistically calculated cut-off value. We evaluated the incidence of late recurrence of atrial fibrillation (LRAF), myocardial injury (high-sensitive troponin I), and the electrophysiologic findings in repeat ablation sessions. This study included 269 patients with PAF. The median follow-up duration was 697 days. The cut-off value of the Pd/Pvm for predicting LRAF was 740.7 ms/mV (area under the curve = 0.81, sensitivity = 58.2%, and specificity = 89.6%). Multivariable Cox proportional hazards analysis showed that high Pd/Pvm (>740.7 ms/mV) was significantly associated with LRAF (p <0.001). The high-sensitive troponin I level was significantly lower, and the ratio of DR-FLASH score >3 was significantly higher in those with high than low Pd/Pvm (p = 0.044 and p = 0.002, respectively). In the repeat ablation sessions, the Pd/Pvm in patients with atrial tachycardia-induced or spontaneously occurring during the repeat CA sessions was significantly higher than in those without (p = 0.009). There was a significant difference between the Pd/Pvm and low-voltage area (p <0.001). In conclusion, the Pd/Pvm is significantly associated with LRAF after cryoballoon ablation in patients with PAF and predicts left atrial low-voltage areas and atrial tachycardia inducibility.
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Fibrilação Atrial , Remodelamento Atrial , Ablação por Cateter , Veias Pulmonares , Humanos , Troponina I , Fatores de Risco , Fibrilação Atrial/complicações , Eletrocardiografia , Taquicardia/complicações , Recidiva , Resultado do Tratamento , Veias Pulmonares/cirurgiaRESUMO
BACKGROUND: Debulking devices are necessary to treat severe calcified lesions. OAS has a unique characteristic that the burr moves forward and backward. There are few studies reporting the differences of ablation style between only-antegrade and only-retrograde OAS. AIMS: The aim of this study was to evaluate the difference of ablation style between only-antegrade and only-retrograde orbital atherectomy system (OAS) using an artificial pulsatile heart model (HEARTROID system®) and optical coherence tomography (OCT). METHODS: The calcified lesion model was inserted into the mid of left anterior descending in the HEARTROID®. Only-antegrade and only-retrograde ablation of OAS were conducted for each five lesions. Pre-OCT, OCT after low speed debulking and OCT after high speed debulking were conducted. The width and the depth of debulked area, the debulked area and the direction of debulked area were investigated. RESULTS: In all of 210 cross-sections, 91 debulked cross sections were chosen for analysis. Only-antegrade group had 47 debulked cross-sections, and only-retrograde group 44 cross-sections. In the evaluation of OCT after high speed debulking, the debulked area (0.76 mm2 [0.58-0.91] vs. 0.53 mm2 [0.36-0.68], p < 0.001) and the depth of debulked area (0.76 mm [0.58-0.91] vs. 0.53 mm [0.36-0.68], p < 0.001) were significantly higher in only-antegrade group compared to only-retrograde group. The debulked bias and the width of debulked area are not significantly different between the two groups. CONCLUSIONS: Compared to only-retrograde debulking, only-antegrade debulking acquired larger debulked area because of larger cutting depth, although the debulked bias and the width of debulked area were comparable between the two groups.
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Aterectomia Coronária , Doença da Artéria Coronariana , Calcificação Vascular , Humanos , Doença da Artéria Coronariana/terapia , Procedimentos Cirúrgicos de Citorredução , Resultado do Tratamento , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/terapia , AterectomiaRESUMO
BACKGROUND: Mitral regurgitation (MR) is associated with an increased risk of developing atrial fibrillation (AF) and high AF recurrence ratio after ablation. Left atrial appendage (LAA) is involved in left atrium (LA) pressure modulation and LAA peak flow velocity (LAAV) is validated as an indicator of LA contractile and reservoir function. LA function is related to the MR pathology, but the relationship between LAAV and improvement in MR after ablation remains unknown. METHODS: The present study included AF patients with moderate or severe MR from the Osaka Rosai Atrial Fibrillation ablation (ORAF) registry. We evaluated MR severity one-year post-ablation and assigned the patients based on MR improvement (at least a one-grade improvement in MR over one year) and investigated the impact of the relevant factors, including LAAV, on MR improvement. RESULTS: This study population included a total of 289 patients [paroxysmal AF (PAF), 112 patients; persistent AF (PerAF), 177 patients]. Kaplan-Meier analysis demonstrated that the patients with MR improvement had a significantly lower risk of late arrhythmia recurrence than those without (log-rank pâ¯<â¯0.001). MR improvement was observed in 56.3â¯% (63/112) of PAF patients and 55.4â¯% (98/177) of PerAF patients. Multiple regression analysis showed that LAAV was an independent and significant determinant of MR improvement post-ablation in both PAF and PerAF patients (pâ¯=â¯0.037 and pâ¯=â¯0.018, respectively), in addition to age and hemoglobin in PerAF patients (pâ¯=â¯0.045 and pâ¯=â¯0.048, respectively). CONCLUSION: LAAV can predict an improvement in MR after catheter ablation in both PAF and PerAF patients.
