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AIMS: Interleukin-16 (IL-16) has been reported to mediate left ventricular myocardial fibrosis and stiffening in patients with heart failure with preserved ejection fraction (HFpEF). We sought to elucidate whether IL-16 has a distinct impact on pathophysiology and prognosis across different subphenotypes of acute HFpEF. METHODS AND RESULTS: We analysed 211 patients enrolled in a prospective multicentre registry of acute decompensated HFpEF for whom serum IL-16 levels after stabilization were available (53% female, median age 81 [interquartile range 75-85] years). We divided this sub-cohort into four phenogroups using our established clustering algorithm. The study endpoint was all-cause death. Patients were subclassified into phenogroup 1 ('rhythm trouble' [n = 69]), phenogroup 2 ('ventricular-arterial uncoupling' [n = 49]), phenogroup 3 ('low output and systemic congestion' [n = 41]), and phenogroup 4 ('systemic failure' [n = 52]). After a median follow-up of 640 days, 38 patients had died. Among the four phenogroups, phenogroup 2 had the highest IL-16 level. The IL-16 level showed significant associations with indices of cardiac hypertrophy, diastolic dysfunction, and congestion only in phenogroup 2. Furthermore, the IL-16 level had a significant predictive value for all-cause death only in phenogroup 2 (C-statistic 0.750, 95% confidence interval 0.606-0.863, P = 0.017), while there was no association between the IL-16 level and the endpoint in the other phenogroups. CONCLUSIONS: Our results indicated that the serum IL-16 level had a significant association with indices that reflect the pathophysiology and prognosis of HFpEF in a specific phenogroup in acute HFpEF.
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Biomarcadores , Insuficiência Cardíaca , Interleucina-16 , Volume Sistólico , Humanos , Feminino , Masculino , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/sangue , Volume Sistólico/fisiologia , Idoso , Doença Aguda , Idoso de 80 Anos ou mais , Estudos Prospectivos , Prognóstico , Interleucina-16/sangue , Interleucina-16/genética , Biomarcadores/sangue , Seguimentos , Função Ventricular Esquerda/fisiologia , Sistema de Registros , Causas de Morte/tendênciasRESUMO
Background Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are novel inflammation markers. Their combined usefulness for estimating the prognosis of patients with heart failure with preserved ejection fraction (HFpEF) admitted for acute decompensated heart failure remains elusive. Methods and Results We investigated 1026 patients registered in the Prospective Multicenter Observational Study of Patients with Heart Failure with Preserved Ejection Fraction. Both NLR and PLR values were measured at the time of admission. Comorbidity burden was defined as the number of occurrences of 8 common comorbidities of HFpEF. The primary end point was cardiac death. The patients were stratified into 3 groups based on the optimal cut-off values of NLR and PLR on the receiver operating characteristic curve analysis for predicting cardiac death (low NLR and PLR, either high NLR or PLR, and both high NLR and PLR). After a median follow-up of 429 days, 195 patients died, with 85 of these deaths attributed to cardiac causes. An increased comorbidity burden was significantly associated with a higher proportion of patients with high NLR (>4.5) or PLR (>193), or both. High NLR and PLR values were independently associated with cardiac death, and a combination of both values was the strongest predictor (hazard ratio, 2.66 [95% CI, 1.51%-4.70%], P=0.0008). A significant difference was found in the rate of cardiac death among the 3 groups stratified by NLR and PLR values. Conclusions The combination of NLR and PLR is useful for the prediction of postdischarge cardiac death in patients with acute HFpEF. Registration URL: ClinicalTrials.gov; Unique identifier: UMIN000021831.
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Insuficiência Cardíaca , Neutrófilos , Humanos , Insuficiência Cardíaca/diagnóstico , Assistência ao Convalescente , Estudos Prospectivos , Contagem de Plaquetas , Volume Sistólico , Alta do Paciente , Plaquetas , Linfócitos , Prognóstico , Estudos RetrospectivosRESUMO
Background Stent thrombosis (ST) remains a significant medical issue. In particular, longer-term mortality and clinical predictors after ST occurrence have yet to be elucidated. Methods and Results This was a multicenter, retrospective, observational study. A total of 187 definite ST cases from January 2008 to December 2017 were enrolled, and the long-term clinical outcomes were investigated. The primary outcome measure was the cumulative mortality after ST occurrence. In addition, independent predictors of mortality were assessed. Among the stent types causing ST, bare-metal stent, first-generation drug-eluting stent, second-generation drug-eluting stent, and third-generation drug-eluting stent comprised 31.0%, 19.3%, 36.9%, and 6.4% of cases, respectively. Median duration from stent implantation to ST was 680.5 (interquartile range, 33.8-2450.5) days. Cumulative mortality was 14.6%, 17.4%, 21.2%, 24.4%, and 33.8% at 1, 2, 3, 5 and 10 years, respectively. The cumulative mortality did not significantly differ by type of stent, and mortality of late ST was higher than that of early ST and very late ST; however, it did not reach statistical significance after the multivariate analysis. Independent predictors of mortality were hemodialysis (hazard ratio [HR], 7.80; 95% CI, 3.07-19.81; P<0.001), culprit lesions in the left main trunk (HR, 8.14; 95% CI, 1.71-38.75; P=0.008), culprit lesions in the left coronary artery (HR, 2.77; 95% CI, 1.10-6.96; P=0.030), and peak creatine kinase (HR, 1.017; 95% CI, 1.011-1.022; P<0.001). Conclusions The 10-year cumulative mortality after ST reached 33.8%. Close follow-up is thus mandatory for patients with ST, especially with hemodialysis, culprit lesions in the left main trunk and left coronary artery, and high peak creatine kinase.
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Trombose Coronária , Stents Farmacológicos , Intervenção Coronária Percutânea , Trombose , Trombose Coronária/etiologia , Stents Farmacológicos/efeitos adversos , Humanos , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/métodos , Estudos Retrospectivos , Fatores de Risco , Stents/efeitos adversos , Trombose/epidemiologia , Resultado do TratamentoRESUMO
Background and Aims: There are two types of serum uric acid-lowering agents, the xanthine oxidoreductase (XO) inhibitor and non-XO inhibitor. We investigated whether febuxostat, XO inhibitor, could produce more favorable effects on coronary endothelial function (CEF) and renal function than benzbromarone, non-XO inhibitor, in hyperuricemic coronary artery disease (CAD) patients. Methods: We divided 21 hyperuricemic patients with stenting for left anterior descending (LAD) or left circumflex (LCX) artery into patients started on febuxostat (F group) and those on benzbromarone (B group). After 8 months, all patients underwent CEF evaluations (acetylcholine provocation test) and optical coherence tomography (OCT) for non-culprit vessels (e.g. if patients received LAD stenting, we evaluated LCX). We compared the diameter ratio induced by acetylcholine and baseline (CEF ratio), thin-cap fibroatheroma and calcified plaque by OCT, uric acid, oxidative stress biomarkers, and renal function including estimated glomerular filtration rate (eGFR) between F and B groups. Creatinine 2 days after stenting was measured to evaluate contrast-induced nephropathy (CIN). Results: Change of eGFR was significantly lower in F group (n= 11) than B group over 8 months while the other parameters including CEF ratio were similar. F group showed favorable effects for CIN. Conclusion: In conclusion, 8-months of febuxostat, XO inhibitor, does not significantly protect CEF but can protect the renal function including CIN in hyperuricemic patients with CAD compared to benzbromarone, non-XO inhibitor.