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Apêndice Atrial , Fibrilação Atrial , Ablação por Cateter , Insuficiência da Valva Mitral , Humanos , Apêndice Atrial/diagnóstico por imagem , Apêndice Atrial/cirurgia , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/cirurgia , Insuficiência da Valva Mitral/etiologia , Resultado do Tratamento , Ablação por Cateter/efeitos adversos , RecidivaAssuntos
Implante de Prótese de Valva Cardíaca , Insuficiência da Valva Mitral , Prolapso da Valva Mitral , Humanos , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/etiologia , Insuficiência da Valva Mitral/cirurgia , Resultado do Tratamento , Prolapso da Valva Mitral/cirurgia , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/métodosRESUMO
Two key echocardiographic parameters, left ventricular mass index (LVMI) and left atrial volume index (LAVI), are important in assessing structural myocardial changes in heart failure (HF) with preserved ejection fraction (HFpEF). However, the differences in clinical characteristics and outcomes among groups classified by LVMI and LAVI values are unclear.We examined the data of 960 patients with HFpEF hospitalized due to acute decompensated HF from the PURSUIT-HFpEF registry, a prospective, multicenter observational study. Four groups were classified according to the cut-off values of LVMI and LAVI [LVMI = 95 g/m2 (female), 115 g/m2 (male) and LAVI = 34 mL/m2]. Clinical endpoints were the composite of HF readmission and all-cause death. Study endpoints among the 4 groups were evaluated. The composite endpoint occurred in 364 patients (37.9%). Median follow-up duration was 445 days. Kaplan-Meier analysis revealed significant differences in the composite endpoint among the 4 groups (P < 0.001). Cox proportional hazards analysis demonstrated that patients with increased LAVI alone were at significantly higher risk of HF readmission and the composite endpoints than those with increased LVMI alone (P = 0.030 and P = 0.024, respectively). Age, male gender, systolic blood pressure at discharge, atrial fibrillation (AF) hemoglobin, renal function, and LAVI were significant determinants of LVMI and female gender, AF, hemoglobin, and LVMI were significant determinants of LAVI.In HFpEF patients, increased LAVI alone was more strongly associated with HF readmission and the composite of HF readmission and all-cause death than those with increased LVMI alone.
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Fibrilação Atrial , Insuficiência Cardíaca , Humanos , Masculino , Feminino , Ventrículos do Coração/diagnóstico por imagem , Volume Sistólico , Função Ventricular Esquerda , Estudos Prospectivos , Prognóstico , Átrios do Coração/diagnóstico por imagemRESUMO
BACKGROUND: Acute decompensated heart failure (ADHF) is the main cause of hospitalization and death of octogenarians, but no data on the 1-year post-discharge mortality rate. We evaluated the clinical status and predictors of 1-year mortality in octogenarians with ADHF.MethodsâandâResults: From the AURORA (Acute Heart Failure Registry in Osaka Rosai Hospital) study, we examined 1,246 hospitalized ADHF patients. We compared the in-hospital mortality rate and the proportion of heart failure (HF) with preserved ejection fraction (HFpEF) between octogenarians and non-octogenarians. After discharge we compared the 1-year mortality rate between these groups, and we also evaluated the predictors of death in both groups. The proportion of HFpEF among the in-hospital deaths of octogenarians was significantly higher than in non-octogenarians (46.2% vs. 15.0%, P=0.031). The 1-year mortality rate after discharge was significantly higher in the octogenarians than non-octogenarians (P=0.014). Multivariable Cox regression analysis revealed that albumin ≤3.0 g/dL and antiplatelet agents were useful predictors of 1-year death after discharge of octogenarians whereas chronic kidney disease was a predictor in the non-octogenarians. CONCLUSIONS: The proportion of HFpEF among in-hospital deaths of octogenarians with ADHF was high as compared with non-octogenarians. When octogenarians with ADHF have severe hypoalbuminemia and antiplatelet agents, early nutritional and medical interventions after discharge may be important to improve the 1-year prognosis.