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PURPOSE: Early recurrence of atrial tachyarrhythmias (ERAT) cause various symptoms and predict worse outcomes after pulmonary vein isolation (PVI). This study aimed to clarify whether ablation index (AI)-guided PVI, which is a novel technology of radiofrequency ablation, could reduce ERAT as compared to conventional contact force (CF)-guided PVI. METHODS: Consecutive atrial fibrillation (AF) patients who underwent initial PVI from September 2014 to August 2019 were enrolled. We divided the patients into two groups: patients who underwent AI-guided PVI (AI group) and those who underwent CF-guided PVI (CF group). Using propensity score matching (PSM), we adjusted for the patient backgrounds. We compared the incidence of ERAT and late reconnection rate of isolated pulmonary veins (PVs) during second session between the two groups. ERAT was defined as any atrial tachyarrhythmias ≥ 30 s during a 90-day blanking period. RESULTS: A total of 697 AF patients (paroxysmal 51%) were enrolled. After the PSM, both groups included 229 patients. The incidence of ERAT was significantly lower in the AI group than that in the CF group (21.5% vs. 36.1%, P < 0.001). Total 118 patients (25.7%) experienced late recurrence of atrial tachyarrhythmias (LRAT) after blanking period. LRAT free survival rate was significantly higher in patients without ERAT than those with ERAT (88.1% vs. 42.0%, P < 0.001). The rate of PV reconnection was lower in the AI group than that in the CF group (45.8% vs. 71.4%, P = 0.028). Multivariate analysis demonstrated that AI-guided PVI was independently correlated with ERAT (OR = 0.415, 95%CI = 0.269-0.639, P < 0.001). CONCLUSIONS: AI-guided PVI can reduce ERAT as compared to conventional CF-guided PVI.
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Fibrilação Atrial , Ablação por Cateter , Veias Pulmonares , Fibrilação Atrial/diagnóstico , Humanos , Pontuação de Propensão , Veias Pulmonares/cirurgia , Recidiva , Taquicardia/cirurgia , Resultado do TratamentoRESUMO
The obesity paradox states higher body mass index (BMI) is associated with better outcomes than normal weight in patients with heart failure with preserved ejection fraction (HFpEF). However, underweight was defined by BMI < 18.5 kg/m2, and results have been inconclusive, in part due to small number of participants. The number of underweight patients with HFpEF is higher in Asian than in Western countries. In this study, we aim to determine the prognostic impact of underweight in patients with HFpEF in Asian population.We enrolled 846 consecutive patients from the PURSUIT-HFpEF registry. We then divided them into three groups by BMI, namely, underweight (BMI < 18.5 kg/m2), normal weight (18.5 ≤ BMI < 23), and overweight (23 ≤ BMI). The underweight group consisted of 187 patients (22%). Over a mean follow-up of 407 days, 105 deaths were reported as all-cause mortality. On multivariable Cox analysis, the underweight group was determined to be significantly associated with higher risk of all-cause mortality than the normal and overweight groups (Hazard ratios [HR]: 2.33; 95% confidence intervals [CI]: 1.45-3.75, P < 0.001; HR: 3.54; 95% CI: 1.99-6.29, P < 0.001, respectively), after adjustment for age, sex, vital signs, and comorbidities.Underweight is a useful predictor of poor prognosis in patients with HFpEF in Asian population.
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Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Volume Sistólico/fisiologia , Magreza/complicações , Idoso , Idoso de 80 Anos ou mais , Povo Asiático/etnologia , Povo Asiático/estatística & dados numéricos , Índice de Massa Corporal , Estudos de Casos e Controles , Causas de Morte/tendências , Comorbidade , Feminino , Seguimentos , Fragilidade/complicações , Insuficiência Cardíaca/epidemiologia , Humanos , Japão/epidemiologia , Masculino , Estado Nutricional/fisiologia , Sobrepeso/complicações , Prevalência , Prognóstico , Estudos Prospectivos , Sistema de Registros , Magreza/epidemiologiaRESUMO
AIMS: At present, the clinical significance of admission hyperglycaemia in heart failure with preserved ejection fraction (HFpEF) patients remains unknown. This study was designed to evaluate the relationship between admission hyperglycaemia and clinical outcome in HFpEF patients, especially in non-diabetic patients. METHODS AND RESULTS: We enrolled 486 non-diabetic HFpEF (left ventricular ejection fraction ≥50%) patients hospitalized due to acute decompensated heart failure from the PURSUIT-HFpEF registry, a prospective, multicentre observational study. We divided non-diabetic patients into two groups, an admission hyperglycaemia group whose blood glucose on admission was ≥7.0 mmol/L (148 patients) and a normoglycaemic group whose blood glucose on admission was <7.0 mmol/L (338 patients). The primary endpoint was all-cause mortality, and the secondary endpoints were heart failure death and other causes of cardiac death. During a mean follow-up period of 400 ± 335 days, all-cause mortality was 69 patients. Twenty-five patients suffered cardiac death. All-cause mortality (P = 0.002), cardiac death (P = 0.009), and heart failure death (P = 0.001) were significantly more frequent in the admission hyperglycaemia group than in the normoglycaemic group. Admission hyperglycaemia was independently and significantly associated with all-cause mortality and cardiac death (HR 2.01, 95% CI 1.20-3.34, P = 0.008 and HR 3.03, 95% CI 1.35-6.96, P = 0.007, respectively). CONCLUSIONS: Non-diabetic HFpEF patients with admission hyperglycaemia when hospitalized for heart failure had poorer clinical outcomes than normoglycaemic patients.
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Insuficiência Cardíaca , Hiperglicemia , Insuficiência Cardíaca/complicações , Humanos , Hiperglicemia/complicações , Hiperglicemia/epidemiologia , Prognóstico , Estudos Prospectivos , Volume Sistólico , Função Ventricular EsquerdaRESUMO
BACKGROUND: Cryoballoon ablation (CBA) and laser balloon ablation (LBA) were developed as alternatives to conventional radiofrequency ablation for paroxysmal atrial fibrillation (PAF). Pathological findings after ablation such as myocardial injury and inflammation are thought to be different between CBA and LBA. However, the different impact of myocardial injury and inflammation after ablation on short- and mid-term outcomes remains unclear. METHODS: Consecutive PAF patients who underwent CBA and LBA were enrolled from the Osaka Rosai Atrial Fibrillation ablation (ORAF) registry. The difference of the acute myocardial injury marker (hs-TnI), and changes of inflammation markers (C reactive protein; ΔCRP, and white blood cell; ΔWBC) after catheter ablation and the difference of the short-term (within 3 months after ablation) and mid-term (from 3 months to 6 months after ablation) outcomes were evaluated between the two groups. RESULTS: The CBA and LBA groups consisted of 55 and 56 patients, respectively. After propensity score matching, CBA and LBA groups consisted of 37 patients, respectively. Hs-TnI value was significantly higher in CBA than LBA group, while ΔCRP and ΔWBC were significantly higher in LBA than CBA group. In the propensity score-matched pairs, the LBA group had a significantly greater risk of short-term arrhythmia recurrence than the CBA group, whereas no significant difference of mid-term arrhythmia recurrence were found between the two groups. CONCLUSION: Myocardial injury and inflammation status differ between CBA and LBA groups. LBA group had stronger inflammation after ablation and had a significantly greater risk of short-term arrhythmia recurrence after PVI than CBA group.
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Fibrilação Atrial , Ablação por Cateter , Criocirurgia , Veias Pulmonares , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/cirurgia , Ablação por Cateter/efeitos adversos , Criocirurgia/efeitos adversos , Humanos , Inflamação/diagnóstico , Inflamação/epidemiologia , Inflamação/etiologia , Lasers , Veias Pulmonares/cirurgia , Recidiva , Resultado do TratamentoRESUMO
BACKGROUND: It is unclear whether balloon size can influence lesion formation. The aim of this study was to evaluate the impact of balloon size on lesion formation during laser balloon procedures in an in vitro model.MethodsâandâResults:Laser energy was applied to chicken muscle using a first generation laser balloon. Laser ablation was performed with 2 different balloon sizes (18 mm and 32 mm) using 2 different power settings (12 W/20 s and 8.5 W/20 s) on the chicken muscle. The lesion characteristics, including maximum lesion depth, maximum lesion diameter, surface diameter and depth at maximum diameter, were compared between the 18-mm and 32-mm balloon groups at 12 W/20 s and 8.5 W/20 s, respectively. We created 40 lesions using laser energy at 12 W/20 s and 80 lesions at 8.5 W/20 s. At both power settings, the maximum lesion depth and the depth at the maximum diameter were larger in the 18-mm than in the 32-mm balloon group. At both power settings, the maximum lesion diameter and the surface diameter were smaller in the 18-mm than in the 32-mm balloon group. CONCLUSIONS: The balloon size could affect the lesion formation during laser balloon ablation. The lesion with the larger balloon size was wider and shallower than the lesion with the smaller balloon size.
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Ablação por Cateter , Terapia a Laser , LasersRESUMO
AIMS: The impacts of high density lipoprotein cholesterol (HDL-C) as an anti-inflammatory and C reactive protein (CRP) as inflammatory properties on the pathogenesis of heart failure were reported. At present, the clinical significance of the HDL-C/CRP ratio in heart failure with preserved ejection fraction (HFpEF) patients remains unknown. METHODS AND RESULTS: We examined the data on 796 consecutive HFpEF (left ventricular ejection fraction ≥50%) patients hospitalized due to acute decompensated heart failure from the PURSUIT-HFpEF registry, a prospective, multicentre observational study. We calculated the HDL/CRP ratios and evaluated the relationship between the values and clinical outcomes, including degree of cardiac function. The mean follow-up duration was 420 ± 346 days. All-cause death occurred in 118 patients, of which 51 were cardiac deaths. HDL/CRP ≤ 4.05 was independently and significantly associated with all-cause death (odds ratio = 1.84, 95% CI: 1.06-3.20, P = 0.023), and HDL/CRP ≤ 3.14 was associated with cardiac death by multivariate Cox proportional hazard analysis (odds ratio = 2.86, 95% CI: 1.36-6.01, P = 0.003). HDL-C/CRP ratio significantly correlated with the product of the left atrial volume and left ventricular mass index as well as the tricuspid annular plane systolic excursion by multiple regression analysis (standardized beta-coefficient = -0.085, P = 0.034 and standardized beta-coefficient = 0.081, P = 0.044, respectively). CONCLUSIONS: HDL-C/CRP ratio was a useful marker for predicting all-cause death and cardiac death and correlated with left ventricular diastolic function and right ventricular systolic function in HFpEF patients.
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Proteína C-Reativa , Insuficiência Cardíaca , HDL-Colesterol , Humanos , Estudos Prospectivos , Volume Sistólico , Função Ventricular EsquerdaRESUMO
Persistent sciatic artery (PSA) is a rare vascular anomaly that can cause acute limb ischaemia (ALI) due to peripheral thromboembolism following aneurysm formation, and surgical repair or exclusion with or without femoropopliteal bypass is the standard treatment for these symptomatic cases of PSA. Here, we report a case of a 70-year-old man with right PSA aneurysm who suffered from recurrent ALI despite the history of right femoropopliteal bypass at the age of 58 for occlusion of right PSA and graft (femoropopliteal bypass graft)-to-tibial bypass at the age of 68 for occlusion of right posterior tibial artery. We performed a catheter angiographic examination using an intravascular ultrasound and performed an endovascular therapy (EVT) for the purpose of jailing the internal iliac artery. This is a rare case of PSA aneurysm presenting with recurrent ALI after femoropopliteal bypass successfully treated with EVT.
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Aneurisma , Arteriopatias Oclusivas , Procedimentos Endovasculares , Idoso , Aneurisma/complicações , Aneurisma/diagnóstico por imagem , Aneurisma/cirurgia , Artérias , Humanos , Isquemia/etiologia , Isquemia/cirurgia , MasculinoAssuntos
Potenciais de Ação , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Átrios do Coração/fisiopatologia , Frequência Cardíaca , Valva Mitral/cirurgia , Taquicardia Supraventricular/etiologia , Ablação por Cateter , Eletrocardiografia , Técnicas Eletrofisiológicas Cardíacas , Átrios do Coração/cirurgia , Humanos , Valva Mitral/diagnóstico por imagem , Valva Mitral/fisiopatologia , Recidiva , Estudos Retrospectivos , Taquicardia Supraventricular/diagnóstico , Taquicardia Supraventricular/fisiopatologia , Taquicardia Supraventricular/cirurgia , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: Transcatheter aortic valve embolization is one of the serious complications of transcatheter aortic valve implantation (TAVI). We present a case of TAVI that needed implantation of three transcatheter aortic valves owing to the embolization of two self-expandable valves (SEVs). CASE SUMMARY: An 88-year-old woman underwent TAVI using a 26-mm SEV. After valve deployment, the SEV embolized to the ascending aorta during the removal of the delivery system (DS) of the SEV (DS-SEV) from the SEV. An additional SEV was implanted, which also embolized upwards. Multi-directional fluoroscopy revealed extreme under-expansion of the second SEV, which caused valve embolization due to catching of the DS-SEVs in the SEVs. Finally, a 23-mm balloon-expandable valve was successfully implanted, which was also under expanded on fluoroscopic assessment. The patient was stable without sequelae at the 1-month follow-up. DISCUSSION: Pre-procedurally predicting SEV under-expansions was difficult because pre-procedural computed tomography revealed no massive calcification on the aortic valve, and fluoroscopy indicated adequate expansion of the SEVs at the angle where the valves were deployed. We verified the possibility of catching of a DS-SEV in an under-expanded SEV in an in vitro test, which showed that the DS-SEV was caught in the extremely under-expanded SEV. Furthermore, balloon dilation might release the catch of the DS-SEV by changing the DS-SEV position. Therefore, we recommend performing multi-directional fluoroscopy to evaluate SEV expansion before DS-SEV removal from an SEV. Furthermore, if catching of a DS-SEV occurs, balloon dilation might be useful for releasing the catch and safely removing the DS-SEV.
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AIMS: Heart failure (HF) readmissions with preserved ejection fraction (HFpEF) are increasing in the elderly, which is a major socioeconomic problem. We investigated the clinical impact of HF readmissions (HFR) on octogenarians with HFpEF. METHODS AND RESULTS: We enrolled consecutive octogenarians (≥80 years old) from June 2016 to February 2020 in PURSUIT-HFpEF registry. We divided them into HFR group readmitted for HF during the follow-up period and non-HF readmission (non-HFR) group. We evaluated the impact of HFR on all-cause mortality, cardiac death, and quality of life (QOL). Additionally, we evaluated the factors at discharge correlated with HFR. HFR group comprised 116 patients (21.4%). Among all-cause deaths, 40 patients suffered cardiac deaths (48.2%). The Kaplan-Meier analysis revealed a similar prognosis between HFR and non-HFR groups as well as similar incidences of HF deaths. The QOL scores had significantly deteriorated by 1 year later in the HFR group (0.71 ± 0.19 vs. 0.59 ± 0.21, P < 0.001), while it was similar at 1 year in the non-HFR group. In the multivariate analysis, diabetes mellitus (DM) (P = 0.019), N-terminal pro-B-type natriuretic peptide (NT-pro BNP) levels ≥ 1611 pg/mL (P < 0.001), and serum albumin level ≤ 3.7 g/dL (P = 0.011) were useful markers for HFR in octogenarians. CONCLUSIONS: In octogenarians with HFpEF, HF readmission was not directly correlated with the prognosis but was well correlated with the QOL. Close follow-up is essential to decrease HFR of octogenarians with HFpEF with DM, high NT-pro BNP (≥1611 pg/mL) and low albumin (≤3.7 g/dL) levels at discharge.
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Insuficiência Cardíaca , Readmissão do Paciente , Idoso , Idoso de 80 Anos ou mais , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/terapia , Humanos , Qualidade de Vida , Sistema de Registros , Volume SistólicoRESUMO
Although several studies have suggested that catheter ablation (CA) of atrial fibrillation (AF) can improve left ventricular ejection fraction (LVEF) in patients with heart failure with reduced ejection fraction (HFrEF), the predictor of improvement of LVEF is unclear. A total of 401 patients with persistent AF underwent an initial CA between September 2014 and October 2019 in our hospital. Among them, we analyzed consecutive patients with moderately or severely reduced LVEF (< 50%) measured by transthoracic echocardiography (TTE) within 2 months before CA and underwent follow-up TTE during sinus rhythm at 6 months or more after CA. These patients were categorized into two groups: improve group (I group) with the absolute improvement of LVEF ≥ 10% at follow-up TTE, and non- improve group (NI group) with the absolute improvement of LVEF < 10% at follow-up TTE. We compared patient characteristics, ablation procedures, and clinical outcomes between the two groups. 81 patients were analyzed, and I group consisted of 48 patients (59%). In the univariate analysis, absence of ischemic cardiomyopathy, left ventricular end-diastolic diameter (LVEDD), and absence of recurrence of AF between 3 and 6 months after CA were associated with improvement of LVEF. A receiver operating characteristics analysis determined the suitable cut-off value for LVEDD was 53 mm (sensitivity: 62.2%, specificity: 86.2%, area under curve: 0.762). A multivariate analysis showed that LVEDD < 53 mm was independently associated with improvement of LVEF (odds ratio 2.58, 95% confidence interval 1.29-6.12; P = 0.021). In conclusion, LVEDD < 53 mm might be an independent predictor of improvement of LVEF after CA of persistent AF in HFrEF patients.
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Fibrilação Atrial , Ablação por Cateter , Insuficiência Cardíaca , Disfunção Ventricular Esquerda , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/cirurgia , Humanos , Volume Sistólico , Resultado do Tratamento , Função Ventricular EsquerdaRESUMO
Vascular complications associated with vascular closure device use is uncommon; however, it sometimes occurs in transfemoral transcatheter aortic valve implantation (TF-TAVI). We present a case of ProGlide (Abbott Vascular, Santa Clara, CA, USA)-related right femoral occlusion following TF-TAVI. An 83-year-old woman, who underwent TF-TAVI using double ProGlide pre-closure technique, presented with right claudication three days after TAVI. Computed tomography showed femoral occlusion of the puncture site. Recanalization without pressure gradient between the proximal and distal sites of the lesion was achieved by balloon angioplasty (BA) with a 4.0 mm balloon; however, early re-occlusion of the lesion occurred the next day after BA. Repeated BA was performed for the re-occlusion site 30 days after TAVI because of persistent claudication. Serial angioscopic images of the lesion revealed that the intima, which was injured at the first BA, had healed at the second BA, indicating that BA with larger balloons could be safely performed. We performed BA with a 6.0-mm balloon without stent implantation. The patency of the lesion was maintained during the 6-month follow-up period. The serial angioscopic findings, which revealed the healing process of the intima injury, were useful in determining a suitable endovascular therapy strategy for ProGlide-related occlusion.
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Right bundle branch block (RBBB) is one of the most frequent alterations of the electrocardiogram. Several studies have shown that RBBB is a risk factor of cardiovascular diseases. However, the clinical outcomes after pulmonary vein isolation (PVI) in patients with RBBB remain unclear. We enrolled consecutive atrial fibrillation (AF) patients who underwent PVI from the Osaka Rosai Atrial Fibrillation (ORAF) registry. We excluded patients with other wide QRS morphologies (left bundle branch block, ventricular pacing, and unclassified intraventricular conduction disturbances) and divided them into 2 groups: RBBB (QRS duration ≥120msec) and No-RBBB (QRS duration <120) groups. We compared the incidence of late recurrence of AF and/or atrial tachycardia (AT) (LRAF) between the 2 groups using a propensity score-matched analysis and evaluated the risk of LRAF using Cox regression model. We finally analyzed 671 consecutive AF patients. The RBBB group consisted of 50 patients (7.5%) and the No-RBBB group of 621 patients. Median follow-up duration was 734 [496, 1,049] days. Hypertension and diabetes mellitus were significantly higher in RBBB group than No-RBBB group. Among the 46 matched patients pairs, Kaplan-Meier analysis demonstrated that RBBB group had a significantly greater risk of LRAF than the No-RBBB group (pâ¯=â¯0.046). The Cox regression model revealed significantly higher risks of LRAF (HR, 2.30; 95% CI, 1.00 to 5.33; p=0.044) in RBBB group compared with No-RBBB group. Non-PV AF triggers were significantly higher in RBBB group than No-RBBB group (pâ¯=â¯0.048). In conclusion, RBBB can be an important predictor of LRAF after PVI.
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Fibrilação Atrial/cirurgia , Bloqueio de Ramo/complicações , Ablação por Cateter , Veias Pulmonares/cirurgia , Idoso , Fibrilação Atrial/complicações , Fibrilação Atrial/epidemiologia , Bloqueio de Ramo/epidemiologia , Estudos de Casos e Controles , Estudos de Coortes , Comorbidade , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Hipertensão/epidemiologia , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Recidiva , Resultado do TratamentoRESUMO
The aim of this study was to investigate the impact of a new optical coherence tomography (OCT)-derived volumetric method for stent expansion (new-OCT method) to predict the target lesion revascularization (TLR) and compare the expansion findings between this new method and the conventional method because, in the real world, there are few clinical data on the new-OCT-method for stent expansion. One hundred forty lesions in 135 patients who underwent OCT-guided percutaneous coronary intervention were enrolled. We compared the new-OCT-method and conventional method to predict the TLR at 1 year. A total of 7 lesions (5.0% of treated lesions) in 6 patients experienced TLR during 1 year of follow up. The minimum expansion index (MEI) using the new-OCT method was significantly lower in the TLR group than non-TLR (60.0% vs. 77.0%; p < 0.001) while the conventional method for assessing stent expansion did not show a statistically significant difference between the two groups (71.3% and 79.7%; p = 0.118). The univariate analysis showed that the stent length, minimum stent area, minimum lumen area, MEI, and renal insufficiency/failure, were significant predictors of a 1-year TLR. The multivariate model identified the stent length, MEI, and renal insufficiency/failure as the independent predictors of TLR and the value of the MEI was the only predictor in the OCT findings. The new OCT-derived volumetric method for stent expansion is superior to the conventional method for predicting the TLR at 1 year. The MEI may be the most practical and efficient way to estimate stent under-expansion.
Assuntos
Doença da Artéria Coronariana/terapia , Vasos Coronários/diagnóstico por imagem , Intervenção Coronária Percutânea/instrumentação , Stents , Tomografia de Coerência Óptica , Idoso , Doença da Artéria Coronariana/diagnóstico por imagem , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Intervenção Coronária Percutânea/efeitos adversos , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: The difference of chronic neointimal conditions of biodegradable polymer-coated and durable polymer-coated drug-eluting stent have not been well investigated. OBJECTIVE: We aimed to compare the angioscopic findings among SYNERGY biodegradable polymer-coated everolimus-eluting stent (BP-EES), ULTIMASTER biodegradable polymer-coated sirolimus-eluting stent (BP-SES), and XIENCE Alpine durable polymer-coated everolimus-eluting stent (DP-EES) 8 months after stent implantation. METHODS: Patients who underwent implantation of BP-EES (n = 30), BP-SES (n = 26), or DP-EES (n = 21) in Osaka Rosai Hospital from December 2015 to April 2017 were retrospectively enrolled. Coronary angioscopic evaluation including dominant grade of neointimal coverage (NIC) over the stent, maximum yellow plaque grade, and existence of red thrombi were performed 8 months after stent implantation. The incidence of major adverse cardiac events (MACE) including cardiac death, nonfatal myocardial infarction, and target vessel revascularization were assessed 1 year after coronary angioscopic evaluation among the three groups. RESULTS: The patient and lesion characteristics were similar among the three groups. Dominant grade of NIC and maximum yellow plaque grade were not significantly different among BP-EES, BP-SES, and DP-EES groups [mean ± SD, 1.50 ± 0.73, 1.58 ± 0.64, and 1.33 ± 0.48 (P = 0.38) and 0.83 ± 0.59, 0.81 ± 0.75, and 0.95 ± 0.38 (P = 0.68), respectively]. The existence of red thrombi was similar among the three groups [20, 12, and 19% (P = 0.67)]. There was no significant difference in the MACE 1 year after coronary angioscopic evaluation among the three groups [0, 8, and 0% (P = 0.13)]. CONCLUSIONS: Coronary angioscopic findings revealed that BP-EES, BP-SES, and DP-EES produced similar favorable NIC 8 months after stent implantation.